Answer Addiction

Tag: buprenorphine

  • Searching For The Next Naloxone

    Searching For The Next Naloxone

    Experts are concerned that naloxone may not be strong enough for synthetic opioids such as fentanyl and carfentanil.

    Naloxone is—at times—a seemingly miraculous drug. Within minutes of naloxone being administered, someone who was unresponsive because of an opioid overdose can start breathing on their own and regain consciousness.

    However, despite its strengths, there are issues with the drug that have left healthcare professionals and policy makers pushing for alternatives. 

    One of the biggest issues with naloxone today is that it is reportedly not as effective at reversing overdoses from powerful synthetic opioids like fentanyl and carfentanil.

    In these cases, a person might need multiple doses of the opioid reversal drug in order to see a benefit. This isn’t just expensive, but can also cost someone their life if there aren’t enough doses immediately available. 

    Another issue is that opioids remain active in the body for longer than naloxone does. Because of this, someone can be revived using the opioid reversal drug, but later slip back into an overdose when the effects of naloxone have worn off. 

    Both of these concerns have led to the search for alternatives to naloxone. 

    “The strategies we’ve done in the past for reversing overdoses may not be sufficient,” Nora Volkow, director of the National Institute on Drug Abuse (NIDA), recently said in a speech at the 2018 National Rx Drug Abuse and Heroin Summit, according to STAT News. “We need to develop alternative solutions to reversing overdoses.”

    Dr. Jay Kuchera, a Florida-based addiction medicine specialist for Resolute Pain Solutions, said that “naloxone is being outgunned” by synthetic opioids that have largely replaced heroin in many areas of the country. 

    “Naloxone seemed to be great for the older opioids,” Kuchera said. “But now that we’re encountering these nonmedical, ungodly [opioids] like carfentanil… we need to get with the times.”

    In 2016, one report found that the market for opioid reversal drugs was valued at nearly $1 billion, so there are good economic incentives for companies to find alternatives to naloxone.

    Opiant Pharmaceuticals, which developed Narcan (the nasal spray version of naloxone), has had early success with a drug that works the same way as naloxone but lasts longer, so that the victim would be less likely to slip into another overdose after administration. 

    “Compounds like fentanyl, carfentanil, and other synthetic opioids act for longer periods of time,” said Dr. Roger Crystal, CEO of Opiant. “The concern is that naloxone’s half-life doesn’t provide sufficient cover to prevailing amounts of fentanyl in the blood.”

    Because many overdose deaths occur when a person stops breathing, scientists are also examining whether they can use drugs to keep a person breathing even while not reversing the overdose itself. For this, researchers are looking at ampakines, a class of drugs that can counteract respiratory depression. 

    Some people argue that funds would be better used to address the causes of addiction or to further study naloxone to see if it is indeed less effective against synthetic opioids, but Volkow said that having new and potentially better options for saving people from overdose is critical.  

    “There are so many people dying that we have to recognize the urgency,” Volkow said. “We obviously value basic science, but at the same time we have to recognize because of the current situation, the development of medication the can help address the crisis has become our top priority.”

    View the original article at thefix.com

  • Medication-Assisted Treatment Options Limited For Medicare Recipients

    Medication-Assisted Treatment Options Limited For Medicare Recipients

    “Medicare beneficiaries have among the fastest growing rate of opioid use disorder, but they don’t currently have coverage for the most effective treatment,” says one official.

    Medication-assisted treatment (MAT) for opioid addiction and dependence is now seen as the gold standard of care by many addiction treatment professionals, but barriers to treatment make it difficult for many Americans over the age of 65 to access medication-assisted treatment on Medicare. 

    According to a report by the Associated Press, Medicare, the federal health insurance program for seniors, will not cover treatment with methadone, one of the oldest and most effective forms of medication-assisted treatment.

    The program covers buprenorphine, another form of MAT, but only a fraction of doctors who accept Medicare have obtained a federal waiver that allows them to prescribe buprenorphine. 

    This combination leaves a vulnerable population at risk. The AP reports that 300,000 Medicare patients have been diagnosed with opioid addiction, but only 81,000 prescriptions for buprenorphine have been written for Medicare patients. 

