Answer Addiction

Tag: medication-assisted treatment

  • For Pregnant Women, Stigma Complicates Opioid Misuse Treatment

    In Pennsylvania, one community health center is working with new and expectant moms to tackle opioid dependency.

    New and expectant mothers face unique challenges when seeking treatment for an opioid use disorder. On top of preparing for motherhood, expectant mothers often face barriers to accessing treatment, which typically involves taking safer opioids to reduce dependency over time. The approach is called medication assisted therapy, or MAT, and is a key component in most opioid treatment programs.

    But with pregnant women, providers can be hesitant to administer opiate-based drugs.

    According to a study out of Vanderbilt University, pregnant women are 20% more likely to be denied medication assisted therapy than non-pregnant women.

    “In the beginning, I was so scared as a new provider to write my first prescription for medication assisted therapy to pregnant women,” said Dr. Linda Thomas-Hemak of the Wright Center for Community Health in Scranton, Pennsylvania.

    The health center serves low-income individuals who are underinsured or lack insurance altogether, many of whom struggle with opioid misuse.

    “Pennsylvania was hit particularly hard by the opiate epidemic that really has plagued, terrified and challenged America,” said Hemak, who is a board certified addiction medication specialist.

    On this episode of the podcast, we speak with Dr. Hemak about whether medication assisted therapy is safe for new and expectant mothers and how the Wright Center is helping women overcome opioid dependency during pregnancy.

    Direct Relief · For Pregnant Women, Stigma Complicates Opioid Treatment
    Listen and subscribe to Direct Relief’s podcast from your mobile device:
    Apple Podcasts | Google Podcasts | Spotify

    Direct Relief granted $50,000 to The Wright Center for its extraordinary work to address the opioid crisis. The grant from Direct Relief is part of a larger initiative, funded by the AmerisourceBergen Foundation, to advance innovative approaches that address prevention, education, and treatment of opioid addiction in rural communities across the U.S. 

    In addition to grant funding, Direct Relief is providing naloxone and related supplies. Since 2017, Direct Relief has distributed more than 1 million doses of Pfizer-donated naloxone and BD-donated needles and syringes to health centers, free and charitable clinics, and other treatment organizations.

    Transcript:

    When it comes to getting treatment for an opioid use disorder, pregnant women have an uphill battle.

    Most patients undergoing opioid treatment are prescribed safer opioids that reduce dependency while limiting the risk of overdose and withdrawal.

    This kind of treatment is called medication assisted therapy, or MAT.

    But with pregnant women, providers can be hesitant to administer opioids.

    According to a study out of Vanderbilt University, pregnant women are 20% less likely than non-pregnant women to be accepted for medication assisted therapy.

    “In the beginning, I was so scared as a new provider to write my first prescription for medication assisted therapy to pregnant women,” said Dr. Linda Thomas-Hemak.

    Hemak is a board-certified addiction medication specialist and CEO of the Wright Center in Scranton, Pennsylvania.

    “Pennsylvania was hit particularly hard by the opiate epidemic that really has plagued, terrified and challenged America,” said Hemak who has been practicing in the state for several years.

    In 2016, the health center launched a comprehensive opioid treatment program to address the growing crisis in their community. They quickly realized a number of patients were pregnant—and had specific needs, from prenatal care to job support. And so, a new program was born.

    “The Healthy MOMS program is based on assisting mothers who are expecting babies or have recently had a child, up until the age of two,” explained Maria Kolcharno — the Wright Center’s director of addiction services and founder of the Healthy MOMS program.

    “We have 144 moms, through the end of August, that we have served in the Healthy MOMS program and actively, we have enrolled 72.”

    The program provides new and expectant moms with behavioral health services, housing assistance, educational support; providers have even been delivering groceries to moms’ homes during the pandemic.

    But the crux of the program is medication assisted therapy.

    Moms in the program are prescribed an opioid called buprenorphine—unlike heroin or oxycodone, the drug has a ceiling effect. If someone takes too much, it won’t suppress their breathing and cause an overdose.

    Nonetheless, it’s chemically similar to heroin, which may raise eyebrows. But while some substances, like alcohol have been shown to harm a developing fetus, buprenorphine isn’t one of them.

    “Clearly there are medications, like alcohol, that are teratogenic. And there’s medications like benzodiazepines that have strong evidence that they are probably teratogenic. When you look at the opioids that are used and even heroin, there is no teratogenic impacts of opiates on the developing fetus,” Dr. Hemak explained.

