Addiction to prescription painkillers is reduced when the individual is given consistent treatment with the drug Suboxone (buprenorphine plus naloxone), according to the first randomized large-scale clinical trial focused on the use of medication for treating prescription opioid abuse.
Pain medications are helpful when taken as prescribed; however, they have high abuse liability, especially when taken for nonmedical reasons. Researchers in this study set out to examine whether the FDA-approved medication Suboxone could help fight this growing problem.
“The study suggests that patients addicted to prescription opioid painkillers can be effectively treated in primary care settings using Suboxone,” said National Institute on Drug Abuse Director Nora D. Volkow, M.D. “However, once the medication was discontinued, patients had a high rate of relapse — so, more research is needed to determine how to sustain recovery among patients addicted to opioid medications.”
Interestingly, researchers also found that there was no extra benefit when intensive opioid dependence counseling was added to the drug treatment.
Suboxone is a combination of buprenorphine to reduce opioid craving plus naloxone, which causes withdrawal symptoms in a person addicted to opioids if Suboxone were taken by a route other than orally, as prescribed.
This combination was developed specifically to prevent abuse and diversion of buprenorphine and was one of the first to be eligible for prescription under the Drug Addiction Treatment Act, which allows specially trained doctors to prescribe certain FDA-approved medications for the treatment of opioid addiction.
Most research focused on treating opioid dependence has been conducted with heroin-addicted patients at methadone clinics. As a result, there has been limited information on how to treat those addicted to prescription painkillers, especially in the offices of primary care doctors. To help remedy this issue, the National Institute on Drug Abuse started the Prescription Opioid Addiction Treatment Study (POATS) in 2007, which was carried out at 10 treatment sites around the country.
“Despite the tremendous increase in the prevalence of addiction to prescription painkillers, little research has focused on this patient population,” said Roger Weiss, M.D., of Harvard Medical School, Boston, and the lead author of the study.
“This is the first large-scale study to examine treatments exclusively for people who were abusing prescription painkiller medications and were treated with buprenorphine-naloxone, which can be prescribed in a physician’s office.”
In the study, over 600 treatment-seeking outpatients addicted to prescription opioids received Suboxone along with brief standard medical management, in which doctors evaluated treatment effectiveness and suggested abstinence and self-help methods. Half of the subjects also received varying degrees of counseling provided by trained substance abuse or mental health professionals.
Results showed that approximately 49 percent of participants experienced a reduction in prescription painkiller abuse during the extended (at least 12-week) Suboxone treatment.
However, when Suboxone was discontinued, this success rate dropped to 8.6 percent.
Reductions in abuse were observed regardless of whether the patient reported suffering chronic pain, and participants who participated in intensive addiction counseling did not have higher success rates when compared to those who did not receive counseling.
According to an annual national government survey, an estimated 1.9 million people in the United States meet abuse or dependence criteria for prescription pain relievers. In addition, the Centers for Disease Control and Prevention report that annually, more people die from prescription painkiller overdoses than from heroin and cocaine combined.
The research is published in the Archives of General Psychiatry.
Source: National Institutes of Health