By Teresa L. Jackson, MD
Director of Addiction Recovery Program
Prince, Michael Jackson, Heath Ledger, Whitney Houston, Amy Winehouse, Philip Seymour Hoffman, John Belushi, River Phoenix, Janis Joplin…the list goes on and on. It’s shocking to hear when a famous rock star or actor has died of a drug overdose.
What’s more disturbing…
- 91 people die each day in the United States from an opioid overdose.
- 33,000 people died from an opioid overdose in 2015. Half of these deaths were from prescription opioids.
- Drug overdoses are the leading cause of accidental death in the United States, ahead of motor vehicle deaths and firearms (deaths).
In the last 15 years, the number of prescriptions for opioid pain medications has quadrupled. Prescription opiates like methadone, oxycodone (Percocet), and hydrocodone (Norco and Vicodin) are the leading cause of prescription opioid deaths. The United States uses 99 percent of the world’s hydrocdone. The majority of people that use heroin started with an opiate pill. Sadly, heroin is readily available and less expensive. We are in the midst of an opioid addiction and overdose epidemic in the United States.
The best way to prevent opioid overdose deaths is to improve opioid prescribing, reduce exposure to opioids, prevent abuse, and stop addiction. Prescribing physicians must carefully regulate opiate prescriptions. Preventing abuse of prescription opiates is a combined effort between physician, pharmacies, patients, and family members. It is very important to keep all controlled substances in a secure location. Never share your prescription and always destroy the medication when it is no longer needed. Pharmacies often accept medications. In addition, they can be discarded in cat litter or coffee grounds.
Early recognition and treatment of addiction to opiates can save lives. Medication-assisted treatment (MAT) combines the use of medication with counseling and behavioral therapies. Unfortunately, behavioral interventions alone have a poor success rate in opioid addiction, with a relapse rate that is greater than 80 percent. The addition of medication to behavioral intervention greatly increases the outcomes. FDA-approved medication such as buprenorphine (Suboxone, Subutex), methadone, and naltrexone improve the success rate and decrease the associated risks of opiate addiction, including HIV, Hepatitis C, and overdose. Extensive literature and systematic reviews show that maintenance treatment with either methadone or buprenorphine is associated with retention in treatment, reduction in illicit opiate use, decreased craving, and improved social function.
Often, patients express concern about seemingly trading one drug for another. Abstinence is always an option; however, MAT allows the brain to heal from opiate dependence. The patient can concentrate on recovery without ongoing withdrawal symptoms and cravings. The brain gradually heals from opiate dependence and the medication can be slowly tapered. One of the most common fears for patients is withdrawal. The Surgeon General and government are responding to this epidemic by increasing funding for the treatment of addiction, including MAT. In addition, life-saving medications that can reverse an opioid overdose are now available to patients who are prescribed opiates and for the loved ones of patients addicted to opiates. Naloxone (Narcan) can reverse an opiate overdose. The nasal spray is easy to use and more readily available now.
Early treatment for opioid addiction saves lives. If you are concerned about a loved one’s use of prescribed opiate pain medication or use of illicit opiates such as heroin, please seek professional help. The combined use of medication, counseling, and behavioral therapies may save his or her life.
MAT: A Case Study
Jane is a 34-year-old woman addicted to heroin. She started using oxycodone in college on the weekends. She began working after college and married a man that also used oxycodone. After a miscarriage and the death of her father, Jane’s use escalated to daily use of up to 600 milligrams of oxycodone. She was spending $600 daily on oxycodone. Her drug dealer introduced her to heroin. Her use of heroin escalated to 2 grams per day. She tried stopping on her own and could not. She tried two detox programs and immediately returned to using. She was overwhelmed with anxiety and cravings without heroin. Upon admission, she was prescribed Suboxone® to help with withdrawal symptoms. Within 24 hours of her admission, her withdrawal symptoms were gone and she was feeling well and participating in groups and activities. Because Jane had been using for many years and relapsed several times after trying to stop on her own and detox, she is candidate for MAT. She was discharged on Suboxone maintenance therapy for at least six months. Suboxone®, in addition to Intensive Outpatient Treatment (IOP) and relapse prevention meetings, is the reason Jane is drug-free today and enjoying life.