Abstinence or maintenance?

MARY REICHARD, HOST: It’s Thursday the 12th day of October, 2023.

Glad to have you along for today’s edition of The World and Everything in It. Good morning, I’m Mary Reichard.

NICK EICHER, HOST: And I’m Nick Eicher.

First up, treating drug addictions.

According to the Centers for Disease Control and Prevention, Fentanyl overdoses are now the leading cause of death for Americans between the ages of 18 and 49.

Some medical providers are turning to medications to help their patients fight addiction before it’s too late.

REICHARD: These medications have become the gold standard of care in many medical circles. But some private rehab facilities, especially faith-based ones, are wary of replacing drug addiction with lifelong dependence on medication.

The story that follows was written by World’s Compassion reporter, Addie Offereins.

EICHER: Let’s begin with basic background about how drugs work. Medicine to treat addiction to opioids falls into two categories: antagonists and agonists. Opioid agonists act like heroin or morphine in that they stimulate opiate receptors in the brain, although to a much lesser degree.

Patients who take medications like Suboxone go into withdrawal when they stop taking them.

On the other end are meds that block opiate receptors. These are opioid antagonists, drugs like naltrexone.

REICHARD: The medical community is divided over whether they should wean their patients off medications like Suboxone. Dr. Warren Yamashita is a physician who specializes in addiction in California. He’s a member of the Christian Medical and Dental Association, which he says advocates for a “whole person perspective to treatment.”

YAMASHITA: Their physical needs, their psychological mental health needs, and doing a spiritual assessment as well. And then creating a treatment plan that then incorporates all those aspects.

EICHER: He said medications like Suboxone are essential because of the abundance of fentanyl on the streets. Only two milligrams of the drug can be deadly—that’s about as much as can fit on the tip of a pencil. He said doctors should wean some patients off Suboxone, but not everyone.

YAMASHITA: The opposite of addiction is not abstinence. The opposite of addiction is really whole person restoration, allowing a person to restore their identity, their relationships, and for those with faith, their relationship with God. And that may, for some people mean that they eventually taper off Suboxone, others it may mean that they do use Suboxone lifelong.

REICHARD: Dr. Annie Peters is the director of research and education at the National Association of Addiction Treatment Providers.

ANNIE PETERS: We were established in the 70s.The original members were mainly abstinence-based.

REICHARD: But she’s noticed a shift toward medically-assisted treatment.

PETERS: There's some people in the treatment world who think that if you're using an opiate agonist like Suboxone that you're still using, but I think that number of people who believe that is getting smaller. I think nowadays, in general, the belief is we have to keep people alive or they can't recover. And so to keep people alive, they often need an opiate agonist.

REICHARD: Some states require accredited treatment facilities to provide medications. Most publicly funded treatment programs have already adopted medication-assisted treatments. At the same time, private rehab organizations are shifting more slowly.

EICHER: Still, a large number of Christian rehab programs are sticking with an abstinence-based approach. Tom Reynolds is the director of His Way, a residential rehab program with campuses in Alabama and Georgia.

REYNOLDS: So most of our guys would view it as kind of a I mean, is it better than dying? Yes. Is it better than being unemployed? And on the streets? Yes, but it's not really sobriety, it's and most of our guys have a vision for sobriety and being dependent on nothing.

EICHER: Reynolds says drug users who’ve tried medication in the past found that doctors rarely encouraged them to wean themselves off.

REYNOLDS: And they wanted to kind of keep it prolonged because it's an income producer. And most of them have gotten really cynical about that.

REICHARD: Some rehab programs are seeking a middle way. One of them is House of Hope in Florence, S.C.

BRYAN BRADDOCK: I don't deny medical assistance in helping the addicted.

REICHARD: That’s CEO Bryan Braddock.

BRADDOCK: If they're currently working with a doctor, then we're not medical professionals. So we're not to tell someone to get off of something.

REICHARD: But he’s wary of switching out illicit drugs for a pill that would mimic the behaviors of addiction. Instead, he urges those under a physician’s care to stick to once-a-month injections of an opioid receptor blocker.

BRADDOCK: As a Christian, we know that man has a trichotomy that we are body, mind, and spirit. And so we feel that if you deny the spiritual side, that you're that someone isn't going to get true victory. There's no medicine that can give you joy and peace out there.

EICHER: You can read more about this online and we’ll include a link in the program notes.

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