PS375 Unit 8 Addiction Medications Paper Example

"Isn't That Just Another Drug?": A PS375 Unit 8 Medications Paper

[Student Name]

Purdue University Global

PS375: Psychology of Addiction

Unit 8 Medications Paper

[Instructor Name]

[Date]

The writer, the program, the client, the family and every detail are composite and illustrative; the articles cited are real.

The Question

Kayla, twenty-six, survived an overdose on fake pills laced with fentanyl and started treatment with us in Tulsa that October. At her first appointment, the program's prescriber recommended buprenorphine, and Kayla agreed. Her mother, at the second appointment, asked the question many families ask: "Isn't that just another drug? How is she clean if she takes it every day?"

As intake coordinator, I am not a prescriber, but families often ask me these questions while scheduling, sometimes before they have met anyone on the clinical team, and I need to answer accurately and point them to the prescriber for anything specific to their relative.

Three Medications

The United States has approved three medications for treating opioid use disorder. Methadone is a full agonist that activates opioid receptors and, given in a stable daily dose, prevents withdrawal and reduces craving without producing the highs and lows of illicit use; it is dispensed through specialized programs. Buprenorphine is a partial agonist that activates receptors less fully, with a ceiling on its effects that lowers overdose risk; it can be prescribed in offices like ours. Extended-release naltrexone is an antagonist that blocks opioid receptors, given as a monthly shot once opioids have fully cleared the body.

The difference between medication and illicit use lies in what the medication does. A stable dose of a long-acting medication, taken as prescribed, steadies the brain systems that opioid use disrupted, rather than repeatedly flooding and withdrawing them. Kayla described it simply after two weeks: "I'm not sick and I'm not high. I'm just me."

Evidence From Overdose Survivors

Larochelle et al. (2018) tracked Massachusetts adults for a year after they survived an opioid overdose. Those who received methadone or buprenorphine died far less often, from overdose or anything else, in the months they were on the medication, compared with those who did not. Extended-release naltrexone was not associated with a significant reduction, though few people received it. They also found that most survivors never received any of these medications that year.

For a survivor of a fentanyl overdose, the medication question is partly a question of who is alive next year.

Deaths During and After Treatment

Sordo et al. (2017) combined cohort studies of methadone and buprenorphine patients with opioid dependence. Death rates were far lower during treatment than outside it. They also found periods of elevated risk: the first weeks after leaving treatment, when tolerance has fallen, and the first weeks of starting methadone. Their conclusion was that longer retention in treatment could save lives.

That finding matters for Kayla's plan. Stopping medication early, especially without support, could put her at higher risk than continuing.

How Long?

Kayla's mother asked how long Kayla would take buprenorphine. McLellan et al. (2000) compared drug dependence with three chronic illnesses, diabetes, hypertension and asthma, and found similar patterns of adherence and relapse across all four. They argued that addiction should be managed as a chronic illness, with ongoing care rather than short episodes. In that light, the question resembles asking how long someone should take blood pressure medication: as long as it helps, with decisions made by the patient and prescriber together. The program's prescriber told Kayla there was no fixed end date and that any taper would be gradual and planned.

Answering the Family

When I spoke with Kayla's mother, I used three points. First, the medication is not producing a high; it is preventing withdrawal and cravings so Kayla can work, parent and attend counseling. Second, research on overdose survivors shows that people on these medications are much less likely to die. Third, many chronic illnesses need daily medication, and needing it is not a moral failure, any more than insulin is for her neighbor with diabetes. Her mother said the mortality data changed her mind more than anything else I told her that afternoon: "I'd rather she take a pill every day than bury her."

Barriers Kayla Faced

Kayla's path to buprenorphine was easier than many clients'. The emergency department referred her directly, our program had a prescriber on site, and her state Medicaid plan covered the medication. Even so, she faced barriers. The nearest pharmacy that stocked buprenorphine reliably was twenty minutes away, and twice in the first month it ran out. Her employer's drug testing policy at the grocery store worried her until the prescriber wrote a letter explaining the prescription. And a cousin told her at a family dinner that she was "still using," which hurt more than she expected. Each barrier was ordinary and solvable, but together they show why so many overdose survivors in the research never receive medication, and why programs need staff who help patients through the practical steps as well as the clinical ones.

Medications for Alcohol Use Disorder

Alcohol use disorder has its own medications, among them naltrexone and acamprosate, which can lower drinking and help people stay abstinent. Dale's physician is considering naltrexone as part of his plan, alongside his counseling. Doctors rarely prescribe them, despite good evidence from many trials, a gap similar to the one Larochelle and colleagues found for opioids.

Safety Planning

Because fentanyl is in the local supply, the program also gave Kayla a naloxone kit and showed her mother how to use it. Medication lowers risk; it does not remove it, especially in the first weeks or after any lapse. Kayla keeps her kit zipped in the side pocket of her purse and her mother keeps a second one in the kitchen drawer, next to the list of numbers she would call. Neither has needed it, and both said that having it made them less afraid rather than more.

Counseling and Medication Together

Medication is not the whole of Kayla's treatment. She attends weekly counseling, earns contingency management prizes for negative tests and has begun trauma-focused therapy. Medication makes those possible by stabilizing her days, and they address what medication cannot: her history, her relationships and her plans.

Conclusion

Kayla's mother asked whether buprenorphine was just another drug. The pharmacology shows it works differently from illicit use, Larochelle and colleagues and Sordo and colleagues show it greatly reduces the risk of death, and McLellan and colleagues' chronic illness comparison explains why it may continue for a long time. The evidence changed her mother's mind.

References

Larochelle, M. R., Bernson, D., Land, T., Stopka, T. J., Wang, N., Xuan, Z., Bagley, S. M., Liebschutz, J. M., & Walley, A. Y. (2018). Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study. Annals of Internal Medicine, 169(3), 137-145. https://doi.org/10.7326/M17-3107

McLellan, A. T., Lewis, D. C., O'Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689-1695. https://doi.org/10.1001/jama.284.13.1689

Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., Ferri, M., & Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ, 357, Article j1550. https://doi.org/10.1136/bmj.j1550