Drug Addiction

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Is Drug Replacement Therapy a Good Option for Recovering Addicts?

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Recently I have been discussing the pros and cons of drug replacement therapy in my professional life. Apparently this is a very touchy subject and people tend to either agree or disagree with it very passionately.

Drug replacement therapy is the idea of using long term drug maintenance as a treatment option. The most popular example of this is Methadone maintenance for opiate addiction. There is also a drug replacement that is similar to this called Suboxone maintenance. There are also some other untested drug therapies being developed right now that will potentially treat other substance addictions other than opiates. My personal opinion is that we will see a trend towards more and more treatment options of this nature in the future.

I’m not sure if that is a good thing or a bad thing, just that there is a high demand for pharmaceutical solutions to the problem of addiction in general. Also, understand that there is a difference between Methadone and Suboxone as a replacement therapy: Methadone is a full opiate agonist while Suboxone contains only a partial opiate agonist. What this means is that people can and do get “high” with Methadone, but the effect is much more subtle with Suboxone.

Two possible opinions

Basically, you could believe one of 2 things about drug replacment therapies.

1) For it - You are of the belief that some people absolutely need a drug replacement therapy in order to recover over the long term. That there is simply no other way for them. That they have damaged their mind and body so much through so many years of abuse that they will never feel “normal” again without the aid of replacement therapy. You believe to deny them drug replacement therapy is to condemn them to death or a lifetime of continuous addiction.

2) Against it - You are of the belief that any addict can eventually become completely drug free and fully recover. That replacing one drug for another only perpetuates the addiction and is really no solution at all. Also, in my research, I found that some arguments against replacement therapies are clearly organized plugs for other controversial opiate treatments.

My stance

It is my belief that drug replacement therapy is a desirable option for a very small percentage of recovering addicts (something like 3 percent or even less). The vast majority of recovering addicts do not actually need a replacement therapy and will in fact be taking a step backwards if they choose to go this route.

But for some of the long term drug addicts who prove to be chronic relapsers, I think replacement therapy starts to look like a viable option. Here’s why:

1) For some people, drug addiction is not their biggest problem - Which is worse: suicide, murder, life in prison, or being on drug replacement therapy? If you think drug replacement therapy is near the top of that list, then you have lost sight of what is truly important. Some people’s lives are a tangled mess of crime and desperation where addiction is only one contributing factor. In this way, replacement therapy might grant some people a new chance at life, whereas they would otherwise self destruct or end up in a much worse outcome.

2) Physical necessity - your body naturally produces a certain level of dopamine (that “feel-good” chemical). Your body does this naturally just so you can make it through your day or be able to handle some basic physical exercise or exertion. Do you know what it is like to have that baseline level of dopamine completely switched off? Imagine living with a nasty case of the flu for the rest of your life. Some long term users of opiates are basically facing a similar situation without replacement therapy.

3) When other options fail - I don’t believe drug replacement therapy should ever be a first line of defense. But after an addict makes several failed attempts at treatment, then looking at drug replacement therapy starts making more and more sense. If other treatment methods continuously fail then it might be time to try something different. The price for not experimenting with a different therapy might be very high indeed.

Keep in mind that if you are on a drug replacement therapy, then you can attend NA meetings but you are not allowed to speak at them, only to listen. NA world services decided this based on the perceived purity of the NA message being shared in their meetings. In other words, they don’t want someone speaking in their meetings that is potentially “high.”

If you’re interested in drug replacement therapy, here is what I found to be the best resource of information regarding it that is not heavily biased against it as a treatment option.

 

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  • http://www.methadonesupport.org Zenith

    Well, I agree partly with you. Your resource–the opiate addiction page from the HBO documentary “Addiction” is a very useful resource and one I use myself and as you said is not biased.

