Eight ways to overcome resistance to medication-assisted treatment

November 17, 2016

Maureen Fitzgerald
Editor, Addiction Technology Transfer Center & NIATx

Outcome studies and research will help get some patients, staff, and community members on board for medication-assisted treatment. But scientific evidence may not convince everyone to embrace a treatment such as buprenorphine (Suboxone®) for opioid use disorders.

And in treatment agencies, lack of staff buy-in can easily sabotage the potential success of any MAT program.

Opposition to MAT can take many forms, from open hostility to subtle resistance.  

This can include segregating MAT clients from non-MAT clients in treatment groups, or discounting sobriety accomplished with the help of medication as not “true” sobriety. Sometimes, MAT patients are told that they won’t be successful in long-term recovery because they haven’t suffered enough.

Strategies for creating buy-in from staff

1.     Education: Most programs find that educating staff helps reduce resistance to MAT. Just as with clients, it is crucial for staff to understand the brain chemistry of addiction, the difference between addiction and dependence, and that MAT is not “replacing one drug for another.”

Check out the case studies on staff education in the NIATx publication, Getting Started with Medication-Assisted Treatment.  (See Changing Staff Beliefs through Education, pp. 6-8). Staff training made a dramatic difference in staff attitudes toward the use of medication for alcohol use disorders, as this chart shows:

New ATTC resource: Supporting Recovery with Medications for Addiction Treatment

And the ATTC Network offers a new online, self-paced course that covers those topics in a series of modules that staff can complete anytime. Treatment experts on the NIDA/SAMHSA/ATTC Blending Team developed the course, titled Supporting Recovery with Medications for Addiction Treatment (MAT). The course is free, with CE credits available for a small fee. It’s available now through the ATTC Network’s online learning portal, HealtheKnowledge.

SAMHSA (The Substance Abuse and Mental Health Services Administration) provides comprehensive information on all forms of MAT on its Medication-Assisted Treatment webpages. Visit the site to find out about publications and upcoming webinars that can be part of your MAT education efforts.
2. Share the evidence. Even though science doesn’t convince everybody, share the evidence anyway. A growing body of research shows that MAT saves lives, reduces drug-related criminal activity and helps people remain in treatment longer. The publication Advancing Access to Addiction Medications: Implications for Opioid Addiction Treatment, produced by the American Society of Addiction Medicine, reviews scientific literature on the effectiveness of three FDA-approved medications for opioid dependence: methadone, buprenorphine, and naltrexone. This review found that all three are effective in reducing opioid use, withdrawal symptoms, infectious disease, and drug-related crime.

WORDS HAVE POWER. PEOPLE FIRST. The ATTC Network uses affirming language to promote the promises of recovery by advancing evidence-based and culturally-informed practices. 
3. Words matter: The way you talk about substance use disorders and MAT can help change attitudes. It probably won’t help to describe MAT as “not abstinence-based” or as “harm reduction.” Instead, talk about MAT as a tool for managing a substance use disorder.   

Find out more: see the new draft set of guidelines from the Office of National Drug Control Policy, Changing the Language of Addiction

4. Use a health analogy: It will help to acknowledge that most people would prefer not to have to take any medication to manage their chronic condition—whether it’s diabetes, hypertension, or a substance use disorder (SUD). Some people can manage these conditions through behavior and lifestyle changes and social support.  But others may require medications—in addition to behavior and lifestyle changes, counseling, and social support.   

5. Affirm other aspects of treatment: Reassure staff that the other aspects of treatment that they provide will continue to be vitally important and that counseling is a required component of a treatment program that includes MAT.

6. Provide structure to ease staff concerns about treatment compliance and use of other drugs. Establish policies that clearly outline patient responsibilities for treatment compliance and the consequences of missing treatment appointments or using other drugs.

7. Address concerns about diversion. Staff may be concerned about patients misusing or diverting medications prescribed for opioid use disorders. Inform them how your agency will prevent diversion. Many agencies require patients in medication-assisted treatment for opioid use disorders to sign informed consent forms that outline the consequences of misuse or diversion of medication. Other strategies include random pill or film counts and observed urine drug screens.

Did you know? A study by Lofwall and Havens found that the strongest predictor of buprenorphine diversion was attempting but failing to access buprenorphine treatment. Based on this, the authors concluded that “improving, rather than limiting access to good quality affordable buprenorphine treatment may be an effective public health strategy to mitigate buprenorphine abuse.” (Lofwall, M. R., & Havens, J. R. (2012). Inability to access buprenorphine treatment as a risk factor for using diverted buprenorphine. Drug and Alcohol Dependence, 126(3), 379-383.)
8. Invite patients to share their stories. Patients’ success stories may be the most effective way to convince staff that medication-assisted treatment is an acceptable path to recovery. In fact, medication has helped many people succeed in recovery after they've completed treatment many times and failed. 

Some stories for you to share:

·      Michael Botticelli, Director of the Office on National Drug Control Policy, wrote about the success story of Gene, a former semi-pro football player, in the ATTC Messenger in September 2015.
·      The ATTC Network’s “In My Own Words” Essay Contest for Recovery Month 2011 invited stories from people who have achieved long-term recovery using methadone or buprenorphine opioid addiction or acamprosate or naltrexone for alcohol addiction.  Their essays were collected in a booklet that you can read and share with others here.

      And about our "In My Own Words" Essay Contest: This year, we've inviting essays from around the globe! The contest runs until December 31, 2016. Visit the web page for submission guidelines and prize information.

Have you tried any of these strategies in your agency? What have you found to be an effective way to change attitudes about medication-assisted treatment? Share your story in the comments section below.

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