Understanding OUD: Comparison to diabetes, and other misconceptions
By comparing OUD to a common disease we can better understand and provide treatment for someone with OUD, and review of common misconceptions.
Both Opioid Use Disorder and Type 2 diabetes are chronic diseases that involve genetic predisposition, environment, and behaviors that contribute to their development and maintenance. The comparison helps us to appreciate the need for treatment of OUD in the prison setting.
In addition, by addressing and exposing common misconceptions about the use of Methadone and other medical drugs, we can adjust any previous bias or hesitation to treatments for OUD.
OUD Treatment Comparison with Diabetes
Misconceptions About MOUD
As you review the following misconceptions, consider whether you have ever held any of these thoughts or beliefs.
Myth #1: Methadone is a substitute for heroin or prescription opioids.
Methadone is a treatment for opioid addiction, not a substitute for heroin. Methadone is long-acting, requiring one daily dose. Heroin is short-acting, and generally takes at least three to four daily doses to prevent withdrawal symptoms from emerging.
Myth #2: Patients who are on a stable dose of methadone, who are not using any other non-prescribed or illicit medications, are addicted to methadone.
Patients taking methadone are physically dependent on it, but not addicted to it. Methadone does not cause harm, and provides benefits. People with many common chronic illnesses are physically dependent on their medication to keep them well, such as insulin for diabetes, inhalers for asthma, and blood pressure pills for hypertension.
Myth #3: Patients who are stable on their methadone dose, and who are not using other non-prescribed or illicit drugs, are not able to perform well in many jobs.
People who are stable on methadone should be able to do any job they are otherwise qualified to do. A person stabilized on the correct dose is not sedated, in withdrawal or euphoric. The most common description of how a person feels on methadone is “normal.”
Myth #4: Methadone rots teeth and bones.
After 50 years of use, methadone remains a safe medication. There are side effects from taking methadone and other opioids, such as constipation and increased sweating. These are usually easily manageable. If patients engage in good dental hygiene, they should not have any dental problems.
Myth #5: Methadone is not advisable in pregnant women.
Evidence suggests that pregnant women addicted to opioids have the best outcomes for themselves and their fetuses when taking either methadone or buprenorphine. Remaining on methadone throughout pregnancy is associated with better outcomes for both mother and newborn compared to attempting abstinence. Methadone use does not cause fetal abnormalities or cognitive impairments in children as they grow. Neonatal abstinence syndrome, which occurs in babies born to mothers on methadone, is manageable and does not pose a significant risk to newborns. Breastfeeding is recommended for mothers on methadone, unless contraindicated for other reasons such as HIV positivity.
Myth #6: Requiring people to taper off MAT helps them get healthy faster.
FACT: Requiring people to stop taking their addiction medications is counter-productive and increases the risk of relapse - this is because tolerance to opioids fades rapidly. One episode of opioid misuse after detoxification can result in a life-threatening or deadly overdose.
In summary:
Recognizing that opioid use disorder (OUD) shares similarities with various other illnesses, such as asthma, diabetes, and high blood pressure, underscores the importance of understanding its complexities, and the need for medically assisted treatment. Like these conditions, lifestyle changes may or may not significantly impact OUD, and some individuals may still require medication despite such changes. Just as medication is not stigmatized for managing asthma or diabetes, the same approach should apply to OUD treatment, including the use of medications like methadone. Embracing this perspective helps combat stigma and promotes compassionate support for individuals seeking treatment for OUD.