Medication-assisted treatment myth and other clarifications

 

Christopher Bueker, BS, LCDC-III

Lindner Center of HOPE-North, Addiction Therapist

 People who struggle with opioid dependency and their families often believe myths and inaccuracies about medication-assisted treatment, which sometimes overshadow the evidence that empirically demonstrates the benefits of opioid substitution therapy.

This article is dedicated to debunking the myth that methadone- and buprenorphine-assisted therapy just replaces one addiction with another.

Myth:

Medication-assisted treatment replaces one addiction with another.

Fact: 

Medication-assisted treatment is evidence-based and best practice for treating Opioid Use Disorder. Medication-assisted treatment leads to patients staying in treatment longer and patient retention is correlated with improved outcome measures for patients diagnosed with Opioid Use Disorder.

There are many differences between an opioid-dependent person using illicit street substances, such as heroin and/or fentanyl and a patient who is taking prescribed medication, such as methadone or buprenorphine for his/her diagnosis of Opioid Use Disorder.

The following are major differences between a person using street opioids and a patient taking prescribed methadone or buprenorphine.

Controlled dose, as prescribed by a Medical Doctor.

People using illicit opioids rarely, if ever measure out their dose. Every time a patient doses with his/her medication, the patient knows exactly how much medication he/she is taking.

Pharmaceutical-grade drug.

People using illicit opioids rarely, if ever obtain pharmaceutical-grade heroin and/or fentanyl. People using illicit street opioids obtain heroin and/or fentanyl that has been produced for the untaxed, illicit market. Rogue chemists that produce illicit opioids often use unsafe and unreliable procedures, which leads itself to a product that contains many impurities. Street opioids are produced with chemicals that are not tested or regulated by governmental agencies, such as the Food and Drug Administration; that is, fentanyl found on the illicit market is produced in clandestine laboratories with no governmental and/or regulatory oversight.

When taken as prescribed, opioid agonist medication significantly reduces the possibility of an opioid overdose.

The regularity of dosing.

People using illicit opioids do not take street substances on a schedule that is regulated by a Medical Doctor. People abusing illicit opioids generally use the heroin and/or fentanyl when they have it available. Their supply is never guaranteed. Patients honestly participating in an Opioid Treatment Program or in an office-based opioid treatment practice receive daily dosing of the opioid agonist medication that they are prescribed. The regularity of their dosing helps to stabilize the patient. The regularity of dosing allows the patient to engage in treatment services.

Medications prescribed in Opioid Treatment Programs such as methadone and buprenorphine are long-acting opioid agonists and illicit opioids are short-acting drugs.

The half-life for heroin is 30 minutes and the half-life of fentanyl is around 2 minutes.  The half-life for buprenorphine is 24 to 42 hours and methadone is 24 to 48 hours. When prescribed at appropriate doses, medications prescribed in OTPs and office-based settings do not produce euphoria, which is most often associated with the highs produced by illicit opioids. The long half-life of the opioid agonist medication allows the patient to achieve steady-state blood levels and allows the patient to function without suffering opioid withdrawal symptoms.

Medical services and talk therapy.

Patients who are in treatment for opioid dependency receive medical care and talk therapy in addition to their prescription of medication. People using illicit opioids do not receive counseling or medical services. While in treatment, patients learn coping skills, trigger identification, and relapse prevention strategies. Clinical providers are responsible for teaching their patients cognitive and behavioral skills such as emotion regulation and replacement behaviors, which are critically important when tapering off the medication.

Medication-assisted treatment is intended as an intervention that does not last forever. Most patients that receive medication-assisted therapy will not be on opioid agonist medication for the rest of their lives. As demonstrated in this article, patients taking methadone or buprenorphine for their opioid addiction is not the same as people who are dependent on street heroin and/or fentanyl. Medication-assisted treatment is evidence-based, which leads to the best opportunity to maintain long-term abstinence of all illicit opioids.