There is a disturbing trend going on that you may have heard about. People wanting to feel more energized, more upbeat, and less stressed out from their busy lives. They start their morning with a cup of coffee and a prescription narcotic pain killer call oxycodone. Well, soon they find themselves addicted, and with a much more serious problem.
Joining me now is doctor Stuart Kloda. He is an Addiction Medicine physician here in New York City.
So let’s talk about the kind of people that you treat, people thought of as not your usual addicts.
Yes, they are a subset of people who are addicted to oxycodone. They are professionals and working people. People that are coming in for treatment while they still have intact families, jobs, and careers. So they realize that they are starting to have a problem, and they come in before things get really bad.
So when we are talking about oxycodone, we are talking about a prescription narcotic that these people are hooked on?
It is a prescription narcotic, correct, although most of the patients that I treat do not obtain the oxycodone by prescription, becuse they really want to be discrete and not be found out.
So what’s going on here, what’s at stake for these people once they start doing this? They are ruining their lives, no?
Right, so it starts to head in that direction. So initially, people that are addicted to opioids, it actually causes them to feel energized, with a mood lift, less anxiety, and a buffer against pressure. That works ok for awhile, but eventually they need higher and higher doses, and they do not get the positive benefits, they get the negative effects from it.
Alright, so they’re taking more and more doses, but it just doesn’t given them what they want. You treat some of these people with a drug called Suboxone, tell me about that.
Well, Suboxone is known as opioid agonist therapy. It’s a different type of opioid, than, say, oxycodone. It works much differently. It doesn’t cause intoxication when taken at correct dosages, and you don’t need to take an escalating dose, and the psychological benefits from it are where people return back to normal. People basically say that once they start taking it, they feel fine, not intoxicated.
So are you though substituting one opioid for another? Kind of like methadone is given to heroin addicts? Are we doing that here, is that the same thing, or no?
Well, you are substituting one opioid for another, but the question that a lot of people have is are are you substituting one addiction for another? And the answer is definitely no. With addiction, it can be defined, in part, by having the inability to stop using drugs and alcohol despite negative consequences, as well as causing dysfunction in one’s life. With Suboxone you are actually getting the opposite. You’re returning somebody back to functionality, and that is the opposite of addiction.
Okay, so then do these people get on Suboxone for a long period of time, or is it something that you’re on for just a short period of time, or does it vary from person to person?
It varies from person to person, and that’s the thing about addiction treatment, it should be individualized.
Now do you have to see a specialist for something like this, or is this something that someone like you manages? What are the restrictions on this?
Basically, the restrictions are any physicians can apply for the special license to prescribe it. When you have an area like New York City, where you have a high concentration of physicians, it’s best to go to somebody who is trained in addiction. But, Suboxone is also being prescribed by primary care physicians, and depending on where you are in the country, that might be the only physician that you are able to go and see, and that’s fine also, because it’s better then overdosing, for example.
Right, now there’s been some issues, some bad press about Suboxone. There’s problems with abuse potential and things like that. Talk to me about that and some other restrictions on this medicine.
Well, there’s an article in the New York Times that highlighted the negative aspects of Suboxone, and the problem with that article is that that’s really what it did, it highlighted all of the negative aspects, and what it seemed to ignore, or touch on just kind of briefly, that there are many many many people who have benefited from this medications. They’re not overdosing, they’re doing better in school, they’re getting higher grade point averages, they are getting promoted at work, they’re making more money. Their family relationships have improved. These are things that I see consistently in patients that I treat.
Now, who would be a candidate for this? Would you say pretty much anybody who’s got this oxycodone addiction, or any kind of opioid addiction? How do you break down who’s a candidate for the Suboxone?
Well, most people are candidates for opioid agonist therapy. You do need to decide the setting that the Suboxone is prescribed in, whether it’s a solo private doctor’s office such as what I have at Columbus Circle, and then on Wall Street in January. Or it could be at a facility where there’s closer monitoring, or even at a methadone program. Some of them are starting to dispense Suboxone as a daily dose, just like methadone, and there’s a lot of support there, and supervision.
Well, Dr. Kloda, thanks so much for shedding some light on Suboxone. Very interesting, and important for people, it’s a huge problem, prescription drug addiction. Thanks so much for coming in.