A: Dr. James Berry
Is MAT just moving from one drug to another?
This is a common question that I’m asked by a variety of people ranging from patients, patients’ family members, other doctors, judges, etc. In most instances, I believe the motivation behind the question is a sincere desire to protect vulnerable people from harm. It seems counterintuitive that a doctor would give a patient with “a pill problem” a pill to solve the problem! Add to this the understandable distrust of pharmaceutical makers whose policies helped fuel our opioid epidemic and certainly engendered suspicion about medications in general.
However, my own experience using medications to treat addiction is that they prevent harm and foster wellbeing. This experience is supported by solid evidence demonstrating that people who are appropriately treated with FDA-approved medications for addiction have much better outcomes than those who are not. A significant reason why these medications can be so helpful is that they minimize the persistent cravings and sickness which overwhelms one who suffers from addiction. It is very difficult to focus on taking care of yourself and participate in healthy activities while every fiber in your body is screaming to satisfy the craving and feel better.
Medications approved for Opioid Use Disorder, for instance, rest on the receptors in the brain responsible for opioid cravings to the point that these cravings are manageable. Over and over again, I have found that once these cravings are under control, patients are much more likely to build recovery tools into their lives. They are more likely to attend mutual support groups, individual therapy, practice wellness and follow up with healthcare appointments. The evidence is also very clear that these medications decrease risk of overdose and minimize the spread of infectious disease such as HIV.
When I have conversations with loved ones who express reservations regarding a patient’s decision to utilize medications as part of their treatment, I ask them to be patient and consider the goals of treatment.
I propose the two most important goals are: number one, keep the person alive and number two, increase the quality of the life lived. I encourage them to not focus so much on the medication, rather focus on the outcomes.
Over time, is he looking stronger? Has she been able to keep a job? Is she attending family functions? Is he parenting better? Is he less irritable? Does she still appear intoxicated?
If the patient doesn’t look or sound any different and is still engaging in unhealthy behaviors than it is possible that one has simply moved from one drug to another. The patient may need a different type of treatment or escalation in care. However, for many, there is a dramatic and palpable difference in wellbeing, which makes it obvious that the treatment is contributing to positive changes rather than the harm of ongoing substance use.
Dr. James Berry
Associate Professor and Chairman of the West Virginia University Department of Psychiatry; Board certified in both General Psychiatry and Addiction Psychiatry