By Brent Boyett, D.O., D.M.D.
In the quest for effective treatment of opioid addiction, it is important that doctors focus not only on providing behavioral support but also medication treatment. This was one of the key messages recently presented to a Congressional subcommittee by a range of medical experts, including Nora Volkow, MD, director of the National Institute on Drug Abuse, and Michael Botticelli, director of the Office of National Control Policy, according to a report on MedPage Today. The hearing witnesses generally agreed that medication combined with behavioral support has been shown to be the most effective treatment for substance use disorders including opioid addiction, yet despite the strong evidence, less than 40 percent of those receiving treatment for opioid addiction are treated with medication.[i] According to research cited by the National Institute on Drug Abuse, the relapse rate for people treated for substance use disorders ranges between 40 to 60 percent. Treatment approaches therefore must be tailored to address each patient’s drug use patterns and drug-related medical, psychiatric and social problems.[ii],[iii] Ensuring that patients are ideally equipped to meet these challenges is a multidimensional problem. Two of the most important approaches to addressing it involve the nature of the medication given to the patient and the resources he or she is presented with outside of the doctor’s office.
Regarding the first of these approaches, ease of use is vital to ensuring that a specific medication is taken as directed over a course of treatment. Buprenorphine and naloxone became the first medications to be approved and affected by the Drug Addiction Treatment Act (DATA-2000), the law passed by the U.S. Congress in 2000 that allows physicians to become eligible to prescribe specially approved opioid-based medications specifically for the treatment of opioid addiction.[iv] Serious attention has subsequently been paid to the design of treatments delivering these compounds to patients.
For example, BioDelivery Sciences’ Bunavail (buprenorphine and naloxone) buccal film is the first FDA-approved formulation of buprenorphine and naloxone for buccal administration. This drug was designed using an advanced drug delivery technology known as BioErodible MucoAdhesive (BEMA). This bioerodible polymer film for application to the mucosal membranes allows for the efficient delivery of buprenorphine while potentially overcoming some of the administration challenges presented by sublingual dosage forms. Bunavail has twice the absorption of buprenorphine compared to the market leader in this category; naloxone is included as an abuse deterrent. As a result of the improved absorption of buprenorphine, which is a result of the BEMA technology, plasma concentrations of buprenorphine can be achieved with half the dose, which may help to reduce the potential for misuse and diversion of the drug.
Each piece of BEMA film consists of a bilayer water-erodible mucoadhesive layer with active drug, with a water-erodible polymer backing layer. The backing layer of the buccal film helps facilitate the one-way flow of medication. The printed mucoadhesive layer is placed on the inside of the cheek; saliva moistens the layer, causing it to bond with the mucous membrane. The medication is subsequently released and diffuses into the cheek’s blood vessels. The medication is then carried throughout the body by the circulatory system. The film adheres to the oral mucosa in seconds and completely dissolves inside the mouth. The buccal format presents several advantages for patients. Unlike Suboxone (buprenorphine and naloxone), it does not need to be kept in place under the tongue, so it is more convenient for patients to talk, swallow and go about their normal daily activities. The BEMA technology also allows twice as much drug to be absorbed, meaning the same effect is obtained with half the dose. It also means less drug is swallowed, which has been shown in studies to reduce the incidence of certain side effects such as constipation.
Effective treatment continues beyond medication therapy by presenting the patient battling opioid dependence with an array of easily accessible resources and information. One such novel support program is called InReach. The program consists of a website and a mobile app that offer a comprehensive array of features to support patients and their families. InReach offers tools to use at all stages during the addiction recovery process, including a series of downloadable charts to record personal goals, moods and emotions, triggers and treatment history. Users of the app can also keep a record of the appointments they have attended, commemorate each small success on the road to recovery and create personal pinboards with motivational messages and photos.
Numerous resources and information can also be found on the InReach website, including detailed definitions and facts about opioids, opioid dependence and treatment options; a primer on coping with triggers (i.e. the factors that can lead to opioid misuse); and insights on the causes of relapse and resources for setting and achieving goals. Additional features include tips for getting and staying motivated throughout the recovery process, information specifically for family and friends, a resource section with links to the websites of several recovery organizations, and inspirational quotes and testimonials from individuals who have completed recovery. InReach is not intended to substitute professional medical advice or to be used as a diagnostic or treatment tool.
Putting the needs of patients who are seeking recovery from addiction first—and providing them with a medication that suits their lifestyle along with other support resources—will go far toward maximizing the chances that a course of treatment is ultimately successful.
Brent Boyett, D.O., D.M.D. is dually trained and practices both Family Medicine and Family Dentistry at Boyett Health Services, Inc. in Hamilton, AL.
[iii] McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000 Oct 4;284(13):1689-1695.