Hoffman’s Death Raises New Questions about Addiction Treatment Drug

Hoffman’s Death Raises New Questions about Addiction Treatment Drug

The death of Oscar-winning actor Philip Seymour Hoffman from an apparent heroin overdose is adding to fears from some addiction experts that a drug often used to treat opioid addiction — buprenorphine – may be contributing to addiction problems, not solving them.

Some in the pain patient community also worry that news coverage about Hoffman’s death could lead to further restrictions on access to opioid painkillers because they are perceived as “gateway” drugs to heroin.

Philip Seymour Hoffman

Philip Seymour Hoffman

Hoffman was discovered dead in his New York City apartment Sunday with a syringe in his arm. According to NBC News, investigators also found dozens of bags of heroin and six bottles of prescription drugs, including the addiction treatment drug buprenorphine – which is more widely known under the brand name Suboxone.

Hoffman did not have a prescription for the buprenorphine, according to investigators.

Buprenorphine is widely used to treat opioid addiction, but it is also a narcotic — prized by heroin addicts for its ability to reduce their withdrawal symptoms between highs.

Buprenorphine is so popular with addicts that it has turned into a street drug to be bartered or exchanged for money, heroin or other illegal drugs. According to one estimate, about half of the buprenorphine obtained through legitimate prescriptions is either being diverted or used illicitly.

“He (Hoffman) bought it from the street to control his withdrawal symptoms. That’s what happens to the vast majority of patients. They use Suboxone to control their withdrawal symptoms, but continue to use heroin to maintain their addiction,” says Percy Menzies, who is president of Assisted Recovery Centers of America, which operates four addiction treatment centers in the St. Louis, Missouri area.

Menzies uses Suboxone as a detox agent for patients in his clinic, but does not recommend it as a long-term medication for addicts. He likens it to using beer as a treatment method for alcoholics.

“We do not use addicting drugs to treat any other addictive disorder, but we are stuck in this complete insanity of using buprenorphine and methadone as the only treatment for opioid addiction. Small wonder, both opioid addiction and the treatment remains so stigmatized. The only people who benefit are the drug companies and the methadone clinics,” Menzies told National Pain Report.

Buprenorphine is most widely known under the brand name Suboxone.

Buprenorphine is most widely known under the brand name Suboxone.

But other addiction experts praise the benefits of buprenorphine and Suboxone.

“Because patients on Suboxone don’t keep taking more and more, they stay on a fixed dosage and over time, can even decrease the dosage. Their cravings stop, they return to work and renew their relationships with friends and family. In short, they get their lives back,” said A. R. Mohammad, MD, an associate professor at the University of Southern California’s Keck School of Medicine.

“There is no cure for addiction, as is the case with all chronic diseases. But when their disease is managed with effective, evidence–based medications over a lifetime, drug addicts – like diabetics – can live a normal, productive life. If nothing less, Philip Seymour Hoffman showed us that a person with the chronic disease of drug addiction can achieve greatness.”

Hoffman had spoken openly about his past substance abuse problems, saying he quit using drugs and alcohol while in his early 20’s. But early last year, the 46-year old actor had a relapse and checked himself into rehab for 10 days. He told TMZ that he was taking prescription medication, and his use escalated to heroin.

“We can’t speak to the treatment that Hoffman received, but we do know that he was addicted to opiates, most commonly known as prescription painkillers and heroin. Hoffman was one of the 100 opiate deaths that occur every day, and what’s all the more devastating is that these deaths are preventable,” said Steve Pasierb, President and CEO of The Partnership at Drugfree.org.

“It’s important to note that we are seeing a migration to heroin from prescription painkillers. More and more, these prescription medicines are harder to access and more expensive than heroin. By starting with greater awareness and action – like safeguarding our medicines and talking with our kids about the dangers of abusing prescription drugs – we will prevent more people from becoming addicted to heroin.”

Some pain patients worry that publicity surrounding Hoffman’s death will lead to new efforts to restrict access to prescription painkillers.

