Answer Addiction

Tag: MAT

  • Lack Of Suboxone Access Leads Users In Need To The Black Market

    Lack Of Suboxone Access Leads Users In Need To The Black Market

    President Trump is expected to sign a bill to expand medication-assisted treatment but it remains unclear as to how soon that will take place.

    A new feature by NPR underscores a potentially dangerous conundrum for health care professionals and individuals seeking treatment for opioid use disorder: while buprenorphine (also known as Suboxone, Subutex and Zubsolv) has proven effective in blocking the effects of opioids, it’s also difficult to find and a challenge to obtain due to federal limits on prescribers.

    As a result, many prospective patients have turned to the illicit market, where Suboxone can be obtained via diversion, or from patients who sell or give away their own prescriptions.

    President Donald Trump is expected to sign a bill to expand medication-assisted treatment (MAT), but as NPR noted, it remains unclear as to how much access will be granted and how soon that will take place.

    Along with methadone and naltrexone (Vivitrol), buprenorphine is one of three federally-approved drugs to treat opioid dependency.

    As the NPR feature stated, while it is less potent than heroin or prescription opioids, including fentanyl, it is possible to overdose on buprenorphine if mixed with other substances.

    But such instances are rare, especially when the drug is formatted with the overdose reversal drug naloxone. As Dr. Zev Schuman-Olivier, an addiction specialist and instructor at Harvard Medical School, said, “The majority of people are using it in a way that reduces their risk of overdose.”

    Despite its effectiveness and relative lack of harmful side effects, obtaining buprenorphine is subject to federal regulations in regard to who can prescribe it—medical professionals need a special waiver to do so—and how much can be obtained. Currently, those doctors that meet the federal requirements to prescribe buprenorphine are limited to treating 275 patients.

    Nurse practitioners and physician assistants may apply for a waiver to administer the medication as well. Under the SUPPORT for Patients and Communities Act, the number of such health professionals and the length of prescription may be increased.

    Until that bill is signed, buprenorphine remains both difficult to obtain and expensive. According to 2016 estimates provided by the U.S. Department of Defense, medication and twice-weekly visits to a certified opioid treatment program are $115 per week or nearly $6,000 per year. That puts the medication out of range for many in need, forcing them to turn to diversion situations for assistance.

    But as NPR noted, that scenario can be dangerous: patients need assistance from a treatment professional for proper dosage and treatment for mental health issues that may come as a part of addiction.

    Diversion has become prevalent enough to warrant calls for more regulations regarding buprenorphine and stronger enforcement against those that break the law. But the NPR story quoted Basia Andraka-Christou, an assistant professor and addiction policy researcher at the University of Central Florida, who said that stricter rules are not what’s needed for patients.

    “I guarantee you, they’re either going to go and buy heroin and get high, which surely is not a great policy solution here,” she said. “Or they’re going to go buy Suboxone on the street.”

    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

  • Senate Passes Sweeping Opioid Legislation, Treatment Advocates Unimpressed

    Senate Passes Sweeping Opioid Legislation, Treatment Advocates Unimpressed

    “None of the bills include providing the one thing communities hit by the opioid crisis need most: funding,” says one treatment advocate.

    A bipartisan effort to stem the opioid crisis, while impressive in scope, does not have what it takes to stem the national opioid crisis, say treatment advocates.

    On Monday (Sept. 17), the Senate passed a package of 70 bills—racking up a cost of $8.4 billion—with a 99-to-1 vote to address various aspects of the opioid crisis. The lone dissenter was Senator Mike Lee of Utah.

    The goal was to tackle the opioid crisis from multiple angles—like expanding access to treatment and thwarting shipments of illicit drugs from abroad—but not everyone is impressed with the expansive legislation.

    Joy Burwell, president and CEO of the National Council for Behavioral Health, which represents American health care organizations that deliver mental health and substance use disorder services, expressed her organization’s disappointment that “Congress missed this opportunity to make a meaningful, long-term investment in our nation’s addiction treatment system.”

    One way to accomplish this, Burwell says, would be to include the the Excellence in Mental Health and Addiction Treatment Expansion Act, a bill that would expand a current program that has shown success in improving access to addiction treatment services.

    The package of bills passed in the Senate, however, falls short of their expectations. “None of the bills include providing the one thing communities hit by the opioid crisis need most: funding,” wrote Burwell in a statement. “Nor do they offer a comprehensive solution to the country’s addiction crisis.”

    The legislation package includes various measures intended to fight substance abuse. They include expanding access to opioid-addiction medication (like buprenorphine); funding recovery centers that provide temporary housing, job training, and other support during a transition to recovery; expanding the scope of mental health professionals where they are in short supply; expanding first responder naloxone programs; and preventing illicit drugs from being shipped via the US Postal Service.

    Sen. Rob Portman of Ohio admitted that the legislation does have missing pieces. “It doesn’t include everything all of us want to see but it has important new initiatives and it’s a step in the right direction,” he said, according to the Washington Post. “Congress is committing itself to actually putting politics aside. It’s not just bipartisan—I think it’s nonpartisan.”

