Treat Drug Addiction (or Overdose) With More Drugs?

Anyone, regardless of age, gender, religion, ideology, or socioeconomic background, can become addicted to opioid pain medication — this is a horrible reality that has ruined so many lives. While prevention is the goal, and recovery is not an easy road, addiction does not have to be the end of one’s life story.

Addiction is highly treatable, and recovery is possible, but the ways in which effective treatment is administered may seem counterintuitive or confusing to many.

“It is very important that Project: Sustain An Abuse Free Environment (SA.A.F.E.), Fulton County Family Partnership (FCFP) and other community agencies take the time to educate the community around the disease of addiction,” Woody Strait from Project: S.A.A.F.E., stated in the group’s January 2021 meeting.

A recent op-ed in the “News” touched upon some of the common myths and stigma surrounding opioid addiction that were highlighted in a local community-wide survey. This article delves deeper into treatment methodologies that are often misunderstood but could be critical for saving lives.

Swift detoxification and complete abstinence might come to mind when thinking of recovery from drug addiction. However, numerous studies have shown those protocols may do more harm than good and often result in the recurrence of drug use. While relapse is a normal step in the recovery process, it could also be life-threatening and increase the risk of fatal overdose.

Supporting and maintaining abstinence is therefore essential but incredibly challenging especially in the early phases of recovery when the symptoms of withdrawal are intense. Ceasing drug use can result in substantial physiological, psychological, and social changes.

Medications have been used as part of recovery treatment to relieve cravings and eliminate the negative symptoms of withdrawal without producing the euphoric effects (the “high”) associated with the addictive drug. FDA-approved opioid agonists, such as methadone, activate the same opioid receptors in the brain that are activated by the addictive drug but produce only mild stimulatory effects and are therefore much less habit-forming.

Opioid antagonists, on the other hand, work in the opposite way by blocking the activation of opioid receptors, like jamming glue into a keyhole so it cannot be opened. They prevent any opioid drug from producing rewarding effects such as euphoria, extinguish the effect from use, and avert overdose. These include medications such as Naloxone (NARCAN®) or naltrexone (VIVITROL®).

Some medications, such as buprenorphine, used in recovery therapy have mixed agonist-antagonist actions that work by both preventing opiate withdrawal and cravings with its agonistic effects, while also blocking against opiate overdose through its antagonist action.

Because some medications used in treating opioid addiction are opioids themselves, there is a common misconception that they replace one addiction with another. This is just simply not how these longer-acting medications, such as methadone or buprenorphine, work in the bodies of those already addicted to opioids. They do not produce a euphoric high but instead minimize withdrawal symptoms and cravings, making it possible for these individuals to function normally, attend school or work, and participate in other forms of treatment or recovery support services to help them become free of their substance use gradually over time.

“Just as body tissues require prolonged periods to heal after injury and may require external supports (e.g., a cast and crutches or a wheelchair for a broken leg), brain circuits that have been altered by prolonged drug use take time to recover and benefit from external supports in the form of medication.” – Research Report by NIH, National Institute on Drug Abuse, June 2018

It is important to reiterate that these treatments are not prescribed in a vacuum. Health experts recommend these medications be administered as part of a comprehensive and individually tailored treatment plan in order to safely and effectively help people with addiction sustain long-term recovery success and reclaim active and meaningful lives. The most effective treatment plans also include counseling and other mental health therapies, along with establishing connections with community support networks, to provide patients with a whole-person approach.

A major challenge in efforts to increase access to these vital medications and therapy protocols is a lack of clear understanding among the public about effective treatments for substance addiction and successful recovery. The community-wide survey results implied that a large majority of local residents do not understand the important role treatment can play in one’s recovery success.

These misconceptions extend well beyond the community. National surveys have shown that half of Americans are not aware that effective treatment for drug addiction exists. This lack of information has real-world impact, impeding efforts to increase the delivery of these therapies, which the vast majority of individuals with opioid addiction do not receive.

Poor public opinion, stigma, and misunderstanding of treatment programs’ safety and efficacy as part of opioid addiction recovery also negatively influence policies such as those related to housing, employment, and insurance equity. Misunderstanding of Naloxone’s role in overdose prevention results in misuse or failure to administer the drug at all, costing many their lives. Those who are undergoing treatment are often stigmatized and connected to the criminalization of drug use and enactment of punitive criminal justice-focused policies.

“The goals and objectives tied to the Human Resources and Services Administration grant have been written to address stigma with education, opportunities to reach out to all members of our communities and to show that options need to be available for those suffering from the disease of addiction” said Strait.

Because this systemic and perceived stigma is so pervasive, individuals who witness an overdose may not call for medical attention or may not inform medical personnel that an overdose has occurred out of fear of legal ramifications. As a result, medical providers may not know to administer or prescribe an opioid antagonist or may not administer an antagonist due to medical liability concerns.

Fulton County residents may not be aware of Pennsylvania’s drug overdose immunity law, which is intended to address this problem and encourage people to call for medical assistance for people that are suffering from drug overdoses without fear of the caller being prosecuted or the person needing medical assistance being prosecuted.

So where do we go from here? If we wish to see our community thrive in the midst of this public health crisis, it is important to remain open to options for opioid addiction treatment and recovery. Just like every individual is unique, the nuances of addiction and recovery are also unique to each person. Those suffering from addiction above all need their community to understand the immense struggle they are facing as they navigate healthcare and their challenging path to recovery.

By Marybeth Shenberger, Public Health Analyst
First printed in the Fulton County News January 14, 2021