    So, opioids like buprenorphine can be safe for pregnant women. What’s not safe is withdrawal.

    If someone is abusing heroin, overdose is likely. In order to revive them, a reversal drug called Naloxone is used, which immediately sends the person into withdrawal.

    But when a woman is pregnant and goes into withdrawal, it can cause distress to her baby, lead to premature birth, and even cause a miscarriage.

    Which is also why these women can’t just stop taking opioids.

    “Stopping cold a longstanding use of an opiate because you’re pregnant is a very bad idea and it is much safer for the baby and the moms to be transitioned from active opiate use to buprenorphine when pregnant,” explained Hemak.

    Because buprenorphine has a ceiling effect and is released over a longer period of time, women are less likely to overdose on the drug.

    Regardless, there’s still a risk their baby goes through withdrawal once they’re born. For newborns, withdrawal is called neonatal abstinence syndrome or NAS.

    Babies may experience seizures, tremors, and trouble breastfeeding. Symptoms usually subside within a few weeks after birth.

    Fortunately, the syndrome has been shown to be less severe in babies born from moms taking buprenorphine versus those using heroin or oxycodone.

    That’s according to Kolcharno who has been comparing outcomes between her patients and those dependent on opioids, but not using medication assisted therapy.

    “Babies born in the Healthy MOMS program, we’re finding, that are released from the hospital, have a better Apgar and Finnegan score, which is the measurement tool for NAS and correlates all the withdrawal symptoms to identify where this baby’s at,” said Kolcharno.

    But NAS is not the only concern women have post-partum.

    During and after delivery, doctors often prescribe women pain killers. For those with an opioid dependency, these drugs can trigger a relapse.

    Dr. Thomas-Hemak says preventing this kind of scenario requires communication.

    The Wright Center works with their local hospital to ensure OBGYNs are aware of patient’s substance use history.

    “We want the doctor to know that this may be somebody that you’re really sensitive to when you’re offering postpartum pain management,” said Hemak.

    That way, doctors know to tailor patients’ post-partum medication regimens. Instead of prescribing an opiate-based pain killer they can offer alternatives, like Ibuprofen or Advil.

    Maintaining an open line of communication between addiction services and hospital providers also helps to reduce stigma.

    Women with substance use disorders have long been subject to discriminatory practices by both providers and policy makers.

    From denying them treatment to encouraging sterilization post-delivery, women struggling with opioid dependency can be hard-pressed to find patient-centered health care.

    But Dr. Thomas-Hemak says, she’s learned to set her opinions aside.

    “I think one of the magical transformations that happens when you do addiction medicine really well is, it’s never about telling patients what to do.”

    It’s about allowing them to make informed choices, she says, and understanding it’s not always the choice you think is best.

    This transcript has been edited for clarity and concision.

    View the original article at thefix.com

  • The Opioid Crisis Is Our Greatest Opportunity

    The Opioid Crisis Is Our Greatest Opportunity

    Overdose survivors need more than a second (or third) chance: they need a parachute. When you’re in free fall, a little more time isn’t much help.

    Perhaps everything that is terrible is,
    in the deepest sense, something
    that wants our love.

    Rilke

    The overdose epidemic in the U.S. has been called “the greatest public health crisis of our time.” It’s also our greatest opportunity.

    The opioid crisis is an identity crisis: it’s a challenge to how we see ourselves. Do we truly believe that we are all in this together? One answer leads us deeper into despair. The other, into a hopeful future.

    It’s been said that “doing more things faster is no substitute for doing the right things.” What are the “right things,” the measures that can resolve the crisis, not just postpone it? The right actions come from the right thoughts. Those thoughts come from feelings, and feelings are never right or wrong. But there are some feelings we are born with. They are our birthright. And one of them is love.

    The Kindness of Strangers

    Hatred never ceases by hatred, but by love alone is healed.

    The Buddha

    Behind the opioid epidemic is a prevailing lack of compassion, of caring about everyone equally. At the heart (or lack of it) of this societal disease is rampant inequality. The social determinants of health: stress, unemployment, lack of support, poor health care, etc. are major drivers of addiction. Many authors promote this view, including Gabor Mate, Bruce Alexander, Sam Quinones, Robert Putnam, and Harry Nelson.

    Our increasing fragmentation affects everyone, poor or rich.

