Top Menu

Treating College Students for Opioid Dependence

/By

Teenage drug abuser

College students who are dependent on prescription painkillers can be successfully treated with buprenorphine/naloxone or sustained-release naltrexone, according to experts.

Some college students misuse their own prescriptions, while others go “doctor shopping” to obtain multiple prescriptions, obtain prescription drugs from friends or buy them from dealers, according to Staff Psychiatrist Joshua Hersh, MD of Miami University in Oxford, Ohio. “They may be mixing drugs in a dangerous combination, or using higher doses of their own medication, which facilitates addiction,” he says.

When Dr. Hersh treats students for prescription drug abuse, he has them sign a release form that allows him to speak with their treating doctor and pharmacist. “If there is an issue with misusing a drug, I can communicate with their treatment providers about concerns I have,” he says. He also checks the Ohio prescription drug monitoring database, to see where students are getting their medication. If the student is from out of state, he can’t always check. Ohio’s database works in conjunction with some states, but not others.

He tries to treat students on an outpatient basis whenever possible. “If they need inpatient care, it costs more, and they have to withdraw from school, so all the work they have done up until that point in the semester is gone. They have to retake the classes when they return,” Dr. Hersh says. Once they return to campus, they often return to the same friends who used drugs with them, making recovery difficult.

Outpatient treatment, while allowing students to stay in school, keeps them in the same environment that got them into trouble in the first place. “They’re around the same people they were using with, so they have to learn to create a new environment, with new housing and friends,” Hersh notes.

At Miami University, buprenorphine/naloxone (sold as Suboxone) has been administered to students by a school nurse to prevent diversion, Dr. Hersh says. The medication is infused into strips that are placed under the tongue.

A study published in 2012 by researchers at Temple University in Philadelphia found opioid-dependent university students can be safely and effectively treated with buprenorphine in a university counseling center. The students were being treated for heroin or prescription opioid use. Lead researcher Peter DeMaria, Jr., MD, noted some students continue to use marijuana while being treated, which presents a challenge.

Since college students are young, those who have become addicted to opioids usually have not been using them for a long time, says Dr. DeMaria, Clinical Professor in the Department of Psychiatry and Behavioral Sciences at Temple University School of Medicine. “The good news is we can intervene early in their addiction. The challenge is their level of denial is higher, and their willingness to connect with services is less,” he says. “Sometimes they’ll use buprenorphine for awhile and they think the problem is cured, and they don’t want to continue treatment. They don’t want to go to counseling or 12-step meetings.”

Dr. Hersh prefers treating students with sustained-release naltrexone (Vivitrol), which is given as a once-monthly shot. “If we can put students on sustained-release naltrexone, we don’t have to worry about diversion and having to taper them off. With naltrexone, you can just stop treatment when the student is ready.”

Naltrexone works by blocking opioid receptors in the brain, without activating them, therefore blocking the effects of opioids. Buprenorphine partially blocks the effects of opioids, so that they produce less of an effect than a full opioid when they attach to an opioid receptor. When a person takes a partial opioid such as buprenorphine, they may feel a very slight pleasurable sensation, but most people say they just feel normal or more energized.

College students being treated for opioid dependence on campus can’t completely change the people they are exposed to, so they are at risk of falling back into harmful drug use patterns, Dr. Hersh notes. “When they’re on naltrexone, they know they can’t get high, since the drug blocks opiate receptors. It’s like a shield around them that prevents them from engaging in opiate abuse.” A disadvantage to naltrexone, he pointed out, is a person using the drug has to detox from opioids about a week before they can start treatment.

Not all college counseling centers provide opioid addiction treatment, but they can refer students to doctors in the area who can help them, says Dr. Hersh. He urges all colleges to provide their safety officers with naloxone nasal spray, known as Narcan, to reverse overdoses of opioids, including prescription painkillers and heroin. “It’s important for college campuses to have as prescription drug abuse becomes more prevalent,” he says.

 

6 Responses to this article

  1. Matt Statman / August 18, 2014 at 2:25 pm

    I work with many college students in recovery from opiate addiction who are abstinent and are academically, socially, physically, psychologically and spiritually thriving in college. Many of them initiated recovery in treatment or detox, but they all sustain recovery in the community with a lot of peer support and some with professional help as well. It is inappropriate and unethical for practitioners not to inform their clients/patients/students that abstinence is a very real possibility and to have resources available to help them achieve that goal if they are interested.

  2. Susan Weinstock MD / August 17, 2014 at 3:32 pm

    Let’s keep this factual. Medication-assisted treatment is supported by the National Institute of Drug Abuse, the American Academy of Addiction Psychiatry, the American Society of Addiction Medicine,
    the Center for Substance Abuse, etc.

