The patient in my office today does not look like your typical drug addict. He is middle-aged, dressed casually in jeans and cowboy boots, a local rancher. He says something I hear often:
“Doc, I never thought it could happen to me.”
Of course, no one starts out with the intention of becoming an opioid addict – it is something that happens slowly and insidiously. At first, maybe he is only taking the medication for pain as prescribed, or just using on weekends. Soon, it becomes an everyday occurrence. Eventually, people need to take drugs in order to feel normal, and then the true cycle of addiction starts.
Opioid addiction occurs in all locations, classes, and races – it could be your neighbor, co-worker, or family member. It could be destroying his life and affecting all those around him. And without treatment, many of these patients will end up either in prison or dead from an overdose or serious health problem associated with drug use.
Many people believe that abstinence based treatment is the only option for opioid addiction that really works. Unfortunately, study after study has shown that abstinence based treatment does not work for the vast majority of opioid-dependent individuals, and relapse to drug use within a few weeks or months is common. In fact, most studies show that 80-90% of patients return to opioid use after abstinence based treatment.
For this large group of patients for whom abstinence based treatment does not work, they are facing a situation of hopelessness and despair – with their daily lives consumed with obtaining and using illicit drugs. The drugs take over their lives, becoming more important than work, family, or spiritual beliefs. Patients literally become powerless over their addiction. Continuing attempts at cutting back or quitting are unsuccessful and eventually patients give up. Patients often feel guilty about their drug use and feel that they are weak and worthless because they can’t stop. These patients are at high risk for suicide.
There is Hope
Treatment of opioid addiction with medications combined with counseling has been shown to have much better effectiveness than abstinence based treatment alone. I am a board-certified Addiction Medicine physician and I spend most of my time treating people with addictions. Paradoxically, the one thing I end up doing the most is prescribing opioids to addicts. How does this make sense?
When people are trapped in the cycle of addiction to opioids, they are continually searching for their next dose, not necessarily to get “high,” but to feel normal and avoid severe withdrawal symptoms. Opioid withdrawal symptoms are intensely uncomfortable and push people to do things they would not normally do, sometimes horrible things such as stealing, lying, violence, child neglect, or selling drugs. When an addict uses an opioid, he gets a few hours of relief, but quickly will need to find another dose since the drugs wear off in a few hours. Most addicts must dose several times a day just to stay out of withdrawal.
When I prescribe opioids for addicts, I use long acting opioids that can keep patients out of withdrawal for 24 hours or more from a single dose. These medications do not make people “high,” since they come on slowly, but only make them feel normal. These long acting opioids must be given with great care and close monitoring and combined with counseling, but in the setting of a Federally approved Opioid Treatment Program (OTP) can give new hope to opioid addicts. Initially, patients must come to the clinic every day to take their dose in front of a nurse who monitors their response, but over time may be able to start taking doses home to take on their own. All OTPs are governed by a set of Federal regulations that have been in effect for decades and are periodically evaluated and updated based on the latest research.
By preventing the cycle of drug use and withdrawal, patients can stop illicit drug use and the behaviors associated with that use. OTPs combine medication with behavioral treatments and counseling with the goal of getting patients to stop illicit opioid use, avoid severe withdrawal symptoms, and have a normal life again. Treatment of opioid addiction with long acting opioids such as methadone or buprenorphine has been considered the standard of care for 50 years. There are over 1,000 Federally licensed OTPs in the US, yet currently none in North Dakota (one of only 2 states without this treatment available). OTP treatment is recommended by the World Health Organization, Centers for Disease Control, and American Society of Addiction Medicine, among others.
My rancher patient comes back to see me several weeks later.
“Thank you so much, doc, for all you are doing for me. Before I heard about your treatment, my life was terrible – I couldn’t get my work done, my wife was getting ready to leave me, and my kids wouldn’t let me around the grandkids. Now I am able to function again – it’s like a miracle.”
Treatment of opioid addiction is not a miracle, but when done with the appropriate expertise, monitoring, and staff, it can result in dramatic improvements. For patients who are ready to give up the drug-using life style, it is almost always effective in helping them return to their normal lives.
This treatment needs to be available in North Dakota, where illicit drug use, either prescription drugs or heroin, is becoming more and more of a problem. Community Medical Services, where I work as the Medical Director for both Montana and North Dakota, has extensive experience in treating opioid addiction.Having staffed the clinic with local medical and clinical personnel, we are ready to open a treatment center in Minot as soon as the moratorium is lifted and are discussing options with officials in Bismarck as well to provide treatment services to the patient population there Our company has specialized in Medication Assisted Therapy (MAT) since 1983 and has some of the best resources in the country to ensure that we are providing the North Dakota population with the best quality treatment available.
If you agree that effective treatment for the scourge of opioid addiction needs to be available in North Dakota, please visit www.ndtreatment.com to sign a petition showing your support. You can make a difference in the lives of the people in North Dakota who are suffering from opioid addiction – let your voice be heard.