Saturday January 19, 2019

Naltrexone and the Opioid Epidemic

Anyone addicted to opiates should seek professional help and consider going to treatment

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Naltrexone
Naltrexone simply blocks any euphoric feelings of alcohol and opioids. It also decreases cravings and the risk of an overdose. Pixabay

Naltrexone is a medication used to treat alcohol and opioid addiction. It’s commonly prescribed and sold under the brand names Revia or Vivitrol. The medication works by blocking opioid receptors in the brain and prevents these receptors from producing reinforcement from endorphins. Naltrexone simply blocks any euphoric feelings of alcohol and opioids. It also decreases cravings and the risk of an overdose.

Naltrexone was first synthesized in 1965, but it took nearly 20 years for it to be approved by the FDA for preventing relapse in opioid-addicted patients. Over the past ten years, naltrexone has become an increasingly popular medication. People who enter drug or alcohol rehab centers are sometimes presented with the option to use the medication as a medicated-assisted treatment. Naltrexone should always be used as prescribed and it is suggested to be implemented as part of a complete treatment plan.

What Caused The Opioid Crisis?

The United States has been dramatically impacted by opioid addiction and is currently in the middle of an opioid crisis. The CDC reports that opioid-related deaths are still rising in nearly every segment of the country. The US has faced its share of drug issues in the past, but nothing compares to the severity of what we are currently facing. In 2016, there were approximately 64,000 deaths from opioid overdoses in the United States.

Percocet, Vicodin, morphine, methadone, codeine, hydrocodone, heroin and fentanyl are all in the opioid family. All of these drugs, minus heroin, can be obtained legally with a prescription from a doctor or physician. When used as prescribed over a short period of time they are very beneficial. Sadly, these meds have a very high potential for abuse and are highly addictive both physically and mentally. The true devastating power of these substances was revealed in the mid-2000’s. Medications like OxyContin and Hydrocodone were being prescribed by the millions every year.

These pills soon flooded the streets and became very popular recreational substances. The rise of “pill mills” rose exponentially, especially in South Florida. 93 of the top 100 oxycodone-dispensing doctors in the United States were located in Florida. These places had doctors who would happily write a huge prescription for anyone who had cash on hand. Some even filled the prescription on the same premises and rarely accepted insurance. People traveled from every corner of the country to Fort Lauderdale, Delray Beach and Miami to visit these clinics. They would then bring the pills back to their hometown and sell them. It wasn’t long before opiates became a national concern.

In 2010, more than 650 million oxycodone pills were shipped to Florida. In 2011, Florida had a total of 856 pain clinics. Hillsborough County alone had over 100 of them. In 2010, oxycodone caused 1,516 overdose deaths in Florida; that is nearly 5 fatal overdoses a day. Opiates were killing more people than any other drug and overdose deaths started to increase rapidly nationwide.

In 2011, new laws were put into effect in Florida to help reduce the dramatic loss of life. One action taken by the Drug Enforcement Administration was “Operation Pill Nation,” which targeted corrupt pain clinics throughout the state. Pill mills started to close, crooked doctors were arrested and the number of pills that were available on the black market declined. According to the DEA, the number of oxycodone pills that were shipped to Florida dropped to under 527 million in 2011.

Naltrexone
Representational image. Pixabay

The Rise of Heroin

The demand for prescription opioids remained, but there wasn’t a supply to back it up. A lot of those struggling with addiction issues turned to heroin. Over 70% of current heroin addicts report that they started using prescription opiates before they ever used heroin. Heroin slowly became a drug of choice for many opioid addicts.

Recently, drug dealers started mixing fentanyl and carfentanil into their heroin. Fentanyl is 50-100x stronger than heroin. Carfentanil is frequently used to tranquilize elephants and can be 10,000x stronger than pure heroin. Overdoses related to heroin use and these synthetic opioids has become increasingly common. In 2016, there were over 100 deaths per day in the United States and this number continues to rise.