    According to the Post, the House passed a similar measure in June. Now the two chambers will go over the differences before sending the package off to Trump.

    View the original article at thefix.com

  • New Dosage Strength Of Opioid Addiction Drug Approved By FDA

    New Dosage Strength Of Opioid Addiction Drug Approved By FDA

    The FDA commissioner noted that the approval will expand access for patients and reduce drug development costs.

    The U.S. Food and Drug Administration (FDA) approved a new dosage strength for a maintenance drug for the treatment of opioid addiction.

    Cassipa, which is a sublingual (applied under the tongue) film that combines the opioid treatment drug buprenorphine and the opioid overdose reversal drug naloxone, will now be available in a 16 milligrams/4 milligrams dosage, and according to FDA Commissioner Scott Gottlieb, should be used in conjunction with counseling and therapy.

    The new dosage strength is approved by the FDA in both brand name and generic versions, and in various strengths.

    The approval underscores the agency’s emphasis on greater development of and access to medication-assisted treatment (MAT) for substance use disorder. The full range of MAT is a key element of the U.S. Department of Health and Human Services’ Five-Point Strategy to Combat the Opioid Crisis, and was the focus of guidelines issued to drug manufacturers for evaluating the effectiveness of new or existing MAT products. 

    In a statement issued in April 2018, Gottlieb described the FDA-approved MAT drugs—methadone, buprenorphine and naltrexone—as “safe and effective in combination with counseling and psychosocial support to stabilize brain chemistry [and] reduce or block the euphoric effects of opioids.”

    The FDA has also cited statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA), which found that patients using MAT for opioid dependency have reduced their chance of overdose death by half.

    In addition to its suggested efficacy for opioid use disorder, Gottlieb noted that newer treatment options like the increased dosage strength for Cassipa will not only “broaden access for patients,” but may also “reduce drug development costs, so products may be offered at a lower price to patients” via the agency’s “streamlined approach to drug development for certain medication-assisted treatments that are based on buprenorphine.”

    This approach is the abbreviated 505(b)(2) pathway under the Federal Food, Drug and Cosmetic Act, which allows manufacturers to use the FDA’s findings regarding the safety of their product to grant approval.

    The FDA is advising that Cassipa should be used in conjunction with a complete treatment plan that includes counseling and other support, and should only be used after the patient is introduced to the drug and stabilized up to a dose of 16 mg of buprenorphine using another marketed product. Additionally, Cassipa can only be prescribed by Drug Addiction Treatment Act-certified prescribers.

    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

  • What Sets Suboxone Apart From Other Medication-Assisted Treatments?

    What Sets Suboxone Apart From Other Medication-Assisted Treatments?

    When taken as prescribed by an opiate addict, Suboxone doesn’t allow me to avoid or escape reality. This is one way it differs form other MATs.

    I’ve used the same pharmacy for over a decade. The tech filling my prescription this morning was the same one that had filled my Vicodin prescription for four years, on the first of the month every 30 days, like clockwork. 

    Today, I smiled at her as she stuffed a different prescription into a small white bag: 28 individually wrapped, “lime” flavored, orange-tinted filmstrips.

    “You’re still on Suboxone?” she questioned.

    “Yep.” I answered. “I don’t see weaning off anytime soon. My recovery is strong and life is good.”

    She raised a skeptical eyebrow.

    “Aren’t you just trading one for another? Wouldn’t it be better to never get on it? Nobody gets off of this stuff… It just seems like a waste…no different than any other drug addict.”

    My body deflated with a sigh, but I tried to give her the benefit of the doubt. I wasn’t expecting these questions from a woman whose career relies on understanding complicated medical pharmacokinetics, but I get it. She doesn’t grasp the complexities of addiction.

    I simply explained to her the differences in lifestyle, motivation and integrity between using illegal substances to get high, and using a medication as prescribed as one of many tools in a recovery program. 

    She’s not alone in her misunderstanding. Suboxone and other forms of medication-assisted treatment (MAT) are confusing and controversial, for addicts and “normies” alike. MAT isn’t the only thing that’s hotly debated. We argue whether addiction is a disease or a choice, what labels we should use, and how anonymous we should be. We quarrel about jargon, literature, sponsors and steps. 

    One thing most addicts and alcoholics can agree on is this: We don’t like to be uncomfortable. The inability to tolerate emotional or physical pain is often what sets us hurling down the spiral of addiction.

    An injury, illness, stress, loss, or combination of all of them (in my case migraines, divorce, job burnout) led us to drink or use to dull the pain. Whether its numbing out, sleeping it off, or chemically re-energizing, we’re professionals at self-medicating.

    Going to extreme measures to either chase pleasure or run from pain, we drink, use, pop, dose, snort, shoot and eat our way to an alternate reality.

