For the millions of Americans struggling with opioid addiction, breaking the habit can be physically and psychologically demanding.
Those who quit abruptly can experience violent withdrawal symptoms for up to 10 days, and once those subside, they still have to cope with anxiety and intense cravings. Relapse is common.
Scott Lukas, director of the Behavioral Psychopharmacology Research Laboratory at McLean Hospital in Belmont, Mass., has spent much of his career researching and developing drugs to treat opioid addiction. Many of the drugs on the market are opioids themselves, but are formulated to deter abuse, while minimizing withdrawal symptoms.
In the video above, Lukas explains the history and science of these opioid treatment medications.
The stakes could not be higher for those addicted to opioids. More than 30,000 Americans died in 2015 from illicit drugs like heroin or prescription drugs such as OxyContin and fentanyl. The epidemic has surpassed the height of the HIV/AIDS crisis in terms of yearly death toll.
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Buprenorphine is an old – 1956 – C-III (where it remains) med, formerly known as Buprex (a transdermal patch) plus formulations administered via IV, oral and IM, its primary uses were to treat Acute (Breakthrough) moderate to severe pain and Chronic Pain. The long half-life increased efficacy in the latter case.
Now used as MAT, and I agree the arseholes at B-R were wrong to use a decades-old medication and launch the price into Near Earth Orbit {ditto generic manufacturers}: Both Subutex & Suboxone are VERY effective. W\ Suboxone, they went International Relations and added an active deterrence by including naloxone; however buprenorphine’s formulation allows for partial agonist properties at the μ-Receptor and antagonist at the κ-Receptor {studies show limited interaction and results at the δ-Receptor & the NOR) The MOR is “The Receptor” of the 3(4) opioid receptors. The correlation between the higher the substance’s affinity, the higher the risk of creating both types of dependence, developing tolerance, misuse & abuse potential.
Buprenorphine, w\ or w\out naloxone, when taking as written, after “x-number” Dr. visits and after achieving therapeutic dosage levels produces a Ceiling Effect: You can take more, but you’re wasting meds/money. Plus, you can’t really add another opioid/opiate {only two can break the binding properties and the dose required is higher than average opioid-naïve dose, but it will do the job as it written: Provide relief from pain! Unless taking extremely high amounts, abuse potential is limited, even after abstinence and half-life elimination, so the inventive to relapse is quite a process.
Is it perfect? Nope. What is? Does MAT work? Yep. Can more be added on the regulation, treatment options, Counseling, insurance and general education? F Yes. But hope is out there! If you or a loved are struggling, there are options. Not all Clinics are bad. Not all treatments work the same for all, but there’s a way to beat the current nightmare and regain control. Buprenorphine saved my life. 15 years ago. Please, consider ANY Medicinal Approved Treatments along w\ Counseling & a Licensed Physician or NP, and possible psychotherapy CAN HELP! I Promise! 12-Steps may be of assistance, but neuroplasticity and neurogenesis make even the most dedicated people different! And stay away from NarcAnon!
You can beat this!
To deal with ongoing opioid crisis Colorado has passed a bill that will permit doctors to recommend medical marijuana for certain health conditions associated with severe pain. Medical marijuana will act as a substitute for opioid.
Source – https://www.myhealthyclick.com/colorado-passes-bill-that-allows-physicians-to-prescribe-medical-marijuana-rather-than-opioids/
To an addict psychopharmaceuticals are life savers in themselves. A major problem with this is they are not treated as short-term programs. I have known many addicts in my life being I am writing from a state correctional facility in Pennsylvania (as an inmate). People get prescribed these medications for years and the same goes with Methadone maintenance programs. Everyone does know that the detoxification from a drug like Suboxone is twice as bad as the detoxification process from heroin or prescription pills and now we have spun the wheel and replaced the bad with the even worse. Then when an unsuspecting addict does start to detox they get scared and are forced to either use their drugs of choice again or suffer agony (which no addict in their right addicted mind will even consider). These programs need to be combined with Psychotherapy or CBT (though I do no promote CBT unless the person has started drug use rather late in life). There should be a time limit on the prescription of these drugs and a weaning off after that time limit. I do not think these drug companies are wrong they do help its just the way they help is a little skewed.
My grandson was on Methadone program for 5 years. $65.00 a week and that was all they cared about, getting their money. Increased his dose to 55 mg a day and gave him 2 weeks supply at a time. We thought he was doing great since he had to go only every two weeks. But, he overdosed when he was just 33 years old. Why give an addict that much Methadone at one time?
Sorry about your grandson. That is NOT how methadone clinics are supposed to work. They are (or were) specifically set up to have the patient/addict go to the clinic EACH DAY for their dose. One day’s dose at a time. Methadone was selected because it has a long enough half life so that once a day dosing is adequate to prevent withdrawal. By definition, addicts cannot control their drug habit. That is why it is set up this way. Then, if the clinic knows what they are doing (only a few do), they’ll GRADUALLY SLOWLY WEAN the patient down. If you go slow, there is zero withdrawal effect.
