Ask an Expert: What Do I Do If My State Won't Support My Treatment?

Ask an Expert: What Do I Do If My State Won't Support My Treatment?

By Larissa Mooney 02/19/15

Today's question is on what to do if your state's political leanings make it difficult for you to access addiction treatment.

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I have a heroin problem (and getting worse) and live in a backward Red state. It's one of the states that won't implement Obamacare and which does not have much to speak of by way of rehabs, even if I could afford it, which I can't.  The medical people I started to see want me to take suboxone. I read about it, including on your website, and it looks to be as addictive as heroin and maybe even worse. What do you think? Is there a safe dosage or way of using it that the local clinic doctors here probably don't know about? Or maybe you've got something better in mind that I can use?  I am checking out NA here but it's not biting me and I need to do something fast.  Thanks. - Randell

 

Larissa Mooney:  Your dilemma is shared by many individuals who are faced with limited treatment options for their addiction, and then receive conflicting advice when it is time to make a decision.  Suboxone is a combination of buprenorphine/naloxone approved for maintenance treatment of opioid dependence. Like many other medications, there are a broad range of experiences reported with buprenorphine, and I would encourage you to work with your physician to make an informed decision about appropriate treatment options given your personal history with addiction and relapse.  What works for one individual may be very different than for another. 

I have treated many individuals who have successfully maintained abstinence from heroin while taking a daily dose of buprenorphine/naloxone. Buprenorphine acts on the same opioid receptor in the brain as heroin, but it is eliminated much more slowly. Therefore by alleviating cravings and withdrawal and the highs and lows of using, crashing, and recovering from heroin, individuals have the opportunity to  function more successfully in their daily lives, engage in therapy, and minimize overdose risk.  

With that said, buprenorphine is not a “cure” and it does not eliminate any risk of drug use. Like many other medications, buprenorphine may be misused or abused. There are longstanding patterns of behaviors and decisions that accompany the illness of addiction, and these issues must be addressed in any comprehensive treatment program whether or not buprenorphine is part of the treatment plan. However given that relapse rates are exceedingly high in heroin users, even with the best of intentions and support, buprenorphine may be a very useful recovery tool for some individuals. 

I do not agree that buprenorphine is “more addictive” than heroin; addiction is marked by loss of control and escalation of substance use over time. When taken as prescribed under the guidance of a physician, many individuals may be maintained on the same daily dose of buprenorphine, and often successfully lower their dose over time. However, similar to other opioids, abrupt discontinuation of buprenorphine will lead to withdrawal symptoms, and slower tapering of the dose may even cause discomfort in some individuals. In addition, when there have been unsuccessful attempts to discontinue buprenorphine, it may be perceived as “addictive”; it is unclear why some individuals successfully taper off the medication and are able to maintain sobriety, whereas others require longer-term maintenance treatment.   

So in summary, buprenorphine is not a “cure” for heroin addiction, and personal experiences with the medication vary widely. We know from research hat relapse rates to heroin are very high, and longer-term treatment with buprenorphine seems to be more successful than short-term in facilitating abstinence from opioids. For some individuals, buprenorphine may be a helpful tool to aid the process of recovery by minimizing cravings and withdrawal, which are common triggers for relapse. 

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Larissa Mooney, MD, is the Director of the Addiction Medicine Clinic at University of California, Los Angeles, and is a board certified addiction psychiatrist with expertise in the treatment of substance use disorders and psychiatric co-occurring disorders. She is also Assistant Clinical Professor of Psychiatry at UCLA.www.LarissaMooneyMD.com     Full Bio.

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