Addiction to narcotics, also known as opioids, is a major problem in this Valley, in this region and in society as a whole.
Prior to recent changes in federal law, the only available treatment for this destructive chronic problem was through the services of methadone clinics which must be visited daily to get each day’s dose. A concern is that methadone can be used as a base for getting high, and thus is an incredible temptation for an addicted patient or an asset for diversion into the abusing community. Recently, with the release of a new drug known as Suboxone which is vastly safer for the patient and the community, federal law has been changed to allow specifically trained primary care providers to now also treat a limited number of patients for addiction to opioid drugs. There are several advantages to Suboxone, relating to a different mechanism of action than methadone.
All of the drugs classified as narcotics can be thought of as a specific key that fits into a specific keyhole in the brain. Heroin is a good example of what we call a pure agonist, which simply means that it can only activate. We also have antagonists, such as Narcan, that can be injected in the emergency department to save people who are dying of an overdose because it knocks other agonist narcotics off the receptors, but has no activity at the receptor itself.
Most of the opioid drugs are agonists or active agents; the variation between them has to do with how long they last. Methadone is the longest lasting, which is why it is used to cover the withdrawal that drives heroin or other narcotic addicts to their next fix.
The special thing about Suboxone is that it has both activating and blocking effects. It preferentially fills all of the receptors in the brain, which keeps other drugs blocked out, but it acts at only 40 percent of full opioid activity, producing adequate pain control and complete control of withdrawal symptoms. Taking 10 times too much does nothing extra, so it has no lethal dose. If the drug is injected into the veins, it causes immediate, punishing withdrawal. When it does get out into the community of drug abusers, it is not preferred because they cannot use it to get high, so addicts generally use it only to cover withdrawal. If an addict decides, for example, to smoke oxycodone to get high while using suboxone, it is a waste of money, and won’t work at all. Suboxone plus heroin equals suboxone only, because of the preferential binding of suboxone to the receptors, completely blocking the effect of heroine.
In recent years, the federal government has determined that there is a huge unmet need for safe and effective treatment for narcotic addiction. Recognizing that Suboxone is a much safer drug, the DEA started developing a program to train primary care providers to supply this to patients in the community as part of an active treatment program for narcotic addiction or for chronic pain management in those with a history of narcotic addiction. This treatment for addiction is increasingly covered by insurance.
If you know someone who has fallen into the pit of dependency, wants to get their life back and is willing to give up getting high, treatment is available locally. Qualified and trained Suboxone providers in our area can be readily found through any Internet search engine. It is my hope that society will come to view dependency not as an absolute moral failure, but as a chronic relapsing condition; and that more people who are addicted to opioids will realize that there is a way to get their life back.
• Alan Johnson is a family practice physician at the Snoqualmie Ridge Medical Clinic.
