TAKE 3 W/ SLP, November 2022
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“Take 3 w/SLP” is Sober Linings Playbook’s monthly summary of stories we think deserve a closer look. Along with a bit of commentary, we include links to additional resources for readers interested in learning more about the topics.
The big news of October turned out to be no news in November (see Halloween is over and it looks like no one got fentanyl candy after all, The Appeal, Nov. 1, 2022). Thankfully, with “rainbow” fentanyl out of the running, I had to look elsewhere for this month’s topics. I realize this “Take 3” suggests three topics, but I was running long on words and short on ideas. This month there are only two: (1) NIDA director Volkow’s call for loosening methadone restrictions; and (2) this month’s episodes of the Dopey podcast.
1. Is methadone reform on the horizon?
A year ago I visited my daughter for parent’s weekend at her college. Heading out for a run on a brisk New England October morning, I passed a methadone clinic down the street from my hotel. A line of patients snaked out the clinic door, through the parking lot and onto the sidewalk. I wondered why that scene existed still today.
I’m more tourist than expert in the world of addiction and treatment, and there is certainly much I do not know. But it seems archaic that after all these years we still require methadone patients to take time out of their day to travel to a clinic and endure the potentially stigmatizing experience of queuing up in public view to receive the daily dose they need.
All forms of medication for addiction treatment are probably more difficult to access than they should be, particularly for black and Latino patients (see Health Equity in Opioid Dependency Treatment: Differences in Opioid Treatment for Black and Latino Patients, Bicycle Health, Nov. 1, 2022). But at least with alternatives such as injectable Vivitrol (naltrexone) and Sublocade (buprenorphine), and prescription Suboxone (buprenorphine), patients enjoy the privacy and convenience that we should all expect when receiving medical care. Why should methadone be so different?
In the U.S., methadone can only be dispensed by federally certified opioid treatment programs (OTPs) under the supervision of a physician. Some of the largest addiction treatment providers are multi-state OTPs whose business models are based on the current rules and restrictions. It’s no surprise then that OTPs have resisted recent federal legislative proposals aimed at loosening restrictions to broaden access to methadone and buprenorphine (See Methadone Clinics Step Up Their Backlash Against Reform, Filter Magazine, Aug. 22, 2022).
Nora Volkow, Director, National Institute on Drug Abuse
There’s absolutely no reason why [doctors shouldn’t be allowed to directly prescribe methadone]…There are countries where physicians are providing methadone, and the outcomes are actually as good as those at methadone clinics…Methadone is underutilized in part because it requires such stringent conditions in order to be prescribed.
For more background on the use of methadone for treating addiction in the U.S., read the excerpt from Dr. Carl Erik Fisher’s book, The Urge: Our History of Addiction (How the Crackdown on Methadone Set Back Treatment for Addiction, Slate, May 5, 2022).
A recent PEW report highlights regulatory changes that could be made to increase access to methadone without congressional approval (Federal Agencies Have Substantial Authority to Boost Methadone Access, PEW Charitable Trusts, Aug. 11, 2022). These changes include eliminating the requirement that methadone can only be dispensed at an OTP.
Rules were loosened during the pandemic to allow for take-home methadone and dispensing of methadone by pharmacies and mobile units. Earlier this month, National Institute on Drug Abuse director Nora Volkow called for broad deregulation of methadone to continue some of those practices (Top U.S. addiction scientist calls for broad methadone deregulation, STAT News, Nov. 16, 2022):
I’m sold on those arguments, and more generally on the idea that it shouldn’t be more difficult to access medications used to treat addiction than to access the medications to which people become addicted.
2. A word on “drugs, addiction and dumb shit” – The Dopey podcast
If you’re looking for a podcast about addiction and recovery that refreshingly doesn’t quite fit the mold, give the Dopey podcast a listen. The official description – a show about “drugs, addiction and dumb shit” – is a bit of an undersell. There’s a lot of smart shit too.
Dave, the host, certainly does have a fondness for war stories (the “dumb shit” related to drinking and drug use) that can be off-putting to some (and a reason I sometimes hesitate to recommend). But the stories are also part of the schtick. They make the show relatable and approachable to many listeners. And to paraphrase what I’m fairly certain I’ve heard Dave say before, “we bring ‘em in with the debauchery, then hit ‘em with a dose of recovery.”
Like the cast of characters on Mr. Rogers’ Neighborhood, regular appearances by recurring guests such as author Erin Khar (Strung Out: A Memoir of Overcoming Addiction) and Dave’s dad bring the listener into the Dopey world. A private Dopey FaceBook group, daily Zoom recovery meetings, and in-person DopeyCon events create opportunities for real connection among the Dopey Nation denizens.
While Dave attributes his own success in recovery to 12-step support and programs, the podcast and the community share a compassion for all who are suffering, and an acceptance of broad and varying definitions of recovery. All are welcome regardless of their readiness to change or the particulars of the recovery path they’re on.
If you’re looking for an entry point, November 2022 is a good place to start. Guests this month included author Jessica Lahey (The Gift of Failure, The Addiction Inoculation), doctors who administer ketamine therapy, author Maia Szalavitz (Unbroken Brain, Undoing Drugs: How Harm Reduction is Changing the Future of Drugs and Addiction) and former childhood actor Shaun Weiss (“The Mighty Ducks”).
A Sept. 2019 profile in The Hollywood Reporter (How “Dopey” podcast transformed into a haven for recovering addicts) provides an overview and history of Dopey, including details about the overdose death of co-host Chris, and the feature story on NPR’s This American Life that helped expand the show’s audience.
It’s worth a listen!
Wishing all a safe and happy holiday season!
Stay strong Dopey Nation and fuckin’ toodles for Chris!