Medication-Assisted Treatment: A Solution to the Statistics?

A three-part series by Guest Blogger Gloria Englund, MA

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Part III

The availability and use of Suboxone is very different now than when Aaron’s final attempt at recovery took place. Then, health insurance paid for Suboxone only when it was administered through an in-patient treatment facility. It was used mainly as a detox tool, not a recovery treatment tool as it is now. Many addiction specialists now recommend that patients with an opioid addiction may be best served with indefinite MAT therapy.  There were not many treatment centers licensed to dispense it and very few doctors licensed to prescribe it. This continues to be a challenge in the treatment world. Many physicians still choose not to seek licensure to dispense Suboxone because they don’t want to deal with the population of people ill with a substance use disorder. Another way the stigma and discrimination still play into the availability of MAT.

True Recovery

I used to think complete abstinence from methadone, buprenorphine (Suboxone), or naltrexone used in MAT, was the only marker for true recovery.

Everything I have learned about SUD and recovery since Aaron’s death tells me that I had a very narrow and uneducated view of what may be necessary to keep the person with an opioid use disorder alive so recovery can happen.

The more options available for MAT to those with SUDs who seek recovery, the better are their chances of remission and the more lives we save.

Since Aaron’s death, I have seen and heard many testaments to the effectiveness of all three of these medications when they are used as recovery tools. But the availability, cost and insurance coverage needs to align in support of these life-saving medications that can prevent overdose deaths.

Evidence-Based Treatment

It’s imperative to remember that MAT programs are evidence-based treatment (EBT) protocols. This means there’s scientific research to back up the practice of medication-assisted treatment as a viable treatment option. In general, the research proves that people on MAT have fewer relapses, live longer and stay in recovery longer than those who do not use it. This is especially true for those with opioid use disorder.

We Need More Education & Information

I believe lack of education about addiction being a brain illness and the public not being properly informed about the life saving properties of MAT is what killed Prince along with the additional 128 people who died of a drug overdose on April 21, 2016. Chronic pain might have brought him to where he was with his illness, but in my opinion, ignorance and stigma kept Prince and those close to him from asking for the right kind of the help, at the right time.

This is the third of a three-part series. We are posting the full series in the Resource section of Our Young Addicts.

Saving the lives of those who are ill from this disease will only happen when the general public becomes educated and demands that the people who suffer from these disorders, deserve the same medical treatment and compassion as does anyone suffering from a chronic illness.

About our Guest Blogger: Gloria Englund, founder of Recovering u breaks new ground in the field of addiction recovery and support. As an ally of the recovery community, she honors all pathways of recovery. She is a psychotherapist, who holds a Master of Arts degree in Human Development. As a certified Recovery Coach, she works with individuals and families dealing with an addiction to alcohol, drugs, food, and relationships. Gloria has personal as well as professional knowledge of addiction and recovery; her oldest son, Aaron, died of a heroin overdose in 2007. As an accomplished public speaker, advocate and published author, Gloria brings a message of hope and recovery to others.

Guest blog posts are welcome additions to the content on this website. Guest blog posts represent the views, opinions and experiences of the author and do not necessarily represent Our Young Addicts. Together, we provide parents and professionals with a variety of perspectives and information.

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Medication-Assisted Treatment: A Solution to the Statistics?

A three-part series by Guest Blogger Gloria Englund, MA. New Protocols, Addiction as a Progressive Brain Disease.

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Part II

Old-school Perception & Protocol – the 1990s

My history with MAT goes back to the 1990s when most people considered substance use disorders a character flaw, and/or lack of will power and motivation. Although the American Medical Association (AMA) recognized alcoholism as disease in 1956 which allowed it to be viewed as a diagnosable condition for which insurance reimbursement was possible, most treatment focused on it being a psychological/behavior disorder. This was the treatment protocol I learned in graduate school in the early ‘90s.

Addiction Recognized as a Progressive Brain Disease

Aaron died in 2007.  It wasn’t until 2011 that The American Society of Addiction Medicine (ASAM) first stated that addiction is a progressive brain disease that is fatal without intervention.

This meant both of us went through our 20-year struggle with his SUD without knowledge of addiction being a brain disease – as I suspect many have. It was a wake-up call for me to learn that this illness is about underlying neurology, not outward actions.

The NIDA soon after stated that addiction is “a chronic relapsing …brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.”  It was so hard for me to grasp that my son’s was ill not only with a physical dependence – but also a psychological compulsion that would create drug seeking behavior no matter what the consequences.

