More on Medication-Assisted Treatment

Post-acute withdrawal


The current misunderstanding around Suboxone as a medication-assisted treatment, MAT, for opiate addiction is confounding. Addiction treatment professionals, whether federally funded treatment providers or private treatment providers, who ban Suboxone from their treatment have much explaining to do.

Addiction treatment is complicated in many ways. The job of the addiction treatment professional, though, is to deal with addiction as it is, with all its complications, not as how it should be or we think it should be. There are many, many opiate addicts lost in a maze of drug use and visits to doctors and clinics that never seem to put them on the right path to recovery. The anti-Suboxone addiction treatment professional who sees an addict in this opiate addiction maze can insist the addict detox and maintain a totally drug free life, but this is not likely a realistic recovery plan.

For one thing, most insurance companies will not pay for expensive inpatient detox from opiates, even if the addict has insurance. If an opiate addict had a perfect situation in which they could spend 10 days or so in detox, then another 40 or so days in inpatient treatment, then in a halfway house situation for up to 6 months, perhaps the detox and drug free plan might work — but, even if this ideal treatment situation is possible, it all depends on the opiate addict staying in treatment, and the history of opiate addicts following through with such treatment after an initial full detox is not a history of success.

The problem with opiate addiction is that the withdrawal is difficult and the post-acute withdrawal is difficult, too. There are therapeutic strategies to help with post-acute withdrawal, like nutrition, exercise, support groups, etc., but it’s unprofessional in my opinion to deny the need for medication for some individuals, and especially with opiate addiction. Recovery from opiate addiction takes a long time — the brain has undergone damaging changes during addiction and the brain has to heal, and this takes time.

Suboxone is a drug that has allowed opiate addicts the time and comfort to get into treatment and stay in treatment without leaving because, whereas without the Suboxone, they feel so depressed and uninspired they just don’t care about recovery.

Addiction treatment professionals treat addiction, and addiction is complicated. Denying treatment to someone who is either taking Suboxone or seeking to take Suboxone just because there’s a bias against Suboxone flies in the face of all the evidence that Suboxone is a very effective MAT for many opiate addicts – denying therapeutic evidence that Suboxone enables recovery whereas before recovery was absent makes no sense in the realm of addiction treatment.

Medically-assisted treatment for opiate addiction


Medically-assisted treatment

As it stands right now there are restrictions on medically-assisted treatment for opiate addiction. Doctors who prescribe Suboxone and similar drugs are limited to a certain number of patients. There is legislation, though, presented by Sen. Edward Markey and Sen. Rand Paul to loosen these restrictions. Because heroin use is on the rise, this is needed regulation.

Suboxone along with counseling and addiction treatment has proved to be an effective treatment for opiate addiction. Opiate addiction is a serious healthcare problem, and in some communities opiate addicts have a difficult time finding a doctor to provide medically-assisted treatment because of restrictive regulations.

This is from Huff Post:

The legislation, known as the Recovery Enhancement for Addiction Treatment Act, would loosen restrictions on the number of patients a doctor could treat with buprenorphine for opioid addiction.

The consensus among the medical establishment is that medically assisted treatments such as buprenorphine (and methadone), along with counseling, represent the best chance for addicts to gain a foothold on sobriety. Both medications can make withdrawal less painful and can significantly diminish further cravings for opioids — greatly reducing the chance of relapse.

The Food and Drug Administration approved using buprenorphine to treat opioid addicts more than a decade ago. But federal regulations placed limits on how many patients a doctor could treat. After getting certified to prescribe buprenorphine, which is sold under the brand name Suboxone, doctors can only treat 30 patients at a time in the first year, and 100 the following year.

In areas hit hardest by the opioid epidemic, those limits have maxed out doctors and created lengthy waiting lists for prescriptions. The legislation would raise the first-year cap from 30 patients to 100 and allow qualified nurse practitioners and physician assistants to prescribe the medication. It also would give doctors the chance to remove the patient cap after one year.

Hopefully this legislation will pass. It’s very difficult to abuse Buprenorphine, and when someone tries they are easily caught. The small risk of abuse is worth taking for the huge benefit to opiate addicts wanting addiction treatment.