Medication-assisted treatment: What it is, who it's for, and how it fights addiction
Brittany HornTreating addiction with medication is the new norm — and considered the best practice by the medical community.
"There is good evidence that medication-assisted treatment is the gold standard," said Dr. Elizabeth Brown, who is trained as a family physician and currently serves as the medical director of the Delaware Division of Medicaid and Medical Assistance.
Medication-assisted treatment comes in many forms, but what exactly does the term mean and who is the treatment best suited for?
We compiled the best practices and what you need to know about medication-assisted treatment options, plus where to get it here in Delaware.
Methadone
What is it and what does it do? A synthetic opioid — available in pill, liquid and wafer forms — used to help people reduce or quit their use of heroin, prescription pain medicines or other opioids. The medication, taken once a day, blocks the euphoric effects of heroin and other drugs, lessens cravings and reduces painful withdrawal symptoms.
How is it administered? Methadone must be administered by a doctor at a hospital or clinic with an opioid treatment program registered with the U.S. Drug Enforcement Administration and certified by the Substance Abuse and Mental Health Services Administration, an agency within the U.S. Department of Health and Human Services known as SAMHSA.
How effective is it? Methadone has been used for decades to treat addiction, but unfortunately, can carry with it the stigma of methadone clinics and long lines of people waiting outside. SAMHSA calls it safe and effective when used as prescribed, though cautions that it can be addictive if abused.
Who is a good candidate? Doctors often say those struggling with addiction can consider methadone as an option if they are attempting to wean off heroin or another opioid. Delaware's Dr. Brown said all people trying to recover from addiction should be offered medication-assisted treatment in whatever form they prefer and that previous failures with other forms of therapy should not be a prerequisite for this treatment.
Where can I get it in Delaware? Numerous providers in Delaware, including Connections Community Support Programs Inc. and Brandywine Counseling and Community Services, offer methadone.
[How one Delaware couple used methadone to stay sober]
Buprenorphine
What is it and what does it do? This opioid medication — also known by the brand name Suboxone (which includes the overdose-reversing drug naloxone) and Subutex —comes in a pill or a film placed under the tongue and is used to reduce cravings for opioids such as illicit prescription painkillers and heroin.
How is it administered? Buprenorphine can be prescribed or dispensed in physician’s offices without the structure that comes with methadone.
How effective is it? SAMHSA says when it’s combined with counseling and behavioral therapies, it “provides a whole-patient approach” to treatment, is safe and effective and represents “the latest advance in medication-assisted treatment.” However, like methadone, it can be abused — or sold, because it can be taken at home.
Who’s a good candidate? SAMHSA says the ideal candidate is someone willing to follow safety precautions, follow through on doctor and therapist visits and avoid alcohol and benzodiazepines (as is the case with methadone, as well).
Where can I get it in Delaware? More providers and doctors are offering this medication throughout the state. Because it doesn't need to come from a specific clinic, people interested in this should look for doctors certified to prescribe buprenorphine.
[Delaware's efforts to fight addiction cause more confusion ]
[These injections can help Delawareans overcome their heroin addictions]
Naltrexone
What is it and what does it do? Known by the brand name Vivitrol, naltrexone is a medication that's used to treat opioid and alcohol use disorders by blocking the effects of and reducing cravings for drugs such as heroin, morphine and codeine. Unlike methadone and buprenorphine, it blocks opioid receivers rather than activating them.
How effective is it? A study from the University of Pennsylvania concludes that naltrexone and other antagonist drug treatments can reduce the rate of relapse. But researchers say more study is needed to determine the long-term effectiveness of naltrexone - which was first approved for opioid dependence treatment by the U.S. Food and Drug Administration in 2010.
Who's a good candidate? Patients interested in using naltrexone must not use opioids and opioid medication for a minimum of seven to 10 days before starting or reintroducing naltrexcone.
Where can I get it in Delaware? More physicians are offering naltrexone throughout the state, including many major treatment providers. The Vivitrol website also allows people to enter their address or zip code and find a provider near them.
How these injections are helping one Delaware man stay sober
Need more help?
The state Department of Health and Social Services has compiled information on all providers offering treatment (and not just medication-assisted) on its website, HelpIsHereDE.com.
This site allows viewers to change what they're looking for and see a corresponding list to match. Connections and Brandywine Counseling are certified to offer all three types of medication-assisted treatment.
Federal websites also allow people to search for providers near them based on the type of treatment they're looking for.
The state runs the following help lines for those in need:
New Castle County: 800-652-2929
Kent and Sussex counties: 800-345-6785
Sources for this reporting include: Louisville Courier Journal, HelpisHereDE.com, U.S. Substance Abuse and Mental Health Services Administration, National Institute on Drug Abuse, American Society of Addiction Medicine, The National Center on Addiction and Substance Abuse, National Institutes of Health.
Contact Brittany Horn at (302) 324-2771 or bhorn@delawareonline.com. Follow her on Twitter at @brittanyhorn.