In the future, researchers may develop a vaccine against drug abuse, like those currently used to prevent the flu, but at this point in the evolution of drug treatment, the drugs that address addiction are only used once drug abuse has already taken hold. Drug abuse is a complex phenomenon that stems from a host of causes and requires multidisciplinary professional efforts to treat. The use of drugs to stop drug abuse is only one response to the drug epidemic in America, but it is proving to be an effective one.
Drugs That Stop Drugs
Medication-assisted treatment (MAT) is the term for the use of pharmaceutical drugs to address drug abuse. At present, MAT is used for only two types of drugs of abuse: alcohol and opioids. In the case of alcohol abuse, the drugs naltrexone, acamprosate, and disulfiram are approved for use in MAT. Regarding opioid abuse, the drugs methadone, buprenorphine (brand names Suboxone or Subutex), and Naltrexone are all MAT-approved.[1]
According to the National Pain Report, in 2012, approximately nine million prescriptions were filled for Suboxone and other buprenorphine-based products.
Source: National Pain Report
In 2013, the National Survey on Drug Use and Health found that 4.5 million Americans were current recreational users of prescription pain relievers.
Source: NSDUH
MAT is often a successful prevention measure. Studies show that MAT has numerous benefits, including:
Improves client retention in treatment |
Lessens risk of death |
Decreases unlawful opioid/opiate abuse |
Reduces risk of infectious diseases |
Lowers criminal behavior |
Improves odds of employability |
Improves outcomes for pregnant women |
Lowers risk of relapse |
Despite the known benefits, opponents disagree with MAT and argue that it essentially replaces one addictive drug with another. Opponents believe total abstinence is the best treatment response.
It is important to note that the abstinence protocol is used in many treatment plans and not all rehab centers are equipped to offer medication-assisted treatment. MAT is generally not a requirement of treatment but rather an option. In the MAT debate, opponents level numerous arguments against this treatment model, including:
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MAT does not “clean the slate.”
Although MAT stabilizes patients, it does not remove all drugs from their systems, and thus, they do not go through recovery drug-free.
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MAT stops withdrawal
It is most often necessary for patients to eliminate all drugs from their systems so psychiatric symptoms can be observed and assessed. MAT can interfere with this process.
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There is no opportunity for true detox
Under MAT, rather than undergoing a traditional detox, medications are used to taper off and then stabilize the patient, which deprives the patient of the opportunity to experience the abstinence method. Note that patients on naltrexone therapy generally undergo a drug-free detox before commencing naltrexone.
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“Magic bullet” thinking is erroneous.
MAT falls under the false belief that there is a pill to cure everything, even addiction to other drugs.[3]
Names to Know
Prescription painkillers, also known as opioids, are a main adversary in the US drug epidemic. There are numerous brand name prescription pain relievers flooding the market, and there is little education about the active ingredients in these drugs. As a starting point, the following are the generic names behinds some of the most well-known brands:
| · Oxycodone (OxyContin) | · Meperidine (Demerol) |
| · Hydrocodone (Vicodin) | · Oxymorphone (Opana) |
| · Hydromorphone (Dilaudid) | · Morphine (Roxanol) |
| · Fentanyl (Actiq) | · Codeine (numerous brands) |
These drugs all have a presence on the street and go by numerous different slang names, in corresponding order:
| · O.C., Oxycet, Oxy, Hillbilly Heroin | · Pain Killer, Demmies |
| · Watson-387, Vike | · Mrs. O, Blues, Blue Heaven, Biscuits |
| · D, Dillies, Smack, Juice, Footballs | · M, Monkey, Miss Emma, White Stuff |
| · Dance Fever, Apache, China Girl | · Captain Cody, Cody, Schoolboy, Lean |
Source: NIDA
Opponents argue that the success of MAT may be skewed more in favor of the benefits to society than the individual in recovery. As MAT is an alternative to drug-free detox, a person who receives MAT may be considered to never make a full recovery of mind, body and spirit. The reduction in crime and the improvement in employment associated with MAT provide the government with an incentive to promote MAT. Opponents are concerned that, in turn, governmental authorities give greater weight to the public’s welfare than the individual’s welfare.There are numerous individual concerns that must not be overshadowed by the societal benefits to MAT. For instance, some MAT recipients become addicted to the replacement narcotic medications.[4]
Proponents of MAT emphasize that it is safe and effective recovery method. They also point out that MAT is not intended to be a standalone therapy and must occur in conjunction with traditional treatment approaches, such as individual counseling and group therapy. According to MAT proponents, research on addiction increasingly demonstrates the strong neurological component of drug abuse. When addiction is conceived of as a largely biological phenomenon, treatment with medication makes more sense.
Advocates of the MAT approach also make clear that this method should not be considered diametrically opposed to abstinence. Rather, treatment should focus on creating the best recovery plan for the individual recovering person’s needs.
