Foundations conference session exposes divisions on medication treatment

A spirited breakout session on medication-assisted treatment for addictions at this week's Moments of Change conference in Palm Beach, Fla., illustrated the wide spectrum of views that persist on medication's place in the continuum of care.

The Sept. 29 session was led by Roland Reeves, MD, FACS, medical director of Destin Recovery Center in Florida's Panhandle, who has integrated medications such as buprenorphine and injectable naltrexone into clinical care at his treatment facility but who remains a staunch critic of what he sees as rampant irresponsible prescribing in the field.

“Maintenance medications don't fix anything,” said Reeves, who has posted blogs for Addiction Professional on physician issues in addiction treatment. He added, “Buprenorphine is greatly misused. Ninety-eight percent of doctors … use it as a pill mill.”

Reeves' strongest criticisms were leveled at methadone maintenance treatment, and this led to some of the more compelling questions from the breakout session's audience, mainly in the form of a strong rebuttal from an advocate of methadone as a life-saving treatment.

Reeves, who has a background in vascular surgery, acknowledged that the only job from which he was ever dismissed took place at a methadone clinic. “In my two years there, I never saw one patient wean off methadone,” he said.

His comments about methadone elicited a strong response from a conference attendee who emphasized methadone treatment's ability to keep an opioid-dependent person alive while an attempt is made to engage him/her in additional services. But Reeves expressed frustration over harm reduction strategies that become an end point, serving for some professionals as a tacit admission that because there are many treatment failures in addiction, a lifelong commitment to maintenance medication is the highest goal someone can reach.

“Are we public health ministers or advocates of individual wellness?” Reeves asked. “In my opinion, methadone will never advance more than being a public health service.”

Facts on buprenorphine

Reeves' presentation on the opening day of the Foundations Recovery Network-sponsored conference offered a mixed assessment of buprenorphine. He called the drug a highly effective pain medication and added that he has been able to see good results in his program for many opioid-dependent patients who use the drug for a few months (as long as they are held accountable for participating in a broad-based treatment program).

He added in reference to resistance to medication-assisted treatment in the 12-Step community, “I firmly believe that if Bill W. were alive today, Suboxone would be part of the [AA] program,” since the AA co-founder was treated with psychotropic medication himself.

Yet Reeves also said that the treatment field lacks protocols for post-detox use of buprenorphine, and says prescribing professionals were sold some untruths about the medication—he referred to a 2013 article stating that buprenorphine has become the most commonly misused opioid in Finland.

Reeves made it clear that he believes addiction treatment professionals must use all tools to combat what he considers the most powerful disease he has ever treated. One of his presentation slides read, “Recovery must include objective and real changes in the reward/learning/drive portion of our brain.”

He added, “I see more deaths here than I did in vascular surgery.”