Medication-Assisted Treatment: A lifeline in the opioid epidemic

BY RHONDA DOTSON, LCSW, LSATP

More than 1,400 Virginians were among the 42,000 Americans who lost their lives to opioid overdoses in 2016. Now a crisis that some contend is worse than the AIDS epidemic at its peak, the hike in opioid deaths is staggering. The Centers for Disease Control and Prevention (CDC) report increases of 34.7 percent in Virginia and 28 percent nationwide.

Substance use disorder specialists believe, and the CDC acknowledges, these statistics may not even tell the full story. In 2013, 249 million prescriptions for opioid pain medication were written by healthcare providers — enough for every American adult to have a bottle of pills. The CDC adds that at least 4.3 million Americans engaged in nonmedical use of prescription opioids in the last month.

Communities are working together to fight the epidemic, and mental health professionals are taking a hard look at opioid use and substance abuse disorders. They believe part of the solution is to treat opioid use as a chronic illness similar to diabetes, heart disease, or arthritis. Their goal is to remove its stigma so that people will seek help and seek treatment. Substance use disorders do not discriminate. As we read or hear in the news every day from the rich and famous to our friends and neighbors, people are dying.

One of the most effective treatments for opioid use disorders is medication-assisted treatment (MAT), which combines the use of medication (methadone, naltrexone, and buprenorphine) with counseling and evidence-based therapies.

MAT is primarily used for the treatment of addiction to prescription pain relievers that contain opiates and opioids such as heroin.

Approved by the U.S. Food and Drug Administration in 2002, one of the more commonly prescribed medications is Suboxone®, a combination of buprenorphine and naloxone (a medication that blocks the effects of opioid medication).

Although it is not a cure for opioid use disorder, Suboxone normalizes brain chemistry, suppresses cravings for opioids and normalizes body processes without the negative withdrawal effects. The use of Suboxone can make addiction recovery possible as long as it is used in accordance with a comprehensive treatment program. Scientific data shows that medication-assisted treatment plus evidence-based therapies can lead to positive outcomes, including less potential for overdose and death, improved changes in lifestyle, and a reduction in crime.

Unlike methadone, which can only be dispensed from specialized clinics, Suboxone can be prescribed in a physician’s office.

Patients can pick up prescriptions at a local pharmacy, and with the necessary counseling, can begin getting their lives back on track. Also unlike methadone, which is often abused, Suboxone squelches the craving for opioids and enables patients to feel “normal” again. Studies show that patients taking Suboxone tend to be more motivated to stop taking opioids. Prescriptions are closely monitored by psychiatrists and other physicians who have been specifically trained in prescribing Suboxone.

The counseling aspect of MAT enables therapists to look at the big picture of the patient’s life. Opioid abuse is crippling, and many people who become addicted to opioids lose their spouses, jobs, transportation, and homes. Patients are provided education on the safe storage of their medication and “begin changing old people, places, and things” associated with a drug-using lifestyle. MAT counselors help people connect with community services, such as housing, financial resources, and other forms of necessary healthcare.

Counseling includes individual and group therapy, motivational interviewing, relapse prevention, and psychoeducation. Counseling helps patients understand the biochemical effects of opioids and helps patients examine the consequences of their behavior. The objective is not to be punitive, but to keep patients engaged in treatment. The more engaged patients are in their medication and counseling, the better the outcomes.

“Healing is in the relationship.”

Patients must feel and believe healthcare providers are offering an environment of trust and safety for patients to share their stories so that the best possible outcome can be achieved.

Treatment also needs to be individualized so that patients get the help they need when they need it. Someone who has abused opioids may first go to an outpatient clinic, but may need a higher level of care. Upon release from inpatient or residential treatment, MAT can be available through an outpatient clinic. Some, but not all, patients may remain on medication-assisted treatment for the rest of their lives.

Medication-assisted treatment is a true lifeline to those with opioid use disorders. The importance of removing the stigma connected to opioid abuse and all substance abuse cannot be overstated as communities, counselors, and physicians work toward recovery of patients, a reduction in the number of lives lost, and an end to today’s opioid epidemic and substance use disorders.

Rhonda Dotson is a licensed clinical social worker and licensed substance abuse treatment practitioner with Centra Mental Health Services. For more information, visit CentraHealth.com or call 434.200.4447.