Introduction and Learning Objectives
Opioid use disorder can be defined as “a problematic pattern of substance use that leads to clinically significant impairment in different areas” (Soyka, 2015). It is usually caused by either physiological dependence or psychological addiction to the substance (Lusk & Stipp, 2018). It has the following important features.
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- Opioid dependence is chronic.
- Opioid dependence is prone to relapses.
- The mortality of opioid dependence is rather high.
In addition to that, comorbid disorders are not rare. One of the potential causes of opioid dependence is a health condition that causes chronic pain and, therefore, warrants the introduction of opioid medication (Lusk & Stipp, 2018). However, Lusk and Stipp (2018) point it out that the use of opioid medication does not necessarily result in addiction.
Opioid dependence, addiction, and use disorders have become prevalent over the past years, which can be partially attributed to a more extensive prescription of opioid medications for pain management (Lusk & Stipp, 2018). As a result, medical professionals need to pay more attention to this problem. One of the solutions to it is the use of Suboxone.
- Suboxone is a Buprenorphine-Naloxone combination.
- Suboxone has been shown to be effective in treating opioid addiction.
The application of this drug to opioid addiction in remission in adult patients is the topic of this presentation, which has the following learning objectives.
- To investigate the specialty population (adults with opioid addiction). Important topics include demographics, size, mental health issues, and the likely causes of addiction development.
- To discuss the treatment options (with a focus on Suboxone). Important topics include the specifics of treatment options, including their effectiveness, availability, and barriers to them, especially cultural ones.
- To use the presented information for improvement suggestions. What can be done to improve the care for this population?
Treatment Options (Focus on Suboxone)
Medication-assisted treatment is a staple of opioid addiction treatment and recovery; it is vastly superior to abstinence-based programs (Lusk & Stipp, 2018). The following substances can be used.
- Methadone (the first drug that was approved for the task; it reduces withdrawal symptoms but is addictive).
- Naltrexone (not recommended for certain populations, including pregnant or breastfeeding women).
- Buprenorphine (including suboxone, which combines buprenorphine with naloxone; the latter is used on its own to counteract overdoses of opioids).
Suboxone has the following characteristics (Lusk & Stipp, 2018).
- Buprenorphine reduces symptoms of withdrawal and cravings.
- Buprenorphine causes diminished euphoria (as compared to opioids).
- Buprenorphine has a lower potential for misuse because the increase of its dosage does not have any improved effects.
- Suboxone specifically appears to have positive effects on depression, which is a common comorbid disorder in the described population.
Suboxone has been compared to other medications with the following results.
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- Suboxone is likely to be as effective as Naltrexone (Tanum et al., 2017). They differ in administration (Naltrexone is administered once a month).
- There exist a few studies comparing Suboxone to Methadone, which yield different results. However, it may be suggested that the two treatments are probably similar in effectiveness while affecting individual aspects of addiction and treatment differently (Soyka, 2015). Their differences can be used to determine the preferable option for individual cases.
Suboxone treatment does not have to be used on its own.
- Comprehensive treatment has been shown to have improved effects in certain populations. Medication-based treatment can be enhanced by additional psychosocial interventions (Dugosh et al., 2016).
- Psychosocial interventions can also increase treatment adherence (Kumari et al., 2016; Lusk & Stipp, 2018).
- Pain management and the treatment of comorbid conditions is very important (Lusk & Stipp, 2018).
Suboxone prescription may be difficult to obtain as compared to, for example, Naltrexone.
- The prescription of Buprenorphine and Suboxone requires holding specific credentials, which limits access to it (Lusk & Stipp, 2018).
- Specialized websites can help in finding a doctor who can prescribe Suboxone (Substance Abuse and Mental Health Services Administration, n.d.).
- By taking relevant courses and obtaining the necessary credentials, medical professionals can increase access to this treatment option.
As a result, the following obstacles to receiving Suboxone treatment can be identified.
- The access to the providers (physicians who can prescribe suboxone and therapists who can offer psychosocial interventions) can be limited, especially in certain areas (for example, rural ones) (Andrilla, Coulthard, & Larson, 2017).
- Physicians do not prescribe this option very frequently, even when they have the necessary credentials, which may be attributed to multiple barriers. They include resistance from other specialists, lack of certainty in the effectiveness of the treatment, concerns about the regulations, and preference of previously used methods (Andrilla et al., 2017).
A Study on the Topic
Andrilla et al. (2017) published the results of a national US-based survey of rural physicians regarding the prescription of Buprenorphine. The following findings were documented.
- A number of important barriers to buprenorphine prescription were noted. They include the lack of confidence in the treatment, preference of previously used methods, concerns about regulations, and some other issues.
- The physicians who prescribed Buprenorphine reported fewer concerns than those who did not.
Why is this research helpful?
- Buprenorphine treatments include Suboxone (Lusk & Stipp, 2018); the results of the study, while not specifically dedicated to one particular substance apply to the discussed medication.
- The study demonstrates that a variety of barriers can limit the access of patients to treatments that have been proven to be effective.
- The findings show that barriers to Buprenorphine prescription may be problematic, but their perceived importance can be reduced after the practice of prescribing it.
- In summary, the study highlights the possibility of reducing barriers to Buprenorphine and Suboxone treatment through Suboxone awareness improvement among prescribing professionals.
Andrilla, C., Coulthard, C., & Larson, E. (2017). Barriers rural physicians face prescribing buprenorphine for opioid use disorder. The Annals of Family Medicine, 15(4), 359-362. Web.
Dugosh, K., Abraham, A., Seymour, B., McLoyd, K., Chalk, M., & Festinger, D. (2016). A systematic review on the use of psychosocial interventions in conjunction with medications for the treatment of opioid addiction. Journal of Addiction Medicine, 10(2), 93-103. Web.
Kumari, S., Manalai, P., Leong, S., Wooditch, A., Malik, M., & Lawson, W. (2016). Factors associated with non-adherence to Buprenorphine-naloxone among opioid dependent African-Americans: A retrospective chart review. The American Journal on Addictions, 25(2), 110-117. Web.
Lusk, S., & Stipp, A. (2018). Opioid use disorders as an emerging disability. Journal of Vocational Rehabilitation, 48(3), 345-358. Web.
Soyka, M. (2015). New developments in the management of opioid dependence: focus on sublingual buprenorphine-naloxone. Substance Abuse and Rehabilitation, 6, 1-14. Web.
Substance Abuse and Mental Health Services Administration. (n.d.). Buprenorphine treatment practitioner locator. Web.
Tanum, L., Solli, K., Latif, Z., Benth, J., Opheim, A., Sharma-Haase, K., … Kunøe, N. (2017). Effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence. JAMA Psychiatry, 74(12), 1197. Web.