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