Abraham Maslow’s Hierarchy of Needs is a theory of psychological health predicated on fulfilling innate human needs in a specific priority. Physiological needs such breathing, food and water are at the bottom the hierarchy. In other words – a human’s first priority is sustaining life. The hierarchy culminates in self-actualization at the top. The compulsion that is characteristic of SUD precludes those basic physiological needs.

This is why many need MAT to get their cravings quelled. If the cravings aren’t under control, they can’t even think about meeting those basic needs of life – so they can go on to recovering their life.

Tapering Off or Long-term Maintenance?

In 2007, most people on MAT methadone programs were encouraged to start tapering off the medication once they had been stabilized for weeks or a few months. The yo-yo effect of trying to taper and failing to find the correct dosage created constant turmoil for Aaron as well as frequent relapses. At that time, both of us attended recovery support groups which promoted that if you were on medication-assisted treatment you weren’t really in recovery because you were still using an opioid medication. And this continues to happen today.

Very few supportive services were offered along with Aaron’s MAT program – which I now know is very important to recovery. You can’t just take a pill or get an injection and recover from this illness. Although behavior and psychological issues may not be a CAUSE of this illness, they do result as we try to SURVIVE the illness.

That’s why MAT needs to be offered along with individual or group therapy, peer recovery support groups, classes on exercise, nutrition – basic life skills – keeping a budget and learning how to seek employment.

Minnesota Recovery Connection, like many other recovery community organizations (RCO) in other states – offer many of these resources on their website and support all pathways to recovery.

Note to readers: Part III will run on Thursday, June 30. We will post the full three-part series in our Resource section.

About our Guest Blogger: Gloria Englund, founder of Recovering u breaks new ground in the field of addiction recovery and support. As an ally of the recovery community, she honors all pathways of recovery. She is a psychotherapist, who holds a Master of Arts degree in Human Development. As a certified Recovery Coach, she works with individuals and families dealing with an addiction to alcohol, drugs, food, and relationships. Gloria has personal as well as professional knowledge of addiction and recovery; her oldest son, Aaron, died of a heroin overdose in 2007. As an accomplished public speaker, advocate and published author, Gloria brings a message of hope and recovery to others.

Guest blog posts are welcome additions to the content on this website. Guest blog posts represent the views, opinions and experiences of the author and do not necessarily represent Our Young Addicts. Together, we provide parents and professionals with a variety of perspectives and information.

Medication-Assisted Treatment: A Solution to the Statistics?

A three-part series by Guest Blogger Gloria Englund, MA. Suboxone, Naltrexone, Methadone

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Part I

I was very uneducated about medications that are affective for substance use disorder (SUD), especially opioid use disorder when my son, Aaron, was still alive. Although he was familiar with Suboxone and methadone, now I believe both of us could have been better informed about how to use methadone along with other support tools that were needed in order to make the treatment the more effective.

Prince’s death has brought the use of Suboxone, a medication that is used to treat opioid use disorder, and the idea of medication-assisted treatment (MAT) for substance use disorders to the forefront of the opioid overdose epidemic. The latest statistic from the National Institute on Drug Abuse (NIDA) is that 129 people are dying every day in the United States from drug overdose; 80 of those deaths involve the use of an opioid.

I believe the stigma and discrimination that accompany substance use disorders, also accompanies the medications that can be used to quell withdrawals symptoms and lesson cravings for those with substance use disorders as they seek recovery.

MAT can greatly reduce the possibility of relapse which often lead to drug overdose that can result in death.

Suboxone

Suboxone, the MAT treatment that didn’t get in Prince’s body soon enough, is one of these medications that is often used to quell withdrawal and cravings for opioids. What exactly is Suboxone? It’s referred to as a partial agonist because it doesn’t bind to the opioid sites as does a full agonist so it produces much fewer endorphins. Because of its “partial” nature, it is much easier to withdraw from than a full agonist like methadone. Suboxone is the commercial name for buprenorphine (partial agonist) combined with naloxone, an opioid antagonist which is very effective at blocking euphoria when combined with the buprenorphine.  Used alone, naloxone (Narcan®) is used to reverse an opioid overdose if administered in a timely manner. Suboxone is also available as a film which is dissolved under the tongue thereby lessening the potential for abuse even more. In May of 2016 the FDA approved a buprenorphine body implant that will dispense medication for up to 6 months but has not stated when in will be available for use.

