Answer Addiction

Tag: Elizabeth Brico

  • What Causes False Positives on Drug Tests?

    What Causes False Positives on Drug Tests?

    Most instant drug tests are notorious for picking up false positives from common medications like antihistamines, antidepressants, antipsychotics, antibiotics, and analgesics. Poppy seeds can give a “true” positive.

    I had a routine during my pregnancy with my elder daughter. Each morning I woke up as late as possible—which never felt late enough—took a quick shower, and waddled over to my bus stop. There, while waiting for the bus, my senses sharpened in the thin, crisp mountain air and the yellow morning sunlight stretching its way across Boulder, Colorado. Sometimes I snoozed a little more on the bus—I’ve always been a sucker for vehicular motion. On less sleepy days, I watched out the window for prairie dogs bopping across the acres and acres of lush green land.

    I was riding into town for Naropa University, where I was attending grad school in the footsteps of Allen Ginsberg, Anne Waldman, and William Burroughs. But every day I turned into downtown several hours early for my classes. It wasn’t by choice, but because I was taking methadone to treat my addiction to heroin.

    Being new to the program meant I hadn’t yet earned take-home doses, so I had to ride in every day before the clinic closed and drink down my syrupy pink dose in front of a nurse. It was annoying, but I discovered a small comfort: my bus dropped me off next to a small, vegan-friendly grocery store called Sprouts. So before I dosed, I would stop in and treat myself to piece of sticky-sweet, lemon poppy seed cake. It would not take long for me to discover the weird, unexpected consequence of my treat.

    How to Get a False Positive for Opioids

    “Your UA was positive,” the nurse said, lips pursed, about two months into the program. I wasn’t showing yet but all the staff knew about my pregnancy.

    “For what?” I asked.

    “Opiates.”

    I laughed. “Well I’m on methadone.” At the time, I didn’t know clinics could differentiate between synthetic and non-synthetic opioids.

    “No, not the methadone.”

    Now I was pissed. I hadn’t used—not since enrolling in the program. Earning a take-home would depend on my compliance with the program, which meant testing negative every time they demanded I pee for them. Worse, a positive drug test during pregnancy could mean a child services investigation down the line.

    “I didn’t relapse,” I insisted. The nurse just stared at me. Then I remembered that urban myth I’d heard—that eating poppy seeds could trigger an opiate positive on a drug test. “I’ve been eating poppy seed cake,” I told the nurse.

    “You’d have to eat a whole lot of poppy seeds for that to happen,” she said.

    But I insisted that the positive was wrong. Finally, she relented and agreed to send my sample for confirmatory testing. A few days later, she reported that the levels of morphine in my urine sample suggested it had, in fact, come from a food source. Turns out, poppy seed positives are not an urban legend at all—in fact, they are even recognized by the U.S. government, which actually raised the opioid detection cutoffs to avoid these types of false positives for military personnel and other government employees.

    The Problem with Poppy Seeds

    Poppy seeds trigger a positive for morphine. Opium and its derivatives—which means any naturally occurring opioid—come from papaver somniferum, a type of poppy plant. It is grown commercially for the development of pharmaceutical drugs and for the harvesting of food-grade poppy seeds. But because of their origin, these seeds can contain tiny amounts of opioid alkaloids, which metabolize similarly to morphine or codeine. It’s not enough to produce a euphoric effect—but it can be enough, depending on how much is consumed, to trigger a positive on a drug test. And that positive is, in fact, a “true positive,” at least in the sense that your body produced that metabolite.

    Poppy seeds will trigger a positive for opioids on a general panel, or for morphine and sometimes codeine on a more detailed test. The problem here is that other opiates—including heroin—will also trigger a morphine positive. Heroin has its own unique metabolite, 6-monoacetylmorphine, but that will only show up for about 24 hours, whereas morphine from heroin use can show for up to a week.

    When my nurse said the test confirmed my positive was the result of poppy seeds, she probably meant the levels were too low to show up in the confirmatory test. The truth is that there is no way to definitively link a morphine positive to poppy seeds, leaving the decision ultimately up to clinical judgment.

    “They do try to correct for this by establishing cutoff limits,” says Ryan Marino, an emergency medicine physician and toxicologist with the University of Pittsburgh Department of Medicine. “So the person who is running the test might see the positive but it’s below the threshold, so it gets reported as negative.”

    In the late ‘90s, the Substance Abuse and Mental Health Services Administration (SAMHSA) changed the detection cutoff for morphine from 300 ng/mL to 2000 ng/mL in an attempt to prevent federal employees from losing their jobs over a bagel topping. While a bagel probably won’t trigger detection at that cutoff, something with a higher concentration of poppy seeds still might, like a poppy seed paste. And the SAMHSA cutoff is a recommendation; if you’re a government employee, your tests should follow that guideline. But other drug test administrators are under no obligation to adhere to the SAMHSA regulations. Treatment facilities or doctors’ offices might use lower cutoffs, making their tests more likely to detect the consumption of poppy seeds.

    False Positives on Instant Urinalysis Kits

    Poppy seeds aren’t the only substance that might trigger an unmerited positive on some drug tests. Immunoassay tests, the kind used in most instant urinalysis kits and as a preliminary screening tool in the lab, are notorious for picking up false positives from common medications. These include antihistamines, antidepressants, antipsychotics, antibiotics, analgesics, and other over-the-counter medicines. Specifically included on the list are ibuprofen, dextromethorphan (an ingredient commonly found in cold medicine that has its own intoxicating properties), diphenhydramine, pseudoephedrine, and ranitidine (an antacid/antihistamine). These drugs can cause positives for different substances, including THC, opioids, or benzodiazepines, but the most common false results are amphetamines.

    Positives that result from poppy seeds are tricky because they are, in a sense, genuine positives. Your body has, in fact, metabolized an opioid alkaloid; it’s just that it didn’t come from an illicit source and it wasn’t in quantities that could produce an intoxicating or euphoric effect. But when a positive for methamphetamine is triggered because you took some cold medicine, that’s a false positive—and that can be determined conclusively by further lab testing.

    Marino says that many of these substances are structurally very similar, “so it makes sense that enzyme tests can’t tell the difference… but if you send it out [to a lab] for gas chromatography-mass spectrometry or liquid chromatography-mass spectrometry testing, that would be able to pick up most of these compounds.”

    The only issue here is whether whoever is testing you is willing to send the sample for another test. If you’re being tested on-site for a job, it’s entirely possible that your employer does not have a system in place for sending your sample to be examined in a lab. So you should definitely tell your employer in advance of the test if you have taken any medications. Hopefully, if it’s one that could trigger a false positive, your employer will give you the benefit of the doubt.

    What About CBD?

    Another substance that trips people up is cannabidiol (CBD). CBD is the non-intoxicating chemical compound found in the cannabis plant, which is generally credited for many of the plant’s medicinal properties. CBD was recently approved by the FDA to treat seizures and is marketed as a medicine called Epidiolex.

    But you don’t have to be prescribed Epidiolex to get your hands on CBD. It’s sold in a variety of stores and can often be found in smoke shops, vape stores, and recreational marijuana shops. People often wonder, however, if CBD can trigger a marijuana positive on a drug test. The simple answer is no: Drug tests look for THC, the intoxicating ingredient in marijuana. They don’t test for CBD, so CBD won’t make you pop positive for THC.

    The reality is a little more complicated. Because CBD is derived from the same plant species as THC, trace amounts of THC can end up in your CBD product. In order for CBD to be (mostly) legal, it has to come from a hemp plant (and there’s some weird politics around even that). That means the plant can’t contain more than a trace amount of THC. So if your CBD is coming from a hemp source—and if you’re buying it from a non-medicinal source in a state that has not legalized recreational marijuana, it probably is—then it’s unlikely to contain more than a trace amount of THC. And that should not show up on a drug test.

