Over the years, buprenorphine has been proven to be an effective medication to provide brain stability for those with opioid addiction. Many inpatient drug rehab programs and outpatient addiction treatment providers provide a medication like buprenorphine to patients. The biggest problem with buprenorphine is that most patients stop taking it too soon. The National Quality Forum recently endorsed a minimum treatment time of 6 months when a patient is provided buprenorphine for addiction. The American Journal of Psychiatry recently published a study based on multi-state Medicaid claims pulled for a four year span, covering over 45,000 beneficiaries combined. The goal was to compare cohorts of patients who were treated with buprenorphine products for various durations of time. Not surprisingly, patients who stayed on buprenorphine longer tended to do better: far less overdoses reported, fewer inpatient hospitalizations, not as many emergency department visits reported, and lower number of opioid prescriptions filled. Although adverse medical results were common among just under half of the entire patient population who stayed on buprenorphine less than 15 months. However, once that time in treatment was attained, emergency room visits, inpatient hospitalizations, opioid prescription fills, and other adverse medical results all went down significantly. When buprenorphine was discontinued anywhere along the treatment timeline, risks of adverse consequences increased. This research is important to recognize because there are a lot of myths about buprenorphine and mediation assisted treatment (MAT). For starters, it is crucial to make sure that the drug rehab or outpatient addiction treatment programs use a non-punitive approach with medication dispensing. This means that a patient gets the medication they need to provide brain stability virtually regardless of their other actions (skipping group, showing up late to counseling, etc.). If the patient needs buprenorphine for neurological stability, it should be given to them so that they can function and to reduce the risk of relapse or overdose. It is also crucial that patients who need to stay on buprenorphine for longer periods of time are allowed to do so without stigma or fear of doing something wrong. Being addicted and dependent are very different–a diabetic is dependent on insulin, not an insulin addict. Some people need buprenorphine for 18 months to reduce their likelihood of relapse or overdose, but other people may need it for three or five years. Still other may require medication assisted treatment for their addiction the rest of their lives. That’s okay. It’s great that we can provide medication to patients that produces brain stability so that instead of being controlled by opioid addiction, they can maintain a job, take care of a family, focus on academics, or maintain other commitments. As medical or treatment providers, we need to make sure that patients have the right medication for their health, history, and current life. Some patients do better with methadone. Other need Suboxone (buprenorphine and naloxone). Still others do far better with a once monthly treatment like Vivitrol. We should never look down on someone because they chose a different medication than the one we endorse, prescribe, or use ourselves. If Vivtrol works best for me and methadone is better for you, then let’s both agree that we’re glad we are stable and in recovery. Any medication assisted treatment is better than opioid addiction. Lastly, let’s recognize that medication is not the end all be all of treatment. Counseling, groups, peer support, and social services are crucial. If someone’s goal is to cycle off of Suboxone or lower their methadone dose (nothing wrong with either of those if one of them is already your goal, but please don’t set a medication goal until you talk to your medical provider and a few peer supporters), they need to be in groups, going to counseling sessions, talking to peer supporters, and engaged with social services. We should not be recommending that patients lower their medication dose simply because they have been taking it for a certain period of time. Instead, let’s come beside them with a comprehensive plan to help promote their recovery–and let them and their medical provider worry about their dose. Recovery is possible, and we can help those affected by addiction start and maintain recovery. It starts with expanding access to buprenorphine, according to the American Journal of Psychiatry’s recent research, but it continues with all of the other elements of addiction treatment. To read the entire research study, please click here.
March 9, 2020