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Medication-Assisted-Treatment for Addiction

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Medication Assisted Treatment, or "MAT" for short, is the use of FDA approved medication for the treatment of opiate/opioid addiction and substance abuse.  It has never been quite as controversial a subject as it is today.  As more and more abstinence-based programs have become mainstream within inpatient treatment centers, the stigma being attached unnecessarily to MAT is discouraging to very high-risk drug addicts and those who have attempted treatment without medication several times and failed. 

When comunity-based groups such as AA began, there was no regulated MAT approved for widespread use in the US.  It was also back then in the 1930's that the medical community had not yet been able to establish that alcoholism or drug addiction was in fact a medical disease.  That fact came later and is now based in numerous evidence from research foundations & hospitals all over the country.

The fact that we all know addiction IS a disease now seems slightly hypocritical for those who still hold a strong personal bias against the use of MAT for addicts; instead refusing to acknowledge any route for treatment other than spirituality and willpower, solving the disease of addiction.  These efforts may help some people but the numbers clearly over time and especially now show that this is not the case for the majority. 

While ALL supporters and providers of MAT also encourge a multi-treatment approach, knowing medication alone is not the answer, there are those who ignore this and begin to spread a dangerous message to addicts who would benefit greatly from MAT methods, along with support groups, IOP's, individual therapy, group therapy, CBT, and other outpatient behavioral and support services.  The message being spread is almost always by those who have never used MAT or who have and did not follow proper protocol.  Very seldom do you hear positive aspects of MAT from people who were very successful using this method, as millions over several decades have. The danger is that someone who is bias against MAT, having been able to get clean and stay clean via abstinence is outspoken regarding the "negative" possibilities of MAT and almost never discuss or encourge the very positive aspects of MAT for the very severe addicts who need MAT to stabilize their physical dependance and then use that time on treatment to work on their behavioral addiction issues and dual diagnosis treatment such as depression or anxiety. 

The bottom line is that what works for 1 addict will not always work for another.  One that coaches or wishes to support other addicts MUST keep this in mind and instead of forcing one specific treatment path, regarding it as the "only way" to sobriety, it is much more supportive & helpful to encourage the addict looking for help to consider all treatment options available and decide for themselves what is best for them. Before discussing the MAT options today, I want to debunk some commonly used statements meant to "deter" addicts away from MAT:

 1.  "It is trading one addiction for another".  This is FALSE.

MAT is medication approved by the FDA for the disease of addiction.  Addiction is now defined as a medical disease and one that is relapsing; a very important characteristic.  An "addiction" is defined as drug abuse that incites "drug-seeking-behavior", largely fueled by the learned & broken dopamine overdrive that causes an addict to enter a state of emergency, hence "drug-seeking behavior".  Once withdrawal begins, the addict is willing to do anything to get and seek their drug.  When you are undergoing correctly as intended, your MAT, your withdrawal & cravings are not just diminshed, they are ELIMINATED at the correct dose.  Without those 2 factors, there IS no addiction, there is only physical dependance on a medication.  Such physical dependance on medication ALSO occurs with patients that take medications daily for almost every other medical disease in existence who would experience withdrawal if stopping thier medication abruptly.  By removing drug-seeking-behavior, addicts being treated with MAT, have shown over & over in decades of studies that there is a remarkably lower occurence of commiting crimes, significant low risk of passing on or catching HIV, AIDS, Hepatitis and other infectious diseases through IV drug use, and ones life is not consumed by this seeking behavior so they are contributing to society, working, going to school, being active in their families and go on to lead normal, healthy lives as well as seek to treat further behavioral therapy.  When someone is truly "addicted" to a drug, none of these other focuses are possible, as drug-seeking is the only behavior on the mind. 

 2.  "When will you get off?"  "You will have to take it forever".  This is FALSE.

Methadone & Suboxone while creating a physical dependance, once a baseline dose is reached where the cravings are gone and there are no withdrawal symptoms, patients have no reason to "rush" nor any reason to want to stop a treatment that is clearly helping them achieve sobriety.  If you began treatment for cancer and it was showing a reduction in tumors, would you then stop? The common answer here would be no.  So this is why many people may choose to stay on Methadone for 10 years, some people stay on Suboxone for 5 years, the length of time is not important; what IS important is that the disease of addiction is in remission and they can focus now on getting their lives back.  Why would one rush to end treatment for an illness that caused immense pain & loss for years of their lives? The fact remains is that people DO, CAN and HAVE gotten off of both these medications successfully.  If the patient follows a taper schedule, slowly, patiently, under a physician's direction and is in a healthy place mentally to do so, receives other outpatient behavioral health services or dual diagnosis services, then the weaning process, albeit slow, can be very painless and can be done with great success.  I know this, because I have done it myself both the "wrong" way and the correct way, the latter which worked out perfectly. 

 3.  "MAT is just a "CRUTCH".  This is TRUE but let me explain...

As Vincent Dole, MD, a developer of the original methadone maintenance treatment—once said:

“There's absolutely nothing wrong with using crutches if it helps a person get back on his feet and move forward in addiction recovery. We need more crutches like that.”