    But you do need to be careful to check your sources, especially if you’re buying from a rec store. Some companies intentionally add small amounts of THC because they believe it potentiates the therapeutic effects of the CBD. Those small amounts can range from 1 percent to 15 percent—and that amount can be detected in a urine test. It’s not a false positive, either. Even if you didn’t “feel” the THC, you still consumed it. So you won’t have much ground for disputing those results. Basically, if you’re going to use CBD, check your sources and make sure the THC levels fall below 0.3 percent, which is the legal limit for a hemp product.

    Drug testing is a politically complicated practice. Many people find it degrading, or feel that it adds an unnecessary element of surveillance into their lives. Nonetheless, if you find yourself in a position in which you have to take a drug test, it’s important to understand how and why a positive could show up even when you haven’t consumed illegal drugs. Bottom line: If you know you’re going to be tested, skip the poppy seed muffin.

     

    Have you ever gotten a false positive? Give us the details in the comments.

    View the original article at thefix.com

  • Florida Versus Evidence: How I Lost My Children Because of Past Drug Use

    Florida Versus Evidence: How I Lost My Children Because of Past Drug Use

    When my first slew of drug tests returned negative, the opposition began slinging whatever they could think of in my direction, hoping something would stick.

    I am living in two worlds. One is a world populated by doctors and advocates, run on the tenets of research and science and reason. It is a world in which addiction is treated with medicine, and where there’s no question that people who use drugs deserve to be safe and free of avoidable infections and diseases. In this world, nobody hesitates to administer naloxone if the occasion calls for it. In this world, people are not afraid to touch the bodies of drug users, and we all understand that if you can self-administer naloxone, you don’t need naloxone. I experience this world through phone lines, e-mails, and social media. I write about this world; this world is my template for how all worlds should be.

    Addiction as Moral Failure

    Then there is the world where my life takes place. In this world, having an addiction is a moral failure. Drug use is met with punishment. Judges replace doctors and toxicologists, making medical decisions and determining the results of drug tests with reckless abandon. In this world, abstinence is the only route to health. In this world, a hit of pot is just as chaotic as compulsive, daily injections of heroin. In this world, there is no sterile equipment; in this world, everyone is sick. Here, you can be sentenced to death just for being the friend of someone who overdoses. This is the world I touch with my fingers and teeth—the world where I walk, and eat, and breathe. This is the world where I live.

    I became involved with the Florida Department of Children and Families in April 2018. I was never charged with a crime or afforded the presumption of innocence, evidentiary standards, or jury decision that would have accompanied a criminal charge. Instead, one judge—virtually accountable to no one and equipped with full immunity—deemed my husband and me guilty of some nebulous pre-crime like the woeful characters in Philip K. Dick’s short-story-turned-film “Minority Report.” Apparently, I am guilty of the possibility of neglecting or otherwise harming my children in the future because I have a diagnosed substance use disorder.

    Since that decision, I have been forced to obey the mandates set forth by my county’s child welfare authorities in an attempt to win back custody of my girls. So far, not a single mandate has been evidence-based.

    I love writing about harm reduction, evidence-based addiction care, and trauma-informed mental health practices. I enjoy staying informed about best practices in addiction medicine. I am proud that I get to help demystify and destigmatize addiction and mental illness, and I am honored to have the opportunity to speak with the researchers who have dedicated themselves to driving us out of the dark ages of addiction medicine. But now that I am living in those dark ages myself, I can’t shake a sense of bitterness: I write about a better world, but it’s one that I only get to view from afar.

    Substance Use Disorder Treatment and Geography

    In 2017, I wrote an article for OZY about the general disparities between addiction care in red states and blue states. I was living in Seattle, Washington, at the time but I’d had some experience trying to get help for addiction in Florida—so I knew how backward providers could be. For example, when I gave birth to my daughter in Palm Beach while on prescribed methadone, hospital staff refused to let me breastfeed her. She was treated for Neonatal Abstinence Syndrome (NAS) and pediatric staff claimed that enough methadone would be passed through my breast milk to potentially harm her. In reality, numerous studies have found the exact opposite to be true and breastfeeding is now recognized as one of the most effective balms for NAS, due to the maternal contact and general health benefits of breast milk. The amount of methadone passed through breast milk is too negligible to help or harm.

    As I wrote in the OZY article, Democratic-ruled states are more likely to offer Medicaid coverage for methadone and buprenorphine, while Republican states are less likely to even offer the medications themselves, much less cover them. People in red states also face harsher penalties for drug crimes and are less likely to be allowed to continue a methadone or buprenorphine prescription while incarcerated. (Though this is a nationwide issue, blue states are leading the reform.) But writing the story from Seattle meant writing from a place of comfort: I was living among the reformers—walking within the pages of history that will be attributed to the good guys. I was able to take my buprenorphine every day because my state insurance covered it. I was surrounded by intelligent, informed people with whom I could speak honestly about my decision to engage in non-abstinence-based recovery. When I wrote about the issues in the system, I wrote from a place of distance. Of privilege.

    I did not appreciate how lucky I was until I dove headlong into the true trenches of the Drug War. 

    In Recovery and Losing Custody

    In Broward County, Florida, my children were removed from me because of unsubstantiated accusations of drug use. When my first slew of drug tests returned negative, the opposition began slinging whatever they could think of in my direction, hoping something would stick. Most of it revolved around the fact that I was poor—but ignorance about mental illness and addiction reared its ugly face yet again. The opposition cited my prior child welfare investigation in Florida—the one that was triggered by my daughter’s NAS. It was a routine investigation that had been deemed unsubstantiated. These types of investigations are typically labeled “harmless.” I had been in compliance with my methadone program, and my daughter’s doctors had no concerns—but five years later, the opposition used that prior methadone prescription as a basis for deeming me an unreliable witness: the dirty, lying junkie. 

    When I was asked under oath whether I had spoken with one of my husband’s siblings about possibly purchasing marijuana, I admitted that I had. Clinicians in addiction treatment recognize that drug cravings are normal and applaud us when we admit that we think about buying drugs but then decide against it. But the guardian ad litem attorney—the counsel whose job it is to protect my daughters’ interests—argued that by considering using marijuana, I placed my sobriety and therefore my children at risk. It didn’t matter that I canceled the purchase and honestly acknowledged that I’d thought about it. The judge called my process of considering marijuana but then deciding against it “drug-seeking behavior.” She gave custody of my daughters to my husband’s parents.

    The terribly irony underscoring the entire proceeding is that if I were still living in a state that embraced the most current research on addiction, I would never even have been in a courtroom. The accusation against me stated that I left my daughters in the care of their grandparents for three days while I used drugs outside of the home. According to the U.S. Department of Health and Human Services, “drug tests do not provide sufficient information for substantiating allegations of child abuse or neglect or for making decisions about the disposition of a case.” Drug use on its own, away from any children, is not child abuse. A parent who leaves their child with a family member to go to a bar for an evening is generally considered to be engaging in responsible substance use.

    The federal government recognizes that child abuse cannot reasonably be defined as placing a child with a trusted caregiver, leaving the home for a couple days, and returning sober. It doesn’t much matter what went on during those two days. True or false—the accusation against me never described child abuse. A more enlightened jurisdiction would have recognized that. The separation trauma that my children and I have endured over the past nine months is completely attributable to our location.

    I used to write about addiction and drug policy from a place of privilege. Now I am writing from the deep trenches. I feel as though I am performing a kind of literary necromancy whenever I publish—except that instead of communing with the dead or demonic, I am writing from within that unillumined place, hoping that, by disseminating research, facts, and the words of distant experts, I can summon reason back into my life.