Methadone

Other readily used medications are methadone (mentioned above) and naltrexone. Methadone is a long-acting opioid agonist medication that is very effective in treating heroin and prescription pain medication addiction. It can only be distributed at specifically licensed clinics. Initially it needs to be dispensed every day requiring the user to make daily trips to the clinic. When the specific dose is determined that stabilizes the patient, then patients can begin to lessen their visits by receiving seven days of doses divided between two or three days a week and eventually, only coming in once a week to receive all seven days for the next week. This daily commitment combined with the difficulty many have in tapering off the medication (and its potential abuse as a full agonist that can be sedating) often outweighs, for some, the positives of its effectiveness in quelling withdrawal and cravings. Methadone is also much less costly than Suboxone if the user needs to pay out of pocket.

Naltrexone

Naltrexone is another MAT drug, but is an antagonist. This means it blocks any opioids from connecting to the receptor sites and can only be used after a patient has completed detoxification from all opioids and all opioid medications like Suboxone or methadone. If a patient uses it while any opioids are in the body, they will go in the immediate withdrawal. Naltrexone is not addictive or sedating and does not result in physical dependence as does Suboxone or methadone. However, poor patient compliance with the daily tablets has limited its effectiveness. A long-acting form of naltrexone called Vivitrol® is now available in a once per month injection eliminating the need for daily use which improves patient compliance. Unlike methadone or Suboxone, anyone licensed to dispense medications can prescribe naltrexone, but the cost may be prohibitive for many.

Note to readers: Part II will run on Thursday, June23, and Part III will run on Thursday, June 30. We will post the full three-part series in our Resource section.

About our Guest Blogger: Gloria Englund, founder of Recovering u breaks new ground in the field of addiction recovery and support. As an ally of the recovery community, she honors all pathways of recovery. She is a psychotherapist, who holds a Master of Arts degree in Human Development. As a certified Recovery Coach, she works with individuals and families dealing with an addiction to alcohol, drugs, food, and relationships. Gloria has personal as well as professional knowledge of addiction and recovery; her oldest son, Aaron, died of a heroin overdose in 2007. As an accomplished public speaker, advocate and published author, Gloria brings a message of hope and recovery to others.

Three-part MAT Series 6/16, 6/23 & 6/30

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It’s about time we talked more about Medication-Assisted Treatment (MAT), and it starts with straight information and open-minded consideration. The next three Thursdays, we will run a series by Guest Blogger Gloria Englund, MA, from Recovering U.

  • June 16 – Defining MAT; Learning about Suboxone, Methadone and Naltrexone
  • June 23 – Ditching old-school perceptions and protocols; Looking at addiction as a progressive brain disease
  • June 30 – True recovery; Evidence-based treatment

We will post the full series as a printable pdf on the Resource section of Our Young Addicts.

Midwestern Mama

 

 

Proud MAT Mom

wrestling

My youngest son is a wrestler – athletically and intellectually. Wrestling didn’t come easy to him, but he simply loved the sport and being part of the school team. At first I would watch his matches with my hands covering my eyes just peeking through my fingers and praying he wouldn’t get hurt. It was a foreign sport to me, but I made it to as many wrestling matches as possible and began tagging Facebook photos with the hashtag #ProudMatMom. He became a better wrestler and I became a more comfortable spectator and supporter of his choice to wrestle.

When he started wrestling in sixth grade in 2011-2012, his older brother (affectionately known in many of my blog posts as #SoberSon), was struggling with addiction and losing the battle. Little did I know that in July 2014 #SoberSon would eventually find his sobriety on a “mat” of his own: Medication Assisted Treatment (MAT)*.

Today, #ProudMATMom has double meaning and I am an avid proponent of MAT as a viable, preferred – and even necessary – treatment for opioid-use disorder.

 Finding a Solution

Not unlike his younger brother, #SoberSon got pinned and lost quite a few matches before experiencing a “win” and committing himself to ongoing training.  After trying several different treatment approaches, and experiencing relapse, #SoberSon through his own anecdotal research came to the conclusion that he wanted to try Suboxone, a form of Medication-Assisted Treatment. He had some other criteria, too: not 12 step and not in-patient.

That trifecta proved a difficult find. Ironically, the option that we found was one I’d never encountered in the years leading up to this and it was within a few miles of our home. Imagine that! Sometimes the solutions are so close, but we don’t even realize it.

Suboxone (Buprenorphine combined with Naloxone)

Gloria Englund, MA, a recovery coach and author of Living in the Wake of Addiction – Lessons for Courageous Caregiving, defines Suboxone as follows:

Suboxone is a partial agonist because it doesn’t bind to the opioid sites as does a full agonist so it produces much fewer endorphins. Because of its “partial” nature, it is much easier to withdraw from than a full agonist like methadone. Suboxone is the commercial name for buprenorphine (partial agonist) combined with naloxone, an opioid antagonist which is very effective at blocking euphoria when combined with the buprenorphine. Used alone, naloxone (Narcan®) is very effective in reversing opioid overdose if administered in a timely manner. Suboxone is also available as a film which is dissolved under the tongue thereby lessening the potential for abuse even more. In May 2016 the FDA approved a buprenorphine body implant that will dispense medication for up to 6 months but has not stated when in will be available for use.”

