Imagine yourself as a patient burdened with a chronic disease that necessitated daily medication adherence to function. Now imagine that medication has become so stigmatized by society that you feel judged and ashamed every time that you use it. That’s the world that individuals with opioid use disorder are forced to live in when they’re prescribed methadone or buprenorphine to get through the day. Without these medications, patients have over an 80 percent chance of relapsing to drug use, yet society proclaims that it’s just “substituting one drug for another”. This dangerous outlook is inappropriately shaping the way opioid use disorder is treated and is leading to unnecessary increasing morbidity and mortality.
We often look at opioid use disorder as a “moral failing” instead of an entangled interaction between genetics, our environment, and the pharmacological effects of opiates. Withdrawal can serve as punishment for illicit drug users instead of having compassion and treating the symptoms with medication so these patients don’t seek to use again.
Methadone is a synthetic full opioid receptor agonist, meaning it binds to the same receptors as heroin, morphine, and opioid medications. Its effects include eliminating withdrawal symptoms and relieving drug cravings. It acts more slowly on these receptors than other opioids and does not produce euphoria like it does for the substances previously listed. Buprenorphine also acts on those same opioid receptors, but is a partial agonist which means it activates them less strongly than full agonists do. Like methadone, it reduces cravings and withdrawal symptoms without producing euphoria. Without these medications, individuals go into terrible withdrawal that precipitates a strong craving to use drugs again.
A touching article detailing personal stories of intense battles with opioid use disorder is an important read for everyone in the medical field and society as a whole. Patients often carried a mindset that they could beat their addiction on their own or were shipped off to abstinent-only treatment centers that prohibited any medication involvement in their treatment plan.
These treatment centers, although good-intentioned, frequently fail without the help of medication. It affords people a safe environment to focus on sobriety for months at a time, but once the stay is over, the need to use is so great that they relapse. The danger of these treatment centers is that they start to lower one’s tolerance over time so once they use the same amount of drugs as they had before, it often leads to death as their bodies cannot handle it.
The root of the problem that dissuades medical treatment for opioid use disorder is stigma. People believe that since they act on the same receptors and produce similar effects as heroin and other opiates, there’s no difference between illicit drug use and treatment with methadone and buprenorphine. They’d rather look past the concrete evidence and studies that point to the obvious need for these medications to fight their addiction and risk relapse and preventable overdose.
What’s arguably most disturbing is that the judicial system often seems averse to medical management for defendants who walk through their courtroom doors. Judges often relegate these individuals to treatment programs that disavow methadone and buprenorphine, or even worse, send them to jail with no support. Some judges go as far to even mandate individuals to stop their methadone or buprenorphine use as part of their sentencing. The judicial system seems to reflect society’s beliefs as we cast judgment on those with opioid use disorder and allow these perceptions to guide an abstinent focused treatment plan instead of leaning on rigorous studies and research that highlight the importance of medical treatment. There should be no reason to judge anyone on methadone or buprenorphine any differently than a patient with diabetes on insulin. At the end of the day, all are life-saving medications.
Brandon Jacobi is a medical student.
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