Using meds to kick drugs: A prescription can help opioid addicts on the road to recovery

Angelic Ewing struggled 20 years with drug addiction – mostly opioids but sometimes methamphetamine.

Now 41, the Spokane resident first got hooked after a back injury as she worked to become a certified nursing assistant.

“I was just 19 and I still remember that day looking in the mirror when I took that hydrocodone, and thinking, oh this feels so good,” she said. “From that day on, it cycled for 20 years.”

But nearly two years ago, she found recovery through medication-assisted treatment, or MAT, a method of using prescribed drugs along with counseling and behavioral therapies.

The Food and Drug Administration has approved three drugs for opioid dependence treatment: buprenorphine, methadone and naltrexone.

Naltrexone blocks the euphoric and sedative effects of drugs such as heroin, morphine and codeine. Buprenorphine and methadone activate opioid receptors in the brain, suppressing cravings, says the Substance Abuse and Mental Health Services Administration.

During her years of addiction, Ewing gave up some of her children for adoption. She watched a son born with opioid dependency go through detox in the hospital. There was domestic violence.

Ewing said after trying multiple other programs, including methadone treatments, this experience is different.

The journey starting in June 2017 followed a dark time that included watching her husband, also addicted, enter the hospital. He died last year.

“I realized I really needed to get help, so I went up to Riverside Recovery Center. I enrolled myself in treatment.”

At Riverside, Ewing was presribed Suboxone – a combination of buprenorphine and naloxone, a medication that blocks opioid receptor sites in the brain. She takes a daily dose on a film placed under her tongue.

A doctor told her that while that medication is important to her recovery, it’s only a part of the equation. She had tried Suboxone back in 2008, too, but this time she tapped into counseling and community resources.

“Part of it is eating healthy and exercise,” she said. “Start doing the things that will make you well on the inside and don’t expect the medication to do all the work. That helped me, because back in 2008, the medication was just thrown at me.”

This time, she went regularly to group therapy sessions and still goes to individual therapy. She plugged into YWCA programs and a local church.

Today, she’s caring for her youngest daughter. She entered Spokane Community College’s Career Transitions program and plans to enroll in fall classes.

This month, a statewide campaign is raising awareness about MAT treatment options and recovery resources.

The Washington State Health Care Authority has launched that campaign, including information on the Washington Recovery Help Line.

Recovery options

Methadone therapy started decades ago in a clinic setting for recovery from addiction to opioid-based drugs, such as heroin or strong prescription painkillers. It’s offered at the Spokane Regional Health District clinic, but the agency also provides other opioid use disorder treatments.

SRHD is accredited to dose with other MAT drugs, including Suboxone and buprenorphine.

The Washington Recovery Help Line website recently launched a MAT locator tool to help people find services statewide. More than 20 providers are listed in or near Spokane.

Among treatment options, buprenorphine has been prescribed here for about a decade, often as Suboxone or Subutex, said Dr. Lora Jasman, an internal medicine physician for MultiCare Rockwood Clinic. She started prescribing it around 2008.

“Buprenorphine works very well, but unfortunately, there’s not been widespread use of it nor widespread knowledge that it is available,” Jasman said.

She said it’s considered a safe drug, unlikely to lead to overdose or death caused when patients stop breathing.

“Buprenorphine has a low risk of that, especially if it’s not prescribed with other controlled substances or used with alcohol,” she said. “It tends to block the craving and make people feel normal without causing a euphoria.”

All three FDA-approved medications have their place, she added, and methadone can work well for many people. But it’s provided only in a methadone clinic, “and sometimes that’s inconvenient or it feels stigmatized.”

Buprenorphine and naltrexone products can be prescribed in a doctor’s office.

Jasman said naltrexone often is offered as a once-a-month injectable medication that is an opioid blocker. It’s prescribed less often, because a patient must be off all opioids for a week beforehand.

Naltrexone also tends to stop cravings and block any effects of other opioids, if taken, such as heroin, she said.

Most MAT patients seem to prefer buprenorphine products, Jasman said. Many also need ongoing behavioral health counseling alongside drug treatment, she added. Patients might have underlying issues such as PTSD, anxiety or the need for mental health support to rebuild lives.

Misconceptions

Jasman said several misconceptions linger around MAT, although it’s proved to work.

“There is common belief that if you take buprenorphine products that you’re exchanging one addiction for another,” she said. “It is true that buprenorphine is a controlled substance, and it’s also an opioid, but it is not trading one addiction for another, because once people get stabilized on that medication, they no longer exhibit addiction behaviors.”

Addiction behaviors include using a drug in higher quantities, being unable to control the use of it, and continuing despite harm.

Patients take buprenorphine to feel well, much like people regularly take high blood pressure medicine, “but they don’t take it to get high, or take it in higher quantities, or take it even though it’s causing harm.

“They start behaving normally, and there is some evidence the brain may even heal.”

Other false beliefs about opioid addiction treatment is that people should go cold turkey, Jasman said.

“The biggest problem with opioid use disorder is the cravings, so what people find is once they have been using opioids for a while, if they develop an opioid use disorder, they have cravings. If they go off the medication, they get the withdrawal, and then they also get terrible cravings to use it again.

“They can’t seem to overcome that because of the changes that have happened in the brain that kind of affect the reward center of the brain.”

For example, buprenorphine clings to the “mu” receptor of the brain, she said, and it doesn’t stimulate it much. But with that cling, any other opioid taken doesn’t seem to have an impact.

“So it doesn’t make the person feel like they would if they took heroin, but it grabs onto that receptor very tightly so the heroin can’t get to it,” Jasman said. “The patient feels normal, because they no longer have those cravings and because the medication is working on receptors that ordinarily would only be satisfied by heroin or another opioid.”

Ewing’s journey

For many patients like Ewing, they’re in MAT for the long term. She graduated from outpatient treatment about a year and three months after first entering Riverside Recovery, but she continues to see doctors there.

Ewing has gone to a reduced Suboxone dosage.

“I stayed sober through my husband’s death in May of last year, which says so much about MAT, and it’s given me the ability to go out into the community and make connections and build my own care team around myself. That’s a huge part of the MAT.”

“The physiological piece and dependence piece of opioid use is so powerful, it creates this vortex that you get sucked into. The MAT kind of stops that. But it doesn’t help build relationships; it can’t feed your soul; it can’t get your body healthy; it can’t rebuild broken relationships. Those are things I have to do, so I got into every therapy I could.”

Generally, if patients get off MAT drugs too quickly, they are at high risk for relapsing, Jasman said. Providers tend to focus on making patients stable and removed from more dangerous drugs.

“If you get the right dose, they don’t feel like they have cravings or need to go use drugs,” she said. “They get their kids back. They stop having legal problems. They drive. They get a job. It’s a remarkable change.”

But other patients need more help.

“Some patients have a lot of psychosocial issues that need to be addressed,” she said. “It isn’t like the medication solves every problem, but it does solve a huge piece of the problem, which is the feeling of cravings or that they have to go back and use heroin or whatever the drug of choice is.”

Buprenorphine most commonly is prescribed as a film placed under the tongue, Jasman said, and more insurance companies are covering that treatment. Without insurance, its cost is roughly $120 a month.