Have You Gone Too Far?
There’s still a way back.
Substance abuse is a broad term that can describe a wide range of dangerous and harmful behaviors involving both legal and illegal substances. Alcohol, tobacco, marijuana, and prescription medications are among the most commonly abused substances in the United States, while the abuse of heroin, cocaine, methamphetamine, and other drugs remains problematic in communities throughout the nation. Depending upon the specific substance being abused, the amount and frequency of that abuse, and certain other factors, individuals who engage in substance abuse are at risk for myriad negative outcomes, including significant physical and psychological damage and the development of a substance use disorder.
Commonly referred to as addiction or chemical dependency, substance use disorders are characterized by a variety of unpleasant symptoms that include prioritizing substance abuse over important issues such as relationships, career, and academic progress, continuing to abuse substances even after experiencing negative repercussions, and experiencing painful withdrawal symptoms when attempting to stop or limit one’s substance abuse.
Drug overdose deaths and opioid-involved deaths continue to increase in the United States. The majority of drug overdose deaths (more than six out of ten) involve an opioid. Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled.2 From 2000 to 2015 more than half a million-people died from drug overdoses. 91 Americans die every day from an opioid overdose.
We now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths. The amount of prescription opioids sold to pharmacies, hospitals, and doctors’ offices nearly quadrupled from 1999 to 2010, yet there had not been an overall change in the amount of pain that Americans reported. Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have more than quadrupled since 1999.
In their search for a less addictive opiate, in the mid-1990s drug companies first designed extended release opiates like Vicodin (containing hydrocodone and Tylenol) and Percocet, which contains oxycodone and Tylenol. Subsequently, they created a purer opiate, containing only oxycodone, most commonly known under the brand Oxycontin.
It is difficult to overstate the degree of devastation that can occur in the lives of individuals who do not receive effective care for substance abuse and chemical dependency. The potential impact of a single experience with substance abuse can range from temporary incapacitation to irreversible damage, including death. As an individual continues to engage in a pattern of substance abuse, both the likelihood and the possible severity of these negative outcomes continues to increase. The physical damage of substance abuse can include, but is not limited to, heart problems, breathing impairments, vision trouble, liver and kidney damage, tics and tremors, and increased risk for certain cancers. Psychological effects may include diminished cognition, anxiety, depression, paranoia, hallucinations, and delusions. An individual whose mind and body has been weakened by substance abuse is at increased risk for academic failures, diminished occupational performance, and deteriorating interpersonal relationships. Other negative outcomes that have been associated with chronic substance abuse and addiction include unemployment, financial setbacks, arrest and incarceration, homelessness, social ostracization, hopelessness, and suicide.
Office-based buprenorphine-naloxone (Suboxone) treatment in the United States has significantly improved access to safe and effective opioid-dependence therapy. Patients averaged 32 years old, 4.3 years of opioid dependence, and were primarily white (93%) and employed (70%). Fifty-two percent used heroin primarily (most by injection), and 70% had no agonist substitution therapy history. Almost half (47%) paid for their own treatment. Suboxone maintenance was associated with good treatment retention and significantly reduced opioid use, and it is helping to reach patients, including injection drug users, without histories of agonist substitution therapy.
The recent advancements in the understanding of the neurobiology underlying addiction related behavior have contributed to the recognition that opioid addiction is a serious complication of chronic opioid intake in some individuals (note that patients receiving opioids for chronic pain do not necessarily develop addiction). Nowadays, addiction is considered a chronic disease of the brain rather than a mental illness carrying a social stigma.
Our treatment program devises careful dosages of medicines that competitively inhibits the pharmacologic effects of exogenously administered opioids and, in line with the classical receptor theory, produces a parallel right shift in the dose-response curves of opioids. Suboxone is readily transported across the blood-brain barrier and, therefore, has a fast onset of action in reversing opioid effects. Its duration of action is limited due to its short elimination half-life of 30 minutes. The ability of suboxone to reverse opioid effects in vivo is mainly determined by the pharmacologic characteristics of the interacting opioid agonist (i.e., the opioid that requires antagonism).
Anesthesiologists use buprenorphine/naloxone for reversal of postoperative respiratory depression induced by potent opioid analgesics, such as fentanyl, sufentail and morphine. Similarly, buprenorphine/naloxone may be used to treat opioid overdose in opioid-dependent patients.
<style=”text-align: center;”>“The best time to plant a tree was 20 years ago. The second-best time is now.” – Chinese proverb
<style=”text-align: center;”>“Believe you can and you’re halfway there.” – Theodore Roosevelt
<style=”text-align: center;”>“What lies behind us and what lies before us are tiny matters compared to what lies within us.” – Ralph Waldo Emerson
<style=”text-align: center;”>“If things go wrong, don’t go with them.” – Roger Babson
<style=”text-align: center;”>“It always seems impossible until it’s done.” – Nelson Mandela