Combating The Opioid Crisis: Understanding Medication-Assisted Treatment
Is abstinence the only way my loved one can get sober?
My initial answer to that question was emphatically YES! … until it wasn’t.
Scientific data, clinician attributions, disease model perspectives and empirical medical evidence simply do not support the abstinence only theory. However, there is well-documented, well supported evidence to the contrary, which got me thinking…
One of the standard medical practices when treating a chronic, progressive, life-threatening disease (which, btw, addiction is) is the administration of medication, which helps patients manage their illnesses. Sufferers of chronic diseases also often rely on a daily prescription to keep their disease under control and effectively managed. We know this to be true and inherently accept it for all disease models except substance use disorder (SUD). People who use medication to treat their substance use disorder are no different than diabetics who require insulin for daily maintenance and normal functioning, yet the idea of treating a SUD with medication is highly controversial and generally not supported.
Why is that?
Perhaps 12-Step ideologies have become mainstreamed, influencing medical practices and social theories. Or maybe it’s because while empirical science proves substance use disorder is a disease, much of the public still doesn't understand addiction, not really believing that it is an actual disease. Is it because, unlike other diseases, SUD feels so personal? Or, is it because the “choice theory” of SUD is prevalent and widespread? It might be because some people view SUD to be a moral failing or sin and/or that SUD drives people to make illegal and immoral choices. Do most people just not understand the nature of the disease—that it’s chronic, progressive and deadly?
The Opioid Epidemic: Increasing understanding and awareness
Former Surgeon General Dr. Vivek Murthy’s report, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, was the first of its kind. It alerted the media to the severity of the problem, which helped inform the public about the Opioid Crisis. And, it led to the current President’s Commission on Combating Drug Addiction and the Opioid Crisis. These critical factors, along with several others, have helped to push medication-assisted treatment (MAT) into the limelight.
A recent article published by Harvard Medical School, Words Matter: The language of addiction and life saving treatments, by Dr. Sara Wakeman, details misinformation regarding MAT. Dr. Wakeman says," Methadone and buprenorphine are lifesaving, effective medications for opioid use disorder. Their use reduces relapse and death far more than any other available treatment. And yet they are frequently referred to as 'replacements,' worsening the mistaken notion that these medications are simply a way to substitute a legal opioid for an illicit opioid. They are not. Addiction is a behavioral syndrome characterized by compulsive drug use despite negative consequences. Patients successfully treated with methadone no longer meet the criteria for active opioid use disorder."
The Surgeon General’s Report on Alcohol, Drugs, and Health also reviewed what we know about substance misuse and how we can use that knowledge to address the issue and its related consequences. According to the report, there are effective strategies and services for SUD sufferers, ranging from behavioral changes to specialty treatment, including MAT, for the full spectrum of problems encountered as a result of the disease.
The Surgeon General’s report, as well as an abundance of medical and scientific studies, clearly show that MAT is not a substitution for one opioid for another. However, even with increasing attention on this treatment for SUD sufferers, much of the public is still misinformed and confused by what these medications really are and do.
In her article, How Effective is Medication-Assisted Treatment for Addiction? Here’s the science, author Kate Sheridan explains.
“Understanding what heroin does in the brain and in the body is crucial to understanding why medication-assisted treatment — sometimes called medication-assisted therapy— works,’ said Dr. Nora Volkow, the director of the National Institute on Drug Abuse. (NIDA is one agency of the National Institutes of Health, which is part of HHS.)
Opiates work by crossing the blood-brain barrier and attaching to receptors on brain cells, which triggers a cascade of neurotransmitters and brain activity and produce the high that people feel. That brain activity can contribute to physiological dependence — … addiction.
MAT can work in one of two ways. Doctors can give people opiates that activate the same receptors but are absorbed into the blood over a longer period of time — staving off withdrawal symptoms and breaking a psychological link between taking a drug and immediately feeling high. Doctors can also give someone an opioid antagonist — a non-opioid drug that sits on those same receptors and blocks them — so that if someone relapses, he or she won’t feel anything. (If someone goes off the drug and relapses, however, that can have deadly consequences. A person’s tolerance for the drug decreases after long periods of sobriety — especially after antagonist treatment.)”
The article continues to explain the substitution process:
“The drug that we’re replacing is a dangerous one that will kill you, and we’re replacing it with a drug that allows you to go back to work and have money in your pocket and allows you to live normally again,’ said Dr. Stuart Gitlow, past president of the American Society of Addiction Medicine.
The argument that what’s right for one person isn’t necessarily right for another person is a valid point, but experts contend that the data has shown that MAT is effective for the general population, though not necessarily equally effective for every individual, given the particulars of someone’s life and someone’s addiction.”
The body of evidence behind MAT is solid according to Dr. Volkow, who says, “'I don’t think that there’s any areas where the data is shaky. It clearly shows better outcomes with medication-assisted therapy than without it.”
The author of the article also continues by saying, “Studies have shown that outcomes are much better when you are on medication-assisted therapy. For one, it decreases risk of relapse — significantly. Second, MAT has also been shown to be effective in preventing infectious diseases like HIV. Third, medication-assisted therapy has been shown to be effective in preventing overdoses.”
A Recovery Coach Who Supports MAT
Those three specific and potentially life-changing things, decreasing relapse, effectively preventing the spread of infectious diseases and efficiently preventing or reducing overdoses, are a few of the primary reasons why I now support MAT.
I confess, to move forward into this mindset has been difficult. Not all of my friends or support system agree with or support my shift in perspective and opinion, and I recognize the need for me to continue to be diligent in my pursuit of understanding MAT.
Some believe that my support of MAT stands in contradiction to my 12-Step program and personal and professional practices. I disagree. And, here’s why. One of the last and primary statements of Bill W. in the Big Book of Alcoholics Anonymous (pg.568) states that an individual can only be defeated if he/she has an "attitude of intolerance and belligerent denial." Couple that with the closing quote by Herbert Spencer in the Big Book, which says, "There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance-contempt prior to investigation." Love and tolerance is our code, we say. So why do we not “tolerate” the scientific data that shows the effectiveness and efficacy of MAT?
I don’t know. But, I do know that, as a recovery coach and a mother of a child who struggles with heroin addiction, I support MAT as a viable option for my daughter if she chooses to pursue it. Neither she nor I have to remain limited to a one-size-fits-all theory of treatment. Nor do I have to surrender my membership and participation in a 12-Step program because I believe in and support MAT.
There Are Many Paths To Healing And Recovery
The road to recovery is wide. Everyone is welcome. I don’t think the question should be how someone gets there, but rather, how can we ensure that everyone has the help, support and resources to get there if they so choose?
I will continue my thoughts on MAT and other related topics in my next post. I hope you will join me as I continue to recover, rebuild and be restored. Personal recovery from the chaos of loving someone with a SUD is a journey, and I invite you to join me as we “trudge the road to happy destiny.”