    View the original article at thefix.com

  • The Problem with "Addicted Babies"

    The Problem with "Addicted Babies"

    The “addicted baby” issue is not simply linguistic. You’re not just contributing to stigma when you use this term, you’re misrepresenting medical facts.

    “She was born addicted, but without methadone, she may never have been born at all.”

    That was the last sentence of my first published article with a major media outlet, Vox. The story was about giving birth to my elder daughter while on methadone. The “she” was my newborn daughter. I was terrified to “come out” as a methadone patient, something I’d hid from my family and friends even through my daughter’s prolonged hospitalization and the child welfare investigation that was triggered by her neonatal abstinence syndrome (NAS), but I was also excited to be published by Vox — and rightfully so. This story would effectively launch my freelance writing and journalism career. What I didn’t realize at the time was that my first big article was factually inaccurate.

    It’s embarrassing, now that I know better, to realize I contributed to a harmful, widespread misunderstanding of addiction as equivalent to dependency. My editor on that story and I have since agreed to a correction in the terminology — but this story garnered enough attention to end up in my then-treatment counselor’s addiction newsletter and to land me a spot on the NPR podcast All Sides With Ann Fisher. Both appearances were well before that correction was made.

    A story that once brought me immense pride now fills me with shame as I remember the stigmatizing mistake I made when I first wrote it, but I remind myself that it was a personal essay — my first major one — and I was simply echoing the language I’d heard over and over again everywhere, from the neonatal intensive care unit where my daughter was treated for NAS to NBC, and even former incarnations of the New York Times. What some of these outlets are finally realizing is that reporting infants as “born addicted to drugs” is, effectively, fake news.

    Doctor Jana Burson, an opioid addiction treatment specialist and outspoken advocate for methadone and buprenorphine, summarizes the issue like this: “According to our definition of addiction…you have to have the psychological component of craving or obsession. By definition infants are not able to experience addiction.”

    Have you ever seen a baby beg for more morphine from her crib, or crawl across the NICU to snatch a dose from another infant? Do you see evidence that they are ruminating over opioids, or that they even understand their discomfort is tied to opioids? Do any infants ever require methadone or buprenorphine maintenance once their physical dependency symptoms have declined, in order to manage psychological addiction and prevent harmful, compulsive drug use?

    Of course, the answer to all of these questions is “No.” Infants born to mothers taking prescribed or non-prescribed opioids are sometimes born with a physical dependency on opioids. This means they will experience physical withdrawal, and may require extra comfort and possibly even titrated doses of opioids to wean them down. Their bodies will tense up, they’ll be extra cranky and have loose stools, and other symptoms of physical distress. It’s a painful experience, and my heart broke watching my own daughter go through it, but the fact remains: neither my daughter nor any other infant is born with an addiction.

    An infant capable of experiencing addiction would be remarkable for reasons far beyond the addiction; she would have capabilities of thought, expression, and action so far advanced beyond any infant born thus far that the government would probably snatch her up for extraterrestrial gene testing! In all seriousness, a baby who could ruminate about drugs, understand consequences, and then intentionally self-administer drugs despite those consequences would be a genius with super-strength. This baby is impossible outside of the X-Men Universe.

    So why do so many media outlets, legal professionals, and even some treatment providers continue to use this incorrect language? In part, it’s probably due to the very thing that makes the language problematic: it’s highly stigmatizing. And stigmatizing, unfortunately, equals drama. Which headline grabs your attention more? “The Number of Babies Born Addicted to Drugs Skyrockets” or “Babies Born with Opioid Dependencies on the Rise.” One is true, one is not, but the one that is not will probably get many more clicks. The consequences of this mischaracterization go beyond delivering incorrect information. “Any time you misstate facts or exaggerate, as many news outlets have, it increases the stigma and makes the problem worse because mothers feel more shame and they’re less likely to seek care…they’ll get less prenatal care because of it,” says Burson.

    Sensationalizing a medical disorder to sell papers or clicks has other real world consequences. Many medications have the potential to cause dependency and for that dependency to transfer from a pregnant woman to her baby. But we don’t say that babies born to moms taking anti-depressants are drug addicted, even though some of them will also experience a mild form of NAS. So why do we say it about babies born to moms who take methadone or buprenorphine, which are the gold standard of care for opioid use disorder for pregnant and non-pregnant patients?

    When you make a mother feel like she is going to turn her child into a “drug addict” by taking these medicines, you scare her from seeking treatment. The problem with that, of course, is that she remains at high risk for illicit drug use, which may cause a dependency in her child but also has other complications, like a heightened risk of miscarriage or stillbirth.

    Pregnant women aren’t the only ones who are harmed by the false equation of addiction with dependence. A lot of people think that people who take methadone or buprenorphine are just trading one addiction for another. In fact, methadone and buprenorphine will continue an opioid dependency, but are evidence-based treatments for opioid addiction approved by the World Health Organization and the FDA.

    This misconception leaks into correctional facilities and drug courts. Most jails and prisons forcibly detox methadone and buprenorphine patients, and many drug court judges disallow their use, even going so far as to order patients to taper off their medication. The false equivalency also harms other opioid patients. Across the country, people who require opioids to manage pain are being taken off their medications as doctors scamper to avoid being labeled “pill mills” or enablers of addiction. In some cases, the pain and withdrawal are so unbearable, these patients commit suicide.

    Because of this stigma, the debate about whether the press should use the term “addicted baby” has been lumped in with other language-centered debates, like whether or not the word “addict” is offensive. Personally, I think that news outlets should absolutely use person-first and medically-based language when talking about people who experience addiction. “Person with a substance use disorder” is a little clunkier than “addict,” but it’s worth it to relieve the sting and prejudice that’s associated with “addict.” But the “addicted baby” issue is not simply linguistic. You’re not just contributing to stigma when you use this term, you’re misrepresenting medical facts.

    It is the job of the press to disseminate the truth. Sometimes mistakes get made, like in my personal essay for Vox when I referred to my daughter as having been born addicted. That’s why we have a process for submitting corrections. When news outlets use terms like “drug addicted babies” or “baby addicts,” they’re misrepresenting the truth, which means they’re not doing their job

    If ever a “baby addict” comes into existence, there will be a far bigger story than the one about her addiction. Until we enter the age of superhumans, however, it is imperative that media outlets perform the most basic function of their job by delivering the actual facts. Babies born to mothers on methadone, buprenorphine, or other opioids may be born with a dependency on opioids. They are not born addicted.

    View the original article at thefix.com

  • The Empty Chair Campaign Highlights Loss and Sorrow Caused by the Drug War

    The Empty Chair Campaign Highlights Loss and Sorrow Caused by the Drug War

    The families of people incarcerated, distanced, or deceased because of the drug war live year-round with the unique suffering of loving someone whose pain you do not have the power to heal. During the holidays, that loss rises to the surface.

    Whether you’re celebrating Christmas, Hanukkah, Kwanzaa, New Year’s Day, or something else this winter, the one element that probably shapes your holiday celebrations most is family. For most of us, that’s joyous, stressful, lovely, and anxiety-inducing all rolled into one. For those of us whose extended family will be present, we might even dread the holidays a little bit, fearing the awkward antics of Uncle Joey or the grotesque way our cousin brags about her perfect life. But for families affected by the war on drugs, winter holiday festivities don’t get to be about celebrating your family or nitpicking your sister’s new boyfriend. Instead, they are shaped by grief and loss.

    If you read the news at all, or even just scroll Twitter every once in a while, you probably know that drug overdose deaths have skyrocketed. Approximately 175 people die by drug overdose every day. That’s 72,000 each year, and the majority of those deaths — almost 50,000 — involve some type of opioid. Alcohol deaths, which are counted separately, account for approximately 88,000 deaths each year, according to the Centers for Disease Control. So the impact of death due to substance use is huge, all on its own. But losing a loved one to a drug-related death is not the only way families are affected by drug use and the stigma that surrounds it.

