Medication Assisted Treatment -Taking the Edge Off
Doctors overseeing medication-assisted treatment programs use prescription medication to help heroin and/or other opiate abusers break their physical dependencies. Some of the prescribed medications available are Suboxone, Vivitrol, and Methadone. Medication-assisted therapy pairs prescription medications like these with behavioral therapy and counseling. Many people are hesitant of medication-assisted treatment programs because they feel they are replacing one drug for another.
Health professionals use many other types of prescription medications to assist in withdrawal and recovery. Drugs such as antidepressants, lithium, sleeping medications, and even medical marijuana are prescribed to ease the transition off of illegal substances. Many users are finally able to receive a proper mental health diagnosis and a prescription for disorders like schizophrenia and bipolar disorder once they are clean.
Using a drug to treat heroin addiction does sound a bit counter-intuitive, so, on the surface, it is understandable that medication-assisted treatment is viewed as substituting one drug for another. Some programs, like SMART Recovery, are very supportive of MAT and other programs that involve doctors prescribing medications.
My MAT Story
In my last year of law school, I had spent most of my savings on Percocets. Low on funds, I had considered switching to heroin, which has a much lower street value. Suboxone appealed to me because I did not have to miss any school to attend detox. A Suboxone-certified doctor instructed me to stay clean for 48 hours (more or less) and then report to his office, three days in a row, to receive my Suboxone. Within those three days, we determined my ideal Suboxone dose, which factored in my tolerance for opiates and pain threshold for withdrawal symptoms. I stayed on the program, taking two pills a day for one year. Unfortunately, I relapsed after a year and was taken off the program.
Ultimately, this relapse was inevitable. I had decided to start Suboxone for the wrong reasons. If I am 100% honest with myself, I would not have quit if the money situation had not been so dire at the time. Since then, I have witnessed Suboxone be a wonderful tool if the user is ready to recover.
A couple of years later, I was sent to an actual detox program for three days. I was given a Suboxone taper to get the heroin out of my system. After completing inpatient detox, I was prescribed Seroquel and Trazadone. At low doses, Seroquel is prescribed for sleep; Trazadone for anxiety. Most, if not all, long-term opiate users struggle relentlessly to sleep more than an hour at a time. It is hard to relax your body and your mind never stops racing. Seroquel allowed me to get at least 6 straight hours of sleep a night so I could stay focused on my recovery during the day.
Outpatient group therapy sessions, AA, NA and Smart Recovery meetings combined were not enough to keep my mood remotely even. Trazadone allowed me to maintain steady emotion so I could deal with tough issues confronted in recovery. I credit most of my sanity in the first months off of heroin to these prescriptions.
During this period, I attended an Outpatient Recovery Program and lived in a sober living house. Eventually, I was promoted to manage the sober living house. As a result, I became familiar with the medical aspect of our client’s recovery programs. For example, one client had a suboxone implant in her arm, which prevented her from having to take a pill every day. Many people view popping a pill daily as addict behavior, so it is good to know they have innovated a way around this!
Overall, if the client was there to recover, medication-assisted treatment was not a hindrance. In fact, I found it gave many clients an advantage.
Unfortunately, it is not realistic to live in a sober living house forever. (As much as I loved the girls, living in a house with that many women for long periods of time would be detrimental to anyone’s sobriety!)
After moving into my own place, I decided to start on the Methadone Program. Currently, I take Methadone every. Methadone has allowed me to stay clean, keep a job, pay my rent and be responsible. I know I can taper off at any time, but for the first time in a long time, I can do things I love, like write this blog post! 🙂
I realize my story may not be enough to change traditional points of view on the subject:
Many people still believe:
You will just be substituting one drug for another if you get on Methadone!
Outpatient, counseling, and meetings are enough for recovery!
You got yourself into this mess, so you need to deal with it!
You are supposed to deal with your emotions by talking it out.
Am I right?
Well, I agree with you….to an extent, but I challenge you to the following thought exercise.
