Medication, abstinence offer different roads to heroin recovery
As medication-assisted treatment for opioid addiction grows in popularity, it also remains controversial.
Methadone and buprenorphine - two of the main medications used to help opioid addicts stay off their abused substances - draw critics because they contain opioids. Methadone is a full opioid used for decades in addiction treatment, while buprenorphine is a newer drug, a partial opioid and partial opioid blocker; it also contains naloxone, the opioid overdose antidote that's increasingly being used by first responders to save lives.
The easy criticism is that putting patients on these medications is replacement therapy, switching out one addictive drug for another of roughly the same chemical characteristics that also leads to dependence, and, if abused, to addiction. Chelsea Laliberte challenges everyone she encounters in her job as founder of the anti-heroin advocacy nonprofit Live4Lali in Arlington Heights to move past that surface-level skepticism.
"I had the same concerns as a lot of other people," Laliberte said. "Isn't this just replacing? How do you actually build back clean, healthy cells when you're on the same type of chemical that you were addicted to? I didn't understand the science behind it."
The science is Kathie Kane-Willis' specialty. She's director of the Illinois Consortium on Drug Policy at Roosevelt University, and a frequent researcher of all angles of the heroin problem. The science says consistent treatment with medication helps recovering addicts avoid the flu-like symptoms of withdrawal: the anxiety, chills, aches, yawning and nausea that combine to feel like death. When addicts don't experience withdrawal, they're more likely to stay in treatment. And the longer someone stays in treatment, the less likely he or is he is to relapse.
"One of the reasons people stay addicted to opiates is to deal with the withdrawal," Kane-Willis said. "That's what makes, in some ways, quitting opiates so much more difficult. One of the things both buprenorphine and methadone do is they remove withdrawal from the equation."
Kane-Willis said research has found these medications more effective at retaining patients in treatment than methods without prescribed medications - like the abstinence track preferred by followers of 12-step recovery programs.
An analysis by Cochrane, a resource for doctors that gathers and summarizes evidence from medical research, found 11 top studies all determined methadone to be "statistically significantly more effective than non-pharmacological approaches in retaining patients in treatment and in the suppression of heroin use." Another Cochrane analysis found consistent doses of 16 milligrams of buprenorphine reduced illicit opioid use better than a placebo.
"We can say it's the most effective," Kane-Willis said. "But we can't say it's the best for any one individual."
It's also impossible to say just how much more effective medication-assisted treatment is, Kane-Willis acknowledges, because too many factors cloud the picture. Variances in the dose of medication prescribed, the length of a person's addiction before seeking treatment, adherence to doctor guidelines and whether mental illness is at play all can affect the success or failure of medication-assisted treatment.
The key is providing options in a world that Laliberte says often tries to shoehorn addicts into abstinence-only recovery and stigmatizes them for seeking help through ongoing treatment with meds.
"You have to give people the tools and they have to do what's right for them," Laliberte said.
Chris Reed of Crystal Lake, president of New Directions Addiction Recovery Services, agrees.
"It's not 'medically assisted treatment is the way to do this;' it's not '12-step is the way to do this,'" Reed said. "It's 'all of those things can work.'"
In Reed's own recovery, he chose not to seek medication.
"For me it was a fundamental issue. I needed a different solution in my life, like, an entirely different solution other than drugs and alcohol," Reed said. "And that wasn't going to happen by only taking one medication. It was going to be me changing every area of my life."
Laliberte said 12-step programs have saved a lot of lives. But Susan McKnight, substance abuse program coordinator for the Lake County Health Department, said one danger comes when people see addiction recovery as a mental-only effort in building the ability to say no.
"We're treating it as a physical disease. It's not an issue of willpower," McKnight said. "Addicts themselves don't understand that. If the general public has that attitude, addicts have it even more because they keep trying and not being able to stop."