Dr. Hillary Kunins, a PCSS Clinical expert, dispels the notion that treating an addiction patient with medication is simply exchanging one drug with another. Learn how physical dependence is not the same as addiction. A good video to share with patients and their families who have questions about MAT.
Dr. Kunins is an Assistant Commissioner at the New York City Department of Health and Mental Hygiene where she leads the Department’s Bureau of Alcohol and Drug Use – Prevention, Care and Treatment.
Communities like Portsmouth, Ohio, regularly make national news for waves of overdoses. On any given day, nearly 100 people across the country die due to opioid overdose. The problem always feels like an uphill battle, and often a losing one for social workers and drug counselors who hope to get clients on the path to sobriety.
Evidence shows that one method, medication assisted treatment (MAT), works; however, for MAT to be truly effective, it takes an entire community.
What Is Medication Assisted Treatment?
Medication assisted treatment is an evidence-based recovery process that combines traditional therapies and detox programs with the use of medication. Medication helps patients manage cravings and provides relief from detoxification symptoms. MAT is useful for people who are addicted to opioids or alcohol.
These are some of the most common medications used to treat in MAT.
Buprenorphine: A partial opioid agonist, buprenorphine is used for the treatment of patients who are addicted to prescription painkillers. This medication is the first opioid treatment not required to be administered in a clinic.
Probuphine: Approved by the FDA in 2016, the probuphine implant requires four rods to be inserted into the upper arm. The rods provide a continuous dose of buprenorphine for six months to alleviate cravings and withdrawal symptoms.
Methadone: Methadone is known as a full opioid agonist, which means that it provides many of the same effects of other opioids. The effects are usually milder and do not impact the patient’s ability to function as much, though.
Naloxone: An opioid antagonist, naloxone can reverse or prevent life-threatening overdoses by blocking opioid activity at receptor sites. Police officers and medical workers typically carry these injections and administer as necessary. Sometimes, users also carry them in case of an emergency.
Naltrexone: Available as an injectable or in pill form, naltrexone is available as a monthly or daily dose and lacks the potential for abuse.
Acamprosate: Sometimes referred to as Campral, acamprosate is used to prevent relapse in alcoholics by lessening the post-acute withdrawal symptoms that often lead to relapse.
Along with medication, patients in an MAT program are required to participate in therapy or counseling.
Healthcare Providers and Community Members Can Erase Stigma
Even though MAT has proven to be an effective form of treatment, there’s still a stigma associated with it, as many believe that it’s about replacing one drug with another. What can be done so that members of behavioral healthcare can recommend this treatment?
Change in Mindset
Addiction is complex. It is a brain disease. Simply viewing addiction as a disease rather than a moral or criminal problem can help make addiction treatment programs, including MAT, more accessible. Despite inclusion in the Diagnostic and Statistical Manual (DSM) and research that states addiction is a disease, many community members and medical professionals do not view addiction in this way. If behavioral healthcare professionals don’t understand addiction as a disease, MAT will continue to be underutilized.
Addiction professionals have a responsibility to educate others on MAT and its effectiveness. There are still misconceptions about what the treatment actually entails.
Social workers, counselors, and others must understand MAT and the evidence that supports this type of program. This also means that healthcare organizations need to mandate ongoing education for staff. Education enables counselors to make appropriate recommendations as to when individuals need abstinence-based treatment or MAT. Both types of treatment can be effective, but which is appropriate for the patients they are treating?
Law enforcement officials should also receive education and training on MAT. This includes promoting MAT as a treatment method for incarcerated addicts. A lack of MAT in prisons means many addicts end up relapsing, and even dying of an overdose because they didn’t receive proper treatment.
Access to Naloxone
Reducing stigma associated with MAT means that access to medication should go beyond the treatment setting. First responders should be trained to carry and administer naloxone. As mentioned earlier in this article, it can be a life-saving step in reducing overdose fatalities. Many states already passed legislation to allow access to naloxone. Healthcare professionals can share research and evidence with community officials to allow access to naloxone or increase supply in cities that already have it.
