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U.S. Doctors: Their Take on Medication Maintenance Addiction Treatment

Addiction has been an issue within our nation for many years and there have been numerous forms of treatment developed to address it. Some of these obviously involve various types of therapy and counseling, but others opt for alternative methods. One of these alternative methods includes something called medication maintenance. Essentially, this is when a struggling addict is placed on a type of medication designed to help them manage their addiction. This methodology is typically used in the realm of opioid addiction, being that there are known medications available for maintenance. Individuals struggling with opioids can deal with both a physical and mental component to their addiction. Opioids can bring about an extremely severe physical dependence and medication management can help to ease the potential withdrawal symptoms that come along with this.

There are two medications that are prominently used for medication maintenance for opioid addiction and dependence, which are methadone and buprenorphine. Methadone has been used for some years and still is in use, but buprenorphine has typically become the more favorable medication for maintenance uses.

Is Methadone like Heroin?

Methadone is somewhat related to heroin in makeup, so one may wonder is methadone like heroin? Realistically, both of these substances are quite potent and addictive, and they have several similarities, but they also have a few differences. Firstly, they are both derived from a substance that is sourced from seeds of the poppy plant. Although, the euphoria that is produced from heroin traditionally comes rapidly, whereas the effects of methadone come as a more gradual onset. In addition, if an individual takes methadone and then attempts to consume heroin, they will likely not experience the usual euphoria that can come from it. One area that these substances do greatly differ is in their withdrawal periods. The withdrawal from heroin tends to last around 7-10 days, but people going through methadone withdrawal can experience symptoms up to 4-6 weeks. Generally speaking, it has been reported that around 40% of heroin users deal with psychological addiction, but a staggering 90% of methadone users suffer from both physical and psychological dependence. When methadone is taken correctly as prescribed, it can help a person to overcome the initial difficulties of dependence and allow them to participate in further treatment. Methadone is only approved to be dispensed from authorized clinics.

Buprenorphine

The effects and purpose of buprenorphine are similar to that of methadone, but it is much less intense, which also makes it generally less likely to be abused. The benefit of buprenorphine is that while it is less intense than methadone, it is still enough to adequately offer a reprieve from withdrawal symptoms when taken in daily doses. It is approved to be used for treating opioid addiction in the privacy of a physician’s office, with the condition being that the physician has signed the correct waivers. Buprenorphine is commonly heard of with reference to the medication, Suboxone. Suboxone is a combination of buprenorphine and Naloxone, which is an opioid antagonist. Buprenorphine was initially approved for treating opioid use disorder in 2002. The hope was that giving doctors the ability to prescribe it within a primary care setting would raise the numbers of patients receiving this type of care, but the actual number of physicians using this methodology has not kept up with the current opioid epidemic we are facing. This medication is also commonly used in detoxification settings as a way to wean individuals off of opioids. When a physician receives a waiver to use buprenorphine, they are able to see 30 patients for it in the first year and 275 in each following year. Yet, many doctors are not seeing anywhere near these kinds of numbers when it comes to treating opioid addicts with buprenorphine maintenance.

This situation of doctors greatly underusing this type of method makes one wonder the reasoning behind it. Fortunately, research was produced that shed some light on the exact reasoning behind this current state. 558 English-speaking physicians had been surveyed by Andrew Huhn, Ph.D. and colleagues from the Johns Hopkins University School of Medicine in the spring/summer of 2016, and they were asked about any drawbacks that they perceived with prescribing buprenorphine. The survey also asked about resources that would encourage doctors without a waiver to get one and take on more patients if they did have one.

Out of this large group, only the small number of 74 physicians said that they did not have a waiver to prescribe buprenorphine, and out of those, a third said that nothing would increase their willingness to obtain a waiver. Reasons for not getting a waiver included concerns of medication reselling (25.7%) and not wanting to be overwhelmed by patient requests for the medication (29.7%).

As far as those who already had a waiver, over half of these physicians said that there was nothing that could increase their willingness to prescribe the medication. Two of the main reasonings for not prescribing at full capacity was not enough reimbursement for services (15.4%) and not enough time for further patients (36%).

What Would Increase Doctor’s Willingness to Employ Buprenorphine

Overall, there were a few different suggestions offered by physicians that would increase their willingness to prescribe or obtain a waiver, which included information regarding local counseling services, continuing education services about opioid use disorder, and mentoring with an experienced provider. While there is currently a large shortage of doctors offering this type of service, the study essentially made it clear what can be done to increase the numbers. From the sounds of it, if physicians can be further educated upon opioid use disorder, mentored or advised by those already using the therapy, and given knowledge about local counseling services, it very well could become a more prominently offered service. Minimally, this gives a basis to move forward into improving this situation. Medication maintenance can be a somewhat valuable type of treatment in that it can help many people begin the road to recovery. Of course, it is generally meant to be a temporary solution and it should be provided in conjunction with some type of therapy or counseling. Buprenorphine maintenance can help a person overcome a physical dependence to opioids, but it does not address any of the mental and emotional factors that are also part of addiction.

When Seeking Treatment for a Drug or Alcohol Addiction

Addiction can be an incredibly hellacious condition, but treatment can help people to break free of it. Here at Best Drug Rehabilitation, we tailor treatment to each individual to ensure that they receive a comprehensive program that addresses their unique needs. We offer numerous modalities, which allows us to craft the perfect program for virtually any person. Every single person and their addiction is unique in many different ways and this is the premise we always keep in mind. We help thousands of people to overcome their addiction each year and would like to do the same for you or your loved one. Do not wait, give us a call today and we can answer any questions that you may have about our program. Freedom from addiction is only a phone call away.

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