Category Archives: Methadone Blog

Opioid Addiction Spiking in Guilford County North Carolina

policeGuilford County is the third most populated county in the state of North Carolina. Located within Guilford County are the cities of Greensboro and High Point – both of which are experiencing a surprising increase in opioid addiction and related overdoses.

The High Point Enterprise news reported that the High Point Vice and Narcotics unit has begun to make a favorable impact on the problem with multiple arrests of those trafficking heroin locally. The article documents that 70 reported High Point opioid overdoses have occurred thus far in 2014 with 9 of those ending in death. Six people were arrested the week of July 14 and are being held on multi-million dollar bonds for their roles in selling or trafficking heroin. To emphasize the local impact, the HP Enterprise reported that 7 overdoses occurred within a 24 hour period on May 16, 2014.

Just 15 miles away in the neighboring city of Greensboro, Rhino Times covered the local explosion in heroin addiction much of which has been driven by individuals turning to heroin when they could no longer obtain prescription opioids like oxycodone. Rhino Times interviewed the Director of Guilford County Emergency Services, Jim Albright, who stated that a particularly strong strain of heroin hit the streets of Greensboro in late April, 2014.

Over the weekend of April 25, the Guilford County EMS responded to an avalanche of calls in response to people overdosing on the new potent version of heroin. Mr. Albright is reported to have identified that 21 overdoses and 5 deaths occurred just in that one weekend. Due to the potency of the drugs, some victims were found with a needle still in their arm.

Highlighted in the article was the life saving properties of Narcan, a drug that quickly reverses the dangerous overdose effects of opiates. Narcan can be administered by injection or squirted into the nasal cavity. As it is absorbed into the body, it restores breathing to those that have overdosed. Narcan is now kept in first responder vehicles, firetrucks, and ambulances. Visit Alcohol & Drug Services for more on Narcan and opioid overdose prevention kits.

For information on methadone as a treatment for opioid addiction, click here.

Why Methadone Is Effective

methadone-researchMany opioid addicted individuals eventually become interested in methadone after hearing others speak of its effectiveness in eliminating opiate withdrawal sickness.

Methadone has been in use for well over 40 years as a leading treatment for opioid addiction. There are now hundreds of methadone clinics in operation across the U.S. The popularity of methadone as an addiction treatment rests in its proven benefit in completely removing withdrawal symptoms and in methadone’s uniquely long half life.

Heroin and most prescription opiates have a quick onset, short duration. In other words, you feel the effect quickly but the effect does not last long. Methadone is designed to remain in an individual’s system for a prolonged period of time thus keeping withdrawal symptoms at bay for a full day or longer.

Someone who is opioid tolerant and adjusted to their daily methadone medication will experience no high whatsoever from the medication. It will not interfere with their daily responsibilities, work, family, or other obligations. Often, families wonder what effect methadone will have on their loved one. Most family members are surprised to see their loved one return to being functional again and able to live a normal daily life.

Methadone is a full opioid agonist and binds very well to the body’s mu opioid receptors. This action causes withdrawal symptoms like nausea, vomiting, chills, ¬†diarrhea, and runny nose to disappear. Once these symptoms are removed, the addicted person can finally resume a full life and refocus themselves on important personal goals.

While the news media have frequently focused on addiction tragedies, the real stories are those in which countless people’s lives have been saved by methadone. In the North Carolina clinic where I have been employed, I have seen enormous numbers of individuals re-engage with their family, their career, their academic pursuits, home ownership, and a rewarding way of life.

There is a considerable amount of misinformation and fear-mongering that goes on around the topic of tapering off of methadone. It is important to emphasize that a patient is physically dependent upon methadone and must take the medication regularly to avoid opioid withdrawal. However, individuals taper off of methadone successfully everyday in programs across the country. Managing your anxiety during the taper process is important because this helps you stay focused and rational as you slowly reduce your methadone dosage.

The key to tapering successfully is to do so gradually and in cooperation with your prescribing physician and methadone clinic medical team. Some people may try to taper off of methadone too quickly and will consequently begin to feel their withdrawal symptoms return. This is most often avoided by simply proceeding slowly with a methadone taper.

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.

Opioid Addiction in the United States

methadone-counselingThe U.S. has experienced a steady rise in the number of people being prescribed opioids and in the number of individuals becoming physically addicted to these medications. In the 1970′s and 1980′s, the typical methadone program client was someone who had graduated to daily IV heroin use.

Fast forward to 2013 and the typical methadone program participant may well be someone who has never used heroin or any kind of injectable drug. With the rise of oxycontin over a decade ago and other popular painkillers, opioid addiction in America moved to unprecedented levels. With this new epidemic level of opiate addiction has come an increasing number of overdose deaths.

Within the last 10 years, Tennessee was for several of those years the nationwide leader in the number of prescribed opioids per resident and the number of opioid overdose deaths. Many of these fatalities were the resulting combination of mixing opioids with benzodiazepines like xanax, klonopin, and ativan. Today, many opioid treatment programs and independent physicians are using much greater caution in prescribing benzodiazepines in their practice, and some have opted out of this completely due to the significant medical risk involved.

As the resulting need for treatment options began to grow, the availability of local methadone programs increased as did the total number of U.S. physicians who were approved to prescribe suboxone. Both methadone and suboxone have been enormously beneficial in helping addicted people gain a new lease on life. These opioid replacement medications, combined with counseling, provided hope for a life after opioid addiction. Unless someone has experienced the ravages of a drug addiction, they may be unable to fully comprehend the benefit provided by opioid treatment using methadone or suboxone.

In the final analysis, we as a nation must guard against the overuse of prescription painkillers. And individuals must exercise due caution and care since there is no substitute for personal responsibility and good personal judgment. As America moves forward in the coming year, we must strive to prevent drug abuse where we can through education and prevention efforts. We must also recognize and support the concept that addiction is a treatable illness, and that methadone and suboxone are an essential element in the opioid addiction solution.

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.