Category Archives: Medication Assisted Treatment

Medication-Assisted Treatment for Teens and Young Adults

opioid-addiction-childrenThere is increasing momentum building for opioid addiction treatment in response to the growing opioid addiction problem in the United States. Many teenagers and young adults who are being introduced to prescription opiates are at risk for developing a crippling drug dependency. The risk is increased as these youth discover that heroin is a relatively cheaper alternative than pain pills purchased on the street.

The Partnership at DrugFree.org has published a 36 page guide outlining opioid addiction and the therapeutic role that medication-assisted treatment can have even for teens and young adults. Methadone, suboxone, buprenorphine, and naltrexone are highlighted in the guide with an accompanying description of each medication and its use in opioid treatment.

Opioid replacement therapy has historically been used as a treatment of last resort in adult populations. The dilemma is that a high percentage of opioid addicted individuals are unable to remain drug free with traditional models of treatment that do not include medication assistance of some variety like naltrexone, buprenorphine, or methadone. Overcoming opioid withdrawal without effective symptom relief presents a serious obstacle in the recovery process.

The Partnership at DrugFree.org recognizes that the wave of opioid addiction in America is mounting. The news media have been covering this issue too with some regularity over the past year. Effective remedies need to be in place as all ages seek help for opiate addiction. If we are to save lives, the stigma of medication-assisted therapy and the misunderstanding around it must be finally removed.

Methadone Dosage Increases

methadone-increaseWhen a new client joins a methadone program, they go through a process called induction. Induction is the initial delivery of a methadone dose and the subsequent increases in dosage over the next 1 to 2 months as the medical team help get the client stabilized & comfortable on a dose of methadone that effectively eliminates their painful opioid withdrawal symptoms.

Induction is historically a high risk span of time since there is an increased risk of accidental overdose with methadone. It is extremely rare that overdose occurs during induction especially if clients are abstaining from other illicit substances during the induction process.

Therein lies the dilemma. Some clients become impatient with the process of methadone induction and will supplement their methadone dose with other unapproved opiates or benzodiazepines. This is dangerous and actually undermines the benefit of what methadone can achieve for the patient.

To help the treatment team determine the level of methadone increase to provide a patient, they use the Clinical Opiate Withdrawal Scale, or COW Scale. This is a withdrawal assessment tool that helps the clinical or medical team determine the prevalence and severity of opioid withdrawal symptoms. The scale produces a score based on the client’s reported symptoms and the team’s observation of withdrawal symptoms. The higher the COW scale score, the more severe the symptomology and thus a greater justification for allowing a higher dosage increase.

Some clinics are known to take clients up 10 mg at a time. Many physicians consider this high risk and too rapid of an increase. Note that methadone is a slow acting, long lasting opioid agonist with a much longer half life than heroin and most other prescription opioids. What this means is that methadone stays in the system much longer and builds cumulatively over time. So the actual effect of a dosage increase is not immediately felt and may take 1-3 days before the full effect of that dosage increase is realized.

With an impatient client, they may receive a dosage increase but not feel the immediate relief they were hoping for. Consequently, they may use additional unapproved opiates that then mix with the methadone increase that is still being absorbed into their system. This puts the client at risk of overdose.

Many clinics use 5 mg increases every few days while some clinics adjust each requested increase in accordance with the COW Scale score. For example, a client may receive several 5 mg increases because they have moderately severe withdrawal symptoms, but then receive a 3 mg increase days later and possibly a 2 mg increase days after that as the symptom severity begins to diminish. This more cautious approach reduces the risk of overdose while still addressing the client’s unresolved physical discomfort.

A well-managed methadone induction is tailored to the individual client’s needs, and the client’s safety is always the chief concern. Methadone dosage increases are provided only to alleviate measurable physical withdrawal symptoms or closely associated anxiety, restlessness, or psychological distress from withdrawal.