    Could the pharmacy tech be right? Am I just trading one negative habit for another in an attempt to evade my problems? Like other opiates, Suboxone causes physical dependence and withdrawal if you stop taking it. How is taking it daily any better than taking Vicodin, Percocet, or heroin? I’ve often heard: “You might as well get in a managed cannabis program and smoke weed every day – isn’t that better than taking an opiate? “

    My answer?

    “No.”  

    But that answer hasn’t always come easily. Even as a grateful patient of this medication, I’ve grappled with the decision. Sobriety means getting honest with myself, taking into consideration anything that might be used as a “crutch” or negate recovery.

    I have to ask myself: Why am I OK with taking Suboxone? Why don’t I feel like a shady addict, living in the shadows and sneaking drugs, even though I am officially still taking an opiate? 

    The answer came to me during a particularly stressful day when all I wanted to do was get high, get wasted and go to sleep. That’s impossible to do in sobriety. I’ve had to learn to cope with emotions, to accept reality, and to tolerate discomfort. 

    A light bulb came on: Suboxone is different because it doesn’t change me or my circumstances. It doesn’t get me high.

    Suboxone doesn’t do what other opiates did for me; I can’t numb physical or emotional pain. On Vicodin and alcohol, I was irritable, suffered memory loss, was incapable of personal growth and spirituality. I spent my time and energy chasing drugs, chasing a high, running from withdrawal. I cannot avoid or escape reality by taking Suboxone. At all.

    When taken as prescribed by an opiate addict, it differs from other harm reduction and medication-assisted treatment such as methadone or marijuana by that fact.

    The form of Suboxone I currently use can’t do anything to enhance my mood even if I take it other than prescribed. I can’t dissolve it in liquid and shoot it, because the Narcan in it (the ingredient that prevents overdose) will put me into immediate withdrawal.

    I can attempt to get high by taking more than prescribed, but once my brain’s receptors are filled, Suboxone ceases to give any more effect. That undeniably sets it apart from other drugs — over-the-counter and otherwise.

    Methadone, on the other hand, can easily be abused. I’ve done it myself. Taking three times the amount of methadone I should have, I went to a meeting to “work on recovery.” I couldn’t tell you what happened at that meeting, or how I got home.

    If I take three times my Suboxone dose, I’ll likely not notice much enhanced effect, and I’ll screw myself over, since I’ll be short three doses and will somehow have to explain to my doctor why I ran out early. I’ll potentially be kicked out of the program as well, without ever even getting high! For an addict like myself, it’s not worth it. 

    Marijuana as harm reduction has become popular, and is considered safe because there’s no lethal dose. However, for daily users and first-time experimenters alike, marijuana impairs judgment, driving, and learning. Smoking weed and then showing up to meditate or work on the 12 steps is counterproductive.

    Treatment centers that prescribe cannabis generally give participants their dose at night, to make sure that they’re not high during meetings and counseling sessions in the daytime. This isn’t necessary with Suboxone – there’s no roller coaster effect of “high” vs “sober.” I feel no different after taking my daily dose than I do when I wake up in the morning prior to taking it.

    I experience every range of emotion, the same as I would without medication. If life is hard and painful and sad, I can’t go to my Suboxone box and take a big dose to make it all go away. But methadone, marijuana, Vicodin, heroin?…..Escaping life and avoiding pain is exactly what they’re good for.

    Suboxone isn’t a perfect fix by any stretch. Prescriptions can be diverted and sold on the street. Active heroin addicts will sometimes buy it to avoid withdrawal, if they can’t get their drug of choice. That’s an unfortunate fact. But is it the worst- case scenario? Every time a person injects heroin, they’re risking death by overdose or a systemic infection. There’s no guarantee that the substance is what the dealer says it is.

    When an addict buys street Suboxone, they’re taking a safer opiate. They’re protected against agonizing, incapacitating withdrawal, which leaves them helpless for their family or employer. They could even have a few days feeling like their “normal” self; maybe even well enough to join a meeting and consider recovery. I don’t condone or encourage the sale of Suboxone on the street.

    There are increasing safeguards set up by prescribing clinics and pharmacies that make it really difficult for someone to get their hands on another person’s medications. I’m just suggesting that Suboxone on the street isn’t the most dangerous or dreadful thing that can happen. 

    Suboxone does have side effects, and it’s important to mention that not all Suboxone is created equally. Addicts are the ultimate manipulators. Certain pill forms can be crushed and used inappropriately (the safest from is widely considered the film strip which is part buprenorphine/part narcan).

    If an opiate-naïve person (one who has not been abusing either heroin or prescription meds) takes Suboxone, s/he will very likely experience an initial sense of euphoria or sleepiness.  But the same can be said for Benadryl, Nyquil, or prescription nerve pain meds such as Gabapentin. The list of drugs that have potential for abuse is extensive. Recreational use is a separate situation altogether; misusing any medication is completely out of line with recovery.

    Abuse is dependent on motives and intention, not the side effects themselves. Nicotine and caffeine are two highly addictive substances that can be mood altering and cause withdrawal if stopped cold turkey. They’re not only acceptable in recovery, they’re plentiful; Coffee is supplied at meetings in unlimited doses. The use of these doesn’t negate one’s sobriety. 

