Opiate overdoses now kill more people each day than car crashes or gun violence. And addiction has affected families from all walks of life. For those who are trying to kick opioid addiction, there is help—medicines that greatly increase the chance of success and reduce the risk of death. What choices are available, and how do they work?
Methadone, a liquid opioid, has been in use since the Vietnam War. Patients have to drink it every day under supervision at a methadone clinic. Methadone is slow-acting and can be used both to prevent withdrawal symptoms and for long-term treatment. The downsides are that it may cause some of the same side effects as heroin, and it can cause depressed breathing in large doses. That’s why it has to be dispensed strictly through a clinic, and the addict needs to go to the clinic every day.
Suboxone can be dispensed as either a pill or a film that dissolves under the tongue. Unlike methadone, it can be used at home. Suboxone combines two different drugs, an opioid called buprenorphine and an opioid antagonist called naloxone, which makes it more difficult to abuse the buprenorphine. If the pill or the film is crushed and snorted or injected, the naloxone blocks the high. Suboxone may cause nausea and constipation but is less likely to cause depressed breathing. Its major drawback? It’s more expensive.
Naltrexone has been around for a long time and can be taken daily in pill form. The old formulation only cost a few dollars a month. However, there is a new, extended-release version called Vivitrol that is getting great results but costs much more. On the plus side, patients who use it report that Vivitrol reduces cravings and increases their time in treatment and their periods of abstinence. Another plus is that, because it’s not a narcotic, it has no street value, so addicts can’t sell it on the street.
Probuphine is the new kid on the block. Similar to a contraceptive implant that gets placed in a woman’s arm, probuphine releases a consistent, low dose of buprenorphine for six months. It’s been designed to combat three problems with Suboxone—the ability to be resold, the problem with people forgetting or refusing to take it, and the fact that while taking it, users experience peaks and troughs of effectiveness, with worse cravings during the troughs. Probuphine was only recently approved by the FDA, so it may be awhile before it is available.
It’s important to remember: drug addiction is a medical illness that requires long-term care, including medications for some. Drugs physically change the brain—quitting is not simply a matter of willpower. And while medication-assisted addiction treatment might not be the answer for everyone, it does work. If you’d like to talk to someone about addiction and what options are available for someone struggling with it, please call Horizon Health Services at (716) 831-1800.