Although medications are good for opioid dependence, most rehab centers do not use them. The BB team decided to look into this problem and tells you.
In 2011, Ian McLoone was at his son's first birthday party when he received a call from a Minneapolis drug rehab center asking him to return early.
McLoon quickly realized he was facing problems. He had missed curfew the previous day while accompanying another client's family on their visit. After receiving a phone call, he told his family he had to leave and embarrassingly left the party. In the following days, the 'bench' awaited him.
«The bench was actually in the hallway. You could sit on it from tomorrow's breakfast to dinner» — recalls McLoone.
While in this position, McLoone, who was being treated for opioid addiction at RS Eden, was unable to participate in most group activities. He was forbidden from attending workshops, socializing with others in the program, or even using the phone or watching television. He was forced to just sit in silence among people. This RS Eden approach to treatment, he says, can be described as, «We tear down to build up again».
In 2011, Ian McLoone was at his son's first birthday party when he received a call from a Minneapolis drug rehab center asking him to return early.
McLoon quickly realized he was facing problems. He had missed curfew the previous day while accompanying another client's family on their visit. After receiving a phone call, he told his family he had to leave and embarrassingly left the party. In the following days, the 'bench' awaited him.
«The bench was actually in the hallway. You could sit on it from tomorrow's breakfast to dinner» — recalls McLoone.
While in this position, McLoone, who was being treated for opioid addiction at RS Eden, was unable to participate in most group activities. He was forbidden from attending workshops, socializing with others in the program, or even using the phone or watching television. He was forced to just sit in silence among people. This RS Eden approach to treatment, he says, can be described as, «We tear down to build up again».
McLoone is now feeling well and has been off heroin since 2010. However, he claims that it was RS Eden's inappropriate stance on methadone, a treatment for opioid addiction, that affected his recovery. In fact, he reported that RS Eden encouraged him to quit methadone, which led to his stigmatization for using the drug. His mother even had to convince him to continue taking methadone, saying, «Why don't you use every means available to you to finally get it right?».
This is the reality of the American drug rehab system.
Drugs like methadone, buprenorphine, and naltrexone are considered the standard in the treatment of opioid addiction. Studies show that these medications can reduce death rates among addicts by 50% or more, as well as better retention in treatment compared to non-medication methods.
However, many rehab centers in the U.S. view medication with distrust or even disdain, preferring methods that are not scientifically validated, such as forensic testing.
According to federal agencies, only 42% of the nearly 15,000 facilities tracked by the Substance Abuse and Mental Health Services Administration (SAMHSA) offer medication for opioid addiction. Less than 3% offer all three federally approved medications: methadone, buprenorphine, and naltrexone.
This is the reality of the American drug rehab system.
Drugs like methadone, buprenorphine, and naltrexone are considered the standard in the treatment of opioid addiction. Studies show that these medications can reduce death rates among addicts by 50% or more, as well as better retention in treatment compared to non-medication methods.
However, many rehab centers in the U.S. view medication with distrust or even disdain, preferring methods that are not scientifically validated, such as forensic testing.
According to federal agencies, only 42% of the nearly 15,000 facilities tracked by the Substance Abuse and Mental Health Services Administration (SAMHSA) offer medication for opioid addiction. Less than 3% offer all three federally approved medications: methadone, buprenorphine, and naltrexone.
As a result, the best approach to combat the opioid epidemic, which has led to more than 700,000 overdose deaths in the U.S. since 1999, is still underutilized. People respond to various surveys by major journalistic outlets (who study the problem) reporting that available evidence-based treatments — including medications — are expensive, difficult to access, and sometimes intentionally ignored by addiction treatment facilities.
While medication-assisted treatment is not the only effective way to combat opioid addiction, techniques such as cognitive behavioral therapy, motivational interviewing, and contingency management are also supported by scientific evidence supporting their effectiveness.
Still, Keith Humphries, a drug policy expert at Stanford, says it's imperative that medication be considered the first line of choice for treating opioid addiction. «No one should be forced to take it, but it should be offered to every person in any decent opioid addiction treatment program» — he writes.