Drug Addiction, Methadone, and Suboxone

suboxone-articleAn article was brought to our attention by Dr. Dana Jane Saltzman, a New York City physician who specializes in the treatment of opioid addiction. Dr. Saltzman uses suboxone in her private practice to help those seeking recovery from a severe opioid habit.

The article was posted in The Village Voice and attempted to depict the duality of opioid replacement therapies. This duality stems from the highly therapeutic & legitimate uses of suboxone (buprenorphine) contrasted against the attempts of some addicts to create a black market cottage industry with the medication selling it illegally online via Craigslist, Facebook, and other social media.

In the world of medicine and addiction treatment, selling suboxone is certainly criminal, and also behavior characteristic of someone who is not grounded in recovery. Many medical & clinical treatment professionals across the country have endeavored for decades to provide safe, effective treatment to suffering addicts. When FDA-approved opioid treatment medications are misdirected and sold on the black market, all varieties of abuse and exploitation occur ending in overdoses and a deepening of damaging social stigma about medications such as suboxone and methadone.

The Village Voice article plays it straight up the middle with perhaps some emphasis on the growing underground market for suboxone targeted to those who want to bypass the cost or inconvenience of signing on with a suboxone-approved physician.

Individuals who attempt to treat their own addiction with opioid replacement therapy are going to fail a high percentage of times. First, most  have no medical basis for understanding the complex nature of opioid addiction in the brain, and they can even deepen their addiction through the inappropriate use of opioid replacements. Addicts often go with what feels right opting for their own intuition as opposed to following proven best practice protocols like those employed in structured treatment programs supervised by suboxone-approved doctors.

Addicts who treat themselves with street suboxone or methadone are also completely missing the counseling component of recovery which addresses the underlying psychological factors that drive addiction. Taking street suboxone without counseling is akin to taking diabetes medication while eating doughnuts. In other words, the individual makes their complicated dilemma even worse.

There are some generic equivalents of suboxone in development which may make opioid replacement therapy more accessible to the larger population. Suboxone and methadone have a definite place in addiction treatment. It is critical however that early recovering addicts receive quality counseling so that they can better understand how to cope with relapse patterns and develop the skills necessary to successfully manage the disease of addiction. Addicts treating themselves with medications acquired on the street will remain stuck in a vicious cycle of addiction.

True recovery requires humility and commitment to higher principles. Chasing shortcuts to recovery creates more pain and wastes valuable time that would be better invested in real solutions.

Choosing To Face Reality

woman-12To be curious is a basic part of human nature. We live each day naturally drawn to things which interest us, which feel good physically or emotionally, or which might incite some curious inclination down inside of us. It is literally wired into the human DNA to be inquisitive and to seek new experiences.

We live in an information age in which most anything one wants to know is available via the internet. We know that drugs are dangerous. Yet, we naturally assume substance problems are something that happens to someone else. We know that addiction is real and can wreck one’s life, but we look past the potential danger and conclude that these risks don’t really apply to us at this time, or in this particular situation.

There is an old saying in recovery circles that no addict started out with the intention to become addicted. This is, of course, true. No one starts out intending to become an addict. So what is it that we tell ourselves when we face the potential dangers of addiction? Do any of these sound familiar?

  • Well, just this one time. One time won’t hurt.
  • I’ll stop before things get out of control.
  • Well, she did it and she doesn’t have a problem.
  • I don’t have to have it. It’s just something I like doing from time to time.
  • I’ve had a terrible day. I deserve a break. It’s not like I’m addicted!

Addiction is a complex problem. Drug use alters brain chemistry. For some people, these neurological changes are rapid and dramatic leaving the individual with an addiction that builds quickly before they are even aware of it. And denial keeps people from facing the truth even longer.

The door to addiction is often wide open and one only needs to take a small step to pass through to that other side where addiction becomes a harsh reality. Facing the truth is always the first step. No one gets well until they admit they are sick. The journey of recovery does not begin until a first step is taken.