Problems: 1. Patient/addict. People will do what they will do. it is not guaranteed that people will not seek extra drugs or otherwise fall off the wagon. 2. A much worse, cynical corporate problem example that your grandson’s situation reminds me of: A venture capital company owned by Mitt Romney, purchased a chain of methadone clinics. Cutting down numbers of counselors/dispensers, made it much more profitable. By dispensing a week’s worth at a time, each staff member can dispnes for 5 times as many patients, they can drastically cut down overhead. Profit goes up. But, remember, patients are to receive counseling/support at the clinic, as well. Reducing that to once per week also increases profit. It sounds like your grandson was in a similar situation. The cold hand of corporate medicine. Not your friend.
BTW. Methadone costs $0.13 per pill cash to the patient. The clinic was buying it for much less.
Can’t believe that folks promote methadone as the maintenance drug. Methadone kills stem cells- which provides replacement cells to the body- look at a Methadone patient- no teeth, they ge rapidly, their bones become brittle- al du to stem cell degradation. Suboxone is much simpler, doesn’t make users feel “of of it” and unable to function. And pray tell when a patient is on a high maintenance does of Metahadone why don’t they get dosed in the evening as opposed to early AM? . When dosed in the AM, and these folks are working, they get “the nods” and temporarily fall asleep- at home, in bed or driving a 30,000 pound truck. Evening doses would allow them to sleep well and have enough active ingredient to last through the day. why do they dose it in the AM. If the dosed it in the PM, people would have less side effects, could function better and get back into society more rapidly.
To those suffering form addiction… to any substance.. SOME help is available. get it.. and et it now. Peace! PG
“The moment a person forms a theory, his imagination sees in every object only the traits which favor that theory.”
Stem cell function is vastly more complex and variable than presented here. The effect of methadone is also variable. there is little if any quality evidence to support this sweeping statement. There is even less to support suboxone as a valid combination, other than to jack the price. The one valid point is buprenorphine, the active agent in suboxone. An overall excellent drug. But variable as well, just like all the rest. The naloxone/buprenorphine combo that is suboxone is just a way to gouge you ten bucks for a dollar’s worth of meds. As for the “nods”, that too is highly variable, endorphin receptor sites having a very complex structure and genentic variablility, with differences in tolerance of various drugs between patients. Some people become more alert on the same drug that others become sleepy on.
Not all methadone regimens are the same, just as all patients do not react to methadone the same. Individualization is the key.
There are other ways to treat opiod addiction without drugs including cranial electrotherapy stimulation, which has been shown in peer studies to eliminate addiction and also to work as an adjunct therapy to treat anxiety and insomnia during detoxification. A number of states including Maine have now approved Medicaid reimbursement.
WoW, lasts ten days my ass. Of course they push Buprenorphine, here’s why. It costs 3-4 times as much as Methadone, which is less that $5.00 a dose. Methadone has been around more that 40+ years, why wouldn’t they use that, they’ve known about it and what it can do for addicts. Because unless they can help big pharma make fat cash they have no interest in the catastrophic opiate epidemic we are in. The other thing about Buprenorphine is it can only treat very low dose addicts.
When a person is addicted and wants treatment/help, they go to a Methadone clinic, where most all will be started at a dose of about 30 milligrams. Which is a relatively low dose, most will continue to increase the dosage until stabilized, which, if they are a long time addict can go as high as 80-100 (maybe even more) a day.
The drug Buprenorphine can only help addicts whose dose of Methadone would be at or under 40 milligrams a day, it can not treat a serious addiction. But they continue to push it. Most all insurance, has no provision for Methadone, BUT most all will/do cover Buprenorphine at the cost of 3-4 times the cost of Methadone, a tested and 40 year treatment of heroin/opiate addiction.
Let’s also quickly look at one other huge payoff here. When they put/force someone into a detox facility, which costs about $25,000.00 – $50,000.00, (or more) for 30 days, (usually) of treatment, 75-80% (may even be higher) of the time, they are addicted within 5 days of release or dead from OD’ing…look at the payoff the hospital and doctors get on this…Holy Crap! In the first months (up to a year) of Obamacare they were sending the same people for 3-4 rounds of this treatment. (that they knew did not work) Finally they put a stop to it and capped it.
So, here we are, in a Huge Opiate crisis, epidemic or whatever your label is and they’re still trying to insure that Big Healthcare Insurance companies and Drug companies get a big fat assed payday…by refusing to cover very low cost addiction medication…for every $2.00 spent on methadone the return is $5.00.
I’m not saying Methadone is for ALL addicts, but most certainly someone that has years of proven addiction, many detox stays, countless jail/prison terms would fit the bill. Children/teens anyone under 25 should not be started on it as a first choice.
Why is it impossible for people like this to get treatment?
Can someone please tell me WTF is happening?!
Point taken. Narcan (naloxone) is the overdose recovery drug we’re equipping people with. On the second point, couldn’t agree more, but, for the Milton Friedman’s of the world, the perfect marketing opportunity! Bazillions to get everyone stared on oxycontin, gazillions to get them off, and a few illions thrown in to cover the opiate side effects (constipation, e.g.) in between. Gotta love the market, although “free” is perhaps not quite the right word!
