Does MAT get you high? Does buprenorphine rot your teeth? Is kratom safe because it’s natural?
We’ve addressed lots of myths about psychiatric medications, medication assisted treatment (MAT) and substance use before, but we’ve still only scratched the surface. With Overdose Awareness Day on August 31, we thought we’d check back in with a couple of our experts to revisit some previous myths, explore some new ones, and find out what’s actually true in the world of MAT and addiction.
Here’s our interview with Daralyn Morgenson, PharmD, BCPP, clinical pharmacist, and Jud Felder, BA, CPFS, CPRP, peer specialist II at the MAT clinic.
Myth #1: MAT gets you high.
FELDER: Myth. The MAT we offer doesn’t get people high because buprenorphine is a partial agonist and doesn’t lead to the full high that can be a factor with methadone.
MORGENSON: There’s also the fact that in Suboxone, the naloxone component is an opioid agonist that acts as an abuse deterrent. So even if someone were to try to inject Suboxone for a high, it wouldn’t be possible because, when injected, the naloxone would chemically block buprenorphine from causing an actual high. That’s one of the reasons Suboxone is such an effective MAT medication – it helps cut cravings and withdrawal, but is much harder to misuse than other options.
Myth #2: Buprenorphine rots your teeth.
MORGENSON: Partially true. If you take good care of your teeth – brushing and flossing regularly, and generally practicing good dental hygiene – the risk of problems is really low. It’s often recommended to wait an hour after taking buprenorphine before brushing your teeth because the acidity can weaken tooth enamel (Like coffee). Rinsing your mouth with water 30 minutes after taking your Suboxone can also help.
FELDER: Methadone can actually be harder on your teeth than buprenorphine. Regardless, it’s really important to take care of your teeth.
Myth #3: Medications like Suboxone are just swapping one addiction for another.
FELDER: Not entirely true. You can become physically dependent on a prescription medication (not just MAT, by the way), but if you don’t use it for the “high” effect, then we wouldn’t necessarily think of that as an “addiction” in the common sense.
MORGENSON: That’s right – from a clinical perspective, we see addiction as both a physical dependence and a need for continued use despite negative consequences. When you’re using MAT as intended, not only does it have minimal negative consequences, but it can have significant benefits, such as the ability to engage in therapy, rebuild relationships, and get back on your feet.
Myth #4: Medications can cure addiction.
FELDER: This is mostly a myth, depending on your definition of “cure.” We know that medication combined with therapy works really well for a lot of people. For some, medication alone frees them from the burden of cravings and withdrawal, which allows them to live a full life. Other people need therapy too, including support groups, to relearn how to deal with emotions, how to understand people and how to interact and communicate with them.
MORGENSON: Medications help you get to a point where you don’t have to stress about withdrawal and cravings, which allows you to engage fully in the therapy to build tools and address the other things that led to the substance use in the first place. Some people can stop medications, some people don’t, and that’s ok.
FELDER: It’s like training wheels on a bike – when you’re first learning, the training wheels let you focus on learning to balance, pedal, and brake. As you get better at those things, you might not need the training wheels anymore.
Myth #5: Suboxone tastes bad.
FELDER: This is true. Some formulations of Suboxone taste better than others, and we offer them. If someone is coming into the MAT Walk-In Clinic and they want a formulation we don’t have, most people will be happy with Suboxone for the immediate term, and then we’ll switch them to their preferred formulation when it becomes available.
MORGENSON: Suboxone on its own can taste metallic, salty, or bitter, so there are often flavorings like mint that can mask some of the taste. One tip we share with people who use Suboxone as part of their ongoing MAT is to wait half an hour after taking it, and then try a mint that contains xylitol, which is a type of sugar free sweetener.
Myth #6: All MAT clinics offer methadone.
MOREGENSON: Myth. Many MAT clinics offer just methadone, some just buprenorphine products, some both. There are several reasons for this. For one thing, getting set up as a Methadone clinic involves a lot of legal hoops on the provider’s side. And from a patient experience perspective, there are often limits on how much medication you can take home at once. When you first start with methadone, you have to go in every single day to receive a dose, which can be a major barrier for people. After a while, some people can graduate to going in weekly to pick up a week’s supply of medication, and some then move to once a month. Overall methadone is much more labor intensive and requires more guardrails than other options.
Our clinic, on the other hand, uses buprenorphine medications like Suboxone. We don’t do methadone. There are still plenty of regulations with these medicines, but they are not as prone to misuse as methadone because of the way they’re formulated, so it’s not nearly as onerous to offer services.