    “Medicare beneficiaries have among the highest and fastest growing rate of opioid use disorder, but they don’t currently have coverage for the most effective treatment,” said Rep. George Holding, a Republican from North Carolina. Holding is sponsoring a bill that would recommend changes to Medicare’s policy toward methadone. 

    Some patients on Medicaid can access methadone treatment, either by paying about $80 per week out of pocket or qualifying for state programs that cover the treatment. However, worrying about how and if their treatment will be covered can take a real toll on their mental health. 

    Joseph Purvis, a former heroin and prescription painkiller user, said he became depressed when he realized that Medicare might not cover his methadone treatment. “I was terrified that I might have to leave the program,” he said. “There’s no way I wanted to go back to addiction on the streets.” 

    Luckily, he was able to access treatment, thanks to a state program. However, he believes that Medicaid should cover this important treatment. “Some people think of methadone as a crutch for addiction but it’s not,” Purvis said. “It’s a tool that allows people to live a somewhat normal life.”

    The issue of access to MAT is especially important given that Medicaid just passed regulations drastically tightening access to opioid pills. The restrictions passed despite objections from some medical professionals who said that many seniors are on high levels of opioids that need to be carefully reduced. 

    “The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient,” Dr. Joanna L. Starrels, an opioid researcher and associate professor at Albert Einstein College of Medicine, said in response to the regulations. “That takes a lot of clinical judgment. It’s individualized and nuanced. We can’t codify it with an arbitrary threshold.”

    View the original article at thefix.com

  • Buprenorphine Exposure Affects Kids At Alarming Rates

    Buprenorphine Exposure Affects Kids At Alarming Rates

    The number of children exposed to the addiction drug rose 215% over three years. 

    As the opioid crisis continues to grow, some children are being put at risk as they are exposed to buprenorphine, an opioid medication used to treat opioid use disorder. 

    A new study published in the journal Pediatrics found that from 2007 to 2016, more than 11,200 calls were made to poison control centers in the U.S. with concerns about children being exposed to buprenorphine. Of those, 86% were about children under age 6 and 89% were unintentional exposures. 

    “This is never prescribed for children under 6. It is a significant risk to them,” Henry Spiller, director of the Central Ohio Poison Center and an author of the study, told CNN. “We’re not quite sure why it stands out so much. Perhaps the parents who have this may not think it’s as risky as their other opiates because it doesn’t have the big effect that the other opiates do for them.”

    Of the 11,275 children exposed to the medication, the overall exposure rate per 1 million grew by more than 215% from 2007 to 2010. It then decreased 42.6% from 2010 to 2013, before increasing again in 2016 by 8.6%.

    Dr. Jason Kane, an associate professor of pediatrics and critical care at University of Chicago Medicine Comer Children’s Hospital, tells CNN that the increase in exposure has to do with the increase in adults using buprenorphine as a treatment option.

    “This is not the first study to show these data, but it is the latest study to show a medication whose design it is to help adults with narcotic or opioid addiction is ending up poisoning, mostly unintentionally, children and in particular those who are most vulnerable,” Kane said. 

    Buprenorphine is an opioid receptor stimulant as well as a blocker. It is considered an opioid but does not have the same effect as other opioids for adults, thought it can still be habit-forming. For children, however, it can have a stronger effect on the respiratory system.

    “In adults, the respiratory depression, the part that slows the breathing and you stop breathing, is limited, and so there’s a lot less respiratory depression in adults,” Spiller told CNN. “That’s why it was felt to be safer. Unfortunately, in very young children under 5, preschoolers, toddlers, infants… that protection isn’t there, and they do get this respiratory depression. It does affect their breathing.”

    Of adolescent exposures, 77% were intentional and more than one-quarter used the medication with another substance. 

    “It was surprising that adolescents were actually using it for abuse. It’s very specific,” Spiller told CNN. “You have to be in a program to get this. It’s carefully managed. It’s not widely available… It is available on the street, but essentially, the majority of this is from these management programs and someone’s in therapy, someone in the house, them or a family member.”

    According to CNN, study authors expect the number of exposures to continue to increase.

    To limit exposure, Kane recommends disposing unused medications, using child-proof caps and making sure medications are labeled correctly.

    “Seven children under the age of 6 died as a result of an accidental poisoning from this drug, which was present in someone’s home, prescribed with the goal of making someone else better,” Kane said to CNN, adding, “that’s a striking thing for me.”

