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7:00 a.m. - 2021-11-13 First, let's clarify the terminology: OPIATE refers to naturally occurring substances such as morphine, heroin, and codeine. Semisynthetic compounds such as oxycodone, fentanyl and methadone are called OPIOIDS. In everyday speech, the two terms are often used interchangeably, and that doesn't constitute a real problem for the layman. To simplify matters for the purposes of this discussion, I will use the term OPIOID, which seems to be the prevalent term in press coverage of our addiction problem. An opioid AGONIST has the same effect as morphine or heroin on an addict. An opioid ANTAGONIST blocks these effects by binding to opioid receptors without eliciting euphoria, but it can bring about severe withdrawal symptoms. Narcan or naloxone, an opioid antagonist, is used to treat overdose and to prevent euphoria in combination with some opioid withdrawal drugs. It can be given by injection or nasal spray and works for 40 to 90 minutes. Unfortunately, some opioids have effects that last longer than that, so it might be necessary to give more than one dose of Narcan, and a call to 911 should follow its administration. Because it is potentially a life-saving drug and must be given right away, Narcan is available without a prescription in many states. Sometimes a Narcan Challenge is given before starting therapy with an opioid antagonist: the Narcan is injected to see if it elicits withdrawal symptoms. These can include rapid heart beat, tremors, sweating, gi upset, yawning, dilated pupils, anxiety or irritability, aching joints, goosebumps, runny nose, or tears. Severity of withdrawal is assessed using a Clinical Opioid Withdrawal Scale, abbreviated COWS. Lofexidine (Lucemyra), an alpha agonist, is sometimes given to manage opioid withdrawal. It is now preferred over an older drug, clonidine, which is more likely to cause dangerously low blood pressure. Medication-assisted therapy (MAT) is statistically more likely to help with opioid addiction than counseling and support groups alone. The goal of MAT is to reduce cravings and withdrawal symptoms without producing euphoria. Unfortunately, less than half of privately funded opioid treatment programs use MAT. Currently, only methadone and burprenorphine are approved for treatment of opioid addiction. Methadone is an opioid agonist, but it acts more slowly and is less likely to produce euphoria. Doses are given under direct observation, and the dose is gradually tapered over time. It has several potentially dangerous drug interactions that need to be monitored whenever the patient has a change in medications unrelated to his or her opioid addiction. Burprenorphine is a mixed agonist-antagonist and is given in gradually decreasing doses. Burprenorphine alone is marketed as Subutex; combined with Narcan, it is called Suboxone. Suboxone prescribers must receive special training. Sublocade is a once monthly burprenorphine injection, and Probuphine is an implantable form of buprenorphine. Naltrexone (Vivitrol) is a once monthly injection of an opioid antagonist used for maintenance therapy, but the patient must be completely detoxified before receiving an injection to prevent severe opioid withdrawal. Many health professionals view opioid as a relapsing chronic condition, and consider MAT maintenance therapy a sensible long-term approach.
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