Answer Addiction

Tag: harm reduction

  • A Practical and Comprehensive Guide to Finding a Suboxone Clinic

    A Practical and Comprehensive Guide to Finding a Suboxone Clinic

    It took me 10 hours of phone calls, 20 voicemails, 3 chewed fingernails, and many packs of cigarettes before I found a Suboxone provider in my new town. This is the list I wish I had then.

    When I pulled a “geographic” a few years ago, leaving Portland for my home state of North Dakota, I underestimated the stress of starting over. In fact, stress isn’t a strong enough word to describe driving 1,300 miles with my recent ex-boyfriend in the passenger seat and the fear of restarting life without heroin; not to mention I had no full-time job prospect, no health insurance, no apartment, and very few of my possessions. I also had a unique fear that loomed over me like an ominous storm cloud: trying to find a new Suboxone* provider in a rural state. 

    It took me almost ten hours of phone calls, twenty voicemails, ten games of phone tag, three chewed fingernails, and many packs of cigarettes to find a clinic that would dispense the medicine I take to maintain my recovery. 

    Unfortunately, my situation is a common one. Despite our nation being in the throes of an opioid epidemic, finding a Suboxone provider is a widespread problem; only about one-third of addiction rehabilitation programs offer long-term use of methadone or buprenorphine (the active ingredient in Suboxone). And according to the National Alliance of Advocates for Buprenorphine Treatment (NAABT), only about half of all Suboxone providers are accepting new patients.

    Finding this life-saving medication shouldn’t be so hard. When you are committed to getting better, you shouldn’t have to worry about whether or not you’ll be able to find a clinic to dispense your medicine. A person with diabetes wouldn’t have to search hard to find insulin. So I’ve compiled a round-up of tips and suggestions. 

    This is the list I wish I’d had in early recovery:

    1. Find friends and family who are supportive of your Suboxone journey.

    2. Remember that your form of treatment is just as valid as all other types of treatment and recovery.

    Although Suboxone is a widely stigmatized and divisive medication in the recovery community, it has been shown to reduce opioid overdose death rates by 40 percent.

    3. Join online support groups and forums for people on Suboxone.

    Since I lived in a rural area, I couldn’t find any in person groups. So I joined secret social media Suboxone support groups on Facebook, recovery Reddit threads, and peer-support forums such as the Addiction Survivors website and Suboxone Talk Zone.

    4. Allow Plenty of Time to Research, Call, and Locate Providers.

    This was the most daunting and lengthy part of finding a new provider. Dr. Bruce Seligsohn has been a board-certified internist in Southern California for 30 years and practicing addiction medicine for 10 years. Dr. Seligsohn advises: “Patients really need to be very careful selecting a doctor if they have a choice. I would suggest that a patient looking for a new doctor do their due diligence and see what comes up online about the doctor.”

    I have compiled the most current resources available as of August 2018. See the sidebar for a sample phone script for calling providers.  

    Pros: Convenience, ease of navigation. You will be able to easily search for a provider based upon zip code, state, and the distance that you’re able to travel for a clinic.

    Cons: Out of date, inaccurate, not comprehensive. Be prepared for hours of phone calls depending on your location and financial situation. Not all providers are listed on the site. I also found that some of the clinics listed were not accepting new patients, had been closed, or had their numbers disconnected.

    Pros: Ease of navigation, instant results. Similar to the Suboxone manufacturer’s website, this is a good launching point for starting your search based upon zip code, state, and the distance that you’re able to travel. 

    Cons:  Not comprehensive and despite being a government resource, it is not up-to-date.

    Pros: Easy to use, more accurate. Treatment Match only connects you with providers in your area who are accepting new patients, reducing dead ends and calls to providers who aren’t accepting new patients or insurance. 

    Cons: Wait time/ lack of timeliness, not as many provider connections. This is not a straightforward directory and while it’s easy to sign up, you have to wait for a provider to respond to your email. The site claims that doctors respond 24/7, including weekends and holidays, but I only heard from them during normal business hours.

    • Yelp Reviews of Clinics

    Pros: Hearing directly from other patients about their experiences, easy to use, instantaneous, accessible.

    Cons: Questionable trustworthiness. Dr Seligsohn said: “Patient reviews can sometimes be very misleading.”

    • Calling Your Insurance Company

    Note: Insurance companies vary widely, so I can only speak from my experience. For example, in Oregon I was easily able to locate a Suboxone provider through my insurance company, but my North Dakota insurance did not provide referrals. They stated that their preferred addiction treatment was therapy and 12-step based treatment programs rather than medication.  

    Pros: Possible thorough list of doctors certified to prescribe Suboxone. Those Suboxone providers who accept your insurance are required to keep their information listed and up-to-date.

    Cons: Time-consuming and you have to deal with the hurdles of bureaucracy. Plus, some studies have found that only about 50% of eligible Suboxone doctors accept insurance. Some insurance companies like mine will allow you to submit an appeal asking them to cover part of your Suboxone visit or prescription, especially in rural areas. I saved all of my receipts and had my psychiatrist and Suboxone doctors write letters of support. After months of appeals, the insurance company agreed to cover part of each appointment. Each month I sent in a claim and receipt, and then I received a reimbursement check about a month later. 

    • Asking for a referral from your primary care provider, psychiatrist, or hospital.

    Another note: This is also difficult to give specific advice on because they vary depending according to location and providers, among many other factors.

    Pros: In-person support and assistance, more direct medical guidance and advice. 

    Cons: Stigma, lack of education about Suboxone, judgement, lack of timeliness. 

