A Doctor’s Perspective on Treating Opioid Use Disorder
Dr. Myra Mathis is a board-certified addiction psychiatrist with the University of Rochester’s Strong Recovery Clinic. She shares common questions she receives from patients and their families about recovering from opioid use disorder and finding the right treatment.
A: Opioid use disorder, in a nutshell, involves an unhealthy relationship with opioid drugs related to craving, control, and consequences–the three C’s. When you’re experiencing intense cravings for opioids, you may have to use more and more to get the desired effect, and you’re not able to control your use. You may have tried to cut back but are unsuccessful. As a result, you deal with the consequences: you may not be able to fulfill role obligations in your life, work, or personal relationships. You may use in dangerous situations and risk your health and wellbeing. The difficult withdrawal symptoms of stopping opioids can make it hard to completely quit, and you may struggle to give up the “escape” opioids offer you. But I want everyone to know: treatment for opioid use disorder works. Connecting with an addiction specialist can give you the tools to reach your goals and live a healthy life. You don’t have to go through this alone.
A: Medications used to treat opioid use disorder are highly effective; they can stop opioid cravings, lessen or prevent withdrawal symptoms, and block opioids’ effects on the body–in combination with counseling and other supports. When you start on medication, we will first assess your health to make sure we understand your specific situation and choose the most effective treatment. You can expect regular urine toxicology screens to see what substances are in your system and if you have any other health concerns that should be addressed. We do this not to judge you, but to make sure the treatment we’re prescribing is safe for you to take. Mixing alcohol or medications like benzodiazepines with some of these treatments can lead to overdoses, and our main goal is to keep you safe and healthy.
Additionally, we will discuss the schedule for your medications. Some medications must be taken every day at a clinic or at home, and some can be injected once a month by your doctor. The type of medication we choose depends on your individual needs and situation, and this can change over time.
Of course, we will guide you every step of the way as you overcome opioid use disorder. It may take a long time, but if you stick with it, you can meet your goals. I see it as an investment. You’ve spent a certain amount of time using substances in a way that’s not healthy, so at least that much time should be invested in moving the other direction–rebuilding your life and getting back to a stable place.
A: I work in an addiction treatment outpatient clinic; within our clinic, we have psychiatrists, psychotherapists, and substance use counselors. We find combining medication with this emotional support is crucial to helping people reach recovery. Opioids are sometimes prescribed to treat physical pain symptoms, but there’s always an emotional and cognitive aspect to pain as well. We need to determine what exactly someone is trying to medicate. Usually the common denominator is that people develop an opioid use disorder because they’re trying to relieve some type of uncomfortable feeling. At first, I focus on addressing someone’s safety, which means supporting them as they stop using, starting them on medication, and providing counseling. But over time, this common narrative tends to arise, and at that point, we can start to focus on the underlying problem and dive deeper.
There is a lot of overlap between substance use disorders and mental health disorders. If you’re only getting medication for your addiction, you may be only addressing one aspect of concern. And often, it’s the mental health challenges that can be triggers for relapse. That’s why counseling is crucial. Not only will a mental health professional be able to give you tools to change your environment and rebuild your relationships, but they can also address the psychiatric disorders that may be contributing to your substance use. Often, self-help groups like Narcotics Anonymous (NA) create a space to support the changes; you’re giving yourself a new social group and sponsor to check in with, learn from, and lean on. There’s also a program called Smart Recovery that uses some of the same principles as NA without the spiritual aspects that may not resonate with everyone.
I want to validate that making a life change like this is hard to do. Building trust in others takes time, especially when it comes to things in your life that are really difficult to talk about. But this work is an investment in yourself. You can make things better. Relationships may not be the same, but they can be repaired. Treatment works.