FELDER: We actually know people who have switched from methadone to buprenorphine in our clinic because of the convenience. With methadone, you have to be at the clinic first thing in the morning every single day. At our clinic, people can get meds to take home and then get connected to ongoing care. One of the types of medications we offer at WellPower for long-term care is Sublocade, a long-acting buprenorphine injectable, which is effective for a month or so depending on the medicine.
Myth #7: Once you start MAT, you have to stay on it for the rest of your life.
FELDER: Not necessarily. Many people don’t need to stay on it – it depends on the person. We’ve had a lot of people who’ve started and then were able to gradually decrease their dose until they no longer needed it at all. That’s where behavioral therapy comes in. Once they titrate down, it might be months before the cravings come back, and that’s when they can practice handling the cravings on their own using the tools they’ve learned in therapy and support groups.
MORGENSON: You just have to get to a point where you’re stable. Some people need the medications over their lives, but not everyone does. It also depends on life stressors – some people do really well for a while without medications, and then a huge life stressor happens and they need more support. And that is ok! We are here for whenever people need to reach out for support.
Myth #8: Kratom is safe because it’s natural.
MORGENSON: Myth – kratom is dangerous. Being natural doesn’t make something healthy. There are lots of things that might be considered “natural” that are actually very dangerous – you could argue some opiates like morphine would fit in this category, because opiates are derived from a plant.
FELDER: I know people who have done Kratom as a kind of harm reduction from heroin because it’s safer. Kratom might not have all of the same risks as heroin, but that doesn’t mean there isn’t significant risk involved with it. We see people in our clinic who have severe withdrawal symptoms coming off Kratom and need Suboxone to get off it.
MORGENSON: Kratom is still addictive, and you can get withdrawal symptoms from it. And high doses can cause effects like seizures, respiratory depression, coma, and impaired consciousness. The good news is that we can treat kratom with MAT and naloxone can help.
Myth #9: If you do a downer, you should do an upper to balance out.
MORGENSON: Big myth. Depressants (the “downer”) and stimulants (the “upper”) don’t cancel each other out. Adding a stimulant when you’ve already done a depressant just adds another thing for the body to work through. It also makes an overdose more likely.
FELDER: The problem is that the first drug is still in your system, and doing an upper doesn’t make it magically go away. And we are definitely seeing an increase in stimulants being involved with drug overdoses.
MORGENSON: The only thing to help is time for your body to process the substance – or to go in and get treatment if you need it.
Myth #10: It takes a long time to get medications when you need them.
FELDER: Lots of programs take several hours to complete a full intake, especially for methadone. That can be a barrier to people, so that’s why we’ve modeled our program to be a true walk-in clinic.
MORGENSON: Yes, you can just come in during open hours (currently Wednesdays 1-4:30 p.m. and we’re looking at expanding in the near future), meet with Jud and me quickly, then depending on your needs, you can fill a prescription in the same building to take with you. Our Walk-in sessions take about one to one and a half hours. So, a full session with us could be faster than just the intake at another program.
Myth #11: MAT is no better than abstinence.
MORGENSON: Huge myth. There’s a ridiculous amount of evidence that MAT is better than abstinence for helping people overcome opioid addiction.
FELDER: MAT also keeps the door open without judgment for people to get help. Because the goal with MAT isn’t to stop using immediately in that moment, it’s how to get help right now and get resources to help get back on your feet in a timeframe that can be sustainable and works for you over the long term.
Myth #12: People who use MAT aren’t really “sober.”
FELDER: Myth. While some recovery groups say you’re not in recovery if you’re in MAT, I would challenge that in saying that recovery looks different for everyone. You can’t say someone’s not in recovery because they’re taking prescribed medication. Each person’s journey is unique, and sometimes that means medicine is part of it. You really have to look at what each individual person needs to get where they’re trying to go. Sometimes that means MAT, but they’re still in recovery.
How to get help with opioid addiction
WellPower’s medication assisted treatment (MAT) clinic can help you cut cravings and prevent withdrawal with the support of medications like Suboxone. Find out more about our program, including our new Walk-In Clinic here, or give us a call at (303) 504-7700.
For help in a medical emergency, call 911. If you or someone you know needs urgent support 24/7/365, call, text or chat 988, the Mental Health Lifeline. In Colorado, you can also visit a walk-in center for immediate, in-person help in a crisis. Denver’s walk-in center (operated by WellPower) is at 4353 E. Colfax Ave. Find another Colorado location closest to you here.
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