A new study conducted by Alkermes plc, developers of the drug Vivitrol, has shown evidence that the drug may hold promise for the treatment of opioid addiction. The naltrexone drug has been tested for an 18-month period.

The results were presented at the U.S. Psychiatric and Mental Health Congress. The findings were a one-year extension of a six-month study on the use of the medication Vivitrol, in which its effectiveness was determined by number of urine screenings that showed opioid-free patients. The patients were also given psychosocial treatment in addition to the Vivitrol administered.

The study’s findings also showed that the safety requirements measured during the extension study for the drug were constant between the extension and the information developed for the product’s label.

Evgeny Krupitsky,Ph.D, M.D., Head of the Department of Addictions at Bekhterev Research Psychoneurological Institute and Professor of Psychiatry at St. Petersburg State Pavlov Medical University, said in an article on Medical News Today that the strong findings confirm the safe use of the drug as an effective treatment for opioid addiction.

In addition, said Dr. Krupitsky, the drug must be used following detoxification for opioid use. The drug is the only drug so far that can be administered once a month to patients and gives recovering opioid addicts and their doctors an option outside of narcotics for treatment of a difficult condition.

The researchers found that the patients in the trial made improvements not only in the initial six-month period, but also continuing through the 18-month extension. Nearly 50 percent of the participants, following treatment for six months with Vivitrol, were able to remain opioid-free for the entire year of the extension study.

The study’s extension also measured how patients responded to the medication in terms of cravings, quality of life, and opioid use, based on reports from the patients.

The study’s findings show that there were minimal levels observed of adverse actions as well as a small rate of pain at the site of injection, in addition to no reports of reactions at the injection site. The findings also show that no participants declined to continue the study through the additional twelve months due to significant negative reaction. The adverse effects most often reported were an occurrence of toothaches and influenza.

Long-Term Trial of Opioid Dependence Successful is a post from: Drug Addiction Treatment

Vivitrol is a time-release version of naltrexone, which blocks the brain’s opiate receptors, eliminating the “reward” one normally experiences from taking opiates. Without the reward, cravings for the drug decrease dramatically.

A small study in Russia found that Vivitrol was 50 percent more effective than a placebo in keeping opiate addicts off drugs for five months. Naltrexone has previously been used to treat alcoholism.

The FDA’s approval will make it considerably easier for people to obtain the drug, as currently most insurance companies don’t cover the cost of the $1,000 monthly shot, and treatment can take a year or more. Naltrexone in pill form can be less effective for longer-term treatment, as people can just stop taking the drug.

Doctors note that Vivitrol won’t be successful alone—it needs to be combined with other forms of treatment, including counseling.

Source: CNN, FDA Okays Drug to Fight Opiate Addiction, October 12, 2010

FDA Approves Vivitrol for Opiate Addiction Treatment is a post from: Drug Addiction Treatment

The Drug Abuse Warning Network (DAWN) provides monitoring of drug-related emergency department visits in the United States. In 2008, nonmedical use of pain relievers was a leading form of drug abuse in the United States among persons aged 12 years or older, second only to the use of marijuana.

Narcotics, or opioids, are pain relievers that are chemically derived from opium. DAWN reports use of the drug when it is being taken differently than prescribed by a doctor.

In 2008, the rate of admissions for the nonmedical use of narcotics pain relievers rose 111 percent, from 144,644 to 305,885. Both male and female patients doubled, as did cases of patients younger than 21 and those 21 and older.

There was also an increase of particular types of narcotics used for nonmedical purposes, including oxycodone products, hydrcodone products, methadone, morphine products, fentanyl products and hydromorphone products.

Emergency department visits related to oxycodone products increased by 152 percent. Hydrocodone products were increasingly used by 123 percent and methadone was increased by 73 percent. Hydromorphone showed the largest increase at 259 percent, but the number of visits related to hydromorphone was minor relatively compared to the other types of narcotics used.

The results reported by DAWN show that between 2004 and 2008 there was a significant difference in the number of medical emergencies that were related to nonmedical use of narcotics. Visits related to certain types of narcotic pain relievers, such as hydromorphone, increased dramatically over the course of the study.

