Methadone Therapy versus Buprenorphine Therapy in Reducing Opioid Overdose - Case Study Example

Methadone Therapy versus Buprenorphine Therapy in Reducing Opioid Overdose

Malcolm Jefferies

Coppin State University

Nursing 582

The Effectiveness of Methadone Therapy Versus Buprenorphine Therapy in Reducing Opioid Overdose Rates among African Americans between the ages of 18 and 25 in Urban Communities.

Introduction

The term opioid overdose refers to a severe condition caused by excessive overuse of opiates (Berkun, Khechen, & Berkun 2016). Although lethal, opioid overdose is a preventable condition that arises from prescription practices that may be as a result of inadequate understanding of the patient’s risk of misuse of medication as well as errors from drug administration or abuse of medication (Boyer, 2012). According to Berkun, Khechen, and Berkun (2016), opioid overdose has become a serious issue of global concern affecting both health and social economic welfare of the society. Berkun, et.al, (2016), details that between 26.4 - 36 million people abuse opioids globally. In the US, the figure is estimated at 2.1 million people.

In opioid overdose, Buprenorphine therapy has proven beneficial owing to its unique pharmacotherapy like the significant reduction of the overdose risk although it has not succeeded in overtaking methadone in the management of opioid overdose (Wheeler, Davidson, Jones & Irwin, 2012). It is crucial to note that this study will assess both methadone and buprenorphine therapies to identify their effectiveness in reducing the opioid overdose rates among African Americans that live in urban communities between the ages 18 and 25.

After the Second World War, methadone was the main route for individuals who had narcotic replacement therapy mainly because in controlled situations methadone treats opiate withdrawal symptoms (Wang, & Liu, 2016).. In 2000, buprenorphine made headlines after it became the first drug to get certification for treating opioid dependence (Wang, & Liu, 2016). According to the Drug Addiction Treatment Act, there is recognition of buprenorphine as the treatment of opioid overdose. Statistics indicate that approximately 1 million Americans depend on heroin (Tapscott and Schepis, 2013).

The deadly opioid overdose epidemic has caused severe damage to our nation and is far more pervasive than most Americans realize (Berkun, Khechen, Berkun, 2016). The State of Ohio, for example, has seen an increase in crime rates and overdose deaths associated with opioids (Gladden, 2016). According to Ruhm, (2017), Studies conducted by the University of Virginia have determined mortality rates resulting from opioid overdose are highly under-reported. Professional medical practitioners have been revisiting many death certificates from the years 2008 to 2014 and determined that death rates were 24% higher than previous reports of the opioids overdose deaths (Rudd, Aleshire, Zibbell & Mathew Gladden, 2016).

Schuchat, Houry, and Guy, (2017) details that although Opioid overdoses affects both sexes equally, fatal opioid overdose rates are higher among men compared to women. A further break down of the data shows that fatalities are higher among white Americans compared to African Americans. Schuchat, Houry, and Guy, (2017) adds that the rates are even higher for younger adults including African Americans between the age of 18 and 25. Rudd, Aleshire, Zibbell and Mathew Gladden, (2016) identifies this population group as the most prominent abusers of the opioids for different reasons such as to get high while others use them because they believe that these opioids will help them significantly when it comes to their studies. According to the Research by the National Institute on Drug Abuse, approximately 1,700 young adults succumbed to an opioid overdose in 2014. (Longo, 2017)

Opioid cases continue to increase. For instance, in 2016 crime labs reported approximately 488 opioid cases compared to the previous year where about 467 cases were reported (Riksheim, Gossop & Clausen, 2014). Cases regarding other opioid overdoes from carfentanil and fentanyl have also increased significantly over the years causing additional consideration from local, state and federal agencies (Schuchat, Houry, & Guy, 2017). If an opioid user has overdosed and was subsequently revived using either methadone or buprenorphine, they are consequently classified as committing a criminal act and maybe reported to the authorities (Kleiman, 2017).

Anderson, Reinsmith-Jones, Brooks & Langsam, (2017) observes that Opioid abusers have been known to steal valuables from those closest to them which include, family and friends in an attempt to fuel their addiction. Such crimes tend to go unreported because of the relationships the victims have with the abuser. There is also a notable increase in breaking and entering (B&E) crimes of properties unrelated to the abusers.

