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Jul 8, 2020   #1

A New Look at Recovery (amid an opioid epidemic)

For the past decade, Americans have been battling a very strong force within themselves. This force is the opioid epidemic. "Nearly 70% of the 67,367 deaths that were labeled "drug overdoses" in 2018 involved an opioid" (CDC, 2020). "In 2015, an estimated 2.4 million people in the United States had a past year opioid use disorder which includes heroin and prescription opioids such as oxycodone and hydrocodone" (SAMHSA, 2015). Not to mention that "2018 data shows that every day, 128 people in the United States die after overdosing on opioids" (NIDA, 2018). A new form of treatment is hitting the streets of America and becoming more popular among the recovery community and doctors/therapists nationwide, plus these techniques date back to the 1920's, believe it or not! Research shows that a combination of therapy and medicine can successfully treat opioid use disorders. Medicated-assisted treatment (otherwise known as MAT), lowers the risk of potential criminal activity, reduces the spread of infectious diseases, provides a range of services to help with mental-health, eliminates drug or opiate cravings, and there is a lower risk of overdose with patients that are maintaining on medicated-assisted treatment. It is a very effective form of treatment for these individuals and tailored down to the individual client just like any other form of therapy in substance abuse disorders. The benefits far outweigh the negative potential effects of using MAT, which will be discussed far much later. For now, the topic is medicated-assisted treatment (MAT) and how it works.

"Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a "whole-patient" approach to the treatment of substance use disorders" (SAMHSA, 2020). This type of treatment is mainly used in treating addiction to opiates such as prescription pain relievers (Vicodin, OxyContin, etc.) that contain opiates or heroin (street-form). "The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug." (SAMHSA, 2020). The drugs that are used are approved by the Food and Drug Administration.

Medicated-assisted treatment (MAT) is done with three main drug and those three are Methadone, Buprenorphine, and Naltrexone. They are all unique in their own attributes and what they do to the human body or brain and how they help the individual. Methadone is a full opioid agonist; in that it fully occupies the mu-opioid receptor in humans. It is known for blocking the euphoric effects of other opioid drugs and making symptoms of drug (opiate) withdrawals less painful. Buprenorphine is a partial agonist; in that it doesn't fully occupy the mu-opioid receptor in humans and because of this it has a "ceiling effect" (this occurs when the effects of a drug plateau and will not increase even with repeated dosing). Naltrexone is an opioid antagonist; in that it blocks or covers, rather than activating the mu-opioid receptor. This means that it blocks the effects of opioids completely if they are used and "are recommended for relapse prevention and for abstinence-based treatment, not for withdrawal management." (PEW, 2016).

"These medications decrease opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission, while increasing social functioning and retention in treatment" (NIDA, 2017).

Looking at these on a much larger scale and on a one-on-one basis, these topics and beneficial reasons for using medication-assisted treatment begin to emerge with more depth and detail. Decreasing opioid use is one benefit of using MAT, this has been proven and one study showed that clients reduced their heroin use by 61.5% (in the past 30 days) (Community Medical Services, 2020). More importantly though, using MAT altogether decreases the amount of opioid related deaths and/or overdoses caused by opioids. Opioid overdoses are happening at an alarming rate in America, but MAT seems to be in the playing field battling this addiction with great results. Opioid overdoses are happening at an alarming rate in this country compared to other countries around the world and something needs to be done to prevent such disastrous outcomes, MAT has been proven to work towards these outcomes of positivity and a future where we are not silent about addiction and the truth about the overdose rate that is happening around us.

"Prison system data show that MAT reduces deaths. Without treatment, the risk of opioid overdose death for people shortly after leaving prison is 129 times that of the general population" (CHCF, 2019). Then, "Rhode Island broadly implemented the use of MAT in its jail and prison system, overdose death rates after release dropped by 61%" (CHCF, 2019).

While patients are utilizing medication-assisted treatment (MAT) rather than street drugs, they aren't trying to scheme up ways to make a quick buck to get their opiate (heroin) fix. Opioid addicts will suffice to anything for their withdrawal symptoms to go away, to chase that euphoric rush, or to alleviate that major pain, but, whatever it is, opiate addicts will do anything they need to in order to get the drug of their choice. Which, long-term results of this are long-term prison sentences which being incarcerated is never an optimistic choice for anyone! Rather than being incarcerated, an individual can start their recovery process with medicated-assisted treatment and would never have to commit a criminal activity again for their daily fix, they would just have to go to their local clinic (these drugs are heavily monitored and secured) to get their daily dosing and some patients have their medicine at home and can dose on their own after gaining privileges with their own doctors/clinics.