If you have an ongoing opioid addiction and have honestly tried to get well, then medication-assisted treatment may be the next step that you take. Addiction progresses. Inevitably, addiction will make your life worse if left untreated. This downhill slide only stops when you make the decision to get into treatment or obtain effective help through some other proven means.

The message is this: Choose to face your own reality! Whatever it is, it can likely be changed. It can likely be improved. But it can only happen with your cooperation and your good intentions. Move in the direction of a solution. Commit yourself to getting help.

Zubsolv For Treating Opioid Dependence

zubsolve-methadoneDr. Jana Burson made a recent post about the newly FDA-approved medication for treating opioid dependence called Zubsolv. Zubsolv is manufactured by a Swedish pharmaceutical company, Orexo.

Zubsolv is a new sublingual (tablet dissolved under the tongue) formulation of buprenorphine and naloxone that is taken once daily to eliminate opioid withdrawal symptoms. As an alternative to suboxone or methadone, Zubsolv was approved in July 2013 as a medication which may be prescribed by physicians for the maintenance treatment of dependency on opioids.

The medication is meant to be taken in conjunction with counseling so as to help the patient learn the necessary skills for avoiding opioid relapse. The sublingual tablet is designed to dissolve in about 5 minutes when held under the tongue.

New products such as Zubsolv bring additional choices to those suffering with opioid addiction. As new products enter the market, there is an improved chance that once costly opioid replacement medications may come down in price and become more readily available to individuals who could not afford them.

The primary ingredients in Zubsolv are buprenorphine and naloxone so it is similar to a Suboxone formulation although promoted by the manufacturer as having a better taste, being a smaller tablet, and dissolving more quickly. Note that suboxone is now offered in a thin film formulation that also dissolves more rapidly than the original suboxone tablets.

Methadone Treatment and Recovery

methadone-recovery-2Recovery is for everyone and anyone with a genuine desire for change. Treatment in a methadone program offers the potential for change, and a new path which can lead to a much improved life.

In the field of addiction recovery, there are a multitude of methadone treatment programs all across the country. These programs vary considerably one to another, and this is a result of treatment philosophy, staff experience & qualifications, funding availability, and the underlying structure and operation of the methadone clinic itself.

Some methadone treatment programs are for profit and some are non-profit. Both can deliver high standards of client care and ethical treatment of their clients. "Good" treatment programs are generally identified as being so by their own clients. Conversely, if a particular methadone program is "not so good", their clients will recognize it immediately and the word will get out very quickly.

What makes a "good" methadone program? From most clients' perspectives, it is these things:

  • checking-in and receiving their medication in a timely fashion
  • being shown courtesy and respect by staff
  • feeling like the clinic is staffed by sincere, committed professionals
  • being treated as an individual instead of a number
  • paying reasonable fees for the service provided
  • rules, regulations, and expectations are clear and are enforced fairly
  • being heard & supported … when there is a problem

What is a "well run program" from a clinic perspective? These are important …

  • has clear policies and operating procedures
  • staff are professional, accountable, and self-motivated
  • there is a culture of respect & consideration shown for all staff and clients
  • costs & expenditures are carefully tracked and managed
  • the program of treatment is designed and delivered with integrity
  • documentation of services is consistently completed in accordance with standards
  • services are funded on a consistent basis (otherwise, the clinic will close)

Methadone treatment, and opioid addiction recovery, are not radically different from other substance abuse treatment programs or models of change. The underlying addictive disorder is fundamentally very similar. What separates opioid addiction from some other addictions is the overwhelming physical dependency that can develop with opioids and the associated withdrawal syndrome.

The cognitive-behavioral changes, and eventual psychological growth, that occur in opioid addiction recovery are exactly the same as in any other addiction recovery path. The essential difference is the utilization of opioid replacement medication to thwart the terrible physical withdrawal symptoms that derail recovery year after year. Methadone and suboxone, when used properly, are highly effective in helping addicted persons move forward with their personal recovery. Methadone treatment … and recovery! They go hand-in-hand, and are not mutually exclusive.