“The public in general has been brainwashed into lumping all drugs into the same problem. There are millions of us who use prescription opioids and painkillers legally. Mr. Hoffman’s demise is a completely different problem and one that should be addressed more by the DEA, instead of going after the legitimate patients and doctors,” said Dennis Kinch, a patient advocate and chronic pain sufferer.

“No one will look into the details and find out this has nothing to do with us. It is another case of people taking drugs illegally which they get from street dealers, not doctors, and who use them for recreational purposes, not clinical.”

In addition to buprenorphine, investigators also found in Hoffman’s apartment the blood pressure medication clonidine hydrochloride, the attention-deficit disorder drug vyvanse, the anti-anxiety drug hydroxyzine, and the muscle relaxer methocarbamol. All are used in addiction treatment clinics to treat patients, according to Percy Menzies.

Authored by: Pat Anson, Editor

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Jared Wilsey

Then perhaps, at least early in treatment, of opioid addiction with Suboxone, we need to do more drug screens to rule out diversion and lapses in treatment during which full agonists are ingested. Suboxone has distinct differences from methadone, and this blows the beer analogy out of the water. It is a PARTIAL u-opioid agonist with a ceiling effect of 2-4 mg per day (little higher if patient swallows rather than sublingually absorbs more of the drug). Once the ceiling is reached, a completely NON-EUPHORIC ceiling other than that felt during relief from anhedonia, depression, and physical illness, more Subuxone will have no further effect. The ceiling effect also eliminates possibility of overdose in tolerant patient. Beer is just dilute alcohol, but has no theoretical ceiling effect.

It is not a perfect solution, because it does cause dependence. But in an addict who needs to make a reasonably fast transition from withdrawing from drug of choice to being functional (e.g., taking care of professional and personal responsibilities), the benefits outweigh the drawbacks for many. If you have no job or the freedom to take a long time from work and and can suffer through endless post acute withdrawal symptoms, you may be better off from a biochemical and physiological perspective. Some of us wanted off the much more damaging drug of choice as soon as possible while keeping our lives on track. Suboxone and a patient committed to recovery is the fast track from chaos to stability.

It can work as a transition drug. Long term maintenance is usually not necessary and introduces the risk of more protracted withdrawal, but is still better than going back to heroin or oxycodone/etc.

John Mott

Buprenorphine (Suboxone) is an excellent treatment for opiate addiction. I have been treating patients with this medication for several years, and most of them have done very well, in many cases turning their life around. Yes, there will be some diversion, it is impossible to prevent that, but overall the benefits greatly outweigh the risks. Most people who have become physically addicted to opiates have great difficulty achieving and maintaining abstinence. Buprenorphine just takes the issue off the table, they take one or two pills a day, and get on with their lives. I don’t think the results with naltrexone are nearly as impressive; patients just stop taking it and relapse. I do agree that patients should never be pressured into a treatment, and that all alternatives should be presented.

Dennis Kinch

There needs to be an objective report about addiction to separate the facts from the myths. It is totally different than dependence or withdrawal. They need to treat the “addictive personality” problem, not the drug problem, especially not with more drugs. We must be heard or this tragedy will somehow fall on us like all the others do. He was a recreational user of heroin, an addict who overdosed. He bought his drugs on the street and made up his own dosage.

We are pain patients and we take meds to help us deal with PHYSICAL pain, usually from illness or injury. Our drugs are prescribed and overseen by a real doctor and believe me, if we didn’t need them we couldn’t get them this way. Most of us have reached the opiate level after years of weaker, non-narcotic meds that weren’t working anymore.

It is time to separate us from them. We are NOT addicts. We are not recreational users nor do we use them to cover up some psychological problem. We do not self prescribe or buy from anyone but a reputable pharmacy. Our meds help us to become more productive with a better quality of life. Period. End of Question!!! LEAVE US ALONE!

I am not surprised at the comments about buprenorphine. If methadone and buprenorphine were so safe and innocuous, why the restrictions by the Feds? Methadone is the only medication given in this country in a clinic setting. Buprenorphine is the only medication that requires a DEA exemption and strict limits on the patients each physician can treat. We all are aware about the deaths that occurred when irresponsible physician prescribed methadone for pain control. The introduction of buprenorphine has barely made a dent in the near epidemic we face with heroin and abuse of prescription opiods.

