Buprenorphine Therapy or Harm Reduction vs Total Abstinence in Treatment of Opioid Dependence - Term Paper Example

Buprenorphine Therapy or "Harm Reduction" vs Total Abstinence in treatment of Opioid dependence Opioids refer to a class of substances that includes natural and synthetic opioid drugs.1 They may be available in prescription form such as morphine, methadone oxycodone and coidene as well as illegal substances such as heroin and cocaine. Opioid dependence, on the other hand, refers to a situation where one is unable to stop using opiates. This may be the case even where it is important or in the best interests of the individual to stop using the opiates. Currently, the most commonly abused opiates are heroin and cocaine. There are instances where an individual has an addiction to those in prescription form such as morphine. ‘Dependence’ came into existence by the World Health Organization (WHO) to refer to a cluster of physiological and behavioral phenomena of variable intensity where drug use has a high priority. The use of the drug is in order to experience its psychic actions and effects or to avoid the discomforts of its absence. It is also frequent to be dependent on more than one drug. Since the emergence of drug dependence, there have been numerous attempts to reduce the effects that the opiates have on individuals and more so to stop the widespread addiction. The opiates are excellent in pain reduction, but it is their ability to cause euphoria to the user that makes them so attractive to most addicts. There are several ways of curing dependence of opiates. Ironically, it seems that drug use best treatment lies in the use of more drugs. However, several forms of treatment have to be administered in order to give the drug user a realistic chance of overcoming dependency. Therefore, psychology is also highly used. Drugs administered include buprenorphine, methadone, naltrexone, diamorphine and levacetylmethadol (commonly referred to as LAAM). Other experimental drugs have also been on the increase. Another major method in use is total abstinence. This entails that an individual attend a group with other recovering addicts in order to rehabilitate. All the mentioned methods were tried and tested. The uses of buprenorphine and total abstinence are two. Both are very good in reducing and even eliminating dependence. Similarly, both have their shortcomings. Buprenorphine is a mixed agonist-antagonist opioid2. This means that the drug exerts effects at both the mu opioid receptor where it acts as a partial agonist, and at the kappa opioid receptor, where it acts as an antagonist. It has a very high affinity at the mu receptor and will easily replace other opiates such as morphine and methadone. Its partial agonist effects instill it with several desirable pharmacological properties. They include lower abuse potentials, lower levels of physical dependence, which mean that, the dependant does not feel the effects of withdrawal. It also offers more safety in overdose compared to other opiates with full agonists. When given in pain relieving doses, buprenorphine is around 20 to 50 more times more potent than morphine. They do not climax and do not continue to increase in direct proportion to doses of the drug. This can be referred to as the ‘Ceiling Effect’. This effect ensures that buprenorphine, unlike other opiates, fatal respiratory depression. The drug has sufficient agonist properties to ensure that individuals addicted to opioids perceive a subjective effect from it often referred to as ‘feeling normal’. Because of its high affinity, buprenorphine may bring about a precipitated absence syndrome that is very difficult to reverse. It produces a blockade of sorts to opioids that should be administered subsequently. This makes the drug very appealing to patients that can be highly motivated as it provides an additional disincentive to continue using the drug. Buprenorphine mostly administered as a pill that dissolves under your tongue. It cannot be swallowed or chewed. It comes in two: Subuxon and Subutex. Both contain buprenorphine, but subuxon contains another medication called naloxone to prevent abuse. It can cause euphoria especially when injected. It can also produce a physical dependence. The drug seems to do so to a lesser degree than full opioid agonists. It, therefore, appears to be easier to stop using medication at the end. Although abused and injected by opioid addicts, its abuse potential appears substantially less when compared to other opiates such as morphine. It also seems as if administering buprenorphine with naloxone has gone a long way in reducing addictions.3 The dosage will vary from once a day to once every couple of days. If pregnant or allergic, the pill without naloxone should not be given. Taking of buprenorphine has various advantages for both doctors and patients. Chances of an overdose are unlikely. As noted the drug contains another medicine, naloxone, which prevents abuse. Another factor which makes abuse of buprenorphine quite hard is the fact that the dosage should be administered by a doctor. The