snake oil salesmanWhen Suboxone first became an option for treating addiction to pain pills back in 2003, some people were excited about having a cure for opioid dependence. Those people were mistaken.  It is true that Suboxone has been a huge benefit for treating opioid dependence, but the medication cannot cause the permanent changes in the brain that would be necessary to prevent relapse.  Instead, in order for the medication to work, people must do what they do with other medications—keep taking it.

I recently read an article on another web site that advocated a certain person’s ‘method’ for rapid opioid detox.  I went to the primary web site for the developers of that method—pulled to the site in the same way that I am drawn to watch late-night commercials for get-rich-quick schemes or male enhancement products.  On the web site I read that they have a new reason to take large sums of money from those addicts fortunate enough to have money, and unfortunate enough to believe their hype— a special, rapid way to change brain function.

We are spending tens of millions of dollars through NIH to understand neuronal ‘plasticity’—the term for the ability of the brain to adapt in response to the environment—and here some guy at a detox clinic has it all figured out!

As I read the web site, I thought about all of the addiction ‘cures’ that I’ve read about over the years, such as the secret blend of amino acids that one program offers  (I wrote to the advocates of that treatment to ask how it works, and was told that they would give me the recipe for only $15,000).   I thought about my opportunity a year or two ago to review the bill of a person treated at one of those $70,000 per month addiction treatment centers out west somewhere;  the bill was padded with one type of therapy after another, with names like ‘mood therapy,’ or ‘PTSD resolution therapy,’ or ‘energy-field releasing therapy.’  The charge for a ‘treatment’?  Prices ranged from $700 – $1200… per SESSION, day after day.  On many individual days, the person was billed for multiple types of therapy, each costing $1000 or more.  Now I know– THAT’S how you get to 70 grand per month!

With all this in mind, I have to wonder– is addiction treatment the last refuge for snake-oil salesmen?  Where are the good folks at the FDA when people throw scientific mumbo-jumbo to extract money from desperate people?  Maybe I should quit charging the peanuts of a typical private practice—where insurers think an hour is worth a hundred bucks, and the state considers an hour worth $37.50—and instead hang a sign, and make a web site, and offer ‘Selective  Cranio- Axial  Meningotherapy’ (SCAM) or Bitemporal Sensory (BS) Therapy or Rapid Intentional Pseudo - Olfactory  Field  Focusing!

I’ve criticized doctors who prescribe Suboxone as well; namely those who take the quick buck to get a person started on Suboxone, then leave the person to find a long-term prescriber on his/her own—knowing that such doctors are impossible to find in many areas.

It is relatively easy to get a person clean for a few weeks.  In fact, if anyone desperately wants to get off opioids, bring me $20,000 and I will chain you to the steel post in the center of my basement—and I’ll even throw in meals.  The hard part, of course, is keeping you clean AFTER you leave.  So for an extra $50,000—the same price charged by many month-long treatment centers—I will provide a couple hours of therapy each day (weekends off of course), and put out an easel for you to draw pictures of traumatic events from your childhood.

Sounds silly, I know—but the truth is even sillier.  I bet that the number of long-term cures from MY basement treatment would rival those from any of the methods or programs that I alluded to. From either program—mine or theirs– the long-term relapse rates would be very high.

Fortunately, there IS a long-term treatment for opioid dependence— buprenorphine– that has proven to be safe and effective.  The way to make the treatment work is to follow the same principles that are used for a host of other medical conditions:  1. Get a good doctor.  2.  Start the right medication.  3.  Keep taking the medication.  Psychotherapy might be helpful as well, but definitive studies on the value of psychotherapy for Suboxone patients have not yet been done.  But we DO know the importance of staying on the medication.

Who knows– you might even save yourself a bundle.

Photo by mr_nightshade, available under a Creative Commons attribution license.