    5. Be Persistent!  

    6. Moving? Set Up an Appointment Months in Advance.

    Dr. Seligsohn advises finding a doctor and setting up an appointment prior to moving. “Patients need to find out as much information about how their perspective new doctor runs his practice…They also need to find out what the doctor’s philosophy is about long-term vs short-term Suboxone. If I was a patient I’d be reluctant to move to an area where there’s a shortage of Suboxone doctors.”


    Sidebar: Sample Phone Script for Calling Suboxone Providers

    I remember being so nervous, overwhelmed, and frustrated while also dealing with the symptoms of opioid withdrawal. Make sure you set aside a few hours for making calls in a quiet, safe place. I know some of these tips might seem like common sense, but when you’re in crisis and everything feels overwhelming, it can be a relief to have a guide.

    1. Introduce yourself and tell them that you’re looking for a suboxone provider.

    2. Where are you located?

    3. Are you accepting new patients?

    • If yes- when is your earliest available appointment?
    • If no- don’t hang up just yet! Ask: do you have a waiting list? Can you give me an estimate for how long it would take me to get an appointment? 
    • Do you have a cancellation list and if so, can you please add me to it?

    4. How often do I need to come to the clinic or office? 

    • Most clinics and offices require monthly or bi-monthly visits, but some require daily visits and dispense suboxone in a similar manner to methadone.

    4. Do you accept my insurance? 

    5. If the clinic does not accept insurance, how much does each appointment cost?

    • How much does the intake appointment/ first visit cost? This is an important question to ask because initial intake appointments can cost anywhere from $100 – $200 more than a regular visit.
    • Some clinics require pre-payment to reserve your appointment and prevent cancellation. Do you require a down payment before the appointment?
    • What forms of payment do you accept? (cash, credit, check?) Note that most clinics do not accept checks.
    • Do you allow payment plans or is payment due on the day of the appointment? A majority of clinics will not allow patients to do a payment plan and payment is due on the day of the appointment.
    • Are there any additional costs or required fees? Some charge additional fees for mandatory counseling, drug screens, etc.

    6. What are the counseling requirements?

    • You may be required to do weekly or monthly therapy groups with others at the clinic, and/or meet with an addiction counselor. This varies depending on how long you’ve been clean and your insurance coverage. (For example, one of my previous clinics had no counseling requirement, but my new clinic requires me to meet with an addiction counselor for one hour each month. Other clinics require weekly or bi-monthly group support meetings.)

    Quick Resource List:

    The Substance Abuse and Mental Health Administration (SAMHSA)’s Buprenorphine Treatment Practitioner Locator

    Suboxone Website’s Treatment Provider Directory

    Buprenorphine Matching System on Treatment Match on The National Alliance of Advocates for Buprenorphine Treatment (NAABT)

    Addiction Survivors

    Suboxone Talk Zone

      

    *(Writer’s Note: Suboxone is the most common brand-name buprenorphine medication, but this article is also applicable for patients seeking any form of buprenorphine treatment including: Subutex, Zubsolv, Bunavail, and Probuphine).  

    View the original article at thefix.com

  • Harm Reduction Program Offers Cannabis As Alternative To Hard Drugs

    Harm Reduction Program Offers Cannabis As Alternative To Hard Drugs

    The Canadian program also offers free fentanyl testing strips and naloxone training.

    A Canadian harm reduction program is hitting the local opioid addiction crisis from a unique angle—by providing cannabis at little to no cost as an alternative to street drugs.

    The High Hopes Foundation, based in Vancouver, Canada—also home to North America’s first legal supervised injection site (SIF)—is the country’s first “full-time cannabis harm reduction program,” CTV News reports.

    While this isn’t the first recovery program to feature cannabis as a treatment, it’s still a rather novel idea that some consider controversial. But Sarah Blyth, president of High Hopes, says the program is a realistic approach to attacking the most potent addictions.

    “It’s not always possible for people to just completely come off all drugs, because they’ve got trauma. They have pain. They need something,” Blyth said last August, according to CBC. “Opiates may not be the best option for everyone so we’re trying to give them the options we have available.”

    High Hopes offers free or low-cost cannabis and CBD oils to people trying to wean off drugs like opioids, which have been a big problem in Canada as well.

    According to CTV News, nearly 4,000 Canadians died of opioid overdose in 2017; about 1,400 of them were in British Columbia, the province that Vancouver resides in.

    The foundation also offers free fentanyl testing strips and naloxone training. According to Blyth, the majority of illicit drug samples analyzed by the Vancouver Overdose Prevention Society tested positive for fentanyl, which raises the risk of overdose.

    The cannabis program, established last year, started out by collecting cannabis donations from registered patients or dispensaries. Once Canada’s marijuana legalization law goes into effect this October, perhaps High Hopes will have an easier time procuring legal cannabis.

    “What we are doing is not fully legal but we see it helps and we are desperate to help people. Watching people die isn’t okay,” said Blyth.

    The program’s goal is to give people with addictions an alternative to using potentially dangerous street drugs. Blyth noted that many are just seeking relief for pain, anxiety or inflammation. “It gives them a way to have an alternative to the drugs that they’re getting on the street,” said Blyth, who is also the founder of the Overdose Prevention Society. “It’s safe, it can reduce pain.”

    View the original article at thefix.com

  • San Francisco Unveils Safe Injection Site Prototype

    San Francisco Unveils Safe Injection Site Prototype

    Alongside accommodations for drug use, the facilities will offer a range of services geared toward giving clients a chance to get well.

    With the city of San Francisco now closer than ever to opening the nation’s first supervised injection facility (SIF), it unveiled a prototype to show how a real facility will operate.

