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Addict In The Family
by Dr. Andrew Byrne
Message to the American Reader from the author. Dated April 2007.
Since this book was written, many changes have occurred both in the nature of illicit drug use as well as approaches to treatment.
Type of drug & type of treatment
In many areas, heroin is no longer the most commonly used opiate. For unknown reasons, it has been displaced by prescribed drugs such as morphine, codeine, oxycodone, hydromorphone, etc. In some cities, (eg. Boston), the addiction treatment drug buprenorphine (Subutex, Suboxone) has also become a common street opiate. Methadone liquid and tablets are also used illicitly in some areas. Common trade names of prescribed analgesics include Percocet, Percodan, Vicodan, Darvon, Demerol and OxyContin.
Due to years of neglect, and despite increasing opioid addiction, very few new methadone clinics have opened and thus there are still waiting lists for methadone in many areas while others have no access at all. The drug LAAM (sometime incorrectly called 'long acting methadone') has been largely withdrawn due to commercial factors over concerns of possible side effects on the heart.
On the bright side, a new agent, buprenorphine, was finally approved in 2003 and is changing the lives of many opiate dependent citizens in America. Buprenorphine has been made available through doctor's offices in the United States under simplified rules called a prescribing 'waiver'. This allows a strong opioid to be dispensed to dependent patients under certain circumstances. The doctor must be specially licensed and only a certain number of patients can be treated at the one time (it was originally 30 per practice). There is a useful internet site providing updated information on the doctors who are approved state by state: http://buprenorphine.samhsa.gov/bwns_locator/
Methadone is still generally only available in the rigid clinic system, unlike most other countries where it can be taken under supervision in community pharmacies, private hospitals/clinics and even in prisons.
Buprenorphine has some similarities with methadone but also some distinct differences. Both are very safe and effective in supervised administration to heroin or morphine addicted individuals who are treated under existing guidelines. Buprenorphine is an opioid agonist with some antagonist properties and with a very strong affinity for the opioid receptor. There appear to be few side effects with buprenorphine although it is not yet considered safe in pregnancy. A combination drug has been recommended by some authorities as being less abusable due to the addition of naloxone, a non-absorbed opioid antagonist (known also as Narcan, used for resuscitation purposes). This may cause sudden and unpleasant withdrawals if injected by people with a current pure agonist habit (eg heroin or methadone) -- but is harmless if taken under the tongue as recommended. In fact, pure buprenorphine can also precipitate an unpleasant but temporary withdrawal state in those currently taking heroin or methadone and that is why the drug should only be commenced in patients who are already in early withdrawals.
Other matters of concern related to drug use and addiction
HIV infection in the modern era; Drug court procedures; Needle programs and other harm reduction services; Harm reduction principles; 'Legalization' issues; Overseas innovations such as heroin prescription trials (German, England, Switzerland, Holland, etc) and Dihydrocodeine prescription in England; Legalized or medicinal cannabis; Supervised injecting rooms (Australia, Canada, Germany, Switzerland, UK, etc); The blocking drug naltrexone, including long acting implants; Self-help approaches such as SMART recovery meetings (CBT based), 'controlled drinking', spontaneous recovery and relapse and the natural history of drug use (http://www.smartrecovery.org/). We will cover these issues in future up-dates. All medical issues should be referred to your own doctor(s) as it is not possible to give individually relevant medical advice without the benefit of a personal history and physical examination.
Visit Dr Byrne's web site for journal summaries on many of these and other related subjects http://www.redfernclinic.com/
On to Chapter One
|Dr. Andrew J. Byrne received the prestigious Marie Award at the 2006 national conference of the American Association for the Treatment of Opioid Dependence.|
|For more information about pain management and opiate pain medication, check out ManagingChronicPain.org.|