Medication-Assisted Treatment Needs Community Support

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.

Addiction Spelled Out in Scrabble Pieces

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.

Education

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.

Original article here posted on psychcentral.com

Op-Ed: The Wrong Way to Treat Opioid Addiction

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.

IllustrationPeopleStandingOnShotGlassBeingPoured

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.

Pill Split In Half Leaking Liquid

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.

Original article here: The Wrong Way to Treat Opioid Addiction posted January 17, 2018

New York Times