Addiction to Opioids Difficult to Treat

Many individuals are prescribed opioids for chronic pain. Opioids such as Vicodin and OxyContin are often used to help alleviate suffering, but they sometimes cause problems as a tolerance to them is established and built up in the patient, making it tempting to up the dosage to continue to relieve the pain.

Once a patient has become addicted to an opioid, it is very difficult to discontinue use without suffering withdrawal symptoms and relapse.

A study was presented at the American Psychiatric Association 2010 Annual Meeting that examined the level of relapse of opioid users. The study was led by Roger D. Weiss, MD, professor of psychiatry at Harvard Medical School in Boston, and chief of the Division of Alcohol and Drug Abuse at the McLean Hospital in Belmont Massachusetts.

The largest study ever conducted for opioid dependence looked at whether adding intense counseling to a schedule of buprenorphine treatment may improve the outcome of the patient, determined the ideal course of medication and whether the presence of chronic pain affects the success of the patient in overcoming an opioid addiction.

Medscape Today reported that The National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study found that opioid users who were treated with a tapering regiment of buprenorphine over 9 months almost universally relapsed.

Dr. Weiss explained, “The trial was designed to help the physician manage patients who are dependent on opioids and want off the drugs but refuse treatment in a drug abuse treatment program.”

The study, involving 653 participants who had been diagnosed with a prescription opioid dependency, compared standard medical management to enhanced medical management for opioid addiction. The standard treatment included the use of uprenorphine, an initial one-hour visit and weekly 20-minute sessions with a physician who provided counseling and addressed any possible side effects.

Enhanced care included 60-minute individualized counseling twice per week that identified interpersonal issues, provided strategies for coping with triggers and high-risk situations, and other more in-depth strategies for dealing with addiction.

The participants were examined after periods of buprenorphine tapering and were measured for abstinence through urine screening. 42 percent of the participants were experiencing current chronic pain during the study.

Among those who received standard medical care, only 7 percent met the criteria for success, and only 6 percent of the enhanced medical management group was successful. “Nearly all patients relapsed after a four-week taper,” Dr. Weiss said.

Even after relapsed patients were enrolled in a second phase of treatment, with random assignment into standard and enhanced medical care groups, 7 out of 8 patients relapsed back to addiction.

The study’s findings also indicate that the patients who experienced chronic pain had consistent results with the other participants in the study. In some cases, the patients reported that their pain level had improved over the course of treatment for opioid addiction.

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