Medication-assisted treatment (MAT) has long been recognized as the gold standard in treating opioid use disorder (OUD). Medications such as methadone and buprenorphine, both opioid-based, have demonstrated their efficacy in reducing the risk of overdose, relapse, and death. These medications help stabilize the brain chemistry affected by opioid addiction, offering a crucial lifeline to individuals in recovery. However, despite the clear evidence supporting MAT, many patients and clinicians still opt for non-opioid medications like lofexidine and clonidine, often due to misconceptions and stigma surrounding opioid-based treatments.
Dr. Eileen Barrett, Senior Medical Director at Workit Health, sheds light on this issue, stating that many individuals are hesitant to use methadone or buprenorphine because of the societal stigma that these medications are simply substituting one addiction for another. This misconception can lead patients to choose non-opioid options, such as lofexidine and clonidine, which can help manage withdrawal symptoms but fail to address the underlying opioid use disorder. Dr. Barrett emphasizes that while these non-opioid medications can alleviate some withdrawal symptoms, they do not treat the addiction itself and may leave patients vulnerable to relapse.
The Efficacy of Buprenorphine and Methadone
Research consistently demonstrates that methadone and buprenorphine are among the most effective treatments available for OUD. These medications do more than just ease withdrawal—they stabilize the brain’s chemistry and reduce the compulsive cravings that drive addiction. Medication-assisted opioid use disorder treatment with methadone and buprenorphine has been shown to significantly reduce the risk of death, overdose, and relapse. Methadone, in particular, has been shown to reduce the risk of death by 38%, while buprenorphine offers a 34% reduction. These figures underscore the critical role these medications play in saving lives.
Furthermore, medication-assisted opioid use disorder treatment helps keep patients engaged in care. A study revealed that methadone kept patients in treatment for an average of 66 days, compared to just 30 days for buprenorphine or naloxone. Maintaining a longer period of treatment is essential to long-term recovery, as it provides individuals with the support and structure needed to rebuild their lives. In contrast, non-opioid medications such as lofexidine or clonidine do not offer the same level of patient retention, which can hinder sustained recovery.
Another important aspect of buprenorphine and methadone is their safety profile. These medications are not harmful to vital organs like the liver or kidneys, and they do not cause cardiovascular disease or respiratory issues—complications commonly seen with illicit opioid use. According to experts, buprenorphine and methadone are “incredibly safe” and can be taken for a lifetime without causing long-term health problems. This makes them an ideal option for individuals with OUD who need long-term support to maintain recovery.
Why Non-Opioid Options Fall Short
Non-opioid medications, including lofexidine and clonidine, are sometimes prescribed as part of a withdrawal management plan. These medications can reduce the intensity of withdrawal symptoms when patients are transitioning from one treatment to another or when they want to taper their medication doses. While these options may provide temporary relief, they do not address the root cause of opioid addiction—the changes in brain chemistry that occur with long-term opioid use.
Dr. Barrett points out that while lofexidine and clonidine may help manage withdrawal symptoms, they fail to treat the underlying substance use disorder (SUD) that drives opioid addiction. Without addressing the brain chemistry imbalances that contribute to addiction, non-opioid medications are unlikely to prevent relapse or support long-term recovery. In fact, they may leave individuals more vulnerable to returning to opioid use once the symptoms of withdrawal subside.
One of the significant issues with non-opioid medications is patient adherence. As Dr. Steven Pratt from Magellan Healthcare explains, patients who start non-opioid treatments often do not continue them, which undermines their effectiveness. Non-opioid medications require strict adherence to dosing regimens, and failure to comply can result in a lack of therapeutic benefit. For some patients, the experience of not achieving the desired results can lead to feelings of failure, further complicating their recovery process.
The Role of Stigma and Misunderstanding in Treatment Decisions
Despite the overwhelming evidence supporting the use of buprenorphine and methadone, many clinicians are still reluctant to prescribe these medications due to stigma. There is a common misconception that opioid-based treatments, like methadone and buprenorphine, are merely substituting one addiction for another. This misunderstanding can prevent patients from receiving the care they need and can lead to clinicians recommending non-opioid medications that do not offer the same level of effectiveness.
The stigma surrounding medication-assisted opioid use disorder treatment is particularly problematic because it can lead to harmful treatment decisions. As Dr. Pratt explains, the stigma surrounding methadone and buprenorphine often stems from the belief that these drugs are perpetuating ongoing substance use. This mindset can result in patients being discouraged from using MAT, despite the overwhelming evidence that these medications are far more effective than non-opioid options. In some cases, patients are told to taper off medications like Suboxone (buprenorphine) to remain in treatment facilities, which can lead to unnecessary suffering and, in some tragic cases, death.
Stephanie Strong, founder and CEO of Boulder Care, shared heartbreaking stories of patients who were told to discontinue their Suboxone treatment in favor of non-opioid medications or other recovery programs, only to relapse or even lose their lives. These stories highlight the devastating consequences of basing treatment decisions on stigma and misconceptions rather than evidence-based practices.
A Call to Embrace MAT as the Gold Standard
To ensure that patients with OUD receive the most effective care, it is essential that healthcare providers, systems, and lawmakers embrace the use of buprenorphine and methadone as the gold standard for treating opioid addiction. Dr. Barrett advocates for a shift in the way medication-assisted opioid use disorder treatment is perceived, urging healthcare professionals and recovery communities to reduce stigma and recognize these medications as the most dignified approach to treating opioid use disorder.
Dr. Barrett’s call to action extends beyond clinicians. She emphasizes the need for healthcare professionals, health systems, patient advocacy organizations, and even lawmakers to work together to create an environment where MAT is seen as a critical tool in the fight against the opioid crisis. By reducing stigma and fostering a better understanding of MAT’s benefits, we can ensure that more individuals with OUD receive the care they need to recover and lead fulfilling lives.
Conclusion
While non-opioid medications can play a role in managing withdrawal symptoms, they cannot address the core issues of opioid addiction. Medication-assisted opioid use disorder treatment with buprenorphine and methadone, with their proven track record of effectiveness, remains the gold standard for treating OUD. These medications not only alleviate withdrawal symptoms but also stabilize brain chemistry and reduce the risk of relapse, overdose, and death. To improve long-term recovery outcomes, healthcare providers must embrace MAT, reduce stigma, and focus on the evidence supporting these treatments. By doing so, we can provide individuals with OUD the best possible chance for a successful recovery and a healthier future.
