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Unread 08-30-2008, 04:53 PM   #1
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Hi,
To help people more easily sort out the fact from fiction on the internet, we are introducing certified posts. These are mini essays based solely on the current existing body of evidence. Certified posts will contain references so you will be able to judge the credibility of the source info for yourself. Our hope is that it will help you decipher the fact from the fiction, so common on the web. Here is a sample of the kind of posts to come.
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Opioid Addiction Is a Brain Disease

Opioid addiction is a chronic brain disease precipitated by fundamental, long-term, changes to the structure and functioning of this organ.1,2

All brain diseases have some form of behavioral expression—Alzheimer's disease expresses itself as memory loss, schizophrenia expresses as unusual mood changes—and opioid addiction expresses itself as a compulsion to use opioids.1,3

The fact that a portion of opioid-addicted patients originally chose to misuse opioids does not make their condition any less the result of disease. Patients' choices (eg, regarding diet, exercise) contribute to the onset or severity of several chronic diseases, including hypertension, CHD, and diabetes.4

Furthermore, while the initial choice to use opioids may have been voluntary, once opioid addiction develops, use is compulsive—not voluntary.5

Provoking Change

The pervasive changes to brain structure and function that distinguish opioid addiction are, without exception, preceded by chronic opioid use. However, chronic opioid use is only one factor in the etiology of this disease, and, by itself, will not cause opioid addiction.3,6

Mu receptors in the brain adapt to repeated opioid exposure by becoming opioid tolerant. Tolerance is recognized as a symptom of opioid addiction, but absent of any other identifying symptoms, it is indicative only of physical dependence on opioids.3,6

The neurological changes that produce opioid tolerance and physical dependence are well understood. These changes appear to correct themselves within a period of weeks following cessation of opioid use.3

The Same, but Different

By contrast, the cluster of symptoms recognized as opioid addiction results from neurological changes that are wider ranging and significantly more complex.3 These neurological changes do not reverse themselves shortly after opioid use has ceased, but often persist for extended lengths of time.2

The hallmark of opioid addiction—compulsive drug seeking and use—stems in large part from powerful opioid cravings brought about by these complex changes.7

Both opioid craving and opioid withdrawal frequently drive patients' drug seeking and use.3

However, only opioid cravings are tied to compulsive drug-seeking and use. Furthermore, cravings can compel compulsive opioid use independently of the presence of withdrawal symptoms or physical dependence on opioids.7

The uncontrollable drug consumption seen with opioid addiction is primarily driven by opioid cravings. This strong correlation between cravings and compulsive drug use is an inherent part of why opioid craving (but not opioid withdrawal) is considered a definitive feature of opioid addiction.7

The biological basis of drug cravings is not entirely understood much beyond the generally accepted notion that cravings are an adverse consequence of repeated activation of the brain's reward circuit initially stemming from chronic opioid use.3,7

One of the theories put forward to explain cravings posits that, over time, opioid's constant activation of the reward circuit alters neurological functioning along those pathways causing them to become "hypersensitized" to both the direct effects of opioids and to the environmental cues associated with their use (ie, triggers). This hypersensitized reward circuit causes "pathologic" cravings for opioids even in response to moderate stimulation.7

Sensitivity to opioid cravings is typically one of the most persistent symptoms of opioid addiction. This persistence is attributable to the comparatively prolonged time required for the opioid-dependent brain to restore some degree of predisease normalcy.2 For this reason, opioid-dependent patients may be vulnerable to drug cravings (and relapse) for months and even years after their last opioid use.7




References
1. Leshner AI, Koob GF. Drugs of abuse and the brain. Proceedings of the Association of American Physicians. 1999;111:99-108.
2. Leshner AI. Addiction is a brain disease, and it matters. Science. 1997;278:45-47.
3. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Science & Practice Perspectives. 2002;1:13-20.
4. National Institute on Drug Abuse and National Institutes of Health. Lesson 5. Drug addiction is a disease—so what do we do about it? In: The Brain: Understanding Neurobiology Through the Study of Addiction. Available at: http://science-education. nih.gov/supplements/nih2/addiction/ other/map.htm. Accessed April 27, 2005.
5. McLellan AT, Lewis DC, O'Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment insurance, and outcomes evaluation. JAMA. 2000;284:1689-1695.
6. American Pain Society. Advocacy & Policy: Definitions Related to the Use of Opioids for the Treatment of Pain. American Pain Society website. Available at: http://opi.areastematicas.com/genera...aceos.AAPM.pdf. Accessed September 21, 2004.

