The Difference Between Appropriate Medication Use and Chaotic Drug Use
May 24, 2019
There is a long-standing stigma about the long-term use of prescription opioids, especially by people with a history of opioid addiction. People in recovery sometimes get flak for using other medications as well, like benzodiazepines which can treat anxiety and seizure disorders. Some people have even reported being chastised in twelve-step groups for using anti-depressants. But this stigma is misapplied. In fact, no substance is “good” or “evil;” all medications have the ability to heal or to harm, depending on how they are used. That applies as equally to opioids as it does antibiotics.
What’s the Difference?
Sometimes, especially when it comes to the use of illegal or non-prescribed substances, the difference between addictive use and non-addictive use can become muddled. For example, if someone who struggles with an opioid use disorder decides to engage in weekly marijuana use, is that a continuation of addictive behavior? Some people say no—if the person uses cannabis in a non-compulsive manner without allowing it to negatively affect other areas of her life, that should be considered okay. Others will say that any non-prescribed drug use in a person with a history of addiction poses a danger, and should be avoided. Ultimately, how a person engages with substances while in recovery is highly personal, and up to the individual.
When it comes to prescribed medications, however, the difference is usually a lot clearer. Addiction is defined by compulsive drug use despite negative consequences. That means someone might not even want to use a drug, knowing, for example, that it will lead to a positive urinalysis at his job interview next week—but he takes the drug anyway. Appropriate medication use is completely different. When someone is using a drug appropriately, it means he is taking it as prescribed by his doctor. That typically means a specific dose at a specific time. It will not have intoxicating effects, and if he experiences worrisome side-effects, he tells his provider and works with her to manage those symptoms. Unlike addictive drug use, appropriate drug use should have life-restoring—not life-ruining—effects.
What Is MAT?
One of the most unfortunate myths caused by the common misunderstanding of addictive versus appropriate substance use is the inappropriate stigmatizing of medication assisted treatment (MAT). MAT, which can also be referred to as pharmacotherapy, is medication treatment for opioid use disorder. The two most common types of MAT programs are methadone and buprenorphine. Both of these drugs are in the opioid family. Methadone is a long-acting full opioid agonist, while buprenorphine is a long-acting partial opioid-agonist. That means that buprenorphine only binds partially to the opioid receptors, but both drugs have a high affinity to these receptors, which means that, at therapeutic doses (which are individual to each patient), they will block the euphoric effects of other opioids. They also manage withdrawal and cravings in opioid addicted patients. They are the gold standards of treatment for opioid use disorder, and both have a strong evidence-based for reducing chaotic drug use and other harmful effects of addiction. But because they are opioids themselves, some people think they are “just replacing one drug for another.” That is why it is important to understand that a patient who takes his prescribed dose at the appropriate time each day is not engaging in addictive behavior. While the drugs do produce a physical dependency—similar to insulin or anti-depressants—they treat addiction; they do not cause or continue it when used as prescribed.
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