“Medication-assisted treatment can be helpful,” the Pennsylvania Republican said in an interview. “It can be one of the pillars of the bridge, but it’s not the whole bridge, and it’s certainly not the destination.”
He, along with a dozen other House members, signed a letter to HHS Secretary Sylvia Mathews Burwell urging the department to analyze the quality and effectiveness of medication-assisted treatment practices before changing the limit.
“We know very little about the DATA 2000 waivered practices, how many patients are in them, what treatment services they receive, how long they stay in treatment, and how often they use illicit opioids or divert the buprenorphine that is prescribed to them,” the letter states.
For health providers, what “recovery” entails—and the best path to get there—varies widely from patient to patient. With all the options, including the three different medications, 12-step programs, and inpatient and outpatient recovery centers, they say it’s imperative that all options are readily available to those looking to start the process.
There’s been a broader recognition that abstinence-only recovery models such as 12-step programs aren’t the holy grail of treatment they were once thought to be, and that medicine, coupled with therapy, can lead to long-term recovery.
“Some of that really has been brought about by this opiate epidemic and the finding that these medications are in fact quite effective for treating the opiate-dependent person,” says Dr. Margaret Jarvis, an American Society of Addiction Medicine board secretary. But, she added, the shift isn’t complete: “The stance that all people need to do is get into counseling and 12-step work is very, very ingrained. There are a lot of people who have worked with that idea for decades, and so for them to be able to make use of the medications, is hard; it’s really hard.”
The tide is turning toward using medication in conjunction with therapy, agrees Larry Gamble, manager of Montgomery County Department of Health and Human Services specialty behavioral-health services, though he also said there’s still a ways to go. If a resident walks into the clinic with a history of opioid use, officials strongly recommend medicine in addition to therapy, Gamble says. But, of course, the patient has to consent, and then health providers work on the best step forward.
It boils down to finding the right treatment for the right patient at the right time, says Waller. Because with every other disease, he says, doctors talk through the risks and benefits of each treatment course—including medication—and substance-use disorders should be no different.
For Emily, it’s suboxone, coupled with therapy, that she credits with keeping her away from opioids since about February. She has been clean for about this long at least three different times (twice were during pregnancies), only to fall back into the abuse-withdrawal cycle. “It’s tough because you’re fighting against your brain,” she says.