When Treatment Triggers Addiction
There is fine line between the treatment of addiction and the exacerbation of addiction when medications used for addiction management are abused by non-prescribed users. The danger plays out dramatically at the neurological level. An ongoing use of opioids (medications to relieve pain such as Vicodin, OxyContin and hydrocodone, and also the illegal drug heroin) causes brain abnormalities to develop that restructure the brain to become addicted to opioid(s).1
What Is the Difference Between Opioids, Opiates and Opium?
Poppy plants contain opium. Organic substances derived from opium, such as morphine and codeine, are opiates. Opium can be converted to heroin, an illegal opiate, through non-organic, synthetic processes. Opioids, such as OxyContin, are similar in molecular structure to opiates but created through a synthetic or partly synthetic process.
When a person is dependent on or addicted to opiates, they must go through the detox process to rid the body of the drug. The length and intensity of this process varies between individuals. However, there is help available for the process. Pharmaceuticals have been proven to be effective in treating brain abnormalities underlying addiction, but there is an ever-rising concern that these very medications invite new addictions.2
The neurobiological factors at play with addiction show that drug addiction is not purely a matter of choice. A deeper understanding of the brain chemistry of addiction can therefore help to reduce the stigma of addiction. The medical community understand that opioids activate areas in the brain that cause an inhibition of the perception of pain as well as pleasurable emotions. The brain then memorizes this feeling and creates cravings for this pleasure again. After the initial stage of pleasure-seeking behavior, when tolerance and dependence have built up, drug use then becomes a matter of compulsion, and at this point, the need for both medical and psychological treatment becomes critical.3
The Difference Between Legal and Illegal Uses of Opiate Treatment
There is an important difference between addiction to prescription drugs and drugs prescribed to help fight addiction. The later relates to neurobiology and professional efforts to perfect addiction treatment whereas the former is another iteration of the illegal drug epidemic in America. For instance, over three million Americans have been prescribed Suboxone (buprenorphine) for the treatment of opioid addiction, including heroin. But in 2010 alone, approximately seven million Americans unlawfully used prescription medications for non-medical purposes. Pain relievers were the most common category of otherwise lawful drugs being used unlawfully.4
Not incidentally, pain relievers such as Vicodin, OxyContin and hydrocodone are opioids, and addiction treatment drugs such as Suboxone are intended to treat addictions to these opioids. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that as of 2011, approximately two million Americans abuse or are addicted to opioids, including heroin and lawful prescription drugs, such as oxycodone and hydrocodone.5
The problem of opiate addiction and treatment is apparent—the most frequently abused drugs are prescription palliative drugs, which are usually opioids, and the opioid medications used in treatment, such as Suboxone, carry a risk of addiction. The cyclical nature of the problem necessitates intervention from the medical community to help protect Americans from opioid addiction.
The Use of Suboxone and Methadone
Both Suboxone and methadone are U.S. Food and Drug Administration-approved pharmacologic treatments for opioid dependence and addiction (other drugs, such as Subutex and naltrexone are also prescribed but less common).
Methadone use in opioid addiction treatment continues to rise as does Suboxone and buprenorphine use. On the street, however, Suboxone is also known as “bupe,” “stop signs/stops,” “box/boxes,” “oranges” and “sub/subs.” Methadone also goes by “dolls,” “done,” “Maria” and “jungle juice/juice.”
One key difference between Suboxone and methadone is that methadone is only available at certified clinics while the Drug Abuse Treatment Act (DATA) of 2000 approved Suboxone and Subutex as the first narcotics for addiction treatment to be available at doctors’ offices. One of the reasons for the difference in availability of these treatments is that Suboxone and Subutex have a lower risk of overdose and potential for abuse compared to methadone.