7. Cam* J, Farr© M. Mechanisms of disease: drug addiction. N Engl J Med. 2003;349:975-986.
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Unread 09-07-2008, 12:31 PM   #2
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Does buprenorphine show up in an employer drug screening?

Buprenorphine will NOT cause a positive result on tests for other opiates. Buprenorphine has to be specifically tested for and isn’t commonly included on standard drug screen panels. The typical urine tests used to detect methadone, oxycodone, heroin, and other opioids check for a different metabolite than that found with buprenorphine and will not show a positive result in buprenorphine (only) maintained patients.

There are in-office tests specifically for buprenorphine that will detect it. These tests are not common but can be purchased on the internet, however we know of none that are CLIA-waved.

When reading in-office dip-strip tests be aware that faint lines are not ‘false positives” see this image of how to read this type of test correctly, and follow the manufacturer instructions: Reading test results

A typical employer multi drug screen might consist of a test for Amphetamine (AMP); Barbiturates (BAR)(Phenobarbital, Secobarbitol, Butalbital); Benzodiazepines(BZO)(Valium, Xanax, Librium, Serax, Rohypnol); Cocaine (COC); Marijuana (THC); Methylenedioxymethamphetamine (MDMA)(Ecstasy); Opiates (OPI); Oxycodone (OXY); Phencyclidine (PCP); Propoxyphene (PPX)(Darvon compounds); and Tricyclic Antidepressants (TCA)

Employers that expand their tests might include some of the following: Hydrocodone (Lortab, Vicodin), Methaqualone (Quaaludes), Methadone, Ethanol (Alcohol)

It is very unusual for an employer to test for buprenorphine, at least for now.


Ref. Buprenorphine: An Alternative Treatment for Opioid Dependence http://www.drugabuse.gov/pdf/monographs/121.pdf
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Unread 09-08-2008, 10:36 PM   #3
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Is buprenorphine treatment just switching one addiction for another?

No– With successful buprenorphine treatment as part of a complete treatment plan including counseling, the patient can put the addictive behavior into remission. The patient may still be “physically dependent” on opioids, (as they were prior to treatment) but this can be managed medically and reduced over time by a slow and gradual taper off of the medication. Physical dependence (often mistaken for “addiction”) is not a dangerous medical condition that requires treatment, addiction is. Addiction is damaging and life-threatening, while physical dependence is an inconvenience, and is normal physiology for anyone taking large doses of opioids for an extended period of time.

It is essential to understand the definition of addiction and know how it differs from physical dependence or tolerance.
The American Academy of Pain Medicine (AAPM), American Pain Society (APS), American Society of Addiction Medicine (ASAM), and The National Alliance of Advocates for Buprenorphine Treatment (NAABT) recognizes these definitions below as the current accepted definitions.

I. Addiction:
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following:
  • impaired control over drug use
  • compulsive use
  • continued use despite harm
  • craving
II. Physical Dependence:
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.


III. Tolerance:
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.

Physical dependence and tolerance are normal physiology. Addiction is a disorder that is damaging and requires treatment.

When a patient switches from an addictive opioid to successful buprenorphine treatment, the addictive behavior often stops. In part due to buprenorphine’s long duration of action, patients do not have physical cravings prior to taking their daily dose. The drug seeking behavior ends. Patients; regain control over drug use, compulsive use ends, they are no longer using despite harm, and many patients report no cravings. Thus all of the hallmarks of addiction disappear with successful buprenorphine treatment.

Therefore, one is not trading one addiction for another addiction. They have traded a life threatening situation (addiction) for a daily inconvenience of needing to take a pill (physical dependence), as some would a vitamin. Yes the physical dependence to opioids still remains, but that is vast improvement over addiction, is not life threatening, and it can easily be managed medically.

