Opioid Addiction Treatment: Science Advances

The good folks at the American Association for the Advancement of Science (AAAS) recently published a deep dive into opioid addiction treatment and, as you might suspect, their conclusions concur on the side of medicine. They also admit that much more work needs to be done.

The Abstract

Everyone knows that opioid use disorders (OUDs) are diseases of the brain with behavioral, psychological, neurobiological, and medical manifestations. Everyone also knows that OUDs can be affected by factors such as genetic background, environment, stress, and prolonged exposure to opioids.

What everyone doesn’t yet know (but the AAAS study makes clear) is that two standard-of-care maintenance medications have a proven long-term positive influence on the health of persons with opioid addiction. Those medications, of course, are methadone and buprenorphine-naloxone (aka Suboxone). Unfortunately, though buprenorphine has been approved for monthly administration (as has naltrexone), neither medication is used as widely as needed. Why? Because of stigma, insufficient medical education or training, inadequate resources, and/or inadequate access to treatment.

Opioid Addiction Rates

The most recent data coming from Substance Abuse and Mental Health Services Administration (SAMSHA), the National Institute on Drug Abuse (NIDA), and other federal government stakeholders shows that over 16 million people in the United States suffer from some addictive disease. The most common addiction is alcoholism. That’s followed by addiction to cannabis, opioids, and cocaine.

It is estimated that least 1 million to 2 million people in the United States suffer from addiction to heroin and other short-acting opioids. It is further estimated that over 37 million people have misused short-acting opioids such as oxycodone and hydrocodone. While the number of actual opioid addicts has only been roughly calculated, approximately 20% of persons who self-administer a prescription opioid for nonmedical use will develop an OUD. That’s an astonishing rate of addiction.

In the past two decades, increasing numbers of prescription opioid abusers have turned to heroin a) because it is cheaper and b) because it’s more widely available. That has sparked a nationwide increase in opioid overdoses. In fact, the number of overdose deaths in the United States has risen to approximately 50,000 per year. New York City alone reports approximately four overdose deaths each day. Much of the increase in opioid-induced overdose deaths can be attributed to heroin mixed with fentanyl, which is becoming more and more prevalent across the country.

Public Health Need for Medication-based Opioid Addiction Treatment

Because of the major stigma of drug abuse, insists the AAAS, there has been an almost complete absence in most medical schools of education about opioid addiction, its diagnosis, treatment of overdose, and chronic pharmacotherapy. In fact, most medical schools have only limited education about any addictive diseases.

Currently, the number of persons in methadone maintenance treatment programs (MMTPs) in the United States is approximately 382,000. The number of persons in buprenorphine-naloxone treatment is approximately 112,000. Considering the sky high rate of opioid addiction, much more work needs to be done.

Studies have shown that fewer than 10% of opioid addicts are able to achieve long-term abstinence without medication-assisted treatment. That means, those who aren’t privy to methadone or buprenorphine maintenance therapy have a much higher capacity to relapse and overdose. It’s also clear that behavioral or cognitive therapies alone aren’t nearly effective to treat opioid addiction (or severe OUD).

The AAAS admits there’s have been a modest increase in both MMTP and buprenorphine-naloxone treatment. Yet, they say it’s disturbing that those overall numbers remain very low, especially given the amount of people afflicted with opioid addiction.

Why Does MMT Work?

Daily compliance is a major factor the effectiveness of medication-assisted treatment. Federal regulations mandate that patients visit the clinic daily to receive their methadone dose. Once a patient has proven themselves, those visits can be reduced to weekly or monthly. On the other hand, strict federal regulations have also limited the number of methadone maintenance clinics. That, of course, reduces the availability of effective opioid addiction treatment.

Expanding the availability of long-acting steady-state medication-assisted treatment is critical. Why? Because an “endorphin deficiency” develops in persons with long-term opioid addiction. And it can best be addressed with medicines. In other words, methadone or buprenorphine maintenance treatment can be considered a long-term “replacement” therapy similar to thyroxin treatment for thyroid deficiency or insulin use for diabetes.

Got that? MMT is replacement therapy. But it’s not replacing one drug for another; it’s replacing much-needed chemicals in the brain. Tell that to the next person who tries to criticize medication-based Opioid Addiction Treatment.

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