Addiction Recovery: Reality or Myth - Part 2 OUD TREATMENT OPTIONS AND SIDE EFFECTS

Updated: Sep 23

From Treatment to Recovery - The journey from drug addiction to recovery begins with awareness of the need for change. Whether is is Opioid Use Disorder (OUD) or any other type of SUD. So... how does healing from addiction happen and what does "help" look like?


Many have made their way out of the entrails of addiction, so why can it not happen to you, your friend or relative, that person in your life who is ensnared by the false promises of euphoria. The opioid epidemic has surmounted the number of deaths second only and has recently

"Readers will cheer for Poses in this potent addition to the literature on drug addiction and recovery."—Kirkus Reviews


Here's a true story that can be an inspiration to all those who believe that there is no cure for addiction and give in and give up. Yes, we ARE capable of healing from addiction—with the right training and inspiration. Once the brain depends on external substances, it must be slowly adapted to less and less until it reaches a homeostatic state on its own. As it keeps getting saturated and depleted by external stimulants, the brain realizes the consequences and wants change. Loved ones and the medical industry help those afflicted with the disorder find the key to their success story.


In Part 1 of this series on recovery from addiction, we looked at the way the brain works and how it is affected by SUDs. https://www.angelaterga.com/post/addiction-recovery-therapies

If you or your loved one are facing an addiction to opioids, you are probably looking for the best option for treatment. Although there are many options available, finding the best one for you may take some research. In order to maximize your chance of recovery, we’ve compiled a list of the most effective treatments for opioid addiction.


The opioid epidemic is responsible for longest sustained decline in US life expectancy since the time of World War I and the Great Influenza. In 2017, nearly 50,000 Americans died from an opioid overdose - with an estimated two million more living with opioid addiction every day.



The Opioid Epidemic: What Everyone Needs to Know is an accessible, nonpartisan overview of the causes, politics, and treatments tied to the most devastating health crisis of our time. Its comprehensive approach and Q&A format offer listeners a practical path to understanding the epidemic from all sides: the basic science of opioids; the nature of addiction; the underlying reasons for the opioid epidemic; effective approaches to helping individuals, families, communities, and national policy; and common myths related to opioid addiction.


If you or your loved one is facing an addiction to opioids, you are probably asking more than just Google for the best option(s) for treatment. Although there are not many options available, finding the best one for you may take some research in order to maximize your chance of recovery.


The estimated cost of the OPIOID EPIDEMIC was $504 BILLION in 2015.2

SUD is a disorder not a disease, and it can be reversed. It may take more than a pill, more than talk therapy, individual or group therapy and as many attempts as necessary, for an individual's total recovery. But just like it takes a village to raise a child, support from friends, family, and the government's willingness to include not only pills but wholesome remedies in the form of supplements into the equation of health insurance coverage for Americans.


Holistic and supplemental IV treatments have proven wise allies when it comes to recovery in general, more so when the illness originates in depleting the brain of its ability to function on its own. These treatments that help bring the brain to homeostasis include nutrition, meditation, and psychological and occupational therapies. BUT WE ARE FAR FROM USING THIS HIGHLY RECOMMENDED TREATMENT IN CONJUNCTION WITH DRUG TREATMENT - And that's where medicine fails to heal. We must have a balance and our brain needs more amounts of amino acids and other brain foods.


Yes, it's a lot of work and it takes a village. It matters! If only we would be a conduit of compassion helps to save one SUD patient at a time, making addiction and death by overdose less prevalent in our society. Why is it (our) society's responsibility? We are the product of our environment, if the war on drugs had been effective, we'd have far less drugs made in labs right here in America and being distributed among users and pushers. Less gadgets but more community resources and emphasis on psychological and emotional community wellness is where the best outlook for the future is at.

How do we train our children's brain? How are our brains kidnapped by the media which encourages us to always want more more more. Never Enough is a memoir by an addiction survivor who eventually studies our brains as a neurologist.



From a renowned behavioral neuroscientist and recovering addict, a rare pause-resisting work of science that draws on personal insights to reveal how drugs work, the dangerous hold they can take on the brain, and the surprising way to combat today's epidemic of addiction.


