Probuphine – formidable hurdles will severely limit adoption

Probuphine – formidable hurdles will severely limit adoption

The battle of treating those living with the disease of addiction is ongoing and ever – challenging.

New treatments and medications are continually being developed, tested and introduced.

One of the newer medications on the market, introduced in 2016, is Probuphine. This drug is unique in its approach as it a buprenorphine implant.

Buprenorphine that sells under the brand names of Suboxone, ZubSolv and Subutex is highly effective in treating withdrawal symptoms and cravings associated with opiate abuse.

It inserted into the upper arm and it slowly releases the medication over a six-month period.

It is the first implant of buprenorphine that helps patients in treatment for addiction to opiates such as heroin, fentanyl, and opioid pain killers. Like all other medications, there are positives and negatives.

Pros and Cons


With an implant in place, compliance with daily medication regimen becomes easy as the patient does not have to remember to take it every day. Also, the chances of misplacing the medication or having it stolen is eliminated.

It is helpful in lowering the risk of relapse as the medication is systematically introduced into the body without any intervention by the patient. It is released at a steady rate, so the patient does not experience any withdrawal symptoms or cravings. It will also help stop the diversion of this medication into the black market.

Probuphine is ideal for those who have been stabilized on a low dose of buprenorphine. It is also a much safer alternative for those who may have children in the home, or someone living in a treatment center.


There are a few concerns with these implants, including;

There is always risk involved with the implants, as it has to be inserted utilizing a surgical procedure, although it is minimally invasive. There is always the risk of infection at the implant site.

Also two physicians may have to be present to do the implant – the prescribing physician and the physician who actually performs the surgical procedure. Besides, there have been problems in extracting the implant after 6 months.

Another barrier to getting the implant is cost. As it is new, some health insurance providers may not cover the procedure, as the patient’s out-of-pocket costs could be considerable.

A potential downside to the implant is that, patients may become overly reliant on the implant and neglect other aspects of their treatment, such as therapy to effect lifestyle changes needed to maintain their sobriety.

If you are considering using this medication, it is advisable to have a professional evaluation and a conversation with your physician.

Research on the web yields real life experiences of people who have utilized this implant. Some patients who went on this medication found that the dosage delivered was insufficient and they continued to experience uncomfortable withdrawal symptoms, such as feeling sick or having cramps, despite the implant.

Others continued to use other opiates, such as kratom, to make themselves feel physically comfortable despite the implant. Some other had to utilize psychotropic drugs as an adjunct in order to feel better.


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Mixing Opiates With ‘Benzos’

Mixing Opiates With ‘Benzos’

Benzodiazepine Withdrawal

According to the National Institute on Drug Abuse, nearly 200 people in the United States die due to opiate overdose every day.

That is of epidemic proportions! Despite various efforts by the federal and state bodies, the epidemic continues unabated.

One of the reasons the opioid overdose deaths continue to rise is because of the influx of fentanyl, which is a synthetic opioid that is 50-100 times more potent than heroin and individuals addicted to opiates spiking the opiate high through the use of another class of drugs called benzodiazepines or benzos.

Benzodiazepines are psychoactive drugs that have legitimate uses in treating a range of mental health illnesses such as anxiety and insomnia. The non-addictive, longer-acting benzodiazepines are also utilized to help individuals addicted to addictive, short-acting benzos and alcohol.

Like opiates, benzodiazepines are also central nervous system depressants. Both opiates and benzodiazepines are used by physicians to help people with genuine ailments. When used together, it can lead to overdose more quickly. Over one-third of all opioid or opiate overdoses happen when they are mixed with benzos.

This combination is dangerous because both drugs cause sedation and slow down breathing to a point where the brain forgets to breathe, causing overdose fatalities. Also, this prescription drug may lead to hard withdrawal symptoms that simply require medical and treatment.

People suffering from addiction often like to mix opiates and benzos because benzos spike the euphoric high caused by opiates. Opiates not only cause intoxication and make a person high but also affect the entire body, which can lead to other illnesses.

When mixing benzos and opiates, the person may experience decreased awareness, confusion, delirium, slow shallow breathing, and nausea and vomiting.

