Marc Fishman

Marc Fishman is a Johns Hopkins researcher and medication-assisted treatment provider whose contribution to the book is a case for treating opioid addiction with both scientific realism and practical urgency. He describes available medications as imperfect but among the best tools for preventing deaths, urges health systems to connect overdose patients with continuing care, and challenges the idea that twelve-step programs alone can meet the needs of an epidemic.

Identity and Historical Perspective

Fishman enters the narrative as a clinician and researcher thinking about the problem across more than one era. He places the modern struggle to treat addiction within a long American history of using one opioid to manage dependence on another: doctors used morphine to wean patients from laudanum, and later used heroin to help patients stop using morphine. In his account, the history of treatment repeatedly gives way to stern prohibition, from the Harrison Narcotics Act to the War on Drugs.

That cycle informs his criticism of all-or-nothing responses. Fishman sees a culture inclined to swing between approaches rather than hold treatment and risk in view at the same time. His perspective does not present medication as a perfect answer; it asks that imperfect care be judged against the consequences of leaving people without effective treatment.

Medication-Assisted Treatment: Benefits and Limits

Fishman regards buprenorphine, Methadone used at Overmountain Recovery, and naltrexone as imperfect options, but says that, scientifically, they remain among the strongest tools available to prevent deaths. His endorsement is qualified rather than triumphalist. He warns that patients who stop maintenance medication face significant relapse rates, and argues that advocates should acknowledge such drawbacks openly instead of presenting medication as a flawless chemical fix.

That candor, in his view, could make skeptics more receptive to treatment. He does not frame the choice as medication versus recovery; he describes the need to recognize both the protections treatment can offer and the risks that remain when it ends. The distinction matters in a book where access to medication is not merely a clinical question: Tess Henry, for example, felt stigmatized in twelve-step meetings because she was taking buprenorphine, and people asked to mentor her declined.

From Overdose Response to Continuing Care

Fishman predicts that the rising costs of addiction-related illness will eventually push health systems to incorporate addiction treatment into ordinary health care. He particularly emphasizes the transition after an overdose: patients need a smoother path from the emergency department to outpatient medication-assisted treatment, rather than having overdose reversal mark the end of the system’s response.

He criticizes the familiar pattern in which someone survives an overdose but is sent away with little more than photocopied Alcoholics Anonymous contact information. The contrast makes his practical concern clear: emergency intervention can preserve a life in the moment, but without a route into continuing care, it does not resolve the treatment gap that follows.

The Limits of Twelve-Step-Only Recovery

In a treatment landscape long shaped by twelve-step philosophy, Fishman stresses that only a small minority of people with opioid addiction achieve long-term sobriety without medication-assisted treatment. He argues that Alcoholics Anonymous cannot be scaled to serve an epidemic of this size and that most people with opioid addiction cannot manage recovery without medication.

His argument gives the book a clinical counterweight to the stigma surrounding maintenance treatment. The narrative records how a person taking buprenorphine could be regarded as not truly clean even when a fellowship’s official policy accepted medication-assisted treatment. Fishman’s emphasis on effectiveness and the limits of abstinence-only support speaks directly to the consequences of that divide, while his insistence on acknowledging treatment’s drawbacks keeps the alternative from being reduced to a simple promise of cure.