    Self-improvement, spirituality, and community connection are now my daily foundation. Suboxone doesn’t impede this. It doesn’t change my perception of reality or my ability to be mindfully present. I no longer look for any means to avoid discomfort (ok sometimes I eat brownies or surf social media– we’re all a work in progress!!)

    Using tools I’ve gained from mindfulness and my recovery community, and maintained on a low dose of Suboxone to help keep cravings at bay, I work though challenges with balance and compassion. If I were still getting high, this wouldn’t be possible. 

    Suboxone’s not a magical cure. But it is a safe alternative to other opiates. It’s a solid tool that helps many of us maintain sobriety and the presence of mind to progress in recovery and personal growth. 

    Tiffany Swedeen, RN, BSN, CPC/CPRC is a certified life and recovery coach, She Recovers Designated Coach, and a registered nurse in recovery herself from opioids and alcohol. Tiffany lives “sober out loud,” proudly sharing her story through advocacy and blogging and is passionate about helping others do the same. Her goal is to eradicate shame and empower all to live a life of radical self-love. You can contact Tiffany through her website Recover and Rise, read her blog www.scrubbedcleanrn.com and follow her @scrubbedcleanrn. 

    View the original article at thefix.com

  • St. Louis Pushes To Expand Medication-Assisted Treatment For The Uninsured

    St. Louis Pushes To Expand Medication-Assisted Treatment For The Uninsured

    The city’s current healthcare program for the poor and uninsured does not cover mental health or addiction services.

    St. Louis officials are asking a federal agency to expand access to medication-assisted treatment under a program that provides healthcare services to uninsured individuals in the city.

    The Gateway to Better Health program, which is federally funded, serves uninsured St. Louis County residents who are living below the poverty line by providing basic health services at community health centers.

    Currently the program does not cover mental health or addiction services, but officials are asking the Centers for Medicare and Medicaid Services to allow the program to cover medication-assisted treatment with Suboxone and naltrexone.

    “We’re the first to admit there are major gaps, and one of our major gaps is mental health and substance abuse services,” Robert Freund, CEO of the St. Louis Regional Health Commission, which operates and monitors the program, told KBIA, Missouri’s NPR affiliate. “It’s only gotten worse as the opioid crisis has really escalated here in our region.”

    The Missouri Department of Health and Senior Services has asked the Centers for Medicare and Medicaid Services to reroute about $2 million currently allotted to the Gateway to Better Health program in order to allow community health centers to distribute Suboxone or naltrexone to people with opioid use disorder. The program would also require $750,000 in local matching funds, which has not been secured yet. 

    The program is also seeking approval to offer counseling, psychological testing and medication-assisted treatment for alcohol use disorder. 

    Freund said that if the community health centers are better able to serve people with substance use disorders, it would cut down on demand at clinics that only treat addiction, many of which are overwhelmed. 

    “We can increase access and decrease the burden on our substance abuse providers,” he said.

    Integrating care for substance use into a larger community center also allows people to seek help without judgement, said Kendra Holmes, the vice president of Affinia Healthcare, which operates community health centers in St. Louis.

    “I think it really helps with the stigma,” Holmes said. “Because you really don’t know what the patient is coming here for. If it were a separate entity, if we called it ‘Affinia Substance Abuse Center,’ there would be a stigma.”

    Affinia Healthcare currently has two providers trained to provide substance abuse treatment, who are paid for with grant money. Holmes said if the federal government approves the changes, Affinia would be able to offer addiction treatment services at more clinics. 

    Freund acknowledged that the requested changes “would be very limited in nature but still very helpful.”

    “We’re under no illusions this would solve our access issue for substance abuse in the eastern region,” he said. “However, it’s a start and it would help.”

    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

  • Microaggressions: How Subconscious Biases Affect Recovery

    Microaggressions: How Subconscious Biases Affect Recovery

    An example of a microaggression in the recovery universe: someone from NA asks someone who’s considering Suboxone: “Are you in denial? A drug is a drug is a drug.” No malicious intent is involved, but the fellow member is left feeling disparaged.

    Politics and Religion: we’re encouraged to avoid these conversations, socially. Conviction can escalate to hostility, hurt feelings and polarization, turning a fun-loving conversation into… “Awkward.”

    Has anyone noticed polarization-creep migrating from political intercourse into our addiction/recovery discussion? A diversifying recovery community means different tribes and subcultures with differing views on recovery and addiction. Many Fix readers are members of a mutual-aid group that gives a sense of identity and belonging. Being tribal is human nature; so, what’s the problem? Maybe it’s a hangover from the current political climate but I’m feeling a little microaggression-fatigue. It’s great to cheer hard for the home-team; but does that mean diminishing the other(s)?