We have a dark and checkered history of using addicting and abusable drugs are treatment. Heroin was touted as the cure for morphine addiction; we had morphine maintenance clinics for years until the Harrison Act. Benzodiazepines were touted as the treatment of alcoholism. We still use benzo. as detox med for alcoholism but rarely maintain a patient on it. Methadone and buprenorphine are both opioid narcotics, no different than many of the opioids used in the treatment of chronic pain. Obviously, they are going to be abused and diverted. Many patients will benefit from them. It is both irresponsible and unethical for a patient not to be offered treatment choices. How often heroin patients tell us that they were told that they need methadone or buprenorphine like a diabetic patient needing insulin! Yet methadone is never offered as a treatment option to physicians, particularly for anesthesiologist. Sadly, the treatment of opioid addiction remain highly segregated. Naltrexone and Vivitrol being offered to ‘motivated’ patients. As a treatment professional, it my responsibility to motivate a patient and offer them treatment choices based on science.

Imagine, how the treatment landscape would be changed if methadone clinics and physicians holding DEA exemption to prescribe buprenorphine, offered naltrexone and Vivitrol as an option.

I would invite the reader to look at what the State of Missouri has done for street heroin addicts and those coming out of the correctional system. It has saved lives by preventing overdoses in the first month of release – the most vulnerable period. No medication, including naltrexone and Vivitrol are without their own limitations. Treatment professionals should make every effort to familiarize themselves with all medications approved by the FDA for the treatment of opioid addiction. Otherwise we are going to face the same stigma of faced by pain doctors who prescribed opioids without warning patients on the addictive liability of this class of drugs.

No chroinic illness has ever been successfully treated or controlled by using addictive and abusable drugs. If we do nothing, I am afraid buprenorphine will become a Scheduled II drug or banned as it has happened in Singapore.

PLEASE! anyone suffering from an addiction to opioids, we urge you to get the facts and gain an understanding of addiction and the treatment options, particularly evidence-based options. Ignorance (or wholly trusting so-called experts) can lead to death in this case. Don’t rule out a lifesaving treatment based on misinformation. Some of the statements made in this article are irresponsible and dangerously incorrect. Learn the purpose of buprenorphine treatment and why it isn’t simply switch one addiction for another- start here: http://www.naabt.org/purpose_of_buprenorphine.cfm

knowledge is the difference between life and death.

http://www.NAABT.org

Charles

Suboxone and Methadone are considered by the federal government, the medical profession and most providers of addiction services to be the most effective treatment for opiate/opioid addiciton. This determination is based on research and thousands of studies conducted over 45 years. Please do not believe what “one source” reports, as is stated in the article. Additionally, when Percy Menzies “likens it to using beer as a treatment method for alcoholics” it shows just how ignorant he is about treating opiate addiction. I would refer ay interested party to this federal publication: http://store.samhsa.gov/product/TIP-43-Medication-Assisted-Treatment-for-Opioid-Addiction-in-Opioid-Treatment-Programs/SMA12-4214

I was so saddened by this tragic lose. I understand that any death from drugs adds fuel to the fire of the controversy of opiate use for pain.
Pain is real and it has negative effects on our bodies if not treated. Opiates are one of the treatments we have. They do have side effects, including addiction and dependency, but so do many medications. We need to look at it with our doctor like any medication. Do the side effects out weigh the benefits? We need to take responsibility to talk with them and get educated. I know that not all doctors are able to help with this decision, that is why we must be educated about options. I had two doctors tell me that Xanax is not addictive. I know that to be false. It says it on the pamphlet you get. Yet when I brought that up, I was told (both times) that it would not be a problem. The first time I was not educated–that was 30 years ago, this time I have decided that my cervical dystonia symptoms are better with another medication and am not taking the Xanax.
I don’t think that outlawing or having pharmacists or drug companies try to manage this is the right way to go. People who need this are the ones being punished and the ones who will get it any way possible will continue to find their high.