Last fall, Time Magazine published a long article entitled "Why We Need Drugs to Treat Opioid Addiction" (Time, October 12, 2016). The article was a supportive argument for the Obama administration's regulatory support for Medication Assisted Treatment (MAT). It repeats many of the compelling arguments to support the use of medications such as Suboxone®:
The medication can lower addicts’ risk of overdose death by more than 50% and their risk of relapse by more than 50% as well. After four years on the medication, a third were not abusing opioids and no longer needed Suboxone® to maintain their sobriety.
Key to the new rules is allowing Physicians Assistants (PAs) and Nurse Practitioners (NPs) to prescribe Suboxone® and other buprenorphine based medications. Many of the critics argue that MAT programs substitute one addiction for another. That misses an important subtlety that the TIME article refutes well:
The key is to think of these measures more as necessary medical treatments, similar to the way people take statins to lower cholesterol or insulin to keep their blood sugar in check. People with addiction may be dependent on the drugs to keep them clean, experts say, but they are not addicted to them, since addiction, as defined in the psychiatric manual, involves severe disruption of daily activities as the craving for the next high takes precedence over all else.
There is a great quote from Dr. Joji Suzuki:
“People tend to confuse the difference between dependence and addiction,” says Suzuki. “Physiologic dependence can occur because you are taking medication on a regular basis, whether it’s an opioid like [Suboxone®] or blood-pressure medications. The body becomes reliant on them. So are addicts who take buprenorphine [Suboxone®’s chemical name] physiologically dependent on another drug? Absolutely. But addicted? Absolutely not.”
Even with overwhelming evidence that MAT is the best available treatment for opioid addiction, too many doctors refuse to get certified to prescribe Suboxone®. Fewer than twenty percent of the doctors in the US prescribe over 90% of all the buprenorphine based medications such as Suboxone®.
We are hopeful that the addition of PAs and NPs to the prescribing pool will greatly open up the opportunity for people addicted to opioids to gain access to medications such as Suboxone®. MATClinics will be adding NPs and PAs as soon as the Federal government approves the waiver forms.