Misinformation and myths about opioid use disorder are everywhere, making it difficult to understand the disease and find effective treatment. A good place to start is with the facts.

 

What are opioids?

Opioids interact with opioid receptors to reduce pain and produce a feeling of euphoria. They include the illegal drug heroin; the synthetic opioid fentanyl; and prescription pain relievers such as oxycodone, hydrocodone, codeine, and morphine. Opioids are often prescribed to treat pain and can be used safely when used for a short time as prescribed by a doctor, but they are not without risks. Side effects include slowed breathing, constipation, nausea, confusion, and drowsiness. Misuse of opioids (including taking the medicine other than prescribed, taking someone else’s medicine, or taking the medicine for the euphoric results) can lead to dependence, restricted ability to breathe, and/or fatal overdoses.

What is opioid use disorder?

Opioid use disorder is marked by a set of cognitive, behavioral, and physiological symptoms and an inability to stop opioid use despite negative consequences. It can result in impaired physical and mental health, as well as serious legal, employment, and family problems. Addiction is a complex, chronic, and treatable disease of the brain, not a moral failing or lack of willpower. Further, drug use can change the brain in ways that make stopping very difficult. It is estimated that 2 million Americans had an opioid use disorder in 2018. The opioid overdose crisis was declared a national public health emergency in 2017.

Can you recover from opioid use disorder?

Yes. Various combinations of treatment and recovery supports work for different people, depending on their stage of recovery. There is no one-size-fits-all approach. People with opioid use disorder need to have access to a full menu of treatment, supports, and services so they can choose what combinations work best for them. This is what is known as “multiple pathways to recovery.” Examples of pathways to recovery include abstinence, medications for opioid use disorder, psychotherapy, education and employment, 12-step groups, peer recovery support, recovery housing, exercise or yoga, and more.

Most people combine multiple supports and services to create their own individualized pathway to recovery. What works in one stage of recovery might not work in another. The important part is to keep trying different methods.

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What does evidence-based treatment for opioid use disorder look like?

Treatment for opioid use disorder must be individualized, using evidence-based components. The US Surgeon General defines these as including:

  • Personalized diagnosis, assessment, and treatment planning.
  • Long-term disease management— as a chronic disease of the brain, addiction has the potential for both recovery and relapse. Long-term outpatient care is critical for sustaining recovery.
  • Access to FDA-approved medications.
  • Effective behavioral interventions provided by trained professionals.
  • Coordinated care for co-occurring physical or mental health conditions.
  • Recovery support services, including mutual aid groups, peer support specialists, recovery residences, recovery-focused educational programs, vocational rehabilitation, fitness, and other community-based services that provide ongoing emotional and practical support.
How do I learn about the different pathways to recovery?

Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. There are many different ways to go through this process of change. The Recovery Research Institute offers an overview of different pathways to recovery and the National Council on Alcoholism and Drug Dependence (NCADD) offers a guide for individuals and families. Massachusetts Organization for Addiction Recovery (MOAR) offers a listing of Massachusetts treatment and recovery services.

If you are a healthcare provider, we recommend familiarizing yourself with the range of substance use disorder treatment and recovery services in your community. Reach out to programs and providers and introduce yourself. Share what you learn with your colleagues and develop resource lists for those you serve. Strong collaborative relationships are critical to enhancing the network of treatment and recovery and will help you to provide warm hand-offs.

If you are a family member of a person struggling with addiction, we recommend you contact Learn to Cope, which provides support and resources to family members and caregivers.

My healthcare provider wants me to try a treatment I am not comfortable with. What are my options?

Ask your healthcare provider to explain why they recommend this treatment for you and if other alternatives are available. Ask if a patient navigator or peer support worker is available to talk with you about your options. You have the right to refuse treatment or ask for more time to consider your options.

What are peer recovery coaches and what do they do?

Peer recovery coaches are typically people who are in recovery from substance use disorder and who have been trained to use their lived experience skillfully to provide nonclinical supports to help others learn about, enter, and maintain recovery. They provide informational, instrumental, emotional, and social support to help people learn about and connect with services, provide empathy, and connect people to a community of individuals in recovery. They listen, facilitate, guide, encourage, and help people build their strengths, recovery capital, and self-advocacy skills.

Peer recovery coaches are distinct from clinical and mutual aid roles and may work in a range of settings, including recovery community centers, hospital emergency rooms or primary care, criminal justice system, recovery residences, and others. They may be paid staff or volunteers. Peer recovery coaches are trained, certified, guided by an ethical framework, and practice self-care and boundaries.

How does individual and group therapy fit into recovery?

Many people find that psychosocial supports like individual and group therapy can be very beneficial for supporting their recovery. They can be helpful for supporting engagement in treatment and development of recovery capital and self-advocacy skills.

What is the role of mutual aid groups in recovery?

Mutual aid or 12-step groups are a part of the care continuum for substance use disorders. They are a form of peer-based recovery support, based on a model of mutuality and self-help. In these groups, people recovering from addiction gather in-person or virtually to provide support and encouragement, share coping strategies, and help others while helping themselves. They are widespread and usually free and can be an important form of recovery support on their own or in combination with other forms of treatment and recovery support services.

