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TheDay.com – Kicking the habit can be a bit easier

TheDay.com – Kicking the habit can be a bit easier.

Kicking the habit can be a bit easier
Suboxone gaining favor as ‘excellent’ drug for pain-pill, heroin addictions

By Judy Benson Published on 1/2/2009

Two months ago, a Groton man in his 30s, recently laid off from his job at Foxwoods Resort Casino, went to a local psychiatrist’s office to start rebuilding his life with the help of the drug Suboxone.The man, who asked that his name not be used, had been abusing prescription narcotic painkillers for several years. His addiction, he said, was costing him $500 a week, taking most of the money he’d recently inherited from a relative and nearly destroying his 15-year relationship with his girlfriend and their two children, with whom he shares a home.

By the time he found his way to the office of Dr. Rajesh Parekh at the CarePlus outpatient program in Groton run by Natchaug Hospital, he was taking so much Percocet, Vicodin, Oxycontin – “you name it, anything I could get my hands on” – he was at the end of his tolerance level, getting sick to his stomach regularly.

”It’s really an ugly thing,” he said in a phone interview. “I realized that the next step after that is heroin, and that’s what scared me. I had to quit.”

He tried quitting on his own, but then a friend told him of another friend who had beaten her addiction with Suboxone treatment and counseling. CarePlus in Groton began offering treatment with Suboxone, a tightly controlled medication to help break addiction to prescription painkillers or heroin, six months ago. The Groton man is one of eight current patients, Parekh said, getting Suboxone along with group and one-on-one therapy sessions.

”It’s excellent treatment,” Parekh said. “It starts working very quickly. People start attending to their work, their family. They stop their drug-seeking behaviors. They’re not stealing, cheating, taking money from their kids’ college education fund. You can literally see the change. They had really been suffering, not sleeping.”

Insurance coverage

Approved by the Food & Drug Administration in 2002, Suboxone had been slow to catch on, but its use has been expanding gradually across the country, and 14,000 doctors are trained and licensed to treat patients with it, said Harriet Ullman, spokeswoman for drug maker Reckitt Benckiser Pharmaceuticals. About 850,000 people across the country have used the drug since its approval, she said, the vast majority because of addiction to pain pills.

Suboxone, a pill about the size of an Advil that dissolves under the tongue, costs about $10 to $12 per day, said Tim Lepak, president of the National Alliance for Advocates of Buprenorphine Treatment, named after the main active ingredient in Suboxone. Medicaid and most major health insurers cover at least part of the cost for a Suboxone prescription.

Lepak’s Farmington-based group, a nonprofit funded by the drug maker, other pharmaceutical companies and donations, advocates Suboxone be used in combination with counseling, because “the medication is only a small part of the treatment,” Lepak said.

”Sometimes people have unrealistic expectations that this is a miracle drug,” he said. “The medication is not going to do everything for them. There’s still a lot of work to do. The biggest mistake people make is that they don’t stay on the treatment long enough” and quickly revert to illegal drug use.

On the Web site for Lepak’s organization, a locator tool lists nine physicians, psychiatrists and programs in the New London and Norwich areas licensed and trained to offer Suboxone treatment, including the Southeast Council on Alcohol & Drug Dependence (SCADD) and the Hartford Dispensary, which runs methadone clinics in New London and Norwich. Also listed are four counselors and therapists.

While it may not be a miracle cure for heroin and pain-killer addiction, Suboxone is widely viewed as an important and effective new treatment. One indication that it is viewed favorably comes from the American Osteopathic Academy of Addiction Medicine. It offers an on-line training course for psychiatrists and other physicians to become licensed to prescribe Suboxone.

”This medication has been very helpful to a lot of people,” said Dr. Stephen Wyatt, president of the board of directors of the academy and medical director of dual diagnosis services at Middlesex Hospital in Middletown.

One of the factors that makes it so significant, said Parekh, is that Suboxone was the first new medication for heroine and narcotic pain reliever addicts since methadone came into use in the early 1970s. It tends not to make patients as drowsy as methadone can, and there is less risk than methadone of fatal overdose.

With the rise of narcotic pain killer abuse and the reluctance of many of those addicts to go to a methadone clinic, Parekh said, Suboxone is providing a more discrete means of treatment for many who would shun getting help if it meant enduring the stigma of being seen at a methadone clinic with hard-core heroin addicts.

According to the National Survey on Drug Use and Health, 5.2 million Americans abused prescription painkillers in 2007, a number far higher than estimates for heroin addicts.

Blocks receptors

Parekh said the patients in his Suboxone program come from all walks of life. One is a manual laborer who hurt his back. His doctor gave him a prescription for Vicodin to quell the pain, and he became addicted. Another patient became addicted after being injured in a car accident. Often, he said, his patients have been getting their painkillers from Internet prescription sites.

