Seattle KIRO 7 recently reported that the solution to our nation’s growing opioid epidemic may be found in our local pharmacies. This is exciting news for the more than 11 million Americans who misused or abused prescription opioids in 2016.
“Nationwide, 25% of those who receive prescription opioids for chronic pain will develop an addiction to them.”
Prescription opioids are highly addictive. Due to the slack prescription laws in the past, many Americans have gotten hooked on prescription opioids and opiates, like fentanyl, Dilaudid, and oxycodone.
Those who are addicted to opioids are often told to “just quit”. Quitting is not as easy as it seems. Those struggling with an opioid addiction usually can’t “just quit”. They have already developed a chemical and physical dependence on the drug. This means that their body needs the drug to survive. When the body is deprived of this drug, it will shut down.
Opioid withdrawals can be not only difficult to overcome, but they can also be life-threatening. According to Seattle KIRO 7, there are several solutions. For many of those who are struggling to get sober, the key to long-term recovery may be found in their local pharmacies.
This discovery can help thousands of Washington residents who are addicted to opioids. Opioid addiction and abuse often result in an overdose. 718 Washingtonians died from an opioid overdose in 2015. This fatality rate is higher than the fatality rate for car accidents.
Medical Detox Is the Missing Key
Opioid abusers trying to quit cold turkey will often fail. They may try to quit using opioids with all their might, but find themselves falling back into the same destructive patterns.
According to Harborview psychiatrist Richard Ries, the missing piece of the puzzle is medication. Medical detox plays a key role in recovery and is a fundamental piece of any well-rounded addiction treatment plan.
“What’s different about opiate addiction, compared to alcohol or cocaine or other addictions, is without stabilizing the opiates system with medications that chances of recovery are about 5% maybe 10%.”
To illustrate this point, Seattle KIRO 7 interviewed a woman named Aubrey.
“My addiction started really young,” she said. “I was like a 13, 14 years old.” Aubrey started with drinking before moving onto other drugs. At age 17, she discovered heroin. Although Aubrey has been sober for 6 years now, her life was once in shambles. She was homeless, got pregnant twice and ended up losing her children. She was only able to get her youngest daughter back.
Aubrey tried to quit several times, but would always find herself relapsing. “I’ve tried to quit with AA (Alcoholics Anonymous), NA (Narcotics Anonymous) meetings,” she said. “But for me, there was always something missing.”
According to Aubrey, she was only able to turn her life around once she was prescribed Suboxone — one of the many addiction medications recommended for treating an addiction to opioids. Once she received the medications that she needed, Aubrey was able to turn her life around.
During her six years of sobriety, Aubrey has gotten married, landed a full-time job, had another child and bought a house. She was finally able to break free from the shackles of addiction and live the life that she dreamed of having.
Suboxone is not the only drug that can treat opioid abuse and addiction. Other popular options include methadone, buprenorphine, and naltrexone. We’ll explore all of these opioid addiction medicines in detail below.
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Methadone is a synthetic opioid. It is a full opioid agonist, which means that it basically has the same mechanism of action as heroin and other strong opioids. It attaches to the same receptors in the brain and creates a sense of euphoria. This stimulation will keep opioid withdrawal symptoms at bay.
Unlike oxycodone and heroin, methadone comes with fewer side effects and less intense withdrawal symptoms. It is easier to withdraw from this drug than it is to withdraw from stronger opioids. While it is easier to wean off methadone, this drug still comes with a potential for abuse. Those who abuse methadone can develop a dependence on it. This is also known as a secondary addiction. Those who develop an addiction to methadone will need to get treated as well.
In addition to treating opiate and opioid addiction, methadone can also be used to treat pain. With that said, those who take methadone for addiction will likely need to continue to take this drug for some time. Methadone maintenance therapy can last for over 10 years.
It’s important to note that methadone is highly effective although it comes with a higher potential for abuse. This drug is one of the more popular opioid addiction treatment medications. In 2011, approximately 306,440 Americans received methadone through opioid treatment programs (OTPs). Thanks to the rise in opioid addiction and abuse rates, this number has since skyrocketed.
Each patient will need a different dose of methadone to ease his or her withdrawal symptoms. 20 mg of oral methadone is equivalent to 5 mg of parenteral heroin. As the purity of illicit opioids can vary, most drug and alcohol rehabs recommend empiric methadone dosing.
In general, methadone treatment doses started at about 10 to 20 mg and will be increased in 10 mg increments until patients no longer experience any withdrawal symptoms. In most cases, 40 mg of methadone will be sufficient for controlling withdrawal symptoms. However, this dosage will not eliminate heroin cravings completely.
Once patients have reached the optimal dose, they will be stabilized on this dose for 2 to 3 days. The dose will then slowly be reduced by 10% to 20% daily or every other day. It’s important to note that each patient will respond differently to the dose reduction. While some patients will fare well with a 20% reduction, others may only be able to get away with a 5% reduction before they start experiencing withdrawal symptoms again.
Tapering off methadone can take weeks, if not months. The entire process can be uncomfortable. To avoid surprises, methadone treatment is recommended only under medical supervision.
