New Medications Continue to Revolutionize Opioid Addiction Treatment at VA

The problem of prescription opioid addiction is nothing new for U.S. military forces. It stretches back to the mid-1800s, when many wounded Civil War veterans became hooked on narcotics used to control their pain

This is a photo of the Wash. D.C., Sanitary Commission Rest House, taken between 1861 and 1869. Disabled Union servicemen received food, lodging and care here.

Addiction treatment often included a stay in a sanatorium or rest home and administration of small doses of opioids. Despite an extremely high relapse rate, addiction therapy didn’t improve much for the next 100 years.

Finally, in the last few decades, highly effective medications have become available and revolutionized the treatment of addiction. The VA now has the tools to help veterans control addiction and return to functional lives, experts said.

One challenge, according to clinicians, is getting patients to overcome the stigma of drug addiction and seek help. Another is an unexpected consequence of the successful drug regimens: Many patients misunderstand the process and think a quick cure is available.

Instead, it is more like a chronic illness for which treatment is a long-term, if not lifetime, process, pointed out Andrew J. Saxon, MD, director for the Addiction Patient Care Line at the VA Puget Sound Health Care System in Seattle.

“People don’t see opioid addiction as a chronic, relapsing condition,” Saxon said. “The body has undergone some extremely physiologic changes.” As in diabetes and other chronic diseases, “maybe sometime in the future you can get off medication if you do everything perfectly, but most people find it hard to do everything so perfectly.”

The importance of ongoing treatment for opioid addiction was underscored by a recent study finding that treatment with a buprenorphine-naloxone combination was most effective in decreasing dependency in patients addicted to prescription opioids when treatment was extended from two weeks to 12 weeks.

In the multisite trial of more than 600 opioid-dependent outpatients, success rates plummeted when treatment was tapered off, even in those patients receiving counseling, according to the study published last month in the Archives of General Psychiatry.

Daniel Kivlahan, PhD

Daniel Kivlahan, PhD, acting National Mental Health Program director, Addictive Disorders at the VA’s Office of Mental Health Services, said he sees the study as a “message to the treatment system.”

“If someone comes in and says, ‘Gosh, I would like to get off of this stuff,’ you really have to manage the withdrawal strategy,” according to Kivlahan, who added that, while counseling is an important part of the package, “medication is really a critical component.”

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