To properly assess an individual with opioid dependency it’s important to know how they became addicted. Was it through pharmaceutical drugs containing Fentanyl? Did their prescription run out, so they went to the street to get ahold of illegal drugs to suffice during excruciating and tormenting times of withdrawal? How much did they take and how long did they take it? What else did they take?
It’s important to know the family history. Are there any other dependencies in the family; alcohol, drugs, etc. Is there any family history of mental illness? What types? Has the patient been previously diagnosed with any mental disorders do they have a history of mental health issues?
It’s important to get a genetic test, as certain genes respond differently to different medications, as often medications are given in place of opioids to help with withdrawal symptoms. These drugs are administered during a specifically timed drawdown, this might take weeks. It’s important to use the right medicines which match the individual’s gene set.
How much damage has been done to the brain’s neurotransmitters, to the patient’s kidneys, and the central nervous system? What is the patient’s health care provider willing to pay to treat the addiction?
How serious is the individual in seeing this through? You cannot help someone against their will, as they will remain dependent still. Has the patient been to a rehab facility previously and relapsed? How many times? What previous medicines have been prescribed in past rehab treatments? Has the patient attempted a do-it-themselves program? Is the family committed, caring, and ‘all-in’ with all their love (cite: 1, 2, 3)?
Opioid Relapse Is All Too Common
When it comes to heroin, only about 28% of the addicts studied in long-term research had stable abstinence after 10-30 years of observation. The 28% is of those who survived, as heroin addicts had 6-20 times more likelihood of dying than the average person in our general population (cite: 6). Those who used medicine replacements/alternatives for the entire duration of the withdrawal period had the best chances of staying clean.
Those who had a co-occurring addiction with meth (Methamphetamine), that is to say, addiction to opioids and meth, had twice the chance of dropping out of a treatment program, thus not even finishing treatment (cite: 4).
A Rutgers University study showed that 46% of those who successfully completed dependency treatment for opioid addiction relapsed within 7-months. Their research also noted that those with a high-risk tolerant personality were most likely to relapse (cite: 8). The Rutgers study was for ‘all’ types of opioid treatment programs, and any situation, bunching it all together. Still, that nears 50%, which is a scary number, and this study is also only for the first seven months. Most of those who were still clean after five years of abstinence were able to maintain a clean life without opioids (cite: 5).
Why is Opioid Addiction Relapse So Common?
Why is opioid relapse so common? Why is it that standard treatments often don’t work? Well, this gets back to our previous statements above. It’s because of how the opioid rewires your brain. And, it’s because most addiction treatment plans don’t take into consideration the patient’s ‘exact situation’.
The best treatment centers spend a significant amount of time doing due diligence, asking the right questions, doing the right tests, and getting to know the patient before preparing a perfect personalized treatment program. No two dependency treatment programs should be the same for the obvious reason; no two situations are completely the same, and no two people are alike. Find a treatment center that pays pay attention to the details.
References:
1.) NIH, National Institute on Drug Abuse website article; “Principles of Effective Drug Treatment (Third Edition),” updated last in January 2018.
2.) “Medication-Assisted Treatment For Opioid Addiction in Opioid Treatment Programs,” by Steven L. Batki, Janice F. Kauffman, Ira Marion, Mark W. Parrino, and George E. Woody, US Department of Health and Human Services, 356 pages.
3.) “An Action Guide for Management of Opioid Dependence: Next Steps for Patients and Families,” by CEPAC, New England Comparative Effectiveness Public Advisory Council, September 2014, part of the “Management of Patients with Opioid Dependence: A Review of Clinical, Delivery System, and Policy Options,” program.
4.) “Long-Term Course of Opioid Addiction,” by Hser, Yih-Ing; Evans, Elizabeth MA; Grella, Christine; Ling, Walter MD; and Anglin, Douglas. published in Harvard Review of Psychiatry: March/April 2015 – Volume 23 – Issue 2 – p 76-89, doi: 10.1097/HRP.0000000000000052.
5.) “Association between methamphetamine use and retention among patients with opioid use disorders treated with buprenorphine,” by Judith Tsui, Jim Mayfield, and Elizabeth Speaker, et. al., published in the Journal of Substance Abuse Treatment.
8.) The Daily Targum, article; “Patients tolerant of risks most often relapse their opioid addictions, Rutgers researchers find,” by Brendan Brightman, published on December 8, 2019.