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Drug Rehab Medical Devices Won’t Work if No One Uses Them

Heroin is derived from the opium poppy. (Pixabay)

We’re still in the midst of an opioid crisis (or an opioid epidemic, or opioid national emergency, depending upon with whom you speak). And while the US government has been criticized for not doing enough, it is doing some things.

Among them is that the US. Food and Drug Administration has initiated “an innovation challenge to spur the development of medical devices” that could reduce or control addiction and the pains that cause some people to become addicted.

Of course, companies can and have come up with such innovations on their own, and FDA isn’t offering a cash prize for the best product. (With the cost of marketing a new medical device estimated from $100 million to several billion, it would take a lot of cash to interest any otherwise uninterested party.) Instead, the intended spur to rapid innovation is the promise of “the opportunity to work closely with the agency to accelerate the development and review of their innovative products”. (Less red tape and hoops to jump through is probably a better incentive than cash.)

Even then, there’s no guarantee that people, insurance companies or doctors will use it. For about two years one game-changing device has been on the market, but it has failed to meet expectations. Probuphine is an almost tamper-proof implant that delivers a steady, non-intoxicating dose of buprenorphine for six months. Buprenorphine is a weak opioid used in medication-assisted treatment (MAT) relapse prevention and to keep opioid addicts from going through withdrawal. It just maintains.

Because Probuphine is an implant, there was next to no chance that the product could be diverted to addicts on the black market, as has been the case with Suboxone, a pill or sublingual film formulation of buprenorphine (combined with the opioid agonist naloxone to discourage tampering). Because it lasts for six months, the patient can’t forget or choose not to take it.

Probuphine has some drawbacks, including the price: about $5,000 for a six-month implant, more than twice that of the pill or film.

(Probuphine’s price is competitive with a more popular – especially among drug court judges, thanks to an intensive lobbying campaign – longer-term MAT: Vivitrol, a once-monthly injectable form of naltrexone, which prevents the patient from getting high on opioids. Six injections of Vivitrol cost about the same as six months of Probuphine. A monthly or weekly injectable version of buprenorphine is under development.)

Another is that doctors have to be specially trained to implant the device. And since it’s a new product, many doctors, patients and insurers may just be waiting to see how it works in real life.

(Norplant, a contraceptive implant from the 1990s that is not dissimilar to Probuphine, was discontinued following “dwindling demand” and lawsuits by patients who claimed side effects that they were not warned about.)

Even though it seems many more could benefit from using Probuphine, the best medical device won’t help anyone if no one actually uses it.

No treatment is ideal for every patient, and MAT alone is rarely recommended. Professional drug rehab for opioids – heroin addiction, oxycodone addiction, hydrocodone addiction – or other drugs (for which there may be no MAT currently) is always a good idea.

It’s not just the addiction; it’s also learning to cope without drugs.