Despite recommendations from an opioid commission and the declaring opioid abuse a public emergency, the number of overdose deaths due to opioids continues to rise.
On Monday the Food and Drug Administration took another step designed to improve matters. Unfortunately, it cannot help matters in the short term because it only calls for the development of new drugs for medication-assisted treatment (MAT).
MAT is for drugs that can sate an addict’s cravings without getting them high. The hoped-for result is there will be fewer overdose deaths and addicts can become functioning and productive members of society.
That is a laudable long-term goal, but those drugs are not likely to become available for years, so it will have no impact on those currently addicted and at risk for overdose. These prospective drugs will have no immediate effect on the walking-dead addicts who can’t hold down a job or take care of their basic human needs because all they are focused on is the next time they get high.
But there are MAT drugs available now if the government stops fighting them.
Buprenorphine, methadone, and naltrexone are all MAT drugs that exist now. Buprenorphine and methadone are opioids, such as the opioid epidemic drugs oxycodone, hydrocodone, heroin, and fentanyl, but much weaker. At prescribed doses, they cause no high for opioid addicts. For this reason, methadone is given out only one dose at a time, once a day at a methadone clinic or doctor’s office. True, in larger doses they can get opioid addicts high, and they can get new opioid users high.
For those reasons, some government officials, politicians, and judges don’t like them. They prefer the third drug, naltrexone, because it is not an opioid and can no-way, no-how get you high. That’s because it is an anti-opioid. It stops you from getting high, even if you do take opioids. It is most commonly used now as the once-monthly injection Vivitrol.
Naltrexone should only be given to addicts who have already detoxed and gone through withdrawal, or else they will go through instant and painful withdrawal. That limits its use to people well on their way to recovery, with three to-10 days of sobriety behind them. Buprenorphine can be started within a day.
That delay means naltrexone is harder to start. In one study, more than four times as many addicts dropped out before starting naltrexone as buprenorphine. Addiction treatment delayed can mean addiction treatment denied.
Buprenorphine (often in its Suboxone formulation with naloxone) and methadone have a longer track record and are easier to start than naltrexone. Tamper resistant-sublingual film and skin patches are available, as is a multi-month buprenorphine implant. A once-monthly buprenorphine injection is in development, too. The only reason to favor naltrexone is an antipathy to opioids or the belief that addicts are bad people who deserve to suffer, that punishment is more important than harm reduction.
While better MAT drugs is a welcome prospect, our existing ones are underutilized. If we want to save lives, then rehabs must be able to offer whichever MAT is best for the individual patient. Treatment should not be limited by prejudice or politics.
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