By Stephen J. Pasierb & A. Thomas McLellen PH. D. Abuse of prescription (Rx) medications, particularly of Rx opioids (medicines that treat pain), continues to be one of the nation’s...
By Stephen J. Pasierb & A. Thomas McLellen PH. D.
Abuse of prescription (Rx) medications, particularly of Rx opioids (medicines that treat pain), continues to be one of the nation’s most concerning health problems. Mistakenly, many adolescents believe that Rx opioids are safe because they are prescribed by a doctor. But when abused, they can be as potent and as deadly as heroin. In fact, many teens and young adults who abuse Rx opioids move on to heroin abuse. The Centers for Disease Control and Prevention calls prescription drug abuse an “epidemic,” and we see it as a public health issue that disproportionately impacts our kids.
But Rx opioid or heroin abuse does not have to be lethal. There are behavioral and pharmacological treatments that can save lives and bring even seriously addicted kids into long-term recovery. The problem is many treatment programs have chosen to either rely on only behavioral treatments or only medications; and most physicians do not have sufficient training in either medication or behavioral therapy to provide effective treatment. So, when parents find themselves at the critical crossroads of what to do for an opiate-addicted child, what can they do to get help? What are our doctors providing, or even offering, to them?
While no one treatment approach is right for every teen, it is clinically sensible — but not easy — to find comprehensive care. We tell families to look for three things: First, the availability of professional counseling; second, medications and regular monitoring for the affected teen; and finally, family therapy to help that teen.
Teens who abuse opioids require professional counseling, combined with regular monitoring, as a minimum requirement of effective treatment. Their families can also benefit from professional therapy, helping them better understand the basis of their teen’s addiction. This therapy can help both them and their child create a practical plan to recovery.
But these essential elements of good care are often not enough. Many young people who have abused Rx opioids will require medication to protect them from physical withdrawal and to reduce their cravings for Rx pain relievers or even heroin.
We are just learning about the biology of opioid abuse and there is much to share with two critical stakeholders in a teen or young adult’s life: doctors and parents. What we know is that there is a biological basis to teen substance abuse, and it’s impacted by a number of factors, including family history and mental health issues. We know too that medication-assisted treatment can aid in the long-term treatment of opioid addiction. But first, parents must learn enough about medication-assisted treatment to weigh the pros and cons and make an informed choice.
All of us in the field of substance abuse treatment, and in health care — clinicians, researchers and educators — can start by helping families understand what medication-assisted treatment is and how it’s used.
The Food and Drug Administration has approved three products to treat opioid addiction: methadone, buprenorphine and naltrexone. These are very different medications with very different effect and side-effect profiles:
Methadone and buprenorphine have some of the same properties as other opioids. They can be abused like other opioids, but at the proper dose, they are effective in reducing withdrawal symptoms and cravings.
Naltrexone is quite different. It is an opioid-antagonist that blocks the effects of prescription and street opioids. It can only be prescribed to a patient who has been completely free of all opioids for at least 7-10 days. When taken, it will block the effects of any opioid use. It is basically chemical armor that protects a person in early recovery from experiencing any “high” or other effects of prescription or street opioids.
None of these medications has an effect on non-opioid drug use; none will prevent the use of marijuana, cocaine or other types of drug use.
These medications have undergone rigorous safety and potency checks, much like maintenance medicines for other diseases like hypertension or diabetes. They’ve also been proven to be successful when used as an integral part of a broader addiction treatment plan and continuing care. Medication-assisted treatment is, as Harold Pollack said in The Washington Post, “an imperfect, yet essential tool” to treat opiate disorders, and as we see it, critical in preventing the migration from prescription painkiller abuse to heroin.
Families can, and should, insist that their treatment providers offer these medications as part of a treatment plan for teen and young adult patients who are struggling with an Rx opioid addiction. It is possible that medication-assisted treatment will not be necessary, but there should be monitoring and management in place to determine whether or when behavioral treatment alone is not adequate. Thousands of young adults are dying needlessly because some treatment programs ignore FDA-approved medications or because physicians have simply provided medications without appropriate referral to family and individual counseling.
All components of care are needed to ensure effective treatment. It is past time to re-think the treatment ideology and professional prejudices that have prevented the comprehensive treatment that is so needed for our teens and young adults. We can and we must do better as prolonged recovery is now an achievable result of comprehensive addiction treatment.
Let’s work together to reduce the misunderstandings associated with the disease of addiction.
And, with the roles of behavioral, pharmacological and family therapies in the comprehensive treatment of this illness, we can help parents bring about recovery for their son or daughter. We need doctors and parents to learn more, and that starts by understanding that medication-assisted treatment can, and is, addressing a real need.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.
Follow Stephen J. Pasierb on Twitter: www.twitter.com/StevePasierb