Yesterday morning, I was seeing patients with a colleague of mine, a physician and medical director of a large clinic providing medical care to residents of an impoverished section of Washington DC. Four patients came in being managed for hepatitis C infection and one of these patients was also HIV-infected. The good news is that the patients who had been treated for hep C infection had been cured with their medicines.
More good news is that the patient who also was HIV infected was controlled on her medications with no detectable virus in the blood. For all these patients, the major risk factor for their infections was injection drug use of heroin. Most of them were still struggling to control the addiction. In addition, another person came to the clinic in opioid-withdrawal seeking medical intervention.
So what are the options for treating opioid addiction? Are there medicines we can use, and if so, how do they work?
The main way that opioid addiction is managed with medication is through what we call substitution therapy. We are going to substitute the abused drug (e.g. heroin) for another opioid-related drug with a profile that may allow us to control the addiction and eventually stop the craving for the drug altogether. It’s similar to how we treat smoking, which is nicotine addiction, with nicotine replacement (an article coming up soon!).
Recall in the previous article I mentioned that heroin was a short-acting intravenous opioid, not that different from morphine. Injecting or snorting the drug produces an intense high but it only lasts a short time. After a few hours without the drug, the person starts feeling uncomfortable and needs more drug.
So the person spends their