The 12 Step program has been around since 1935 The first 12-step program was published in 1935 when the founders of AA, Bill Wilson and Dr. Robert Smith, released the group’s guiding document, Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, better known as “The Big Book”.

Wilson's promising Wall Street career was damaged by his alcohol SUD, which affected his health and for which he sought treatment. His desire to heal from alcoholism initiated him in a local fellowship called the Oxford Group. The group was a Christian organization that was founded as a way to help men overcome bad habits, moral shortcomings, and particular sins. The core tenets of the Oxford Group were honesty, purity, unselfishness, and love, virtues that would later be emphasized in AA.









How do medications for OUD (Opioid Use Disorder) work, and what are their side effects and terms of use?


Methadone:

The percentage of methadone overdose deaths declined between January 2019 and August 2021.

Methadone is a long-acting opioid agonist taken by mouth as a liquid or pill. It is a Schedule II drug, which means it has a high potential for abuse, and its dispensing is closely monitored and regulated by the Drug Enforcement Agency.

Like all opioids, it can cause respiratory depression and death if blood levels get high enough. This is especially concerning since it stays in the blood for almost three days.


Concurrent benzodiazepine use increases the risk of overdose even further in patients taking methadone for opioid use disorder treatment or for chronic pain.


*Methadone's peak respiratory depressant effects typically occur later, and persist longer than its peak analgesic effects. (Methadone Dosing oasas.ny.gov), and this may be the cause of many overdose deaths. For the treatment of


SUD patients in Methadone treatment reduce illicit opioid use more effectively than placebo, medically supervised withdrawal, or no treatment.

as numerous clinical trials and meta-analyses of studies conducted in many countries show.23,24,25 Higher methadone doses are associated with superior outcomes.26,27 Given the evidence of methadone's effectiveness, WHO lists it as an essential medication.28

Methadone treatment has by far the largest, oldest evidence base of all treatment approaches to opioid addiction. Large multisite longitudinal studies from the world over support methadone maintenance's effectiveness.29,30,31 Longitudinal studies have also found that it is associated with:32,33,34,35,36,37,38,39,40

Reduced risk of overdose-related deaths.

Reduced risk of HIV and hepatitis C infection.

Lower rates of cellulitis.

Lower rates of HIV risk behavior.

Reduced criminal behavior


Fatal side effects can occur if you use opioid medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing.

Methadone may cause a life-threatening heart rhythm disorder. Call your doctor at once if you have a headache with chest pain and severe dizziness, and fast or pounding heartbeats. Your heart function may need to be checked during treatment.

Your doctor may recommend you get naloxone (a medicine to reverse an opioid overdose) and keep it with you at all times. A person caring for you can give the naloxone if you stop breathing or don't wake up. Your caregiver must still get emergency medical help and may need to perform CPR (cardiopulmonary resuscitation) on you while waiting for help to arrive.


  • weak or shallow breathing, breathing that stops during sleep;

  • severe constipation;

  • a light-headed feeling, like you might pass out;

  • fast or pounding heartbeats, fluttering in your chest, shortness of breath;

  • low cortisol levels--nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness; or

  • serotonin syndrome - agitation, hallucinations, fever, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, diarrhea.


Naltrexone

XR-NTX reduces illicit opioid use and retains patients in treatment more effectively than placebo and no medication, according to findings from randomized controlled trials.41,42,43

In a two-group random assignment study of adults who were opioid dependent and involved in the justice system, all participants received brief counseling and community treatment referrals. One group received no medication, and the other group received XR-NTX. During the 6-month follow-up period, compared with the no-medication group, the group that received the medication demonstrated:

Longer time to return to substance use (10.5 weeks versus 5.0 weeks).

A lower rate of return to use (43 percent versus 64 percent).


Treatment with naltrexone is a short-term MSR intervention designed to assist the individual during the early stages of recovery in avoiding relapse. The drug works by blocking the pleasurable sensations of opioids or alcohol, which eventually reduces cravings.

