Opioid abuse is a serious issue across the United States and the rest of the world, resulting in broken families, addiction, financial loss, death, severed relationships, and serious medical complications. Opioid abuse can begin from prescription painkillers after major surgery or can stem from a mental health disorder such as depression or can even be brought on by another substance abuse disorder such as alcohol use disorder. Regardless of how or why the individual became hooked on opioids, medically assisted treatment for opioids combined with psychotherapy has shown to be extremely beneficial for helping individuals safely withdrawal from opioids and heal from their addiction. Medication-assisted treatment (MAT) is known to decrease opioid use, opioid-related overdose deaths, criminal activity, and infectious diseases while increasing social functioning and treatment retention rates. Treatment with MAT also is known to reduce symptoms of neonatal abstinence syndrome and length of hospital stay. Medications that are used in medically assisted treatment for opioids include buprenorphine (Suboxone), extended release naltrexone (Vivitrol) and methadone.
Addressing myths about MAT for opioid abuse
Myth: Methadone and buprenorphine DO NOT substitute one addiction for another. When an individual is treated for opioid addiction, the dosage of medication used does not get them high but instead helps reduce opioid cravings and withdrawals. These medications restore balance to the brain circuits affected by addiction, allowing the individual’s brain to heal while working toward recovery.
Myth: MAT is not practical because it does not immediately end drug dependence. Opioid use disorder is not “cured” by the use of MAT. Addiction is a “chronic” (long-lasting) disease. Medical treatment for addiction can be compared to medical treatment for other common chronic diseases like diabetes or high blood pressure. Just as diabetes is not “cured” by the use of insulin, and individuals with high blood pressure often continue taking medications for many years, individuals with opioid addiction are not “cured” but instead well-managed by MAT.
Myth: There is not any proof that MAT is better than abstinence. MAT is evidence-based and is the recommended course of treatment for opioid addiction. The National Institute on Drug Abuse, Substance Abuse, and Mental Health Services Administration, National Institute on Alcohol Abuse and Alcoholism, Centers for Disease Control and Prevention, and other agencies emphasize MAT as first-line treatment.
Methadone versus naltrexone versus buprenorphine
Methadone and buprenorphine are opioid-based and result in physical dependence, but are fundamentally different from short-acting opioids such as heroin and prescription painkillers. Short-acting opioids such as heroin work directly on the brain resulting in euphoria and sedation. In contrast, MAT medications help individuals disengage from drug-seeking behaviors, overcome physical withdrawals, and become more receptive to behavioral treatments. Injectable naltrexone is not opioid-based and does not result in physical dependence. Methadone is a long-acting opioid that is given immediately in the initial stages of MAT to lessen the physical withdrawals. Methadone is increased over time until the individual can physically manage the withdrawals and after a couple of days, the individual is slowly weaned off of methadone and is commonly placed on a long-term medication such as buprenorphine or naltrexone. For individuals to begin buprenorphine (Suboxone) or naltrexone, they must not have any opioids in their system.