MEDICAL/BEHAVIORAL COUNTER MEASURES

[Note:  This posting is a continuation of a report on the development of a civics unit of study.  This unit is directing students to formulate informed positions on the opioid epidemic.  It is being developed in real time.  Writer wants to express gratitude to Wikipedia for identifying the bulk of the research this blog has used in the development of this unit.[1]]

So, where is this effort at in developing a unit of study of the opioid epidemic?  To date, this blog has divided the topic into a list of aspects or elements.  That list includes a short history, a definition of the crisis in terms of federalist values, a description of how the epidemic affects individual victims, production and distribution of opioid drugs, demographic factors of the crisis, and governmental reactions. 

The various postings, leading to this one, have addressed each of these aspects by mostly reporting related factoids and insights.  These in turn have been discovered or proposed by related research.  The reader is invited, using the archive feature, to review those postings if he/she is new to this blog.

This posting continues this progression by sharing factoids and insights associated with medical counter measures.  This aspect promises to be the last before advancing to the next step in developing this unit; i.e., developing lesson ideas.  This next step considers targeted lesson plans that will utilize the information that those prior postings reported.

As for medical counter measures, this topic can be addressed from two perspectives:  generally, and through the lens of the effects of various drugs, such as methadone, have on patients.  This posting will utilize both perspectives:  that of the medical approaches generally and a look at a number of drugs used in drug addiction treatment protocols.

Factoids:

·        There seems to be a national strategy emphasis; i.e., to talk more on prevention than on treatment of those already addicted.[2] 

·        Among either doctor-prescribed or doctor-regulated treatment regimens there are both medical and behavioral components.  They count on various drugs – kratom, naloxone, methadone, or buprenorphine – and then combine it with behavioral treatments including individual and group therapies, residential treatments, and 12-step programs.[3]

·        Probably the most known treatment drug is methadone; it has been the most studied of the various drug treatment options.  It has been in use since the nineteen-sixties.[4]

·        Buprenorphine comes in various forms including an implanted form called Probuphine.  The implanted form lasts six-months.[5]

·        Between the years 2003 and 2011, the use of buprenorphine has increased 40%.[6]  More recent figures are needed.

·        For most addicts of opioids, a treatment strategy that either lacks a drug or behavioral component, the evidence shows that the strategy is less effective for most patients.[7]

·        There are other components available as counter measures.  They include:  harm reduction approaches,[8] the drug, naloxone,[9] needle exchange programs,[10] and the use of blue lights in public spaces – it discourages injecting drugs since it is harder to detect veins.[11]

Insights:

·        Methadone, itself, happens to be a long-acting opioid.  As such it can function to replace heroin with just a single daily dosage by attaching chemically to the opioid brain and spinal cord receptors.  This leads to activating the brain and spinal cord in such a way as to diminish symptoms, reduce cravings, and suppressing highs that heroin and other opioids induce.  The aims, of this regimen, are to taper off the dependency the user has under a controlled environment and to increase the likelihood of avoiding a relapse.  Since, it is a controlled regimen, the patient needs to pick up daily dosages from a methadone clinic.  This is not feasible for all addicts or it adds to the possibility of patients being stigmatized since their treatment is a fairly public activity.[12]

·        Over-use of opioids has serious consequences.  Dependence on the drug are associated with contraction of HIV and to overdosing.  To meet this challenge, there has been two overall approaches:  medical and behavioral.  What is better?  It depends on the addicted person.[13]

·        Growing in popularity is a treatment that uses buprenorphine.  Like methadone, in terms of usage, there is much less of a controlled regimen.  Yes, there is the need for a prescription to attain this drug, but less regulated demands.  Patients receive month-long prescriptions, so there are no daily visits to clinics.  The claim by its advocates is that it is safer than methadone and its use aims at reducing or quitting the use of heroin or other opiates.  In addition, it is credited with eliminating cravings and withdrawal symptoms but not inducing a euphoric high.[14]

·        Since buprenorphine can be administered through physician offices and only call for a visit once every month, consequently, the cost of detox is reduced drastically.[15]

With that, this phase of developing a unit of study is done; now, the focus will be, with the next posting, the designing of lessons.  As a point of reference, this unit is visualized as a week-long unit with four instructional lessons and one evaluative lesson.