Patients who have overdosed on opioids should be monitored closely during their first few days of treatment. The primary signs that a young adult who has overdosed include; pinpoint pupils, dizziness, slurred speech, snoring, frothing at the mouth, slow pulse, slow breathing, nausea, vomiting and unconsciousness where the victim cannot be roused (Boyer, 2012).

(Tapscott and Schepis, 2013)

Fig.1.0 showing non-medical use of prescription drugs (opioids) in young adults

(Tapscott and Schepis, 2013)

Significance of the study

The use and overdose of opioids constitute a huge threat to public health. Nationwide approximately 1,000 people a day seek medical attention for a prescription opioid overdose (Rudd, et. al, 2016). Therefore, there is need for a study that informs on best interventions. This study is thus of great significance to the society since it provides the important information about the trends of opioid overdose, treatment option outcomes as a public health intervention beneficial to the public health problem of opioids. The study benefits various stakeholders in the public health such as researchers, health care practitioners, health care organizations and health financiers, opioid abusers, their families, governments and the society at large.

The impact of the study to the stakeholders mentioned are numerous. It provides an opportunity for health care practitioners to reduce the opioid overdose risk through primary care. According to Rudd, et.al, (2016), half of all harms and deaths are caused by prescription opioids. In the year 2014, about 2 million individuals mostly youths in America were highly dependent on the opioids. Since the information about the findings in this studied shall be shared, it will play a huge role in expanding the treatment options reducing errors in medication that often arise from prescription. The resultant effect shall be an improved patient outcome. Therefore, from an economic point of view, this research study will have plentiful effects on human health and longevity leading to increased production and subsequent growth of the national economy.

The information gained from this study will build into the health information database. As such, the study will generate knowledge that will guide policy and programs in addition to the delivery of health services to the public. The study shall provide the empirical evidence grounded on solid research. Since health care interventions should be evidence-based, the study shall be a fundamental source for health metrics useful for public health actions and accountability. Therefore, the study will provide evidence that can be applied in a judicious and conscientious manner to intervene on opioid overdose cases.

Statement of the Problem

Opioid misuse continues to ravage the United States and many other nations. Six out of 10 deaths in America involve an opioid overdose and the damage continues to increase at an uncontrollable rate. For instance, between the years 2000 to 2015 over five hundred thousand individuals’ mostly including African American youths between 18 and 25 year have died as a result of an overdose of opioids (Volkow, Frieden, Hyde, & Cha, 2014).

Studies have shown a rise in opioid related crimes (Anderson, Reinsmith-Jones, Brooks & Langsam, 2017). Such trend can be explained by the abuser’s desire to find ways to fuel their addiction. Clark, Wilder and Wistanley, (2014), identifies Prescription opioids as the leading causes of the opioid overdose. The number of opioid prescriptions dispensed from pharmacies, hospitals, and clinics have quadrupled since 1999 (Schuchat, Houry, & Guy, 2017). The health care system has not been effective in applying the correct measures to reduce the damage caused from the extensive opioid overdose epidemic (Gladden, 2016). The opioid overdose has now become a public health concern and needs an intervention whether resulting from prescription usage or illegal drugs (Berkun, Khechen, Berkun 2016).

The primary problem with the administration of buprenorphine is that only 30,000 doctors have a license to prescribe it. These doctors are only limited to 30 opioid overdose patients in the initial year and 100 after the first year (Wikner et al., 2014). This limitation was designed to ensure patients remain on a prescription therapy until they are placed in a treatment program. Only 10,000 of the 30,000 doctors licensed have met the requirements to provide therapy up to 100 opioid overdose patients in a single year.

Wikner et al., (2014) details: Methadone access is restricted to specific clinics. Some consider these clinics to be in less desirable or dangerous neighborhoods. Often many young adults fear for their personal safety and refuse to visit these facilities. The Obama administration tried to reduce this medical problem by proposing the increase of the opioid overdose patients to be seen yearly from 100 to 200, but this proposal still cannot meet the increasing demand for the opioid therapy treatment. Using methadone or buprenorphine as an immediate therapy for an overdose patient is crucial in saving lives and preventing future crimes.

