Any discussion around addiction suffers from a few things, one if which is misinformation. Both the general public, and people in 12 step programs both have a very poor understanding of what drug replacement/maintenance therapy is, and what the different drugs are.
-Drug replacement therapy for opiates was never meant to be a stand alone option. It has always been meant to be used in conjunction with some sort of private therapy or a structured outpatient program. Unfortunately, this isn’t normally the case, because therapy and programs are expensive and in short supply in the US.
-Methadone and buprenorphine (Suboxone) are both used in opiate replacement therapy, but are very different drugs. Without going into the how they work on the brain chemically, methadone gets you high and buprenorphine doesn’t (after a day or so). Further, it’s possible to stack additional opiates with methadone to achieve a high, where buprenorphine really bind to the receptors in your brain making it nearly impossible to achieve a high from another opiate. The catch is getting off of long term buprenorphine use is absolutely horrific. Acute withdrawal can last for 28 days, and long term withdrawal up to a year. It is also extremely expensive in the US, and can be hard to get a doctor to prescribe, because special training is required. A second issue is that chemically methadone and buprenorphine are more physically addictive than any other opiate, including heroin. These were meant to be used as short term replacements (especially suboxone) to get the patient through the worst withdrawals and start learning to live without opiates. They have become long term solutions, so people are staying on them for decades. This isn’t necessarily a bad thing, but physically, mentally and financially there are a lot of negatives to using drug replacement therapy in perpetuity.
-“Recovery” This is really a term from 12 step programs - it isn’t medical. “Recovery” refers to, in the 12 step context, of being abstinent from drugs AND actively “working the program” (attending meetings, going through the 12 step process). I think a lot of confusion sadly occurs because many people can completely turn around there lives with the help of drug replacement therapy, and stop actively abusing opiates, but people in 12 fellowships, and counselors who recommend them, don’t consider these people in “recovery”. They are “abstinent”, which in the 12 step lens is considered no good.
