What if you could take a medication such as Suboxone (buprenorphine) and make it last a full month? Would that find success in the climate of our current opioid epidemic?
Reuters says that “Indivior believes its long-lasting Sublocade injection, which is being launched in the United States in the week of Feb. 26, will become a blockbuster medicine, despite the fact initial sales are likely to be slow.”
So the idea behind buprenorphine is that it is a partial synthetic opiate drug.
Let’s break this down a bit. Drugs such as methadone or heroin or vicodin are all what we call “full opiates.” Those drugs all flood the receptors in the brain to the point that the person will eventually go into a coma and die if they keep taking them. Full opiates overwhelm the brain and create euphoric effects.
But a partial opiate such as buprenorphine is different. It is a partial opiate, and once the medicine fills up the opiate receptors in the brain, it stops. The drug does not overwhelm the brain and eventually cause a coma. And therefore there is no profound euphoric effect either. It just “tops off” the opiate receptor tank that is inside the human brain.
Also, the opiate molecule that is buprenorphine fits into the human opiate receptors in the brain better than any other molecule. Therefore, if someone is taking this medication, their opiate receptors are “topped off” and other opiate drugs that they take will not be nearly as potent or effective, because the receptors are already filled. So in a way it prevents the addict from getting high on their drug of choice, because the Suboxone has already filled in those brain receptors.
So what does this mean in terms of a new, long lasting injection?
A few things. One is that, for the typical opiate addict, getting “high” is no longer a fun and exciting experience, but instead it becomes the avoidance of feeling dope sick. In other words, just taking enough of an substance in order to feel well becomes the equivalent of getting high.
What this mean is that buprenorphine, even though it is a partial opiate that does not truly “flood the brain,” can still be abused by addicts because it at least causes them to feel “well” even if it is not a full blown, euphoric effect.
So one of the problems in the world of opiate addiction medication is that people will sell, use, and abuse something like Subutex in order to self medicate. They will melt an oral pill of it and shoot it if necessary, and obviously that defeats the purpose of the medication.
So how does the once monthly injection version of the medicine differ? It makes it so that this version of the medication is not out on the streets in the hands of the patient, but instead is only distributed from the doctor’s office. That keeps it off the streets and reduces the abuse potential of this medicine down to near zero.
Second, it takes the daily decision for the struggling opiate addict where they ask themselves “Do I want to take my medicine today and stay on the path of recovery again?” and it reduces that decision down to once per month.
This is huge. As someone who once attempted to use Antabuse to avoid alcohol, I can attest to the fact that the decision making every day will eventually wear the struggling addict down to the point of relapse: You can simply skip your once per day pill, and then relapse the next day or so.
But with a once per month medication, once you make that decision to go to the doctor’s office and get your shot, you are fairly rock solid for the next 30 days.
I think it is important to realize that while medications are advancing and the innovation is welcome, simply improving our medical technology alone is not likely to solve the problem of opiate addiction in this country.
In order to truly overcome opiate addiction we are going to have to supplement all of these medications with therapy, group support, and a way to empower the individual to rebuild their life in recovery. One of the things that opiate addicts may not anticipate is that there are so many other ways in which their addiction can manifest itself. For example, I have known opiate addicts who have said “I don’t have a problem with alcohol, it doesn’t bother me at all, I can take it or leave it, and opiates are my only real problem.” Then a year later they are back in treatment, saying “you were right, I learned the hard way that a drug, is a drug, is a drug.”
This is not to mention the fact that our addiction can manifest itself in terms of sex, food, media, and a million other things. So we need to do more than just to hope and rely on a medical “cure” for addiction, because while that may help us significantly when it comes to our substance of choice, that medical solution does not necessarily show us how to change our lives, change our thinking, and avoid other potential dependencies.
As such, MAT, or medication assisted treatment, is just that–a supplement to the real recovery program that needs to be a much more holistic approach. This means that the medication piece is only one sliver of the overall treatment that you should receive, and it cannot be the only focal point. In order to thrive in recovery the struggling opiate addict has to rebuild their entire life from the ground up with new healthy relationships, new healthy habits, and building a support network that allows them to overcome temptations.
I am hopeful for new medical innovation in the world of MAT, but I think we also need to be realistic when we hear about new developments. We cannot work a passive program of recovery in the hopes that new medications will make the process automatic or easy for us. Recovery is tough, and I highly doubt that a magic pill (or injection) is ever going to change that. Stay vigilant!