Using Naltrexone to Treat Opioid Addiction and the Side Effects

Naltrexone can be taken orally on a daily basis or it can be given once a month using a timed release injection. It should not be used by anyone who is actively addicted to and using opiates. If they are to use it while under the influence they can instantly enter withdrawal. There are some side effects that can occur when someone uses naltrexone. The following information was provided by Micromedex, a collection of evidence-based clinical references, and powered by Truven Health Analytics.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare Side Effects

  • Abdominal or stomach pain (severe)
  • Blurred vision, aching, burning, or swollen eyes
  • Chest pain
  • Confusion
  • Discomfort while urinating or frequent urination
  • Fever
  • Hallucinations or seeing, hearing, or feeling things that are not there
  • Itching
  • Mental depression or other mood or mental changes
  • Ringing or buzzing in the ears
  • Shortness of breath
  • Swelling of the face, feet, or lower legs
  • Weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More Common Side Effects

  • Abdominal or stomach cramping or pain (mild or moderate)
  • Anxiety, nervousness, restlessness or trouble sleeping
  • A headache
  • Joint or muscle pain
  • Nausea or vomiting
  • Unusual tiredness
Naltrexone
Representational image. Pixabay

Less Common Side Effects

  • Chills
  • Constipation
  • Cough, hoarseness, runny or stuffy nose, sinus problems, sneezing or sore throat
  • Diarrhea
  • Dizziness
  • Fast or pounding heartbeat
  • Increased thirst
  • Irritability
  • Loss of appetite
  • Sexual problems in males

No one should ever use Naltrexone without it being prescribed by a licensed doctor or physician.

Conclusion

Naltrexone has helped in relapse prevention, but there needs to be enhanced efforts in preventing the drug abuse from occurring in the first place. This is a critical time to combat prescription fraud and illegal drug trafficking. Communities need to unite and share vital information and tools to combat drug abuse with the goal of minimizing its social and economic impact.

Anyone addicted to opiates should seek professional help and consider going to treatment. Once a person is properly detoxed and has made it through an inpatient program, they have just begun their journey in recovery. When a person gets ready to leave treatment it’s crucial to set up a substance abuse aftercare plan. Naltrexone is commonly prescribed to people in treatment and it is a great component to consider in an aftercare program.

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The Best Way To Help Teenagers Stop Vaping Still Unknown

About two-thirds of U.S. teenagers do not realize that Juul contains nicotine, according to a recent survey by the Truth Initiative, an anti-smoking advocacy group.

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e-cigarette, vaping
In this April 11, 2018, photo, an unidentified 15-year-old high school student uses a vaping device near the school's campus in Cambridge, Mass. Health and education officials across the country are raising alarms over wide underage use of e-cigarettes and other vaping products. The devices heat liquid into an inhalable vapor that's sold in sugary flavors like mango and mint — and often with the addictive drug nicotine. VOA

The nation’s top health authorities agree: Teen vaping is an epidemic that now affects some 3.6 million underage users of Juul and other e-cigarettes. But no one seems to know the best way to help teenagers who may be addicted to nicotine.

E-cigarettes are now the top high-risk substance used by teenagers, according to the latest U.S. figures, which show that Juul and similar products have quickly outpaced cigarettes, alcohol, marijuana and other substances that have been tracked over more than four decades.

The handheld devices heat a liquid solution that usually contains nicotine into an inhalable vapor. Federal law prohibits sales to those under 18, though many high schoolers report getting them from older students or online.

In recent months, government officials have rolled out a series of proposals aimed at keeping the products away from youngsters, including tightening sales in convenience stores and online. In November, vaping giant Juul voluntarily shut down its Facebook and Instagram accounts and pulled several flavors out of retail stores.

e-cigarette, cigarettes
Customers puff on e-cigarettes at the Henley Vaporium in New York City. VOA

But there’s been little discussion of how to treat nicotine addiction in children as young as 11 years old. While some adolescents should be able to quit unaided, experts say many will be hampered by withdrawal symptoms, including anxiety, irritability, difficulty concentrating and loss of appetite.

Physicians who treat young people now face a series of dilemmas: The anti-smoking therapies on the market — such as nicotine patches and gums — are not approved for children, due to lack of testing or ineffective results. And young people view the habit as far less risky, which poses another hurdle to quitting.

The harshness of cigarette smoke often limits how much teenagers inhale, sometimes discouraging them from picking up the habit altogether. That deterrent doesn’t exist with e-cigarette vapor, which is typically much easier to inhale, according to experts.

