I’m a little sick and tired of hearing discussions that continuously talk about opiate replacement therapy (think methadone, suboxone, subutex) as not being true addiction treatment because those individuals are still using a drug. While some recent advances will hopefully allow more and more people to achieve medication assisted recovery through antagonist therapies (like naltrexone and its once a month wonder Vivitrol), agonist therpy, or replacement therapy, has been working wonders with heroin addicts and other opiate addicts who have tried quitting multiple times and have failed only to succeed wonderfully using these medications.
What replacement therapy as addiction treatment looks like
A recent comment on this blog compared using suboxone to get off heroin to drinking beer while trying to quit liquor. Let’s assume for a second that this is a worthy comparison (although buprenorphine is a partial agonist for opiate receptors and not a full agonist), the one thing it’s missing is context, so let’s give it some: take Paul, a daily drinker who puts down a fifth of Vodka or more on a daily basis. He’s been doing this for years and the physical toll has been immense – His liver is failing along with his health and his pasty white skin looks good with his shuffling and Wernicke-Korsakoff syndrome due to improper thiamin (vitamin B) intake. He hasn’t been able to hold down a job for years due to the shaking and blacking out not to mention the need to always have alcohol around for when the withdrawal starts. He’s tried to quit drinking several times but the DTs, shakes, and generally horrible feeling almost always makes him go back to drinking soon after and even the few attempts at medically supervised addiction treatment failed when he relapsed within weeks of leaving treatment. One day, someone promises Paul a solution to all his problems and gives him a magical beer that he has to drink in the morning when he wakes up. Not believeing it, but figuring “what the heck,” Paul keeps drinking all that day but then remembers to take that pill early the next morning… He still drinks that first day, though not as much because he doesn’t feel like he needs it, and day by day he begins to consume less liquor and finds himself having that one beer in the morning and sometimes another in the middle of the day. Within a few weeks he’s drinking no more liquor and all he has are those two beers every day. He feels great, has started getting some color back and is looking healthier than ever. He’s even managed to get a little job, though he’s not overcommitting yet not fully believing that this will really last. His memory returns fully and he feels like he did 20 years earlier, hardly believing he’s given so much up for that liquor he doesn’t really want anymore. A year later Pual feels like a new man and never looks back.
Keeping our options – Replacement therapy included
As far as I’m concerned that story, which we hear over and over with buprenorphine-using ex heroin addicts, is not only worth keeping patients medicated forever but makes the notion of not offering replacement therapy when it is appropriate simply crazy. I didn’t even get into the fact that reductions of this kind in heroin use bring about other great health benefits like lower injection rates that bring down HIV/AIDS and hepatitis C infections not to mention all the other complications that injecting is good for.
Like we’ve said many times here on A3, there is no single addiction treatment that will work for everyone but it is absolutely crazy to dismiss therapies that have been repeatedly shown to work (yes, including AA and other 12-step based approaches) and make lives endlessly better. We have a whole box full of addiction treatment tools, let’s not start trying to hammer with a flathead screwdriver please…