Opioid addiction…

Opioid addictionDr. Michael J. O’Connell, New Hampshire recently commented that the horn blowing by politicians and law enforcement over “complicity of physicians in the heroin crisis” is an attempt to affix and thereby shift blame for the recent spate of overdose deaths.  The current theory goes that by ‘over-prescribing’ opioids to patients in the ER, post operatively for pain control, and in family practitioner offices for chronic maladies, that the consumers ‘become’ addicts, get ‘hooked’.  This is utter nonsense, and for which there is not one shred of evidence.  While an understandable layman’s intuitive conclusion, but nonsense nonetheless.

Perhaps officials, governors, drug czars and police chiefs alike, are too familiar with the old model of blaming the demon alcohol for the alcoholic.  To blame prescriptions for opioid addiction and Jack Daniels for alcoholism is like blaming a deck of cards for a gambling addiction.  It’s like blaming malls for compulsive shopping, or restaurants for obesity.

Addiction is an extremely complex condition, and reducing it to a simple ‘cause and effect’, while serving the accusers very well, does nothing to solve the problem of addiction.  Addiction requires a susceptible individual (the right combination of social experience and genetic makeup), stress, and yes, availability of agent.  With respect to availability of opioids, they always have been, whether by black market or by prescription or by cultivating poppies. Nothing has changed in overall availability in a century.

Opioid addiction among young pregnant women…

Opioid Addiction among young pregnant women 2

As addiction to various forms of opioids becomes even more prevalent, among young women than ever are presenting for delivery on methadone, heroin, oxy and other drugs.  This causes a considerable nightmare for those healthcare workers administering to the newborns.

Neonatal abstinence syndrome (NAS) is the withdrawal of the baby from the drugs mom abused before and during pregnancy.  The treatment for the newborn is continuation with gradual weaning from some form of opioid, often IV morphine.  The process can take weeks in the hospital and costs are staggering.  The treatment for the mom is less complicated and requires little additional hospital stay, but is just as unpalatable from a societal perspective.

There are few answers to this gestational addiction problem, but buprenorphine is a solid drug to address the issue while society figures out the underlying problem.  If the pregnant addict confesses to her addiction, and converts to buprenorphine (Subutex, Suboxone) early in pregnancy, the NAS is markedly reduced to just a few days.  The problem is how to convert the mother from the methadone, or oxy or whatever potent opioid she is taking to the buprenorphine?  Many studies are now emerging that support the safety of doing this in a gradual manner during the first trimester.  The process must be monitored by a provider experienced in such a transition, is very familiar with buprenorphine, and also has access to urine tox screening and quantitative LCMS.

A Brief Overview of Suboxone, by Michael O’Connell, MD, MHA

Pill BottlesSuboxone, the trade name for sublingual buprenorphine, is used for the treatment of opioid addiction and also off label for chronic pain. Unlike methadone, a commonly used treatment for opioid addiction, Suboxone generally provides no noticeable high or state of sedation. As such, Suboxone treatment may prove to be more appropriate than methadone, as it provides far less potential for misuse. Health care professionals in many countries have noted a lower rate of relapses in patients treated with Suboxone. Some have even gone so far as to dub it a “miracle pill.” While not exactly miraculous, it is extremely useful in combination with group counseling.

Derived from the opium poppy plant, Suboxone reacts with the k-opioid receptors within that portion of the brain that is directly involved with pain, consciousness, and addiction potential. Suboxone was initially used in 1980 as an injectable analgesic, but was later discovered to possess properties that aided in withdrawal of patients from potent opioids.

In addition to its use in treating opioid addiction, Suboxone can also be prescribed “off label” for moderate to severe chronic pain. Cancer patients as well as individuals who suffer from neuropathic or musculoskeletal pain, especially those who are highly tolerant and dependent on potent opioids, may benefit greatly from this drug. Many physicians choose this medication over others due to its high safety profile, long shelf life, and often surprisingly good analgesic qualities.

About the Author:

Dr. Michael J. O’Connell of Barrington, New Hampshire, has forged a distinguished career spanning over three decades, as entrepreneur, physician, businessman, philanthropist and healthcare consultant. As former owner, administrator and CEO of a 225+ employee multi-specialty medical practice, Dr. O’Connell has dedicated his entire professional life to helping patients with family medicine and especially those experiencing chronic pain and all aspects of addiction.