    “We tribal humans have a ‘dark side,’ ironically also related to our social relationships: We are as belligerent and brutal as any other animal species,” says author and UC San Diego Professor Emeritus Saul Levine, MD, in “Belonging Is Our Blessing, Tribalism Is Our Burden.” “Our species, homo sapiens, is indeed creative and loving, but it is also destructive and hostile.”

    Levine cautions that for all the psychological good that belonging offers us, “Dangers lurk when there is an absence of Benevolence. Excessive group cohesiveness and feelings of superiority breed mistrust and dislike of others and can prevent or destroy caring relationships. Estrangement can easily beget prejudice, nativism, and extremism. These are the very hallmarks of zealous tribalism which has fueled bloodshed and wars over the millennia.”

    How does “zealous tribalism” present in the recovery community? Abstinence-focused tribes have dearly held views that differ from our harm-reduction fellows. Inside the abstinence-model tribe, it’s not all Kum Ba Yah, either. Refuge Recovery clans, SMART Recovery, Women for Recovery and the 12-step advocates may feel a superiority/inferiority thing that comes out in how we talk about each other. SMART followers may look down on 12-stepping as stubbornly old-fashioned. 12-steppers might see Life Ring or other new tribes as acting overtly precious with their dismissal of tried-and-true methods. Focusing in even more, we see NAs, CAs and AAs each rolling their eyes at each other’s rituals or slogans. In AA, secular members and “our more religious members” finger point at each other about who’s being too rigid and who’s watering down the message. These are examples of what Levine calls “belonging without the benevolence.” Finding “our people” is great. Part of what makes us feel included might also over-emphasize the narcissism of small differences.

    “Meeting makers make it!”
    “That’s not sober; that’s dry. The solution is clearly laid out in the 12 steps—not meetings!”
    “AA’s a cult that harms more people than it helps!”

    These are tribal battle cries—sincerely held feeling based in part on our unique lived experience and in part on an ignorance we’re not conscious of.

    If you love the fight and you don’t care what others think of you, this article might not hold your attention. We’re going to talk about how to get along better. On the other hand, if you see yourself as empathetic and regret falling prey to us vs. them conflicts, let’s talk about cause and corrective measures.

    Recovery professionals curb their own biases through professional practices; we can borrow their best practices to avoid getting defensive or dismissive with people who hold divergent worldviews. If our goal is to connect with others, an increasingly diverse world of others presents challenges.

    “In my early career, I was adamant about abstinence as the only viable solution to alcohol and other drug problems,” recalls William White, author of Recovery Rising: A Retrospective of Addiction Treatment and Recovery. As a historian and treatment mentor, White learned from lived-experience, clinical practice, study and research. His 2017 book advocates for treatment professionals to exercise “professional humility and holding all of our opinions on probation pending new discoveries in the field and new learning experiences. Many parties can be harmed when we mistake a part of the truth for the whole truth.”

    If 100% of my knowledge about harm reduction is from harm reduction failures who tell their story of decline in a 12-step meeting, I could “mistake a part of the truth for the whole truth.” What would I know about harm reduction success stories if I only go to 12-step rooms?

    Treatment professionals are adapting to cultural diversity in their practices. Bound by a Code of Ethics, NAADAC (the Association for Addiction Professionals) has embraced the concept of “cultural humility.” Cultural humility is a fiduciary duty for professionals to be sensitive to client race, creed, sexual orientation, gender identity and physical/mental characteristics when providing healthcare.

    “Cultural humility is other-oriented. Cultural humility is to maintain a willingness to suspend what you know or what you think you know based on generalizations about the client’s culture. Power imbalance between counselor and client have no place in cultural humility. There is an expectation that you understand the population you’re serving and that you take the time to understand them better,” explains Mita Johnson, the Ethics Chair for NAADAC, who teaches cultural humility to addiction/treatment professionals. Dr. Johnson says, “Addiction professionals and providers, bound by ethical practice standards, shall develop an understanding of their own personal, professional and cultural values and beliefs. Providers shall seek supervision and/or consultation to decrease bias, judgement and microaggressions. Microaggressions are often below our level of awareness. We don’t always know we are doing it.”

    Microaggression—today’s buzzword—google it. In The Atlantic’s “Microaggression Matters,” Simba Runyowa elaborates on the insidiousness of this behavior: “Microaggressions are behaviors or statements that do not necessarily reflect malicious intent, but which nevertheless can inflict insult or injury. … microaggressions point out cultural difference in ways that put the recipient’s non-conformity into sharp relief, often causing anxiety and crises of belonging on the part of minorities.”

    Here’s how that might look in our recovery universe: someone from NA, a complete abstinence-based fellowship, asks someone who’s thinking about medication-assisted treatment with Suboxone: “Are you in denial? A drug is a drug is a drug.” No malicious intent is involved but the fellow member is left feeling disparaged. Maybe the well-intended NA had a negative experience with medically assisted treatment (MAT) and has a visceral feeling about it, “Taking drugs to stop drugs isn’t clean.” But NA doesn’t work for everyone. Yours or my anecdotal experience will bias us. Maybe expressing my own personal experience, or just listening without commenting, would be more culturally humble.