    The public was invited to view the demonstration, titled Safer Inside, at Glide Memorial Church in the city’s Tenderloin neighborhood from August 28-31.

    San Francisco is not the only city that has fielded the possibility of opening a supervised injection facility, which is prohibited under federal law. However, that’s closer to reality than ever, after final revisions of the bill (AB186) to allow the city to establish a SIF were approved by the state Assembly. AB186 now awaits the signature of Governor Jerry Brown.

    The goal of opening such a site is to keep drug use off the streets, while giving people a safe place to use.

    “I refuse to accept what we see on our streets—the needles, the open drug use, the human suffering caused by addiction—as the new status quo,” said Mayor London Breed in a statement. “Safe injection sites are a proven, evidence-based approach to solving this public health crisis.”

    The San Francisco Chronicle offered a glimpse inside the Safer Inside demonstration. “Clients” who wish to use the facility register upon entering, and are then led to the injection room. They are provided with a “harm reduction kit” containing clean syringes, disinfecting wipes, cotton balls, tourniquets, and “cookers” to cook the drug.

    They may inject at a table facing a small mirror that will allow staff to observe from a distance. “This way, we can check in on them without actually having to invade their space and their privacy,” said Kenneth Kim, clinical director at Glide. Afterwards, clients are ushered to a “chill-out room” where they can ride out their highs.

    Despite the accommodations for drug use, public health officials are most proud that these facilities will offer a range of services geared toward giving clients a chance to get well. Services include meal services, showers, dental care, and mental health and medical referrals, according to the SF Chronicle.

    “The readiness to take that next step or maybe go to recovery can start in a place where there’s dignity and respect and relationships,” said Anel Muller, who designed the prototype facility. “That’s not something that will happen overnight, but once you’re creating those great foundations, it becomes much easier to talk about a lot of different things.”

    The greatest hurdle San Francisco officials may face is the federal government. Last Monday (August 27), US Deputy Attorney General Rod Rosenstein reiterated the federal government’s stance on SIFs—declaring them “very dangerous” and that they will “only make the opioid crisis worse.”

    “Because federal law clearly prohibits injection sites, cities and counties should expect the Department of Justice to meet the opening of any injection site with swift and aggressive action,” said Rosenstein.

    View the original article at thefix.com

  • Dopesick: An Interview with Beth Macy

    Dopesick: An Interview with Beth Macy

    It takes the average user eight years and five to six treatment attempts just to achieve one year of sobriety. And in an era of fentanyl and other even stronger synthetic opioids, many users don’t have eight years.

    As recently as a few years ago, the opioid crisis could be referred to as a “silent epidemic,” perhaps in part due to its degrading nature. Opioid addiction is frequently described using metaphors of slavery, or enslavement, and those within its clutches are liable to feel acutely ashamed. No longer, however, is it possible to argue that the scourge of opioid addiction is being overlooked.

    No doubt that is partly due to the growing enormity of the problem. For each of the past several years, more people have died from drug overdoses than American service members were killed during the entire Vietnam War.

    Meanwhile, energetic and compassionate journalists have been doing outstanding work, covering the crisis from various vantages. Chief among them is Beth Macy, a New York Times-bestselling author, who first began noticing the effects of opioid addiction as a reporter for the Roanoke Times, where she worked for 25 years until 2014. Now she is out with Dopesick: Dealers, Doctors, and the Drug Company That Addicted America. Gracefully written and deeply reported, Dopesick should act as a vade mecum — a handbook, a guide, an essential introduction — for anyone who may be seeking insight into the deadliest and most vexing drug epidemic in American history. 

    Beth spoke to The Fix over email:

    The Fix: The first chapters of your book, on the origins of the opioid crisis, cover some material that others have explored (most notably Barry Meier, in Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic). Still, I don’t have the sense that many people are aware of the role that Purdue Pharma played in setting off current epidemic. Briefly, what is their culpability? And why do think their crimes aren’t crimes better known? 

    Beth Macy: I think Meier’s book, Pain Killer, was too early, initially published in 2003, and it was largely set in central Appalachia — a politically unimportant place. Also, let’s not overlook the role that Purdue took in stifling Meier. As I write in the book, company officials had him removed from the beat after his book came out, arguing that he now had a financial stake in making Purdue look bad.

    After the 2007 plea agreement, in which the company’s holding company, Purdue Frederick, pled guilty to criminal misbranding charges and its top three executives to misdemeanor versions of that crime, Purdue and other opioid makers and distributors spent 900 million dollars on political lobbying and campaigns. Purdue continued selling the original OxyContin formula until it was reformulated to be abuse-resistant in 2010, continued for years after that pushing the motion that untreated pain was really the epidemic that Americans should be concerned about. Their culpability in seeding this epidemic is huge.

    You weren’t able to talk directly with any of the Purdue executives who made fortunes from OxyContin, and who criminally misled the public about its addictive potential. But you spent an afternoon interviewing Ronnie Jones, who is currently serving a lengthy prison sentence for running a major heroin distribution operation in West Virginia. How were Jones’s crimes (and his rationalizations for his behavior) different from those of the Purdue executives you wrote about?

    Great question. Jones refused to see that he brought bulk heroin to a rural community in ways that overwhelmed families and first responders in the region with heroin addiction; he told me he believed he was providing a service — his heroin did not have fentanyl in it, he argued, and it was cheaper than when people ran up the heroin highway to get it in Baltimore (and safer because they could stay out of high-crime places).

