Safer Solutions: Medication for Opioid Use Disorder Doesn’t Swap One Drug for Another
About 50 percent of Americans used a prescription medication in the past 30 days—from short-term antibiotics to emergency inhalers to lifelong treatment for a genetic condition. People are prescribed medications for many different reasons and use them in many different ways. This is no different when it comes to medications used to treat opioid use disorder (OUD).
One argument against using medications for OUD (MOUD) is that it doesn’t represent true recovery because it’s just “swapping one drug for another.” In the most basic sense, the goal is for individuals to take MOUD in order to stop using illicit drugs. But the argument lacks a nuanced understanding of OUD and ignores the most important goal of treatment: helping people return to healthy, productive lives.
What are MOUD?
Both buprenorphine and methadone can be used to treat OUD. Approved by the Food and Drug Administration (FDA), experts consider them the “gold standard” OUD treatment. These medications can substantially reduce the risk of returning to illicit drug use and dying from overdose. For many people, they prevent relapse to active drug use and enable them to work, take care of their families, and live healthy, stable lives—and they do so more effectively than treatments that don’t include medication.
This is a great success story, but some people are hesitant to support MOUD treatment upon learning that these medications are themselves opioids. While both buprenorphine and methadone bind to the same receptors in the brain as drugs like fentanyl and heroin, they act differently. MOUD reduce cravings for illicit drugs, block the “high” produced by those drugs, and reduce the painful withdrawal symptoms that often drive people to return to using drugs. However, they do not generally produce the intoxicating effects of other opioids and are far safer than illicit drugs.
MOUD offer individualized care
Just as people use drugs for their own individual reasons, each person pursuing medication for OUD treatment will have their own journey. Some patients use MOUD for a short period, slowly lowering their dose until they stop needing the medication. Others use MOUD for years, and some might take it indefinitely.
This pattern mirrors other types of treatment. Some people use antidepressants to manage a particularly hard time, while others take them for most of their lives. Some people dependent on nicotine use nicotine-replacement therapy (NRT) as a short-term solution; however, research supports longer NRT use if the alternative is a return to smoking. Alcohol use disorder can be treated with naltrexone, a prescription medication that helps reduce cravings and can be used in the short or long term.
Taking MOUD is not the same as active addiction
If a person’s body requires a substance to function optimally, it means they have become physically dependent on it. While many substances—including coffee, antidepressants, and even insulin—can cause physical dependence, it’s not the same as addiction. Most people who regularly consume any opioid (including MOUDs) become physically dependent, but not all become addicted.
But because MOUD reduces people’s compulsive relationship with opioids and allows them to make healthier choices, dependence on these medications doesn’t constitute addiction or OUD. Instead, people taking MOUDs are often in active recovery, living healthy and fulfilled lives thanks (in part) to their medication.
MOUD treatment is recovery
A common definition of OUD highlights the instability and harm often associated with the condition: “Individuals with OUD have a pattern of opioid use that leads to significant issues, such as health problems and difficulty meeting major responsibilities at home, work, or school.”
Patients stabilized on methadone or buprenorphine don’t face these impairments. In fact, MOUD is the catalyst that allows many people with OUD to lead full, productive lives that include careers, child-rearing, family and community commitments, and other elements we associate with healthy living.
Recovery means different things to different people, which makes it hard to define. The National Institute on Drug Abuse says that “[r]ecovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential … [b]eing in recovery is when those positive changes and values become part of a voluntarily adopted lifestyle.” Notice that this definition could apply to more health conditions than just OUD. For example, a person being treated for anxiety or rheumatoid arthritis might also experience recovery (or remission) thanks to medication.
MOUD facilitate health, stability, and wellness, just like other medications. However, the stigma surrounding OUD prevents people from recognizing this. MOUD give people who use opioids a path toward recovery and freedom from addiction—not a substitute high.