For most of the last century, the ability of doctors and treatment centers to help opiate addicts has been limited by the federal government. The “Harrison Narcotic Act” of 1914, originally designed as a tax act, was misinterpreted by the Supreme Court to prohibit the prescription of opiates to opiate addicts, even in the course of their treatment. From then on, an entire line of practice – the tapering of opiate dosage to ease the pain of withdrawal – was against the law.
METHADONE – SOLUTION OR PROBLEM?
The one exception has been methadone. When used properly, methadone can be an effective treatment for opiate addiction. However, the idea of maintaining addicts on a substitute drug led the Federal Government to restrict methadone so tightly that the drug could only be prescribed by specific clinics. These clinics vary widely in the quality of care they provide. In addition, methadone causes euphoria (a high), which has led to some addicts using methadone clinics to subsidize their opiate addiction and abuse methadone. Also, methadone maintenance clients eventually reach a point where it is nearly impossible to ever successfully detox from the methadone, because after long-term use, methadone withdrawal symptoms have been reported to be 10 times more severe than those of heroin and lasting sometimes as long as 3 to 4 months in duration, compared to the 7 to 10 days of withdrawal symptoms that an average heroin addiction can produce. The combination of these factors have proven methadone maintenance to be counter-productive in treating opiate addiction and has limited the effectiveness of methadone for detoxification purposes, as well.
SHOOTING UP, SLAMMING, INJECTING, SMOKING OR SNORTING HEROIN
There are three basic routes of administration used by heroin addicts. Injection, often called “shooting up” or “slamming heroin” in the illegal drug world, is by far the predominant method used by heroin addicts. Smoking heroin or “Chasing the Dragon” as smoking heroin using foil and a straw is known by heroin addicts, runs a distant second and sniffing or snorting heroin is rarely a heroin addicts method of choice. Ingesting heroin orally is almost unheard of.
Some prescription opioids such as Oxycontin or Dilaudid can be injected even though they come in tablet form. However, the manufacturers of more recently developed synthetic opiates such as Methadone and Suboxone have gone to great lengths in making it nearly impossible to inject them, thereby helping to minimize their abuse.
UNMISTAKABLE SIGNS OF OPIATE ABUSE AND ADDICTION
There are many signs that would indicate a person is addicted to, or at least abusing opiates. If a person is exhibiting any of the following signs, there is good cause for concern. If a person is displaying multiple signs, they should be considered red flag warnings.
Some of the more obvious signs of opiate addiction are: constricted (pinpointed) pupils, nodding out, increased activity level before nodding out, use of laxatives (heroin causes constipation), vomiting, loss of established friendships, new undesirable friends, depression, track (needle) marks on arms, sudden change in behavior, itching and scratching, weight loss, cessation of menstruation, finding bent spoons with burn marks, disappearance of spoons, stolen credit cards and checks or cash, aluminum foil with burn marks, new purchases returned for a cash refund, pawn slips found around the house, theft of household valuables, blood spots on clothing, bottles of vinegar or bleach (used to clean syringes) and little cotton balls.
SEVERE OPIATE WITHDRAWAL SYMPTOMS
Some of the more acute withdrawal symptoms associated with “Cold Turkey” heroin or opiate detox are 3 -7 days of severe muscle aches and spasms, profuse sweating, diarrhea and severe cramping caused by dehydration. Worse are the withdrawal symptoms caused by abrupt discontinuation of the use of some of the pharmaceutical opiates such as Oxycontin and particularly Methadone. These substances can produce weeks and sometimes even months of opiate withdrawal symptoms such as the sweats, muscle and joint aches, spasms, cramping, diarrhea, vomiting and dehydration leading to possible convulsions.
SUBOXONE® ELIMINATES BEDRIDDEN AGONY OF OPIATE WITHDRAWAL
The “Drug Abuse Treatment Act of 2000″ allows detox centers and physicians to minimize an addict’s symptoms of opiate withdrawal with Suboxone detox protocol. Whereas drugs like morphine, heroin and methadone are opioid receptor agonist – meaning they fully bind opioid receptors – Suboxone® (buprenorphine) is a partial opioid receptor agonist. This gives Suboxone® the ability to relieve even the acute symptoms of opiate withdrawal without producing the euphoria (high) of the full agonist drugs like oxycontin, heroin, morphine, demerol, vicodin and methadone. For the first time, physicians and detox centers can use Suboxone to provide a safe and comfortable detox for all opiate addicted patients with the capacity to comply with treatment.
Suboxone®, a sublingual tablet, comes in two dosage forms: 2 mg buprenorphine/0.5 mg naloxone and 8 mg buprenorphine/2 mg naloxone.
Because of its ceiling effect and poor bioavailability, buprenorphine is safer in overdose than opioid full agonists. The maximal effects of buprenorphine appear to occur in the 16-32 mg dose range for sublingual tablets. Higher doses are unlikely to produce greater effects.
OPIATE ADDICTION TREATMENT WITH SUBOXONE
This section provides a brief overview of the clinical use of buprenorphine (Suboxone®) for heroin, methadone and all other opiate addiction treatment.
Ideal candidates for heroin and other opiate addiction treatment with Suboxone® are individuals who have been objectively diagnosed with an opiate addiction, are willing to follow safety precautions for treatment, can be expected to comply with the treatment, have no contraindications to buprenorphine therapy and who agree to buprenorphine treatment after a review of treatment options. There are four phases of Suboxone Detox Protocol: induction, stabilization, titration and treatment.
This phase is the medically monitored startup of buprenorphine therapy. Buprenorphine for induction therapy is administered when an opiate-dependent individual has abstained from using heroin or other opiates for 12-24 hours and is in the early stages of opiate withdrawal or detoxification. If the patient is not in the early stages of withdrawal, i.e., if he or she has other opioids in the bloodstream, then the buprenorphine dose could cause acute withdrawal.
Induction is typically initiated as observed therapy in the physician’s office and is carried out using Suboxone®.
This phase begins when the patient has discontinued the use of his or her drug of abuse, no longer has cravings, and is experiencing few or no withdrawal symptoms. The buprenorphine dose may need to be adjusted during the stabilization phase. Because of the long half-life of buprenorphine it is sometimes possible to switch patients to alternate-day dosing once stabilization has been achieved.
The titration phase is reached when the patient is doing well on a steady dose of Suboxone®. Once the patient shows no sign of opiate withdrawal, the patient is then titrated (stepped-down) from the buprenorphine therapy, until he or she is drug-free. This phase replaces what is otherwise known as “detoxification”.
Effective treatment of heroin, methadone or any other opiate addiction requires comprehensive attention to all of an individual’s medical and psychosocial co-morbidities. Pharmacological therapy alone rarely achieves long-term success. Thus Suboxone® detox protocol should be combined with concurrent behavioral therapies and with the provision of needed addiction treatment services. This point is of such importance that physicians must attest to their capacity to refer patients for addiction treatment and counseling when they submit their Notification of Intent to SAMHSA (Substance Abuse and Mental Health Services Administration) before they can begin prescribing Suboxone® for the purpose of opiate detox.