Over the five year period of DAWN monitoring, it is clear that nonmedical use of narcotic pain relievers is a growing problem. Six major types of narcotic pain relievers showed significant increases, indicating that narcotics are widely misused.

The findings of the study show that there is a need for increased education about the misuse of narcotic pain relievers. Individuals prescribed the narcotic need to be cautioned about the risk of dependence and signs of an increased tolerance level to the drugs.

In addition, medical personnel need to be educated on how to watch for signs that a person may be misusing their narcotic pain reliever. Careful monitoring is needed for patients on narcotics to prevent the misuse or overdose of opioids.
 

Emergency Department Treatment of Nonmedical Narcotic Use is a post from: Drug Addiction Treatment

An opioid is a chemical that binds to opioid receptors, located in the brain and spinal cord and the gastrointestinal tract. Opioids produce natural painkillers, like endorphins, and can be derived from the poppy plant (opium) or manmade, such as codeine. Opioids are commonly abused and opioid addiction is now recognized as a treatable medical disorder of the central nervous system. Widely abused opioids are oxycodone, hydromorphone and hydrocodone, and pharmaceutical names include OxyContn, Vicodin, Percocet or Lortab.

When frequently exposed to certain chemicals, especially those found in illicit drugs like opiates, the body tries to maintain a sense of balance. When this balance is disrupted because the drug is removed, the symptoms of withdrawal occur. It’s difficult to clearly determine how many Americans are currently experiencing drug withdrawal, but the number may approach 4 million.
For many users, the opiates bring a sense of euphoria and have a tranquilizing effect. However, over time, people who abuse opiates will experience a stopping of endorphin production. This is caused by damage to the brain’s nerve cells. Eventually the user becomes dependent on the opiates to produce endorphins because the body can no longer carry out the task. Many patients feel unable to stop abusing the drug because of extreme cravings and its addictive nature.

Patients seeking treatment for opioid abuse may present similar symptoms as other mental disorders, making a clear diagnosis challeging. Withdrawal may seem like a bad case of influenza: sneezing, fatique, diarrhea or vomiting. Leg or abdominal cramps, chilling or goosebumps and pupil dilation may also be present. Though violent mood swings and anxiety may occur, unlike other drug withdrawal symptoms, hallucinations and seizures are not likely to occur.

Withdrawal length varies based upon type of opioid used. Heroin withdrawal may last up to ten days and peaks between 36 hours and three days. For methadones, withdrawal can last two weeks and peaks at around 72 to 96 hours. Patients recovering from opiate addiction may also be at higher risk for HIV or illnesses connected to AIDS, such as pneumonia.

In 1997, the Waismann Method of Accelerated Neuro-Regulation was developed and has treated thousands of patients successfully. During this hospitalized treatment, medications are administered to flush the opiate receptors while the patient is asleep under mild anesthesia. Typically, patients will see a faster withdrawal process and can be released in less than a week. Follow-up treatment includes drugs to stop the body’s cravings for opiates under careful observation.

Due to potentially life-threatening health risks, experts recommend opiate addicts recover in a professional detoxification program under medical care, preferably certified for addiction recovery. Most patients will also need further treatment once detoxification has been completed. Due to the highly addictive nature of the drugs, many may return to the opiates for a second cycle.

Opiate Withdrawal Syndrome Recognized as Medical Disorder is a post from: Drug Addiction Treatment

Opiate withdrawal can be a miserable experience, with symptoms including agitation, muscle aches, vomiting, and extreme discomfort. The symptoms usually subside after about a week, but for some they could persist for several months. Individuals may also experience craving for the drug for years after withdrawal.

Two medications are approved for use with opioid addiction. Methadone and buprenorphine are commonly offered to offset the effects of opioid withdrawal. Only 8 percent of all substance abuse treatment facilities offer this kind of treatment.

In order to offer methadone or buprenorphine to combat opioid withdrawal symptoms, the facility must be a certified Opioid Treatment Program (OTP). Individual physicians may also enroll in specialized training to prescribe buprenorphine addiction products in their practices.

