The opiate crisis that we are facing today has caused us to consider new forms of treatment. The current belief is that if you use every available tool that we have then it will increase the addict’s chances of remaining clean. One of those tools is MAT, or medication assisted treatment.
In years past, MAT typically meant methadone, which was a very strong drug that was usually used to replace heroin. The methadone experiment largely failed though because methadone itself was very, very addictive.
Today, new medications have been developed that are far less addictive, such as Suboxone or Subutex (buprenorphine). This medication is only a partial opiate rather than a full opiate, and therefore the abuse potential is far, far less. However, because this form of MAT is such a highly specialized use, they have made it very difficult for most doctors to even be able to prescribe the medicine to struggling addicts.
Vox says that “So many [doctors] don’t even have the legal ability, as Fox does, to prescribe buprenorphine, one of the medications widely regarded as the gold standard for opioid addiction care.”
This is crazy.
The intention was not to make it difficult to get help to struggling opiate addicts. When they first started using and developing Suboxone, there was not really a huge opiate crisis going on just yet. So they wanted to insure safety with the medication and so they put all sorts of extra regulations on it. Essentially they made it so that an MD had to take an extra class in order to be able to prescribe this particular medication. As you can imagine, most doctors were quite annoyed at this idea, and don’t have a ton of extra time in their busy schedule to be taking extra classes.
So there is this gap–you cannot just go to your regular doctor and get help with an opiate addiction. Instead, you have to dig around, find a provider that is authorized to prescribe it, and then try to get in with an appointment to see this “special” doctor.
Had they been able to foresee the opiate crisis, it is likely they never would have made it this difficult to help struggling addicts. If they had predicted all of the overdose deaths that would result from opiate abuse, they probably would have realized that the risk and reward involved with Suboxone makes it a very safe bet–especially when compared with making it difficult to get the medicine.
So the push now is to get more and more doctors to go take the certification so that they can then “help out” with the opiate crisis and be able to prescribe Suboxone to people.
The reason that Suboxone helps so much is because it is a partial opiate. Let’s take a closer look at what is actually happening when a person gets addicted to opiate drugs.
If a person is addicted to opiate based drugs for a long period of time it can actually “rewire the brain” to some extent. But how exactly does this happen, and what does Suboxone and MAT have to do with this?
Every human body has a dopamine system in it that is actually part of our survival mechanism. If your body gets overly stressed in a fight or flight situation, it may need to deliver some extra dopamine in order to allow your body to fight and survive an intense situation. Your body can provide a bit of its own natural pain relief in this way, by regulating its own dopamine.
Because of this system that exists within each human body, your brain has a number of opiate receptors in it. Those receptors can then accept an opiate molecule when you take medication, and as those opiate receptors fill up it provides relief from pain. This literally “dopes the brain” and causes the mind to forget about the pain, or to ignore the pain. The effect is similar to placing a rag in between the clanging bells of an alarm clock–the pain signals are still there, they still exist, but the rag in between the bells is the opiate that causes the brain to ignore the pain.
Now in order for this system to exist and function properly, there has to be a baseline.
This baseline comes in the form of your body’s own dopamine that it is constantly producing every day. There is just a tiny trickle amount of dopamine being delivered to your brain at all times. This trickle amount is necessary for the system to function properly when your body is stressed and suddenly needs a boost of more dopamine. The baseline is essential for the system to work.
Now imagine that you are addicted to prescription opiates (or heroin) and you are putting those drugs into your body every day. At some point, your body is going to notice that those opiate receptors are constantly being “filled,” and therefore it will realize that it does not need to create its own dopamine supply for the day. The tiny trickle that it normally supplies for you is not needed, so the body “shuts that off” so to speak.
This is fine so long as the opiate addict continues to abuse opiates every day. As soon as they stop, however, their body is going to get suddenly very upset with them. This is because that baseline is gone and their body is no longer producing the trickle amount, and suddenly all of those opiate receptors in their brain are starving for attention.
It normally takes the body about 3 to 5 days for that trickle production of dopamine to “turn back on.” For some opiate addicts who have abused drugs for years and years, it can take even longer. And in many cases that production will only be partial when it does start back up, leaving the opiate addict to experience cravings for a long time to come.
This is where Suboxone and MAT come into play. When a person takes Suboxone, the partial opiate molecules fill in all of those starving opiate receptors, satisfying the cravings, without really getting the person “high” or euphoric. If the person attempts taking more and more Suboxone, they don’t get any “higher” or euphoric from doing so. The medication simply “tops off the tank” by filling in those opiate receptors, then it stops. That’s all it does.
So you can see how this medication could be extremely useful in helping a struggling opiate addict to get off their drug of choice and stay off of it. Hopefully they can break down some of these barriers and make it easier to access this type of medication. We need to do everything that we can in the fight against opiate addiction.