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.

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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 The problem is an outdated ideology that views needing a medication to function as a form of addiction.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.

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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

Podcast – Addressing Patient Resistance to Medication Assisted Treatment

This PCSS Podcast discusses up-to-date pain medicine and substance use disorder topics with the goal of increasing the general education of healthcare providers.  Medication-assisted treatment is widely accepted treatment for patients with opioid use disorders. Still, patients have many reasons, spoken and unspoken, to be reluctant to start this potentially life-saving treatment.

On this episode, Ashley Braun-Gabelman, PhD, discusses the importance of addressing this resistance and why it’s important to explore this barrier to treatment head on. Dr. Braun Gabelman is a clinical psychologist in Addiction Recovery Services at University Hospitals Cleveland Medical Center and an Assistant Professor in the Department of Psychiatry at Case Western Reserve University School of Medicine. She specializes in the treatment of substance use and co-occurring disorders including major depression, anxiety disorders, and PTSD.

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Click PLAY below to listen to this clear and easy to follow podcast that touches on the very essence of what holds many people back from seeking help: STIGMA.

PRESS RELEASE: Addiction Policy Forum Announces New Initiatives

Washington (December 12, 2017) – Today, the Addiction Policy Forum announced several new initiatives to help millions of families in the United States struggling with opioid addiction and other substance use disorders. The programs put in motion key elements of the organization’s multi-year plan announced in October, Priorities to Address Addiction in America, which provides a comprehensive, action-oriented approach to addressing the growing opioid epidemic.

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Addiction Policy Forum Logo

Developed by experts at the Addiction Policy Forum, the programs announced today will address the areas of prevention, recovery support, medical innovation, and healthcare system integration. Support from key partners, including a significant commitment from the Pharmaceutical Research and Manufacturers of America (PhRMA), will enable the Forum to scale the initiatives nationwide.

“We hear all too often that families and community leaders don’t know where to turn for services that can help loved ones who are in crisis – or prevent the crisis from happening in the first place,” said Jessica Hulsey Nickel, president and chief executive officer of the Addiction Policy Forum. “By working closely to families and experts in the field, we’re creating localized resources and evidence-based tools that will make a real difference in addressing substance use disorders. We are grateful to all of our partner organizations for their ongoing commitment to this important issue.”

The programs introduced today by Addiction Policy Forum include:

  1. The Addiction Resource Center: This online portal will be a comprehensive resource to assist patients and their loved ones with substance use disorders. The new platform, with support from the Chris and Vicky Cornell Foundation, will guide patients through a validated self-assessment tool, help them develop a proposed treatment plan, and provide a guide to reliable, evidence-based information about resources in their local area. Initially, the Forum will host a database of local resources in Ohio, Maryland and Minnesota. Over the coming months, new states will be added so that more and more Americans suffering with substance use disorder will have a place to turn for help.

  2. Prevention Initiative: Community Anti-Drug Coalitions of America (CADCA) and the Addiction Policy Forum will create and distribute educational kits and essential resources on prevention as well as prescription drug disposal and misuse. With more than 5,000 community coalitions throughout the country and a track record of helping create drug-free communities globally, CADCA is uniquely positioned to disseminate evidence-based prevention resources to scope and scale nationally.

  3. Emergency Medicine Initiative: The Addiction Policy Forum will work with hospitals to develop tools to support effective post-overdose interventions. This project will ensure that health systems have the necessary protocols, assessment tools, and linkages between care and follow-up to turn an overdose into an opportunity for intervention and connection with treatment and recovery. Pilots underway with Mercy Health Systems and Berger Hospital in Ohio will produce open-source tools and protocols necessary to support emergency departments across the country in implementing interventions to help patients who overdose.

  4. Research to Find a Cure: Together with our partners such as Faces & Voices of Recovery, the Addiction Policy Forum will launch the Addiction Science Initiative: Advancing Treatment and Recovery. This initiative will raise funds to support research by the National Institute on Drug Abuse (NIDA)* on treatment and recovery from substance use disorders, including opioid use disorder.

