Why Medication-Assisted Treatment is Important for Opiate Addicts in Early TreatmentAnna Ciulla
Why is Medication-Assisted Treatment important for opiate addicts in early treatment? Discover the reasons here:
The gold standard for treating heroin and opiate addiction is Medication-Assisted Treatment (MAT), which refers to the use of doctor-prescribed medications in combination with behavioral therapies to achieve a safe and comfortable detox and a better recovery outcome. MAT is especially important during detox and treatment, as an evidence-based intervention for blocking the euphoric effects of opiates, relieving physical cravings, and normalizing brain and body function after these drugs leave the system.
Suboxone (also known as buprenorphine) is the primary MAT for opiate addiction, because research has shown its short-term use is safe and effective when taken as prescribed. Following a short-term regimen of Suboxone, sometimes the medication, naltrexone, is also introduced.
This article will explain why Suboxone is typically administered for opiate addiction in early treatment, and will cover the following related topics:
- research into how Suboxone lowers rates of relapse for opiate addicts
- a description of how Suboxone works to reduce cravings and other withdrawal symptoms
- firsthand information about what clients at Beach House Center for Recovery can expect in the way of MAT for opiate addiction, from an interview with addiction psychiatrist Dr. Edward Zawadzki, the medical director at Beach House Center for Recovery
- the critical importance of counseling and social supports in addition to Suboxone
How Suboxone Lowers Relapse Rates Among Opiate Addicts
Suboxone is important in early treatment because of the high rates of relapse among heroin and opiate addicts. These generally are higher for heroin and opiates than for other drugs— as high as 80 or 90 percent by some estimates, due to the intensity of cravings.
Suboxone has lowered these rates of relapse among opiate addicts, according to research. One study found that clients receiving buprenorphine experienced less severe withdrawal effects and stayed in inpatient rehab longer, thereby decreasing their likelihood of relapse.
Behavioral interventions on their own, moreover, have shown limited value for improving recovery outcomes for people with opiate addiction, according to studies. The purpose of Suboxone treatment is thus to relieve the debilitating symptoms of withdrawal and the intense cravings during detox, so that:
- clients can more quickly adjust and stabilize to early sobriety
- and achieve a better response to the behavioral interventions they receive during inpatient treatment.
Dr. Zawadzki remembers a time when clients in detox from heroin and opiates were without the help of Suboxone, and could expect only to “sweat it out” in early detox.
“Back in the day not long ago you had to use other meds to control autonomic instability and the sensations you were experiencing, like changes in pulse and blood pressure,” he said. Before Suboxone, clients at most could receive blood pressure meds and anti-seizure drugs during detox, but nothing that actually helped them through withdrawal without having to endure “incredible discomfort” and the prospect of “pretty abysmal” relapse rates.
Since 2002, though, when the Federal Drug Administration approved Suboxone for medical use, the picture has looked more promising for those considering opiate treatment. Thanks to Suboxone, opiate addicts can more comfortably ride out the flu-like withdrawal symptoms and drug-induced ups and downs of early recovery, without experiencing the same intensity of cravings that they otherwise would.
How Suboxone Reduces Cravings and Withdrawal Symptoms
Unlike “full agonist” opiates like heroin and other painkillers, which bind snugly and in a perfect match to the brain’s opioid receptors, Suboxone is a “partial agonist” that binds to the same receptors, only faster and imperfectly. The result is a limited opiate effect without the addictive euphoria and cravings that opiates produce. And Suboxone also tends to bind longer to the brain’s receptors than opiates do, meaning a slower release that doesn’t produce as dramatic a withdrawal effect.
For a great majority of clients in opiate treatment, these chemical binding properties of Suboxone make it a safe and effective form of medical relief during detox. That’s true with rare exceptions—say, for example, an allergy to the drug that makes its side effects intolerable, in which case another medication may be prescribed. In essence, the receptors are tricked into thinking they have been satisfied with an opiate, only without the euphoria and potentially life-threatening respiratory depression, as information from the National Alliance of Advocates for Buprenorphine Treatment has described.
At Beach House, Dr. Zawadzki typically recommends a seven to ten day taper on Suboxone. Once withdrawal has begun and it is safe to administer Suboxone—if MAT begins too early, it can actually exacerbate withdrawal symptoms—clients can expect a gradual 2mg decrease in their daily Suboxone dosage. The medication, naltrexone, which also helps to ease cravings, comes near the end of detox. (Naltrexone, another evidence-based MAT for opiate addiction, can interfere with Suboxone.)
The starting dosage of Suboxone can vary, depending on the severity of an opiate addiction. Someone who has been taking high amounts of opiates will need a higher starting dose of Suboxone, according to Dr. Zawadzki. An in-depth psychiatric assessment at the start of treatment helps his medical team determine when to introduce Suboxone and the appropriate dosing level.
Other Key Components of MAT
Medication is only one component of MAT, however, according to best practices in MAT, as laid out by the Substance Abuse and Mental Health Services Administration. Counseling and social support play an equally critical role in helping clients successfully recover from opiate addiction. Research has shown that when all of these components are in place, MAT is more likely to be effective at preventing relapse. (For more related information, see “Why Medication Alone Will Never Be the Only Answer to Addiction.”)
There are dangers to long-term Suboxone use, moreover, which make learning new behavioral tools for coping with stress and other addiction triggers an important part of recovery. In this sense, Suboxone is like a set of training wheels that helps opiate addicts ease into recovery. As they begin to develop new recovery skills and more life balance and confidence in their journey towards healing, they can stop using the training wheels. In the interim, though, those training wheels (i.e., Suboxone) serve as a much-needed support.