Why would I want to avoid the gold standards in treatment for opioid addiction?
There is some disagreement in the addiction treatment literature on how effective addiction treatment is without medication. Yet, one thing that most experts do agree on is that the success rate for “abstinence-based” treatment is very low. The rate of success of addiction therapy without medication-assisted treatment (MAT) is probably in the range of 1% to 15%.
With MAT, using medications such as Suboxone or methadone, the odds are much better. With Suboxone, and related buprenorphine meds, the chance of succeeding is around 50%. Methadone has a 75% chance of success, but there are many drawbacks to methadone treatment, to the extent that Suboxone treatment has mostly taken over as the gold standard of treatment for opioid use disorder.
How do you define success?
Of course, when it comes to scientific studies, there must be a way to measure variables in the experiment. To compare success rates for treatments, there has to be a definition of success that allows scientists to measure it.
In the case of studying addiction treatments, urine drug screens are often used as measurements. A study may look at urine tests that show the test subjects to be opioid free over a period of time as a measure of success.
For example, if a new drug is on the market, they may point to a study of 100 individuals where they measured urine drug screens over a three-month period. Those subjects who made it through the three months opioid free would be considered successful outcomes for the drug study.
Is success as simple as passing a urine drug test for a few months?
In any kind of contest, there has to be a measurement to show the winner and the runners-up. For example, if you were running in a race, you would want to know how far away is the finish line. Imagine winning the race, only to find out that they were looking for the runner with the best running style, and not the fastest.
Yet, in life, measuring outcomes is more complex, because overcoming opioid addiction is not an athletic event and it is not a scientific study. Treatment for drug addiction is about working with individual human beings who have different needs and challenges.
If a doctor walked in to see you in an exam room and said that they had three treatments with success rates of 15%, 50%, and 75%, which would you choose? Would you want to hear more, or just sign up for the treatment with the highest number of successes?
Who is the greatest guitar player to ever live?
If you are a fan of classic rock music, you may be aware that many fans are focused on who plays a particular instrument the best. Fans of a rock group may brag to their friends that their favorite band’s guitarist is the best in the world. Music magazines cater to this athletic-like comparison and publish top ten lists, naming their opinion of who is the best guitarist in the world, or of all time.
Often, these top rock guitarist lists put Jimi Hendrix at the top. Most musicians who work in rock music agree that he was the best rock guitarist of all time, in originality, sound, and influence on future generations.
Does that mean that rock fans should only listen to Jimi Hendrix? Should all other guitar players pack up and go home? Should we delete all the other rock music, because who wants to listen to second best, third best, or even 10th best?
The fact is that any particular musician’s playing is not going to appeal to everyone. We do not all want to hear the same music over and over again. When they publish a top ten list of the best guitar players of all time, each player on the list has their place in the world of music.
When it comes to medical treatments, it is important to have choices.
Just like great guitar players, different types of addiction treatment have their place in the world. Success is not all about how many opioid-free urine test results you have had in a three month or 12-month period.
While remaining opioid-free during opioid addiction therapy is an important measure, it is also important to consider quality of life and life goals. How are you going to feel about showing up to a methadone clinic every single morning for weeks, months, or even years?
For many patients, the difference between Suboxone and methadone treatment comes down to the initial hours, or days, between quitting opioids and starting treatment. Methadone can be started right away. Suboxone treatment is usually started at around 24 hours after the last opioid use, though in some cases it can take days before a patient can start Suboxone.
The starting point for Suboxone depends on the type of opioid the patient was using on the streets. A certain amount of that opioid must be cleared from the patient’s system before starting Suboxone, or the patient will suffer from an uncomfortable precipitated withdrawal reaction.
What about abstinence-based treatment? Does it still have a place in opioid addiction treatment?
While rehabs, parents, and 12-step meeting members will often recommend abstinence-based treatment as the ideal for opioid addiction treatment, doctors tend to not recommend it. There is a great deal of misunderstanding between the traditional ideals of addiction treatment that go back for generations compared to evidence-based modern medicine.
In the world of addiction recovery, many people claim that medication-assisted treatment is simply trading one addiction for another. This is one of many slogans that you might hear in a rehab or recovery meeting that sounds good at first, but does not stand up to scrutiny.
When a person uses heroin or pain pills to get high, and they become addicted, their behavior reflects their addiction. Addiction is characterized by self-harm, obsession, and compulsive use with a lack of self-control. It is very unpleasant to be addicted and have your waking life consumed by your obsession with getting and using drugs.
Patients who are prescribed Suboxone usually stop exhibiting addictive behavior during treatment. The results can appear to be miraculous.
In fact, the success of Suboxone therapy can lead to treatment failure early on.
