There is an episode on the podcast Crackdown that posits that, despite less effective results, doctors will still push Suboxone over Methadone when prescribing opiate replacement therapy. In theory, Suboxone is supposed to be safer because it has Naloxone chemically baked into the compound which prevents additional opiates from connecting to their neurological receptors. In short, it prevents you from getting high. Methadone, just being another opiate, allows additional opiates to be used on top of it if the prescription isn’t strong enough to prevent withdrawal. The podcast describes the social rewards of appeasing the medical professionals and being one of the “good” recovering addicts, despite the additional challenges that recovering on Suboxone has over Methadone, and the bitter disappointment of the failure that can come along with that. Ultimately, the podcast concludes that Suboxone is preferred by healthcare workers because it discourages the euphoria that is associated with opiate use on a molecular level.
To be upfront, I struggled with this on a personal level. I have worked with drug users for years, and I always went along with what the doctors and nurses suggested when it comes to opiate replacement therapy because they allegedly know “what’s best” when it comes to prescribing medication. I was told Suboxone is better because it prevents overdose, and who cares what the drug users themselves think, because if they want recovery and no longer want to get high, then why do they want to get high? I didn’t know better, and I didn’t have anyone offering any counterpoints, so it just became an assumed truth: Suboxone is better than Methadone.
Of course, when Mary Poppins says that a spoonful of sugar helps the medicine go down, we just blindly accept that firing the dopamine receptors in the brain is an easy way to make adhering to a pharmaceutical regimen more palatable. Heaven forbid you need a pharmaceutical regimen to overcome addiction, however. Then it’s no sugar for you!
Why do we care if those seeking a less life-threatening way of living their lives happen to have a bit of pleasure within it? While I certainly can’t speak for everyone, I bet that it likely has something to do with the emotional reaction to drug use as a fundamentally hedonic lifestyle. We see the panhandler begging for change, decrepit and not having showered in months, and we think, that’s just the consequences of a lifetime of seeking pleasure right there, and so sad that they still haven’t learned that this is where euphoria leads you. Its cure must therefore involve the complete annihilation of any synthetic joy because only real, pure happiness is socially acceptable.
It doesn’t matter that addiction is the learned coping mechanism developed in response to trauma. No one cares about that. As much as people talk about the opioid crisis being a health crisis, no one seems to do anything about it which would be strange if, as a culture, we accepted addiction as what it actually is. Opiates have killed well over a thousand more people in British Columbia than have died from Covid-19 since Covid-19 became a thing, and the response to Covid-19 has been to shut down the world. We don’t care: drug deaths are the tragic but earned result of insatiably seeking an impure pleasure.
Moral foundations theory is the belief that our morals are determined by the core emotional responses we have to certain situations. We respond with compassion to instances of harm, with indignation to cheating, with disgust to degradation, and so on, and thus are born the moral guidelines of care, fairness, sanctity, etc. Looking at the lives of a drug user, we might be moved to compassion, sure, but the judgier among us are likely to react with disgust. This creates the blueprint for moral blame toward those who indulge in profane pleasure, and thus it becomes that much easier to avoid caring about how many people who use drugs are dying.
If there is a profane pleasure, then surely there must be sacred pleasure, right? What would that be? It certainly isn’t sex, and the social categorization of sex workers would likely fall well within the scope of my thesis here. In Christianity, heaven is described as hanging out with God – being close to God is the sacred pleasure. Within Islam, heaven is a nice garden. Epicurus, the philosopher of socially appropriate hedonism, recommends just having some nice cheese as a sacred pleasure one might indulge in. The thing is though, these all seem kind of… incredibly lame and boring. Don’t get me wrong: cheese is fine, spiritual contemplation can be relaxing, and gardens are quite pretty, but is this really what we want for our sacred pleasure? It seems like the sacred euphoria is to not really have all that much pleasure in your life at all. And that’s the point: all pleasure is inherently profane. The sacred life is about restraining yourself from pleasure because pleasure is dirty.
We’re all susceptible to this. The thing about moral foundation theory is that we all have emotions, and while some emotions may hit us individually harder than others, we can’t escape them. I myself am guilty of this, as I was describing my own thought process above. But remember, addiction is miserable. It’s an endless cycle of desperately trying to escape overwhelming pain. It is patently false to describe addiction as hedonic excess because the euphoria from any drug, let alone the banality of methadone, pales in comparison to the suffering of addiction itself. If the maxim about suffering being the road to sanctity were true, there would be none more sacred than the drug addict.
As bizarre as the moral condemnation of all pleasure is, it is completely irrelevant to the discussion at hand. It’s a trap constructed by the likes of Nancy Reagan, anti-drug campaigns, and ultimately, the racist origins of the drug laws themselves. They used to give opiates to children to calm them down, and even gave it the kind of kitschy name you’d expect for such a product, Mrs. Winslow’s Soothing Syrup. Not that this was particularly healthy for the kids, but it gives you an idea as to the benign perception of narcotics prior to their criminality. Unfortunately, racism needed a way to control immigrant communities, drug use was thus linked to those communities, and drug laws were born to prevent Asian men from boning white women. The disgust associated with drugs was created and perpetuated outside their capacity to induce pleasure (excluding the ecstasy of interracial sexy-times), and so it makes sense that the lived experiences of drug users are irrelevant to our moral condemnation today.
I am writing this piece as a means of organizing my thoughts. I did not have a conclusion in mind when I started, and so it’s actually been a longer process than it normally would be for me to write one of these things. I have to come to grips with my own biases and take the time to reflect on what they are and where they come from. The debate about the comparable benefits between Methadone versus Suboxone is pretty niche, but I knew going into this that the exploration of this topic was going to touch on more than just that. The social attitude toward drugs and the moral condemnation toward their users is ubiquitous, and no one is exempt. Even drug users will hold themselves to a higher moral standard than other drug users citing the arbitrary standard of, “Well, I would never do such and such!” as a means of separating themselves from the impure. Sometimes they end up getting to the point where they do that thing, and this is often brought up in 12-step meetings as the time they knew they had lost control. Sometimes, a new bar will be set, “I may have done such and such, but I would never do such and such!”, and the desire to maintain moral purity remains.
In all honesty, Suboxone does work for some people. It’s good to have as an option for those who might genuinely want it. The point is that we shouldn’t use moral condemnation borne out of historical racism to coerce people into a recovery that doesn’t work for them. Addiction is hard enough as it is.
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