When Treatment Triggers Addiction
There is often a fine line between treatment of addiction and exacerbation of addiction when legal pharmaceuticals intended to alleviate addiction in turn become abused by non-prescribed users. The danger plays out dramatically at the neurological level. An ongoing use of opioids (medications to relieve pain such as legal pharmaceuticals Vicodin, OxyContin and hydrocodone, and also the illegal drug heroin) causes brain abnormalities to develop that restructure, or rewire, the brain to become dependent or addicted to opioid(s).
What Is the Difference Between Opioids, Opiates and Opium?
Poppy plants contain opium. Organic substances derived from opium, such as morphine and codeine, are opiates. Opium can be converted to heroin, an illegal opiate, through non-organic, synthetic processes. Opioids, such as OxyContin, are similar in molecular structure to opiates but created through a synthetic or partly synthetic process.
Whereas the drug-dependent brain can successfully respond to detoxification in as little as 30 days, the drug-addicted brain presents a much more complex treatment scenario. Pharmaceuticals have been proven to be effective in treating brain abnormalities underlying addiction, but there is an ever-rising concern that these very medications invite new addictions. These treatments can therefore have the effect of giving with one hand and taking away with the other, thus compromising the entire goal of treating addiction and alleviating the American drug epidemic.
The neurobiological factors at play with addiction treatment implicitly challenge any view that drug addiction is purely a matter of choice. A deeper understanding of the brain chemistry of addiction can garner greater compassion for the many obstacles facing people with drug addictions and also help to reduce the stigma of addiction.
The slippery slope of drug abuse is well understood in the medical community. For example, opioids activate reward systems in the brain that cause a pleasurable release of the chemical dopamine. The brain then memorizes this feeling and creates cravings for this pleasure again. After the initial stage of pleasure-seeking behavior, when tolerance and dependence have built up, drug use then becomes a matter of compulsion, and at this point, the need for both medical and psychological treatment becomes critical.
The Difference Between Legal and Illegal Uses of Opiate Treatment
A discussion on drugs prescribed for addiction treatment is a different animal from public concerns about the illegal use of prescription drugs. The former relates to neurobiology and professional efforts to perfect addiction treatment whereas the latter is another iteration of the illegal drug epidemic in America. For instance, over three million Americans have been prescribed Suboxone (pharmaceutical name is buprenorphine) for the treatment of opioid addiction, including heroin. But in 2010 alone, approximately seven million Americans unlawfully used prescription medications for non-medical purposes. Pain relievers were the most common category of otherwise lawful drugs being used unlawfully.
Not incidentally, pain relievers such as Vicodin, OxyContin and hydrocodone are opioids, and addiction treatment drugs such as Suboxone are intended to treat addictions to these opioids. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that as of 2011, approximately two million Americans abuse or are addicted to opioids, including heroin and lawful prescription drugs, such as oxycodone and hydrocodone.
The maliciousness of the problem of opiate addiction and treatment is readily apparent – the most frequently abused drugs are prescription palliative drugs, which are usually opioids, and the opioid medications used in treatment, such as Suboxone, carry a risk of addiction. The circuitry of the problem necessitates a heightened vigilance in the medical community in the prescription of legal opioids and an increased public awareness to keep Americans off this slippery slope.
The Use of Suboxone and Methadone
Both Suboxone and methadone are U.S. Food and Drug Administration-approved pharmacologic treatments for opioid dependence and addiction (other drugs, such as Subutex and naltrexone are also prescribed but less common).
The incidence of methadone use in opioid addiction treatment continues to rise; in 2011, approximately 306,000 people were treated with methadone in opioid treatment programs (OTP) compared to 227,000 in 2003.
The administration of Suboxone or buprenorphine at opioid treatment centers and non-OTPs (such as approved doctors’ offices) also continues to rise; in 2004, 1,670 patients were treated at non-OTPs and 727 patients at OTPs, compared to 25,656 and 7,020, respectively, in 2011. It is clear that the demand and need for opioid treatments continue to increase in response to growing addiction to opioids, such as heroin and a battery of lawful prescription opioid painkillers, that are consumed unlawfully.
With the street being center stage on the war on drugs, a helpful detection tool for opioids is to know their street names. Suboxone is also known as “bupe,” “stop signs/stops,” “box/boxes,” “oranges” and “sub/subs.” Methadone also goes by “dolls,” “done,” “Maria” and “jungle juice/juice.”
One key difference between Suboxone and methadone relates to their administration and distribution. Methadone is only available at certified clinics, while the Drug Abuse Treatment Act (DATA) of 2000 approved Suboxone and Subutex as the first narcotics for addiction treatment to be available at doctors’ offices. One of the reasons for the difference in availability of these treatments is that Suboxone and Subutex have a lower risk of overdose and potential for abuse compared to methadone.
It is clear that the pharmaceutical manufacturers of opioids are working to curb their unlawful consumption by taking measures such as adding chemicals like naloxone to block pleasurable effects, but to date, there are no medication treatments that promote drug abstinence without the potential for addiction in non-prescribed users.
