If you read the headlines in the United States lately, you are probably fairly overwhelmed by the massive opioid crisis that the nation seems to be facing. Based on the onslaught of headlines that we see, the problem just keeps getting worse and worse, with no apparent relief in sight.
However, that may be about to shift. Vox says that “Diagnoses of opioid use disorder declined from 2016 to 2017, from 6.2 per 1,000 patients to 5.9.” So not a huge change, but certainly a move in the right direction.
So the question is, why is this finally happening, and what can we do to improve upon it?
There are several theories about why opiate abuse is declining. One potential reason is that the public awareness of it has increased drastically in the last few years. Everyone has heard of the opiate crisis, everyone knows that it can be deadly due to overdose, everyone knows that painkillers can be highly addictive and that we need to approach such substances with an extra degree of caution. You cannot walk around in this world today and casually observe modern media and not be aware of the opiate problem. It is definitely represented very strongly in the media and even within popular culture to some extent.
One of the reasons that we see better outcomes, less overdose, and less experimentation from teens and kids is due to this new level of awareness. But another reason that we may be seeing improved outcomes has to do with treatment services–getting people to access those services, increasing awareness of treatment options, and letting people know that there are solutions available. Going to inpatient treatment is perhaps the single best choice for a struggling opiate addict, because the level of care that they will receive at inpatient treatment is very comprehensive in terms of meetings, therapy, peer support, aftercare, and so on. Inpatient treatment is the “total package” solution that most addicts are going to benefit the most from, so it is the most highly recommended solution for most people.
One other possibility may be that the standard of care for opiate addiction has improved to include MAT, which stands for “medication assisted treatment.” The old medication based solution for opiate addiction was methadone, which was a highly controversial practice because methadone is, in itself, highly addictive. In fact, the withdrawal symptoms from methadone can be far more powerful and even more dangerous than from other opiates, including heroin. Methadone maintenance was a form of harm reduction that arguably failed in the long run, though it is still potentially in use today.
What is more exciting and perhaps prompted the turning point in the war on opiates is a newer medication known as Suboxone, or Buprenorphine combined with Nalaxone. This medication can be taken as a maintenance type of drug and it is not as powerfully addictive and dangerous like methadone is–not even close.
In order to fully appreciate the transformation that can occur with a drug such as Suboxone, you need to understand a bit more about how opiates affect the brain, and how withdrawal works.
There are “full opiates” and there are “partial opiates” out there. Heroin, methadone, and vicodin are all considered to be “full opiates,” and this means that when the go into the human brain, they not only fill up all of the available opiate receptor sites, but they also overwhelm those receptors and produce a feeling of euphoria. This is what makes a person feel “high.”
To recap that: A full opiate floods the brain and causes you to feel high.
A partial opiate, such as the buprenorphine that is found in Suboxone, does not flood the brain and overwhelm those receptor sites and cause people to get high from the substance. Instead, buprenorphine is a perfect match for the opiate receptors, and once it fills those sites up, it stops flooding the brain. This is why taking extra Suboxone is not going to get a person any “higher” than what they already feel.
But wait, you say: “I thought that a partial opiate did not get you high at all. What is going on here?”
The problem is that opiate addicts tend to go through periods of getting high, followed by withdrawal and feeling sick. So when they can avoid feeling sick, this is a little bit like “getting high,” even if they are not boosted into the stratosphere with full blown elation and euphoria. Take an opiate addict who is in full blown withdrawal, give them a little bit of an opiate–partial or full–and they are going to feel as if they just had a tiny dose of their drug of choice. It is going to feel a bit like getting high.
Does this mean that people taking Suboxone as maintenance are walking around feeling euphoric all day? Not at all. It just prevents them from feeling sick. And it helps to prevent cravings for “full” opiates as well, which is why it has been clinically tested and proven to reduce relapse and to help opiate addicts to remain clean.
So that is the current state of MAT, and that is how we are able to improve our success rates when it comes to treating struggling opiate addicts.
So the next question is: How can we increase this trend and improve outcomes even more? How can we really dial things up and get even better numbers for the following years to come? How can we overcome the opiate crisis for good?
The answer seems to be at this point: More education, more treatment, more access to MAT, and more public awareness. Some of what we have been attempting has worked to improve outcomes. Therefore we just need to double our efforts and try to do more of the same.
It is important to realize too that there is a momentum effect when you are sobering up a community. That is another way of saying that if you sober up one person, that one person can then go on to help sober up two more. Now obviously in the real world this is not going to be true in every case, but we see the idea and the concept being displayed all the time in various settings. “Healed people heal people.” We need to realize that we may, at some point, reach a tipping point in which enough struggling addicts have transformed their lives and are now able to help others.
Hopefully this is the start of a new trend towards increased sobriety and seeing more and more opiate addicts transform their lives. Finally, some good news for once regarding the opiate crisis. Let’s double our efforts and make sure that this trend continues!