Turn to any TV channel and you are likely to see an ad for medications to prevent HIV infections. All it requires for patients to take just one pill a day. Let me emphasize the word ‘prevent’. Prevention is a key strategy to prevent new infections and prevent reinfections in patients who have been successfully treated. This multi-pronged strategy has worked wonders in fighting the AIDS/HIV epidemic. One prong that is still highly recommended is the use of condoms. The other prong is life-long treatment with anti-retroviral medications for those who tested positive for the virus. Patients are encouraged to stay on these medications even if the virus is undetectable on testing. The third important prong is daily ingestion of highly effective medications to prevent infections in high-risk patients. I have rarely heard a word about stopping treatment for AIDS/HIV and become ‘abstinent’ from medications. Staying on medications is abstinence from infections.
Why can we not adopt a similar strategy in the treatment and prevention of opioid and alcohol use disorder? Let’s stay with the ‘virus’ analogy. The virus called opioids is everywhere and mutating. The ‘mutation’ has gone from prescription opioids to heroin and now fentanyl.
How do we treat and prevent opioid use disorder? We have two effective medications for treatment – methadone and buprenorphine and one for prevention naltrexone. Learn to use them creatively. Encourage patients to stay on these medications indefinitely. They should have the option to switch from one to the other. Switching to naltrexone requires patients to off opioids for several days. Similarly, naltrexone is highly effective to maintain sobriety from alcohol or cut down of drinking. Alcohol use disorder is a growing and often overlooked problem.
Why are we so hesitant to encourage patients to stay on these highly effective medications? In one word ‘abstinence’. The field has this peculiar obsession of recovery being equated with abstinence from any medication. This must end. Patients are getting mixed messages. Abstinence is achieved when patients stop using illegal drugs or drugs obtained illegally. Staying on anti-craving medications when the ‘viruses’ of drugs and alcohol are raging is a life-saving strategy. Please stop muddling the definition of abstinence.
Misguided groups are adding to the confusion by saying abstinence is an unattainable goal and therefore, patients should have access to safe injection sites. My response, if patients are incentivized to stay on any one of the FDA approved anti craving medications, long-term abstinence is achieved.
Percy Menzies, M. Pharm. is the president of Assisted Recovery Centers of America (ARCA), an integrated treatment center for addictive disorders and mental health based in St Louis. He can be reached at: firstname.lastname@example.org.