I recently had the opportunity to interview Mark L. Kraus, M.D., FASAM*, an addiction medicine specialist and a diplomat of the American Board of Addiction Medicine. He is also an internist in private practice and Assistant Clinical Professor of Medicine at Yale University School of Medicine.
There were two parts to the interview. In the first part, we discussed the signs of addiction and the difference between physiological dependence and addiction. You can read that portion of the interview here: Dr. Mark Kraus Discusses Opioids and Addiction
In the second part of the interview, we discussed treatment options for opioid addiction or dependence other than rehab facilities. One resource Dr. Kraus directs people to is the Web site TurnToHelp.com, which offers patient case studies, a questionnaire to determine if you might be dependent on a prescription painkiller and a physician finder to locate a doctor certified to prescribe treatment.
Suboxone as a Treatment Option
The TurnToHelp.com Web site talks about Suboxone (buprenorphine) as a treatment option for patients who have addiction problems or who want to break their physiological dependence on opioids. I noted that Suboxone is still an opioid and asked why taking it is better or safer that taking other opioids.
Dr. Kraus said, “The answer is it's a partial mu agonist. It's not exactly an opioid. It looks and smells and tastes like it, but is not exactly the same. It works at the same site in the brain, has a stronger affinity for those sites in the brain, and breaks away from them slower. So it is an opioid in that regard.
“It's an opioid that can be used very safely as was shown in a study that was conducted by the National Institute of Drug Abuse and was published in the Archives of General Psychiatry that showed that medicine-assisted treatment with Suboxone works very effectively in an office-based setting.
“The other medication we haven't mention in medical-assisted treatment for opioid dependence is methadone, which also works very well in methadone treatment programs, which are usually methadone clinics. We also know that methadone and buprenorphine can be treatments for pain and they are effective treatments for pain.
“So the point is that it (Suboxone) is an opioid and has all the properties and qualities of an opioid. It can become addictive and one needs to taper oneself off. That's not different than a pain medication patient who gets treated with an opioid. They can't just stop the opioid. They have to taper down and off. The reason is, they've established this physiological dependence, which has affected the brain chemistry. The scale is evenly weighted as to use and non-use when you want to get off, so they are similar.”
Suboxone vs. Methadone
Next I asked how Suboxone differs from methadone and whether it is a better treatment option.