    The Impact of the War on Drugs at the Holidays

    There are currently 200,000 people locked up in state prisons for drug crimes, and 82,000 convicted of drug crimes in federal detention facilities. These people are fathers and mothers, brothers and sisters, uncles, cousins, sons, daughters, and friends. Their loss is felt year-round by those who love them, but families affected by the drug war have an especially difficult time during the holidays. The pain of the season is why, each year since 2012, Moms United to End the War on Drugs runs their Empty Chair Campaign. It starts around Thanksgiving and extends through the December holidays. While families gather to celebrate love, unity, and forgiveness, the empty chair symbolizes those who cannot be present — either through death, incarceration, or the stigma that latches onto people who use drugs or struggle with addiction.

    “Part of the goal of the Empty Chair Campaign is to also destigmatize the loss of a loved one through overdose,” says Diane Goldstein, a retired police officer who now chairs the Law Enforcement Action Partnership, a group of criminal justice officials working toward system reform. Goldstein says she was inspired to work on criminal justice reform after watching her own brother struggle with substance use and mental health issues. Eventually, he died of a poly-substance overdose.

    “My mother was horribly embarrassed by my brother’s death and couldn’t talk about it,” Goldstein recalls. “I think you see a lot of families who that occurs with, so we are inclusive, not just of the victims of the drug war — which isn’t really a war on drugs, it’s a war on people — but to family members as well. It’s intended to reduce the stigma of the criminalization of drug use, support drug users, and help change the criminal justice system from criminalization to a public health approach.”

    The Empty Chair Honors an Absent Loved One

    The Empty Chair Campaign uses the symbol of the empty chair at the family table to stand in for the missing family member and highlight their absence. To participate, you can change your Facebook avatar to the empty chair logo, or you can post a photo of an empty chair at your table with a photo of your loved one and a label explaining why they’re missing: incarceration, accidental overdose, stigma, drug war violence.

    Gretchen Bergman, the executive director of Moms United to End the War on Drugs as well as its parent organization A New PATH, spent decades living with the overwhelming fear and anxiety unique to parents of children with drug addictions. That anxiety grew as she watched two sons sink into the world of destructive shame, stigma, and involvement with the criminal justice system which is now inextricably linked with addiction, thanks to the drug war.

    “My sons both tended to be leaders,” Bergman recalls, “My younger son was always a risk taker. He was the guy who jumped off the roof and dove into the swimming pool…My older son was very thoughtful, more cerebral.”

    Perhaps it was that cerebral nature which helped Bergman’s elder son, Elon, survive the prison system as he cycled through during his active addiction. He spent a combined eight years in prison, and three years on parole — and it all began when he was just 20, with a marijuana charge. Elon first acquired a taste for IV heroin behind bars, says Bergman, an addiction which would rule his 20s.

    “Today, because of our change of laws, he wouldn’t even be arrested at all,” Bergman notes of her son’s initial marijuana arrest — touching on a bitter truth that the lack of drug law uniformity has created across the United States. Whether or not a person becomes caught in the destructive and self-perpetuating criminal justice system depends largely on when and where they were arrested. Marijuana arrests are also disproportionately weighted against people of color, with the American Civil Liberties Union reporting that black people have historically been 3.73 times more likely to be arrested for marijuana than their white counterparts despite equal rates of use.

    Family Celebrations Marred by Grief

    For the Bergman family, the war on drugs became a constant, uninvited guest at their holiday celebrations. Year after year, Gretchen Bergman found herself faced with the decision: should she spend the holidays with her son in prison or with the rest of her family? Even when she decided to attend the big family dinner — knowing she’d spend the night nursing her broken heart as she thought of her son cold and alone in his prison cell — she didn’t always have her youngest son Aaron with her, either. Though Aaron never got caught up in the cycle of release and re-incarceration that seems to follow people with felony convictions, he used IV drugs for decades. The shame that often accompanies this type of drug use, which is so heavily stigmatized that even other drug users feel superior to people who use needles, led Aaron to stay on the streets and miss family functions.

    “We really thought we were going to lose him because his health was compromised, and he seemed so lost, and he became a multi-drug user,” Bergman recalls. “But I always believed he was still there.”

    Today, both of Bergman’s sons are in recovery. Aaron, the younger son, managers a sober living home owned by his older brother Elon.

    Julia Negron, who runs the Suncoast Harm Reduction Project in Florida, grew up around drugs. She ended up in the foster care because of her mother’s drug use, and eventually battled her own heroin addiction. She has never known a life not touched by drug and alcohol misuse. And, not surprisingly, she has lost a number of friends and family members to drug-related complications, including overdose. But the experience that haunts her most was the total helplessness she felt as the mother of a drug-addicted child being forced through the criminal justice system instead of guided toward drug treatment that could have truly helped him.

    “It’s just terrible,” she says about the holiday celebrations when her son was absent. “It’s not just that they’re not there, you feel they’re unjustly being held somewhere. You feel like it’s a hostage situation.” She recalls packing her family, including young grandchildren, into the car one Thanksgiving and driving them four hours across the California desert to get to the facility where her son was being held. “By the time we went through security and they had to strip search him and do all their stuff on that end,” she says, “they managed to use the entire time allotted to visiting…We never did see him.”

    Parents and families of people incarcerated, distanced, or deceased because of the drug war live year-round with the unique suffering of loving someone whose pain you do not have the power to heal. During the holidays, that loss rises to the surface, almost as tangible as the missing person. The Empty Chair Campaign does not seek to cure this sorrow, which won’t abate until the drug war is finally given the ceasefire we all need. Instead, it hopes to bring it to the surface, in order to raise awareness and honor those very real people who deserve their seat at the family table.

    “What kind of kills you is you know the person inside, you know who he is,” says Bergman, describing the experience of having a child who is incarcerated for having a substance use disorder. “Right at the time he needs treatment and healing, which would have involved introspection, he’s behind bars, where in order to survive you have to harden your heart. You watch him disappear into that shell that he needed to in order to survive in that cold, concrete, violent atmosphere. It’s terrible to watch.”

    Have you lost someone due to the drug war? Let us know in the comments.

    View the original article at thefix.com

  • Promising New Treatments for Opioid-Dependent Babies

    Promising New Treatments for Opioid-Dependent Babies

    Compassionate care for the mothers was crucial to positive outcomes for opioid-dependent babies.

    I gave birth to my daughter in late January of 2014. It was the kind of birth you see in the movies—the contractions started hard and grew closer together within moments. By the time I realized I was in labor, I was already in too much pain to walk. I began needing to push while my husband was on the phone calling for an ambulance. The 911 operator had to walk him through the beginning of my daughter’s delivery. Luckily, paramedics showed up to take over while she was still crowning. The lieutenant who delivered her said it was her first completed childbirth. I will never forget holding my newborn daughter in the elevator while we rode down to the ambulance, or how the entire labor and delivery staff burst into applause when we wheeled into the hospital. But the joy and pride of my wild, badass childbirth was quickly replaced by a deep sense of guilt.

    Within hours, my daughter began showing symptoms of opioid withdrawal—symptoms like rigid limbs, sneezing, and a sharp, screeching cry that burrowed into my belly and filled me with self-loathing. The withdrawal was from methadone, which I was prescribed and taking under a doctor’s supervision. Methadone has been the gold standard of care for pregnant people with opioid dependencies since the 1960s. I did the right thing. Still, watching my newborn daughter go through withdrawal was excruciating. Unfortunately, the treatment she and I received at the hospital—after that initial congratulatory applause—did not make the experience easier.

