Sunday, April 16, 2017

Bad Solution #2: Aversion Therapy

Another flawed solution to this "opioid epidemic" is born out of good intentions, and it is the one at the top of the FDA's list of solutions to the problem. It involves making prescription opioids "unappealing" to those solely interested in the euphoric component and "getting high."

Naltrexone and naloxone are two medications that are used in addiction recovery. Both of these drugs work in the body to directly counteract the effects of opioids. These and other similar medications are now often being paired and manufactured with opioids. They can be formulated so that, when the opioids are taken "properly" they will pass through the individual and eventually be harmlessly purged through urination and perspiration. These are prescribed for those feeling pain and work just as effectively as the traditional opioid-only prescription medications. If, however, the medication is misused--like when a pill is crushed for snorting or for processing into an "injectable" form--the opioid-blocker part of the medication kicks in. Although manipulating the medication in this way would normally increase the speed at which the opioid is metabolized and increase the speed and intensity of the euphoria experienced by the user, the "partner" in this medication tandem prevents the opioid from working altogether, and can actually induce the unpleasantness of withdrawal effects.

The downside here is that the medication must be inappropriately manipulated in order for the opioid blocker to activate. There is nothing to stop someone from keeping the medication in tact and then still overdosing on the medication in its natural form. This idea is, however, being touted as the best solution to this opioid epidemic as though any attempt to abuse the medication will prevent it from working, but it must be misused in a very specific way for this solution to work. In short, it prevents misuse, but not abuse, of the medication.

The alternative would be to find a way to manufacture a drug that prevents abuse which is a far greater problem than the misuse I was just describing. "Antabuse" (not kidding, that's its name, but the generic drug is called Disulfiram) is a drug that has successfully been used to help alcoholics shake off any "desire" they might have to drinking. This medication creates the nauseating effects of binge drinking every single time a person drinks. The premise is simple, have the brain either associate something negative (like nausea, vomiting, and a headache) with the intake of certain substances. It is a very effective program, and certainly, something similar could be developed to pair with opioids, like ipecac that would make a person violently ill every time they took the opioid. However, the downside with this tandem is that you have to take it voluntarily and only a person who wants to avoid the euphoria and break their own desires for that "high." Obviously, it would have no appeal for those legitimately taking opioids for pain relief. It would only serve those who have made a conscious choice to associate the effects of opioids with something negative.

Neither of these options are good options in the sense that one (the first) operates completely on a principle of distrust and the other only works in an environment of total trust.

The net result of these approaches, and, to repeat, the first one is being touted by the FDA as the best solution to this current societal problem, is that it treats all opioid users, including the predominant users who are in genuine pain, as the criminals responsible for causing the problem. And yet, the worst of it is the reality is that anyone intent on abusing opioids can still freely do so.

Next post "Bad Solution #3: Just Deal with It," will be published on or about April 30, 2017.

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