TEMECULA – Addiction treatment has, for the last 40 years, relied on various medications to enhance safe detoxification. Medications, like benzodiazepines – Valium, Klonipin, Ativan, etc. – allow physicians to slowly help the brain to achieve homeostasis and avoid life-threatening seizures or delirium tremens. Other medications, like Disulfiram or Antabuse, have served to dissuade alcoholics from drinking by creating severe sickness if used in conjunction with alcohol.
More recently, after much resistance from the addiction treatment field, antidepressants like Prozac, Paxil, Zoloft, etc. became acceptable to the addiction industry. Now, medications are emerging like Campral and Naltrexone, with the promise of diminishing cravings. The point is that medications have been a part of “abstinence based” treatment for years. While the field, gradually, accepted these medications; the ultimate goal of treatment programs was abstinence-based outcomes.
The philosophy was reinforced by 12-step programs like Alcoholics Anonymous and Narcotics Anonymous, which often served as the personal recovery foundation for most of the management and clinical staff in programs across the country.
A small group of treatment programs, which believe in harm reduction, held that for some, drugs like opiates were best treated with Methadone and was far superior to abstinence. An uneasy, begrudging acceptance existed between these two schools of thought. However, Methadone programs were viewed, for the most part, as pseudo-treatment and that those on methadone, were not in recovery. All of this turmoil was about to change in 2004.
With the epidemic of opiate addiction in 2004, medications like Hydrocodone, Oxycodone and others resulted in a flood of pain pill users admitted to treatment facilities, jails and emergency rooms. The truce gave way to open conflict and criticism. The addiction field formed into two adversarial camps, resulting in name calling and further division. It was during 2004 that Hill Recovery outpatient program decided to use Buprenorphine or Suboxone, with tremendous success and much criticism. The recovery center was called an “opiate maintenance” program by inpatient peers and was openly criticized for using Buprenorphine over extended periods of time. Hill Recovery considered it patient -centered treatment, and outcomes soared. Unfortunately, even today the American Society of Addiction Medicine reports that less than 30 percent of treatment programs offer medications, but the positive results were irrefutable for the center.
To make matters increasingly contentious, but infinitely more hopeful for the opiate addict, the medication for opiate dependence was approved and championed by the federal government. It also was demonstrated, in study after study, to work. As the Drug Enforcement Administration clamped down on the national spread of pain pills, addicts began to discover that heroin was cheaper and easier to acquire. Emergency rooms, morgues and treatment programs began to fill with heroin-dependent patients.
Programs willing to use Buprenorphine medication-assisted treatment programming were few in 2004. However, they saw their recovery rates sky rocket with greater patient retention and found unique ways to use Buprenorphine, in conjunction with treatment; thus, enhancing outcomes from single digits to high double digits.
The inpatient programs were having their philosophical foundations rocked, while many potential patients were now going into outpatient treatment or seeing individual Buprenorphine-certified physicians, instead of going into opiate detox in residential programs.
Finally, science had caught up with the addictions industry. Ironically, organizations like the National Association of Alcohol Treatment Providers were threatening to boycott the American Society of Addiction Medicine because of their support of Buprenorphine and its confirmed success at helping to save lives. Simultaneously, the federal government and the most prestigious physician’s groups were in direct conflict with the largest and oldest inpatient treatment provider’s group over a medication that was demonstrated to save lives and served to help opiate addicts find their way to recovery.
Then, the unthinkable happened. The Hazelden Institute, directed by Dr. Marv Seppala, bought the Betty Ford Center, who were both staunch critics of Buprenorphine, and announced that they were going to begin to open Betty Ford Center outpatient programs and embrace medication-assisted treatment along with long-term use of Buprenorphine. This move proved to be a game changer, as both were key figures in NAATP.
In the 1980s, The Hazelden Institute was the leader in the creation and integration of the 28-day treatment program and 12-step programming with family therapy. The Betty Ford Center furthered the treatment of children from addicted families, under Jerry Moe’s brilliant leadership.
Today, the field of addiction treatment is at another crossroads, as they begin to integrate science deeper and deeper into the field. Treatment centers must acknowledge that abstinence from addictive substances can be enhanced by the schooled, studied embrace of medication enhanced recovery.
It is important to note the key factors that allow Buprenorphine to be so effective and safe. Buprenorphine does not create a tolerance, produce a high or lead to overdose. It serves as a blocker on the Mu and Kappa receptor sites, while still eliminating the acute and post-acute withdrawal from opiates and whose anhedonia causes the relapse for so many patients. A secondary gain is that Buprenorphine procedures significant pain relief for 0-6 pain levels and also, serves as a major source of reduction of damaging stress hormones like cortisol. Its sublingual administration makes its highly advantageous for patients who have had gastric bypass procedures.
The field needs to define the parameters, goals and standards that define “recovery.” By splitting into warring camps, treatment centers confused patients and diluted the care that patients deserve.
Ultimately, the future of treatment will increasingly consist of medication-assisted treatment, with the goal being abstinence, plus life function enhancement. Too many people are dying and losing loved ones in this epidemic of opioid addiction. Saving lives must supersede filling beds.
Abstinence-based, medication-assisted treatment is here to stay and will serve to continue to save thousands of lives.
For more information about Hill Alcohol and Drug Treatment, visit www.hillrecovery.com or call (951) 719-3685.