Despite considerable research evidence being available to dispel myths -confusion about common harm reduction strategies has stubbornly persisted in the wider population, preventing them from becoming mainstream.

5 Apr 2019

The US has historically been resistant to supporting harm reduction programs for people who use drugs. While some object to harm reduction approaches on ideological groundsi.e., abstinence is the only way, drug use is immoralmost reject interventions like syringe exchange programs and maintenance medications based on commonly held myths.

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Recent public interest in finding innovative solutions to the opioid-involved overdose crisis provides an opportunity to revisit long-held misconceptions. Policymakers owe it to their constituents to base their decisions about which interventions to support on the best available evidence. 

While many US harm reductionists are today advocating for “radical” approaches that also have proven efficacylike safer consumption spaces and heroin-assisted treatment, it’s important to remember that much of the wider population is not there yeteven with more “vanilla” forms of harm reduction.

Given the severity of the current crisis, a discussion that helps debunk or at least bring clarity to myths like those below can only be valuable.

Myth 1: Maintenance medications for treatment of opioid addiction simply substitute one addiction with another.

Methadone, buprenorphine (Suboxone), and naltrexone (Vivitrol) are widely used to treat opioid addiction. Not only are they FDA-approved, but they have been around for decades, undergone rigorous efficacy testing, and are considered safe.

However, many are opposed to this form of treatment because of the belief that these medications simply replace one addiction with another. This thinking is partly due to unfortunate terms found in both the media and research literature, like “replacement therapy” or “substitution treatment.” Even the widely used term “medication-assisted treatment” sends the subtle message that these medications are not legitimate standalone interventions, but rather adjuncts to treatment—perhaps even a “crutch” for weak-willed patients. 

The results of countless studies are unequivocal that these medications workand a more appropriate term for them might simply be “medications.” 

What’s important to note is that these medications do not always have to be paired with counseling to be effectiveunlike the implication of the phrase “medication-assisted.” In fact, evidence in support of these medications is so strong and convincing that they are now considered the gold standard for treating opioid addiction by the World Health Organization and many other leading authorities.

Maintenance medications have characteristics unlike those of illicit opioids such as heroin or fentanyl. When prescribed properly, they have gradual onsets, diminish cravings, block the euphoric effects of other opioids, and do not intoxicate the user. 

Most importantly, the evidence is clear that patients receiving medication for opioid addiction generally do better than those who do not. Studies show that such patients are more likely to secure employmentavoid arrestreduce use of opioidslower HIV seroconversion, and improve overall quality of life. And quite simply, these medications save liveswith buprenorphine, for example, cutting risk of overdose death by a staggering 50 percent

To properly eliminate this myth, a rethinking of how success is defined in mainstream treatment is needed. Providers of all kinds should be aware that complete abstinence from all drugs is not always a prerequisite for treatment success, especially when it comes to prescribed medications. Treatment success can take many forms. 

And although most patients stay on medication temporarily, those who choose to remain maintained for longer periods of time or indefinitely, because they are experiencing benefits, should also be considered success stories. The point is that just as with other chronic conditions, opioid addiction sometimes requires extended or lifelong use of medication.  

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