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    opioid addiction

3rd November 2020 • Sticky Post

Opioid Replacement Therapy: Weighing the Costs/Benefits

 

Opioid Replacement Therapy (ORT) is a way to lessen the impact of addiction to opiates and opioids by replacing dangerous drugs like fentanyl and heroin with legal, long-acting, non-euphoric drugs such as methadone and suboxone. Advocates cite a host of benefits that can be obtained through Opioid Replacement Therapy, including reducing the risk of HIV transmission, overdoses, and crime, while helping the addicted to hold down jobs and maintain functional relationships. Opioid Replacement Therapy also theoretically keeps individuals in treatment by reducing the symptoms of withdrawal and the cravings for illicit drugs. It sounds appealing, and methadone has been a popular treatment for years. The World Health Organization has labeled it an essential medicine, and it’s used without question by health-care providers the world over (almost 50,000 kgs. of it are manufactured every year). But is ORT really the best way to treat opioid addiction?  

Methadone: Pros and Cons

Opioid replacement therapy: weighing the pros and cons

Opioid replacement therapy: weighing the pros and cons

As a long-acting opioid, as well as an opioid agonist, methadone ensures that the user typically needs a single daily or bi-daily dose and that they cannot experience highs even if they use other opioid drugs. This allows those who use the substance to return their lives to some sort of normality. Since most users are obtaining a single dose every 24-48 hours in an outpatient setting, they are free to go about their daily business unencumbered from intoxication or the need to secure more drugs. Furthermore, enrollment in an opioid replacement program generally nudges the user towards meaningful interactions with the health-care system which can successfully steer them towards a more complete recovery. 

A study from Harvard University’s medical school found that approximately 25% of methadone users would successfully wean themselves from the substance over the long-term, 25% would continue using it indefinitely, and 50% would eventually return to their previous addiction. A 2009 study from the Cochrane Review concluded that methadone treatment increases the chance of successful treatment outcomes by helping to retain patients in treatment and that it decreases heroin use compared to programs that don’t offer opioid replacement therapy. The study also found that methadone didn’t actually decrease the risk of mortality or prevent criminality in a statistically significant way.

While methadone programs offer some substantial benefits to those grappling with addiction, they come with substantial side-effects and risks. Common side-effects include nausea, vomiting, sexual dysfunction, slowed breathing, and itchy skin, and there is some evidence that prolonged use can cause a number of lung and respiratory issues. Meanwhile, neuroscientists are still discovering the effects methadone use has on the brain, as experiments with rats have shown that a three-week course of methadone led to a “significant” – 70 percent – reduction of a signal molecule that supports memory and learning in the brain’s frontal lobe and hippocampus. Methadone is also a deeply addictive substance, which causes worse withdrawal symptoms than the heroin that it replaces. And the risk of overdose doesn’t go away for those using methadone. In fact, the American Center for Disease Control reports that methadone is to blame in a full third of all prescription painkiller related deaths occurring in the USA. 

Methadone has helped many addicts by acting as a first step towards recovery, offering a measure of stability in their lives, and enticing them to interact with recovery professionals. But the side-effects and risks associated with its use are deeply concerning, and there are other options available for those looking for ORT.

Naltrexone and Buprenorphine

Naltrexone and Buprenorphine

Naltrexone and Buprenorphine

Like methadone, buprenorphine is a synthetic opioid that can reduce or curtail the symptoms of withdrawal. Suboxone, the most common variety of buprenorphine, also contains a substance called naloxone, which causes serious and deeply unpleasant side-effects if the substance is injected. It is included to reduce the potential for abuse. Suboxone was approved for use by the American Food and Drug Administration in 2002, and it has become incredibly popular. In 2013 the drug made $1.55 billion in sales, more than Adderall and Viagra combined!

Buprenorphine treatment has some significant advantages over methadone. It has less potential for abuse because of the inclusion of naloxone. It has also proven to be a safer alternative. A 6-year study conducted by researchers in England and Wales found methadone was more than 6 times more likely to cause overdose deaths than buprenorphine, with 2,366 mortalities associated with methadone use, and only 52 related to buprenorphine.

