After Opioid Addiction: What It’s Like to Go Through Medication-Assisted Treatment

Realizing he was addicted to opioids, known as opioid use disorder (OUD), Jeff Born found a clinic specializing in MAT. From chronic pain to overdosing, he shares how he got his life back. 

After a 9,000-pound titanium bar fell on Jeff Born’s legs and crushed them while he was at work, he wound up with two prosthetic legs – and an addiction to opioid pain medications. Following the catastrophic 2003 workplace accident, Jeff was in terrible pain. He endured two amputations and had extensive nerve damage. His doctors prescribed oxycodone and other narcotic pain relievers along with antibiotics. For the next two years, he took the opioids freely as they helped to manage his pain enough that he could function day to day. But as the doctors reduced his dose and eventually stopped writing him a prescription in 2005, he realized he was addicted.

From Pain Management to Opioid Addiction

Once he was no longer taking his prescribed opioids, Born recalls going through withdrawal, an experience he calls “drug sickness.” He says, “It’s like having the flu, times a million. You have vomiting, diarrhea, a runny nose, and runny eyes.” Without help to deal with his opioid addiction and withdrawal, it was not long before Born began buying black market drugs from others – just so he felt well enough to get out of bed and take a shower.

By 2014, he was spending almost $100 a day on street drugs just to get a fix. He began to sense that everything in his life was falling apart. He knew he needed to do something or it would just be a matter of time until he died. Then, in 2016, he overdosed on heroin that – while he did not know it – had been laced with fentanyl. First responders were able to revive him with emergency naloxone, but the near-fatal experience made Born realize that he could not survive unless he got help.

Finding a Medication-Assisted Treatment Program

Born looked up a list of facilities that provide treatment to those who are addicted to opioids, and made an appointment at the first one he came across: Spectrum Health System, a nonprofit treatment center in Millbury, Massachusetts, that offers inpatient treatment, outpatient treatment, detox, medication-assisted treatment (MAT), and more.

"I had to be there at 5 am for the intake, and there was no guarantee that I was going to get in,” Born recalls. Fortunately, he was accepted into Spectrum’s outpatient program which involved one-on-one counseling with a therapist as well as group sessions that allowed him to listen to the stories of other patients in similar situations. “It was just so wonderful to talk to someone,” he says.

While he was not assigned to one specific doctor, Born had the opportunity to see various addiction specialists and nurses during the early phase of his treatment. Since he was having a lot of trouble sleeping and still had cravings for heroin (his street drug of choice), among other clinical factors, his doctors decided that Born was a good candidate for MAT. According to the US Substance Abuse and Mental Health Services Administration (SAMHSA),  medication-assisted treatment is the use of FDA-approved medications, along with behavioral therapies and counseling, to provide a “whole-patient” approach to the treatment of a substance use disorder (SUD) such as opioid addiction, which is clinically termed opioid use disorder (OUD). 

Methadone, a synthetic opioid agonist, relieves drug cravings by acting on opioid receptors in the brain. Although they are same receptors that other opioids such as heroin, morphine, and opioid pain medications activate, methadone occupies and activates these opioid receptors more slowly, and euphoria does not occur. Methadone can come with side effects such as constipation, increased sweating, sedation, and sexual impotence.

The partial opioid agonist known as buprenorphine, also used in MAT, binds to the same opioid receptors but activates them less strongly than methadone. And naltrexone, an opioid antagonist, blocks the activation of opioid receptors and is often effective in treating OUD because it prevents any opioid drug from producing a pleasant effect such as euphoria.

Ever since the US government declared a public health emergency around opioid misuse and addiction in 2017, FDA has been pushing for expanded coverage and training in MAT. The SUPPORT Act, signed into law in October 2018, for instance, calls for recommendations on enhancing the treatment and prevention of opioid addiction within Medicare and Medicaid programs, such as through coverage and payment of MAT services. The bill also increases the maximum number of patients that practitioners may initially treat with MAT.

Fortunately for Born, his treatment at Spectrum is covered by his health insurance even though he does not hold a job.

In addition to receiving methadone as part of his medication-based opioid addiction treatment, Jeff participates in regular individual and group therapy sessions. (Image courtesy Spectrum Health Systems)

 

Going through Medication-Assisted Treatment: It’s Not Just Medication

The first step for Born as part of his MAT program was a prescription for methadone to help keep his opioid cravings at bay. He had first undergone a period of detox that helped to keep his withdrawal symptoms in check. Still, it took three months to find a stable dose that would not leave him with a craving for opioids. He was started on a low dose of methadone that was then raised by 5 milligrams (mg) every two weeks. Currently, he takes 108 mg of methadone each day. The typical therapeutic dose of methadone can range from 80 to 120 mg per day, explains Eric Roldan, clinical program director at the Millbury Spectrum site.  The methadone comes as a liquid, and Born drinks it each day.