dosage is a single pill. Buprenorphine is long acting. Once an individual has taken the pill once per day for several days, his doctor can easily change the dosage to once every several days. This also reduces the chances of the development of an addiction. Once seen that the patient can take sufficient care of himself, the doctor may go ahead and prescribe brupenorphine so that the individual can take his dosage at home. If, in need of a prescription, only licensed doctors should do so. The use of the drug has several side effects and care should be taken when using it. First precaution that should be taken is one should know which drug best suits him. There are two forms of buprenorphine. Tests to determine allergies and pregnancy should be taken. The side effects may still kick in even when one is said not to be allergic. Perhaps an obvious warning that most people ignore is looking for the right doctor. It is also imperative that the user avoids taking illegal drugs or even alcohol that may slow down breathing. Its side effects include dizziness, vomiting, sweating, and lack of sleep among others. It can, therefore, be seen that buprenorphine has provided a very good way to treat dependency. Its usefulness stems from its unique pharmacological and safety profile which encourages adherence to treatment and reduces the possibility for both overdose and abuse. Because of its unique pharmacological properties, doctors may want to consult with addiction specialists. It offers special and a variety of advantages to many patients but is not a drug for all4. Care must be taken, and each patient must be carefully analyzed in order whether or not he can receive the drug. Abstinence refers to voluntarily going without something. In recovery, abstinence means not turning to any mood, behavior or psychology altering substances to alter the way we feel5. Total abstinence is also a method that can be used to try and counteract the effects of dependence of opioids. It may not be in prevalent use like the use of drugs such as brupenorphine and methadone. The reluctance to embrace such methods to cure patients is because of its novelty in the medicinal industry. For quite a long time, people understood that only drugs can cure the sick. As noted, no single treatment method can be applied in curing opioid dependence. Total abstinence can be achieved through a common program referred to as the 12 step program. Once an individual overcomes the major hurdle that is withdrawal, he can then seek help from other individuals that were affected in a similar manner. The program is a set of values that have been accepted by a group of individuals who come together and share experiences6. It can be hoped that these experiences coupled with actual drugs will help the individual to overcome addictions of any sort and even opioid dependence. The program has several principles upon which it operates. They include: i) An admission that one cannot control his addictions, ii) A recognition that a higher power exists, and it can help. iii) Examining past errors with a sponsor. This sponsor is usually a member who has overcome his addiction and is more experienced. iv) Making amends for these errors. v) Learning to live with a new code in life. vi) Helping others in a similar predicament Once the patient makes these visits, his goal becomes to become a holistic individual. He seeks recovery in the physical, emotional and mental aspects. First off is the admission that one is powerful against what has brought him there. Sometimes the lack of a strong spiritual base or spiritual malady may be mentioned. This is to show that the patient fell into the addiction due to a lack of obedience to a higher power. Members then proceed to share their own problems on the road to recovery or even whilst in addiction. This should be done in order to stick to the first step that emphasizes self-admission. A statement such as, “Hey I’m Wilson, and I’m an addict”. Sponsorship from another member who is more experienced or who has been part of the group for a longer period. The sponsor should be expected to guide one to total abstinence. He shall be your guide and anytime an urge to take drugs comes over you should contact him as fast as possible. The 12 step program can be beneficial if utilized well by the patient. It, however, has drawbacks such as lacking confidentiality and a requirement of strong willed individuals. In summary, different methods exist to treat dependence of opioids. Two methods from different ends of the spectrum can be used. Brupenorphine is a drug that is invaluable in the treatment of opioid dependency. However, there seems to be a glimmer of hope for those who choose total abstinence. What is not in question is that if a patient is to recover then both methods should be considered. Works Cited B, Waltson. Facts about Buprenorphine. Routledge, 2005. Print McNicholas, Laura. Guidelines for the Clinical Use of Brupenorphinal in the Treatment of Opioid Addiction, Routledge.2004. Print Strain, Eric C. The Treatment of Opioid Dependence, JHU Press. 2006. Print . Read More