One of the most controversial therapies ever to hit the substance abuse and addiction treatment community is Drug Replacement Therapy or simply called DRT.
Before you can weigh in your opinion on that matter, especially regarding its supposed effects – whether beneficial or detrimental – on substance addiction treatments, it is crucial to establish an understanding of the fundamental premises of both sides of the argument.
The Fundamental Idea of Drug Replacement Therapy
It is quite easy to understand why proponents of DRT say that the regimen can greatly improve addiction recovery outcomes. In essence, Drug Replacement Therapy involves the administration of certain medications or drugs as substitutes for another drug. As the term implies, the new drug replaces the substance from which the person is addicted to or is currently abusing. If the person wants to quit using a particular substance, he will usually undergo moderate to severe withdrawal symptoms. To help minimize these effects, a replacement drug is administered to help the person get through the withdrawal of the original addicting substance. One of the most classic examples of a drug replacement therapy is the use of methadone as a replacement for heroin.
Proponents of DRT cite many benefits, which often include the following.
- Negates a criminal element – DRT proponents contend that by giving individuals a completely legal substance to allow them to experience the same effects of the illicit substance they are addicted to, then they will not have to resort to obtaining these highly illegal substances just to get the high that they need. For instance, since methadone is legally prescribed by doctors, individuals can still enjoy the same effects of euphoria and relaxation that they also get from heroin. Since possession of heroin is a felony, giving individuals methadone effectively negates the criminal element inherent in heroin possession. Additionally, they don’t have to steal or perform other unlawful activities just to obtain the “high” they are craving for.
- Focuses on the individual – It is said that individuals who sign up for DRT effectively opens up access to a variety of assistance. This can have tremendous benefit on the person’s health in the long-term. There are also some experts who believe that this gradual change in the person’s addiction status could potential lead to other benefits in the future.
- Facilitates change – Supporters of Drug Replacement Therapy believe that individuals who receive methadone or any other replacement drug are more likely to voluntarily admit themselves to a substance abuse and addiction treatment facility. It is believed that this is a much more practical and more valid method of getting the effects they require without having to resort using illicit substances.
Methadone and Suboxone
Currently, there are two drugs or substances used in DRT: methadone and Suboxone. Both of these substances are synthetic opioids and as such have the same detrimental health effects as any other opioid. However, there is a considerable difference between methadone and Suboxone. Whereas methadone is classified as a full opiate agonist, Suboxone is classified as a partial opiate agonist. Partial opiate agonists mean that their effects are quite limited even with an increase in the dose administered.
This difference has the following implications:
- Because of the partial agonist classification of Suboxone, it has a lower potential for abuse (less addicting). On the other hand, methadone is much easier to abuse (highly addicting) owing to its full agonist nature.
- Since Suboxone has a low substance abuse potential, individuals can readily take it home. Individuals on methadone therapy, on the other hand, have to visit the same clinic every single day to obtain their methadone treatment. Only during the last stages of the DRT that individuals on methadone can be given take-home doses.
- Suboxone is effective only for mild to moderate opiate addictions. If the individual has a severe opiate addiction problem, only methadone can help.
- Methadone poses a higher risk for fatal overdose than Suboxone.
- Suboxone is composed of buprenorphine and naloxone as its primary active ingredients.
- Suboxone is more expensive than methadone for the simple reason that it doesn’t have any generic preparations yet.
Why is DRT Controversial?
There are two schools of thought on the role of DRT in substance abuse and addiction treatment.
Advocates of DRT believe that the therapy is needed to help individuals recover in the long term. The central idea is that substance addiction has already damaged many of the individual’s normal physiologic processes making a return to normalcy very impossible to attain. Additionally, they believe that other alternatives simply don’t work because the withdrawal symptoms are just too severe to guarantee 100 percent compliance with treatment regimens.
Critics of DRT consider the therapy as nothing more than exchanging one addicting substance for another; essentially swapping an illicit and unlawful substance for something that is completely lawful. Critics further argue that giving another addicting substance of the same class can have a cumulative effect on the individual’s addiction, further worsening the addiction, not lessening it.
Weighing Your Options
While it is true that chronic opiate abusers and addicts have already damaged their body beyond repair, the number of these individuals is sufficiently small. The greater majority of substance abusers still have their minds and bodies fully intact, albeit compromised. It is believed that undergoing DRT is actually a step backwards in addiction treatment. Nevertheless, DRT can be considered in the following instances.
- Physical necessity – Chronic use of opiates can deplete the brain’s natural supply of dopamine. It would be difficult to motivate a person to recover without this neurotransmitter.
- Social and legal issues – Issues with the law and desperation can sometimes be overwhelming reasons for getting DRT.
- Option of last resort – When all else fails, including long-term inclient rehabilitation and cognitive behavioral therapy, the DRT may be considered.
It should be evident that Drug Replacement Therapy must never be made as your principal option for addiction recovery. While some clinics and even doctors have grown complacent in the management of substance dependence, it is still your choice to make. There are better and safer alternatives to DRT. You just have to learn more about them from your trusted substance addiction treatment center.