Why Are We Questioning Opiate Replacement Medications And Naltrexone For Opioid Dependence?

You wouldn't question someone using Nicorette to quit smoking.
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If you decided to take charge of your health and quit smoking, would you be able to trust your doctor had good advice for you?

The answer is probably yes. Most health care professionals would tell you to throw out your pack of cigarettes and consider using one of several nicotine replacement therapies (NRTs) ― like the nicotine patch, gum, lozenge or nasal spray ― or medications like Wellbutrin/Zyban or Chantix. They would tell you that one of the most effective ways to stop smoking is to use these treatments in your effort to quit cigarettes for good.

Also helpful is that your insurance company would likely cover the medication you were prescribed, and the nicotine gum would be easy to come by, as it is sold over the counter at most pharmacies at a relatively manageable cost ($50 for a box of gum).

In fact, many states and municipalities offer “quit smoking” hotlines that provide nicotine replacement options such as the patch for free. And if you tell the people in your life, like friends and family, that you are on the patch or taking a medication to quit smoking, they would most likely say, “That’s great! I’m proud of you for trying to quit smoking!” or “Wow! That’s cool you’re willing to do that in order to stop.”

But what if you’re struggling with an opioid problem, like pain medications or heroin? Can you be confident and comfortable with the treatment recommendations you’ll receive? Are you as sure that the people in your life would have a positive response to your desire to use medications to help you stop?

The answer is probably “no.” There are a number of FDA-approved, evidence-based medication-assisted treatments (e.g., buprenorphine, naltrexone/Vivitrol, methadone) for opioid use disorders, which are treatments that support long-term recovery and significantly reduce overdose rates. However, the traditional (typically 12 step-based) drug and alcohol treatment industry has been shockingly slow to support their use.

Even more astounding is that many doctors in the treatment industry have not been educated about the effectiveness of medication-assisted treatments or trained to use them. In fact, if you seek treatment for an opioid use problem, there is a significant risk that the treatment professional you speak with will either not offer these medications or have ideological opinions about them that negatively influence how you feel about using them. As many opioid users will attest, there is a sense that you are “just an addict looking for another drug.” A cigarette quitter would never expect such feedback from their doctor.

Additionally, it’s likely you will have to drive long distances to find a provider willing to prescribe these medications, and your health insurance may not cover them. The out-of-pocket expenses are considerable and outside of most people’s financial means. For example the monthly injection of Vivitrol, which blocks the effects of opiates, therefore reducing use, can cost $1,000-$1,500 a month.

Finally, if you are lucky enough to find the resources to get on one of these life-saving medications, it’s highly likely that telling your loved ones you are taking medication to help manage your addiction will result in lots of questions and concern and, even worse, some version of: “Okay... but when will you really get sober?” This gut punch is often the final straw that contributes to opiate users being reluctant to get the help they need and that is available. This is not to fault friends and family. They have simply soaked up messages from the treatment industry.

An estimated 2 million Americans are dependent on opioids. Drug overdoses are now the leading cause of death for people under 50 years of age, exceeding 64,000 in 2016. This is the largest annual jump ever recorded in the country, an approximate 22 percent increase over the 52,404 recorded in 2015. The data also suggests this problem will only worsen in the second half of 2017.

America’s opioid habit is an undeniable tragedy and is one of the worst public health crises in the nation’s history. It is made all the more tragic by the fact that there are many viable, proven treatments for the problem, yet they are not widely known or accepted. This must change if we are to stem the tide of opioid addiction in this nation and prevent more loss of life.

Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.