    I also agree that a certain segment of the opioid addicted require replacement therapy to live a normal life–however, I believe it is endorphins that most of them are difficient in–some may have a congenital deficiency while others may have created permanent damage by long term opiate use. However, I don’t agree that this is “3%” of the population. Do you have any studies that back this assertion up? Because from what I have seen, read and experienced, the relapse rate for traditional, abstinence based treatment is very very high.

    Also, to withhold the most effective treatment until a patient has spiraled through countless abstinence based rehabs and talk therapies and meetings, relapsing time and again, leaves the person with an even greater chance of needing permanent replacement therapy, if they live long enough to make it there. Often, people who do make it to MMT are in serious condition–jobless, homeless, familyless, seriously ill with hep C or HIV, burdened with a long criminal record, etc. Yet, even so, the average success rate (i.e., free of illicit drugs and leading a better, more productive, normal life) is 65% to 90%–far higher than any other modality.

    I saw a TV show last night about former baseball star Jose Canseco. He had spent 20 years injecting himself with illegal steroids. As a result, when he stopped using them, his testosterone level was very low. He went to a doctor and the doctor measured his levels and found them quite low indeed. He started him on a testosterone gel. Jose came back a few weeks later only very minimally improved. The doctor referred him to an endocrinologist who could design a better replacement program for him. Before he left, Jose asked the doctor if he thought there was any chance he might require these drugs for the rest of his life. The doctor stated that there was “a very good possibility”, and told Jose that he had caused his body to shut down it’s natural production of the chemical by overuse of steroids–the brain/body sensed there was plenty on board and stopped producing it. Only time would tell whether the damage was permanent, said the doctor.

    No one questioned this or found it odd. Diabetics who no longer make insulin with their pancreas require supplemental insulin. Men and women who no longer make estrogen or testosterone may require supplemental hormones. But those whose endorphin system has shut down due to long term abuse of short acting opiates (or who were trying to self medicate a congenital deficiency) are told to gather in a circle, join hands and pray–or write sin lists and read them to God–or go to meetings several times a day til the desperate urge to feel normal goes away. This is NOT how we treat other biochemical maladies–but it IS how we treat this one–and only this one.

    Opioid addiction treatment is based heavily, in the USA, on a book written by a stockbroker in 1937 who overcame drinking by having a “spiritual experience” while under the influence of Belladonna. A member of a fringe religious sect, The Oxford Group, he borrowed heavily from their tenets in developing his “12 step program’, which was in no way based on science, evidence or medicine. This program has remained unchanged, with no updates whatsoever, for 70 years–and this is what we offer addicts in 97% of our rehab centers.

    Of course, methadone is not appropriate for all opiate addicts. Just as some diabetics can manage with diet and exercise to control blood sugar while others may require oral drugs or even insulin, opiate addicts vary in what degree of treatment they require as well. However, if the patient were direly ill, with a widely fluctuating blood sugar, the doctor would not advise trying prayer and support groups instead of medication, agreeing to medicate them only if they “failed” at this other method several times over and got much sicker first.

    Opiate addiction is very difficult to treat, has a large degree of stigma attached to it, and the fallout of untreated or mis-treated illness is very high–job loss, jail, serious illnesses, death. Opiates are not “evil” drugs. Yes, they are “mood altering”–as are antidepressants and other helpful medications. But we need our natural opiates because they regulate mood, control pain, and enable us to feel happiness and pleasure. If a person is experiencing severe, ongoing depression, anhedonia, lethargy, etc as a result of dysfunctional brain chemistry–they may NEED something to “alter” their mood. Properly dosed and not mixed with other drugs, methadone does not cause a high or euphoria, but simply enables the person to function normally.

  • http://bottlecappie.wordpress.com bottlecappie

    I totally agree with everything Zenith said.

    I have been taking Suboxone for about a year now, and this medication has enabled me to get my life back on track. Suboxone put the symptoms of addiction – compulsive behavior, cravings, withdrawals – into remission so I could rebuild my life. And it kept my depression and chronic pain at bay enough for me to do the work I needed to do to improve my physical and psycological health.

