Proven Medical Solutions to Opioid AddictionOctober 23, 2017
Our country is seeing as many overdose related deaths from opioid addiction as there were deaths in the civil war. The numbers are staggering. We must utilize any treatment that prevents overdose deaths. Here are some of the choices that have proven to save lives.
Opioids, a class of drugs used to treat pain, often cause feelings of euphoria, are highly addictive, and have claimed some notable lives—Prince, Philip Seymour Hoffman, Chris Kelly, Michael Jackson, and Heath Ledger all died with some form of opioid in their system. The most commonly abused varieties are hydrocodone, morphine, codeine, oxycodone, heroin and fentanyl.
The use of opioids often spurs a vicious and relentless cycle wherein some people start using prescription pain medications for legitimate reasons (e.g., after accidents, following surgery, or to help manage chronic pain). But because of the highly addictive nature of opioids, when some individuals lose access to a prescription, they turn to heroin as a substitute. Heroin, also an opioid, is often easier to obtain and cheaper on the streets than other alternatives. It is estimated that 4 out of 5 new heroin users got their start by using prescription opioid pain medications.
National efforts to fight the opioid addiction epidemic include the creation of opioid prescribing safety guidelines, enhanced statewide drug monitoring programs, new best practices in handling overdoses, and Medication-Assisted Treatment (MAT) to assist those suffering from opioid addiction.
Medication Assisted Treatment for Opioid Addiction
Medication Assisted Treatment is a hotly contested issue in the opioid addiction recovery world; one side strongly advocates for MAT and the other side vehemently opposes it. One side believes that MAT should never be used, including never using drugs to help addicts go through detox. The other side believes in using medication beginning with detox and tapering down over a period of time as the dependency lessens. Still, others believe that use of drugs for long-term maintenance and stability yields the best results.
Proponents of MAT hope that patients experience decreased cravings and do not abuse opioids. The reduction in cravings, whether MAT is used in detoxification or in on-going maintenance, may reduce illicit use, crime, and help people stay in treatment and long-term recovery.
It’s a tricky, complicated issue. With approximately 1 in 4 Americans either directly or indirectly affected by the epidemic, it is important to understand the facts.
What is Medication Assisted Treatment
Medication Assisted Treatment for opioid addiction primarily uses one of the following medications: methadone, buprenorphine, and naltrexone.
Methadone is dispersed through special opioid addiction treatment centers often referred to as methadone clinics. Methadone maintenance therapy or MMT is seen as preferable to using other opioids because it is long acting and is metabolized slowly. It can stabilize individuals and prevent withdrawal, which can include flu-like symptoms including fever, body aches, nausea, and dehydration.
Some people believe that methadone has strong potential for abuse, or that it creates ‘walking zombies’ due to the stupor it can sometimes cause. This stupor may be a matter of monitoring and dosage; it is extremely important to titrate the dosage in order to control cravings and manage withdrawal, however, very few clinics make these types of fine dosing adjustments. They tend to err on the side of prescribing too much rather than too little, thus causing the adverse side effects.
Buprenorphine, the active ingredient in brand name medications Suboxone and Subutex is commonly used in detox situations to reduce symptoms of opioid withdrawal. It is also used to control long-term symptoms through extended maintenance programs. It can be used in addiction treatment centers or at home through a prescription. Many advocate for buprenorphine as a safer alternative to methadone due to its ‘ceiling effect’—that is to say, individuals do not develop a tolerance above a certain dosage level. Like methadone, buprenorphine is long-acting and slow metabolizing, which removes the high as well as the subsequent withdrawal of short-acting opioids.
Advocates believe that buprenorphine normalizes the brain and that patients do not walk around high or in a drug-induced stupor. However, those opposed to its use claim that it can act as a gateway drug to other addictions if the individual has not used other opioids.
Naltrexone (Vivitrol and ReVia)
Naltrexone, the primary active ingredient in Vivitrol and ReVia is also used to treat opiate abuse. It decreases cravings and the desire to use; however, a downside is it appears to block cravings in some individuals and not necessarily in others.
These drugs are not to be confused with naloxone, which has received a great deal of attention in the media recently due to its successful use in reversing the effects of life-threatening opioid overdoses. Naloxone has no potential for abuse and has already saved thousands of lives. Anyone can be quickly trained to administer naloxone, making it ideal for emergency overdose situations. Lately, however, reports have emerged that the drug has increased in price, preventing some small communities from being able to purchase it.
As our nation fights the opioid addiction epidemic, more and more of us have begun to feel its impact. Addiction, a chronic brain disease, has long been misunderstood and MAT, while controversial, is another component to an illness historically weighed down by stigma. The use of Medication Assisted Treatment will likely remain controversial, and whether it is prescribed will—and should—be up to individual healthcare providers on a case-by-case basis.
Regardless, both advocates and opponents of MAT agree that behavioral therapy, group therapy, recovery support, community support, and a general wellness plan are just as important when fighting addiction.
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Written and Published by – Kill The Heroin Epidemic Nationwide, Heroin News and the National Alliance of Addiction Treatment Centers (NAATC)