Answer Addiction

Tag: MAT

  • Dope Sick: Breaking Down Opioid Withdrawal

    Dope Sick: Breaking Down Opioid Withdrawal

    The strength it takes for a broken down, tormented person, feeling sick and hopeless every single day, to say, “No more” to their source of relief is something many people cannot even fathom.

    Dope sickness (from opioid withdrawal) or even just the fear of dope sickness can trigger a desperation and panic unlike any other. This fear, in large part, drives the addiction that has led to the opioid epidemic, which claimed 64,000 overdose deaths in 2016 and is now classified as a public health emergency. Or some say it’s the high that keeps opioid users chasing the dragon all the way to hospitals, jails, and institutions. Much like an abusive relationship that long overstays its welcome—often by years and even decades—it starts with love and butterflies but then transforms into a much darker animal, tethering a person in place not with love but with the fear of what happens when you leave it behind.

    How does someone know when their dose is wearing off and they need another fix? They’ll start to feel hot and cold at the same time, getting goose bumps and perspiring simultaneously; their eyes begin to water and they yawn repeatedly; they feel intense cravings coupled with severe anxiety, and their stomach starts to turn. These early onset symptoms of withdrawal work like an internal alarm in the brain, signaling to the nervous system that it desperately needs what is missing. These symptoms typically occur 6-12 hours after the last dose, and their intensity varies based on how often and how much of the drug the person is using. Opioid (painkillers such as oxycodone, vicodin, and codeine, as well as heroin) addiction is a progressive disease in which tolerance builds, so the required dose grows larger, and the withdrawal worsens. The deeper you are in the hole, the farther out you must climb.

    Once someone begins to experience the first stage symptoms of withdrawal, panic sets in. There is an overwhelming sense of impending doom because, as most seasoned junkies know, the only thing worse than the first stage of opioid withdrawal is the second. Muscle aches, pains, and spasms can cause a person to kick their legs and flop around like a fish out of water. Just as a fish longs for water to breathe again, the person in opioid withdrawal longs for a hit to end their agonizing race toward what feels like death. Vomiting, diarrhea, and severe stomach cramps keep them crawling to the bathroom, if they even make it, if they even have access. These physical symptoms are paired with deep depression, anxiety, and the torture of knowing that the hell could simply cease if they get their fix. And this typically goes on all 24 hours of each day that it lasts—typically just over a week—because insomnia prevents any relief that sleep would bring.

    It is the fear of that torment, which words can’t really do justice, that shackles people to a substance which indefinitely curses them with relief and pain. It is also that fear that compels them to lie, cheat, and steal. People who have become addicted to opioids wake up one day, deeper into their addiction then they’d ever anticipated, and look in the mirror only to see a stranger. They look at childhood photos of themselves and feel overcome with sadness, asking themselves, What happened? Their mothers do the same thing, looking at their baby’s photos and asking themselves where they went wrong. It’s difficult to separate the person from the addiction: although one entity does seem to overtake the other, that can be reversed and they are, in fact, two distinct realities.

    In most cases, a rotten egg is not born into this world destined to be a thief, robbing to feed their addiction. What once was a promising honor student, the girl next door, the boy working behind the deli counter, or the kid who loved fishing has now slowly, pushing the limits a bit farther each time, transformed into that thief overcome with fighting the terror of withdrawal. It’s as if they’ve sold their soul to the devil, stealing for it, lying to loved ones, to anyone, cheating people just to survive, just to feel well. When someone with an addiction hits rock bottom, and they hate themselves at this point, they think they’ve had enough and they want their soul back. But they can’t just stop. There’s a debt to pay.

    The strength it takes for a broken down, tormented person, feeling sick and hopeless every single day, desperate enough to do things they’d never imagine themselves capable of doing, to say, “No more,” is something many people cannot even fathom; it is standing up to the fear of the agony of withdrawal, of feeling like you’d gladly crawl out of your own skin if you could. For many people, it’s also facing the fear of life unaltered, buffer-less, possibly for the first time.

