Myths about willpower and moral weakness prevent people with opioid use disorder from receiving effective medications such as methadone, buprenorphine, and naltrexone

The most effective scientific treatment for opioid use disorder is medication. Methadone and buprenorphine prevent cravings and other withdrawal symptoms, while naltrexone works by blocking the effects of opioids.

Despite abundant research showing that these drugs reduce the risk of relapse and overdose, many people, regardless of their relationship to opioids or the people who use them, are still reluctant to advocate the use of these drugs. And most people who would benefit from such treatments don’t have access to them.

We study opioid use disorder and the attitudes surrounding it. To better understand medication hesitancy to treat opioid use disorder, we and our colleagues conducted focus groups with three populations intimately affected by the opioid crisis: those in recovery, their friends and family, and the their health care providers, as well as with members of the community with no direct link to opioid use disorder. We spoke to 101 people throughout rural and urban Indiana.

We asked what they thought about using medications to treat opioid use disorder. We found that all four groups had negative views on medication use. Regardless of who they were, participants expressed an underlying belief that opioid use disorder results from a moral weakness that can be overcome with willpower and a commitment to behavior change, despite the research-based evidence overwhelmingly demonstrate that opioid use disorder is a chronic brain disease best managed with medication.

In all four groups, we heard three myths about medication use for opioid use disorder. Research reveals that these stigmatizing beliefs run counter to reality.

The drug is not exchanging one drug for another

Many of our participants expressed the belief that using drugs is like using opioids to get high. This misperception is likely rooted in the outdated idea that recovery is defined by total abstinence from all substances, except perhaps caffeine and nicotine. As one service provider who works with people in recovery stated, if you’re on Suboxone or on methadone and not tapered off, you’re using.

The truth is, taking medications isn’t the same as using prescription or street opioids to get high. These drugs do not produce the same euphoric or high experience as heroin, morphine, or other opioids. In different ways, methadone, buprenorphine, and naltrexone all reduce cravings and enable people to stay sober and work, raise children, and engage in productive, healthy living activities—all challenges for people who do. good when they use opioids to get high.

Medications are an important part of long-term recovery

We found that people’s general discomfort with the idea of ​​using medications to treat opioid use disorder led to a belief that such treatment should only be used as a stepping stone to sobriety. One community member we spoke to said, “It’s a way to wean them off everything.” I think it’s just one of the steps they need to take to get clean.

The belief that drugs should only be used for a short time runs counter to research showing higher relapse rates after tapering. U.S. Department of Health and Human Services guidelines discourage rapid tapering and state that long-term use is the best way to prevent relapse, overdose, and death.

Long-term treatment counts as success

Many of our study participants expressed the belief that long-term use of medication means that the treatment hasn’t worked. As one family member said, if you’ve been at it for 10 or 15 years then it doesn’t really help.

The myth that long-term drug use means that the drug is ineffective or has failed runs counter to both the life outcomes of those on maintenance treatment and the physiological reality that such drugs may remain necessary to normalize brain function for the recovering person.

Just as those with high blood pressure or diabetes may need to continue taking medications long-term, so some people with opioid use disorder may. Keeping people treated and alive through the use of drugs is treatment success, not failure.

An estimated 3 million Americans have had or are currently struggling with opioid use disorder. The latest data from the US Centers for Disease Control and Prevention estimates that nearly 83,000 deaths in 2022 involved opioids.

Methadone, buprenorphine and naltrexone are life saving drugs. Myths associated with their use cause avoidable relapses, overdoses, and deaths by preventing people from using the most effective tool to enter and maintain recovery.