Foster Development Of Novel Pain Treatment Therapies
As we continue to confront opioid abuse and addiction, we must also take steps to help those with acute and chronic pain who need access to medicines, including opioids, get improved treatment alternatives. Transitioning from the current market, dominated by conventional opioids, to one in which most opioids have abuse-deterrent properties, holds significant promise for a meaningful public health benefit. While these innovative formulations are designed to make it harder for people to manipulate the opioid drug so they cant be abused, its important that prescribers and patients understand that these drugs are not abuse-proof, and they do not prevent addiction, overdose, or death.
Training Authorization And Coordinated Care
Even though most physicians in America can prescribe powerful and dangerous opioid painkillers with few restrictions, doctors must become specially certified in order to prescribe addiction medications.
There are many restrictions on where medications can be offered and who can administer them. And due to these restrictions, many clinicians and facilities have limited capacity for the number of patients they can accept at one time. In many communities, only some medications are available, which limits patients options.
Doctors and patients have to jump through countless administrative hoops.
Some clinicians refuse to administer medicationseven when they are authorized to do sobecause of personal beliefs, the lack of coordinated care with mental health professionals , the additional time commitment required, and the potential threat of raids by the Drug Enforcement Administration and the FBI.
Whats more, its hard to access medications even within traditional addiction treatment centers. Few inpatient treatment facilities offer all three FDA-approved medications for opioid use disorder. While the American Society of Addiction Medicine has defined detailed standards of care, there is no established national accreditation program for treatment facilities in the U.S.
Approaching A Loved One About Opiate Addiction
Common losses that make an addicted person see the need for treatment are the destruction of important relationships , significant health problems, financial devastation, and loss of freedom . As you talk to your loved one, you can empathetically and non-judgmentally bring up some of the major losses youve seen them endure due to their substance use. Avoid blaming your loved one for these losses and instead place your focus on your concern for them and the need for treatment.
You can also talk about what you and others who love them have lost during their addiction and lay out clear boundaries you expect them to respect from this point forward. Express that youre here for them and that youre on your side, but make it clear you wont be enabling their drug or alcohol abuse anymore, if you have been.
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Medical Detox And Rehab
Some people choose to detox on their own. This is not only harder but also more dangerous than detoxing with a doctor. Medical detox is the best way to get sober in a safe, comfortable environment. For those addicted to alcohol or Benzos, medical detox is a must.
A supervised detox is the first step in treating any type of addiction.
A supervised detox can alleviate health issues. Physicians track the patients heart rate, temperature, breathing rate, and fluid levels. Physicians help relieve any discomfort the patient may be feeling. They also adjust any medication doses according to the patients needs and make long-term plans for medication. Those with separate health issues should also seek medical detox. Withdrawals can complicate problems like high blood pressure. A physician can prevent any issues that may arise from attempting to detox alone.
Break free from addiction.
Detox is often a part of inpatient rehabs. In most cases, inpatient rehab takes 30 to 90 days. The first week consists of closely observed detox. Rehab includes other treatments, such as behavioral therapy, to make recovery more successful. If you or a loved one wants to explore rehab options, contact a treatment provider now.
Reviewed by Certified Addiction Professional: December 7, 2018
How Can You Avoid Addiction To Opioids
If you or a loved one is considering taking opioids to manage pain, it is vital to talk to a physician anesthesiologist or other pain medicine specialist about using them safely and exploring alternative options if needed. Learn how to work with your physician anesthesiologist or another physician to use opioids more wisely and safely and explore what pain management alternatives might work for you.
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Addiction Treatment Professionals Are A Vital Part Of Recovery
Whats better for opiate addiction recovery: a hospital or an addiction treatment center? Despite the incredible medical care that a hospital can provide, opiate users who were treated at a formal treatment center had significantly lower rates of death, according to a 2017 study. Identifying addiction and receiving treatment that not only addresses the medical needs, but also the psychological long-term needs of those addicted to opiates, is an important aspect of recovery.
Source: U.S. National Library of Medicine. . Opioid Abusers at Higher Death Risk When Addiction Specialists Not Part of Care. Medline Plus.
How To Find Quality Treatment
Denver Health is state licensed and joint commissions accredited in the treatment of substance abuse and behavioral health. The Substance Abuse and Mental Health Services Administration encourages patients to choose a treatment location that is effective in treatment and recovery from substance use disorders based on these five signs of quality treatment, which Denver Health meets or exceeds:
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Opioid Agonists And Partial Agonists
Studies show that people with opioid use disorder who follow detoxification with complete abstinence are very likely to relapse, or return to using the drug.10 While relapse is a normal step on the path to recovery, it can also be life threatening, raising the risk for a fatal overdose.11 Thus, an important way to support recovery from heroin or prescription opioid use disorder is to maintain abstinence from those drugs. Someone in recovery can also use medications that reduce the negative effects of withdrawal and cravings without producing the euphoria that the original drug of abuse caused. For example, the FDA recently approved lofexidine, a non-opioid medicine designed to reduce opioid withdrawal symptoms. Methadone and buprenorphine are other medications approved for this purpose.
