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Suffering From Opioid Addiction? Find Relief With This New Treatment
David Rutz, MD discusses medication assisted treatment for opioid addiction for the millions of Americans with chronic pain, and how the opiate addiction treatment program at Bryan Health can help to give them their lives back.
Featured Speaker:
David Rutz, MD
Dr. David Rutz is a family medicine physician with East Lincoln Family Health. Transcription:
Suffering From Opioid Addiction? Find Relief With This New Treatment
Melanie Cole, MS (Host): Millions of Americans suffer from opioid use disorder, which has contributed to thousands of overdose deaths. Medication assisted treatment can help you or a loved one overcome his or her opioid addiction. My guest today is Dr. David Rutz. He’s a family medicine physician with East Lincoln Family Health Professionals. Dr. Rutz, tell us a little bit about the state of opioid use today and why are they so addictive?
David Rutz, MD (Guest): Well, I think it pretty much began about 25 years ago when the evening news on CBS suggested that we, as physicians, were terrible in treating the millions of Americans with chronic pain. So, we got on board and began to prescribe opiates for chronic pain without really very good science behind it. What we found out eventually was that they really didn’t work that well at all for chronic pain under a lot of circumstances, and we ended up getting a lot of people addicted. So that was the issue. As far as the overuse of these medications, and by the way, the pharmaceutical industry got pretty much involved in developing a lot of these different agents for our use, which was part of the problem.
Melanie: So, tell us a little bit about opiate addiction and treatment options that have been available. Then speak about what’s a little bit different about your program and what you want the listeners to know about it.
Dr. Rutz: Well, the issue with opiate addiction became quite apparent just relatively recently. In the last few years, we’ve seen an increase in number of deaths. Interestingly enough, the average lifespan of a female American is now shortened because of death occurring in younger women because of opiate abuse and overdose. When I realized that patients were beginning to become afflicted by these drugs, I wanted to find a way that I might be able to assist them.
Now there was a time when if you found out a patient was abusing your prescriptions, you fired them from your practice, which was probably the worst thing you could do. That’s when they needed you the most. Now I can offer them this treatment program and assist them as far as their addiction is concerned.
Melanie: So, tell us a little bit about how the treatment works. Because people hear about withdrawal and they hear about behavioral therapies and all kinds of different treatments for opiate addiction, but when they hear medication assisted treatment they think, “Are you just replacing one for the other?” So, speak about the treatment a little bit.
Dr. Rutz: Well medication assisted treatment, of course a lot of people understand Methadone, which has been around for many years. There’s also a non-opioid medication called Naltrexone, which can be injected once a month. The one that I use is called buprenorphine, which also comes under different manufactures. Suboxone is probably the one that’s most familiar.
The idea with medication assisted treatment is basically to do less harm. This is a chronic disease for which we do not have a cure. The idea of replacing an opiate with a medication assisted treatment is to prevent the cravings and the withdrawals that are so devastating for somebody who’s addicted to these substances. In so doing, we can reduce harm. If they're not spending significant amounts of their family budget on obtaining drugs or doing illegal things in order to get drugs, then we have reduced harm.
I sometimes think of in the same way as a diabetic who you would say has an addiction to food. Because of their obesity, they have damaged their pancreas. We can't cure their diabetes, so we control their disease with medications. I think it’s similar as far as these drugs are concerned. I think what we’re learning as well is that these opiates are probably causing some brain damage if you will, to use the term loosely. That is why we feel like we need to control this disease as we can't cure it.
As far as the patients when they enter this program, they need to be in withdrawal with this particular drug in order to initiate it. Which is interesting because withdrawal is the one thing that patients dread the most. When they first start using opiates, they get a little euphoric. They get a buzz and they get addicted. Then the tolerance sets in and they have to keep increasing the dose in order to maintain that buzz that they get. Eventually, it’s not about getting high anymore. It’s just about not getting sick because withdrawal is horrible. You talk to anybody who’s gone through this. It’s probably the worst experience of their lives. So, we understand that. When I ask patients to come in to withdrawal, understandably they don’t trust me. This drug works every so much better when the patient is in withdrawal.
