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Opioids Crisis: Despite controversy, medication-assisted treatment is one path to recovery



For the Gazette
Monday, March 27, 2017

If medical providers use medicine to treat and manage chronic conditions such as heart disease, asthma and diabetes, why is it difficult to understand that medication can effectively treat opiate addiction, also a disease — and for many sufferers, a chronic, but manageable, condition?

There is something unnerving to people about the idea of treating addiction to a drug with a drug. Yet, effective response to the opioid epidemic must come in many forms on many fronts, including more treatment options, better access to treatment, prescriber training and prescription monitoring so opiates are not over-prescribed. Also important is prevention, public education about safe drug storage and destigmatizing addiction.

These are a few time-tested public health strategies. Medication Assisted Treatment, commonly referred to as MAT, is another.

Opioid addiction is a chronic, relapsing brain disease characterized by compulsive substance use, cravings and continued use despite known harmful consequences. As the result of opiate misuse, the brain is essentially rewired, creating a dependence that for some people can be intractable without MAT. Three FDA-approved medications treat opioid addiction: methadone, buprenorphine and naltrexone. The medications differ in the way they impact the brain to relieve symptoms of opioid withdrawal and diminish cravings or block the euphoric effects of the drugs. They all help prevent relapse.

In most cases, the goal of treatment is to get someone off MAT, although that might not be appropriate in all cases. For example, long-term, high-dose users may settle into a maintenance dose of MAT for the long haul. Here is some information about each of these drugs:

Methadone, around since the 1960s and the oldest MAT, suppresses withdrawal symptoms and blocks other opioids. It has high potential for abuse so it must be taken daily in certified opioid treatment programs.

Once a person is stabilized on a therapeutic dose and other conditions are met, he or she may be allowed to take home doses following certain criteria. This is helpful because methadone clinics are often sparsely located, which means daily clinic visits can be onerous.

Methadone is suitable for people dependent on high doses of opioids. It is used as a maintenance drug because it has no serious long-term side effects. While it is recommended that people on methadone engage in counseling, it is not strictly required.

Buprenorphine, also known under the brand name Suboxone and around since 2002, is prescribed by physicians who have passed additional certification and must be used in conjunction with additional counseling and services. Treatment takes place in a medical office where patients are evaluated weekly or less frequently depending on stability and recovery progress.

Buprenorphine suppresses withdrawal symptoms and cravings and does not cause euphoria or sedation in opiate-dependent individuals. It can be taken by tablet or film dissolved under the tongue. It has a lower risk of abuse, dependence and side effects than methadone. Once a patient is stabilized, there may be opportunity to self-administer the medication at home.

Naltrexone, given in daily or monthly doses, can be prescribed by any clinician with prescribing authority. It must be used only after individuals have completely detoxed from opiates. Naltrexone works as an opiate-blocker in the brain, taking away the reward of getting high, and therefore any incentive for using opiates. It is available in a pill form and an extended release 30-day injection, called Vivitrol. It is used for people coming off methadone or buprenorphine, when they face especially high risk of relapse.

From where I sit, as program director of the Northampton-based OnCall Healthy Living Program, MAT is an effective tool that saves lives and prevents relapse for people who have struggled with opiate addiction for years, or in some cases, decades. I’ve seen MAT not only save lives, but help put people back on track to lead healthier, more fulfilling lives.

Addiction is an illness with broad impact: People who struggle with it are at greater risk for infectious diseases, family disruption, violence, child abuse or neglect, loss of productivity and criminal behavior (to support a habit so powerful it makes people do things they never imagined they would). There is also grave risk of overdose and death.

According to state data, suspected unintentional opioid overdose deaths increased in Hampshire County from 17 in 2015 to 28 in 2016, a 65 percent increase. The increase state wide is also concerning: it was 1,747 in 2015 and went up to 1,979 in 2016, a 13 percent increase in deaths.

Those numbers are too high. MAT saves lives. Used properly, and in conjunction with other treatment including therapy and peer support — including working with recovery coaches or participating in a support center such as the Northampton Recovery Center — these medications prevent needless deaths and help people to reenter the workforce.

MAT can improve family relationships and allow users to eventually return to living the kind of productive lives their addiction may have robbed them of.

Critics suggest that MAT switches people addicted to one drug over to another one. That is incorrect. Addiction is a chronic disease and these medicines help people manage their chronic condition. Addiction is treatable. It may not be curable, but like other chronic diseases, addiction can be successfully managed. Treatment enables people to counteract addiction’s powerful disruptive effects on their brain and behavior and regain control of their lives.

Lynn Macdonald, program director at OnCall Healthy Living Program, is a member of the Hampshire HOPE opioid prevention coalition run through the city of Northampton’s health department. Members of Hampshire HOPE contribute to this monthly column about local efforts to address the opioid epidemic.