    The same is true of the MAT fan who says, “12-steppers are deluded by a faith-healing 80-year-old modality; only five-percent of people get helped from the 12 steps.” These types of arguments are not other-oriented. This is tribalism. 

    A simplistic solution to avoiding lane-drift is to listen more and share in first person. Prescriptive communicating—as opposed to a descriptive narrative—will, inadvertently, engage us in microaggression.

    Just when “Why can’t we all just get along” seemed hard enough, there’s more than one subconscious microaggression we need to be aware of. Derald W. Sue, Ph.D., a psychology professor at Columbia University, describes three microaggressions: micro–assaults, micro–insults and micro–invalidations.

    Micro–assaults are most akin to conventional discrimination. They are explicit derogatory actions, intended to hurt. Here’s an AA example: disparaging a humanist AA in a meeting by quoting Dr. Bob’s 1930s view, “If you think you are an atheist, an agnostic, a skeptic, or have any other form of intellectual pride which keeps you from accepting what is in this book, I feel sorry for you.” No one feels “sorry for” their equal. Inferiority is implied.

    “A micro–insult is an unconscious communication that demeans a person from a minority group,” Dr. Sue reports. Using another 12-step creed-based example, “CA includes everyone; it’s ‘God as you understand Him.” Who is likely to feel demeaned by Judeo/Christian-normative language?

    We could rightfully credit 1930s middle-America Alcoholics Anonymous founders for their progressive—always inclusive, never exclusive—posture; “everybody” in 1939 America meant Protestants, Catholics and Jews. The AA of the 1930s was culturally humble. Today, inadvertently, this same language is less effective at gateway-widening. Today, just 33% of earthlings embrace this interventionist higher power of the early 12-step narrative. According to the Washington Times, globally, 16% of people have no religion and 51% have a non-theistic, polytheistic faith. Sikhs or Muslims may share monotheism, but they worship a genderless deity; no room for “Him” of any understanding. Cultural humility accommodates all worldviews, without asking others to speak in the language of the majority.

    “Minimizing or disregarding the thoughts, feelings or experiences of a person of color is referred to as micro–invalidation.” This is how the American Psychiatric Association rounds out Dr. Sue’s three types of microaggression. “A white person asserting to minorities that ‘They don’t see color’ or that ‘We are all human beings’ are examples.”

    Disregarding or minimizing in our community might be telling someone: “You can participate in your online groups if you like but don’t treat InTheRooms.com like real meetings. Face-to-face is the only way to connect with real people.” If expressed in first person, instead of disregarding the other, the message could relate a personal experience and an informed belief. Have we learned everything about the person we’re talking to? Social anxiety disorder or a dependent partner, parent or child at home could be reasons why the online meeting is the superior option for them.

    To William White’s point, what do I really know about the comparative benefits of online community vs. traditional meetings? Maybe I could consider his informed advice of “holding all of our opinions on probation pending new discoveries in the field and new learning experiences.”

    Mita Johnson identifies a challenge with microaggression—it’s subconscious. How do we correct subconscious behaviors? Dr. Sue authored a couple of books to help combat microaggression at an individual, institutional and societal level: Microaggressions in Everyday Life: Race, Gender and Sexual Orientation and Microaggressions and Marginality. Sue offers five steps to help connect us with more varieties of addicts/alcoholics. “Microaggressions are unconscious manifestations of a worldview of inclusion, exclusion, superiority, inferiority; thus, our main task is to make the invisible, visible.” Here are Dr. Sue’s five practices:

    1. Learn from constant vigilance of your own biases and fears.
    2. Experiential reality is important in interacting with people who differ from you in terms of race, culture, ethnicity.
    3. Don’t be defensive.
    4. Be open to discussing your own attitudes and biases and how they might have hurt others or revealed bias on your part.
    5. Be an ally. Stand personally against all forms of bias and discrimination.

    I gave it a try. Taking inventory—in these five ways—of my prejudices and preconceived ideas helps identify my insensitivities. It helps thinking/acting more other-oriented. Secondly, more than ever, it’s a good time for more active listening and less instruction. Getting defensive, even to microaggression coming my way, escalates the divides. Admitting my assumptions and the faulty conclusions is a version of “promptly admit it” that is so familiar. Finally, how can I “Be an ally?” It’s not hard, today, to stand up for myself when I’m being disrespected. Now will I say something when someone else is being invalidated, insulted or dismissed? Yes, there’s a time to mind my own business but if I’m committed to “be an ally,” can I stay silent when another is being ganged up on by the tyranny of the majority?

    When I’m tempted to be tribal when confronted with other individuals or recovery groups, I try to remember that all people who suffer from process or substance use disorder have been subjected to microaggressions. William White identifies a few of the more cliché slights we all face:

    • “Portrayals of the cause of substance use disorders as personal culpability (bad character) rather than biological, psychological, or environmental vulnerability.
    • Imposed shame, e.g., being explicitly prohibited by one’s supervisor from disclosing one’s recovery status out of the fear it would harm the reputation of the company.
    • Misinterpretation of normal stress responses as signs of impending relapse.”