Methadone is a synthetic opioid agonist that eliminates withdrawal symptoms and relieves drug cravings by acting on opioid receptors in the brainthe same receptors that other opioids such as heroin, morphine, and opioid pain medications activate. Although it occupies and activates these opioid receptors, it does so more slowly than other opioids and, in an opioid-dependent person, treatment doses do not produce euphoria. It has been used successfully for more than 40 years to treat opioid use disorder and must be dispensed through specialized opioid treatment programs.12
Every Patients Needs Are Different
While buprenorphine and naltrexone are very convenient and eliminate the need for daily dosing at a clinic, methadone is highly effective for many patients. Working closely with a coordinated care team, including family, friends, counselors, and clinicians to identify the best strategy will help ensure the chances of successful treatment and recovery.
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What Are The Facts About Opioid Addiction
According to the National Institute on Drug Abuse, opioids include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone , hydrocodone , codeine, morphine, and many others.
Opioids are highly addictive due to the combination of pain relief and euphoria, with even legally prescribed use by a doctor leading to dependence, addiction, overdose incidents, and deaths.
As opioid misuse has evolved into a national crisis, the statistics regarding the epidemic reveal the alarmingly addictive nature of the substance :
- Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.
- Between 8 and 12 percent of people using an opioid for chronic pain develop an opioid use disorder.
- An estimated 4 to 6 percent who misuse prescription opioids transition to heroin.
- About 80 percent of people who use heroin first misused prescription opioids.
Overdose rates are at record highs across the country, with more than 104,000 Americans dying from drug overdose in the 12-month period ending in September 2021. The rapid rise of overdose deaths is being driven primarily by the lethal synthetic opioid fentanyl, increasingly mixed sometimes unknowingly with other drugs like cocaine and methamphetamine.
Advocating For Access To Addiction Medications
Want to advocate for access to addiction medications in your community? Nervous about having a conversation about medications with your doctor? Here are some helpful resources.
- Challenging the Myths, a one-page PDF from the National Council on Behavioral Health
- MAT Support Organizations, a list of nonprofits and government agencies from SAMHSA
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Buprenorphine As A Treatment For Heroin Dependence
Buprenorphine is a partial opiate agonist, which means it stimulates the cell receptors that are normally stimulated by opioid drugs like heroin and methadone, resulting in a much weaker response. Suboxone tablets contain buprenorphine.
Characteristics of Suboxone include:
- It is as effective as methadone in managing the symptoms of heroin withdrawal.
- Suboxone use on its own is very unlikely to cause overdose.
- Methadone withdrawal can be unpleasant and lengthy, while the effects of Suboxone withdrawal are mild and brief.
- A short course of Suboxone can help a person to withdraw from their methadone maintenance program.
- Only one daily dose is needed, due to its long-lasting effects.
Long-acting injectable buprenorphine is also available for some patients, with injections given either weekly or monthly depending on individual needs.
Advantages Of Medication For Heroin Dependence
Some of the advantages of methadone and buprenorphine maintenance treatments include:
- They arent injected, which reduces the risk of blood-borne viruses such as hepatitis and HIV.
- They are manufactured using strict controls, unlike street drugs, which can vary in strength and contain harmful fillers.
- The effects of heroin last only a few hours, while the effects of pharmacotherapy treatments last from 24 hours to a couple of days, or longer in the case of long-acting injectable buprenorphine.
- The person who is heroin dependent no longer has to worry about getting heroin many times every day, which reduces anxiety.
- With their dependence stabilised, the person can focus on looking after themselves, including improving their health, nutrition, relationships and employment situation.
- Pharmacotherapy treatments cost less than heroin, so the person can put their money to better use.
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Effective Medications Are Available
Medications, including buprenorphine , methadone, and extended release naltrexone , are effective for the treatment of opioid use disorders.
- Buprenorphine and methadone are essential medicines according to the World Health Organization.3
- A NIDA study shows that once treatment is initiated, a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid use disorder. However, because naltrexone requires full detoxification, initiating treatment among active users was more difficult with this medication. Once detoxification was complete, both medications had a similar effectiveness.
- Medications should be combined with behavioral counseling for a whole patient approach, known as Medication Assisted Treatment .