According to a recent survey by the National Survey of Substance Abuse Treatment Services, facilities that specialized only in opioid treatment are more likely than other types of treatment centers to be operated by a private for-profit organization (92.9 percent versus 83.3 percent).

Most OTPs are located in a metropolitan area, with 44.8 percent of those specializing only in opioid treatment located in a large central metropolitan area.

According to the survey, facilities that specialized only in opioid treatment were also more likely to focus specifically on substance abuse, instead of a mix of substance abuse and mental health treatment.

Counseling is an important component of recovering from an opioid addiction and getting past withdrawal symptoms to avoid a relapse. Almost all of OTPs (99.6 percent) specializing in opioid treatment provided individual counseling to their clients. The most used types of therapy were substance abuse counseling and relapse prevention.

Facilities offer a variety of options for payment. Almost all OTPs accept cash or self payment, but those specializing specifically in OTP are less likely to accept other types of payment or have sliding fee scales or free treatments for those who cannot pay.

It is clear from the information gathered in the survey that facilities specializing only in OTPs may be limited in the facets of treatment they can offer clients who struggle in more than one area of substance abuse or mental disorders.

It is very helpful for healthcare providers and counselors to have the information from the survey so that they are informed about the many types of care available. With this information, referrals can be made to ensure the best possible fit for those undergoing the uncomfortable process of opioid withdrawal.

Opiate Withdrawal is a post from: Drug Addiction Treatment

No One Starts Out Trying to Abuse Drugs

Unless someone is deliberately suicidal, they generally don’t start out trying to abuse drugs. Drug abuse, dependence and addiction occur over time. And, no, it isn’t just illegal drugs that cause addiction. Millions of Americans are addicted to one or more prescription drugs. What typically happens is you have some medical problem and you go to your doctor to find out what it is and what can be done about it. Let’s say you fall and hurt your low back. This is common enough and certainly something we can all relate to. The doctor asks some questions such as how long you’ve had the condition, what brought it on, where the pain hurts, when does it hurt most, what type of pain is it, and other questions. He then performs a physical examination and orders X-rays. Since you’re in pain, he gives you a prescription for a painkiller, an opiate.

Opiates are narcotics, and because they have a high potential for addiction, they are generally prescribed for only 1 to 2 weeks. Depending on the level of pain, your doctor may prescribe varying strengths of opiate. Some of the more common are:

• Codeine (Tylenol-3)
• Fentanyl (Actiq)
• Hydrocodone (Vicodin, Lortab, Norco, Panlor)
• Methadone (Dolophine, Methadose)
• Morphine (MS Contin, Oramorph SR, Avinza)
• Oxycodone (OxyContin, Percocet, Percodan, Percolone)
• Propoxyphene (Darvocet-N)

You take the medication for the prescribed period, but find that you still have pain. You may go back to the same doctor or see another one and repeat the same procedure. What you’re looking for is a new prescription for another painkiller. The problem with this is that you are contributing to your own addiction.

According to WebMD, opiates are not intended to be taken until all the pain goes away. Their intended use is just to get patients through the most severe pain. By continuing to take opiates, you risk dependence and addiction. Long-term abuse of opiates leads to potentially severe withdrawal symptoms when you suddenly stop taking them.

What happens after you’ve been taking opiates, or some other prescription drug with a high potential for addiction, and you realize you’re hooked? You certainly didn’t want to become dependent on the drug, but once you are, you’re in for a difficult time getting off your dependence.

One Plus More Doesn’t Mean Better

If you have a nagging pain that sometimes becomes acute and you have a prescription from your doctor in the medicine cabinet, it’s tempting to pop more than one pill to make the pain go away faster. At least, that’s what you tell yourself. The truth is, however, that taking more than the recommended dose does not make it better. In fact, it could lead to complications that may be uncomfortable, dangerous, or potentially life threatening.

Watch Out for Drug Interactions
Many Americans, especially the elderly, take multiple prescription medications on a daily basis. It’s not uncommon for a diabetic woman in her 80s, who also suffers from heart disease, high blood pressure and early Alzheimer’s, to be taking insulin, a blood thinner, blood pressure medication and several more medications. Recent studies show that the average person over 65 takes between two and seven prescription medications daily.

