methadone maintenance for narcotic addiction

How Methadone Maintenance Became The First Pharmacological Treatment For Narcotic Addiction

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During the 1960s, there was a surge of heroin abuse in this country. So much so, in fact, that it became a public health problem. During those days, addiction was seen as a lifestyle choice associated with criminal and antisocial behavior. In 1962, however, Vincent P. Dole, a Rockefeller researcher, started to look at it as an unresolved health problem as part of his role as New York City’s Health Research Council’s chairman. He was the first to propose that addiction is a disease, and particularly a metabolic disease that manifested in behavior.

“The most important principle to recognize is that addiction is a medical disease. And, as a medical disease, it’s the responsibility of the medical profession.”

So committed was Dole to understanding the problem that he made it the sole focus of his laboratory research. Prior to this, his focus was on metabolism and obesity. However, he felt he needed to devise a pharmacological approach to treating the chronic illness of heroin addiction. This eventually resulted into the development of the Methadone Maintenance Treatment, or MMT.

The Development of MMT

By the end of 1963, Dole attracted clinical investigator Mary Jeanne Kreek and psychiatrist Marie Nyswander to his research project. Together, they conducted a study of heroin addiction at the Rockefeller University Hospital. Within six months, they understood the potential of MMT, moving away from the concept of using methadone for short term detox option only.

What the team’s study showed was that there are a number of key benefits of methadone maintenance treatment. “It’s not a perfect medication, it’s not without side effects, and it’s not for everyone – but methadone maintenance treatment (MMT) offers significant advantages over the use of heroin or the illicit abuse of prescription opiates. If you or someone you love needs help for an opiate addiction, methadone maintenance treatment deserves consideration.”

Specifically, the study found that:

• Methadone reduces heroin cravings.
• Methadone stops withdrawal symptoms.
• Methadone is non-euphoric, meaning people do not get high from it. This effect is known as “narcotic blockade”.
• Methadone only needs to be taken once per day.

The study conducted by Dole and his team was repeated by others with similar results. Long term studies were also conducted, and those were pivotal in the FDA approval of the drug in 1972, which was when methadone started to become an official treatment option.

“For nearly three decades, methadone hydrochloride (6-dimethylamino-4, 4-diphenyl-3-heptanone hydrochloride) has been the primary means of treating opiate addiction. Approved by the Food and Drug Administration (FDA) in 1947 for analgesic and antitussive uses, methadone was shown to be effective in treating opiate addiction in the mid-1960s and was approved by FDA for this use in late 1972.”

Of interest is also the fact that Mary Jeanne Kreek developed a method to analyze and measure levels of opioids and methadone in the blood and tissue. It was this that enabled researchers to understand the long-acting properties of the drug. The team truly changed the way addiction is treated.

Did They Do Enough?

Today, MMT continues to be controversial. That said, it is also accepted as the most effective form of addiction treatment. Additionally, the trend and use of Methadone is increasing.

“While the number of facilities with OTPs has remained constant at around 1,100 to 1,200 since 2003 (8 to 9 percent of all substance abuse treatment facilities), the number of clients receiving methadone on the survey reference date increased from about 227,000 in 2003 to over 306,000 in 2011.”

It is believed that around one million people around the world now use MMT to help combat their opiate addiction. While this is just a fraction of the number of people who suffer from an opiate addiction, this is mainly due to barriers to access the treatment, rather than due to the ineffectiveness of MMT.

For their work, Dole and Nyswander received the first ever National Drug Abuse Conference annual award in 1978. By 1982, the New York Urban Coalition, the Committee of Methadone Program Administrators, and the New York State Division of Substance Abuse Services started the Nyswander-Dole Award, which continues to be hosted by the American Association for the Treatment of Opioid Dependence (AATOD), Inc.