MAT opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission.4,5,6 After buprenorphine became available in Baltimore, heroin overdose deaths decreased by 37 percent during the study period, which ended in 2009.6
MAT Increases social functioning and retention in treatment.4,5 Patients treated with medication were more likely to remain in therapy compared to patients receiving treatment that did not include medication.4
Treatment of opioid-dependent pregnant women with methadone or buprenorphine Improves Outcomes for their babies MAT reduces symptoms of neonatal abstinence syndrome and length of hospital stay.7
Opioid Crisis In America
The opioid addiction crisis in the United States is one of the most significant public health emergencies in this generation. Opioids are a class of drugs that include fentanyl which the Centers for Disease Control and Prevention has classified as the most commonly used drug in overdoses, the illegal drug heroin and pain relievers available legally by prescription, such as oxycodone , hydrocodone , codeine, morphine and others.
With its hospital-wide dedication to opioid addiction eradication, supported by a full-service Behavioral Health Services and Addiction Treatment Services, Denver Health is working in partnership with the City of Denver on a five-year plan to directly confront this national health challenge.
Denver Health joins the City of Denver alongside more than 100 governmental agencies and community organizations in its Opioid Response Strategic Plan, designed to:
- Prevent Substance Abuse and Misuse
- Improve Treatment Access and Retention
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How Long Will I Take It For
If you’re taking methadone for maintenance therapy, you will usually take it long term.
If you’re taking it for detox, your dose will gradually be reduced until you do not need to take it anymore. This can take up to 12 weeks. It can sometimes be quicker, for example if you’re detoxing in hospital or residential rehab.
Opioid Use & Abuse Statistics In The Us
A national study in 2018 estimated that among Americans aged 12 or older:7
- About 10.3 million people had misused opioids in the last year.
- About 9.9 million people had misused prescription opioids in the last year.
- Approximately 808,000 people had used heroin in the last year.
- Approximately 2 million people had an opioid use disorder.
- About 1.7 million people had a painkiller use disorder.
- Approximately 526,000 people had a heroin use disorder.
Hydrocodone was the most commonly misused prescription opioid, with about 5.5 million Americans aged 12 or older abusing it in 2018.7 Oxycodone was the second-most commonly misused prescription opioid, with approximately 3.4 million Americans aged 12 or older abusing it in 2018.7
Efforts to address the opioid epidemic have led to prescription opioids becoming less available, and people have turned to alternate routes to obtain them in some cases.8 People may buy prescription opioids from others, which can be very costly, while heroin has similar effects and can be cheaper and easier to access.6 In people who use heroin, 80% have a history of prescription opioid misuse.6, 8, 9
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Medications Are Not Widely Used
Less than 1/2 of privately-funded substance use disorder treatment programs offer MAT and only 1/3 of patients with opioid dependence at these programs actually receive it.8
- The proportion of opioid treatment admissions with treatment plans that included receiving medications fell from 35 percent in 2002 to 28 percent in 2012.9
- Nearly all U.S. states do not have sufficient treatment capacity to provide MAT to all patients with an opioid use disorder.10
Counseling And Behavioral Therapies For Opioid Addiction Treatment
Your chances of beating narcotic addiction are better with long-term maintenance therapy that includes medications along with some form of counseling or behavioral therapy. This is known as medication-assisted treatment .
Counseling with a qualified health professional helps you deal with any personal or social problems that may be leading to addiction or making it worse. These include:
- Your feelings of self-worth
- Problems at work or home
- People around you who use drugs or alcohol
Your treatment program may involve one or more of these:
- Contingency management uses incentives or rewards to help you meet goals such as sticking with medications or attending treatment.
- Motivational interviewing helps you identify reasons why you might not want to change your behavior.
- Cognitive-behavioral therapy shows you why you might be using drugs, builds your belief that you can address your problems, and teaches you to cope with struggles more effectively.
- Family therapy brings in people who care about you to strengthen your treatment.
- 12-step groups involve defined goals such as attending meetings or getting a sponsor.
- Support groups introduce you to people who know from experience what youâre going through. They can offer their own tips for recovery and help you deal with any setbacks.
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Medication For Opioid Addiction
The symptoms of withdrawal are a major reason for relapse and further prescription drug abuse. But medications can help you through opioid withdrawal and prevent symptoms. After the initial detox, youâre at risk for relapse. Experts say psychological and social factors are the main drivers that could push you back to using. Stress and situations that remind your brain of the pleasure the drug can bring are common triggers. Successful, lifelong therapy to stay opioid-free usually involves long-term medication as well as counseling or talk therapy programs.
Methadone is a long-acting opioid that affects the same parts of your brain as the drug youâre having a problem with, but it doesnât get you high. You can take it every day, but you have to go to a special clinic to get it. The correct dose prevents withdrawal symptoms and eases drug cravings.
Buprenorphine is another medication that is approved for the treatment of opioid dependence. It hits the same receptors in your brain, but not as strongly. It has less risk of lethal overdose, so experts often favor it. It is also available in combination with naloxone.
It comes in several forms:
Lofexidine hydrochloride is not an opioid, but you can use it to ease symptoms for a rapid detoxification. It has been approved for use for up to 14 days.
Clonidine is similar to lofexadine and alsoused to treat symptoms of opioid withdrawal.