Before you can respond to a problem, you have to be able to say what it is.

Drug addiction is a disease. That’s what the American Medical Association says. That’s what the American Psychiatric Association says. That’s what the National Institute of Drug Abuse in the National Institutes of Health says.

Methadone is the most effective treatment for opiate addiction ever devised. So why aren’t additional funds for the medication part of a new proposal to address Maine’s drug epidemic? 2015 Press Herald file photo/Whitney Hayward

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry,” according to the American Society of Addiction Medicine. Dysfunction in these parts of the brain results in “characteristic biological, psychological, social and spiritual manifestations.”

As death from opiate overdose strikes more Maine families, the demand for the state to do something grows stronger. But despite strong scientific consensus that addiction is a treatable disease, there is still significant political controversy over whether it should be battled by police or by doctors.

We have said before that the right approach is not either but both, and we support the framework proposed by a bipartisan group of lawmakers, which would devote new resources to law enforcement as well as to expand treatment options. But even within the treatment proposal outlined earlier this month, there remains a stubborn tendency to treat opioid addiction as bad behavior and not a brain disorder. If this attitude doesn’t change before the bill becomes law, Maine will have missed an important opportunity to save lives.

MEDICAL APPROACH

As currently conceived, there is $5 million of state funds to be spent on the opiate crisis, but no additional money for what decades of experience and research have shown to be the most effective way to treat this disease – with medicine.

Methadone, the most effective treatment for opiate addiction ever devised, is not on the list. Neither is Suboxone, a similar medication that doesn’t have to be distributed in clinics.

Instead, there is a focus on residential treatment and peer support – approaches that do not have the same track record of success in treating opiate addiction.

Why? Because too many people still treat opiate addiction as a choice that can be combated only with willpower. The consensus of the medical community is that they are wrong.

Opiates block pain and anxiety, and, in high doses, produce euphoria. Over time, the chemicals change the brain’s structure, so that long-term users often report craving them just to feel “normal.” Once dependent, users will go through painful withdrawal symptoms that many find intolerable.

At this stage, some will do anything to get more drugs, which leads them to a variety of criminal behaviors including drug dealing, prostitution and robbery. The addict needs progressively higher doses to experience the desired effect, sometimes leading to overdosing and death.

Methadone is a medicine designed to combat the illness. It is a long-acting opioid that prevents withdrawal and blocks cravings. With a single daily dose (a heroin addict may need four doses a day), a methadone patient doesn’t get “high,” and can pursue a normal life. That means that they can hold a job and receive treatment for other underlying mental illnesses, which may have contributed to their addiction. While in treatment, the patients live longer, commit fewer crimes and have a lower rate of infectious diseases, like AIDS, that are spread through the use of dirty needles and unsafe sex.

BEST RECORD

It’s not perfect. Some patients cheat and keep taking illicit drugs, but after a half-century of tracking its use, methadone has a better record of success than any treatment for any kind of drug or alcohol addiction, according to a report by the Harvard Medical School.

Still it remains politically controversial, because of the insistence that drug addiction is a moral weakness. The addicts chose to take drugs, the argument goes, so they should suffer the consequences.

But we don’t consider diabetics to be immoral for taking insulin, or people with heart disease for taking cholesterol-lowering medicines – even though those conditions could have been brought on by unhealthy eating.

Opiate addiction is also a chronic disease that can’t usually be treated with behavior modification alone. We know that people respond well to medication, and it is wrong for lawmakers to make that form of treatment unavailable for reasons that don’t have a scientific basis.

When lawmakers begin work on the opiate response bill next month, getting medication-supported treatment to the people who need it should be a top priority.

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