Purpose of the Study

The study seeks to prove that the use of methadone is a more effective therapy than buprenorphine. Although both Methadone and buprenorphine are the medications used for the treatment of an opioid overdose amongst young adults. There is a raging debate on the effectiveness of these treatment therapies. Methadone connotes a synthetic opioid agonist that is long-acting and can be taken once daily for a patient who has overdosed. Methadone replaces the need for multiple doses of an opioid like heroin daily (Schuckit, 2016). It has been proven to stabilize the opioid overdose lifestyle by reducing death rates, crime rates and promiscuous behavior which could result in the spread of HIV and other diseases.

Methadone is a significantly regulated Schedule II medication that some clinics offer as their only treatment option. The specialized clinics that provide methadone therapy can just accommodate about 15 to 20 percent of the opioid overdose patients (Peddicord, Bush & Cruze, 2015). These treatment clinics have been the center of controversies in their local the communities. Some residents of these communities fear the addicts who suffer from opioid overdoses are not getting the treatment they badly deserve. Many of the clinics have limited locations and are unable to meet the burgeoning demand. In addition, many patients refuse to attend these clinics for fear of being stigmatized. The emergence of specialized buprenorphine clinics has been established to improve the treatment outcomes of opioid overdose patients. A 14-week study done by different medical practitioners showed that tapering the buprenorphine and methadone therapy highly discouraged the abstinence of the users from opioids and within a short period, the patients would go back to abusing the opioid and possibly overdosing it (Peddicord, Bush & Cruze, 2015). The primary recommendation for the study is a maintenance therapy using either methadone or buprenorphine. This review will determine the effectiveness of each medication.

It is essential that the opioid overdose patient remain in a safe environment such as a hospital for approximately 48-72 hours before taking their first buprenorphine dose (Schuckit, 2016). This will aid the patient in a receiving prompt medical care when necessary. The patient must have been using less than 31 mg of methadone daily for seven days before seeking buprenorphine treatment and should not have taken any opioid 24 hours before they receive the first dose (Schuckit, 2016). Before a clinician may administer buprenorphine as a therapy, they must ensure that the patient is in withdrawal or below the aforementioned thresholds prior to initiating treatment.

As a medication methadone has a high maintenance strength compared to buprenorphine. There is a requirement to taper down the dose to avoid significant withdrawal symptoms that could cause the patient’s condition to further deteriorate. Both the buprenorphine and methadone specified clinics carry out several tests to identify if a patient has overdosed on an opioid. The physical examination, includes assessing respirations if they are below 10 per minute and if the pulse rate is below 40 per minute and examining the pupils if they are dilated (Whelan & Remski, 2012). Laboratory testing is vital including a urine analysis to determine if an opioid overdose has occurred.

The development of buprenorphine and the existence of the Drug Addiction Treatment Act enacted in the year 2000 brought a positive change in the treatment of the opioid treatment by allowing physicians to provide office-based treatment enabling more African American youths in urban communities to access an opioid overdose treatment (Peddicord, Bush & Cruze, 2015). Using buprenorphine for an opioid overdose is not as widespread and treatment centers have been very slow to adopt this fairly new therapy. Young street-involved opioid users who overdosed are less likely to receive buprenorphine compared to those on prescription opioids. Furthermore, studies conducted in the past years show that the use of buprenorphine is more prevalent in the rural communities and only 64 percent of its use was in the office-based settings in urban areas (Peddicord, Bush & Cruze, 2015). So buprenorphine may not be as efficient as methadone is in the reduction of opioid overdoses in young African American adults located in urban areas.

Methadone is a full opioid agonist and is the preferred method for treatment. There is a high risk that users can overdose if abused or improperly administered. Buprenorphine, on the contrary, is a partial opioid agonist which has fewer chances of being overdosed by the patient and therefore the primary reason it is used for its unique pharmacological efficiency (Whelan & Remski, 2012). Methadone was first introduced in Germany in 1937 for the treatment of opioid addiction. In 2002 Buprenorphine was approved by FDA (Food and Drug Administration) as an alternative therapy.

Methadone and Buprenorphine both work differently in the body. Methadone alters the manner in which the brain and the nervous system respond to pain. This therapy is efficient and effective during the detox phase after an overdose. It reduces the adverse symptoms that result during a withdrawal. It can be administered in two different methods. Methadone that can be consumed by first dissolving them in the liquid is known as the Diskets, while others are just readily available for drinking (Tanner, Bordon, Conroy & Best, 2011).

