As defined by the Substance Abuse and Mental Health Services Administration (SAMHSA)
“Opioid addiction is a neurobehavioralsyndrome characterized by the repeated,compulsive seeking or use of an opioid despiteadverse social, psychological, and/or physicalconsequences.
Addiction is often (but not always) accompanied by physical dependence, a withdrawalsyndrome, and tolerance. Physical dependence is defined as a physiological state ofadaptation to a substance, the absence of which produces symptoms and signs of withdrawal.
Withdrawal syndrome consists of a predictable group of signs and symptoms resulting from abrupt removal of, or a rapid decrease in the regular dosage of, a psychoactive substance. The syndrome is often characterized by over activity of the physiological functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug.
Real patient testimonial: Natalie -- Opioid Addiction treatment
Tolerance is a state in which a drug produces a diminishing biological or behavioral response; in other words, higher doses are needed to produce the same effect that the user experienced initially.”
According to SAMHSA, from 2000 to 2010, there was a 5 fold increase in opioid dependence treatment admissions. There were four times as many people dependent on prescription opioids than on heroin in 2011, approximately 426,000 vs. 1.76 million. Opioid dependence trends toward younger adults aged 18 to 34.
There are two main components to addiction. The physical dependence and the psychological and behavioral component. Each of these must be addressed in a successful treatment plan. The physical dependence is addressed using medication. We use buprenorphine and naloxone in combination as Suboxone or Zubsolv. Generics are also available.
How does Buprenorphine work?
Is buprenorphine treatment just trading one addiction for another? (from NAABT.org)
No- with successful buprenorphine treatment, the compulsive behavior, the loss of control of drug use, the constant cravings, and all of the other hallmarks of addiction vanish. When all signs and symptoms of the disease of addiction vanish, we call that remission, not switching addictions.
The key to understanding this is knowing the difference between physical dependence and addiction.
Buprenorphine will maintain some of the preexisting physical dependence, but that is easily managed medically and eventually resolved with a slow taper off of the buprenorphine when the patient is ready. Physical dependence, unlike addiction, is not a dangerous medical condition that requires treatment. Addiction is damaging and life-threatening, while physical dependence is an inconvenience, and is normal physiology for anyone taking large doses of opioids for an extended period of time.
It is essential to understand the definition of addiction and know how it differs from physical dependence or tolerance.
The American Academy of Pain Medicine (AAPM), American Pain Society (APS), American Society of Addiction Medicine (ASAM), and (NAABT) National Alliance of Advocates of Buprenorphine Treatment, have recognizes these definitions below.
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
- Physical Dependence:
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.
Physical dependence and tolerance are normal physiology. Addiction is a disorder that is damaging and requires treatment.
When a patient switches from an addictive opioid to successful buprenorphine treatment, the addictive behavior often stops. In part due to buprenorphine's long duration of action, patients do not have physical cravings prior to taking their daily dose. The drug seeking behavior ends. Patients; regain control over drug use, compulsive use ends, they are no longer using despite harm, and many patients report no cravings. Thus all of the hallmarks of addiction disappear with successful buprenorphine treatment.
Therefore, one is not trading one addiction for another addiction. They have traded a life threatening situation (addiction) for a daily inconvenience of needing to take a medication (physical dependence), as some would a vitamin. Yes the physical dependence to opioids still remains, but that is vast improvement over addiction, is not life threatening, and it can easily be managed medically. It's also important to note that the physical dependence pre-existed the buprenorphine treatment and was not caused by it.
Addiction is a brain disease that affects behavior. This addictive behavior can be devastating to the patient and their loved ones. It's not the need to take a medication that is the problem, many people need to take a medication, but rather it is the compulsive addictive behavior to keep taking it despite doing harm to one's self or loved ones that needs to stop. Whether or not the person takes a medication to help achieve this shouldn't matter to anyone. If a medication helps stop the damaging addictive behavior, then that is successful treatment and not switching one addiction for another.
This underscores the need to address the psychological and behavioral aspects of addiction at the same time as we medically address the physical dependence. Psychological therapy or counseling with behavioral modification is highly encouraged. Our successful patients not only are compliant with their medical treatment but they also are fully engaged in addressing the psychological issues that are fundamental to addiction.
Common adverse reactions to buprenorphine treatment include headache, insomnia, nausea, constipation, sweating, diarrhea, depression, runny nose, anxiety, and low blood pressure. These reactions are common and usually minor. Many of them can be addressed by an adjustment of the dose.
More serious reactions include respiratory depression and/or arrest, anaphylaxis, severe hypotension, liver damage, and dependency. These reactions though serious, are extremely rare. I have never seen it in all the years I have prescribed buprenorphine.