vivitrol Archives - Ben Carrettin

Opiate Addiction: Detox and Withdrawal

Today, opiate addiction is all too common. Both prescription and nonprescription sources, such as online or through unregistered merchants, have made it so easy to purchase these drugs. Regardless of how vital living a healthier life is, using drugs like opiates are more socially accepted in some cultures, especially Western ones. The spread and impact across the US has become an epidemic. And the likelihood is high that you or someone you know has struggled with addiction. That’s why understanding Opiate Addiction: Detox and Withdrawal is so important.

What Are Opiates and Opioids?

Opiates are a class of drugs that act as central nervous system depressants. They are typically derived from opium –a substance that is produce naturally from poppies.Opiates are also referred to as narcotics. They also occur in the form of opioids. Opioids are opiate-like medications that are chemically made.

Opiates and opioids block pain signals that your body sends to your brain. They do so by attaching to structures called receptors. They can target nerve cells in your brain, spinal cord, or other body parts.

How Does a Person Become Addicted?

The opiate stimulates the brain’s reward system in a powerful way. This is a critical reason why people can so quickly become dependent. It is highly addictive, especially in the early phases of misuse. With time,the need for opioids becomes stronger. It goes beyond a basic desire for pleasure.Tolerance and reliance are linked to this high drive.

Opiate addiction occurs as it triggers your brain to release the feel-good chemical, namely dopamine (video). That is why it is simple for anyone to develop a pattern of drug abuse and addiction. It happens to individuals, particularly while seeking to address problems from pain management to emotional worries and stressors. Sometimes innocently enough by way of medical treatment by providers who were ignorant or dismissive of the risks that can lead to numerous mental and physical health issues. There can be short or long term negative-effects from drug addiction.

What Happens If I Stop Using Opiates On My Own?

While opiates can relieve pain and create euphoria, they can produce numerous unwanted side effects as well. They may include sudden withdrawal symptoms, unmanageable agony, and suicidal thoughts. It can all occur when opiate usage is stopped or doses are reduced rapidly. Drastically cutting back or stopping abruptly can easily prompt withdrawal. The body requires time to heal after the addicted person quits using the drug.

Even well into recovery the withdrawal symptoms begin to appear. This is due to something called Post Acute Withdrawal Syndrome (PAWS). You could have detox symptoms like restlessness, tears, cramping, flu like symptoms, etc. And yes, it can happen even when the opioid dosage is progressively reduced.

Opiate Withdrawal Symptoms & How Long Do They Last?

Opiate withdrawal symptoms can be very unpleasant and intense. Medical detox is the safest , least uncomfortable and most efficient method of eliminating opiates or other drugs.

Within 24 hours after the last dose, a person will typically begin to experience a combination of the symptoms. The significant indications are flu-like, fever, sweating, and vomiting.

Pain in the muscles

Diarrhea, vomiting, or nausea

Restlessness

Sweating

Anxiety

Dilated pupil

Watery eyes

Cramping / abdominal pain

Increased heart rate

Frequent and excessive yawning

Goose bumps

Insomnia

Shakes / tremors

The symptoms may last from few days to a week or even longer. In any case, they will eventually subside and disappear. After the last opioids intake, opiate withdrawal symptoms often begin 12 to 48 hours later. The worst ones usually manifest between 24 and 96 hours. After discontinuing opiate use for 5 to 7 days, you will start to feel better. However, the detox process can continue longer for some patients.

Opioid Withdrawal varies depending on multiple variables during the medical detox process. It could rely on factors such as the type of painkiller being misused, the individual’s level of drug tolerance, the duration of their addiction if they used several drugs and their mental and medical histories.

Why Is Additional Care Crucial For A Complete Recovery?

People in active addiction typically reject that their drug use is a problem. They are hesitant to get help. In some cases, an intervention might inspire someone to seek or accept help. Professional and appropriate interventions seek to provide an organized opportunity to make adjustments and get treatment before circumstances worsen. In most cases whether with an intervention or not, it can be helpful to involve their closest friends or family to provide physical and mental support.

