Boulder County experts say new medication could ease detox, but treatment mix still needed

The U.S. Food and Drug Administration approved the first nonopioid treatment for use in managing opioid withdrawal symptoms in adults on Wednesday.

While the new drug, Lucemyra, can‘t treat withdrawal long-term, it could ease the effects of the acute symptoms that appear in the first few weeks. This could make people more likely to stay in detox, according to Ann Noonan, director of SUD Center of Excellence at Mental Health Partners, a nonprofit community mental health center in Boulder.

“One of the things that we know is clients that have opiate dependence fear withdrawal more than they fear relapse,” Noonan said.

Lucemyra, also called lofexidine, was first developed as an antihypertensive drug to treat high blood pressure, but researchers discovered that it could also treat some of the withdrawal symptoms because it affects a neurotransmitter believed to cause a number of withdrawal symptoms, according to Robert Valuck, a professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.

The FDA has approved it for use in adults for up to the first two weeks of treatment, which is typically when people experience acute withdrawal symptoms.

According to Valuck, most people describe it as being like a really bad case of the flu — dozens of times worse than the worst flu you‘ve ever had. Withdrawal can cause runny nose, anxiety, difficulty sleeping, muscle aches, sweating, vomiting and headaches. People also lose control of their gastrointestinal tract as the body starts to reset, Valuck said, causing diarrhea.

Typically, opioid medications like methadone and suboxone are used to treat withdrawal for long periods of time. Valuck describes it as taking someone who is going 150 mph on heroin down to 75 mph on methadone, and so on.

“It‘s extremely rare for people to quit nicotine cold turkey. Less than 1 percent of people do it, and there‘s a reason for that,” he said. “It‘s the same thing” with opioids.

There aren‘t many medications aimed at treating acute symptoms right now, Valuck said, and the lack of options is part of the problem doctors face when finding the best ways to help people manage their withdrawal.

“Everybody is extremely different,” he said, with not only their physiology but also what substances other than opioids they may also be misusing. “We want to make the toolbox a lot more robust with more tools in it.”

Noonan is optimistic about the possibilities with more medication, but said people shouldn‘t look at opioid medications such as methadone and buprenorphine as being equivalent to heroin.

“The stigma that is attached to those two drugs is really undeserved,” she said.

Methadone can increase the success rate of those trying to get off of opioid drugs by 60 percent, according to Noonan. Lucemyra will get people “to that front door,” but isn‘t the same as the drugs that can serve as ongoing treatment.

Valuck said the goal is to taper as much as possible with those medications, though sometimes people stay on some amount of methadone or other drugs forever.

People are able to work, have families and live with these medications, which he said is a better alternative to shooting up heroin and living without hope.

“First use is a choice,” he said, but once someone has an addiction, it is a “chronic unremitting brain disease.”

Neither Valuck or Noonan knows what the impact of the approval will mean for patients. At this time, there is no information on the drug‘s price or insurance coverage, Valuck said. However, Noonan said that new drugs tend to be more expensive.