Dear Hossein,
I am pleased to hear that you are doing well and that you have completed the questions for this year’s co-guide examination. The number of people in Congress seeking this role and preparing for the exam is quite remarkable. The demand for D.sap seems to be rising each year. It must be difficult keeping up with this demand in light of all of your other responsibilities. I have the bottle of D.sap you sent me some years ago placed on a shelf above my writing desk among other items that you have shared with me as symbols of Congress 60 and our collaborations. Thank you for your detailed answers to my questions. I found your comparison of OT with methadone and buprenorphine particularly interesting as well as your remarks on less post-treatment support needed for OT due to its healing properties.
Most of the research done on methadone and buprenorphine in the U.S. has focused on their corrective properties—their ability to reduce illicit opioid use as long as the medications are taken but without claim of any permanently corrective properties once the medications are no longer taken. That is why the question of post-treatment support is so critical following cessation of methadone or buprenorphine maintenance in the U.S.
The potential curative properties of OT deserve far more research attention than what they have received. That is confirmed by the experience of Congress 60 with the DST method since the founding of Congress 60. I will share the information you provided with others as these questions are posed to me. As to your question about methadone, I can provide a general answer and if that is insufficient I will have one of our addiction medicine specialists respond to your question in more detail. Methadone in the U.S. is approved for use in the treatment of pain and in the treatment of opioid addiction, but the latter, unlike buprenorphine, can only be prescribed within a federally approved opioid treatment program. It is used on a daily basis in oral dosages generally ranging from 25-80 milligrams, with some individuals requiring dosages in excess of 100mg. Efforts are made to match the dosage to the duration and intensity of each individual’s physical dependence.
For decades, there have been debates about low-dose versus high dose methadone maintenance. The research to date suggests that the higher doses (50-80 mg) result in greater reductions in illicit opioid use and less use of other substances. There is very little research on the effects of 100+mg per day. While most patients treated for opioid dependence take the drug once per day, some patients use split dosing each day to minimize side effects and assure metabolic stabilization over the 24 hour period. I can provide articles on any of this if that would be of interest. I am continuing to refine my presentation on the needed integration of medication support and psychosocial support in the treatment of alcohol and opioid dependence in the U.S. that will be presented as a keynote at the major annual conference for addiction professionals. Some of the main ideas in the presentation include the following:
1) There are multiple pathways and styles of addiction recovery and ALL are cause for celebration.
2) There are people served in traditional psychosocial treatment settings not achieving sustained stable recovery who could benefit from medication or related neurobiological support for recovery. Such support may be crucial to those who present with high addiction severity/complexity/chronicity & low recovery capital.
3) There are similarly people in medication-assisted treatment who could benefit from a broad spectrum of psychosocial supports to enhance the long-term recovery process, particularly patients wishing to later sustain recovery without medication support.
4) Integrating and uniquely combining and sequencing siloed approaches to harm reduction, addiction treatment, and recover support based on individualized assessment of problem severity and degree of recovery capital will elevate treatment and recovery outcomes beyond those now being achieved. An example of such effective integration is the Congress 60 recovery community in the Islamic Republic of Iran.
5) Integrating varied supports across the stages of long-term personal and family recovery is the ideal model of sustained recovery management.
I’m looking forward to presenting this material with Drs. Seppala and DuPont next month. Please extend my warm regards to your family and to all members of Congress 60.
Friends and Brothers Forever