Medically assisted treatment (MAT), which involves using drugs such as methadone or buprenorphine to both manage cravings and, in the case of buprenorphine, block the effects of other opioids, has shown been shown to reduce overdose deaths by nearly 50 percent. A study in Massachusetts found a 59 percent reduction in overdoses for those on methadone and a 38 percent reduction with the use of buprenorphine. However, their use is not allowed in many treatment facilities, prisons and abstinence-based recovery programs.
Why? MAT is effective in part because the medicine includes opioid agonists—meaning they interact with opioid receptors and are able to reduce withdrawal symptoms. They are, in effect, milder forms of the drugs themselves. In a view in which the drug, and not our relationship to it, is the matter of moral concern, this is anathema.
This belief, buttressed by Christian theological developments about substances, holds back progress on addressing addiction and overdoses. An addiction does not involve being taken over by an evil or demonic substance; it stems from a disordered relationship with one. Prohibition and punishment have failed. Approaching addiction as only an individual moral flaw—instead of a public health crisis—has only made things worse. And the eschewal of effective approaches like MAT means more needless deaths.
These beliefs have real consequences. If my doctor had used blame and shame to confront me and then immediately cut me off from pain medicine, I likely would have found myself in the position many others have: seeking them illicitly. Yes, addiction can be harmful but so can the way we have chosen to treat those with addictions as a society.