Almost one hundred years ago, prescription drugs like morphine were available at almost any general store. Women carried bottles of very addictive potent opiate based pain killers in their purse. Many individuals like Edgar Allen Poe died from such addictions. Since that time through various federal, state and local laws, drugs like morphine are now prescription drugs; however, this has not stopped the addiction to opiate based pain killers. Today’s society combats an ever increasing number of very deadly addictive drugs from designer drugs to narcotics to the less potent but equally destructive alcohol and marijuana. With all of these new and old drugs going in and out of vogue with addicts, it appears that the increase of misuse and abuse is founded greater in the prescription opiate based painkillers.
With the growing number of individuals addicted to these narcotics, the need for better therapies and treatments to end these addictions has grown exponentially. Of these therapies and treatments prescribed to these patients, the newest and seemingly most celebrated is a treatment known as Suboxone therapy. This therapy is for those individuals who have opiate addictions and are seeking help toward a more speedy recovery (Thompson-Gargano, 2004).
As of today this type of treatment is one of the most widely known options for clients who have opiate issues. This treatment is a combination of two different drugs: buprenorphine and naloxone. Buprenorphine is a lower form of opiates that is given to the patient with opiate addictions because it provides them with fewer side effects when coming off the addiction. Naloxone is a blocker medication that is primarily given in emergency rooms to individuals who have overdosed wit...
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... I. (2007). Treating opioid addiction with burenorphine-naloxone in community-based primary care settings. Annals of Family Medicine, 5(2), 146-150.
Sarpatwari, A. (2012). Just say no: the case against the reclassification of buprenorphine. University of Maryland Law Journal of Race, Religion, Gender, and Class, 12(2), 376-395.
Stuckert, J. (2013, November 13). How is suboxone treatment different than drug abuse? Retrieved from http://psychcentral.com/lib/how-is-suboxone-treatment-different-than- drug-abuse/0008583/2
Tanner, G., Bordon, N., Conroy, S., & Best, D. (2011). Comparing methadone and suboxone in applied treatment settings: the experiences of maintenance patients in Lanarkshire. Journal of Substance Use, 16(3), 171-178.
Thompson-Gargano, K. (2004). What is buprenorphine treatment like? Retrieved from http://www.naabt.org/education/what_bt_like.cfm
Naloxone [Narcan] is a structural analog of morphine that acts as a competitive antagonist at opioid receptors, thereby blocking opioid actions. Naloxone can reverse most effects of the opioid agonists, including respiratory depression, coma, and analgesia (Lehne, 2013). Naloxone may be administered IV, IM, Intranasal, or subQ. Following IV injection, effects begin almost immediately and persist about 1 hour. Following IM or subQ injection, effects begin within 2 to 5 minutes and persist several hours (Lehne, 2013).
The methadone program at Rosthern Hospital is a very active and intense program. Boast over 20 patients that are regular methadone users, the involvement of the physicians, pharmacists, nurses, and addiction counselors are key (Melle, 2016). Dr. Melle is the coordinator of the methadone program at Rosthern Hospital. His roles include, patient recruitment, patient care management, follow up care, and most importantly prescription and dosage of the methadone (Melle, 2016). Pharmacist’s role in methadone treatment is providing the methadone to the hospital, as well as in Warman pharmacy they monitor and dispense some methadone to some of the patients in the methadone program. Addiction counselors are an outside resource that the staff at Rosthern hospital can utilize. There are not social workers or counselors at Rosthern, but Dr. Melle and the nurses prefer if their patients are regularly seeing an addiction counselor while in the methadone program. Finally, the nurses role in the methadone program is early treatment and monitoring of patients during detox, the continued monitoring or patients when methadone doses change, dispensing methadone and monitoring our patients in the recovery program, and observation of patient’s success during the program. Together the interprofessional team has successfully treated dozens of patients, and the methadone program address the needs of both the patients and the addiction issues that are plaguing the surrounding communities (Melle,
The documentary states that over 27,000 deaths a year are due to overdose from heroin and other opioids. According to the Center for Disease Control and Prevention in 2015 prescription pain relievers account for 20,101 overdose deaths, and 12,990 overdose deaths are related to heroin (Rudd et al., 2010-2015). The documentary’s investigation gives the history of how the heroin epidemic started, with a great focus on the hospice movement. We are presented with the idea that once someone is addicted to painkillers, the difficulty in obtaining the drug over a long period of time becomes too expensive and too difficult. This often leads people to use heroin. This idea is true as a 2014 survey found that 94% of respondents who were being treated for opioid addiction said they chose to use heroin because prescription opioids were “more expensive and harder to obtain (Cicero et al., 2014).” Four in five heroin users actually started out using prescription painkillers (Johns, 2013). This correlation between heroin and prescription painkiller use supports the idea presented in the documentary that “prescription opiates are heroin prep school.”
A relatively newer biologic, rituximab provides an alternative strategy for treating the presenting patient. A genetically engineered chimeric anti-CD20 monoclonal antibody, rituximab exerts it therapeutic action by selectively targeting CD-20 positive B-cells1212, 18. As CD-20 is expressed exclusively on pre-B and mature B lymphocytes; stem cells and plasma cells are not implicated in rituximab therapy. The over expression of B-cells expressing the CD-20 surface antigen in the synovium of RA-affected joints has been well established18. The potential mechanisms by which these B-cells contribute to the immunopathogenesis of RA are as follows: they can act as antigen presenting cells, secrete pro-inflammatory cytokines (including tumour necrosis factor-alpha), and generate rheumatoid factor (RF) and other auto-antibodies whilst also activating T cells12. Hence, the rituximab mediated depletion of B-cells is thought to prevent these potential mechanisms from occurring thus controlling the progression of the disease18.