    At the 2007 sentencing hearing, Purdue executives and their lawyers repeatedly claimed they had no knowledge of crimes that were happening several rungs down the ladder from them; that the government had not proved their culpability in the specific crimes. According to new Justice Department documents unearthed and recently published by The New York Times , that was simply not true. For two decades, Purdue leaders blamed the users for misusing their drug; they refused to accept responsibility for criminal misbranding that resulted in widespread addiction and waves of drug-fueled crime that will be felt in communities and families for generations to come.

    You quote a health care professional who said that previous drug epidemics began waning after enough people finally got the message: “Don’t mess with this shit, not even a little bit.” That provoked a thought: Shouldn’t we be long past this point with opioids? On the one hand, I’m enormously sympathetic to anyone who is struggling with addiction. But it’s frustrating to realize that the opioid crisis is still building. Why aren’t more people as risk-averse about heroin as they obviously should be?

    The crisis is still building because the government’s response to it has largely been impotent. And it’s been festering for two decades. Opioid addiction doesn’t just go away. It takes the average user eight years and five to six treatment attempts just to achieve one year of sobriety. And in an era of fentanyl and other even stronger synthetic opioids, many users don’t have eight years. I hope we will soon get to the point of public education where no young person “messes with this shit, not even once,” but right now we still have 2.6 million people with opioid use disorder. Even though physicians have begun prescribing less, we still have all these addicted people who should be seen as patients worthy of medical care, not simply criminals. Too often that doesn’t happen until we’re sitting in their funeral pews.

    One of the women you write about, Tess Henry, slid down a long road. You got to know her and her family quite well, over a number of years. And some of the other stories in this book are just as heartbreaking.

    It was a lot of pain to absorb and process, yes. And yet my heartache was nothing at all compared to what these families are going through.

    In a couple instances, Tess reached out to you directly, asking you for help. How did you calculate how to respond?

    I took it case by case; I just went with my gut, and I got input from my husband and trusted friends along the way. I decided it was okay to drive Tess around to [Narcotics Anonymous] meetings, recording our interviews as I drove, with her permission. But it wasn’t okay when she texted me late one night to come get her from a drug house. (I referred her plea to her mother and recovery coach instead.)

    I occasionally gave her mother unsolicited advice because I cared about her and I cared about Tess, and I felt I had access to objective information about medication-assisted treatment that Patricia didn’t have. When Tess was murdered on Christmas Eve, I put my notes away and for several days just focused on being a friend to her mom. But I did accompany the family to the funeral home when they made arrangements (taking occasional notes), and I was there in the room of the funeral parlor with her mom and her grandfather when they said goodbye to her. It took funeral technicians two days to prepare her body for that. It was the most heartbreaking scene I’ve ever witnessed. There was no need to take notes in that moment. I will never forget it as long as I live. I said a tearful goodbye to our poet, too.

    Was there ever a risk, over the course of your reporting, of becoming too involved in the lives and predicaments of the people you were writing about? 

    Always there’s a risk, but I’ve been doing this for more than 30 years now, and I know that my greatest skill — which is that I get close to people — can also be my Achilles. When I trust my gut and try to do the right thing — always also getting advice from editor and reporter friends along the way, including my husband, who is just so smart and so spot-on always — it usually works out.

    I’m grateful to have read Dopesick. But at various times it left me infuriated, appalled, and depressed. Can you leave us with anything to be hopeful about? 

    There are some pretty heartening grassroots efforts that I spotlight at the book’s end, mostly involving providing access to treatment and harm-reduction services. And Virginia just became the 33rd state to approve Medicaid under the Affordable Care Act, which will help 300,000 to 400,000 people in the commonwealth have access to substance use disorder services. Seventeen more states to go! There is so much more work to be done, especially in Appalachia, where overdose deaths are highest and resistance to harm reduction programs (easy-access MAT and syringe exchange and recovery) can be severe. My goal is that Dopesick not only educates people but also mobilizes them to care and create what Tess Henry called “urgent care for the addicted” services in their own hometowns.

    View the original article at thefix.com

  • Safe Injection Sites Get Green Light From California Lawmakers

    Safe Injection Sites Get Green Light From California Lawmakers

    “I am committed to opening one of these sites here in San Francisco, no matter what it takes, because the status quo is not acceptable,” said Mayor London Breed.

    Last week, California lawmakers green-lit a bill that would allow safe injection sites in San Francisco as part of a three-year pilot program. 

    The forward-thinking measure, authored by Assemblywoman Susan Talamantes Eggman and state Senator Scott Wiener, has already enjoyed support from local advocates and lawmakers.  

    “I am committed to opening one of these sites here in San Francisco, no matter what it takes, because the status quo is not acceptable,” Mayor London Breed said Monday. 

    Eggman voiced similar support for the proposed program. “Should we keep trying what has failed for decades,” she said in a statement, “or give San Francisco the choice to try something that we know saves lives, reduces disease, and saves money?”

    The city’s Director of Health Barbara Garcia estimated that San Francisco has more than 22,000 people using IV drugs. 

    Last year, a slightly broader version of the bill stalled in the state Senate. That iteration of the would-be law would have authorized six counties—Alameda, Humboldt, Los Angeles, San Francisco, and San Joaquin—to participate in the harm reduction program.

    The current version applies only to San Francisco:

    “This bill would, until January 1, 2022, authorize the City and County of San Francisco to approve entities to operate overdose prevention programs for adults that satisfies specified requirements,” the bill reads, “including, among other things, a hygienic space supervised by health care professionals, as defined, where people who use drugs can consume preobtained drugs, sterile consumption supplies, and access to referrals to substance use disorder treatment.”

