New formulations of Suboxone, and crystal meth’s impact on the gay community were two of the topics discussed at the recent annual meeting of the New York Society of Addiction Medicine. This is the first of a two-part report on the meeting, “Addiction Medicine 2013: Emerging Problems, Current Treatment.”
Suboxone (buprenorphine and naloxone), used to treat opioid dependence, will no longer be available in tablet form starting in March, because of the risk of children becoming poisoned after swallowing the drug. The company has switched to making a film version of the medication, which is put under the tongue.
Dr. Edwin A. Salsitz, MD, Medical Director of Office-Based Opioid Therapy at Beth Israel Medical Center, explained at the recent New York Society of Addiction Medicine annual meeting that the new formulation is safer because it is difficult for children to get into the film strip packages.
The U.S. Poison Control Centers found the rates of accidental pediatric exposure with Suboxone tablets were 7.8 to 8.5 time greater than seen with Suboxone film, according to a news release by the company that makes the drug, Reckitt Benckiser Pharmaceuticals.
Other formulations of buprenorphine are being studied, Dr. Salsitz said. He described a study, published in the Journal of the American Medical Association in 2010, that found buprenorphine implants placed under the skin on the inner arm in people with opioid dependence resulted in less opioid use over 16 weeks, compared with placebo implants. The implants are not yet commercially available.
“I think this will be a useful product in terms of reducing the diversion/misuse problem with buprenorphine,” Dr. Salsitz said. “It’s very much needed.”
Buprenorphine is also available in a seven-day transdermal patch (sold under the name Butrans) for treatment of moderate to severe pain. It is not approved for opioid addiction treatment, and it is currently illegal to prescribe it off-label for this purpose, he noted. Dr. Salsitz noted the patch, like the tablets, could lead to accidental pediatric exposure.
Gay Community Sees High Rate of Crystal Meth Use
Crystal meth use is pervasive in a subset of the male gay community, according to the director of the Addiction Institute of New York. Petros Levounis, MD, says in this community, abuse of meth and other substances may help them deal with social stress and discrimination.
“Rates of substance use disorders are somewhat higher for people who identify as gay, lesbian or bisexual,” Dr. Levounis said at the recent annual meeting of the New York Society of Addiction Medicine.
He noted, however, that people who identify as not completely gay or straight have much higher rates of substance use disorders than those who are completely gay, straight or bisexual. “Maybe these people don’t have the comfort of having a stable sexual identity,” he said.
Meth is a particular danger in the gay community because it decreases inhibition and judgment, while increasing sensation-seeking and resulting in extreme sexual arousal. This leads to unsafe sex and HIV transmission, Dr. Levounis noted. “The internet has exacerbated this problem by making both buying drugs and finding sex partners easier.”
Although meth can cause erectile dysfunction, many male meth users use erectile dysfunction medications to address this problem, he added.
Gay men who have body dysmorphic disorder, or “reverse anorexia nervosa,” in which they see themselves as smaller than they actually are, may use meth to feel better about their appearance.
The good news is that patients can recover from meth addiction, Dr. Levounis said. Because patients often experience an intense return of cravings from 45 days to six months after stopping meth use, treatment should last at least six months. Treatment can include group psychotherapy, individual counseling and family therapy.