Harm Reduction In Action: Medication Assisted Treatment Explained

A World Without Pain

Imagine walking through the world as though there was no pain to be felt. Stubbing your toe felt like a small annoyance, heartbreak a mild disruption, and traumatic childhood memories just a dull twist in your chest. Sounds a bit enticing, no? To enter the warmth of the womb or be wrapped in a cozy blanket at every moment—this is how it can feel to live your life as an opiate addict.

It’s no wonder why opiate use disorder (OUD) has become a nationwide epidemic, affecting all social classes, races, genders, and religious sects in America. Three million U.S. citizens currently suffer from OUD (Azadfard et al., 2023). No one is immune, and the treatment of this disorder begins with understanding how and why someone ends up there. Then can begin the healing—often within the structure of a drug rehab or addiction recovery program designed to address both physical dependence and emotional pain.

How Did We Get Here?

There are varied schools of thought around how to treat OUD. Some purists in recovery believe no medication should be used. Others—psychiatrists, counselors, and treatment providers—see value in certain medications. And then there are those who lie on the fence. But with overdose rates rising and fentanyl contaminating almost every street drug, the role of medication in reducing harm is undeniable. For many, entering a substance abuse treatment program may be the first safe step toward stability.

Opiate use was officially declared a national epidemic in 2017 (Sharp et al., 2021). Since then, medically assisted treatment (MAT) has played a key role in decreasing overdose deaths. But before diving into pharmacological treatment, we need to explore what leads a person toward OUD in the first place.

Trauma is at the root for many. Risk factors include a family history of substance use, sexual abuse (especially in females), adverse childhood experiences, and comorbid psychological disorders like depression, bipolar disorder, and ADHD (Kaye et al., 2017). Physical pain can also be a factor, especially when someone begins using legally prescribed pain relievers that eventually lead to misuse and addiction.

As Preston et al. found, specific opioid receptors and endogenous opioids in the brain affect both pain and pleasure. A person suffering from OUD is seeking relief—whether emotional or physical—and as long as the opioid is present in the system, that relief is accessible. But once it’s gone, the pain returns tenfold.

Opioids and the Brain

Opioids bind to receptors in the central and peripheral nervous systems, providing effective pain relief. They also trigger the release of endorphins—neurotransmitters that mute pain and heighten pleasure, creating a sense of euphoria (Mayo Clinic, 2022). Over time, the brain’s natural production of endorphins slows, and the same amount of drug no longer produces the same effect.

The National Library of Medicine outlines the effects of opioid receptor activation:

• Delta: Analgesia, antidepressant effects, physical dependence
• Kappa: Analgesia, depression, hallucinations, sedation
• Mu: Analgesia, euphoria, respiratory depression, GI slowdown, physical dependence

Peripheral mu receptors, found in areas like the bronchial muscles and digestive tract, help explain why opioids suppress cough and cause constipation.

Long-term opioid use alters receptor sensitivity and pain perception. This can lead to opioid-induced hyperalgesia (OIH)—when the person becomes more sensitive to pain rather than less (Azadfard et al., 2023).

The mu opioid receptor (MOR) is key in both pain relief and addiction. Full agonists activate the receptor, inhibiting spinal cord pain signals (Al-Hasani & Bruchas, 2011), but chronic use leads to tolerance and the need for higher doses. The MOR is located in several areas of the brain, including the cortex, thalamus, and hypothalamus, all of which influence emotion, perception, and memory—critical components in the addiction cycle.

Pharmacological Treatments: Agonist vs. Antagonist

Pharmacological treatment varies based on the client’s needs and preferences. The MAT model, once heavily stigmatized, is now more widely accepted thanks to growing research and a rising sense of urgency. These treatments are often incorporated into inpatient rehab or outpatient addiction recovery programs for clients who need medical support to begin the detox and recovery process safely.

Two main medications are used to treat OUD: buprenorphine, a partial MOR agonist, and naltrexone, an MOR antagonist. While some in recovery circles argue that using these medications means a person isn’t “truly sober,” it’s important to understand what these medications do.

Naltrexone (in pill or injectable form as Vivitrol) is considered safer by some due to its lack of psychoactive effects. As an antagonist, it blocks opioid receptors, reducing both cravings and the ability to feel the drug’s effects. Brewer (2023) points out that unlike opiate agonists, it carries no risk of abuse or withdrawal. One client I spoke with about their experience on naltrexone shared:

“I don’t feel like it’s detracting from my sobriety at all, but I do feel like it’s an extra protection… I’m not saying I’ll be on it forever, but I know I’m okay being on it for now.”

Buprenorphine is becoming more common, despite lingering stigma from the medical field. It provides opioid-like effects to a lesser degree and has been shown to reduce cravings. As a partial agonist, its misuse potential is lower, but it still requires specialized training to prescribe. Under the Drug Addiction Treatment Act of 2000, prescribers must complete training before treating opioid-dependent patients (Kumar et al., 2023). Still, this medication has proven effective, especially in early recovery, and is now offered in many structured substance abuse treatment settings.

Psychotherapy and the Addict

Medication alone cannot address the emotional and psychological roots of addiction. Most people suffering from OUD are not just numbing pain—they’re numbing their entire experience of being human.

That’s where therapy comes in. Without addressing the core of that pain—whether it’s trauma, grief, shame, or hopelessness—lasting recovery is unlikely. That’s why many addiction recovery programs are now designed to integrate both psychiatric medication and psychotherapy, often delivered in a drug rehab setting.

In my own clinical perspective, psychotherapy is vital. Many clients begin in a robotic, detached state. They’re existing but not truly living. Once the opiate is removed, simple tasks can become overwhelming. Feeling anything at all—joy, grief, pain—can be terrifying.

Cognitive Behavioral Therapy (CBT) is a useful starting point. Teaching clients that their feelings and thoughts don’t have to dictate their actions can be empowering. Over time, clients begin to learn how to tolerate discomfort, grieve their losses, and embrace life without the shield of substances.

It is our responsibility as clinicians to offer a safe, non-judgmental space—one that supports the blank slate of recovery and centers the dignity of the client above all else.

How Do I Find My Footing?

Being in recovery is not just about not using. It’s about learning how to live again. That means navigating everything from housing to employment to community support.

As a non-medical psychotherapist working alongside clients on pharmacological regimens, I know the value of a wraparound care model. If a client is still struggling despite outpatient care, I’d recommend entering an inpatient rehab program, where shared experiences and real-time support can change lives.

In terms of ongoing support, I believe in encouraging 12-step programs (NA, HA, AA), which provide built-in community and accountability. For housing and employment, I’d point clients toward programs like:

• Anti-Recidivism Coalition (ARC): Helps formerly incarcerated individuals with housing and job opportunities
• Recovery Bridge Housing / Pilot programs: Temporary housing support for those in early recovery
• Chrysalis: Employment services and job readiness for people re-entering the workforce post-addiction

Clients need help navigating these psychosocial stressors, and my role includes guiding them toward these resources.

Reflections

Ultimately, my role is not to be the expert, but to support my clients in finding what works best for them. My job is to foster integrated care, collaborate with psychiatrists, and empower clients to make informed decisions. One psychopharmacology course does not make me a prescriber—but it does make me a better-informed partner in their journey.

If I can hold space for a client to move from pain to possibility—to live, rather than numb—then I am doing what I came into this field to do.