Charter Health’s Addiction Medicine practice has helped many people with substance abuse. The service focusses on opioid addiction and alcoholism. Helping our patients overcome addiction has proven extremely rewarding to the Charter team. We are fully credentialed to prescribe buprenorphine, buprenorphine/naloxone (Suboxone), oral naltrexone, and injectable naltrexone (Vivitrol).
Charter offers a multidisciplinary approach to help each patient get clean, stay clean, and live well. Our experience in behavioral health frequently proves important as the underlying cause of substance abuse was often stress, depression, anxiety, and pain. We will engage other specialists across the Mass General Brigham system as needed and with your input, including a recovery coach, social worker, psychologist, and psychiatrist.
At your first visit, we will take an in-depth medical, behavioral, and social history as we seek to understand you as a unique individual and identify the factors that led to your addiction. We will identify your support systems (i.e. family, significant other, friends) and we will start to define goals for recovery and your long-term aspirations in life. A treatment plan will be put in motion.
Opioid Deaths in the United States
Opioid abuse and the associated risk of death is a public health emergency in the United States. Approximately 70% of all overdose deaths in the last 5 years have been from opioids. Deaths from synthetic opioids such as Fentanyl have dramatically increased since 2013 and now account for twice as many deaths compared to other opioids. Many deaths from fentanyl are from illicitly manufactured fentanyl from other countries that are sold on the street as heroin.
Medications for Opioid Use Disorder
Most patients with opioid use disorder (OUD) are started on medication to help control cravings. The most common medication we use for OUD is Suboxone. Suboxone is a sublingual film (under-the-tongue) that contains buprenorphine and naloxone. Buprenorphine is a partial opioid agonist that binds to opioid receptors in the brain to relieve or prevent withdrawal symptoms. Naloxone is an opioid antagonist that acts as a deterrent to using opioids.
Vivitrol is the preferred option for some patients with OUD. Vivitrol is the long-acting injectable form of naltrexone. It is administered monthly and is slowly released into your system. Naltrexone is not an opioid, but it does bind to opioid receptors in the brain to help suppress cravings for heroin, fentanyl, oxycodone, and other opioids. As it is not an opioid, there is no abuse potential with naltrexone. A patient must be off opioids for at least 7-14 days before starting naltrexone in order to avoid a painful withdrawal syndrome. For this reason, we often start with daily administered oral naltrexone for a few days prior to injecting Vivitrol.
Vivitrol for Alcoholism
For medical therapy of alcoholism, our first-line medical therapy is usually Vivitrol. Vivitrol is described above. How Vivitrol works to reduce cravings for alcohol is not clear, but it most likely relates to its binding of the brain’s opioid receptors. Importantly, the patient cannot be on chronic opioids and Vivitrol at the same time. Otherwise, the injection of naltrexone will potentially result in painful withdrawal syndrome.
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