Thank you to Heather Hajek for the following report. I found the report on several health pages with RSS feeds, but unfortunately there is no byline to the article that says where ‘Heather Hajek’ writes– I did a Google search for her name and came up with a few more health articles, so I assume she is a health reporter for some newspaper. But if you find this, Heather, thanks– and I suggest you add a line to your articles stating where you are writing, as your articles are placed in newsfeeds without any identifying information.  The article:

Nausea Drug Can Help Reduce Symptoms in Opiate Withdrawal

Opioid addiction, whether illegal heroin or legally prescribed medications, is a growing problem in the United States. There are companies that are working on opioid substitutes or tamper-proof opioids, but as of now morphine is still the painkiller most prescribed by doctors after surgery, and codeine is in many prescriptions, including cough suppressants. In 2007, 12.5 million Americans 12 or older were using prescription opioid medications for non-medical purposes according to the National Survey on Drug Use and Health.
Larry F. Chu, M.D., assistant professor of anesthesia at the School of Medicine, Stanford University, said that opioid abuse is rising at a faster rate than any other illicit drug use, but only about a quarter of those who are opioid dependent seek treatment. Chu said that one barrier to treatment is that when a person stops taking the drugs suddenly it is like “bad flu” with agitation, insomnia, diarrhea, nausea and vomiting.

Chu was among a group of Stanford University researchers looking for ways to prevent the symptoms of withdrawal and was the lead author of the study on their research published in the Journal of Pharmacogenetics and Genomics. The researchers say that a drug already approved by the FDA appears to avoid some of the problems that accompany withdrawal. The drug, ondansetron, is approved to treat nausea and vomiting for those receiving chemotherapy. The scientists warned that the drug will not solve the problems that occur with the continued use of the opioids, but in tests with mice it reduced the symptoms of their addiction, jumping and pain sensitivity.
Since the drug was already approved for use in humans, the scientists then used the drug in eight healthy humans who were not opioid dependent. The group received a single large dose of morphine and in another session at least a week later they took ondansetron in combination with the morphine. The participants then completed questionnaires to assess their withdrawal symptoms. Similar to the mice, humans receiving ondansetron with the morphine had a significant reduction in withdrawal symptoms.
Ondansetron is completely different from other treatments used to treat addiction. One drug, clonidine, causes severe side effects and requires close medical supervision. Methadone and buprenorphine are not satisfactory because they replace the opioid addiction with their own addiction. “It’s like replacing one drug with another,” said co-investigator Gary Peltz, M.D., Ph.D., professor of anesthesia.
A clinical study to test another ondansetron-like drug for opioid withdrawal is planned in a larger group of healthy humans, and the research team will continue to test ondansetron in the treatment of opioid addiction. The scientists warn that ondansetron will not resolve the problems of continued use of painkillers. It will treat the symptoms of withdrawal, but not the addiction.
We now have a number of medications to help with opiate withdrawal.  I will certainly be offering Zofran to my patients who are tapering off Suboxone (those who have been on Suboxone for a sufficient length of time to extinguish the conditioning from addiction, and who are taking Suboxone once per day in an ‘automatic’ way– not ‘as needed’).  I will write back with the experiences of my patients with Zofran, which has the generic name odantreson.  Ironically, I gave many people Zofran back in my anesthesia days, as it is a good treatment for post-operative nausea.  And here I am prescribing it once again, as a psychiatrist… Who would have thought?!
As for the ‘etc’: I am receiving more and more comments and questions from people out there as the blog has become higher ranked on the search engines.  I am very grateful for the readership, and for the nice comments from people.  I am also flattered that people come to me with their questions– that you trust me with your questions.  I realize that there are many doctors out there who do not take the time to understand the issues involved in addiction, and doctors who do not take the time to talk to their patients.  I enjoy writing back to people and hearing a bit about their lives.  BUT…  tonight my wife said ‘you sure are always on that computer’… which all married people know translates into ‘it is pissing me off that you are always on that computer’.  And when I told my 14-y-o daughter that she was on the computer too much, she pointed out that I am too.  And I couldn’t really argue with her.   So…  please forgive me for not writing back as much going forward.  I feel bad about it, but I just cannot keep up.  I have said this before, and hesitate a bit… but if you have something that you really cannot find by searching the blog (most answers to questions are in here somewhere), if you drop me a $20 donation you will make me feel so guilty that I will have to respond.  I get an e-mail notice of any donation;  I’ve had 3 donations in the past year– I just add that because if I don’t someone will write and accuse me of ‘making a fortune off this blog’.  I AM happy to say that the Google ads are bringing in about 3 bucks per day– not quite enough to retire…
Thank you for your understanding.  If there is a topic you think I am missing here, always be sure to let me know!


