MENTAL HEALTH
MEDICATION ASSISTED TREATMENT FOR
ADDICTION: An Opportunity for Healing
Trauma
Christopher Stewart, MD
A
ddiction is a traumatizing illness for those with the
addiction, as well as the larger circle of people in their
lives. For opioid addiction, the experience of trauma
is universal for both those seeking help and the loved
ones who are seeking help on their behalf.
Family members, friends and anyone who has been enlisted to
rescue someone having an overdose, are forever changed by the ex-
perience. Having a family member who is addicted can be terrifying.
Most health care professionals have had experiences with addicted
patients that have been disturbing. The feeling of helplessness and
despair that is often present in patients and their families can be
quite challenging to manage.
Feeling inadequate, not prepared or “not having enough expe-
rience” are all commonly referenced by helping professionals; these
contribute to trauma experiences among caregivers. Furthermore,
the relationship of trauma to addiction shows a strong correlation
between opioid addiction and past emotional trauma, especially
early childhood adversity. The landmark study known as the Adverse
Childhood Experiences Study (ACE), is an ongoing research study
conducted by the American Health Maintenance Organization
Kaiser Permanente and the Center for Disease Control and Pre-
vention (The Adverse Childhood Experiences (ACE) Study, n.d.).
Over 17,000 participants were recruited for the study between
1995 and 1997 and have been in long-term follow up for health
outcomes. The study has demonstrated a strong association of ad-
verse childhood experiences with health and social problems across
the lifespan. Recent research using these results has demonstrated
that people who are most likely to experience problems with opioid
addiction are those who suffered multiple adverse childhood expe-
riences, and that those with opioid addiction are also more likely to
have elevated ACE scores (Stein, et al., 2017). The implications for
treatment are significant and call on those providing treatment for
opioid addiction to consider the issue of trauma in their patients
when implementing evidence-based practice.
The Drug Addiction Treatment Act (DATA) waiver of 2000 was
an Act of Congress created to address the opioid epidemic; this law
created the treatment described as Office Based Opioid Agonist
Treatment (OBOT), commonly referred to as “Suboxone clinics.”
These are named after the initial brand name of the combination
drug behind this legislation. It granted the drug orphan status
in order to encourage its manufacture by outside corporations.
Buprenorphine, a partial mu-opioid agonist, is the active drug
that provides the biological effect associated with the treatment,
and naloxone is an opioid antagonist that is formulated with the
buprenorphine as a deterrent for misuse. The naloxone is only bi-
ologically activated when the patient attempts to misuse the drug
by either crushing the drug in order to snort or inject.
Before this legislation, it was not legal for a physician to prescribe
opioids to an opioid-addicted patient unless the patient was in a
(continued on page 24)
DECEMBER 2018
23