New Prescriptions for Addiction Treatment
New prescriptions are making it easier to kick old drug addiction habits and stay clean.
By Colette Bouchez
Reviewed By Charlotte Grayson
Shortly after radio talk-show host Rush Limbaugh publicly admitted addiction to prescription painkillers, he made a beeline for treatment. But coming to the decision to get that care -- much like for the more than 20 million Americans addicted to a wide variety of substances -- took a lot longer.
Indeed, experts say most people with substance abuse problems put off or even avoid treatment, not only because of the stigma attached to drug treatment programs, but also because many believe quitting drugs or alcohol will be nearly as difficult as living with the addiction. And for a long time, that was at least partially true.
"It's not like you could just go to your local doctor's office and get a prescription to help you get off drugs. You had to go to a drug clinic, and for many there was lots of embarrassment and sometimes certain difficulties associated with the treatment itself," says Gopal K. Upadhya, MD, a psychiatrist and medical director of New York's Areba Casriel Institute, the nation's oldest private drug and alcohol treatment center.
Now, however, much about the treatment of addiction has changed. Not only has the entire issue of substance abuse been reclassified from a social condition to a medical one -- thus removing a lot of the stigma -- but new medications are also making it possible to actually get a prescription for addiction right from your primary care doctor.
Among the drugs most frequently prescribed is Suboxone, which is used to treat addiction to painkillers like OxyContin (what hooked Rush Limbaugh) as well as heroin, and last year doctors wrote some 80,000 prescriptions.
"This medication is one of the most exciting things to happen in the world of drug treatment, not only because it works so well, but because you don't have to go to a drug treatment center or clinic to get it -- any psychiatrist or even a regular family doctor can prescribe it, and that alone helps to bring in a lot of people who might not ordinarily go for treatment," Upadhya tells WebMD.
While all addictive substances affect slightly different areas of the brain, the one thing they share in common is stimulation of the reward centers, the areas of the brain that release the pleasure hormones that make us feel good.
In the past, treatment was limited to those drugs that stimulated these same pleasure centers. But those drugs also produced a similar high. In the case of heroin addiction, the treatment drug methadone was often widely criticized because of its similarity to the substance being abused and its potential for abuse as well as dangerous overdosing."It was like substituting one addiction for another," says Upadhya. Suboxone, however, works in an entirely different way. By competing with heroin or opiate painkillers for the same receptors deep within the brain, Upadhya says it's able to knock out the withdrawal symptoms without "producing the high."
In addition, he says, because the drug has a built-in "ceiling effect" -- meaning that increasing the dosage will not enhance the satiation effects -- it becomes virtually impossible for addicts to abuse. And that, he says, makes it safer to prescribe without risk of overdose.
While Suboxone is fast proving successful -- one clinic boasts an 88% success rate after six months of treatment compared with just 50% for methadone -- not everyone has equal success. For some addicts the effects are simply not strong enough to cut the craving, while for others, side effects including headache, withdrawal syndrome, pain, nausea, and sweating can make treatment difficult. Still, experts say for most who try it, it offers the promise of treatment success with far fewer problems.
Addiction Treatment: Treating Alcoholism the New Way
Some experts believe that one of the factors responsible for the success of Suboxone lies not only in the power of the primary drug, but also in a second compound contained in this drug -- a medication known as naloxone. A powerful anti-addiction drug in its own right, naloxone, sold under the brand name Narcan, has also become a mainstay in the modern treatment of alcohol addiction. In fact, it's one of just two medications approved by the FDA for this purpose.
"When used in alcohol addiction, naloxone reduces cravings and diminishes the length of time alcohol is used while increasing the length of time an abstinent person might remain abstinent, " says Marc Galanter, MD, director of the division of alcohol and substance abuse at NYU Medical Center/Bellevue in New York.
Now joining naloxone in the fight is the drug Campral, approved by the FDA in August 2004. Galanter says it works much the same way as naloxone to stimulate the reward centers of the brain -- in this instance, by elevating levels of a brain chemical known as GABA. This, he says, reduces the need for alcohol without activating the numbing effects patients normally get from drinking.