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Medically Managing All Opiate Withdrawal
Symptoms With Suboxone Detox Protocol
For
most of the last century, the ability of doctors and
treatment centers to help opiate addicts has been
limited by the federal government. The "Harrison
Narcotic Act" of 1914, originally designed as
a tax act, was misinterpreted by the Supreme Court
to prohibit the prescription of opiates to opiate
addicts, even in the course of their treatment. From
then on, an entire line of practice - the tapering
of opiate dosage to ease the pain of withdrawal -
was against the law.
METHADONE
- SOLUTION OR PROBLEM?
The
one exception has been methadone.
When used properly, methadone can be an effective
treatment for opiate addiction. However, the idea
of maintaining addicts on a substitute drug led the
Federal Government to restrict methadone so tightly
that the drug could only be prescribed by specific
clinics. These clinics vary widely in the quality
of care they provide. In addition, methadone causes
euphoria (a high), which has led to some addicts using
methadone clinics to subsidize their opiate addiction
and abuse methadone. Also, methadone maintenance clients
eventually reach a point where it is nearly impossible
to ever successfully detox from the methadone, because
after long-term use, methadone withdrawal symptoms
have been reported to be 10 times more severe than
those of heroin and lasting sometimes as long as 3
to 4 months in duration, compared to the 7 to 10 days
of withdrawal symptoms that an average heroin
addiction can produce. The combination of these
factors have proven methadone maintenance to be counter-productive
in treating opiate addiction and has limited the effectiveness
of methadone for detoxification purposes, as well.
SHOOTING
UP, SLAMMING, INJECTING, SMOKING OR SNORTING HEROIN
There
are three basic routes of administration used by heroin
addicts. Injection, often called "shooting up"
or "slamming heroin" in the illegal drug
world, is by far the predominant method used by heroin
addicts. Smoking heroin or "Chasing the Dragon"
as smoking heroin using foil and a straw is known
by heroin addicts, runs a distant second and sniffing
or snorting heroin is rarely a heroin addicts method
of choice. Ingesting heroin orally is almost unheard
of.
Some
prescription
opioids such as Oxycontin
or Dilaudid can be injected even though they come
in tablet form. However, the manufacturers of more
recently developed synthetic opiates such as Methadone
and Suboxone
have gone to great lengths in making it nearly impossible
to inject them, thereby helping to minimize their
abuse.
UNMISTAKABLE
SIGNS OF OPIATE ABUSE AND ADDICTION
There are many
signs that would indicate a person is addicted to,
or at least abusing opiates. If a person is exhibiting
any of the following signs, there is good cause for
concern. If a person is displaying multiple signs,
they should be considered red flag warnings.
Some of the
more obvious signs of opiate addiction are: constricted
(pinpointed) pupils, nodding out, increased activity
level before nodding out, use of laxatives (heroin
causes constipation), vomiting, loss of established
friendships, new undesirable friends, depression,
track (needle) marks on arms, sudden change in behavior,
itching and scratching, weight loss, cessation of
menstruation, finding bent spoons with burn marks,
disappearance of spoons, stolen credit cards and checks
or cash, aluminum foil with burn marks, new purchases
returned for a cash refund, pawn slips found around
the house, theft of household valuables, blood spots
on clothing, bottles of vinegar or bleach (used to
clean syringes) and little cotton balls.
SEVERE
OPIATE WITHDRAWAL SYMPTOMS
Some of the
more acute withdrawal symptoms associated with Cold
Turkey heroin
or opiate detox are 3 -7 days of severe muscle
aches and spasms, profuse sweating, diarrhea and severe
cramping caused by dehydration. Worse are the opiate withdrawal symptoms caused by abrupt discontinuation of the use
of some of the pharmaceutical opiates such as Oxycontin and particularly methadone. These substances can produce
weeks and sometimes even months of opiate withdrawal
symptoms such as the sweats, muscle and joint aches,
spasms, cramping, diarrhea, vomiting and dehydration
leading to possible convulsions.
SUBOXONE®
ELIMINATES BEDRIDDEN AGONY OF OPIATE WITHDRAWAL
The
"Drug Abuse Treatment Act of 2000" allows
detox centers and physicians to minimize an addict's
symptoms of opiate withdrawal with Suboxone
detox protocol. Whereas drugs like morphine, heroin
and methadone are opioid receptor agonist - meaning
they fully bind opioid receptors - Suboxone® (buprenorphine)
is a partial opioid receptor agonist. This gives Suboxone®
the ability to relieve even the acute symptoms of
opiate withdrawal without producing the euphoria (high)
of the full agonist drugs like oxycontin, heroin,
morphine, demerol, vicodin and methadone. For the
first time, physicians and detox centers can use Suboxone
to provide a safe and comfortable detox for all opiate
addicted patients with the capacity to comply with
treatment.
THE
FORMULA
Suboxone®,
a sublingual tablet, comes in two dosage forms: 2 mg
buprenorphine/0.5 mg naloxone and 8 mg buprenorphine/2
mg naloxone.
SAFETY
Because
of its ceiling effect and poor bioavailability, buprenorphine
is safer in overdose than opioid full agonists. The
maximal effects of buprenorphine appear to occur in
the 16-32 mg dose range for sublingual tablets. Higher
doses are unlikely to produce greater effects.
OPIATE
ADDICTION TREATMENT WITH SUBOXONE
This
section provides a brief overview of the clinical use
of buprenorphine (Suboxone®) for heroin, methadone
and all other opiate addiction treatment.
Ideal
candidates for heroin and other opiate addiction treatment
with Suboxone® are individuals who have been objectively
diagnosed with an opiate addiction, are willing to follow
safety precautions for treatment, can be expected to
comply with the treatment, have no contraindications
to buprenorphine therapy and who agree to buprenorphine
treatment after a review of treatment options. There
are four phases of the Suboxone
detox protocol: induction, stabilization, titration
and treatment.
INDUCTION
This
phase is the medically monitored startup of buprenorphine
therapy. Buprenorphine for induction therapy is administered
when an opiate-dependent individual has abstained from
using heroin or other opiates for 12-24 hours and is
in the early stages of opiate withdrawal or detoxification.
If the patient is not in the early stages of withdrawal,
i.e., if he or she has other opioids in the bloodstream,
then the buprenorphine dose could cause acute withdrawal.
Induction
is typically initiated as observed therapy in the physician's
office and is carried out using Suboxone®.
STABILIZATION
This
phase begins when the patient has discontinued the use
of his or her drug of abuse, no longer has cravings,
and is experiencing few or no withdrawal symptoms. The
buprenorphine dose may need to be adjusted during the
stabilization phase. Because of the long half-life of
buprenorphine it is sometimes possible to switch patients
to alternate-day dosing once stabilization has been
achieved.
TITRATION
The
titration phase is reached when the patient is doing
well on a steady dose of Suboxone®. Once the patient
shows no sign of opiate withdrawal,
the patient is then titrated (stepped-down) from the
buprenorphine therapy, until he or she is drug-free.
This phase replaces what is otherwise known as "detoxification".
TREATMENT
Effective
treatment of heroin, methadone or any other opiate
addiction requires comprehensive attention
to all of an individual's medical and psychosocial co-morbidities.
Pharmacological therapy alone rarely achieves long-term
success. Thus Suboxone® detox protocol should be
combined with concurrent behavioral therapies and with
the provision of needed addiction treatment services. This point is of such
importance that physicians must attest to their capacity
to refer patients for addiction treatment and counseling when they submit their Notification of
Intent to SAMHSA (Substance Abuse and Mental Health
Services Administration) before they can begin prescribing
Suboxone® for the purpose of opiate detox.
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