The words "clean" and "sober" have merged in the popular lexicon and also underpin much drug control and treatment.
A growing body of science suggests we need to rethink that widely held belief about addiction. Rather than abstinence, a substitute drug may provide the safest, or even the only, road to sobriety for many. This is especially true for people who have become dependent on opiates such as Oxycontin and heroin.
Kentuckians should adopt an open mind toward medication-assisted treatment, or MAT, which incorporates physician-prescribed medicines, such as buprenorphine and naltrexone, into treatment plans that also include counseling and medical care.
Lives are at stake.
Kentucky's rate of fatal overdoses quadrupled from 1999 to 2010 when we recorded the nation's third-highest (23.6 per 100,000 people), behind West Virginia and New Mexico. That's according to a report by the Trust for America's Health.
In 2013, Kentucky's fatal overdose rate declined to 22.9 per 100,000, according to state data, while in some southeastern counties the rate exceeded 40.
Of the roughly 1,000 people who are dying each year of drug overdoses in Kentucky, almost all of those autopsied by the state medical examiner had opiates in their blood, often in combination with other drugs.
The Huffington Post examined 93 deaths from heroin in 2013 in the Northern Kentucky counties of Boone, Campbell and Kenton. Reporter Jason Cherkis obtained histories for 74 of them.
Fifty-three of those 74 overdose victims had some experience with abstinence-based treatment, ranging from long-term residential programs to court-ordered participation in Narcotics Anonymous. While there's no way to know how many might have been saved, access to MAT would have improved their chances.
Skeptics say MAT just trades one drug for another. But used as prescribed, the substitute drugs enable users to function normally, hold a job, go to school, without the impairment and craving that drive abusers to crime and other risky acts.
As the Trust for America's Health said in its 2013 report, "Treatment approaches largely lag way behind developments in brain research and knowledge about the most effective forms of treatment."
Kentucky is starting to catch up with the research.
The Department of Corrections plans to educate prisoners about post-release options for MAT, which has become a practical alternative for many more Kentuckians thanks to the Medicaid expansion.
The Affordable Care Act made substance-abuse treatment broadly available through Medicaid in Kentucky for the first time last year, when Medicaid paid $41 million for buprenorphine drugs, the most well known of which is Suboxone, for Kentuckians.
In February, the federal government said it would withhold grants from drug courts that bar MAT. Kentucky receives almost $12 million in federal grants for drug courts in 12 counties, including Fayette.
In response, Kentucky lifted its ban on drug-court participants using substitute medicines beyond six months. Kentucky Chief Justice John Minton has enlisted a task force, including judges from around the state, to study medication-assisted treatment, beginning later this month.
Kentucky is suffering so deeply from opiate abuse we can't afford to leave any effective tool unused.