Medication addiction treatment... are we circling the drain?

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I'm not an expert on addiction treatment. Most of what I know has more to do with being raised by heroin addicts than with my nursing career.

In my personal history, medication assisted treatment doesn't work. In any of my parents' countless recovery attempts (both inpatient and outpatient) all the methadone ever did was keep them from getting sick off the withdrawal symptoms. Sure, this is an obvious way to get someone into rehab, anyone who has been through abstinence withdrawal is terrified of it, but they usually still sent them home with prescriptions or weaned them off the methadone days before discharge. Once the methadone is gone they were looking for anything they could get their hands on again. In the outpatient settings, my mom would usually not even get through the whole methadone program without using again. Then she would stay on the program because, well hey, methadone is great too. Anytime one of them came back from rehab I usually got 2-3 weeks before I was coming home to blacked out windows and an empty fridge.

I'm watching "Warning: This Drug May Kill You" and I'm learning about brand new drugs available for the same thing. Some quick reading on Lexicomp and they are essentially Methadone without the social stigma. Doctors in the documentary are praising this method and comparing it to a nicotine patch. My cousin has been chewing nicotine gum for nearly 15 years now. It's better than smoking because he's not inhaling carpet glue and rat poison, but he is still addicted.

I thought I would get some objective thoughts on the matter. Pharma companies marketing opioid pain medications as "harmless" and "non-addictive" in the 90's played a large role in creating this crisis. Now the same companies seem to be profiting off the problem they created by releasing new "solutions" identical to the one that hasn't been working for the last twenty or so years (at least in my eyes)

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I think medication addiction therapy is an essential part of addictions recovery, but it isn't the whole picture. You need to address why someone started using in the first place. This involves counselling, wanting to get better and hard work. I think we are an instant society and therefore want instant results, which is why we gravitate towards "magic pills" which will "solve" any proble,

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I think that's a reflection of our culture to put emphasis on "better living through chemicals". It's not unique to addiction treatment. High cholesterol? Statin. Diabetes? Metformin/glip/etc. Depression? Another one of the most frequently prescribed meds.

Of course, we do say something a sentence or two about lifestyle factors... but you know, it's hard changing behavior or a thought process so why bother...

I remember as a newer nurse I had a patient with a DVT asking me why this happened. I was completely blown over that no provider made the connection between his morbid obesity and smoking to his current condition. We only talked to him about the anticoagulant.

Pills are just easier. Too easy.

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The truth is, heroin kills (especially in places where it's being cut with fentanyl). Medications like suboxone remove the craving and high from the equation, and allow addicts to participate actively in their recovery. I'm not suggesting staying on suboxone forever, but being in a drug treatment program and being on suboxone looks a lot like recovery to me.

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I used methadone successfully to kick a severe, illicit opiate habit. It was the only way I could do it. I was on it for 3 months then tapered off over 12 days. I've been clean from opiates for 3 years. It is well researched and has about a 50% success rate...while that isn't stellar, it's certainly better than nothing. Of course some people abuse it, 50% fail. But for the 50% it helps, it's a life saver.

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Vivitrol is pretty good... it's naltrexone in a once a month shot... and there's no way to reverse it.

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I used methadone successfully to kick a severe, illicit opiate habit. It was the only way I could do it. I was on it for 3 months then tapered off over 12 days. I've been clean from opiates for 3 years. It is well researched and has about a 50% success rate...while that isn't stellar, it's certainly better than nothing. Of course some people abuse it, 50% fail. But for the 50% it helps, it's a life saver.

Congratulations! I'm sure you have yourself to thank more than the methadone. But if the drug worked then it was worth it. This is what I was hoping to learn. Though I admit I wasn't very optimistic. It is great to get the insight and experience of someone who came out the other side of the treatment.

Thanks

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The truth is, heroin kills (especially in places where it's being cut with fentanyl). Medications like suboxone remove the craving and high from the equation, and allow addicts to participate actively in their recovery. I'm not suggesting staying on suboxone forever, but being in a drug treatment program and being on suboxone looks a lot like recovery to me.

I know it kills, it does far more than that. I grew up as collateral damage of the drug. My concern isn't with the medications removing the craving, more like the medications replacing the craving. Eventually they have to stop taking the medication and be opioid free. With an embarrassing mental health and addiction treatment network in this country and dwindling funding to treat patients suffering from the long term effects of addiction (physiological, psychological, and socioeconomical) , most don't get much care after they are weaned off the meds. This creates a high rate of relapse and the death rate on relapse is higher because patients have a lower tolerance.

With the new long term drugs are patients getting treatment too and only weaned off when they are ready? or do they all get weaned off at the same rate? is there potential for these drugs to become their new problem and them just go back to street drugs when their doctors take them off?

Mostly, is spending on these drugs going to get better results in the big picture for the most patients than expanding our reimbursement for providers and increasing funds for long term therapy and harm prevention programs?

I can't help but feel like its a bandaid that is really only able to help a select demographic.

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Specializes in Public Health, TB.

I believe that Subutex and Suboxone are given over long periods of time, and in my state at least, are only prescribed by specially trained practicioners who must include counselling as a part of treatment. The advantage to it is that given in the community, instead of patients needing to travel 1 hour each way for methadone. Making medication assisted treatment more readily available in theory, should allow patients to be employed instead of spending so much time traveling to and waiting in line at methadone clinics.

From my understanding, opioids cause a disruption in brain chemistry in multiple neurotransmitters/receptors and it takes a long time, for them to normalize.

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Specializes in IMC, school nursing.

My experience is limited, but my brother was a heroin addict because of hip issues. He was placed on suboxone, not great for pain relief. He weaned himself off and only took Tylenol arthritis for his pain preop. What got him clean? Not suboxone, that kept him from feeling the WD symptoms, but the reason he didn't go back for the high was faith based. He, as well as other people I know who have been clean for years comes down to a perspective that what they were doing was wrong, health didn't play into the equation. After all, obesity is just addiction with a legal substance and health issues is not enough for 40% of our population. Not in step with psychiatrists, but let's face it, we are having a trans generational issue with the psych community in our country.

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