zenith · February 20, 2009 at 7:40 am

Hey Doc
I saw that article and a couple more on the same topic, and was wondering about the study used. They said they gave 8 healthy, non opioid dependent volunteers a dose of morphine, then a week later another dose with zofran added, and asked the to fill out questionnaires on their “withdrawal symptoms”. What on earth kind of withdrawals would you have after ONE dose of morphine, in a non addicted individual? I read two different articles that both described the process of testing the drug in this way–that makes no sense to me.

SuboxDoc · February 20, 2009 at 10:08 am

Excellent point! I had the same reaction, and should have mentioned that the ‘study’ was nothing like what all of us are dealing with.
I have given zofran to several people at this point– 8 mg every 8 hours– and I can assure you that it is not a ‘wonder drug’. There is an impression that it makes things a bit less severe, but you know how the ‘placebo effect’ goes…. So alas… doesn’t appear to be the miracle we all want.
Thanks for bringing this important point to everyone’s attention.

lmgmiami · February 24, 2009 at 7:10 am

I have a friend that has been using Suboxone but because of the cost has not been taking it regularly. Fortunately he has been able to stay off the Oxy and become much more productive. It has been a hard road, I don’t need to tell you. He battles with a diagnosed chemical imbalance which he takes Wellbutrine regularly now and occasionally the clonopine for anxiety. I don’t know how he does it but he some how has managed to continue going through college (he is a senior at a major university) and not letting his family in on his problem. His biggest problem now is the constant feeling of nausea and after reading this I am wondering if it is the suboxone that is the culprit. It has been some time now since he has done any oxy. I have tried telling him to take the suboxone everyday and slowly come off of it but his constant thought of the cost has him on this roller coaster of only half dosing or when he is having a really good day not taking it at all. I understand that this is not recommend way of taking it but in some ways it has helped him. How long do you have to be completely off the suboxone for the nausea to stop?

jillbecker83 · June 18, 2010 at 8:02 pm

Thanks for the info on zofran. I’m in the process of getting off suboxone and need help on the days I lower my doses or skip pills. I’ve got bottle from when I had the flu a few months back and think I’ve even got some leftover from pregnancy. I do have a question if you do get back with me. Will phenergen work the same way? I’ve got tons of those too. But the only thing with that is when I was pregnant I had severe restless legs when I would take it for some reason. So I just want to make sure it’s not going to make that sympton worse. I’ve been on subs for six months, got off for 3 weeks while taking nucynta and tried to wean off that and thought that was way too hard. So I’m slowly coming down this time. I’m at 2mg a day. I did take one extra tonight though. I just was so tired. It’s so hard to take care of a baby when you can’t move! This would be easier if I could just lay on the couch and not have to worry about anybody else. It’s hard when you have kids. But I love her so much and she is the reason I’m doing this. Wow I’ve rambled. Well hope to hear from you. Thanks again.

    SuboxDoc · June 20, 2010 at 4:22 pm

    To answer your question, I don’t think phenergan will cause you to have restless legs– is usually doesn’t anyway, as it is an antihistamine and antihistamines don’t have that effect. But phenergan may not be as effective as zofran for withdrawl, since zofran works entirely differently.
    As most people who read my blog know, because of the long-term risk of relapse, I generally recommend that people just stay on Suboxone for a very long time– especially if they are struggling with pain or taking care of small children. That’s just my opinion… but the drug appears to be safe for taking long-term. I try to help my patients come to terms with having a chonic illness, and stay on the drug until they are in their 30’sor older, when their lives are back on track. I sell recordings called ‘how long are you going to take that stuff? on a web site– the web site is— and the recordings are designed for family members and others who don’t ‘get’ the point of taking Suboxone.
    Take care,

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