Category Archives: addiction

Buprenorphine and opioids

October 2, 2014

Buprenorphine as Opioid Receptor Antagonist

buprenorphineBuprenorphine is a semi-synthetic opioid derived from thebaine. It is a pain killer and has gained a great deal of notoriety for its ability to interrupt severe opiate addiction, including heroin and methadone addictions. It got approved in 2002 by the FDA for use as an opiate addiction treatment. Dependence on pain drugs is common but very dangerous and that is why buprenorphine is of importance in fighting opioid independence.

Today, buprenorphine is being used in office based treatment of opioid dependent patients. Buprenorphine is a partial mu-opioid receptor agonist. Several clinical studies indicate buprenorphine is effective in managing opioid addiction and dependence. In all of the clinical tests Buprenorphine was found to be more effective than placebo for managing opioid addiction. However, it may not be superior to methadone incase high doses are needed. It is comparable to lower doses of methadone, however. When using buprenorphine, there are critical phases that must be followed. These phases include; include induction, stabilization, and maintenance. Experts advise that Buprenorphine therapy should be initiated at the onset of withdrawal symptoms and adjusted to address withdrawal symptoms and cravings. Advantages of buprenorphine include low abuse potential and high availability for office use. Disadvantages include high cost and possible lack of effectiveness in patients who require high methadone doses. Most family physicians are required to complete eight hours of training before they can prescribe buprenorphine for opioid addiction. Let’s get all the detailed facts here.

It is estimated that 898,000 adults in the United States are opioid dependent. Treating opioid dependence as a chronic disorder improves outcomes and opioid maintenance is the most effective way to decrease illicit use in patients who are addicted to opioids. Without opioid maintenance, it will be easy for any user of opiates for pain to be an addict of the same therefore various strategies must be put in place to exercise opioid maintenance for the safety of the patients. Over the past years Methadone has been the treatment of choice in the United States; however, methadone maintenance programs typically have stringent entrance criteria, long waiting lists, and primarily are located in urban areas. It has been verified that only 14 percent of patients who are addicted to opioids are treated in traditional methadone clinics. Research from the 1970s demonstrated that the analgesic buprenorphine (Subutex), a partial mu-opioid receptor agonist, may effectively treat patients with heroin addiction.

In the Drug Addiction Treatment Act of 2000 physicians are authorized to provide office-based treatment for opioid addiction. Through this act physicians are allowed to prescribe Schedule III, IV, or V “narcotic” medications that are approved by the U.S. Food and Drug Administration (FDA) for patients with narcotic-use disorders. In 2002, buprenorphine and combination buprenorphine/naloxone (Suboxone) was approved by the FDA to manage opioid dependence .It is therefore a legally usable drug that is available in health centers and clinics.

How to use

As stated earlier the Management of opioid addiction with buprenorphine can be divided into three phases: induction, stabilization, and maintenance. The induction phase includes the initial transition from illicit opioid use to buprenorphine and typically lasts three to seven days. Patient education is important during this phase and should emphasize the risk of precipitating withdrawal if buprenorphine is initiated too soon after opioid use. Generally, buprenorphine should be initiated 12 to 24 hours after short-acting opioid use and 24 to 48 hours after long-acting opioid use. It is preferable for most patients to use combination of buprenorphine/naloxone tablets.  It is however advised that pregnant women who are to use buprenorphine and some patients using long-acting opioids such as methadone should use the buprenorphine-only formulation. For those who are on long- acting opioid use, the methadone dose should be less than 30 mg and the patient should switch to the combination tablet after several days.

When the patient has shown opioid withdrawal symptoms, the initial doses should be administered under physician observation (4/1 mg buprenorphine/naloxone or 2 mg buprenorphine if the patient is dependent on a long-acting opioid). It is important for the physician to monitor the patient for precipitated withdrawal and excessive side effects like sedation). If the patient continues to exhibit signs of opioid withdrawal after two hours, another 4/1 mg dose of buprenorphine/naloxone should be administered. Patients who are dependent on long-acting opioids should receive 2 mg buprenorphine every one to two hours. The maximum recommended first-day dosage of buprenorphine is 8 to 12 mg. If the patient continues to show signs of withdrawal, the physician may administer adjunctive nonopioid and symptomatic treatments to help the situation.

