With Medically Assisted Treatment (MAT) becoming the go-to approach for fighting the opioid crisis, a lot of buzzwords and comparisons are thrown around.
“Gold standard” is the most common label, and because the model is centered around giving patients medications like Suboxone and Methadone, you’ll hear the words “miracle drug” used often. To anyone who questions the ideology of substituting powerful opioid narcotics for illegal drugs like heroin, or opposes the new school of treatment, you’ll hear frequent accusatory cries of stigma and shaming.
Even more popular is likening MAT to insulin and cancer treatment. Often when regulators step in to work toward requiring behavioral therapy or counseling into the MAT framework, they’re shut down by advocates who state they’re endangering people and ignoring facts. A warden who opposed MAT being instituted amongst inmates was immediately attacked. “Would you tell a diabetic they couldn’t have access to insulin?” is a common retort posed when examining this subject.
Let’s get real here and talk about something that no one else wants to. The classification of addiction as a disease was a positive move in the field of treatment because it allowed for a shift in how addiction is viewed and gave greater access to care for many people. Addiction absolutely has a physical, medical component that requires professional care. But this classification is being abused, and substance abuse is being made into a purely physical issue. Even more, a strictly chemical one.
There’s no denying that there’s a mental, behavioral side of addiction that is responsible for why some people get hooked on the same drugs that others can put down. This is illustrated quite easily when we see people who are given powerful opioid narcotics for injuries and lengthy post-op periods, who then get off them and resume a healthy life. Similarly, there’s a large number of cases among genetic twins where only one of them develops an addiction.
So, when we put people on opioids in place of other opioids and call it treatment, we’re completely denying addiction and turning it into dependence. Dependence to opioids, and subsequent withdrawal, is a physiological process that occurs in any human who’s given opioids for extended periods. Addiction is the compulsive behavioral process in which a person continues to take substances despite adverse consequences. It could be said that the mental and behavioral aspects are the totality of where the addiction lies, given that otherwise, we’re merely discussing dependence.
And that’s all MAT does; treat dependence. Yet, it doesn’t quite accomplish that even, as it maintains a person’s reliance on opioids, often for life. That’s why they call it “maintenance.”
Comparing this to medical treatments such as insulin and chemotherapy may be trendy but is grossly inaccurate. Type 1 diabetes and cancer are strictly physical processes, with visible physiological pathologies. While they may be influenced by behavior, they are not defined by it. Addiction is unique as a medical classification because its symptoms are the person’s behavior. You can’t observe the “addiction” or lack thereof within a person’s physiology. Only it’s consequences.
Don’t be misled; with proper medical supervision, people can and do stop using opioids altogether. They will be uncomfortable for an acute period. But rather quickly, they’ll be physically much healthier. Often malnourished, they’ll gain weight and show a noticeable bodily improvement in nearly every way. Once through all withdrawal symptoms, and with a stabilized physical state, relapse can only be precipitated by mental and behavioral processes. But this is ignored in MAT’s approach.
Pushing for MAT and against non-chemical therapeutic models is simply furthering addiction. It’s not a matter of stigma, but common sense. Claims that MAT drugs “allow the brain to heal from addiction” are thrown around very carelessly and are entirely unfounded. The ideas that one opioid hurts and another one heals are silly and dangerously misleading.
As a former employee at a drug rehabilitation facility, I can tell you firsthand that there are many people out there wishing they never went down the MAT road. The miracle drugs they were told were the solution is now the same old ball and chain. They would call in looking for help. Many would say to me the MAT drugs were harder to get off than heroin, and there is a science to back this up. With longer half-lives, Suboxone and Methadone can leave someone in an acute, sleepless withdrawal for weeks rather than days. And when they’d look to doctors and the treatment industry for answers, they’d just get pushed more pills.
Addiction isn’t strictly medical. And perhaps there isn’t a one-dimensional answer. But we must stop subscribing to the quick-fix mentality that chemicals alone will address the complexities of human behavior. Comparing medications like insulin to MAT is like comparing apples to oranges or ... in this case, opiates.