Concerns about misuse of methadone, while entirely well founded, may not presently warrant removal of this opioid from addiction treatment. For decades, methadone has been a common form of opioid addiction treatment and often proven to have the following successful results:
- Lessens the impact of opioid withdrawal symptoms
- Diminishes cravings for opioids
- Brings the patient to a level of tolerance that curbs the withdrawal symptoms without inducing the euphoric effects of the methadone
- Sets the patient on a sustainable path to detoxification
Similarly, the wholesale removal of Suboxone is not an easily attainable response to concerns at present as the drug has proven to be a successful. Research shows that at the one-year mark 40 to 60 percent of patients in Suboxone treatment maintain sobriety. Suboxone has been proven to have the following results in treatment:
- Diminishes withdrawal symptoms
- Lessens drug cravings
- Has little to no euphoric effect (compared to methadone) due to the presence of the chemical naloxone
- Blocks effects of other opioids for at least 24 hours
Concerns with Suboxone Treatment
One of the most compelling concerns surrounding opioid treatment is the manufacture of the opioids themselves which results in the availability of these drugs to the public. For instance, incidents of emergency room visits due to Suboxone complications rose tenfold from 2005 to 2010, with 3,161 and 30,135 hospital intakes respectively. More than 50 percent of the intakes were related to non-medical use of Suboxone. In 2011, poison control center reports of buprenorphine poisoning were five times greater than the number reported in 2006. One distressing statistic relates to Suboxone and children. In 2010 and 2011, Suboxone was a drug children commonly ingested accidentally.
As Suboxone is a relative newcomer to the opioid addiction treatment market (approved in 2002), the true thrust of the problems it presents may be undetected among doctors and coroners who do not have the clinical experience or testing devices to properly screen for Suboxone abuse. Further, shortcomings in detection have assisted the illegal proliferation of Suboxone both on the streets and in prisons, which only gives Suboxone abuse problems greater momentum.
In light of the prevalence of Suboxone misuse, the following safeguards can be implemented to curb its dangers:
- Develop drug-testing apparatuses that are sensitive to Suboxone detection
- Increase training of law enforcement to detect Suboxone street sales
- Increased Suboxone prohibition in prisons
- Additional law enforcement efforts to root out doctors who engage in unlawful prescription writing of Suboxone
- Public education on children’s accidental intake of Suboxone
Concerns with Methadone Treatment
While research surveys show that Suboxone is rarely deadly, deaths resulting from methadone are alarmingly on the rise. From 1999 to 2005, methadone-poisoning deaths increased by 486 percent compared to a 66-percent increase in all deaths due to overall poisoning. Further, the percentage increase in methadone-poisoning deaths was the greatest percentage increase among all opioids, although in absolute numbers there were more deaths attributed to other opioids overall. Poison control center data from 2005 – 2006 found that 35 percent of all methadone deaths resulted from abuse. These statistics illuminate a rise of mortality rates within the opioid subset of methadone.
In light of these mortality statistics, the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services (SAMHSA) has recommended the following measures be put into place to temper the increase in methadone-poisoning deaths:
- Continuing education of medical professionals. Some methadone-poisoning deaths result from fatal drug interactions. Enhanced medical screening and intake procedures to uncover the presence of other drugs in patients would be beneficial.
- Patient education. It is important for methadone therapy patients to understand how use of other drugs in combination with methadone doses can prove fatal.
- Develop technologies to better test patient toxicity levels. Methadone is long-acting with the result that some patients build up toxicity and new dosages result in poisoning.
- For patients who dose at home, increased education. Patients are more likely to appropriately consume their take-home doses if educated on the effects of overdosing. Further, it is critical for patients to advise people in their living environment to avoid the methadone supply as use by non-users can prove fatal, especially for children who are at risk of accidental consumption.
Notwithstanding the benefits of both methadone and Suboxone, the health risks of these opioid medications remain both a private and public health concern. The drug epidemic in America presents a serious issue, and efforts to treat addiction can have the adverse effect of supplying the black market with new opioids ripe for abuse, despite the efforts of medical professionals, law enforcement and government. The facts on opioid addiction at the level of user consumption compel one conclusion: Treatment is necessary.
Find the Right Course of Treatment
At The Oaks at La Paloma, we tailor treatment to your needs or those of your loved one. We offer state-of-the-art facilities and a professional staff with extensive clinical experience. We take a holistic approach to treatment and have numerous resources to promote the healthy lifestyle we will work with you to achieve.
For more information, call our toll-free number, (877) 345-1887, today to speak with one of our admissions coordinators about how our programs can offer you the hope of lasting recovery.
 Kosten, T. et al, “The Neurobiology of Opioid Dependence: Implications for Treatment” p. 13 (2002) Research Archives. Accessed 12 June 2014.
 Anson, P. “Sharp Rise in Suboxone Emergency Room Visits” National Pain Report (2013) Accessed 12 June 2014.
Kosten, T. p. 14.
 Anson, P. “Suboxone, the New Drug Epidemic?” National Pain Report (2013). Accessed 12 June 2014.
 National Institute on Drug Abuse “Topics in Brief: Prescription Drug Abuse” (2011) National Institute on Drug Abuse. Accessed 12 June 2014.
 Substance Abuse and Mental Health Services Administration (SAMHSA) “Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011” (2013) SAMHSA Accessed 12 June 2014.
 U.S. Food and Drug Administration. “Subutex and Suboxone Questions and Answers” (2013) U.S. Food and Drug Administration. Accessed 12 June 2014.
 Stuckert, J. “How Is Suboxone Treatment Different Than Drug Abuse?” PsychCentral Accessed 12 June 2014.
 Anson, P. National Pain Report
 Sontag, D. “Addiction Treatment with a Dark Side” (2013) New York Times Accessed 12 June 2014.
 Anson, P. National Pain Report
SAMHSA “Substance Abuse Treatment Advisory: Emerging Issues in the Use of Methadone” (2009) SAMHSA Accessed 12 June 2014.