To prevent opioid abuse, doctors are being asked to cut back on the frequency with which they prescribe opioid medications. For this reason, a doctor will be reluctant to prescribe a strong pain medication even when it’s needed. Doctors who are more liberal in the prescribing of pain medicines are sometimes prosecuted by the Drug Enforcement Administration (DEA); this discourages otherwise well meaning physicians from relieving people’s pain.
One thing doctors can do to help patients to not become addicted to the pain medicines they prescribe is to not stop the medications suddenly. A patient who is prescribe for example Percocet after an injury, takes it as prescribed for 4 weeks, then is told by the doctor that he doesn’t need it any more, is now dependent on the medication. He stops taking it, and then has withdrawal symptoms. He then obtains it on the street in order to stop the withdrawal symptoms. If the doctor had simply tapered the dose of the medication gradually, the patient would not have had withdrawal symptoms, and would not have been forced to obtain the drug on the street.
Once a patient is addicted to opioid medication, there are 3 pharmacologic treatment options: methadone, buprenorphine and naltrexone. Methadone is an opioid which has a long halflife. That is, it takes a long time to get into and out of the patient’s system. For this reason, it does not give the patient such a boost when it’s taken. It is therefore not considered to be as addictive. However, in many ways it’s just substituting one addiction for another. Methadone can only be administered at licensed addiction centers, where patients usually have to show up every day for their daily dose.
Buprenorphine (Suboxone, Zubsolv) is not nearly as addictive as methadone, although it is still an opioid medication. People who are on buprenorphine are much more likely to lead productive lives, so it is a preferable treatment option. It can be prescribed on a weekly or monthly basis, so it is much more convenient for patients. Doctors can prescribe buprenorphine after obtaining a special license to do so, but it does not need to be administered only at licensed addiction centers as methadone does. So any doctor can obtain a license to prescribe it. Unfortunately, there are far fewer doctors certified to prescribe buprenorphine than there are patients who need treatment.
Naltrexone (Vivitrol) can be given as a oncemonthly injection. It is a good option for those who have already gone through one of the above treatment options and are ready to go on maintenance therapy. This medication causes severe withdrawal symptoms if it is given to a patient who is taking any opioid medications, so in this way it discourages abuse of opioids.
An integral part of treatment for opioid addiction is substance abuse counseling. People who are on medications for opioid addiction are much more likely to succeed in treatment if they are also taking part in counseling on a regular basis.
As we go forward from this current crisis of opioid addiction, it is hoped that doctors will prescribe opioid pain medications only when appropriate, and in such a manner as to minimize the development of opioid addiction and dependence. Also, it is hoped that more physicians will become certified prescribers of buprenorphine, since it is such an effective treatment for opioid addiction.