There is a lot to be learned in the fine print of the deep dive into drug overdoses conducted by KFF Health News, formerly Kaiser Health News, running in the Oregon Capital Chronicle last week.

The main issue exposed by journalist Taylor Sisk is the reduced effectiveness of drugs prescribed for heroin and cocaine addiction in treating fentanyl and xylazine, better known as “tranq.”

Commonly administered doses of buprenorphine, better known as Suboxone — the brand name for a combination of buprenorphine and naloxone — have proved less effective against fentanyl, and commonly used doses can trigger violent, immediate withdrawal. Neither Suboxone nor methadone is designed to treat addiction to xylazine or stimulants.

The fine print is that the drugs used to treat substance abuse do not treat the causes of substance abuse, they treat the symptoms. Without a therapeutic to treat the psychological addiction to dealing with stress through substance abuse, the chemical therapeutic fails if the substance changes.

The fact that Suboxone doesn’t work with tranq is an indication that the cause of the addiction is psychological, the manifestation is physical. A recent study of substance abuse causes in the United Kingdom found depression leads to substance abuse, not the other way around:

Many adult participants referred to episodes of poor mental health such as periods of depression during adulthood, which led to associated increases in their substance use. These episodes were often triggered by significant and/or traumatic life events.

The evidence linking addictions to a unified source of stress displacement suggests that treatment for the stress must accompany any addiction-breaking drug for the patient to recover. A recent survey from a team of researchers in Boston published in The American Journal on Addictions indicates the benefits of a prescribed digital therapeutic (PDT) in treating substance use disorder (SUD):

Patients with SUD exhibited robust engagement with a PDT, high rates of retention through 12 weeks, and substantial rates of abstinence at end of treatment when the therapeutic was used in a real-world setting. PDT’s hold promise as a new way to access effective SUD treatment.

It is not surprising that the chemical treatments for drug addiction are continuously chasing a moving target, as the formulations of street drugs are constantly morphing. But the causes of addiction might not be a moving target. They might share a common source and bend to a common solution.

Written by Steve O’Keefe. First published November 4, 2023.

Sources:

“Evolving overdose crisis shakes previously effective treatments,” Oregon Capital Chronicle, November 2023.

“A Qualitative Exploration of the Views of Adults and Adolescents Accessing a Substance Misuse Treatment Service,” International Journal of Environmental Research and Public Health, May 2023.

“Evaluation of real-world outcomes associated with use of a prescription digital therapeutic to treat substance use disorders,” American Journal on Addictions, October 2022.

Image Copyright: sdm1984.