eNewsletter - October 2017
Behavioral Health Partners
Fighting opioid addiction with the help of medication
Recent data from the Centers for Disease Control and Prevention (CDC) indicates that well over 100 Americans die every day from drug overdose. Opioids are a prime contributor to the rise in overdose deaths.
Public health officials have called the current opioid epidemic the worst drug crisis in American history, killing more than 64,000 Americans in 2016. This is a considerable increase over the previous year. Overdose deaths surpass the number of deaths from car crashes and gun homicides combined. Heroin-related overdose deaths have more than quadrupled since 2010.
The CDC has reported that every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids. This is a national — and local — crisis that demands additional treatment methods and better access to those options.
In February 2016, President Obama proposed spending $1.1 billion over two years to expand access to treatment for opioid addiction. The bulk of that money was earmarked for medication-assisted treatment (MAT), which typically refers to medications used in treating opioid use disorder.
In November 2016, the U.S. Department of Health and Human Services (HHS) took steps to address the country’s opioid epidemic by expanding access to MAT for opioid use disorders. In spring 2017, new FDA Commissioner Dr. Scott Gottlieb made the opioid epidemic a top priority.
How does medication-assisted treatment work?
For many years, substance use disorders were primarily treated with psychosocial methods such as individual and group counseling. These treatments, combined with support groups and 12-step programs, have been and continue to be successful in treating many types of addiction.
Opioids are different. Opioid withdrawal symptoms are so intense that it can be difficult for someone to even get started on the road to addiction recovery. Medication-assisted treatment is used as part of a comprehensive treatment program that includes behavioral therapies such as counseling.
MAT helps manage addiction so those therapies can begin, and be maintained. While these medications could be used for years, once an individual is stabilized and their addiction is under control, transition off the medication can be considered.
In the 1960s, methadone was introduced in the United States as a way to curb opioid withdrawal and cravings. Since then, more options to medically treat opioid addiction have come on the market:
- Methadone: This lessens the painful symptoms of opioid withdrawal and blocks some of the euphoric effects of those drugs. Methadone comes in pill, liquid or wafer form and needs to be taken daily at a facility with a licensed opioid treatment program (OTP).
- Buprenorphine (Suboxone, Zubsolv, or Bunavail): Much like methadone, this suppresses withdrawal symptoms and cravings for the abused drug. Buprenorphine treatment was introduced in the U.S. in 2002, and while similar to methadone, it is less prone to abuse and lasts longer. It is typically given as a pill or a dissolvable film for daily use, but unlike methadone it can be prescribed by a certified prescriber and taken at home.
- Probuphine: This is a newer medication-assisted treatment, which was FDA approved in May 2016. It consists of four rods the size of matchsticks implanted under the skin that offers controlled release of buprenorphine for six months.
- Naltrexone: This medication works differently than methadone and buprenorphine by blocking the euphoric effects, and other effects, of opioids. If a person on naltrexone relapses, they would not get the high they normally would get from the abused drug. In 2007, the FDA approved an extended-release naltrexone injection (Vivitrol), which lasts four weeks.
The main controversy over these medications is that the first three are themselves opioids. But they don’t produce as much of an addictive use pattern as other opioids, and they can protect people from cravings and withdrawal.
Isn’t MAT just substituting one drug with another?
This is the big stigma surrounding medication-assisted therapy. Many people think the only true way to fight addiction is recovering without the use of medications. Some people certainly can and do fight opioid addiction without medication, but most people relapse early in recovery. Medications provide a little extra help, and the result is significantly lower relapse rates.
Still, MAT isn’t a perfect treatment. There are downsides and barriers to how the treatment is administered.
Because these medications are opioids, they’re prone to abuse. It’s rare, but it happens. While their effects are different than other opioids, they do have some street value. They also continue the physical dependence on an opioid. If you stop taking the medication, you will go into withdrawal.
Opioid withdrawal can cause muscle aches, diarrhea, abdominal cramping, nausea and vomiting. Patients often say they didn’t continue using the drug to get high, but instead to keep from getting sick. By using medication to ease withdrawal symptoms, it’s much easier for patients to begin other therapy methods to fight their addiction.
Medication-assisted treatment requires a strong commitment from the patient. To be most effective, these medications need to be taken consistently, and for most of them, that means daily.