Melanie: So, tell us about the medication itself. It is reducing cravings? Since you said they have to be in withdrawal, does it help them to stop thinking about it? Does it help with the physical symptoms of the physiological symptoms? What does it really do?
Dr. Rutz: Well the drug, buprenorphine is an opiate. We just discussed why are you just giving them another opiate? Well it’s about doing less harm. When a patient is initiated on this particular drug buprenorphine, we must have them in withdrawal. The drug is very powerful as far as it’s attraction to a receptor in the brain. This particular attraction is so powerful in fact that it will dislodge other opiate molecules. Be it hydrocodone, oxycodone, methadone, heroin. The thing though it that it does not stimulate the receptor to the same degree that these other drugs did.
So as a result, if you give somebody buprenorphine when they're still having a lot of drug in their symptom, it will kick off that opioid from the receptor in the brain, it will attach itself, but since it doesn’t stimulate as much it’s as if you just precipitated a state of withdrawal. So that’s why it’s really important when they enter the program that they are in withdrawal. My problem is they don’t trust me, and they don’t trust the drug and they hate with withdrawal. So sometimes it’s difficult to get them back in a state of withdrawal that makes the process go much more easily. In fact, inducing somebody when they're in significant withdrawal is ever so much easier when they are feeling bad. I can get them out of withdrawal in maybe 40 to 60 minutes. They are amazing relieved and impressed by how this drug works for them.
Melanie: Well I am impressed by what you just said. I was not expecting you to say 40 to 60 minutes. So, you want them to be in withdrawal and then you can give them medication and get them out of withdrawal that quickly. So really what would be the barriers that they would face? Why wouldn’t they want to do it this way?
Dr. Rutz: Yes, excellent question. I think that some of the barriers would be that A, they don’t trust the drug. They don’t really think it’s going to help them. B, there may be a financial issue. Although when you think about it, some of these people are spending hundreds of dollars everyday getting drugs off the street. I think the other barrier too is insurance coverage as far as medication assisted treatment is concerned, which is a little bit better. The flipside is also the behavioral side of this equation.
When I'm working with patients with opioid addiction, there are multiple other what we call comorbidities. Other conditions that are going along with these people. Attention deficit disorder, post-traumatic stress disorder, major depressive disorder, generalized anxiety disorder. These are all conditions that are very often seen in individuals. I think it’s because somebody gave them an opiate for a dental extraction or a sprained ankle, and they realized this is a very special medication. That’s kind of how the process gets started. So, getting them to other psychotherapy or psychological services is really critical, but sometimes the insurance is a barrier to that.
Melanie: Well I can see how that would be something that would concern them. So, what would you like them to know as a wrap up, Dr. Rutz, about opiate addiction in this country, the program that you're offering through Bryan Health and how important it is if they have a loved one or they themselves are suffering from opioid addiction that they seek help. What do you want them to take away from this very important segment?
Dr. Rutz: Well, the fact is two things. One, this is a chronic disease that there is no cure. Two, that we can control their symptoms. We can stop their cravings, we can stop their withdrawal. We can have them resume a normal life. With newer developments in this area, there is actually a new medication that’s an injectable that can be given once a month. So, they don’t even have to worry about taking anything orally. This is a sublingual product, underneath the tongue in other words, which is kind of inconvenient. So, this medication is very effective. It controls cravings, it controls withdrawal symptoms, it returns these people to their normal lives, and also it improves their family budgets. They can start taking care of their family again. They have better work records. It just makes an amazing turn around in their lives.
The takeaway though is it may go on for years. We don’t know the answer yet. Nobody has done any scientific study to show that this drug after a certain period of time can be stopped. So, I just want the people to understand that if they have a loved one or they're individually addicted to these drugs, there’s an excellent treatment program that does not involve going to a clinic every single day, like a methadone clinic. It’s done in the privacy of a doctor’s office. Nobody needs to know. These records are actually better protected legally than regular medical records. So, we protect their privacy, we do it in the office one to one with myself, and we can really change their lives around. Make a huge difference for them and their family.
Melanie: Wow. Thank you so much, Dr. Rutz. What a wonderful program and great work that you're doing. That you so much for coming on and explaining this so that people understand if they have a loved one who is suffering from opioid addiction. So important. Thank you again for joining us. And a special thank you to our podcast partner, Union Bank and Trust. This is Bryan Health Podcast. For more information, please visit bryanhealth.org. That’s bryanhealth.org. I’m Melanie Cole. Thanks so much for listening.
