There is an ongoing conversation in the treatment field today regarding the use of medication in the treatment of substance use disorders where one party is stating unilaterally that this is merely a substitution of one addiction for another. This stigma is reinforced by the decades-old argument against the use of methadone to treat various opiate addictions.
What is Medication-Assisted Treatment
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), use of FDA-approved medications working in concert with evidence-based therapies has proven effective in the treatment of addiction and may help recovering users stay in treatment longer, extending periods of sobriety while paving the way for successful, long-term recovery. This combination of therapies is known all over the world as medication-assisted treatment, or MAT. The belief is that, among the many pitfalls facing alcoholics and drug addicts, the phenomenon of craving is one of the most formidable. Taking them off of the table is a good first start when combating the disease of addiction. Science has been able to divine certain medications which have proven successful in helping to fend off these cravings, alleviating anxiety and reducing the odds of relapsing into old behavior.
This level of treatment, unsupervised, has almost always led to new dependencies on the medication being used which became an anthem of, “Meet the New Boss, Same as the Old Boss”.
These medications are as many and varied as the addictions they combat, but all are usually prescribed to treat two major drugs of addiction: opioids and alcohol. There are currently no FDA-approved drugs used to treat other types of drug addiction, such as methamphetamine, marijuana, or cocaine dependence.
METHADONE
Colloquially known as the “Grandfather of MATs”, methadone is a full opioid agonist (which means it produces similar effects to other opioids). Unlike heroin, methadone is longer-acting and has milder effects which shouldn’t impact an individual’s ability to function. It is for these very reasons that it was introduced to the American public in 1947 after over a decade of research and development by Germany. It is used primarily to alleviate withdrawal symptoms (keeping addicts from becoming, “dope sick”) as well as dampening cravings that could lead to lethal use of an addict’s, “drug of choice”.
In fact, one dose can prevent craving and withdrawal for up to a day and a half. However, in order to prevent abuse, methadone is doled out and administered at clinics on a set schedule. Drug addicts are required to appear at said clinics at a predetermined time every day in order to receive their daily dose of methadone which was supposed to, in theory, allow them to function in the real world without having to resort to the use of illicit drugs.
This regimented routine – with the threat of withdrawal ever constant – led to prolonged newer addictions, this time to methadone, which drew public scrutiny when it was discovered that there were Americans who had been on, “Methadone Maintenance” for sometimes as long as a decade.
Anyone deciding to suddenly stop using methadone would likely still experience unpleasant withdrawal symptoms, so it became important for medical professionals to oversee cessation.
BUPRENORPHINE
Approved for opioid addiction by the FDA in October 2002, Buprenorphine – sold under the brand name Subutex – is a partial opioid agonist that is used to treat someone who is addicted to an opioid. Drug like heroin, oxycodone, methadone, hydrocodone, morphine, opium and others are full agonists; they activate the opioid receptors in the brain fully resulting in the full opioid effect. Unlike Methadone, which is a Schedule II substance, Buprenorphine, which was previously used as a pain reliever, is a Schedule III substance (denoting it as a drug with a lower potential for abuse.
While Buprenorphine isn’t a full opioid, it acts much like one, causing moderate receptor site activity without creating a euphoric state when taken as directed.
As a result, buprenorphine will prevent withdrawal symptoms from, and reduce cravings for, opiate drugs like heroin and prescription pain killers.
Of the few medications used to combat opioid dependence, buprenorphine is the first that can be prescribed for and obtained directly from the doctor’s office, eliminating the need to journey to a methadone clinic. Buprenorphine, however, is never prescribed in isolation; it is always part of a comprehensive recovery program designed to address the patient’s individual needs.
Buprenorphine has also proven difficult to overdose on, due to the ceiling effect that buprenorphine has; once you reach a certain dose, the effects plateau and don’t increase with higher doses.
NALOXONE, like buprenorphine, is an opioid agonist that blocks the activity of opioids at the receptor sites, potentially reversing or preventing life-threatening overdoses. Naloxone injections are often administered in medical emergencies to those who are experiencing an opioid overdose. When combined with Buprenorphine, a newer step-down medication called SUBOXONE is created.
To this end, Subutex and Suboxone often work hand-in-hand in helping drug addicts recover from opiate addiction.
Subutex is usually administered at the onset of withdrawal, and the patient is kept comfortable while their physical addiction subsides over the course of many days. Then, when appropriate, the patient is switched to suboxone at the same dose of buprenorphine they had been receiving as Subutex.
There are recorded cases of addicts remaining on suboxone for prolonged periods of time, but none of these periods are anywhere as invasive as with methadone, and a very high percentage of drug addicts elect to use this time as a “weening-off” period, stepping down their dosages until suboxone is no longer needed at all and full recovery is finally enjoyed.
