Another drug that is being prescribed more commonly in recent years for control of opiate addiction symptoms is buprenorphine, which has comparable efficacy to methadone. It comes in several forms–Buprenorphine and suboxone (a combination of buprenorphine and naloxone) and Subutex. A third medication, naltrexone, is not an opioid drug like methadone and buprenorphine. Instead, it blocks the effects of opioids such as heroin and morphine. People starting to experiment with opioids, and those in the early stages of addiction may benefit from naltrexone treatment; but unlike the other drugs, it is not of significant value in severe or chronic cases. Like methadone, naltrexone does not help addicts to stop drinking or from using drugs illicitly. It is relatively effective and safe, but not perfectly so.
Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and more recently opioid addiction. Under the brand name, Revia, Depade and an extended-release form, Vivitrol. For people who have stopped drinking, Naltrexone reduces the craving for alcohol, perhaps by affecting the neural pathways in the brain where the neurotransmitter dopamine is found. In the case of opiate addiction, Naltrexone works by blocking the effects of drugs like heroin and cocaine in the brain. As an opioid receptor antagonist, Naltrexone blocks the normal reaction of the part of the brain that produces the feeling of pleasure when opioids are taken. It is commonly prescribed for 12 months for opiate addicts trying to manage drug dependence; and like methadone, it should always be done under the direct supervision of a physician.Naltrexone side-effects include: upset stomach, nervousness, anxiety, or muscle and joint pain. Usually these symptoms are mild and temporary, but they can be more severe and longer lasting. Rarely, Naltrexone can cause more severe side effects including confusion, drowsiness, hallucinations, vomiting, stomach pain, skin rash, diarrhea, or blurred vision. Anyone experiencing any of these symptoms should notify their healthcare provider immediately. Large doses of naltrexone can cause liver failure manifested by: excessive tiredness, unusual bleeding or bruising, loss of appetite, pain in the upper right part of the stomach, dark urine, or yellowing of the skin or eyes; and anyone experiencing any of those symptoms should be seen by a healthcare provider immediately.
A medical advisory was published by the Utah Department of Health in December, 2012 warning care-providers about some of the hazards of buprenorphine, citing 246 deaths in Utah, alone, in 2011. While buprenorphine is considered to be an important and effective tool for the treatment of opiate addiction in opioid tolerant individuals, it, like, methadone is not without problems and hazards. State health departments now regularly send out warnings to medical providers about abuse of prescription drugs, and have all agreed that buprenorphine is becoming a problem related to its overuse and improper use. The Utah Poison Control Center reports that an average of 36 children are exposed to buprenorphine each year and have noted an increase of 34% in the last two years. Exposure by children can result in serious injury and even death due to respiratory depression. Pediatric exposure is particularly dangerous because of the nearly universal behavior of oral exploration during early child development.
The dangers in children occur when: a child mouths or sucks on a tablet, which is far more dangerous than simply swallowing the pill, because absorption is more rapid; the drug has the potential to cause delayed and persistent respiratory depression—for up to 24 hours after ingestion. The risk remains even if most of the pill is removed from the child’s mouth before it is swallowed; in children under age six years, the effects include drowsiness, vomiting, agitation, rapid heart rate, constriction of pupils, and–most importantly—respiratory depression which may be fatal.
Parents are urged to seek immediate medical help if a child puts a buprenorphine tablet in his or her mouth even if clinical symptoms have not yet appeared. Common sense precautions are recommended for patients who have been prescribed the drug to protect children: keep the drug out of sight, out of reach, and beyond the ability of children to get into the container, i.e., keep it in a locked box, heavy sealed bag, or a locked cabinet; make certain the drug remains in its original labeled container and that containers have child-resistant closures; if pills become separated from their labeled container, they should be discarded; no pill or pill container should ever be left out on a counter, sink, dresser, or nightstand even though that may suit the convenience of the adult; discard used drug film wrapping immediately into the trash and fold it in such a way as to make it very difficult for a child to get at the residue on the paper; do not store buprenorphine in pockets, bags, purses, etc. even for a brief period; and, finally, avoid leaving the drug in a bathroom, car, or any publicly accessible place. Drug addicts are known to steal and to try almost any drug, and they may be the source of exposing an innocent child to the poison.