A holistic solution that involves the whole community is necessary to combat the opioid epidemic, reduce fatalities, and direct people to the appropriate treatment option, whether it’s MAT or not. Community officials and healthcare providers should also look to treatment centers as resources. What can they learn from the individuals who are working with these patients? In order to make MAT effective, it takes community involvement before, during, and after treatment.
Recently, the Centers for Disease Control and Prevention (CDC) released guidance that excluded buprenorphine from the narcotic mg equivalent (MME)/day calculation. OARRS will now calculate and display a patient’s narcotic (opioids) and buprenorphine equivalences separately.
Buprenorphine is often used as a form of medication assisted treatment (MAT). For most of 2017, a typical dose of buprenorphine, when prescribed for MAT, was 16 mg. This would result in a Patient Report of 480 MME value.
To reflect this change, the OARRS system will be making upgrades to the MME column in the patient reports starting on April 11th. This will include:
Buprenorphine excluded from displayed MME calculations
Summary section of Patient Report will no longer only display Active Daily MMEs
Prescriptions section of Patient Report to be updated to reflect mg/day for buprenorphine
Before Joe Thompson switched treatments for his opioid addiction, he was a devoted stay-at-home father, caring for his infant son after his wife returned to work. His recovery was aided by the anticraving medication buprenorphine. But after over two years free of heroin, Mr. Thompson, a former United Parcel Service worker from Iowa, relapsed and decided to try another kind of treatment program.
Unfortunately, his new counselors insisted that continuing his buprenorphine, though it was approved by the Food and Drug Administration, was just as bad as using heroin, according to his wife, Deborah. He wasn’t even allowed to start therapy until he’d been abstinent for several weeks. Stressed by withdrawal, he went to a third center. It, too, banned medication. Within a week of entering the program, he was dead from a heroin overdose. He was 35.
Buprenorphine is one of only two treatments proven to cut the death rate from opioid addiction by half or more. But the programs Mr. Thompson tried viewed abstinence as the only true recovery — even though abstinence treatment has not been shown to reduce mortality and is less effective than medication at preventing relapse.
Unfortunately, Mr. Thompson’s experience is more the rule than the exception. Only about one-third of American addiction programs offer what many experts worldwide see as the standard of care — long-term use of either methadone or buprenorphine. Most programs view medication as a crutch for short-term use and provide only talk therapies.
This widespread rejection of proven addiction medications is the single biggest obstacle to ending the overdose epidemic. Funding isn’t the barrier: Outpatient medication treatment is both more effective and significantly cheaper than adding inpatient beds at rehabilitation centers. The problem is an outdated ideology that views needing a medication to function as a form of addiction.
Rather than defining addiction as destructive, compulsive behavior, this ideology focuses on physical dependence. If you need a drug to avoid being physically ill, you are considered addicted. So Prozac would be considered addictive, but not cocaine, because quitting Prozac abruptly can cause flulike symptoms while stopping cocaine doesn’t, even though it elicits extreme craving.
In the 1980s, crack cocaine made clear just how addictive cocaine could be, even without physical withdrawal symptoms. Today, both the National Institute on Drug Abuse and the Diagnostic and Statistical Manual of Mental Disorders reject the idea that addiction is synonymous with dependence. Unfortunately, many clinicians, including doctors, haven’t caught up.
What is addiction, then? The root problem is craving, which drives a compulsion to use drugs despite the harm they cause. That’s what makes crack addictive, while Prozac can be therapeutic.
Because methadone and buprenorphine are opioids themselves, it’s easy to assume that using them is “substituting one addiction for another.” However, the pattern of taking the same dose every day at the same time means that there is no high or intoxication. Patients on maintenance doses are able to nurture a baby, drive, work and be a loving spouse.
In these patients, addiction is replaced by physical dependence. And that’s not a problem for those who have health care coverage: It’s no different from needing antidepressants or insulin. When a drug’s benefits outweigh its risks, continued use is healthy, not addictive.
Sadly, though, there’s another reason for widespread skepticism about addiction medication. It comes from the fact that many patients will continue to misuse opioids. Medication reduces relapse more than abstinence does — but relapse is still common, as in Mr. Thompson’s case. In abstinence treatment, however, relapsers drop out and are invisible; with medication, they often remain in treatment.