    My daughter’s level of discomfort was rated using the same system used by the majority of U.S. hospitals. It’s called the Finnegan Neonatal Abstinence Scoring Tool (though its inventor, Dr. Loretta Finnegan, notes with a laugh that her name was tacked onto it later without her knowledge). It consists of a comprehensive list of observable newborn withdrawal symptoms. Hospital staff, usually treating nurses, observe the babies every four hours and tally up the number of listed symptoms they observe. Each symptom is a point, and the overall score for that observation period is used to determine how to move forward with treatment. Usually a score above eight means the infant should begin an opiate wean, or have his dose raised if he has already been started on medication.

    The scoring system is the product of meticulous observations recorded by Finnegan in the early 1970s, when babies were dying from opioid withdrawal simply because nobody knew how to define and treat it. But in 2014, when my daughter was subject to it, and when her scores caused her to be sent to the Neonatal Intensive Care Unit (NICU) to be medicated with titrated doses of morphine for over a month by staff who were less than welcoming to me, I resented the Finnegan Score. Other methadone and buprenorphine-dependent mothers whom I have spoken with have related similar discontent with the system. Usually, the complaints center around variability between the way that different nurses score the babies, or at having their babies sent to the NICU. It turns out, the way some of these hospitals use the scoring system is not in keeping with best practice, according to its creator.

    Loretta Finnegan, who is now the Executive Officer of the College on Problems of Drug Dependence, says that inter-rater reliability is key to correct usage of the tool, and recommends that hospitals which use it conduct re-orientations “a minimum of every six months.” She also doesn’t believe that the modern NICU set-up is appropriate for babies who are experiencing NAS without other complications. In fact, she says that “the NICU is the worst place for these babies,” because of the overstimulation caused by the noise and bright lights. Finnegan puts out a training manual, and gives recommendations for the care of infants include swaddling, non-nutritive sucking, decreased stimulation, and plenty of access to mom. When she was doing her clinical work in Philadelphia, she says they “had [their] moms come in every day,” and that “compassionate care for the mothers” was crucial to positive outcomes for the babies. If I had received treatment more in line with Finnegan’s protocols, I probably would have resented the scoring system—and my daughter’s extended hospital stay—a lot less, and I suspect that other mothers would agree.

    But besides providing better training to staff who are using the current standard NAS protocol, there are a couple of promising new tools for NAS that could help decrease hospital stays for infants, and promote better trust between parents and hospital staff. One of these tools, developed by Matthew Grossman, M.D., an assistant professor of pediatrics at Yale School of Medicine, is called “Eat, Sleep, Console.”

    Renee Rushka gave birth to her daughter in July 2018, while taking methadone prescribed for opioid addiction. Her daughter was treated for NAS at Danbury Hospital in Connecticut. She says that they used the Finnegan NAS Scoring System to assess her baby, but they also performed another form of assessment. Although she says she never heard the term “Eat, Sleep, Console,” and she can’t remember the exact measures, she describes a protocol that sounds very much like the system first developed and researched by Grossman in 2014.

    Grossman’s system essentially measures exactly what the name implies—whether the baby is eating at least one ounce of milk, whether the baby can sleep for an hour straight, and whether she can be consoled within 10 minutes of becoming fussy. The protocol suggests maternal contact and non-pharmacological approaches whenever possible. Pharmacological intervention is indicated based on the infant’s level of functioning and comfort, rather than with the goal of reducing all withdrawal symptoms. According to Grossman’s trial conducted at Yale New Haven Children’s Hospital, only 12% of infants required morphine therapy, as opposed to 61% using the Finnegan system (though the study does not tell us whether they used it the way Finnegan herself recommends), and it significantly reduced the length of stay for many of the babies.

    Rushka reports that her experience with the combined Finnegan and ESC-like approach was extremely positive. She brought her baby home, healthy, after five days, having required zero medication intervention. She also notes that she did not feel judged by the staff, and even recalls receiving compliments and affirmations about her recovery—pointing toward the compassionate, inclusive approach that both Finnegan and Grossman deem crucial to the care of opioid-dependent infants. Finnegan expresses concerns that inter-rater reliability might also be an issue should ESC become more wide-spread, in part because of the design simplicity. But she’s definitely in favor of various treatments being designed for NAS. “In most diseases there are many ways to treat them,” she notes, adding, “I just need to see more proof [that ESC works.]”

    Another promising new tool for treating NAS takes a surprising form. It’s a crib called SNOO, whose designer was not initially thinking about NAS at all—his goal was to reduce Sudden Infant Death Syndrome (SIDS). Pediatrician Harvey Karp says that the crib can not only sense when a baby is in distress, but also what level of distress he’s experiencing—and will rock and emit soothing sounds to help calm the baby, similar to a human caregiver, but all while the real caregiver gets some much-needed rest. Karp says that “NAS babies are more skewed to the irritable side,” then, “the more sciencey way of saying it is that they have poor state control…basically you take a child with terrible state control and give them the rhythmic stimulation they need to get down to a calmer state…it’s so important to our neurology that even adults calm down this way; it’s not an accident we fall asleep in planes, trains, and cars. It’s an echo to this ancient, ancient response to the normal womb sensation.”

    Currently, Mark Waltzman, Chief of Pediatrics at South Shore Hospital in Boston, is conducting a study to test the efficacy of the SNOO in reducing distress in babies with NAS. He’s also using Grossman’s Eat, Sleep, Console tool to assess the babies’ level of discomfort. Waltzman’s study is still enrolling, so there’s no data available yet, but he is hopeful that SNOO will offer a relatively simple, non-pharmacological approach to treating the discomfort associated with NAS.

    It has been almost five years since my elder daughter was treated for NAS. Mothers across the country still report complaints similar to the ones I had then—but there are also moms like Rushka who are finding community and support in the hospitals where their babies are being treated. Regardless of the outcome of Waltzman’s SNOO trial, or further testing for Grossman’s Eat, Sleep, Console tool, the fact that this kind of diverse attention is being paid toward NAS—and alongside it a resurgence of the compassion toward the mothers that Finnegan first championed in the 70s—gives me a sense of much-needed hope. Maybe attitudes about addiction are making a positive shift within the medical community. Maybe, in the future, experiences like mine will be obsolete, and all opioid-dependent mothers and infants will have the compassionate care and affirmative respect enjoyed by Rushka and her daughter.

    View the original article at thefix.com

  • An Open Letter to Addiction Treatment Providers

    An Open Letter to Addiction Treatment Providers

    There’s something wrong with addiction patients feeling the need to ask for medical advice from their communities because they don’t trust their providers.

    Maybe you’re a psychiatrist. Maybe you’re a dosing nurse at a methadone clinic. Maybe you’re an inpatient counselor. Maybe you work in an emergency department, or you’re an OBGYN; maybe you don’t specialize in addiction at all, but you regularly come into contact with people who are struggling with the condition. If you’re a medical professional, and all or some of your clients have a substance use disorder (SUD) diagnosis, this letter is for you.

    I am a person in remission from a substance use disorder. I’m here to tell you that addiction patients need you to understand our condition. That sounds basic, I know. It is basic. But here’s the thing: too many of you don’t understand. I’m not trying to attack you. I’m not saying you’re all misinformed. There are unquestionably many caring and well-informed providers doing excellent work in this arena. But it’s also true that enough of you are misinformed to be causing major problems for SUD patients. And that needs to change. Like yesterday.

    Right now my husband is white-knuckling his way through methadone withdrawal while his clinic works on getting him safely back on his therapeutic dose after one of you, a behavioral health doctor, rapidly dropped him 100 milligrams without consent, for no medical reason, while he was in the hospital for mental health reasons. And in 2014, my newborn daughter went through over a month of neonatal withdrawal from my prescribed methadone, which could have been prevented or lessened if my pre- and postnatal providers had made a few small changes to their protocols; sadly, this kind of medical treatment is still provided to mothers and infants across the country.