…In a Recovering Drug User’s Shoes
Instructions: As you read, imagine yourself in the situation. How would you feel? How intense would your emotions be? Do not stop to think about coping with emotions as they arise. Instead, feel each emotion pile onto the previous until you reach the end of the story.
You walk into Dream Company Inc’s reception area. You are there to interview for your dream job. You arrive early. After all, you didn’t have to set an alarm to wake up this morning.
You check in with the receptionist, Anna, a beautifully thin blonde, ten years your junior.
You suck in your gut because the birth of your latest bundle of joy left your figure looking more pear than hourglass. Anna says she will be right with you, without bothering to look up from her computer screen.
You find a seat in the upscale reception area on one of the benches outlining the walls. It is obvious the interior designer was aiming for a hip, modern look, avoiding comfort at all costs.
You become hyper-aware. You lick your teeth to remove any lipstick transfer you may have missed. You picked earth tone eye shadows to compliment your new suit and tan skin and you perfectly shaped your brows. You are especially proud of your near-professional highlight and contouring job; slimming your nose and raising your cheekbones.
Makeup is on point, but as soon as you sit, your eyelids start to sting. The tingling becomes uncomfortable and the weight of your eyelids becomes too heavy to bear. If you don’t do something, your eyes will water, and your makeup job will have been for nothing. So, you blink…
Louder now, “Ms. Applicant? Ms. Dream Applicant?”
Your attention snaps to the receptionist, now standing three feet in front of you.
“Ms. Dream Applicant, they are ready to see you now. Come right this way.”
Walking down the long hallway, you glimpse a mirrored wall in the room at the end of the hall. In the reflection, around a conference table, sits 8 of the company’s top board members. Heads bowed, reviewing personal copies of the cover sheet and resume you sent over two weeks prior.
A million thoughts race through your mind, but reality warps. The hallway turns into a funhouse, miles long, mirrors reflecting distorted images replace the office doors.
You quickly account for how you ended feeling the way you do.
14 days ago: First phone interview complete. You are confident it went well.
10 days ago: You loaded up on Vitamin C when you started to feel sick.
7 days ago: Admitted to the hospital for pneumonia. Treated with IV meds
5 days ago: Sent home with antibiotics. Not able to sleep more than a couple of hours at a time due to an awful cough.
Last night: While finishing up your presentation, you felt the burning pain of a yeast infection. At this point, sleep was not possible. You used these extra hours awake to prepare your presentation for the interview.
Six hours of sleep in four days was going to have to be enough.
Your heart rate rises, gravity seems stronger, and you focus on avoiding an epic trip over your perfectly matched heels. Too scatter-brained to have switched your phone to silent, it rings as you walk through the interview room door. You look down at your phone and read:
From: Husband <3
I want a divorce…
Okay, Ashley, what the hell does any of this have to do with recovery and medications???
Let me explain:
Each event listed on the left produces an emotional response similar to the event listed on the right.
The third column lists how the events are alike, resulting in similar emotional responses
|Interview Event:||Recovery Program Event:||Emotional Response:|
|Biggest Interview of your life||Getting clean and starting a recovery program||Life-changing events with the potential to start a positive new life chapter|
|Preparing your makeup, judging your appearance||Starting from scratch with old tattered clothes, negative self-esteem||Comparing ourselves to others is natural, but, in situations like these, we are overly critical of ourselves|
|Admitted to hospital for pneumonia||Entering detox for a few days||Both physically exhausting and painful, leaving you feeling weaker than you ever have before|
|Yeast infection||Post-acute withdrawal syndrome (PAWS): After detox, the patient experiences PAWS symptoms that can be relentless for months||More physically exhausting health issues, that just will not let up|
|Cough preventing sleep for more than 2 hours, seeing the funhouse illusion in the hallway||Months of not being able to sleep after detox, becoming delusional||Your mind starts to play tricks on you when you have not slept. It becomes very hard to make good decisions and reasoning skills are severely affected. Completely honest self-reflection is near impossible.|
|Text from the husband about divorce||Issues dealt with in counseling or outpatient treatment||Issues like divorce, rape, abuse, mental health disorders, making amends, and so on are enormously stressful for all of us.|
So, truthfully, after feeling each emotion listed in the right column, how would you feel if you were Ms. Applicant?
