Currently
there are basically 6 recognized treatment approaches that include counseling
and psychosocial support in various treatment settings to treat moderate to
severe opioid use disorder (heroin and/or pain medication addiction). All have
certain advantages and disadvantages which can be summarized as follows:
1. Cold
turkey, or non-medical detox, followed by complete abstinence
• Advantages: low cost
• Disadvantages: high failure
rate
2. Medically
prescribed detox or withdrawal management, with or without buprenorphine or
methadone used in a taper, followed by abstinence
• Advantages: less discomfort
during withdrawal
• Disadvantages: high
failure rate after treatment episode is complete
3. Detox
(medical or non-medical) followed by initiation of a naltrexone containing
product such as Vivitrol, Revia or a non-FDA approved naltrexone implant
• Advantages: Effective as long
as the individual remains motivated or able to stay on the naltrexone as
prescribed
• Disadvantages: Abstinence
from all opioids is usually required for several days prior to initiation of
treatment.
4. Methadone
maintenance
• Advantages: effective for
select individuals using established, well studied treatment protocols
• Disadvantages: Restrictive
and often impractical due to current Federal laws
5. Oral
administration of a buprenorphine containing product such as Suboxone, Subutex,
Zubsolv, Bunavail or their generic equivalents.
• Advantages: Effective,
well tolerated, accessible through a licensed prescriber
• Disadvantages: problematic in
certain settings such as incarceration, unstable housing, and sober living
homes due to misuse and diversion. Difficult to monitor treatment compliance at
times.
6. Probuphine
which is a 6 month, long-acting buprenorphine implant in the arm
• Advantages: effective in a
select population. Addresses many concerns over medication compliance,
diversion or misuse during the 6-month implant period.
• Disadvantages: must be
administered in a structured medical setting by a physician that has been
trained and certified for insertion and removal of the implants using minor
surgical technique. Possible complications related to performing this type of
invasive surgical procedure.
There
is now a 7th approach that will be available starting March 2018 that is
expected to be effective, accessible and able to address the frequent problems
of compliance, diversion, and misuse of buprenorphine containing products. This
new product is being introduced by the same company that released Suboxone in
2003 and revolutionized how we look at and treat opioid use disorders. This new
product received FDA approval in November 2017 based on favorable data as a
completely new buprenorphine delivery system and will be marketed as Sublocade.
Sublocade
is a Schedule III (CIII) once monthly buprenorphine extended-release
subcutaneous injection that can easily be administered by a physician or other
qualified healthcare provider that is currently licensed to prescribe
buprenorphine containing products.
Because
Sublocade is injected once a month in a controlled setting under medical
supervision, the chance of misuse or diversion is likely to be very low. It is
expected that most insurances will cover this treatment as part of a structured
treatment program that includes counseling and psychosocial support.