    Every damn day SUD patients crowdsource medical information from social media communities and online forums, often due to mistrust in the medical community when it comes to addiction care.

    Sara E. Gefvert, a certified recovery specialist who runs the Methadone Information Patient and Support Advocacy (MIPSA) Facebook group, says that she created MIPSA because she saw members of other communities receiving unreliable responses to medical questions. “Many MAT sites and groups I saw were not monitored frequently for correct and accurate content or were only adding to the misinformation and stigma that persons in recovery face, especially being on medication-assisted treatment.”

    In just one day, questions asked in five separate addiction treatment-focused Facebook groups included: 

    What kind of pain relief options are available during labor while I’m on buprenorphine?
    Should I raise my methadone dose if I have psychological but not physical cravings?
    Is it normal to lose my sex drive while on methadone?
    Am I still in recovery if I drink alcohol occasionally?
    Can cold-turkey opioid withdrawal kill you?
    Is it safe to detox while pregnant?
    Can you combine buprenorphine and methadone?
    Should my methadone be making me nod out?

    And others along those lines.

    These are all medical questions with real world consequences—some dire. The answers to these questions should be coming from trusted providers with medical expertise. Sure, people crowdsource medical information from the internet all the time, but it’s usually about pretty mild concerns, or trying to squirrel out whether they should go to a doctor. On the other hand, these addiction specific questions are often accompanied by complaints that the patient couldn’t get a straight answer from her treatment provider, or that the information she received was the opposite of what she read in a research study or an online article. There’s nothing wrong with people seeking community input on issues they’re facing, especially when the answers are reviewed by knowledgeable and professionally trained administrators like in the MIPSA group.

    There is, however, something wrong with addiction patients feeling the need to ask for medical advice from their communities because they don’t trust their providers.

    This seems to be an especially prevalent issue for medication-assisted treatment (MAT) patients. I was on methadone for about a year in 2013 and 2014, and on buprenorphine from 2014 to June of 2018 (with a short break of about five months in 2016). Before starting methadone, I was actively addicted to heroin for close to five years. In all of that time, I heard a lot of different things from a lot of different doctors, nurses, counselors and detox staff in virtually every region of the country. For example:

    Buprenorphine is only good as a detox aid.
    Buprenorphine works best as a long-term treatment.

    Methadone is more addictive than heroin.
    Methadone creates a dependency but effectively treats addiction.

    Breastfeeding while on methadone is unsafe.
    Breastfeeding while on methadone can help ease neonatal withdrawal.

    I can’t count myself sober if I take medication
    I’m at an increased risk of relapsing and overdosing if I detox.

    Addiction is a disease.
    Addiction is a spiritual malady.

    How was I supposed to tease out the truth from all that?

    With all the confusing and contradictory information that patients receive about addiction, it would be easy for someone to assume that the medical science is still out. In reality, there’s quite a lot of straightforward, peer-reviewed data about substance use disorders. Frankly, there is no excuse for a medical provider to ignore these facts. For example, decades of research have shown that methadone (a long-acting opioid agonist) and buprenorphine (a partial opioid agonist), help deter opioid misuse, decrease the risk of fatal overdose, and may help to correct neurochemical changes that took place during active addiction.

    To quickly address some of the other misinformation I’ve encountered:

    • Both methadone and buprenorphine treatment are appropriate, and in fact designed, for long-term use. Patients who choose to taper from these medicines can do so safely, but there is no generalized medical reason why someone with an opioid use disorder should be forced off either medication.
    • Breastfeeding while on methadone or buprenorphine is considered safe as long as the mother is not using other substances.
    • If a patient is using these medicines as prescribed and is not using other substances in a compulsive manner, they are in remission from their substance use disorder. In other words, they’re sober (though defining oneself with the term “sober” is a personal choice).
    • Addiction is medically defined as a disease. Which means that the onus is on our medical providers to stay informed about the science of this disease.

    Ultimately, you can’t be held responsible for everything your patient does. But you do have a responsibility as a treatment provider to give your patients accurate and informed medical advice.

    According to the Substance Abuse and Mental Health Administration (SAMHSA), about 20 million adults in the United States have a substance use disorder. So we’re not talking about some rare condition that only a handful of specialists can be reasonably expected to understand. This is a common, treatable disorder with a robust body of solid research behind it. You need to read that research. You need to stay informed. If you don’t have an answer to a patient’s question, you need to refer them to an accessible colleague who will. You took an oath to do no harm. Staying informed about addiction medicine is part of keeping that oath.

    Sincerely,

    Elizabeth Brico

    View the original article at thefix.com

  • Should You Breastfeed Your Baby If You're on Methadone?

    Should You Breastfeed Your Baby If You're on Methadone?

    My daughter was born with neonatal abstinence syndrome but I was not allowed to nurse or have her in the room with me; the hospital staff said the methadone in my breast milk could be dangerous. They were wrong.

    Earlier this summer several news outlets reported on the death of an 11-week-old infant in Philadelphia by what appeared to be a drug overdose. The mother, who has been charged with criminal homicide, blamed the drug exposure on her breast milk. Although an autopsy revealed that the infant’s drug exposure also included amphetamine and methamphetamine, many news outlets chose to focus on the fact that the mother was a methadone patient. The death of an infant by drug exposure is unquestionably terrible; unfortunately, misleading articles make what is already a tragedy even worse by insinuating or directly stating that the methadone content in the breast milk was involved in the infant’s death.

    Stigma around methadone use in the United States has a long shadow. Prescribed primarily to treat opioid use disorder (but also sometimes for pain management), methadone is a long acting opioid that builds in the patient’s bloodstream to create a stable, non-euphoric equilibrium when used correctly. It is a highly effective form of both addiction treatment and harm reduction, shown to reduce overdose deaths by 50% or more. Unlike short acting opioids like heroin or morphine, methadone prevents patients from experiencing the physical chaos of sedation and withdrawal, and can help re-balance neurochemical changes that take place during active addiction. For decades, methadone has been considered the gold standard of treatment for opioid use disorder, including during and after pregnancy.

    But in spite of the demonstrated benefits of methadone and its pharmacological differences from commonly misused opioids, it has, for many years, acquired a popular status as “legal heroin.” Social media is flooded with memes mocking methadone patients or complaining that they don’t deserve “free methadone” when other drugs cost money (in fact, methadone has a price tag like any other medication). Even other people in recovery or the throes of active addiction disparage methadone, sometimes referring to it as “liquid handcuffs” because of the stringent regulations requiring daily trips to a clinic during the first several months of treatment.

    This stigma leaks into every aspect of patient care. For me, it prevented me from seeking treatment for years. I was terrified to get on methadone. Who would volunteer to be “handcuffed” by a treatment system? But when I learned I was pregnant, my doctors urged me to get on methadone. They said that attempting to withdraw from heroin would be dangerous for my developing baby, and continuing to use would be even riskier.

    I was reluctant, but I enrolled in a methadone maintenance program as my doctors advised. Because of that, I had a healthy, full-term pregnancy. But at the Florida-based hospital where my daughter was taken after a speedy, unplanned home birth, I was not allowed to breastfeed. My daughter suffered neonatal abstinence syndrome (NAS), a condition caused by opioid withdrawal that occurs in some babies whose mothers used methadone or other opioids while pregnant; she was dosed with morphine to wean her down from the methadone she received in utero, and the hospital staff told me that adding my methadone dose via breast milk could be dangerous. Because of that, my milk production dwindled, and my daughter—who stayed in the hospital over a month—never learned to properly latch. After she came home, she suffered colic, constipation, and sleep disturbances as we worked through various formulas trying to find one that was gentle on her stomach.

