Docs advocate fighting opioids with opioids

Medication-assisted treatment doctor advocates visited Havre Monday to put on multiple presentations praising the benefits of opioid antagonists to treat people with opioid addiction.

Twenty medical professionals in all of Montana are legally allowed to use opiates like Methadone, Naltrexone or Buprenorphine to treat people with opioid addiction, said Dr. Bruce G. Trigg.

Bullhook Community Health Center, said a clinic representative, has two employees wavered to administer opioids.

Trigg, a native of New York, began the presentation describing how the opioid epidemic began and how large the problem has become.

It started with "over- and mis-prescription" of opioid painkillers, he said. Reasons doctors over- and mis-prescribed opioids include industry greed, as well as laziness and naivete on the part of doctors.

Pain is subjective. Trigg said he recently attended two talks. One speaker said 102 million people reported they were in pain and the other speaker said 160 million Americans report they are in pain. It's unclear, Trigg said, if people are in emotional or physical pain, or both.

As blurred as the real cause for people's suffering may be, one thing that's for sure is there's a problem, Trigg continued.

Dr. Greg Holzman, who accompanied Trigg, cited statistics about Montana's drug problem.

Drug overdoses are the third leading cause of injury-related death in Montana, accounting for 1,334 deaths between 2003 and 2014; Montana's data mirrors the national average at 5.4 per 100,000 people who overdose and die on opiates from 2013 to 2014; and since 2,000, more than 700 Montanans have died from an opioid overdose.

"This is a crises," Trigg told the small crowd in Bullhook's Jon Tester Room.

One of the things needing to be done to address opioid addiction, Trigg said, is switching from treating it as a criminal justice issue to looking at it as a medical issue.

"People don't hate people with spleen disease, but they do for addiction," he said. "It's the only disease people go to jail for their symptoms."

In fact, he would later add, opioid antagonists are anti-crime drugs, citing a SAMHSA graph that showed crimes such as drug dealing went from 16 percent to 1 percent after 30 days. In that category, in six months, the number of those who went back to drug dealing was 3 percent.

Addiction, "a brain-centered disease whose symptoms are behaviors" is something one has no control over, Trigg said. And it's time to start treating it like every other disease is treated, with medicine.

"These are people with a disease that meets every criteria of a disease."

To fight this epidemic, it's important to prevent people from starting drugs, reduce opioid addiction by providing access to medication-assisted treatment and reversing overdoses with things such as naloxone, Trigg said.

"Everyone using high-dose opiates should have in their house a kit of naloxone, he said," adding that it reduces opioid overdose by 95 percent.

A great portion of the 4 o'clock presentation was dedicated to praising one specific opioid antagonist, Buprenorphine.

"It's as close to a perfect treatment as you can get."

Buprenorphine, an opioid often sold in the streets, was approved by the Food and Drug Administration in 2002. Physicians are required to complete eight hours of training to administer it and they can treat up to 30 patients a year. Naloxone is usually added to discourage injection.

Buprenorphine is said to prevent drug withdrawal, block or diminish the effects of other opioids, and prevent cravings that continue for some people after detox.

Buprenorphine, Trigg said, is a drug many in the law enforcement community are concerned about. However, Buprenorphine has a threshold for how high someone can get, making it "almost impossible" to overdose on. Also, Trigg said, a lot of illegal use is for self-medication that leads to treatment entry.

Trigg cited, via PowerPoint, a few studies to support that medication-assisted treatment works. A study published in Lancet in 2003, shows that of 40 heroin addicts, 70 percent were still on Buprenorphine after a year and none had died. The treatment includes counseling. With the placebo - in that same study - after a year, 0 percent were still on it and 20 percent had died.

A 2003 study reported by The New England Journal of Medicine, showed that, after six months of medication-assisted treatment, 57 percent of participants were still on Buprenorphine. A 2006 study by the Journal of General Internal Medicine shows that after one year, patients were still in treatment, using Buprenorphine.