Buprenorphine is another opioid agonist. Unlike methadone, it is a partial opioid agonist. This means that it has a similar mechanism of action to methadone. However, it is not as addictive and comes with a lower potential for abuse. After all, it has a “ceiling effect”. After a certain dose, this drug won’t have an effect on the body.
“More and more Americans are relying on buprenorphine to treat an addiction to opioids and opiates. While only 1,670 people received buprenorphine from Opioid Treatment Programs (OTPs) in 2004, as many as 25,656 opioids users relied on this drug in 2011. This number has multiplied several folds since then.”
Buprenorphine can be purchased in its generic form. However, for the purpose of treating opioid abuse, it is often combined with other drugs. Many opioid addiction medications contain buprenorphine. Some meds that contain buprenorphine include:
- Bunavail. This is a buccal film that is often placed inside the cheek. This drug has a higher bioavailability of buprenorphine than Suboxone, so a smaller dose can achieve more.
- Suboxone. This is the same drug that helped Aubrey recover. Suboxone contains both buprenorphine and naloxone. Naloxone is an opioid overdose antidote. It reverses the effects of opioid overdoses. The presence of naloxone makes this prescription medication a lot safer. Suboxone comes in two forms: a tablet and a film form. The tablet will dissolve under your tongue, and the film is usually placed under the tongue or inside the cheek.
- Probuphine. This is an implant that is usually placed under the skin of the upper arm. This implant will slowly release buprenorphine over the course of six months. This medication is most ideal for those who tend to be forgetful and may not be as diligent in taking their medication.
- Zubsolv. Zubsolv is similar to Suboxone, as it also contains both buprenorphine and naloxone. This prescription drug comes in tablet form. The main difference Zubsolv and Suboxone is that Zubsolv has a higher bioavailability of buprenorphine. This essentially means that a lower dose of Zubsolv can accomplish the same thing as a higher dose of Suboxone.
Buprenorphine and buprenorphine-containing products are very popular. They are highly recommended by many drug addiction treatment centers. Most of these drugs are recommended mostly for inpatient detox services.
Buprenorphine doses are usually divided into three distinct phases: induction, stabilization and maintenance.
During the induction phase, an addiction expert will need to determine the initial dose of the medication. In general, most patients will need to be initiated within 12 to 24 hours if they were addicted to a short-acting opioid and within 24 to 48 hours if they were addicted to a long-acting opioid.
The initial doses are usually 4/1 mg buprenorphine/naloxone or 2 mg buprenorphine. Another dose can be administered to patients if they continue to exhibit signs of opioid withdrawal. Those who are dependent on long-acting opioids will usually receive 2 mg buprenorphine every one to two hours. The recommended daily dosage is 8 to 12 mg.
After that, patients enter a stabilization phase. Most patients will require a minimum daily dosage of 12/3 to 24/6 mg of buprenorphine/naloxone. The dosage may be slowly reduced during this time. Doctors must ensure that patients are compliant with their prescription. Therapists may also determine whether there is a need for further psychosocial addiction treatment.
The maintenance phase comes after the stabilization phase. This phase is indefinite and will need to be tailored for each patient individually.
Methadone vs Buprenorphine
Many addiction experts are switching over from methadone to buprenorphine or buprenorphine-containing products. This is because buprenorphine and buprenorphine-containing products are able to offer the following advantages over methadone:
- Lower risk of toxicity even with higher doses
- Lower potential for abuse
- Less severe withdrawal symptoms after discontinuation
- Higher accessibility for outpatient detox treatment programs
- Protective overdose factor with a “ceiling effect”
Although buprenorphine and buprenorphine-containing products are able to offer quite a few advantages over methadone, this doesn’t mean that methadone doesn’t have some unique advantages of its own. Methadone tends to be cheaper and tends to have a higher retention rate.
Many studies have looked at the advantages and disadvantages of methadone treatment and buprenorphine treatment. Our addiction experts can walk you through the features of each type of medication, so you will gain a better understanding of both drugs.
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Also known as Vivitrol, naltrexone is an opioid antagonist. It works in a different manner than methadone or Suboxone. Instead of stimulating the opioid receptors, naltrexone actually inhibits it from being stimulated. Those who receive naltrexone will usually already have gone through a medical detox program. This drug cannot be prescribed to those who still have opioids or alcohol in their system.
Vivitrol injections are offered at The Evergreen at Northpoint. Unlike methadone and Suboxone, naltrexone is a once-a-month injection. The dose does not need to be tailored to each patient because everyone receives the same dose. These two features of Vivitrol give it an edge against methadone and Suboxone. This drug is perfect for those who tend to forget to take their medication. There is also less leeway for prescription errors as everyone gets the same dose.
Due to the nature of this drug, it is also an ideal candidate for those seeking outpatient detox services.
Naltrexone is one of the newer opioid addiction medications available, but it is quickly gaining popularity. It is able to accomplish the following:
- Block alcohol or opioid cravings
- Prevent patients from experiencing euphoria even when taking opioids; thus, removing the incentive to abuse or misuse drugs
- Ease patients into long-term recovery when combined with a complete recovery program
Many studies have looked into the effectiveness of Vivitrol. These studies found that 90% of those who received Vivitrol were able to abstain from opioid use. Those who received Vivitrol services also reported a 55% decrease in cravings and were 17 times less likely to relapse than those who took a placebo drug.
