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Substitution drugs and community recovery paths as a response to opioid addiction

An integrated treatment between the pharmacological approach and community recovery paths as a response to the problem of opioid addiction. This is the summary reached at the end of the webinar “Opioid use disorders: epidemiology and treatment” organized by San Patrignano in collaboration with the Weill Cornell Medical College, NewYork – Presbyterian Hospital.

A comparison between the Italian experience of drug treatment system made up of  SerDs (Public Addiction Services) and therapeutic communities, and here more specifically San Patrignano, and American doctors and researchers who are experiencing a plague of abuse/addiction from opioid painkillers, resulting from an indiscriminate and easily accessible prescription. A situation followed by a new spread of heroin and of very powerful and lethal synthetic opioid drugs. “Opioid overdose in the United States has become the leading cause of death in the age group of 20-40,” explained Jonathan Avery, M.D. Director of Addiction Psychiatry Weill Cornell Medical College, NewYork – Presbyterian Hospital – In the USA we had over 70 thousand deaths only in 2017″.

Thus the interest in understanding how to offer a valuable aid to drug addicts since that the main solution adopted so far in the United States was to contrast drug addiction with pharmacological treatment. “Addiction is a brain disease – explained Lipi Roy, medical director of the Housing Works of New York – and is the number one most stigmatized social problem. there is a very high social stigma related to drug addiction. The first problem is that, in the United States, only 10 percent access to treatment. Although I’ve always been in favor of medications, I recognize that addiction affects all aspects of life and these must be taken into account. In some cases, medications can be very effective, but in others I believe that both medical assisted treatments and psychotherapy are needed. We need a multidisciplinary approach like that used by San Patrignano but together with medications and personalize the treatment of each individual “.

Roger Weiss, M.D. Professor of Psichiatry, Harvard Medical School raised some doubts: “According to our studies, prescription drugs users had a higher success outcome and counseling did not improve outcomes. Discovering the experience of San Patrignano, on the other hand, shows how important psychosocial treatment is. But what to do for those who have no way of accessing such a well-structured community or who cannot follow it for so long? “.

Luigi Stella, professor of Pharmacology, Toxicology and Teratogenesis at the University Federico II of Naples and President of the Italian Drug Addiction Society, replied: “There must be a close connection between public drug addiction services and communities as we have in Italy. We, as services, pick the patients and send them to the therapeutic communities and today almost none of them enter in the community without drugs. The medical approach, and that of the therapeutic community, is the same since we have verified that multidisciplinary treatment can lead to very important results “.

To underline the importance of a long-lasting psychoeducational recovery path, Antonio Boschini, head of health and therapeutic programme of San Patrignano: “Three years of recovery are a lot, but it is also true that in the second period residents are oriented towards studies and professional training. Furthermore, if a 18 years old guy faces an opioid  use disorder with agonist treatment, would he follow it for a shorter period? Since drugs drive the brain, isn’t an agonist drug more dangerous to chronicize a drug addiction after 20 years? I know that the world of drug treatment is far from recovery, but they must find a way to communicate. The problem of addiction must be examined not only from a neurobiological perspective, but also in other way. We must think differently and explore all the possibilities to help people, because drug addiction often arises from a previous unease”.

Phaedon Kaloterakis, assistant director of Kethea,  the most important drug rehabilitation and social reintegration center in Greece, has tried to find a common point between speaker talks: “Pharmacological treatment and recovery are two approaches that are also very distant, but we must begin to treat the problem of drug addiction as psychological, biological and social problem. A synergy must be created between those like us who work in the field of drug addiction and we must organize meetings and discuss and listen to each others sharing our experiences as much as possible”.

Gabriele Manella, associate professor in Sociology of the environment and territory, University of Bologna has underlined the relevance of these comparisons: “We need to have effective and measurable community programs. In order to support the importance of going beyond the pharmacological treatment, the communities need to carry out follow-up researches in order to  understand how people are after some time, how social reintegration has been and the success rate of the recovery path ” .

Letizia Moratti, co-founder of the San Patrignano Foundation, closed the webinar: “Following the community since 1979 over the years we have been convinced of one thing: drug addiction is not a chronic and incurable disease, but a situation from which the person can be completely recovered “.


20 November 2020
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