Medication Assisted Treatment: A Good Solution?

As you begin to walk alongside someone who struggles with addiction, you may find detox or in-patient rehab treatment to be a necessary option. How do you determine the right path? There are many options including Biblical counseling and discipleship based programs (see options here). You will find a popular approach in our culture is Medication Assisted Treatment (MAT). Understanding the benefits and dangers of this treatment will inform your counsel and provide wise first steps toward biblical care. First, we will define MAT and what it accomplishes. Then we will express when we believe it is appropriate to use MAT. Finally, we will discuss the downfalls of MAT and the biblical response to it.

THE PROPOSED MAT SOLUTION

The MATclinic news and information blog describes MAT:

Medication assisted recovery programs are supported by numerous studies and are based on the premise that opioid addiction is a chronic disease that affects the brain and not simply a moral failing. In fact, MAT medications like Suboxone are approved by the US Food and Drug Administration for treating opioid abuse. Success in recovery is driven by a "whole-patient" approach, which is a combination of medications, counseling, and dedicated case management.

In line with the secular view that addiction is a disease, MAT prescribes medication as a treatment for this “disease.” According to SAMHSA (Substance Abuse and Mental Health Services Administration): “Buprenorphine, methadone, and naltrexone are used to treat opioid use disorders to short-acting opioids such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone. These MAT medications are safe to use for months, years, or even a lifetime. As with any medication, consult your doctor before discontinuing use.”

(Note: The medications to treat addiction are manufactured by the same pharmaceutical companies that make the semi-synthetic opioids that can lead to addiction.)

MAT Effectiveness

According to SAMSHA, MAT is effective in these ways:

“In 2018, an estimated 2 million people had an opioid use disorder which includes prescription pain medication containing opiates and heroin.”

“MAT has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services for these individuals. MAT provides a more comprehensive, individually tailored program of medication and behavioral therapy that addresses the needs of most patients.”

“The ultimate goal of MAT is full recovery, including the ability to live a self-directed life.” “This treatment approach has been shown to:

-Improve patient survival

-Increase retention in treatment

-Decrease illicit opiate use and other criminal activity among people with substance use disorders

-Increase patients’ ability to gain and maintain employment

-Improve birth outcomes among women who have substance use disorders and are pregnant

Research also shows that these medications and therapies can contribute to lowering a person’s risk of contracting HIV or hepatitis C by reducing the potential for relapse. Learn more about substance misuse and how it relates to HIV, AIDS, and Viral Hepatitis.” 1

Notice the language here. The ultimate goal is full recovery. However that is not what MAT has been shown to accomplish, according to this list. By SAMHSA’s own information, MAT treatment outcomes are not full recovery.

PROPER USE OF MEDICATION ASSISTED TREATMENT

There are medications, when used properly, that can help in detoxification, and anxiety. However we believe this should be a short term solution as it does not facilitate heart change that is necessary to overcome addiction. Medication used for emergency overdose prevention can be life saving.

Naloxone

Naloxone is a medication approved by the Food and Drug Administration (FDA) designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids, such as heroin, morphine, and oxycodone. Naloxone is administered when a patient is showing signs of opioid overdose, and is a temporary treatment with short term benefits. Because Naloxone is used during an active overdose to prevent death, it is critical to obtain medical intervention as soon as possible after administering/ receiving naloxone.

If you are not familiar with Naloxone, this short video provides instructions on how to administer if necessary.

Detoxification

Drug detox is the natural process of ridding a substance from the body. However, a professional drug detox program, also sometimes referred to as “medically managed withdrawal,” entails the use of a set of interventions (such as medications and other therapies) to safely manage the side effects that occur when someone stops using drugs or alcohol. The goal of a detox program is to minimize the potential physical harm that may result after a sustained period of use. Detox from alcohol, especially, can have life-threatening consequences. A short term detox from any narcotic is wise. Since addiction is both physical and spiritual, it is necessary to address the real, physical needs before entering a longer treatment program or intensive accountability discipleship plan. Once the physical components are addressed, it takes time for one to become clear minded and be able to make thoughtful choices. An extended in-patient treatment program provides time for the mind to clear and enable one to address the emotional and spiritual components of addiction. Biblical Counseling/discipleship based treatment options are available (see options here).

Anti-Anxiety/Depression Medication

With wisdom and prayer, in some cases, these medications can be extremely helpful for a season. You will most likely see high levels of anxiety in an addict that is trying to stay sober. Sometimes it’s more than they can physically bear. This is especially true for addicts who have experienced trauma and abuse (whether it occurred before or during one’s use). In cases of extreme anxiety manifested in physical ways, it might be helpful for someone to take anti-anxiety medication to bring them to stability in which they can benefit from other means of treatment (counseling, etc). In all circumstances, you must consider the whole person and the effects addiction has on the physical body.

In our experience, finding a Christian physician with similar beliefs (and goal of true sobriety) with whom to partner in these cases is extremely helpful. The decision to use anxiety medication requires discernment and loving care to decide what is best for each individual. Anxiety and even depression is a natural response when someone is starting a new life. Substances have been the source of comfort and escape for many years and losing this close companion will cause physical, emotional and spiritual distress.

Cautions and Downfalls of MAT

While MAT is presented as a treatment for opioid use disorder, statistics show that up to 70% relapse after individuals stop the MAT program. 2 Some may overdose or die while on MAT programs. Even doctors that recommend MAT programs recognize the potential for overdose and relapse. In an article from the Harm Reduction Journal, an initial conclusion states that “A considerable number of patients enrolled in MAT have experienced overdose. Our study highlights that there are identifiable factors associated with a patient’s overdose status that may represent areas for intervention. In particular, longer duration in MAT is associated with a decreased risk of overdose.” 3 The conclusion in this study affirms that the longer an addict stays in the MAT program, the less likely overdose becomes.

