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If you think that rehab is the best option for anyone with any addiction, a mindset adjustment is desperately needed. For opioid addiction, rehab without medication is ineffective and often deadly. By contrast, using evidence-based medicine as treatment vastly reduces the mortality rate for those addicted.
Rehab myths to dispel right now
Myth #1All rehabs are created equal.
“Rehab” is a catch-all to describe residential programs as well as outpatient stints where you attend group therapy and 12-step meetings. There’s no standardization, and many rehab programs for opioid addiction forgo evidence-based treatment using medication.
Myth #2You can “fix” opioid addiction.
Opioid addiction is a chronic disorder that needs to be managed long-term, like any other chronic illness, rather than something that can be “cured” during a short stint in rehab.
Myth #3 There must be a reason it's the “go-to” solution for addiction.
All addictions are different. The unique way in which opioids overtake the brain means that medication is almost always needed. As long as rehabs remain unregulated and unstandardized, they cannot be the default solution.
Myth #4It's a worthwhile investment.
Many people drain their savings or go into debt paying for repeated stints in rehab, which is an investment with very little return when evidence-based treatment is not offered.
Myth #5They have high success rates.
The rehab industry thrives on low success rates. After relapse, families don’t think that rehab doesn’t work; they just think it wasn’t enough.
Stats that make us angry
• The opioid epidemic remains the #1 cause of death for Americans under 50.1
• Every 5 minutes, someone dies of a drug overdose.2
• 2 out of 3 rehabs in America don’t prescribe medication.3
• Once released from rehab, 90% of people who do not receive medication relapse within 3 months.4
Should you gamble your life on rehab?
Research says, f*ck no.
To anyone who says “rehab saved my life”
We’re so glad that rehab worked for you, but that doesn’t change our message. The rehab industry is in desperate need of an overhaul. Too many families are hanging their hopes (while emptying their bank accounts) on rehab programs. Yet the majority of rehabs for opioid addiction deny people the gold standard of treatment. Simply put: We cannot pretend that rehab works for most people, because it doesn’t.
The truth about rehab from people who’ve been there
"I've been to rehab twice, and it took a lot from me. It took away my self-esteem, convincing me that I couldn’t get better on my own at home. It took my savings. And it took me from my family. The cost is just too high, and it didn’t work."
— Ophelia Nurse Practitioner
"Rehab offered no medication other than Tylenol. However, when I hadn't slept in days, and asked for something to help me sleep, they did offer a turkey sandwich."
— Ophelia patient
"Rehab cost me my dignity, 35 days away from my regular life, family and friends, then another half a month in a sober house that I left, as it was not helping me get better."
— Ophelia patient
You have (good) questions. We have answers.
Buprenorphine (most commonly found in the drug compound called Suboxone) is a partial opioid that binds to the same receptors in the brain as traditional opioids and reduces cravings and withdrawal symptoms but does not produce the same “high” when taken at a prescribed therapeutic dosage. It’s intended as a long-term treatment for people with OUD, and makes overdoses less likely and less deadly. In fact, all three of the federally-approved medications for opioid addiction — buprenorphine, methadone, and naltrexone — vastly reduce the mortality rate and keep people in treatment. The problem is access. Expanding access to care through telehealth visits is at the core of Ophelia's mission.
Addiction rehab is a model that was first created on the basis of the 12 steps of Alcoholics Anonymous. As time went on, this model was used to address other addictions. While some rehab facilities do provide evidence-based treatments (aka MAT), the majority do not — instead offering non-evidence-based techniques like 12-step meeting attendance and counseling.
