The idea is to replace the drug of choice with a drug that will 1) not provide a high, and 2) reduce withdrawal symptoms.
Opiate addicts are a little more functional on replacements than on heroin, but this is only because they don't have to worry about how they're going to "stay well". People can be functional heroin addicts if they don't have to worry about sourcing their next dose. In Chasing the Scream, Johann Hari says that some countries give the give their opiate addicts all the heroin they need, and provide a safe, supervised environment for use. Most addicts eventually age out of their addiction.
I met a real drug addict about a year ago, but I didn't realize it at the time. She fluttered from topic to topic like a butterfly, and I said, to myself, "this woman is high as a kite..." She told me about going to the Methadone clinic every day. She gradually invited me into her world, and I learned that the methadone wasn't enough to fill the "holes in her soul". She supplemented her opiates with the street pharmacy's medicines.
With my influence, by about six months she was doing much better. She quit methadone and alcohol cold-turkey. Then the mental health system got a hold of her, and it's been a real struggle ever since.
Calling the mental health system "Psychiatric torture" is not fair to the suffering endured by people who've actually been tortured, but it precisely describes the hopelessness and futility endured by people who are "treated" with drugs that do not address any of the causes of their condition. "Psychiatric Abuse" will have to suffice.
She got addicted to anxiety medications during her fifth mental hospital stay. She'd only wanted them as-needed, but they forced her to take that pill every day. Two weeks after she was released, she hatched a stupid plan to get through the benzodiazepine withdrawal. We got together the second night of her stupid plan, and had a little fight. She said that I didn't understand that she wasn't going to get addicted again, she just needed it so she could sleep. She said it was barely any heroin at all, and just to spite me, she prepared a second shot and did that too.
When she revived, she was immediately terrified by the sudden presence of people in uniform. The firefighters should've followed protocol and taken her to the hospital, but I'd told them that she was already on court-ordered treatment, so they decided to just disappear into the night. After a few more minutes, the police decided they could leave too. The only evidence I have that anyone was there is the nebulizer used to squirt the anti-opiate drug into her nose.
She did very well for the next two weeks. But I was 2 hours away, and she was left to take care of herself, with the added burden of having to take court-ordered anti-psychotic sedatives. She was back in the mental hospital about 5 weeks after her release from the fifth mental hospital stay.
Psychiatrists must be trained to not care why their patients are in their care. They gave her a new anti-psychotic, but she was still quite delusional when she was released from her sixth mental hospitalization.
By this point I'd obtained the drug that she actually needed. It worked exactly as I thought it would, I brought her to live closer to me, and she started to recover from her anti-psychotic-induced brain trauma. Her new psychiatric nurse initially wanted her to stay on the anti-psychotic sedative, but eventually realized the patient doesn't actually need to be permanently sedated.
But she ran out of anxiety medication recently... Her new court-ordered-treatment provider said they didn't provide those drugs, so my friend went to source them from her old "friends". Street drugs are much easier to source than specific second-hand prescription medications.
Street drugs caused her to become psychotic again. She would have come out of it in a day or two, like the previous time, but the police were called. They found heroin. Unlike the previous set of officers, who took the heroin and left, these officers took her to the county jail.
It is stupid to lock people who are trying to recover from mental health issues in cages, where they are taught to be helpless. Her mother, family attorney, case manager and I are working on figuring out where to go next. I don't need to wonder what people who don't have a defense attorney on retainer would do in this situation: most of us would be 100% screwed.
If the politicians wanted to end the opiate epidemic, they would treat it as a public health problem, and stop punishing people for self-medicating their emotions with nature's pharmacy.