Suboxone patients sometimes feel as if they have been cured of their addiction when the treatment starts to work. They feel as if they are “normal” again because the obsession has been lifted, and they no longer think about drugs all the time. And, the effects of drug use go away, so the patient’s thinking becomes clear, they have energy, and they start to feel physically healthy again.
To make matters worse, because Suboxone has a long half-life, a patient may skip a day without feeling sick from opioid withdrawal. Because of the long-lasting nature of the medication, the patient believes even more that they are cured and can stop treatment on their own.
Unfortunately, Suboxone treatment does not work well unless it is continued for an extended period of time. While it works quickly and effectively for many patients, it is not a fast and easy fix for opioid addiction. It takes time for the brain to heal and for a Suboxone patient to be ready to start the tapering process to complete treatment.
What if I want to skip the Suboxone and methadone treatments altogether?
Quitting opioids without medication-assisted treatment often leads to relapse. Relapse means that you quit drugs and then go back to using them again, and it happens for a variety of reasons.
Opioid withdrawal is a severe mental, physical, and emotional ordeal. It involves a collection of very uncomfortable physical symptoms, combined with anxiety, depression, and intense drug cravings. These symptoms usually peak at about 72 hours, but they can persist for days, and even weeks. Some symptoms will come and go for months for some people.
Imagine having the worst sickness of your life and being completely miserable, knowing that a single drug use will alleviate all of your symptoms almost immediately? If you relapse, you are not going to tell yourself that you have completely failed and given in to drug use for life. You will justify that you are using drugs this one last time and then you are going to try quitting again.
While the success rate for quitting opioids without long-term Suboxone therapy is not as good, it is possible. If you are determined to quit opioids without Suboxone, your doctor should inform you of the risks, but then, it is still your decision. After discussing all options, your doctor should support your commitment to quitting opioids without MAT.
Medication-assisted treatment without Suboxone or methadone.
When people discuss different options for quitting opioids, comparing abstinence-based treatment to Suboxone or methadone, it is important to consider that, even with abstinence-based therapy, medications can help with the most difficult phases of opioid withdrawal. If a patient can successfully get through the initial days and weeks of withdrawal sickness after quitting opioids, their chance of long-term success is much greater.
Fortunately, there are medications that can make opioid withdrawal more tolerable. Many of the worst symptoms are related to an overactive peripheral nervous system. With medications to target the nervous system imbalance, and supplements to help replenish depleted brain chemicals, opioid withdrawal is not nearly so unpleasant.
If it is possible to treat opioid withdrawal and get a patient through the worst symptoms of quitting opioids without using Suboxone, why not do this for every patient?
Quitting opioids without Suboxone or methadone MAT is still not easy. It is critical to have a strong support system in place. With family support and peer support from local addiction recovery groups, staying opioid-free will be easier. Staying involved and vigilant is important.
Also, recovery from opioids without MAT will be more difficult. For patients who have jobs that require their full energy and mental focus, including taking care of a family, the prolonged withdrawal and recovery from opioid dependence can make life harder. People around you may not understand that you need time and support to get past this difficult time in your life.
One of the great benefits of Suboxone treatment is that, not only does it have a high long-term success rate, it also provides short-term ability to function optimally. A person with a full life, including a high pressure job and a family to take care of will be able to hit the ground running, getting back to handling life again quickly without much down time.
What is the best option for me? Should I skip the Suboxone and methadone?
This is a very personal and individual decision. First, you must be aware that you will have a better chance of remaining opioid-free long-term with Suboxone or methadone treatment. Also, you will feel better right away, able to get back to functioning normally in your life.
Also, Suboxone and methadone are life-saving treatments. Street opioids are deadlier than ever, so you must be aware of the risks of foregoing medication-assisted treatment and choosing abstinence-based therapy.
If you are already involved in a recovery program, such as Narcotics Anonymous, or Alcoholics Anonymous, you may feel very strongly about avoiding MAT. You may also have a strong support system in place, including a sponsor, and close friends who you communicate with regularly who support your recovery from addiction.
For people who feel strongly about avoiding MAT, and they are aware of the higher risk of relapse, it is possible to overcome opioid addiction without medications such as Suboxone.
Having the support of your doctor is still important, even if you do not take Suboxone. Your doctor can help you with short-term medical treatment to get through the difficult early withdrawal symptoms.
You may also want to consider staying in rehab for a while, even if it is an outpatient rehab program. Or, as an alternative to rehab, there are professional sober companion programs to help keep you accountable in your recovery while allowing you to continue in your daily life activities.
While Suboxone treatment may be the best option for treating opioid addiction, with its safety and convenience advantage over methadone, as well as higher success rates over abstinence-based treatment, it is not your only option. You can still see a Suboxone doctor and choose, in the end, not to take Suboxone. While it is important that you are aware of the risks of avoiding MAT, it is ultimately your decision.