Currently, "sixty-five percent of all incarcerated individuals meet the criteria for a substance use disorder, majority being of opiate-use disorder" (NIDA, 2017). That is a lot of people that are incarcerated that are also battling addiction and studies have shown that "forced discontinuation of methadone treatment during incarceration can lead to a reluctance to engage in future treatment, due to the severe and extended withdrawal symptoms that occur when these medications are abruptly discontinued" and rather "opioid dependent patients allowed to continue methadone treatment during incarceration are less likely to be re-arrested than those who are detoxified in jail; over 97 percent of those receiving methadone continued treatment after release" (NIDA, 2017).

Not only that, but there's also cost efficient reasons why when it comes to the criminal justice system - "analysis of crime costs in California estimated that treating criminal justice-involved persons with methadone or buprenorphine resulted in a cost savings of nearly $18,000 per person over 6 months compared to detoxification alone" (NIDA, 2017). More inmates need access to healthcare that provides adequate treatment for opiate use disorders, or substance use disorders in general. It is estimated that roughly "11 percent of inmates who need substance use treatment in the United States receive any form of it" (NIDA, 2017).

There is an organization called Community Medical Services, that offers these services in 9 states across the country. They treat roughly 12,000 patients in Arizona alone. They have their own treatment statistics that they have came up with after many trial and testimonies. They have estimated that crime rates go down by 19% and that jail time goes down by 25%, as well as a 44% reduction in arrests (Community Medical Services, 2020). This organization also took some studies on employment and there was a 49% increase in employment after 6 months of MAT.

Medication-assisted treatment helps reduce the spread of infectious diseases that would otherwise be spread in the active addiction cycle, especially with the use of IV drug use. With IV drug use, needle/syringe sharing, is common trait, and increases the likelihood of transmitted diseases in the act of live addiction. "Infectious diseases (ID) and HIV clinicians across the country are reporting notable increases in cases of infectious diseases directly linked to injection drug use (IDU), including infective endocarditis (infection of the lining of the heart), hepatitis C (HCV) (including infection in pregnant women and transmission to their newborn infants), HIV, skin and soft tissue infections, and bone and joint infections" (IDSA, 2017). When someone is on MAT, all these risks of infectious diseases get put to the side.

Medication-assisted treatment also helps individuals with mental-health. "Methadone Maintenance Treatment (MMT) programs offer psychotherapy and counseling with each methadone dose to improve psychological health and behaviors" (Addiction Center, 2019). These programs can come face-to-face with issues regarding co-occurring disorders, which is when an individual is diagnosed with both a mental health disorder and an addiction or substance use disorder. "7.7 million adults have co-occurring mental and substance use disorders" (NIDA, 2018). These programs encourage education on healthy coping strategies to prevent relapse, as well as learning to manage stress, anxiety, depression, and conflict.

Individuals with opioid use disorders would normally use more than one time a day. This increases tolerance, which increase the dosage and frequency of the drug. In general, they get stuck in the cycle of repeating the process of finding drugs, using, being high, and recovering from withdrawal symptoms. When involved in an MMT program, they are free from this cycle. "Methadone and Buprenorphine specifically help "break the cycle" of addiction by allowing individuals to focus on their recovery, relationships, family, jobs, and improve psychological health" (Addiction Center, 2019). The beneficial aspects of this treatment are insurmountable compared to the negative side effects that could possibly come along with MAT.

There are a couple of things that may sway someone away from MAT, the biggest factor being that because the drugs used in MAT are heavily regulated and must be handled at specific locations where there are doctors with a specific license. This is where it becomes a problem in finding a client a location nearby because majority of these programs are in communities where addiction is prevalent. What about the other communities though? There needs to be more of an abundance of MAT clinics, so that clients can easily get to their medication instead of traveling miles away daily or so that more opportunities are given to these individuals that need this type of treatment.

Medicated-assisted treatment can also have some negative side effects, and those side effects may include, but are not limited to drowsiness, dizziness, constipation, over-reliance, and over-dose. The first three side effects are common side effects with many drugs prescribed by doctors everywhere. However, over-reliance is very common with MAT. Over-reliance is when an individual depends on the drug to be the miracle drug for an individual's addiction, when, these drugs need to be maintained with using psychotherapy, positive environments and relationships, and also adjusting and changing your behaviors and attitudes that came with someone's active addiction.

