The efficacy of newer methods of combating and treating opioid dependence has been subject to much debate over the last forty years. One of the most widely accepted but also most controversial methods of treatment today is Medication Assisted Treatment (MAT), which involves the substitution of an illicit substance with one controlled by a physician. The theory surrounding this style of treatment centers around the addict relinquishing control and eventually tapering off of whatever the primary substance was.
Results from this style of treatment have varied inconsistently since its inception. Some studies have shown that longer term Buprenorphine-Naloxone (Suboxone®) regiments can drastically increase the chances of sustainable long term recovery [Cite source 1]. Other studies seem to confirm the exact opposite, with both short and long-term Suboxone® treatment being ineffective for maintainable recovery [Cite source 2].
Research on Medication Assisted Treatment is vital to understanding how to better combat this opioid epidemic that is sweeping this country. What was once a problem among adults and elderly, has now began to trickle down to our adolescent youth. Since 2008, the number of teenage patients admitted to the hospital from the emergency department, testing positive for opioids, has doubled [Cite source 4]. This is a problem that has and will only continue to worsen, unless research and treatment methods are adapted to better help cope with this growing problem. One of the biggest obstacles in the war against opioid addiction is the overall lack of understanding about the disease. Seeking to better understand this problem, and the methods using to combat it, this essay will attempt to help better comprehend the overall efficacy of Medication Assisted Treatment, and if a better solution exists.
The disease recognized as Opioid Use Disorder [Cite DSM V], lists only a few reasons why one becomes addicted to opiates, lightly touching on predispositions and environmental factors. Because this is classified as a disease, just as any other disease would, the treatment styles are strikingly similar. If a person is diagnosed with a bacterial infection, the typical treatment after diagnosis would be a regiment of antibiotics. In those who are dependent on opioids, once a diagnosis is reached, medication is used to counter and treat the patient. Doctors and scientists alike have come to accept this as a viable form of treatment, even though overall success rates, especially in adolescents, are in the single digits [Cite source 6].
The articles cited below all attempt to provide some further clarity not only into the effects of opioid dependence on adults and adolescents, but also the methods being using to treat them. Seven peer-reviewed articles, as well as the DSM-V have been used to help compile a more comprehensive picture of this epidemic, as well as offering what this author feels are a better, more practical alternative. Three articles described the treatment program as well as the results of both long and short-term Buprenorphine-Naloxone therapy. Each study yielded similar results, with longer term treatment being more effective [Cite sources 1,2 & 3]. However, two out of three articles, go on to clarify that although the longer term treatment yielded better results, the overall rate of success was still low.
Two articles discuss more in depth the emergence of this epidemic in our nations adolescent population and what is being done to help identify and treat the problem [Cite source 4 & 5]. Opioid overdoses and misuse diagnoses are becoming more prevalent as physicians and health care professionals become better trained on the signs and symptoms. This deeper understanding and education of the problem has allowed patients to receive the care they need more efficiently and in a timelier manner. However, with this new understanding, the rate of diagnoses has increased. The rate in increase is not necessarily because of an increase in overall opioid use, although that does play a significant role, but more in the reduction of misdiagnoses.
Timely treatment is crucial in helping the patient achieve long-term success. There is a direct correlation between the length of use (time spent in active addiction), and efficacy of Medication Assisted Therapy [Cite source 6]. Adolescents who are exposed to treatment options have higher rates of success than those who sought treatment after prolonged addiction. Resources are becoming more widely available for opioid addicted youth willing to seek assistance. Further information about the causes of adolescent opioid abuse are discussed in the last article. This gives us perhaps the most comprehensive understanding as to the causes and conditions associated with the disease, and more importantly answers the long asked question of “Why?”.
For many years, and even still today, scientists and doctors have tried to find a correlation between genetics and addiction. In some cases, links have been found, however, they have also been easily debunked. One issue that persists that was briefly mentioned prior, is trying to treat this as one would any other disease, with medicine. According to Megan Moreno, MD of the University of Wisconsin School of Medicine and Public Health, the root of addiction lies in our environment [Cite source 7]. Physiological factors don’t necessarily play a role in addictive behavior as was once thought. Our immediate circumstances and over environment are the biggest factors in our day to day life as well as our overall decision making. For adolescent individuals, there is a direct relation between trouble in the home and drug use. This understanding has allowed doctors to explore taking different approaches to treating the disease, without the need to find a miracle cure in the form of another substance.
The consensus amongst physicians, scientists, doctors, and psychologists seems to be, the best way to treat opioid dependence is with Medication Assisted Treatment. Substituting one harmful drug, for a less harmful drug in a supervised setting, is the most effective way to combat this epidemic. The research into the efficacy of other methods of treatment is still minimal, however those results could lead to a more sustainable and realistic approach. It is important to remember that the solution to a problem, sometimes lies outside of the synthetic knowledge of a medical professional. According to the sources above, one is led to believe that Medication Assisted Treatment is the best and most successful option available, nonetheless, a healthy amount of doubt is needed, as all results can be subjective.
There are a variety of other methods that can be used to combat opioid addiction. One of the preferred alternatives to Medication Assisted Treatment, is known as CBT or Cognitive Behavioral Therapy. CBT has been used to treat a variety of disorders, and is becoming more prevalent in the treatment of various addictions. Because addiction is understood to be a disease of the mind, treating the underlying symptoms rather than the substance itself, has yielded positive results. The thought process behind CBT is that by merely treating the substance and not the behaviors associated with the substance, the user is still left with diseased thinking. This reverse approach, whereas the behaviors are modified, ultimately relieves the necessity for the addict to want the substance.
Another method, which has proven successful over the last 80 years, are twelve-step programs. Developed by Alcoholics Anonymous founder Bill Wilson in 1939, the twelve-step program has evolved well beyond combating alcoholism into hundreds of addictions and compulsions. The twelve-step approach allows the addict to gradually relinquish his or her own control and admit defeat over the disease, ultimately allowing them to surrender their control to a “higher power” of their own conception. This process, has proven successful for millions of addicts and alcoholics since its inception. Various other experimental methods of treatment exist, and more continue to be developed. The overall need for effective treatment only continues to grow as the opioid epidemic gets worse.
Opioid dependence is just as much a psychological disorder as it is a physical disorder. Understanding that addiction and the behaviors associated with it, is a disease that is rooted in the mind. Upon removal of the substance, one is still left with the attitudes, behaviors, and thoughts that accompany addiction. Cognitive behavioral therapy has the potential to be more effective in treating addiction, however the results of CBT versus MAT therapies are still inconclusive. While the research above seemed to support the initial hypothesis of the efficacy of Medication Assisted Treatment, the overall results inclusive of all treatment options, comparatively speaking, hasn’t been conducted. The large amount of subjectivity associated with success rates and relapse rates, leaves many studies imprecise. Until certain parameters and variables can be established to measure these levels, overall success is impossible to measure.
