Medication May Have Saved Cory Monteith

August 12, 2013

SuboxoneFollowing the tragic death of Cory Monteith, the media has paid a lot of attention to opiate abuse, mostly noting increases in prevalence as well as some terrible, tragic outcomes. One important piece of information however, seems to be missing from all of the media coverage: there are medications that would have significantly increased the odds that Mr. Monteith (and countless other people) would be alive today.

One such medication is Naltrexone (an injectable form that lasts a month is called Vivitrol). This medication is an opiate antagonist that blocks the binding of opiates in the brain (in other words, there is no euphoric effect or “high”) and reduces risk of over dose.  People taking naltrexone have no motivation to use opiates because of this “blocking” effect.

The other important medication in the treatment of opiate abuse is Buprenorphine, more commonly known as Suboxone, which is a “maintenance” medication (opiate agonist). This medication (along with methadone) is described as “maintenance” because as an opiate itself, it has repeatedly been shown to be most effective when taken over a long duration, sometimes years, and “maintains” the person on a legal, long-acting opiate. As a maintenance medication, it significantly reduces cravings and allows people to have the mental and physical energy to focus on putting their lives together without the strain of constant cravings states. While Suboxone works in a similar way as methadone, it can be prescribed by a physician in a private office.  It is also often used to help get people get off of opiates and help with the withdrawal symptoms associated with that process (detoxification).

Several well-known rehabs and substance abuse clinics advertise their use of Suboxone in this latter respect, to help get people off of opiates in a comfortable and safe manner. They also proudly advertise that they don’t support anyone leaving their facility on a prescription (maintenance dose) of Suboxone.  While they note the benefits of leaving “substance free,” they minimize the fact that many opiate abusing clients are at significantly increased risk for death due to overdose upon their release.

In a 2011 study, Weiss, et al. looked at the outcomes of participants treated with buprenorphine.  In the first phase of the study, opiate dependent participants were given buprenorphine for 2 weeks, and then were tapered off over 2 weeks (a relatively rapid tapering, similar to what happens in a detox at rehab) and followed up with for an additional 8 weeks.  This rapid taper use of buprenorphine resulted in only 6.6% of those treated remaining abstinent from opiates 8 weeks after the taper; over 93% of the participants had relapsed back to opiate use within 2 months.  In the second phase of the study, participants were given buprenorphine for 12 weeks as a maintenance medication.  At the end of that 12 week “on medication” period, 49.2% of the participants were abstinent from illicit opiates.  These clients then completed a 4 week taper (somewhat more gradual than the first group) off of the medication and were followed up 8 weeks later.  Again the rate of abstinence fell, this time to 8.6% (or over 91% having relapsed to opiate use). These results were essentially the same whether participants received counseling and medication during the study or medication only.  The take away?  People struggling with opioid dependence who stay on opiate maintenance medication have significantly better outcomes (remember, 49% compared to 6-9%), than people who are tapered off, most of whom have relapsed back to opiate use within a very short 2 months.

We are not suggesting that every opiate abuser get on a maintenance medication for the rest of their lives.  We are, however, encouraging people who struggle with opiate use (and their families) to insist that their treatment providers, doctors, and psychiatrists examine the most current evidence and rethink their stance on these life-saving medications.

No one would recommend that people stop wearing seat belts (a clear and obvious life-saving device) because it’s a “crutch” that keeps one from learning to drive safer and avoid accidents.  Doctors do not withhold blood pressure medication because diet and exercise can do the same thing.  In the substance use treatment world however, many people are encouraged to get off of medications that may save their lives so that they can be “substance free.”  A change in attitude and proper use of opiate medications will save many lives, and they may well have saved Mr. Monteith’s.

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