START's Response to New York Post's Published Article "Four deadly PC myths of opioid addiction"

START's Response to New York Post's Published Article "Four deadly PC myths of opioid addiction"

Written by: Steven Kritz, MD, Corporate Compliance Officer 

Response to: Four deadly PC myths of opioid addiction

Having followed Betsy McCaughey’s well-reasoned and well-researched critiques of the Affordable Care Act since before the law’s passage; I was surprised and disappointed by her comments regarding the Trump administration’s campaign to address the heroin and pain-pill epidemic in her article entitled: Four deadly PC myths of opioid addiction.

For almost 16 years; I have held administrative positions at START Treatment & Recovery Centers (START), an outpatient opiate treatment program located in Brooklyn and Manhattan.  We have provided behavioral therapy and pharmacotherapy with methadone and buprenorphine to treat heroin addiction for over 45 years.  Prior to that, I was a practicing primary care physician in rural upstate New York for over 19 years.

While Dr. McCaughey’s article covers a number of themes, I will focus my remarks on just two of them. First; there is no longer any question that addiction is a (chronic) disease.  Research has definitively shown that those patients, who abuse heroin or other opiates for a long enough period of time, will eventually develop structural brain damage that is irreversible.  The fact that this structural brain damage is a consequence of patients “choosing” to abuse opiates vs. the structural brain damage that occurs for other reasons in Parkinson’s or Huntington’s is irrelevant to determining whether addiction is a disease. 

Opiate abusers who develop structural brain damage will require pharmacotherapy for the rest of their lives.  In 2009, our agency published a study in a peer-reviewed journal on the benefits of treating opiate abuse as a chronic disease.  We provided data showing that our success far exceeded that in treating hypertension, diabetes or hyperlipidemia.  Only those patients abusing opiates that have not reached the point of structural brain damage may be in a position to make a decision to quit… and as Dr. McCaughey states, only “some succeed.”

Continuing on the disease theme; it is rather curious that Dr. McCaughey cites the work of Carl Hart to support her position.  I have met and spoken briefly with Dr. Hart at scientific meetings over the years; Dr. Hart has been a supporter of START’s work for decades; and Dr. Hart had been very close to Beny J. Primm, MD, the late founder and Executive Director of START for over 40 years (then known as Addiction Research & Treatment Corporation).  In addition, Dr. Hart supports the disease model of addiction; contrary to what Dr. McCaughey implied.

Second; Dr. McCaughey’s presentation would have us believe that the disease model, the decision model, and the legal model are mutually exclusive approaches to dealing with this epidemic.  Nonsense!  While I work in the disease model sector, I’m very much a proponent of an “all of the above” approach.  The debate should be about how we best allocate limited resources between these modalities, based on good data; not by having a political food fight.

The most critical shortcoming from the suggestions by President Trump and Governor Christie lies in their support for long term inpatient care while leaving out the long term outpatient care that is provided by many agencies, including START.

It is way past time for the various factions to stop warring with each other.  It’s killing us.