Medication-Assisted Treatment

“AATOD has been the number one advocate, resource, and trainer for the field of medication-assisted treatment for opioid addiction since its inception. Given today’s challenges, that role is more important than ever and AATOD continues to enthusiastically accept those challenges for all of us in the field; patients, medical staff, clinicians, researchers, manufacturers, and regulators.”

Thanks to the work of Dr. Dole and his team, there has been a tremendous increase in the understanding of addiction. While MMT is still controversial and certainly not accepted by all, it is undeniable that it has helped hundreds of thousands of people the world over. What is perhaps even more vital is Dr. Dole’s overall legacy.

“The underlying theme in Dr. Vincent P. Dole’s work is the effect of metabolism on behavior. This led to groundbreaking investigations at The Rockefeller University in electrophoresis, lipids, obesity, addiction, and the development of methadone maintenance in 1964 with his late wife, Dr. Marie E. Nyswander. Dr. Mary Jeanne Kreek, a research resident in his laboratory in 1964, is now continuing addiction research as a professor at Rockefeller. Dole developed methadone detoxification in the New York City jail system and office-based methadone medical maintenance with Nyswander. His major concern was to resolve the stigma that methadone patients encounter.”

Methadone Success Rates

Unfortunately, the stigma of addiction still exists. Nevertheless, there is now greater acceptance of the concept that addiction is not a lifestyle choice nor a sign of weakness. People with addiction are victims of circumstances and develop a disease for which the medical community must provide treatment.

There continue to be significant failings that perpetuate the stigmatization of addicts, particularly through the criminal justice system. The focus is on incarceration, hoping that people will magically come out of the system “cured” and free from substances.

In reality, most addicts who enter the system come out just as addicted as before. Fortunately, it’s possible to beat your addiction and start living free from the chains of the disease, contact (855) 976-2092 to learn more.

 

Sources

[1] Bierer MD, M. (2017, January 25). Is Addiction a “Brain DIsease”? Retrieved from Harvard Health Publishing – Harvard Medical School: https://www.health.harvard.edu/blog/is-addiction-a-brain-disease-201603119260

[2] Bell, J., & Zador, D. (n.d.). A risk-benefit analysis of methadone maintenance treatment. – PubMed – NCBI. Retrieved February 14, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/10738842

[3] Rettig, R., & Yarmolinsky, A. (n.d.). Read “Federal Regulation of Methadone Treatment” at NAP.edu. Retrieved February 14, 2019, from https://www.nap.edu/read/4899/chapter/2

[4] Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (April 23, 2013). The N-SSATS Report: Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011. Rockville, MD. Retrieved From: https://www.samhsa.gov/data/sites/default/files/N-SSATS%20Rprt%20Trnds%20Use%20Methadone%20&%20Buprenorphine%20at%20SA%20Trmt%20Facs%20%2003-11/N-SSATS%20Rprt%20Trnds%20Use%20Methadone%20&%20Buprenorphine%20at%20SA%20Trmt%20Facs%20%2003-11/sr107-NSSATS-Buprenorph.htm

[5] American Association for The Treatment of Opioid Dependency. (n.d.). AATOD | About Us. Retrieved February 14, 2019, from http://www.aatod.org/about-us/

naloxone overdose prevention drug

Opioid Addiction And The Overdose Crisis

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Opioids are made up of a wide range of drugs. They include heroin, an illegal street drug; fentanyl and methadone, which are synthetic opioids; and prescription pain relievers, such as morphine, codeine, hydrocodone, and oxycodone. All of these drugs are chemically related. They interact with the brain and the nerve cells, which all have opioid pain receptors.

Opioids Are Addictive Drugs

When used therapeutically, opioid drugs have tremendous benefits. They act mainly as a painkiller, thereby significantly increasing the quality of life, particularly if patients suffer from chronic pain. However, they are also addictive and habit-forming, even when used on prescription, and the addiction can be both physical and psychological.

“Opioid addiction involves more than just physical dependence. Aside from physical dependence, opioid addiction also involves psychological dependence. This means that the drug is so central to the person’s life that the need to keep using becomes a craving or compulsion, even if the person knows continued use is harmful.”