Suffering From Opioid Addiction? Find Relief With This New Treatment
Melanie Cole, MS (Host): Millions of Americans suffer from opioid use disorder, which has contributed to thousands of overdose deaths. Medication assisted treatment can help you or a loved one overcome his or her opioid addiction. My guest today is Dr. David Rutz. He’s a family medicine physician with East Lincoln Family Health Professionals. Dr. Rutz, tell us a little bit about the state of opioid use today and why are they so addictive?
David Rutz, MD (Guest): Well, I think it pretty much began about 25 years ago when the evening news on CBS suggested that we, as physicians, were terrible in treating the millions of Americans with chronic pain. So, we got on board and began to prescribe opiates for chronic pain without really very good science behind it. What we found out eventually was that they really didn’t work that well at all for chronic pain under a lot of circumstances, and we ended up getting a lot of people addicted. So that was the issue. As far as the overuse of these medications, and by the way, the pharmaceutical industry got pretty much involved in developing a lot of these different agents for our use, which was part of the problem.
Melanie: So, tell us a little bit about opiate addiction and treatment options that have been available. Then speak about what’s a little bit different about your program and what you want the listeners to know about it.
Dr. Rutz: Well, the issue with opiate addiction became quite apparent just relatively recently. In the last few years, we’ve seen an increase in number of deaths. Interestingly enough, the average lifespan of a female American is now shortened because of death occurring in younger women because of opiate abuse and overdose. When I realized that patients were beginning to become afflicted by these drugs, I wanted to find a way that I might be able to assist them.
Now there was a time when if you found out a patient was abusing your prescriptions, you fired them from your practice, which was probably the worst thing you could do. That’s when they needed you the most. Now I can offer them this treatment program and assist them as far as their addiction is concerned.
Melanie: So, tell us a little bit about how the treatment works. Because people hear about withdrawal and they hear about behavioral therapies and all kinds of different treatments for opiate addiction, but when they hear medication assisted treatment they think, “Are you just replacing one for the other?” So, speak about the treatment a little bit.
Dr. Rutz: Well medication assisted treatment, of course a lot of people understand Methadone, which has been around for many years. There’s also a non-opioid medication called Naltrexone, which can be injected once a month. The one that I use is called buprenorphine, which also comes under different manufactures. Suboxone is probably the one that’s most familiar.
The idea with medication assisted treatment is basically to do less harm. This is a chronic disease for which we do not have a cure. The idea of replacing an opiate with a medication assisted treatment is to prevent the cravings and the withdrawals that are so devastating for somebody who’s addicted to these substances. In so doing, we can reduce harm. If they're not spending significant amounts of their family budget on obtaining drugs or doing illegal things in order to get drugs, then we have reduced harm.
I sometimes think of in the same way as a diabetic who you would say has an addiction to food. Because of their obesity, they have damaged their pancreas. We can't cure their diabetes, so we control their disease with medications. I think it’s similar as far as these drugs are concerned. I think what we’re learning as well is that these opiates are probably causing some brain damage if you will, to use the term loosely. That is why we feel like we need to control this disease as we can't cure it.
As far as the patients when they enter this program, they need to be in withdrawal with this particular drug in order to initiate it. Which is interesting because withdrawal is the one thing that patients dread the most. When they first start using opiates, they get a little euphoric. They get a buzz and they get addicted. Then the tolerance sets in and they have to keep increasing the dose in order to maintain that buzz that they get. Eventually, it’s not about getting high anymore. It’s just about not getting sick because withdrawal is horrible. You talk to anybody who’s gone through this. It’s probably the worst experience of their lives. So, we understand that. When I ask patients to come in to withdrawal, understandably they don’t trust me. This drug works every so much better when the patient is in withdrawal.
Melanie: So, tell us about the medication itself. It is reducing cravings? Since you said they have to be in withdrawal, does it help them to stop thinking about it? Does it help with the physical symptoms of the physiological symptoms? What does it really do?
