Opioid addiction treatment patients at Addiction Recovery Resources in Louisiana participate in the same group sessions whether they are receiving buprenorphine, injectable naltrexone, or no medication at all. In a National Conference on Addiction Disorders (NCAD) session on integrating medication and 12-Step approaches in treatment, facility owner A. Kenison Roy III, MD, said observations so far indicate little difference in overall outcome among the three subsets of patients.
“There is no difference in adherence, or the ability to do Step work,” said Roy. “There is long-term recovery in all three, and there is relapse in all three.”
Roy pointed out the difficulty of engaging opioid-dependent patients into abstinence-based treatment, then described the advantages of programming that blends a 12-Step orientation with medications such as buprenorphine and Vivitrol. Studies in outpatient settings show that use of buprenorphine improves treatment engagement and most life outcomes at six months, Roy said, adding that there is no evidence that buprenorphine works when programs limit its use to detox only.
He spent much of his NCAD session trying to debunk myths about buprenorphine, pointing out that patients on the drug do not escalate their doses or experience symptoms of addiction, for example.
“The place for ideology in treatment should be tempered by science,” Roy said.
He said the medication option at least should be there for all patients, and should not be based on the level of care in which they are placed. Once a patient is on buprenorphine, he said, he/she should stay on the medication as long as needed to meet important individual life goals. When he is asked the duration question, Roy likes to answer it this way: “When the patient has a house, a spouse and is halfway through Step 9.”
From there, weaning a patient off the medication can be achieved in nearly all cases, he said, although the process can be painstaking.
Roy added that the tenets of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) make no judgment about use of medications prescribed by a physician. Comments from the session audience, however, suggested that maintenance medication-using patients still face discrimination in some 12-Step meeting rooms, often being told they are not in recovery if they are on maintenance drugs.