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
The State of Massachusetts is experiencing dramatic levels of opioid abuse and their Governor, Deval Patrick, is sharply focused on addressing the problem. A compelling Boston Globe article has highlighted the growing problem with heroin and other opiates across the state noting that 185 people died of heron overdose between November 2013 and February 2014.
Also mentioned in the article was the state’s plan to increase funding for drug treatment by $20 million and to prohibit the sale of Zohydro, a highly potent prescription painkiller that has drawn much attention and criticism due to its ability to potentially worsen the opioid epidemic in America.
Governor Patrick has declared the opioid abuse problem a public health emergency and is taking active measures to increase the availability of naloxone to Massachusetts public workers so that they can intervene to save the lives of those experiencing an opiate overdose. Naloxone is a powerful opioid antagonist that reverses the effects of opioid overdose within minutes. Numerous overdose victims have been saved in recent years as a result of medical personnel or bystanders having access to naloxone.
The state also intends to crack down on the over prescription of pain medication and will be requiring physicians and pharmacies to participate in the prescription monitoring program. Participation was previously only voluntary, but will now be mandatory. Prescription monitoring reduces the prevalence of “doctor shopping” and also the diversion of prescription medications to the street where they are resold at a premium.
While naloxone can save lives by reversing the effects of opioid overdose, methadone also saves lives by removing the desperate daily struggle to avoid opioid withdrawal. This daily struggle often leads to premature death or long term incarceration. Suboxone (buprenorphine) provides the same medication-assisted support which allows those lost in addiction the ability to stabilize and move forward again. It is important to emphasize that medication-assisted treatment should always incorporate long term counseling and recovery-building since addiction is not just a physical dependency problem. The psychological component of addiction is what is addressed through counseling and therapy.
Zohydro ER (extended release) is a new opioid-based pain medication just recently approved by the FDA and scheduled to be released for use in March of 2014. More than 40 healthcare organizations, advocacy groups, and physicians have come forward in a desperate appeal to the FDA to revoke the approval of Zohydro ER.
The medication is touted to be many times more potent than standard dosage hydrocodone, and the mounting fear is that Zohydro could lead to immediate abuse and overdose deaths across the country. This concern is in part stemming from the recent explosion in heroin use in the United States and the steady increase in opioid overdose fatalities that has emerged in the last five years.
One characteristic of Zohydro that presents increased risk is that it can be easily crushed and then snorted or injected. The medication was designed specifically for special pain management scenarios in which standard pain management interventions are not effective.
The manufacturers of Oxycontin brought a reformulated version to market some years ago that made if difficult for individuals to crush Oxycontin and misuse it. However, Zohydro was not designed with this tamper-resistant technology included.
Among the professional groups expressing grave concern over Zohydro is ASAM (the American Society of Addiction Medicine). Of particular note too is the fact that 28 State Attorney Generals have urged the Food and Drug Administration to re-examine their decision to approve the drug.
In lieu of the present opioid addiction epidemic that is sweeping the nation, it would seem that Zohydro will likely undergo some modification to insure less abuse potential. To see the drug removed from the market, before it has an irreversible harmful impact, is a goal around which most reasonable people can agree.
For additional reading on the escalation in prescription opioid addiction, review Black Market For Painkillers.
Benzodiazepines are a classification of drugs primarily prescribed to treat anxiety and panic attacks. They have been in use for over thirty years and are typically utilized for short term periods from several days to three months maximum.
Benzodiazepines are sometimes administered just prior to medical procedures or surgery to help calm a patient. Common examples include valium, ativan, klonopin, librium, and xanax. These medications have also been used successfully on a short-term basis to help reduce alcohol withdrawal as patients undergo alcohol detoxification.
For opioid treatment programs, benzos present a particular risk due to the higher probability of abuse and overdose death when mixed with methadone, other opioids, or alcohol. Benzodiazepines depress the central nervous system and can shut down respiration when combined with other CNS depressants. This lethal drug combination has resulted in numerous accidental deaths – even among experienced drug users.
While limited and carefully monitored benzodiazepine use can be clinically justified in some cases, prescribing physicians (and methadone clinics) must be vigilant and cautious in their use of these medications due to their risk of abuse and overdose with opioid dependent patients.
Many opioid treatment programs around the country have adopted a no benzodiazepine policy and will not induct a patient with methadone until the patient has successfully detoxed off of any benz medications, and is able to test negative for the drug.
Some prospective patients have been on benzodiazepines for many years – long past any justifiable therapeutic or medical necessity. Several years ago, an OTP was approached by a client seeking admission who had been taking klonopin by prescription for 25 years. She had experienced several overdose episodes during that time period. The prospective patient voluntarily completed a successful detox off the klonopin, and she demonstrated incredible courage in pursuing this goal. She remained benz free and has tested negative for illicit substances for 3 years now. While she was afraid and doubtful that she could complete the benz detox, she surprised herself and the clinic staff in what can only be described as an incredible commitment to change and a new life.
For those patients diagnosed with a severe anxiety disorder, benzodiazepines may be indicated in select cases. Cognitive-behavioral therapy can also be effective in helping individuals learn to cope successfully with anxiety although it will require strong commitment to the therapy process and a considerable degree of work. With benzodiazepine treatment alone, the medication only manages the symptoms … but does not treat the underlying cause of the anxiety. For that reason, treating anxiety exclusively with benzodiazepines (at the exclusion of therapy) can be a disservice to a patient.
Physical dependency on benzodiazepines can be quite powerful and withdrawal from them dangerous. No one should ever try to self-detox from a benzodiazepine addiction due to the risk of seizure and possibly death.
Posted in Addiction Recovery, Benzodiazepine, Drug Safety, Drug Treatment, Methadone, Methadone Clinics, Opiate Addiction, Suboxone
Tagged ativan, benzo, klonopin, overdose, valium, xanax