Charles* is one of the lucky ones.<\/p>\n
Three decades after he first sneaked his little brother\u2019s hydrocodone cough medicine, 20 years after he started dissolving morphine pills in a heated spoon and injecting the milky solution into his veins, Charles has found his way back to what he calls a \u201cnormal\u201d life.<\/p>\n
He didn\u2019t die from an overdose or liver failure. He didn\u2019t end up in prison, and he didn\u2019t commit suicide. Call it chance, fate or divine intervention, in 2004 Charles became the first patient enrolled in a new \u201cmedication-assisted\u201d treatment program at Vanderbilt Psychiatric Hospital, part of Vanderbilt University Medical Center (VUMC).<\/p>\n
The drug he takes, buprenorphine, works like methadone. It blunts his craving for hydrocodone and morphine without causing an opioid \u201chigh.\u201d He can only get the drug if he participates in a recovery program that includes individual and 12-step facilitated group therapy.<\/p>\n
\u201cIt\u2019s been amazing,\u201d says Charles, now 47, who requested anonymity because his co-workers don\u2019t know his history. \u201cI\u2019ve been able to work, buy a house.\u201d Even so, he says, \u201cit\u2019s a daily struggle. I\u2019ve slipped up, relapsed even on the buprenorphine. But (the program) outweighs anything I\u2019ve been through before.\u201d<\/p>\n
Buprenorphine, a long-acting opiate developed in the 1970s as a \u201csafer\u201d analgesic, has become a mainstay of many drug treatment programs. Although less addictive than its sister drugs, hydrocodone and Demerol, it still has potential for abuse and has earned in some circles the nickname \u201cprison heroin.\u201d<\/p>\n
\u201cThere are people who abuse it,\u201d says Reid Finlayson, M.D., associate professor of Clinical Psychiatry and Behavioral Sciences. \u201cAnd people have died from overdosing on buprenorphine.\u201d But when it\u2019s given as part of a treatment program, it helps addicts \u201cstabilize\u201d so they can work on their recovery, he says.<\/p>\n
About a decade ago, Vanderbilt Psychiatric Hospital\u2019s drug treatment program became the first in the region to use buprenorphine to treat opioid dependency. At about the same time, Peter Martin, M.D., was participating in a national trial testing buprenorphine in opioid-dependent pregnant women.<\/p>\n
Published in 2010 in the New England Journal of Medicine the Maternal Opioid Treatment Human Experimental Research (MOTHER) study found that infants born with opioid dependency who received buprenorphine required shorter periods of treatment for neonatal abstinence syndrome (NAS) and shorter hospital stays than those treated with methadone.<\/p>\n
\u201cAt that time the standard of care for the treatment of opioid-dependent women was methadone,\u201d says Martin, professor of Psychiatry and Behavioral Sciences and founder of the Division of Addiction Psychiatry. \u201cOur paper changed that.\u201d<\/p>\n
Buprenorphine doesn\u2019t prevent NAS, says Stephen Patrick, M.D., MPH, M.Sc., assistant professor of Pediatrics, but getting pregnant women off prescription opiates or heroin will decrease their risk of dying from an overdose and increase the chances that their babies will go to term and have higher birth weights.<\/p>\n
\u201cAs a neonatologist, that\u2019s an OK trade-off,\u201d Patrick says. \u201cI\u2019d rather see healthy moms and fewer babies born preterm.\u201d<\/p>\n
Martin did a similar calculation when, in 2004, he admitted Charles to the buprenorphine recovery program at Vanderbilt Psychiatric Hospital. Charles, he says, \u201cwas so addicted to opioids that he would go to dentists to have teeth pulled.\u201d<\/p>\n
\u201cJust about all of my teeth were pulled, perfectly healthy teeth. You\u2019d just say it hurts. A dentist in town was ready to help. He\u2019d give me Percocet,\u201d Charles says.<\/p>\n
A mouth has only so many teeth. So Charles started hanging out at drug stores. He\u2019d approach elderly people as they left with their little white prescription bags. Some of them needed money more than they needed their medicine.<\/p>\n
After a few years, Charles turned to morphine. He\u2019d dissolve the pills in a heated spoon and inject the solution into a vein in his arm. Then his veins started to collapse. Not only was he physically ill, he was just plain tired.<\/p>\n
Increasingly, he thought about suicide.<\/p>\n
\u201cThe closest I got was in 2004,\u201d he says. \u201cI put some bleach in a syringe. I was ready to be done with it. I thought about it for several hours, and decided I don\u2019t want anyone to find me like that.\u201d<\/p>\n
That\u2019s when Charles came to Vanderbilt. But he found more than buprenorphine. He discovered that what he\u2019d always considered to be a moral failing was nothing of the kind. He had a chronic disease that he would have to learn to manage\u2014for the rest of his life.<\/p>\n
\u201cBuprenorphine is used to shape behavior,\u201d explains Martin, co-author of the book, \u201cHealing Addiction.\u201d Only if patients consistently practice proper behaviors for recovery will they get the medicine. \u201cUltimately, patients have to be able to do this on their own,\u201d he says.<\/p>\n
\u201cVanderbilt was the first place where I was taught that addiction is a disease,\u201d Charles says. \u201cDr. Martin was the first doctor to get me to understand that it has to be treated every day. You have to work on what got you started in the beginning.\u201d<\/p>\n
* Charles\u2019 last name has been omitted to protect his privacy.<\/em><\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Charles* is one of the lucky ones. Three decades after he first sneaked his little brother\u2019s hydrocodone cough medicine, 20 years after he started dissolving morphine pills in a heated spoon and injecting the milky solution into his veins, Charles has found his way back to what he calls a \u201cnormal\u201d life. He didn\u2019t die…<\/p>\n","protected":false},"author":209,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_links_to":"","_links_to_target":""},"categories":[20,31],"tags":[],"class_list":["post-1358","post","type-post","status-publish","format-standard","hentry","category-vm-related-content","category-winter-2017"],"acf":[],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pcDnub-lU","_links":{"self":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts\/1358","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/users\/209"}],"replies":[{"embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/comments?post=1358"}],"version-history":[{"count":1,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts\/1358\/revisions"}],"predecessor-version":[{"id":2696,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/posts\/1358\/revisions\/2696"}],"wp:attachment":[{"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/media?parent=1358"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/categories?post=1358"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medschool.vanderbilt.edu\/vanderbilt-medicine\/wp-json\/wp\/v2\/tags?post=1358"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}