The Department of Behavioral Health and Developmental Disabilities (DBHDD) long ago identified methadone as the gold standard for opioid use disorder in Georgia. But, don’t be misled by those words: While the people who address addiction issues from Atlanta to Savannah and throughout the state have long recognized the benefits of methadone treatment, Suboxone has also been recognized as an effective therapy.
Researchers from the National Institute on Drug Abuse collected data in Atlanta revealing that statistics on both heroin and prescription pain pills had remained stable for several years, but 2014 showed a large increase in heroin use. Hospital admissions caused by heroin jumped from 4.3% to 6.1% in one year, proving that opioid use disorder should not be taken lightly. Abuse of prescription pain pills caused approximately 3.1 percent of admissions, increasing at a slower rate than heroin. Even so, considering the total numbers of primary hospital admissions, those figures represent a significant number of people who are battling opioid use disorder. In Georgia, oxycodone is the opiate pain pill most often prescribed—and abused.
The untold story behind the increased heroin hospitalizations is the fact that heroin addiction often follows prescription pain medication abuse. A person first gets hooked on pain pills prescribed for a genuine medical problem—an injury or illness or surgery that is treated by a doctor’s prescription for an opiate medication. When the doctor determines that the patient has had adequate time to heal and no longer needs the prescription, it is often too late, the addiction has taken hold. Individuals will try visiting a number of doctors to obtain the pills they no longer need to stay well, and when they can no longer get the medication from doctors, they look next to the medicine cabinets of family and friends. Finally, when all other resources have been exhausted—and if they can’t afford to buy the pills on the street—they turn to heroin. Heroin is significantly less expensive than buying prescription opiates on the street, and unfortunately, can become the only choice. This is the ugly side of opioid use disorder that is often overlooked or misunderstood.
The Gold Standard for Opioid Use Disorder
Abstinence-based therapy combined with cognitive behavioral changes can help people through detox and recovery from many substances, but opiates are different. Similar to other drugs, opiates activate the brain’s reward pathways, so that a person suffers relentless cravings for their drug of choice over time. Opioid use disorder is hallmarked by such horrible withdrawal symptoms that the person cannot stay clean, no matter how much they may want or need to. As one ex-user puts it, “fluids leak out of every body opening”; their eyes water, their nose runs, they sweat, they vomit, and they get diarrhea. Beyond that, people in treatment for opioid use disorder in Georgia have reported that their bones feel like they will break. Even though they are sweating, they get the chills, and they shake uncontrollably. They itch. Their muscles hurt. They can’t sleep, and they can’t stay awake. Opiate withdrawal won’t kill a person, but they often wish it would.
Both Methadone and Suboxone have long been recognized as the most effective treatments for opioid use disorder treatment. Despite long-standing stigmas against medication-assisted treatment, it can no longer be said that getting into medication-assisted treatment is just trading one addiction for another. Both Methadone and Suboxone are longer-acting than heroin or pain pills, so the person seeking recovery can take their medication early in the day and not experience cravings or withdrawal symptoms for 24 hours or even longer. They can reclaim the lives that they have lost to opiate drugs.
Methadone and buprenorphine offer much safer options for opiate drug addiction. In Georgia, both generic buprenorphine and brand-name Suboxone are approved at the lower co-pay tiers on the PeachCare formularies although physicians must contact the pharmaceutical insurance office to provide what is known as “prior authorization,” explaining why the person needs the medication. Methadone is not on many approved drug formularies.
Buprenorphine, the generic of Suboxone, is a partial agonist, which means it binds to the brain’s receptors but it has a relatively weak opiate effect. When someone takes a low dose, they may believe that they are getting high just as they would with their drug of choice. But even if they take more of the buprenorphine, the feeling of being high will not increase. There is a ceiling. Methadone is a full opiate agonist, which means it meets the brain’s opiate receptors just the same as heroin or pain pills, and it is much easier to abuse.
Counseling and Education for Opioid Use Disorder
The Commission on Accreditation of Rehabilitation Facilities (CARF) requires that programs providing Methadone or Suboxone treatment must also offer counseling. Treatment for opioid use disorder in Georgia does not require that you attend, although each individual program may have requirements around attendance in individual or group counseling sessions.
Medication-assisted treatment facilities also provide relapse prevention education, including:
- Education. Once you learn about your drug of choice, why you became addicted, and how it affects your body and your brain, you will become better armed to fight the addiction.
- Family Participation. Your addiction impacts more than just yourself. Families, friends and those who care about you suffered with you, and may have been involved in the issues in your life that played a role in your drug use. You will explore these issues and work toward healing the relationships with your loved ones. Additionally, your family will become educated, not only about drugs, but about their role in supporting your recovery.
- 12-Step Meetings. No matter what your drug of choice, you will develop a more secure recovery if you attend 12-step meetings. If you hesitate to attend because you don’t want to tell people at AA or NA that you are taking methadone or buprenorphine, then don’t tell them. It’s between you and your doctor what medications you take.
- Take Your Time. Previously, people believed Methadone treatment to be long-term and Suboxone to last for only a short while. Current practice is that a person can remain on Suboxone over the long haul, as well. As long as you see your doctor regularly—and you won’t receive your medication if you don’t—then there is no harm in making the choice to use Suboxone.
Ultimately, you and the doctor will decide together whether to choose methadone or Suboxone for your opioid use disorder. Why not call your local medication-assisted treatment program so that you can discuss your options with a drug recovery professional in person?