    The revised version also retools the language, calling it an overdose prevention program instead of a safer drug consumption program. Whatever it’s called, greenlighting the program would not skirt federal drug laws and it’s not clear how the federal government would respond to such a program were it put into effect.

    “People are injecting drugs whether or not we intervene,” Wiener said, according to the San Francisco Examiner. “Safe injection sites provide people with an opportunity to inject in a clean, safe environment, with healthcare personnel available to prevent overdoses, and with an opportunity to offer people addiction, healthcare, housing, and other services.”

    Now, the bill is waiting for a vote in the state Assembly. The last time around, the lower chamber approved the bill 41-33, according to Curbed. 

    If the measure sails through the Assembly this time around, it’ll still need a signature from Gov. Jerry Brown before it becomes law, potentially taking effect at the start of next year.

    View the original article at thefix.com

  • Pawn Stars: The Opioid Edition

    Pawn Stars: The Opioid Edition

    If you are at risk for overdose or use needles to shoot up drugs, come see Brandi and she’ll take care of you – no frills, no questions, no judgment.

    On a cold November morning in 2015, Brandi Tanner and her husband stopped to pick up their 10-year-old niece from her grandmother’s house.

    “Grandma’s sleeping funny,” said the little girl when they came to the door. She wasn’t dressed for school, as she usually would be at this time of morning. Concerned, Tanner and her husband stepped into the house and headed for his mother’s bedroom. They knocked on the door, but no one answered. Glancing at each other with wide eyes, they swung open the door. Grandma had rolled off the bed and her body was wedged between the dresser and the nightstand. She wasn’t breathing.

    “I didn’t really have time to process that she was dead,” says Tanner. “The only thing I could think was ‘Damn, I need to call people. I need get the family out of the house so the police can take pictures.’”

    Tanner’s mother-in-law had died of an opioid overdose, an increasingly common cause of death in Vance County, North Carolina. Tanner herself had previously struggled with dependence on opioids and though the years she’d seen the prevalence of addiction rise in her community.

    “It was so hard to see my husband lose his mother,” she says. “I wanted to do something to help him and other people, but I didn’t know what to do.”

    About a month after her mother-in-law’s death, Tanner was working at a pawn shop where she had been employed for several years. It was right before closing and she was tired. Every day people came into the shop to sell items in order to buy opioids. And it seemed like every week she received news of someone else who had lost a family member. She had just started to shut down the register when a tall stranger strode into the shop.

    “There were other employees in the store but he headed straight for me like he knew I was the one who needed him,” Tanner recalls. “He walked up and asked if I wanted to help save lives from overdose. I was like, hell yeah. Where do I sign up?”

    The tall stranger was Loftin Wilson, an outreach worker with the North Carolina Harm Reduction Coalition, a statewide nonprofit that works to reduce death and disease among people impacted by drugs. That year, the organization had received a federal grant to prevent overdose death in Vance County in partnership with the Granville-Vance District Health Department. Over the past few years, the two agencies have worked closely to increase access to harm reduction services and medication-assisted treatment in Vance County.

    Vance is a rural community of fewer than 50,000 people. Driving through, one can’t help but notice large, pillared villas adjacent to dilapidated trailer parks, a scene that amidst acres of yellowing tobacco fields is reminiscent of plantations and slave quarters. In Vance County, a quarter of the population lives below the poverty line and addiction has flourished. From 2008-2013 Vance had the highest rate of heroin overdose deaths in the state: 4.9 residents per 100,000 compared to the state average of 1.0 per 100,000 (NC Injury Violence Prevention Surveillance Data). But those were sunnier days. By 2016, the heroin overdose rate for Vance County had jumped to 11.2 per 100,000. In 2017, based on provisional data, it was 24.2 per 100,000 (NC Office of Medical Examiners) and 2018 is already shaping up to be the deadliest year yet.

    The chance meeting between Wilson and Tanner at the pawn shop proved to be pivotal to outreach efforts in Vance County. Wilson had years of overdose prevention experience in a neighboring county, Durham, but Tanner knew her community and everyone in it. The two teamed up and began reaching out to people in need. Driving around in Wilson’s rattling pick-up, they visited the homes of people at risk for opioid overdose to distribute naloxone kits.

    The following summer, the North Carolina General Assembly legalized syringe exchange programs, and Wilson and Tanner began delivering sterile injection supplies along with naloxone. By 2018, a grant from the Aetna Foundation to combat opioid overdose had enabled them to purchase a van in which to transport supplies and to expand outreach work in Vance County.

    In July 2018 I visited Tanner at the pawn shop, where she still works. Thanks to Tanner’s efforts, the pawn shop has become a de facto site for syringe exchange and overdose prevention. Walking into the shop, the first thing I notice is that Tanner packs a glock on her right hip. It’s necessary these days in Vance County, which has seen a remarkable rise in drug-related gang violence this year. In March 2018, nine people were shot over a span of two weeks in Henderson, a small town of 15,000 residents. In May, four more people were killed in less than a week, prompting Henderson Mayor Eddie Ellington to make a formal plea to the state for resources. One of the murders occurred at a hotel a stone’s throw from the pawn shop.

    The danger doesn’t seem to faze Tanner. She weaves through displays of jewelry, rifles, and old DVDs as customers drop in to buy and sell. It’s a respectable stream of business for a Monday afternoon. Tanner handles the customers with ease, teasing them in a thick southern twang, inquiring after their kids and families, and discussing the murders, which more than one person brings up unprompted. She calls everyone “baby” and is the kind of person who will buy gift cards and toiletries just so she can slip them unnoticed into a customer’s bag if she knows the individual is down on her luck.