In 1906, the Pure Food and Drug Act, that was years in the making was finally passed under President Roosevelt. This law reflected a sea change in medicine-- an unprecedented wave of regulations. No longer could drug companies have a secret formula and hide potentially toxic substances such as heroin under their patent. The law required drug companies to specify the ingredients of medications on the label. It also regulated the purity and dosage of substances. Not by mere coincidence was the law passed only about five years after Bayer, a German based drug company began selling the morphine derivative, heroin. Thought to be a safe, non-habit forming alternative to morphine, heroin quickly became the “cure-all drug” that was used to treat anything from coughs to restlessness. Yet, just as quickly as it became a household staple, many began to question the innocence of the substance. While the 1906 law had inherent weaknesses, it signaled the beginning of the end for “cure-all” drugs, such as opiate-filled “soothing syrups” that were used for infants. By tracing and evaluating various reports by doctors and investigative journalists on the medical use of heroin, it is clear that the desire for this legislative measure developed from an offshoot in the medical community-- a transformation that took doctors out from behind the curtain, and brought the public into a new era of awareness.
Opioid’s chemical composition consist of many highly addictive substances which cause the human body to become quickly tolerant. Many opioid users become addictive to the substance because the doctors have been over prescribing. “In the United States, there were 14,800 annual prescribed opioid (PO) deaths in 2008” with the US having less restrictions (Fischer, Benedikt, et al 178). The United States have implemented more regulations so that “high levels of PO-related harms been associated with highly potent oxycodone formulas” will decrease (Fischer, Benedikt, et al 178). With the regulations, it does not change the fact that opioids are is destructive. The regulations assistance by lessening the probability of patients becoming addictive to opioid. There are numerous generations that are effected and harmed by the detrimental effects of opioids on opioid-dependent patients.
There are different forms of Opioids manufactured such as Morphine, Oxycodone, Buprenorphine, Hydrocodone, and Methadone. They are marketed under different brands such as Demerol, Oxycontin, Tylox, Percocet, and Vicodin and can be prescribed in liquid, tablets, capsules, and patches.
On the typical day, over 90 people will die at the hand of opioid abuse in America alone (National). In fact, as of 2014, nearly 2 million Americans were dependent and abusing opioids. The Opioid Crisis has affected America and its citizens in various ways, including health policy, health care, and the life in populous areas. Due to the mass dependence and mortality, the crisis has become an issue that must be resolved in all aspects.
This leads to the second school of thought on medically assisted treatment. There has been a great deal of debate about the medication used to treat Opiate addiction, methadone. Many feel that the drug methadone is simply trading one drug in for another, as the addiction to methadone is quick and almost more powerful than an opiate addiction (Nelson, 1994). The withdrawals effects are far more intense with methadone and for this reason it is a lifetime maintenance medication. Some suggest that more rehabilitative programs are needed that would address the social problems the users have to help them recover, instead of the methadone program that is viewed...
The purpose of methadone is to help clients control their urges for addiction and withdrawal symptoms for a better future. From listening to the charge nurse, there could actuality be a possibility to help patients who are addicted to opioids, manage their lives and create a better future without dependency or addiction. Many clients start off on the wrong foot, but through the help of the methadone clinic, many patients continue to live their lives to the fullest. Methadone management has helped many clients discover their purpose in society and to function adequately.
Liehr, P, Marcus, M, Carroll, D, Granmayeh, K L, Cron, S, Pennebaker, J ;( Apr-Jun 2010). Substance Abuse; Vol. 31 (2); 79-85. Doi: 10.1080/08897071003641271
The rate of death due to prescription drug abuse in the U.S. has escalated 313 percent over the past decade. According to the Congressional Quarterly Transcription’s article "Rep. Joe Pitt Holds a Hearing on Prescription Drug Abuse," opioid prescription drugs were involved in 16,650 overdose-caused deaths in 2010, accounting for more deaths than from overdoses of heroin and cocaine. Prescribed drugs or painkillers sometimes "condemn a patient to lifelong addiction," according to Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention. This problem not only affects the lives of those who overdose but it affects the communities as well due to the convenience of being able to find these items in drug stores and such. Not to mention the fact that the doctors who prescribe these opioids often tend to misuse them as well. Abusing these prescribed drugs can “destroy dreams and abort great destinies," and end the possibility of the abuser to have a positive impact in the community.
Methadone revolutionized the treatment of opioid addiction in the 1960s by providing the first effective, practical, and legal alternative to detoxification for the treatment of opioid addiction.
About 55% of people that use suboxone are within the age group of 20-40 and 38% within the age group of 40-60. Also, approximately 60% of those that use suboxone are male. “According to a survey, the number of clients that use buprenorphine increased from 727 to 21,236 between 2004 to 2015. This does not include those who received buprenorphine through independent waivered physicians (Alderks, 2017)”. This showed that the use of buprenorphine had about 48%
The Journal of Neuroscience Dobler-Mikola, A. Gschwed, P. Gutzwiller, F. Steffen, T. Rehm, J. Uch engagen, A. Feasibility, Safety, and Efficacy of Injectable Heroin Prescription for Refractory Opioid Addicts: a follow-up study. The Lancet, volume 358, pg. 1417-1420. Everitt, B. Robbins, T. (1999) Drug addiction: bad habits add up. Macmillian Magazines, volume 389, pg.