Would you ace that interview?
No, NO ONE WOULD.
See what I mean? After examining the sheer number and weight of emotions experienced in recovery, it is a wonder ANYONE has done so successfully. No wonder recovery rates are so low.
The average person would not succeed under the conditions laid out above.
However, if a doctor is willing to responsibly prescribe medications to help with sleep, cravings, emotions, etc., real recovery work might be possible.
A Closer Look
Medication Maintenance Prescriptions and Recovery
“You are just substituting one drug for another!”
Suboxone and methadone are opiates, so it is easy to classify them as substitutes for illegal opiate use. However, with a little more research, it becomes clear that an opiate abuser does not get high taking Suboxone or Methadone. The high after snorting Percocet or shooting heroin is in a different class completely.
I could say, trust me, I would know, but I’ll offer an analogy anyway:
Let’s say you are cutting onions when something startles you. Your hand slips and you slice open your finger, blood gushing everywhere. The high from Suboxone is equivalent to relief attained from bandaging the cut, avoiding infection and allowing natural healing. The heroin high is equivalent to the relief attained from using your self-healing superpowers, immediately healing the wound and stopping all pain.
Most opiate users abused substances long enough to change our brain chemistry. Like the bandage facilitates gradual healing of the skin, Suboxone allows for the gradual healing of the brain’s opiate receptors. Like the bandage guards against infection, Suboxone guards against relapse by binding onto opiate receptors without producing a high.
Unlike heroin and pain pills, Suboxone can bind to opiate receptors and simultaneously allow them to heal. Over time, our brain chemistry can work toward equilibrium while on Suboxone.
Trust me, if I wanted to substitute my heroin use for something, it would not be Suboxone. Heroin users looking to substitute will settle for nothing less than a drug-producing an equivalent high.
Prescriptions for Underlying Psychological Conditions and Recovery
Many people abuse substances to self-medicate for serious underlying mental disorders. After detox, a healthcare professional is more capable of making a true diagnosis. Receiving a diagnosis is a relief. Suddenly, there is no reason to continue dangerously self-medicating. A schizophrenic will be prescribed a medication to quiet the voices instead of continuing to shoot meth. A bipolar will finally get a lithium prescription, balancing his emotions, instead of shooting heroin to make the pain go away.
Taking the Edge Off
Lastly, and this will not be a popular point of view to some, but I promised honesty.
Sometimes, it is okay to just ‘take the edge off’. Once you experience an opiate high repeatedly, there are not many things that sound appealing anymore. Let’s support doctors who are responsibly writing prescriptions to ‘take the edge off.’
Medical Marijuana is a great example of a drug that can take the edge off. Legal in most states, tremendous work has been done in using marijuana to treat pain disorders and PTSD. I am hoping to see an increase in the use of medical marijuana for opiate treatment.
Sometimes saying “at least it is not heroin” is okay. Accepting that we need to let people in recovery take the edge off somehow, changes everything. Once the edge is gone, the focus shifts 180 degrees. Instead of feeling crappy and scheming for the next easiest way to get high, the focus is on getting better and forgiving ourselves.
Don’t forget to read the Warning Label!
It is no secret that many substance abusers received their first opiate from a doctor. There are some shady, money-hungry doctors out there. Common sense needs to be used when prescriptions are used in recovery.
If Xanax is the drug of choice, a good doctor will not prescribe Xanax or other benzos, trusting the patient to take it as prescribed. The same goes for any mind- or mood-altering drugs. A legit doctor will examine each situation on a case by case basis.
Ideally, a patient’s counselor, psychiatrist, and doctor form a recovery team to discuss the best path forward. The more communication the more comfortable the patient becomes. If a patient is comfortable, he gains confidence in his ability to recover. Confident patients are more likely to stick a program, stay out of jail, off the streets, and most importantly, OUT OF THE MORGUE.
Remember, no two people become dependent on drugs in the same exact manner. Therefore, no two treatments will be alike. We must conform treatment to the individual, not the individual to the treatment.