At Harmony Recovery Group, we offer Medication Assisted Treatment (MAT) plans that help patients to manage opiate cravings in the long-term and help them build a new life in sobriety. However, there are many myths and misconceptions about Medication Assisted Treatment that we would like to clear up.
Firstly, many types of Medication Assisted Treatments exist, encompassing medications like Suboxone, Subutex, Methadone, Vivitrol, and Naltrexone.
In our facilities we use Suboxone, which we consider the safest option for an assisted recovery. Suboxone works because it binds to the same receptors as opiates in order to reduce withdrawal symptoms and cravings. It binds 7x stronger than morphine. Because of this, patients are unable to abuse opiates with Suboxone because they will have no effect due to the binding effect on the receptors.
Suboxone use reduces the risk of relapse significantly. Studies have shown that Suboxone reduces the risk of relapse by 3x compared with other forms of MAT such as Vivitrol and Naltrexone. And those forms of treatment have a 3x reduction in relapse compared to going cold turkey. Compared to non-medication assisted treatment, there is a 75% improvement in retention rates in sobriety programs.
We spoke with Dr. Jill Thompson, Board Certified Doctor in Addiction Medicine and our Medical Director at our facility Midwood Addiction Treatment, to discuss the common myths and misconceptions around Medication Assisted Treatment.
Myth: “Medication Assisted Treatment is Just Legal Heroin”
Beuprenorphine, the primary ingredient in Suboxone, is not heroin. It is made a different way. Narcotics like Oxycontin, Hydrocodone and other opiates are called Full Agonists whereas Buprenorphine is a Partial Agonist. Even though Buprenorphine binds to the same receptors that narcotics do, it acts very differently. For example:
1. You can never become tolerant to Buprenoprhine.
With any other narcotic the more you take it, the more you start to need. A dose that once created a feeling now feels like nothing at all because you develop tolerance to it. With Buprenorphine you are always on the same dose and you never need to go up in dosage. Jill says, “For example, I had a patient who was on the same dose for 17 years. Unfortunately he passed away in a car crash a few years ago but we had never once changed his dose the entire time I treated him.”
2. Buprenorphine has what’s called a Sealing Effect
This means you cannot take more and more of the medication and get higher and higher. As Jill says, “Your receptors become saturated at a certain dose and that’s it. You can’t take more and more and feel euphoric like you can with opiates.”
3. Unlike opiates, it is nearly impossible to overdose on Buprenorphine.
The only reported incidents of overdose have been when the medication was mixed with high amounts of other medications such as Benzodiazepines. There is no known case of overdose from Buprenorphine on its own.
Other MAT medications, like methadone do not have this protection against tolerance nor the sealing effect, making them quite different from the safety of Suboxone. For example, with methadone, a patient can become tolerant and need higher doses and they can also take higher doses and become high.
Myth: People Who Use MAT Aren’t Actually Clean
This simply isn’t true. What is your definition of “Clean?” Does it mean not getting high? Not getting altered or impaired? Being able to function in everyday life? If the answer to these questions is “yes”, then people on MAT are in fact Clean and Sober.
Dr. Jill puts it this way: “There is a difference between addiction and dependency. Addiction encompasses having a physical and psychological craving for something that is so strong you will do anything to get it. Dependency is the same as if you were a Diabetic and had to take insulin everyday. You are dependent on your insulin for your disease. Yes, someone who is using Suboxone in their MAT program is dependent on it, but it is the same as any medication out there to treat chronic illness. You still have to go to meetings, you still need to do the work, but you have help in managing your condition.”
Because Suboxone does not impair patients and the sealing effect means there is no way to take more and feel altered, they can get a job, they can concentrate, and they can function as normal.
Taking a pill once a day for your medical condition does not mean you are not clean.
Myth: Medication Assisted Treatment is a Lifelong Commitment
Many people think that if they start taking MAT, they will never be able to get off of it. The truth is, with the exception of using it in Detox for a week to get off of drugs, Suboxone is not a short-term fix but it is not a life-long commitment either. You can come off of it if you want to.
As Dr. Jill says, “People are very different and this is a very individualized thing. The phrase “longer term” will be different for different people. Some people may want to come off in a year or two, some people may want to be on it for the rest of their lives. At this point in time, we do not know of any reason people cannot stay on it indefinitely.” In fact, the FDA recently released a statement saying that they advocated using Suboxone for indefinite treatment. However, if patients do want to come off of it, they certainly can.
If and when you want to come off the medication, it’s important to reduce the dose in a slow and controlled manner. When people decide to skip their dose at random or get off on their own, this creates a very high risk of relapse. If the medication reduction is down systematically with a trained professional, you should not run the risk of relapse. This is because with careful tapering, you won’t be feeling bad or noticing you are withdrawing from it. Dr. Jill suggests patients plan on committing 6-12 months to tapering off slowly and safely.
Myth: Suboxone Causes Precipitated Withdrawal
This is a common misconception among opiate users and is not true. Buprenorphine, the active medication in Suboxone, has been around for decades. But, in the early 2000’s Buprenorphine was approved for use in drug treatment. At the time its brand name was Subutex and it was purely made of Buprenorphine.
Unfortunately heroin users realized that it could be abused and began to liquify it and inject it. In this manner, a user can in fact get high from Buprenorphine. But, it’s most important use to users was the drug’s ability to stave off withdrawal. If a heroin addict is going to run out of heroin they will typically go into withdrawal within 6-12 hours. With Buprenorphine (brand name Subutex), they won’t go into withdrawal for 2-3 days.
When Subutex began to flood the streets for this purpose, the manufacturer changed the formula to include Naloxone. Thus, the combination was named Suboxone.
As most people know, Naloxone is the medication that can stop an overdose. It works intravenously by immediately removing all the heroin left on the body’s receptors. However, Naloxone only works when injected. If Suboxone is administered orally, as intended, the small amount of Naloxone is inert and will not have this effect.
Now, if a heroin user tries to shoot up Suboxone, the Naloxone is fully effective. The user will go into immediate, precipitated withdrawal. This means that all the withdrawal symptoms a user would experience over 48 hours happens in the next two hours.
No Need To Fear Suboxone
Heroin users are often afraid of Suboxone, thinking they will go into immediate withdrawal if they take it. This is absolutely false. If taken as recommended, orally, Suboxone will block cravings and prevent withdrawal symptoms. In the case that there is heroin in your system, the Suboxone will knock it off and bind to receptors instead, because it is much stronger. If you try to use heroin on top of Suboxone, you will feel nothing because the Suboxone binds that much tighter. That is why it is so effective in preventing cravings. The Naloxone in the pills is simply to prevent intravenous abuse on the street level. It is completely inactive in pill form.
In the end, choosing the type of treatment for your needs is a very personal choice that should be made with the guidance of a trained professional. We hope this cleared up some of the myths around Medication Assisted Treatment. If this sounds like the right fit for you, or if you are seeking any type of substance abuse treatment, please contact us today. We are here to help.