The U.S. continues to grapple with epidemic levels of opioid abuse; more than 28,000 Americans died from overdosing on opioids in 2014, according to the Centers for Disease Control and Prevention. But what treatment options exist for those who are recovering from addiction?
William Morrone, DO, the president of the American Osteopathic Academy of Addiction Medicine, and Merideth Norris, DO, an addiction medicine specialist in Kennebunk, Maine, discuss available treatments—which may or may not include medication, but ideally should incorporate counseling and peer support—and explain why it’s hard to put a timeline on recovery.
“No single treatment is appropriate for all persons at all times, so an individualized treatment plan is critical,” explains Dr. Morrone. Some patients avoid medications and stop using opioids through support from counseling or peer support groups, such as 12-step programs. Others receive medication-assisted treatment, which combines therapy with medications that lessen cravings and block the pleasant sensations of opioids. These medications include:
- Methadone, which requires daily visits to a special clinic at the beginning of treatment. This may be a good option for patients who need extra accountability, though the frequent visits can pose scheduling challenges for people who work.
- Buprenorphine or combination buprenorphine/naloxone, also known as Suboxone. Both medications can be prescribed in a normal office setting by addiction medicine physicians who’ve completed extra training. Because patients who are given buprenorphine alone may abuse or resell it, Dr. Morrone notes, combined buprenorphine/naloxone is a safer option.
- Naltrexone can be prescribed in a normal physician office setting. “Naltrexone has no street value and cannot be abused, so it’s another good option for patients who pursue medication-assisted treatment,” Dr. Morrone notes.
Whatever treatment approach is used, Dr. Morrone and Dr. Norris agree, counseling and peer support should be incorporated whenever possible.
“There’s evidence that the combination of pharmacologic and non-pharmacologic interventions may be more effective than either approach used alone,” Dr. Morrone says. “The greatest sin in addiction medicine is providers writing buprenorphine prescriptions and not connecting people to counseling.”
Duration of treatment
Because care plans for patients with addiction are so individualized, it’s difficult to generalize about how long treatment might last, Dr. Morrone says. “Treatment doesn’t last for an arbitrary number of months or years,” he says. “If you’re treating a 27-year-old patient who’s been injecting heroin for 13 years, you can’t help him restructure his life in 90 days.”
Instead, Dr. Morrone says, osteopathic physicians focus on helping patients pursue functional goals such as finding employment, rebuilding their coping skills, healing dysfunctional family relationships and avoiding friendships with people who encourage them to use.
Dr. Norris likens addiction recovery to recuperating from a stroke. “After a stroke, people’s outcomes are really variable—some recover completely, some have to learn how to walk again and some never get out of a wheelchair,” she says. “It’s not that one of them did it wrong; it’s that the stroke affected a different part of each person’s brain. Substance abuse disorders also injure the brain, so recovery is similarly variable.”