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Medication Assisted Treatment more than suboxone doctors
There’s a belief that using medication in the treatment of substance abuse disorders as trading one addiction for another. However, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), use of FDA-approved medications in conjunction with evidence-based therapies can be effective in the treatment of addiction and may help recovering users stay in treatment longer, extending period of sobriety which increases the chance of successful recovery.
MAT or medication-assisted treatment is the combination of therapy and FDA-approved medications. MAT is common in treatment for opioid and alcohol substance use disorders.
What is Medication-Assisted Treatment (MAT)?
MAT can skip inpatient detox, managing withdrawal symptoms on an outpatient basis so as not to disturb home life and employment.. The recovery process after addiction usually is followed by strong cravings to use even after successful completion of treatment and detox. The cravings are a normal occurrence for those struggling to stay clean. This can interfere with treatment and increase the risk of relapse. Fortunately, certain medications have proven very successful in managing withdrawals and suppress these cravings promoting abstinence.
The combination of medications and clinical accountability, along with therapies that teach the recovering user to manage craving and triggers for relapse on a cognitive/emotional level helps promote sobriety.
Methadone has been used for decades to treat people who are addicted to heroin and opioid narcotic pain medicines. When taken as prescribed, it is safe and effective. It allows people to recover from their addiction and to reclaim active and meaningful lives. For optimal results, patients should also participate in a comprehensive medication-assisted treatment (MAT) program that includes counseling and social support. Methadone treatment is considered the “gold standard” of opioid addiction and heroin addiction treatment. There is no ceiling effect with methadone as there is with buprenorphine drugs like Suboxone, Subutex, Bunavail, etc., that limits their effectiveness in managing withdrawals and cravings. Methadone is, therefore, indicated for persons with intermediate to heavy opioid or heroin dependencies. See comparison chart under Buprenorphine, below.
How Does Methadone Work?
Methadone works by changing how the brain and nervous system respond to pain, both physical and emotional, allowing the opioid dependent person to level out and live a normal life again. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.
Naltrexone blocks the euphoric and sedative effects of drugs such as heroin, morphine, and codeine. It works differently in the body than buprenorphine and methadone, which activate opioid receptors in the body that suppress withdrawals and cravings. Naltrexone and it’s long acting injectable form, Vivitrol, are used after detoxification to prevent getting high because it does not manage withdrawals or cravings. This is because it is an opioid antagonist, not an agonist. Since cravings for opioids and heroin can extend for several years after detoxification, a person may be at-risk for relapse. Furthermore, should a person relapse, the euphoria blocking aspect may frustrate them so they often take more and more, attempting to override the antagonist. While Naltrexone blocks the high, it does NOT block the respiratory suppression. One study found, “The mortality rate for naltrexone was four times higher than for methadone.” In addition, a month-long injectible blocks use of an opioid for pain management including emergency surgeries, presenting certain risks.
Patients on naltrexone may have reduced tolerance to opioids and may be unaware of their potential sensitivity to the same, or lower, doses of opioids that they used to take. If patients who are treated with naltrexone relapse after a period of abstinence, it is possible that the dosage of opioid that was previously used may have life-threatening consequences, including respiratory arrest and circulatory collapse. As with all medications used in medication-assisted treatment (MAT), naltrexone is to be prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs.
Buprenorphine (aka, Suboxone, Subutex, etc)
Buprenorphine is marketed as Suboxone, Subutex, and other trade names. The National Alliance of Advocates for Buprenorphine Treatment provides the chart, below, that compares the efficacy of buprenorphine drugs, like Suboxone and Subutex, with methadone. One can readily see that buprenorphine plateaus out in effectiveness at about 32 mg, well below the level needed for many with intermediate to heavy addiction to manage their withdrawals and cravings. If there has been a history of failed buprenorphine treatment, this may well be a contributing factor.
Many people are under the impression that buprenorphine (Suboxone, Subutex, etc.,) is much easier to get off than methadone. The chart, below indicates the respective intensity of withdrawals over time for methadone, buprenorphine, and heroin.
While methadone takes longer to withdraw from than burpenorphine (Suboxone) the relative intensity of those withdrawals is nearly the same. However, the white chart above indicates that methadone is much more effective for managing withdrawals from and cravings for opioids and heroin at intermediate to higher levels of dependency. For this reason, methadone is considered a better choice for persons who have intermediate to higher dependency levels of addiction.