Is buprenorphine treatment just switching one addiction for another?
<font>No– With successful buprenorphine treatment as part of a complete treatment plan including counseling, the patient can put the addictive behavior into remission. The patient may still be “physically dependent” on opioids, (as they were prior to treatment) but this can be managed medically and reduced over time by a slow and gradual taper off of the medication. Physical dependence (often mistaken for “addiction”) is not a dangerous medical condition that requires treatment, addiction is. Addiction is damaging and life-threatening, while physical dependence is an inconvenience, and is normal physiology for anyone taking large doses of opioids for an extended period of time. </font>
<font>It is essential to understand the definition of addiction and know how it differs from physical dependence or tolerance.</font>
<font>The AmericanAcademy</font><font> of Pain Medicine (AAPM), American Pain Society (APS), American Society of Addiction Medicine (ASAM), and NAABT recognizes these definitions below as the current accepted definitions.
I. Addiction:</font> <font>Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. </font>
II. Physical Dependence: <font>Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. </font>
III. Tolerance: <font>Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.
Physical dependence and tolerance are normal physiology. Addiction is a disorder that is damaging and requires treatment.</font>
<font>When a patient switches from an addictive opioid to successful buprenorphine treatment, the addictive behavior often stops. In part due to buprenorphine’s long duration of action, patients do not have physical cravings prior to taking their daily dose. The drug seeking behavior ends. Patients; regain control over drug use, compulsive use ends, they are no longer using despite harm, and many patients report no cravings. Thus all of the hallmarks of addiction disappear with successful buprenorphine treatment. </font>
<font>Therefore, one is not trading one addiction for another addiction. They have traded a life threatening situation (addiction) for a daily inconvenience of needing to take a pill (physical dependence), as some would a vitamin. Yes the physical dependence to opioids still remains, but that is vast improvement over addiction, is not life threatening, and it can easily be managed medically..</font>
<font>Addiction is a brain disease that affects behavior. This addictive behavior can be devastating to the patient and their loved ones. It’s not the need to take a medication that is the problem, many people need to take a medication, but rather it is the compulsive addictive behavior to keep taking it despite doing harm to one’s self or loved ones that needs to stop. Whether or not the person takes a medication to help achieve this shouldn’t matter to anyone. If a medication helps stop the damaging addictive behavior, then that is successful treatment and not switching one addiction for another.</font>
<font>The Essence of Drug Addiction- By Alan I. Leshner, Ph.D., Former Director, National Institute of Drug Abuse, National Institutes of Health</font>
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