Guest: Dr. Indra Cidambi
Presenter: Neal Howard
Guest Bio: Indra Cidambi, M.D. is recognized as a leading expert and pioneer in the field of Addiction Medicine. She founded the Center for Network Therapy (CNT), New Jersey’s first state licensed Ambulatory (Outpatient) Detoxification care and treatment facility, and currently serves as its Medical Director working to to help patients addicted to substances such as alcohol, anesthetics, benzodiazepines, opiates and suboxone.
Dr. Cidambi received her medical degree from Tashkent State Medical Institute in the former U.S.S.R and completed her residency at Maimonides Medical Center in Brooklyn, New York. She was then selected for the prestigious Fellowship in Addiction Medicine at New York University/Bellevue Hospital in New York City. Dr. Cidambi is Board Certified in General Psychiatry and double Board Certified in Addiction Medicine (ABAM, ABPN). She is fluent in five languages, including Russian.
Segment overview: Dr. Indra Cidambi, MD, discusses ambulatory detox.
Health Professional Radio – Ambulatory Detox
Neal Howard: Hello and welcome to Health Professional Radio, I’m your host Neal Howard. Our guest in studio today is returning to talk with us about Ambulatory Detox and Addiction Medicine as whole. Dr. Indra Cidambi, recognized nationally and internationally as an expert and pioneer in the field of Addiction Medicine. She founded the Center for Network Therapy, New Jersey’s first state licensed Ambulatory Detoxification Care and treatment facility and she’s currently serving as that facility’s Medical Director. She’s here to talk with us about a new drug delivering implant that’s been developed. How are you doing today Dr. Cidambi?
Dr. Indra Cidambi Thank you, I’m doing good Neal.
N: Thank you.
C: I am here with you to talk about the new implantable Suboxone that’s on its way for their approval.
N: Yes, I absolutely, now it has already been through the testing phase. It’s waiting just for approval now. Talk about how this new drug delivering implant differs from normal Suboxone addiction treatment.
C: Yeah, in order to go into this sort of find because it’s an implantable rod-shaped, four rods that needed to be placed, inserted subdermally in the upper arm of a patient who suffers from Opioid dependence. So this is mainly for the maintenance treatment, in other time this can be implant with I would like to kind of take you back to explain a little bit about Buprenorphine. This Buprenorphine is a Suboxone, Subutex which are taken under the tongue and this will develop so that it can serve as a safer alternative to Methadone which is the traditional way of people going to Methadone Clinic and which is a full agonist of the new receptor, Opioid receptor. So that kind of…Buprenorphine. And then Buprenorphine came into the market, this is the three things that we were looking into. Buprenorphine gives a ceiling effect for respiratory depression at a moderate dose. So that means one does not, it’s an impossible you’re going to overdose on Buprenorphine, that’s one expectation. And the second one was there will be no physical dependence to Buprenorphine and they will have very mild withdrawal symptoms. There will be physical dependence to Buprenorphine was associated with mild withdrawal symptoms even though they get addicted to Buprenorphine itself. And the third one will be limited attract to drug of abuse related to Methadone, because Methadone is a full agonist and Buprenorphine is a partial agonist-antagonist. So it kind of you don’t start abusing the medication. Then Buprenorphine displays a full agonist of the receptor of the brain, there is to reduction in receptor activation and therefore it can produce withdrawal effects that what I mean by that it will suddenly if somebody is taking Opioid and then they take Buprenorphine there will be a sudden severe symptoms of withdrawal, and when the Buprenorphine so that kind of makes them want to wait before they take Buprenorphine, okay.
C: Despite all these things, you did see that there’s been an illicit drug market for Buprenorphine. And there’s a diversion, abuse and misuse and also accidental poisoning of small children with Buprenorphine, and there were deaths among young children. That’s why having said this, kind of sets the stadium for us to understand why they are, Suboxone, Subutex, Buprenorphine are already in the market, Methadone is available, why are they looking at something different, right? So this kind of explains, now they were looking at … injection or an implant product, so that it will kind of drive the diversion abuse potential and the death among the young children.
N: Now let’s talk a bit about the Opioid addiction epidemic as a whole in order to understand how this brand new drug delivering implant will benefit addicts going forward?
C: Yeah, you see this epidemic, national opioid overdose…is what we are looking at, and for a total overdose death of 47,055 lethal drug overdoses in 2014. That’s a leading cause of accident in all of deaths right now after the accidental deaths in the US now. This has been a driving epidemic and you see Opioid overdose total 39,400 really just related to overdose and deaths from heroin.
C: And the prescription pills you know pills in 2014. So you see the trend of newly increased in the overdose and deaths of the prescription pills and the Heroin used right now.
N: Do you think that our culture of continued levels of high stress add to the I guess to the Snowballing effect of this epidemic? I mean because it’s not like Opioids just came on the scene but it seems though there’s now there’s this explosion.
