May 13, 2015

by Erin Beck, Staff writer

Just because some drugs used to treat opiate dependence are sold on the street does not mean they aren’t legitimate medicines with the ability to save lives, an expert on addiction treatment said during a Governor’s Substance Abuse Regional Task Force meeting Monday.

Dr. Carl “Rolly” Sullivan, director of the addictions program at the WVU School of Medicine, said Suboxone, the brand name for buprenorphine and naloxone, is in demand because it helps addicts, whose brains have been chemically altered by long-term opiate use, to function normally. He noted that getting in to see a doctor to prescribe the drug can be difficult.

Sullivan also took issue with doctors who set arbitrary time lines for taking their patients off Suboxone and buprenorphine.

“If you had somebody with diabetes and they were sick and you got them on insulin and they got well, you would never say, well that’s great, you’re well, now let’s get you off that insulin,” Sullivan said.

Sullivan, who has worked in addiction treatment since 1985, spoke at the Saint John XXIII Pastoral Center in Charleston before dozens of people from 10 counties in the region. He talked about medications over the years that have been used to assist in opiate addiction.

He described the year 2001 as a low point in his career, after the “opiate tsunami” hit in the late 1990s. While the abstinence model worked “pretty well” for the alcoholics who made up the bulk of his practice before that, it was resulting in relapses and overdose deaths for his opiate-addicted patients.

Methadone, when it began being used for opiate addiction in the early 2000s, helped about half the people, he said, but clinics quickly became focused on making money and keeping people coming back to the clinics instead of recovery.

Sullivan, who was medical director at Chestnut Ridge Hospital for nine years, said he thinks buprenorphine was “hands-down the best thing to happen” in the field of opiate addiction treatment. He started using it with his patients in 2003.

“It didn’t get them high,” he said. “These people just felt normal.”

It was also different from methadone, because patients don’t overdose and die on it, he said.

However, the government mandated that doctors could only give it to 30 patients at a time.

They would say things like “You don’t want your office filled up with a bunch of drug addicts,” he said. “What if grandma’s in there?”

He said the limit is now 100 patients.

“Nobody can tell you really why that is,” he said.

Sullivan also recommends adding counseling and 12-step programs.

“Remember it’s medication-assisted treatment, not just medication treatment,” he said.

He had harsh words about naltrexone, a medication that blocks the effects of opiates so that drugs don’t produce the desired high, as a treatment.

“It’s one of the drugs that sound great in theory,” he said.

But it was “an absolute spectacular failure, because nobody would take it,” he said.

He then clarified that there were a couple groups that would take it — doctors, if they had to in order to keep their ability to practice, and parolees, if they were court-ordered.

The drug companies have recently tried to pitch the drug again in injectable form as Vivitrol.

During the last legislative session, the West Virginia State Legislature passed a bill, sponsored by Delegate Chris Stansbury, R-Kanawha, to begin a pilot program involving giving that drug to offenders in the criminal justice system. Stansbury was in attendance at the event Monday evening.

http://www.wvgazette.com/article/20150511/GZ01/150519823