Ideal vs reality based treatment (Stigma part 1)
I want to address the subject of treatment of opioid use disorder with medication assisted treatments (MAT). This is a topic that will begin a series on stigma. Let’s start off by acknowledging that this topic may feel controversial to some. I am hoping that when you finish reading this post, you will have a better understanding of why it has been and perhaps why it shouldn’t be. This is mostly geared towards Buprenorphine, though to be clear, MAT does not just refer to Buprenorphine and in a later post, I’m going to explain about the sheer stigma associated with the term MAT in general, but that’s for a later day.
Before we begin discussing MAT, let’s talk about the fact that opioid use disorder is a chronic condition. It therefore like all chronic conditions cannot simply be “cured” and requires chronic management. I think we can all agree on that; as even if you hold to an “abstinence only” philosophy, you still would encourage the use of mutual support meetings and continued recovery work, right? Agreed, so chronic conditions require chronic management, albeit at different intensity levels. Effective treatment is not a “one and done”, nor is it like treating an infection with an antibiotic.
The medical community recommends that opioid use disorder requires a multifaceted, multimodal approach to treatment. That would be the fancy way of saying that treatment involves a variety of key ingredients, including therapy, mutual support, step-work, pharmacotherapy where appropriate, etc. When I treat someone with MAT, I do not suggest to them that this is all they need – no “That’s it, you’re good to go”. I always encourage the use of a variety of strategies, explaining very clearly that I cannot be certain which areas will work best and that the evidence most supports the need to utilize a multitude of approaches to reach the most successful outcomes.
So now what about the ideal goal? The ideal goal for most medical conditions is to make behavioral changes and not need medication. This is true for diabetes type 2, high blood pressure, and high cholesterol, to name a few of the most common conditions. Now then, how many people do we know who are successfully able to manage these conditions without the use of medications? I dare say the numbers are rather low. But what if we didn’t give them a choice? What if we said, “You have 28 days to get your diabetes and weight under control, change your diet and then that’s it, no more Metformin” (a common diabetes medication). How many would have a controlled blood sugar? If you said “none”, you’d be nearly correct. So why expect this of people with another chronic condition, say like opioid use disorder? Do we ever kick someone with a high blood sugar out and say “come back when you really want this” or “if you were serious, you’d keep your blood sugar under control.” No, that sounds ludicrous! But we say this to people with opioid use disorder all the time. We tell them that if they want it, they’ll get it together.
Perhaps there’s a more realistic goal. Maybe the use of MAT is helping the person to stay in recovery, get and maintain a job, spend time with their children and loved ones, stay out of legal trouble, find and maintain housing and achieve a quality of life they deserve. Why deny them that? Because they aren’t doing what we think they should do? Because they are on medication? I don’t buy it. I believe that the medications for opioid use disorder help someone to be the person they deserve to be, to live the life they deserve to be living. It’s not about judging them and refusing to acknowledge their accomplishments. Remember, the person with diabetes still needs to watch their diet and exercise. No doctor that I know has ever said, “oh yeah, just take this pill and your diabetes will be all better”. Similarly, someone utilizing buprenorphine still needs to do the work. It isn’t about whether or not they are serious or “really want it”. It’s about not dying and getting into recovery, however they achieve it.
I know I may not have convinced everyone, but I urge you all to please give this at least a thought. People are dying and we have treatments that can help. Stigma is killing people as well, by preventing people from seeking treatment or utilizing all available treatment options - and that we need to also fight.
Please join me in supporting the use of MAT for people suffering with opioid use disorder. If you have more questions or know someone in need of treatment, or if you are in need of treatment, here are some resources below. There are a lot of good and effective ways to achieve this, so please contact myself (or someone else local to you, and get help).
Some helpful resources about MAT specifically include:
If you need treatment from an addiction psychiatrist, please contact me at 954-755-2885. My office is located at 5551 North University Drive, Suite 202, Coral Springs, Florida 33067, with Kimmel Psychology. I have evening hours available as well. Don’t wait.