Buprenorphine/Naloxone Effective in Opioid Addicts With Co-Occurring Disorders
Buprenorphine and naloxone are two medications often used together to help individuals recovering from an addiction to opioid drugs or medications. A significant number of the people affected by an opioid addiction also have diagnosable problems stemming from a serious mental health issue such as major depression, bipolar disorder or an anxiety disorder. In a study published in March 2014 in The American Journal of Drug and Alcohol Abuse, researchers from five U.S. institutions sought to determine if the buprenorphine-naloxone combination still produces treatment benefits in recovering prescription opioid addicts also affected by a co-existing mental health problem.
Buprenorphine first entered use as an approved treatment for opioid addiction in the early 2000s. It belongs to the same family of substances as all commonly abused opioid drugs and medications (including heroin, hydrocodone, codeine, morphine and oxycodone). However, unlike those drugs and medications, buprenorphine only partially triggers the highly pleasurable brain sensations that constitute a key underlying factor in the eventual development of opioid abuse and opioid addiction. During addiction treatment, doctors can use the medication as a temporary or ongoing substitute for the opioid substance causing problems for any given individual. When used in this manner, buprenorphine helps the individual transition from uncontrolled substance intake to controlled intake or abstinence without exposure to severe symptoms of opioid withdrawal.
Although buprenorphine is less powerful than heroin or other common targets for opioid abuse and addiction, some people still attempt to abuse the medication instead of using it as prescribed by a physician. Doctors commonly offset the risks for buprenorphine abuse by simultaneously prescribing naloxone, an anti-opioid medication that can stop any opioid substance from reaching the brain. When given in the proper amount, naloxone strictly limits the window of effectiveness for buprenorphine while still giving the opioid medication enough time to produce a treatment benefit for recovering addicts. An FDA-approved medication called Suboxone contains a therapeutically balanced amount of buprenorphine and naloxone.
Opioid Addiction and Co-Existing Mental Illness
More than half of all people in the U.S. affected by substance abuse or substance addiction have diagnosable symptoms of some other serious mental health problem. Particularly common co-existing mental illnesses in affected individuals include bipolar disorder, major depression and anxiety-related conditions called panic disorder, agoraphobia, general anxiety disorder and social phobia (social anxiety disorder). In a study published in 2013 in the American Journal on Addictions, researchers from the Medical University of South Carolina assessed the rate of bipolar disorder, major depression and anxiety disorders in 85 people diagnosed with a dependence on a prescription opioid medication. Forty-seven percent of these individuals met the criteria for diagnosing one of the three listed categories of mental illness. As a rule, the people diagnosed with both addiction and another mental health issue had more severe problems than their counterparts not affected by another mental health issue.
Impact on the Effectiveness of Buprenorphine-Naloxone
In the study published in The American Journal of Drug and Alcohol Abuse, researchers from Harvard Medical School, McLean Hospital, the National Institute on Drug Abuse and two other institutions used information from 360 people to assess the effectiveness of buprenorphine-naloxone treatment in individuals recovering from prescription opioid dependence/addiction. In addition to opioid-related problems, 180 of the participants had a simultaneous diagnosis for some form of mental illness. All of the participants received a 12-week course of buprenorphine-naloxone as part of their treatment.
The researchers found that, compared to the men enrolled in the study, the women were about 60 percent more likely to have a simultaneous diagnosis for a co-existing mental illness. As a group, the participants affected by a co-existing mental illness had significantly worse problems upon entering treatment than the participants not diagnosed with another mental health concern. However, after receiving 12 weeks of combined buprenorphine and naloxone, they actually had opioid-related treatment results that were superior to the results obtained by those individuals only affected by opioid addiction.
The findings indicate that people simultaneously impacted by prescription opioid addiction and a co-existing mental illness do indeed benefit from buprenorphine-naloxone treatment. The study’s authors don’t know why simultaneously affected individuals may actually experience improved treatment outcomes. They point toward a need for further research to explore this finding in order to determine if it can be used in the development of improved treatment options for opioid addicts dealing with additional mental illness.