    There are different methods of withdrawing from opioids. Doctors sometimes offer benzodiazepines or clonidine, a blood pressure lowering drug, to temper the misery. There’s the good old fashion “cold turkey” which comes from the cold flashes and goosebumps you experience, or “kicking dope” which comes from kicking your legs around in weird spasms for over a week. And of course, we can’t have this discussion without mentioning the two big whoppers, Suboxone and methadone. These are known as medication assisted treatment (MAT), and they work wonders for many people. But one day you might want to get off of them, and that’s another opioid detox.

    Something worth mentioning about MAT is that if you take it long enough, you have the chance to rebuild a “normal” life. You can go to school, kickstart your career, do all the things that being a full-fledged junkie makes impossible. Stay on as long as you need; I even heard about one guy who got himself through law school on Suboxone. So there are upsides, incredible advantages really, but at the end of the day, after you’ve obtained your PhD, you still have to pay that debt.

    I once heard someone say, close your eyes and picture an addict. Whatever picture came into your mind, that’s the stigma of addiction. But there’s not just one static image, because addiction comes in layers. There’s the first layer, how it originated. Maybe a doctor prescribed Norcos for an ankle sprain and neglected to mention what you might be signing up for. According to drugfree.org, almost 80% of people who shoot up heroin started with the misuse of prescription medication. The next layer is when the drug takes over, and your identity—who you are—is now overwhelmed by the addiction, hiding your actual self somewhere beneath. And finally, hopefully, there’s the detox—the week or two of pure hell as the drug leaves your system and you start learning how to function without it.

    But when you do, finally, make it to the other side, however worn and broken down you may feel, it feels like the first day of the rest of your life. It’s a terrifying feeling, but you come out triumphant, and victorious.

    View the original article at thefix.com

  • Too Often, Insurers Cover Opioids But Not Addiction Treatment Meds

    Too Often, Insurers Cover Opioids But Not Addiction Treatment Meds

    “Buprenorphine and methadone are incredibly effective medications… So I really do think it’s a stigma issue.”

    As is the case for many people battling opioid addiction, Mandy’s dependency started at home. She was prescribed an opioid for back pain, and her insurance company gladly covered the cost of the pills.

    However, after Mandy became dependent on opioids and was prescribed buprenorphine to help with her rehabilitation program, her insurer stepped back, unwilling to pay.

    “It makes me want to go out and use [drugs],” Mandy said when she spoke to Vox. The 29-year-old who lives in the Chicago area asked that only her first name be used. “It’s way easier to get opiates or heroin… It’s so much easier than dealing with this bullshit.” 

    Many Americans who had no problem getting their insurance companies to pay for addictive opioid pain pills have found that getting insurers to cover treatment—particularly medication-assisted treatment (MAT) that relies on pharmaceuticals like buprenorphine—is an uphill battle despite the fact that the drugs have been proven effective. 

    “Buprenorphine and methadone are incredibly effective medications,” said Tami Mark, a health economist at RTI International, a non-profit that conducts policy research. “If you had any other drug with their kind of effect size, it would be immediately covered… So I really do think it’s a stigma issue.”

    For people in early recovery, like Mandy, refusals to cover medications or delays in getting prescriptions approved can be deadly.

    “The risk of relapse is incredibly high,” said Sara Ballare-Jones, a social work case manager at the University of Kansas Health System. She often has patients wait three days to get their medications approved because they require prior authorization from the insurance companies.

    In Mandy’s case her claim was denied, leaving her to pay out of pocket for buprenorphine, which costs nearly $3,000 each year. The 29-year-old said that is a huge amount to have to pay while also handling daily expenses like student loans and rent.

    “I’m feeling all these old issues and all this shit, and then it’s just more bullshit,” she said. “I’m just trying to reenter society… It’s really hard.”

