In Case You Haven't Heard…

Abstract

At last week's COMPA symposium (see article, page 1), Mark Parrino delivered a quip that drew broad laughter from attendees. It was something a psychoanalyst friend told him years ago: “If you want to know the difference between a neurotic and a psychotic, the neurotic builds sandcastles in the sky. The psychotic moves in and pays rent.” He was cautioning against building a system of methadone reform which, in reality and practice, won't work. Some of the promoters of this new system are lawmakers, as his remarks indicated. Parrino, president of the American Association for the Treatment of Opioid Dependence, was also defending his position of opposing office‐based physician prescribing of methadone. Noting that many reporters have challenged him on this policy, saying it was just protecting opioid treatment program (OTP) turf, Parrino went on to discuss the origins of the OTP system in the 1970s. Nobody wanted to provide methadone to people with opioid addiction. And he added that many more services are needed for these patients, who have mental health disorders, HIV, hepatitis, homelessness, and trauma, just for example. Medication alone won't solve these problems, he said. Yet, when federal officials tell him that they are going to expand treatment, and he asks, “What is treatment?,” the response is, medication. Medication is important, but not the only part of treatment for addiction. Don't start furnishing that sandcastle, or it will be too late.