  5. Recovery Initiative: The Forum will work with national partner Faces & Voices of Recovery to support the growth of statewide recovery community organizations across all 50 states and to enhance recovery support throughout the nation.

“Taken together, the programs and partnerships announced today by the Addiction Policy Forum represent the most comprehensive, direct approach to the opioid crisis in America to date,” said Gen. Barry McCaffrey, advisory board chair for the Addiction Policy Forum and former Director of the Office of National Drug Control Policy. “The 21 million Americans who are living with the disease of addiction need our help urgently – there is simply no more time to waste. By welcoming all stakeholders to the table and focusing on action over rhetoric, we can have a lasting impact on this crisis.”

In the coming months, the Addiction Policy Forum will roll out additional initiatives that build on its efforts to implement a comprehensive response to addiction, including a partnership with the National Association for Children of Addiction (NACoA) to assist children who are impacted by addiction. In addition, the National District Attorneys Association (NDAA) and Treatment Alternatives for Safe Communities (TASC) Illinois will work with the Forum to improve the criminal justice response to substance use disorders. A partnership with Young People in Recovery (YPR) will assist in linking individuals to age-appropriate recovery support services. Further, the Forum will engage the Legal Action Center to expand awareness and understanding of substance use treatment insurance coverage parity requirements, and to support advocacy efforts to improve compliance with the law.

Programs are also in development to significantly enhance crisis support services with Live4Lali and to provide medical professionals with ongoing education about the identification and treatment of substance use disorders.

A copy of the Addiction Policy Forum’s comprehensive 8-point plan can be found here.

Link to original press release here.

The Addiction Policy Forum

The Addiction Policy Forum is a 501(c)3 established in 2015 as a diverse partnership of organizations, policymakers, and stakeholders committed to working together to elevate awareness around addiction, and to improve programs and policy through a comprehensive response that includes prevention, treatment, recovery, and criminal justice reform. Jessica Hulsey Nickel, whose own family was devastated by addiction, is the founder of a coalition of 1,700 families impacted by substance use disorders and is available for further explanation and interviews by media.

For more information, visit www.addictionpolicy.org and follow us on www.twitter.com/AddictionPolicy.

Contact:

Jay Ruais

(603) 475-0332

jruais@addictionpolicy.org

*NIDA does not participate in the business affairs, lobbying, or fundraising activities of the Addiction Policy Forum, or any other organization.

Stretching the Scope — Becoming Frontline Addiction-Medicine Providers

NEJMlogoOn 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.

Link to original article here: Stretching the Scope — Becoming Frontline Addiction-Medicine Providers

Link to audio interview with author: Audio interview

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Dr. Rapoport

Major Science Report Lays Out a Plan to Tamp Down Opioid Crisis

The National Academies report includes recommendations for federal agencies, states and medical personnel.

When the U.S. Food and Drug Administration screens new opioid drugs it should better anticipate how people might abuse them in the real world, the National Academies of Sciences, Engineering and Medicine warns in a major report issued Thursday on the country’s opioid crisis, which kills 91 people a day—often via overdoses on prescription drugs. The FDA needs to move beyond its traditional focus on clinical studies about drug effectiveness and side effects, and to seek public health data on potential abuse, the Academies advises in its 400-page proposal for targeting the deadly issue.

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The FDA had asked for the report, and its release comes as several states are suing pharmaceutical companies over allegations that they downplayed the addictive nature of certain prescription painkillers and helped fuel the current crisis. “The focus of the request from the FDA was for advice on what they could do to evaluate [opioids] more completely before approving them for use,” says Stanford University anesthesiology professor David Clark, a member of the Academies committee that drafted the report. A key recommendation, Clark says, is for “the FDA to move beyond its standard matrix of considerations for drug safety and—at least for opioids—move into a more public health–centered matrix of considerations which could help us predict what might happen for people beyond the intended recipient of the drug.”