    In this regard there is no us vs. them. Just “us.”

    Not everyone believes that shining a light on microaggression will solve hostilities towards each other. “There are many problems with studies of microaggressions, technical and conceptual. To start, its advocates are informed by the academic tradition of critical theory,” Althea Nagai argues in “The Pseudo-Science of Microaggressions.” Nagai identifies confirmation bias found in almost all focus groups and the problem of unintended consequences when institutionalizing anti-microaggression policy.

    Nagai’s National Association of Scholars article continues, “There is nothing in the current research to show that such programs work. I suspect most fail to create greater feelings of inclusion. Research suggests they create more alienation and sense of apartness. The recent large-scale quantitative studies suggest that increased focus on ethnic/racial identity exacerbates the problems they are supposed to address. In other words, ‘social justice’ and diversity programs may actually backfire, creating less inclusion, more polarization.”

    Dr. Sue cautions us about weaponizing microaggression; other-oriented cultural humility is to take inventory of my microaggressions—not to fault-find other’s behaviors. Social psychologist Lee Jussim in Psychology Today says keep it personal—not global: “To understand how we can all unintentionally give offense through our own ignorance or insensitivity—thereby increasing our ability to make the same points without being hurtful.”

    “I’d rather step on your toes than walk on your grave,” is a rationalization we hear in the rooms. How do I neither pussy-foot around and avoid being a dick? Beyond intellectualizing, cultural humility is introspective. In “Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes,” cues from professionals show me how to re-frame how I interact with others: “Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique to redressing the power imbalance in the patient-physician dynamic and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and the defined population.”

    For me, this nails how to stay other-focused: Professionals (or anyone who wants to relate to others better) should “relinquish the role of expert and become the student of the patient with a conviction and explicit expression of the patient’s potential to be a capable and full partner in the therapeutic alliance.”

    I don’t need a course or a degree to “become the student” of others. Instead of acting like I know what’s best for others, I can be a fellow traveler; think about other-focused approaches globally; but act locally.

    View the original article at thefix.com

  • SAMHSA Voice Awards Honor Walter Ginter’s MARS™ Project

    SAMHSA Voice Awards Honor Walter Ginter’s MARS™ Project

    Many people on MAT feel unwelcome at meetings, and this sense of alienation and rejection often leads to relapse. That’s where MARS™ comes in. We want people on MAT to be embraced and accepted in recovery.

    Held at Royce Hall on the UCLA campus in Westwood, the 13th annual SAMHSA (Substance Abuse and Mental Health Administration) Voice Awards recognized an essential figure in the national battle against the opioid epidemic. As the founder of the Medicated Assisted Recovery Support (MARS™) Project, Walter Ginter was honored with a Special Recognition Award for his efforts in combating the opioid epidemic and helping people who use Medicated-Assisted Treatment (MAT) stick to the path of recovery. In the greater recovery community– ranging from treatment centers across the country to 12-step groups—many people have a negative view of MAT which has led to a lack of support for people trying to overcome opioid addiction. 

    SAMHSA has been at the helm of national efforts to destigmatize the medications typically used in MAT such as buprenorphine, methadone, and naltrexone. Beyond supporting physicians and researchers, SAMHSA has tried to reduce the negativity associated with traditional perspectives on opioid recovery. According to many loud voices in Narcotics Anonymous (NA), if a person is on medication that has been prescribed to help them overcome opioid withdrawal symptoms or to refrain from using heroin or other illicit opioids, then they are not really clean. In contrast to this judgmental perspective, the SAMHSA website states: “Medicated-Assisted Treatment (MAT) is the use of FDA- approved medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

    Indeed, a “whole-patient” approach is what is needed to stem the tide of what has become the greatest drug epidemic in U.S. history. With the introduction of fentanyl and other powerful prescription narcotics to the illegal drug trade, the stakes are higher than ever before. According to the National Institute on Drug Abuse, “Every day, more than 115 people in the United States die after overdosing on opioids.”

    Given such a devastating statistic, Arne W. Owens hopes the SAMHSA Voice Awards can raise awareness by bringing the recovery community together with the entertainment industry. As the Principal Deputy Assistant Secretary, Owens was the highest-ranking member of SAMHSA at the Voice Awards Show on August 8, 2018. Asked by The Fix how the Voice Awards can make an impact on the opioid epidemic, Owens said, “We hope to incentivize more positive portrayals in film and television of treatment and recovery for substance use disorders. We believe hearing positive stories about treatment and recovery helps to inspire others, shifting negative attitudes. For example, it would be good to see writers and directors positively represent MAT in film and television. Beyond raising awareness, such representation would help to reduce stigma.”

