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Consider Community Services and Medication-Assisted Treatment
Guest Editorial by Emma Stanton, M.D., Associate Chief Medical Officer for Beacon Health Options
Many people are familiar with the problem of addiction, but most people are not fully aware of their treatment options. With more than 1,200 reported deaths in Massachusetts in 2014 from opioid overdoses, it is imperative that we learn what makes recovery more successful.
Two areas are particularly important: community care and medication-assisted treatment.
Recovery happens in the community
What may seem like the preferred route isn’t necessarily so. While inpatient detoxification is sometimes necessary, research has shown that treatment is more successful when delivered in the community. People recover better from a chronic disease like addiction when they access local services and live in their own homes. The evidence is clear about what works: the 2007 National Institute for Clinical Excellence Guidelines recommend that “staff should routinely offer a community-based program to all service users considering opioid detoxification,” with just a few exceptions.
This research bears out internationally as well. In England many outcomes, such as whether people completed treatment, are routinely tracked in a national database, and the evidence shows that community care is more effective than inpatient treatment. Indeed, Australia’s 2014 National Drug Strategy mirrors the UK’s community-based model for detoxification.
If you or a loved one is struggling with an addiction, make sure you know all of your options. Ask your doctor about community-based treatment. Do not assume that inpatient treatment is your only alternative. In fact, the opposite is true – particularly when you engage in medication-assisted treatment, which has been shown to significantly reduce the risk of relapse.
What is medication-assisted treatment?
Medication-assisted treatment combines the use of behavioral therapy with medications such as methadone and buprenorphine to treat opioid addiction. Buprenorphine (Suboxone, Buprenex, or Subutex), which helps to ease withdrawal symptoms and cravings, can be given in a physician’s office, unlike methadone treatment, which must be done in structured settings such as clinics. Buprenorphine and methadone are highly effective when part of a treatment plan that also includes behavioral therapy. In fact, therapy with either medication reduces the risk of relapse by approximately 50 percent. One study of MassHealth members found that roughly five percent of people taking buprenorphine or methadone for opioid addiction relapsed at 12 and 24 months of treatment, as compared to approximately 20 percent of persons not taking either medication.
An advantage of both medications is that individuals can stay at home, in their communities, when taking these medications Not only can they stay in their communities, but it is preferable for them to do so. With home-based treatment, individuals can learn to use their community- and family-based support systems to cope with the daily temptations of drugs and maintain a healthy lifestyle.
Dr. Stanton is Associate Chief Medical Officer for Beacon Health Options. Originally from London, England, she was nominated as one of Health Service Journal’s most inspirational women in health and also one of their Top Innovators in England’s National Health Service. She is a senior associate at the Institute for Strategy and Competitiveness, Harvard Business School, where she researches the value-based approach to health care delivery.
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