Bob Geldof’s Attitude

I don’t know much about Bob Geldof.  In fact, the sum of my knowledge of his existence comes from what I read on Wikipedia a few minutes ago.  I stumbled across a headline about his daughter’s tragic death about a year ago.  Apparently he made a comment about her death, and the media exploded in reaction to that comment— that he expected that she would die, given that she was addicted to opioids.  The media refers to his daughter as ‘Peaches’, so apparently she was associated with some measure of notoriety that allows a person to use only one name.   From my review of the headlines I learned that her mother, Paula Yates, also died of a drug overdose about 15 years ago.

Again, I know nothing about Bob Geldof.  The news reports about his comments say that he was appointed an honorary knighthood by Queen Elizabeth II.  He was also described as a ‘man of peace’, who was active in the ‘fathers’ rights movement’.

I’m writing this short post because he was quoted as saying ‘there was nothing that could be done’ about his daughter’s addiction.   As a doc who treats opioid dependence, I believe that his comments would have been accurate 15 years ago, when Peaches’ mother died.  But since about that time, effective tools for treating opioid dependence have been available.  Methadone has been around for decades, of course, but many addicts reject methadone maintenance for a number of reasons— including the hassles associated with maintenance treatments, and the stigma associated with methadone, which is seen by some addicts as a ‘poor man’s treatment’.

But buprenorphine-based medications have been around for over a decade.  Suboxone is the medication most-associated with buprenorphine treatment.  I realize that people addicted to opioids cannot be forced into treatment, but if the ‘sphere of influence’ around an addict— the family, the friends, and the media, for example– favored treatment with buprenorphine, the suffering addict would be more-likely to seek out that treatment.  And the great thing about buprenorphine treatment is that opioid addicts do not need to get it perfect.  If a patient is ambivalent about treatment to the point of taking the medication intermittently, and using heroin intermittently, the chance of that person dying from overdose is greatly reduced.

Over the years I’ve had a number of young patients who were not fully ready to commit to an abstinent lifestyle.  They had sufficient consequences to understand that heroin would kill them if they didn’t seek treatment…  but they still had occasional days or nights when their cravings would lead them to use.    But with buprenorphine in their bloodstream, the effects of heroin and other opioids were blunted, and the risk of death from overdose was greatly-reduced.    I’ve written about how I don’t understand the attitudes of doctors who kick people out of treatment for struggling. Most of the patients who I’ve treated over the years who struggled eventually stopped struggling and left heroin behind.

In these modern times. we don’t have to conclude that ‘nothing can be done’.   We have a solution to opioid dependence in buprenorphine, a medication that reliably prevents overdose even in patients who aren’t fully ready for abstinence.  Understand that I don’t intend to validate bad behavior.  But as a parent, I realize that we need a way to keep our kids alive until they reach a level of maturity where they realize the true nature of the risks they are facing.    I don’t know anything about Bob Geldof, but I disagree with any father’s comment that ‘nothing could have been done’.  If people were more-aware of the escape from addiction provided by buprenorphine, I believe that more people would seek out that escape.

I don’t know Bob Geldof or his daughter.  But it is a shame that neither of them knew about buprenorphine.