Difference between methadone and morphine

There are some differences between methadone and morphine. Some of the differences lie in their costs and uses. Here are some of the differences.

Methadone is much cheaper as compared to morphine. For this reason many physicians favor methadone. Methadone also lasts longer than morphine- it lasts ten times longer than morphine. Methadone also lasts longer than morphine in the body. It takes 24 hours while morphine takes only 2-3 hours only in the body. However methadone should not be used for slight pain despite its availability and cheaper cost.

Another difference is that methadone is excreted through urine while morphine is excreted through the liver and bile ducts before its exit in the urine.

 

BuprenorphineThese drugs are also used in different situations. Methadone is mostly used after unsuccessful use of morphine or when the patient has a history of drug abuse. If tis patient is morphine it may lead to relapse hence methadone is considered safer than morphine. Morphine is addictive while methadone is not addictive.

Here at AWAREmed we are dedicated to finding the best solutions to chronic illnesses and that is why Dr. Dalal Akoury (MD) is always in the forefront advocating for integrative medicine since it is only through integrative medicine that a person can be healed wholly. Do not hesitate to call on her for help in managing any sort of chronic pain as well as other diseases.

 

Buprenorphine as Opioid Receptor Antagonist

 

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Proper use Opioids to Curb Addiction and Dependence

October 1, 2014

 

Better Use of Opioids to Curb Addiction and Dependence

opioidsThe opioid drugs have brought relief to many people that were suffering severe pain enough to even disable them. The use of these drugs however should be done with extreme caution as this is like a double aged knife. We talk of collateral damage here with this I mean that these drugs should be used in a manner that they are safe enough not to cause myriad problem such as addiction and dependence on these records.  Today there are millions of Americans who depend on these opioid drugs to overcome what might otherwise be agonizing, crippling pain. However, each year, the numbers of people who have become addicted to these drugs rise. The very same drugs that help them to overcome the pain are poising a great danger in their lives needless to mention the use of these drugs has led to death of many Americans. The main cause of these deaths is overdose. Prescription opioid overdoses caused more than 16,000 deaths in the United States in the year 2010 alone. This is for times the number of deaths that were recorded in 1999 to have been caused by prescription opioid overdose. In the past it was not  easy for both private and public health facilities to act on these unpleasant statistics but slowly they seem to lay strategies to curb the use of these opioid drugs and so far these strategies have shown positive results as very many lives have been saved not only in America but also in other continents.

The Centers for Disease Control and Prevention has cited Florida as one of the cities where the deaths have dropped owing to these strategies that have been employed by the health sector. The deaths dropped from 3201 as was in 2010 to 2666 in 2012. The report clarifies that most of these deaths were reduced due to reduction in prescription of these drugs to pain patients. There were fewer prescriptions to these opioid drugs as a result of in the policy that regulated the flow of these drugs. These policy changes led to a close of 250 of the state’s pill mills that were considered high volume pain medication dispensaries.

The United States remains far and away the world’s largest user of prescription opioids, with 259 million prescriptions written in 2012, according to the CDC — twice as many, per capita, as the next-largest consumer, Canada. A separate CDC report issued the same day as the Florida update showed that prescription rates vary widely among states. Now, when we take America out of the picture and we begin to find reasons why there are problems with the opioid medications we learn that one of the causes of these problems is;

Irresponsible prescription

Every patient entrusts his with the doctor, however in some situations this dependence may be abused either intentionally or unintentionally. Some doctors are opiophobiac and hence reluctant to give right doses to the patients while in some scenarios a patient may be handled by a doctor who is not experienced in pain treatment hence may either overdose or under dose the patient. Cases of overdose are a major cause of deaths from use of these pain drugs.

