First of all, before you form an opinion based on the title of the article, please let me state as clearly as possible, that the use of buprenorphine (suboxone) is not really my issue here. If we back up for a moment, I can absolutely affirm that the values of programs who prescribe buprenorphine and those of abstinence-based programs are exactly the same: We all want to save lives. That really is the bottom line. I agree there is evidence that shows that the use of buprenorphine allows many individuals to get off heroin and participate in treatment. That evidence is not my issue either.
The issue for me is the unqualified endorsement of the use of buprenorphine as the only viable treatment for opioid use disorder to the exclusion of other treatment modalities that are also proven to be effective.
The opiate epidemic has intensified fears of families and communities, and with good reason. In a reaction to the demands of communities, there has been a movement from legislators and the medical community towards medication-assisted treatment (MAT) that focuses almost exclusively on the use of buprenorphine, which is itself an opioid based narcotic. This has also led to treatment becoming more individualized and away from a longer length of stay and the therapeutic community model.
And, what is even more disturbing, is that many of the most vocal proponents of MAT completely ignore approved medications that are extremely effective, but not opioid based: Naltrexone and Vivitrol (extended release Naltrexone). These medications negate the effects of opiates in the brain and have been shown to reduce cravings, thus allowing clients to participate fully in treatment without any opioid based medications.
MARR has just completed an 8-year study that demonstrates the efficacy of an abstinence-based model that works with clients who are suffering from opioid use disorder. We found that as we modified our program structure to meet the needs of these clients, we began to see higher retention rates and successful completion rates that consistently surpass the national averages for long-term treatment programs.
I have no doubt that evidence shows that buprenorphine works. However, it is unfortunate and misleading, to the public at large and to helping professionals, to ignore existing and emerging evidence that shows that abstinence-based programs, particularly those that are long-term, based in the therapeutic community model, and who use Naltrexone and Vivitrol as support medications, are effective as well.
We are all working very hard to save lives and address this terrible epidemic. It is clear that we need a variety of modalities in our treatment approaches in order to be effective across a broad spectrum of clientele. Please don’t be intimidated by the strong, singularly focused voices out there right now. Let your voice be heard about the practices and modalities that you know work for your population!