Another barrier is that not every substance abuse program offers medication-assisted treatment because not every physician is certified to administer it. Prescribers must complete special training and become licensed to use these medications — it’s not just part of getting your M.D. In the case of buprenorphine, physicians can only prescribe the drug to a limited number of patients at any given time — although the federal government eased this rule in 2016. Even so, it can still be difficult for patients to find a physician who can administer medication-assisted treatment.
Still, research has found that when combined with behavioral therapy, MAT can significantly reduce opioid use and crime rates, prevent infections such as HIV from non-sterile drug abuse equipment, keep people in treatment longer, and improve their quality of life. We haven’t found similar medications to be as effective for any other substance use problems so far. We just need to be cautious and careful about the way we implement the treatment, just as we would with any medical condition.
Addiction is a disease. It’s not a simple choice, behavior or moral failing. Medication to treat other diseases is not withheld, and it should not be withheld from persons receiving treatment for addiction. As with treatment for any disease, prescribers try to minimize the risks of that medication. Physicians are responsible for closely monitoring patients and making sure they are properly using the medication, including taking it on time and at the recommended dose.
How can we expand access to addiction treatment?
- Increase the number of treatment facilities and healthcare providers When someone decides they are ready to confront their addiction, time is of the essence. If there are no treatment facilities in the area, or if the facilities have long wait lists, that person may not have the resources to travel or be able to stay motivated until they can get a spot in a treatment program. The availability of medication-assisted treatment needs to be more widespread. On July 6, 2016, the HHS took a step in that direction. The organization increased the number of patients that a physician prescribing buprenorphine is allowed to treat from 100 to 275. This treatment requires more work by the physician— from training to needing to see each patient frequently. But for physicians who are dedicated to MAT, this is an encouraging development. Recently, Linden Oaks Behavioral Health opened a MAT Clinic to expand access to medication-assisted treatment in the Chicagoland area.
- Make treatment more affordable Deductibles, co-pays and other cost barriers put treatment out of the grasp of too many people. Although the Affordable Care Act has survived repeal for the time being, it is important to voice to lawmakers that coverage for addiction treatment and access to MAT is vital.
What’s next in the fight against opioids?
Along with expanded access and better affordability, there are a few additional things we can do to help people in our community fight opioid addiction — and potentially save their lives.
- Develop new treatment methods
The most recent FDA approval was for buprenorphine rods. This device won’t be right for all patients, but some will benefit greatly from it. They won’t have to worry about taking medication every day, getting refills every month, or, because it’s hidden under the skin, having friends or co-workers know they’re taking it. It also eliminates the risk of a patient turning around and selling the medication on the street. We need to keep working to develop treatment methods that improve patients’ odds of success.
- Expand access to naloxone
Naloxone is not a medication-assisted treatment, but instead prevents opioid overdoses by reversing the toxic effect of the drug. It’s administered through an injection or nasal spray. Make no mistake, this drug saves lives. The CDC said more than 26,000 overdoses were reversed between 1996 and 2014 thanks to naloxone.
It’s become routine over the past few years for emergency responders to carry naloxone, and there’s been a push to make it even more accessible. Illinois residents are able to buy naloxone at the pharmacy. Here at Linden Oaks Behavioral Health, we talk to patients about where to get naloxone and how to use it in the event of an opioid emergency. If they have been abstinent for a while, their tolerance may have gone down. This can increase the chance of overdose, so we want them to know how they can reduce their risk of death.
- Examine how we prescribe opioids
The medical system and physicians need to take some responsibility for stopping this crisis as well. Opioids have been overprescribed for too long. To help combat this, the CDC in March 2016 issued revised guidelines for prescribing opioids for chronic pain.
In response, this fall Edward-Elmhurst Health started a system-wide initiative to educate all system prescribers on guidelines for prescribing opiate medication. Educating patients about best practices, risks and alternatives to opioids also needs to be a priority. One advantage we have in Illinois is the presence of a strong prescription monitoring program, which physicians use to look up patients’ prescription histories to help prevent abuse. To date, 37 states have prescription monitoring programs and 11 more are in the process of implementing it.
Our country’s opioid addiction problem didn’t happen overnight, and it won’t be fixed overnight, either. But together — as doctors, patients and community members — we can turn the tide.
If you would like to learn more about medication-assisted treatment or to schedule an assessment for the Linden Oaks MAT Clinic, contact our Help Line 24/7 at 630-305-5027.