The US Food and Drug Administration (FDA) has approved Lucemyra (lofexidine hydrochloride) to treat opioid withdrawal symptoms in adults. This drug may lessen the severity of withdrawal symptoms; however, it may not prevent them.
Lucemyra is only approved for a treatment period of up to 14 days. The medication is not meant to be used as a treatment for opioid use disorder (OUD). It’s one part of a long-term treatment plan for patients with OUD.
Opioid Withdrawal Symptoms
When someone has been taking opioids over a period of time, he will develop a physical dependence on the drugs. This is to be expected, and doesn’t necessarily mean that a patient has become addicted to the medication. Withdrawal symptoms can occur in patients who have been using opioid pain medications as directed by their doctor and people with OUD.
For patients taking opioid pain medications as directed by a doctor, opioid withdrawal is typically managed by slowly tapering off the drug. This strategy is used to lessen the effects of withdrawal symptoms. Some patients are able to avoid experiencing withdrawal symptoms entirely.
In a patient with OUD, withdrawal is typically treated by substituting another opioid medication. In time, the dose is gradually reduced or the patient is switched to a maintenance therapy program. These medication-assisted therapy (MAT) treatments may use drugs like methadone, buprenorphine or naltrexone. Medications may be prescribed to treat specific symptoms, such as aches and pains or stomach upsets.
Lucemyra is taken orally and works by reducing the release of the brain chemical norepinephrine. Its actions are believed to play a role in several opioid withdrawal symptoms.
The Drug Enforcement Administration (DEA) announced that it has issued and served a Suspension Order on Morris & Dickson Company. The wholesale pharmaceutical distributor is situated in Shreveport, Louisiana.
The DEA alleges that the distributor failed to identify “large suspicious orders for controlled substances.” These substances were sold to independent pharmacies that the DEA says had questionable need for the drugs.
Hydrocodone and Oxycodone Purchases
The investigation centered on purchases of hydrocodone and oxycodone. It revealed that in some instances, the pharmacies were allowed to buy six times as much as a normal order. Regulations are in place requiring distributors to identify orders which are out of the norm; the DEA is alleging that Morris & Dickson Company failed to identify these large orders. As a result, millions of hydrocodone and oxycodone pills were distributed, in violation of existing law.
DEA Acting Administrator Robert W. Patterson stated that pharmaceutical distributors have an obligation to make sure that all controlled substances being ordered are for legitimate purposes. Distributors have a duty to “identify, recognize and report” any suspicious orders to the DEA.
Company Failed to File Suspicious Order Reports
The DEA became aware of the high-volume orders involved in this investigation in October, 2017. The Agency’s records revealed that the company hadn’t filed any suspicious order reports on any of the pharmacies placing the large orders. On review, the purchases made weren’t in line with the pharmaceutical market:
• Independent retail pharmacies were buying more of the drugs than the largest chain pharmacies in the state.
• The pharmacies were buying more narcotics than several of the largest pharmacies in a single zip code.
The DEA states that more than four million people in the US are addicted to prescription pain medications. This figure includes 250,000 adolescents. Drug overdoses are the leading cause of death in the United States, surpassing deaths from motor vehicles accidents or deaths due to firearms.
Length of Opioid Prescriptions and Opioid Addiction
Every day, people who were only seeking a little pain relief unwittingly become addicted to opioids.
Most get prescriptions from their doctors following surgery or an injury. Many seek relief for ongoing back pain. Some borrow pills from friends just to take the edge off after a stressful day at work. None ever plan on getting hooked.
In 2016, 66% of all fatal drug overdoses in the U.S. involved an opioid. What was only an area of concern in the late ‘90s is now a full-blown crisis.
If you’re worried about your opioid habit, you may have reached out to us just in time. Keep reading to find out how your lawmakers and the professional caregivers at Desert Cove Recovery can help you.
The idea behind shorter prescriptions is to take unnecessary pills out of circulation. Limiting doses will result in less potential for abuse. Even people who use painkillers responsibly fail to properly dispose of the extras; stockpiles in home medicine cabinets are tempting.
