Stigma Surrounding Medication-Assisted Treatment in Opiate Addiction

For the past twenty-five years, I have always had some type of an addiction. For the last thirteen years, I struggled with opiate addiction, which led to my experience with medication-assisted treatments. I had once been treated with Suboxone and now I am currently receiving Vivitrol injections monthly, and I could not be more thrilled. I did not get to this point of being thrilled by myself. It took professional therapy and psychosocial therapy, and twelve- step meetings. I had to surrender to this disease to understand how it affected me, and others around me. I wholeheartedly believe in medication-assisted treatments. But, there will always be people in our society that will declare that medication-assisted treatment for opiate addiction is substituting one drug for another or that an addict is a moral failure and a menace to their community. Those who suffer from opioid addiction fight for their lives every day, feeling the stigma from their communities, their families, and their friends. Those people refuse to understand that medication-assisted treatment is a medical method for helping opiate addicts in achieving their recovery. It is disappointing to tell you that those who stigmatize are wrong and that their ignorance does not give them the right to judge others, especially when they have no knowledge of how or why the medication-assisted treatment works. Their stigmas are causing deaths every day and keeping people addicted. I was a victim of this stigma many times.

     You must first understand what addiction is and how it affects the brain. As defined by the American Society of Addiction Medicine,

Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations (ASAM).

Once a person becomes addicted to opiates, they are unable to function normally without opiates. The reward area of the brain wants nothing more but what is rewarding. Once this is triggered, cravings begin. So now the addict is dependent on opiates to feel their perception of normal, socially, physically, emotionally, and mentally. Changes are always occurring that are affecting the addict’s judgment, impulse control, and social behavior. The addict will now do whatever he has to do to feed this craving, despite the consequences. There are several reasons that a person may experiment with opiates, some examples are, the feeling of euphoria, it relieves stress, suffering from trauma, improving performance, curiosity, or peer pressure. As the addict continues to use opiates, his tolerance level increases, which causes physical and mental dependence.

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     Once an addict realizes that he has a problem, he may seek treatment from medication-assisted treatment (MAT).  MAT is a highly effective treatment for substance use disorders that should be used in combination with counseling (Miller-Temple). MAT is proven to reduce drug use and overdose deaths, it reduces infectious diseases, and criminal activity, it also improves retention in treatment (Volkow, et al. 2064).  As written by the Legal Action Center, “MAT for opioid addiction utilizes medications to stabilize brain chemistry, block the euphoric effects of

opioids, relieve physiological cravings and normalize body functions” (lac.org). The goal of MAT is to get the patient to feel normal with little side effects, no withdrawals and to control cravings (Miller-Temple). There are currently three medications approved by the FDA for preventing opioid use disorder: Methadone, buprenorphine, and naltrexone (Connery 63). Methadone is a narcotic used to treat pain and drug addiction. It is a full agonist which means that it attaches to the brain’s opioid receptors for a full opioid effect and can be given immediately to treat withdrawals and cravings. It is given in a controlled clinical setting, usually daily because of its high potential for abuse and because of the dangerous side effects when taking too much (Miller-Temple). People can overdose and die on methadone, as stated byKate Sheridan of STATnews.com. Buprenorphine (in this case Subutex) is a narcotic used to treat moderate to severe pain in low doses and is used for opioid withdrawal at higher doses (Thomas, et al. 168). Buprenorphine is a partial agonist, which means that it has a “ceiling effect” to protect from respiratory depression (lac.org). If doses are increased, a plateau will occur, and no further feelings of euphoria can be felt. Because it is a partial agonist, the addict has to be in mild to moderate withdrawal before receiving a dose to avoid precipitated withdrawal (lac.org). Buprenorphine is also given in combination with naloxone, this is called Suboxone, but this is to avoid misuse of the medication (lac.org). Suboxone and Subutex can only be prescribed by specially trained physicians (Thomas, et al. 159). Naltrexone is considered an antagonist and can be prescribed by any licensed physician (Miller-Temple). It is not a narcotic; therefore, it does not produce euphoric effects and it blocks opioid receptors. It is used for alcohol and opioid use disorders. It can be prescribed to take orally, daily or is administered by monthly injection every twenty-eight days. An opioid addict must completely detox before starting naltrexone to avoid severe withdrawals. Withdrawals are usually characterized as “flu-like” symptoms, due to the physical symptoms that are produced (Connery 69). Most do not take into effect the cognitive distress that persists in untreated opiate use disorder (Connery). Cognitive distress contributes to opioid relapse and treatment dropout, as stated by, Hilary Smith Connery, MD, Ph.D.(69).Medication-assisted treatment, in conjunction with professional therapy, drug screening, and/or twelve-step programs can lead to a successful recovery.

