Cancer Treatment Today » Addiction Medicine

Subutex and Suboxone for Addiction

M Levin, MD — Fri, 10 Aug 2012 00:42:25 +0000

Buprenorphin comes in a formulation that can be taken via patch thorugh the skin or under the tongue. In October 2002, the Food and Drug Administration (FDA) approved buprenorphine monotherapy product, Subutex®, and a buprenorphine/naloxone combination product, Suboxone®, for use in narcotic addiction treatment. IT saturates narcotic receptors and prevents a “high”. The combination product is designed to decrease the potential for abuse by injection.

The transdermal form is already well-established for treatment of chronic cancer pain. It was recommended for this purpose by a consensus conference(Pergolizzin et al). The sublingual form is much less studied in this setting. Notably, studiedas logn ago as 1979 by Robbie. He concluded that this sublingual preparation seems worthy of addition to the commercially available range of analgesics in clinical practice. Other publications appeared occasionally over the next 20 years and have been generally supportive. In 2005, Malinoff found it to be well tolerated and safe and appeared to be effective in the treatment of chronic pain patients refractory to other pain medications. It continued to be mildly recommended in more recent reviews.

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Antabuse

M Levin, MD — Sun, 05 Aug 2012 15:04:32 +0000

Antabuse, or disulfiram, is approved for the treatment of alcohol abuse and alcohol dependence by the U.S. Food and Drug Administration. When alcohol is consumed it is metabolized by the body into acetaldehyde, and then into acetic acid, which is harmless. Antabuse interferes with this step, causing a buildup of acetaldehyde As a result, there is a build up of acetaldehyde five or 10 times greater than normally occurs when someone drinks alcohol. This causes unpleasant side effects and discourages alcohol use. FDA indication is: “in the management of selected chronic alcohol patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage. Disulfiram is not a cure for alcoholism. When used alone, without proper motivation and supportive therapy, it is unlikely that it will have any substantive effect on the drinking pattern of the chronic alcoholic.”

It is not universally effective because it is a sufficiently short acting that one can stop it and return to alcohol use in a few days. There is a high rate of noncompliance and recidivism (returning to drinking) According to the U.S. Substance Abuse and Mental Health Services Administration, Antabuse (disulfiram) is more appropriate for older, motivated individuals and in those who are supervised during daily ingestion. Predictors of efficacy with disulfiram include patients highly motivated for abstinence, people who are married or have a good support system, people with behavioral contracts to take the medication, and people legally compelled to take disulfiram.”

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Inpatient Versus Outpatient Alcohol Rehab

M Levin, MD — Tue, 19 Jun 2012 14:57:44 +0000

There are many similarities between inpatient and outpatient alcohol rehab programs. Both types of treatment programs provide direction and guidance to the patients and their families to educate them about what alcoholism is and how to set and meet appropriate goals for treatment and recovery. Inpatient therapy involves a 24/7 stay in a residential treatment facility that is isolated from the outside world. The goal is to provide a setting that keeps distractions and temptations to a minimum and allows the patient to focus on recovery. These types of treatment programs can be as short as four to six weeks or as long as several months to a year, depending on the severity of the addiction. Inpatient alcohol rehab is beneficial for those who are severely addicted or who have had trouble succeeding in other treatment settings in the past.

Outpatient alcohol rehab is generally suggested for those who aren’t heavily addicted to alcohol but still need help breaking their addiction to this drug. Treatment usually involves one or more meetings per week that can last from one to several hours and include behavioral therapy, group therapy and single therapy sessions, as well as educational classes and other treatments.

Outpatient treatment allows individuals to continue working, going to school and – in general – continuing their normal life. Inpatient treatment is much more costly than outpatient treatment. Inpatient therapy has the advantage of being an environment free from distractions and temptations, whereas outpatient therapy will allow one to be exposed to temptations that may lead to relapse. Inpatient therapy also allows one to recover physically going back to the ‘real world.’

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