    But these negative ideas about methadone distribution in breast milk are flat out wrong. We know that methadone is a highly potent, long-acting opioid that is extremely dangerous if given to infants and children directly. No amount of methadone syrup should be administered to an infant or child by a parent or caregiver without physician approval. But studies have demonstrated that the amount of methadone that gets passed into breast milk is negligible, and will not harm an infant, even a newborn. A 2007 study of methadone-maintained mothers in addiction recovery found that methadone concentrations in breast milk remained minimal in the first four days postpartum, regardless of maternal dose, time of day after dosing, and type of breast milk being expressed. The daily amount of methadone ingestible by the infants did not rise above .09 mg per day. To help prevent even that slight fluctuation, John McCarthy, a practicing and teaching psychiatrist who has treated opioid-dependent pregnant and postpartum women for over 40 years, suggests splitting nursing mothers’ methadone doses in two—a measure that should have begun during pregnancy to help minimize the risk of NAS. “It’s not dangerous to nurse on a once a day dose, but it’s not the best way to give the medication. The baby should be given a smooth level of methadone.”

    Some people believe that breastfeeding an infant with NAS while on methadone will help decrease withdrawal symptoms by providing a minute amount of the same drug from which the infant is withdrawing. According to experts like Jana Burson, a doctor specializing in the treatment of opioid addiction, this belief is also false: “some mothers erroneously think their babies won’t withdraw if they breastfeed—that’s wrong. There’s not enough methadone in the breast milk to treat NAS.” Of course, breastfeeding a child who experiences NAS is beneficial, both because of the health benefits of breast milk, and because maternal contact is important for babies in distress. “Breastfeeding will help in the general sense that babies like to breastfeed and it’s calming, but not because babies are getting methadone in the breast milk.”

    Sandi C., a methadone-maintained mother based out of Massachusetts, breastfed her son for two and a half years, and plans on breastfeeding the baby she is currently expecting. Like me, Sandi was addicted to heroin when she learned she was pregnant. She began on buprenorphine, a partial-opioid agonist used similarly to methadone, and switched to methadone partway through her pregnancy. But her postnatal experience was different than mine.

    “I’m really fortunate that my area is really encouraging of breastfeeding,” says Sandi. “Actually, I wasn’t sure if I could breastfeed and [my doctor] said ‘definitely breastfeed, we encourage it.’” Like my daughter, Sandi’s son was diagnosed with NAS. But instead of being sent to the Neonatal Intensive Care Unit (NICU), her son was allowed to be in the hospital room with her, where Sandi could hold and breastfeed him as much as he needed. Her son was released after just two weeks, less than half the time my daughter spent in the NICU at our hospital in Florida. She continued to breastfeed at home until he was over two years old.

    “He never got sedated,” she recalls. “Everything was fine.”

    Just because methadone is safe for breastfeeding moms doesn’t mean the same is true for other drugs. If the Philadelphia baby’s death was in fact caused by what many outlets have called “drug-laced breast milk,” it would have been due to the amphetamines, not the methadone. Methamphetamine breast milk exposure has not been studied as extensively as methadone, but current recommendations are that lactating women should wait 48 hours after their last use of methamphetamine before resuming breastfeeding. Experts like Burson and McCarthy agree that mothers on methadone maintenance who are not using other substances can safely breastfeed. “All of the major medical groups recommend it,” Burson said, adding, “even on higher doses they all recommend that mothers on methadone breastfeed.”

    View the original article at thefix.com

  • PTSD Service Dogs Are Saving Lives

    PTSD Service Dogs Are Saving Lives

    “If I could pin a medal on Aura, I would,” Evans asserts. “I feel safe in my own world since I’ve had Aura. She’s life saving.”

    United States Army Command Sergeant Major Gretchen Evans’ life changed forever in 2006. This was her ninth combat tour since joining the Army in 1979. It was early spring, Afghanistan, and snow still peaked the mountains, but the chill in the air was beginning to shudder into the warmth that heralded the time for going home. One instant shortly before departure would change her homecoming from routine to medically urgent. While taking enemy fire, a nearby rocket blast left Evans with a traumatic brain injury and total hearing loss. She also suffered post-traumatic stress disorder (PTSD). Although the injuries sustained on that last tour in Afghanistan meant the end of Evans’ 27-year military career, she believes she’s had PTSD ever since her first tour to Grenada in 1983.

    “You just learn to keep that stuff in control because it wasn’t okay or acceptable to exhibit PTSD symptoms while in active duty,” says Evans, who began finally treating her psychological trauma in 2008. Since accepting and addressing her PTSD diagnosis, Evans has used several different treatments including therapy, medication, and identifying her personal triggers. But one of her most helpful aids comes in the form of her faithful service dog, Aura.

    Companion animals have entered the mainstream conversation in recent years as reaping a host of physical and mental health benefits for their owners. These boons include everything from lower blood pressure to decreased anxiety. Emotional support animals have gained popularity among people struggling with disorders like depression and anxiety. These animals are able to provide comfort, companionship, and a sense of purpose to some people who have shown resistance to other, more formalized treatments. Given the rising popularity of emotional support dogs and other pets, it’s important to recognize their distinction from service animals. Service dogs, which include Psychiatric Service Dogs, receive specific training related to their handler’s disability. We have probably all encountered a seeing-eye dog helping his visually impaired handler keep from walking into a busy intersection, for example. Emotional support dogs are less specialized and not covered by the Americans with Disabilities Act—which means you can’t claim discrimination if your therapy dog gets kicked out of the supermarket. The distinction may seem unfair for those who swear by their companion dog, but it does allow those with a qualifying disorder to receive highly specialized assistance. For people with PTSD, that assistance can be life changing.

    The science on service dogs for PTSD is still relatively sparse. That which does exist tends to focus on the benefits for combat personnel, like Evans, which leaves little to no evidence for the use of psychiatric dogs in the treatment of PTSD related to sexual assault, natural disaster, or other forms of trauma. Nonetheless, there is strong anecdotal support of service dogs for the treatment of trauma survivors, and PTSD is now a service-dog qualifying disorder in the United States.

    Evans received Aura free-of-cost through an organization called America’s Vet Dogs, which provides service dogs to disabled U.S. veterans and first responders. Organizations like these are important because Veteran’s Affairs does not currently provide service dogs for their members. Aura is technically categorized as a hearing-aid dog because Evans’ deafness is considered her primary disability, but Evans says the training Aura received for her PTSD has been life-changing after a series of false-starts when it came to her psychological recovery.

    “In the beginning I tried excessive exercise…I tried meditation…I swam with the sharks, which is not really all that relaxing, and I did virtual reality…which works for a lot of veterans, but I had ten million things that happened to me, not just one trauma.” In the end, she says, a combination of medicinal, psychological, and community support helped her come to a place where her PTSD is manageable. And Aura.

    One of Aura’s dominant PTSD-related tasks comes in the form of something that may sound simple to those who have never experienced a trauma nightmare: waking Evans up. This is a task echoed in the emerging literature on PTSD service dogs. The animals act by removing covers from their handler, nudging them, or even jumping onto their handler’s chest if other efforts are unsuccessful. This assistance alone is crucial, because, unlike average nightmares, PTSD-related nightmares typically replay the events or emotions of the trauma in such vivid detail that those who suffer from them may fear returning to sleep, leaving them fatigued and emotionally drained before the day has even begun.

    Evans says Aura also helps her feel safe in the world. The combination of hearing loss and combat-related PTSD can leave Evans feeling vulnerable in public, especially in settings where she has to stand in line or navigate a crowd of unfamiliar people. Her service dog helps to alert her when strangers are approaching from behind, and to provide a berth that minimizes unwanted contact—all of these important for the reduction of hypervigilance, a common PTSD symptom that leaves sufferers feeling anxious, alert, and physically fatigued.