Addiction is a brain disease that affects behavior. This addictive behavior can be devastating to the patient and their loved ones. It’s not the need to take a medication that is the problem, many people need to take a medication, but rather it is the compulsive addictive behavior to keep taking it despite doing harm to one’s self or loved ones, that needs to stop. Whether or not the person takes a medication to help achieve this shouldn’t matter to anyone. If a medication helps stop the damaging addictive behavior, then that is successful treatment and not switching one addiction for another.

urges:
Psychological desire for a substance. Urges can usually be suppressed by will. Urges are less powerful than cravings. Urges are often passing and temporary. Cognitive skills can be learned to effectively suppress urges

cravings:
Physiological need for a substance. Powerful desire for a substance that cannot be ignored. Unnaturally strong desire/urge for a substance. An overpowering urge that people are ill-equipped to control through will. Usually it cannot be suppressed indefinitely and results in taking the substance. Craving (formerly called psychological dependence ) is an intense desire to reexperience the effects of a psychoactive substance. Craving is the cause of relapse after long periods of abstinence.(N Engl J Med 2003;349:975-86.)

Sources:
The Essence of Drug Addiction- By Alan I. Leshner, Ph.D., Former Director, National Institute of Drug Abuse, National Institutes of Health http://www.nida.nih.gov/Published_Articles/Essence.html
http://www.naabt.org/tl/The_Essence_of_Addiction.pdf
NIDA publication: The Neurobiology of Opioid Dependence: Implications for Treatment Thomas Kosten
MD, Tony George MD http://archives.drugabuse.gov/PDF/Pe...s-Neurobio.pdf
The American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine - consensus document – February 2001,
http://opi.areastematicas.com/genera...aceos.AAPM.pdf
American Academy of Pain Medicine - http://www.painmed.org/
American Pain Society - http://www.ampainsoc.org/
American Society of Addiction Medicine - http://www.asam.org/

Additional Reading (editorials)

Physical Dependence or Addiction? Maia Szalavitz, May 14, 2007
http://www.stats.org/stories/2007/ph...d_may14_07.htm

What’s in a Word? Addiction Versus Dependence in DSM-V
by
CHARLES P. O’BRIEN, M.D., PH.D., NORA VOLKOW, M.D., T-K LI, M.D.
http://ajp.psychiatryonline.org/cgi/reprint/163/5/764 (PDF)
http://ajp.psychiatryonline.org/cgi/...full/163/5/764 (HTML)


Physical dependence and Addiction, and why.
http://www.addictionsurvivors.org/vb...ad.php?t=15332
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Unread 09-10-2008, 06:30 PM   #4
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Are there other uses for Buprenorphine? and some clarification on what products can be used for what indication by law. DATA-2000 is unlike any other law that pertains to pharmaceuticals.

The Food and Drug Administration (FDA) has approved Buprenex® ( an injectable formulation of buprenorphine) to treat pain. However, by law, Buprenex cannot be used to treat opioid dependence(addiction), even by DATA-2000 wavered physicians. (Buprenex PI)

Buprenorphine has also been found to relieve refractory depression, but this particular use has never been approved by FDA. Refractory depression is depression that has not responded to other treatments. Some patients, who suffered from depression in the past, have experienced relief of symptoms on buprenorphine. (Bodkin,1995)

FDA has approved Subutex®( buprenorphine) and Suboxone® (buprenorphine/naloxone) to treat opioid dependence (addiction). However, neither Suboxone nor Subutex has been approved by the FDA for the treatment of depression or pain. Thus any use of Suboxone® and Subutex® for pain or depression is considered an off-label, unapproved use of these medications.

The D.E.A. articulates policy on the use of buprenorphine for pain and other off-label uses of buprenorphine products under DATA2000. Letter to Doctor Heit

Clarification: Buprenorphine is intended for the treatment of pain (as, Buprenex®) and opioid dependence (addiction) (as, Suboxone® and Subutex®). In 2001, 2005,and 2006 the Narcotic Addict Treatment Act was amended to allow qualified physicians, under certification of the DHHS, to prescribe Schedule III-V narcotic drugs (FDA approved for the indication of narcotic treatment) for narcotic addiction (up to 30 patients/physician at any time, 100 for those who meet certain criteria) outside the context of clinic-based narcotic treatment programs (Pub. L. 106-310). Suboxone® and Subutex® (and their generic versions) are the only treatment drugs that meet the requirement of this exemption (not Buprenex®, Butrans®, or pharmacy compounded buprenorphine products). Source: DEA
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Unread 09-27-2008, 04:06 PM   #5
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Thumbs up Is buprenorphine addictive?

