Is Buprenorphine the Best Place to Start When Treating Opiate Addiction in Young People?
With all of the recent news surrounding the invention of new buprenorphine based addiction treatments, there has been a lot of talk about the benefits of MAT, or Medication-Assisted Treatment. The topic is mired in controversy, with some of the biggest proponents being family members who have lost loved ones to opiate addictions. While this article is not attacking or ignoring the potential benefits of buprenorphine and other Medication-Assisted Treatments in the right settings, I do want to play devil’s advocate here and explore the possibility that when it comes to young people struggling with opiate addiction, buprenorphine might not be the best starting point.
When Harm Reduction Can Work
Of course, any exploration of an unpopular perspective would be incomplete without first acknowledging that the issue is not black and white. There are a number of situations where MAT can be greatly beneficial – specifically when helping individuals with years of opiate addiction behind them. When someone has been physically addicted to prescription pain killers, heroin or any other opiate for many years, the possibility of reducing the damage to their health and the risk of overdose is very important. A 50 year old addict who has been physically dependent on opiates for decades can experience monstrous withdrawal symptoms and has to contend with rewiring behaviors and habits that have become deeply entrenched into their every day life. If MAT can help this individual increase their quality of life and safely change their lifestyle, then it can certainly be beneficial. Buprenorphine can also be very useful in clinical settings to help an individual get through their AWS (acute withdrawal symptoms).
No One-Size Fits All Solution
When working with addicts in recovery of any age, one of the tenants of effective help is understanding that addiction is not black and white, and there is no one-size fits all solution. There are all kinds of different circumstances that lead people to get sober. While the underlying addiction is the same, regardless of age or circumstance, effectively helping people means recognizing them and treating them as individuals.
This means that the approach to working with young people getting sober has to be different on a certain level than the one working with people who are a lot older. Expecting an 18 or 19 year old to respond to things the same way that a 40 or 50 year old will is unrealistic. This is one of the reasons that peer grouping is so effective in recovery. When you are willing to meet someone where they are at rather than expect them to be somewhere else, the chance of reaching and helping them is much higher.
Understanding that what works for one person or one group of people may not necessarily work for another is a key component when it comes to successful recovery. But what does all of this have to do with MAT?
The Progression of Addiction
There are a lot of different methods and approaches when it comes to dealing with addiction. In order to be effective when working with someone, the approach taken has to be dynamic and designed to be effective what that specific individual. With that being said, young people – 17, 18, 19, 20 year olds, etc – do not have the same kind of addiction history as someone who is 2 or 3 decades their senior. Expecting a treatment approach that is effective with a 50 year old to work the same way with someone much younger is unrealistic. Most of the time they have not been strung out on opiates for the same length of time. This is good news for their chances at having a totally new life, free from drugs and alcohol. Does it make sense to guide their first attempts at recovery with a new substitute opiate, when they haven’t yet fallen into the same decade long pattern as older, more experienced users?
Abstinence and Recovery
To make the claim that young people have no chance of achieving recovery independent of medication assistance, is a limiting belief that removes their opportunity to do otherwise. Many young people have been using for a short enough period of time that not only is abstinence a distinct possibility, it is absolutely obtainable. Giving a young person the appropriate support and addressing the underlying issues contributing to their addiction gives them a long term solution that is not dependent on continued consumption of a drug. They are not as far in the progression of their disease and physical dependence has not been going on for as many years. To turn around and place them in a position where their “sobriety” is now contingent on a partial opioid agonist before trying other methods sells them short.
This is not to mention the physical and emotional side effects that come with long term buprenorphine use. Just like heroin or any other opiate, buprenorphine is both physically and psychologically addictive. It works on the same receptors as heroin in the brain and while the euphoric effects it produces are less than that of traditional opiates, it is still highly addictive. Coming off of a buprenorphine dependence can take weeks or months to get through the physical withdrawal and the emotional impact can be equally difficult and uncomfortable. Making this the de facto answer to a young person who has potentially only been using opiates for a few years is shortsighted.
The initial stabilization that buprenorphine provides can also be accomplished by utilizing initial detox services and then helping a young addict get placed into a healthy community setting of peers. These sorts of measures and long-term community and emotional support, are much more effective when it comes to helping young people get and stay sober.
Limiting A Young Person’s Options
To force a young person into a situation where they begin to rely ultimately on buprenorphine in order to maintain stability in their life is not addressing the causes and conditions of their addiction in the first place. There are definitely situations where MAT has it’s uses, and there are treatment facilities and programs that utilize buprenorphine and are working hard to help save the lives of many addicts. But using it as a primary means to treat young people who are battling opiate addiction does not make sense and can box them into a situation that has long term negative effects.