"Substitution Treatment" vs "Chronic Drug Abuse": A False Dichotomy

(Search Keywords: substitution, treatment, methadone, buprenorphine, drug policy, addiction treatment bureaucracy, opioid replacement, maintenance)

I recently came across this line in a drug-policy article in a UK based journal, The Gaurdian:

"What else does research tell us about treatment? We need both more treatment, which the Affordable Care Act (aka "healthcare reform") will provide, and also dramatically better treatment. Treatment regimes based on opiate substitution (eg, with methadone and buprenorphine) have strong scientific evidence of effectiveness."

Well surprise, surprise. Might I add that more recent experience has shown heroin maintenance "treatment" is even more effective. Who would have thought that simply allowing consenting adults "addicts" the drugs that they want would be helpful in reducing criminal activity and improving their overall health? 

In order to continue our progress toward rational, dignified drug policies; we now must learn to stop pathologizing & medicalizing the personal use of psychoactives. This in part can be accomplished by letting go of the symbolic meanings which have been arbitrarily attatched accross the contextual spectrum of drug uses and drug-types, effectively ridding our policy discourse of the false dichotomies of "maintenance treatment" vs "habitual drug abuse" - the superficial divides between medicines & "dangerous drugs", methadone & heroin, licit & illicit, prescribed pharmacotherapy & self medication "drug abuse". 

Enforcement and policy officials worldwide are seeing the success of these opioid substitution treatments; yet it seems US officials & policymakers cannot bridge the logical gap between a) the efficacy of regular doses of narcotics (i.e. maintenance programs); and b) the notion that adult drug users ought to be simply given access to the narcotics they enjoy (outrageous idea, I know). 

The social & personal benefits of "treatment" with daily methadone, buprenorphine, morphine and even heroin, become increasingly clear, yet policy mavens have yet to acknowledge the ever more apparent reality that the primary destructions and harms underlying our "drug problems" lie in irrational US drug policies and UN conventions, rather than the drugs themselves.

Discussion:

There seems to be only one rational incentive for drawing a conceptual divide between a) legally supplying methadone to "addicts" on a regular basis, and b) allowing drug users to obtain and administer their drugs of choice on their own and by their own terms; that incentive being to maintain the financial interests and power-control monopoly of the multibillion dollar "addiction treatment" bureaucracy. Its intrusive level of control over the adult drug user is no more than a paternalistic assault on intellectual & spiritual freedom, with the seeming objective of ensuring the individuals' perpetual dependence upon the illusion of dignity & phony validation that this repressive system provides.