The opioid epidemic has affected us all in some way. Perhaps it’s a distant relative or a close friend, or maybe it touches even closer to home, such as a spouse, son or daughter, locked in a lethal tug-of-war with the disease of addiction. It’s one thing to read headlines and news stories about what is now being called “the opioid epidemic,” but when the disease sinks its teeth into someone we love, the epidemic becomes alarmingly real.
Despite state and national efforts to battle the opioid abuse and addiction, these powerful pain-relief drugs—some illicit, some legal but illegally abused— continue to tear apart families and disrupt lives, from the gentrified streets of Philadelphia neighborhoods to the most posh neighborhoods of Bucks County and the Main Line, and from homeless high school dropouts to highly paid doctors, lawyers and CEOs.
Addiction often begins with prescription painkillers in the aftermath of a surgery or an injury, or perhaps it starts as a purely recreational pursuit. But when the pills are no longer accessible or too costly, many turn to a more insidious master, the street drug heroin.
“It’s the mother of all narcotics—easy to get, inexpensive and incredibly addictive,” says Dennis J. Bonner, M.D., a physician with the Industrial Health Care Center in Levittown. “A lot of people see heroin as some distant problem, something you can find only in the worst neighborhoods, but it’s everywhere. In Levittown 30 years ago, a hit of heroin would cost $30. Guess what it is today: $3.”
A Waking Monster
Distilled from the opium poppy, heroin can be smoked, snorted or injected intravenously, the last of which offers the fastest route to the high. Heroin addiction causes severe cravings that urge the user to seek it out relentlessly, and the user feels compelled to do “whatever it takes” to acquire their next “hit.” Addiction to the drug is highly injurious; it not only causes neurochemical and molecular changes to the human brain, but it also exposes the user to a number of life-threatening diseases and conditions, ranging from HIV and hepatitis to liver disease and seizures.
Another all-too-common side effect: death. Chasing a high can lead to fatal overdoses, especially with the influx of heroin laced with the immensely powerful pain medication fentanyl. In 2016, Pennsylvania coroners and medical examiners reported more than 4,600 drugrelated overdose deaths, an increase of nearly 40 percent over the year prior, according to the U.S. Drug Enforcement Administration.
“With heroin, there’s a monster in your head,” says Dr. Bonner. “If it wakes up, it means to kill you and destroy everything you hold dear.”
Although many who want to “live clean” have sought out treatment through inpatient and outpatient detox and rehabilitation centers, overcoming the disease can prove quite difficult. Some people require multiple attempts, in and out of treatment centers, usually at considerable expense—as much as $2,500 a day, according to Dr. Bonner—before the treatment takes root, if it does at all.
Dr. Bonner says one innovative form of medication-assisted rehabilitation— Suboxone—has proven remarkably effective in treating opioid dependence. He cites a National Institutes of Health study, showing that more than 70 percent of patients who have taken Suboxone after one year have succeeded in breaking addiction’s hold on their lives. By comparison, his research finds that less than 10 percent of patients succeed when they opt for traditional detox/rehab treatment without supplemental medication.
“If you look at the numbers of people who take one tablet of Suboxone two to three times a day, there’s a good reason why it’s effective: Suboxone stops the cravings—the feeling that you have to have a hit or otherwise you’ll lose your soul,” he says. “If a patient comes into my office and they haven’t had a hit of heroin for 12 or 15 hours, they’re not feeling well—they’re dope sick. If that same person takes a tablet of Suboxone, 20 minutes later he’s feeling better and the cravings have stopped. He’s essentially rehabbed and detoxed.”
Returning to Normal
The U.S. Food and Drug Administration approved Suboxone—a combination of two drugs, buprenorphine and naloxone— for medical use in 2002. The opioid buprenorphine attaches to the same receptors as other opioids, meaning it can help to suppress withdrawal symptoms and reduce cravings. Naloxone, meanwhile, essentially blocks or minimizes the effects of the opioid to prevent it from being abused.
Dr. Bonner carefully monitors each Suboxone patient to oversee his or her progress, as well as to prevent any interactions with other medications the patient may be taking. Even so, a patient’s recovery doesn’t begin and end with Suboxone. Dr. Bonner also prescribes necessary lifestyle adjustments and directs patients to participate in other therapeutic modalities, such as psychosocial group therapy.
“A physician who administers Suboxone has to be a physician primarily, not a pill dispenser,” he says. “With every patient, you have to get inside the person’s head to see how they’re doing, to ask if they’re having any cravings, and to make sure they’re going to their support meetings. The meetings won’t help with the addiction, per se, but they are a great way to rid themselves of any emotional baggage that people have accumulated as a result of their struggles with addiction, so it can improve their state of mind.”
In other words, with the right motivation and monitoring, the treatment can help to restore the promise of a normal life.
“The program prevents people from doing things they might have done to feed the habit that they’re not very proud of,” he says. “Now they’re off the street, back with their families, getting their work lives back in order. In its essence, it gets them back to being a functioning member of society.”
Although currently available only in oral form, Suboxone will soon be available as a monthly shot to be administered by a qualified physician. At present, most insurance companies cover the cost of the medication, though Dr. Bonner says some insurance providers have decreased the amount of treatments they will cover. Some patients choose to pay for the medication out of pocket as a way to protect their privacy.
“Suboxone puts the monster to sleep,” Dr. Bonner says. “The ultimate goal is to be free of medication, but the most important thing is that they’re on the road to recovery. It’s the first step to reclaiming your life.”
The Industrial Health Care Center Rehabilitation and Occupational Specialists
1854 Veterans Highway