And remaining in treatment is important because it cuts overdose risk, even during relapse. Many highly traumatized people also need the continued health care support before they are able to quit street drugs.
When we fail to understand that these medications can be used both to reduce harm and stabilize people in recovery, we risk letting the perfect be the enemy of the good. For some, medication is a way to reduce risk while drug use continues. For others, it’s a path to rapid recovery. Often, people will need to take the first route to survive long enough to reach the second.
For harm reduction to work, maintenance drugs need to be almost as accessible as street drugs. Whenever people take buprenorphine rather than heroin, their risk of dying is lowered, especially since so much heroin these days is tainted with deadly strong fentanyl. For stabilization, people need empathetic counseling that doesn’t view dependence as continuing addiction.
Change will require innovative measures. The governmennt should stop funding and insurers should stop covering any program that does not use all the F.D.A.-approved anticraving medications and does not provide informed consent about their effectiveness. While abstinence can work for some, we need many options. We also need to rethink our regulations for methadone and buprenorphine prescribing.
Then we need to publicly recognize that recovery on medication is every bit as valid as any other treatment. What matters is whether, as Freud put it, you can love and work, not the chemical content of your brain or urine.
Despite current treatment guidelines, fewer than 10 percent of adults with co-occurring mental health and substance use disorders receive treatment for both disorders, and more than 50 percent do not receive treatment for either disorder. The findings highlight a large gap between the prevalence of co-occurring disorders and treatment rates among U.S. adults and the need to identify effective approaches to increasing treatment for those with these conditions. An analysis of data from U.S. adults with both a mental health disorder and a substance use disorder indicates that only 9.1 percent of those adults received both types of care over the past year, and 52.5 percent received neither mental health care nor substance use treatment.
The study, based on data collected from the 2008-2014 National Survey on Drug Use and Health, reports that 3.3 percent of the adult U.S. population, or some 7.7 million individuals, suffers from both a mental health and substance use disorder. Those adults with co-occurring disorders who did receive both types of treatment tend to have more serious psychiatric problems and accompanying physical ailments and were more likely to be involved with the criminal justice system compared to individuals who did not receive both types of care. The primary reasons for not seeking care were inability to afford treatment, lack of knowledge about where to get care, and a low perceived need among those with both disorders.
Why do they do it? This is a question that friends and families often ask of those who are addicted.
It’s difficult to explain how drug addiction develops over time. To many, it looks like the constant search for pleasure. But the pleasure derived from opioids like heroin or stimulants like cocaine declines with repeated use. What’s more, some addictive drugs, like nicotine, fail to produce any noticeable euphoria in regular users.
So what does explain the persistence of addiction? As an addiction researcher for the past 15 years, I look to the brain to understand how recreational use becomes compulsive, prompting people like you and me to make bad choices.
Myths about addiction
There are two popular explanations for addiction, neither of which holds up to scrutiny.
The first is that compulsive drug taking is a bad habit – one that addicts just need to “kick.”
However, to the brain, a habit is nothing more than our ability to carry out repetitive tasks – like tying our shoelaces or brushing our teeth – more and more efficiently. People don’t typically get caught up in an endless and compulsive cycle of shoelace tying.
Another theory claims that overcoming withdrawal is too tough for many addicts. Withdrawal, the highly unpleasant feeling that occurs when the drug leaves your body, can include sweats, chills, anxiety and heart palpitations.
For certain drugs, such as alcohol, withdrawal comes with a risk of death if not properly managed.
The painful symptoms of withdrawal are frequently cited as the reason addiction seems inescapable. However, even for heroin, withdrawal symptoms mostly subside after about two weeks. Plus, many addictive drugs produce varying and sometimes only mild withdrawal symptoms.
This is not to say that pleasure, habits or withdrawal are not involved in addiction. But we must ask whether they are necessary components of addiction – or whether addiction would persist even in their absence.
Pleasure versus desire
In the 1980s, researchers made a surprising discovery. Food, sex and drugs all appeared to cause dopamine to be released in certain areas of the brain, such as the nucleus accumbens.
