The Dangers of Opioid-Replacement Therapies: Continuing a Half-Baked Life
Life on opioids is a cruel existence in which drug seeking, withdrawal sickness, and the constant specter of overdose are ever present. It is estimated that in the US, 2.1 million people are addicted to opioid painkillers and just under a half-million more are addicted to heroin. The number of deaths from accidental overdose has skyrocketed to one every 19 minutes. Emergency room visits are also up to levels that can at times overwhelm staff and resources. According to the CDC, those who are most at risk of overdose are those who have used opioid medications long-term for pain management and those who have used the drugs without a prescription in the last month – roughly 14 million people at risk of immediate death. The scope of the problem is vast. It is little wonder that opioid addiction has been labeled epidemic and has caused people from all walks of life to look for solutions.
Evidence-Based Addiction Treatment
Evidence-based care has become the latest tag-line for treatment. Evidence-based simply means that research studies have been done on the efficacy of a particular treatment modality. This is important, because for many, many years, addiction treatment was not based on evidence-based therapies. Up through the 1980s, residential, outpatient, and self-help programs were for the most part based on the 12-step model of recovery. This treatment program, on its own, has an extremely poor success rate, about 5-10%. While that was good enough for millions of people to recover from alcoholism and addiction, it was clear that better treatments needed to be developed. Much research was done and two, often competing, evidence-based treatment methods were developed: opioid-replacement therapies (ORT) and psychotherapy based abstinence programs.
Opioid-Replacement Therapies (ORT) Show Harm Reduction Results
There is no question that if you want to immediately decrease the number of opioid related overdose deaths in this nation, decrease emergency room visits for overdose and drug related accidents, and reduce the spread of diseases like HIV and hepatitis, providing access to ORT is a smart public health decision. (In this case, ORT should include both methadone and Suboxone therapies.) Although the number of people who receive long-term benefits from this treatment seems to be small, that is eventually, most addicts receiving ORT treatment relapse and have high mortality rates, there is no doubt that accidental overdose death rates fall when ORT is available to addicts. As a tool in the public health arsenal, ORT has a proven place to reduce the disease related harm of opioid addiction by decreasing HIV and hepatitis transmission rates and reducing mortality due to accidental overdose.
Long-Term Advantages of Evidence-Based Abstinence Therapies
The problem with long-term ORT treatment, setting aside the high relapse and mortality rates, is that the individual is never actually sober. While ORT advocates liken treating opioid addiction to long-term maintenance treatment of diseases like diabetes or high blood pressure, the analogy falls apart when you look at the nature of the medications given for these different disorders. Unlike diabetes or high blood pressure medications which do not cause mind-altering affects, methadone and Suboxone each leave the user impaired on some level. Those who use methadone or Suboxone can be subject to DUI arrest when operating a motor vehicle and can become easily intoxicated if the drugs are combined with other substances, including over-the-counter or prescription medications, such as those to treat anxiety or depression. Though ORT advocates suggest that it is safe to leave children in the care of someone who is on methadone or Suboxone maintenance, to do so is unwise for the health and safety of the children. Too few on ORT take their medications strictly as prescribed and many children die when they accidently ingest ORT medications. ORT medications themselves can cause overdose and death, not just for children, but for adults as well.
Instead of an either/or situation between ORT treatment and abstinence based addiction treatment programs, both should be offered and used for all addicts.
ORT therapies are useful only to those who are addicted to opioids – such as prescription painkillers and heroin. Other therapies have been developed that help all addicts maintain fully-abstinent, long-term recovery, providing an opportunity to create a dynamic, meaningful life. These evidence-based abstinence therapies are heavily predicated on the use of intensive one-on-one psychotherapy to get at the underlying root causes of addiction. This treatment model looks at addiction not as a chronic disease with symptoms to managed, but as a brain disorder that is subject to complete recovery.
Recent developments in neuroscience have shown that in the addiction process, neurons on the brain wire together, making it impossible for the addict to develop and maintain proper, healthy, normal decision-making function. ORT therapy does nothing to address this brain problem. However, with psychotherapy to get at the psychological pain or trauma that caused a person to use in the first place combined with complementary therapies, such as yoga and mindfulness meditation to address the brain dysfunction, complete, abstinent, long-term recovery can be maintained. This allows the addict to lead a dynamic and meaningful life, engaged in family and community.
As a public health policy, ORT has an important place in American healthcare. It is proven to reduce disease transmission rates for diseases like HIV and hepatitis. It also reduces the number of emergency room visits for accidental overdoses and saves lives from overdose deaths. As a symptom relief and means of reducing the suffering caused by opioid addiction, ORT is an important tool. But ORT should not be confused with or substituted for long-term, abstinence based therapies. Psychology-based therapies are proven to get at the root causes of addiction and when combined with complementary and alternative medicines, such as yoga and meditation, important changes can be made to the brain that allow the individual to recapture a meaningful, drug-free life.
Do not condemn opioid users to a half-baked life in which they continue to be slaves to a maintenance drug. Use ORT for what it is good for and encourage addicts to transition from ORT into other evidence-based treatment modalities that have shown proven success for putting families and lives back together. Addicts deserve access to all forms of care that are evidence-based and effective.