Tackling the Opioid-Overdose Epidemic

opiatesThe study “Medication-assisted therapies – tackling the opioid-overdose epidemic” highlights an underserved population in America and world. You can read the study here…

 

The rate of death from overdoses of prescription opiates in the United States more than quadrupled between 1999 and 2010. In 2010, prescription opiates were involved in 16,651 deaths, representing 82% of all opioid deaths and far exceeding the 3036 heroin deaths.  This has been my experience in my addiction practice, although the change in formulation of Oxycontin to a paste that is hard to abuse (snort or shoot up), and the cheap heroin flooding the market the past few years has had an affect as well.  In Portland, Oregon, we are seeing a huge rise in heroin use and deaths.

Opiates should be used for acute pain.  They are wonderful after major surgery for short-term pain management.  For chronic pain, you are guaranteed the development of dependence or addiction. Once addicted or dependent, the suffering experienced when trying to get off the opiates is too much for most people and good people are lost in the cycle of withdrawal, seeking relief with opiates only to build more dependence, and so on.

One great solution is medication-assisted therapy (MAT).  This typically involves suboxone (Buprenorphine), naltrexone (vyvitrol), or methadone.

Naltrexone works by blocking the opiate receptors and thus the dependent person cannot get the pleasurable effects from the opiate.  The problem with that is they feel so hopeless, with anxiety and depression escalating that most won’t stay with that therapy, and it carries a risk of severe depression and suicide.

For the methadone approach, most are familiar with methadone clinics. These are government-funded clinics where the physicians are compensated by the numbers of patients they are “helping”.  I know a lot of these physicians personally and they are well-intentioned, and subscribe to the theory of harm reduction.  It goes like this: if I can get you on a really high dose of methadone, your opiate receptors will be flooded and full and there will be no additional benefit from using. This can reduce needle sharing and reduce HIV and Hep C transmission, thus reducing harm.

The sad truth about methadone programs like these is that these patients are hardly healthy, nor to they have hope for a better future.  Over time, such high doses of opiates will shut off the pituitary, reducing other hormones like testosterone, leading to depression, anxiety, loss of libido and erectile function, and general worsening of health.  This is hardly reduction of harm in my mind. 

I am a board-certified addictionologist, with a strong belief in guiding those who have become opiate dependent to a life free of opiates.  It can take as many years as you were using to get you back to normal, but it can be done.  Buprenorphine (Suboxone or Zubsolv) are partial agonists and partial antagonists of the opiate receptors.  They will give a partial opiate effect so you don’t go into withdrawal, but you won’t get “high” (unless you take these when you are not an opiate addict or dependent person). The other advantage is you cannot overdose on these medications and while you are taking them, if you do relapse on pure opiates they will have no effect.  That is actually only partially true.  The plan is to gradually wean the dose of the Buprenorphine and at the lowest doses, it no longer blocks enough of the opiate receptors and one could get “high”.

The epidemic of prescription-opioid overdose is complex. Greater access to MATs is crucial. Doctors also must avoid inappropriate prescribing of opioid analgesics.   Physicians can reduce unnecessary opioid prescribing, by routinely checking data from prescription-drug monitoring programs to identify patients who may be misusing opiates.

If you know someone who may have become addicted or dependent on opiates, help them find an addiction specialist who can help them taper off of the opiates.  It can take 6 to 18 months to taper slowly.  A rapid taper is often followed by relapse.

I run a clinic called “Fair Start” for ages 30 and under who need to taper off of opiates.  Contact us if you need our help.

 

 You can also visit the National Institute on Drug Abuse website to learn more here…

 

 

Dr. Paul

 

 

 

 

 

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