Patient, Population or Problem
Lately, the number of people who take opiates has considerably grown. Of particular concern is the use of drugs by young people aged 16-25, which is becoming one of the most acute social problems of modern American society. Young people start using opiates because of deep personal concerns, as a protest against a lifestyle and existing relationships, or driven by the desire to be admitted to some company and feel grown-ups. The long intake of opiates leads to drug addiction, which is not easily cured.
Opioids bind to opioid receptors in the brain, stimulating the release of endorphins. The changes in opioid receptors cause opioid addiction. At the physiological level, intracellular changes occur after the first four doses. An addiction takes longer to form, with constant binding of receptors. Driven by a strong desire to continue taking the drug, a person gradually enhances the dose as the quantity of opiates required to achieve euphoria increases. When opioids stop entering the body, withdrawal syndrome develops. The longer a person uses opioids, the more severe is the withdrawal syndrome when refusing them. Long-term addicts, as a rule, do not respond well to intervention, be it medical or educational.
Interventions
The two most common interventions used in fighting opioid addiction are behavioral treatment and the use of medication. Behavioral treatment encompasses “drug counseling, psychotherapy, and family therapy” (Volkow et al., 2019, p. 11). These strategies are aimed not only at the problem of drug addiction but also “at evaluations to assess the degree to which other problems are present, their severity, and on delivering interventions that address them” (Volkow et al., 2019, p. 11). The strength of behavioral therapy lies in its comprehensive character. However, medical interventions allow to curb the desire to take opiates and, ultimately, were found more effective.
The treatment with methadone is found “to provide relief from craving and withdrawal” with no addiction effects. However, it is not easily available and can be found only in licensed clinics. Moreover, the drug itself produces dependence and “results in acute withdrawal” (Volkow et al., 2019, p. 5). Despite its negative effects, the drug was found to be the most effective treatment in comparison to other kinds of treatment. There is “strong evidence that it reduces illicit opioid use and risk of overdose and improves other outcomes” (Volkow et al., 2019, p. 6). The alternative to methadone is Naltrexone, which can be obtained more easily since the clinic does not have to get a license to prescribe it. However, patients need to be properly detoxified before the drug can be used, and its effectiveness is smaller.
Comparison
Comparing the number of youths with drug addiction who receive medication and behavior therapy, it was found that the latter is much more prevalent. Thus, the majority of youths (52%) receive only behavior therapy, which is often not enough to effectively treat the dependence (Knopf, 2020, p. 7). Behavior therapy is less effective since “for naltrexone, youths were 46% less likely to discontinue treatment than those who received behavioral treatment only; for methadone, 68% less likely” (Knopf, 2020, p. 7). Therefore, the PICO question can be answered positively. In people belonging to the 16-25 years old age group, the treatment with methadone is more effective than treatment with naloxone or behavioral therapy for opioid addiction.
Outcome
The relevant outcome of methadone usage is the discontinuation of opioid use. If the therapy is not interrupted, young people have a chance to return to normal life and fight their addiction. However, in cases where only behavioral therapy is used, the relevant outcomes include a high percentage of deaths and complications due to the inability of people belonging to the 16-25-year-old age group to fight their addiction without medication.
References
Knopf, A. (2020). Teens not getting treatment after OD: Medicaid. The Brown University Child and Adolescent Behavior Letter, 36(3), 1-7. Web.
Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and treatment of opioid misuse and addiction: A review. JAMA psychiatry, 76(2), 208-216. Web.