Medical experts consider alternative therapy to combat opioid epidemic
The National Institute on Drug Addiction estimates that more than 90 Americans die each day from opioid drug overdoses.
In Connecticut, more people are dying of drug overdoses than from homicides, suicides and motor vehicle crashes combined, according to the Office of the Chief Medical Examiner.
In 2016, 917 people died of accidental drug overdoses in Connecticut compared to 87 homicides, 387 suicides and 319 motor vehicle accidents.
The medical examiner’s office reports there were 538 overdose deaths in Connecticut during the first half of 2017, more than half of which involved some form of opioid. That number, the office projects, could climb to nearly 1,100 deaths by the end of the year.
Solution or substitution?
In the face of rising opioid deaths, some medical experts are advocating the use of methadone and buprenorphine — both opioid replacement therapies — to treat opioid addiction.
“There is absolutely no cure, right now, for addiction,” said Dr. Yngvild Olsen, medical director of the Institutes for Behavior Resources and REACH Health Services in Baltimore, Maryland. “There’s no magic bullet that’s going to work for everybody. But there can be lifelong management and people can do that in different ways, depending on the severity of their addiction.”
Effective treatment of opioid addiction, Olsen said, “often combines the use of medications,” such as methadone or buprenorphine, and “behavioral intervention.”
Olsen and Dr. Robert Newman, president emeritus of Continuum Health Partners — a New York organization that helps diagnose patients who have an opioid-use disorder — and director of The Baron Edmond de Rothschild Chemical Dependency Institute of Beth Israel Medical Center, advocated for opioid replacement therapy during a recent lecture at the Hilton Stamford.
“No treatment of opioid addiction in the last 50 years has been as capable of attracting patients, of retaining patients and of helping patients as methadone,” Newman said. “What methadone does in most people is it reduces the craving for opiates.”
Dr. John Douglas, service chief of the Outpatient Addiction Program at Silver Hill Hospital in New Canaan
and a fellowship-trained addiction psychiatrist, said opioid replacement drugs reduce the probability of relapse, thereby reducing the risk of death.
“The reality with opioid addiction is that most people will relapse without taking a maintenance medication, and that relapse is usually very unforgiving and often results in death,” he said.
“The opioid replacement therapies help treat a person’s craving and physical withdrawal symptoms so they can break the cycle of drug seeking and engage in treatment,” Douglas added.
Though there is some risk that patients could abuse methadone or buprenorphine, Douglas said “they’re not as fast-acting as heroin or the other opioid drugs that people tend to abuse,” making them “less abusable than fast-acting opioids that people would prefer to use when trying to get high.”
Focus on treatment
“The focus has to be on those who are dealing with addiction today and those who do not have access to treatment,” Newman said. “As long as methadone and/or buprenorphine are not a widely available to treat addiction, more people will continue to die.”
According to the Substance Abuse and Mental Health Services Administration, methadone works by changing how the brain and nervous system respond to pain. It lessens the symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs.
Starting in the 1950s, Newman said methadone was widely used in the United States to treat opioid addiction. As communities saw positive results, Newman said clinics opened across the country to combat the increasing abuse of heroin and other opioid drugs.
Then came the controversy.
“The efficacy of methadone has been repeatedly shown to be beyond any question,” Newman said. “And yet has been rejected over the course of the last 40 years by medical professionals and by politicians, and it continues to be rejected, because methadone has been mischaracterized as a crutch or substitute drug rather than a means of saving lives.”
As the belief mounted that methadone substituted one addiction for another, Newman said funding for clinics decreased and many closed their doors, sending recovering addicts back to the streets looking for a fix.
“It’s just inconceivable,” he said. “And it’s based on this false notion that all we’re doing is substituting one drug for another.”
Until public perception changes and policymakers view methadone funding as a priority, Newman said the country’s opioid crisis will continue.
But that’s not all that needs to change, Olsen said.
Though addiction is characterized as a chronic disease, Olsen said the medical community and insurance companies treat addiction as an acute problem, only offering short-term solutions.
“We have people go through detox and that’s it,” she said. “Insurance companies may pay for 60 days or 90 days or 120 days of treatment and that’s it. That may work for a broken leg, but that’s not going to work for a chronic disease such as addiction.”
Olsen said until addiction treatment is viewed as a condition that requires lifelong maintenance, addicts will continue to struggle in their recovery.
In his practice, Douglas said he recommends patients take methadone or buprenorphine once a day for at least one year.
“Evidence shows the longer people take these maintenance treatments, the better they do,” he said. “There is no time restriction as to how long a patient can take them.”
After a year, Douglas said a patient may re-evaluate taking the opioid replacement drugs, but discontinuing the treatment does come with a risk of relapse.
In addition to the medication, Douglas said therapy and participating in support groups such as Alcoholics Anonymous or Narcotics Anonymous are crucial components to learning how to maintain sobriety.
“None of these drugs on their own are going to cure the problem,” he said. “These substances need to be used in tandem with a treatment program and while working on constructive coping skills that don’t involve abusing drugs.”
“We know what can help,” Olsen said. “From decades of research, we know that the benefits of treatment that includes a medication for opioid addiction, reduces the risk of HIV infection by about six-fold, it reduces the risk of inflectional hepatitis B and C, it increases rates of employment, decreases crime, decreases loss of life and, most importantly, it reduces the risk of overdose. And that to me right now, in the era of fentanyl where we are losing all of these people — our neighbors, our friends, our family members — that is imperative No. 1.”