    View the original article at thefix.com

  • Medication-Assisted Treatment Saves Lives But Is Severely Underutilized

    Medication-Assisted Treatment Saves Lives But Is Severely Underutilized

    A new study found that in the year after an overdose less than one-third of patients were prescribed methadone, buprenorphine or naltrexone.

    A new study found that drugs used to reduce opioid use in people with addiction are seriously underutilized.

    The medical journal Annals of Internal Medicine published the study, which followed close to 18,000 adults in Massachusetts. The participants in the study had gone to an emergency room between 2012 and 2014 for a non-fatal drug overdose.

    Although using drug therapy to treat opioid addiction is considered a “gold standard” of treatment, the study found that just 30% received any of the Food and Drug Administration-approved medication-assisted treatments.

    The FDA advises treatment for opioid addiction as a combination of behavioral therapy and the parallel use of one of three drugs. Methadone, buprenorphine, and naltrexone are all drugs approved for assistance in reducing drug cravings in those addicted to opioids.

    Science Daily reported that the study showed a 59% reduction in fatal opioid overdose for those receiving methadone, and a 38% reduction for those receiving buprenorphine over a 12-month period. The drug naltrexone was unable to be evaluated due to a small sample size.

    In the past, naltrexone has been shown to be as effective as methadone and buprenorphine, but there are high dropout rates and a refusal to try the drug in the first place.

    Science Daily reports this could be due to the fact that patients utilizing naltrexone cannot use any opioids for seven to 10 days. Methadone and buprenorphine can be started much sooner.

    As the opioid addiction crisis worsens, health officials are eager to find ways to assist people with addiction in withdrawal and abstinence from the drug. The Fix reported on an FDA-approved device that helps reduce opioid cravings, called “Drug Relief.”

    The study also found that in the year after an overdose, not quite one-third of patients were prescribed one of the three FDA approved drugs—with methadone at 11%, buprenorphine at 17%, and naltrexone at 6%. Five percent received more than one medication.

    According to Science Daily, Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), said, “A great part of the tragedy of this opioid crisis is that, unlike in previous such crises America has seen, we now possess effective treatment strategies that could address it and save many lives, yet tens of thousands of people die each year because they have not received these treatments. Ending the crisis will require changing policies to make these medications more accessible and educating primary care and emergency providers, among others, that opioid addiction is a medical illness that must be treated aggressively with the effective tools that are available.”

    View the original article at thefix.com

  • Using Marijuana to Treat Opioid Addiction

    Using Marijuana to Treat Opioid Addiction

    When I’m on marijuana, the thought of injecting toxic drugs into my body seems totally unhealthy and unappealing.

    If you believe that medication-assisted treatment (MAT) for opioid use disorder (OUD) is wrong because it’s “just substituting one drug for another,” then you’re really not going to like this article. It’s not about one of the three major forms of MAT approved for opioid addiction: buprenorphine, methadone, or naltrexone. It’s about another medication, which does not cause a physical dependency, nor does it contribute to the 175 drug overdose deaths that take place each day in the United States. It has fewer harmful side effects than most other medications, and has even been correlated with a reduction in opioid overdose rates. Nonetheless, it is more controversial than MAT and, in most states, less accessible. In fact, Pennsylvania is the only state that has approved its use for OUD—and only as of May 17, 2018. In New Jersey, it was recently approved to treat chronic pain due to opioid use disorder.

    The medication I’m describing is, of course, marijuana.

    Abstinence-based thinking has dominated the recovery discussion for quite some time. Since Alcoholics Anonymous began in the 1930s, the general public has associated addiction recovery with a discontinuation of all euphoric substances. Historically, that thinking has also extended to medication-assisted treatment, even though MAT is specifically designed not to produce a euphoric high when used as prescribed by people with an already existing opioid tolerance. The bias against MAT is finally beginning to lift; there is now even a 12-step fellowship for people using medications like methadone or buprenorphine. But marijuana, which is definitely capable of producing euphoria, is still under fire as an addiction treatment.

    In addition to the ingrained abstinence-only rule, another reason that most states don’t approve the use of marijuana for OUD is that there is little to no research backing its efficacy. Even in Pennsylvania, the recent addition of OUD to the list of conditions treatable by marijuana is temporary. Depending in part on the results of research performed by several universities throughout the state, OUD could lose its medical marijuana status in the future. And other states that have tried to add it have failed, including Maine, Vermont, New Hampshire, and New Mexico. It’s not that any research has shown marijuana doesn’t work for OUD. There simply has not been much—if any—full-scale research completed that says it does.

