Thoughts on Treating Withdrawal Symptoms with Meds

[guest940422]

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)

[hppygr8ful, ASN, RN, EMT-I]

I need some clarification - are you talking about medicating someone in active detox or are you talking about suboxone maintenance?

[hrnurse]

Do you feel that the Methadone delays the inevitable withdrawal?

Broadly speaking re: med assisted withdrawal . Nurses have protocols for meds to ease withdrawal symptoms, yes . A person's suffering is subjective and detoxing or withdrawing is not a time for judgement, whether they are a long time substance abuser or not . Many pts know the exact process and even the meds they can have to assist with symptoms .

[bitter_betsy, BSN]

I didn't vote - I'm not sure I'm really qualified to choose. I've never done drugs myself and I haven't even been drunk that many times (insert Goody Two Shoes song lyrics here). I preface my comments with that information because I don't understand - I've never been in their shoes and I don't have any idea how to honestly react to this, and I've not received any sort of formal knowledge on the situation. I only know what I have experienced as the child of an alcoholic, the wife of an alcoholic and a by-standing "friend" of a "former" drug-addict. Please don't interpret this as me throwing stones or passing judgement - because I am in no way qualified to do either.

As an outsider - my boyfriend has a friend that has been on I believe suboxone for more than 5 years (he used to do meth and now this is his legal addiction). I don't understand why he hasn't been weaned (when we've spoken about it - he says that they can't - he has to do this the rest of his life). In my non-educated and non-involved option, it seems that 5 years would be plenty of time to slowly lower his dose to get him completely clean - yet his dosage hasn't changed in the 5 years. My boyfriend takes him to his monthly appointments and I often wonder if someone shouldn't say something about this doctor and his revolving prescription service. I'm sure that it benefits him somehow but that isn't my monkey as long as it isn't involving my boyfriend any.

My x-husband was an alcoholic. There were so many times we took him to the hospital to get help to stop drinking and our hospitals here wouldn't keep him. I didn't really understand then and don't understand any more now. He was a binge drinker and once he started to drink, he felt he couldn't stop. He didn't do drugs until he was drunk, so I'm sure the drugs added to his perception. As soon as he started experiencing any sort of perceived withdrawal symptoms, he would start drinking again. This would go on for about 2 weeks. I thought he was going to die so many times. When the drinking would begin, he wouldn't come back home, so other than phone calls I really didn't have to deal with him much unless his mother got involved or he showed up back at home. I once took him to an inpatient facility (at his request) over 2 hours away from our home. When we got there, he got violent with staff and left (after I started heading back home). They called me to come get him, but I couldn't find him. He ended up coming home about a month later. We never talked about what happened. I never asked how he got home. He eventually ended up getting sober (through Teen Challenge). Now he is a testosterone and steroid junkie (and stuff in little brown vials that he had to heat up in a pan to inject - no idea what that was and I'm probably better off not knowing). I finally left the abuse when my daughter remarked that "if he ever hits you - you aren't going to get up". I took her to my moms that night, I left the next day. He chose needles over our marriage. I'm much happier - not sure about him.

I firmly believe the following:

1) treatment is only possible when the person wants to get better - if at any point the person doesn't want to get better - regardless of previous good intensions - treatment of any sort will fail

2) treatment is only treatment if the treatment has an ending plan. Substituting addictions is very real and happens all the time.

3) your good intentions will never matter

4) some people cannot be helped

5) Those that are willing to be helped, must be supported (maybe encouraged is a better word) for the rest of their lives. Very few are actually ever "cured". Its a constant struggle for them. Their desire to be "healed" must be stronger than their desire for the drug and I believe there must be a constant flow of this in their life in order for that to happen.

[Neats, BSN]

I have worked in the medical arena for 40 years (started when I was 14). Most of this has been in direct contact with drug users ether in prison, emergency department and yes nursing home.

I also have 5 half siblings who are addicted to drugs and have been all their adult lives (all for at least 20 years).