Dr. Rutz: Well the drug, buprenorphine is an opiate. We just discussed why are you just giving them another opiate? Well it’s about doing less harm. When a patient is initiated on this particular drug buprenorphine, we must have them in withdrawal. The drug is very powerful as far as it’s attraction to a receptor in the brain. This particular attraction is so powerful in fact that it will dislodge other opiate molecules. Be it hydrocodone, oxycodone, methadone, heroin. The thing though it that it does not stimulate the receptor to the same degree that these other drugs did.
So as a result, if you give somebody buprenorphine when they're still having a lot of drug in their symptom, it will kick off that opioid from the receptor in the brain, it will attach itself, but since it doesn’t stimulate as much it’s as if you just precipitated a state of withdrawal. So that’s why it’s really important when they enter the program that they are in withdrawal. My problem is they don’t trust me, and they don’t trust the drug and they hate with withdrawal. So sometimes it’s difficult to get them back in a state of withdrawal that makes the process go much more easily. In fact, inducing somebody when they're in significant withdrawal is ever so much easier when they are feeling bad. I can get them out of withdrawal in maybe 40 to 60 minutes. They are amazing relieved and impressed by how this drug works for them.
Melanie: Well I am impressed by what you just said. I was not expecting you to say 40 to 60 minutes. So, you want them to be in withdrawal and then you can give them medication and get them out of withdrawal that quickly. So really what would be the barriers that they would face? Why wouldn’t they want to do it this way?
Dr. Rutz: Yes, excellent question. I think that some of the barriers would be that A, they don’t trust the drug. They don’t really think it’s going to help them. B, there may be a financial issue. Although when you think about it, some of these people are spending hundreds of dollars everyday getting drugs off the street. I think the other barrier too is insurance coverage as far as medication assisted treatment is concerned, which is a little bit better. The flipside is also the behavioral side of this equation.
When I'm working with patients with opioid addiction, there are multiple other what we call comorbidities. Other conditions that are going along with these people. Attention deficit disorder, post-traumatic stress disorder, major depressive disorder, generalized anxiety disorder. These are all conditions that are very often seen in individuals. I think it’s because somebody gave them an opiate for a dental extraction or a sprained ankle, and they realized this is a very special medication. That’s kind of how the process gets started. So, getting them to other psychotherapy or psychological services is really critical, but sometimes the insurance is a barrier to that.
Melanie: Well I can see how that would be something that would concern them. So, what would you like them to know as a wrap up, Dr. Rutz, about opiate addiction in this country, the program that you're offering through Bryan Health and how important it is if they have a loved one or they themselves are suffering from opioid addiction that they seek help. What do you want them to take away from this very important segment?
Dr. Rutz: Well, the fact is two things. One, this is a chronic disease that there is no cure. Two, that we can control their symptoms. We can stop their cravings, we can stop their withdrawal. We can have them resume a normal life. With newer developments in this area, there is actually a new medication that’s an injectable that can be given once a month. So, they don’t even have to worry about taking anything orally. This is a sublingual product, underneath the tongue in other words, which is kind of inconvenient. So, this medication is very effective. It controls cravings, it controls withdrawal symptoms, it returns these people to their normal lives, and also it improves their family budgets. They can start taking care of their family again. They have better work records. It just makes an amazing turn around in their lives.
The takeaway though is it may go on for years. We don’t know the answer yet. Nobody has done any scientific study to show that this drug after a certain period of time can be stopped. So, I just want the people to understand that if they have a loved one or they're individually addicted to these drugs, there’s an excellent treatment program that does not involve going to a clinic every single day, like a methadone clinic. It’s done in the privacy of a doctor’s office. Nobody needs to know. These records are actually better protected legally than regular medical records. So, we protect their privacy, we do it in the office one to one with myself, and we can really change their lives around. Make a huge difference for them and their family.
Melanie: Wow. Thank you so much, Dr. Rutz. What a wonderful program and great work that you're doing. That you so much for coming on and explaining this so that people understand if they have a loved one who is suffering from opioid addiction. So important. Thank you again for joining us. And a special thank you to our podcast partner, Union Bank and Trust. This is Bryan Health Podcast. For more information, please visit bryanhealth.org. That’s bryanhealth.org. I’m Melanie Cole. Thanks so much for listening.