But is this really sobriety? Let’s look more closely at the medications used by MAT.

Buprenorphine (Suboxone, used to treat opioid abuse) is itself a narcotic drug, classified as an opioid and schedule III narcotic. If you search buprenorphine, you will see things like “High risk for addiction and dependence. Can cause respiratory distress and death when taken in high doses or when combined with other substances, especially alcohol or other illicit drugs such as heroin or cocaine,” (drugfree.org) According to SAMHSA, “Buprenorphine is an opioid partial agonist. It produces effects such as euphoria or respiratory depression at low to moderate doses.” 4

It is concerning that the medications used to treat opioid addiction are easily manipulated to achieve a similar high as the original drug of choice.

Using MAT can provide a false sense of safety that leads to overdose of MAT. “Even after the effects of methadone wear off, the medication’s active ingredients remain in the body for much longer. Unintentional overdose is possible if patients do not take methadone as prescribed.” 5

Many people overdose and can die when they go off MAT. If someone chooses to use after a period of using MAT, they are at risk. “Patients on naltrexone, who discontinue use or relapse after a period of abstinence, may have a reduced tolerance to opioids. Therefore, taking the same, or even lower doses of opioids used in the past can cause life-threatening consequences.” 6

Addicts are prone to misuse narcotics. If an addict is given a 30 day supply of Suboxone (buprenorphine), the daily dose could be multiplied to achieve a similar high that came from the illicit drug. This is very common in Methadone treatment and is referred to as “Methadone addiction.”

Real-Life Evidence Against MAT

Like many teenagers, Sarah started partying with friends. Pain pills for fun turned into a complete heroin addiction. Sarah’s family helped her enter a local rehab facility. There she was given Suboxone as a “treatment” for her addiction with an ongoing prescription. Sarah was deemed “sober,” and left the facility. Years later, she was fully dependent on Suboxone to function. When Sarah inquired of her doctor about weaning off the MAT, she was told that it was not the right time. Sarah continued taking the prescribed medications until one day she called the doctor for a refill and the doctor was nowhere to be found; the practice shut down and the office phone was disconnected. Sarah was dependent on MAT to “stay sober.” Without it, she did not know what to do and immediately returned to heroin.

Dan struggled with addiction his entire life. His addiction destroyed his life and family. For years he sought the solutions and answers of the culture to fix his problem. He believed the lie that his problem was a disease and therefore he sought every solution presented; Cognitive Behavior Therapy, Electroconvulsive Therapy (shock therapy), treatment programs, and finally MAT. At 52, Dan overdosed and died. The cause of Dan’s overdose was multiple prescribed MATs to “treat” his addiction, including Buprenorphine.

These treatments were labeled “safe” by their doctors, but drove Sarah and Dan deeper into their addictions, and for Dan, death. These are true stories that are sadly not uncommon. There is no hope for change in the MAT Solution. In a controlled medical facility, and for a short time, MAT can be useful. Otherwise, there are few instances when MAT is appropriate.

ALTERNATIVE RESPONSE

“Perhaps the most troubling pitfall of MAT is the tendency for people to rely on the medication as their primary treatment instead of working to heal the root psychological and emotional causes of addiction. Without identifying and addressing the primary reasons for addictive and compulsive behavior, a person will simply become addicted to the new substance—even one prescribed as part of a MAT plan. The lack of essential behavior modification and resolution of inherent causes for addiction in general often sets someone up for failure with MAT programs.” 7

This is where the church is needed, and why we, as believers, can and should be caring for those who struggle with addiction. God is the Great Physician addicts need, and the church is His hospital. God created us for community. For an addict trying to get sober, community is literally life-saving. The church is the community God intended. But exhort one another every day, as long as it is called “today,” that none of you may be hardened by the deceitfulness of sin. Hebrews 3:13. Replacing one drug with another “approved” drug is not the solution. Rather, we enter in, point addicts to Christ, guide them practically in their daily walk and love them through the trials of life. For addicts, as it is for all of us, that includes viewing the past and addressing trauma through a Christ-centered perspective.

A biblical view of addiction gives a path to care for a struggling addict and equips you to help those walk in the light, in truth and freedom. Rejecting the solutions of the culture will result in freedom, not simply sobriety, or idol swapping. (See Addiction: Conflicting Solutions article). In 1 Corinthians 10:14 Paul says “Therefore, my dear friends, flee from idolatry.” Medication Assisted Treatment may be helpful in the short-term to prevent overdose death and wean off chemical dependence. However, someone using MAT is still in bondage, and is not fleeing from idolatry. Alternatively, when one is taught the transforming power of the gospel, and the practical implications for life, that person is truly free.

Therefore, preparing your minds for action, and being sober-minded, set your hope fully on the grace that will be brought to you at the revelation of Jesus Christ. 1 Peter 1:13

For freedom Christ has set us free; stand firm therefore, and do not submit again to a yoke of slavery. Galatians 6:1

Additional resources:

Addiction: Conflicting Solutions Article in the Church Toolkit

Addictions: A Banquet in the Grave, Edward T Welch

The Authors:

Liz Beck is the founder of Hope for Addiction.

Lara Kees is support staff for Hope for Addiction.