    Drug overdose is the leading cause of death for Americans under the age of fifty…

    Our material lives may be outwardly prosperous, but our psychological and spiritual lives are in freefall. What is driving us to self-destruction? There are many factors, all with one unifying theme: we are no longer living in community with one another and, consequently, we are lonely.

    Francie Hart Broghammer

    We all hunger for the same thing. The question is this: do we love our neighbor as ourselves? That’s not just a commandment; it’s a requirement. How do we rebuild community? First, by taking full responsibility for the fallout of not being one.

    For Whom the Boom Tolls

    Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Compassion becomes real when we recognize our shared humanity.

    Pema Chodron

    I live in Asheville, a city that has recently, like the opioid crisis, exploded. Tourism is at an all-time high, and Asheville has appeared in dozens of destination top ten lists. It has also been ranked second in the country in gentrification.

    Asheville sits in the heart of Appalachia, where the opioid crisis is at its worst. In 2017, North Carolina had the second highest increase in opioid deaths in the country. The Blue Ridge Parkway runs through town and I spend a lot of time there, mostly foraging. That’s where last summer, for the first time, I found not mushrooms, but needles.

    Despite the crisis, the city just spent six months trying to shut down the local syringe exchange. The same thing is happening in other cities. In Asheville, the exchange had been operating without incident for over two years — until the houseless (a.k.a., homeless) in adjacent areas were kicked out to make way for new development.

    Addiction depends on denial. What if development is the real addiction? Will we face up to the dark side of gentrification or just try to make it “go away?”

    If a canary dies in a coal mine, you don’t blame the canary. Yet blaming the victim is exactly what we’ve been doing.


    Blue Ridge Parkway, 8/20/18 

    License to Ill

    A man came to the Rabbi and said, “Rebbe, my son has turned against me. What should I do?” The rabbi said, “love him even more.”

    Hasidic story

    Most people by now have heard that naloxone (Narcan) can prevent a deadly overdose. So many Americans are dying — often from a mix of drugs, but mainly due to opioids — that naloxone should be as ubiquitous as aspirin. Everyone using a drug that may contain opioids should carry it like an EPI pen. And with the increasing prevalence of fentanyl, a single dose may not be enough. Everyone should know how to tell how much naloxone to give someone in the midst of an overdose. This should be basic, universal knowledge.

    But keeping someone alive is just the beginning. In fact, while naloxone may be physically safe, it does have one significant side effect: precipitated withdrawal. And not helping someone through it is like catching them from falling only to drop them from higher up.

    A Devil’s Bargain

    Be kind, for everyone you meet is fighting a hard battle.

    Ian Maclaren

    As one response coordinator describes it, precipitated withdrawal is like “the worst flu you’ve had… times 100.” For some, the feeling is so bad that they find themselves dying, so to speak, to use again.

    To the uninformed, it is inconceivable that someone who nearly died from a drug would run out that very same day and buy more of it. Narcan works by binding to opioid receptors, blocking the effect of narcotics like heroin. In drug users with a physical dependency, it also has the effect of causing severe withdrawal symptoms. This all but guarantees that the first thing a user will think of after their overdose is reversed is getting another fix…

    Christopher Moraff

    Naloxone is not just a “bandaid on a bullet hole.” It can feel like ripping open a wound. For “withdrawal is the very situation that [users] are seeking to avoid in the first place.”

    “A dose of naloxone,” according to the Chief Medical Officer for a Connecticut health agency, “is a chance. But if it’s not coupled with immediate offers of treatment, it may be a slim chance that leaves the revived individual running back to the same dealer who sold them their last lethal dose.”

    Overdose survivors need more than a second (or third) chance: they need a parachute. When you’re in free fall, a little more time isn’t much help.

    Back on the Chain Gang

    Without forgiveness, our lives are chained, forced to carry the sufferings of the past and repeat them with no release.

    Jack Kornfield

    “They’re usually very angry when we bring them around,” says one responder. “One kid yelled at me, ‘You think this will make me stop doing drugs?’” Indeed, one substance abuse specialist in Ohio says that 67% of people revived with naloxone in her area use again within 24 hours. NPR reports that “about 30 percent of those revived with Narcan at Boston Medical Center have been revived there more than once… and about 10 percent of patients more than three times. Those statistics are in line with what’s seen in ERs elsewhere, public health officials say.”

