Prescribing medication for someone seeking help for chemical dependency may seem odd and confusing, especially if the problem involves prescription drugs, but there are many circumstances in which the right medication plan can aid in recovery. When used appropriately, medication-assisted treatment can save lives. There is ample research indicating that patients do well with medication-assisted treatment plans, but it is common for patients, family and therapists to balk at the idea of taking another prescription drug when the goal is to stop taking illegal drugs, abusing alcohol or abusing prescription drugs.
Twelve-step programs are sometimes critical of medication-assisted treatment, discouraging members by saying they are not really sober if they are taking prescription drugs for their dependency. Despite the evidence that medication-assisted treatment can help patients with chemical dependency, using drugs to get off drugs carries a stigma.
Even within the addiction treatment community, many professionals scoff at medication-assisted treatment, dismissing it as a temporary fix or taking the easy way out, and saying that the patient is not really in recovery. That approach is disheartening to those of us who have seen how effective medication can be in helping patients, particularly those who have tried and failed to recover from their addictions many times.
Unfortunately, even many experienced treatment professionals have never seen these medications used effectively and appropriately. The misconception is that the patient is just replacing one drug with another. He or she may not be dependent on OxyContin anymore, but now there is a dependency on Suboxone (buprenorphine). That may be an improvement, some say, but the patient is still dependent on a drug and some of the drugs prescribed in treatment can be abused.
Both methadone and buprenorphine have made their way to the street as drugs of abuse, so it is not uncommon for family members to question why a doctor would prescribe what may have been one of the drugs involved with the patient’s addiction.
That criticism may be valid if the drug is the patient’s only treatment for dependency, but that should never be the case. Medication must be integrated into the patient’s overall care plan, and a responsible physician will not prescribe a drug like methadone as a standalone treatment for chemical dependency. Rather, the physician will coordinate the use of medication with other facets of care to ensure that it is used in the most effective way and without encouraging abuse.
Treatment medications must be only part of a comprehensive program to help the patient stabilize and get to the point where he or she can enjoy the benefits of recovery and live a self-directed and fulfilling life.
It is important to understand that medication does not fix chemical dependency. Medication-assisted treatment is not an alternative to other care. Rather, it can help stabilize the patient while he or she receives counseling, therapy, psychosocial support and education in relapse prevention skills – all the things that take time to integrate into a person’s life.
Another reason for considering medication-assisted treatment is that the brain of a chemically dependent person needs time to heal. In this early stage of recovery, the patient has little impulse control and virtually no way to counter the urge to use drugs.
The right medication can help the patient regain a normal state of mind, eliminating or reducing the highs and lows that come with dependency. The patient will not think about the drug all the time, giving him or her a chance to focus on lifestyle changes and other aspects of recovery.
A carefully structured medication plan can help the patient get through the most difficult period of recovery successfully and then may not be necessary as the patient becomes better able to resist the urge to use drugs.
The most commonly used medications for chemical dependency are methadone, buprenorphine and naltrexone (brand names Revia and Vivitrol). Methadone and buprenorphine are used to treat opiate addiction. These drugs do not make the patient high, but they reduce cravings for the problem drug.
Naltrexone is used sometimes to treat opiate addiction and also alcoholism. It works differently, blocking the effect of opiates so that the patient does not get high. This helps prevent relapse because the drug removes the pleasurable aspect.
All three medications are available in pill form, and methadone also can come as a liquid or wafer. Naltrexone also comes in a once a month injection called Vivitrol. Patients take methadone, buprenorphine or oral naltrexone daily.
In addition to overcoming skepticism, there can be several other barriers to providing medication-assisted treatment. Physicians are limited in how many patients they can treat using buprenorphine.
Cost has been a challenge as well, as commonly used medications like Vivitrol, buprenorphine and methadone can be expensive, but the Affordable Care Act and other changes in health insurance may make medication-assisted treatment available to more people.
A physician must carefully assess the patient’s particular situation and decide if medication would be helpful, and if so, which one, what dosage and for how long.
For instance, some patients dependent on opiates and other drugs need inpatient detox and treatment because the structure of a residential program keeps them from relapsing. They don’t have access to drugs, and they do have access to treatment professionals and other resources.
Those patients may be able to stop drug use altogether and all at once. For those patients, medication-assisted care may not be necessary. But not everyone can afford residential treatment. Outpatient detox and treatment takes longer for a patient to reach a point of controlling the urge to use drugs. In these cases, a prescribed medication can help the patient taper off drugs or more quickly reach a point of cessation.
Not all outpatients are appropriate candidates for medication-assisted treatment, however, because a certain amount of structure, support and accountability is necessary to make the medication-assisted treatment successful.
A good candidate for medication-assisted treatment is the patient who has been to multiple abstinence-based programs but is still not stable. These patients may have unusually strong cravings for their drug, and they may not have the family or community support necessary to remain sober.
In some patients, the brain chemistry is such that an abstinence-only approach is doomed to failure because the physical addiction is so strong. When a patient has tried recovery multiple times and is chronically relapsing, it is not productive to simply insist that he or she try the same thing again. In those circumstances, medication-assisted treatment should be considered seriously.
The type of medication prescribed for chemical dependency will depend on what drug the patient is addicted to and other factors. For instance, buprenorphine is most effective for patients who are opiate-dependent and without other significant drug use. The reason is that sometimes when the prescribed drug stops or interferes with the use of the opiates, a patient who uses other drugs will just start using those more. Not much is achieved in that situation.
The patient who is dependent only on opiates has a much better chance of recovery with prescribed buprenorphine than someone who will be tempted to switch to another familiar drug. In another example, buprenorphine also can be effective for patients who have a drug addiction related to chronic pain. This medication relieves pain but also dampens cravings, making it easier for the patient to progress in recovery.
Medication-assisted treatment should be considered a valid option for the right patients. When used properly medications are not alternatives to other treatment but can, in fact, make those treatments more successful. The best results will be achieved by working with a physician who is experienced in medication-assisted treatment.