Unfortunately, once a person is in the grips of opioid addiction, a range of negative consequences are likely to occur. These include engaging in risky behavior, an increased chance of infection with blood-borne diseases, criminal behavior, and loss of social life. Perhaps the greatest risk of opioid abuse is that there is a chance of having an overdose, which can be fatal.

In case of an overdose, it is possible for the symptoms to be reversed if someone is provided naloxone immediately.

“The drug naloxone is sometimes called a “save shot” or a “rescue shot” because of its ability to bring someone back from an overdose.”

In this country, there is an epidemic of addiction to opioids, particularly prescription painkillers. It should be noted that some improvements have been made, mainly by making it more difficult to obtain these drugs. It is in teen groups that improvements have been made, which is a positive development. However, deaths related to heroin have been rising since 2007. Thankfully, drugs such as methadone, naltrexone, and buprenorphine are available to help in the treatment of opioid addiction.

The Effectiveness of Treatment

A study completed by the National Institute on Drug Abuse (NIDA) found that opioid addiction can be effectively treated with the right medication.

“A study comparing the effectiveness of two pharmacologically distinct medications used to treat opioid use disorder – a buprenorphine/naloxone combination and an extended release naltrexone formulation – shows similar outcomes once medication treatment is initiated. Among active opioid users, however, it was more difficult to initiate treatment with the naltrexone.”

The Overdose Crisis

In this country, around 115 people die every day as a result of an opioid overdose. Indeed, this is a national crisis that affects every element of society, including economic welfare, the legal justice system, and public health. According to the Centers for Disease Control and Prevention (CDC), the economic burden of this alone is staggering.

“The total economic burden is estimated to be $78.5 billion. Over one-third of this amount is due to increased health care and substance abuse treatment costs ($28.9 billion). Approximately one-quarter of the cost is borne by the public sector in health care, substance abuse treatment, and criminal justice costs.”

The overdose crisis didn’t happen overnight. Towards the end of the 20th century, pharmaceutical companies claimed that opioid pain relievers were non-addictive, leading to an increase in prescription rate. Unfortunately, it was soon realized that these drugs were in fact highly addictive and that there was widespread abuse. By 2015, some 33,000 died of an opioid overdose in that year alone, and that included overdoses on legally obtained prescription drugs. Furthermore, some 2 million people were addicted to prescription painkillers, compared to 591,000 people with heroin addiction (some people were addicted to both).

It is now known that:

• Between 21% and 29% of people who take prescription painkillers misuse their drug.
• Between 8% and 12% of people who take prescription painkillers develop a use disorder.
• Between 4% and 6% of those who have a use disorder transition to heroin.
• Around 80% of heroin users used prescription painkillers first.
• There was a 30% increase in incidences of opioid overdose between July 2016 and September 2017 in 45 states.
• There was a 70% increase in the incidences of opioid overdose between July 2016 and September 2017 in the Midwestern region.
• There was a 54% increase in the incidences of opioid overdose in large cities in 16 states.

Clearly, this is a public health crisis that affects everybody in this country.

“With continued increases in opioid overdoses, availability of timely data are important to inform actions taken by EDs and public health practitioners. Increases in opioid overdoses varied by region and urbanization level, indicating a need for localized responses. Educating ED physicians and staff members about appropriate services for immediate care and treatment and implementing a post-overdose protocol that includes naloxone provision and linking persons into treatment could assist EDs with preventing overdose.”

The impact of the overdose crisis is significant. There has been a marked increase, for instance, in the number of babies born with neonatal abstinence syndrome due to maternal opioid abuse during pregnancy. Additionally, there has been a marked increase in the number of diagnoses of both hepatitis C and HIV.

What Is Being Done

The U.S. Department of Health and Human Services (HHS) has announced five key priorities to address this crisis.

