Is It Time For A New Consensus?

Is It Time For A New Consensus?

A recent post by Benjamin Levenson on LinkedIn began Why is #Buprenorphine/#MOUD the #StandardOfCare for #OpioidAddiction promulgated by both #ASAM/#AMA? Because as Wakeman, et.al. just affirmed, it’s the only therapy that reduces overdose & opioid-related morbidity. Their seminal work ???? https://lnkd.in/evVRMFV ???? showed that NO OTHER recovery pathway delivered meaningful reductions...during an OD Crisis. It was the debate and comments the post attracted that motivated me to respond, only to discover I had exceeded the allowed number of characters - so I have "posted" as an article. Forgive me.

Whilst I hesitate to post in such a polite but potentially febrile debate, and am reticent to cite my lived experience, despite a wider academic acceptance of autoethnographic qualitative research in recent years, I was reminded of the work of the defunct UK Drug Policy Commission (closed in 2012 as it had “finished it’s work”), SAMHSA and The Betty Ford Institute several years ago. UKDPC was an independent body intended to provide objective analysis of the evidence concerning drug policy and practice.

In 2008 they formed a “consensus” group in an attempt to create a “starting point for discussion - among policy makers, service providers, commissioners and, importantly, service users – from which we hope will flow further consideration of what recovery-orientated services might look like.”

The Consensus group of 16 members stated “In recent months (in 2008) an increasingly polarised debate has developed in the UK which has tended to portray abstinence and maintenance approaches to drug treatment as an ‘either/or’ issue. At its most extreme, the debate appears to suggest that substitute prescribing is incompatible with recovery.”

The group looked at a (then) recent report of the Betty Ford Institute Consensus Panel in the US (which involved key individuals in the field of Addictions and Recovery in the US, including William White and Thomas McLellan) as a starting point for undertaking a similar process in the UK.

In 2010 SAMHSA in the US, offered a definition of recovery as A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. The definition includes “They (Pathways) may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches

In the wrap up of the UKDPC report it was noted “Clearly, drug-free programmes will not necessarily be recovery-orientated just because of their abstinence philosophy and, similarly, maintenance programmes will not necessarily lack a recovery orientation just because they involve the use of medication. Therefore there is a requirement to identify what characteristics make services (and the treatment system generally) recovery-orientated, regardless of the specific modalities employed. We believe the statement can help all services to recognise their role in the recovery process and to make important changes to enhance that role.”

The report quoted William White in a statement, aimed (I guess) at myopic 12 steppers, “How recovery is defined has consequences, and denying medically and socially stabilized methadone patients the status of recovery is a particularly stigmatizing consequence”

I seldom disagree with William White, however the anti, or just plain ambivalent, attitudes toward the obvious benefits (to some) of 12 Step programs carries their own chare of stigmatising and potentially, consequence.

All three reports/definitions mentioned here from 10+ years seem to echo many of the comments here.

Is it time for another consensus group?

See

https://www.ukdpc.org.uk/wp-content/uploads/Policy%20report%20-%20A%20vision%20of%20recovery_%20UKDPC%20recovery%20consensus%20group.pdf

https://store.samhsa.gov/sites/default/files/d7/priv/pep12-recdef.pdf




 


 





James Hitchen

Founder | Addiction & Eating disorder Specialist | Therapist & Coach | Mental Health Campaigner & Speaker

4 年

Great question!

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