This suggested to many in the scientific community that these areas were the brain’s pleasure centres and that dopamine was our own internal pleasure neurotransmitter. However, this idea has since been debunked. The brain does have pleasure centres, but they are not modulated by dopamine.
So what’s going on? It turns out that, in the brain, “liking” something and “wanting” something are two separate psychological experiences.
“Liking” refers to the spontaneous delight one might experience eating a chocolate chip cookie. “Wanting” is our grumbling desire when we eye the plate of cookies in the centre of the table during a meeting.
Dopamine is responsible for “wanting” – not for “liking.” For example, in one study, researchers observed rats that could not produce dopamine in their brains. These rats lost the urge to eat but still had pleasurable facial reactions when food was placed in their mouths.
All drugs of abuse trigger a surge of dopamine – a rush of “wanting” – in the brain. This makes us crave more drugs. With repeated drug use, the “wanting” grows, while our “liking” of the drug appears to stagnate or even decrease, a phenomenon known as tolerance.
In my own research, we looked at a small subregion of the amygdala, an almond-shaped brain structure best known for its role in fear and emotion.
We found that activating this area makes rats more likely to show addictive-like behaviors: narrowing their focus, rapidly escalating their cocaine intake and even compulsively nibbling at a cocaine port. This subregion may be involved in excessive “wanting,” in humans, too, influencing us to make risky choices.
The recent opioid epidemic has produced what we might call “involuntary” addicts. Opioids – such as oxycodone, percocet, vicodin or fentanyl – are very effective at managing otherwise intractable pain. Yet they also produce surges in dopamine release.
Most individuals begin taking prescription opioids not for pleasure but rather from a need to manage their pain, often on the recommendation of a doctor. Any pleasure they may experience is rooted in the relief from pain.
However, over time, users tend to develop a tolerance. The drug becomes less and less effective, and they need larger doses of the drug to control pain. This exposes people to large surges of dopamine in the brain. As the pain subsides, they find themselves inexplicably hooked on a drug and compelled to take more.
The result of this regular intake of large amounts of drug is a hyperreactive “wanting” system. A sensitised “wanting” system triggers intense bouts of craving whenever in the presence of the drug or exposed to drug cues.
These cues can include drug paraphernalia, negative emotions such as stress or even specific people and places. Drug cues are one of an addict’s biggest challenges.
These changes in the brain can be long-lasting, if not permanent. Some individuals seem to be more likely to undergo these changes.
Research suggests that genetic factors may predispose certain individuals, which explains why a family history of addiction leads to increased risk. Early life stressors, such as childhood adversity or physical abuse, also seem to put people at more risk.
Addiction and choice
Many of us regularly indulge in drugs of abuse, such as alcohol or nicotine. We may even occasionally overindulge. But, in most cases, this doesn’t qualify as addiction. This is, in part, because we manage to regain balance and choose alternative rewards like spending time with family or enjoyable drug-free hobbies.
However, for those susceptible to excessive “wanting,” it may be difficult to maintain that balance. Once researchers figure out what makes an individual susceptible to developing a hyper reactive “wanting” system, we can help doctors better manage the risk of exposing a patient to drugs with such potent addictive potential.
In the meantime, many of us should reframe how we think about addiction. Our lack of understanding of what predicts the risk of addiction means that it could just as easily have affected you or me.
In many cases, the individual suffering from addiction doesn’t lack the willpower to quit drugs. They know and see the pain and suffering that it creates around them. Addiction simply creates a craving that’s often stronger than any one person could overcome alone.
That’s why people battling addiction deserve our support and compassion, rather than the distrust and exclusion that our society too often provides.
Article written by: Mike Robinson, Assistant Professor of Psychology, Wesleyan University.
The American Society of Addiction Medicine (ASAM) is proud to announce the acquisition of a $2.2 million grant from the state of Ohio to help combat the prescription opioid and heroin crisis. Ohio has been awarded over $26 million through the 21st Century Cures Act from the Substance Abuse and Mental Health Services Administration (SAMHSA) to strengthen their healthcare system. ASAM is grateful to be a part of building a strong healthcare system, particularly for patients with addiction, in Ohio. The grant-funded project is beginning immediately and is projected to continue through April 2018.
