The Evolution and Future of Treating Opioid Use Disorder

When you think of opioid (painkillers, heroin, fentanyl, etc.) addiction, what do you think of? Most likely, the words and ideas that come to mind are the stereotypes featured in movies and television. This is a fundamental flaw that the United States addresses and stigmatizes an issue that is more genetically based than a lifestyle choice. Most opioid addictions start with a "harmless" prescription to address pain issues. In fact, 1 out of every 10 people prescribed an opioid will become addicted or dependent after a few months of use. This supports the general consensus throughout the medical community that addiction is a mental disease rather than a "pick your self up by the bootstraps" issue.

The most common methods of treating opioid addiction have not changed much since 1935 with the creation of the 12-Step program. Then in the 1970's, methadone, the first medication-assisted treatment, was discovered as a promising treatment option. Since the inception of 12-Step programs, they have dominated the addiction treatment industry in the United States. EVen as other developed, first-world countries moved away from these methods to more scientifically based treatments. Healthcare has been constantly evolving so why hasn't our treatment of addiction kept pace? 

There are many reasons the 12-Step movements have high recidivism rates. First, they self-report their success rates at about 50 percent; however, The American Society of Addiction Medicine states that about 10 percent of 12-Step members actually become sober and stay sober (reference 1). Another contributing factor to the decline in 12-Step's popularity has been low member retention rate (reference 2). Addiction specialists attribute the 5-15 percent retention rate to the 12-Step programs' belief that the individual is powerless over his or her addiction and must submit to a higher power. Just like any other disease, there are parts that are uncontrollable but through dedication and being proactive one has the ability to make positive decisions in managing it.

This might leave you contemplating what the alternative to 12-Step programs might be? The most successful method of addiction treatment, in terms of sobriety, relapse and retention rates, is medication-assisted treatment. Medication-assisted treatment originated with the use of Methadone for detoxing and treating opioid addiction in the 70's and has been the most-used protocol since. Methadone has success rates of 60-70 percent (reference 5) when taken correctly -- which happens rarely (reference 3) due to its high potential of being abused. Just like 12-Step programs Methadone has its fallbacks: it is involved in 1 out of 4 opioid-related deaths and dominates a large market share on the black market. Patients also must visit designated methadone clinics daily to receive their medication. These clinics are often located in high-crime areas and the process is time-consuming and can get in the way of their professional or personal lives. 

The shortcomings of methadone and 12-Step programs all led to the need for an alternative detox/treatment method and in 2002, the FDA approved Suboxone. This revolutionary drug is a combination of two drugs: Buprenorphine and Naloxone. Combining these two drugs limits the craving and effects of other opioids and fills the brain's pleasure responses to opioids with a non-intoxicating alternative which allows the patient to begin The Pathway to Addiction Independence with the least amount of resistance possible. Another benefit to Suboxone is six times safer than methadone (reference 4) due to it being a partial opioid agonist instead of a full opioid agonist like Methadone. Now, what does that mean? A full agonist means that the larger dose you take the more intoxicated you become where a partial agonist has a cap on the level of intoxication therefore, decreasing the risk and appeal of abuse. This equated to Suboxone being hailed as a more effective treatment method compared to Methadone with a significantly lower risk of an overdose (reference 5). 

The future of treating addiction is extremely exciting and promising. There are some gaps that can be filled to increase success rates in the technology and medication development fields. Apps that track a user's activities and behaviors and promote sticking to the treatment plan through rewards based on the users interests are becoming popular. There has also been an emergence of social media apps that are centered around sober living are all getting attention throughout the addiction treatment community while decreasing the stigma associated with addiction. On the medication development side, a new medication dubbed Vivitrol is making headlines. However, like every other treatment method, Vivitrol has its setbacks. For example, the user needs to be completely detoxed before treatment can commence where Methadone and Suboxone can be started as a detox aid. Possibly the most futuristic idea out there right now is vaccines that block the intoxicating effects and the possibility of becoming addicted to substances; these vaccines are in the early stages of development but, show a lot of promise. The most controversial treatment option being researched uses psychedelic drugs, like "magic mushrooms" and LSD. Both of these are currently illegal but show some evidence in helping get over addictions (as well as other medical uses like treating depression and PTSD) to many substances contrary to what the governments' classification of these drugs would lead you to believe. 

Study after study has proven that medication-assisted treatment by its self does not work for long-term recovery, that's where behavior modification therapy and counseling comes into play. Our program, The Pathway to Addiction Independence by Komedix, utilizes Suboxone combined with behavior modification therapy and counseling to give our patients the safest and most comprehensive treatment program recommended by The American Society of Addiction Medicine. However, we refuse to be complacent and always strive to be at the forefront of innovation which is why you need to stay tuned to learn about our pending partnership with an extremely reputable tech company that will increase success rates while decreasing relapse rates even further! If you or a loved one is being affected by the opioid epidemic, give me a call today at 210.842.2475 to learn more about The Pathway to Addiction Independence by Komedix.

 

References:

1. The Surprising Failures of 12 Steps. Available at https://www.theatlantic.com/health/archive/2014/03/the-surprising-failures-of-12-steps/284616/

2. Success of Narcotics Anonymous. Available at http://www.soberforever.net/addictionblog/index.php/success-of-narcotics-anonymous/

3. Methadone. Available at http://www.minddisorders.com/Kau-Nu/Methadone.html

4. Prescription Painkiller Overdoses. Available at https://www.cdc.gov/vitalsigns/methadoneoverdoses/index.html

5. A Comparison of Suboxone and Methadone in the Treatment of Opiate Addiction. Available at https://www.omicsonline.org/open-access/a-comparison-of-suboxone-and-methadone-in-the-treatment-of-opiateaddiction-2155-6105-1000248.php?aid=64527

 

Alcohol and drugs contribution to crime

Alcohol and drugs go hand in hand with crime. A whopping "1.9 million out of the 2.4 million juvenile arrests last year had substance abuse and addiction involvement, while only 68,600 juveniles received substance abuse treatment." Drug abuse is also rampant in our prison system with 50% of inmates being clinically addicted to some substance. Read more here https://www.ncadd.org/about-addiction/alcohol-drugs-and-crime