Naltrexone belongs to a class of drugs known as opioid antagonists and works by blocking the mu opioid receptor. It blocks the effects of alcohol and opioid medications, preventing the intoxication these substances cause. Naltrexone also modifies how the hypothalamus, pituitary gland and adrenal gland (hypothalamic-pituitary-adrenal axis, HPA axis) interact to suppress the amount of alcohol consumed.

Naltrexone comes as an extended-release intramuscular injection and as oral tablets. The branded versions of naltrexone tablets (Revia, Depade) have been discontinued, but generic versions are available.


Naltrexone can cause serious side effects, including:

1. Risk of opioid overdose.

You can accidentally overdose in two ways.

  • Naltrexone blocks the effects of opioid drugs. Do not take large amounts of opioids, including opioid-containing medicines, such as heroin or prescription pain pills, to try to overcome the opioid-blocking effects of this medication. This can lead to serious injury, coma, or death.

  • After you receive a dose of the extended-release injection form of this medication, its blocking effect slowly decreases and completely goes away over time. If you have used opioid street drugs or opioid-containing medicines in the past, using opioids in amounts that you used before treatment can lead to overdose and death. You may also be more sensitive to the effects of lower amounts of opioids:

  • after you have gone through detoxification

  • when your next naltrexone injection is due

  • if you miss a dose of this medication

  • after you stop naltrexone treatment It is important that you tell your family and the people closest to you of this increased sensitivity to opioids and the risk of overdose.

  • There is no data specifically addressing switching from buprenorphine or methadone to naltrexone, however some patients have reported severe manifestations of precipitated withdrawal when switched from an opioid agonist to opioid antagonist therapy.

  • Patients switching from buprenorphine or methadone may be vulnerable to precipitated withdrawal for up to 2 weeks.

  • Be prepared to manage withdrawal symptomatically with non-opioid medications.

  • To achieve best possible results, implement compliance-enhancing techniques, especially medication compliance

Commonly reported side effects of naltrexone include: streptococcal pharyngitis, syncope, anxiety, arthralgia, arthritis, dizziness, drowsiness, fatigue, frequent headaches, headache, joint stiffness, nasopharyngitis, nausea, nervousness, obsessive compulsive disorder, panic attack, pharyngitis, posttraumatic stress disorder, sedated state, sinus headache, vomiting, induration at injection site, malaise, pain at injection site, and tenderness at injection site. Other side effects include: muscle cramps, muscle rigidity, muscle spasm, stiffness, depression, and twitching. See below for a comprehensive list of adverse effects.Usual Adult Dose for Opiate Dependence


Oral: IN TABLET FORM Initial dose: 25 orally once a day Maintenance dose: 50 mg orally once a day (if no withdrawals on 25 mg/day)

Naloxone

Naloxone blocks or reverses the effects of opioid medication, including extreme drowsiness, slowed breathing, or loss of consciousness. An opioid is sometimes called a narcotic.


Naloxone is used in an emergency situation to treat a possible opioid overdose in an adult or child.

Naloxone should not be used in place of emergency medical care for an overdose.

Naloxone is also used to help diagnose whether a person has used an overdose of an opioid.


Because naloxone reverses opioid effects, administration may cause sudden withdrawal symptoms such as:

  • nausea, vomiting, diarrhea, stomach pain;

  • fever, sweating, body aches, weakness;

  • tremors or shivering, fast heart rate, pounding heartbeats, increased blood pressure;

  • goose bumps, shivering;

  • runny nose, yawning; or

  • feeling nervous, restless, or irritable.


Naloxone is a centrally acting opioid receptor antagonist. Naloxone binds with the highest affinity to the mu-opioid receptor subtype in the central nervous system (CNS). Naloxone

works to reverse opioid overdose.


BUPRENORPHINE

Buprenorphine is an opioid medication. Buprenorphine sublingual tablets (given under the tongue) are a prescription medicine used to treat opioid addiction (either prescription or illegal drugs), as part of a complete treatment program that also includes counseling and behavioral therapy.

Buprenorphine sublingual tablets are most often used for the first 1 or 2 days to help you start with treatment.

