Health Take-Away: Medication-aided treatments can break cycle of opioid addiction

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We've all seen the alarming headlines about the ever-widening opioid crisis in this country, where, by the latest counts, nearly 50,000 people a year — more than 130 people every day — die from opioid-related drug overdoses, a two-fold increase in a single decade. While those stories may accurately convey the scope and depth of this national crisis, they don't always clearly communicate that some highly effective medicinal treatments actually are available to help break the addiction cycle and potentially save millions of lives.

Medication-assisted treatment of opioid use disorder is a proven method using FDA-approved medications that help people through the painful stages of withdrawal and chemically relieve the fierce cravings that can lead to relapse. These medications are designed to normalize brain chemistry and block the euphoric effects of addictive opioids. They are a bridge to help an opioid-dependent person regain a balanced state of mind, free of drug-induced highs and lows, able to physically and mentally escape their constant obsession with these opioids. They give people the opportunity they desperately want and need to re-assert control over their lives.

Like heart disease and diabetes, opioid addiction is a chronic disease, a medical condition that can last for the rest of your life. However, it can be medically managed. Just as a person with chronic diabetes can lead a healthy, productive life by adhering to a regular regimen of insulin, a person with chronic opioid use disorder can control their addiction pharmaceutically. Taking medication for opioid addiction is not the same as substituting one addictive drug for another. Used properly, the medication does not create a new addiction. Rather, it helps people manage their addiction so that the benefits of recovery can be achieved and maintained. People can safely take treatment medication as long as needed — for months, a year, several years, even for life. It is important to understand that the health risks of relapse with non-prescribed opioids are far greater than the risks of lifetime treatment.

There are three main choices of medication: methadone, buprenorphine and naltrexone. Methadone and buprenorphine are long-acting opioids which prevent the emergence of withdrawal symptoms and diminish cravings. The person feels normal, not high. Naltrexone helps overcome addiction in a different way, by blocking the effect of opioids. It prevents them from inducing their typical effects and also diminishes cravings.

Methadone is administered daily in specially licensed clinics only. Buprenorphine and naltrexone are dispensed at treatment clinics or prescribed during regular office visits by doctors, who must have special approval to do so. The form and dosages of these medications and the frequency of taking them can vary, depending on what the prescribing physician believes best suits the patient. Some patients take them daily by mouth, others are given monthly injections and there are variations in between. People who are stable in recovery may be prescribed a greater supply of medication — up to a month at a time — to take at home.

People on medication-assisted treatment can also benefit greatly from counseling, including one-on-one sessions with a professional and/or group sessions with others in treatment. Those interactions can provide encouragement to stick to treatment, helping people make healthy decisions, handle setbacks, cope with stress, and move forward with their lives.

The most important take-away here by far is that medication-assisted treatment can truly break the cycle of opioid addiction, one person at a time. No, it's not some sort of "magic pill" that will reverse the current opioid crisis. The social forces driving this epidemic of addiction will not be erased pharmaceutically. But for anyone suffering from this brain disease called opioid addiction, these medications absolutely open the door to life-saving, life-long recovery.

Douglas R. Molin, M.D., is a physical medicine and rehabilitation specialist focusing on opioid dependence and pain medicine at Berkshire Medical Center.

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