    The biggest criticism emerging from the practice of using service dogs to support PTSD recovery is that dogs have a considerably shorter life span than humans, which could potentially leave an attached handler devastated by the loss. Though merely speculative at this point, this concern merits further research, especially when it comes to the care of survivors who witnessed or experienced loss of life.

    Research on PTSD dogs is still young and much of the extant literature relies on self-reports. Like many aspects of trauma research, it has thus far focused mostly on combat veterans. It will likely be years before we have a large body of data confirming the experiences of combat trauma survivors like Evans, and even longer before that is applied to survivors of other types of trauma. Until then, we have the testimony of those whose lives have been changed by these animals.

    “If I could pin a medal on Aura, I would,” Evans asserts. “I feel safe in my own world since I’ve had Aura. She’s life saving.”

    View the original article at thefix.com

  • Using Marijuana to Treat Opioid Addiction

    Using Marijuana to Treat Opioid Addiction

    When I’m on marijuana, the thought of injecting toxic drugs into my body seems totally unhealthy and unappealing.

    If you believe that medication-assisted treatment (MAT) for opioid use disorder (OUD) is wrong because it’s “just substituting one drug for another,” then you’re really not going to like this article. It’s not about one of the three major forms of MAT approved for opioid addiction: buprenorphine, methadone, or naltrexone. It’s about another medication, which does not cause a physical dependency, nor does it contribute to the 175 drug overdose deaths that take place each day in the United States. It has fewer harmful side effects than most other medications, and has even been correlated with a reduction in opioid overdose rates. Nonetheless, it is more controversial than MAT and, in most states, less accessible. In fact, Pennsylvania is the only state that has approved its use for OUD—and only as of May 17, 2018. In New Jersey, it was recently approved to treat chronic pain due to opioid use disorder.

    The medication I’m describing is, of course, marijuana.

    Abstinence-based thinking has dominated the recovery discussion for quite some time. Since Alcoholics Anonymous began in the 1930s, the general public has associated addiction recovery with a discontinuation of all euphoric substances. Historically, that thinking has also extended to medication-assisted treatment, even though MAT is specifically designed not to produce a euphoric high when used as prescribed by people with an already existing opioid tolerance. The bias against MAT is finally beginning to lift; there is now even a 12-step fellowship for people using medications like methadone or buprenorphine. But marijuana, which is definitely capable of producing euphoria, is still under fire as an addiction treatment.

    In addition to the ingrained abstinence-only rule, another reason that most states don’t approve the use of marijuana for OUD is that there is little to no research backing its efficacy. Even in Pennsylvania, the recent addition of OUD to the list of conditions treatable by marijuana is temporary. Depending in part on the results of research performed by several universities throughout the state, OUD could lose its medical marijuana status in the future. And other states that have tried to add it have failed, including Maine, Vermont, New Hampshire, and New Mexico. It’s not that any research has shown marijuana doesn’t work for OUD. There simply has not been much—if any—full-scale research completed that says it does.

    But street wisdom tells a different story. Jessica Gelay, the policy manager for the Drug Policy Alliance’s New Mexico office, has been fighting to get OUD added as a medical marijuana qualifying condition in New Mexico since 2016. Although she recognizes that research on the topic is far from robust, she believes cannabis has a real potential to help minimize opioid use and the dangers associated with it.

    “Medical cannabis can not only help people get rest [when they’re in withdrawal],” says Gelay, “it can also help reduce nausea, get an appetite, reduce anxiety and cravings…it helps people reduce the craving voice. It helps people gain perspective.” I can relate to Gelay’s sentiment, because that’s exactly what marijuana does for me.

    I am five years into recovery from heroin addiction. I don’t claim the past five years have been completely opioid free, but I no longer meet the criteria for an active opioid use disorder. Total abstinence does not define my recovery. I take one of the approved drugs for OUD, buprenorphine, but as someone who also struggles with post-traumatic stress disorder (PTSD) as the result of physical and sexual assault, I experience emotional triggers that buprenorphine doesn’t address, leaving me vulnerable to my old way of self-medicating: heroin. But what does help me through these potentially risky episodes? Marijuana. For me, ingesting marijuana (which I buy legally from my local pot shop in Seattle, Washington) erases my cravings for heroin. It puts me in touch with a part of my emotional core that gets shut down when I am triggered. When I’m on marijuana, the thought of injecting toxic drugs into my body seems totally unhealthy and unappealing—probably the way it seems to someone who doesn’t have an opioid use disorder. It’s not a cure-all, but it stops me from relapsing.

    High Sobriety is a rehabilitation program based out of Philadelphia that provides cannabis-based recovery for addiction, with a focus on addiction to opiates. Founder Joe Schrank, who is also a clinical social worker, says that treatment should be about treating people where they are, and for people with chronic pain or a history of serious drug use, that can often mean providing them a safer alternative—one that Shrank, who does not personally use marijuana, says is not only effective, but even somewhat enjoyable.

    “[Cannabis forms] a great therapeutic alliance from the get-go. Like, we’re here with compassion, we’re not here to punish you, we want to make this as comfortable as we possibly can, and the doctor says you can have this [marijuana]. I think it’s better than the message of ‘you’re a drug addict and you’re a piece of shit and you’re going to puke,’” says Schrank.

    People have been using this method on the streets for years, something I observed during my time in both active addiction and recovery. Anecdotally, marijuana’s efficacy as a withdrawal and recovery aid is said to be attributed to its pain-relieving properties, which help with the aches and pains of coming off an opioid, as well as adding the psychological balm of the high. The difference between opiated versus non-opiated perception is stark, to say the least. The ability to soften the blow of that transition helps some users acclimate to life without opioids. Even if the marijuana use doesn’t remain transitional—if someone who was formerly addicted to heroin continues to use marijuana for the rest of his or her life instead—the risk of fatal overdose, hepatitis C or HIV transmission through drug use, and a host of other complications still go down to zero. Take it from someone who has walked the tenuous line of addiction: that’s a big win.

    Marijuana may also be able to help people get off of opioid-based maintenance medications. Although there is no generalized medical reason why a person should discontinue methadone or buprenorphine, many people decide that they wish to taper off. Sometimes this is due to stigma; friends or family members who insist, wrongly, that people on MAT are not truly sober. Too often, it’s a decision necessitated by finances.

    For Stephanie Bertrand, detoxing from buprenorphine is a way for her to fully end the chapter of her life that included opioid addiction and dependency. Bertrand is a buprenorphine and medical marijuana patient living in Ontario, Canada. She is prescribed buprenorphine/naloxone, which she is currently tapering from, and 60mg monthly of marijuana by the same doctor. She says that marijuana serves a dual purpose in her recovery. It was initially prescribed as an alternative to benzodiazepines, a type of anxiety medicine that can be dangerous, even fatal, when combined with opioids like buprenorphine. The anxiety relief helps her stay sober, she says, because she’d been self-medicating the anxiety during her active addiction. She now also uses a strain that is high in cannabidiol (CBD), the chemical responsible for many of cannabis’ pain relieving properties, to help with the aches and discomfort that come along with her buprenorphine taper. She says the marijuana has gotten her through four 2mg dose drops, and she has four more to go.

    Bertrand would not have the same experience if she were living in the United States. MAT programs in the States tend to disallow marijuana use, even in states where it has been legalized. But studies tell us this shouldn’t really be a concern. Two separate studies, one published in 2002 and the other in 2003, found that MAT patients who used cannabis did not show poorer outcomes than patients who abstained. Although this reasoning alone doesn’t mean marijuana helps with recovery, these findings set the groundwork for future research.

    Do the experiences of people like me and Bertrand represent a viable treatment plan for opioid use disorder? It will likely be a few years before we have the official data. Until then, it’s high time we stop demonizing people in opioid recovery who choose to live a meaningful life that includes marijuana.

    View the original article at thefix.com