“At HHS, we’re ready to fight alongside… the millions of Americans who are trying to find recovery or help their loved ones do so… The Trump Administration is committed to bringing everything the federal government has to bear on this health emergency.”

These five priorities are:

1. To improve access to treatment
2. To promote the use of drugs like naloxone
3. To focus on better public health surveillance to increase understanding of the epidemic
4. To provide support for addiction and pain research
5. To advance pain management best practice

One the latest initiatives was launched in April 2018, which is the Helping to End Addiction Long-Term (HEAL) Initiative, in which various agencies have come together to find a scientific solution to the national opioid crisis, with a focus on both treatment and prevention.

Want to Learn More?

Do you want more information on methadone clinics and methadone treatment? Are you still on the fence about whether or not this is the right approach for you?

If so, check out our methadone treatment blog posts today or call us at (855) 976-2092 for more resources to help you make an informed decision about how to navigate the recovery process.

At Methadone Near Me, we only post information that comes from trusted sources. Please see the list of sources below to do your own studying on this topic. We encourage you to dive deeper and learn all you can.

Sources

[1] Mental Illness & Addiction Index. (n.d.). Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index

[2] Nadia Kounang, CNN. (2016, April 28). What is naloxone? Retrieved from https://edition.cnn.com/2016/04/28/health/what-is-naloxone-narcan-opioid-overdose/index.html

[3] Opioid treatment drugs have similar outcomes once patients initiate treatment. (2017, November 14). Retrieved from https://www.nih.gov/news-events/news-releases/opioid-treatment-drugs-have-similar-outcomes-once-patients-initiate-treatment

[4] Florence CS , et al. (n.d.). The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. – PubMed – NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27623005

[5] Vital Signs: Trends in Emergency Department Visits for Suspected … (2018, March 8). Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm6709e1.htm

[6] Secretary Price Announces HHS Strategy for Fighting Opioid Crisis. (2018, March 7). Retrieved from https://www.hhs.gov/about/leadership/secretary/speeches/2017-speeches/secretary-price-announces-hhs-strategy-for-fighting-opioid-crisis/index.html

fentanyl a synthetic heroin

Heroin And Fentanyl – Two Addictive Opioids

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Heroin and fentanyl are two common opioids with significant dangers. Heroin is made using morphine, a natural substance. The Drug Enforcement Agency (DEA) has listed heroin as a Schedule I drug.

“Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse.”

Fentanyl is an opioid, but it is synthetic, meaning it is man-made.It is also incredibly dangerous, as reported by the National Institute on Drug Abuse (NIDA).

“Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent.”

Fentanyl is a schedule II drug, however, because it has accepted medicinal uses. In fact, it was developed as a prescription painkiller. That said, being a schedule II means that it is recognized to have a high abuse potential. Fentanyl is available on prescription but it is also illicitly manufactured. It is cheap and easy to obtain and also often used to fill or cut heroin.

Unfortunately, fentanyl is incredibly lethal in many different ways. Only a small dose of 0.25mg can be lethal and this opioid’s absorbed through the skin.

“The drug can be absorbed through the skin or accidentally inhaled. In 2015, a New Jersey police officer had shortness of breath, dizziness and slowed breathing after coming into contact with fentanyl.”

As a legal prescription, it is available as sublingual or buccal tablets, oral or nasal sprays, transdermal patches, and injections. When used illegally, people chew or suck on the patches, insert it into their body, or even scrape off the gel after which it is injected. In tablet form, it can be crushed and injected, smoked, or snorted.

Overdose, Side Effects, and Other Dangers

There has beena significant increase in the number of overdose deaths as a result of both fentanyl and heroin, according to the Centers for Disease Control and Prevention (CDC).

“The United States is experiencing an epidemic of drug overdose (poisoning) deaths. Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin).”

The CDC has also reported that, between 2002 and 2013, fatal heroin overdose numbers quadrupled, and fatal overdoses of fentanyl and other synthetic opioids almost doubled between 2013 and 2014.

