A Louisiana-based addiction medicine specialist says that every day in the program he founded, he sees patients on medication-assisted treatment working their recovery alongside patients not on medication, with no difference in the two groups' adherence to treatment or commitment to 12-Step work. This has reinforced to A. Kenison Roy, MD, medical director of Addiction Recovery Resources, Inc., the benefits of individualized and comprehensive treatment strategies.
“There have not been drugs coming into the program, or disapproval of buprenorphine by non-buprenorphine patients,” Roy told a session audience Aug. 4 on the final day of the National Conference on Addiction Disorders (NCAD) in St. Louis. “I don't have people coming to me saying, 'Sam's on Vivitrol; I want Vivitrol.'”
In his session on medication-assisted treatment, Roy focused largely on buprenorphine, saying that while a prominent colleague in the field abandoned prescribing the drug for opioid dependence because it appeared to diminish the patient's hard work necessary for a lasting recovery, he has noticed none of this among his patients.
“I don't see any change in [the level of] spiritual growth for people on medication,” said Roy, who in 2014 at NCAD received Addiction Professional's Outstanding Clinicians Award in the physician category.
Roy, who has always demonstrated as much of a distaste for an over-reliance on prescribing as he has for blanket rejections of medication-assisted treatment, listed these among the factors that make an opioid-dependent individual a good candidate for buprenorphine:
A previously failed abstinence-based treatment experience.
Poor psychosocial skills/support.
An adolescent onset of use and an overall drug-using lifestyle (as opposed to someone who may have spiraled into an addiction later in the life cycle, such as through an addiction to prescription medication following surgery).
The comorbidity of addiction and pain, where pain has become incorporated into the patient's denial system.
Those with later-onset addiction might be better candidates for the monthly injectable formulation of naltrexone sold as Vivitrol, Roy said.
Buprenorphine patients in Roy's Metairie, La.-based program agree to the terms of a buprenorphine contract that seeks to build several safeguards into the delivery of service. Terms include pledges to participate in counseling while on the medication, as well as to receive the drug only in the setting of their treatment visits.
Roy maintains a balanced view that touts the benefits of medication in keeping patients engaged in their treatment, but also acknowledges that medication without psychosocial and spiritual support is doomed to fail. He minces no words, however, when addressing any lingering biases in the treatment field about the use of medication treatments in addiction.
“Buprenorphine does not make patients loaded; it's not switching addictions,” Roy said. He added in response to a question from the workshop audience, “There are some [12-Step] sponsors who will not sponsor people on buprenorphine. I just tell [the patient] to find another sponsor.”