    It’s also incredibly frustrating for Mandy, who knows firsthand how easy it is to get insurers to cover opioids. “I never paid a dime for my opioids. Those were always covered,” she said. “But I’m paying all this money for the treatment.”

    Mandy’s doctor, Dennis Brightwell, said that he usually sees issues with private insurance companies. While Medicaid is required to cover most medication-assisted treatments, most private insurers balk at covering them, putting vulnerable patients in an awkward position.

    “If you send a commercial patient to the pharmacy, you don’t know until they get there how it’s going to go,” Brightwell said. “Sometimes it’s not such a problem. Sometimes it’s a prior authorization that is pretty straightforward. Sometimes it’s very difficult to get them to approve it. And there’s not an easy way to find out upfront what medications they approve.” 

    View the original article at thefix.com

  • Language Matters: A Recovery Scientist Explains the Impact of Our Words

    Language Matters: A Recovery Scientist Explains the Impact of Our Words

    If a person has internalized the negative stereotypes associated with being “an addict,” are they more likely to have a fixed mindset and believe they cannot improve or change?

    Over 21 million Americans have substance use disorder and fewer than 3.8 million individuals receive treatment each year. 28 percent of the individuals who need treatment, but do not receive it, report stigma as a major barrier to accessing care. If we want to destigmatize addiction — a highly stigmatized disorder — then we need a unified language.

    The words we use have been shown by researchers to not only negatively influence our attitudes toward people in recovery and people who use substances — to the extent of suggesting that a health condition is a moral, social, or criminal issue — but they also impact access to health care and recovery outcomes.

    This article isn’t a mandate for everyone to start policing language, but it was motivated by a genuine desire to look at the evidence: how we speak to someone with substance use disorder matters. In the midst of a public health crisis, we can’t dismiss the use of language as just semantics, trivial, or being overly politically correct. We don’t have that luxury when 64,000 Americans die from drug overdoses each year and over 88,000 die from alcohol-related causes.

    Building upon an already existing foundation of work in this field, recovery scientist and researcher Robert Ashford and colleagues conducted a larger study of the general public measuring both implicit and explicit bias elicited by certain common words and phrases, which was published in June. I was fortunate to speak with him about the study, the impact of language, and how we can apply this information to help fight stigma.

    The Fix: Let’s say you’re among peers in recovery and you refer to yourself by a term which your study has shown to be a derogatory, like “addict,” “alcoholic,” or “substance abuser.” How does that contribute towards the stigma those in recovery face?

    Robert Ashford: This is an interesting question, and one from an evidence perspective, we don’t have exact answers on. Anecdotally, we believe that even though it is probable that this type of language has an impact on things like self-stigma, self-esteem, and a sense of self-worth, it is more important that people have the right to label themselves as they choose, especially as it concerns the recovery community. The fact is that the use of pejorative labels has had a decades-long place in popular mutual-aid programs like AA and trying to tell the mutual aid recovery community what to do isn’t a goal, nor should it be in our minds. At the end of the day though, it is important for people in recovery to understand that the use of such labels may become internalized over time, leading to decreases in self-esteem and such. However, without more evidence, it is merely hypothetical at this point.

    In what ways does it impact their lives? For example: their access to, and quality of, healthcare?

    Generally, the use of terms such as “substance abuser,” “addict,” and others have been found to be highly associated with negative attitudes (i.e. bias) in the general public, among behavioral health professionals, and in medical professionals. These negative associations ultimately lead to all types of stigma (social and professional) and ultimately to very explicit discrimination. On a personal level, we know that just over 25% of individuals with a severe substance use disorder don’t seek treatment each year due to the belief that they will be stigmatized or discriminated against by their friends, neighbors, or employers. Additionally, this type of bias has also been found to decrease the willingness and efficacy of medical services delivered to patients that have a severe substance use disorder. Access and the quality of treatment in the United States has many barriers and enhancing those barriers through the use of language is an easy fix – just by changing the way we talk!

    What would be an alternative, less-stigmatizing term?