Although methadone does pose a potential risk of addiction, methadone has been a helpful agent in addiction treatment for many years producing the following results:
- Lessens the impact of opioid withdrawal symptoms
- Diminishes cravings for opioids
- Brings the patient to a level of tolerance that curbs the withdrawal symptoms without inducing the euphoric effects of the methadone
- Sets the patient on a sustainable path to detoxification
Similarly, research shows the efficacy of Suboxone in that at the one-year mark 40 to 60 percent of patients in Suboxone treatment maintain sobriety. Suboxone has been proven to have the following results in treatment:
- Diminishes withdrawal symptoms
- Lessens drug cravings
- Has little to no euphoric effect (compared to methadone) due to the presence of the chemical naloxone
- Blocks effects of other opioids for at least 24 hours
Concerns with Suboxone Treatment
With increased availability for Suboxone, the dangers of misuse also increase. For instance, incidents of emergency room visits due to Suboxone complications rose tenfold from 2005 to 2010, with 3,161 and 30,135 hospital intakes respectively.More than 50 percent of the intakes were related to non-medical use of Suboxone.5 In 2011, poison control center reports of buprenorphine poisoning were five times greater than the number reported in 2006. One distressing statistic relates to Suboxone and children. In 2010 and 2011, Suboxone was a drug children commonly ingested accidentally.6
To help protect against Suboxone misuse, the following safeguards can be implemented to decrease its dangers:
- Develop drug-testing apparatuses that are sensitive to Suboxone detection
- Increase training of law enforcement to detect Suboxone street sales
- Increased Suboxone prohibition in prisons
- Additional law enforcement efforts to root out doctors who engage in unlawful prescription writing of Suboxone
- Public education on children’s accidental intake of Suboxone
Concerns with Methadone Treatment
While research shows that Suboxone is rarely deadly, deaths resulting from methadone are alarmingly on the rise. There was a sharp increase in methadone overdose deaths between 1999 and 2006; however, there has since been a decrease in deaths. Nevertheless, there is still an overwhelming number of deaths from methadone overdoses each year (3400 people in 2014).7
In light of these mortality statistics, the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services (SAMHSA) has recommended the following measures be put into place to protect users from methadone-poisoning deaths:
- Continuing education of medical professionals. Some methadone-poisoning deaths result from fatal drug interactions. Enhanced medical screening and intake procedures to uncover the presence of other drugs in patients would be beneficial.
- Patient education. It is important for methadone therapy patients to understand how use of other drugs in combination with methadone doses can prove fatal.
- Develop technologies to better test patient toxicity levels. Methadone is long-acting with the result that some patients build up toxicity and new dosages result in poisoning.
- For patients who dose at home, increased education. Patients are more likely to appropriately consume their take-home doses if educated on the effects of overdosing. Further, it is critical for patients to advise people in their living environment to avoid the methadone supply as use by non-users can prove fatal, especially for children who are at risk of accidental consumption.
The risks of these Suboxone and methadone remain both a private and public health concern. The drug epidemic in America presents a serious issue, and efforts to treat addiction can have the adverse effect of supplying the black market, despite the efforts of medical professionals, law enforcement and government. There is only one compelling conclusion: Treatment is necessary.
Citations
1 “How Does Someone Become Addicted to Opioids?” NIDA for Teachers. 2017. Web. Accessed 3 July 2017.
2 “Opiate and opioid withdrawal.” Medline Plus. 2016. Web. Accessed 3 July 2017.
3 Pat Anson. “Sharp Rise in Suboxone Emergency Room Visits.” National Pain Report. 2013. Web. Accessed 3 July 2017.
4 “Misuse of Prescription Drugs.” NIDA. 2016. Web. Accessed 3 July 2017.
5 “Understanding Drug Use and Addiction.” NIDA. 2016. Web. Accessed 3 July 2017.
6 Anson, Pat. “Suboxone: The New Drug Epidemic?” National Pain Report. 2013. Web. Accessed 3 July 2017.
7 “Prescription and Over-the-Counter Medications.” NIDA. 2015. Web. Accessed 3 July 2017.
8 “Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011.” SAMHSA. 2013. Web. Accessed 3 July 2017.
9 “The Facts About Buprenorphine.” SAMHSA. 2014. Web. Accessed 3 July 2017.
10 Stuckert, J. “How Is Suboxone Treatment Different than Drug Abuse?” Psych Central. 2016. Web. Accessed 3 July 2017.
11 Anson, Pat. “Sharp Rise in Suboxone Emergency Room Visits.” National Pain Report. 2013. Web. Accessed 3 July 2017.
12 Sontag. D. “Addiction Treatment With a Dark Side.” The New York Times. 2013. Web. Accessed 3 July 2017.
13 Foul, M., et al. “Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies.” CDC. 2017. Web. Accessed 3 July 2017.