I am a father. I make choices that will help my children feel loved and be protected and supported as they grow. As the founder and CEO of an elite addiction treatment center, I think too of my clients and work diligently to bring them the best of the latest treatments for addiction. I care about their health and well-being. But sometimes, the needs of these groups, children and addicts, come into conflict.
One of the ways to treat opioid addiction that has gotten a lot of attention is opioid replacement therapy (ORT). These are pharmaceutical therapies designed to substitute methadone or Suboxone for heroin or prescription pain killers. There is evidence to support the idea that these drugs will cause a decrease in death rates from accidental overdose if used widely; however, for a number of reasons, I do not support their use nor do we offer ORT at my treatment center. One of the most important reasons I do not support ORT is the risk to children.
What is ORT? Be it Suboxone or methadone, ORT is a replacement medication for opioid pain medication or heroin. ORT drugs are widely used in treatment centers during detox to ease withdrawal symptoms. Some treatment programs provide prescriptions for the long-term use of these drugs, as harm reduction for individuals who choose not to be part of abstinence based programs. At present, Suboxone is often preferred over methadone. Daily doses can be taken at home rather than in a clinic. Methadone is also more easily abused than Suboxone. Suboxone has an ingredient that makes some users ill when the drug is crushed and used intravenously. In theory at least, ORT is given in doses that do not allow a person to get high, but enough to keep the individual from feeling dope sick. There are reports, however, that Suboxone is being abused by a significant number of addicts.
Are these drugs safe? Methadone and Suboxone are considered to be “safest” when a tolerance has developed in the user. Addicts understand this as the state when they might technically test as having enough drugs in their system to be high, but they feel normal. Most doctors choose Suboxone over methadone because of a perception that Suboxone has less potential for abuse. However, the clinical results Suboxone has shown are questionable and its use is highly controversial among addiction treatment professionals. Still, the Obama administration wants to put over a billion dollars into ORT and other therapies in an effort to decrease the number of overdose deaths associated with prescription painkillers and heroin.
What is the danger to children? Some medical literature on Suboxone suggests that it is both appropriate and safe to leave children in the care of someone who is on ORT, but there is also a considerable amount of experience that suggests otherwise. The “safety” of those on Suboxone to supervise children is based on the medication being used exactly as prescribed after a preliminary dosing period has provided a patient with their best tolerated dose. Those of us who work with addicts know these are pretty “iffy” scenarios. The nature of opioid addiction is not to take medications in the prescribed dose. What do we do with the children of addicts during the dosing stabilization period and how do we identify relapse quickly to keep children out of danger? The truth is that most ORT users are going to relapse or die while on an ORT treatment plan. Mortality rates are high for ORT users, as are relapse rates. ORT is a Band-Aid solution at best.
Additionally, there is a great deal of evidence showing that children who live in homes where Suboxone is present are at high risk of accidental ingestion and overdose leading to death. It is simply a health danger to have Suboxone in the home, particularly with children present. While some might argue that ORT is good for addicts, pediatricians warn it is dangerous for children.
Further, there are problems related to ORT users driving under the influence. Some states make provisions for ORT users to drive, others do not. Still other jurisdictions require that the police prove that the medication caused impairment. In any case, it is entirely possible that even where it is legal to drive while using Suboxone as prescribed, the user may be too impaired to safely drive. This is because there are several contraindications for drug mixing with Suboxone. This is a safety hazard for both children and the general public.
We must be children’s advocates. I am involved daily in the struggle to help addicts break free from opioid addiction and regain control over their lives. In the last ten years at my treatment center, we have gone from seeing about a quarter of our residents on pain pills or heroin to nearly seventy-five percent using those drugs. Our business is booming, with expansion from 18 beds to 100 in the last five years and further expansion plans to double that again underway. And despite our efforts and those of other treatment centers, America is still losing more than 40,000 people a year to accidental overdose.
But in our desperation to get in front of this problem, we must not put children in unnecessary danger. The best treatment available for addicts remains abstinence based. It is possible to give addicts their lives back, and to give their children safe, supportive, productive homes to live in. Would you leave your children in the care of an ORT patient? Would you allow someone on ORT to drive your child to soccer, cook dinner, give your child a bath, or make decisions in the event of an emergency? I leave my children in the care of recovered addicts all the time, those who have an established abstinence and the ability to put the needs of the children in their care above all else. In my opinion, those on ORT therapy do not possess that clarity of mind. The health and welfare of the entire family, not just the addict, must be taken into consideration when we are making clinical decisions.
ORT has the potential to be a stepping-stone to abstinence-based recovery, not the end of the road as a maintenance therapy. We owe our children better than that.