Another source of complication is, the patient may be afraid of these drugs as they are often portrayed negatively by the media. The fear of addiction and dependence may make a patient not to use the drugs as prescribed.

Due to the problems that were faced by both doctors and patients in dealing with the opioid medications, the universal precautions were developed to offer a structured rational approach to pain patients and serve “as a guide to start a discussion within the pain management and addictions communities. They are not promoted as complete precautionary measures but as a guide to opioid medications.

The difference between physical dependence, addiction and PSEUDO-ADDICTION

These three have different meanings. However they have always been confused causing fear among patients using these drugs. Physical dependence is the case that arises when a person has been using these drugs for some time. The body physically becomes dependent on these drugs so much that when you stop using them you will show signs of withdrawal. This is normal and happens with other medications not only with opiates.

Addiction on the other hand is a case when a person losses control of the drugs. He no longer can maintain the doses as prescribed but begins to take much more than the prescribed doses. In most cases those addicted to a drug will not accept that they are but will go through all hustles to satisfy their craving for the drug.

 What is pseudo-addiction?

opioidsWhen a pain patient on opioids begins behaving in a manner that most addicts do but in real sense he is not addicted, this is called pseudo-addiction. The patient will demand for more drugs because the doses he got have not settled the pain. They will even use more than the prescribed doses in a bid to cool the pain and are often early to request for more drugs since they overused the ones they were given to cool the pain . The difference between pseudo-addiction and addiction is the reason behind the need for more drugs; an addict needs more drugs to satisfy his craving while in pseudo-addiction a patient needs more drugs because of the pain.

You need more information to stay away from dependence on alcohol and drugs as these have crippled societies and that is why here at AWAREmed we are dedicated to finding the best solutions to addiction and dependence on substances. Dr. Dalal Akoury (MD) is always in the mood of helping any patient to be addiction free. Do not hesitate to call on her for help in managing any sort of chronic pain or any type of addiction as well as other diseases.

Better Use of Opioids to Curb Addiction and Dependence

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Opiophilia Replaced By Opiophobia

October 1, 2014

Opiophilia Replaced By Opiophobia the Pendulum Is Again In Motion

OpiophobiaThere are certain phenomena in the medical field that are rather hard to understand. We were brought up knowing that opioids and like substances were bad and should be avoided at all costs and we did that but as we grew and each of us went his way in matters there are mysteries that we met. As everybody else chose careers I chose to be here practicing medicine and I tell here my perception of opiates and like substances were changed here we use them as drugs especially as pain management drugs. To many people this may sound irrational. How do you use a drug that has dangerous effects to treat an illness? Don’t worry we had the same questions and curiously we waited to have these mysteries unraveled. We use these drugs in doses that are only able to address the pain and for a time that may not cause any serious health problems. However as patients were put on these drugs the whole medical industry work up to the realization that the use of these drugs in most cases resulted in the patients being addicted to the drugs and hence demanded more and more of these drugs. These drugs are rewarding in nature and so patients that are put on these drugs will automatically tend to crave for them. That is when opiophilia became a disease to be fought from all corners to help patients on these drugs to evade addiction and dependence on these drugs.

What is Opiophilia?

Opiophilia is a love of opioids, the love for opioids may not begin as a choice but may begin gradually when a patient is prescribed opiates to help him in pain management.  In the past the doctors had given a blind to the possibility of pain patients under opiate drugs to be addicted on these drugs as they believed that the dosage was not enough to make the develop dependence on these drugs. However as patients take these drugs they will become addicted as the drugs are rewarding in nature. This therefore means that before a doctor prescribes opiate to a chronic pain patient he should assess the patient and develop exit strategies that will help these patients avoid addiction.

Fortunately, the medical industry has fought opiophilia and better strategies have been put in place to ensure that patients on these drugs are safe. Opiophilia seems an already won battle. Apart from proper pain management by use of these drugs other natural ways of pain management have been embraced to help patients where necessary. These natural pain cures include Prolozone therapy, PRP and prolotherapy. These natural pain cures are now used worldwide to help patients with chronic pain.