Some people who regularly take numerous medications have a system to ensure they take their pills in the right order and at the right time. This may be a pill container with pills portioned out for each day, or pill bottles lined up on the kitchen counter in the order they are to be taken, bottles numbered in sequence, ribbons tied around some, markings made with multi-colored felt tip pens on others. In short, it’s a mixed bag. The trouble is, mistakes happen all the time.

Grandma forgets that she already took her heart medicine this morning, so she takes it again, along with her lunch and a few more medications she usually takes at that time. Grandpa complains that somebody stole his medication because he knows he didn’t take it and the pills don’t add up right. He takes his medicine a second time. Both of these examples illustrate what can happen with the elderly due to forgetfulness, confusion, difficulty concentrating or other problems associated with aging.

The risk for drug interactions, along with food/drug interactions and side effects, increases with such mistakes. Some medications, when taken out of sequence or in combination with other medications, may not work or may result in dangerous side effects. It’s an unfortunate fact that most adverse drug reactions reported each year involve people older than 60.

Never Mix Drugs and Alcohol

This should be a no-brainer, but it isn’t. Despite printed warnings on prescription labels, warnings on TV advertisements for medications, numerous newspaper, TV and Internet stories about the dangers of mixing drugs and alcohol, people still do it.

According to Harmful Interactions: Mixing Alcohol with Medicines, a publication from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), of the National Institutes of Health (NIH), mixing alcohol with medications puts you at risk for dangerous reactions. Here are just a few of the many conditions for which medications are commonly prescribed and the interactions of those drugs with alcohol.

• Allergies/colds/flu – drowsiness, dizziness, increased risk for overdose
• Angina (chest pain), coronary heart disease – rapid heartbeat, sudden changes in blood pressure, dizziness, fainting
• Blood clots – occasional drinking may lead to internal bleeding; heavier drinking may cause bleeding or have the opposite effect, resulting in blood clots, strokes or heart attacks
• Diabetes – abnormally low blood sugar levels, nausea, vomiting, headache, rapid heartbeat, sudden changes in blood pressure
• High blood pressure – dizziness, drowsiness, fainting, heart problems (such as arrhythmia, changes in the heart’s regular heartbeat
• Muscle pain – drowsiness, dizziness, increased risk of seizures, increased risk for overdose, memory problems, impaired motor control, slowed or difficulty breathing

Know who is taking what

How many individuals are in your household? How many of them are regularly taking prescription medications? Who dispenses the medication? Do you rely on the individual to self dispense, or do you make it a practice to remind them or put the medicine out for them to take?

The reason these questions are important is that it is so easy to lose track of who’s taking what and for what condition. Without some system of oversight, there are bound to be dosing errors, medication not taken at the proper times or at all, or medicines taken together that shouldn’t be. Someone has to take responsibility for this. Who is it in your house?

If there are only two adults, say a husband and wife, you’d think that each person should be able to handle their own medication schedule. That’s true to a point. But what often happens is that one person is usually the one to order and pick up prescription refills so that ongoing prescriptions don’t run out. The other person, who may be taking the medication, just follows his or her daily routine of taking it. It would be logical for the one who orders the medications to somehow keep tabs on all the medications in the household. In other words, institute a tracking system for who’s taking what.

Take an inventory, marking what medications are for what condition, how often the medicine is to be taken, who takes it, when it should be taken, and anything else pertinent. Once this is in place, it becomes easier to notice gaps, or something out of the ordinary.

Knowing what medications your loved one is taking will also help you to be able to quickly spot a potential drug interaction – with another drug and/or food. And, if some new medications are introduced, keep a close eye for any indications of side effects.

Mind Expiration Dates

Never permit outdated medications to remain in the medicine cabinet or anywhere else. While some medications may be effective for some period of time after their expiration date, it’s not a good idea to take the chance. This is especially true for life-saving medicines for heart conditions, diabetes, and other conditions.

Go through the house today and toss out all expired medications. If some of these are still necessary, contact your doctor to get a new prescription. Write the expiration date of the newly-obtained medication on the tracking list along with other pertinent information.

