The Food and Drug Administration recently approved Lucemyra, following a strong 11-2 vote from the Psychopharmacologic Drugs Advisory Committee. Lucemyra, whose chemical name is lofexidine, is the first non-opioid medication specifically approved to manage opioid withdrawal symptoms. This decision came after two placebo-controlled trials demonstrated that Lucemyra significantly alleviates severe withdrawal symptoms and increases the likelihood of completing a seven-day detoxification period.
Typically, patients undergoing opioid withdrawal use medications like morphine or buprenorphine to gradually reduce their opioid use. With Lucemyra, patients can avoid further opioid use and more smoothly transition to Vivitrol, a medication that fully blocks opioid receptors. While opioid withdrawal is not life-threatening like withdrawal from alcohol or benzodiazepines, it can still be extremely painful and distressing. Lucemyra offers a potential new option for those seeking recovery from opioid addiction.
What Is Lucemyra?
Lucemyra (lofexidine) is a selective alpha-2 adrenergic receptor agonist. This means it works by reducing the release of adrenal chemicals in the body. Specifically, it lowers the production of norepinephrine, a neurotransmitter that is released in response to stress, often referred to as the “fight or flight” chemical. When opioids are abruptly removed from the body, norepinephrine levels can spike, contributing to the stress and discomfort of withdrawal.
Clinical studies have shown that Lucemyra effectively decreases the production of norepinephrine during opioid withdrawal. However, these studies have only compared Lucemyra to a placebo, so its effectiveness relative to opioid tapering treatments remains unclear. Unlike opioid-based tapering medications, which carry a risk of addiction, Lucemyra offers a non-opioid alternative for managing withdrawal symptoms.
Additionally, Lucemyra can be used alongside opioids for pain relief, offering a potential option for patients who are wary of opioid medications. It could be prescribed as a supplementary treatment, without the extensive certification required for opioid prescriptions.
The FDA’s approval of Lucemyra has been hailed by US WorldMeds as a significant development in addressing the opioid crisis. While Lucemyra is currently available only in tablet form, it holds promise for those transitioning to injectable treatments like naltrexone, which necessitate being opioid-free before administration. Experts suggest using Lucemyra during the peak withdrawal period, which typically occurs five to seven days after the last opioid use.
Lucemyra is manufactured by Catalent Pharma Solutions at their Kentucky facility in the U.S.
The Timeline for Opioid Withdrawal
Opioids interferes with the brain’s ability to naturally manage and respond to pain, leading to a disruption of normal balance and the onset of painful withdrawal symptoms when the drug is discontinued.
When opioids are introduced into the body, they target the central nervous system, affecting opioid receptors that regulate the brain, cardiovascular system, and breathing. Consequently, withdrawal symptoms can impact various bodily functions, including heart rate, blood pressure, skin temperature, breathing rate, and emotional state.
Withdrawal symptoms generally begin within 6 to 12 hours after the last dose of the drug. For individuals who have used opioids for an extended period or at high doses, symptoms might start appearing up to 30 hours after the last use. Common initial symptoms include:
This initial phase of withdrawal gradually leads to peak symptoms, which usually occur around 72 hours after the last opioid use. These peak symptoms are often more intense and resemble those of a cold or flu. This phase represents the most challenging part of withdrawal and generally subsides within a week. During this period, individuals might experience:
Post-Acute Withdrawal Symptoms
For some individuals in recovery, symptoms can persist for days, weeks, or even months after the initial detoxification period. Post-Acute Withdrawal Symptoms (PAWS) vary based on factors such as body weight, gender, and the extent of drug use. Although PAWS are typically less severe than the initial withdrawal symptoms, they can still be challenging and require attention. Common PAWS include:
Rerouting Reward Pathways in the Brain
In 2016, researchers at Stanford identified specific nerve centers in the brain responsible for triggering intense withdrawal symptoms. They focused on a cluster of neurons associated with the brain’s reward system. By studying morphine-addicted mice, the scientists pinpointed the neural pathway involved in withdrawal responses. Through surgical intervention, they were able to reduce the activity of this pathway, significantly alleviating withdrawal symptoms in the mice.
While this approach is still far from being approved for human use, scientists remain hopeful about its potential. However, a significant drawback is that reducing the efficacy of this neural pathway might impair the brain’s natural “fight or flight” response.
Looking to the Future
Detoxification is often one of the most difficult stages of recovery, but it doesn’t have to be overwhelming. When undertaken in a secure and supportive setting, and with the aid of appropriate medication, the recovery process can be more manageable. Seek out local drug and rehab treatment centers to connect with compassionate professionals who can assist you in safely and effectively overcoming substance dependency and achieving a healthier, drug-free life.
