Q: Can you tell me more about a medication that is being prescribed to treat opioid addiction that you only need to take once a month? I would like to be able to discuss this with my nephew over the holidays.
Opioid addiction or opioid use disorder is a widespread problem affecting many Canadian families. Fortunately, effective treatment options exist to manage the symptoms of opioid addiction, especially when they are combined with counselling. Today, I’ll discuss the most common treatments; they are not a cure for addiction but help to promote recovery by reducing drug cravings and reducing the symptoms of opioid withdrawal.
When opioids such as codeine, morphine, oxycodone, hydromorphone, fentanyl or heroin are taken they travel in the bloodstream to the brain where they attach to an opioid receptor. Once attached, pain signals become blocked, and a pleasurable “high” feeling can be experienced. When the opioid starts to wear off and leaves the receptor, people with opioid addiction start to crave their next dose. If they do not take it, they will go into opioid withdrawal.
With most opioids withdrawal begins six hours after the last dose, but this varies based on the person and the opioid. Symptoms include nausea, vomiting, excessive sweating, runny eyes, runny nose, yawning, sneezing, dizziness, diarrhea, muscle aches, goosebumps, shaking, anxiety and insomnia. They can become so intense that for some people, taking their next dose becomes about preventing withdrawal and not necessarily about getting “high.” Withdrawal can turn dangerous if medical complications such as seizures occur.
Methadone is a long-acting synthetic opioid used to treat chronic pain and opioid addiction. It attaches to the same opioid receptor as other opioids but without producing the same “high.” It is taken daily, usually in a liquid form and the effects last for 24-36 hours. By keeping methadone attached to the opioid receptors, drug cravings and withdrawal symptoms are managed. However, if you miss a dose or are late taking your dose, you may start to experience those symptoms. Methadone has potential for abuse as “high” feelings can be experienced if someone takes more than their prescribed dose or if someone who is not stabilized on methadone takes it, which is extremely dangerous due to how long methadone lasts.
Suboxone is a brand of medication containing short-acting buprenorphine and naloxone that is taken daily by dissolving a pill or film under your tongue. Buprenorphine is a partial opioid agonist, meaning it attaches to the opioid receptor just like methadone but there is a limit to how many receptors it can attach to. Suboxone has gained a lot of popularity locally in the last handful of years due to this limit as it results in less abuse potential than methadone. The other ingredient naloxone attaches to opioid receptors as well but works as a block to keep other opioids from attaching. This helps reduce the risk of an overdose if other opioids are taken.
Sublocade is the drug you are asking about, and it is a brand of buprenorphine that is injected just beneath the skin of the abdomen every 28 days. It’s the same partial opioid agonist that is in Suboxone but is a longer-acting version. Sublocade is indicated for people with moderate to severe opioid addiction whose withdrawal symptoms have already been stabilized with Suboxone. An advantage to using Sublocade is that the drug remains at a steady level in your system all month long whereas drug levels may fluctuate with Suboxone or methadone depending on how regularly you take your dose. It also conveniently cuts down the need for daily medication and reduces visits to the pharmacy. Sublocade is only available for injection at your prescribing clinic, which virtually eliminates its potential for abuse as patients do not have access to their doses.
When deciding which treatment is best for you, things such as your other medications, your medical conditions, your medical history, the severity of your addiction, and your personal preferences need to be considered.
Anyone taking opioids, whether they are by prescription or not, should have a naloxone kit on hand. Accidental overdoses can occur at prescribed doses especially when opioids are combined with alcohol or other sedatives. Overdose causes weakness, dizziness, confusion, tiredness, uncoordinated movements, blurred vision, slurred speech and life-threatening breathing problems. Naloxone given by injection or nasal spray removes the opioid from the receptor and reverses the effects of the overdose. If naloxone is given, you must call 911 right away for emergency care.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.