Finding the magic number is no easy task. In the Centers for Disease Control and Prevention guidelines, the recommended length of opioid prescription is three to seven days. Some experts challenge those numbers, pointing out that they are far too conservative for major surgeries like hysterectomies. They also argue that unreasonably short prescriptions will only prompt patients to get refills.
There’s no easy fix, but the opioid addiction crisis has everyone’s attention. That’s a good thing.
Understanding Opioid Addiction
Prescription opioids are closely related to morphine, codeine and heroin. Commonly used opioids include methadone, hydrocodone and fentanyl. One of the most frequently prescribed remedies, oxycodone, is twice as powerful as morphine.
Synthetic opioids attach to receptors in the brain so that your perception of pain is altered. If you have a legitimate need for them on a short-term basis, they’re a godsend. However, they have great potential for becoming addictive.
Synthetic Opioids are Addictive
Dopamine is a natural feel-good chemical that gives you a warm sense of pleasure and reward when you’re enjoying yourself. In mentally healthy people, it’s always at just the right dose.
In addition to relieving pain, opioids signal your brain to increase production of dopamine. The excess might result in a rush of intense euphoria. There’s a severe letdown when the sensation wears off.
People become addicted to opioids when they try to duplicate that initial high by increasing the dose or combining pills with other drugs like alcohol. The body quickly builds tolerance, and the vicious cycle of addiction begins.
You may have an opioid addiction if you’ve experienced even one of these symptoms:
Taking opioids after your pain has subsided
Taking higher doses than prescribed
Taking opioids that aren’t prescribed to you
Trying without success to stop
Using opioids recreationally
Combining opioids with other substances
Craving opioids when you’re not using them
Lying about opioid use
Becoming defensive when friends or family members express concern
Sleeping during waking hours
Experiencing irritability, mood swings or depression
Your chances of becoming addicted are significantly higher if you have a mental problem such as depression, anxiety or eating disorder. You’re also at greater risk if anyone in your family struggles with substance abuse. Traumatic events in your past, like divorce, domestic violence or rape, will also make you more susceptible to opioid addiction.
Getting Help for Addiction
Substance abuse can start with one bad decision, but after that, the painkillers take over. Like other drugs, they teach your brain to crave them.
Drug addiction is a chronic disease with no cure, but it can be managed just like asthma or diabetes can. Just as people become addicted every day, people start to recover every day.
Choosing Desert Cove Recovery for Help With Opioid Addiction
Our caregivers at Desert Cove Recovery have years of experience with people just like you. Our comprehensive treatment plans utilize time-tested approaches that help recovering addicts stay clean for good:
The 12-step model
Cognitive behavioral therapy
Individual and family counseling
Holistic approaches such as prayer, meditation, yoga, art, music or massage
Exercise classes and outdoor activities
With professional help, you can break free from the grip of opiate addiction. Call Desert Cove Recovery today to speak with a caring counselor. We’ll tailor a unique treatment plan that’s just right for you.
Attendees at a presentation during Hospital Medicine 2018 learned that the drug buprenorphine is appropriate to prescribe for hospitalized patients with opioid use disorders. The same medication is also effective for treating the acute pain experienced by patients being treated using buprenorphine.
Significant Increase in Drug Overdose Deaths
Dr. Anika Alvanzo, from John Hopkins Medicine, made a presentation at the conference. She referred to the significant increase in drug overdose deaths over the past 20 years. The number of fatalities jumped from three percent per year between 2006-2014 and 18 percent per year in the years 2014-2016. Dr. Alvanzo said that a large number of these deaths can be linked to increased use of synthetic opioids.
Types of Prescription Pain Medications
While some people refer to opioids to describe all types of prescription pain medications, they differ in the way they are made.
• Opiates are natural pain medications that are derived from opium. The opium is extracted from the opium poppy and is used to make medications such as morphine and codeine.
• Synthetic opioids are manufactured by humans and include methadone and fentanyl.
• Semi-synthetic opioids are a hybrid made from making chemical modifications to opiates. Drugs in this category include oxycodone, hydromorphone and buprenorphine.