    Any term that puts the focus on the individual as a human is bound to be less stigmatizing. For example, individuals are not “addicts” or “substance abusers,” but rather, “people with a severe substance use disorder” or a “person who uses substances.” Language changes constantly, but the one commonality in terms of bias and stigma seems to be that when we can restore or focus on the humanity of an individual through our language, we will be speaking from a better place.

    How might that term be more empowering to the individual, and in what ways?

    As a person in recovery, I can speak personally that when using terms that are rooted in humanity, I get a better sense of myself and the conditions that I have either lived with or am living through. Often times when we are in the midst of a severe substance use disorder, faced with a constant barrage of language that is meant to disempower and dehumanize, we began to internalize those labels. While it is possible in certain settings that these terms are used as a reminder of a previous identity – intending to provide some sense of catharsis in the recovery process, or a mechanism for not returning to a previous state – I think it is equally plausible that we can be reminded and have that benefit by using terms that don’t immediately degrade our very essence as people.

    I’m curious how a growth mindset versus a fixed mindset might inform our choices of words? Corollary, how does each mindset inform how we interpret what we hear from others?

    This an interesting question, especially in applying the growth and fixed mindset theories from childhood development and education to the field of substance use and recovery. The theory suggests that those who believe they can improve or change (growth mindset) are more likely to engage in activities that allow them to grow, and those that believe they cannot improve or change (fixed mindset) or less likely to do so. In the context of recovery and substance use, this has immense potential to inform how language truly does impact individuals in or initiating recovery. If a person has internalized the negative stereotypes associated with being “an addict,” are they more likely to have a fixed mindset? While there are surely myriad reasons for the challenges faced by people with a severe substance use disorder, mindset may indeed be a big part of it.

    You’ve done an incredible amount of work in educating both those in recovery and clinicians about the importance of the language we use. Some of your research features infographics about negative language and presents a positive alternative (below). For those who may need further clarification, what is the difference between pharmacotherapy (or medication to treat substance use disorders) and medication-assisted recovery?

    The infographics we made from our results have sure inspired a lot of conversation – which is exactly what we hoped for as scientists! One of the constant topics has been around “medication-assisted treatment,” “pharmacotherapy,” and “medication-assisted recovery.”

    Pharmacotherapy is the use of medications to treat a disorder/disease/ailment – specific to our field, this would imply treating a substance use disorder with medications. The term had significantly more positive associations than a similar term, “medication-assisted treatment” from our tests and we wanted to make the suggestion to use it instead.

    “Medication-assisted recovery” on the other hand can be considered the use of substance use disorder medications, combined with the use of recovery support services such as MARS recovery meetings, engaging with a peer recovery support specialist, utilizing a recovery community organization, or attending a MAR-friendly 12-step meeting. The biggest difference is that not everyone who uses substance use disorder pharmacotherapy wants, or would consider themselves, in recovery. Keeping the two terms separate gives people an option, and from a research prospective, both terms are associated with the positive and their use isn’t likely to elicit implicit bias among the general public.

    Figure: Suggested Recovery dialects


    View the original article at thefix.com

  • Medication-Assisted Treatment Options Limited For Medicare Recipients

    Medication-Assisted Treatment Options Limited For Medicare Recipients

    “Medicare beneficiaries have among the fastest growing rate of opioid use disorder, but they don’t currently have coverage for the most effective treatment,” says one official.

    Medication-assisted treatment (MAT) for opioid addiction and dependence is now seen as the gold standard of care by many addiction treatment professionals, but barriers to treatment make it difficult for many Americans over the age of 65 to access medication-assisted treatment on Medicare. 

    According to a report by the Associated Press, Medicare, the federal health insurance program for seniors, will not cover treatment with methadone, one of the oldest and most effective forms of medication-assisted treatment.

    The program covers buprenorphine, another form of MAT, but only a fraction of doctors who accept Medicare have obtained a federal waiver that allows them to prescribe buprenorphine. 