Why do Rehab centers reject the scientific approach?
When RS Eden opened its doors in the 1970s, some patients had to endure some pretty strict measures: sometimes having their heads shaved and being forced to wear diapers. These practices were inspired by the Synanon movement, associated with one of RS Eden's founders, according to Dan Kane, the organization's president.
While medication-assisted treatment is not the only effective way to combat opioid addiction, techniques such as cognitive behavioral therapy, motivational interviewing, and contingency management are also supported by scientific evidence supporting their effectiveness.
Still, Keith Humphries, a drug policy expert at Stanford, says it's imperative that medication be considered the first line of choice for treating opioid addiction. «No one should be forced to take it, but it should be offered to every person in any decent opioid addiction treatment program» — he writes.
Why do Rehab centers reject the scientific approach?
When RS Eden opened its doors in the 1970s, some patients had to endure some pretty strict measures: sometimes having their heads shaved and being forced to wear diapers. These practices were inspired by the Synanon movement, associated with one of RS Eden's founders, according to Dan Kane, the organization's president.
Synanon, which began as a rehabilitation program for drug addicts, transformed over time into what is now often seen as a «violent cult», and at this point the organization no longer exists. However, some of the techniques that originated at Synanon continue to be used in the field of drug treatment to this day.
When McLoon ended up at RS Eden (by court and government funds), the practices of shaved heads and diapers were long forgotten. The center operated methods such as «bench» punishment and a technique known as «play» based on Synanon's approaches.
As part of this practice, patients wrote down and sent complaints about their tribesmen over the course of a week, which were then read out in group sessions. Participants were expected to mount vigorous defenses, which sometimes escalated into emotional arguments and even fist fights, as McLoon recalls.
When McLoon ended up at RS Eden (by court and government funds), the practices of shaved heads and diapers were long forgotten. The center operated methods such as «bench» punishment and a technique known as «play» based on Synanon's approaches.
As part of this practice, patients wrote down and sent complaints about their tribesmen over the course of a week, which were then read out in group sessions. Participants were expected to mount vigorous defenses, which sometimes escalated into emotional arguments and even fist fights, as McLoon recalls.
Kane acknowledged that his program has erred in the past. While benching is no longer used, «playcalling» is still used, and he generally defends such practices at RS Eden. «Confrontation» is a term with many nuances and different levels, he noted. «We believe that people have to accept their true selves before they can change themselves». Kane also added: «Our main focus is to help people overcome the level of denial».
However, there are scientific studies showing that similar confrontational methods can exacerbate the problem.
On the other hand, accessing medication-assisted treatment for opioid addiction remains a challenge for many.
Some addiction patients often share their stories of difficulty in finding medication-assisted treatment with BB team members. Eitan, who asked to use his Jewish name as a pseudonym, began seeking help as a teenager when his mother died of asthma due to a lack of inhalers.
At two outpatient centers in Arizona — Mirasol Recovery Centers and Desert Star Addiction Recovery Center — Eitan was required to follow a strict and, in his opinion, unhelpful 12-step approach. Despite the programs' claims that alternative methods were available, Eitan felt a lack of answers and them to his questions, and ultimately neither center provided him with medication.
«It made me less inclined to get treatment. I felt really misunderstood» — Eitan noted.
Richard Poppy, owner of Desert Star, noted that «not all approaches are appropriate for everyone» and despite Eitan's experience, they support the use of medication-assisted treatment, although they do not initiate buprenorphine or methadone therapy. Mirasol subsequently closed its services for addicts and switched to treating eating disorders.
Eitan eventually moved to Massachusetts, where he now receives outpatient treatment at Boston Medical Center, where he was quickly offered medication to manage his addiction. He was prescribed naltrexone, which experts say helped reduce cravings for alcohol and opioids.
While the data on the effectiveness of medication for alcohol addiction is less reliable than for opioids, experts say it can be a good option for some patients.
