On MAT, remember recovery is the goal
Editor’s note: Ever since the Whig concluded its “Voices of Recovery” series in 2015, many have asked the paper to continue discussing recovery and addiction. As an extension of that focus, we now present “Shift the Focus” an every-other-week column by Lorri Irrgang, a local author, recovery advocate and mother of someone in recovery. Join us as Lorri discusses many topics pertinent to the recovery movement.
ELKTON — As many of you know, my last column was about the stigma that runs rampant in our county around substance use disorder (SUD.) For those of you that read “Stigma — Are you guilty?” I can only hope that I was able to change at least one person’s way of thinking about the disease of addiction.
It is easy for people to sit in the judgement of others until someone near and dear to them is suffering. It is often then that a person steps back and re-evaluates their opinion. Many times it takes trauma to occur for empathy to set in. With addiction, that could even mean the death of a loved one.
An acquaintance of mine once expressed that she felt “these kids need to get their acts together. Their parents did not keep enough structure in their home.” I put on my shield of armor and knew that what I was about to tell her would open myself up to possible criticism. I took a deep breath and proceeded to inform her of how my son was “one of those kids” and I was one of those parents.
She got the strangest look on her face. She did not know what to say. Through conversation, the stigma she had placed on addicts and their families changed. It was clear she lacked education about the disease of addiction and the effects it has on the family.
We have seen the overdose rate skyrocket in the past five years in our country. Last month in Cecil County, we had 55 overdoses, seven of which were fatal. These overdoses were of loved ones from all socioeconomic classes. They ranged in age from 27 to 75. Some were children and others someone’s spouse, aunt, uncle, mother or father. A few were even someone’s grandparent. Some were from divorced homes and other were not. This disease does not discriminate and neither should we.
We must start to accept that each person has the right to pursue what works for his or her recovery. It is for this reason that we must be open-minded about the treatment options available. The goal is for sobriety, so why not support however our loved one chooses to reach that goal? As a family member, our recovery is different and separate from our loved one. We must remember that.
Many people accomplished long-term sobriety with complete abstinence. This means they have not had a drink or a drug during their journey toward sobriety. Many people in recovery believe this is the only way to remain sober. This method takes a great deal of courage and hard work — but it does not work for everyone.
A more controversial way toward sobriety and regaining their lives is through medication-assisted treatment (MAT.) Other than complete abstinence, this is the most effective intervention to treat opioid use disorder. It is more effective than either behavioral interventions or medication alone.
I have heard situations where people who have choose abstinence ostracize their fellow peers for choosing MAT. My dear friend’s daughter, a single mother, has struggled trying to remain sober for several years after the loss of her father and sister. She is currently on a MAT program that is working for her. She goes to work, pays her bills and takes sole responsibility for her child. Yet, she is not comfortable going to local 12-step meeting. The stigma that this abstinence-based program projects is that people on MAT are “not really sober.”
I question how knowledgeable the public is about MAT? Is our loved one substituting one opioid for another? If this is a chronic disease, isn’t there a chance that maintenance medica- tion is beneficial? It is for this reason that I want to provide some basic information about MAT that is available for your loved one.
To understand MAT, we need to understand what happens to the addicted brain: It is hijacked. Opiates work by crossing the blood-brain barrier. Once across, they attach to the receptors on the brain cells. This triggers the brain activity that produces dopamine. This chemical helps control the brain’s reward and pleasure center. The high that people feel is a result of this.
In 1960, methadone (an opiate) was first used to treat people addicted to heroin or narcotic pain medicines. People take this once a day in pill or liquid forms. This drug works because it changes how the brain and nervous system respond. It creates an effect called cross-tolerance. Methadone lessens the withdrawal symptoms from the opiates. At the same time, it is blocking the euphoric effects of other opiate drugs. If they decide to take heroin, morphine, oxycodone or hydrocodone, they do not feel it. This leads to the disadvantage of this MAT. People can overdose and die on methadone because they do not feel the high that is being blocked. Consequently, they take too much.
Methadone must be prescribed in a structured clinic. There is a potential for addiction of this medication. Methadone therapy when prescribed correctly is tapered off over a period of time.
The latest advance in MAT is buprenorphine. The FDA approved this drug in 2002 to treat addiction. This medication occupies the same receptors in the brain that opiates target. It diminished the symptoms of withdrawals, symptoms and cravings. If a person tried to use heroin at the same time as buprenorphine, the heroin would have no effect.
A patient takes buprenorphine orally. Patients must be off opioids or alcohol for seven to 10 days prior to receiving this medication. This drug can be administered in physicians’ offices versus structured clinics. This gives increased treatment access for this drug.
Suboxone is a combination of naloxone and buprenorphine. It locks onto the opioid receptors in the brain. Other drugs are prevented from attaching to those receptors and blocks cravings. Suboxone helps with detox and abuse is less likely.
Naltrexone is also an opioid antagonist used to treat both alcohol and opioid addiction. It blocks the “high” that users experience when they use opioids. It helps to discourage further drug use. This in turn minimizes the relapse risks. Vivitrol injections are an extended release medication of this group and last about a month. It is useful to prevent relapse after a successful detox from other opioids, and can be used as an alternate to suboxone or methadone.
A typical treatment process for MAT includes a physician consultation and evaluation. The physician determines whether the patient is suitable for MAT. If the patient is suitable, the doctor will prescribe the medication. The medication cannot be taken until the person begins to experience withdrawal symptoms. This includes an induction phase to determine the proper dose. Then the stabilization phase to determine the minimal dose required to avoid withdrawal. Lastly, the maintenance or withdrawal phase from the medication.
When structured clinics or physicians are prescribing MAT appropriately, counseling and psycho-social support groups is part of this treatment. This is an important component that provides individual or group counseling. It includes family support, as well, and referrals to services in the community.
For long-term recovery, a strong and supportive 12step program offers the best chance of success. It is up to our loved one’s personal choice whether abstinence or MAT is right for them. With accurate information from a health care team, our loved one can make that choice. Remember, sobriety is the goal. How they get there is up to them.
If you or a family member need support, call Let’s Get Real/S.T.E.P.S. Recovery Resources at 443-350-0909. You do not have to do this alone!