Interview with Dr. Nathan Day, Medical Director VODP

---

Opioid medications change our brains.  Whether we started opioids to get high or with a prescription for pain, the reality is that our brains change from opioid use.  Over time our brains adapt to our opioid dose by decreasing the number and effectiveness of  our natural opioid receptors.  This makes it so that the old dose we used to take doesn't work anymore.  It also makes it so that when we don't have opioids we get profoundly sick.  Having a normal amount of opioid receptor stimulation is needed for anyone, opioid user or not, to feel okay.  Soon we are trapped so that we need opioids just to function.

Research shows that people who stop using opioids on their own or after going to rehab, jail or a hospital stay are very likely to have a slip and use again sometime in the following weeks and months.  Research has shown that abstinence based treatment significantly INCREASES the risk of overdose and death because the person who was using loses tolerance to opioids after not using.

The first line, preferred treatment option in Alberta today  is called buprenorphine/naloxone or suboxone (brand name).  It is a partial opioid agonist, meaning that it goes to the same receptors as regular opioids but only turns them on enough to take away the sickness and reduce cravings not make the experienced opioid user feel high.  This medication is safe and effective.  It is safe enough that you should be able to get take home doses relatively quickly. 

We also have in Alberta two long acting options called sublocade and probuphine.  Both of these are long acting forms of buprenorphine (like suboxone) and really help with stability, maintenance and convenience.  We also are seeing great results for people who also experience pain with sublocade.  There are pros and cons to every treatment option.  VODP prescribers would be happy to run through options with you.  The long acting products work really well for people who can't be at a pharmacy regularly.

Methadone is another good option that has been around for a long time.  It is a full opioid agonist so it has higher risk of overdose and misuse.  Because of this the regulations around methadone prescribing are understandably more restrictive.

It is amazing what treatment can do for a person.  Within hours the person usually feels much better.  They feel so much better that they often tell us that they finally feel like themselves again.  I have seen many people who look completely different, feel completely different after only a week or two of medication.  We also hear from the vast majority of our clients that the sickness is completely gone and that cravings are down to 2-3 out of 10 from 10 /10 before starting.

The medical research is clear.  Opioid dependency treatment saves lives.  It protects against overdose.  It also increases the chances that a person will go back to work, stay out of jail, help them improve their family relationships and be more fulfilled.

Given the high amount of fentanyl and its analogues in our drug supply right now, it is really important that we use the tools that we have to save lives.

Addiction treatment is good for everyone.  It is obviously good for people who have been using and for their families and loved ones.  It is also good for the public.  Healthcare costs for people who struggle with opioid use go down between 30 and 50% after starting treatment depending on the study you look at.  In our program we have seen large reductions in emergency department use and hospital use after treatment.  

Sometimes a person gets so afraid of opioid sickness that they would do almost anything to avoid it.  These leads to social costs that can be avoided.

In Alberta and B.C. a large majority of the people dying from fentanyl are men who previously worked and paid taxes.  They frequently work in resource and construction.  Many started on opioids because of pain.  Just because a person has an addiction problem does not mean that they are not valuable members of our society.  Treatment is an emergency and should be treated that way.

Finally I would also like to say that people who get opioid addiction treatment actually have to get medication insurance through blue cross or other plans just like anyone else including our friends and neighbors with diabetes.

This question really depends on the pain problem and should be discussed with a physician.  However it is my experience that suboxone is reasonably effective for pain control for many people.