“ASAM is ready to help Ohio take on this project,” said Ohio State Chapter President Dr. Shawn Ryan, “this will make a difference locally for the physicians who treat addiction and save lives in Ohio.”
The objectives of the project include conducting 42 live 8-hour waiver-qualifying CME trainings, providing access to ASAM’s online waiver-qualifying CME for up to 2,000 physician learners, and providing financial compensation to those physicians who meet training and waiver requirements. All goals and objectives will be completed within the funding period (from July 1, 2017 – April 30, 2018).
On our infectious diseases (ID) consult service, we recently cared for Mr. C., a young man with Staphylococcus aureus tricuspid valve endocarditis, septic arthritis, and empyema that were consequences of his opioid use disorder (OUD). Several years earlier, he had started taking oxycodone at parties, and eventually, when the cost of pills became prohibitive, he’d progressed to injecting heroin. His days were consumed by the logistics of obtaining heroin to stave off the exhausting cycle of opioid withdrawal. Despite his deep desire to stop using, he was initially ambivalent when we offered to start treatment with buprenorphine, which is commonly coformulated with naloxone as Suboxone (Reckitt Benckiser). “Doc,” he said, “you gotta understand that as an addict, the scariest thing right now is the idea of putting another opioid in my body, even if it’s going to help me.”
Although Mr. C. had done well on buprenorphine in the past, accumulating several months of recovery, he felt overwhelmed by the prospect of starting the process again. In the days after his clinical status stabilized and the ID service defined his antibiotic course, we kept visiting Mr. C. on the ward. We confronted the dual imperatives to treat his infection and his OUD to reduce his near-term chance of dying from an overdose or relapsed infection. During our visits, we discussed his resolving empyema, but also his cravings, withdrawal symptoms, and readiness to start buprenorphine treatment. On the day before his discharge, as he faced impending relapse, Mr. C. decided he was ready. That afternoon, we completed an observed buprenorphine induction and made an appointment to see him the following week in the ID clinic for ongoing buprenorphine and antibiotic treatment.
As the opioid use and overdose epidemic ravages the United States, bearing witness to the physical and psychosocial consequences of addiction has become part of many physicians’ daily work. Despite our position on the epidemic’s front lines, the remarkable reality is that we remain systematically undertrained and underengaged in addiction-treatment efforts. Though we have taken steps toward recognizing our profession’s complicity in the epidemic’s roots, most physicians feel paralyzed when it comes to effecting change for individual patients.
The history of medicine is, in part, the history of physicians stretching the scope of their practice to answer the pressing needs of their times. In the face of OUD, a treatable illness with a striking capacity to rapidly and definitively alter the lives of our patients, their families, and the communities we serve, we have been late and ineffective in our response. In recent years, the number of hospitalizations for the medical consequences of OUD has escalated, and in 2015 alone, more than 33,000 people died in the United States from opioid-related overdose.2 Yet rates of active physician engagement in addiction treatment remain embarrassingly low.
At some point, it became culturally acceptable to treat all conditions in a patient except addiction. It’s a diagnosis still frequently and falsely regarded as untreatable — a convenient assumption driven by the stigma against people with this disease. ID specialists have historically been ardent advocates for social justice and public health, championing patients on the margins of society who have stigmatizing illnesses. In the age of the opioid epidemic, treatment of life-threatening infections arising from injection drug use accounts for an increasing proportion of our practice. Far too often, however, infections that we treat resolve while underlying substance use disorders are left to fester.
Under the federal Drug Addiction Treatment Act of 2000, physicians who register with the Drug Enforcement Administration, regardless of their subspecialty, can receive a waiver to prescribe buprenorphine for OUD treatment after undergoing 8 hours of training. According to the Substance Abuse and Mental Health Services Administration, the federal body that oversees the buprenorphine waiver program, there are currently 37,448 physicians with such waivers, representing only approximately 4% of all professionally active U.S. physicians. Nationally, the distribution of physicians with waivers is grossly uneven, and many suffering communities are left with little to no capacity for buprenorphine treatment. Obtaining a waiver is one concrete action that all physicians can take to help stem the tide of this epidemic. Physicians practicing in clinical contexts in which long-term prescribing is not possible can prescribe a short course of buprenorphine therapy as a bridge to long-term treatment managed by one of a growing number of primary care physicians and psychiatrists.