Keep in mind that addiction is extremely taxing on the mind and body of the person struggling with it. Desperation and feelings of hopelessness can be overpowering and sometimes people attempt to hurt themselves. At the front end of treatment, it is usually the recommendation to only pursue drug detox under the supervision of a medical professional.

Entering Detox and Effects on Family

The strain from detoxing from opiates, or any drug or alcohol, can tear apart happy, loving homes. For example, as relatives battle over how to interact with a child who has been taking opiates, conflict becomes norm. Trust erodes and starts to disappear. If a family member tries to stop using on their, they may be tearful, erratic or act aggressively.

During medical detox is not the time to have deep, constructive conversations. It’s too early for the person seeking recovery and often times it’s too early for the loved ones who are still raw from the chaos, fear and emotional upheaval in the family. Those detailed conversations can wait until the person enters Residential, PHP or IOP level of care. In each of these there will be clinical professionals to facilitate these re-connections in a healthy and safe way.

Rational discussions are hard between the intense emotions and fears of all involved and the biology at play in the struggling addict. A lot fo times there are years of pain, fear and hurt feelings to work through for everyone involved. Addiction affects the whole family. It can help to talk to someone who is professionally trained and experienced in working with families facing addiction.

Leaving Opiate Addiction Detox Too Early

Leaving opiate addiction treatment during detox can bring negative changes. Many people in detox treatment begin to feel physically better long before they have actually even begun the work it will take for sustained recovery. This is why so many people leave treatment after only a handful of days. This is a serious and critical issue because the person is very likely to fall right back into use and may even accidentally overdose without intending to. Leaving treatment early puts the person struggling with addiction is a very dangerous position.

Can People Die from Opiate Withdrawal?

Yes, if left untreated, persistent vomiting and diarrhea can lead to heart failure, hypernatremia (a high blood salt level), and dehydration. A professional, medical detox facility will pay very close attention to this and be monitoring the client day and night. Otherwise, unless you have other complicating medical conditions, opiate withdrawal symptoms, while intense and uncomfortable are typically not life-threatening.

A Few Final Thoughts on Opiate Addiction

Any drug addiction, whether opiates, alcohol, benzos, cocaine or something else puts you at serious risk. Liver, stomach, kidney, heart and brain can all be damaged and a variety of other complicating medical problems can begin. The destruction on relationships and emotional health is no less severe.

It takes courage to look at yourself and admit you have a problem. And even more courage to step into the unknown and allow someone to help you. Stay open-minded. You don’t have to be perfect – you get to be human. Begin by being willing to begin something new.

The first step to a better life than you can imagine is to reach out and get professional help.

Breathe. You CAN do this.

“What Is Vivitrol?” I get asked that more and more often. Vivitrol is the injection (shot) form of a medication known as Naltrexone. And it’s use has grown significantly over the past several years – and for good reason. This article is intended to give you a little info and hopefully provide some clarity too.

Most commonly used for Opioid and Alcohol Withdrawal and to inhibit cravings
Comes in oral (Naltrexone) and IM (Vivitrol) forms
Must be prescribed by an approved physician
Is not meant to be a “magic pill” cure
Like other Medication-Assisted Treatment (MAT) options – the highest successful outcomes are when it is paired with therapy/treatment and support.
It is very different than other MAT out there at this time.

*If you or someone you love is struggling with addiction, please cheack out this resource page*

Naltrexone is an opioid antagonist that has the highest affinity for the -opioid receptors. In addition to its ability to block the effects of opioids, this compound has very few, if any, inherent effects. In 1994, the Food and Drug Administration of the United States gave its approval for the use of Naltrexone in the treatment of alcoholism (Kranzler, Wesson, Billot, Clinical, & Research, 2004).

In spite of this permission, the studies that have been conducted to determine whether or not Naltrexone is effective in treating alcoholism have produced mixed results. Patients failure to follow the prescribed treatment regimen while taking oral Naltrexone is one factor that contributes to the treatment’s overall lack of efficacy.