    Later in the afternoon, a young female enters the shop. She and Tanner nod at each other without exchanging words. Tanner finishes up a transaction with a customer and slips out the back door. She is gone for a couple of minutes, then reappears alone. This, I come to find, is what overdose prevention looks like in Vance County.

    “I used to hand out [overdose prevention supplies] from inside the shop, but people were embarrassed to come in and be seen taking them,” explains Tanner. “Now people just text me to let me know they are coming. Sometimes they come in the shop and other times I just leave my truck open out back and they get the supplies and leave.”

    Henderson is the kind of town where everyone knows everyone’s business. News travels fast and so do rumors. Even though almost everyone has someone in their family using opioids, stigma still runs deep, so Tanner doesn’t advertise the exchange. Word travels by mouth: If you are at risk for overdose or use needles to shoot up drugs, come see Brandi and she’ll take care of you – no frills, no questions, no judgment. She sees a couple participants a day on weekdays and nearly a dozen every Friday and Saturday. A couple times a week she drives her truck to visit people who don’t have transportation, just to make sure they are taken care of too.

    I ask Tanner to take me to her truck where she keeps the supplies, and she obliges, leading me behind the store to a dusty parking lot where her SUV is stuffed with naloxone, syringes, and other sterile injection equipment. I pepper her with questions as she moves the boxes around to show me what’s inside.

    Tanner looks younger than her 35 years, but acts much older. Over the next half hour she recounts a life of homelessness, addiction, incarceration, losing friend after friend to opioid overdose, and finding her mother-in-law’s body three years ago. She relates the stories as though we were discussing the weather, completely emotionless, but still, you can tell it hurts.

    “I try not to think about it,” she says with a wave of her hand when asked how she handles the trauma of losing so many people. Later, she admits that some nights she sits at home and writes down her feelings, then tears up the thoughts and throws them away.

    “It’s hard not to get attached to people if you see them every week,” she acknowledges. “But I do the work because I want to help my town and my people. This is the place where my kids are growing up.”

    We go back inside and I take a last look around the store. The blue-screened computers and racks of DVDs create the feeling that you’ve gone back in time, yet in some ways this pawn shop is the most forward-thinking entity in Vance County. Here, people received tools to save lives even before they were legal.

    Before leaving Vance’s open fields to return to the city, I ask Tanner if she has a final message for people at risk for opioid overdose. For a moment, her voice hardens.

    “I know what it feels like to not have anybody give a shit if you are here or not,” she says. Then her tone softens. “But I want people to know they are not alone. There are people out there who care and can help.”

    View the original article at thefix.com

  • Dan Bigg, The Godfather Of Harm Reduction, Has Passed Away

    Dan Bigg, The Godfather Of Harm Reduction, Has Passed Away

    Bigg, who co-founded the largest community-based naloxone distribution network in the country, was 59 years old. 

    On Tuesday, the harm reduction community lost a godfather. Dan Bigg, co-founder and Executive Director of the Chicago Recovery Alliance, died suddenly at home at 59 years old.

    Bigg started his journey to harm reduction in the mid-1980s working at the Illinois Health Association’s Drug Addiction AIDS Project. He was frustrated at the growing rate of HIV infection among people who injected drugs and how stigma often forced people with HIV out of their 12-step recovery programs, alienating them from support systems.

    Along with a few other people, he put together an HIV information and support group composed of active and former drug users. In time, the support group didn’t seem like enough. Bigg wanted to do more. So in 1992 he co-founded the Chicago Recovery Alliance (CRA), a place where former and active drug users and people with HIV could find community and health resources.

    One of Chicago Recovery Alliance’s first programs was a syringe exchange, which was against Illinois law at the time. But laws never stopped Bigg. By teaming up with public health researchers, CRA was able to start distributing sterile syringes to help prevent the spread of HIV. But that exchange was just the beginning.

    In 1996, Bigg’s dear friend and co-founder of CRA, John Szyler, died of a heroin overdose. In his grief, Bigg launched a new initiative, one that would eventually be replicated across the country and save tens of thousands of lives—the first community-based naloxone distribution program.

    At the time, naloxone, a medication used to reverse opioid overdose, was only available in ambulances and emergency room departments. Bigg put forth the novel and controversial idea to put naloxone into the hands of people who need it most—active drug users. He began working with medical doctors to figure out a distribution model that would be as hassle-free as possible for people who use drugs and their loved ones.

    The program was met with criticism from those who said that active drug users were not capable of utilizing naloxone properly, or that giving them access to a life-saving drug would encourage risky behavior. To these people, Bigg gave the middle finger. Any positive change as a person defines it for him or herself, was his philosophy. A life saved was certainly positive change.

    The CRA would become the largest community-based naloxone distribution network in the country and soon be replicated in dozens of other states.

    Bigg was honored with the Norman E. Zinberg Award for Achievement in the Field of Medicine at the International Drug Policy Reform Conference in 2015 and won numerous other awards. But he was not a man for frills or recognition. He continued the work tirelessly up until the day he died because he believed it was the right thing to do.

    The harm reduction community honors him. The people saved with community-based naloxone owe him their lives. The world has lost a legend.

    View the original article at thefix.com

  • Suboxone: A Tool for Recovery

    Suboxone: A Tool for Recovery

    With medication-assisted treatment (MAT), people with opioid addictions are given the chance to rebuild their lives—often from the ashes and debris of drug-induced destruction—without having to fight cravings and withdrawal.

