One of the risks associated with the progression of opioid addiction is the increased probability of an addicted person moving to injectable heroin as a last resort in dealing with opioid withdrawal. In the early years of methadone’s adoption in treatment centers, it was used primarily to help heroin addicted individuals detox from heroin and eventually remain heroin free.
While heroin is definitely resurfacing, the opioid epidemic of recent years has primarily been about prescription opioids taken orally. Following this pattern of use, users eventually discover that crushing and snorting pills is a more efficient means of getting an opioid into their system. Injecting is typically the last step in this progression of the disease of addiction.
But with injection comes a variety of new risks and health problems such as skin abscesses, localized infection at the site of injection, as well as hepatitis C (a viral infection of the liver) and HIV infection acquired through needle sharing with infected persons. A recent story in the news highlighted a sudden increase in HIV infections in Scott County (Indiana) in conjunction with the rise of opioid addiction there and injectable drug use.
Indiana’s governor has temporarily approved the use of needle exchange programs to help reduce the risk of virus transmission resulting from the use of dirty needles. The story indicated that the number of documented HIV infections had risen month over month. The county is presently trying to locate over 100 people who may have been exposed to the HIV virus in connection with injecting opiates.
Methadone and other medication-assisted treatments have been conclusively proven to reduce heroin/opiate relapse and injection drug use. For many individuals trapped in a daily cycle of perpetual drug abuse, the risk of acquiring a deadly infection increases with every day that they are not in treatment receiving help.
Treatment leads to recovery, and recovery leads to dramatic lifestyle change. Many patients who choose methadone as a tool in their personal recovery never go back to injecting drugs. This obviously is a life saving choice.
Someone recently stated “If you’re dead, you can’t recovery.” This is a rather blunt way of expressing a profound and meaningful truth. Addiction does rob loved ones, friends, family, and neighbors of life, health, and happiness. Recovery has the ability to restore all of these. Let us keep our minds and hearts open about the value of medication-assisted treatment. It is making a real difference for numerous people around the world.
Posted in Drug Safety, Harm Reduction, Heroin, Medication Assisted Treatment, Methadone, Methadone Clinics, Methadone Maintenance, Relapse Prevention, Suboxone
Tagged Harm Reduction, Hep C, Hepatitis, HIV, Indiana
More communities across the U.S. are facing the devastation of opioid overdose. The impact on families is profound as they often struggle with questions of “Could we have done more?” and ponder what else must be done to address this growing national epidemic.
Highlighted in the news this week was the heroin overdose death of a Louisville cheerleader and the suspected opioid overdose death of a 27 year old man in North Carolina found slumped behind the wheel of his pick-up truck with an empty bottle of painkillers and a spoon beside him.
Naloxone is an FDA-approved medication that reverses the effects of opioid overdose. It is an opioid antagonist and consequently knocks opiates off of the body’s opioid receptor sites thus reversing central nervous system and respiratory depression which are the most dangerous consequences of opioid overdose. In many cases, naloxone quickly restores breathing and allows overdose victims to regain consciousness in a relatively short period of time. Naloxone is administered by injection or intranasally as a mist.
An increasing number of emergency first responders are now carrying naloxone kits as are some police units in select areas of the country. Local government is now more involved too with new legislation having been proposed in the last year to dramatically increase funding for the provision of naloxone kits.
Ideally, naloxone will one day become readily available without prescription to anyone via their local pharmacy. There is no upside to politicizing something as beneficial as naloxone because it simply saves lives. Note that the medication itself produces no drug high.
Methadone is FDA-approved for pain management and the treatment of opioid addiction. Methadone is a relatively safe and highly effective medication when used exactly as prescribed. It is currently in use in the United States and around the world following years of conclusive research on methadone’s efficacy and safety.
It is important for patients receiving methadone to know that it can interact with other central nervous system depressants like alcohol and benzodiazepines such as xanax, klonopin, valium, and librium as well as similarly acting non-benzodiazepine agents like ambien (a popular sleep aid). When methadone is mixed with these other medications, there is an increased risk of sedation and loss of consciousness. In extreme cases, individuals mixing methadone and other CNS depressants have gone into respiratory failure.
