Suboxone Effective, but Not a Cure for Treatment of Prescription Painkiller Addiction
The effectiveness of Suboxone in treatment of prescription painkiller addition has recently shown promise in a new large scale study that looked at treating a class of patients that previous studies have not addressed toward treating prescription painkiller addiction. The study tested the effectiveness of Suboxone in separate 2-week and 12-week initial doses with and without supportive drug counseling. The results of treating prescription painkiller addiction with Suboxone yielded some unexpected outcomes that indicate regardless of the drug abused, addiction remains an onerous task to overcome.
According to the Centers for Disease Control (CDC), 100 people die per day in the U.S. from drug overdose with the majority of drug overdoses being due to prescription painkiller medications. In comparison to previous overdose death rates in the U.S., today the numbers have more than tripled since 1990.
The three most commonly abused prescription drugs include three classes of medications:
1. Opioids—used for pain relief that include hydrocodone (Vicodin), fentanyl (Duragesic and Fentora), oxycodone (OxyCotin, Percocet), methadone and codeine.
2. Benzodiazepines—sedatives to induce sleep and relieve anxiety that include alprazolam (Xanax), diazepam (Valium) and lorazepam (Ativan).
3. Amphetamine-like drugs—Central Nervous System stimulants for treating ADHD including dextroamphetamine/amphetamine (Adderal and Adderal XR) and methylphenidate (Ritalin and Concerta).
Of the three classes described, there is a growing trend of prescription painkiller addiction and abuse from opioid-containing medications that resulted in 14,800 deaths in 2008. Moreover, there has been a 300% increase in sales of prescription painkillers since 1999. Currently, prescription painkillers kill more people than cocaine and heroin combined.
Prescription painkiller death occurs though sedation effects that slow down breathing. What typically happens with abusers of pain meds is that it takes increasingly higher doses to achieve the feelings of euphoria. At some point the doses are so high that breathing is depressed enough to cause complete cessation, resulting in death.
The source of prescription painkillers is almost entirely through prescriptions rather than through direct theft and black market street sales. The majority of prescription painkillers are prescribed by primary care and internal medicine doctors and dentists; furthermore, approximately 20% of prescribers prescribe about 80% of all prescription painkillers released to the public. In 2010, the CDC reports that enough painkillers were prescribed to medicate every American adult around-the-clock for one month.
However, of higher concern is the fact that over three out of every four people who abuse prescription painkillers do so from drugs prescribed to someone else. Sources of prescribed painkillers are broken up statistically as follows: 55% are obtained from friends and relatives, 17.3% are prescribed from a doctor, 11.4% are bought from a friend or relative, 4.8% are taken from a friend or relative without permission, 4.4% are from a drug dealer or stranger and the remaining 7.1% are from other sources.
The rise in number of Americans abusing painkillers has resulted in a need for studies that address the most effective ways for treatment of painkiller prescription addiction. Previous studies were geared more toward addressing the problems of heroin addiction. Researchers today, however, propose that individuals with painkiller drug addiction have a better prognosis for recovery than heroin addicts and therefore may benefit from methods different than those used on heroin addicts.
In a recent article published in the journal Archives of General Psychiatry, researchers from McLean Hospital and Harvard Medical School report that people addicted to prescription painkillers can at least temporarily succeed in overcoming their addiction by taking the medication buprenorphine-naloxone (Suboxone).
The paper’s lead author, Roger Weiss, MD, Chief of the Division of Alcohol and Drug Abuse at McLean Hospital, points out that prescription painkiller addiction is an understudied problem in need of data for treatment that is not based on heroin addiction. "Despite the tremendous increase in the prevalence of addiction to prescription painkillers, little research has focused on this patient population," said Weiss. "This is notable because recent data tell us that the use of prescription painkillers for non-medical reasons is 20 times more common than heroin and 50 percent more people seek treatment for prescription drug abuse than for heroin."
In a nationwide study, 653 treatment-seeking outpatients dependent on prescription opioids were given Suboxone in a multisite, randomized clinical trial using a 2-phase adaptive treatment research design. Phase 1 was a brief 2-week stabilization period of Suboxone treatment followed by a 2-week tapering period and an 8-week post-medication follow-up.
If a patient did not show addiction recovery from Phase 1, he or she was then admitted into the Phase 2 trial which consisted of a longer 12-week initial stabilization period of Suboxone treatment, followed by a 4-week tapering period and an 8-week post-medication follow-up. Furthermore, 50% of the patients were given drug counseling during their clinical trials.
What the researchers found was that during the Phase 1 trial only 6.6% of the Suboxone treated individuals were successful in overcoming their addiction, with counseling apparently not playing a factor in their recovery. During the Phase 2 trial, 49.2 % of the patients were successful due to the longer period of initial Suboxone stabilization treatment. Again, with addiction counseling not being a contributing factor to their success. However, overall the successes were short-lived as the success rates dropped significantly as patients relapsed several weeks after the tapering off periods.
"We were surprised by some of these findings because there was an overall assumption that this population—those who have had little to no exposure to heroin—would do better in terms of not needing long-term medication intervention," said Weiss. "It is clear that given the prescription drug abuse epidemic, we need to continue to look at the viability of longer-term use of Suboxone and whether it can continue to provide sustained recovery from addiction to pain medications."
The researchers concluded that Suboxone is effective toward treatment of prescription painkiller addiction, but that with discontinued treatment the likelihood of an overall unsuccessful outcome (relapse) is high even with counseling. The authors of the paper believe that their results raise the question for future studies on how long patients need to be treated with Suboxone to achieve permanent addiction recovery.
Reference: Arch Gen Psychiatry. November 7, 2011. doi:10.1001/archgenpsychiatry.2011.121