Can You Ever Stop Opioid Replacement Therapy?

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Can You Ever Stop Opioid Replacement Therapy?

Medication-assisted treatment, or MAT, is currently considered the gold standard for opioid use disorder. MAT combines the use of FDA-approved medications–typically methadone or buprenorphine, but sometimes naltrexone–with a holistic program that includes psychotherapy, life skills development, and positive lifestyle changes.

Studies have shown that patients receiving MAT have significantly better outcomes, including longer recovery and fewer overdoses, than patients receiving psychotherapy alone. The primary reason for this appears to be that methadone and buprenorphine blunt the intense cravings people typically experience when recovering from opioid use disorder. Another major benefit of methadone and buprenorphine is that a patient doesn’t have to detox completely before starting treatment. This can save her from several days of painful withdrawal symptoms and accelerate the pace of recovery.

MAT is sometimes criticized as simply replacing one addiction with another. A patient who is addicted to heroin, for example, is given methadone instead and sent on his way. This characterization is inaccurate. First, medications are most effective when used as a part of a comprehensive recovery program. Patients can participate more fully in treatment when they aren’t distracted by intense cravings. Second, medications allow patients to live normally, while opioids do not. What’s more, MAT reduces the risk of overdose and infections such as hepatitis and HIV. And prisoners who are given MAT have lower rates of relapse and recidivism.

It is, true, however, that methadone and buprenorphine are addictive. Some people even find them more addictive than heroin. This raises the question of whether someone on MAT can ever stop using the medication without relapsing. There doesn’t appear to be a clear answer to this. The answer largely depends on the individual and her motivation for quitting MAT. Some people want to quit because they intend to relapse. Others want to be completely drug free. Others don’t like how they feel on the medication.

While it is possible to taper off off methadone and buprenorphine, most people take it indefinitely. Long-term opioid use can significantly rewire your brain and it may take a very long time for that to change. It’s important to consider your motivation for quitting medication. If it’s only because you believe you aren’t really sober if you are taking medication, you may want to evaluate the pros and cons. If the medication allows you to function normally and minimize your risk of relapse, while quitting is far more likely to lead to relapse, it’s probably better to keep taking the medication. If your concern is more practical, you may have other options, such as switching from methadone to buprenorphine, which can be prescribed by an addiction doctor so you don’t have to get it from the clinic every day.

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