    Walter Ginter is an ideal example of someone who has dedicated his life to reducing stigma and raising positive awareness about MAT. Dedicated to improving the recovery community, Ginter has been a board member of both the National Alliance for Medication Assisted Treatment and Faces & Voices of Recovery. In collaboration with the New York Division of Substance Abuse, Yeshiva University and the National Alliance for Medication Assisted (NAMA) Recovery, Walter Ginter became the founding Project Director of the Medication Assisted Recovery Support (MARS™) Project.

    MARS™ is designed to provide peer recovery support to persons whose recovery from opioid addiction is assisted by medication. To be in a MARS™ group through the Peer Recovery Network PORTAL™, a person has to be in a MAT program. As Ginter writes on the MARS™ website, “The Peer Recovery Network was created as a way for peers in recovery to more effectively organize their community, to communicate with each other, and to have a stronger voice for advocacy efforts.”

    In 2012, Ginter helped create the Beyond MARS Training Institute at the Albert Einstein College of Medicine. With a variety of models and options, Ginter created a curriculum where opioid treatment programs and recovery professionals can be trained to implement MARS™. The original MARS™ project has expanded from its beginnings to include 17 programs across the United States and two in Haiphong, Vietnam. Ginter believes this is just the beginning of the expansion, both nationally and internationally.

    On the red carpet before the Voice Awards ceremony, Walter Ginter spoke with us about the struggles he has faced as an early advocate of MAT, revealing both an innate decency and a keen sense of humor. With a smile, he mentioned how people always ask him why MARS™ uses the trademark symbol. Some of them even think that he’s trying to corner the name of the planet for profit.

    But MARS™ has a trademark for a particular reason, Ginter explains. In the vast majority of cases, the organization does not mind when people use the name. They do enforce the trademark, however, when people who are not certified as trainers try to set-up MARS™ groups and conduct MARS™ trainings. In most cases, rather than follow the protocols, they are hijacking the name to do what they want and make a profit. As an organization with a mission that envisions “the transformation of medication-assisted treatment (MAT) to medication-assisted recovery (MAR),” Ginter believes that protecting the integrity of the organization must remain a priority.

    Sitting inside, away from the hot Los Angeles sun and the red carpet, Walter Ginter went into more detail about the early struggles that MARS™ faced. “Very few people come to MAT as their first course of treatment. In the vast majority of cases, they’ve already been to 12-step meetings, particularly Narcotics Anonymous. Although they initially felt welcomed at those meetings, those feelings shift after they start to work a program that includes medication-assisted treatment. Suddenly, you no longer feel welcome at the meetings, and this sense of alienation and rejection often leads to relapse. To fill in the resulting hole, we want MARS™ to give the same type of mutual support that 12-step provides. We want people on MAT to be embraced and accepted in recovery.“

    We asked Walter Ginter to detail this rejection in context. Scratching his chin, he said, “Look, telling people that they are not in recovery is evil. People on MAT were told that they couldn’t share in NA meetings since they weren’t really clean. By not allowing people to talk in meetings, they become alienated. However, it’s worse than alienation because it undermines what they’re doing to get well. The thought process goes something like this: If taking the medication that I need means I’m not in recovery, then why should I act like I’m in recovery? What does it matter if I do a line of coke on the side or have a drink?”

    Walter Ginter saw too many people on the verge of getting well through medication-assisted treatment subvert their recovery with this line of thinking and some other thought processes as well. Not wanting to take any chances, he set up MARS™ as a viable alternative both to treatment centers hostile to MAT and non-supportive recovery support groups like many NA meetings. In the past several years, MARS™ has had remarkable success with people on MAT. It has helped them find true recovery, a fact that has left initial opponents quite frustrated.

    In fact, Ginter ended our talk with a description of one of these encounters. As he told the following story, Ginter’s smile appeared again. “One day an opioid treatment counselor from a local New York rehab burst into my office and banged her fist on my desk. She said ‘What kind of voodoo are you doing here?’ Surprised by such an accusation, I replied “Excuse me?” She went on to explain: “Well. I have a client that wouldn’t stop doing coke. She would get off the heroin, but she always tested positive for cocaine. Since she’s joined your program, now she’s not only off the heroin, she’s no longer testing positive for coke or any other drug. How did you make that happen?’”

    Ginter shook his head as if he’d gone through the same rigmarole many times before. He describes how he sat the recovery counselor down and explained to her quietly: “There’s no magic or voodoo or anything else. We simply gave her medication that worked while telling her that she was now in true recovery. We gave her a vision of medication-assisted recovery, then let her make her own choice. She realized on her own, ‘Well, now I really can be on medication and in recovery. However, I can’t be in recovery if I’m still doing other drugs on the side. Today, I like being in recovery and the future it promises, so I’m going to stop doing the coke. Indeed, I will embrace this path that is set before me.’” 

    Given the promising picture that he painted, it makes perfect sense that Walter Ginter was honored with the Special Recognition Award at the 2018 SAMHSA Voice Awards. After all, how many people are dedicating themselves in such a precise fashion to saving lives by shifting perspectives and offering a viable alternative like Medication Assisted Recovery Support (MARS™)?

    View the original article at thefix.com