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[1] The writer also wants to state that where possible, he has checked the sources and has at times added to the listed research.

[2] Emma E. McGinty, Alene Kennedy-Hendricks, Julia Baller, Jeff Niederdeppe, Sarah Gollust, Colleen L. Barry, “Criminal Activity or Treatable Health Condition?  News Media Framing of Opioid Analesic Abuse in the United States, 1998-2012,” Psychiatric Services, December 1, 2015, accessed August 20, 2018, https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201500065 .

[3] Ibid. AND Jennifer C. Veilleux, Peter J. Colvin, Jennifer Anderson, Catherine York, and Adrienne J. Heinz, “A Review of Opioid Dependence Treatment:  Pharmacological and Psychosocial Intervention to Treat Opioid Addiction,” Clinical Psychology Review, vol. 30, no. 2, March 2010, 155-166, abstract accessed August 23, 2018, https://www.sciencedirect.com/science/article/pii/S0272735809001421 .

[4] “Methadone,” Substance Abuse and Mental Health Services Administration, accessed August 23, 2018, https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone .  This cite is a good source for general information about methadone.  For example, the cite points out that this drug is also addictive, and this fact helps explain why a high level of supervision needs to be part of any regimen using this drug.

[5] “New Medication Formulations Could Quickly Make a Difference for Treating Opioid Addiction,” National Institute on Drug Abuse, August 22, 2017, accessed August 23, 2018, https://www.drugabuse.gov/about-nida/noras-blog/2017/08/new-medication-formulations-could-quickly-make-difference-treating-opioid-addiction .

[6] L. W. Turner, Stafan P. Drszewski, R. Mojtabai, Daniel Webster, S. Nesbit, R. S. Stafford, and G. Caleb Alexander, “Trends in Buprenorphine and Methadone Sales and Utilization in the United States, 1997-2012,” Value in Health, May 2013, abstract accessed August 23, 2018, https://www.valueinhealthjournal.com/article/S1098-3015(13)01627-6/fulltext?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1098301513016276%3Fshowall%3Dtrue .

[7] Jennifer C. Veilleux, Peter J. Colvin, Jennifer Anderson, Catherine York, and Adrienne J. Heinz, “A Review of Opioid Dependence Treatment:  Pharmacological and Psychosocial Intervention to Treat Opioid Addiction,” Clinical Psychology Review.

[8] Andrew Kolodny, David T. Courtwright, Catherine S. Hwang, Peter Kreiner, John L. Eadie, Thomas W. Clark, and G. Caleb Alexander, "The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction," Annual Review of Public Health, vol. 36, 2015, 559–574.  Accessed June 25, 2018, see https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-031914-122957 .

[9] David W. Dixon and Ryan P. Peirson, “Opioid Abuse Treatment and Management,” updated June 21, 2018, accessed August 23, 2018, https://emedicine.medscape.com/article/287790-treatment .

[10] “Syringe Services Programs,” Center for Disease Control and Prevention (CDC), n. d., accessed August 23, 2018, https://www.cdc.gov/hiv/risk/ssps.html AND Kris Clarke, Debra Harris, John A. Zweifler, Marc Lasher, Roger B. Mortimer, and Susan Hughes, “The Significance of Harm Reduction As a Social and Health Care Intervention for Injecting Drug Users:  An Exploratory Study of a Needle Exchange Program in Fresno, California,” US National Library of Medicine National Institutes of Health, August 1, 2017, accessed August 23, 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129746/ .

[11] Michael Rubinkam (Associated Press), “Retailers Experiment with Blue Lights to Deter Drug Users from Shooting Up in Bathrooms,” St. Louis Post-Dispatch, June 24, 2018, accessed August 23, 2018, https://www.stltoday.com/news/local/crime-and-courts/retailers-experiment-with-blue-lights-to-deter-drug-users-from/article_065090bf-cee2-5fe4-833b-b57989057281.html .

[12] David W. Dixon and Ryan P. Peirson, “Opioid Abuse Treatment and Management.”

[13] Ibid.

[14] Bryan Schwartz, “My View:  New Approach Needed for Opioid Epidemic,” Portland Tribune, July 25, 2017, accessed August 23, 2018, https://pamplinmedia.com/pt/10-opinion/367132-248727-my-view-new-approach-needed-for-opioid-epidemic- .

[15] Ibid.