The far-reaching span of illicit drug use and the subsequent effects are by no means new in this country, but in the midst of the worst drug epidemic in history—spawned from the gross over-prescription of opioid narcotics—researchers, concerned families and the government alike, are searching frantically for a viable solution to this problem. Given the imminently dangerous effects of heroin and the possibility for acute overdose and death, the need for safe preventative measures is more pertinent than ever.
As is the case with all psychotropic substances that pose the threat of addiction, complete abstinence from the drug is the most commonly recommended means of recovery, but unfortunately, the rate of sustained recovery from addiction by abstinence alone is dismal, with less than ten percent of those seeking to cease their drug use remaining clean for prolonged periods. And while the reasons for this are multi-faceted and hard to pinpoint given the subjective nature of behavioral health, the numbers remain the same, thus leaving a major gap in the successful treatment of this fatal disease.
What are Maintenance Medications?
Over the years, there has been a number of alternative methods proposed in the treatment of opiate addiction. One of these methods, which has caused quite a bit of controversy, is “maintenance medications”. These medications, either prescribed by a physician or dispensed at specially designated clinics, are essentially opiate narcotics with similar chemical attributes to those of heroin. The guiding philosophy behind this is one of harm reduction, a school of thought which promotes policies that aim to minimize the negative consequences of drug use under the acknowledgment of it’s inevitable presence, rather than aim for strict abstinence as we have tried for so long in this country. Along with the introduction of drug-replacement therapy, we have also seen things such as clean needle exchanges, with similar goals of reducing the harm done by illicit drug use at any cost.
What are Methadone & Suboxone?
Under the umbrella of maintenance medications, there are a few key players with slightly different mechanisms of action, the two most popular of which being methadone and suboxone. Methadone, first introduced to the US market in the 1940’s, is a completely synthetic opiate with effects similar to those of morphine.
Heavily addicted heroin users looking to step away from the lifestyle associated with addiction will often opt to move to methadone maintenance, choosing to show up at the clinics every morning for a daily dose as to go through the rest of their lives without having to deal with the getting and using of drugs. While some people are able to remain off of heroin for long periods of time using methadone, many do go back to it.
The Dangers of Methadone
One of the major issues that has come up with methadone, besides the fact that users can get high from the drug itself, is the fact that it does not deter the use of other drugs in any way, often times only supplementing the existing habits of the addict. Much like other opiates, methadone can be abused, sold at street value, and lead to overdose. Another huge detriment in the use of methadone as a means of drug-replacement therapy is the extraordinarily long half-life in the body. Often times, individuals who opt for methadone maintenance will find that it is nearly impossible to come off of the drug due to the drawn-out and overwhelming symptoms of withdrawal. All of these things considered can make this a very poor candidate for long term recovery from heroin, but years later another alternative was created that filled in some of the gaps left by methadone—Suboxone.
The Dangers of Suboxone?
Originally introduced as a treatment for severe, chronic pain, suboxone was approved by the Food and Drug Administration in 2003 for the treatment of drug addiction in the US. Suboxone is the brand name for a drug that is actually made up of two different chemicals—buprenorphine and naloxone—which in conjunction were thought to provide a fool proof means to overcome opiate addiction.
Buprenorphine, much like methadone or heroin, acts on the opiate receptors, giving it analgesic (pain-killing) qualities. As such, it is also highly addictive. Naloxone, on the other hand, is actually an opiate blocker which a higher binding affinity to the receptor site than heroin, morphine, oxycodone, methadone, or any other abused narcotic with the exception of buprenorphine, thus ensuring that the individual does not abuse suboxone in conjunction with other illicit drugs.
One of the other trademark characteristics of suboxone, or buprenorphine in particular, is the absence of euphoria upon administration. It is believed that suboxone cannot be abused in any way, although many street users beg to differ, stating that there is, in fact, some recreational value associated with suboxone. If nothing else, suboxone is often just used as a buffer, allowing addicted individuals to remain “well” when they cannot find or afford their drug of choice. And while there has been some rate of long term success with suboxone as drug-replacement therapy, it still displays a dismal rate of sustained cessation from illicit drugs, with many users having opted for suboxone maintenance and having returned to their drug of choice.
Why Replacement Therapy Doesn’t Work
So all of this raises the question of why these drugs are so ineffective? In theory, if taken as advised, drugs like suboxone should be a cure-all solution for any individual caught in the grips of opiate addiction. Of course, they are not. There are a couple of theories as to the gross inefficiency of drug-replacement therapy, one of which is that as a means of treatment, it does not address the addictive behavior at all.
In fact, it only serves to reinforce it. Some people believe that replacing one drug with another and prolonging the maladaptive behavior will generally end with the same outcome, as the user will tend to go back to their drug of choice. Others believe that without addressing the underlying emotional issues at hand, the psychological components which drive drug addiction will always draw the addict back to a place of comfort in drug use.
Medical Detox is Recommended for Drug Abuse
All things considered, it seems that a dynamic and multi-faceted approach in the treatment of addiction is necessary, drawing aspects from psychological, environmental, as well as medicinal fields in order to ensure the greatest hopes for success. That said, there is one area where the drugs spoken of above are of great importance—the detox process. Given the awful symptoms associated with opiate withdrawal, it is highly recommended that individuals seek out some level of supervised, or clinical, detoxification facility.
Drugs like methadone or suboxone, prescribed in a short taper, can greatly reduce the discomfort of withdrawal, which is often one of the biggest impediments in the cessation of opiates for the user. The facilitation of a slightly easier detox process by these medications has proven to be a great asset in the overall treatment of drug addicts, but they are not a cure all. If you, or someone that you know is struggling to get off of drugs, please reach out for professional help.