Dr. Hernandez has provided a three-part series on opioid use disorder, alcohol use disorder, and Kratom use as well as treatment options and first steps to take.
Jul 12th, 2019
Are you or a loved one struggling with abuse and dependence on substances such as opiates or alcohol?
Have you recently experienced a hard time as a result of substance abuse such as the loss of a job or difficulty managing all of your responsibilities?
Drug and alcohol addictions are such prevalent issues and yet, can often be a taboo subject to address. People are often unsympathetic and impatient and often don’t understand the struggle involved. Sometimes all we need is someone who understands the complexities of the issue and an open ear to listen, and an offer to help. Dr. Hernandez, a board-certified psychiatrist here at CPCH, has created a three-part series detailing helpful information of the addiction to three common substances often experienced: opiates, alcohol, and Kratom. She has artfully explained critical information regarding the origination and use of these substances as well as information on treatment and medication management for overcoming an addiction to these substances.
The following information is provided by Dr. Hernandez who has significant experience treating mental health and substance abuse issues and knows the path to effective treatment. Have a look for yourself to see the ways that Opioid use can affect your life as well as your friends and family.
Opioid use disorder treatment
The goal of treatment is to engage the patients in long term recovery. Decreasing risk for overdose and improving physical and psychological health.
There are two treatment modalities:
1-Detoxification followed by therapy (intensive outpatient, or rehabilitation). This modality of treatment should not be the first line as the risk of relapse is about 90% in 3 months. The patient’s risk of OD significantly increases as tolerance for opioids is lost very quickly (within a few days)
2-Medical assisted treatment of opioid use disorder is the first-line treatment for opioid use disorder.
There are 4 medications that are FDA approved for the treatment of opioid use disorder
-Oral naltrexone and naltrexone IM
Methadone is a full mu-opioid receptor agonist. It was introduced for the treatment of opioid abuse in 1964. Over the years treatment with methadone has demonstrated superiority to treatment without medications. 85% of the patients remain in treatment at 3 months. It also decreases risky health behaviors and crime.
Methadone is only available at Methadone clinics where patients are seeing daily for medication administration. Adherence to this type of intensive treatment is very difficult for patients who lack transportation, lived far away from a treatment center or lack of time and financial resources to visit the facility daily.
Buprenorphine is a partial mu agonist and a kappa antagonist. It activates the mu receptors at lower levels making it less reinforcing and decreasing its risk for abuse. Kappa antagonist has shown to decrease dysphoria. It has a ceiling effect making almost impossible to OD on it (minimal risk of respiratory depression) and it causes less physical dependence. Buprenorphine has a very high affinity for the mu receptor it is very hard to displace it from the receptor by other opioids. Buprenorphine is a much more convenient treatment as it requires less monitoring, is more accessible easily prescribed by physicians or extenders as an office-based treatment.
Naltrexone is an opioid antagonist that blocks the reinforcing effects of opioids. It is available in oral and intramuscular (monthly injection) form.
Naloxone or Narcan is given to patients to reverse respiratory depression caused by opioid overdose. Narcan can be bought in pharmacies without a prescription.
Have you been considering treatment but don’t know where to begin? Visit our blog at https://dev.cognitive-psychiatry.com/blog for more information regarding these substances and the most specific and effective treatment methods for each substance.
Give us a call at 919-636-5240 to set up an appointment. Let us help you get better, faster.
Andrea Hernandez, MD, is a board-certified psychiatrist at Cognitive Psychiatry of Chapel Hill, North Carolina. Fluent in both English and Spanish, Dr. Hernandez treats adult patients with mental health and substance abuse disorders.