The politics of addiction

No one’s quite sure how addiction works—why among a group of friends who share a few lines of coke or a balloon of heroin at a party, one becomes an addict and the other nine never pass the point of being recreational users. Or why one person can toss out a bottle of leftover Vicodin once he’s recovered from his back sprain while another finds himself doctor shopping for prescriptions, unable to function without more and more pills. Genetics and environment play a role, though there are always exceptions to the rule.

One thing is certain: Addiction changes a person’s brain chemistry to the point where the brain can’t function normally without the drug. Drugs become all a person thinks about because they are, literally, all the brain wants. Few addictive substances take over the brain quite like heroin.

“Telling a heroin addict to just say no is like telling someone who’s bipolar to have a nice day” is how Dennis Whitmyer puts it.

Whitmyer is the Southern California director for CRC Health. CRC operates five drug treatment facilities in San Diego County serving roughly 1,500 addicts, the majority of whom show up every day, 365 days a year, to receive a dose of methadone in the form of a pink, cherry-flavored liquid that they count on to keep their drug cravings at bay.

Last October, the same week wildfires broke out around San Diego County, a couple thousand doctors, nurses, drug counselors and public officials gathered at the San Diego Sheraton for the annual meeting of the American Association for the Treatment of Opioid Dependence (AATOD), the national trade organization for providers of what’s known as medically assisted drug treatment. While there are a small handful of drugs used to treat opiate addiction, methadone is the biggie and received much of the focus at the conference, where featured speakers comprised a who’s-who of the drug-treatment world, from the current head of California’s Department of Alcohol and Drug Programs to the director of the national Center for Substance Abuse Treatment. San Diego Mayor Jerry Sanders was scheduled to give a welcome speech, though he had to cancel because of the fires.

Whitmyer, who chaired the conference’s hospitality committee, noticed an absence among attendees—no one from the County of San Diego, the region’s overseer of public-health programs, signed up to attend.

“That was a national program that was attended by 2,000 people and there was no one from the county there, in our own backyard, to learn about the benefits of medically assisted treatment,” Whitmyer said.

No one was there because medically assisted drug treatment, also referred to as narcotic-replacement therapy, is not a service the county provides. Politics and cost—likely more the former—appear to be the reasons why, and the county’s not alone in its refusal to embrace what Kathy Jett, director of the Division of Addiction and Recovery for the California prison system, referred to as “one of the most stigmatized fields there is, despite all the research.””

Methadone, like heroin, is an opiate. Like heroin, it binds to opiate receptors in the brain; but, unlike heroin, it doesn’t produce a euphoric effect. When used in a drug-treatment setting, methadone eases the debilitating symptoms of opiate withdrawal and, when accompanied by counseling, allows a recovering addict’s focus to be not on the sickness and craving that accompany withdrawal but, rather, on getting her or his life in order. An added bonus of methadone is that since it binds to opiate receptors, an addict on methadone who injects heroin won’t experience a high because the seat’s already taken.

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• Published: 01/29/2008
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• Other Stories by Kelly Davis