“The methadone works on the physical dependence,” explains Roldan.  “But through behavioral therapy, we also address addictive thinking, working through that process and setting goals for the client. It’s important for the clients to build healthy relationships with their family and friends again.”

There is a difference between drug addiction and drug dependence, points out Roldan. “When people use the word ‘dependence,’ they are usually referring to a physical dependence or substance,” he says. “Dependence is characterized by the symptoms of tolerance and withdrawal. While it is possible to have a physical dependence without being addicted, addiction is usually right around the corner.”

And, he adds, addiction is marked by a change in behavior caused by the biochemical changes in the brain after continued substance abuse. “Substance abuse becomes the main priority of the addict, regardless of the harm they may cause to themselves or others,” says Roldan. “An addiction causes people to act irrationally when they don’t have the substance they are addicted to in their system.” Read more about the difference between opioid addiction and opioid physical dependence.

Some individuals who go through MAT stay on their medication for the rest of their lives, while others are weaned off of it in a year or two, Roldan explains, adding that it’s recommended for all patients to stay on the MAT medication for at least one year and then to be re-evaluated. For Born, who has now been on methadone for three years, MAT provides relief of his original pain symptoms but does not lead to addiction. 

At Spectrum, MAT also includes cognitive behavioral therapy (CBT) and relapse prevention therapeutic groups; the latter help clients learn how to handle urges and cravings and what to do in high-risk situations. “They learn to be careful about people, places, and things,” he says, including why it is important to avoid old hangouts where perhaps illegal drugs were obtained. Also covered in therapy sessions are co-occurring disorders, addictive thinking, and family dynamics, says Roldan.

For Born, the group sessions are especially helpful. “It was such a change from what I had become used to, which was never having anyone to talk to about my cravings,” he says. “Through counseling, I have learned to maintain focus in my life as I want it to be. I find that it is so important to talk to other people about what is going on.”

Alternative Treatments for Opioid Addiction

MAT works for many, but not for everyone, experts say. “Medication-assisted treatments have significant evidence of efficacy and effectiveness to support recovery in a large number of individuals who struggle with opioid use disorders,” explains Francisco Moreno, MD, a professor of psychiatry at the College of Medicine Tucson. “These two medications allow an individual who has an addiction to opioids to feel and function well by blocking the physical need of the addicted brain to receive an abusable opioid,” he notes, however, “some forms of MAT, such as methadone and buprenorphine, have been criticized because of concerns that we may be merely substituting one drug of abuse for another.” In addition, says Dr. Moreno, “depending on the patterns of drug use, some people may be less likely to benefit from one or either of these substances,” he adds. “A third option is an opioid antagonist called naltrexone, which discourages people from using opioids by blocking the ability to get high while using the medication.”

MAT is “by far the best strategy that we have for management of opioid use disorder,” says Harshal Kirane, MD, director of addiction services at Staten Island University Hospital in New York City. “Along with non-pharmacological approaches, it is important to consider MAT as an option.”

As with any pharmacological treatment, MAT can come with undesirable side effects, such as those that affected Born, until a stable dose is found, and not all individuals feel that MAT is enough to support their sobriety. This is why supplemental and complementary therapies such as CBT and group sessions can be helpful.

Still, some individuals facing OUD may want to avoid substance use altogether, even if prescribed. There are various other options besides MAT. The 12-step recovery programs like Narcotics Anonymous, various community-based recovery groups, and individual and group counseling all are available, says Dr. Kirane. Professional addiction therapy is another option, says Jennifer Schneider, MD, who is based in Tucson and is certified in addiction medicine and pain medicine. “Professional addiction therapy can be a very effective and valuable modality,” she says. “When you treat just with medication, you are not addressing the whole problem. Just throwing pills at a person is not going to help them make any fundamental changes. You need to address their problems with individual and group therapy.”  

MAT, she adds, can open the door for an individual with OUD, and can help them to get the help necessary to make changes. “But this is only the first step," Dr. Schneider is quick to note. “It is not the solution but it can be instrumental in helping you make the changes you need to make.” (Additionally, Dr. Schneider clarifies that MAT means “therapy that is assisted by medication.” It is not meant to mean that the medication IS the therapy.)

Moving on After Opioid Addiction

For Born, who will turn 65 in June 2019, MAT gave him a second chance at life. “I was addicted to heroin for almost two years and I tried everything to get off it on my own,” he says. “I can’t imagine what my life would be like if I did not get some type of medication to help me.”

He continues to value his relationships with the other clients at Spectrum and he says he doesn’t mind the 20-minute drive to the facility to get his daily methadone dose. He also continues to attend individual therapy sessions bi-weekly and group sessions weekly. For him, MAT has been a successful way to stay addiction-free and keep his chronic pain at bay. For others facing the same challenge, he says: “When everything is just falling apart, get help before it’s too late. I was lucky. Spectrum saved my life.”

Updated on: 05/13/19
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