Category Archives: Medication Assisted Treatment

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.

Safety and Security With Methadone

methadone-safetyIf you are currently a client in a methadone clinic, then you have most likely heard treatment staff emphasize the importance of safety with methadone and the necessity of carefully securing take home methadone doses. Methadone is a powerful medication that is tremendously helpful to recovering individuals. It is also potentially lethal in the wrong hands and consequently must be deliberately safeguarded.

There is a recently published article on Bloomberg regarding methadone being diverted and then taken by someone who later died from an overdose. This turn of events has led to newly proposed legislation in five states (Maine, Indiana, Minnesota, West Virginia, and Pennsylvania) that would further tighten regulations regarding the operation of methadone clinics and their award of methadone take home medication to their clients.

The reported misuse of methadone, and associated deaths, was allegedly tied to several private, for-profit clinics that operate in these states. One of the criticisms of the private, for-profit clinics was that they are not providing "enough services". This is intended to mean that the clinics in question were not providing sufficient education & counseling support or adequate monitoring of those who receive take home methadone.

It is critically important that all methadone clinics (both private and publicly supported) implement thorough measures to educate clients on methadone safety concerns as well as institute monitoring protocols like 24 hour callbacks and random drug testing. 24 hour callbacks require take home recipients to return to their home clinic within 24 hours and to produce their methadone take home doses for count and inspection by the clinic's medical staff.

It is also important that methadone clinics only award take home medication privileges to those clients who have achieved certain progress milestones such as successive months of clean urinalysis, attendance to required counseling sessions, the absence of criminal charges, and demonstrated appropriate behaviors & attitude toward staff and peers at the clinic.

When individuals intentionally divert methadone doses or mishandle methadone through lax practices (such as leaving it sitting out in plain view), they put others at risk and ultimately undermine the delivery of methadone services in the community. In other words, the mistakes of a few can negatively affect everyone. This also erodes the community's confidence in methadone as a life-saving medical treatment.

In the end, it is the shared responsibility of all methadone clinics and their clients to insure that methadone is taken as prescribed, and safeguarded from diversion. When proper precautions are not honored, tragedies will occur. This will lead to state legislators taking matters into their own hands with additional laws & regulations that may keep worthy individuals from receiving a valuable privilege. Take home medication is so very beneficial to honest, hard-working individuals in recovery. It frees them to seek employment, hold a job, care for family, and to more easily meet many other important responsibilities in their lives.