Some studies have also shown that in order for subjects to have greater reductions in alcohol consumption and risk of relapse as compared to subjects who were treated with a placebo, they must be highly compliant with the Naltrexone treatment. Utilizing formulations that provide sustained release or depot treatment is one approach that can be taken to address this issue.

VivitrolTM, a depot injectible dosage form of Naltrexone, was approved by the FDA on April 13, 2006, for the treatment of alcohol dependence in patients who are capable of withdrawing from drinking in an outpatient setting and who are not actively drinking at the beginning of therapy. Patients must also not be drinking at the time treatment begins. The recommended dosage of Vivitrol is 380 milligrams, which should be injected once per month or every 28 days.

Both DepotrexTM and NaltrelTM are examples of alternative depot parenteral formulations of Naltrexone. Naltrel helped to promote abstinence and decreased the incidence of relapse in two samples of alcohol-dependent subjects, while Vivitrol was shown to be effective at reducing heavy drinking among alcohol-dependent males (Chick et al., 2000; Monti et al., 2001).

The use of Naltrexone provides a blockade against the intoxicating and reinforcing effects of opioid-like compounds, which, in theory, can result in the elimination of drug-taking behavior. It does not produce euphoric effects, and as a result, it is not abused. Additionally, it does not result in physiological dependence on the user.

Similar to the situation with alcohol, the primary challenge presented by the oral formulation of Naltrexone for the treatment of opium or heroin dependence is low compliance (adherence). Long-acting sustained release formulations of Naltrexone (injectable or implantable) may help to develop compliance and, as a result, augment the efficacy of abstinence-oriented treatments with Naltrexone for heroin or opium dependence. Following the completion of opioid detoxification, the administration of Vivitrol is done for the purpose of preventing a return to opiate dependence (B. A. J. T. Johnson & management, 2007).

Mechanism of Action

Dopaminergic pathways, (which have their origins in the ventral tegmental area, relay to the nucleus accumbens with neuronal inputs from other limbic regions, and progress to the cortex), are responsible for mediating the reinforcing effects of alcohol, which are associated with the substance’s potential for abuse. An antagonist for the mu-opioid receptor, Naltrexone, reduces the positive effects of alcohol through two distinct mechanisms. First, it prevents alcohol from causing beta-endorphin stimulation of dopamine neurons directly in the nucleus accumbens. Second, it prevents beta-endorphin from disabling the tonic inhibition of dopamine cells caused by gamma-aminobutyric acid neurons in the ventral tegmental area (Koob & Research, 2003; Wise & Bozarth, 1987).

Oral Dosage Form and Its Effects

In alcohol-dependent people who had recently stopped drinking, taking oral Naltrexone was effective at reducing the likelihood of relapsing and going back to drinking heavily. Its general effectiveness has been limited by two consequential factors, one of which is that the pharmacokinetic properties of oral Naltrexone lead to significant fluctuations in plasma levels with oral daily dosing. A medication adherence rate of at least 85 percent is necessary in order for there to be a therapeutic response. First, the low plasma trough level of oral Naltrexone reduces the efficacy of the drug, which may explain why this requirement exists. Second, it is believed that high peak levels are responsible for adverse events, and it is estimated that up to 15% of people who receive oral Naltrexone will discontinue treatment due to adverse events, particularly nausea (B. A. Johnson & Ait-Daoud, 2000).

Therefore, optimizing the pharmacokinetic profile of Naltrexone by developing a deep intramuscular injection that would release Naltrexone over the course of several weeks would make the drug more effective as a whole. Therefore, plasma levels would remain relatively constant, and while they would be low enough to cut down on the number of adverse events, they would still be high enough to produce the desired anti-drinking effects. In other words, even though it is not anticipated that the effect size of the long-acting, intramuscular formulation of Naltrexone will be greater than the effect size of oral Naltrexone, it is likely that the overall outcome will be improved because of the increased compliance and longer exposure to a therapeutic dose (Bartus et al., 2003).