Buprenorphine Availability a Bridge to Treatment for Opioid Use Disorders
Dr. Alvanzo stated during her presentation that there are currently three medications approved by the Food and Drug Administration (FDA) for treating opioid use disorder: buprenorphine, naltrexone and methadone. She went on to say that when buprenorphine is prescribed to patients on discharge from hospital, it “significantly increases” the likelihood that the patient will seek professional treatment. Approximately 75 percent of patients were in treatment one month after discharge.
The doctor urged her colleagues attending Hospital Medicine 2018 to consider getting their buprenorphine certification so that they can order the drug within the hospital and at discharge for patients. She referred to buprenorphine availability as a “bridge to treatment” for opioid use disorders patients.
The current opioid crisis is responsible for producing a new epidemic among teens and young adults. It’s a potentially-fatal bacterial heart infection called endocarditis.
This condition is most commonly seen in older adults. Now doctors are seeing it in much younger patients more often due to opioid drug use.
What is Endocarditis and How is is Related to Opioid Abuse?
Endocarditis is a bacterial infection of the inner lining of the heart chamber and its valves. The condition occurs when bacteria are enter the body, then are spread through the bloodstream until they attach themselves to damaged parts of the heart. It is spreading through the use of shared needles by IV drug drug users.
The clump of bacteria grows over time, and the infection can be life-threatening if it isn’t treated, according to Dr. Sarah Wakeman, the Medical Director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital.
How Infection is Spread
In a doctor’s office, clinic or hospital setting, a health care worker will swab a patient’s skin with a disinfectant to kill bacteria before administering an injection. The purpose of this step is to avoid pushing bacteria from the skin into the body with the needle. Opioid drug users who are using needles may not be taking this step, which has led to the increase in endocarditis cases.
Endocarditis Treatment Not Enough for Opioid Use Disorder Patients
Endocarditis can be treated using intravenous antibiotics over a long time. If the damage to the heart valves is severe, surgery may be recommended to replace them.
If the patient is also injecting opioids, such as heroin, treating the infection is only treating half of the problem. The opioid use disorder is still present, and the patient will go right back to using once if he doesn’t get appropriate help for the addiction.
According to a 2016 Tufts University study, hospital admissions for endocarditis due to injectable drug use increased from 3,578 in 2000 to 8,530 in 2013. The study also found that a large number of these cases involved young people aged 15-24.
The American Dental Association its members to reduce the number of opioid painkillers they are prescribing. The Association announced a new policy stating that members should “essentially eliminate” opioids from the list of remedies they have at their disposal, “if at all possible.”
Weekly Limits for Narcotics
The Association also wants to have a time limit put in place on prescriptions of no more than one week at a time. Under the new policy, dentists would be required to complete a mandatory education program that encourages use of other pain relievers.
Dentists Prescribe Most Opioids to US Teens
Dental practitioners are the leading source of opioid prescriptions for US teens, even though they write less than seven percent of opioid prescriptions in the US. During the period from 2010-2015, the most notable increase in dental prescriptions was for patients aged 11-18. The rate jumped from close to 100 per 1,000 patients to 165 per 1,000 patients. Among all age groups, the rate increased from 131 per 1,000 patients to 147 per 1,000 patients.
Other Options Shown to be Just as Effective
The number of opioid prescriptions written by dentists continues to rise even though evidence has shown that ibuprofen and acetaminophen control most dental pain effectively, according to an analysis conducted on five studies. The results were published in the Journal of the American Dental Association. These over-the-counter medications are less risky than opioids, which are addictive.
When dentists prescribe opioids, they tend to prescribe Vicodin or Percocet to relieve the short-term pain from procedures such as wisdom teeth extractions, dental implants and root canal work.
Dr. Paul Moore, Professor at the University of Pittsburgh’s School of Dentistry and the co-author of the analysis, said that the fact dentists are still prescribing opioids when other options are just as effective most of the time is “a little disturbing.”
The Association’s new policy supports requiring dentists to complete continuing education courses on limiting opioid use to retain their license. A number of states have already adopted this policy.
