Change, at Ground Level
...real progress has been made -- especially with the most challenging population, the very chronic, relapsing, “street" drug user.
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The Cannabis Cure?
An answer such as vigorous exercise or meditation or going to a meeting will never be as universally attractive to someone a few weeks sober as “well, here, why don’t you toke this?”
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Twenty-Eight Days
As any case manager knows, making a referral can be a challenge, since many fall by the wayside during transition to another provider, different therapist, etc.
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Focus on Demand
Many new programs are started in the hopeful expectation that they’ll become self-supporting within a few years.
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Pharmaceutical “Cures”
From a patient’s viewpoint, physicians can be somewhat blase’ about risks associated with a medication.
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In the News: Kaos Around Kratom
It may be that kratom is a drug that some can use without much difficulty, while for others, it becomes pathological.
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Methadone Maintenance and Crime
So even if drug use decreases, and clients continue on methadone, they don’t necessarily make the other much-desired (by society) changes — such as giving up crime.
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Medication Assisted Treatment
In terms of a comfortable detox, Suboxone was a success. In terms of a return to opiate use, it was a failure.
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The Last Dose
Reliable stats on relapse can be hard to come by, but return-to-heroin rates appear to run above 80% (and in some cases, higher).
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Reducing Harm vs… Well, Reducing Harm
My longstanding rule is to design your program to treat your population, not some idealized group of subjects who did well in a research setting with a significantly different structure.
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The Monitoring Model
We spend a great deal of time in treatment seeking to increase patient motivation, but these programs do not rely on a motivated patient.
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Opioids and the Assumption of Failure
It also suggests that the ‘return to heroin’ rate among former maintenance clients may be even higher.
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The EBP Conundrum
When a clinician uses an EBP, she’s reassuring herself that it’s likely to be more helpful than if she sat on her hands and did nothing.
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