    This combination leaves a vulnerable population at risk. The AP reports that 300,000 Medicare patients have been diagnosed with opioid addiction, but only 81,000 prescriptions for buprenorphine have been written for Medicare patients. 

    “Medicare beneficiaries have among the highest and fastest growing rate of opioid use disorder, but they don’t currently have coverage for the most effective treatment,” said Rep. George Holding, a Republican from North Carolina. Holding is sponsoring a bill that would recommend changes to Medicare’s policy toward methadone. 

    Some patients on Medicaid can access methadone treatment, either by paying about $80 per week out of pocket or qualifying for state programs that cover the treatment. However, worrying about how and if their treatment will be covered can take a real toll on their mental health. 

    Joseph Purvis, a former heroin and prescription painkiller user, said he became depressed when he realized that Medicare might not cover his methadone treatment. “I was terrified that I might have to leave the program,” he said. “There’s no way I wanted to go back to addiction on the streets.” 

    Luckily, he was able to access treatment, thanks to a state program. However, he believes that Medicaid should cover this important treatment. “Some people think of methadone as a crutch for addiction but it’s not,” Purvis said. “It’s a tool that allows people to live a somewhat normal life.”

    The issue of access to MAT is especially important given that Medicaid just passed regulations drastically tightening access to opioid pills. The restrictions passed despite objections from some medical professionals who said that many seniors are on high levels of opioids that need to be carefully reduced. 

    “The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient,” Dr. Joanna L. Starrels, an opioid researcher and associate professor at Albert Einstein College of Medicine, said in response to the regulations. “That takes a lot of clinical judgment. It’s individualized and nuanced. We can’t codify it with an arbitrary threshold.”

    View the original article at thefix.com

  • Medication-Assisted Treatment Saves Lives But Is Severely Underutilized

    Medication-Assisted Treatment Saves Lives But Is Severely Underutilized

    A new study found that in the year after an overdose less than one-third of patients were prescribed methadone, buprenorphine or naltrexone.

    A new study found that drugs used to reduce opioid use in people with addiction are seriously underutilized.

    The medical journal Annals of Internal Medicine published the study, which followed close to 18,000 adults in Massachusetts. The participants in the study had gone to an emergency room between 2012 and 2014 for a non-fatal drug overdose.

    Although using drug therapy to treat opioid addiction is considered a “gold standard” of treatment, the study found that just 30% received any of the Food and Drug Administration-approved medication-assisted treatments.

    The FDA advises treatment for opioid addiction as a combination of behavioral therapy and the parallel use of one of three drugs. Methadone, buprenorphine, and naltrexone are all drugs approved for assistance in reducing drug cravings in those addicted to opioids.

    Science Daily reported that the study showed a 59% reduction in fatal opioid overdose for those receiving methadone, and a 38% reduction for those receiving buprenorphine over a 12-month period. The drug naltrexone was unable to be evaluated due to a small sample size.

    In the past, naltrexone has been shown to be as effective as methadone and buprenorphine, but there are high dropout rates and a refusal to try the drug in the first place.

    Science Daily reports this could be due to the fact that patients utilizing naltrexone cannot use any opioids for seven to 10 days. Methadone and buprenorphine can be started much sooner.

    As the opioid addiction crisis worsens, health officials are eager to find ways to assist people with addiction in withdrawal and abstinence from the drug. The Fix reported on an FDA-approved device that helps reduce opioid cravings, called “Drug Relief.”

    The study also found that in the year after an overdose, not quite one-third of patients were prescribed one of the three FDA approved drugs—with methadone at 11%, buprenorphine at 17%, and naltrexone at 6%. Five percent received more than one medication.

    According to Science Daily, Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), said, “A great part of the tragedy of this opioid crisis is that, unlike in previous such crises America has seen, we now possess effective treatment strategies that could address it and save many lives, yet tens of thousands of people die each year because they have not received these treatments. Ending the crisis will require changing policies to make these medications more accessible and educating primary care and emergency providers, among others, that opioid addiction is a medical illness that must be treated aggressively with the effective tools that are available.”

