Buprenorphine is the molecule in common to all the forms of substitution treatment of opioid addiction. It has replaced Methadone as the gold standard. It is a partial agonist of the opioids. It has about 25 per cent of opioid activity which is enough to eliminate the opiod cravings and almost as important re-establish the mood that was previous to the opioid use.
Buprenorphine has an activity ceiling, so the risk of overdosing with buprenorphine is minimal with the exception of children or opioid naive adults, those that have never used opioids. Buprenorphine is an antagonist of opiods through competition for the receptor: the affinity of buprenorphine for the opioid receptors is higher than the affinity of other opioids so it displaces the opiod molecules from the place where they exert their activity, inducing a precipitated withdrawal.
Subutex is the commercial brand name of buprenorphine, it is the original substance. Suboxone is a combination of Buprenorphine and an antagonist of the opiods called naloxone, the active principle of Narcan. The appropriateness mixing Buprenorphine with naloxone, is widely challenged. In other areas of this blog we will review the controversy in detail.
With drug abuse rising, an array of companies have found new ways to turn the problems of addicts into billable fortunes. And few are as profitable as those focused on the lowliest byproduct of any stint in rehab: urine.
Testing has long been part of recovery, a way for clinics to ensure that patients are staying clean. But starting in 2010, as opioid abuse evolved into a crisis and the Affordable Care Act offered insurance to millions more yo
ung people, the cost of urinalysis tests soared.
It was soon common for clinics and labs to charge more than $4,000 per test, and to test clients two or three times a week.
Today, many clinics have pushed into an industry once dominated by stand-alone labs, running their own testing operations and, in some cases, pocketing far more from urine testing than from other aspects of treatment. With huge profits for the taking, clinic-owned labs are multiplying — and upending the testing industry.
“In a lot of these places, the patients are basically just there to urinate, and management calls them ‘thoroughbreds,’” said Bill Griffin, a retired insurance fraud investigator in Florida. “This happens all day long, with thousands and thousands of kids. This is a billion-dollar fraud in Florida alone.”
The tests have caught the attention of the F.B.I. and the Palm Beach County State Attorney’s Office, which launched a task force — called Operation Thoroughbred — to investigate clinics and sober living homes.
(Reference to full article on the NY Times 12/27/2017 or simply follow the link below:
Many of my readers have witnessed the resuscitation of somebody that overdosed with opioids. He or she is breathing very slowly or is already in respiratory paralysis. She is given Naloxone (Narcan), a physiological antagonist of the opioids and very soon she is awake, agitated, in acute withdrawal. If you remain at the scene you will notice that 15 to 20 minutes later the individual is going back to sleep and probably a second injection of Narcan is necessary. You wonder why, this is the simple explanation: Narcan is metabolized and inactivated by the body in 15 to 20 minutes. That substance, Naloxone, is added to Buprenorphine, and the combination is called Suboxone. Being the same substance it is eliminated by the body at the same speed, so in 20 minutes Suboxone turns into Buprenorphine, whose brand name is Subutex. We can say that Suboxone turns into Subutex in 20 minutes. Is there a need to pay three times more money just for 20 minutes of unnecessary antagonism ? The substance that remains working for 24 hours is Buprenorphine that by stimulating the surviving opioid receptors eliminates the craving for opiods.
After 15 years of giving free hands to the pharmaceutical industry to create physical dependence to opioids in hundreds of thousands of Americans, the government finally realized that something must be done. 72,000 of those dependent individuals died last year due to opioid overdose. Its first instinct was to invest more money in rehabilitation programs; the bad news is that there is overwhelming evidence that they do not work. Less than 10 percent of those that complete a rehab program are able to stay sober for six months.
After years of discussion in the American Psychiatric Association the expression Substance Abuse was removed from the official Diagnosis Manual of Mental Disorders, DSM 5; It was one of the best accomplishments that the group of psychiatrists working with addictions has obtained in recent years. Nobody likes abusive people , the word abuse puts the patient under a negative light at the very moment that a diagnosis is made which is the crucial point and marks the beginning of the treatment. It creates an asymmetric relation between doctor and patient, the doctor is high in the safe terrain of rightfulness and the patient is down, carrying the miserable status of being an abuser. To make the things worse the patient is not only the offender but the victim, blamed for reason of his illness. That chapter should be over but is not: most doctors and institutions still use the expression that drives the treatment in the direction of failure. It is time to rectify. Starting with DSM V the expression to be used is Substance Use Disorder.
Two months ago, a great contribution to the field was published, it is the book Fentanyl, Inc. How Rogue Chemists are Creating the Deadliest Wave of the Opioid Epidemic, by Ben Westhoff. Katherine Tobin, PhD, former member of the US China Economic and Security Review Commission wrote: “Americans face a deadly and growing public health crisis, the worst of which is to come. Through this courageous reporting Ben Westhoff takes us to the heart of the problem. In Fentanyl, Inc., he shines a light of the human wreckage and damage caused by the most powerful and dangerous of the opioids, fentanyl and its derivatives. He shows how addiction, mislabeling, and pourposely or mistakenly mixed drugs lead to tragic ends.” I strongly recomend to read this valuable book.