TREATMENT FOR OVERDOSE AND ADDICTION

TREATMENT FOR OVERDOSE AND ADDICTION

In case of overdose, the opiate antagonist naloxone (Narcan) almost immediately reverses the life-threatening suppression of breathing. Treat­ing opiate addiction is another matter. As with other addictions, there is no easy solution. People have tried many of the strategies used for alco­holics. A number of groups, such as Narcotics Anonymous, emphasize abstention, attendance at meetings, and so forth.

In addition, two drugs have proved to be very effective in treating nar­cotic addiction. Methadone is a long-acting opiate that can be given on an outpatient basis to patients in treatment programs. The idea of this strat­egy is to allow the addict to avoid withdrawal and the constant need to procure the drug. The other advantages of methadone are that the drug is given orally, without the risks of IV administration, and that the dose is controlled and can gradually be worked down. Although some complain that this method just substitutes one addiction for another without addressing the social and psychological reasons for the addiction, patients' lifestyles do improve. The bottom line is that methadone works—it helps users abstain and get back to productive lives and decreases mortality compared to users receiving non-drug-based therapy. Recently, buprenor­phine, another opiate drug, has been approved for the treatment of opiate addiction in the form of a pill that you place under the tongue, or an implant placed under the skin to provide the drug constantly It is some­what different from methadone. It also stimulates opiate receptors and provides a "substitution" strategy. But when an addict takes buprenor­phine, it keeps effective agonists like heroin from getting to the receptors. So it has just enough activity to stave off withdrawal. The addict doesn't get high on buprenorphine and can't get high on heroin. Some formula­tions of buprenorphine are combined with naloxone, so if users inject it rather than taking it as a pill, he or she cannot get high and likely will experience withdrawal symptoms. The goal of this formulation is to decrease potential abuse. The reason for this formulation is that buprenor­phine, unlike methadone, can be prescribed by a doctor. Methadone can only be used in conjunction with a clinic visit: this is a real turnoff to long-term clients who complain that the only' time they are around the old drug-taking environment is when they are forced to visit the clinic to receive their medication.

Pellets containing long-term-release preparations of the opioid antago­nist naltrexone are also available. Like buprenorphine, they are implanted under the skin and provide the drug continuously In this case, they keep the user from getting high as long as they last—and that's the problem. The pellets wear out, and the user simply goes back to getting high. The success of this strategy is less than those using methadone or buprenor­phine. Another strategy that received some (undeserved) attention was the idea of putting a patient to sleep with a general anesthetic fin' the first eighteen to twenty-four hours of withdrawal along with an opioid antago­nist to help speed the normalization of opioid receptor function. Again, this was based on valid pharmacology—the opioid antagonist would help remove any remaining opioid from sites where it was active. However, it is extremely dangerous to put someone under anesthesia for so long. Fur­thermore, these programs typically offered little follow-up, and people were just as likely to start using opiates again after this program as if they had not been treated. Most reputable physicians have rejected these treat­ments. Finally, scientists are studying ibogaine, a chemical contained in an African shrub, after some sensationalistic reports in the addiction underworld that one ibogaine experience led them to give up opioids for­ever. Ibogaine is a hallucinogen, and although research is progressing, it seems unlikely that it will pan out to be a mainstream treatment for opi­oid addiction. While there are numerous clinics around the world, the National Institute on Drug Abuse decided that it has too many side effects to commit resources to studying its potential, and so there is little about it in the scientific literature.