Robert Lepolszki had kicked his heroin addiction. In 2013, the 28-year-old from Long Island was in a methadone treatment program — which lets addicts replace heroin, a very deadly opioid, with methadone, a safer opioid that doesn't produce a euphoric high like heroin, to suppress withdrawal symptoms. For him, methadone acted like medicine for heroin addiction.
But then Lepolszki was arrested for an old drug sale and placed in front of a drug court, which push addicts to treatment instead of jail. These courts tend to take a hard line on addiction, and this court was no different. Judge Frank Gulotta Jr. said Lepolszki could only avoid incarceration if he quit all drugs — including methadone, the one drug keeping him off heroin.
Methadone treatment programs "are crutches — they are substitutes for drugs and drug cravings without enabling the participant to actually rid him or herself of the addiction," Gulotta wrote, NBC 4's Ann Givens and Chris Glorioso reported. "It must be remembered, the purpose of this program is to rid the participant of all addictions."
Lepolszki died of a heroin overdose six months later.
The drug court fundamentally misunderstood drug addiction
Gulotta, like other critics of methadone treatments, was repeating a common refrain: Using methadone to quit heroin only replaces one drug with another.
But as drug and science journalist Maia Szalavitz explained in the New York Times, this line of thought fundamentally misunderstands drug addiction and why it's a problem:
Addiction is not simply needing a substance to function: If that were the case, we would all be considered addicted to food, water and air.
Instead, addiction involves compulsive behavior in the face of negative consequences; obsessively pursuing a drug or experience even though it is ruining your life. Maintenance replaces unhealthy behavior with simple dependence, the need to take a drug to avoid withdrawal. And that is not a problem with a legal, safe supply.
Under this view, methadone isn't an addiction. The drug is not anywhere as deadly as heroin if used as advised. And since it doesn't produce a euphoric high like heroin, it doesn't lead to addicts looking for more and more as their tolerance increases, which raises their chances of overdose. It is, simply, a medication for opioid addiction.
There's solid science behind the safety and efficacy of methadone and Suboxone, another drug with similar benefits. Decades of research have deemed them effective. The Centers for Disease Control and Prevention, National Institute on Drug Abuse, and World Health Organization acknowledge their medical value.
But since methadone and Suboxone are, like heroin, opioids, many people view them as simply masking an addiction rather than treating it. And although this flies in the face of the accepted medical literature, it's a criticism that's widespread enough to make it to drug courts and some popular rehabilitation programs.
This is a serious public health concern. With heroin and opioid painkiller overdose deaths rising over the past two decades, public health experts and policymakers are looking for the most effective way to treat addictions that are killing thousands of Americans each year.
Based on the medical literature, there are thousands of deaths that could potentially be prevented through methadone and Suboxone. So denying the science in this case isn't just misguided — it's deadly, as Lepolszki's tragic story shows.