More hospitals are changing their policies about dispensing opioids to emergency room and surgical patients. Drugs like OxyContin, Vicodin and fentanyl, which are prescribed to temporarily provide relief for moderate to severe pain, have also caused irreparable damage. It’s difficult to determine how many people who currently have an addiction to opioids were first exposed to the drugs at a hospital, but it is often where people first encounter them.
Hospital patients aren’t the only ones who were at risk of becoming addicted to painkillers. People who were prescribed large amounts of this class of drugs would often end up with leftover pills. More than 50 percent of Americans who misuse opioids get them from friends or family members, according to the National Survey on Drug Use and Health.
Now there is an increasing number of hospitals and other medical practices that are reducing the number of pills being prescribed for pain. Doctors are saying that opioids are not the only choice for treating acute pain and that less potent options are often just as effective. In the past six months, Rush University Medical Center has given patients recovering from surgery ibuprofen, acetaminophen and gabapentin, which is used to treat nerve pain. A mild opioid medication is used to treat sharper spikes of pain and more acute pain.
Dr. Asokumar Buvanendran, a pain specialist at Rush University Medical Center, said that patients were “more satisfied” with the new protocol. It represents a trend that is hopefully leading more people away from these deadly drugs.
According to experts, opioid use skyrocketed in the 1990s when doctors started prescribing them to patients much more often. During this time, physicians were influenced in their choice to provide medicines in this class to patients by aggressive pharmaceutical company marketing tactics.
Rethinking Approach to Treating Pain
Most of the opioids were given to chronic pain patients. They were also the first choice for post-surgical pain or for patients visiting emergency rooms complaining of pain.
Doctors had the idea that drugs didn’t cause addiction; abusers were solely responsible for their own plight if they became addicted. Research has now shown that the properties of the drugs themselves change brain chemistry in users to cause the addiction.
New Opioid Prescribing Guidelines Help Doctors Make Better Decisions
Northwestern Medicine now talks to patients about the dangers of opioids before surgery. Patients are asked to bring any unused medication to follow-up appointments with their surgeon, so that the drugs can be disposed of safely.
All doctors in the state are required to enroll in a database to monitor painkillers and prescriptions that are commonly abused, a measure to seek out those who may be “doctor shopping” to get drugs. Some hospitals have similar in-house systems.
The Centers for Disease Control and Prevention has called for doctors to prescribe a maximum of seven days’ worth of opioids for patients to take home for acute pain. Many emergency departments today are only giving out 24 – 72 hours’ worth of pills.
While some chronic and severe pain patients may feel these tougher prescribing practices are prohibitive to their care, hopefully there is some comfort knowing that their inconvenience could be contributing to saving lives.
Legislators and other policy makers throughout the country continue their efforts to combat the drug epidemic in America, especially with regards to heroin and other opiates. For example, lawmakers in Washington are seeking to change the way the Evergreen State approaches treating opioid addiction. House Bill 2489 and its counterpart in the Senate would make significant changes to the state law to make medication-assisted therapy the treatment of choice for opioid addiction, according to reports.
Treatments for Opioid Dependency
Medication-assisted therapy is one type of treatment where people dependent on the drugs are prescribed substitute medications such as buprenorphine or methadone to keep withdrawal symptoms under control while providing supportive counseling and other services.
Many studies have shown that the incorporation of such medication can be beneficial, although most treatment specialists still recommend only short-term usage, as continuing to take the drugs for years results in its own dependency. However, used for stabilization and then a tapering process bolstered by intensive treatment can improve early relapse rates for many users.
Offering Many Forms of Treatment
The deputy chief medical officer for the Washington Health Care Authority, Charissa Fotinos, pointed out that updating the state treatment guidelines would help to put across the message that addiction is not a moral failing on the part of those affected. It may not encourage more people to seek help, but it will change the tone of the conversation for those who do reach out for assistance.
Opioid users themselves stated in a survey they were very interested in medications to help them reduce their drug use. They are interested in obtaining the most effective treatment for their addiction, according to the University of Washington’s Alcohol and Drug Abuse Institute, which conducted the survey of needle exchange clients.
The bill will change the current language, and it includes directions to expand access to treatment options across the state. Many of these expanded treatment provisions hinge on funding that will be provided in Governor Jay Inslee’s new budget.
