The nation’s leading researcher in opioid addiction says a third medication-assisted treatment shows promise for treating addicts, who face barriers to care that include low insurance coverage, social stigma and a lack of treatment options.
Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), said a new study shows that naltrexone is effective in keeping patients off drugs.
“The beauty of having now three medications — as opposed to initially just methadone, then buprenorphine — is that you have different alternatives,” Dr. Volkow said in an interview with The Washington Times.
The study was published Wednesday in the journal The Lancet and led by NIDA researcher Dr. John Rotrosen.
Dr. Volkow said the fact that naltrexone is as effective in treating addiction as buprenorphine is one of the study’s most important findings.
“The widespread belief is that patients do not do as well when they are treated with naltrexone than when they are treated with buprenorphine even though there was no data to support this,” she said. “So these new studies showing that they have equivalent efficacy should hopefully change these perspectives.”
Naltrexone requires patients to completely detox from opioids before starting treatment, resulting in high drop-out rates before the drug can take effect and making doctors less likely to prescribe it. It’s a significant hurdle before treatment begins and increases a person’s chance for relapse — where the risk for overdose is extremely high,” Dr. Volkow said.
“When you relapse, you’re at a very high risk of overdoses — so to be able to come up with alternative treatments that can improve, that can prevent that relapse will be very valuable,” she said.
Researchers are working to find solutions to better initiate patients into naltrexone, which has a number of advantages for patients who don’t respond to buprenorphine.
Naltrexone, known as an opioid antagonist, blocks certain receptors in the body so that the narcotics don’t produce a euphoric effect. Patients also are not physically dependent on naltrexone — unlike buprenorphine, an agonist that can cause patients lacking the drug to suffer withdrawal symptoms.
“So, yes, there are individuals that don’t want to be on an opioid agonist, in whom naltrexone, then, is a better option,” Dr. Volkow said. “But there may be some instances where patients don’t respond to naltrexone, where buprenorphine gives them an opportunity for recovery.”
An estimated 2 million people in the U.S. have an opioid addiction, and 60,000 people died from an overdose in 2016.
Expanding access to medication-assisted treatment is one of the top recommendations of President Trump’s commission on combating the opioid crisis, which he declared a public health emergency last month.
Dr. Volkow expressed optimism that commission’s recommendations — which include expanding insurance and Medicaid coverage for treatment — will help stem the crisis.
“So the barriers of limited access to medication as well as lack of coverage, hopefully will be helped by this declaration of emergency,” she said.
What’s more difficult to overcome, she said, is the misconception that medication-assisted treatment, like methadone or buprenorphine, is just trading one addiction for another.
“That basically represents lack of understanding about how these medications work,” she said. “But that stigma is one of main barriers that has limited the delivery of treatment to patients.”
The social stigma of addiction, however, has started to change because of it’s prevalence.
“I think that one of the issues that have been forced by the crisis is recognizing how widespread addiction is,” said Dr. Volkow, an award-winning psychiatrist. “It has also forced our country to see that addiction is not just a disease of the other — those that are different than me — but is actually a disease of all of us.”
• Laura Kelly can be reached at lkelly@washingtontimes.com.
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