Medication-assisted treatment (MAT) is a scientifically proven and effective way to help deal with the current growing opioid dependence. Yet it still faces significant amounts of push-back for multiple reasons, the most common of which are stigmas, costs, and misunderstanding. Many people still go back and forth on the medication-assisted treatment debate.
It might surprise many people to know that while MAT is being used in many areas of the world to help battle the ever-growing opioid epidemic, that its use is still being heavily debated. According to the latest figures, the abuse of opioid-based prescription drugs has tripled in just three years. Those who work in treatment and rehabilitation are searching for a working solution. Medication-assisted treatment plays a vital role in helping opioid addicts overcome their addiction.
Medication-Assisted Treatment: an Evidence-Based Approach
Medication-assisted treatment offers an evidence-based approach that is a blend of medications and behavioral therapy to treat those with substance use disorders (SUDs). MAT is currently thought to be the gold standard as a treatment for opioid addiction.
The primary medications used in MAT are methadone or buprenorphine. Recently a new medication, extended-release naltrexone has received approval for treating those with an opioid use disorder. Then, of course, there is naloxone. According to the National Council for Behavioral Health, is well on its way to playing a vital role in local efforts to battle the increasing levels of opioid overdose and the high number of deaths.
In a report issued by Christina Andrews, Ph.D., an assistant professor at the College of Social Work at the University of South Carolina, there are approximately 2.5 to 3 million people in the United States living with an opioid use disorder. When you look at numbers this high and the research done, it is easy to see that there are simply not enough people receiving medication-assisted treatment.
Andrews had this to say about the research and its results:
This is concerning considering the fact that we have 20 years of evidence documenting that medication is more effective at moving people to recovery and keeping them in recovery than any other method. It raises some very serious issues.
The Controversy Continues to Rage
You would think that implementing Medication-Assisted Treatment (MAT) would be cut and dried, but sadly it’s not. Far too many people still do not have a good understanding of how medication-assisted treatment works. According to Nick Szubiak, MSW, LCSW, assistant vice president of addiction and recovery for the National Council for Behavioral Health, there still remains a lot of bias and discrimination when it comes to substance use disorders. Along with this, there is a stigma connected with the use of medication-assisted treatment.
A large part of the problem lies in the fact that so many patients entering rehab or the hospital for their SUD are being told that MAT is simply substituting one drug for another. The stigma associated with the medication-assisted treatment debate often results in patients feeling as though they can’t talk about their recovery.
While the use of MAT may have helped them to “kick” their habit, they are afraid to talk about the process. Another issue they face when not being able to talk about the use of methadone or buprenorphine as part of their recovery is the inability, to be honest. Honesty plays a huge role in the recovery process. Many people are being told that if they are on MAT, they have not recovered, because they have swapped one drug for another.
It’s a Catch 22
Part of the problem for many with SUD is that their primary care providers are less than helpful. In many cases, medical personnel, including primary care providers and those working out in the field, along with social workers lack adequate training with regard to addiction. Lack of training and education has proven to play a major role in the problem.
Szubiak had this to say:
What makes MAT so controversial is the judgment surrounding the use of medications—maybe even an opioid—to treat someone who has an opioid problem. To some, it sounds a lot like we’re saying to treat alcohol addiction with vodka instead of gin. It doesn’t make sense until you take a step back and look at the neurobiology of addiction and what’s actually going on in the brain.
The belief that any type of addiction is more of a personal problem, defect, or moral failing creates a huge flaw in the thinking pattern. Because of these beliefs, any changes that are going on in the brain of substance abusers get ignored.
It’s a Chronic Disease
Herein lies yet another controversy. Those who are out there every day working in the field understand that any type of addiction, drugs or alcohol, is a disease that is known to alter the brain’s chemistry. But there are those including Sally Satel, MD, a world-renowned addiction psychiatrist who say the calling this problem a “disease of the brain” could make treating it more difficult than it already is.
By placing a large amount of emphasis on the way addiction affects the neural pathways, we fail to take into account the behavioral, cultural, psychological, and social aspects of heroin addiction. What many do not understand is that these areas also have tremendous power. When people change their worldview, environment, and their relationships, they have a much higher recovery success rate.
It Takes More Conversation
According to Linda Rosenberg, president and CEO of the National Council for Behavioral Health continued discussion is an important part of developing ways to fight the current opioid epidemic. Although many agree that medication-assisted treatment is the gold standard when it comes to treatment for opioid addiction, far too few people have access to MAT.
When it comes to treating opioid addiction, the medical community and social workers continue to do their best to ignore the problem. Because of this, access to medication-assisted treatment becomes even more restricted. Very few people go into social work with the intention of helping those with an opioid use disorder.
Further complicating the issue is the number of addicts with a dual diagnosis such as PTSD or depression. While addiction specialists know that those with some form of SUD and underlying mental illness are not like to progress through the recovery process in a straight line. But just because this is a known fact, providers still have a hard time accepting the use of MAT in the treatment of those with active opioid addiction.
Addiction Should Be Treated as Chronic Health Condition
If we were to see a patient who presents with a chronic health condition and did not respond well to the initial treatment, would we pull away from them and stop searching for an effective treatment? The answer to this is certainly not. Yet when an addict in recovery relapses, this is exactly what many providers do, telling them to come back when they are ready.
Instead of treating addiction like it is a voluntary condition, we must start treating it as if it were a chronic medical condition. However, those who owe their lives to a successful 12-step program feel that the medication-assisted treatment debate undermines these programs where an “abstinence is the only way” approach is used.
The simple reality is that those working in the field need to treat the 12-step program with respect. Any type of recovery program that has a reasonable success rate should not be ignored. Keep in mind that MAT is only the first step in a long-term treatment program. Those who undergo MAT will find they still need to feel as though they are part of a community and need access to recovery housing. When addicts in recovery hear people telling them that they are not “fully recovered” they tend t to internalize this thought process. For those who need treatment for opioid addiction to think this way, they risk missing out on a life-saving form of treatment.
Other Barriers to the Medication Assisted Treatment Debate
Beyond the issues of stigma with regard to MAT, being able to afford it continues to be a barrier to successful treatment. Medicaid is less than generous when it comes to funding for MAT. Private insurance companies are a little more generous, but patients face the issue of certain medications not being covered. When you stop to realize that different medications work for different people, it’s easy to see why this could be a big problem.
Training can be another major obstacle to overcome. For example, in order to be able to administer buprenorphine, the medical provider must undergo an 8-hour training program. This discourages many providers from introducing any form of medication-assisted treatment for opioid addiction. Then there is the “worry” that bringing “this type of person” into their offices can prove to be an issue.
Just as being able to provide MAT for substance abusers is important, so too is finding ways to change the way everyone from social and medical workers to the general public sees addiction and those who succumb to it. Only then can any real changes in treatment for opioid addiction be made. Progress, albeit very slow, is being made as more mental health clinics are adding medication-assisted treatment to their programs and people are starting to listen. This is good news for those actively seeking treatment.
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