One of the key dangers is that people often think they are using heroin, unaware of the fact that it also contains fentanyl. Because the latter is so much more potent, the toxic buildup it creates can cause an overdose at a much lower dose than heroin. When breathing slows down too much, an overdose occurs. At that point, body temperature plummets, pulse slows, and the victim often feels lethargic, drowsy, and confused. Their pupils contract to pinpoints and they may lose consciousness as well.

Any overdose can be life threatening. Narcan (naloxone) is a drug that can reverse the effects of the overdose as an opioid antagonist, but only if administered early enough. If someone overdoses on fentanyl, or on part heroin cut with fentanyl, they often require multiple naloxone doses because it is so potent.

Both opioids can also have a long term negative impact on the cardiovascular and respiratory system. Additionally, it can cause brain damage, leading to permanent cognitive problems. Those who choose to inject the substances are also at increased risk of HIV/AIDS, hepatitis C, skin abscesses, track marks, scarring, and collapsed veins.

Opioid Addiction and Dependence

Both heroin and fentanyl are known to be highly addictive drugs. Both substances, when abused, lead to a euphoric “high” that is incredibly intense. Dependence can develop very rapidly. As soon as the brain is accustomed to opioid presence, it stops absorbing, transmitting and producing functioning chemical messengers, including dopamine, which tell the body to feel pleased. Because of this chemical malfunction, the body starts to feel unbalanced, requiring the drug to once again feel “normal”. Once the effects of the drug wears off, it leads to the person experiencing significant withdrawal symptoms as well. Common symptoms are:

• Insomnia
• Agitation
• Irritability
• Anxiety
• Depression
• Flu-like symptoms

As a result, many would rather take the drug than experience these withdrawal symptoms. Unfortunately, this is a slippery slope leading to people having no more control of how much they take and when. Once drug use becomes compulsive, the chemistry of the brain has changed significantly. At this point, an addiction has developed.

As shown by research conducted by the American Society of Addiction Medicine (ASAM), addiction is a serious problem associated with opioid abuse.

“Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin. It is estimated that 23% of individuals who use heroin develop opioid addiction.”

Both heroin and fentanyl are incredibly powerful and dangerous. It is vital that treatment options are put in place so that those who have become victims of addiction are given the help that they need. The U.S. Food and Drug Administration (FDA) has approved a number of drugs and medications to help people who have developed an opioid dependence. These include naltrexone, buprenorphine, and methadone. These are pharmaceutical drugs that have been shown to be particularly effective if offered in conjunction with counseling and other behavioral therapies. These drugs are highly useful in controlling the withdrawal symptoms, thereby helping addiction patients become more receptive to therapy as they do not feel as uncomfortable as before.

Heroin and fentanyl are short-acting drugs. This means that their effects only last for a few hours at a time. FDA-approved medication like methadone, on the other hand, is a long-acting substance, which means only a single dosage is required in a 24 hour period. It is not recommended that people go “cold turkey” if they use either fentanyl or heroin, as it is unlikely that they will be successful and relapse at that point where it is incredibly dangerous. Medication and therapy are available for patients, although it is very important that some of the barriers to access to treatment, both perceived and real, are addressed. To get the help you need or to be there for someone you love contact us for more information (855) 976-2092.

Sources

[1] Drug Scheduling. (n.d.). Retrieved from https://www.dea.gov/drug-scheduling

[2] National Institute on Drug Abuse. (2016, June 6). Fentanyl. Retrieved from https://www.drugabuse.gov/drugs-abuse/fentanyl

[3] Nadia Kounang, CNN. (2018, November 5). What you need to know about fentanyl. Retrieved from https://edition.cnn.com/2016/05/10/health/fentanyl-opioid-explainer/

[4] Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. (2016, January 1). Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm

[5] American Society of Addiction Medicine. (2016, January 1). Opioid Addiction – 2016 Facts & Figures. Retrieved from https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf