Development of Safer Medications The development of effective, nonad-


dicting pain medications is a public health priority. A growing number of older adults and an increasing number of injured military service members add to the ur- gency of finding new treatments. Research- ers are exploring alternative treatment approaches that target other signaling systems in the body such as the endocan- nabinoid system, which is also involved in pain.59 More research is also needed to better understand effective chronic pain management, including identifying factors that predispose some patients to substance use disorders and developing measures to prevent the nonmedical use of prescription medications.


HOWCAN PRESCRIPTION DRUG ADDICTION BE TREATED?


Years of research have shown that substance use disorders are brain disorders that can be treated effectively. Treatment must ust take into account the type of drug used and the needs of the individual. Suc- cessful treatment may need to incorporate several components, including detoxifica- tion, counseling, and medications, when available. Multiple courses of treatment may be needed for the patient to make a full recovery. The two main categories of drug ad- diction treatment are behavioral treat- ments (such as contingency management and cognitive-behavioral therapy) and medications. Behavioral treatments help


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www.RobinhoodIntegrativeHealth.com Elizabeth Bozeman, MD


Dr. Elizabeth Bozeman is a Board Certified Family Physician. She is also board Certified in Preventive, Holistic and Integrative Health. She trained at the Mayo Clinic and has been practicing for 15 years. She has a passion for helping people get better using a more natural and holistic approach. She helps patients with balancing hormones, thyroid function, fatigue and offers prolotherapy for musculoskeletal injuries.


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patients stop drug use by changing un- healthy patterns of thinking and behavior; teaching strategies to manage cravings and avoid cues and situations that could lead to relapse; or, in some cases, providing incentives for abstinence. Behavioral treat- ments, which may take the form of indi- vidual, family, or group counseling, also can help patients improve their personal relationships and their ability to function at work and in the community. Addiction to prescription opioids can additionally be treated with medications including buprenorphine, methadone, and naltrexone. These drugs can counter the effects of opioids on the brain or relieve withdrawal symptoms and cravings, help- ing the patient avoid relapse. Medications for the treatment of addiction are admin- istered in combination with psychosocial supports or behavioral treatments, known as medication-assisted treatment (MAT).


Medication-Assisted Treatment (MAT) Naltrexone is an antagonist medica-


tion that prevents other opioids from bind- ing to and activating opioid receptors. It is used to treat overdose and addiction. An injectable, long-acting form of naltrexone (Vivitrol®) can be a useful treatment choice for patients who do not have ready access to health care or who struggle with taking their medications regularly. Methadone is a synthetic opioid ago-


nist that prevents withdrawal symptoms and relieves drug cravings by acting on the same brain targets as other opioids such as heroin, morphine, and opioid pain


medications. It has been used success- fully for more than 40 years to treat hero- in addiction but is generally only available through specially licensed opioid treat- ment programs. Buprenorphine is a partial opioid agonist—it binds to the opioid receptor but only partially activates it—that can be prescribed by certified physicians in an office setting. Like methadone, it can re- duce cravings and is well tolerated by patients. In May 2016, the U.S. Food and Drug Administration (FDA) approved the NIDA-supported development of an im- plantable formulation of buprenorphine. It provides 6 months of sustained treat- ment, which will give buprenorphine- stabilized patients greater ease in treat- ment adherence. There has been a popular misconcep- tion that medications with agonist activity, such as methadone or buprenorphine, replace one addiction with another. This is not the case. Opioid use disorder is as- sociated with imbalances in brain circuits that mediate reward, decision-making, impulse control, learning, and other func- tions. These medications restore balance to these brain circuits, preventing opioid withdrawal and restoring the patient to a normal affective state to allow for effective psychosocial treatment and social func- tioning.


While MAT is the standard of care for treating opioid use disorder, far fewer people receive MAT than could poten- tially benefit from it. Not all people with opioid use disorder seek treatment. Even


Elizabeth Bozeman, MD


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