Here we are deep in the middle of Recovery Month. As I’ve stated during the last couple of weeks, the whole purpose of Recovery Month is to focus on the fact that alcohol and drug addiction exists, and yet, it is very treatable. I think of Recovery Month as a time to showcase all of the great advances and treatments that have been discovered by scientific research over the last two decades. Why are these research findings important to promote? Because these scientific breakthroughs create a great deal of hope for the patients and families that this life-threatening disease affects. Just to make sure that you are aware of all of the Recovery Month activities in your area, here is the website that you can browse for activities both nationally and in your area (searchable by zip code) - http://www.recoverymonth.gov/
In the last couple of weeks I also have discussed the issues surrounding Michael Jackson’s death and what we can learn from it, specifically:
Don’t fall into the trap of thinking that addiction is untreatable and don’t accept treatment that is only 12-step based – you will need more than just that alone. Rather, learn about the latest scientific treatments for you or your loved one’s particular substance addiction and then ask any treatment program that you choose to implement those specific breakthroughs for you or your loved one. The whole reason that I helped to create www.enterhealth.com and wrote the book Healing the Addicted Brain was to specifically teach you these concepts, so that you can do exactly that - learn how to approach and treat this chronic brain disease comprehensively. You see, by teaching you, I have empowered you to help change “the treatment system” (which is currently broken,) one patient at a time. I want you to become an educated consumer of addiction treatment services and literally pull our country’s antiquated addiction treatment system into the 21st century. You can easily do this, once you educate yourselves about the state of the art scientific breakthroughs.
So today, I want to continue that education by discussing one of the most exciting anti-addiction medications that we have in the field of addiction treatment – Suboxone, a great treatment tool for opiate or narcotic addiction. Examples of narcotics (opiates) are heroin, OxyContin, Vicodin, etc.
Opiates have been used for pleasure and for treating pain for thousands of years, but abuse again became prevalent during the second half of the 19th century after the invention of the hypodermic syringe. By the early 1960s, the medical profession concluded that no known treatment could cure more than a small fraction of long-term opiate addicts – 70 to 90 percent of whom would relapse within a short time. As part of research to determine if addicts could be maintained on stable doses of prescription opiates, a synthetic narcotic called methadone was found to be effective in stabilizing opioid addicts, without the euphoria or other negative effects of opiates. It also had the advantage of being cheap, significantly orally active, and long-acting.
Methadone maintenance treatment then moved into the mainstream, allowing addicts to be restored to productive lives, reestablish relationships with families and improve their physical and mental health. Unfortunately, Methadone treatment has a great deal of “red tape” in order to get it, and also, it can only be given to a patient through a licensed Methadone treatment center – which means that the patient has to go down to the center and wait in line to get their Methadone each day. All of these “hurdles” to get Methadone, have prevented the majority of narcotic addicts from having access to it in the first place. Methadone has received more scientific scrutiny and evaluation than nearly any other medical treatment or human service program to date. However, methadone maintenance treatment has remained a controversial issue among addiction treatment providers, public officials, policy makers, the public at large and the medical profession itself.
Over the past decades, the use of opioids, including prescription painkillers and heroin, has grown significantly. According to the National Survey on Drug Use and Health, in 2003 more than 1.5 million people were dependent on or abusing prescription painkillers or heroin. Making matters worse, the average purity of heroin on the street, increased from 39% pure to over 70% pure – the higher the purity, the easier it is to get addicted and the more dangerous it becomes. Unfortunately, only a fraction of these opiate addicts (maybe 25% at most) were currently receiving treatment for their chronic medical illness of narcotic addiction. Even more startling is the fact that the 75% of this population that is not in treatment is contributing 50% of the new HIV positive cases and 30% of all new Tuberculosis (TB) cases each year.
Recognition of the urgent public health need for new opioid-dependence treatment alternatives led to Congressional approval of the Drug Addiction Treatment Act in 2000, giving physicians the right to use approved opioids (buprenorphine) to treat opioid dependence in their offices. Initially developed to treat pain, buprenorphine was approved by the FDA for this purpose in October 2002. Buprenorphine is a partial opioid agonist, meaning its opioid effects partially mimic those produced by full opioid agonists such as hydrocodone or heroin and partially mimic those produced by opioid antagonists such as naltrexone. The primary formulation, Suboxone®, contains buprenorphine and naloxone, an opioid antagonist to discourage people from dissolving the tablet and injecting it. Consequently, I, and most practitioners, only prescribe Suboxone to their narcotic addicts, as it has less potential for diversion (being stolen and sold on the street) or misuse.
Suboxone is an amazing and life-saving medication which is used to reduce illicit opioid use and help patients stay in treatment by blocking the effects of opioids, decreasing cravings, suppressing symptoms of withdrawal and blocking the high from and opiate relapse. Most narcotics addicts seem to benefit from Suboxone, regardless of their histories of opiate addiction. Suboxone is very safe and effective and is a revolutionary step in the treatment of narcotic addiction. It can be easily used in both the detoxification and maintenance phases of opiate treatment. Also, because of its ease of use and excellent safety profile, its adoption by the growing number of primary care physicians who are screening for and recognizing narcotic addiction in their patient populations and then referring them to appropriate psychosocial treatment programs, should make a very positive impact in the treatment success for narcotic addicts.
Finally, oral naltrexone has also been successfully used to treat narcotic addiction. Once-daily ingestion of a 50 mg tablet will almost completely block any narcotic which an addict will attempt to use. Consequently, naltrexone prevents any euphoria or other benefit which an addict may hope to achieve through an opiate relapse. Because daily administration is required, it is best to have an addict take naltrexone under direct observation to enhance their compliance (for this reason Vivitrol, which is currently only approved for the treatment of alcoholism at this point (see previous blog entry), may be another option for this population.) Naltrexone treatment is not successful in all narcotic addicts, yet there is strong data that it significantly enhances a sobriety program when used with impaired professionals (physicians, nurses, lawyers etc) who are highly motivated to stay sober. In fact, I have found in my own practice that naltrexone treatment for a year after completing a successful course of Suboxone, can be a very useful strategy to achieve continued long term sobriety when combined with other longer term therapies (e.g. 12 step programs, psychiatric treatment, family therapy as well as nutrition / wellness programs)
Look for much more detailed information regarding Suboxone, Vivitrol, naltrexone and methadone in Healing the Addicted Brain or visit www.enterhealth.com/healingtheaddictedbrain. Also, there are two excellent websites specifically focused on the use of Suboxone for opiate addiction:
Both of these sites really have a great deal to offer both the opiate addict and their families.
In closing, I hope that today I have, yet again, provided you a glimpse into the amazingly effective treatments that the latest scientific research has discovered. My purpose is to inspire hope, optimism and resulting success for long term sobriety.
Thanks for reading.
Harold Urschel III MD