A story came to my attention this week about a new drug in testing to treat the symptoms of acute opiate withdrawal “such as vomiting, sweating and muscle pain”. While I have nothing against the drug itself, or any real objection to its testing, I do think it will end up being a waste of time in the fight against addiction.
Withdrawal symptoms are a terrible experience, and if experienced they should be treated, but they do not need to happen. When I put my opioid-dependent patients on buprenorphine, they experience a brief period of sickness before their first dose, but the buprenorphine relieves their withdrawal symptoms. As long as they are on an adequate dose, they will not go into withdrawal while they are taking their medication. That is why I am such a strong advocate for this therapy; it removes the two worst acute consequences of addiction, withdrawal and cravings, by acting directly on the brain systems causing the problem.
The search for a new drug to treat acute withdrawal symptoms is not something that is important to the field of medication maintenance. That drug will be useful primarily for practitioners who put their drug-dependent patients through “detox”, which does not work. Whether it is cold-turkey or a graded decrease in the drug of choice, it is not an effective treatment for addiction. Withdrawal symptoms are horrible for the patient and can be medically dangerous; even if withdrawal symptoms are treatable with this new drug, I have not seen any evidence that it will help the psychological cravings that drive patients to relapse. And if it can control both withdrawal and cravings, then it will be functionally equivalent to buprenophine, and I am not convinced we should be spending money to research it when we already have a suitable medication.
Obviously we do not yet have the full picture on this particular drug, since it is still in testing. But the “detox” mentality as a whole needs to go; it is not and has never been an effective treatment for addiction, and making it less horrible for the patient will not make it work any better.