A small implant that delivers a constant stream of a drug that eases physical withdrawal from opioids, limits cravings and blocks their effect in the brain is being hailed as a game changer in the fight against heroin and prescription painkiller addiction. It is expected to be available by the end of June. The Food and Drug Administration in May approved the implant containing buprenorphine, an opioid replacement drug that can be used as a stepping stone to abstinence or as a replacement opioid. The implant, called Probuphine, consists of four matchstick-size rods that are placed under the skin in the upper arm. Probuphine solves three key problems seen with previous treatments:
- Patients don’t have to remember to take a pill every day.
- There’s no choice — patients cannot just stop taking Probuphine.
- The medication can’t be abused (sold on the street or crushed for heightened effect).
The implant, which is put in place by a doctor in a simple office procedure, delivers six months of continuous buprenorphine treatment. Buprenorphine has been used for years to treat opioid addiction, but only in pill form and in a film that is placed under the tongue. It’s also known by the brand names Subutex and Suboxone. Buprenorphine is the only active ingredient in Subutex, but Suboxone contains both buprenorphine and the opioid blocker naloxone. Buprenorphine is a partial opioid, and unlike typical drugs of abuse, it produces a lower level of euphoria and helps those dependent on full opioids like prescription pain pills and heroin wean themselves. Here’s a short video that explains how buprenorphine works. Street diversion of buprenorphine in the oral form has been a problem across the country. Some patients sell some or all of their buprenorphine on the street. Oftentimes, they use the proceeds to buy heroin. Police seizures of buprenorphine in the U.S. rose from 90 in 2003 to more than 10,500 in 2010.
Probuphine Only First Step in Recovery Process
While medication is important, it is only part of the recovery process from the abuse of opioids or any other drug. Lasting recovery requires treatment that gets to the root causes of drug use, such as trauma that’s led to depression, or another comorbid disorder that has caused the user to self-medicate with substances. Recovery isn’t defined by sobriety alone. Without therapy that works to heal the whole person — body and mind — users are far more likely to relapse. Nora Volkow, head of the National Institute on Drug Abuse, calls Probuphine a “game changer,” saying it will help people stay on the medication while their brain circuits are gradually restored from the damage caused by drug use. “Today brings a new ray of hope for many people with opioid use disorder,” Volkow wrote in a blog post. “Buprenorphine, methadone, and depot naltrexone (a long-acting formulation of the opioid antagonist naltrexone) — a group of treatments known as medication-assisted treatments or MAT — have been demonstrated to help patients recover from opioid use disorder, improve their social functioning, and reduce their risks for overdose and for contracting HIV or hepatitis C; buprenorphine and methadone have also been shown to lessen patients’ risk of criminal activity.” Deaths from drug overdoses have hit a record in the U.S., rising 14% from 2013 to 2014, according to the U.S. Centers for Disease Control and Prevention (CDC). More than 47,000 people died from these drug overdoses in 2014 (the last year for which statistics are available) due to opioid pain relievers like OxyContin, Vicodin and Percocet, and the street drug heroin, the CDC reported. Every 19 minutes, someone dies from an accidental overdose, according to the agency.
Roots of Opioid Abuse
The prescription painkiller epidemic began in the 1990s, when doctors began writing prescriptions for the medications much more frequently due to concerns that patients with severe pain were not getting adequate relief. Between 1999 and 2008, U.S. sales of narcotic painkillers rose 300%, according to the CDC. In just two counties in Florida — Broward and Palm Beach — pain clinic doctors dispensed more than 9 million tablets of oxycodone in a six-month period to a total population of only 3 million people. Heroin abuse intensified when people who could no longer get the pills from a doctor turned to the street equivalent. One study showed that people who abuse prescription painkillers are 19 times more likely to start using heroin. The study also found that eight out of 10 people who started using heroin abused painkillers first. Probuphine was developed by Braeburn Pharmaceuticals under a license agreement with Titan Pharmaceuticals. Doctors who wish to prescribe Probuphine must sign up for a four-hour training session. Braeburn is conducting training sessions in 55 cities over the next six weeks, the company reported.