For those who have chosen to receive methadone in an opioid treatment program, they will discover that a proper dose of methadone not only eliminates opiate withdrawal & cravings, but will also block the euphoric effects of any other opiates. This is typically a positive side effect in that it discourages illicit opiate use or supplementing with street drugs like heroin. Since methadone binds so well to the brain’s opiate receptor sites, any other opiates that are ingested have no means of creating a euphoria or a high since the body’s opiate receptors are occupied by methadone. This removes the incentive to misuse other opiates and can facilitate the process of recovery.
There are instances in which a patient’s physician has prescribed a benzodiazepine for anxiety management while also prescribing methadone. Such decisions should always be accompanied by a thorough discussion with one’s doctor of the potential risks & complications. There are other, safer alternatives for treating anxiety such as Buspar and cognitive therapy. These other options should be considered when a patient is already receiving methadone. In addiction treatment, the use of benzodiazepines for anxiety is typically monitored carefully through increased random urinalysis testing and medication counts.
Posted in Benzodiazepine, Buprenorphine, Drug Safety, Heroin, Methadone, Methadone Blog, Methadone Clinics, Methadone Maintenance, Methadone Safety, Prescription Drugs, Suboxone
Tagged alcohol, klonopin, overdose, xanax
Soon to be released is a new oral buprenorphine based product called Bunavail. Bunavail is manufactured by Biodelivery Sciences and is a combination of buprenorphine and naloxone. It is a thin film formulation that is designed to adhere to the inner cheek where it quickly dissolves and is absorbed into the mucosal lining of the mouth.
The medication is touted as delivering about twice as much active ingredient into the patient’s bloodstream compared to sublingual suboxone. Bunavail is scheduled to be released in the third quarter of 2014. A press release by the company mentions that the medication will compete with other products in the $1.7 billion dollar opioid dependency treatment market.
Bunavail is a new advancement in drug delivery technology according to the press release and is reported to produce less constipation than other competing buprenorphine products. Patients can also speak freely while the medication dissolves.
With an estimated 2 million plus people addicted to opioids in the United States, new medication alternatives are welcomed.
Biodelivery Sciences is described as a specialty pharmaceutical company with a focus on pain management and addiction treatment. The company is based out of Raleigh, North Carolina. Bunavail’s FDA approval was announced on June 6, 2014.
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Somewhat of a surprise was the recent ruling that the state of Massachusetts cannot ban the powerful new painkiller, Zohydro, from being prescribed in the state. The manufacturer of Zohydro, Zogenix, had argued that the ban was not constitutional and must be reversed.
The state governor, Deval Patrick, had announced his intention to make Zohydro unavailable since the manufacturer’s initial plan was to provide it without a tamper-proof component to deter abuse and potential overdose.
Judge Rya Zobel ruled that the state of Massachusetts had exceeded its authority in banning the drug, and she consequently implemented a preliminary injunction temporarily reversing the ban. The governor expressed disappointment that the public’s safety concerns were not sufficient to halt the sale of Zohydro, but he stated he would pursue other channels for addressing the widespread opioid abuse problem that is continuing to grow in the state and across the country.
Opioid pain medications have become a primary drug of abuse for a number of age groups. Deaths by opioid overdose now surpass deaths by homicide and motor vehicle accidents in numerous states.
While Zohydro may be an effective pain management medication, it will very likely be sought (and purchased illegally) by those with severe opioid addictions trying to avoid daily opioid withdrawal sickness. Sadly, overdose deaths will result from the use of this medication in similar fashion to the problems that surfaced when oxycontin hit the market. Please keep yourself informed, and if you are suffering with opioid addiction and withdrawal sickness, seek treatment immediately. There is opioid detox, methadone medication assistance, and private physicians using suboxone to help patients cope with their addiction.