Promising Fixes for Opioid Addiction

For the past 70 years, the Hazelden Betty Ford Foundation in St. Paul, Minnesota, has been treating drug and alcohol addictions with a combination of 12-step programs, counseling, and other interventions. Despite the evolution of these tactics over time, the dropout and relapse rates for enrollees have remained high.

Two years ago, the foundation tried a different tack. It offered a new mixture of medications — Suboxone and Vivitrol — to about 500 opioid addicts. Suboxone contains buprenorphine and is a partial opioid agonist that activates the brain’s opioid receptors. Vivitrol is an extended release medication that blocks those same receptors.

The residential program dropout rate [at Hazelden] decreased from 20 percent to around 5 percent with the use of medication.

The use of these medications has helped to decrease the dropout rate. Whereas more than 20 percent of patients dropped out of the residential program in 2013, that number decreased to around 5 percent with the use of medication. The medicated treatment was also accompanied by counseling and other interventions as well.

Many were skeptical of the notion of treating a drug addiction with more drugs. Buprenorphrine is an intense narcotic that can cause dependence, and overdosing on the drug carries the same risks as an opioid overdose — respiratory depression and death. But these new statistics from the program at Hazelden showed that medication treatments had the ability to help a high percentage of addicts overcome dependence successfully.

Tracking data from a large demographic of users has been difficult for researchers over the years, and this amount of well-documented evidence is turning heads in the drug treatment industry. About 114 people in the U.S. die every day from drug addictions, adding up to about 44,000 people each year. The Substance Abuse and Mental Health Services Administration estimates that up to 90 percent of addicts are unable to access help when they need it most.

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These medications could change that. Dependence on opioids is not the same as addiction, Dr. Emily Brunner, an addiction recovery specialist at Hazelden, told LifeZette.

“You can get anyone physically dependent on painkillers,” she said. “It’s a physical side effect of taking them and then getting sick when you’re not using them. That’s not the same as addictive behavior, where you’ve developed a craving or attachment to the drug.”

These drugs cause some of the same activity as traditional opioids, but without the euphoria.

Among the benefits of medication-assisted treatment — it prevents cravings without giving the patient a high. “Instead of yo-yo-ing up and down, it’s in the system as a long-acting medication,” Dr. Brunner said. “It prevents the drive to relieve the feeling of being sick.”

Drugs with buprenorphrine swamp the opioid receptors in the brain, causing some of the same activity as traditional opioids — but without the euphoria. People simply feel normal again.

“I can’t honestly say enough good things about my experience with Suboxone,” Nikki Seay, a 30-year-old senior editor for Recovery Brands in San Diego, California, said.

Seay began using opioids to treat a back injury suffered during nursing school. “They [the opioids] gave me a lot of energy, which I didn’t have to begin with,” Seay said. “Taking two pills made me feel better, and taking four made me feel even better. It just spiraled down from there. It was four or five months before I realized I was in deep.”

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Seay finished nursing school and began working at a clinic — but her dependence was getting worse. “I wasn’t getting high anymore. I was just trying to avoid withdrawal,” she said. Her supervisors at the clinic noticed the signs, and she had to travel to Nashville, Tennessee, to defend her license in front of the state nursing board. “I had prepared a speech, and they didn’t even want to hear it. They didn’t have time for me.”

Seay ended up waiting tables and becoming estranged from her family — until one day she woke up sick of her life and ready to change. But help was harder to find than she had imagined. When she called a local rehab facility, she learned they had an eight-week waiting list. She stuck it out, and when she was finally admitted to the facility, they started her on Suboxone immediately.

Two weeks later she was done taking the medication.

When people are on buprenorphrine, they can’t take any additional opioids, or they’ll go into precipitated withdrawal. Seay knew this, and it helped keep her sober.

“I think that mental deterrent helped me because I couldn’t take anything on top of it,” she said. “It was a very easy taper. I had built it up in my mind that it was going to be a nightmare — that I was going to be sick and miserable forever. It was easy compared to what I had imagined.”

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The medication allowed her to feel like herself again, and she began working through therapy to figure out why she had developed an attachment to drugs in the first place. Now five years sober, she works with Recovery Brands to connect other opioid users to addiction treatment facilities. There are more than 14,500 treatment facilities across the country, and Seay and the team at Recovery Brands help people navigate those facilities to make informed decisions about their care.

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Seay says that medication-assisted treatment was the right move for her, but she emphasizes that each individual has to find the right treatment for his or her own case. Suboxone isn’t a one-size-fits-all medication.

There’s a long way to go before medication-assisted treatment becomes the norm nationwide. People are wary of trading an opioid dependence for a narcotic. Dr. Brunner at Hazelden said increasing the availability of this treatment will involve training doctors and nurses in addiction recovery and expanding government funding to treatment services. But she remains hopeful.

“There’s a huge transformative capacity in treating addiction,” she said. “I get to watch people who are really, really struggling come back to life and get back with their family and go back to work and be happy — with low intervention on my part. There’s a lot of hope in treating addiction, and I think sometimes that gets lost.”

She added, “There are effective treatments — and they are available. It’s just an issue of getting people access to them.”