Are You a Good Candidate for Naltrexone?
Although naltrexone is a highly effective opioid addiction medicine, it is not necessarily a good choice for everyone. Those who are interested in this medication need to first determine whether they are a good candidate for it.
Naltrexone is a great drug for opioid addiction recovery. Those who are interested in taking this drug must:
- Have no opioids or alcohol in their system for at least 7 to 14 days before taking the drug
- Not be pregnant
- Not have any of the following diseases: kidney disease, liver disease or a history of hemophilia or other bleeding problems
If you’re wondering whether you or someone that you know may be a good candidate for Vivitrol services, contact us for more information. Our addiction experts offer a free addiction assessment over the phone. We can assess your situation to determine whether you’ll be a good fit. If you’re not an ideal candidate for Vivitrol services, we can look into other alternatives for you.
Addiction Medications Are Not a “Cure” But a Treatment
While the above addiction medications can ease withdrawal symptoms, they are not a cure. Just because someone is taking these medications, it doesn’t necessarily mean that they will magically overcome their addiction. These medications don’t work in the same way as flu medication.
Medical detox is merely a part of a comprehensive addiction treatment plan. Those who are hoping to achieve lifelong sobriety will need to also have the following evidence-based treatment approaches in their treatment plan:
- 12-Step Facilitation and mutual support groups, like Opioid Anonymous or Narcotics Anonymous meetings
- One-on-one or group counseling
- Family therapy and support programs
- Behavioral therapies, like Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT)
- Relapse prevention and continuing care plans
- Integrated treatment and additional medical intervention
- Psychiatric care and medications for co-occurring disorders
- Drug education workshops and skill-building activities
There are many other types of evidence-based treatment approaches that can be integrated into a successful substance abuse treatment plan. For example, some facilities offer art therapy or other relaxation classes that help patients learn how to better manage addictive behaviors and cope with cravings or destructive thoughts.
The Evergreen at Northpoint offers outpatient rehab and drug detox program. Our addiction specialists assess the physical and psychiatric condition of each patient to design a highly tailored treatment plan. We offer three levels of outpatient treatment: standard outpatient treatment, an Intensive Outpatient Program (IOP) and a Partial Hospitalization Program (PHP).
Receive Inpatient Care at Our Other Location
If you struggle with a serious addiction to opioids and need a more intense level of care, we can refer you to one of our other drug and alcohol treatment centers: Northpoint Washington.
Northpoint Washington is one of our newest drug and alcohol rehab facilities. It’s also located in Washington State, and it also offers an empirical treatment program. This modern addiction treatment facility has 44-beds and can offer a 28-day residential opioid addiction treatment program. It’s a beautiful facility and can offer an intimate and private environment for opioid users to focus on their recovery.
Those who opt for addiction treatment at this facility will receive around-the-clock nursing care and a wide range of evidence-based treatments. Northpoint Washington offers a wide range of opioid treatment medications as well.
The Cost of Opioid Addiction Medications
Although you’re now aware of a fundamental key to your recovery, you may still hesitate to get help. Don’t worry. You’re not alone.
Many people hesitate to get help because they’re afraid that they won’t be able to afford it. This thought causes them to feel anxious. As a result, these individuals may avoid trying to get help. This isn’t an irrational fear.
Drug and alcohol treatment can be quite costly. According to the National Institute on Drug Abuse (NIDA), here are some of the average costs for certified OTPs:
- $126.00 per week or $6,552.00 per year for methadone treatment
- $115.00 per week or $5,980.00 per year for buprenorphine treatment
- $1,176.50 per month or $14,112.00 per year for naltrexone treatment
Fortunately, private health insurance plans offer some coverage for opioid addiction treatment thanks to the Affordable Care Act (ACA). The amount of coverage that each policyholder has will vary depending on the terms and conditions of their plan. Some plans will cover the entire cost of treatment while others will limit policyholders to certain medications.
If you’re worried about the cost and would like to know what you’re covered for, verify your insurance with us. We’ll help you figure out what’s most feasible financially. Our addiction experts can even help you figure out whether you qualify for any federal or state-funded programs. Our goal is to help make addiction treatment as affordable as possible.
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The Evergreen at Northpoint Offers Many Medical Detox Options
Regardless of what you’re looking for, The Evergreen at Northpoint can offer you what you need. We assess the needs of each patient to determine the type of medications that will best help their situation. Our addiction experts can prescribe methadone, buprenorphine-containing products, and naltrexone as they see fit.
We will monitor each patient while they are undergoing detox. Those who are not responding as positively to one medication can be easily switched to another. We can also tailor the dose of each medication to each patient. Our highly-tailored program ensures that each patient will recover in a safe and comfortable manner. We have Joint Commission Accreditation, so you can be sure that we offer a high quality of care.
We’ve helped hundreds of people overcome addiction. Check out our testimonials for more information! If you have any further questions or if you have any experience with addiction medications, feel free to comment below!