ISPP 2015

Career Opportunities in Pharmacy
Medication-Assisted Treatment Overview: Naltrexone, Methadone & Suboxone l The Partnership



the neurobiology of addiction is a field that has really exploded over the last let's say 30 years we are able to actually see what is going on in the brain in the addicted individual the impact of the drugs that they are using on the brain and then in some cases the impact of some of the medications of pharmacotherapy that we use to treat their addiction we can see improvement in brain function which is very exciting so as opposed to 50 years ago when people thought that addiction was a problem of character or personality or a criminal personality or weakness of will or other ways of looking at addiction we're really looking at it as a neurobiological disease or to put that in simple terms of brain disease we all agree that addiction is a chronic disease that it has currently no cure but excellent treatments and that remission or recovery which I use synonymously are our goals that can be met by many patients through a variety of different treatments including pharmacotherapy treatments and non-pharmacological people that are looking for medication assisted treatment and it really depends on the underlying condition that they're suffering from if they have a problem with alcohol dependence they may be looking at options like now Trek's own or antabuse if they have a problem with opiate dependence they may be looking again and they'll track soon but they also might be looking at methadone or suboxone the naltrexone is actually a blocker and in both blocks the high people get from alcohol when they do that and it actually also blocks the high people get from pain pills or heroin methadone is what's called a full agonist you can look at the receptors in the brain as a door and a full agonist opens the door completely into the brain which allows the full activity of an opiate and so methadone acts as a replacement therapy for opiates so if someone's in withdrawal from heroin or pain pills they're gonna that's going to allow the full activity into the brain to replace that but the problem with a full agonist is sometimes people can also have negative there's risks of overdose Reuben or Feeny locks owner suboxone is what's called a partial agonist and that's like opening the door partway and by opening the door partway you're actually able to let enough in to to help with withdrawal symptoms and cravings but not so much where there's a risk of overdose or people look sedated or out of it most of the evidence shows that if there is a pharmacotherapy which has been shown to be effective and to help with that addiction problem that the use of that pharmacotherapy in addition to the use of a variety of psychosocial treatments such as one-on-one counseling or groups or going to a mutual help group like AAA or NA that the combination of the psychosocial treatments along with the pharmacotherapy will usually provide better results than either one alone I like to use the slogan that all treatments work for some people no one treatment works for everyone often people are reading online so often they have an idea when they come into the office what medication is gonna work best for them and we have a discussion about it what's right for them involves a lot of the you know there's basic differences between these different options and they would have to evaluate those differences on their own and then talk to a physician about these differences and kind of find the right fit for them one of the most common misconceptions and myths by both patients but really more often significant others and again the mutual help groups is that when you take view preneur Fein or you take method on you're just replacing one drug with another and this is just not true because we're usually replacing a short-acting opioids which is generally causing damage to the patient's brain with a long-acting opioids which is meant to normalize and stabilize the brain and we actually have data now to support the idea that method on and Oh buprenorphine will improve brain function it is very important for the patient and their significant others to understand physical dependence does not necessarily equal addiction let's take a patient who's on insulin for diabetes they must take their insulin every day if they don't they get sick but nobody ever says that they're addicted to insulin they just say they're on insulin they have to take it every day if you develop opiate dependence when you're 20 there's a very good chance you're not gonna live past 40 so I would say that's deadlier than diabetes that's deadly your thyroid disease so plus the loss of functioning you know even with thyroid problem diabetes people can often make it to work they can often go to school with people with active opiate dependence that they can't do those things there's a complete loss of functioning it's easy to withdraw people over a week but to maintain the abstinence from non prescribed or illegal drugs that's the challenge and that's where these medications come into play

9 thoughts on “Medication-Assisted Treatment Overview: Naltrexone, Methadone & Suboxone l The Partnership

  1. Been on both and subutex was the worst withdrawal ever. It was like reverse withdrawal, meaning it got worse as time went on not easier.
    After a rather short detox over a week with subutex i thought it was a cake- walk! Damn was i wrong! After 3 weeks i was kicking all night long. spasms constantly keeping me awake even in my arms, my elbows and shoulders were kicking!
    It's called paws-post acute withdrawal syndrome … and it was brutal. It literally lasted 4 months and i caved in and went back on subutex. After another few years on it i was coming undone and went back on methadone and it saved my life.
    I've never had methadone withdrawals that came even slightly close to that.

  2. All that they say is true but they are ignoring the one drug that can actually cure addiction by resetting the brain back to how it was before drugs of addiction were introduced to it. That drug is Ibogaine and in two days it cures the addict. Why is it being ignored, could it be that there's no money in a cure while maintenance programs ensure return custom through the addicts life.

  3. Methadone Maintenance saved my life!!! I was a homeless prostitute before getting on this medication. Now I am a responsible productive citizen. I am raising my children and leading a happy healthy life.

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