    “Science-based treatment is especially important in the addiction field because many myths and personal biases have infiltrated the treatment ares and are often accepted without question”

    Kathleen Brady, M.D. Ph.D.
    Past President, American Academy of Addiction Psychiatry

    “Research shows that a combination of addiction treatment medication and behavioral counseling is the best way to ensure success for most patients.”

    Nora Volkow, M.D.
    Director, National Institute of Drug Abuse

    Regarding a father and his 26 y.o. addicted son who were unaware that effective FDA-approved medications for opioid addiction were available, even after spending $150,00.00 on treatment.
    “This is not simply inappropriate – it is unethical.”

    A. Thomas McLellan, Ph.D.

    • Jason Schwartz / August 17, 2014 at 9:37 pm

      There’s no doubt that the medical establishment supports the use of buprenorphine.

      They also supported the use of fluoxetine, buspirone and naltrexone for alcohol dependence in the 1990s.

      “Argument from authority” is considered a fallacious form of argument, but I’d make the following points.

      First, though I have a lot of respect for Volkow, there’s growing evidence that buprenorphine patients receive no benefit from added behavioral treatments. (http://addictionandrecoverynews.wordpress.com/2013/07/27/buprenorphine-therapy/)

      In response to McClellan, there’s not doubt it is unethical for a patient to not even know what their options are. However, given buprenorphine’s booming sales, it’s hard to imagine that there are many patients who are unaware of it as an option.

      Regarding Brady’s point, science-based treatment is very important. To this point I’d offer a few observations.

      First, physicians do not treat their peers with buprenorphine, they opt for abstinence-based treatment and have excellent long term outcomes. (http://www.ncbi.nlm.nih.gov/pubmed/19161896)

      Second, despite the fact that opioid addiction is a chronic illness, I’ve seen little long-term research on buprenorphine. Few studies look beyond 12 weeks. Large numbers of patients are lost at 12 weeks and the numbers at 12 months are terrible. (http://www.ncbi.nlm.nih.gov/pubmed/24953168 and http://www.ncbi.nlm.nih.gov/pubmed/24695018)

      Third, the science-base for maintenance drugs is built around REDUCED use, REDUCED over dose, REDUCED crime, etc. These measures do not align well with goals of most patients. Most patients want full recovery and the evidence-base does not speak to those goals.

      Fourth, if we can get patients to continue taking the drug (As pointed out above, that’s a big if.), we do not have any evidence-base for getting them off the drug. We’re talking about patients who might be taking the drug for 50 or 60 years. McClellan expresses concerns about ethical failures in relation to informed consent issues. Is this conversation happening with patients?

  3. Matt Statman / August 14, 2014 at 1:37 pm

    In an ideal world all institutions of higher education would have strong and vibrant abstinence based collegiate recovery programs where communities of recovering students could support each other and receive support from faculty and staff as they enjoy a healthy and sober college experience.

    http://collegiaterecovery.org/

    In an ideal world all people addicted to opiates would also have access to adequate abstinence based treatment similar to the kind that Dr. McLellan and colleagues call “The standard for Recovery”

    http://www.ncbi.nlm.nih.gov/pubmed/19161896

  4. Susan Weinstock MD / August 14, 2014 at 1:01 pm

    In an ideal world, all colleges would offer buprenorphine to opioid dependent students. Although this treatment isn’t curative, we do know that it blocks craving, prevents relapse and allows individuals to lead normal lives. Like other chronic illnesses, opioid dependence requires long-term treatment. Dr. McLellan and other addiction experts have spent years trying to convince the treatment community that this chronic illness must be treated like all other chronic illnesses. Physicians do not taper diabetics off their insulin. When will we all recognize and accept that “tapering off ” is ill-advised?

    It would be helpful to have more data comparing long-acting naltrexone with bup/naloxone. Many patients report craving and dysphoria on long-acting naltrexone. As result, they often drop out of treatment and begin using again. This is a recipe for overdose.

  5. Chuck / August 14, 2014 at 11:29 am

    I don’t know why am reading a certain amount of forceful attitude from the doctor. How about the idea of asking the patient what they want? or is he afraid of the answer. Without the patient’s
    motivation and commitment. There is little this good doctor can do other than coercion.

    I agree with the treatment, if that is what the patients (I mean the students) wants. My problem is with the implementation. Learning from the Methadone Maintains Treatment experience before the 2000 ACT that change the system to a more scientific, reliable system and with more dignity and respect. Somehow, seems like professionals are forgetting what they learned in college.

Leave a Reply

Please read our comment policy and guidelines before you submit a comment. Your email address will not be published. Thank you for visiting Drugfree.org


six + = 13

Disclaimer:
Reproduction in whole or in part of this publication is strictly prohibited without prior consent. Photographic rights remain the property of Join Together and the Partnership for Drug-Free Kids. For reproduction inquiries, please e-mail jointogether@drugfree.org.