I cannot see anyone that could argue against that when the crutch you are using for your disease is helping you to recover so you can live safely and enter recovery again.  This doctor's dream came true when in 2002 Suboxone was added to the list of options for medications to treat opiate addiction and is now also showing extremely higher success rates than non-medication therapy options when used correctlyMethadone itself has shown that for every $1 spent on the treatment, it saves taxpayers $12.  This number has grown every single year since the 1960's and is considered the most cost-effective treatment option for MAT and for addiction treatment options altogether today. 

 Medications developed to treat opioid addiction work through the same receptors as the addictive drug, but are safer and less likely to produce the harmful behaviors that characterize addiction if the proper dose is achieved. Three types include:

1.  agonists, which activate opioid receptors

2.  partial agonists, which also activate opioid receptors but produce a diminished response

3.  antagonists, which block the receptor, and interfere with the rewarding effects of opioids. Physicians prescribe a particular medication based on a patient’s specific medical needs and other factors. Effective medications include:

Methadone (Dolophine or Methadose), is a slow-acting, opioid agonist. Methadone is taken orally, so that it reaches the brain slowly, dampening the “high” that occurs with other routes of administration while preventing withdrawal symptoms. Methadone has been in use since the 1960s to treat heroin addiction and is still an excellent treatment option, particularly for patients that do not respond well to other medications; however, it is only available through approved outpatient treatment programs, where it is dispensed to patients on a daily basis. This can make this treatment option unattractive as it becomes part of your daily routine and can be difficult to fit around a work shedule, though most clinics have long windows of open dosing hours. 

Buprenorphine (Subutex, Suboxone), is a partial opioid agonist. Buprenorphine relieves drug cravings without producing the “high” or dangerous side effects of other opioids. Suboxone is a novel formulation, taken orally, that combines buprenorphine with naloxone (an opioid antagonist) to ward off attempts to get high by injecting the medication. If an addicted patient were to inject Suboxone, the naloxone would induce withdrawal symptoms, which are averted when taken orally as prescribed. The FDA approved buprenorphine in 2002, making it the first medication eligible to be prescribed by certified physicians through the Drug Addiction Treatment Act. This approval eliminates the need to visit specialized treatment clinics, expanding treatment access to a wider population in a more private setting. 

Naltrexone (Depade, Revia) is an opioid antagonist. Naltrexone is not addictive or sedating and does not result in physical dependence; however, poor patient compliance has limited its effectiveness. Recently an injectable long acting formulation of naltrexone called Vivitrol received FDA approval for treating opioid addiction. Given as a monthly injection, Vivitrol should improve compliance by eliminating the need for daily dosing. To avoid withdrawal symptoms, Vivitrol should be used only after a patient has undergone detoxification. Vivitrol provides an effective alternative for individuals who are unable to or choose not to engage in agonist-assisted treatment.

Newer medications in clinical trials currently are:

Probuphine: a long-acting version of buprenorphine that is showing promise in clinical trials. An implant inserted under the skin, Probuphine can deliver medication continuously for 6 months. Like Vivitrol, it aims to prevent abuse and diversion and increase treatment adherence by eliminating the need for daily dosing.

Vaccine research: Vaccines are being developed to help combat a variety of addictions including heroin. A heroin vaccine, currently under development, would corral heroin in the bloodstream and prevent it from reaching the brain and exerting its euphoric effects. This approach could guard against relapse and be an effective addition to a comprehensive treatment plan for heroin addiction.

 

The conclusion is that MAT has successfully shown positive results no matter how long a patient stays on the treatments if used properly and as intended while managed by a physician.  Yes, there is bad press -but mainly this negative word of mouth stems from when patients do not obtain the medications from a physician or clinic, buy them on the street, use them with other street drugs or non-prescribed medications, use them improperly or dose improperly and do not follow the weaning process which is so CRUCIAL to the success of MAT. 

While there are other options than MAT and ones that can and do work for many people, the numbers consistently show that those who go through a "detoxification" only process using MAT, then released into the same environment where they used drugs, with no outpatient medication treatment whatsoever, have a relapse rate of 90%.  And that relapase rate has been shown to occur within 2-4 weeks at most. 

So if MAT did not work for you or you do not want to acknowledge the very real and documented efficacy of MAT, that is fine; but don't use your personal opinion to discourage others who could access a treatment route that could save their life and provide them with sobriety for the first time in years of suffering and attempts at recovery.  Guidance and support are invaluable, but making statements as if they are facts, that are completely incorrect, is very dangerous and does not benefit the addict who needs to know the options that exist for them. 

To learn more about MAT, especially Methadone & newer formulations being developed, visit The National Institute on Drug Abuse, also called NIDA.

And for the most recent Suboxone information look up Roger Weiss' 2011 Archives of Gen Psych paper where the success rate was 49% at 4 months with buprenorphine treatment. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Erika Cormier, author of  the memoir, "As the Smoke Clears", understands first hand that addiction isn't always a "visible" disease.  She has dedicated her life to helping other women suffering from addiction and has drafted a bill to place caps on the high cost of outpatient addiction-related services.



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