Is buprenorphine addictive?

Although there is the potential for addiction to buprenorphine, the risk is low. Few people develop the dangerous uncontrollable compulsion to buprenorphine that we know as addiction, despite the fact that most have already shown a higher than average susceptibility to addiction.

Buprenorphine will maintain a level of physical dependence to opioids but that should not be confused with addiction, is manageable and can be resolved with a gradual taper once the patient is ready.*

People can become addicted to anything that causes pleasure; consider gambling, sex, food, and internet. There is even a condition where patients drink so much water they dilute the sodium concentration in their blood, causing some level of intoxication (hyponatremia). They are addicted to this behavior, although water is not considered addictive. Substances and activities all have some potential addiction liability. Many factors including genetics and environment contribute to someone’s potential for becoming addicted

The brain has a natural reward system that helps us to learn that things that cause pleasure are good and should be repeated. This helps our species survive by reinforcing the desire for food and sex. These activities initiate a biochemical sequence and release dopamine in the brain. This feels good and is reinforced when repeated. Some substances can trick the brain and initiate the same biochemical sequence, but to a greater and unnatural degree. The brain interprets this activity as the most pleasurable and hence the most necessary for survival, and creates a memory of the activity and cravings for more. The cycle reinforces itself and can lead to addiction (uncontrollable dangerous compulsive behavior)

Research has shown that substances that reach the brain faster have a higher potential for addiction. Also substances that provide a stronger effect cause more reinforcement. This begins a cycle of euphoria then craving then euphoria, craving and so on. Each time the cycle completes it reinforces a memory in the brain, the more frequent the cycle the more reinforcing.

The potential for addiction has to do with 3 main things, the speed of the onset, the level of reinforcement (pleasure), and the duration of action. IV heroin, is fast acting, strong euphoria, short duration. This gives it a high potential for addiction. Drugs with short intense cycles provide more potential for addiction than drugs with long “flatter” cycles.

Buprenorphine has a slow onset, mild effect, and long duration, which puts it at some risk of being addictive, more than water, but less than full agonist opioids, like heroin, morphine, oxycodone, and hydrocodone.

In countries where only Subutex is available (buprenorphine without the naloxone safeguard added), some people have injected their buprenorphine, thus decreasing the onset time and increasing euphoria, this in turn increased the potential for addiction and thus more people became addicted to it. The risk of addiction is less when taken sublingually as directed.

* to fully understand this you must be clear on the accepted clinical definitions of physical dependence and addiction. http://www.addictionsurvivors.org/vb...48&postcount=1


Further Reading: Drug delivery methods, ranking addiction potential
http://learn.genetics.utah.edu/conte.../delivery.html
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Unread 10-02-2008, 10:09 AM   #6
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What if I need pain medication for surgery, or acute pain?

You will still be able to be treated for pain with elective dental or surgical procedures. Your doctors should speak with each other about the plan. They will likely stop your Buprenorphine medication, at least 36 hours before the procedure, and then when you are ready to go back on Buprenorphine you will need to be re-induced, which means stopping your pain medicine, experiencing mild withdrawal (for a very short time) and restarting your Buprenorphine.

What the PCSS Mentors recommend (print and bring to your doctor)

Your doctor can contact The SAMHSA-funded Physician Clinical Support System (PCSS) and consult one of the buprenorphine mentors.


Recommendations for Patients Receiving Maintenance Buprenorphine Therapy (Ann Intern Med. 2006;144:127-134. Acute Pain Management for Patients Receiving Maintenance Methadone or buprenorphine Therapy) (print and bring to your doctor)


Treatment options are as follows:
  • Continue buprenorphine maintenance therapy and titrate a short-acting opioid analgesic to effect. Higher doses of full opioid agonist analgesics may be required to compete with buprenorphine.

  • Divide the daily dose of buprenorphine and administer it every 6 to 8 hours to take advantage of its analgesic properties. However, these low doses may not provide effective analgesia in patients with opioid tolerance who are receiving OAT. Therefore, in addition to divided dosing of buprenorphine, effective analgesia may require the use of additional opioid agonist analgesics (for example, morphine).

  • Discontinue buprenorphine therapy and treat the patient with full scheduled opioid agonist analgesics by titrating to effect to avoid withdrawal. With resolution of the acute pain, discontinue the full opioid agonist analgesic and resume maintenance therapy with buprenorphine, using an induction protocol.

