What Rabbis Don’t Get About Opioids. And The Consequences Are Deadly.

A congregant, let’s call him Joe, walks into a rabbi’s office and bravely discloses that he is addicted to illicit opioids. After a lengthy discussion the rabbi sends Joe away with a twofold prescription: 1. Start attending 12 Step meetings; 2. Start attending regular worship and study sessions at the synagogue.

The rabbi seems to have presented Joe with a good recovery plan. But what is missing? The rabbi, with all good intention, neglected to recommend the most important course of action: Treatment.

12-Step programs and synagogue involvement may be well and good, but they do not constitute treatment. They may not give Joe what his brain, body and soul need in the moment. For his brain unfortunately has been damaged by a drug that is relentless in its hold on almost every aspect of his life. Joe has developed a severe opioid use disorder and without treatment, he may die.

I am concerned about the way our American Jewish culture responds to the addiction problem — especially the opioid crisis.

Why is this problem not openly discussed in many Jewish communities? Do we honestly believe that heroin use doesn’t happen to Jews, or that illicit use of prescription opioids isn’t prevalent among us? Why do I not see Jewish residential and outpatient treatment programs offering methadone or buprenorphine to patients who need them?

When I reach out to rabbinic colleagues and offer to speak about the opioid crisis in their congregations, why do many of them appear uninterested or unresponsive? These questions cry out for immediate answers that courageously affirm the reality of the crisis within our own population as well as the need to embrace medical solutions along with spiritual and religious ones.

In his commentary to the siddur, Rabbi Lord Jonathan Sacks describes the Refuah (healing) prayer in the Amidah as a prayer “that medical treatment be successful, and that God Himself be part of the healing process. We are both body and souls: the health of one affects the of the other.” A process that targets the healing of the soul, without regard for the medical healing of the body is incomplete. In the case of opioid use disorder, considering the alarming rates of overdose, a misguided process like this becomes downright dangerous

In my second career, after retiring from the full-time rabbinate, I worked as a counselor in an outpatient treatment center for substance use disorders in New Haven CT for almost 10 years. I helped treat hundreds of clients, many of whom were prescribed medications like methadone and buprenorphine for opioid dependence. This medication assisted treatment (MAT) combined prescribed opioid medication with counseling and therapy to enhance recovery outcomes. I saw firsthand how large numbers of these patients were able to reclaim their lives, rebuild their family relationships, maintain steady employment, wake up in the morning without even thinking of using illicit drugs.

Research has shown MAT, not abstinence-based programs, is a necessary treatment for the majority of people with opioid use disorders.

Now, with overdose rates involving heroin at an alarming peak, we can no longer imagine that solving the problem using non-medical, spiritual and religious supports alone will be effective. Judaism’s value of pikuah nefesh, saving lives, demands that we put aside theories suggesting that the transforming power of Torah study and worship combined with 12-Step programs alone will bring about long term recovery.

I am all in favor of utilizing these spiritual supports and programs as additional useful elements in a recovery plan, but let’s put first things first: Refer people at risk to programs that provide MAT, stop telling them that medications like methadone will only replace one addiction with another addiction, stop stigmatizing treatments that can save lives and prevent an ongoing public health disaster that is now causing more deaths than the AIDS epidemic of the 80’s and 90’s.

Once Joe’s rabbi understands this, she will be able to truly perform the work of a spiritual guide and healer. She will point him in the direction that will give him a chance of reclaiming his life. She will suggest that he seek an assessment and evaluation from a MAT provider and worry about the Jewish piece later, if that’s appropriate. She will be guided by the Jewish principle of pikuach nefesh and recommend a medical approach that will promise a more hopeful outcome for Joe.

In Genesis chapter 21, Abraham and Sarah cast out Hagar and Ishmael and cruelly fail to provide them with sufficient provisions. Facing death by thirst, Hagar cries out to God to save her and her son. In the next verse (v. 17) we are told that God hears the cry of the boy (not Hagar) “ba’asher hu sham, from where he is.”

But there is no direct reference in the verses to Ishmael actually crying out. Perhaps it is his silent cry out the depths of his despair and suffering that God notices. Thousands are crying out for help today; they may be silent out of shame or out of lack of readiness for change or out of fear of having to do without their drug of choice.

The opioid epidemic and its victims cry out for our immediate attention. What is needed now is wise direction on the part of our leaders as well as family and friends who are affected.

In the words of Hillel, “If not now, when?”

Rabbi Richard L. Eisenberg is a certified addictions counselor and a retired congregational rabbi.

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