As Bachaar Arnaout, MD, an addiction psychiatrist and an Associate Clinical Professor of Psychiatry at the Yale School of Medicine, wrote in this powerful piece, “The original design of the rehab model — as well as the majority of research data — pertain to alcohol, which may be less applicable to other addictions. For example, opioid addiction can be successfully treated pharmacologically, with a relatively limited role for elaborate psychosocial interventions. Or even worse, sending those who struggle with opioid addiction to rehab programs that do not offer pharmacotherapy with buprenorphine, methadone, or injectable naltrexone is a recipe for disaster. The overwhelming majority of people relapse to opioid use after such programs, but their tolerance to the lethal effects of the drug goes down. On balance, one wonders whether it may be safer to keep using than attending programs that — rather than lowering the risk of relapse — lower tolerance and thus increase the risk of overdose. But the answer is not to continue using — it is to seek evidence-based treatment. We do have life-saving medications for opioid addiction, and it is infuriating that we keep toying with people’s lives by sending them to programs that do not provide them.”
Fair enough. Quarter in the swear jar. We’re being provocative, but for good reason. How many more people have to die before we collectively start using our voices in bold ways, and insisting on change? If that takes yelling, swearing, and offending some people along the way, so be it. There’s nothing “soft” about a disease that takes two hundred Americans lives every day due to overdose, and so we’re unapologetically not being soft about our message here: Sending those who struggle with opioid addiction to rehab programs that do not offer MAT is, quite frankly, disastrous.
While there is no doubt a small fraction of people for whom rehab has worked, and we are so glad it worked for you, research shows that successful treatment via rehab is the exception, not the rule. The data shows 90% of people will return to use after a rehab stint. Many who are forced to detox without MAT risk deadly overdoses if they relapse. While everyone should tell (and celebrate) the story of what worked for them, we cannot afford to keep pretending that rehab isn’t a severely flawed — and potentially deadly — path for most people.
There are several employees at Ophelia who have previously worked at rehabs. We see you, and we appreciate you. If our message has caused you to stop and think about what’s offered at your rehab center, and what life-saving treatment might be missing, we’ve done our job. Our goal is to get all of us on the same page with evidence-based treatment that works. Are you helping people start and continue life-saving medication? Are you connecting them with the right resources for MAT once they leave your care? If you want to partner with Ophelia, send us a message at TKTK — we’d love to talk.
We make no bones about it — Ophelia is a business. But while there are many “bad apples” in healthcare that put their financial gains ahead of their impact on helping people, that’s not all for-profit companies, and it’s not us. Ophelia exists because widespread access to life-saving medication doesn’t, and we are determined to change that. We must break through this narrative that what’s good for business is bad for society. After all, Ophelia’s business success simply means that we’ve helped more people, and that’s something we’re unapologetic about.
It's tempting to say that someone is addicted to something if they take it every day. But this isn't correct or helpful. Remember, OUD cannot be cured. The best way to live with OUD is to accept it as a chronic disease, and there is no shame in taking medication to treat any chronic illness. If you don’t judge those who take insulin injections every day for diabetes or medication to keep HIV from becoming AIDs, there should be no judgment of people taking medication for addiction. Taking Suboxone, as prescribed, is not drug abuse.
Moreover, while a very small percentage of those with opioid addiction can recover without medication by attending rehab, there is absolutely no way of determining who they are. On the other hand, MAT is a proven approach that works for most people, which is why we should offer it as a first line of treatment to anyone in need of help.
No. One of the reasons opioid addiction is so powerful is that people feel like they must keep using the drugs in order to stave off withdrawal. Medications like Suboxone, since they are opioids themselves, can stop withdrawal symptoms without getting you high. By taking a maintenance dose of Suboxone, you significantly reduce the risk of relapse and therefore overdose. Read more about Suboxone here
Insurance is supposed to cover services for addiction just like any other medical or behavioral health condition. Unfortunately, insurance plans have long refused to cover addiction treatment with "parity" with other common conditions. Medication based treatment for OUD is the gold standard. The beneficial impact of medications (such as Suboxone) on reducing overdose and death from OUD are well established, yet many insurance plans put limitations on accessing these life-saving medications. Many insurers today are more likely to cover short-term detox than long-term high quality care with MAT (medication-assisted treatment).