The Groton man who began treatment two months ago said he often bought narcotic pain relievers from co-workers.

Ending addiction to narcotic pain relievers or heroin without quelling the cravings with Suboxone or methodone is extremely difficult, Parekh said, because the withdrawal symptoms are so debilitating. In addition, anatomical changes have taken place in the brain under the influence of the drugs that have essentially rewired it to need continued regular doses. Suboxone blocks those receptors.

Patients begin treatment with a physical exam. After a meeting with Parekh, he gives them a prescription for Suboxone that can be filled at only one local pharmacy. The patient is instructed to return the next day with the Suboxone, unopened. Parekh watches the patient take the drug, then has them stay in the office for several hours to monitor any reaction. He said he controls access and use tightly because there is some potential for “diversion,” when a prescription drug is resold illegally. Suboxone has a street value, he said, of about $10 to $20 per pill.

It helps addicts by relieving them of the fierce withdrawal symptoms caused by stopping use of narcotic pain killers or heroin, Parekh said. It also contains a chemical that blocks the brain’s pleasure receptors stimulated by the illegal drugs, so that taking them along with Suboxone would have no effect.

Initially, patients are seen every couple of days, then once a week, when a seven-day prescription is renewed, and drug tests, blood pressure and other physical signs are checked regularly. They are required to attend weekly group therapy sessions and meet individually with a counselor. Typically, Parekh said, patients take Suboxone daily for six months or more.

”It takes at least six months to a year to turn your life around,” he said.

He stressed that the medication alone won’t enable someone to overcome addiction, because the underlying causes that led to the self-destructive behavior need to be addressed in the group and individual therapy. Patients also need to learn how to avoid a relapse, he added.

One of those patients, the Groton resident, said he’s learned new coping skills and is working on rebuilding his relationships with his family.

”I would recommend Suboxone absolutely,” he said. “It’s saving my life right now, as long as I take it day by day.”

J.BENSON@THEDAY.COM

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  1. George Clarke
    January 5, 2009 at 8:51 pm

    R E A D E R’S C O M M E N T S

    Posted – 1/3/2009 1:40:06 PM The Day site.
    Dear Judy: Good article on Suboxone, Subutex. Buprenorphine. Couple of places of interest to me: 1) “It tends not to make patients as drowsy as methadone can”, When on the right dose of methadone, this is not a problem. There is no problem driving a car either. 2) “Suboxone is providing a more discrete means of treatment for many who would shun getting help if it meant enduring the stigma of being seen at a methadone clinic with hard-core heroin addicts.” Stigma…. The Methadone Clinics have helped many addicts from all walks of life over the years. And, where did they go before there was Suboxone? Many people had to go to the clinic. They leave after they drop in and go off to work like most everyone else, They have families and lead productive lives in the community. You would never know they were a methadone patient unless you were camped out every morning in front of a clinic and saw them. Most clinics do not have a big sign up on the side of a building. Under the federal regulations, methadone patients can earn take homes up to one month too, but it takes a lot more time to get them than the suboxone which has a ceiling limit at 32 mg. See # 3 below. Stigma Methadone Today Note the references to AA and NA. http://www.methadonetoday.org/dole_nys.htm3) Not mentioned was one of the conditions of suboxone which means it may not be the right medication for many addicts. Suboxone is an agonist – antagonist. This means that there is a maximum dose after which, it will knock its effectiveness down. This is usually around 32 mg. Many will need the full agonist methadone if the suboxone will not hold them. It is this ceiling limit that keep suboxone from causing a patient a bit safer than methadone and thus, it can be prescribed for addiction through authorized MD’s unlike methadone which , for addiction, has to go through a certified methadone clinic. For pain, any MD can use methadone. Suboxone is a great medication and is helping those who it can. The same for Methadone. Here are some statistics concerning Oxycontin and heroin. http://www.oas.samhsa.gov/2k5/oxycodoneH/oxycodoneH.cfm

  2. January 4, 2009 at 2:23 am

    Yes that is very true, Lou. When Suboxone first started to be used in Maine we actually had a Doctor move here (as the opiate addiction “Crisis” in the US started in Maine) and he sold prescriptions for Subs over his CELL PHONE! Back then docs could only have thirty patients and he had something like 200. A pharmacy reported him and he left town leaving many patients to fend for themselves.

    I think medications of all types will start to become a huge part of addiction treatment. As patients and their families start to demand more effective treatment for the huge amount of money they dish out for it!

  3. Lou
    January 3, 2009 at 8:57 pm

    Suboxone is a huge break through in addiction treatment. At first I think a lot of doctors got accredited to dispense it as a revenue source, and did not offer counseling or therapy. That was my son’s experience when it first came out. The doctor did not even drug test. Now that there has been some trial & error, most doctors know it is not magic by itself, but can be most effective with ancillary care.

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