There are many stigmas with medication-assisted treatment or pharmacotherapy. Treating addiction with drugs is hard to understand for many people. But, since the 1930s, doctors have been using medications to fight opioid addiction.
In addiction treatment, pharmacotherapy is the effective use of medications to treat addiction and promote recovery. The National Library of Medicine states the main goals of pharmacotherapy are:
Medication therapy management (MTM), combined with behavioral therapies, treats the “whole person.” Therapies and recovery support programs address the mental and emotional challenges of addiction while FDA approved drugs treat physical dependency.
The 2018 National Survey on Drug and Health (NSDUH) reports that 86 percent of adults drink alcohol. And 14 million suffer alcohol use disorder (AUD). Heavy alcohol use is dangerous and can lead to serious health issues.
The Centers for Disease Control (CDC) defines excessive drinking as:
Benzodiazepines are sedatives that manage anxiety. However, the brain reacts to benzos the same way as alcohol. Long-acting benzos like Valium may help during the detox process. The World Health Organization recommends benzos for AUD as they effectively reduce the risk of alcohol withdrawal syndrome.
Naltrexone blocks the euphoric effects of alcohol use. When a person on Naltrexone drinks alcohol, they will not feel good and will not “catch a buzz” from the alcohol. Naltrexone is most often helpful for people who have been to treatment for AUD multiple times.
DTs or Delirium Tremens are seizures from alcohol withdrawal. DTs are one of the most severe risks of alcohol detox. Antiepileptic medications like Gabapentin, Valproate, and Carbamazepine may help those fighting dependency.
Disulfiram is the first FDA- approved medicine for AUD. But, it is not as common as the others. Disulfiram can be prescribed once detox is complete. It does not reduce cravings but instead makes a person very sick if they drink. When drinking while taking this drug, it causes nausea, fevers, and increases the heart rate. These effects can be life-threatening, leading to heart attack, convulsions, and can be fatal.
Medication therapy management is standard and beneficial in Opioid Treatment Programs (OTPs). There are three FDA-approved medications for treating opioid use disorder (OUD), Methadone, Buprenorphine, and Naltrexone. Even though some are controlled substances and have addictive qualities, they can be used safely for extended lengths of time.
Methadone Maintenance Treatment is helpful in the long-term treatment of opioid addiction. And include heroin, morphine, codeine, and semi-synthetic opioids like oxycodone and hydrocodone. Methadone reduces cravings and withdrawal symptoms. And, it also blocks the effects of opioids on the brain.
People addicted to opioids often relapse several times. Methadone can help prevent relapse. It is a long-lasting opioid, and the brain reacts the same as when on opioids. So, when using Methadone in treating OUD, it prevents the cravings and withdrawal symptoms of opioids. Reducing cravings allows the focus to be only on recovery.
Naltrexone or Vivitrol is one medication for AUD that is not a controlled substance. It helps treat AUD as well as OUD. Naltrexone reduces cravings and blocks the harmful effects of opioid use, eliminating the desire to use.
Naltrexone is not used during the detox phase of recovery. If it is used while still physically dependent on opioids, Naltrexone can cause withdrawal symptoms. Because of this, a person must be in recovery for a minimum of 7 days. Naltrexone use could be extended, depending on the severity of their addiction.
Buprenorphine is the first drug for opioid dependency that can be prescribed or dispensed by a general doctor. In-office dispensing offers a more discrete approach to treating OUD than going to a Methadone clinic for treatment.
When taken as prescribed, buprenorphine can prevent withdrawal symptoms and reduce cravings. But, it doesn’t cause the feeling of euphoria that opioids do. Buprenorphine is faster working than Methadone. And it also has a lower risk of overdose than Methadone.
Suboxone is a combination of Buprenorphine and Naloxone. By working together, the drugs reduce cravings, block the effects of opioids, and reverse the effects of opioids. Suboxone prevents withdrawal symptoms and promotes recovery.
A neurotransmitter is a chemical that carries signals through the nerves. They work to keep the brain functioning, the heart beating, and has a variety of psychological functions. The use of drugs and alcohol alters the neurotransmitters in the brain, causing dependency, cravings, and withdrawal symptoms.
An agonist is a drug that activates specific responses when it binds to a neurotransmitter. Full agonists activate opioid receptors entirely; this results in a full opioid effect. Full agonists include heroin, oxycodone, and methadone.
An antagonist is a drug that blocks opioids. It attaches to the opioid receptors without activating them. Antagonists block the harmful effects of opioids. And include Naltrexone and Naloxone. Naloxone is used to reverse a heroin overdose.
Mixed agonist-antagonist drugs act as both an agonist and an antagonist. Receptors act differently to opioids. A mixed agonist-antagonist may bind to one receptor as an agonist and another as an antagonist. Buprenorphine and Suboxone are mixed agonist-antagonists used to treat opioid use disorder.
Medication therapy management is extremely beneficial for the treatment of opioid and alcohol addictions. Without therapy, support groups, and lifestyle changes, the medication won’t stop a relapse. Treatment is available in an urgent care setting, inpatient setting, and outpatient setting.
Urgent care settings use MAT to safely detox members from drugs and alcohol. A variety of medications are helpful in urgent care settings. The medicines used to relieve withdrawal symptoms include:
Inpatient treatment allows members to receive treatment while still in a MAT program. One benefit of MAT in an inpatient setting is the ability to address an issue right away. Whether it is an adverse reaction to a drug or a symptom of withdrawal, trained professionals can evaluate on the spot. Medications used in inpatient MAT programs include:
Not everyone can leave responsibilities in life and go to inpatient treatment. Outpatient treatment offers medication-assisted treatment to help the recovery journey. In outpatient treatment, members will have to go to a Methadone clinic or doctor’s office to receive the drugs in MAT. This takes away the privacy of therapy.
But, outpatient treatment gives members all the benefits of medication-assisted treatment while at home. Members who have completed an inpatient program or are highly motivated in their sobriety can find great success in outpatient treatment.
Medication-assisted therapy is beneficial for many people fighting an addiction to opioids or alcohol. There are positive factors to using MAT in a recovery journey. The drugs used in a MAT program can reduce cravings and stop the pleasurable effects of opioids and alcohol. The intense cravings can interfere with focus and participation in therapy. Participating in a MAT program increases the chances of a lasting recovery.
According to SAMHSA, MAT improves overall survival and increases time in treatment. MAT enhances the ability to get a job and handle life’s responsibilities free of drugs and alcohol. Women with a substance use disorder find MAT programs helpful in improving birth outcomes.
MAT alone does not “fix” an addiction. People have the misconception that one pill can fix it all. But, unless a comprehensive recovery program is combined with MAT, it may not be successful.
There is still a stigma around the use of MAT in addiction treatment. Many people believe it is substituting one drug for another. Unfortunately, they are the same people that believe addiction is a choice and not a disease. The stigma can lead a person with an addiction to leave treatment and go back to their substance of choice.
Are you or someone you love fighting an addiction to opioids or alcohol? Sana Lakes BWC offers medication therapy management to ease and assist in the recovery journey. Contact us today and learn more about how we can help you on your recovery journey.
References:
https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat
https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics