Opioid dependence is a growing problem worldwide. Latest estimates suggest 16 million individuals suffer from some form of opioid use disorder (OUD). Reports estimate that more than 500,000 US citizens are dependent on heroin.
Fortunately, despite these alarming numbers, opioid dependence is treatable. Available treatment options include psychosocial rehabilitation programs, use of medications, or both in combination. In the subsequent sections, we compare and contrast medication-assisted vs. abstinence-based treatments.
As the name implies, abstinence-based treatment means simply abstaining from opioid use altogether without any medication assistance. It is the most common form of treatment for substance abuse in the United States today, mainly because it is difficult to find and access medication assistance. Thus it is often used as a matter of necessity instead of patient preference.
Abstinence-based treatment relies on personal willpower along with social and psychological support to help individuals through withdrawal symptoms and keep them motivated to discontinue opioid use. It is a reasonable option for patients if they do not want to use medication-based treatment.
Abstinence-based treatment programs were originally used for alcohol-dependent patients in 1935, the most famous being Alcoholics Anonymous (AA). The program, formally a 12 step program, provides individuals with a social support group and a gradual step-by-step path to counter their alcohol dependence. Since then, multiple twelve-step programs addressing a variety of substance disorders have emerged. Many patients swear by them as a means for providing the support necessary to abstain from the use of opioids.
However, twelve-step programs have historically discouraged the use of any medication, as they have (incorrectly) assumed that medication assistance merely “substitutes one addiction for another.” While well-intentioned, this often propagates unnecessary and even counterproductive stigma around Medication for Addiction Treatments.
Although abstinence-based programs are certainly helpful for some individuals, there is a distinct lack of evidence backing their efficacy on a population level. Studies have repeatedly shown that abstinence-based programs for opioid dependence should be supplemented with medications for the best results.
Medication for Addiction Treatment for opioid dependence (MAT) advocates combining the use of medications with behavioral and psychological support. Using FDA-approved medications for OUD helps reduce cravings and prevent withdrawal symptoms, which are the most common reason for opioid relapse. Extensive research has demonstrated the efficacy of MAT in not only decreasing opioid use but also preventing opioid-related deaths.
Currently, three medications have been approved by the US Food and Drug Administration (FDA) in the medical treatment of opioid dependence. These drugs namely, methadone, buprenorphine, and naloxone, act in differing ways on the opioid receptors in the brain.
Methadone, the most commonly used medication for opioid dependence worldwide, binds to opioid receptors in the brain and activates them. Put simply, it stimulates the same receptors activated by opioids, thereby preventing withdrawal. Thus, methadone reduces withdrawal symptoms without causing many of the adverse effects associated with opioid use.
However, since methadone functions similarly to opioids, methadone treatment does carry similar risks associated with opioid use - the risk of abuse. Buprenorphine, on the other hand, is associated with a lesser risk of abuse as it does not contain the same potential to “get high” as methadone does. In addition, methadone can only be prescribed out of a specialty clinic. This proves to be a logistical challenge for many patients, requiring that they come in person on a frequent (often daily to weekly) basis to receive their medication dose.
Buprenorphine/naloxone (Suboxone) activates the same receptors as methadone but only partially. Thus, it reduces the risk of abuse or overdose while still preventing withdrawal symptoms. Suboxone treatment is the only approved outpatient treatment for opioid dependence, given its efficacy and relatively safe profile.
Naloxone functions entirely differently from methadone and buprenorphine. Naloxone is an opioid antagonist, which means that it binds to opioid receptors but does not activate them. It prevents patients who then take an opioid from getting “high” on that opioid because all the opioid receptors are blocked by the original naloxone.
Although naloxone carries no abuse potential, it does not prevent withdrawal symptoms immediately after stopping opioids in the same way as methadone or buprenorphine/naloxone (Suboxone). For this reason, it is more commonly used to maintain someone’s abstinence over time but not to help them during acute withdrawal.
Given the effectiveness of MAT, its use has risen rapidly: Only 7 European countries provided methadone for OUD in 1980. By 2009, it was being used in more than 70 countries worldwide. Adoption rates for MAT are also increasing in the US, with roughly 50% of individuals with OUD now receiving medications.
Research consistently proves MAT to be the superior treatment modality to abstinence-only treatments. One study found 49% of individuals on MAT were able to successfully manage their opioid dependence, compared to only 7% of individuals following an abstinence program. A randomized controlled trial showed that retention (a measurement of how long patients manage to stay off of opioids) was greater for MAT (438.5 days) as compared to abstinence-based treatment (174 days). Another study found that 75% of individuals on buprenorphine remained consistent with their treatment for one year compared to patients that did not use medications.
The National Treatment Outcome Research Study (NTORS) demonstrated significantly lower rates of opioid use in individuals using MAT compared to abstinence-based treatment. In this study, participants reported a significant improvement in their quality of life when on MAT. This percentage dropped from 49% in patients receiving Medication for Addiction Treatment to 7% when they were tapered off the medication.
Abstinence treatment programs are associated with significantly higher relapse rates. According to one study, 59% of individuals undergoing an abstinence-based program relapsed within one week, with the number reaching 90% within one year.
The evidence is abundantly clear: Medication for Addiction Treatment is much more efficacious than abstinence-based programs. Coupled with the proven safety profile of buprenorphine, naloxone, and methadone, Medication for Addiction Treatment is so far our most potent weapon in the war on opioid dependence.
To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment in comparison to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.