Note to readers: I’m excited to share an upcoming blog by Gloria on MAT and also an interview with her about her book, which is a must-read for parents.

Be Open-minded to Treatment Options

For my son, Suboxone has provided the stability he needed to focus on his recovery. He tried Naltrexone (also available as Vivitrol) during an in-patient treatment program but didn’t find relief; he was still craving opiates, which meant his head was anywhere but the treatment group. All he could think about was getting out so he could get his fix. He was just passing time, counting days, and was convinced he could moderate his use upon discharge.

Of course, he couldn’t and he returned to use within a few months of completing in-patient treatment. He was overwhelmed with freedom, a poor-fit after-care plan and insufficient means through employment, housing, and support. He wasn’t interested in coming home and we weren’t sure we were ready either. It was an awkward, difficult time of transition that went the wrong direction quickly.

From Relapse to Recovery

That relapse and its devastating demise unified our family and son’s friends. Together, we conveyed our concern for his well-being and voiced our very real fear that he was going to die soon.

He said, “Thanks but no thanks” to returning to treatment.

He wasn’t ready to stop using, but with hindsight, he was shifting from needing to stop to wanting to stop, and he learned that Suboxone might just be the best way for him to treat his opioid-use disorder.

Suboxone accomplishes three things for my son: 1) It takes away withdrawal symptoms; 2) It eliminates cravings; and 3) It makes it impossible to get high (for at least 48 hours) if he were to use an opiate. This combination provides incredible stability as he actively works an integrated treatment plan.

Right away, he enrolled in a high-intensity out-patient (HIOP) treatment program offered by the MAT clinic. In addition, he met one-on-one with a counselor. He has progressed from dosing daily at the clinic to picking up a week’s supply at a time. He passes all of the random, monthly UAs and sees his counselor regularly. More importantly, his self-confidence and self-esteem is returning: He got a job within a few months of starting Suboxone and has held it ever since, and he enrolled in college courses and has gotten straight A’s.

Stigma from Unexpected Sources

Unfortunately, like many aspects of addiction, Suboxone users, proponents and supporters encounter stigma. Interestingly, the stigma – from my perspective – comes from the broader recovery community and not from the general public.

These folks (certainly not everyone) seem to feel that recovery must not include medication assistance – they say it’s trading one drug for another, that it’s just another form of addiction.

This simply isn’t true as my son and many others will attest.

More encouraging, however, is the open-mindedness that friends, family and the general public seems to take regarding Suboxone, and perhaps more so with the news that Prince was about to start using Suboxone. They are amazed to learn that such an option exists. They see it as comparable to taking an anti-depressant or anti-anxiety medication to treat those brain disorders. They see it as taking insulin for diabetes, as taking cholesterol-lowering medication … they see medication as a form of treatment for a chronic disease. In this case, the chronic disease is a brain disorder known clinically as substance-use disorder or opiate-use disorder, or more familiarly as addiction (which takes us down a whole other rabbit hole of lexicon vs stigma).

Like any medication – prescribed, over the counter, or illegal street drug – Suboxone can be abused, it can be used to get high, and it can be sold on the street. UNLESS, it’s being used with integrity as prescribed and under the care and guidance of a physician who specializes in opiate addiction. AND, when it’s used in conjunction with other treatment protocols – group, individualized therapy, mental health, support, etc.

Future Plans

We’re fairly new to Suboxone – just two years in July 2016 – but the benefits are amazing. I understand that some physicians and people believe in life-long maintenance; others believe it’s possible to taper off Suboxone, slowly and with full support.

My son’s clinic believes in an individualized approach to MAT offering a general guideline that it takes 18 to 24 months for a person to stabilize (their life) using Suboxone in conjunction with ongoing counseling services. My son would like to taper off, very slowly, at some point. Our family will support him in that decision and remain open minded to the possibilities that it brings.

But, as he says, “Why mess with what’s working?” I wholeheartedly agree.

With MAT, Suboxone in particular, our family is no longer wrestling with opioid addiction and that makes me a very, very #ProudMATMom.

*Medication-Assisted Treatment (MAT): This is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful

Midwestern Mama

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