On MAT, re­mem­ber re­cov­ery is the goal

Cecil Whig - - LOCAL -


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!

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