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How Effective is Drug Replacement Therapy?

Can Drug Replacement Therapy Actually Help Patients Recover from Addiction?

You may have heard about drug replacement therapy (DRT) before. If you have read a bit about it, you have probably noticed it is quite the divisive issue in the substance abuse rehabilitation community. It is important to discuss both sides of the argument and come to a basic understanding of why there is so much controversy surrounding this method of substance abuse treatment.

Idea Behind Drug Replacement Therapy

The idea behind DRT is that it serves as long-term drug maintenance. Perhaps the most famous example of this is those people struggling with an addiction to opioids are prescribed methadone. An alternative option is the use of Suboxone maintenance. There are a number of ideas behind the implementation of DRT.

The following are just a handful of the key benefits that proponents claim it has:

Removal of a criminal element – When you give a user an alternative to heroin or any other opioid drug, it would mean that the user would not have to acquire the illicit substance to feed his or her addiction through illegal means. Oftentimes this means that users do not have to steal, beg, or perform other illegal activities in order to receive the ‘high‘ they crave.
Focus on the person – If the person signs up to receive DRT, it should become easier to provide assistance where necessary. This could benefit the overall health of the patient in the long-term. Some believe that slow, gradual change could lead to benefits down the road.
It can lead to change – Proponents of the therapy believe it is far more likely that a patient enters rehab when using an alternative such as methadone and Suboxone as opposed to using illicit substances.

Difference Between Suboxone and Methadone

One of the main controversies regarding drug replacement therapy is the fact that methadone itself is a dangerous substance with great potential for health problems. Even though both are synthetic opioids, the difference is that Methadone is a full opiate agonist whereas Suboxone is a partial opiate agonist (meaning that even when taken in large doses, the effects of the substance are limited).

This leads to the following breakdown:

Because Suboxone is much harder to abuse, patients can take it home. Meanwhile, it is much easier to abuse Methadone, meaning that patients must travel to the same clinic every day for their medication. During the later stages of DRT, methadone patients may receive take-home doses.
Those struggling with serious addiction and heavy opiate habits will not find effective relief from their withdrawal symptoms with the use of Suboxone. For those people, methadone simply works better because it is much stronger.
Methadone has far more potential for addiction than Suboxone. The risk of a fatal overdose is much greater with methadone than with the use of Suboxone
The active ingredients in Suboxone are buprenorphine and naloxone. Meanwhile the active ingredient in methadone is the same as the name of the brand itself.
Suboxone is far costlier than methadone and does not have generic versions available.

Two Possible Opinions

As previously discussed, drug replacement therapy is a deeply divisive issue.

There are two camps in this situation:

For it – These people believe that in order to recovery in the long term, DRT is unavoidable. These people believe that there are possible alternatives available for these people struggling with dependence because the withdrawal symptoms would simply be too severe. Many believe that the long-term abuse of opioids has caused the patient to damage their body and mind in such drastic ways that a “normal” life may not be attainable. Many of these people believe that denying this treatment is condemning users to a lifetime of continuous addiction or even death.
Against it – The belief here is that DRT is nothing more than swapping an illegal drug for a legal one. Considering that both substances are highly addictive, oftentimes the dependence on the substance slowly ‘ramps up‘ instead of becoming less. The people who speak out against DRT believe that this is not the way to help a person but rather to perpetuate the addiction.

Weighing the Options

When talking about necessity, we have to take into consideration that an extremely small percentage of recovering addicts would ‘need’ this type of DRT. For many of these long-term users, the duration and intensity with which they have used opioids in the past have damaged their body in such a way that a ‘healthy’ life may not be attainable anymore. However, we have to remember that this is only true for an extremely small percentage of long-term drug abusers.

The vast majority of patients in recovery may actually be taking a step backwards when relying on alternative substances. This means they can avoid functioning without the comfort of synthetic opioids, which is an important part in long-term recovery.

We have to consider the following factors:

Not the biggest problem – For some people struggling with dependence, criminal problems, violence and desperation are far bigger issues than the actual dependency on a substance. Perhaps in these situations this help would allow for an alternative way of living their lives.
Physical necessity – Is it possible for someone to live his or her life when the baseline level of dopamine has dropped completely? Some long-term users may find themselves in this particular predicament without DRT. While it is important that a patient manage to recover from dependence, there has to be a ‘light’ at the end of the tunnel, something to look forward to.
When other options fail – Few people will argue that drug replacement therapy should be the ‘standard’ in recovery. However, in actuality it should be the very last resort. Only if all other options have been attempted – which includes even cognitive therapy and long-term inpatient recovery – have not provided the desired results, perhaps DRT is preferable to the alternative.

What Should You Do?

As mentioned, DRT must never be the primary option when helping someone. It is unfortunate that some physicians and clinics have become complacent when it comes to treating dependence. It is not an easy choice or one that should be taken lightly. Learn more about drug replacement therapy and the highly effective alternative solutions that are available.