The fight against opiophilia was won but that did not end all the problems associated with the use of opiates in managing pain in patients. Another disease came and replaced opiophilia and this is opiophobia.

Opiophobia is a disorder or affliction, so named because people affected have a great aversion to the use of prescription opioids for the treatment of pain, to the point where they will actually refuse to take or administer it. This is rather new disease in field of drugs and addiction. This term is also used to refer to instances when doctors fear or are unwilling to prescribe opioid medication to patients.

In most cases doctors who have had unwillingness to prescribe opioid medications are often counseled and so they go back to administer the drugs. Opiophobia should be addressed just as much as opiophilia since it is the opioid that goes deep in managing pain. This is because the only direct biologic pain-relief system in the human body is the endogenous opioid receptor system, consisting of endorphins and their tissue based action sites, or receptors. Using opioid based drug in pain offers instant relief and so the opiates still remain to be the best pain relief medication. The public as well as the doctors may be subject to opiophobia owing to the negative information that are spreading concerning the use of opiates in dealing with pain. The major concern of these groups is that they know that when a patient has used the opiates for a short term or long-term pain then he becomes addicted and will show symptoms of withdrawal once he stops using the drugs. This may be true but this is also true with other medications doesn’t a diabetic patient become dependent on insulin? Needless to mention several strategies have been put in place to ensure safe exit from the use of these drugs. When you are dependent on any drug for medical purposes. That is not abuse.

Because of opiophobia and opiophilia State regulators have been introducing legislation to severely curtail availability of opioid class of medication this unfortunately may be a disadvantage rather than an advantage as there are patients that are already dependent on these drugs needless to mention there is no alternative that has been put in place that can work effectively enough to replace opioid class of drugs in managing pain.

OpiophobiaExit strategy from opioid therapy

There is need for a safe exit strategy to help the patients evade any possible danger that may come from using the drug. However it is better for a doctor to formulate a safe exit strategy. He will be able to do so depending on such factors as; consistence of a patient’s behavior with drug addiction, patient’s willingness to cooperate with an outpatient-based opioid analgesic tapering plan, patient’s history with substances disorders. All these assessments will help the doctor to formulate a safer exit plan for the patient.

Here at AWAREmed we are dedicated to finding the best solutions to chronic illnesses and that is why Dr. Dalal Akoury (MD) is always in the forefront advocating for integrative medicine since it is only through integrative medicine that a person can be healed wholly. Do not hesitate to call on her for help in managing any sort of chronic pain as well as other diseases.

Opiophilia Replaced By Opiophobia the Pendulum Is Again In Motion

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IV Amino Acids and Mitochondrial Rejuvenation for Weight Management

October 1, 2014

Amino Acids and Mitochondrial RejuvenationUse of IV Amino Acids and Mitochondrial Rejuvenation for Weight Management

The holiday period usually presents one big problem to many people: unplanned for gains in body weight. There is good news, however. You can successfully manage your weight during this period by preparing thoroughly for it. And you can prepare by two main methods: use of IV amino acids and mitochondrial rejuvenation. We shall look at both methods in detail in the sections that follow.

What is IV vitamin and amino acid therapy?

This is a special form of therapy in which essential nutrients like vitamins, amino acids and others are carefully mixed and injected directly into the system of an individual as a way of treating a wide range of diseases and improving the general state of health.

The effectiveness of this therapy is a result of several factors. To begin with, the amino acids and other nutrients that are introduced to the body in this therapy are in a simple form that is required by the body. What this means is that once the nutrients find their way into the body, they are immediately absorbed and utilized for maximum effect.

You can contrast this with what happens when you rely entirely on your diet for supply of the nutrients. When this is the case, the process that the nutrients have to be taken through before being made readily available to your body is long and winding. First, the food has to be digested. This usually takes some time. Second, the absorption process has to take place successfully for the nutrients to be made available in your system. This process is raft with a number of shortfalls. Your body may have its own conditions which hamper the rate and extent of digestion and absorption of nutrients. All these contribute to a low level of intake of nutrients in your body.

