New medications that help combat opioid addiction may be on the horizon, assuming drug companies take up a new offer from the federal government.
Under the new policy, reported Sunday by The New York Times, the Food and Drug Administration will allow pharmaceutical companies to sell these medications even though they don’t necessarily “cure” addiction.
The new policy is part of a series of measures unveiled over the past week to step up federal efforts to cope with an epidemic of opioid addiction that cost the lives of more than 50,000 Americans last year.
Medication-assisted treatment, as it’s known, is considered by experts to be one of the most promising paths forward in stemming the nation’s opioid epidemic. It’s also controversial, since it often uses opioid-based medicines to do so.
So far, FDA has approved three drugs for MAT use: methadone, Suboxone and Vivitrol. Here’s a look at how they work, and how similar medications approved under the new policy might work to treat opioid addiction.
Methadone and Suboxone
The common factor between these two is that they’re both opioids. Methadone is the generic name for the drug that doctors have used to treat addiction since the 1970s. Suboxone is the brand name of a much more recently approved drug, a combination of buprenorphine – an opioid and Suboxone’s primary agent – and naloxone, the overdose-reversal medication.
Like other opioids, methadone and Suboxone activate the brain’s opioid receptors. Everyone has these receptors. When bound by natural chemicals that our bodies produce, the receptors work to decrease pain and create a sense of well-being, among other things.
External chemicals – like heroin and the more dangerous fentanyl, and pain medications such as OxyContin – also bind to these receptors, though with a much stronger effect than the body’s natural chemicals. And like any addictive substance, the more a person uses one of these drugs, the more of it they need to induce that euphoric sensation.
By binding to those opioid receptors, methadone and Suboxone reduce cravings for the strong drugs like heroin and OxyContin, and research shows they do so safely when used correctly. But they still risk being misused by patients, so only doctors with specific training and certification are allowed to administer them. Methadone is stronger and significantly more regulated than Suboxone.
As of now, about 47,000 U.S. doctors have permission to prescribe Suboxone. That’s a big jump since last year, when only about 14,300 were able to prescribe it. But data indicates that’s still far from enough.
This is where naltrexone – more commonly known by the brand name Vivitrol – comes in.
Vivitrol
This one is not an opioid, so it’s not addictive and can’t be misused or abused, and doctors can prescribe it without special certification.
FDA first approved Vivitrol in 2006 to treat alcohol addiction, and in 2010 the agency approved it for opioid addiction treatment.
Unlike methadone and Suboxone, which activate the brain’s opioid receptors, Vivitrol blocks those receptors. So even if a person uses an opioid while taking Vivitrol, they won’t get high. They will, however, experience extreme withdrawal symptoms, meaning they’ll get violently, sometimes dangerously, ill.
For this reason, the person needs to be at least seven days clean when they start treatment with Vivitrol.
Also, while methadone and Suboxone are taken orally, often every day, Vivitrol is administered through a monthly injection. It lasts for 30 days, and recent research has shown it to be just as effective as daily Suboxone treatment. This can be useful for people who lack easy access to providers. But a big hurdle exists in getting people past that seven-day hump so that they can actually start Vivitrol treatment.
The Kicker
Those are the medications available to doctors for opioid addiction treatment right now. But remember, this is medication-assisted treatment. Medication is only one part. Experts widely agree – so much so that it’s required by law – that people recovering from opioid addiction need supplemental treatment, like behavioral therapy and group recovery support, in addition to medication.
And every patient is different, meaning not every one of these medications will work for everyone.
Bonus
Check out this National Geographic article for a look at another new way scientists are looking to treat addiction.