    But street wisdom tells a different story. Jessica Gelay, the policy manager for the Drug Policy Alliance’s New Mexico office, has been fighting to get OUD added as a medical marijuana qualifying condition in New Mexico since 2016. Although she recognizes that research on the topic is far from robust, she believes cannabis has a real potential to help minimize opioid use and the dangers associated with it.

    “Medical cannabis can not only help people get rest [when they’re in withdrawal],” says Gelay, “it can also help reduce nausea, get an appetite, reduce anxiety and cravings…it helps people reduce the craving voice. It helps people gain perspective.” I can relate to Gelay’s sentiment, because that’s exactly what marijuana does for me.

    I am five years into recovery from heroin addiction. I don’t claim the past five years have been completely opioid free, but I no longer meet the criteria for an active opioid use disorder. Total abstinence does not define my recovery. I take one of the approved drugs for OUD, buprenorphine, but as someone who also struggles with post-traumatic stress disorder (PTSD) as the result of physical and sexual assault, I experience emotional triggers that buprenorphine doesn’t address, leaving me vulnerable to my old way of self-medicating: heroin. But what does help me through these potentially risky episodes? Marijuana. For me, ingesting marijuana (which I buy legally from my local pot shop in Seattle, Washington) erases my cravings for heroin. It puts me in touch with a part of my emotional core that gets shut down when I am triggered. When I’m on marijuana, the thought of injecting toxic drugs into my body seems totally unhealthy and unappealing—probably the way it seems to someone who doesn’t have an opioid use disorder. It’s not a cure-all, but it stops me from relapsing.

    High Sobriety is a rehabilitation program based out of Philadelphia that provides cannabis-based recovery for addiction, with a focus on addiction to opiates. Founder Joe Schrank, who is also a clinical social worker, says that treatment should be about treating people where they are, and for people with chronic pain or a history of serious drug use, that can often mean providing them a safer alternative—one that Shrank, who does not personally use marijuana, says is not only effective, but even somewhat enjoyable.

    “[Cannabis forms] a great therapeutic alliance from the get-go. Like, we’re here with compassion, we’re not here to punish you, we want to make this as comfortable as we possibly can, and the doctor says you can have this [marijuana]. I think it’s better than the message of ‘you’re a drug addict and you’re a piece of shit and you’re going to puke,’” says Schrank.

    People have been using this method on the streets for years, something I observed during my time in both active addiction and recovery. Anecdotally, marijuana’s efficacy as a withdrawal and recovery aid is said to be attributed to its pain-relieving properties, which help with the aches and pains of coming off an opioid, as well as adding the psychological balm of the high. The difference between opiated versus non-opiated perception is stark, to say the least. The ability to soften the blow of that transition helps some users acclimate to life without opioids. Even if the marijuana use doesn’t remain transitional—if someone who was formerly addicted to heroin continues to use marijuana for the rest of his or her life instead—the risk of fatal overdose, hepatitis C or HIV transmission through drug use, and a host of other complications still go down to zero. Take it from someone who has walked the tenuous line of addiction: that’s a big win.

    Marijuana may also be able to help people get off of opioid-based maintenance medications. Although there is no generalized medical reason why a person should discontinue methadone or buprenorphine, many people decide that they wish to taper off. Sometimes this is due to stigma; friends or family members who insist, wrongly, that people on MAT are not truly sober. Too often, it’s a decision necessitated by finances.

    For Stephanie Bertrand, detoxing from buprenorphine is a way for her to fully end the chapter of her life that included opioid addiction and dependency. Bertrand is a buprenorphine and medical marijuana patient living in Ontario, Canada. She is prescribed buprenorphine/naloxone, which she is currently tapering from, and 60mg monthly of marijuana by the same doctor. She says that marijuana serves a dual purpose in her recovery. It was initially prescribed as an alternative to benzodiazepines, a type of anxiety medicine that can be dangerous, even fatal, when combined with opioids like buprenorphine. The anxiety relief helps her stay sober, she says, because she’d been self-medicating the anxiety during her active addiction. She now also uses a strain that is high in cannabidiol (CBD), the chemical responsible for many of cannabis’ pain relieving properties, to help with the aches and discomfort that come along with her buprenorphine taper. She says the marijuana has gotten her through four 2mg dose drops, and she has four more to go.