Even though people using both usually know that it is a dangerous combination, they still do it to intensify the high. When people use substances repeatedly, they build up a tolerance and need more or stronger doses to achieve the same high.

Dr Cidambi, a leading expert in addictions, said, “We need to find a way to reverse the growth trend of benzodiazepine abuse. I truly believe that, unless we do something immediately, our country is on the brink of escalating the national drug epidemic into a pandemic.”

Dr. Cidambi has some recommendations for limiting the co-abuse of benzos with opiates:

Patients being prescribed benzodiazepines for anxiety need to be monitored closely and they should not be prescribed beyond a short period of time – say about 3 months. While many states are limiting the prescriptions for opiates, there are no limits on the prescriptions for benzos. The prescribing physician should be aware of the addictive nature of these medications and recommend the patient also address the issue through talk therapy such as Cognitive Behavioral Therapy, or CBT. After three months the patient should be switched to non-addictive medications.

The prescription monitoring systems that most states currently have should be extended across state lines or made national. This is because Many people get prescriptions filled across state lines.

Utilizing alternative types of therapy like meditation and acupuncture should be considered, along with outpatient talk therapy and non-addictive medications.

For more information, please contact us.


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Will Government Initiatives Help The Opioid Crisis?

Will Government Initiatives Help The Opioid Crisis?

Around 30 states have implemented new laws and policies, limiting physician’s ability to prescribe opioid pain pills to their patients. The most common method is to put a limit on the first prescription for opioid pills, stipulating that it should be for a week or less. There are also rules about the potency of these pills.


Some state governments have also increased or initiated funding to educate people on the dangers of opioid addiction, treatment, and prevention. This needs to be stronger than a warning label from the pharmacist.


States hope to lower the rate of addiction to opiate pain pills and slow the supply of legal opiate pain pills that seeps into the black market. However, the problem is deeper with ingredients, such as fentanyl, and pill makers available on the dark web. Building a wall would have little effect as small quantities of fentanyl to make these pills come through the mail.


Curbing prescriptions is a start, but people who have already developed an addiction will find the pills needed to sustain their addiction harder to obtain from legal sources, such as their doctor. Many individuals addicted to opiates order variants of the drug online from other countries and have them delivered right to their door.


Individuals addicted to opiates go “doctor shopping” to find other doctors who turn a blind eye or have several fake IDs set up to evade identification to ensure their supply never runs out. People who obtain opiate pain pills through their doctor sometimes sell the pills to other individuals addicted to opiates, rather than use it themselves. Some doctors also continue to prescribe them, for physical and mental health concerns.


Street drugs are the answer for many people who have been thrown off the system and this is riskier. Alternatives to opiate pain pills, such as heroin or fentanyl are often cheaper on the street, readily available and are often times much more potent. There is also the concern that people needing their fix will take whatever is available, and that can raise the risk of overdose.

Dr. Cidambi argues there are better ways to deal with the problem.

First is education. Many of these medications are prescribed by physicians who do not fully understand the addictive nature of these medications. Healthcare providers need to be educated on these issues so they can prescribe responsibly. They will be armed with information about the dangers the medications pose, are will be able to counsel their patients.

Once they understand the potential dangers, they will also be able to recognize the signs of addiction. Through continuous education, they will understand how addiction develops and be able to intervene before the patient becomes addicted.

Second is to provide more treatment options. Working with a patient on an outpatient basis allows them to engage in treatment while not disturbing their daily life. It also reduces the stigma associated with the disease of addiction.

The integration of the home environment into treatment and involvement of family, or other loved ones results in better outcomes. This is vital, as the patient is still in touch with his work and the patient’s family now understands the chronic nature of addiction better. It enables the patient to begin making lifestyle changes when they are in treatment with professional detox support.


SAMHSA: Why Addiction is a Disease and Why is it Important

SAMHSA: Why Addiction is a Disease and Why is it Important

SAMHSA recognizes CNT’s Dr. Cidambi as a leader in addiction treatment; SAMHSA invites Dr. Cidambi to participate in a panel discussion on why Addiction is a Disease. Dr. Cidambi highlighted to SAMHSA’a audience the fact that a move to increased outpatient treatment for the disease of addiction will lower stigma and help people suffering from this disease to more freely engage in treatment.


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