You don’t know what the hell you are talking about. I had a 450 mg Oxycodone a day habit and am now treating it with 12mg suboxone. It has been a lifesaver for me. Unless you are in recovery yourself don’t go spouting “facts” which are untrue. It will discourage people from getting help because they think it won’t work. Yes it works for people with large addictions Methadone is more dangerous to trust people with take-homes because of how powerful it is and how easy to overdose. Suboxone is not as easy to overdose on. That is why people are pushing suboxone harder than methadone
Your frustration is right on the money. It is worse than you presented. You can buy methadone for $0.11 per pill, cash, at Walgreens. There’s just too much money in blowing smoke up people’s skirts and restricting supply of meds. Buprenorphine has also been around a long time. It was an injectable pain med for decades before it was found to be useful for addiction/substitution. So, it too, is dirt cheap. Except that Reckitt-Benckiser has a monopoly on the market, brand and generic as well. And they raise the price 5x by adding the totally useless naloxone to it. Don’t get me started on the ripoff that is “Recovery” either.
The best solution? 1. You have to want to stop. 2. Counseling and support. Lots of it and ongoing. 12-step is good if you are self motivated and find the right group. 3. Simple gradual reduction. This works with any opioid, buprenprhone, methadone, oxycodone, etc. But criterion #1 must be met or all is useless.
Buprenorphine is an old – 1956 – C-III (where it remains) med, formerly known as Buprex (a transdermal patch) plus formulations administered via IV, oral and IM, its primary uses were to treat Acute (Breakthrough) moderate to severe pain and Chronic Pain. The long half-life increased efficacy in the latter case.
Now used as MAT, and I agree the arseholes at B-R were wrong to use a decades-old medication and launch the price into Near Earth Orbit {ditto generic manufacturers}: Both Subutex & Suboxone are VERY effective. W\ Suboxone, they went International Relations and added an active deterrence by including naloxone; however buprenorphine’s formulation allows for partial agonist properties at the μ-Receptor and antagonist at the κ-Receptor {studies show limited interaction and results at the δ-Receptor & the NOR) The MOR is “The Receptor” of the 3(4) opioid receptors. The correlation between the higher the substance’s affinity, the higher the risk of creating both types of dependence, developing tolerance, misuse & abuse potential.
Buprenorphine, w\ or w\out naloxone, when taking as written, after “x-number” Dr. visits and after achieving therapeutic dosage levels produces a Ceiling Effect: You can take more, but you’re wasting meds/money. Plus, you can’t really add another opioid/opiate {only two can break the binding properties and the dose required is higher than average opioid-naïve dose, but it will do the job as it written: Provide relief from pain! Unless taking extremely high amounts, abuse potential is limited, even after abstinence and half-life elimination, so the inventive to relapse is quite a process.
Is it perfect? Nope. What is? Does MAT work? Yep. Can more be added on the regulation, treatment options, Counseling, insurance and general education? F Yes. But hope is out there! If you or a loved are struggling, there are options. Not all Clinics are bad. Not all treatments work the same for all, but there’s a way to beat the current nightmare and regain control. Buprenorphine saved my life. 15 years ago. Please, consider ANY Medicinal Approved Treatments along w\ Counseling & a Licensed Physician or NP, and possible psychotherapy CAN HELP! I Promise! 12-Steps may be of assistance, but neuroplasticity and neurogenesis make even the most dedicated people different! And stay away from NarcAnon!
You can beat this!
Good as far as it goes, but what about naltrexone (vivitrol – daily pill/monthly injection)?
Those are drugs that are taken ONLY after the person is no longer addicted. If these are given to someone that is actively addicted it will put them into an immediate state of withdrawal. These are used to keep the person from using at all after they have completely detoxed. They block the receptors in the brain where the opiates bind to get you high, so because they are blocked, no matter what they use….they can not feel it.
Vivitrol is not “treatment”. It is to opiate addiction what the mythical chastity belt was to sex. A preventative. That does not “treat” the withdrawal or the underlying addiction.
No argument from me, I didn’t mean to say vivitrol was treatment. However, used in combination with intensive in or out patient programs, a potentially powerful treatment support because, as you mention, a complete blocker. Not sure with the appearance of fentanyl and, our newest killer, the animal tranquilizer carfentanil, about the efficacy of vivitrol and/or narcan, but it works with elk! https://www.ncbi.nlm.nih.gov/pubmed/8722260
Narcan has been around for a while and our public safety folks and needle exchange are equipped – and, yes, people can snap out and be difficult. Had a discussion this a.m. with a former ER doc about this and previously with fire fighters and needle exchange staff; bottom line, better in a bad state than dead. The real problem we should be discussing is the lack of funding, at every level, for recovery centers, intensive recovery programs, medical school training on addiction, and educating the medical profession as to its part in passively over prescribing opiates. And, of course, prevention and ending the stigma – but there’s no profit in those! There’s a current documentary on PBS making the argument that the doctors are maybe not at fault, they’re just trying to treat pain – unfortunately, the doc making the biggest argument in support of opiate use also seems to be taking big bucks from the you-know-whos (more here): https://www.statnews.com/2017/03/24/pain-documentary-public-television/