BTG Fall 2018

History of help The oldest drug used in medication- assisted treatment is methadone, which has been in use in the U.S. since the 1940s, first as a pain-reliever, then as a treatment for opioid addiction. Methadone clinics usually wean clients off the drug by gradually lowering the dosage, in order to reduce the risk of relapse. The opiate-blocking drug suboxone has been an FDA-approved treatment for opioid addiction since the early 2000s. It contains buprenorphine, a drug that helps fight the symptoms of withdrawal, and naloxone, the drug used to reverse opioid overdoses. In opioid addiction treatment, suboxone is used for either short-term detox (about two weeks) or maintenance treatment. One of the advantages of using suboxone to relieve opiate withdrawal symptoms is that, unlike methadone, it works “almost immediately,”McCreary says. Before suboxone became available, librium and Klonopin were more commonly used to relieve opiate addiction symptoms, “which took five to seven days to work.”

Protocol prevents abuse The protocol for administering suboxone is designed to prevent abuse or misuse of the drug, McCreary points out.The client receives the water-soluble suboxone strip under the tongue and must remain in the office until it has dissolved. One improvement over previous generations of medication- assisted treatment programs is that most clinics require clients to also participate in group therapy to address the psychological aspects of their addiction and begin long-term recovery. Patients are also regularly tested by urinalysis to ensure they aren’t using any illicit drugs while in medication-assisted treatment. For most clients, medication-assisted treatment is intended as a short-term therapy, and should include a treatment plan developed and monitored by the physician “so the client can learn to live an abstinence-based lifestyle,”McCreary says. Vivitrol, the newest addiction treatment medication, has several advantages over methadone and suboxone. Because vivitrol is an extended-release medication, its effects last for 30 days – rather than requiring weekly or daily dosages – and it can be used to treat alcoholism. Going forward, as scientists learn more about the biology of opiate addiction, the availability and effectiveness of opiate blocker medications should continue to improve, she notes. “One of the advantages of using suboxone is that it works almost immediately.” – Melody McCreary

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