Ensure Safety Precautions

While we’re on the subject of inventory and expiration dates, here’s another important tip. If you have young children or teenagers in the house, or if your elderly parents or other relatives live with you, take appropriate safety precautions for all medications. Keep them locked up in a medicine cabinet.

Does this sound extreme? You may be surprised to know that teenagers say the easiest way to obtain prescription medications – that they take for non-medical purposes – is to simply raid their parents’ medicine cabinet or one at the home of their friends. Eager to experiment, test the bounds, fit in with the crowd, and take risks, adolescents and teens gravitate toward this “open candy store” pharmacopeia. Alcohol is often involved and the results can be catastrophic. Mixing prescription drugs used for non-medical purposes with alcohol can lead to impaired driving, overdose, seizures, increased heartbeat, increased blood pressure, stroke, unconsciousness, coma and death.

Ask for Pharmacist Consult

Whenever you get a new prescription, ask for a consult with the pharmacist. Inquire what potential side effects this new drug has, and how it may interact with other medication you or someone else you’re getting the prescription for takes. Of course, the best practice is to have all your prescription drugs filled at the same pharmacy. If you do most of your ongoing prescriptions through a mail-order pharmacy, contact their customer service department and speak with a pharmacist to ask the appropriate questions.

End Date

Surely none of us wants to go on taking medication forever. Even if we have an ongoing condition, the possibility exists that the doctor can reduce the strength or frequency of a prescription. He or she may even recommend we stop taking it at a certain point.

Make it a practice to ask your doctor how long you’ll need to take this medication. Bring in your list of medicines that you currently take and go through each one with the doctor. This is especially important if you’ve obtained prescriptions at other doctors. Your primary doctor should advise you on the protocol for keeping, reducing, changing or quitting medications. This may be done in consult with the original prescribing doctor.

Take Charge of your Health

There’s no better way to keep on top of what to expect than to be proactive. It’s up to you to become knowledgeable about the medicines you take, how they may affect you, how they can interact with other prescriptions, over-the-counter drugs, food and/or alcohol. It’s also important that you know your body and be alert to signs that something’s wrong.

Don’t just take medication like it’s a vitamin. Medicines are very powerful. They can, in some instances, and when taken correctly, mean the difference between life and death. When taken without regard for the dangers, or abused and taken to the point of dependence and addiction, they can also mean the difference between life and death – in this case, unintended.

Know that addiction to prescription drugs can easily sneak up on you if you’re not paying attention to the signs. Take as little medication as you need for the shortest period of time. If you find that you do get into trouble, feeling a dependence on the prescription drug, seek medical attention and counseling.

Bottom line: be smart about prescription addiction. The life you save may be your own (or that of your loved one).

Be Smart About Prescription Addiction: What You Don’t Know May Kill You is a post from: Drug Addiction Treatment

Dr. Sack explained that Suboxone is one of two forms of the medication buprenorphine, which was originally developed to treat pain. Suboxone binds to the opiate receptor in the brain and suppresses pain in the same way that opiate drugs like morphine, heroin, and other opiates do. However, as the dosage increases, Suboxone blocks the opiate receptor and doesn’t allow it to be stimulated. Unlike Subutex, the other form of buprenorphine, Suboxone contains naloxone, which blocks the effects of opiates when injected intravenously.

Put simply, Suboxone acts like other opiates but blocks the level at which someone can experience euphoria, making it impossible for someone to get high from other opiates like OxyContin, heroin, codeine, morphine, and Vicodin. This way, clinicians can use Suboxone to block the withdrawal symptoms without having to worry about the client relapsing. In addition, the naloxone prevents people from getting high on Suboxone by injecting it rather than taking it sublingually.

Dr. Sack explained that 25 to 30 percent of Promises clients are dependent on opiates and that about two-thirds of those clients also abuse other drugs. At Promises, Suboxone is usually used for 3-4 days, but can be used for up to 14 days depending on the severity of the dependence. Once a person starts exhibiting withdrawal signs, he or she is given Suboxone and the withdrawal symptoms are stopped within 12-15 hours.

