Opioid agonist treatment (OAT) is a treatment for opioid use disorder. It involves the use of medications such as methadone, buprenorphine, and slow release oral morphine.
People First Radio spoke with Nanaimo addictions medicine specialist Dr. Jess Wilder, and BC Centre for Substance Use Co-Medical Director Dr. Paxton Bach about the treatment, which Bach called “the gold standard” in treatment for opioid use disorder.
“ These are by far the best medications we have at reducing risk of unregulated use and reducing risk of overdose death at engaging people in treatment and proving quality of life,” he said.
According to Bach, the increase in drug related deaths compared to ten years ago isn’t due to an increase in the number of people using drugs.
“In the current public health crisis and the current toxic drug crisis, overdose deaths have obviously skyrocketed, and that’s directly attributable to an increasingly volatile drug supply,” he said.
“It’s not that there are more people using drugs than ever before, it’s just the consequences are far greater. So one of the key questions is, in this climate, in this context, are these medications still effective? And the answer there is, we can say pretty definitively is ‘yes, they’re still life-saving medications.'”
However, Bach said that having people stay on the medications over a long term period can be a challenge.
“People will.Ideally be on these medications for extended period of times, that may be months or even years. And unfortunately our current retention in the province is much less than that. Probably, less than 50% to retain beyond three months right now. So that is a really key question. We’re accessing more people than we ever have before, but how do we improve the retention on treatment for people who really are or might be benefiting from these medications?”
Bach says he thinks stimulants (like methamphetamine and cocaine) are an underappreciated contributor to the drug poisoning crisis.
“There’s certainly some level of involvement of these stimulants in the overdose crisis, and that is probably a phenomenon that is not fully appreciated yet,” he said.
“When I’m talking about the treatments for opioid use disorder, we have relatively few, but we know that they’re very effective. Unfortunately, when we’re talking about treatments for stimulant use and stimulant use disorder, we have almost nothing,at least no medications, that are.particularly effective and very few other interventions that have shown kind of much long-term benefit.”
Bach says a behavioural intervention called contingency management has been shown to be effective for helping people with stimulant use disorder. It involves offering people short term rewards, like gift cards, for meeting specific goals, like remaining abstinent from stimulant use.
“It’s been studied and shown to be effective in all sorts of areas in medicine, from the management of hypertension, to any number of different things. But for the treatment of stimulant use disorder specifically, it is by far the most effective treatment,” he said.
“Providing people small rewards of often in the forms of cash or gift cards for measurable behavior change, week by week, which might include something like abstinence from stimulants, it is a very effective short-term treatment for stimulant use disorder.”
Bach says contingency management’s effects haven’t necessarily been shown to be longstanding over time, which he says means it’s important that it be paired with other interventions. Hw says another challenge is that the medical system isn’t very well adapted to helping people access non-pharmacological interventions.
“ We’re very good at getting people access to medications for diabetes, pretty bad at getting them access to a diabetes nurse. We’re very good at getting people access to medications for hypertension or for high blood pressure, but not particularly good at getting them access to lifestyle changes.”
Dr. Jess Wilder says she feels there’s a tremendous amount of stigma around OAT, both within and outside of the addiction medicine community.
She says there can be a perception that if someone is on OAT medication, then they aren’t in recovery, a perception Wilder says she feels needs to change.
“ I think that the biggest misconception is that if you’re on OAT, then you’re not truly in recovery and that you’re not truly abstinent. Everybody has…different personal ideas about that. But again, this is a medication to treat a medical disorder, and I would hope that we can over time start to normalize that the common misconceptions about OAT therapy and the stigma and shame that surrounds those treatments really ultimately prevents people from accessing help,” she said.
“And when we stigmatize things, when we force them into dark corners, it doesn’t shame people out of using drugs, it shames people out of accessing support.”
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