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Can Medications Treat Addiction? Or is it just “trading one addiction for another?”

Maile Shoul, Project Manager, Opioid Task Force of Franklin County and the North Quabbin RegionMaile Shoul, Project Manager, Opioid Task Force of Franklin County and the North Quabbin RegionOver two million people in the United States suffer from an opioid-use disorder related to the misuse of either prescription opioids or heroin. In Massachusetts, more than 275,000 people, or nearly one in 20 residents over the age of 11, have opioid-use disorder, as of 2015. Opioid addiction affects people from every race, ethnicity, gender and class.

Many people seeking treatment for opioid-use disorder take prescription medications such as methadone, Suboxone or Vivitrol. This category of medications is often referred to as either “MOUD” (Medications for Opioid Use Disorder) or “MAT” (Medication-Assisted Treatment). Research shows that these medications are not only safe but much more effective at treating opioid addiction than counseling alone. But these medications still carry a stigma and are misunderstood. Are they a legitimate form of treatment? Or are they just trading one addiction for another?

While addiction has long been considered to be primarily a moral failure, research now shows that addiction has complex physical and neurological components. When taken properly, prescription opioids can relieve pain safely. However, when taken improperly, opioids can overwhelm the brain’s pleasure receptors, causing an intense high. If this is done repeatedly, the brain will become accustomed to opioids. This repeated, high-level exposure can lead to chemical changes in the brain reducing the number of pleasure receptors. Opioid receptors also live in other parts of the body, including the gastrointestinal tract. In the absence of opioids, a person may experience emotional and physical symptoms such as depression, diarrhea, nausea, vomiting and chills. Research shows it can take months or years for people to fully recover from the physical and neurological changes that result from opioid-use disorder.

While medications are not the right fit for everyone, research consistently shows that medications to treat addiction significantly increases adherence to treatment, compared with counseling alone.

When a person is ready to seek treatment, they often check in to an inpatient detox or rehab facility. In detox, medical professionals supervise people in withdrawal from drugs. The detox process typically lasts three to five days. They may be given medication or other therapies (such as acupuncture) to help ease the symptoms of withdrawal. “Rehab” usually refers to an inpatient program that offers intensive treatment including counseling, case management, and transition planning. There are different levels and settings, lasting a few weeks to a few months.

While detox and rehab can be life-saving, they are not sufficient for long-term treatment for opioid use disorder. Having a strong support system, either through support groups or informal channels, is vital, but many people need more support. The use of medications such as methadone, Suboxone or Vivitrol is the recommended treatment for opioid addiction by the Centers for Disease Control and Prevention, American Academy of Addiction Psychiatry, American Medical Association, and the National Institute on Drug Abuse. While medications are not the right fit for everyone, research consistently shows that medications to treat addiction significantly increases adherence to treatment, compared with counseling alone.

Methadone has been used safely for decades to treat opioid-use disorder. It must be prescribed by a physician. Due to federal regulations, most people prescribed methadone must go to a designated methadone clinic to receive it. Methadone is a Schedule II drug, meaning that it is a narcotic with potential for abuse. Unfortunately, these federal regulations can make it difficult for people to access this medication. Other Schedule II drugs include Oxycodone and codeine, which are not subject to the same restrictions.

Suboxone is the brand name of buprenorphine-naloxone, another prescription medication that can treat opioid addiction. Suboxone is not subject to as many restrictions as methadone, and can be prescribed by an addiction specialist or by a primary care provider. The prescription can be filled at a pharmacy, which allows people to take it at home.

Vivitrol is the brand name for naltrexone, which is prescribed to treat opioid-use disorder and alcohol-use disorder; alcohol-use disorder affects over 15 million people in the United States. Naltrexone comes in pill and injection form and blocks the brain’s cravings for opioids or alcohol. It is not a controlled substance and can be prescribed by any health care provider who is licensed to prescribe medications.

To some people, methadone and Suboxone are controversial because they are opioids. Why, one may ask, would you use an opioid to treat opioid addiction? Aren’t you just trading one addiction for another? To understand the answer, it’s important to understand what “addiction” actually is. Addiction is characterized by compulsive drug seeking and continued use despite harmful consequences. In contrast, most people who take medications for opioid-use disorder as prescribed have an increased level of stability in their lives. Now that they are not preoccupied with withdrawal or cravings, they can hold a job, rebuild their relationships and focus on their health.

Methadone and Suboxone have potential for abuse, which is why it is important to take them exactly as prescribed. Many other medications have very legitimate therapeutic uses and also have the potential for abuse, but it seems that medications that treat addiction carry a far greater stigma.

It is true that many people taking these medications will be physically dependent on them, as stopping the medications will bring on withdrawal symptoms. However, physical dependence is not the same as addiction. Just as a person with diabetes may be physically dependent on their prescription diabetes medication, taking the medication does not cause harmful consequences or drug-seeking behavior. As with diabetes medication, many people taking medications for opioid-use disorder may need to continue taking their medication for many years in order to remain healthy.

Medications for opioid-use disorder are effective, but because of their stigma, they are underused. It is important to dispel the myths surrounding these medications so that everyone who wants access to these life-saving medications is able to obtain them.