    Suboxone is a prescription medication that treats opioid addiction. It contains buprenorphine and naloxone, active ingredients that are used to curb cravings and block the effects of opioids. Although a major player in addiction recovery today, and often referred to as the gold-standard of addiction care, many in the recovery community remain resistant and even wary, including a large portion of rehab facilities and many members of the 12-step community.

    How does Suboxone work? When an opioid like heroin hits your system, it causes a sense of euphoria, reduced levels of pain, and slowed breathing. The higher the dose, the more intense the effect. Buprenorphine and heroin are both considered opioids, but the way they bind with the opioid receptors in the brain differs. Heroin is a full agonist, meaning it activates the receptor completely and provides all of the desired effects. Buprenorphine is a long-acting partial agonist. While it still binds to the receptor, it is less activating than a full agonist, and there is a plateau level which means that additional doses will not create increased beneficial effects (although they may still cause increased adverse effects). In someone who has been addicted to opioids, buprenorphine will not cause feelings of euphoria—the sensation of being “high.” Naloxone is paired with the buprenorphine to discourage misuse; if Suboxone is injected, the presence of the naloxone may make the user extremely ill.

    Jail Physician and Addiction Specialist Dr. Jonathan Giftos, M.D. offers this analogy: “I describe opioid receptors as little ‘garages’ in the brain. Heroin (or any short-acting opioid) is like a car that parks in those garages. As the car pulls into the garage, the patient gets a positive opioid effect. As the car backs out of the garage, the patient experiences withdrawal symptoms. Buprenorphine works as a car that pulls into the same garage, providing a positive opioid effect—just enough to prevent withdrawal symptoms and reduce cravings, but unlike heroin, which backs out after a few hours causing withdrawal—buprenorphine pulls the parking brake and occupies garage for 24-36 hours. This causes the functional blockade of the opioid receptor, reducing illicit opioid use and risk of fatal overdose.”

    Critics and skeptics of medication-assisted treatment (MAT) believe that using Suboxone is essentially replacing one narcotic with another. While buprenorphine is technically considered a narcotic substance with addictive properties, there are important differences between using an opioid like heroin or oxycontin and physician-prescribed Suboxone. Similarities between using heroin and Suboxone are that you have to take the drug every day or you will experience withdrawal and likely become very ill. Aside from the physical dependency, which is without a doubt a burden, Suboxone offers people in recovery the opportunity to live a “normal” life, far removed from the drug culture lifestyle they may have been immersed in while using heroin.

    People are dying every day from heroin overdoses, especially now in the nightmarish age of fentanyl. People in recovery from opioid addiction are living, free from the risk of overdosing, on Suboxone. Suboxone is a harm reduction option that while initially raised some eyebrows is gaining more traction, and considered an obvious choice for treatment by addiction medicine professionals. While someone using heroin is tasked daily with coming up with money for their drugs, avoiding run-ins with police or authorities, meeting dealers and often participating in other criminal activity, someone using physician-prescribed Suboxone is not breaking the law. They are able to function normally and go to school or get a job, and they are often participating in other forms of ongoing treatment simultaneously. People are given the chance to rebuild their lives—often from the ashes and debris of drug-induced destruction—without having to fight cravings and withdrawal.

    There is a common misconception about Suboxone, and medication-assisted treatment in general, that it is a miracle medication that cures addiction. Because of this idea, many people use Suboxone and are disappointed when they relapse, quickly concluding that MAT doesn’t work for them. When visiting the website for the medication, it reads directly underneath “Important Safety Information” — “SUBOXONE® (buprenorphine and naloxone) Sublingual Film (CIII) is a prescription medicine indicated for treatment of opioid dependence and should be used as part of a complete treatment plan to include counseling and psychosocial support.”

    So, as prescribed, Suboxone is intended to be only part of a treatment plan. It is but one tool in a toolbox with many other important tools such as counseling or therapy, 12-step meetings, building a support system, nurturing an aspect of your life that gives you purpose, and practicing self-care. It is medication-assisted treatment, emphasis on the assisted.

    With that being said, the type of additional treatment or self-care a person participates in should fit their own individual needs and comfort level and not be forced on them. Like a wise therapist once said, “Everybody has the right to self-determination.” Twelve-step meetings, although free and available to everyone, are not the ideal treatment for many people struggling with addiction. Therapy is expensive. People using Suboxone or other MAT shouldn’t be confined to predetermined treatment plans that have little to do with an individual’s needs and more to do with stigma-imposed restrictions.

    It’s unlikely that you’ll find a person claiming that simply taking Suboxone instead of heroin every day saved their life. It is not the mere replacement of one substance for another that is saving lives and treating even the most hopeless of people who have opioid use disorder; it is the relentless pursuit of a new way of life, a pursuit which includes rigorous introspection and a complete change of environment, peers, and daily life. Through the process of therapy, 12-step, using a recovery app, or whatever treatment suits you best, a person can face their demons, learn healthy coping mechanisms, and build confidence without the constant instability of cravings and withdrawal. Suboxone is giving people a chance that they just didn’t have before.

    So why is there such a stigma tied to the life-saving medication? Much of it comes from misinformation and is carried over from its predecessor—the stigma of addiction. It is hard for people who have a pre-existing disdain for addiction in general to swallow the idea that another “narcotic” medication may be the best form of treatment. In addition to addiction-naive civilians or “normies” as 12-steppers might call them, many members of the Narcotics Anonymous community are not completely sold on Suboxone’s curative potential either. Some members of the 12-step community are accepting of MAT, but you just don’t know what you’re going to get. You may walk into a meeting and have a group that is completely open and supportive of a decision to go through the steps while on Suboxone, or you may walk into a meeting of old-timers who are adamant that total abstinence is crucial to your success in the program.

