Anne Giles

Anne Giles is a local addiction counselor who argues that opioid addiction should be treated through evidence-based medical care rather than cultural suspicion or criminal-justice restrictions. Her account of medication-assisted treatment links patients’ access to care with the authority of physicians, the limits placed on prescribing, and the financial barriers facing clinics.

Identity and Position

Giles appears in the book as a counselor angered by cultural resistance to medication-assisted treatment (MAT). She challenges the assumption that counseling must be the principal or sufficient response to opioid addiction, pointing instead to research supporting MAT alongside psychosocial support. An analysis of international studies in The Lancet, as described in the book, found that the best treatment combines the two, while also showing some benefit from medication with minimal support. Giles’s argument is therefore not that support is irrelevant, but that opposition to medication can obstruct treatment with evidence behind it.

Her position counters the idea that a patient taking medication is merely substituting one opioid for another. Elsewhere, the book shows the practical consequences of that stigma through Tess, who felt judged in twelve-step meetings for taking buprenorphine; people asked to sponsor her declined. Giles’s anger at cultural bias speaks to this larger divide, though the account does not establish a personal connection between the two women.

Medicine Against Criminal-Justice Restrictions

Giles’s sharpest institutional claim is that courts should not practice medicine. In her view, criminal-justice skepticism can override clinical judgment even as national understanding of MAT’s benefits grows. The distinction matters because treatment decisions made through suspicion or punishment may deny patients a medically supported option; for Giles, prescribing belongs with doctors rather than judges.

She also connects barriers to formal treatment with the use of illicitly obtained Suboxone. Giles argues that people buy it outside the medical system to self-medicate because federal rules do not permit enough physicians to prescribe it. In this account, illicit use is not simply evidence of individual misconduct: it is also a sign that regulated access has failed to meet demand. Her critique thus turns attention from the drug alone to the conditions that shape where patients can obtain it.

Costs, Access, and Emergency

Giles identifies a second practical obstacle in the economics of treatment. Privately operated clinics, she says, accepted cash because Medicaid reimbursements were delayed and covered only a small portion of their costs. Patients therefore faced a system in which physician availability was restricted while existing services could remain financially inaccessible. Her account presents access as an institutional problem produced by regulation and inadequate payment, not merely by a patient’s willingness to seek help.

She presses the urgency of the crisis through an analogy to Ebola: given rising opioid-related deaths, HIV, and hepatitis C, Giles argues, the response should be commensurate with an emergency. Her appeal for doctors to be allowed to treat patients, and for a response on the scale of an epidemic, gives her criticism a concrete direction. In the book’s broader treatment of addiction, her stance exposes the cost of letting legal skepticism and cultural stigma displace health care.