The new bill and the funding would work together to create a “hub and spoke” treatment network in areas of Washington. Six pilot sites are operating in the western part of the state with federal funding received last fall.
Under this treatment model, clients are referred to a central hub to get started on their treatment. Once they are stabilized, they can get ongoing care, including counseling and medication, from a mobile provider or a clinic located closer to their home.
There continues to be a high demand for medication-assisted treatment (MAT) for opioid addiction. To date, however, states like Ohio only haveabout two percent of doctors that have completed the training necessary to prescribe or dispense buprenorphine. This is the main ingredient in the addiction treatment drug Suboxone, and other similar medications.
Plan to Double Healthcare Professionals Providing Buprenorphine
The state is planning to double the number of healthcare professionals certified to provide Suboxone (and other addiction treatment medications) to patients over the next 18 months. The federal government has provided $26 million in grant funding under the 21st Century Cares Act so that more healthcare providers can get training. Under existing law, doctors, as well as nurse practitioners and physician assistants (PAs) can dispense buprenorphine.
Waiver to Treat Patients for Opioid Addiction
Under the Drug Addiction Treatment Act of 2000 (Data 2000), doctors can apply for a waiver allowing them to treat patients with buprenorphine in their office, clinic, a community hospital or “any other setting where they are qualified to practice.” To qualify for a physician waiver, a doctor must be:
• Licensed under state law
• Registered with the DEA (Drug Enforcement Administration) to dispense controlled substances
• Agree to treat a maximum of 30 MAT patients during the first year
• Qualify to treat MAT patients, either by training or by professional certification
A doctor who has completed at least eight hours of classroom training focused on treating and managing patients with opioid use disorders can qualify for a waiver. The new training program for medical professionals is 1.5 days of classroom instruction, and participants are expected to continue their education through online courses and seminars.
Medication-Assisted Treatment Growing in the United States
The National Institutes of Health Studies says that MAT is a very effective method for treating opioid addiction. Studies conducted in 2014 revealed improved long-term recovery rates over traditional treatment methods, though it often takes finding the perfect balance for each individual as to how long they stay on the medication. Ideally, they would work toward being off of it in 2 years or less, and many people seek to use Suboxone for short-term tapering to simply ease opiate withdrawal symptoms.
For a number of patients, their first introduction to opioid pain medications occurs when they seek treatment in an Emergency Room (ER). Since doctors have more than one option for treating pain, what would happen if they offered over-the-counter pain medications instead of these strong, potentially addictive drugs instead?
A new study looked at what would happen if doctors took this approach to patients who visited the ER for treatment of sprains and broken bones. The results found that pain relievers sold under brand names as Tylenol and Motrin were as effective as opioids for treating severe pain.
Treating Acute Pain Without Opioids
The study involved 411 adult patients who sought treatment in two Emergency Rooms in New York City. All of them received ibuprofen (the main ingredient in Motrin) and acetaminophen (the main ingredient in Tylenol) or one of three opioid drugs: codeine, oxycodone or hydrocodone. All patients received standard doses, and none were told which medication was being administered.
The patients rated their pain levels on a score of 1-10 before being given their pain medication and again two hours later. The researchers found that for an average patient, the pain levels dropped from a 9/10 to approximately 5/10. There was little difference reported between the two groups.
Dr. Andrew Chang, Professor of Emergency Room Medicine at Albany Medical College in New York State, explained that ibuprofen and acetaminophen affect different pain receptors in the body. He went on to say that using them together may be especially effective.
These results dispute the standard ER practice used for treating acute pain. It could lead to changes that could help prevent new patients from being given opioids, which have such a high potential for abuse.
Although the study didn’t continue to follow the patients after they left the hospital, it is likely that the pain relief continued while taking the OTC remedies.
Long-term opioid use often starts after patients are introduced to the drugs in an acute pain treatment situation. Emergency Rooms have given them to patients more often in recent years, although more states have limited the number of pills that can be given out. According to previous studies, approximately one-third of ER patients received an opioid painkiller during their visit. Approximately 20 percent of ER patients leave the hospital with a prescription for an opioid pain medication.