    Another reason people are unconvinced is the length of time Suboxone users may or may not stay on the medication. Again, there is a stigma that shames people who use Suboxone long-term even though studies have shown long-term medication-assisted treatment is more successful than using it only as a detox aid. If Suboxone is helping a person live a productive life in a healthy environment, without the risk of overdose, that person should have the right to do so for however long they need without the scrutinizing gaze of others. While their critics are tsk-tsking away, they may be getting their law degree or buying their first home.

    Suboxone is a vastly misunderstood and complex medication that has the potential to not only save the lives of people with opioid addictions, but also allow them to recover and rebuild lives that were once believed to be beyond repair.

    View the original article at thefix.com

  • Planned Safe Injection Sites Put On Hold In Canada

    Planned Safe Injection Sites Put On Hold In Canada

    Advocates of safe injection sites called the Canadian health minister’s decision to halt the opening of the facilities “horrifying.”

    A trio of planned safe injection sites in Ontario, Canada have been put on hold while the province’s new health minister conducts a review to determine if such facilities “have merit.”

    Health Minister Christine Elliott said that she remains unconvinced that such sites are effective in reducing drug overdose deaths and the spread of HIV infection; she also cited concerns from neighboring businesses over security and biohazard refuse as core reasons for the review.

    Advocates of safe injection sites and harm reduction policies called the health minister’s decision “horrifying,” that runs contrary to the needs of individuals in the midst of Canada’s opioid epidemic.

    The CBC reported that in a letter sent on Friday, August 10, to health integration networks and health units in the province, Roselle Martino, assistant deputy minister of the population and public health division, said that the approval process for new safe injection sites in the cities of Toronto, Thunder Bay, and St. Catharines would be halted immediately.

    The sites would allow for supervised injection of opioid drugs, grant access to harm reduction support and allow users to safely dispose of needles and other paraphernalia.

    In the letter, Elliott wrote that she will be “reviewing the evidence and speaking to experts to ensure that any continuation of supervised consumption services and overdose prevention sites are going to introduce people into rehabilitation and ensure people struggling with addiction will get the help they need.”

    CTV News also noted that Elliott will address how local businesses have been impacted by existing sites. The network cited concerns by Mark Garner, a member of the Downtown Yonge Business Improvement Area (BIA) in Toronto, who said that his organization has found discarded needles in the area near the Works, the city’s first supervised injection site, which opened in November 2017.

    Garner stated to CTV that while his organization supports efforts to reduce drug overdoses, the businesses in the BIA have felt the need to increase security and allocate funding to clean up discarded needles, especially ones discarded in toilets which have caused plumbing issues.

    “This is the number one tourist destination in Canada,” he said. “How do we integrate that into the neighborhood, what resources are needed, and how do we make it safe for everybody?”

    But harm reduction advocates and health care professionals have expressed alarm at the province’s move, which some described as a decision motivated more by politics than any actual health concern.

    “It’s a complete disaster, and I do worry about people on the ground,” said Marilou Gagnon, an associate professor of nursing and president of the Harm Reduction Nurses Association. “The science is very clear that overdose prevention sites do work, and we’ve known this since the ’80s. [I’m] extremely concerned about a government going against science.”

    View the original article at thefix.com

  • "Methadone Pope" Dr. Robert Newman Dies At 80

    "Methadone Pope" Dr. Robert Newman Dies At 80

    The doctor famously commissioned an unused ferry boat to serve as a temporary methadone clinic when a private clinic shut down in 1972.

    The “methadone pope” passed away this month, sparking a conversation about his groundbreaking contributions to the worlds of harm reduction and medication-assisted treatment (MAT) for substance use disorder.

    Dr. Robert Newman spent his career advocating for methadone access and defending patients’ rights.

    As a young public health doctor in New York City, Newman was instrumental in expanding the city’s methadone program. In its first year, it served 20,000 people.

    “He was on the front lines of advocating for methadone, when no one else was talking about it, when it was taboo and unwelcome,” said Kasia Malinowska, of the Open Society Foundations. “He thought that methadone was an effective, easy, cheap public health intervention; that it’s insane to deny it to people who are so deeply in need.”

    Newman believed in methadone’s ability to help people trying to quit heroin live normal lives. He further defended patients who did not wish to taper off the medication.

    “There’s no moral judgment as to how much penicillin one uses to treat gonorrhea, and there shouldn’t be any moral judgment as to how much methadone a patient is receiving if the result is satisfactory,” he said in 2011, according to the Huffington Post.

    The doctor famously commissioned an unused ferry boat to serve as a temporary methadone clinic when a private clinic shut down in 1972; and Newman would transport methadone from the makeshift clinic using his son’s stroller.

    Newman defended NYC’s methadone program when Mayor Rudy Giuliani tried shutting it down in 1998. The mayor believed that methadone maintenance was just substituting one substance use disorder for another.

    Newman also defended patients’ right to privacy when the government ordered that he relinquish patients’ methadone records to law enforcement—and won.

    “Not only was he passionate about this, but he was courageous. He was totally willing and prepared to go to jail,” said his nephew Tony Newman, director of media relations at the Drug Policy Alliance.

    The doctor’s advocacy did not end with methadone. As president of Beth Israel Medical Center, Newman advocated needle exchanges for drug users “long before the AIDS outbreak generated broader support for such controversial programs,” the New York Times reported.

    Under his leadership, the hospital became the world’s largest provider of methadone, serving about 8,000 patients by 2001, according to the Times.

    View the original article at thefix.com