Hopefully, this will help some to understand the benefits of MAT for people who cannot maintain long-term sobriety from heroin, or other types of opiates. Not mentioned is that for low to medium pain levels, buprenorphine is an option for chronic pain patients with tendency's to abuse opiates, or regular pain patients.
The use of opiates by mankind has been a part of civilization for millennia, and for just as long, humankind has dealt with addiction. Opiates come in all different types, but they are all a morphine derivative, coming from the same plant, the opium poppy. The difference between opiates is based on the chemical makeup, and the number of times that morphine has been synthesized. In principal, there is no difference between pharmaceutical grade opiates, and heroin. Because of this, we are seeing an epidemic unlike anything before. To combat this, doctors and scientists have developed a replacement therapy to help adjust users to a life without. What is MAT? Medication assisted treatment is an option for opiate dependent persons, who cannot seem to maintain sobriety longer than a year. You replace your drug of choice (opiate, sometimes alcohol) with a prescription opiate antagonist, which keeps the person from going through withdrawals, and controls the urges and the temptation to use, helping adjust the patient to a “normal” life. After detoxing from opiates, it is recommended that patients engage in replacement therapy to prevent further relapse. Many do not, though, because of lack of access, not enough funds, not educated enough, and preconceived notions about what “drug-free” means. Other research found that the lower the patients perceived relapse tendency, the less likely they are to express interest in MAT (Journal of Substance Abuse Treatment, 2016). There is also a stigma around medication assisted treatment (MAT) because it consists of replacing one drug, with another. On the surface, it sounds contradictory. How can a person expect to get better, when they are still using a drug? The part people do not seem to understand is that MAT is proven effective to treat heroin and opiate dependency, and addiction. To be successful, however, more than simply replacing one opiate with an opiate antagonist, is needed. For example, my treatment includes twice weekly drug-counselor appointments, and I meet my doctor twice a month to evaluate my progress. I chose to enroll at a suboxone clinic, over methadone, because when I am on suboxone, it blocks all opiate receptors, no matter what dosage I am on, so I could not get high, even if I wanted too. I found out that users of methadone can still get high, compounding the effects, despite it being the most widely used treatment option. Some other common MAT drugs are:
Buprenorphine is the MAT drug of choice in areas where Methadone is not widely available. It is used as a maintenance therapy drug, helping the user to adjust to a “normal’ life, but is less effective than methadone. As stated earlier, however, one cannot get high while taking suboxone because it blocks the receptors, no matter what dose. When taken regularly, it reduces opiate taking behavior (Behavioral sciences & Law, 2011). (There are other options as well, but these are most common in America). Another benefit of replacement therapy for opiate addiction is that it is beneficial to incarcerated users, who without proper treatment either continue use in jail/prison, or quickly relapse after being released. MAT can help reduce recidivism rates for non-violent drug offender, lower mortality rates, and reduce Hep-C infections, per a study in the Behavioral Sciences and Law Journal. It seems that there is a proven, scientific, method to help treat opiate dependent persons, however, the stigma around being on a replacement drug leads many prospective patients to view MAT as an unacceptable option. The AA/NA notion of 100% abstinence limits the acceptance of MAT within the recovery community. In conclusion, the major hurdle to MAT being widely accepted is the attitudes held about addiction, and drug replacement therapy. Many medical professionals with less formal education and training on the subject show they are less supportive of MAT, but with the right training they become less supportive of confrontational techniques, and more towards MAT (Substance Use & misuse, 2012). To break the stigma, we need more MAT patients to voice their progress, and start a dialogue about the benefits for people who want to get off heroin/opiates, but cannot maintain long-term sobriety. Note to reader: Yes, I am a MAT patient, and I am aware that it could give readers the idea that I am biased. I may be biased towards this treatment option, but only because I have experienced the effects. I have tried since 2011 to get off heroin for good. I would stay clean for 9 months, a year, another year, but relapse in between. This led me to MAT as an option. I believe I have been successful because I truly want to be off heroin. I hate what that drug has done to me; the friends I’ve lost, or are imprisoned, the pain and suffering caused to my family, but that was never enough to keep me from using. When I would start to think about it I would become so transfixed that I could not think about anything else. The only way to stop the urge, was to use. Since being on suboxone since August of 2016, I can count on one hand the number of urges I have felt, let alone wanted to use. I started on 8mg, and am now down to 2mg. I will maintain over the summer, and then consider weaning down to a lower dose, and maintain that for another year. What it is allowing me to do is to build healthy habits, and a daily routine that does not involve using. I do not feel high, but I also am not sick, so I am as “normal” as I can be, given my history. When I have some time under my belt off heroin, then I will wean all the way off. It is something I will discuss with my doctors, and I will not make any change to my treatment without first discussing everything with them. Sources: 1. Pecorar0, Anna, Michelle Ma, and George E. Woody. "Science and Practice of Medication Assisted Treatments for Opioid Dependency." Substance Use & Misuse 47 (2012): 1026-040. Informa Health Care, 1 June 2012. Web. 29 June 2017. 2. Gordon, M. S., Kinlock, T. W. and Miller, P. M. (2011), Medication-assisted Treatment Research with Criminal Justice Populations: Challenges of Implementation. Behav. Sci. Law, 29: 829–845. doi:10.1002/bsl.1015 3. Kenney S.R., Bailey G.L., Anderson B.J., Stein M.D. Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification. Addictive Behaviors, Volume 73, 2017. 4. Ramsey S.E., Rounsaville D., Hoskinson R., Park T.W., Ames E.G., Neirinckx V.D., Friedmann P. The need for psychosocial interventions to facilitate the transition to extended-release naltrexone (XR-NTX) treatment for opioid dependence: A concise review of the literature. Substance Abuse: Research and Treatment, Volume 10, 2016
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AuthorI am a grateful recovering alcoholic and substance abuser. I graduated from CSU with a BA in business, and am now a law student pursuing a career in the legal field. I hope you enjoy my site! Feel free to introduce yourself and share a story with me that I will publish! Archives
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