When asked if Suboxone itself is addictive, Dr. Sack said, “Drugs that have the greatest addiction potential have short half-lives and are absorbed quickly into the brain. Suboxone has a very long half-life and takes a while to reach the brain, so it has a much lower addiction potential. People can and do take Suboxone recreationally, but doctors just need to manage people to make sure they use it correctly. In addition, the euphoric feelings that come with Suboxone are much less intense than other opiates because of its long half-life, so people are less likely to abuse Suboxone.”

Suboxone is approved for maintenance like methadone, but Promises doesn’t use it this way. “For most people who are dependent on opiates and other drugs or alcohol, the goal of recovery is to be off drug completely, so staying on methadone or Suboxone for maintenance kind of defeats the purpose,” Dr. Sack said. He acknowledged that some opiate users will benefit more from maintenance treatment but that the ultimate goal is to get them off of drugs completely.

The advantage of using Suboxone instead of methadone is that if someone does use street drugs while taking Suboxone, it’s very unlikely for that person to overdose. In addition, methadone can only be dispensed from a methadone clinic, and patients must visit the clinic every day to get their dose. Suboxone, however, can be prescribed by a physician.

Of Suboxone’s efficacy, Dr. Sack said, “Data shows that buprenorphine is 50-100% more effective than other available treatments such as clonidine, and that a higher percentage of people who use buprenorphine complete their withdrawal. For maintenance treatment, the results are similar to methadone in that about 60% of people who are given maintenance treatment with buprenorphine stay on the treatment and don’t use illicit drugs while they’re on it.”

Suboxone: Safe, Comfortable Withdrawal from Opiates is a post from: Drug Addiction Treatment

Buprenorphine is a medication that virtually stops withdrawal symptoms from opiate drugs such as heroin, methadone, Vicodin, OxyContin, codeine, and morphine. Many people find it extremely difficult to recover from opiate addiction because the withdrawal symptoms are so severe, so buprenorphine ameliorates the process.

At Tompkins, opiate-dependent prisoners are started on buprenorphine about one month prior to their release date, given a 30-day supply as they leave, and then linked to a licensed provider for continuing care. New inmates can also be given the drug to help with detoxification when they first arrive. The facility’s mental health director, Dr. John Bezirganian, started the program a few years ago.

Tompkins County is the only jail outside of New York City to offer such medication-assisted therapy, and the only one in the state to use buprenorphine. Rikers Island in New York City offers short-term detoxification treatments with methadone, a drug used to help wean heroin addicts off the drug. However, methadone is controversial due to its addictive nature.

Buprenorphine, however, is not addictive. No matter how much one takes, he or she will only get 20-30 percent of the effect of a full dose of heroin or morphine. In addition, if a person taking buprenorphine tries to take heroin or another opiate, he or she won’t be able to get high. Unlike methadone, buprenorphine has no street value and can be prescribed by a primary care physician. (People using morphine must go to a licensed dispensary every day to get their dosage.)

Dr. Bezirganian said he manages many of the buprenorphine cases himself, both in jail and in the community, and that it seems to be effective. Though not all inmates prescribed the treatment continue with it upon their release, many of them do, and Bezirganian said he believes it have saved more than one life.

“It’s a highly risky time when people leave a jail. If they return to their environment, there is a high risk of accidental overdose, and relapse in general,” Bezirganian said. “This way, at least they have a shot at choosing recovery.”

In November 2006, the New York State Commission on Correction notified county sheriffs and jail administrators of new federal regulations permitting easier administration of buprenorphine, and said that safe and effective opioid withdrawal treatment in jail is part of the generally recognized standard of adequate medical care. However, Tompkins is the only jail that provides this therapy.

The Human Rights Watch report said that the other 56 New York counties could correct this problem immediately, adding that punishment for drug use in New York State prisons is severe and out of proportion to the seriousness of the offense.

Prisoners who may be drug dependent are punished for symptoms of a chronic, relapsing disease,” it said. “Drug dependence treatment is withheld from prisoners who may need it as part of the disciplinary sanction.”

New York Prison Lauded for Opiate Addiction Treatment Program is a post from: Drug Addiction Treatment