«I didn't want recovery to mean fighting 12-step cravings for the rest of my life» — Eitan says, adding that this was the approach that was seen as the only path to recovery at the facilities he attended before his admission to Boston Medical Center.
Drug dependence treatment
In the 1980s and 1990s, France faced a heroin epidemic affecting some 300,000 people, resulting in numerous overdoses and an increase in diseases such as HIV and hepatitis. In response, authorities expanded doctors' authority to prescribe buprenorphine starting in 1995, which helped increase the number of people receiving medication-assisted treatment and led to a 79% reduction in overdose deaths by 1999.
There are now three medications approved in the U.S. to treat opioid addiction: buprenorphine, methadone, and naltrexone. Buprenorphine and methadone are opioid agonists, activating the same receptors in the brain, but when used correctly do not cause euphoria, helping to ease withdrawal. These medications have substantiated scientific evidence and are supported by multiple health organizations.
Eitan eventually moved to Massachusetts, where he now receives outpatient treatment at Boston Medical Center, where he was quickly offered medication to manage his addiction. He was prescribed naltrexone, which experts say helped reduce cravings for alcohol and opioids.
While the data on the effectiveness of medication for alcohol addiction is less reliable than for opioids, experts say it can be a good option for some patients.
«I didn't want recovery to mean fighting 12-step cravings for the rest of my life» — Eitan says, adding that this was the approach that was seen as the only path to recovery at the facilities he attended before his admission to Boston Medical Center.
Drug dependence treatment
In the 1980s and 1990s, France faced a heroin epidemic affecting some 300,000 people, resulting in numerous overdoses and an increase in diseases such as HIV and hepatitis. In response, authorities expanded doctors' authority to prescribe buprenorphine starting in 1995, which helped increase the number of people receiving medication-assisted treatment and led to a 79% reduction in overdose deaths by 1999.
There are now three medications approved in the U.S. to treat opioid addiction: buprenorphine, methadone, and naltrexone. Buprenorphine and methadone are opioid agonists, activating the same receptors in the brain, but when used correctly do not cause euphoria, helping to ease withdrawal. These medications have substantiated scientific evidence and are supported by multiple health organizations.
Naltrexone, which blocks the effects of opioids and can reduce cravings, requires complete withdrawal, making it more difficult to use than buprenorphine and methadone. It is also used to treat alcohol dependence, but its effectiveness is lower.
No drugs have yet been developed for cocaine or methamphetamine. Despite their proven efficacy, the drugs are often stigmatized because they are perceived as a substitute for one drug for another. However, addiction is not just drug use, but compulsive behavior that negatively affects a person's life.
Medications help to reduce the risks and transform the substance use disorder back to regular use. The effectiveness of treatments varies from person to person, and for some patients they can be a life-saving tool. As one patient noted: «It's not a panacea, but it's a time when I didn't think about substances».
Why is medication-assisted drug treatment often rejected?
Despite the evidence, many drug treatment centers do not offer medication therapy. Some shy away from the use of medication, supporting the stereotype that such drugs merely replace one addiction with another. This contrasts with other areas of medicine, where medications are often used to treat a variety of conditions.
Kane, president of RS Eden in Minnesota, characterized methadone as an «opioid replacement drug» and labeled it more of a tool than a definitive solution.
He acknowledged that some patients may need to take the medication for life, but noted that it can be a challenge. He expressed hope that patients would be able to quit methadone during or at the end of the RS Eden program. «As far as 'encouragement to quit,' that's pretty hard to define» — he added.
At RS Eden, McLoone said, the message was pretty obvious: He felt pressured to give up methadone until his mom intervened. (RS Eden did not comment on McLoone's specific situation, citing doctor-patient confidentiality).
Resistance to medication-assisted treatment is linked to the moral evaluations and stigma that have accompanied addiction treatment for decades. For most of American history, addiction was viewed as a moral failing rather than a medical condition. This has led to the exclusion of addiction from the health care system, leaving it to be managed by religious and spiritual communities, the criminal justice system, Alcoholics Anonymous, Narcotics Anonymous, and other 12-step programs.