The 18-member committee, which worked on the report for more than a year, identified specific steps that states, federal agencies and medical providers should take to stem the tide of abuse of substances including heroin, fentanyl and prescription drugs—even as they ensure pain patients have access to legal relief. Any policy that aims to restrict lawful access to prescription opioids would drive some people toward the illegal market, the report warns. Instead it urges states, regulators and public health agencies to work toward universal access to evidence-based interventions for substance abuse, including treatment programs and full coverage of medications approved to fight addiction. The report calls for expanding access to the overdose antidote naloxone to laypeople, and also says jurisdictions should explicitly authorize syringe exchange as well as their sale or distribution. “Reducing the scope of the epidemic of opioid addiction is my highest immediate priority as commissioner,” the FDA’s Scott Gottlieb said in an e-mailed statement. “I was encouraged to see that many of [the Academies’] recommendations for the FDA are in areas where we’ve made new commitments.”

The Academies’ report also recommends increasing the FDA’s formal reevaluations of opioid approval decisions, in order to ensure that the drugs’ benefits still outweigh the risks. It advises the FDA and other federal health agencies to improve their data tracking on pain and opioid use, and to invest more money in research for a clearer picture of the opioid epidemic—and for potential ways to combat it, such as programs that track prescribing and dispensing information.

Officials battling the crisis on the ground applauded some of the Academies’ findings. “The report is in line with the work we are already doing in Baltimore City,” says Leana Wen, the city’s public health commissioner. “We have had needle exchange programs for over 20 years, and we also have a very aggressive naloxone program.” The report focuses on improving research and regulatory actions before a prescription drug hits the market, Wen notes. “All these are important, but I continue to emphasize what I see on the frontlines—a need for increased access to treatment that is evidence-based and well established.” With naloxone’s price rising and a shortage of substance abuse treatment beds, these are crucial needs, she says.

The report also says states should take specific actions, such as creating more year-round programs in which pharmacies or other establishments take back unused prescription painkillers—so they do not sit around patients’ houses, where they might be abused or stolen. (According to the National Institute on Drug Abuse, nearly half of young people who inject heroin abused prescription opioids first.) “The concerns on this point are more impetus rather than obstacle,” Clark says. “It is not uncommon to have drug take-back programs through churches, pharmacies, universities, and public interest groups and community organizations. But none of those organizations are set up to do that kind of thing on an ongoing basis.” Some pharmacies have already moved in this direction by setting up drop boxes to dispose of old drugs when someone comes in to fill a new prescription, he adds.

The President’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by New Jersey Gov. Chris Christie, also aims to come up with concrete recommendations. It was scheduled to release an interim report last month but has not done so, and now expects to put the report out at the end of this month, around its next meeting. “The Commission is continuing to look at how the administration can best address this unprecedented crisis and will be releasing its [final] report in October,” Richard Baum, acting director of the Office of National Drug Control Policy, told Scientific American in an e-mailed statement. “The Trump administration is committed to addressing the opioid epidemic,” Baum wrote, and in just six months it has “sent nearly $500 million to the states to address the epidemic locally, begun work on the president’s first National Drug Control Strategy and established the President’s Commission on Combating Drug Addiction and the Opioid Crisis.” (The latest version of the Senate health care bill, released Thursday, also would include $45 billion to help support substance abuse treatment.)

Addressing the opioid epidemic requires action in the medical and patient community as well, the Academies’ committee says. It advises states to create better pain education materials for medical schools, medical licensing boards and the public. States and the federal government should also work in concert to help boost access to medication for addiction—and to make sure patients can afford it, the report says. Managing the opioid crisis is a balancing act requiring trade-offs when it comes to restricting the lawful opioid supply, influencing prescriber practices, cutting demand and reducing harm, the committee members wrote. Yet they add that their proposal should, “leave adequate space for responsible prescribing and reasonable access for patients and physicians who believe an opioid is medically necessary.”

Article by: Dina Fine Maron on July 13, 2017

Link to article here: Major Science Report Lays Out a Plan to Tamp Down Opioid Crisis

Route to recovery: how people overcome an opioid addiction

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.

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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.

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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.

Written by: Amanda Holpuch 6/22/2017

Link to article here: Route to recovery: how people overcome an opioid addiction