    Bertrand would not have the same experience if she were living in the United States. MAT programs in the States tend to disallow marijuana use, even in states where it has been legalized. But studies tell us this shouldn’t really be a concern. Two separate studies, one published in 2002 and the other in 2003, found that MAT patients who used cannabis did not show poorer outcomes than patients who abstained. Although this reasoning alone doesn’t mean marijuana helps with recovery, these findings set the groundwork for future research.

    Do the experiences of people like me and Bertrand represent a viable treatment plan for opioid use disorder? It will likely be a few years before we have the official data. Until then, it’s high time we stop demonizing people in opioid recovery who choose to live a meaningful life that includes marijuana.

    View the original article at thefix.com

  • Medical Schools Focus On Addiction Medicine Training In Light Of Opioid Crisis

    Medical Schools Focus On Addiction Medicine Training In Light Of Opioid Crisis

    Medical students are seeking out addiction medicine training and schools are making adjustments to fulfill their needs. 

    The opioid crisis is changing the way some medical schools are approaching training, according to the San Francisco Chronicle. 

    At the University of California, San Francisco (UCSF) School of Medicine, this is being done by implementing a yearlong fellowship in addiction medicine, the Chronicle reports. 

    The fellowship program is funded by the city and county of San Francisco and works to incorporate addiction medicine into overall medical training, rather than just psychiatric medicine. 

    Dr. Hannah Snyder is one of the fellowship participants and is expected to complete the program this month. 

    “I started learning about treating addiction and realizing we had highly effective medications to treat addiction,” Snyder told the Chronicle. “I got really excited about that because there’s a way to prevent people from having those complications in the first place.”

    According to the Chronicle, Snyder works at Ward 93 as part of the fellowship. Ward 93 is a methadone clinic at San Francisco General Hospital. There, she meets with patients to discuss treatment. 

    Snyder is also assisting other U.S. hospitals with new protocols for treating those with opioid use disorders. The Chronicle states that this “primarily means getting patients started on buprenorphine or methadone—two long-term prescription medications for opioid-use disorder—when they come to the hospital after overdosing or having severe withdrawal symptoms.” 

    The fellowship at UCSF School of Medicine isn’t the only one of its kind. In fact, since 2011, 52 U.S. addiction medicine fellowships have been accredited by the Addiction Medicine Foundation. 

    Fellowships are typically completed by doctors who have already finished their three- to six-year residency in a specific area and wish to take part in more training in a subspecialty, the Chronicle notes. It wasn’t until 2016 that addiction medicine was recognized as a subspecialty. 

    Dr. Anna Lembke, a psychiatrist at Stanford School of Medicine, is working to add addiction medicine courses to Stanford’s curriculum. 

    “It’s the dawning awareness within the medical community that addiction in general is a growing problem in our patient population,” she told the Chronicle. “The opioid epidemic has put it front and center in a way that gives people permission to focus on it. Suddenly there are research dollars available to study it, and federal grants. It has momentum it never had before.”

    At Stanford specifically, students are the ones pushing for additional education in the area. The Chronicle states that Alexander Ball, a fifth-year medical student, partnered with Lembke to create lectures centered around pain and addiction for first and second-year students. Some were incorporated into courses this year, and more will be next year, the Chronicle notes. 

    The lectures concentrate on opioid prescribing, administering buprenorphine and other medications and motivational interviewing, which is a counseling technique. 

    At UCSF, buprenorphine training has been offered as optional for residents and faculty since 2011, the Chronicle reports. Buprenorphine is used to treat opioid dependence and is a Schedule III narcotic, meaning doctors have to complete eight hours of training and get a waiver in order to prescribe it. 

    According to Dr. Scott Steiger, associate professor of medicine and psychiatry at UCSF, the buprenorphine training is drawing more and more medical professionals. 

    “Last year, we had to turn people away because we had reached our capacity for the room, which was 77,” Steiger told the Chronicle. “The next one (this spring), we had it in an auditorium to fit all the people. It’s telling that people are trying to get as much training as they can.”

    View the original article at thefix.com