Naltrexone is another synthetic opioid that was originally intended for use in pill form. The American government concluded that it “does not produce tolerance or withdrawal. Poor treatment adherence has primarily limited the real-world effectiveness of this formulation. As a result, there is insufficient evidence that oral naltrexone is an effective treatment for opioid use disorder.” However, in 2010 an extended-release, injectable form of naltrexone was approved by the FDA. This version requires a single injection per month and has been found to be as effective as buprenorphine in reducing opioid use. However, withdrawal from opioids must be completed before this type of naltrexone is safe to use, which is a significant barrier for many addicts.

Buprenorphine and naltrexone can offer a sufferer the benefits of methadone treatment, along with reduced risk of overdose, death, and abuse. However, like methadone, they are imperfect solutions that can help addicts to manage their affliction and lead them into treatment but also create a new dependence that can take years to break free of.

Effective Alternatives

Opioid Replacement therapy: weighing the costs and benefits

Opioid Replacement therapy: weighing the costs and benefits


You may already know about Iboga’s ability to treat withdrawal symptoms and substance cravings, as well as its remarkable restorative effects on the brain. If you don’t, you may want to read this post on iboga’s effectiveness in treating opioid addiction. In addition to its clinical benefits, the substance induces an ego-free, reflective state that can also help addicts deal with past trauma and certain mental health issues.

Unlike methadone, iboga isn’t habit-forming and is extremely unlikely to be abused. There is no evidence that it is physiologically or psychologically addictive. While systematic, controlled clinical trials in the US and Europe have yet to be conducted (mainly because the substance is classified as a Schedule I drug), there are countless testimonials from people who credit iboga with saving their lives and allowing them to escape from addiction.

Iboga use is not without risk. It can exacerbate pre-existing cardiac conditions, and in abnormally large doses it may induce seizures. But even though it is often self-administered, or used in unsafe settings due to its murky legal status, it is still safer than methadone, causing 1 death in every 427 reported treatment episodes, compared to a 1:364 mortality rate for methadone.

5th December 2019

The Opioid Epidemic: Calculating the Costs

The opioid epidemic continues to impose a tremendous human and societal cost on the world. Big pharmaceutical companies have gotten us into a horrendous mess by dishonestly, unethically, and even illegally pushing opioid painkillers on a public that was unaware of the significant risks of dependency and addiction. Purdue Pharma, the maker of Oxycontin and an industry leader who reaped immense profits from peddling dangerous drugs, recently settled a lawsuit in Oklahoma for a whopping 270 million dollars. There are still approximately 2000 other lawsuits waiting to go to trial across the United States, alleging that Purdue and other large pharmaceutical companies “engaged in deceptive marketing that downplayed the addiction risk from opioids while overstating their benefits.” Before the financial settlements and jury awards start to roll in, let’s take a long look at the human and financial costs of the opioid crisis.

The Pain Paradox

The Opioid Epidemic

The opioid epidemic has roots not just in irresponsible marketing campaigns, but in the structures of our health-care systems and societal approaches to dealing with pain. In America, HMOs have largely replaced family physicians, and doctor-patient interactions have shifted from intimate, familial relationships focused on long-term health to a customer service model. Meanwhile, funding for holistic, multi-disciplinary approaches to pain management has dried up in many countries. These trends created the conditions which allowed opioid use to spread like wildfire.

Rather than addressing the root causes of pain and working on long-term solutions, physicians (and dentists, the most common issuers of fast-acting opioids) settled on temporary pain relief via pills. Everyone involved with the health-care system was incentivized to settle for oxycontin instead of pursuing the more expensive, complicated, and slower psychosocial and physical solutions that would enable the afflicted to successfully manage their pain.

The Opioid Epidemic's Terrible Human Toll

According to the American Centers for Disease Control, over 700,000 people died of drug overdoses between 1999 and 2017, with 68% of the deaths (almost 400,000 fatalities) involving an opioids. By 2017 the number of deaths involving opioids was 6 times higher than it had been in 1999, and 130 Americans were being killed by opioid overdoses every day! Americans are now more likely to die from an opioid overdose than from a car crash.

Opioid prescriptions were frequently given not just for severe long-term pain, but also for routine procedures which caused a few days of manageable pain, like wisdom teeth removal, bone fractures, and minor surgery. Relying on pills to avoid a few days of discomfort led millions to years of addiction and even death. As evidence mounted that exposure to opioid painkillers heightened the risk of abuse and addiction, the prescriptions continued to pile up.

