NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., WALTER F. WRENN III., MD., JULIE KILLINGWORTH, LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
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COVID, GUN VIOLENCE, VOTER RIGHTS, OPIATE ADDICTION
Every since my surprising arrest God gives me insights that I then put on paper. I have spent a lot of time thinking about opiate addiction. We all have differing opinions about what addiction is and how we deal with it.
With everything going on in the world, Covid, gun violence, voter rights attacks, climate change, inflation, how important is addiction?
What percentage of individuals are addicted and what harm has this addiction caused. I believe that some feel it is very important. Some say it is not important. I believe that addiction in actuality only affects the addicted individual. Fear of death from an overdose is what family members and friends are concerned about.
Physicians like myself have put what happened to those of us who prescribed opiate pain medication, on the front burner. Our concern is about “us” not addiction.
I have a question. If addicted individuals didn’t die from using drugs would addiction be bad? So it’s not an addiction that is bad. It is our belief that addiction is responsible for drug overdose deaths that we are reacting to.
Another question concerns the treatment of opiate addiction. What drives the opiate-addicted individual to seek help? Are they seeking relief from withdrawal symptoms (so-called dope sickness) or seeking physiological relief?
WALTER F. WRENN III., MD PART 1
What is the best way to achieve their goals? I will discuss treatment interventions but long-term success can only be determined with clinical trials lasting for 2 years with yearly follow-up. This is similar to the system used to follow cancer patients. A person is diagnosed with cancer. They undergo treatment. Yearly they get a letter that tracks their progress. From that data information concerning longevity is accumulated and the effectiveness of treatment is evaluated.
MEDICAL ASSISTED TREATMENT
We have what is called MAT(medication-assisted treatment). The first and well-known MAT treatment was Methadone. It was used exclusively for individuals addicted to Heroin. Methadone was given in small doses with the goal of preventing withdrawal and eliminating illicit drug use. Counseling was mandatory 3 times a week. No one determined why or what was the value of counseling. It was just part of the program. Most individuals enrolled in Methadone programs were court-ordered. They had to go to the clinic daily except Sunday. On Saturday they received their daily dose and a take-home dose for Sunday. Methadone served as a substitute for heroin and is legal.
Today Methadone is given in large doses. When individuals are seen after treatment they are somnolent. The next similar drug was Suboxone ( buprenorphine/naloxone) a drug used by placing it under your tongue. This is an outpatient treatment primarily done in a doctor’s office.
This doctor has taken an eight-hour course and has received a waiver. For the first year, they can treat 30 patients in a 30-day span. After a year they can treat 100 patients in any 30-day period. After another year they can ask to treat 275 patients for any 30-day period.
When these drugs were designed and used the physiological actions were not known or valued. They worked. People who used them got relief from withdrawal symptoms and the initial goal of not using illicit drugs was achieved. Not only were individuals who used heroin getting relief but the new class of people using opiate pain medication was also getting relief.
WALTER F. WRENN III., MD PART 2
Initially, 24 mg of Suboxone was given after a brief induction period. Suboxone like Methadone was to be used along with counseling. Pennsylvania as well as other states decided that individuals could be treated with a daily dose of 16 mg. I and other physicians noticed an increase in illicit opiates in our patient’s urine.
We didn’t understand why. Edwin Chapman M.D.did a study that showed 85 percent of his black patients were rapid metabolizers and therefore needed 24 to 32 mg daily to prevent withdrawal. This study further collaborated when Sublocade was introduced. Sublocade is a Buprenorphine preparation given subcutaneously once every 28 days.
After 7 days of receiving Suboxone, you are given 300mg Sublocade. After 28 days you are given 300mg again. After the next 28 days, you are put on a monthly dose of 100 mg. They also found out in the Sublocade clinical trial that you needed twice the plasma level of buprenorphine to prevent cravings as you needed to prevent withdrawal. In addition individuals who used heroin needed 300 mg monthly as a maintenance dose.
Studies had shown that Suboxone had a celling effect but the significance wasn’t understood. After reviewing the Sublocade data it was apparent to me that the reason for relapse was due to not giving enough medication to prevent cravings.
Cravings are responsible for relapse. In those states like Pennsylvania that approve 16 mg daily physicians are undertreating their patients and are unknowingly contributing to the increase in overdose deaths. Of course, another significant contributor is counterfeit Xanax, Oxycodone, Adderall, and Soma containing fentanyl along with fentanyl-laced cocaine.
The solution to the increase in overdose deaths lies not only with MAT but also in an approach used in other countries. While they use Methadone and Suboxone they also supply prescription opiates and heroin. Overdose deaths have decreased tremendously. Addiction is not treated as a crime. Health care providers are not arrested and incarcerated.
How can countries that treat the same disease approach it from an entirely different perspective? MONEY...95 percent of lawsuits against individuals and companies occur in the US. Pharmaceutical companies were not sued outside of the US.
Large sums of money from lawsuits against pharmaceutical companies were awarded to states who won them using the lie that pharmaceutical companies produced “Highly Addictive Medication and lied about them causing addiction. Any medication approved by the FDA in the same class has the same warnings.
Why then were the pharmaceutical companies that make Percocet, hydrocodone,, and Tylenol with codeine not sued?
Physicians were accused of “Over-Prescribing ” and being on the payroll of the pharmaceutical companies and thus equally responsible for the opiate epidemic. Completely ignored was the role of opiate receptors in the brain and body. Few took the time or made any effort to investigate the role of opiate receptors. Had they would have discovered that the effect of opiates on the receptors is not dose-dependent.
They would have discovered that Methadone and Suboxone work because of their actions on opiate receptors. They would understand that countries that supply opiate medication to their citizens do so not to prevent addiction but to reduce overdose deaths. Just because you don’t like something doesn’t mean you can’t understand it.
The requirement that MAT is used along with counseling raises additional questions. How do you counsel a receptor? Let’s understand the problem before we treat it. Then use all available treatment methods.
Walter F. Wrenn III M.D.
FOR NOW, YOU ARE WITHIN