staying powerNEWS AND NOTES

Our Approach to the Opioid Epidemic

By Peter Ronan, MD, Medical Director of Addiction Medicine at UHS

Since 2000, our country and community have been experiencing a rapid increase in the abuse of opioids. We are now in the middle of an epidemic, with many addicted and many dying of overdoses. How did this happen? Opioids are a class of drugs that can be legally prescribed to relieve pain. Medications like oxycodone (Oxycontin), hydrocodone (Vicodin), codeine, morphine, fentanyl and others can be effectively used for short periods. Because these medications can produce significant euphoria, they can lead to misuse and potentially to addiction. These prescription medications can also end up in the hands of others, where they frequently lead to addiction. Once addiction occurs, some users may turn to heroin, which is similar in effect, often less expensive, and usually easier to obtain.

UHS has been helping people overcome addiction for more than 40 years. We have found that treatment for opioid use disorders requires a specialized approach. Traditional detoxification programs where medication is given to treat withdrawal and tapered off usually work well for alcohol withdrawal and withdrawal from other drugs, but not for opioid use disorder. After detox from opioids, the individual is often left with residual achiness, malaise, fatigue, insomnia, craving, depression and anxiety. These symptoms make it very difficult to complete treatment. The relapse rate after detox from opioids is exceptionally high, with up to 90 percent of patients returning to use within a year.

Relapse with opioids after detox is different than with alcohol or other drugs. With opioids, the individual has lost tolerance to the drug and the amount they used before detox may now be lethal. In addition, there is no way to know how potent the heroin is or whether more powerful drugs such as fentanyl have been added. This combination may explain many of the overdose deaths we are seeing.

Research has shown that medication assisted treatment combined with intensive counseling is the most effective way to treat opioid use disorder. Our physicians prescribe buprenorphine/naloxone or methadone to suppress withdrawal symptoms and craving. These medications, when used correctly, do not cause euphoria or impairment. They help individuals feel well so they can actively participate in treatment and get back on the rails of their lives. We view these medications in the same way as we view medications for hypertension, diabetes or other medical illnesses. These are evidence-based treatments for a medical problem.

 

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