For anyone considering MAT therapy, these opposing views can be discussed with supervising addiction specialists to reach an informed decision about the best course of treatment. While it is true that certain drug recovery associations, such as Narcotics Anonymous, do not advocate MAT, it is ultimately a personal decision that should not be unduly influenced by this broad debate.
Types of Medications
Methadone
According to Common Sense for Drug Policy, as of March 30, 2012, at 1,167 opioid treatment programs, 25 percent of patients received methadone or buprenorphine.[5] First introduced in the 1960s, methadone is an opioid agonist that is used to treat opioid abuse.[6] The active ingredient is always methadone hydrochloride, and this medication comes in tablet, liquid and powder form.
Each methadone dose must be measured to the user’s height and weight, and the goal of this drug is to block cravings without inducing significant euphoric effects. One of the greatest benefits of methadone is that it stores in the body, and once a recovering person is stabilized on this medication, a single dose can last 24 to 36 hours. Stabilization also means users will not experience euphoria, and thereby prevent methadone abuse.[7]
A National Institute on Drug Abuse (NIDA) survey of research literature concluded that methadone is an effective treatment for addiction to heroin and prescription pain reliever abusers.[8] For instance, a summary of 52 research studies involving 12,075 participants, found that methadone was more effective than no treatment, detoxification, L-aacetylmethadol (LAAM), buprenorphine and a combination therapy of heroin and methadone.[9]
Studies also show that longer stays in a rehab program correlates directly with long-term recovery. One study focused on methadone maintenance programs and found that after 2.5 years 150 participants showed substantial improvement in health as well as quality of life indicators like fewer legal problems.[10]
Still another study compared participants in a continuous methadone maintenance program with those who had six months of methadone treatment and then detoxed. The study found that ongoing methadone maintenance was the superior form of treatment. Individuals in this type of program stayed in treatment longer, used heroin less, and experienced a reduction in drug-related HIV risks, such as sharing needles.[11] While these studies support the use of methadone to treat opioid abuse, there are numerous treatment program designs that can incorporate this drug. It is important to work with a qualified addiction specialist to create the right methadone-involved treatment plan.
Buprenorphine
Buprenorphine is a generic drug approved for treatment of opioid abuse. The drug comes in pill form and is intended to be dissolved under the tongue, not swallowed or chewed. Buprenorphine features in two brand name drugs: Suboxone and Subutex. Suboxone also contains naltrexone whereas Subutex does not. The purpose of adding naloxone is to prevent drug abuse. When a person taking Suboxone tries to abuse opioids, the naloxone will cause them to experience undesirable withdrawal symptoms.[12]
- Overdose is unlikely if buprenorphine is taken in strict compliance with doctors’ orders.
- The drug is long-acting; prescribed users may initially have to take it every day, but over time, may be able to take the pill every other day.
- Buprenorphine can be provided at a clinic, or an approved doctor can prescribe the medication and the recovering person can take this therapy at home.
- A person can take buprenorphine for as long as needed.[13]
Buprenorphine is a dependence-forming drug, which means that discontinuing use or the familiar dosing will trigger withdrawal symptoms. As buprenorphine therapy is voluntary, if a person wishes to stop using this method and cross over to full abstinence, it is important to consult the prescribing physician. The best practice is to safely taper off buprenorphine and not to suddenly stop taking it.
Naltrexone
This MAT drug is a non-opioid (i.e., it is not a narcotic) and designed specifically to block the euphoric effects associated with narcotic and alcohol abuse.[14] Unlike with methadone and buprenorphine, any doctor permitted to write prescriptions can prescribe naltrexone. Naltrexone may not reduce or end cravings. If cravings persist, it is necessary to discuss the matter with a qualified doctor.
According to the Substance Abuse and Mental Health Services Administration, there are numerous benefits to naltrexone use. Those persons in recovery who are a good match for naltrexone can benefit from this therapy in some of the following important ways:
- Naltrexone has little to no abuse potential.
- It is proven to help avoid relapse.
- A person may quit using naltrexone at any time.
- Cessation of use does not cause withdrawal symptoms.
- Taking naltrexone should not have a depressive effect.[15]
Naltrexone therapy occurs after a recovering person has fully detoxed. If any opioids are present in the body, naltrexone can have the effect of worsening the side effects of withdrawal. Naltrexone is approved for use for as long as an individual needs it to avoid a relapse. Naltrexone does not appear to present any health threats if used in the long-term, but it is important to get tested for liver damage as it may cause liver issues if used in large doses.
