image by: Igotsober Alcohol & Opioid Recovery Center
Up until a few years ago, only medical professionals were familiar with naloxone, a medication used to revive opioid overdose victims. Now librarians, school nurses, baristas, parents - anyone who might need to save a life – can carry naloxone and administer it in emergencies as a nasal spray sold as Narcan.
Now comes a provocative new study by economists Jennifer Doleac of the University of Virginia and Anita Mukherjee of the University of Wisconsin. Their paper, The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime, concludes that naloxone, which works by dislodging opioid molecules from the brain to jump-start breathing, may not increase the number…
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Research shows that MAT results in what we addiction specialists call harm reduction. This means that while some of these patients may not be ready to be opioid-free, we want to keep them alive and achieving the greatest level of functioning. We don’t want them engaging in self-destructive behaviors like relapsing to street drugs, committing crimes, overdosing or acquiring infectious diseases like HIV. And there’s good evidence, some of which was presented as recently as Jan. 23, 2018, that medications have helped decrease HIV, hepatitis C and crime, as well as improve function.
Houry emphasized that “ EDs are a critical entry point for prevention of overdose , with opportunities to improve opioid prescribing, respond to overdoses with overdose education and naloxone distribution, engage in motivational interviewing of patients, initiate treatment for opioid use disorder, and improve surveillance efforts in collaboration with health departments.
The much-anticipated results of a study of competing opioid addiction treatment medications were just published in The Lancet. Researchers Joshua Lee MD and John Rotrosen MD of NYU School of Medicine and Edward Nunes of Columbia University Medical Center, compared the effectiveness of the more popular buprenorphine and a newer medication, injectable, long-acting naltrexone.
Their findings startled many in the addiction field. Both drugs proved equally effective in preventing relapse to heroin or other opioids once treatment had begun.
It seems like a paradox: Most doctors and scientists agree that the best way to treat opioid addiction is with other opioids. That’s because opioids are so powerful that they change the brain chemistry of the people who use them.
If we don’t provide even the bare minimum in evidence-based treatment, this crisis will keep getting worse.
While little training is required for doctors to prescribe opioids for pain, onerous restrictions are placed on physicians who wish to and currently do prescribe oral buprenorphine. These restrictions exist because buprenorphine does have the potential to be misused. Yet the restrictions placed on it far exceed those on prescription opioid painkillers, for which the potential for abuse is high.
This video episode from Moving Upstream explores why medication-assisted treatment is a preferred therapy for opioid addiction, but few rehabs offer it.
“We already have an effective treatment that people aren’t getting access to,” he said. “The primary challenge is getting it to people.”
That means most of these treatments just substitute one opiate for another, as Price correctly noted. Doctors think this is a good thing?
Yes, they do. “The drug that we’re replacing is a dangerous one that will kill you, and we’re replacing it with a drug that allows you to go back to work and have money in your pocket and allow you to live normally again,” said Dr. Stuart Gitlow, past president of the American Society of Addiction Medicine.
And the United States could, too
Prescription drugs designed to treat addiction are being traded alongside heroin and painkillers.
Unlike most opioid addiction treatments, Lucemyra is not derived from opioids themselves.
Before Joe Thompson switched treatments for his opioid addiction, he was a devoted stay-at-home father, caring for his infant son after his wife returned to work. His recovery was aided by the anticraving medication buprenorphine. But after over two years free of heroin, Mr. Thompson, a former United Parcel Service worker from Iowa, relapsed and decided to try another kind of treatment program.
Medication-assisted treatment is often called the gold standard of addiction care. But much of the country has resisted it.
The World Health Organization calls these medications “essential” because expanding access to them reduces crime, infectious disease, and death. In blocking access, these all rise.
Given all of this, it should come as a shock that only a quarter of patients who sought treatment for opioid-use disorders in the U.S. received these medications. This is particularly problematic because drug treatment programs have a notoriously high dropout rate. Those that are given these medications stay engaged in the process for longer than those who don’t use them.
A study found that patients on methadone or buprenorphine were significantly less likely to die by overdose than patients who didn’t take them. Methadone was associated with a 53% reduction in overdose risk, and buprenorphine was associated with a 37% decline.
In contrast, people who took naltrexone were just as likely to overdose as those taking no medication. More research is needed to determine whether naltrexone makes a difference.
A combination of funding, bureaucracy and fear of perpetuating addiction are to blame.
For people who do want treatment, however, the good news is that three FDA-approved medications exist to treat opioid addiction. Together, the three are often termed “medication-assisted treatment,” or MAT.
MAT is one of the most effective forms of therapy for substance use disorders but is widely misunderstood. Take a look at our new infographic and separate fact from fiction!
Medications, including buprenorphine (Suboxone®, Subutex®), methadone, and extended release naltrexone (Vivitrol®), are effective for the treatment of opioid use disorders.
Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.
They're safe, effective, and very well researched. Learn how addiction medications work and why they're still so hard to access, despite the evidence.
At At Bedrock Recovery Center, our treatment programs offer the use of MAT during treatment and beyond. Using MAT after you transition to everyday life again can help keep you in recovery and prevent relapse., our treatment programs offer the use of MAT during treatment and beyond. Using MAT after you transition to everyday life again can help keep you in recovery and prevent relapse.