Nowhere was harder hit by the opioid epidemic than rural communities in America. The state of West Virginia alone was showered with 780 million oxycodone and hydrocodone pills, amounting to “433 pills for every man, woman and child” in the state. One town with a population of 392 and a single pharmacy received 9 million pills in a two year period. Kanawha County, with a population of 190,000 received 66 million oxycodone and hydrocodone pills.

Pharmaceutical companies and legislators were finally forced to address the issue and limit the supply of pills, but that has led to even worse problems. As the legal supply of opioids has dried up, more and more addicts have turned to the black market, which is largely comprised of Fentanyl-based pills. Fentanyl, a powerful synthetic opioid, is manufactured in China, shipped to Mexico where it is processed into counterfeit pills, and distributed around the world. Fentanyl is 30-50 times stronger than heroin and can be lethal in doses of just 2 milligrams. As a US Attorney in Ohio has noted: “One of the truly terrifying things is the pills are pressed and dyed to look like oxycodone. If you are using oxycodone and take fentanyl not knowing it is fentanyl, that is an overdose waiting to happen. Each of those pills is a potential overdose death.”  

The Financial Cost of the Opioid Epidemic

A report from Altarum, an American healthcare research and consulting firm, calculated that eliminating opioid addiction and overdoses would create an annual benefit to the US economy of $115 billion. They calculate that the total cost of the opioid epidemic since 2001 has been over $1 trillion and that an additional $500 billion will be added to the sum by 2020. Others calculate the cost to the government alone at approximately $80 billion annually, without even factoring in the cost of healthcare fees, legal expenses, and lost productivity on individuals and families.

These immense sums boggle the mind, but they fail to reckon with the profound impact of the opioid crisis on communities. Trauma, fractured families, decreased property values, loss of community well-being, educational impacts, and a myriad of other social problems whose impact has yet to be gauged are on their way. The opioid crisis has left behind it a wake of devastation, poverty, and heartbreak. But is there anything that can be done to reverse the tide of human misery?

What's Next?

The opioid epidemic: calculating the costs

One necessary step for dealing with the current opioid crisis is embracing the principles of harm reduction. The medical establishment has led millions of people toward addiction by profitably over-prescribing pills. Their victims shouldn’t face criminalization and stigma for following a doctor’s advice. The Portuguese model has shown great promise for dealing with addiction by treating addiction as a health issue. It’s time for other countries to follow suit.

Another important tool for dealing with rampant opioid addiction is iboga therapy. The treatment is a proven success in dealing with substances such as Oxycontin and Oxycodone, acting as an addiction disruptor and opioid antagonist. If governments are serious about battling the plague of opioid addiction, the time to begin clinical trials is now!

But perhaps the most necessary step in dealing with this massive crisis is changing our understanding of pain. Pain management is a necessary part of life, and all of us will have to deal with intense physical and mental pain at some point. It’s time for the medical establishment to embrace comprehensive, holistic pain management plans. Pressure, stretching, motion, and touch are all proven to relieve pain. Cold and vibration-based therapies have been clinically proven to limit opioid use and dull perceptions of pain while the body heals. Sleep hygiene, ibuprofen, magnesium supplements and a host of other options have shown to be as or more effective than opioids in dealing with certain varieties of pain. As Dr. Amy Baxter of Pain Care Labs argues, changing the paradigm from a focus on pharmaceuticals to creating comprehensive, individual “pain plans” will destroy the false dichotomy of pills and “complementary” treatments. There isn’t a “Big Yoga Lobby” taking doctors on expensive promotional junkets yet but using some of the windfalls from lawsuits against pharmaceutical companies to create one wouldn’t be a bad idea.    

22nd May 2019

The Opioid Epidemic: Information for Parents

Back in the late 1990s, people began using prescription and non-prescription opioid drugs with increasing frequency. Throughout the past few decades, these potent and dangerous painkillers have become more popular globally, and have caused a massive spike in overdose deaths around the world. In 1999, 4000 Americans died from overdose deaths. By 2017 that number had ballooned to 72000, and over 2/3s of overdose deaths that year were related to opioid use. The opioid epidemic has seen drug overdoses become the leading cause of death for Americans under the age of 50. Here’s what parents need to know about this horrific threat to their children’s well-being...

Opioids: what are they?

