The opioid epidemic is a top killer in the United States, costing more people their lives than automobile accidents. The Unites States is the leading country in opioid addiction in the world. About 80 percent of the world’s opioid supply is consumed in the United States. It is difficult to read or watch the news without coming across exposure to an individual who overdosed or a family affected by suicide due to opioid addiction. These prescription painkillers are one of the most widely prescribed classes of drugs in the world and are also found on the street in illegal forms such as heroin. Up to 28,000 people died from opioid related deaths in 2014 alone. This is more than any year on record, and at least half of these deaths involved a prescription opioid.
Treatments for opioid abuse aren’t being used
Although long-term opioid treatments such as methadone, an opioid agonist, and Suboxone, an opioid partial agonist combined with an opioid antagonist, are effective, counseling and support groups are also necessary for long-term maintenance therapy. Treating this epidemic is a multidisciplinary approach. Being treated in the emergency room for opioid overdose is just the first step in the long battle of addiction. Unfortunately, a majority of treatment stops after an individual is discharged from the emergency room.
Maia Szalavitz writes that “the hours or days when people are hospitalized after overdose are perhaps the best opportunity to start people on maintenance medication. This not only rapidly relieves withdrawal but is also the only approach known to cut the overdose mortality rate by half or more.” She adds that maintenance can involve the ongoing use of opioid medications like methadone, buprenorphine (Suboxone) or even heroin and that no other treatment options seem to have the same effective impact as this method.
Naloxone and naltrexone sound similar and are both used to treat opioid addiction via blocking opioid receptors. These opioid antagonists have been shown to reduce deaths from opioid overdose by 50 to 70 percent Naloxone is an injectable opioid antagonist given to individuals who are in an acute state of opioid overdose. It has a very short duration of action and causes symptoms of opioid withdrawal almost immediately after being administered. By eliminating opioid binding to receptors, naloxone prevents respiratory depression and causes agitation, nausea, vomiting and severe muscle pain, which are all side effects of opioid withdrawal. Naltrexone is an oral opioid antagonist and is much more potent than naloxone. In addition, it has a longer duration and also takes a longer time to reach its peak activity. While naloxone is administered in emergency care settings, naltrexone can be administered in outpatient settings over a long period of time.
Unfortunately physicians are very limited in prescribing naltrexone for opioid withdrawal. Not many physicians are licensed to prescribe this medication, and they have a very strict limit on the number of patients they can prescribe to as well as the number of prescriptions they can write. “Only 30,000 doctors are licensed to prescribe buprenorphine – and they are limited to 30 patients in the first year, and 100 thereafter … only 10,000 of those doctors actually do have the paperwork to prescribe for 100 and many of them don’t even see any patients.”
Emergency room physicians are unlikely to prescribe long-acting opioids to patients who have been withdrawing from narcotics. Discharging patients with a three-day supply of naltrexone, scheduling a follow-up appointment with an addiction specialist and supplying them with inpatient and outpatient addiction treatment services can help the patient obtain long-term care. Having the tools to reduce opioid overdoses by 50 percent, and not using them correctly has been one factor in perpetuating the opioid epidemic cycle.
Sovereign Health of California provides holistic, evidence-based treatments for those struggling with opioid addiction. We make sure to offer to most up-to-date treatment methods and create personalized programs based on each individual patient’s needs. To learn more about our effective treatment programs and how we can help you, please contact us via our 24/7 helpline.
About the author
Kristen Fuller, M.D., is a senior staff writer at Sovereign Health and enjoys writing about evidence-based topic in the cutting world of medicine. She is a physician author who also teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is an outdoor and dog enthusiast. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.