How MAT Drugs Work in the Brain
As mentioned earlier, methadone is an opioid agonist, which means it activates opioid receptors in the brain. When methadone enters the blood stream and reaches the brain, it bonds with opioid receptors. These are also the same receptors to which heroin and prescription pain relievers bond. The binding of methadone to opioid receptors blocks the euphoric effects of opioids while at the same time stopping cravings altogether (because it activates the site). While it is possible for methadone to induce a high, methadone causes less of a euphoric reaction than other drugs.[16]
Buprenorphine is categorized as a partial agonist. This drug also binds to opioid receptors in the brain, but it does not perfectly fit. The result is that buprenorphine excludes other drugs from bonding with the receptor site while at the same time producing a lesser degree of opioid effects (making it a partial agonist). Since buprenorphine blocks other opioids, taking additional opioids like heroin should have minimal effect. Further, the bond between buprenorphine and the opioid receptor site lasts longer than with other opioids. Buprenorphine can bond with a receptor for up to three days.[17]
Naltrexone is classified as an opioid antagonist, which means it does not activate opioid receptors in the brain. Naltrexone bonds with opioid receptors to block opioids like heroin and prescription pain relievers. Unlike methadone and buprenorphine, naltrexone does not activate the receptor site at all and therefore will not produce any euphoric effects. Since naltrexone does not produce euphoric effects when it bonds with opioid receptors, it cannot be used to help treat withdrawal. The real benefit of naltrexone is its ability to prevent opioids from attaching to opioid receptors and unleashing full euphoric effects.[18]
Insurance
MAT drugs are associated with different costs. MAT isn’t right for everyone, but for those who have a drug treatment plan that includes this form of therapy, there may be a concern about how to pay for it. For persons covered by health insurance, the first step is to contact the insurance provider to learn if these medications are covered. Remember, depending on the specific medication, it may be introduced during different phases of treatment.
For instance, although detox services may be covered under insurance, the best practice would be to learn whether a MAT drug, such as Subutex, is included. Regarding maintenance therapy, such as methadone, if insurance will not cover treatment, there may be a federal or state-funded clinic that will provide free or low-cost doses. The Affordable Care Act (ACA) has introduced numerous changes into the health care system, including an expansion of substance abuse coverage. Whether a person has received Medicaid under ACA, or purchased a health care plan from the ACA marketplace, it is necessary to contact the provider and inquire about coverage terms.
Importantly, there is a call across the nation for health care to provide adequate coverage for substance abuse treatment. In December 2012, high-ranking state officials and members of the National Association of State Alcohol and Drug Abuse Directors approved the first ever consensus statement that MAT should be covered by public and private health insurance plans.[19] The officials noted that their consensus was based on numerous scientific findings that MAT drugs help to prevent relapse, are sustainable forms of treatment, and improve the quality of life of recipients. For this reason, there was a consensus that no one who could possibly benefit from MAT should be denied this therapy.
As addiction science progresses, the biological reasons for the high rate of relapse are becoming increasingly clear. For instance, drug abuse can have long-term effects on brain structure and predispose a brain for relapse even decades after last use. As MAT therapies are safe for long-term use, there is an opportunity to prevent relapse for years.
Although the presence of MAT drugs prevents 100 percent abstinence, MAT may significantly improve the odds of a drug-abuse-free life for many. For this reason, access to these programs, by making them free, affordable, or covered by most insurance providers, is crucial. Even if a recovering person, working in conjunction with an addiction treatment specialist, ultimately decides not to pursue this method, it is important that it at least be an option.
Citations
[1] “Pharmacotherapy for Substance Use Disorders.” (n.d.). Substance Abuse and Mental Health Services Administration. Accessed May 16, 2015.
[2] Ibid.
[3] Borchert, W. & Rosier, M. (April 2012). “The Meds Controversy.” Renew Magazine. Accessed May 16, 2015.
[4] Ibid.
[5] “Methadone and Opioid Substitution Therapy.” (n.d.). Common Sense for Drug Policy. Accessed May 16, 2015.
[6] “About Methadone and Buprenorphine.” (2006). Drug Policy Alliance. Accessed May 16, 2015.
[7] Ibid.
[8] “Methadone Research Web Guide.” (n.d.). National Institute on Drug Abuse. Accessed May 16, 2015.
[9] Ibid.
[10] Ibid.
[11] Ibid.
[12] “The Facts About Buprenorphine.” (2011). Substance Abuse and Mental Health Services Administration. Accessed May 16, 2015.
[13] Ibid.
[14] “Naltrexone (Oral Route).” (n.d.). Mayo Clinic. Accessed May 16, 2015.
[15] “The Facts About Naltrexone.” (2012). Substance Abuse and Mental Health Services Administration. May 16, 2015.
[16] “How Does Methadone Work?” (July 8, 2012). Addiction Blog. Accessed May 16, 2015.
[17] “How Does Buprenorphine Work in the Brain?” (n.d.). The National Alliance of Advocates for Buprenorphine Treatment. Accessed May 16, 2015.
[18] “Naltrexone? What is it and what does it do?” (n.d.). The National Alliance of Advocates for Buprenorphine Treatment. Accessed May 16, 2015.
[19] “NASADAD Issues Consensus Statement Endorsing Medication-Assisted Treatment.” (April 21, 2013). Addiction Treatment Forum. Accessed May 16, 2015.