Thus, the current model of treatment presentation — the 28-day stay in a rehab center — emerged. Known as the Minnesota Model, it was popularized by the Hazelden Foundation, now the Hazelden Betty Ford Foundation, as a way to help people with addiction. The idea was to send patients to several weeks of treatment away from their usual drug-using environment for a few weeks of recovery.
Paul Earley, president of the American Society of Addiction Medicine (ASAM), characterized the Minnesota Model as an «integrated approach»that «combines elements of AA, psychosocial therapy, and group therapy».
«It was used as a metaphor for emergency intervention» — he explained. «You would be in treatment for 28 days, and then when you left the center you would be told, 'Good luck. Attend AA meetings and you'll be fine». That model only works for a very small percentage of people with addictions». Earley observed that because there were no alternatives, the concept spread across the country, and short-term treatment for chronic illness became standard practice.
Paul Earley, president of the American Society of Addiction Medicine (ASAM), characterized the Minnesota Model as an «integrated approach»that «combines elements of AA, psychosocial therapy, and group therapy».
«It was used as a metaphor for emergency intervention» — he explained. «You would be in treatment for 28 days, and then when you left the center you would be told, 'Good luck. Attend AA meetings and you'll be fine». That model only works for a very small percentage of people with addictions». Earley observed that because there were no alternatives, the concept spread across the country, and short-term treatment for chronic illness became standard practice.
McLoone experienced a delayed recovery after a four-month stay at RS Eden, where he was wrongly accused of opioid abuse and kicked out. He found a suitable outpatient program in the Fairview network that had a positive impact on his treatment while using methadone. He went on to attend graduate school at the University of Minnesota to prepare for a career as an addiction and mental health counselor.
In 2015, he began gradually reducing his methadone dosage, facing difficulties with the strict rules for obtaining it in the United States. McLoon said the rules were very difficult to adhere to, which made his daily life and work difficult.
Some patients may need methadone long-term, similar to insulin for diabetics, but having strict restrictions creates difficulties. «No other medications are prescribed like this» — says a spokesperson for the Harm Reduction Coalition. Buprenorphine, while prescribed in traditional medical settings, is also subject to strict regulations, making it difficult to access: according to 2017 data, 47% of U.S. counties did not have physicians authorized to prescribe it.
These regulations aimed at preventing abuse create an environment where rehab centers are more likely to use unproven methods instead of medication-assisted treatment that has been scientifically proven effective. Sue, a spokeswoman for the Coalition, criticizes these methods, emphasizing their ineffectiveness.
In 2015, he began gradually reducing his methadone dosage, facing difficulties with the strict rules for obtaining it in the United States. McLoon said the rules were very difficult to adhere to, which made his daily life and work difficult.
Some patients may need methadone long-term, similar to insulin for diabetics, but having strict restrictions creates difficulties. «No other medications are prescribed like this» — says a spokesperson for the Harm Reduction Coalition. Buprenorphine, while prescribed in traditional medical settings, is also subject to strict regulations, making it difficult to access: according to 2017 data, 47% of U.S. counties did not have physicians authorized to prescribe it.
These regulations aimed at preventing abuse create an environment where rehab centers are more likely to use unproven methods instead of medication-assisted treatment that has been scientifically proven effective. Sue, a spokeswoman for the Coalition, criticizes these methods, emphasizing their ineffectiveness.
Now McLoone, who previously worked in the grocery industry, is looking to change approaches to treating addiction from within. He began working at Alltyr Clinic in St. Paul, founded by Mark Willenbring, which promotes scientific approaches to rehabilitation. Today, McLoon is the clinic's lead therapist.
He notes that he understands people's cautions about medication, but for him, continuing on methadone was the best solution. «I was able to finish rehab, get a job and build the life I dreamed of. Methadone was the deciding factor in that process» — he summarizes.