Amino Acids and Mitochondrial Rejuvenation

However, the fact that this therapy entails direct administration of a high concentration of vitamins, amino acids, calcium and other nutrients to your system makes it quite effective and useful. Also, effectiveness and usefulness the therapy is enhanced by the fact that it can be tailored to your individual needs.

What is mitochondrial rejuvenation?

Your body functions properly because of the energy that is produced in mitochondria, special organelles in your body cells. When the mitochondria are functioning properly, you feel energetic and in good shape all the time. However, a decline in their form and activity is immediately felt in the form of fatigue and general decline in vitality.

To correct this, rejuvenation of the mitochondria is necessary. This is an essential process for one to remain generally healthy. When there is biogenesis of the mitochondria, an individual is left feeling healthy and younger. This plays an important role in helping you manage your weight as well

Role of mitochondria in overall health of an individual

There are several ways in which the condition of the mitochondria is directly related to the general state of your health. For example, the process of aging is directly linked to damage of the mitochondria in the body cells. A high rate of mitochondrial damage has been identified as one of the main causes of aging in individuals.

Second, degeneration of mitochondria has been identified as one of the main and common characteristics of many forms of chronic diseases. Debilitating conditions created by diabetes and cancer can be attributed to the high rate of damage of mitochondria in the body cells of the patient.

Third, the damage of mitochondria and the consequent degradation of the health of an individual have been identified as a result of destruction of the internal structure of the mitochondria. The mitochondria are highly complex organelles made up of intricate structures. It is the destruction of the internal structures that renders the entire mitochondria non-functional, thus setting the stage for the undesirable health effects that follow.

This underscores the importance of well functioning mitochondria in the health of an individual.

How IV Amino acids and mitochondrial rejuvenation help in weight management

There are several ways in which this happens. First, since one of the many benefits of the IV amino acids therapy is in enhancing the overall repair and activity of the body cells, it is useful in enhancing the rate of repair of the cell mitochondria in your body. Therefore, getting this therapy can play an important role in helping you manage your weight through the holiday.

Second, the process of managing your weight requires a careful balance between the amount of fat and muscles. On one hand is the need for speedy burning of fats to ensure that excess fat does not accumulate in the body and lead to unnecessary gain of weight. On the other is the need to build up lean muscles at a fast rate to ensure that the weight of the body remains within the desired levels.

At the heart of all these processes is the role of the mitochondria. Their perfect functioning determines how well these processes take place, therefore determining how well you manage your weight. Since the IV amino acid therapy has been known to provide to the body essential nutrient, some of which are quite necessary for proper functioning of the mitochondria, it can be said that the therapy is quite useful in rejuvenating the mitochondria. This, by extension, will help you successfully manage your weight through the holiday season.

The sole goal of AWAREmed Health and Wellness Resource Center is to help you achieve and maintain optimum health and wellness. That is why we have designed our services in such a manner that your needs take the center stage. Therefore, feel free to contact Dr. Dalal Akoury, a renowned medical practitioner, for a consultation session on how to tackle any particular health condition. She will ensure that you have your health in perfect condition. We are located in Myrtle Beach, South Carolina.

Use of IV Amino Acids and Mitochondrial Rejuvenation for Weight Management

 

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Naltrexone and Alcoholism

September 30, 2014

Naltrexone promising for alcoholism and SUD

NaltrexonePeople addicted to alcohol and other substances may have certain behavioral changes that are not healthy for them and even for the people they live amongst. This therefore means that specific actions should be taken to offer them assistance as they fight addiction to be able to quite these unhealthy cognitive behaviors. Most people addicted to alcoholism and other substances of abuse will experience dysfunctional emotions, maladaptive behaviors and cognitive processes. All these need to be addressed to help the person to overcome. There are several therapies that can be used either singly or in collaboration with other therapies to help in this process. One of these therapies is the cognitive behavioral therapy often shortened as CBT.

