Quarrel reignites over opioid addiction, recovery
Remarks by a top U.S. health official have reignited a quarrel in the world of addiction and recovery: Does treating opioid addiction with medication save lives? Or does it trade one addiction for another?
Health Secretary Tom Price’s recent comments – one replying to a reporter’s question, the other in a newspaper op-ed – waver between two strongly held views.
Medication-assisted treatment, known as MAT, is backed by doctors. Yet it still has skeptics, especially among supporters of 12-step programs such as Narcotics Anonymous, because it involves opioid-based medications.
Price appeared to side with that camp when he said during a recent visit to Charleston, W.Va.: “If we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven’t moved the dial much.”
In an opinion piece published last week in the Charleston Gazette-Mail, he twice mentioned his agency’s support for medication-assisted treatment.
Because of how opioids act on the brain , people dependent on them get sick if they stop using. Withdrawal can feel like a bad flu with cramping, sweating, anxiety and sleeplessness. Cravings for the drug can be so intense that relapse is common.
Medication-assisted treatment helps by moving a patient from powerful painkillers or an illicit opioid such as heroin to a regular dose of a legal opioid-based medication such as buprenorphine or methadone. The ideal dose is big enough to fend off withdrawal, but too small to produce a euphoric high. Patients can drive, rebuild relationships and get back to work.
With counseling and education about addiction, patients can get back on track. They eventually can taper off medications, but some take them for years.
Researchers studying these treatments use drug screening to see whether patients are staying off illegal drugs. If someone uses heroin while in treatment, it shows up in their urine.
A 2014 review of 31 studies found methadone and buprenorphine keep people in treatment and off illicit drugs.
The review by the Cochrane Collaboration, an international group of scientists that evaluates research, found each drug worked better than a dummy medication.
Methadone and buprenorphine can be abused and both can cause overdoses, particularly methadone. But researchers have found that methadone prevents more overdose deaths than it causes.