Here is my take on drug use:

1. Environment has a huge impact on recidivism of using again.

2. We do not address the real reason why people use drugs

3. When you need inpatient help getting off medication it should be for a long time not the typical 30 days, this is not long enough

4. People who use drugs need to go to a supportive commune type living arrangement and to learn life skills over a period of at least one year. And learn a trade in which to support them selves. They need to relearn how to live life in a manner that makes them productive citizens.

5. Hold these people accountable for their actions no wriggle room.

6. Only people who want to change will change.

7. It can be a learned behavior.

Some of my siblings have been arrested over 45 times for drugs and related to drugs, they continue to use even as they reach their 50's. The amount of monies society has "had to" invest in them they could have had a free ride to Harvard, bought a small home for them, and given them a stipend each month.

One of my half siblings told me some very truthful remarks, they did tell me they did not care what I could do with the information. Here are the remarks after I had a conservation with them after 20 years of being out of their life: "I use because I like to get high", "I want to forget my sucky life" (they were not suicidal), "I don't care how much I cost my community", "I use, this is my life", "Winters are easier to get high than summer because more people are sick in the winter and I can go through your medication cabinet/cupboard", "I just say what they want to hear in therapy, they are not real, it is just a word game", "my user friends-we compare who are the good doctors and who are the ones who will not give us anything, we know when they are working" and lastly "I will not quit, I may stop now and then but I like to get high so I will always use". When asked why stopping and then restarting again they told me because there maybe "some bad stuff going around and I do not want to hurt myself".

It was an eye opener for me and I still think environment is the key to being successful. All my half siblings have always lived in the same area all their life, do not want the help, think it is OK to live off society, have expectations they will be taken care of no matter what, and do not think what they are doing is hurting them.

What I have discovered is each person is an individual and life although should be precious can be harsh with choices one makes. What I will never understand is why a person thinks rehab can work for all when some people just do not want the help.

[cayenne06, MSN, CNM]

I firmly believe the following:

2) treatment is only treatment if the treatment has an ending plan. Substituting addictions is very real and happens all the time.

Why do you believe this? Opioid dependence is NOT the same as being a drug addict. Addiction is a behavior pattern. Dependence is a disorder that is TREATABLE through medication and therapy.

The goal is not to be free of opiates, per se. It is to improve the health and well being of the patient, and to prevent relapse into addiction.

There are risks to medical treatment, and it's not for everyone. But it is a proven strategy with better long term outcomes than a counseling-only approach.

In my non-educated and non-involved option, it seems that 5 years would be plenty of time to slowly lower his dose to get him completely clean - yet his dosage hasn't changed in the 5 years. My boyfriend takes him to his monthly appointments and I often wonder if someone shouldn't say something about this doctor and his revolving prescription service.

Some people can achieve remission through lifestyle changes alone, others may taper off after developing the skill set to maintain sobriety. Still more may discover through trial and error that they are at high risk of relapse off of medication. Others may even require dose increases due to worsening tolerance or certain medical conditions etc. Some people will go off, then recognize the danger signs of a relapse and ask to be put back on treatment preventatively.

Even the most motivated and responsible person may not be able to control their disorder through lifestyle alone, and could require ongoing pharmaceutical management in conjunction with individualized harm-reduction counseling. This is true whether we are talking about diabetes, drug dependence, or any myriad of health conditions.

eta- there is a genetic predisposition to substance abuse, and chronic drug use creates tenacious changes in your neural wiring. These factors are still in play, even if the addiction/dependency in question is treated in full.

As usual, prevention is the best medicine.

[Lurkndmurk, ADN, RN]

This all depends on what the circumstances is. I think suboxone / methadone / subutec is an amazing medication that can benefit individuals.

I don't believe EVERY single individual should be put on the same time period to end their doses either.

I do believe that the MORE time they stick to their routine treatment meds, the better. A couple of months isn't going to help them break their years of addiction mentality.

Medication can be used as a crutch, personally I would rather have someone taking their methadone as prescribed than shooting up; it gives them a way out & back into being a normal human being.

They need time to adjust, to get their lives back on track.. I sincerely don't think that they are substituting one for the other. Its completely different chasing a high compared to maintaining & preventing withdrawals.