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You Survived an Opioid Overdose. How to Make Sure You Stay Alive

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You—or a loved one—just survived an opioid overdose. You’re relieved and shaken at the same time. You may not realize it, but you’re also very vulnerable to repeating the same scenario—the year following an overdose is a very high-risk period for another potentially fatal overdose. And making things worse, there’s a good chance that you were sent home without a plan to get the help you need—treatment with a medication to get you or your loved one off the opioid.

A study done at the Grayken Center for Addiction at Boston Medical Center found that only three in 10 survivors of opioid overdoses went on to get what’s called medication for addiction treatment, or MAT, using one of the three drugs—methadone, buprenorphine or naltrexone—approved by the FDA for this purpose. Yet the researchers also showed how taking one of them saves lives. Deaths from opioids were reduced by 59% among people taking methadone and by 38% among people taking buprenorphine in the year following the overdose, compared with people who didn’t take any anti-addiction drugs. (Too few people received naltrexone for the researchers to draw any conclusions about it for this purpose.)

Why aren’t more people getting this life-saving treatment? Some aren’t told about these medications or aren’t told in a strong enough way to inspire them to pursue treatment—they might just be handed a pamphlet or given a casual referral. Other patients, if approached immediately after an overdose, may be too overwhelmed by powerful withdrawal symptoms to process the information about addiction therapy, explained Marc Larochelle, MD, the study’s lead researcher. Some simply don’t have access to a medication for addiction treatment program. Tip: You can look for programs in your area on the website of the Substance Abuse and Mental Health Services Administration (SAMHSA).

Misunderstandings about these medications are also a barrier to their use. This is not substituting one addiction for another—these treatments do not produce the highs associated with opioids or heroin. They eliminate withdrawal symptoms and cravings by acting on opioid receptors in the brain.

YOUR OPTIONS FOR ENDING OPIOID ADDICTION

By US law, methadone can be given only through an opioid treatment program certified by SAMHSA. A patient must start treatment by going to the program’s clinic every day to get that day’s medication—it can’t be sent home with a patient from a hospital or picked up at a neighborhood pharmacy. This combination of required clinic visits and medication can be very effective for people who do well with (or need) such a structured program. However, methadone clinics do not exist in many rural areas. On the other hand, if you can make the commitment, once you’re doing well on methadone and have not missed any appointments or relapsed, you may be able to start taking the medication at home, depending on your local clinic’s policy on home methadone use. 

Buprenorphine can be easier to use. It’s prescribed by your doctor, and you can get it at any pharmacy. You will see your doctor weekly at first, but these check-ins are spread further apart as time goes on.

While both medications are effective, response is very individualized. Some people feel better with methadone than buprenorphine and vice versa. Trial and error may be necessary.

Both medications are taken over the long term as maintenance therapy. There is no good data on if or when to taper off, so you will need to work with your health-care provider—and understand that while individuals can permanently overcome their addictions, statistically, relapse rates go up when people go off these medications regardless of how long they were taken. In the study, those who used methadone did so for about five months on average, and those who used buprenorphine did so for around four months.

If you are using opioids nonmedically, even if you’ve never OD’d, don’t delay—talk to your doctor or contact an opioid treatment program near you about methadone or buprenorphine therapy. These drugs can help occasional opioid users, and those who have only recently become addicted kick the habit, too.

The best way to make a decision on which therapy is best for you is to talk to your primary care doctor about your options and/or visit your state’s department of health website to see what resources are readily available in your community.

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Source: Marc R. Larochelle, MD, MPH, general internist and researcher at the Grayken Center for Addiction at Boston Medical Center and lead author of the study titled “Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association with Mortality,” published in Annals of Internal Medicine. Date: October 6, 2018 Publication: Bottom Line Health
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