The UK is hurtling towards a US style crisis around opiates/opioids such as heroin, methadone, tramadol, oxycodone, codeine and fentanyl
- In 2019 50 million prescriptions for opioids were written, an 35% increase over 10 years
- Overdoses are up by 87% and 5 people are dying every day from opioid overdoses
- Deaths are up by approx. 41% in a decade to around 2000 a year
- The number of people hospitalised due to opioids has jumped to close to 12,000 a year
Outside of new approaches to prescribing there is a need for new ways to look at treatment.
Buvidal and Intensive addiction focussed psychotherapy
Dr Helmy is a psychiatrist with more than 20 years of experience in mental health disorders and drug misuse. He is an International Fellow of the American Psychiatric Association, an appointed fellow of the International Society of Addiction Medicine and a member of EMDR Association UK & Ireland.
Together with Help Me Stop he and his colleagues at Ciconia Recovery London have devised an effective end to end treatment programme for opiate dependence using a new type of medication – Buvidal
Buvidal is effective in reducing opioids and opiates withdrawals and cravings. The main difference between Buvidal and other daily opiate detox medications such as methadone or oral Subutex is that you only need to be dosed weekly or monthly which is especially useful for those who have day to day commitments such as work.
While Buvidal is a game-changer for many, it is essential to remember that it is not a “silver bullet” or cure for opioid dependence it only deals with withdrawals and cravings and without including an intensive psychotherapy programme such as Help Me Stops online or face to face programme relapse is not only likely but inevitable.
WHAT IS BUVIDAL?
Approved by the National Institute of Health and Care Excellence (NICE) Buvidal is also known as long-acting injectable Buprenorphine. Buvidal is given as an injection under the skin – this is known as a ‘subcutaneous’ injection, or a ‘subcut’. Once injected, the medication forms a deposit of Buprenorphine under the skin.
HOW DOES IT WORK?
Buprenorphine has some of the same effects as other opioids (e.g. heroin, morphine). However, it tends not to make people as drowsy. Many people report they are more clear-minded and energetic on Buprenorphine compared to methadone.
Buvidal does not contain naloxone, which is put in other medications such as Suboxone.
Buvidal is given as a subcutaneous (under the skin) injection. When injected, it turns into a deposit, or “depot”, of Buprenorphine. The depot is slowly absorbed by the body, lasting for a specific time (a week or a month depending on the given dose).
WHAT IS DEPOT?
You may have heard of, or even used, medications and contraceptives that are given as a depot. Being on a depot medication means the medication is stored under THE skin and releases gradually, instead of having to be taken daily.
Depot products are not like implants. You do not have to get anything removed before you are re-dosed. With Buvidal, your system will have absorbed most of the medication by the end of the set period.
Some people get Buvidal confused with a different product, the naltrexone implant, which is an entirely different medication.
PHARMACOLOGY OF BUPRENORPHINE – HOW IT AFFECTS YOUR BRAIN?
Buprenorphine’s effects come from how it interacts with two types of opioid receptors in your brain – the mu receptors and the kappa receptors. Most opioids (e.g. heroin, fentanyl, morphine) are ‘full agonists’ at these receptors, meaning they fully trigger them. Buprenorphine is different to these opioids in a few ways.
Buprenorphine is a strong ‘partial agonist’ at the mu receptor, which gives it a lot of its unique effects. It binds to these receptors much more tightly than other opioids. It can even ‘kick-off’ other opioids from this receptor. However, because it is only a ‘partial agonist’, Buprenorphine does not give you the same opioid-like effects as methadone, heroin, or other opioids.
Buprenorphine is also an ‘antagonist’ at the kappa receptors. This means that Buprenorphine blocks these receptors, which is one of the reasons Buprenorphine can block the effects of other opioids.
Buvidal is available weekly and monthly in many dose strengths in prefilled syringes.
You may be worried that your injection will not hold you the full week or month. Generally, there will be no problem because depot Buprenorphine builds up and stays in your body for a long time. A comprehensive assessment will help inform dosing regimes.
PROS & CONS
When deciding whether to try Buvidal you should think carefully about the pros and cons. Depot Buprenorphine does not work the same for everybody and is only effective in relapse prevention as part of an integrative treatment programme
- More convenient so can carry on with daily tasks, including work
- In most cases you only have to go to the clinic once a month
- No waiting at pharmacies
- Many people report better moods, greater mental clarity, and energy
- Able to fully engage in intensive addiction-based psychotherapy almost immediately (vital to preventing relapse)
- Level treatment – less effects of the ups and downs of daily dosing
- Some people report better sleep
- If you decided to take opiates on top of Buvidal, you are not likely to feel the effect of the opiates you are taking, so you will effectively be wasting your time
- Some people find it painful for about a minute – a bit like an insect sting
- Some people experience mild headaches
PRINCIPLES OF EFFECTIVE TREATMENT
Based on scientific research the following key principles should form the basis of any effective treatment programme
- Addiction is a complex but treatable disease that affects brain function and behaviour.
- No single treatment is right for everyone.
- People need to have quick access to treatment.
- Effective treatment addresses all a client’s needs, not just his or her drug and alcohol use.
- Staying in treatment long enough is critical.
- Behavioural therapies and peer support have the best evidence in achieving long term abstinence
- Medications are often an important part of treatment when combined with behavioural therapies.
- Medically assisted detoxification is only the first stage of treatment.
The staff at Help Me Stop have all had problems with drugs or alcohol in the past, so we know first-hand how easy it is for your drinking and use of drugs to get out of hand. Equally we know, as psychotherapists, and through life experience how to beat it. As one of our former clients says we have a programme that helps you deal with your drug and alcohol issues and “deal with real life on life’s terms”.
Help Me Stop offers a free assessment, which we can do face to face or online. We also offer range of effective, intensive face to face and online programmes to address alcohol and drug use. Call us now on 0208 191 9174 or jump onto Live Chat/email us directly at https://helpmestop.org.uk/contact-us
If you would like to speak to Dr Helmy directly he can be reached at https://www.ciconiarecovery.com/i/
Chris Cordell is Help Me Stop’s General Manager and is a senior associate member of the Royal Society of Medicine, Certified International Recovery Specialist, member of the International Society of Addiction Medicine and a member of the Federation of Drug and Alcohol Professionals.