On May 27th, 2011, actor Jeff Conaway died from complications of opioid dependence. His death has been attributed to several causes—sepsis, pneumonia, and aspiration among them— but there is little debate over the ultimate cause of his death at the age of 60 years, that being addiction to opioid pain medications.

Mr. Conaway reportedly struggled with chronic pain and addiction to pain medications for a number of years. His situation was particularly tragic—living with severe pain that was relieved by nothing save for a substance with the power to destroy him. Such situations are, unfortunately, not uncommon.

Ready for a little controversy?  A decade or so ago, a new approach to addiction treatment was developed under the general heading of ‘harm reduction.’ Proponents of the approach realized that many addicts will never achieve total sobriety from all intoxicating substances, efforts were best focused on reducing the most harmful consequences of addiction—drunk driving, overdose deaths, and the use of the most addictive substances.

Treatment centers focused on the use of opioids, and reduced emphasis on marijuana. Other harm reduction approaches include clean needle exchanges, and some proponents have even argued for the development of ‘shooting galleries’ where addicts can use heroin in a ‘safe’ environment.

I relapsed in 2000 after seven years of sobriety, and my attachment to opioids progressed much more rapidly than during my initial addiction.  I wrote a post a number of months ago that described ‘living on two levels,’ and that was my experience at the time—as if one part of my personality was frantically taking ever-increasing doses of dangerous narcotics while the other part, horrified, looked on.

Eventually my behavior caught the attention of enough people that I was confronted about my addiction.  I had been trying to stop using on my own for several months, but I argued over the need for residential treatment.  I remember sitting with the hospital CEO, babbling that I would be able to straighten myself up on my own if I had a few weeks of sick-time, and his response:  ‘Jeff, you have needle marks on your hands!’

I’ve shared my opinion that traditional treatment methods for opioid dependence—i.e. residential, usually step-based treatments—are a waste of limited resources.  I’ve written that relatively few opioid addicts successfully complete such treatments.  And many of those who ‘clean up well’ after two or three months die from relapse and overdose, months or years down the line.

Those who disagree with me sometimes pointedly ask “if getting clean without Suboxone is impossible, how did YOU do it?!” My usual answer is that my situation was and is very unique, and it would be misleading to compare my experience to that of most people.  But in case someone uses my experience to justify a similar path as mine, i.e. through residential treatment, I’ll expand on my answer.