The OPIOID CRISIS: Plenty of Treatment Need-to-Knows

E

ach and every day in the US some 120 people die subsequent to an opioid overdose. If lives weren’t enough, the total economic burden of prescription opioid abuse is right at $80 billion a year. This is stunning crisis news that calls for action. And action has to include education. So how ’bout we hit the treatment neck of the woods…

True, we work exclusively with the mood and anxiety disorders here on Chipur. However, an opioid crisis discussion is relevant. And that’s because m/a disorder sufferers are perfect candidates for opioid abuse and dependence, should we find ourselves trying to manage significant physical pain.

Why?

Certainly, we have our emotional, mental, and “stress-magnet” leanings. But let’s not forget that opioids can have an anti-depressant effect. In fact, modulation of our endogenous opiate system is at the heart of an antidepressant in the late stages of development (Alkermes: ALKS-5461).

The Opioid Very Basics

So if we’re going to discuss opioid abuse/dependence treatment, we’d better bone-up on some basics…

First, some terminology. “Opioids” include “opiates,” which are drugs derived from opium (e.g. codeine, morphine). The remaining opioids include semi-synthetic and synthetic drugs (hydrocodone, oxycodone, etc.) and endogenous peptides (endorphins, etc.). Bottom-line: “opiate” is typically limited to the natural alkaloids found in the resin of the opium poppy.

Okay, so how do opioids work? Simply, they bind to opioid receptors principally found in the central and peripheral nervous systems, as well as the gastrointestinal tract. Keep in mind, there are numerous receptor classes and the response differs by receptor.

Treatment Considerations

As we discuss treatment for opioid abuse/dependence, we need to keep the following forward and ongoing in our thinking…

1. Meds play a huge role, but shouldn’t fly solo
2. Psychosocial interventions are the best co-pilot
3. Co-occurring disorders (e.g. panic disorder + opioid dependence) are real and there will be trouble if the non-substance piece is ignored

Psychosocial Interventions

Seemed to be the best option to use the term “psychosocial interventions” instead of “therapy.” See, with the exception of co-occurring disorder situations, where, say, the depression or PTSD component require treatment, I’m not so sure formal psychotherapy is a fit. I mean, cognitive-behavioral therapy (CBT) alone in the treatment of opioid abuse/dependence isn’t especially effective.

That said, there’s still a ton of merit to face-to-face work when it addresses motivation, direction, education, frustrations, stress-reduction, family dynamics, and more.

Finally, the power of support groups looms large. After the initial stages of withdrawal, participation in a 12-step, or other, group is extremely helpful.

Medications

A variety of meds are available for the treatment of opioid abuse/dependence. And, of course, the purpose of all of them is to get one off of opioids and continue-on in recovery.

As you likely know, opioid withdrawal isn’t deadly, but it sure is horribly uncomfortable. And most folk would struggle making it through even one day without medicine. So in comes the med – substitute – and then it’s tapered-down.

 

Okay, here’s a non-all-inclusive list I constructed on drugs.com. I selected prescription meds, including off-label applications. The list is in order of popularity…

• Suboxone: A brand name for the combo buprenorphine and naloxone (Narcan). Available in sublingual tablet and film. Details just below.
• buprenorphine/naloxone (generic): Buprenorphine is an opioid receptor partial agonist that produces almost big-league opioid effects. Naloxone is an opioid receptor antagonist that blocks the effects of opioids.
• buprenorphine: Details above.
• Vivitrol: Extended-release naltrexone. Details just below.
• naltrexone: An opioid receptor antagonist that may decrease the desire to use opioids over time and decreases overdose risk. It’s not a controlled substance.
• Zubsolv: Buprenorphine/naloxone combo that works just about identically to Suboxone; however, it comes in a very small sublingual tablet. Its bioavailability is reported to be superior, which is important because quicker absorption equates to lower dose required to achieve optimal effects. And that means reduced risk of cross-addiction and unwanted side effects.
• Bunavail: Buprenorphine/naloxone combo that works just about identically to Suboxone and Zubsolv; however, it delivers its dose via film through the buccal mucosa of the cheek. Same superior bioavailabilty details as Zubsolv.
• Probuphine: Buprenorphine delivered via subdermal implant. It’s reported to provide non-fluctuating buprenorphine blood levels around the clock for six months after the treatment procedure.
• Sublocade: Long-acting buprenorphine delivered by injection. Restricted to those who have initiated treatment with a transmucosal buprenorphine-containing product and have been stabilized on dose for more than seven days.
• lofexidine: An adrenergic (adrenaline/epinephrine) receptor agonist used to reduce the physical symptoms of withdrawal. It’s not a controlled substance.

So there’s a list of med options for you. Of course, you’re encouraged to do your due diligence and openly chat with your doc.

And never, ever, ever forget, buprenorphine is an opioid. That means you can become dependent upon it, and if you get cute with dosing it can kill you.

Got it?

Let’s Wrap It Up

So, yes, the US is smack-dab in the middle of a stunningly deadly opioid crisis. No doubt we need to deal with cause. But at the same time, we have to continue to promote and teach treatment.

Hope you, or someone you know, can use these need-to-knows, and that they help. Please spread the word.

(FYI: The Zubsolv image is not an endorsement. Just thought it would be a good fit.)

Hey, hundreds of Chipur mood and anxiety disorder-related titles are standing-by. Why not dig in?