Sunday, June 22, 2008

New Asheville clinic offers safer treatment of opioid addiction

A new clinic is making a safer alternative treatment for opioid addiction more widely available in Western North Carolina.

Crossroads Treatment Center opened in April and specializes in treating people with suboxone, a drug approved by the Food and Drug Administration in 2002.

The biggest advantage of the drug over methadone, which has traditionally been used to treat opioid addiction, may be its safety. A person cannot overdose on suboxone, and because it does not provide the same high as methadone, it is less likely to be abused.

“There are some people who do very well with methadone,” said Dr. Karl Schroeder, a psychiatrist at the VA Medical Center in Asheville. “But because it is a full-on narcotic, if you want to abuse methadone, you can take extra high doses to get blitzed on it. Methadone is one of the more dangerous things for death by overdose. With suboxone, the advantage is in safety. By itself you can’t overdose and kill yourself.”

The increased availability of the drug, a pill that can be prescribed by a doctor, may mean more people in WNC who are addicted to opioids seek treatment. The region is home to a high number of people addicted to the drugs.

Schroeder said he has prescribed suboxone to about two dozen patients at the VA. While it may be too costly for some patients, for others, suboxone helps them break their addiction.

“For many people it’s wonderful,” he said. “They talk about it as being a small miracle in their lives. … They get on suboxone, and they feel normal, and they don’t think about drugs all the time.”

Need for treatment

Dr. Elizabeth Stanton and Vicki Ittel, the former director of the Buncombe County Health Center, opened the new center to offer more treatment options for people addicted to opioids.

“There are just not enough of us,” Stanton said. “I think there’s a huge need in this community.”

WNC is home to many people addicted to prescription painkillers, and the number of people abusing these drugs nationwide increases every year.

Opioids are drugs derived from opium, like morphine, codeine and heroin, and some prescription drugs that have similar chemical properties, including oxycodone, hydrocodone and fentanyl.

“In WNC, we clearly have an increased incidence of narcotic addiction over the general population,” said Dr. Paul Martin, head of the Asheville Buncombe Drug Commission and a specialist in addiction medication.

Martin said he and others who study addiction don’t really know why more people in WNC are addicted to drugs, but what is clear is that there is a need for treatment.

Nick Reuter, a senior public health analyst at the Substance Abuse and Mental Health Administration, said less than half of people who need treatment are getting it.

Treatment for addiction to opioids typically involved methadone. Both methadone clinics in Asheville are operating at capacity and have waiting lists, Martin said.

“We know clearly that the capacity of the methadone programs around the country are not nearly sufficient to meet the need for narcotic addiction,” he said.

Advantages of suboxone

Methadone was the prescribed treatment for opioid addiction until the Food and Drug Administration in 2002 approved two products, suboxone and subutex, which contain buprenorphine, a long-acting opioid.

In 2007, the number of patients being treated for opioid addiction with buprenorphine surpassed the number of patients being treated with methadone, Reuter said.

Methadone patients must visit a clinic daily for treatment, and some stay on methadone for the rest of their lives.

But buprenorphine-containing drugs can be prescribed by a family doctor, are taken in pill form at home and have fewer side effects. Some patients can stop taking the drugs after a few months. This makes these drugs not only more accessible for some people seeking treatment, but also a more appealing choice for some patients.

Reuter said the increased availability of suboxone and subutex has gotten more people into treatment for their addiction. He said 60 percent of patients using the drugs for treatment report never having accessed drug treatment before.

Woodlands Treatment Center in Greenville, S.C., has seen a 92 percent success rate in keeping people off of opioids over its four years of operation, Stanton said.

While some physicians in WNC are licensed to prescribe the drug, not many treat patients in large numbers, Ittel said. The required counseling that goes along with prescribing the drug can be time-consuming and hard to work into a regular medical practice, she said.

For that reason, she said Crossroads is filling a niche market in the region. The clinic is seeing about 50 patients. That number is expected to increase as more people learn about the treatment.

Potential for abuse

Although there have been reports of abuse of buprenorphine, they are fewer than abuse of other drugs in the same class, Reuter said.

Buprenorphine-containing drugs are less appealing to addicts than heroin and methadone because they don’t produce the same kind of euphoria, and when injected at high doses, the drugs can precipitate withdrawal symptoms.

“Two recent studies seem to suggest that (suboxone abuse) has leveled off and started to decrease, but the amount of suboxone dispensed every year continues to increase,” Reuter said.

Methadone still around

While buprenorphine-containing drugs have expanded treatment options, Reuter said there is a need for methadone to stay around. He said methadone is useful for people who are more highly dependent on opioids.

Suboxone also comes at a price. Reuter said suboxone treatment costs around $300 a month, compared with about $30 a month for methadone.

The Crossroads clinic charges around $275 a month, which does not cover the cost of the drug, and they do not take insurance, Stanton said.

The pill, which costs around $5 a day, is covered by insurance and government programs like Medicare and Medicaid.

Ittel said the treatment costs far less than what some people are paying to get their drugs on the street.

“It will be a nice option for a niche population, but as it is prescribed now, it won’t replace methadone programs,” he said.


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