    Addiction is a serious, progressive disease with dire consequences. Suboxone isn’t a perfect treatment, but I don’t see why it should be reserved for addicts who chronically relapse. If anything, it should be given to people in the earlier stages of addiction when it has a better chance of actually arresting the disease.

  • http://whatmesober.com DZ

    I agree with Zenith that effective measures should not be left until all else has failed. To do so is not ethical, among other reasons.

    However, I disagree with the concept of long-term replacement until all else has failed — “all else” including medically-supervised detox in a clinical setting using buphrenorphine or Suboxone, followed by therapy and 12-step or similar support. Until that option has been visited, provided by competent practitioners (as opposed to the many store-front docs who advertise “outpatient detox”) I do not believe long-term replacement therapy to be either indicated OR ethical, since it does not create the degree of freedom to live one’s life that is enjoyed by those who are able to become abstainers.

    I am a firm opponent of methadone therapy. It has been superseded by more effective treatment. Those on that protocol should be switched to Suboxone, then tapered off if possible.

    All of the above is predicated on support from governmental agencies. If we took the billions we are wasting in the “War On Drugs” and put even a third of it into competent treatment, we could make tremendous inroads into the addiction problems in this country, including alcohol and other non-opiate substance problems.

  • Evie Dense

    River, I believe it is 2.5%. And my cousin thinks it is 3.27%. Where is your evidence? DZ by accident, where is your evidence that methadone has been overtaken by more effective treatment? People look up to your for guidance: you could help them by presenting them with facts as well as your beliefs.

  • Patrick

    Thank you everyone for your comments.

    Evie Dense (ha ha, I get it!) – I do not have evidence that it is 3%, but if you read the sentence again you will see that I was hypothesizing, not stating a fact….my point is only that a small percentage of opiate addicts are in need of long term drug therapy solutions (in my opinion). What percentage do you think is more realistic? We would like to hear more of your input….

    Great discussion so far though, thanks again everyone!

  • George Clarke

    There is a need to address the stigma against Methadone. It is the stigma that keeps peoople away from Methadone Maintenence Treatment. Much of this originates in the XA concept. For example, when siting a clinic, the opposition trying to change zoning, does not take into account that there are XA meetings in town which draw addicts who are still using or drinking and they are not taken into account at all in the zoning. For the history of STIGMA please see:

    http://www.methadonetoday.org/dole_nys.htm

  • Sandy

    How can a ‘patient’ afford the medication? Is there a reduced price according to income? My husband has been trying to get off of Methadone with therapy due to ability to pay. I am afraid it will kill him. He has already been diagnosed with diabetes. Our quality of life is going down hill with him. Please give me some info on how to help him. He has been on therapy dosage for five years now and was doing real good. We are loosing our Insurance and he has been reducing his dosage and I am remembering WHY he went to the Clinic to begin with. PLEASE HELP. Sincerely, Sandy

  • Patrick

    Five years is a long time to be on Methadone and that will not be easy to just get off it real quick. The slower the better. I would personally suggest seeking a doctor’s advice and possibly asking him about alternatives to Methadone but that is going to cost as well.

    He could also go to a treatment center for getting off the Methadone, even though he was using it legally he can still seek help for the detox. Some treatment centers might be able to get funding for him so it pays to call around and ask questions.

    Good luck to you Sandy and to your husband as well.

  • Dr. Detroit

    My belief on Opiate based replacement therapy, 12 Step programs, Abstinence based programs is simply this…The reason for the high percentage of relapse in abstinence based programs is ambivalence not knowing if this is or is not what I want to do in most cases just not done yet. In replacement therapy don’t need to relapse they have not started to recover yet..still using…….Addicts that are ready to stop using will do so no matter whether it is abstinence based or replacement therapy, when you have had enough nothing will stand in your way of recovery …………and by the way you never are recovered until your dead if you are an authentic addict. which includes alcohol (drug)