I read @drcarlhart #DrugUseForGrownUps this weekend. I am even more inspired by his work & courage. I so appreciated his reflections on his own academic journey, importance of cognitive flexibility, and evidenced reminder that most ppl who use drugs do not develop addiction. 1/
He shines a light on how deeply broken our approach to drug use is. Racism drives drug policy and the drug war and its many foot soldiers have created a giant smokescreen which allows for massive funding for surveillance, imprisonment, and even murder of Black and brown bodies 2/
The book is decidedly not about addiction, and that’s sort of the point. Sizeable minority of ppl do develop addiction. We need effective, human-centered treatment & harm reduction to save lives, like welcoming care, MOUD, drug checking, overdose prevention sites, safe supply 3/
But we don’t talk enough about fact that for many ppl drug use has positive effects and does not cause harm. We are more comfortable accepting this for socially accepted use (ie alcohol) where many ppl enjoy w/o problem, others develop AUD or have other health related harms 4/
What causes harm without a doubt? Prohibition, unpredictable drug supply, fear mongering, racism. To quote a different @drcarlhart article pathologizing all drug use is killing Black people. So let’s knock it off and embrace solutions driven by science, delivered w/ compassion 5/
Rigid, inflexible thinking helps no one. It’s possible to acknowledge positive aspects of drug use & also harms of addiction & prohibition. Let’s focus on investing $$ in communities, building resilience, repairing harms of racism & poverty, funding harm reduction & treatment 6/6

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More from @DrSarahWakeman

5 Feb 20
Excited to share study ⁦@LarochelleMarc⁩ ⁦@darshaksanghavi⁩, others & I did comparing effectiveness of different #opioid use disorder treatments. Bottom line- only methadone or buprenoprhine associated w/ reduced #overdose at 3 and 12 months jamanetwork.com/journals/jaman…
We looked at claims data for nearly 41,000 individuals w/ OUD and compared outpatient counseling, IOP, detox/residential, naltrexone, or methadone/buprenorphine to no treatment on outcomes of overdose or opioid-related ED or hospitalization at 3 months.
1st takeaway: despite evidence supporting MOUD w/ opioid agonist therapy, in this insured population only 12.5% of cohort received methadone/buprenorphine and average treatment duration was shorter than would be recommended at ~150 days.
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