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ore than 50,000 people die of opioid overdoses every year and now more people are being killed by opioids than trac accidents or guns. All of us know someone with the disease of opioid addiction and everyday we either personally deal with the devastation that opioids cause, or read or hear about it. Opioids are taking lives the way that the AIDS epidemic did when it was at its peak in the 1980s and early 1990s.We were able to control the AIDS epidemic, and if the government, the health care system, law enforcement and each and every one of us decides that we are going to defeat this epidemic, we will. First things first: it’s a chronic disease A lot of people think that opioid addiction is a weakness, a personal failure or a character aw. Society and people like to feel stronger by making others feel weak. But we know from medical research that opioid use disorder is a chronic disease, much like diabetes, high blood pressure and asthma. And like these diseases, it has no cure, the same relapse rates, and, if you want to follow it, excellent and successful treatment. If you take diabetes as an example you know that some people have a “touch of sugar” and others are insulin dependent diabetics. In mild diabetes, some patients only need to watch their diet and exercise regularly, others take pills to lower their blood sugar, and some have to inject high doses of insulin every day. So, too, everyone who is prescribed or tries an opioid doesn’t get addicted.We have receptors in our brains called mu receptors, which opioids latch onto and we experience an opioid high. Everyone’s brain is dierent and many factors like our genes, the age at which drugs are tried, the dose used, the potency of the drug, whether it is eaten or injected, our social and family condition, and our psychiatric issues all control the mu receptor and whether we don’t get a high, get a bit of a high or a very intense one. Before determining the right treatment for opioid use disorder it is vital to understand that this is a chronic disease. If you don’t understand and accept this, treatment is For any treatment to be successful the patient has to be motivated. Families, courts, jobs or a society pushing a person to get sober doesn’t work.e motivation has to come from within the person. I like to tell patients that I don’t have the motivation pill, and if I did, my face would be on the cover of Time magazine! Patients who have been through treatment multiple times know that when it was successful, they had internal motivation.e times it didn’t they were either half-hearted or had been pushed by other people or factors. As physicians we try to give the best treatment we can for the patient, but we are not always able to judge the strength of a patient’s motivation and dedication towards their recovery. It is very easy to see through the patient who is half hearted and trying to dupe the system. Because of the large number of people that need treatment, we have no patience, or room, for people that are either not ready for recovery, or are trying to use the system, or both.We want to save the life of someone who really wants sobriety, not play games with patients. Counseling is essential/Customizing treatment to each patient With every kind of treatment, patients are more successful with sobriety when they go through group and individual counseling.ese sessions help the patient understand what started their addiction, what their relapse triggers are, what to do in case of a crisis, the importance of sober support and getting back to school or work. How often a patient should get counseling has not been scientically established; all we know is that counseling helps a lot with recovery.We assess each patient and try to determine how severe their addiction is, as well as their family and social situation, and come up with an individualized service plan to best help the patient. Some patients do well with once a week group therapy, while others have to start with three to ve times a week counseling sessions. Yet others need to be in an inpatient facility or in residential treatment. It is important to customize or tailor the treatment to each patient instead of adopting a one-size-ts-all approach. probably not going to work for you. There ain’t no motivation pill
Treatment choices 1. Abstinence-based treatment 2. Methadone maintenance 3. Buprenorphine-naloxone: Suboxone, Zubsolv, Bunavail 4. Naltrexone pill 5. Naltrexone injection: Vivitrol Abstinence-based treatment: you’re kinda on your own e phrase “cold-turkey” comes from opioid withdrawal because when opioids are stopped suddenly the person feels cold, has goose bumps, sweating, nausea, vomiting, diarrhea, insomnia, anxiety, irritability and muscle and bone pain.While the patient may feel that they are going to die; opioid withdrawal does not kill and usually after two to ve days, the severe withdrawal symptoms go away and the patient may just be left with some cravings. In the old days, all we could do was help patients through the withdrawal with medications like Zofran for nausea/vomiting, Imodium for diarrhea,Motrin for pain, Flexeril for muscle pain and clonidine for cravings. And we counseled patients and hoped for the best.is form of treatment doesn’t work well for all patients, in fact only a minority maintains sobriety with this and relapse rates are high. It remains a choice for those patients who don’t want any medication-assisted treatment and there are patients that maintain long-term sobriety with this and counseling. Methadone maintenance: e original treatment Methadone is a long-acting opioid and in the 1970s methadone clinics started in cities across the United States.e government tightly regulates methadone clinics because methadone is a very powerful, long acting and dangerous opioid and can kill easily. In a methadone clinic a physician evaluates the patient, and calculates their methadone dose, mainly based on their opioid use. e patient drinks liquid methadone in the presence of a nurse and has to come every day to take the liquid methadone.
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