Methadone, Suboxone and Vivitrol; Medically-Assisted Treatment (MAT) for Drug Addiction
Drug addiction in this country has reached a level so great that we now call it an “epidemic”. And in truth, it has spread as fast as many globally known contagions. So, what do we do about it?
The first step in fighting addiction to drugs such as heroin and substances like alcohol is to understand that once you become addicted to these substances, it changes your brain. Addiction becomes like a disease; a chronic ailment of a major organ or system (ie the brain). Many would say addiction is a disease.
While some of the damage can be healed with time, therapy, community support and medically-assisted treatment, others are permanent and will at most be brought to an “in remission” state (your brain does not un-learn what has traveled along it’s “reward pathway”). A better understanding of this brain disease goes a long way for someone fighting addiction as well as to help, inform and support their loved ones.
Opiates and the Brain
Once addictive substances enter our body they go strait to our brain and bind to opioid receptors in our brain. Our brain responds by producing a substance called dopamine. Dopamine makes us feel pleasurable and it is the substance in our brain that causes “the high” we feel under the influence of these addictive substances. With persistent use or abuse, our brain is reprogrammed to expect and crave for this pleasure. This craving and longing becomes the basis of addiction-in-action and if the body does not receive the substances it craves, it experiences withdrawal symptoms. This is the cause of not only the behavioral changes in addicts but also the bodily side effects such as nausea, vomiting, headaches and muscle aches. These reasons also make it clear that while use of these substances is by free will in the beginning, once a person is addicted, they are in fact struggling with a disease and require treatment to counteract the above mechanism.
There has been a lot of controversy (and misinformation) in the addiction treatment field when it comes to methods of intervention and care. For the addict and family looking for treatment options, just trying to find the right treatment center or physician can in itself seem overwhelming. When it comes medication-based interventions and treatment it can seem almost impossible to determine what is research, what is opinion/personal account and where the line between them falls. Hopefully the information below will at least give you a basic run-down so you can feel better informed and prepared to talk with your doctor.
(*Please note; we do NOT support all of these treatments. This article is simply to give you some clear, basic information).
Methadone is a drug that belongs to the class of drugs (which includes heroin and morphine) that binds to the opioid receptors in the brain discussed above and causes the usual effects that these drugs produce. Methadone is an “agonist” – an opiate used to treat an opiate. However, these drugs reportedly don’t produce the same high associated with drugs such as heroin. In this way they are used to reduce the cravings associated with addiction and limit the withdrawal effects seen in drug abuse. Methadone dosage is carefully adjusted and tapered off with recovery and abandonment can cause resumption of the withdrawal symptoms.
However, methadone is itself a habit forming drug and is intended only to be taken under the supervision of doctors and with proper counseling. Moreover, alcohol should be avoided when taking methadone. It can also cause slow breathing, alter heart rate and cause dizziness or weakness. If overdosed or severe side effects are seen, a physician should be contacted immediately as overdose has the capability of being fatal. Methadone is a “lifetime” treatment – meaning it is used for maintenance and being eventually off it is rarely a part of the treatment plan.
Suboxone is a combination of Buprenorphine and Naloxone. It is a partial agonist opioid treatment. Suboxone acts in a similar manner as Methadone by attaching to the opioid receptors and causing the above mentioned effects in the same manner. However, Suboxone is a partial-agonist opiate and causes these effects “partially”. This means that the intensity of the effects are not the same level as when using Methadone even though the general effects are the same. Reportedly, if you increase the dose of Suboxone beyond a particular level, the strength of any side effects will not increase any further even though the dosage is increased. This makes Suboxone much safer for use as any overdose or abuse is not nearly as potentially harmful as with Methadone. However, patients who were addicted to extremely high doses of opiates may not benefit as these drugs won’t produce the intense effects they crave. Additionally, there are concerns that some physicians may be prescribing the drug as a “maintenance” treatment, like Methadone – which is very expensive and to many is contrary to many of the missions of addiction treatment in that this prevents the addict from ever really becoming drug free.
Vivitrol is a non-addictive drug, unlike both Methadone and Suboxone, and helps prevent drug use or relapse. Vivitrol blocks the opioid receptors in the brain and is said to be an antagonist – having no opiate properties at all. By blocking the receptors it blocks the high or pleasure one normally feels with drug abuse and helps eradicate withdrawal symptoms. It is taken as an intramuscular injection (IV) every month which is intended to stop any chance of abuse or overdose and also makes successful compliance much easier for the patient.
However, it is only started after the patient has stopped taking the substance for seven to ten days. Care should be taken that no substance abuse is carried out while taking Vivitrol because serious withdrawal symptoms can occur. Side effects include damage to the liver and hence if any symptoms associated with liver damage such as nausea, vomiting or jaundice occur, a physician should be contacted. (Vivitrol can be started while in a residential treatment program and before discharge. You can speak with your physician to determine if this is right for you).
It is important to note that it is ill advised and potentially deadly to begin and/or continue the treatment of addiction by yourself. This should only be done under the supervision of physicians and counselors who will help you decide and locate the best treatment options available based on your personal situation and need. Detox should always be done in a safe, professional and medically monitored environment.
And keep in mind, abstinence is the best path, over time. Any treatment for addiction that sees medication as a long-term treatment or “maintenance” should be treated very cautiously. Addiction recovery isn’t easy – anything worth doing rarely is. So, if someone is “selling” you a fast cure, in all reality, it probably isn’t. Medication for addiction recovery is like a cast for a broken limb; it may be needed for a brief period to hold things in place while healing begins – but who wouldn’t question wearing one for several months or years? Talk to a seasoned, addiction professional and also talk to a doctor or psychiatrist who is actually trained and boarded in addiction medicine.