Patients are typically given 380 mg of the long-acting injectable (LAI) form of Naltrexone once every 28 days, and oral Naltrexone is typically titrated up to the target dose of 50 mg per day. Although the use of LAI Naltrexone does not require a trial period of oral Naltrexone, it is standard practise to determine the patient’s level of toleraance with oral doses before moving on to higher concentrations. It is possible that the use of LAI Naltrexone has benefits for adherence when compared to the use of oral Naltrexone. This is due to the fact that non-adherence is common among patients who are taking medication for alcohol use disorder.

3.1% of patients in the study were given any form of Naltrexone, but only 0.24% of patients were given LAI Naltrexone. This information was obtained from a study. Even though about 40% of people have experienced alcohol abuse of some kind at some point in their lives, very few people are actually receiving the help they need. According to the findings of the same study, the patients who were given the intramuscular injection were more likely to make use of both outpatient and inpatient mental health services. Patients battling alcohol use disorders who receive treatment that is both pharmacologic and makes use of mental health resources have better outcomes as a result of their treatment. These resources for mental health include individual drug counselling, care management, monitoring of a patient’s substance use, and intensive outpatient treatment, among other options (Aletraris, Shelton, & Roman, 2015; Marienfeld, Iheanacho, Issa, & Rosenheck, 2014).

More research is needed in order to find out the effects and outcomes of drug with the use of oral dosage form and other dosage forms.

References

Aletraris, Lydia, Shelton, Jeff S, & Roman, Paul M %J Journal of substance abuse treatment. (2015). Counselor attitudes toward contingency management for substance use disorder: Effectiveness, acceptability, and endorsement of incentives for treatment attendance and abstinence. 57, 41-48.

Bartus, Raymond T, Emerich, Dwaine F, Hotz, Joyce, Blaustein, Marc, Dean, Reginald L, Perdomo, Brigido, & Basile, Anthony S %J Neuropsychopharmacology. (2003). Vivitrex®, an injectable, extended-release formulation of naltrexone, provides pharmacokinetic and pharmacodynamic evidence of efficacy for 1 month in rats.28(11), 1973-1982.

Chick, Jonathan, Anton, Raymond, Checinski, Ken, Croop, Robert, Drummond, D Colin, Farmer, Roger, . . . alcoholism. (2000). A multicentre, randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of alcohol dependence or abuse. 35(6), 587-593.

Johnson, Bankole A %J Therapeutics, & management, clinical risk. (2007). Naltrexone long-acting formulation in the treatment of alcohol dependence. 3(5), 741.

Johnson, Bankole A, & Ait-Daoud, Nassima %J Psychopharmacology. (2000). Neuropharmacological treatments for alcoholism: scientific basis and clinical findings. 149(4), 327-344.

Koob, George F %J Alcoholism: Clinical, & Research, Experimental. (2003). Alcoholism: allostasis and beyond.27(2), 232-243.

Kranzler, Henry R, Wesson, Donald R, Billot, Laurent, Clinical, DrugAbuse Sciences Naltrexone Depot Study Group %J Alcoholism:, & Research, Experimental. (2004). Naltrexone depot for treatment of alcohol dependence: a multicenter, randomized, placebo‐controlled clinical trial.28(7), 1051-1059.

Marienfeld, Carla, Iheanacho, Theddeus, Issa, Mohammed, & Rosenheck, Robert A %J Addictive Behaviors. (2014). Long-acting injectable depot naltrexone use in the Veterans’ Health Administration: a national study. 39(2), 434-438.

Monti, Peter M, Rohsenow, Damaris J, Swift, Robert M, Gulliver, Suzy B, Colby, Suzanne M, Mueller, Timothy I, . . . Research, Experimental. (2001). Naltrexone and cue exposure with coping and communication skills training for alcoholics: treatment process and 1‐year outcomes. 25(11), 1634-1647.

Wise, Roy A, & Bozarth, Michael A %J Psychological review. (1987). A psychomotor stimulant theory of addiction.94(4), 469.