How do we Treat Opioid Addiction?

This week I want to share two articles about the opioid epidemic and treatment options. The first article is about a company who marketed their drug in allegedly unethical ways. The second article is about a study that may prove medications can help heal the brain of someone who is addicted to opioids. Below you’ll find these articles and my thoughts on their implications.

Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.

Suboxone maker Reckitt Benckiser to pay $1.4 billion in largest opioid settlement in US history 

Reckitt Benckiser, the company that makes the drug Suboxone, agreed to pay the U.S. government $1.4 billion for how it marketed the medication. They were accused of telling physicians their drug was less addictive and safer than other drugs that contain its active ingredient, the opioid buprenorphine. Additionally, they were accused of using their “Here to Help” program, designed as a resource for patients addicted to opioids, to send those patients to doctors they knew would prescribe Suboxone.

Mark’s Thoughts:
ICYMI…One of the solutions to the opioid epidemic is apparently tainted as well. About how they marketed the product. Sound familiar? That’s what Big Opioid Pharma (e.g. Purdue Pharma) has battled in lawsuits and the federal government for a decade+. Of course, when settlements happen nobody officially accepts blame (they just want it to go away). However, when you pay $1.4 billion (with a ‘b’) to settle, there are lots of questions (1.4 billion of them) to ask in regards to the validity of the charges levied against them. For more context, read this 4/13/17 article. You can make up your own mind on how this settlement should be viewed, but there remains no doubt that marketing of opioids has been a real problem. “Opioid withdrawal is difficult, painful, and sometimes dangerous; people struggling to overcome addiction face challenges that can often seem insurmountable…Drug manufacturers marketing products to help opioid addicts are expected to do so honestly and responsibly.” Um…yeah…that should go without saying. Unfortunately, it requires saying. And paying (for not doing).

A peek into opioid users’ brains as they try to quit

Scientists are studying the effect that drugs made to fight opioid-addicted patients have on altering the addicted brain, not just the addiction symptoms. Opioid addiction changes the way the brain works, meaning even after they are no longer used the individual could still be highly susceptible to falling back into the addiction (relapse). Scientists are studying whether three drugs–methadone, buprenorphine and extended-release naltrexone–can heal (during treatment of) the damaged neural networks.

Mark’s Thoughts:
And speaking of MAT or medication assisted treatment (Suboxone is one of the drugs included in this treatment), NIDA is trying to figure out how the addicted brain reacts as opioids are tapered. This research will be something very useful to watch unfold. They don’t yet have the desired number of study participants but hopefully publicizing it will help them continue their research. Dr. Nora Volkow has long been a proponent of MAT (I’ve seen her speak on several occasions) so her thesis is grounded in her opinion. It will be interesting to see if this study (and maybe others) prove her thesis. For more info about MAT, the Las Vegas Recovery Center offers a very helpful summary, including this statement – “It should always be offered in an environment that teaches clients how to live and function better, introduces them to community supports, helps them deal with stressors and co-occurring psychological and psychiatric conditions, and facilitates a healthier, happier life.” Which corresponds to some posted comments:

From Jared Payton: “While I will certainly be interested in this study, I have a contrarian view on Suboxone and MAT.  As someone who has a heroin/opioid addict in the family and as someone who has spent a lot of time with the recovery community, Suboxone and similar drugs are just trading one addiction for another.  Suboxone abuse is almost as rife in some communities as opioid abuse.  It’s got plenty of street value as well.  I’m of the opinion that somewhere down the road, we are going to realize that there is a Suboxone epidemic.   If you speak to segments of the recovery community, many are dismayed at the explosion of MAT programs.  In 2019, especially here in New England, the number of addiction treatment programs that don’t lead with Suboxone or similar drugs is paltry.  It’s probably not too hard of a leap to figure out why for those of us who understand how money moves through the world of pharmaceuticals and their ancillary streams.  Suboxone is definitely not a wonder drug and is extremely problematic for many communities including here in lovely Portland, Maine.”

And my response: “Thanks for that important perspective. You are right in that Suboxone can be abused, can be addictive, and can be life-long once started. The federal government has been hyper-focused on MAT (beyond buprenorphine also includes methadone – which certainly has lots of attendant issues – and naltrexone – somewhat off-label beyond alcoholism) for several years (read my 10/22/15 blogpost “Obama, Opioids, and MAT“). They seemingly have excluded – certainly don’t talk as much about – abstinence thru methods like a 12 Step Program. Obviously not everything works for everybody – some people with OUD need that drug-for-drug substitution while others find the ability to overcome without. So we all need options so that an individual can find what works for them. But any time somebody says they have THE answer for something so complex, I start to wonder.”

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Until Next Week,