     Most people mistake the choice of using drugs with the actual disease of addiction. They don’t understand why an addict can’t just stop using drugs and believe it is a choice. Addicts are looked at, by our society, as moral failures and cowardly. The addict and their families are blamed for what they have become. No one person chooses to be an addict. We all make bad choices throughout our lives, unfortunately for some, the choice to use that first opioid created a downward spiral into addiction. These addicts had no idea that they already had a genetic predisposition in their brains, waiting to be awakened. No one criticizes those that developed diabetes, or hypertension, or cancer. These are diseases that are also refractory to cure, but treatment and recovery are possible (Volkow, et al. 2064). When it comes to MAT, they believe that the addict is substituting one drug for another. The addict becomes dependent on MAT medications because the body becomes reliant on them, so stopping cold turkey would create withdrawals, which defeats the purpose of being treated with MAT (William). This would be like asking a person that is taking Zoloft to “just stop”.  Their bodies are physically dependent on it and they have to slowly stop using the medication, but they are not called Zoloft addicts or

“junkies” (William). Another stigma that affects the addict comes from their own recovery community, Narcotics Anonymous. While this twelve-step program describes itself as practicing total abstinence, members claim to welcome anyone with a desire to stop using drugs or alcohol, but a MAT client will likely be lectured or denied speaking during meetings (Brico). Speaking from personal experience, I have never been told that I could not speak at a meeting because of being under the treatment of MAT medication. I did hear some opinions on the matter by those that disagree with those that are being treated with MAT. This proved to me that most are ignorant about naltrexone, believing that it is a narcotic, when in fact it is not. I agree with Elizabeth Brico, who states,

The time has come for Narcotics Anonymous, Alcoholics Anonymous, and other 12-step programs to update their approach or step aside. Abstinence-based models are too dangerous to rule the recovery community any longer. (Brico)

     Stigma with medication-assisted treatment in addiction causes deaths every day and keeps people addicted. The Centers for Disease Control and Prevention states, “drug overdoses are now the leading cause of accidental death in America, surpassing traffic fatalities at the beginning of this decade with more than 36,000 deaths annually” (CDCP). If we could further educate our communities about what addiction is and how opiates affect the brain chemically and electrically, I believe that medication-assisted treatment would be more widely accepted. People would understand what medication-assisted treatment is, how it works to prevent relapses, and why it helps prevent infectious diseases, prevent death, and retention in treatment. But, people will always have their own opinions about medication-assisted

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treatment, because it has always been that way in our culture. If it wasn’t for medication-assisted treatment, I would not be writing this paper. MAT gave me a second chance at life. It helped me understand what addiction is and how it affects the brain. I had to learn how to change my thinking, my behaviors, and my actions through therapy and twelve-step programs.

Now that I have learned how to use these new tools, I want to help other addicts become aware of their addiction and how to achieve recovery.

WORKS CITED

• “2010 National Hospital Ambulatory Medical Care Survey.” Centers for Disease Control and Prevention, Jul 2014.
• “American Society of Addiction Medicine.” What Is an Addiction Specialist?” Web. 07 Oct. 2018
• Brico, Elizabeth. “By Shunning Medication-Assisted Therapy, 12-Step Meetings are Making the Opioid Crisis Worse.” STAT. STAT, 7 Oct. 2018. Web. 15 Oct. 2018
• Connery, Hilary Smith. “Medication-Assisted Treatment of Opioid Use Disorder.” Harvard Review of Psychiatry 23.2 (2015): 63-75. Print.
• Miller-Temple MD, Kay. “What’s MAT Got to Do with it? Medication-Assisted Treatment for Opioid Use Disorder in Rural America.” Rural Health Information Hub. 7 Oct. 2018.
• New York, NY: Author. Retrieved from http://lac. org/wp-content/uploads/2014/07/LAC-The-Case-for-Eliminating-Barriers-to-Medication-Assisted-treatment. Pdf, 2015
• Sheridan, Kate. “How Effective Is Medication-assisted Treatment for Addiction?” STAT. STAT, 15 May 2017. Web. 07 Oct. 2018
• Thomas, Cindy Parks, et al. “Medication-Assisted Treatment With Buprenorphine: Assessing the Evidence.” Psychiatric Services 65.2 (2014): 158-70. Print.
• Volkow, Nora D., et al. “Medication-Assisted Therapies-Tackling the Opioid-Overdose Epidemic.” New England Journal of Medicine 370.22 (2014): 2063-066. Print.
• William-Publisher of this Community (http://killtheheroinepidemicnationwide.org/author/stopheroin_db/) / September 9, 2016 (http://killtheheroinepidemicnationwide.org/2016/09/09/suboxone-methadone-brutal-truth-medicine-assisted-treatment/)