C: No. No that’s not just the stress alone. In the past what happened was there was a moment there they were looking at pain as a fifth vital sign, meaning they said any patient who comes to the doctor’s office you need to ask about pain as if you do the other vital signs like blood pressure, pulse and temperature. And then they said also look at the heart rate and then ask for pain as a fifth vital sign. Once that came into practice there had been … writing prescription for pain if patients were like talking about pain and the doctors were prescribing and you see the reason of prescription pill. And so once that happened wherein those who have the predisposition to become an addict they started refusing these prescription pills and eventually they’re being dropped out of treatment by the specialist and then these patients were suffering from withdrawal symptoms. They didn’t know where to turn to and they ran to the market and bought pills by paying $30, $40 per pill, and that became very expensive for them and they had to turn to less expensive method of keeping the withdrawal under control so they turned into Heroin. And you see that there’s trend of … to get worse and it’s been increasing and so many young people have come into life of this Opioid addiction. It’s absolutely out of control right now.
N: Do you see an absolutely huge reduction in the rate of relapse using this new method of Opioid addiction treatment?
C: That new method is not yet in the market and I cannot say that that is going to be the answer or not because as I told you like from Methadone to Buprenorphine and we do benefit with Buprenorphine and people could take Buprenorphine the way they are supposed to, meaning they take the medication, they get the therapy and they are going to the 12-step program and if they are maintaining the sobriety lifestyle, it does help. So the reason why we are even looking at the new medication because of the three things – we don’t want diversion, we don’t want people abusing, and we don’t want misuse of medication and they didn’t want the young children to die. So those are the reasons why the Probuphine implant have been studied right now. We’re trying to get the first steps into the treating but then we don’t if this is an answer as we said… Buprenorphine comes with this the Probuphine, the as I said the major concern, there are concerns and let me tell you like implantable contraception that they’ve been using in the United States had lots of problems like pain in the other side of implantation. And also infection, numbness and this is all about the contraceptive pill that they implanted that they used in the past, along with the bleeding and the hematoma. And the worst thing with the contraceptive implants were that it affected…of the median cutaneous nerve and damaged that that led to the permanent disability. So that’s why most of them are gone and eventually one of implantable contraceptive still in the market right now. So looking at that picture we wanted to see if Buprenorphine is also an implantable so there’s is a concern about that. But that’s only a minor concern, but then one of the most important thing for us to pay attention to is that these implantables are not conducive for the common prescribers, what do I mean by that, and that if you see the Buprenorphine that’s being prescribed 32% of the prescriptions for Buprenorphine, naloxone sublingual tablets are the pills have been written by General Practitioners, Family Medicine Practitioners and Doctor of Osteopathy. While some of these guys are prepared to do some minor surgical procedure while others are not because they implant itself is a minor surgical procedure, okay. So 22% of the Suboxone prescriptions were written by psychiatrists, these professions are not trained to do a minor surgical procedure, but even that’s not a big deal. You can train these, the doctors and we can get that thing but then we don’t have offices that are equipped to do this kind of minor surgical procedure there. So that is a big issue, even if the Probuphine, the marketed, they’re active, the ones who want to bring Probuphine they say, they’re asking that they will train the doctor, but then they can give us all the training but you won’t have the office which is facts for this level of surgical implant. And also with this kind of implant we want to make sure that you implanted four of those and the implantation tissue and that’s … a huge procedure for that. So if you make a mistake they do a hematoma and also the worst thing is like is the implant is kind of moved away hard kind of propose and you need to send the patient to get an MRI. And that means you should be attached to an MRI center. And if that’s not feasible then it’s going to be a problem. And looking at that, that means you’re going to have two specialists working hand in law, meaning one of the surgical minor surgical licensing. So those kinds of healthcare professionals will be implanting, removing the thing, under the supervision of the prescriber, meaning the ones who don’t have this expertise or the specialty… to be ready for them to be able to implant, put the implant and remove it. So then now you are talking about two people working collaboratively. That is the big question mark, is that doable? So that…is a big problem.
N: Now in closing Dr. Cidambi, where can we get more information on the web about your therapy and The Center for Network Therapy?
C: It is on the web. It is recoveryCNT.com, so it’s Center for Network Therapy. And we also have a Facebook and they get all information through our center and they can call 732-560-1080. We are open seven days a week and there will be an answering service after hours and we will be able to listen to their calls. And there’s no waiting period for patients to get in for treatment.
N: Thank you so much. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been in studio this afternoon talking with Dr. Indra Cidambi, leading Addiction expert and Medical Director at New Jersey’s first licensed out-patient substance abuse detox facility known as The Center for Network Therapy. She has more than a decade of experience in Addiction, Medicine as in depth knowledge and vast experience in addictive substances treatment and rehabilitation. It’s been great having you here with us today Dr. Cidambi.
C: Thank you very much.
N: Transcripts and audio of this program are available at hpr.fm and you can subscribe through our podcast on iTunes.