Other forms of buprenorphine are used to treat moderate to severe pain.

Warnings

Buprenorphine sublingual tablets are not for use as a pain medication.

MISUSE OF OPIOID MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep buprenorphine in a place where others cannot get to it.


Fatal side effects can occur if you use buprenorphine with alcohol, or with other drugs that cause drowsiness or slow your breathing.


Opioid medicine can slow or stop your breathing, and death may occur. A person caring for you should give naloxone and/or seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Call your doctor at once if you have:

  • opioid withdrawal symptoms - shivering, goose bumps, increased sweating, feeling hot or cold, runny nose, watery eyes, diarrhea, muscle pain;

  • noisy breathing, sighing, shallow breathing, breathing that stops during sleep;

  • slow heartbeat or weak pulse;

  • a light-headed feeling, like you might pass out;

  • chest pain, trouble breathing;

  • low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness; orOpioid withdrawal symptoms - shivering, goose bumps, increased sweating, feeling hot or cold, runny nose, watery eyes, diarrhea, muscle pain;

  • noisy breathing, sighing, shallow breathing, breathing that stops during sleep;

  • slow heartbeat or weak pulse;

  • a light-headed feeling, like you might pass out;

  • chest pain, trouble breathing;

  • low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness; or

  • liver problems - nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

  • constipation, nausea, vomiting;

  • headache;

  • increased sweating;

  • sleep problems (insomnia); or

  • pain anywhere in your body.

SUBOXONE

Generic name: buprenorphine and naloxone (oral/sublingual) [ BUE-pre-NOR-feen-and-nal-OX-one ] Dosage form: buccal film, sublingual film, sublingual tablet. Drug class: Narcotic analgesic combinations

Suboxone contains a combination of buprenorphine and naloxone. Buprenorphine is an opioid medication, sometimes called a narcotic. Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse.

Suboxone is used to treat narcotic (opiate) addiction.

Suboxone is not for use as a pain medication.

here are alternative drugs in different forms available to treat opioid use disorder.

Talk with your healthcare provider which option would be best suited to you.

Buprenorphine

  • Subcutaneous injection (Sublocade), Implant (Probuphine), Sublingual (Subutex)

Buprenorphine and naloxone

  • Sublingual (Bunavail, Zubsolv)

Lofexidine

  • Tablets (Lucemyra)

Methadone

  • Tablets (Dolophine)


Common side effects of Suboxone include headache, diarrhea, constipation, and nausea. In addition, some people become attached to the relaxation Suboxone can cause, and that can lead to addiction and/or drug relapse.

  • Insomnia and restlessness.

  • Decreased ability to concentrate.

  • Damage to the heart and circulatory system.

  • Damage to the respiratory system.

Suboxone can slow or stop your breathing, and may be habit-forming. MISUSE OF THIS MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH.


The potential for paranoia and hallucinations - Increased aggression and restlessness - Increased heart rate and blood pressure - Increased potential for heart attack or stroke - The potential for seizures.


HOW LONG SHOULD TREATMENT FOR OUD, OPIATE USE DISORDER, LAST?
Less is better, of course, to avoid side effects. What are the steps in the treatment for OUD?


Suboxone Statistics

  • More users have had success using Suboxone to overcome their opioid addiction than with Methadone or placebo pills.

  • Taking this to overcome addiction has been found to be more effective than quitting without anything at all.

  • Some studies have found that long-term use may be related to everything from low testosterone to tooth decay.

  • Quitting opiates is possible when using this as long as it's provided by a medical professional.

Medical withdrawal dosage will vary based on each individual and what their past addiction was. Each person needs to be under medical supervision at this time to avoid feeling severe withdrawal symptoms or craving opiates.


Generally this is going to be used for a year or longer in order to gradually get a patient off of opioids all together. Quitting cold turkey can be extremely difficult and often results in the user abusing the drugs more than they were in the past. This can easily lead to overdose, which may be fatal with some individuals.


Suboxone helps to overcome opiate addiction by attaching to receptors inside the bran that were once overcome by opiates. After the Suboxone takes these over, the body wi