As a small group of ID fellows and faculty practicing at Beth Israel Deaconess Medical Center, a large tertiary care hospital in Boston, we have pursued this strategy. We offer buprenorphine in conjunction with antibiotics to patients who are hospitalized with infectious complications of injection drug use. We ask patients about injection practices, counsel them about harm reduction, and prescribe intranasal naloxone for overdose reversal, recognizing that OUD is marked by both recovery and relapse. We partner with colleagues in social work to build viable treatment plans to facilitate recovery and eventually transfer addiction care to long-term programs. As we have waited for institutional capacity to increase, we have also started to offer inpatient buprenorphine induction for patients without concurrent infection.
We anticipated some resistance on both the institutional and the provider levels, but in practice, we have largely encountered appreciation, and our work has served as one impetus for a larger hospital initiative to address the opioid crisis. This pilot program was born in our ID division, but we believe it is replicable by any physician group — for example, surgical teams discharging patients admitted with OUD-related complications or psychiatry teams discharging patients with both substance use disorder and mental illness. For all physicians, it is vital to recognize that medication treatment for OUD is a cornerstone of recovery for most patients, and when it’s omitted, high rates of relapse are consistently observed.
We are wading into the turbulent waters of our patients’ lives to see them through to a time when they are clear of their infection and on the continuum of recovery. Though our efforts are still relatively new, we have been changed by the experience. Some of our patients have had relapses or haven’t returned for care. But we’ve also seen remarkable successes — patients who presented in the depths of addiction and illness who have subsequently reconnected with their families, have started to work again, and now use opioids less or not at all. By providing the bridge to long-term addiction treatment, we have observed patients remain in care at higher rates and start to mend their badly damaged sense of trust in a medical system that has long treated them with judgment and neglect.
We are providing this care outside the realm of traditional ID consultation because the crisis demands it. Today in the United States, another 91 people will die from an opioid overdose.5 Under the watchful eyes of physicians, many people survive their acute illnesses only to die in public restrooms, in private homes, or on the street. There are many inspiring examples of physicians and health care communities that have similarly stretched the scope of their practice, and lives have been saved as a result. We believe it’s time for more of us to join the movement.
Two months after being discharged, Mr. C. continues to receive buprenorphine treatment. He gets his prescriptions through a program close to his home, where he attends weekly group meetings and individual counseling sessions. He wholly understands the gravity of his infection; his heart valve has been left severely damaged, and he still feels weak. But he has reconnected with friends and family and is making plans to return to work. He is in early recovery from his OUD and from the chaos, social isolation, and depression that come with it. As we see it, the medical community is also in early recovery — moving past implicit biases, stigma, and fear to connect with our patients and respond to a defining crisis of our time.
Alison B. Rapoport, M.D., and Christopher F. Rowley, M.D.
COMPLEMENTARY BUPRENORPHINE WAIVER COURSE FOR RESIDENT & FELLOW ASAM MEMBERS – $40 NATIONAL DUES
ASAM is one of the DATA2000 organizations that can provide the 8-hour online training for physicians, nurse practitioners and physician assistants needed to obtain the waiver to prescribe buprenorphine.
More and more people in the US are able to identify a friend, relative or neighbor who has succumbed to opioid addiction as it increasingly damages the nation.
It’s a frightening reality, but there are options available for people hoping to gain control of their condition and live a life that isn’t dictated by these potent drugs.
What are the routes to recovery from addiction? The Guardian explored that question and more as part of a series of pieces this week looking at survivors of addiction and how to tackle it.
Can opioid addiction be cured?
There is no cure for addiction, but the disease can be managed just like other chronic medical conditions including diabetes and high blood pressure.
That’s one of the reasons people who are no longer addicted to drugs or alcohol might describe themselves as being “in recovery”. Recovery means different things to different people but generally describes someone who is able to live life without it being disrupted by addiction.
How do you get to be in recovery from opioid addiction?
