Since 1971, qualified physicians in the United States have been prescribing narcotic medications such as methadone to treat opioid addiction. But this treatment hasn’t come easy, or without its share of debate.
The Methadone Controversy
Russia is one of several countries where methadone is controversial. Recently, members of a Kremlin youth group launched a protest outside a methadone conference, where a group of physicians and specialists were gathered to discuss methadone treatment for drug addictions. In Russia and other countries struggling over this debate, critics of methadone argue that it traps patients in their addictions for life, leaving them addicted to yet another drug.
Methadone is used as a gradual therapy for recovering heroin users, allowing physicians to relieve their patient’s craving for heroin and block the effects of opiates. With methadone, the gradual and mild onset of the “high” prevents users from gaining the pleasurable effects associated with heroin.
However, opponents argue that methadone treatment substitutes one opioid for another, and fear of methadone being sold on the black market is a big concern. Often patients are left struggling with their addiction to methadone, causing their treatment to be lengthy or fail altogether.
In the United States, methadone treatment has become more regulated and widespread in recent years. An individual’s methadone treatment is often viewed as treatment for a disease rather than a poor moral choice. Therefore, treatment may continue throughout the patient’s life, allowing their bodies to be maintained with methadone and avoiding the symptoms of withdrawal altogether. While not a complete solution for a drug free life, methadone treatment has been found to decrease heroin related deaths and crime, and help individuals achieve greater control of their lives.
Buprenorphine and Suboxone
Today a new opioid medication is making its way into treatment facilities, doctor’s offices, and even homes. Buprenorphine is a partial opioid agonist, which causes it to be less addictive than either heroin or methadone. The “high” produced by buprenorphine is less intense, and the side effects are less dangerous. In general, buprenorphine is safer than methadone, and it is easier for a patient to discontinue buprenorphine than to detox from methadone. The NIDA views buprenorphine as a safer, more acceptable maintenance drug than methadone for the treatment of heroin addiction.
A form of buprenorphine, Suboxone, has been rapidly gaining approval for the treatment of opiates. Suboxone contains buprenorphine and naloxone, an opioid antagonist which is to be taken orally. As long as it is taken by mouth as prescribed, the naloxone causes no side effects. If a user would dissolve the Suboxone and inject it in order to get high, the injected naloxone would cause sever withdrawal symptoms. This special formulation of buprenorphine and naloxone is considered safer than just buprenorphine because it so strongly discourages misuse.
The future of drug addiction treatment with Suboxone looks promising. With the support of the NIDA and the SAMHSA, and with further testing, there is hope that in the future this will be a widespread, successful treatment for drug addiction in the United States and other countries.
1. Schwirtz, Michael, Russia Scorns Methadone for Heroin Addiction The New York Times July 22, 2008
2. Blaine, Jack D., Buprenorphine: An Alternative Treatment for Opioid Dependence NIDA Research Monograph, Number 121, 1992
3. National Institute on Drug Abuse, 1999. Principles of Drug Abuse Treatment: A Research-Based Guide. NIH Publication No. 99-4180.
4. Marion, Ira J., Methadone Treatment at 40 Science and Practice Perspectives December 2005
5. Wunsch, Martha Buprenorphine: Balancing Access with Quality of Care (NIH) February 2008
6. Condon, Timothy P., and Clark, Wesley Buprenorphine in the Treatment of Opioid Addiction: Balancing Medication Access with Quality Care (NIH) February 2008
Sometimes it can be hard to understand addiction. If you have never experienced it, it may be hard to sympathize. Some even wonder why drug addicts can’t quit on their own!
Many drug addicts actually feel this way themselves. Especially in the beginning, they feel that they can quit on their own – that they have complete control and power over their addiction. Either out of shame over their addiction or pride in their will, they try to stop without treatment. Long-term resistance usually is not accomplished in these situations.
Long-term drug abuse has long-lasting and significant effects on the human brain. These problems can continue long after the individual ceases using drugs. This can include the continued compulsion to use drugs as a behavioral effect, despite the well-publicized consequences of the habit.
Realizing that drug abuse has such biological effects can explain why that person has such difficulty maintaining their resistance to drug abuse without proper treatment and rehabilitation. Relapse occurrences are especially more common when these biological effects combine with locations and objects that remind one of their past with drugs, running into people from their drug-using days, or even the stress and pressures of family or work.
The important thing to remember is that all of these can be overcome with proper treatment from a professional. Research supports the notion that even the most severely addicted individual can actively participate in a treatment and rehabilitation program. This active participation is crucial to the success of the treatment and encourages the continued long-term abstinence from drugs and addiction.
With proper help, the drug addicted person learns the appropriate strategies for coping with their addiction and cravings. This includes ways to avoid drugs and prevent relapse, as well as dealing with a relapse if such a thing occurs. Behavioral therapy, including psychotherapy, cognitive therapy, and counseling, can be a huge benefit to an addict learning these strategies and the proper behavior. Treatment can also include medications to combat some of the biological effects, like the ones that were discussed above.
The best treatment programs are tailored to meet the needs of the individual, as factors such as age, race, gender, culture, history of abuse, and type of addiction can all contribute to the variables of the addiction. This can include behavioral therapy, medication therapy, or a combination of both.
The drug addict is not alone, and it is important to ensure them that they are not. Through proper treatment and rehabilitation, they can succeed in overcoming this problem.
The term “dual diagnosis” refers to someone who has been diagnosed with a major mental health problem and a substance addiction at the same time. Nearly half of all patients with mental health problems abuse drugs and alcohol. They often go hand-in-hand. For example, those dealing with alcoholism may be coping with mental illness. Those suffering from depression may disguise their symptoms with dependence on drugs or alcohol.
The first problem is diagnosis itself. A substance abuse problem can affect mental health disorder symptoms by either aggravating them, or masking them. On top of that, symptoms of substance abuse can closely resemble the symptoms of mental health disorders, so defining what is causing each symptom is increasingly difficult. Patients may also use one disorder to cover for the other. For example, an alcoholic patient suffering from bipolar disorder may agree to treatment of the disorder to cover up for his or her alcoholism. Upon completion of the psychiatric help, the patient may drop out of treatment entirely.
The families of those suffering from dual diagnosis also face increased problems related to the disorder. Most mental health services are ill-prepared to deal with both the mental health disorder and the compounded substance abuse problem. They also, then, cannot effectively treat and assist the families of those afflicted. Families also deal with the violence associated with their sick relatives. Domestic abuse and suicide is very common among those with the compounded diagnosis. It has also been reported that sexual abuse is prevalent among those dealing with dual diagnosis as well.
So what to do about these problems? For starters, many in the mental health profession are beginning to recognize that substance dependency is a problem, and they have stopped relegating it to a symptom. By doing so, they broaden their view of their patients and do not mistakenly categorize substance abuse under the mental health disorder “umbrella”. There has also been an increased awareness of dual diagnosis in the medical field. This has led to more discussions on treating both disorders simultaneously, rather than one at a time. By doing so, treatment effectiveness increases, as both the mental health disorder and the substance abuse are treated at each stage of rehabilitation. This increased awareness also results in more education on the topic for those in the medical field, which can only lead to further discussion, and treatment that can be effective for both the patient and their families.
