Best Practices for Treating Opiate Addiction

Confronting the epidemic.

Posted Feb 23, 2018

Deaths due to opioid addiction have reached an all-time high, with no sign of relief in sight. Addiction is a complicated illness that often requires several treatment attempts before an addict successfully kicks the habit. We have good research showing us which strategies work to fight addiction. Yet some addiction centers aren’t using it. Why is this? It’s not clear, but it may be that the anti-drug dogma of many addiction treatment models has spiraled into a religious doctrine that hurts addicts.

Two Drugs That Can Save Addicts’ Lives

Most people know that 12-step programs, therapy, and addiction rehab facilities that focus on psychological counseling can save lives. But what most people know turns out not to be true. Two drugs approved by the Food and Drug Administration (FDA) for the treatment of opioid addiction are the most effective antidotes to this deadly disease.

The two drugs, methadone, and buprenorphine, are opioids that can wean addicts off of their dependency. Administered in an outpatient clinic setting, they’re safe as long as patients are carefully monitored. Yet many addiction facilities completely eschew these drugs, arguing that they are addictive, dangerous, or both. Others treat them only as short-term solutions. Addiction researchers, however, increasingly consider long-term use of one of these drugs to be the gold standard in addiction treatment—a gold standard that less than a third of addiction clinics apply.

Many experts are understandably skeptical about how an addictive drug could treat addiction to another addictive drug.

In a 2016 study published in Addiction, researchers compared opioid addiction treatment options in more than 151,000 people seeking treatment for opioid dependency. Some participants received only psychotherapy, which many rehab facilities treat as the gold standard for addiction. Others received either only opioid addiction medication, or medication combined with other treatments.

People who received only psychological support were about twice as likely to die of opioid poisoning than those who used medication.

That’s just the beginning of the opioid treatment story. Research also shows that medication-based treatment is significantly more affordable, and results in fewer health expenditures. Available on an outpatient basis, medication-based treatment can help people in recovery avoid paying tens of thousands of dollars for inpatient treatment.

The Frustrating Reality of Addiction Treatment

At its core, addiction is a chemical dependency. Many rehab facilities treat it as a moral failing—often while simultaneously emphasizing that addiction is a disease. By expecting addicts to think their way into sobriety, or to get there with a few mantras and a little psychological support, many addiction clinics fail addicts. This might be why about half of addicts relapse, often shortly after leaving residential treatment.

When addicts stop using a drug to which they’re addicted, they experience a plethora of biological changes. The urge to use becomes stronger and stronger. While it eventually subsides, it can come back. Addiction permanently changes the brain. So an addict who uses again will become addicted again.

Common wisdom suggests that using opioid addiction medication merely replaces one addiction with another. This is inaccurate. These drugs reduce or eliminate cravings, and are safe for long-term use. People using these drugs aren’t addicts; they’re taking medication. For many people in recovery, those medications can be life-saving.

It’s time for addiction clinics to accept this reality and begin offering evidence-based, effective, life-saving treatment.

Preventing Opioid Addiction: Another Area Where Practitioners Ignore Best Practices

Opioid addiction treatment providers are continually failing addicts. One recent study found that 91 percent of people who survive opioid overdoses are prescribed more opioids. Data consistently suggests that doctors prescribe more opioids than are necessary, and that they fail to monitor their patients for signs of opioid addiction.

We can do better. The CDC has published clear guidelines for reducing the opioid addiction death toll. Those include:

  • Avoiding opioids whenever possible, and recommending other treatments.
  • Prescribing the lowest effective dose of opioids, and increasing the dosage only as necessary.
  • Monitoring patients for signs of opioid dependency before, during, and after treatment.

These guidelines are potentially life-saving. People considering opioid therapy for chronic pain or any other condition should choose only doctors who diligently follow them.

More than 600,000 people died of drug overdoses between 2000-2016. Most overdoses were due to opioids. It’s time to end this epidemic with science-based treatment.

References

CDC guideline for prescribing opioids for chronic pain. (n.d.). Retrieved from https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

Mohlman, M. K., Tanzman, B., Finison, K., Pinette, M., & Jones, C. (2016). Impact of medication-assisted treatment for opioid addiction on Medicaid expenditures and health services utilization rates in Vermont. Journal of Substance Abuse Treatment, 67, 9-14. doi:10.1016/j.jsat.2016.05.002

Mole, B. (2015, December 30). 91% of patients who survive opioid overdose are prescribed more opioids. Retrieved from https://arstechnica.com/science/2015/12/91-of-patients-that-survive-opioid-overdose-are-prescribed-more-opioids

Pierce, M., Bird, S. M., Hickman, M., Marsden, J., Dunn, G., Jones, A., & Millar, T. (2016). Impact of treatment for opioid dependence on fatal drug-related poisoning: A national cohort study in England. Addiction, 111(2), 298-308. doi:10.1111/add.1319

Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., . . . Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ. doi:10.1136/bmj.j155

Szalavitz, M. (n.d.). The wrong way to treat opioid addiction. Retrieved from https://www.nytimes.com/2018/01/17/opinion/treating-opioid-addiction.htm

Understanding the epidemic. (2017, August 30). Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html