Many doctors, politicians and even patients overlook or resist one of the most effective treatments for drug abuse: medication-assisted treatment (MAT) with Suboxone (a tamper-resistant form of buprenorphine) or methadone.
Seeing a patient rushed to the emergency room because of a drug overdose seems a sure sign that the patient needs help with drug abuse, but not all of them are willing or able to quit cold turkey. That’s when MAT is helpful. Both Suboxone and methadone are low-dose opioids that control the cravings to use drugs, the withdrawal pains caused by a sudden cessation of drug use, but – when used as prescribed – do not get the patient high.
Yet an Annals of Internal Medicine study found that of the patients administered the anti-overdose drug naloxone by an emergency medical technician or ER nurse or doctor, less than a third were offered MAT. Of those that were given Suboxone, 40 percent fewer died over the following two years than those who were given no MAT, and 60 percent fewer died if they were given methadone.
A third drug, Vivitrol (a once-a-month injectable version of naltrexone), is sometimes ordered by the courts, but doesn’t work the same way or has the same life-saving results, according to the study. It is not an opioid, so rather than control cravings, it prevents opioids from working. If the patient has not already been weaned off opioids, administration of Vivitrol will cause instant, painful withdrawal.
Another drawback is that Vivitrol only controls opioids, and an addict desperate to get high may well try some other, more dangerous form of drugs, such as methamphetamine.
The study found that the patients who received Vivitrol (usually only one 30-day dose) “were no more likely to be alive after a year than those who were not offered or did not take a medication.”
So, why does the least effective (maybe ineffective) drug receive the most support from courts and politicians? Lobbying by the manufacturer directly to drug courts and the prejudice of many that use of Suboxone or methadone is just substituting one addictive drug for another, not a cure.
Well, aside from the fact that it is widely believed that there is no “cure” for addiction (except possibly a radical brain reset with psychedelic drugs), only treatment, MAT is not intended as the sole treatment. Treatment must be tailored to the individual, but there are some common elements: detox, cognitive behavioral therapy, support groups, relapse prevention skills, aftercare, and sometimes MAT.
One reason that Suboxone and methadone aren’t more widely prescribed is that some doctors are afraid to for fear of being labeled a Doctor Feelgood or charged with running a pill mill. Another is that some patients worry that they are not beating their addiction if they have to keep taking an opioid. And some politicians don’t like the idea that insurance or the government is providing addicts with drugs.
That’s the wrong attitude. MAT is more akin to providing a diabetic with insulin, or someone with high blood pressure the appropriate medicine.
We need evidence-based solutions to the problem of addiction, not solutions that sound good or appeal to our politics or morals but that don’t work.