My own anecdotal stories of trying to have various forms of a lit review outlining some of the drawbacks of addiction treatment medications is what drove me to write this paper. I also have a colleague who does the "controversial research" on tapering buprenorphine for women who are pregnant and want to be tapered. It is controversial because it goes against current ACOG guidance (which has a very shaky scientific underpinning), but it is remarkably successful at preventing neonatal abstinence syndrome (NAS). He eventually has gotten his research published in lower tier medical journals, but was pulled from presenting it at ACOG after having been accepted. That was not because the science was bad, but because it differed with the current guidance. Others at the University of Tennessee had done similar research finding the same effect. The primary driver of that research finally retired because of the exhausting treadmill of trying to power through the gatekeeping.
I have also been looking into funding more deeply. I frequently try to find grants to support the investigation of alternatives or additions to medication for my own research. I would love to see scientifically sound studies comparing various treatment modalities to determine effectiveness. That is nearly impossible without funding programs that test abstinence as a goal. Currently, SAMHSA's State Opioid Response (SOR) Grants explicitly mandate that grant recipients must ensure patients have access to all three FDA-approved forms of MOUD: methadone, buprenorphine, and injectable naltrexone. Section 501 of the Public Health Service Act (42 U.S.C. § 290aa) gives SAMHSA the legal authority to do this. The latitude in this law would allow SAMHSA to fund the study of abstinence promoting research, but it currently doesn't. Why?
I appreciate Clements’ interesting piece, but I would like to see more evidence. Are there anecdotes of scholars like this being excluded from grants and publications? Is there systemic evidence of this bias?
Then we have the question of how to help address this problem. Ironically, one solution is precisely the opposite of what HxA urges: We need more scholar-activists. Clements is a social justice activist (“I want to eradicate” addiction). This is in no way incompatible with her being a scientist. It seems the solution is that we need more activists in the field who want to cure addiction, rather than people who view it as simply a job where one acquires grants from pharmaceutical companies.
The other solution is a little known aspect of the Shils Report at the University of Chicago, which says that scholars should be judged by the quality of their research rather than the quantity of money they generate from grants. This wouldn’t solve all the problems of groupthink, but it would help address the corrupting influence of corporate grants.
I don’t think he’s an activist. He simply wants to do research to find the most effective way to treat addiction. As someone who’s been on methadone, buprenorphine and now is in long term recovery without medication and who worked in the treatment industry around this time it switched from non medication treatment to medication assisted treatment, I think that research is needed.
Thanks Mark. I have heard so many stories from people who are thrilled to be off medication. I'm happy for you. I do think medication can be a tool, but it's not the only tool. I'm all about people having the ability to choose their path to recovery, but I want to be able to help people make informed decisions. We need to be able to conduct studies that compare treatments. If we do good science, we will find what is and is not effective. That's what I'm asking for.
My own anecdotal stories of trying to have various forms of a lit review outlining some of the drawbacks of addiction treatment medications is what drove me to write this paper. I also have a colleague who does the "controversial research" on tapering buprenorphine for women who are pregnant and want to be tapered. It is controversial because it goes against current ACOG guidance (which has a very shaky scientific underpinning), but it is remarkably successful at preventing neonatal abstinence syndrome (NAS). He eventually has gotten his research published in lower tier medical journals, but was pulled from presenting it at ACOG after having been accepted. That was not because the science was bad, but because it differed with the current guidance. Others at the University of Tennessee had done similar research finding the same effect. The primary driver of that research finally retired because of the exhausting treadmill of trying to power through the gatekeeping.
I have also been looking into funding more deeply. I frequently try to find grants to support the investigation of alternatives or additions to medication for my own research. I would love to see scientifically sound studies comparing various treatment modalities to determine effectiveness. That is nearly impossible without funding programs that test abstinence as a goal. Currently, SAMHSA's State Opioid Response (SOR) Grants explicitly mandate that grant recipients must ensure patients have access to all three FDA-approved forms of MOUD: methadone, buprenorphine, and injectable naltrexone. Section 501 of the Public Health Service Act (42 U.S.C. § 290aa) gives SAMHSA the legal authority to do this. The latitude in this law would allow SAMHSA to fund the study of abstinence promoting research, but it currently doesn't. Why?
I appreciate Clements’ interesting piece, but I would like to see more evidence. Are there anecdotes of scholars like this being excluded from grants and publications? Is there systemic evidence of this bias?
Then we have the question of how to help address this problem. Ironically, one solution is precisely the opposite of what HxA urges: We need more scholar-activists. Clements is a social justice activist (“I want to eradicate” addiction). This is in no way incompatible with her being a scientist. It seems the solution is that we need more activists in the field who want to cure addiction, rather than people who view it as simply a job where one acquires grants from pharmaceutical companies.
The other solution is a little known aspect of the Shils Report at the University of Chicago, which says that scholars should be judged by the quality of their research rather than the quantity of money they generate from grants. This wouldn’t solve all the problems of groupthink, but it would help address the corrupting influence of corporate grants.
I don’t think he’s an activist. He simply wants to do research to find the most effective way to treat addiction. As someone who’s been on methadone, buprenorphine and now is in long term recovery without medication and who worked in the treatment industry around this time it switched from non medication treatment to medication assisted treatment, I think that research is needed.
Thanks Mark. I have heard so many stories from people who are thrilled to be off medication. I'm happy for you. I do think medication can be a tool, but it's not the only tool. I'm all about people having the ability to choose their path to recovery, but I want to be able to help people make informed decisions. We need to be able to conduct studies that compare treatments. If we do good science, we will find what is and is not effective. That's what I'm asking for.