  • Convert patient from buprenorphine to methadone at 30 to 40 mg/d. At this dose, methadone will prevent acute withdrawal in most patients.

In case of emergency, for those maintained on Buprenorphine

We never know what could happen. What if there is an emergency and you need to be treated for pain? Worse yet what if you are unconscious? A potential problem is you could be unnecessarily under-treated for pain. Since many doctors out there are still unfamiliar with Buprenorphine, there are a few documents that will be helpful. We suggest you print out a few of these and tell a loved one or your “in case of emergency” person, where they are.


Your Bupe doctor’s name and phone number. A list on any other medications you are on or conditions you may have along with all insurance info and any other relevant medical or personal information


The PCSS Mentor brochure, the docs can call and speak with a buprenorphine expert http://www.naabt.org/documents/pcssbrochure.pdf

PCSS-clinical guidelines- Treating acute pain in buprenorphine maintained patients: http://www.naabt.org/documents/PCSSA...inGuidance.pdf

The buprenorphine illustration, for a quick understanding http://www.naabt.org/collateral/How_Bupe_Works.pdf

A print out of the 72 hour rule, for dispensing buprenorphine in emergencies: http://www.naabt.org/documents/three-day-rule.pdf

This article explains practical treatment issues http://www.naabt.org/documents/Pract...rations%20.pdf

Keep this in a folder, jump drive, or CD, just in case of emergency. Hopefully it will never be needed.



Most of these files are PDF files and require the standard reader to view them. This comes with newer computers but if these files don’t open for you, you can download the free and virus free reader here. This is something you only have to do once and will allow you access to all kinds of information as the pdf file format is becoming more and more popular. http://www.adobe.com/products/acrobat/readstep2.html
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Unread 12-29-2008, 01:38 PM   #7
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Thumbs up What is drug addiction?

What is drug addiction?
Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking, use despite harmful consequences, inability to control drug use and craving. It is considered a brain disease because the brain is altered from its otherwise healthy state - that changes its structure and how it works. These brain changes can be long lasting, and can influence harmful behaviors seen in people who use drugs compulsively.(1)

What is physical dependence?
Physical dependence is defined as a normal physiologic state of adaptation to a substance, the absence of which produces symptoms and signs of withdrawal.

Why knowing the difference is so important?
Addiction is a disorder while physical dependence is normal physiology that can be managed medically. Someone can be physically dependent but not addicted, like patients being treated for chronic pain who take the prescribed amount of opioid medication and don’t seek drugs compulsively. Someone can also be addicted but not physically dependent as with non-substance addictions like gambling, sex, internet.

The neurological changes that produce physical dependence are well understood. These changes appear to correct themselves within a period of weeks following cessation of opioid use.(3) By contrast, the cluster of symptoms recognized as addiction results from neurological changes that are wider ranging and significantly more complex.(3) These neurological changes do not reverse themselves shortly after opioid use has ceased, but often persist for extended lengths of time.(2) The patient's struggle for recovery is in great part a struggle to overcome the effects of these changes. (3)

Stopping the damaging addictive behaviors is what is important, not the physical dependence. Symptoms of withdrawal are NOT by itself an indication of addiction and not reason for treatment, because they are easily controlled and don't ruin lives like the uncontrollable compulsive behavior of addiction.

Not all of the addiction field uses these terms properly and it can lead to confusion or misdiagnosis- for more on this see:

What’s in a Word? Addiction Versus Dependence in DSM-V
by CHARLES P. O’BRIEN, M.D., PH.D., NORA VOLKOW, M.D., T-K LI, M.D.
http://ajp.psychiatryonline.org/cgi/reprint/163/5/764 (PDF)
http://ajp.psychiatryonline.org/cgi/...full/163/5/764 (HTML)

Physical Dependence or Addiction? Maia Szalavitz, May 14, 2007
http://www.stats.org/stories/2007/ph...d_may14_07.htm

The American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine - consensus document – February 2001, http://opi.areastematicas.com/genera...aceos.AAPM.pdf