There are many different mutual aid recovery support groups with different philosophies. For example,

  • Self Management and Recovery Training (SMART Recovery) is a network of secular mutual aid groups.
  • Medication-Assisted Recovery Anonymous (MARA) is a group specifically for those using medications for opioid use disorder recovery.
  • Narcotics Anonymous is an abstinence-based fellowship based on the 12-Step Alcoholic Anonymous model, with a spiritual focus.
How do medications for opioid use recovery work? Isn’t it just substituting one drug for another?

Research shows that a combination of medications for opioid use disorder (also known as medication-assisted treatment) and therapy can successfully treat substance use disorders and help sustain recovery.

There are many misconceptions and myths surrounding medications for opioid use disorder, which often make it difficult for people to access appropriate care and treatment and lead to stigma and discrimination. One persistent misconception is the medications for opioid use disorder “substitute one drug for another.”

This is an incorrect and dangerous myth. Medications for opioid use disorder act on the opioid receptors in the brain to reduce painful withdrawal symptoms and cravings that cause chemical imbalances in the body, without causing euphoria. They provide a safe and controlled dosage that helps people overcome opioid addiction. They are proven to be effective and help many people achieve recovery, however they are highly underutilized. For a more detailed explanation, see the National Institute on Drug Abuse’s Medications to Treat Opioid Use Disorder Research Report.

How do I know which medication for opioid use disorder is right for me? What about side effects?

There are three medications currently approved by the US Food & Drug Administration for opioid use disorder: methadone, buprenorphine, and naltrexone. It is important to share your recovery goals and concerns about managing side effects with your health care provider when you discuss medication options. Treatment with medication should be individualized for each person, and is best combined with other recovery supports, like support groups or therapy. You can use the shared decision making tool, Decisions in Recovery, to learn more about medications and their side effects or read SAMHSA’s TIP 63: Medications for Opioid Use Disorder. Most people are able to work, go to school, drive, and live a full life while using medications for opioid use disorder. The FDA recommends that medication use be re-evaluated periodically, however there is no recommended maximum duration of treatment.

Is a person considered “abstinent” or “sober” when using medication for opioid use disorders?

Addiction is a chronic, treatable disease, like diabetes or high blood pressure. However, there is little to no stigma associated with taking medication to treat diabetes or high blood pressure. Yet, people who use medications for opioid use disorder are often shamed for not being truly “abstinent.” Achieving recovery goes beyond remission of symptoms or ceasing substance use. It is a process of change and growth through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Many experts note that the question of whether a person is “sober” or “abstinent” while using medications for opioid use disorders as prescribed has little meaning. The use of medications to treat an opioid use disorder is one pathway to recovery. Not using any medications is another pathway.

What are the considerations for pregnant or postpartum women using medications for opioid use disorder?

Pregnant or postpartum women should consult with their healthcare provider on the safest course of action. The Journey Recovery Project is a website designed to support pregnant or postpartum women to know their options. Health care providers and social service providers can consult SAMHSA’s clinical guidance and manual on collaborative approaches to treating pregnant women with opioid use disorder.

What is person-centered care?

Person-centered care, according to SAMHSA, means people have control over their services, including the amount, duration, and scope of services, as well as choice of providers. The World Health Organization notes that person-centered care is respectful and responsive to the cultural, linguistic, and other social and environmental needs of the individual.

In person-centered care, health and behavioral health professionals work collaboratively with people who use substance use disorder services. Person-centered care supports people to develop the knowledge, skills and confidence they need to effectively manage and make informed decisions about their own health and health care.

What does it mean to provide person-centered care?

Person-centered, or patient-centered care, is a way of thinking and doing things that sees the people using services as equal partners in planning, developing and monitoring care to make sure it meets their needs. Care focuses on the person’s problem and their unique strengths, not the diagnosis.

The Institute of Medicine defines patient-centered care as “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” Person-centered care expands the focus of care to include both person-centered and disease focused outcomes. It goes beyond traditional treatment topics to include issues such as physical health, relationships, employment, education, spirituality, housing, recreation, and community.

According to the New England Journal of Medicine, most definitions of patient-centered care have several common elements that affect the way health systems and facilities are designed and managed, and the way care is delivered:

  • The health care system’s mission, vision, values, leadership, and quality-improvement drivers are aligned to patient-centered goals.
  • Care is collaborative, coordinated, and accessible. The right care is provided at the right time and the right place.
  • Care focuses on physical comfort as well as emotional well-being.
  • Patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected.
  • Patients and their families are an expected part of the care team and play a role in decisions at the patient and system level.
  • The presence of family members in the care setting is encouraged and facilitated.
  • Information is shared fully and in a timely manner so that patients and their family members can make informed decisions.
Why is person-centered care so important?

Effective person-centered care strengthens the voice of the individual, builds resiliency, and fosters recovery.  It involves shared decision making and fosters individual self-direction in treatment planning. While the primary goal of a person-centered care plan is to improve individual health outcomes, healthcare providers also benefit through improved patient satisfaction.

How do you promote person-centered care?

Person-centered care is promoted by identifying and taking into account the person’s needs, risks, strengths, and socio-cultural determinants such as family supports, home location, and personal capacity. The person should have access to their health records, be able to actively participate in their own care, and receive services focused on their needs and preferences, informed by advice and oversight. 

Creating simple and timely appointment scheduling and encouraging family and caregiver engagement fosters person centered care. Two-way communication and eye contact are crucial.  When someone is hospitalized, person-centered care is promoted by giving the person authority to identify who can visit and when and by allowing the patient to define who their family is beyond blood relations.