Overdose seems out of character to be a side effect of treatment, right? For most addiction medications, there is very little risk of overdose. There's no reason anyone would take too much disulfiram or too much naltrexone. The risk is mainly from methadone. "Although methadone is safe when taken as directed, people do try to use it to get high, which can result in an overdose, sometimes a fatal overdose" (Recovery Ways, 2019) This is also why methadone can only legally be dispensed at clinics and absolutely nowhere else! Also, it should be noted that "combining medications used in MAT with anxiety treatment medications can be fatal; types of anxiety treatment medications include derivatives of Benzodiazepine, such as Xanax or Valium" (SAMHSA, 2020). This shouldn't shy anyone away from getting the treatment they deserve. There needs to be more acceptance for MAT instead of the stigma that still exists and surrounds around addiction and treating addiction.

"MAT has about the same success rate as that for other chronic diseases requiring difficult behavioral changes, and outcomes are as good as those for diabetes and COPD and many people go on to reestablish productive, satisfying lives" (CHCF, 2019). The tragic impact of opioid addiction on individuals, families, and whole communities cannot be ignored when viable treatment is available and shown to have high success rates. MAT is clearly effective and should not be ignored as a form of treatment for people with opiate use disorder. Understanding the science behind addiction and treatment can help change how people view addiction and treatment and the stigma around it. Addiction is a chronic disease and not a character flaw. Training in the concepts of trauma-informed care can help staff over-come bias and change practices and these talking points can help inform conversations to change hearts and minds. It is the forefront and a new look of recovery in our generation! MAT is the way to go, because we are all humans at the end of the day and everyone deserves adequate and proper treatment when it comes to any form of disease, including addiction!

Works Cited

Addiction Center, AC. "Medication-Assisted Treatment for Opioid Use Disorders." Addiction Center, 18 June 2020

CDC, Centers for Disease Control. "Understanding the Epidemic." Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 19 Mar. 2020

CHCF, California Health Care Foundation. "MAT for Opioid Use Disorder: Overcoming Objections", CHCF, August 2019

Community Medical Services, CMS. "Quarterly Report: Community Medical Services", CMS, May 2020

IDSA, Infectious Diseases Society of America. "Infectious Diseases and Opioid Use Disorder." IDSA, March 2018

National Institute on Drug Abuse, NIDA. "Opioid Overdose Crisis" National Institute on Drug Abuse, 2018

National Institute on Drug Abuse, NIDA. "Treating Opioid Addiction in Criminal Justice Settings." National Institute on Drug Abuse, 3 June 2020

PEW, PEW. "Medication-Assisted Treatment Improves Outcomes for Patients With Opioid Use Disorder." The Pew Charitable Trusts, 22 Nov. 2016

Recovery Ways, wpengine. "3 Risks of Medication Assisted Treatment." Recovery Ways, 10 Jan. 2019

Substance Abuse and Mental Health Services Administration, SAMHSA. "Medication and Counseling Treatment." SAMHSA, 2020

Holt [Contributor] - / 9,531 2963  
Jul 9, 2020   #2
You need to kick off the essay with a backgrounder on what you call " a very strong force within themselves". It would be better for the essay if you can start off with a quick story of an Opiod addict and how he got started, then how it ended for that person. It would help illustrate the "darkness" that the Opioid addiction brings on, It will also make it easier for the reader to relate to your research paper.

To lessen your quotes or source usage in the presentation, you need to stop using the cut and paste method and instead, learn to offer your understanding of the information. Rather than simply paraphrasing, explain what you understood of the information you provided. You should also choose only the most important references to quote in the paper. You have to choose only the important references that can help strengthen your presentation. As of now, you are relying too much on citations to build your paper. You are just sticking in the quotes to help you create a semblance of a research paper. However, that is not a research paper is created. You need to figure out what you really want to focus on within the paper first. From what I can tell, the paper lost its focus from "darkness" to "MAT". If your real focus is MAT, then you should revise the start of the essay to reflect that instead of using the "very strong force" argument as it does not apply to the totality of your presentation.

As for your vocabulary, you are writing a paper that requires technical vocabulary for the discussion. Only you can double check the vocabulary usage in this case. Mistly because you wrote the paper focusing on a medical treatment. So you can't really expect to use general everyday words for the paper. Your other option, is to use a professional editing service to help clean up your presentation, vocabulary, and grammar issues within the paper.
OP stevensoursjr 1 / 1  
Jul 9, 2020   #3
Thank you for your feedback! I'm trying to see where I could possibly go with adding a personal story in their about an addict. I think I may leave that out of it, but I am definitely going to take out a few or more of those in-text citations and work around them with information that I have already. Also, I will be changing the start of my essay to carefully lay out the thesis for my paper. The "darkness" part of the essay does kind of need more to go with it, so I will probably altogether take that out and add in something else. However, I wanted to thank you for your response and review! I appreciate it!