Sources:
1. NIDA, National Institute on Drug Abuse - Addiction: "Drugs, Brains, and Behavior - The Science of Addiction" 2008 http://www.naabt.org/documents/NIDA_..._addiction.pdf
2. Leshner AI. Addiction is a brain disease, and it matters. Science. 1997;278:45-47.
3. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Science & Practice Perspectives. 2002;1:13-20.
http://archives.drugabuse.gov/PDF/Pe...s-Neurobio.pdf

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Certified Posts are posts endorsed by the National Alliance of Advocates for buprenorphine Treatment (www.NAABT.org) They are intended to help viewers decipher what is fact and what is opinion, or just plain misinformation. These posts are supported by credible references from the current body of evidence, which are always included in the post, for further scrutiny. Still, your use of information contained in this post is entirely at your own risk NEVER take any online advice without first discussing it with a qualified healthcare professional. Any information you read here should only serve to inspire you to investigate further with credible, verifiable references sources like your doctor.
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Unread 12-29-2008, 02:59 PM   #8
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Default Is continued addictive behavior a voluntary behavior?

Is continued addictive behavior a voluntary behavior?

The initial decision to take drugs is mostly voluntary. However, when addiction develops, a person's ability to exert self control can become seriously impaired. Brain imaging studies from drug-addicted individuals show physical changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction.(1) The patient's struggle for recovery is in great part a struggle to overcome the effects of these brain adaptations.(3)

Behavior modification can help recondition the brain and reverse some of the brain changes, medication can sometimes help too, but often it is a combination of both. Not all of the brain adaptations resulting from addiction can be reversed, so patients need to develop strategies to compensate. Cognitive tools may be enough for some patients while others will require a combination of cognitive tools and medication to keep the addictive behavior in remission.(4)



1. NIDA, National Institute on Drug Abuse - Addiction: "Drugs, Brains, and Behavior - The Science of Addiction" 2008
3. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Science & Practice Perspectives. 2002;1:13-20.
4. NAABT - http://www.naabt.org/education/behav...-the-brain.cfm
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Unread 03-04-2011, 10:44 AM   #9
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Default What are the pros and cons of Rapid-Detox?

What are the pros and cons of Rapid-Detox or UROD?


Rapid detox - detoxification under anesthesia
UROD- Ultra Rapid Opioid Detox


Pros:
Treatment is administered in the intensive care unit where there are experts available to mange the intense symptoms of the induced withdrawal such as seizures. The medical professionals who perform this method of detox are experienced in it.

Cons:
It is not sufficient treatment for the brain disease of addiction. Detoxification is only the first step of a recovery, removing the opioids from the body does not do anything to treat the brain disease of addiction. Changes to the structure and function of the brain due to addiction may persist for months and if not treated usually result in relapse. Detox does not eliminate the cravings, and does not address the problems that lead to the addiction in the first place, unless psychosocial care is employed after the actual detoxification.

It is physically dangerous, which is why it is done in an intensive care unit, and it is very expensive ($17,000 +/-) making it unavailable for most people. Modern addiction treatments have rendered a painful detoxification obsolete and not necessary, instead patients can transition directly to a treatment medication. It is difficult to find data that reports the long-term outcomes of patients who are treated with inpatient detoxification. Proponents offer their own selected patient survey results as their only evidence as to efficacy. This method of detoxification is often a high profit private enterprise. Real data as to actual efficacy especially over time is extremely difficult to obtain or validate. There is however credible data that shows reasons not to use rapid detox.For example: In 2005 this was printed in the prestigious Journal of the American Medical association: "Rapid opioid detoxification with opioid antagonist induction using general anesthesia has emerged as an expensive, potentially dangerous, unproven approach to treat opioid dependence."
(JAMA. 2005;294:903-913)


"In general, the data do not support using general anesthesia during detoxification," said Herbert Kleber, M.D., vice chair of APA's Council on Addiction Psychiatry and a coauthor of the report. "The critical thing is not what happens during detox, but what happens after, and we found no difference between the groups. In addition, there were serious life-threatening adverse effects in the anesthesia group."

"Anesthesia-assisted detoxification should have no significant role in the treatment of opioid dependence," wrote Patrick G. O'Connor, M.D., M.P.H., in an editorial accompanying the JAMA report..."When detoxification is provided to patients, other approaches using clonidine, methadone, or buprenorphine are likely to be at least as effective as anesthesia-assisted detoxification and also are safer and far less costly." (Psychiatry News October 7, 2005)


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