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Updated for August 2018
For people who wish to free themselves from their opioid dependence, there are many new choices to help them achieve their goals. There are new drugs that have been approved for use that will help relieve withdrawal symptoms.
While great care must be taken in deciding which option best fits your needs, it is incredibly helpful to know all of the options available to you.
FDA Approves New Treatments for Opioid Addiction for 2017-18
The Food and Drug Administration (FDA) approved several drugs to help fight opioid addiction in 2017. Read how these new drugs can help aid and kick the addiction.
The first new drug is called Zubsolv, which combines buprenorphine and naloxone, both of which have been used to treat opiate addiction. Zubsolv, which is made by Swedish drugmaker Orexo, is a tablet that dissolves under the tongue and comes in a menthol flavor.
Like other treatments, Zubsolv is to be used as a maintenance treatment with counseling and psychosocial support for those suffering from opiate addiction. But patients will require less of this drug to achieve the same results as currently used treatments.
Others like Suboxone, Subutex, and Bunavail come as film strips to be dissolved under the tongue. They have been introduced over the last decade and are also highly effective in helping patients with their opioid dependence.
However, beware of the abuse of these treatments, for they can also lead to addiction. Suboxone, because it’s popularly prescribed, has produced its own addiction epidemic as well as a few deaths from abusing it. These particular treatment drugs are to be placed under the tongue, while patients have been known to dissolve the film in water and inject the drug directly into the bloodstream, causing complications and death.
This is why Zubsolv is considered a breakthrough. As a tablet, it cannot be dissolved as easily.
The FDA has also approved a buprenorphine implant called Probuphine that will provide a constant low-level dose for six months to patients who are already on a complete treatment program. The drug consists of four one-inch rods that are implanted in the skin of the forearm.
The reason for the implant is that, like with taking any pill, they are easily forgotten or skipped, making the recovery journey that much more bumpy. This way, the patient need not worry about the daily pill and can deal with other issues.
The other opioid withdrawal drug is lofexidine hydrochloride, which is the first non-narcotic and non-addictive medication of its kind approved by the FDA. In the United Kingdom, as BritLofex, it has been used to detoxify more than 200,000 opiate addicts successfully.
It suppresses the release of adrenaline in the body’s nervous system, thereby reducing some of the withdrawal symptoms. It does not reduce the cravings.
This drug is an adrenergic receptor agonist, which means that it stimulates the central nervous system’s receptors to produce a physical reaction – the lessening of the withdrawal symptoms.
Methadone and Buprenorphine
Previously, there were only two drugs that were used for the treatment of opioid withdrawal symptoms, and they were methadone and buprenorphine (with and without naloxone). Unfortunately, both still make the body physically dependent on them.
Therefore, it is encouraging to find a drug that is non-narcotic and non-addictive, like lofexidine, that can help patients manage debilitating withdrawal symptoms associated with opiate detoxification, such as:
- Stomach cramps
- Muscle pain
While the majority of options for buprenorphine are sublingual or taken orally, the FDA recently announced its approval of an injectable form of buprenorphine under the brand name Sublocade. Touted as a long-term maintenance drug for opioid dependence, Sublocade offers a few key benefits over oral suboxone:
- First, Sublocade is slowly and steadily released into the bloodstream over the course of a month, and injections are only needed once per month.
- Second, since the injection must be given by medical professionals, it is more likely that patients will keep on schedule and receive their medications at exactly the times recommended.
- This also makes sure that drug diversion (selling the medication on the streets to others) is not possible, and only the patient meant to receive the medication will receive it.
Sublocade is recommended strictly for the ongoing maintenance of opioid dependence and not for the early stages of treatment, such as detox.
In fact, professionals state that because the initial treatment phases use tapering and dose changes to meet the needs and comfort levels of patients, Sublocade would not be a good fit for anyone who hasn’t already been through the initial treatment phases. For those who have completed initial treatment, however, and are looking for a long-term opioid maintenance solution, this option may be a literal lifesaver.
Much like Sublocade, CAM2038 is an injectable medication designed for maintenance for those with opioid use disorders. Though still in its investigational phase, the FDA has accepted the drug for priority review — which gives hope that the drug will be available for distribution in 2018.
If approved, the drug would be available in syringe form, pre-filled with doses ranging from 8 mg to 32 mg for weekly maintenance and 64mg to 160mg for monthly maintenance. A few of the benefits of the drug include a minimized risk of abuse or diversion and the ability to provide flexible dosing for maximized patient comfort.
Recently, naltrexone has been added to the list of non-narcotic treatments for opioid dependence as well as alcohol addiction. It is in the class of opiate receptor antagonists, which means that it blocks the effects of opioid drugs. Naltrexone cannot reduce the cravings, though. It is used as a once-a-month injection to prevent relapse after detoxification.
Both lofexidine and naltrexone have been used concurrently in rapid detoxification cases. Naltrexone is given to block the opioid receptors, thereby sending the patient into immediate withdrawal and accelerating the detoxification process. Meanwhile, lofexidine is given to relieve the withdrawal symptoms.
If no other opiates are introduced, effective detoxification takes about three days with this combination. Keep in mind that with lofexidine by itself, detox takes about 10 days.
