11 votes

There's a gold-standard treatment for opioid addiction, one of America's top killers. What keeps treatment centers from using it?

2 comments

  1. 45930
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    Calling methadone the "gold standard" and comparing it to "abstinence only" (and by extension condoms) seems extreme. It seems to me like being addicted to methadone is less likely than heroin to...

    Calling methadone the "gold standard" and comparing it to "abstinence only" (and by extension condoms) seems extreme.

    It seems to me like being addicted to methadone is less likely than heroin to cause death or job loss or whatever else. But it's a stretch to call that the gold standard solution. In my opinion drug addiction is a personal thing that needs to be dealt with on a case by case basis. Im not a doctor, but it's not like the medical community is in firm agreement themselves.

    I will give you that methadone should be an option. I'm not sure how I feel about revoking state funding to centers that don't accept it, but I think ideally any patient should be able to get it. What I mean is that some clinics should offer it, but all clinics shouldn't be forced to.

    5 votes
  2. JohnLeFou
    Link
    So a big element in recovery isn’t just managing the addiction but the withdrawal and the patients life around it. There are a few pros and cons between methadone, buprenorphine, and medically...

    So a big element in recovery isn’t just managing the addiction but the withdrawal and the patients life around it. There are a few pros and cons between methadone, buprenorphine, and medically assisted withdrawal.

    Methadone has proven to be effective in terms of mortality. This is partly I believe because not only does it stave off withdrawal it is dispensed in tiny portions to avoid selling/abuse. The long half life that makes it attractive for this purpose also makes it difficult to safely manage especially since dosages are highly varied. This means the patient has to come to a treatment center on a daily or near daily basis. This alone provides routine and structure where there was panic about getting to the next dose of opioid. This also allows them to get their life together and fix the problems around their addiction (job, homelessness, etc) before tackling getting off. They can taper off when they have a support system in place to help them manage.

    bup/naloxone has a unique position in that you only have minimal extra regulation and training vs a doctor with lots of training to prescribe it unlike methadone. This provides access for rural patients and avoids overburdened clinics. It is also an agonist/antagonist. This means that when you use other opiates on top of it they are not as effective. If heroin always cranks your receptors more toward 10, buprenorphine turns it toward 5, whether you are above or below. This also makes getting off of it very difficult. Because of available strengths with little protocol to taper.

    Ultimately we all want the patient to function without, but that has strong evidence that it leads to more deaths in the long run. Without a fantastic support network it is near impossible for someone to recover after getting initial assistance with acute withdrawal. Narcotics Anonymous tries to build this network, but it’s hard to build where there is no sober foundation in place where you have clean friends and family willing to help.

    3 votes