Treating Opioid Dependence with Opioids

Publisher Summary This chapter examines the extent to which treatment is primarily driven by the patient’s best interests, as opposed to the interests of government, the treatment industry, and the pharmaceutical industry. Drug use can be initially considered a matter of personal responsibility, and persistent use despite experiencing harm may be considered a failure of personal responsibility. It seems plausible to hypothesize that there is a subpopulation of heroin users that is more likely to take risks, less likely to be deterred by social disapproval or penal sanctions, and particularly vulnerable to developing the chronic, relapsing type of addiction. A divergence of views about the most effective way to use methadone is compatible with the assumption that opioid substitution treatment (OST) is at least a well-intentioned attempt to improve the health of heroin addicts. Ethical concerns over OST go further. Prescribing opioids to heroin addicts is counterintuitive and from its inception has challenged the dominant paradigm of addiction treatment, which is based on the principle that abstinence is necessary for recovery from addiction.