About Opioid Dependence
What Is an Opioid?
Opioids are drugs that are either derived from opiates (drugs created directly from opium, such as morphine or codeine) or are chemically related to opiates or opium. Examples of opioids include some prescription painkillers (such as oxycodone, hydrocodone, buprenorphine, methadone) and heroin.
What Is Opioid Dependence?
The most common way that people refer to opioid dependence is as an addiction. An individual is generally considered opioid-dependent when 2 things occur:
• Repeated opioid use is needed in order to feel good or avoid feeling bad and
• The opioid use continues in spite of its negative effects. For example, people who are opioid-dependent will feel a need to keep using opioids even if it hurts the user’s health, job, finances, or family.
With almost two million people in the United States dependent on opioids, it is more common than most people may think. While many people may know someone who has been affected by opioid dependence, the condition is still largely misunderstood.
Opioid Dependence Is a Medical Condition.
For some, drug use can begin as a choice, but frequent use can cause the brain cells to change the way they work. Researchers have discovered that many drugs, including opioids, cause long-term changes in the brain. With repeated use, the brain “resets” itself to believe the drug is necessary for survival. As dependence develops, a person’s behavior also changes, and he or she may become compulsive in seeking the drug and its effects. These brain changes prove that opioid dependence is a chronic disease, which is why people have cravings years after they stop taking drugs.
Changes in the brain can lead to:
• Opioid tolerance (the need to take more drug to get the same effect, or getting less effect from the same amount of the drug)
• Opioid withdrawal symptoms when opioids are not used
• Taking larger amounts of opioids than planned and for longer periods of time.
What You Need to Know About SUBOXONE
What is SUBOXONE?
SUBOXONE is a prescription-only partial opioid agonist that blocks other opioids from attaching to receptors in the brain, decreases cravings, and suppresses withdrawal symptoms. Buprenorphine, the active ingredient in SUBOXONE, works by strongly binding to opioid receptors.
1.A person is in a mild-to-moderate state of withdrawal (-) as the opioid of dependence begins to leave the receptors.
2. Buprenorphine attaches to receptors as the other opioid leaves the person’s system. Withdrawal symptoms start to get better (+) because buprenorphine is filling up the receptors. In addition, buprenorphine reduces cravings.
3. Buprenorphine firmly attaches to the receptors and blocks other opioids from attaching. With adequate maintenance doses, buprenorphine fills most receptors. The buprenorphine has a long duration of action, so it doesn’t wear off quickly.
What You Need to Know About SUBOXONE Treatment
How Effective Is SUBOXONE?
A number of clinical trials have established that buprenorphine is effective at:
• Retaining patients in treatment
• Reducing opioid use by:
— reducing symptoms of withdrawal
— reducing cravings for opioids
In all studies, patients received regular counseling along with their medication.
How Do Most Patients Start SUBOXONE Therapy?
Once arrangements have been made for an appointment, the doctor should ask the patient to arrive in a state of moderate withdrawal. This may be difficult because withdrawal symptoms can be very uncomfortable. Withdrawl symptoms include:
sweating, restlessness, tremors, dilated pupils, nausea and/or diarrhea, anxiety and irritability, and cold symptoms.
Why Do Patients Have to Be in Withdrawal?
It is important for patients to be in moderate withdrawal when taking the first dose of SUBOXONE to avoid precipitated withdrawal. Here’s how precipitated withdrawal occurs:
1. When there are high levels of other opioids in the system, SUBOXONE competes with the other opioid molecules and knocks them off the receptors.
2. SUBOXONE then replaces those opioid molecules on the receptors.
3. Because SUBOXONE has less opioid effects than full opioid agonists, the patient may go into withdrawal and feel sick, which is called precipitated withdrawal.
By already being in the first stages of withdrawal when taking the first dose of SUBOXONE, the process will be easier and SUBOXONE should make the patient feel better.
What Happens in the Maintenance Phase?
Once the patient is stabilized on a dose that keeps withdrawal symptoms and cravings under control, he or she will start feeling better physically, but this does not mean he or she is “cured.” Counseling options that meet his or her needs should be discussed and scheduled. Continued support should be provided. During the maintenance phase, medication should still be taken as directed and counseling should be a part of ongoing treatment.
The Importance of Counseling
Counseling can be very effective in addressing the psychological and behavioral aspects of opiate dependence. When a medication-assisted treatment program is combined with counseling, the likelihood of success is increased. In counseling, one can learn how to recognize events that may trigger the use of opioids. The patient can also learn ways to cope with events or social situations he or she may have associated with past drug use or that may trigger him or her to return to drug use.
Counseling has other benefits, too, such as:
• Helping patients substitute positive behaviors for substance use
• Helping patients work toward realizing their treatment goals
• Providing support, encouragement, and hope
At Beachway, counseling and support is made available.
In addition, you may want to visit the following websites:
The SUBOXONE website provides information on treatment for opioid dependence with SUBOXONE. It features encouraging patient stories, as well as a physician locator.
The Turn to Help website offers information on opioid dependence, various treatment options, patient stories, and resources to help you and your loved one better understand the condition and recovery process. The site includes sections for the person who is seeking treatment as well as for friends or loved ones searching for information.
The National Alliance of Advocates for Buprenorphine Treatment (NAABT) is a site designed to educate the public about the disease of opioid dependence and the buprenorphine treatment option. It features online support communities, patient stories, frequently asked questions, and a locator.
The National Alliance of Advocates for Buprenorphine Treatment provides a physician, counselor, pharmacy, and treatment facility locator that can help your loved one find the help that he or she needs.
The Partnership for a Drug-Free America is a nonprofit coalition of communication, health, medical, and educational professionals working to reduce illicit drug use and help people live healthy, drug-free lives.
The National Institute on Drug Abuse provides information and scientific facts about drug abuse.
The Center for Substance Abuse Treatment (CSAT) offers additional information on buprenorphine including information in Spanish.