Cognitive behavioral therapy (CBT) for substance use disorders has demonstrated efficacy when used as a monotherapy as well as when used with other treatment strategies.  There are articles that have been written that support the use of cognitive behavioral therapy, clinical elements of its application, novel treatment strategies for improving treatment response, and dissemination efforts. Although CBT for substance abuse is characterized by heterogeneous treatment elements such as operant learning strategies, cognitive and motivational elements, and skills building interventions across protocols several core elements emerge that focus on overcoming the powerfully reinforcing effects of psychoactive substances.  Apart from CBT there are also other methods that are used in treating people that are alcohol and other substances dependence. One of these options is the use of Naltrexone.

What is Naltrexone?

Naltrexone is a synthetic drug that is similar to morphine. It is used in treatment of alcohol and heroine addictions. It works by blocking opiate receptors in the nervous system. It helps people to stay away from alcohol as it lowers the cravings for alcohol.

Naltrexone is a medication that is FDA-approved for the treatment of alcohol dependence. Meta-analyses of studies on the impact of Naltrexone medication has demonstrated positive effects on outcomes this treatment was found to work even better in helping the addicts to abstain from taking alcohol. Based on the accumulated evidence of the effectiveness of this medication it received strong recommendations as evidence-based treatments for alcohol dependence in the National Quality Forum’s National Voluntary Consensus Standards for the Treatment of Substance Use Conditions, as well as the VA/Department of Defense Clinical Practice Guidelines for Management of Substance Use Disorders (SUD). Based on these guideline recommendations, the “VA Uniform Mental Health Services Handbook” states that naltrexone and another drug known as acamprosate should be offered and be made available to all Veterans diagnosed with alcohol dependence, if not medically contraindicated. Also noteworthy is that a recent meta-analysis of seven placebo-controlled randomized trials of a newer medication, topiramate, found it had a more positive overall effect size than that from the first seven trials of naltrexone. This therefore makes it is a very promising medication.

However with all the accumulated evidence, clinical practice guideline recommendations, and VA policy, implementation of these medications within the VA healthcare system has been low overall, and highly variable. Among the more than 200,000 VA patients with a documented alcohol dependence diagnosis, less than 6% have received an approved medication. The majority of VA patients with alcohol dependence diagnoses (65%) are never seen in specialty substance use disorder clinics. However, even among those seen in specialty clinics, prescribing rates remain below 10%, with rates varying from 0% to 21% across facilities. Extremely low prescribing rates and significant variation across facilities suggest that significant gaps exist in access to these medications. Owing to their effectiveness they should be made available to every patient.

In most cases the medications for alcohol and substance abuse dependence are approached as cocktail where various strategies are used in treatment of the patient. It is however recommended that naltrexone should be part of the treatment offered and made available to patients with alcohol dependence. This is because of their effectiveness in fighting alcohol as well as other substances dependence

The role of naloxone rescue in Heroin users

Naloxone is a drug that has found favor with most health experts owing to its effectiveness in fighting heroin overdose. For WHO it is an essential drug. The use of naloxone in health institutions is legal since it is approved by food and drug act (FDA).  Not long ago, the Food and Drug Administration approved a new hand-held auto-injector of naloxone. This device may be of great help to family members of heroin addicts as well as caregivers.

How does it work?

NaltrexoneIn case of and heroin overdose, the respiratory and central nervous systems are depressed to life-threatening levels and the addict may stop breathing. When this happens is no action is taken the patient may die. So when the person is treated with naloxone the drug will block the heroine receptors hence making it impossible for it to bind on the receptors that are located in the brain and spinal cord.

Finally, dependence to any substance is dangerous and so should be fought seriously. Here at AWAREmed we are dedicated to finding the best solutions to all addicts and that is why Dr. Dalal Akoury (MD) is always in the forefront advocating for integrative medicine since it is only through integrative medicine that a person can be healed wholly. Do not hesitate to call on her for help in managing any sort of drug addiction as well as other diseases.

Naltrexone promising for alcoholism and SUD

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