There are many routes for addiction treatment but the one with the most scientific support combines medication, counseling and recovery meetings.
“If people do those three things together, their chances of getting onto a path of recovery are significantly better than if they try to detoxify off the heroin or the pills they are taking and try to go immediately go to an abstinence-oriented program, where they are not taking any medication to help them during the early stage of their recovery,” said Samuel Ball, president and CEO at the National Center on Addiction and Substance Abuse.
How does medication help treat drug addiction?
Medication is used to stabilize people when they quit using opioids. These drugs include opioids like methadone and buprenorphine, which can reduce the painful effects of withdrawal by lowering the amount of opioids people are taking. They can also help people who want to quit using stave off overwhelming cravings.
A third medication treatment, naltrexone, is different in that it blocks the effect of opioids and it has been studied less closely than the other two drugs.
Isn’t using these drugs just substituting one type of opioid drug for another?
No, though the US health secretary Tom Price said it was last month. Price’s comment sparked a furor among health professionals – nearly 700 researchers and practitioners sent a letter urging Price to “set the record straight”.
“The perception that persons receiving long-term therapy with medications – especially with buprenorphine and methadone – are not actually in recovery is widespread but grossly inaccurate,” the letter said.
The Department of Health and Human Services then clarified that expanding access to medication-assisted treatments is a key element of the federal government’s plans to curb opioid addiction.
That said, these drugs aren’t perfect. Buprenorphine and methadone can and have been abused by opiate users, which is why it is recommended these drugs be taken alongside other therapies.
What happens if people quit using opioids without medication?
For people who abruptly quit, a cluster of unpleasant symptoms can occur as part of withdrawal: anxiety, body aches, nausea, vomiting, diarrhea, agitation.
There is a school of thought that the sheer unpleasantness of withdrawal will push someone out of addiction for good, and that certainly works for some people, but Ball warned it is not something worth betting on.
“I think If you asked me 10 years ago, I might have said detoxing and trying an abstinence-oriented approach, maybe that’s worth a try one time,” said Ball. “And then if that doesn’t work try one of the medications.”
These days, however, Ball said the addiction crisis has “become so life and death” that he thinks medication should be incorporated from the beginning of addiction treatment.
Why can’t people just decide to quit?
There is a narrative, often perpetuated by the media, of people becoming stubborn and quitting on their own once and for all – whether it’s because of a revelation triggered by an emotional low point or, in the case of one person the Guardian spoke with, spending some time in jail where they were forced to withdraw without any support.
“It’s miraculous, and great stories to hear, but I think for many people with opioid addiction, it’s not a realistic thing to plan for, if that kind of epiphany happens for you, it’s wonderful, but you can’t make it happen,” Ball said.
He said the “chances of you staying alive for a longer period of time” are much higher if you access other forms of treatment, particularly medication.
How effective is rehab at treating addiction?
If pop culture is your guide, the answer to addiction can be found at a swanky beach house rehab center in Malibu, California, or sunny Florida.
These centers – just like residential centers in less idyllic locations across the US – can certainly be effective, but they aren’t required to provide evidence-based treatment, so the efficacy varies wildly.
Some centers don’t have a trained physician or psychiatrist on staff around the clock or only offer a couple hours of therapy each week – an insufficient amount for someone who has deemed their problem so severe they aren’t safe at home.
Also, there is a potentially enormous cost tied to rehab that do not always reflect the quality of service. Insurers don’t always cover these programs, and if they do, they limit how long they will cover the service for.
That is a huge problem because addiction experts agree that addiction can’t be resolved in a short period of time.
How long does it take to recover?
This is obviously different from everyone, and must be considered alongside the fact that relapse is common.
Though it would seem like taking up drugs again is a failure, the US National Institute of Drug Abuse (Nida) said relapse is a sign that treatment needs to be adjusted or started again and is certainly not an indication that someone has irreparably harmed their chances of living a life free from addiction.
Relapse is common for 40% to 60% of patients being treated for addiction and 50% to 70% of people with asthma and hypertension, according to the Nida. The agency notes those disease also have physiological and behavioral components people must manage, particularly when experiencing a relapse.