Now, more medications treat opioid use disorder
Drug-related deaths hit an all-time high in the United States recently, with most of those fatalities due to opioid overdoses. New medical treatments can help respond to overdoses and opioid use disorder, preventing some deaths.
In Illinois, 2,944 people died from opioid overdoses in 2020, which was a 33% increase from the previous year. The increase is due to the prevalence of synthetic opioids such as fentanyl, according to the Illinois Department of Public Health. Even in small doses, fentanyl can be deadly.
A combination of medication and behavioral therapy can successfully treat substance use disorders, help in recovery, and prevent overdose deaths.
First responders have been using naloxone, the main ingredient in Narcan, to reverse opioid overdoses and revive people on the spot. But it’s not a treatment solution — people whose lives have been saved with naloxone can, and often do, go back to using opioids.
Another medication, buprenorphine, helps treat opioid use disorder, diminishing the effects of physical dependency such as withdrawal symptoms and cravings. When used with counseling and behavioral therapies, buprenorphine can treat opioid dependency.
And now, buprenorphine has become more widely available. Until 2021, the schedule 3 controlled substance was restricted. To prescribe it, practitioners had to go through specific training and apply for a waiver.
New medical treatments can help respond to overdoses and opioid use disorder.
In spring 2021, the Biden administration lifted many of these restrictions in a dramatic deregulation meant to reduce barriers to treatment.
At Timberline Knolls, a residential treatment center in Lemont, Suboxone — a combination of buprenorphine and naloxone — is used as a step-down or tapering medication once a patient has entered withdrawal. It also can be effective on a longer-term basis.
Suboxone is highly effective as part of an integrated care protocol, says therapist Cynthia Bill, lodge director of the women’s addiction program. “It takes some of the edge off withdrawal,” she says.
Once the taper is complete, many patients move on to naltrexone (Vitirol), administered once monthly. Naltrexone blocks opioid receptors so users who relapse aren’t able to get high. Bill calls it “a safety net” to encourage the person to stick with therapy, self-help groups, and other behavior modifications.
Vitirol removes opioids’ allure as a go-to for life’s stressors, Bill says. “Patients become receptive to developing new coping skills instead.”
Like all medications, these have limitations. Finding the right dosage can take time. Some people are allergic. Others experience side effects — notably, shallow breathing — that must be monitored. Additional side effects range from headache to nausea to drowsiness.
But, Bill says, “as long as these medications are monitored and used well as part of a comprehensive, integrated program, they can be used successfully.”