A drug that works as both an agonist and antagonist to the opioid receptors, pentazocine was the first mixed agonist-antagonist marketed in the United States. Pentazocine itself is an opioid — a synthetic opioid, to be exact — and has shown promise in being utilized as a harm-reduction drug for opioid dependence.
Pentazocine is not the drug of choice for treating opioid dependency, as it has been found that suboxone and buprenorphine are better suited for opioid replacement and opioid tapering and detox. However, Pentazocine is more likely to be used to treat chronic pain in patients with a history of opioid abuse, as the drug is manufactured with naloxone. With this mixed agonist-antagonist formula, there is a ceiling to the drug’s effects. This means that a person who is attempting to get high from the drugs will only “feel” the effects of the drug within its specified limits.
A partial agonist, buprenex is an injectable form of buprenorphine that will produce feelings of euphoria and will slow breathing but will not receive a feeling of a “rush” or “high.” With a slow release and long-lasting effects, buprenex can be used for induction, stabilization, and maintenance of opioid addiction.
This drug is primarily used in harm reduction therapy and treatment in intravenous heroin and opioid users with drug-seeking behaviors and attempts to re-wire the brain to not associate opioid treatment with a high while still helping to manage withdrawal and chronic pain.
Modafinil is a stimulant drug used to treat sleep apnea, narcolepsy, and other sleep disorders. However, studies have been done on how Modafinil can help those who have previously had an addiction to opioids.
In studies, Modafinil was tested for the prevention of relapse in opioid addiction. It was found that Modafinil blocks the reinstatement of extinguished opiate-seeking behaviors. Simply put, this means that the subjects that were pretreated with Modafinil were less likely to relapse and seek opioids than subjects that were not treated with the drug.
Modafinil is not currently being used for extensive treatment of opioid dependence in the United States.
An antidepressant drug, Mirtazapine works to re-balance serotonin and norepinephrine in the brain. It has recently been considered for use in treating addiction to alcohol, benzodiazepines, opioids, and cocaine.
Since substance abuse and addiction highly affect the reward centers of the brain and cause imbalances in serotonin and norepinephrine, it is considered that Mirtazapine can be an ideal way to help to restore the natural balance in the brain following drug addiction.
It is believed that the drug can be especially helpful in the post-acute withdrawal phase and can lessen the severity of effects caused by Post Acute Withdrawal Syndrome (PAWS).
As an anti-epilepsy medication, studies have recently shown that Vigabatrin is an improved anti-addiction medication. This drug is not currently recommended for treating addiction, however, as the list of adverse side effects outweighs the benefits at this time. Particularly, it has been found that long-term use of Vigabatrin can cause eye damage (in up to 40% of those treated).
Researchers are currently working with Vigabatrin to try and find a more targeted delivery method with fewer side effects because the drug truly does show promise for treating opioid addiction — with tests showing that the drug will block the breakdown of GABA. This breakdown of GABA leads to some of the strongest cognitive symptoms in opioid withdrawal, and it is hoped that a future more-targeted therapy using Vigabatrin can result in higher levels of GABA neurotransmitters in the brain and lessen the symptoms of opioid withdrawal.
A GABA-B Agonist, Baclofen is primarily used as a muscle relaxer. Because of how it works on the GABA system in the brain — the GABA receptors play a role in the mechanism of action in addictive drugs — baclofen has already been used in treating addictions like alcoholism and opioid use disorders (OUD).
In the treatment of opioid addiction, Baclofen has been shown to reduce anxiety during acute and post-acute withdrawal, decrease cravings for the drug, and decrease the obsessive thoughts and worries that are common symptoms of opioid withdrawal.
Another anti-epileptic medication that has shown benefits in the treatment of alcoholism and opioid addiction, Topiramate is often used during opioid detox to prevent seizures and can be used to prevent migraines and serious headaches.
Studies into how Topiramate helps to prevent relapse when being used for addiction treatment are still ongoing, but the studies have shown that those who used the drug during drug and alcohol detox not only had a more comfortable experience — and less severe withdrawal symptoms — but also had higher success rates in continuing to stay sober.
Studies into Opioid Dependence Vaccines
Scientists have been experimenting with an addiction vaccine, something that would make it impossible for a recovering addict to get high should they decide to relapse and seek their drug of choice. Researchers have been working on a vaccine since the 1990s when fentanyl became a problem. In the ’90s, a nicotine vaccine emerged, but it failed in trials.
With the new epidemic of opiate abuse, there is now renewed interest in a polyvalent vaccine, one which will attack several different types of drugs. The way the vaccine would work is to “teach” the body’s immune system to attack the various drug molecules as they come into the bloodstream before making it to the receptors in the brain.
The biggest obstacle to making this vaccine a reality is funding. Most big pharmaceutical companies aren’t interested in funding addiction research. Despite this, it is still a promising alternative treatment option, and with the right formulation and more experimentation, can be a new and creative solution to opioid dependence.
Editor’s Note: This post was originally published in January 2017 but updated in December 2017 to reflect newer research and advancements in opioid addiction treatment.
An intervention is not about how to control the substance user; it is about how to let go of believing you can.
“The most formidable challenge we professionals face is families not accepting our suggested solutions. Rather, they only hear us challenging theirs. Interventions are as much about families letting go of old ideas as they are about being open to new ones. Before a family can do something about the problem, they must stop allowing the problem to persist. These same thoughts and principles apply to your loved one in need of help.”Mike Loverde, MHS, CIP