Kicking any addiction requires discipline, patience and a willingness to follow a treatment plan — something that doesn’t come easily to many young people, experts said.

“Teenagers have their own ideas of what might work for them, and they’re going to do what they do,” said Susanne Tanski, a tobacco prevention expert with the American Academy of Pediatrics. “But we desperately need studies to figure out what’s going to work with this population.”

Vaping, teeth,e-cigarette, cigarettes
Nicotine vaping on rise among US teenagers: Survey. Pixabay

Youth Use

Since debuting in the U.S. in 2007, e-cigarettes and other vaping devices have grown into a $6.6 billion business. Driving the recent surge in underage use are small, easy-to-conceal devices like Juul, which vaporizes a high-nicotine solution sold in flavors such as creme, mango and cucumber. Despite industry worries of a crackdown on flavors, the FDA has made no effort to ban the array of candy and fruit varieties that companies use to differentiate their offerings.

E-cigarettes have become a scourge in U.S. schools, with students often vaping in the bathroom or between classes. One in 5 five high schoolers reported vaping in the last month, according to 2018 federal survey figures.

Juul and other brands are pitched to adult smokers as a way to quit smoking, but there’s been little research on that claim or their long-term health effects, particularly in young people. Nicotine can affect learning, memory and attention in the teenage brain, but there’s virtually no research on how e-cigarette vapor affects lungs, which do not fully mature until the 20s.

“It’s frightening for me as a pediatrician because I really feel like there’s this uncontrolled experiment happening with our young people,” Tanski said. “They don’t perceive the harm, and we can’t show them what it’s going to be.”

Tanski and other experts will meet this Friday at the Food and Drug Administration to discuss the potential role for pharmaceutical therapies and non-prescription medications such as nicotine gums and patches.

Vaping, teeth,e-cigarette, cigarettes
In this Feb. 20, 2014 file photo, a customer exhales vapor from an e-cigarette at a store in New York. A growing number of e-cigarette and vaporizer sellers have started offering college scholarships as a way to get their brands listed on university websites. VOA

Regulators acknowledge they are starting from square one: The FDA “is not aware of any research examining either drug or behavioral interventions” to help e-cigarette users quit, the agency noted in its announcement.

The FDA will also hear from researchers, vaping executives, parents and teenagers.

“We want to make sure our voices are heard and that — most importantly — our kids’ voices are heard,” said Meredith Berkman, who plans to speak at the meeting with her 10th-grade son.

Berkman said she first realized her son and his friends were “Juuling” last year when she heard them repeatedly opening and closing his bedroom window. With two other New York City mothers, she formed the group Parents Against Vaping E-cigarettes, which is asking the FDA to ban all e-cigarette flavors.

“Unless the flavors are off the market, kids are going to continue to be seduced by these highly addictive nicotine-delivery systems like Juul,” Berkman said.

Quitting smoking is notoriously difficult, even for adults with access to various aids and programs. More than 55 percent of adult smokers try to quit each year, yet only about 7 percent succeed, according to government figures.

Nicotine gums, patches and lozenges are available over-the-counter for those 18 and older, and are occasionally prescribed “off-label” for younger patients. They provide low levels of nicotine to help control cravings. Prescription drugs include Zyban, an antidepressant, and Chantix, which blocks the effects of nicotine on the brain. But neither has shown positive results in teenagers, and both carry worrisome side effects, including suicidal thinking for Zyban and nausea and abnormal dreams for Chantix.

Vaping
Many people may be vaping nicotine through e-cigarettes, smoking. Image source: post-gazette.com

That leaves counseling as the go-to option for teenagers trying to quit cigarettes.

In November, Colorado dropped the minimum eligibility age for its quit-smoking hotline from 15 to 12, in response to the explosion in vaping among students as low as 6th grade. The state’s underage vaping rate is the highest in the U.S., with 1 in 4 high school students reportedly using the products in the last month, according to federal data. The state’s over-the-phone and online programs provide free coaching to help users create a quit plan, manage cravings and avoid relapse.

But even counseling has shown only “limited evidence” in helping teenagers, according to an exhaustive review of the medical literature published in 2017.

Still, addiction specialists see growing demand for such programs, particularly group sessions that often have the mos