30 Sep Buprenorphine Use in Hospital Helps Get Addicts Into Treatment
Addiction specialists can use a medication called buprenorphine to help people enrolled in treatment for opioid addiction. However, substantial numbers of people addicted to opioids never enter treatment. In a study published in June 2014 in the American Medical Association journal JAMA Internal Medicine, researchers from five U.S. institutions looked at what happens when an opioid-addicted individual first receives buprenorphine treatment while in a hospital for other medical reasons. These researchers concluded that initiation of addiction treatment in a hospital increases the likelihood that an affected person will enter an appropriate program and decrease his or her involvement in opioid use.
Opioids and Opioid Addiction
Opioids are a wide range of legitimate medications and illegal drugs that trigger mind alteration and pain reduction by accessing naturally occurring sites in the brain and body called opioid receptors. Well-known and widely distributed opioid medications include oxycodone, morphine, codeine and hydrocodone. Well-known illegal opioid substances include heroin and opium. People in the U.S. abuse prescription opioids more than any other medications, the federal Substance Abuse and Mental Health Services Administration reports. This same agency reports that heroin use among non-incarcerated and non-homeless Americans has effectively doubled since 2007. The rate of use is almost certainly even higher among incarcerated and homeless individuals.
Like all classic forms of substance addiction, opioid addiction stems from repeated increases in a key chemical inside the brain’s pleasure center. Eventually, chronically heightened levels of this chemical will create changes in brain function that lead to the development of physical opioid dependence. In turn, physically dependent people who abuse an opioid drug or medication have very strong chances of transitioning to an addicted state that involves unchecked opioid intake, recurring urges to consume more opioids, the need to consume ever-increasing amounts of opioids in order to feel “high” and the appearance of opioid withdrawal when intake does not meet the brain’s expectations.
Buprenorphine is an opioid substance that has a much weaker effect on the brain and body than commonly abused opioid drugs or medications. Physicians exploit this relative weakness by using the medication as a temporary or long-term substitute that allows an opioid addict to stop uncontrolled substance intake without falling into a severe state of withdrawal. Buprenorphine is especially useful because, unlike some other opioid-based addiction treatments, it can be prescribed in a doctor’s office rather than in a specialized facility. This means that physicians who don’t focus their practices primarily on addiction-related issues can prescribe the medication in a generalized hospital setting.
Usefulness of Hospital Prescriptions
In the study published in JAMA Internal Medicine, researchers from Boston Medical Center, the Boston University School of Medicine and three other institutions used an examination of 139 adults seeking treatment for a separate medical issue to explore the usefulness of prescribing buprenorphine in a non-specialized hospital environment. All of the participants were affected by opioid dependence/addiction and had a history of opioid drug or medication abuse; none of the participants was enrolled in a treatment program for opioid-related issues. Half of the study participants received buprenorphine while in the hospital; the other half detoxified from opioid use but did not receive buprenorphine.
The researchers compared the rate of entry into opioid treatment among both groups one month, three months and half a year after hospital discharge. They also compared relative changes in ongoing patterns of opioid abuse. At some point during the six-month period following hospitalization, fully 72.2 percent of the participants who received buprenorphine entered a buprenorphine-based treatment program; conversely, only 11.9 percent of the participants who did not receive the medication entered such a program. At the time of the final study follow-up, 16.7 percent of original buprenorphine recipients remained active in treatment; only 3 percent of the non-recipients remained in treatment. In addition, in the one-month period prior to the final follow-up, the participants who first received buprenorphine while in the hospital had significantly lower rates for opioid abuse than the participants who only detoxified while in the hospital.
The study’s authors concluded that people affected by opioid dependence/addiction who receive buprenorphine in a hospital while not enrolled in an opioid treatment program have substantially increased odds of later entering treatment and reducing their opioid intake. However, they also note the fact that, after entering treatment, large numbers of individuals who first received the medication in a hospital do not remain involved for extended periods of time.
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