    View the original article at thefix.com

  • Generic Suboxone Strips Get The Green Light

    Generic Suboxone Strips Get The Green Light

    The FDA’s move could mean wider availability and more competitive pricing for the popular addiction-fighting drug. 

    The FDA last week sparked a flurry of legal wrangling when it gave the go-ahead for two drugmakers to sell generic versions of Suboxone strips.

    Part of an agency push to expand access to medication-assisted treatment, the move could open up the door to more competitive pricing for the popular addiction-fighting drug—but it also turns up the heat in an ongoing battle between drug companies intent on protecting profits. 

    “The FDA is taking new steps to advance the development of improved treatments for opioid use disorder, and to make sure these medicines are accessible to the patients who need them,” Commissioner Scott Gottlieb said in a statement. “That includes promoting the development of better drugs, and also facilitating market entry of generic versions of approved drugs to help ensure broader access.”

    Currently, the brand-name under-the-tongue strips are sold by Indivior and cost around $200 per month without insurance. The British company is already embroiled in litigation over claims that it strategically worked to block competition from generic Suboxone in order to maintain soaring profits. At one point, the drug brought in $2 billion in sales a year, according to FiercePharma.

    But now, the Pennsylvania-based drug maker Mylan and the India-based company Dr. Reddy’s both have the green light to bring out generic versions of the drug. Mylan did not immediately comment on the approval or its plans moving ahead, but the Hyderabad competitor issued a statement Friday praising the move and detailing its 2 mg, 4 mg, 8 mg and 12 mg formulations.

    “With opioid addiction becoming increasingly prevalent in America, the full approval and launch of our generic equivalent of Suboxone could not have come at a more critical time to help patients,” said Dr. Reddy’s CEO Alok Sonig. 

    But Indivior took the matter straight to the courthouse and on Friday—just a day after the FDA announcement—the company won a temporary restraining order blocking Dr. Reddy’s from moving forward with its product release in light of ongoing patent litigation. A judge will decide on the path ahead at a June 28 federal court hearing in New Jersey. 

    Indivior CEO Shaun Thaxter put out a statement expressing surprise at his competitor’s decision to launch the generic drug—and promised to keep up the courtroom fight.

    “We will continue to pursue all legal avenues, including an immediate injunction until the legal status of our intellectual property is confirmed by the courts,” he said.

    And Mylan won’t necessarily have an easier time pushing out its generic formulation of the medication-assisted treatment, as the company had previously agreed to delay its generic launch until 2023.

    Suboxone, which combines naloxone and buprenorphine to ease withdrawal and fight cravings, initially hit the U.S. market in 2002 as a pill. Five years later, Indivior announced plans to launch a sublingual film, a formulation that wouldn’t immediately have a generic alternative. 

    But in 2016, 35 states joined together to sue the company for anticompetitive practices. The states claimed that Indivior raised unfounded safety concerns to delay the FDA’s approval of the generic Suboxone tablet. Then, the company allegedly used those concerns to push strips over pills, a move that the states alleged was intended to prevent patients from taking generic versions of the pill. 

    The Federal Trade Commission (FTC) has since been investigating the company over antitrust claims, according to reports. 

    Whatever the legal drama surrounding the drug approvals, the FDA framed its announcement as an important step toward increasing access to lifesaving treatments and reducing stigma around medication-assisted treatments.

    “The FDA is also taking new steps to address the unfortunate stigma that’s sometimes associated with the use of opioid replacement therapy as a means to successfully treat addiction,” Gottlieb said. “When coupled with other social, medical and psychological services, medication-assisted treatments are often the most effective approach for opioid dependence.”

    View the original article at thefix.com

  • Using Marijuana to Treat Opioid Addiction

    Using Marijuana to Treat Opioid Addiction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com