Buprenorphine is a synthetic opioid that generates a weaker euphoric impact compared to methadone. Buprenorphine is a combination of buprenorphine and naloxone and can be administerd in two different method. Such methods may include in the form of a tablet, through soluble film put under the tongue (Tanner, Bordon, Conroy & Best, 2011). Therefore, owing to its therapeutic qualities, methadone is a more effective therapy than buprenorphine.

Research question

Is methadone a more effective therapy than buprenorphine?

Assumptions

Methadone and buprenorphine are considered very effective therapies for overdose patients. However, according to Furst (2013), there are chances that the use of these two therapy treatments could lead to addiction. A patient becoming fully addicted to methadone or buprenorphine while on therapy has not been scientifically proven. Research proves that the correct dosage of methadone or buprenorphine save lives after an opioid overdose.

Theoretical Definitions

Effective: The extent to which a specific treatment method or product attains its intended impact in a community or clinical setting. In this case, it is the extent to which methadone and buprenorphine revive an opioid overdose patient.

Mortality Rate: The death number resulting from a particular cause and in this case the opioid overdose amongst the African Americans between the ages 18 to 25.

Morbidity rate: The frequency in which a particular disease or condition occurs in a given population.

Test: A procedure conducted to determine the effectiveness, quality, reliability or existence of something. In this study, tests are done to identify the presence of an opioid overdose in the body of an individual.

Taper: To reduce something gradually. In this case, methadone is progressively reduced as the opioid overdose patient recovers.

Operational Definitions

Buprenorphine: It is a prescription medicine that consists of buprenorphine and naloxone. It is a partial opioid agonist and is used for the treatment therapy of an opioid overdose.

Methadone: Methadone refers to an opioid medication that is used as a treatment therapy for opioid overdose where it reduces the withdrawal symptoms of the overdose patient without causing the patient to be high.

Opioid overdose: A severe condition that results from the excessive use of opioids including heroin and morphine among others.

Withdrawal: The group of symptoms resulting from the discontinuation of the use of the opioid drugs.

Therapy: The treatment of a medical condition to prevent it from occurring again. In this study, it is the treatment of an opioid overdose to prevent it from happening again.

Methadone: an opioid available as liquid, tablet or injection and works on parts of the brain including the spine to block the “high” feeling that results from opiates. It also reduces the desires for opiates as well as withdrawal symptoms of the same.

Buprenorphine: a semisynthetic narcotic analgesic available in the form of C29H41NO4.HCL used to control pains that could be severe or moderate resulting from dependence on opioids.

Outcome variable: a variable that is manipulated during an experiment to observe the resultant effect on the dependent variable.

Summary

The knowledge and information gained from this study displays the need for an effective treatment plan for opioid overdoses. When comparing both methadone and buprenorphine it’s apparent that methadone is more efficient. It’s the preferred therapy for providing overdose treatment for young African American adults between the ages 18-25 who live in urban communities. The reason behind this choice is that methadone has been working for the treatment of opioids since the year 1937. This fact, therefore, gives surety for the use of this drug because there is a lot of research done regarding it which means there is more evidence about its effectiveness in the therapy as compared to the buprenorphine which is relatively new (Whelan & Remski, 2012).

Cost-effectiveness is an essential aspect to consider when determining what are the best options to study. Since the research is community-based and methadone will be more efficient. It’s more cost-effective in a community setting as opposed to buprenorphine which is more cost-effective in a clinical setting. Despite the fact that methadone has some disadvantages related to its use including the risk of addiction. It’s important to realize that this risk can be minimized by correctly taking the prescribed doses. Methadone provides a long-term healthcare solution as opposed to buprenorphine which only offers a temporary solution to an opioid problem that may be permanent.

It is essential for the many healthcare systems to introduce the use of methadone as a therapy. It will aid in the reduction of crimes, deaths and other harms that result from an opioid overdose. It will significantly reduce the number of opioid overdoses deaths and harms in African Americans between 18-25 years in urban communities. This study provides significant information on the pros and cons of each of the treatment therapies for nurses. These nurses will be educated on how to administer methadone or buprenorphine. The information from this study will assist in the enhancement of care that is being provided and long-term sustainable health for opioid overdose patients.