Why Are We Questioning Opiate Replacement Medications And Naltrexone For Opioid Dependence?

December 18, 2017

This article was first published on the Huffington Post in September, 2017

If you decided to take charge of your health and quit smoking, would you be able to trust that your health care provider had good advice for you? The answer is probably yes. Most health care professionals would tell you to throw out your pack of cigarettes and consider using one of several Nicotine Replacement Therapies (NRT’s – like the nicotine patch, gum, lozenge, nasal spray) or medications like Wellbutrin/Zyban or Chantix. They would tell you that one of the most effective ways to stop smoking is to use these treatments in your effort to quit cigarettes for good. Also helpful is that the nicotine gum would be easy to come by, as it is sold over the counter at most pharmacies, at a relatively manageable cost ($50 for a box of gum). In some cases, it may be covered by insurance providers and many states and municipalities offer “quit smoking” hot lines that will give you nicotine replacement options such as the patch for free. And if you tell the people in your life, like friends and family, that you are on the patch or taking a medication to quit smoking, they would most likely say, “that’s great, I’m proud of you for doing what you need to stop smoking” or “wow, that’s cool you’re willing to do that in order to stop.”

And if you’re struggling with an opioid problem, like pain medications or heroin? Can you be confident and comfortable with the treatment recommendations you’ll receive? Are you as sure that the people in your life would have a positive response to your desire to use medications to help you stop?

The answer is probably (and accurately) “no.” There are a number of FDA approved, evidence-based Medication Assisted Treatments (e.g., buprenorphine, naltrexone/Vivitrol, methadone) for opioid use disorders, which are treatments that support long-term recovery and significantly reduce overdose rates. However, the traditional drug and alcohol treatment industry has been shockingly slow to support their use. Even more astounding is that many doctors in the treatment industry have not been educated about their effectiveness or trained to use them despite comprehensive efforts such as the Surgeon General’s Report last year reiterating the important role of these treatments. In fact, if you seek treatment for an opioid use problem, there is a significant risk that the treatment professional you speak with will either not offer these medications or have ideologic opinions about them that negatively influence how you feel about being prescribed them. As many opioid users will attest, there is a sense that you are “just an addict looking for another drug.” Would the cigarette quitter expect such a comment from their doctor?

Additionally, it’s likely that you will have to drive long distances to find a provider willing to prescribe these medications and your health insurance may not cover them. And the out-of-pocket expense is financially out of reach for most; for example the monthly injection of Vivitrol which blocks the effects of opiates and therefore reduces use can cost $1000-$1500 a month.

Finally, if you are lucky to find the resources (and right doctor) to get on one of these life-saving medications, it’s highly like that when you find the courage to tell your friend/parents/girlfriend/husband that you are taking a medication that helps you manage your addiction you will get lots of questions and concern and even worse, some version of: “Okay… but when will you really get sober?” This last punch in the gut is often the final straw that contributes to opiate users being reluctant to get the help they need and that is available. And this is not to fault friends and family. They have simply soaked up the same messages from the treatment industry and our culture, that somehow these medications are part of the problem and not part of the solution.

Over two million Americans are estimated to be dependent on opioids and drug overdoses are now the leading cause of death for people under 50 years of age. America’s opioid habit is an undeniable tragedy, and is one of the worst public health crises in the nation’s history. It is made all the more tragic by the fact that there are many viable, proven treatments for the problem yet they are not widely known or accepted. This must change if we are to stem the tide of opioid addiction in this nation and prevent more loss of life.

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