Opioids have become an epidemic. While they can be extremely helpful to those who need them, they also can be addictive and dangerous. Technically speaking, opioids are a class of medication that includes morphine, hydrocodone, oxycodone and fentanyl, all of which typically are used to treat pain. This can include pain after surgery or, more recently, chronic pain. In our country, drug overdose is the leading cause of accidental death, and opioids are responsible for the majority of them. The rate of opioid deaths nearly quadrupled between 1999 and 2008. Now, more than 2.5 million Americans struggle with addiction to prescription pain relievers or heroin, many of them people we know and care for deeply.
Psychiatrist Dr. Julia Wood from Blount Memorial Parkway Psychiatric Service says these addictions can be extremely powerful. “Addiction causes people to choose the immediate reward of a drug over longer-term enjoyment of family and friends,” she said. “As an outsider, it can be hard to understand how someone can become stuck in the cycle of opioid addiction. However, powerful reward circuits in the brain are activated when an individual abuses a drug, and these powerful circuits can overpower a person’s desire to do anything else. With opioid addiction particularly, the craving can be incredibly powerful and not on par with any other craving that those of us without an addiction are familiar with feeling,” she explained. “Most people with an opioid addiction desperately want to stop using. They don’t want to be addicted, but they feel powerless over the cravings to use,” she added.
Despite the pitfalls of opioids, Wood says there are treatments available. “Opioid addiction is especially dangerous as the risk of death from overdose is high and the relapse rates, even after prolonged periods of abstinence, are higher than for many other drugs, especially those we’re most familiar with such as nicotine and alcohol,” she said. “There are three medications on the market used to treat opioid use disorder: injectable naltrexone, or Vivitrol; buprenorphine, or Suboxone; and methadone. Two of these treatments, buprenorphine and methadone, are opioids themselves, while injectable naltrexone, or Vivitrol, is not. Injectable naltrexone, or Vivitrol, has not received as much study as methadone and buprenorphine and, as such, is not as readily used,” she explained.
“Most of the people I meet, patients and families alike, would prefer to avoid the use of medication in treating opioid-use disorder,” Wood continued. “People will say to me ‘It’s just another pain pill.’ However, medications such as buprenorphine and methadone have been shown to reduce relapse rates, reduce mortality and reduce the behaviors that increase transmission of hepatitis C and HIV. When used properly, medication can help people return to healthy lives with increased functioning. If someone is taking buprenorphine as prescribed and is able to hold down a job and engage with family and friends, the outcomes can be wonderful. The goal is to function well and be able to experience the joys and sorrows that life brings,” she explained.
But, Wood says, without treatment, odds of opioid relapse are high. “Unfortunately, without one of these three medications, the relapse rate is between 85 and 95 percent, and that rate of relapse can persist years after an individual achieves sobriety,” she said. “However, it is not easy to obtain access to methadone or buprenorphine. Most physicians who prescribe these medications do not take commercial insurance. These medications also are highly regulated, and many doctors find that, in order to have the time available to properly assess, prescribe and follow the letter of the law, they need to charge a higher rate than insurance allows. Unfortunately, this cuts off access to many individuals with addiction. Injectable naltrexone, or Vivitrol, may be more easily accessed, as many doctors who accept insurance, including those of us at Blount Memorial Hospital, are able to start people on that when appropriate,” she added.
Wood sees patients at Parkway Psychiatric Service, which now is located at 220 Associates Blvd. in Alcoa. For more information or to schedule an initial appointment, call Parkway Psychiatric Service at 865-980-5377.