Medication Assisted Treatment is Not Gaining Widespread Acceptance Yet

Medication Assisted Treatment is Not Gaining Widespread Acceptance Yet

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More and more studies are being done lately on the effectiveness of various forms of addiction treatment. The opiate crisis is the main driver of this research.

One of those methods of addiction treatment is MAT, or medication assisted treatment.

The Salt Lake Tribune says “This widespread rejection of proven addiction medications is the single biggest obstacle to ending the overdose epidemic. Funding isn’t the barrier: Outpatient medication treatment is both more effective and significantly cheaper than adding inpatient beds at rehabilitation centers. The problem is an outdated ideology that views needing medication to function as a form of addiction”

So the argument is that people are not accepting of MAT because it looks like “using one drug to medicate for another drug addiction.” People look at the model and say “aren’t we just switching out a legal drug for an illegal drug?”

The main MAT substance lately is Suboxone or Subutex, which contains a partial opiate molecule known as buprenorphine. This partial opiate is such that it does not overwhelm the brain and flood the opiate receptors and get the person “high,” but instead it simply fills up all of the receptors and then it just stops doing anything more. So the addict who is taking Suboxone feels “well” but they don’t really get euphoric and high.

However, the general population does not understand this, because they are not addicted to opiates and they are not familiar with the difference between getting high on opiates and feeling euphoric versus just “topping off the opiate tank” and feeling “well.” These subtle nuances are only really understood by the person who is addicted to the drugs.

So while those are important differences, the public perception is that Suboxone–or any MAT drug for that matter–must work in the same way that methadone did when we started experimenting with it a few decades ago. People got hooked on methadone because it happens to be a very, very powerful opiate drug. In some ways methadone is actually stronger than heroin–in particular, its half life is longer so it is a much “stickier” substance than heroin, and in many ways it is harder to get off of methadone than it is to get off heroin.

The public got to watch the failed methadone experiment unfold before it, and now our memory of the MAT approach may forever be tainted.

So there is a strong argument to be made that public perception needs to change so that we can get more Suboxone into the hands of struggling opiate addicts everywhere, and if we could just get more acceptance and more distribution of this “better form of MAT” then all of our opiate crisis problems would be solved.

I want to challenge this thinking a bit and say: Maybe not so fast. Let’s look at this a little closer.

I am definitely on board for the idea that we should drop this negative stigma surrounding MAT programs, or any addiction treatment program that seeks to help people.

However, I would caution people who are strong proponents of the MAT approach to really look at the long term results of MAT versus traditional treatment approaches. And the reason that I bring that up is because I have worked in a substance abuse facility for several years now, and I have gathered a lot of subjective data in my own observations, and I believe that data is telling a very strong story.

Let me draw an analogy if you will. I want you to consider the world of quitting smoking. I am talking about cigarettes here. There are various products on the market to help people to quit smoking, and all of those products can be judged against people who simply try to “gut it out” cold turkey.

Now if you are doing a study of say, the effectiveness of the nicotine patch, then you have fifty participants wear the patch and you have fifty participants wear a placebo patch that delivers no nicotine. And then you measure after a week, after a month, after 3 months–which people are still off of cigarettes and which people have relapsed.

I have studied this extensively and I know that if you look in the short term, if you consider the results of this experiment in the short run, then the people who are getting the “real” nicotine patch do much better and they relapse less frequently. Nearly none of the placebo people make it to the end of the study–they almost all go back to real cigarettes.

This is because they are steadily being delivered nicotine, so no cravings, right? They then publish studies that support the nicotine patch as being effective.

However, if the study lasted for 90 days, and then you fast forward and you look at 6 months later, or 12 months later, you find something very interesting: The people who did so well with the nicotine patch have all relapsed, and even though only a few of the cold turkey quitters were able to gut it out successfully, those cold turkey people stayed quit forever!

In other words, in the short run, the people getting “real” nicotine did far better. But in the long run they fared only the same or even worse. They were sort of “set up to fail” because they had this crutch in the beginning, and later on when they removed the nicotine patch it all fell apart. They were never forced to learn the coping skills that the cold turkey quitters had to learn right from the beginning.

I point out this analogy to caution the world about MAT solutions. I am not trying to steer you away from MAT necessarily; what I am saying is exactly this: Based on my own subjective observations, MAT is not a replacement for traditional treatment. It may supplement treatment, but it cannot replace it. And the article cited is trying to argue that it is more effective than “an inpatient bed at a facility” while also being far cheaper. But having worked in the field and watched hundreds of opiate addicts try to use Suboxone in order to “take a shortcut to their recovery,” I have noticed that nearly all of those people end up in a detox bed eventually anyway.

Again, those are my own observations, I did not perform a formal study or anything. I just have this mild skepticism towards MAT because the mindset that gravitates towards MAT is the mindset that is looking for a quick fix, for a shortcut. And it is my experience that such a shortcut does not really exist in the world of addiction treatment.

My suggestion to you or anyone who is struggling with addiction or alcoholism is to give real treatment a chance, knowing that it may or may not include MAT at some point. But I do not think it is wise to grab on to the idea of MAT and hold on to that as being your primary solution for addiction. I think that is a dangerous strategy that can only lead to taking on additional relapse risk in the future. Better to build a real foundation of recovery at an inpatient facility and use MAT as the supplement that it was intended to be, not as a primary solution. Good luck!