Every day and every news cycle there are stories about people struggling with addiction and the stakes are only getting higher with over 70,000 people succumbing to overdose last year. August 31st was International Overdose Awareness Day, a day when we remember those we have lost to overdose and bring attention to this issue to try to prevent future overdoses. We want everyone to know that there are effective treatments for addiction and that there are ways to prevent and reverse overdoses. Knowing some key terms can help you better understand this epidemic and how we can help those in need.

Opioids - first of all, let’s talk about opioids. Opioid based medications are pain-relieving medications that can be made from the poppy plant (e.g., morphine or codeine) or they can be made in a lab (e.g., fentanyl and methadone). Heroin is also an opiate which is made from the poppy plant. All opioids reduce the perception of pain and increase feelings of pleasure. At low doses, opioids induce feelings of wellbeing and are sedating, but at high doses, they can slow breathing and heart rate to the point of overdose and death.

Fentanyl is a highly potent synthetic opioid approved by the FDA for use as a painkiller and anesthetic. Fentanyl is prescribed for patients who need relief from severe pain, such as those who have recently had surgery. When used medically, it is given in a shot, a patch, or in lozenges. It is also manufactured and sold illegally as a street drug. Like other opioids, it works by binding to opioid receptors in the brain, but because it is so potent, it only takes a tiny amount to induce feelings of pleasure, euphoria, and relaxation. Fentanyl is 50-100 times more potent than morphine and 50 times more potent than heroin, so even a small dose miscalculation can result in a fatal overdose. The recent increase in overdose deaths is directly linked to the introduction of fentanyl into the illicit drug markets. Much of the heroin sold in the US is now laced with fentanyl and unsuspecting consumers can easily overdose if they take it.

Narcan is a nasal spray or injection used to treat opioid overdose by immediately reversing the effects of the opioids. When administered, it quickly travels to the opioid receptors and works as an antagonist, which means it knocks all opioids (e.g., heroin, morphine or fentanyl), off the receptor and then binds tightly to the receptor and doesn’t let the opioids back in. Narcan is what emergency medical workers use to revive people who have overdosed. It was reported that Demi Lovato’s friends kept it on hand and it may have saved her life by using this medication. Anyone can be trained to administer this medication. If you have a friend or loved one who is struggling with opioids, you should consider getting narcan to have in case of an overdose.

Medication Assisted Treatment (MAT) is the use of medication in combination with counseling and behavioral therapy to provide support, skills and strategies to achieve and maintain recovery. There are three FDA approved treatments for opioid use disorder: methadone, buprenorphine and naltrexone. Research has shown that MAT is the most effective treatment for opioid use disorder and that these medications have been proven to reduce the risk for overdose.

Methadone was FDA approved more than 40 years ago. This medication is used to treat opioid use disorder and is usually given once a day in liquid form, often in a cherry liquid, like cough syrup. It is an opioid agonist, meaning it activates the opioid receptors in a way that is similar to illegal opioids, but it doesn’t produce euphoria and people can function normally when they take it. This medication is easy to start and has been proven to be very effective in helping people stop using heroin and other opioids. But, because it is a controlled substance, it is highly regulated and people have to enroll in a clinic in order to receive it. While methadone is very effective, the way in which it is administered can be challenging for some people. However, it is a good choice for people who need a lot of support and counseling because comprehensive treatment is often available at the Opioid Treatment Programs that provide it.

Buprenorphine (Suboxone) was approved by the FDA to treat opioid use disorder in 2002 and can be prescribed by a physician in a private practice office setting. It is a partial opioid agonist, which means it fits into the opioid receptor, but doesn’t produce a full opioid effect, so it results in less physical dependence and it cannot cause overdose. Initially it was taken sublingually, meaning it was placed under the tongue until it dissolved, but more recently a monthly injection was developed to reduce the burden of daily dosing. This medication is fairly easy to start and is more accessible because it can be prescribed in a physician’s office.

Naltrexone for opioid use disorder was approved for oral use by the FDA in 1984 and for injectable use in 2010 This medication is used to treat both opioid use disorders and alcohol use disorders. It works by binding to opioid receptors in the brain and blocking opioids from binding to them. It can be taken once a day orally (ReVia) or by a monthly injection (Vivitrol). After someone has taken naltrexone, they will not feel any opioids that they consume, because their opioid receptors are blocked by the medication. In this way, it reduces the desire and craving to use and helps patients abstain from using opioids. People who want to take this medication for opioid use disorder must be opiate free for at least seven days which can be a challenge for patients who struggle to taper off opioids. This is a good choice for people who want to stop taking opioids altogether.

Naltrexone has also been shown to reduce alcohol use because it reduces the pleasurable effect of alcohol, so people who take it, tend to drink less and are more able to abstain from future drinking because it just doesn’t feel as good to drink when they are taking this medication.

As the opioid epidemic continues, and more people are affected, the chances that you’ll know someone who is struggling with opioids, or who cares for someone who is struggling increases. Honest and open conversation about addiction and addiction treatment is an important way to ensure that people are informed and aware of their options. At Wholeview Wellness we provide treatment both for people who are using drugs and alcohol and for those who care about them. If you are interested in learning more about treatment, don’t hesitate to call us at 212-204-8430.