Opioids are a class of moderately to extremely strong painkillers that include oxycodone (marketed as OxyContin and Percocet), hydrocodone (Vicodin and Norco), and fentanyl, which is synthesized to act as an opiate, similar to morphine and heroin. According to WebMd, opioids work by binding to opioid receptors in the brain, spinal cord, and other areas of the body. They reduce the sending of pain messages to the brain and reduce feelings of pain. Opioids are used to treat moderate to severe pain that may not respond well to other pain medications.” Because this class of drug is extremely potent and widely available, opioids have become popular both as a medical treatment and as a recreational drug.

How did the opioid epidemic get started?

Because of morphine abuse in the late 1800s and early 1900s, doctors were initially reluctant to prescribe opioids, and their use in medicine was quite rare until the 1980s. In 1980, an article in the New England Journal of Medicine titled “Addiction Rare in Patients Treated With Narcotics” generated a great deal of attention, and, coupled with lobbying and promotion from the pharmaceutical industry, convinced doctors that opioids could be safely prescribed. In 2017, the NEJM published a rebuttal of the article, stating that the conclusions were based on hospitalized patients only, and not on patients taking the drugs after they were sent home.” Meanwhile, the study’s author, Dr. Herschel Jick has stated that he never intended to justify widespread opioid use.

Is the opioid epidemic happening only in the USA?

While 80% of global opioid use occurs in the USA, the opioid crisis has spread across the globe, and young people are at a higher risk than others. In Europe, Canada and Australia, prescription drug abuse rates among teenagers are similar to the USA. Studies in Lebanon, China and Saudi Arabia have found that 1 in 10 teenagers had used painkillers for non-medical purposes, and statistics from Europe show that prescription opioids account for 3/4s of overdose deaths among those aged 15 to 39. Meanwhile, in the UK, 3756 people died from drug poisoning in 2017, the highest number on record. Fears exist that the opioid crisis could grow into a global pandemic.

How does the opioid epidemic compare to previous drug scares?

Sadly, the answer to this question is absolutely yes. Opioids have a sedative effect on the parts of the brain which regulate breathing, which causes respiratory depression, respiratory failure, and far too often, death. Mike Stobbe, a medical writer for the Associated Press, writes that there were fewer than 3,000 overdose deaths in 1979, when a heroin epidemic was raging in U.S. cities. There were fewer than 5,000 recorded in 1988, around the height of the crack epidemic. More than 64,000 Americans died from drug overdoses last year [2016], according to the U.S. Centers for Disease Control and Prevention.”

What is fentanyl?

Perhaps the most terrifying part of this whole horrorshow is fentanyl, a new synthetic opioid painkiller that is 50-100 times stronger than morphine, and 30-50 times more potent than heroin. Pure white, odorless and scentless, fentanyl can be lethal in doses of just 2 milligrams! The drug is so potent that police and first responders have overdosed just from touching it or inhaling small amounts. It’s estimated that $800 million worth of fentanyl pills have been shipped to the US from China over the past two years, and AP reporters recently found Chinese manufacturers ready and willing to ship carfentanyl, an elephant tranquilizer so powerful that it has been labeled a chemical weapon.

Deaths from fentanyl have increased by 540% since 2015, and they account for the largest number of opioid overdose deaths. Heroin, cocaine, and other drugs often contain fentanyl, and accidental overdose deaths caused by unknowing consumption of fentanyl are becoming more common. The deaths of Prince and Mac Miller were both fentanyl-related. A US Attorney in Ohio, a region hard hit by the opioid crisis, recently warned that One of the truly terrifying things is the pills are pressed and dyed to look like oxycodone. If you are using oxycodone and take fentanyl not knowing it is fentanyl, that is an overdose waiting to happen. Each of those pills is a potential overdose death.” The American DEA claims that a kilogram of fentanyl can be bought in China for $3,000 to $5,000, then smuggled into the United States to generate over $1.5 million. The profitability of this drug leads traffickers to adulterate other drugs with fentanyl without the knowledge of the drug user.

What can we do?

While various governments have declared states of emergency and vowed to take measures to address this crisis, drug users and their families can’t afford to wait on legislative solutions. Opioid addiction comes with a ghastly collection of risks, and we would urge anyone suffering from it to look for immediate detox and treatment. Iboga treatment has been proven to be very effective for many addicts who abuse oxycodone and other members of the opioid family of drugs, eliminating many of the withdrawal symptoms and cravings related to opioid dependence.

Abusing opioids is a game of Russian Roulette. It’s time to stop playing and get the help you need!

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