Important Policies on Opioid Addiction Therapies Using Methadone and Buprenorphine
등록일 2019년 01월 07일 월요일
수정일 2017년 11월 13일 월요일

Photo by: MikeBiTa

More than 190,000 people died in 2015 because of drug-related activities, according to Statista.Opioid addiction is now an epidemic considered by health experts that can be stopped if only people seek treatment.Two medications are available that can treat people with opioid dependence – methadone and buprenorphine.

Methadone Treatment for Opioid Dependence

Methadone is an opioid medication that reduces withdrawal symptoms in people addicted to narcotic drugs like heroin.It has been extended from specialized clinics to office-based opioid therapy as treatment options for methadone-maintained opioid-dependent patients.

Before methadone can be introduced as a treatment for opioid-dependence, the patient must undergo a complete physical and psychiatric evaluation.The patient must be at least 18 years old, must have been physiologically dependent on narcotic drugs for at least a year, and must meet the criteria for opioid dependence.The criteria quantifies the patient in terms of drug tolerance, withdrawal symptoms, opioid use in greater quantities, use of narcotics in longer periods of time, failure to quit or cut back, time devoted to use or obtain narcotics, interference with social or recreational activities, and ongoing use of narcotics even with the awareness of drug-dependence problem caused by related substances.Physicians must be sharp enough to watch out for any signs of drug-seeking behavior or relapse in formerly addicted patients.

The early introduction of methadone dosages is meant to constrict withdrawal symptoms in addicted patients.The effects of methadone should reduce the craving for narcotics and reach the tolerance threshold but should avoid euphoria and sedation caused by overmedication.The initial dosage from 20 to 30 mg is considered safe and appropriate for the early introduction of methadone.It usually takes between 4 and 10 days to achieve steady-state maintenance dosing.If the patient's dosage becomes effective for at least 24 hours, the maintenance phase of dosing is achieved.The maintenance phase lasts as long as the treatment continues to benefit the patient.

Photo by: Roberta F.via Shutterstock

Since methadone is an opioid medication, detoxification from the drug involves the introduction of withdrawal symptoms.Short-term methadone detoxification should not exceed 30 days while long-term detox lasts from 31 to 180 days.It is recommended that physicians should perform gradual detoxification instead of instant discontinuation of methadone.In terms of detoxification dosage, it is usually safe to set methadone dosage in a low dosage, about 10 mg, before starting the additional medications.This will help the patient's body to adjust to the reduction of methadone dosage during the detoxification process.

Patients undergoing methadone treatment are susceptible to medical problems.Diseases, such as HIV, hepatitis, and tuberculosis, must be discussed by the physician to the patient and their family members to prevent further transmission.

1.HIV infection among opioid-dependent people has a prevalence rate of up to 60 percent.A series of medical examination, such as CD4 T-lymphocyte count, viral load, and details of the patient's immunizations must be determined.HIV makes a prognosis of other diseases like tuberculosis worse.

2.Hepatitis B and C viruses are prevalent among opioid-dependent patients with infection rates of up to 80 percent.Physicians should perform screening tests to know the disease's status and health of the patient's liver.

3.Tuberculosis is very common among people with latent HIV-seropositive intravenous drug users.Regulations require that patients receive tuberculosis screening before being admitted to a methadone clinic.

People who are under methadone treatment usually suffer pain from withdrawal symptoms, it is caused by the opioid substitution therapy.Physicians should not increase the dosage of methadone to prevent addiction to the drug and should only prescribe non-narcotic pain relievers.If the patient experiences chronic pain, it is recommended to work with pain clinics for a broad spectrum of interventions to manage pain.

Buprenorphine Treatment for Opioid Dependence

Buprenorphine is also an opioid medication used to treat drug addiction, moderate acute pain, and moderate chronic pain.It may be combined with naloxone to treat opioid drug dependence.Buprenorphine is an alternative to methadone for the treatment of drug addiction because it offers several advantages.

- Higher doses of buprenorphine have a lower risk of toxicity.

- It is more effective at less than the recommended daily dosage.

- Discontinuation has less severe withdrawal symptoms.

- It is more accessible for office-based treatment programs.

- It is less expensive compared to methadone.

- It is more effective than methadone in patients with higher drug tolerance.

- It has higher treatment retention rate than methadone.

For HIV treatment, two studies in 2000 found that patients under buprenorphine treatment were more likely to follow to the highly active antiretroviral therapy and that the drug did not affect the patient's viral response to HIV medication.

For hepatitis, physicians must screen opioid-dependent patients for hepatitis B and C infection.Buprenorphine is metabolized in the liver and it has been found that the drug can damage the liver of a patient with hepatitis C, according to a study in 2001.

Additional Information

- The most widely prescribed opioid between 2006 and 2014 was hydrocodone sold as Vicodin.It is a semi-synthetic opioid manufactured with natural and synthetic ingredients

- Heroin-related overdose deaths are rising but it can be prevented by the naloxone treatment.Heroin is manufactured from opium poppies refined in four primary sources – South America, Mexico, and southeast and southwest Asia.

- Fentanyl is a 100 percent synthetic opioid that was originally made as a powerful anesthesia.

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