Reducing the harm addiction does to addicts, their loved ones -- and their community
For many years now, we’ve known that addiction to opioids, including heroin, is a bona fide disease, a persistent mental illness that hijacks the brain in ways that are different from but no less profound than schizophrenia or bipolar disorder.
Nonetheless, most people still judge people with this illness harshly. That’s at least partly because one of the first casualties of addiction is honesty, and most addicts lie – even to themselves – to deny or cover up their illness. They sometimes steal from strangers and even from their own families. They can become combative, abusive and unreliable. Those behaviors make compassion hard to come by.
No matter how well we understand that addiction is a disease, nothing makes those crimes any less criminal, or their perpetrators any less accountable. To excuse that behavior is to become an active participant in the disease.
Nonetheless it’s a fine line between accountability for bad behavior and penalizing someone for having an illness. Staying on the right side of that line means focusing on accountability measures that address both the bad behavior and the illness. Drug courts are a great step in that direction. But it’s only one step on a long and winding road.
In the past few years, scientists have learned a lot about the brain changes caused by addiction. But progress in finding effective treatments for addiction is far slower. The one thing we know for sure is that no one treatment method works for everyone. To be effective, the treatment needs to be comfortable for a person’s culture, race, language, LGBTQ status, mental health, and spiritual beliefs.
And of course, treatment needs to be available. That’s more likely than it used to be, but it still usually requires a wait. And all too often, people are sent to the first treatment program that has an opening rather than the one that would serve their particular needs.
For treatment to work, people also have to be ready to let go of their addictions. When being high is the only time a person feels OK – and for some, the only time in their lives when they’ve ever felt OK – coming to the state of mind of being ready to quit is a process shrouded in mystery. It comes when it comes. Some people in recovery describe it as a state of grace.
But there are ways to help those who are still in the grip of their disease. We can take measures that prevent overdose deaths and the spread of diseases like HIV or hepatitis. We can make wider use of newer medications that alleviate the craving for opioids. And we can help people with addictions find a safe space where they can be honest about their addictions without being judged.
The recent establishment of Olympia Bupe Clinic, which opened this past January, helps achieve all those goals. The Bupe Clinic is a walk-in facility in the Capital Recovery Center that offers same-day prescribing of Suboxone (a brand name of the generic drug buprenorphrine), which prevents the horrible sickness that is caused by withdrawal from heroin. It can wean someone off heroin, and, taken regularly, it can help sustain recovery over the long term.
Some patients who come to the clinic want to get and stay clean. Some come to find ways to just use less. Others come because they are out of money and going into withdrawal. They may not intend to give up their opioid use, but getting suboxone gives them a break from it. It means they don’t have to choose between getting much sicker, stealing, or doing sex work to buy drugs. And being on suboxone for even a few days opens a new window: Patients can feel what it would be like to be clean. That can be a revelation.
Patients also can connect with peers who are in recovery. One aphorism of the addiction treatment community is that “addiction is the opposite of connection.” Patients treasure the chance to talk honestly about their addiction, the life experiences that led to it, and how they cope with it. Finding an empathetic space where their honesty is respected helps patients reclaim some self-respect, and, for a while at least, put down their burden of shame and stigma.
Addiction is a disease from hell. Reducing the harm it’s doing to its victims is not “enabling,” it is common sense. It reduces the harm for all of us. We are grateful to the Olympia Bupe Clinic and all who do this important work.