    According to a former agent for the DEA, one woman in Ohio, within 24 hours of being revived for the the sixth time, was using again. In the first half of 2017, one man in North Carolina was revived fourteen times.

    To be clear, I am not saying naloxone provides a safety net that encourages people to take bigger chances. Studies have shown that naloxone does not increase drug use any more than free condoms increase sex. Nor am I saying we should place limits on the number of times we revive people.

    What I am saying is that naloxone is no miracle drug. When you “come to,” the problem remains. Overdose survivors are 24 times more likely than the general population to die in the following year. One study found that for those revived with naloxone, nearly one in ten are dead within a year, the majority within the first month. Follow up is critical. But even that is not enough.

    Not by Locks Alone

    Few things can help an individual more than to place responsibility on him, and to let him know that you trust him.

    Booker T. Washington

    In June of 2019, New Jersey became the first state to allow paramedics to administer buprenorphine along with naloxone to ease the pain of withdrawal. Buprenorphine is the drug that, like methadone, is used in opioid replacement therapy. But this measure will, according to one expert, “make a meaningful difference only if rescued individuals are linked immediately to ongoing treatment and agree to participate in that treatment.”

    “Immediate” is key. And at least one hospital in New Jersey has been making that link, through state-paid recovery coaches, since 2017. A coach might work with someone “for weeks or months.” And the cost to taxpayers of helping people in this way is surely far less than the cost of leaving them on their own.

    Unfortunately, however, getting people into treatment is not enough. Not all treatment is good treatment. In fact, much of it is worse than doing nothing at all.

    Under the Rug

    Beware of all enterprises that require new clothes, and not rather a new wearer of clothes.

    Thoreau

    People usually go to rehab for 28 days, maybe a month and a half. In most cases, the treatment fails, if you regard failure as return to use. A study reported in the Irish Medical Journal found that 91% of people who go through rehab are using again within a year; 80% in the first month.

    “Most honest program directors,” says veteran addiction expert Julia Ross, “will admit to 90% relapse rates, and I assume that if they admit to 90%, it’s probably worse.” Drug courts are no better. A national study of seventy-six drug courts found a reduction in the rate of rearrest of only 10 percent.

    Moreover, when people come out of abstinence-based rehab, their tolerance has gone way down, so they are more likely to overdose. This is a common reason why fentanyl is killing people: it’s much stronger than they are expecting, especially in an opioid-naïve state. Making fentanyl test strips available can help prevent overdose, but that still doesn’t deal with the basic issue of why they’re using in the first place. What pain are they killing?

    Zero Tolerance

    Winning isn’t everything; it’s the only thing.

    Henry “Red” Sanders

    I watched my grandmother die a very slow death. At 90 years old, after three cancers, open heart surgery, and several strokes, she still fought tooth and nail. Christopher Ryan, author of Civilized to Death, compares our approach to death to the final minutes of an NBA basketball game. We drag it out. We go for quantity instead of quality. Is that also our approach to addiction? As long as they don’t die, we’re OK. This is similar to abstinence-based approaches to addiction treatment: As long as you don’t use, you’re OK. This amounts to saying, “it’s more important to look good than to feel good.”

    To be clear: I’m not saying we should just let our neighbors die. I’m saying we need to do more than just keep people alive; not less. We need to treat the cause, not just the symptom.

    Spare the Prod

    If you want to be heard, whisper.

    Author Unknown

    The overdose crisis is part of a larger epidemic of despair. The facade of America as the “land of opportunity” is failing. Asheville today is “booming.” For whom? Are we saving lives or just saving face?

    Fortunately, Asheville has begun to address its weak spots, and we now have three needle exchanges. We all need to look in the mirror and face where we — as a community, as a country — are really at. Because not doing so is killing us. Whether we die quickly from overdose or slowly from alcoholism, cancer, or depression, we are ALL canaries in a coal mine. And you can’t just rake the canary over the coals.

    It’s one thing to save lives. But throwing someone into withdrawal without providing detox support or throwing them out of treatment because they’ve relapsed is like hitting a child to make them stop hitting other children. Such heavy-handed measures only perpetuate a cycle of abuse. Even a magic bullet leaves a wound.

    Sticks and Phones

    Can you love people and lead them
    without imposing your will?

    …leading and not trying to control:
    this is the supreme virtue.

    The Tao Te Ching

    There’s a reason our greatest leaders practice nonviolence. If all we do is arm people with naloxone, if we fight firearms with firearms, the conflict will only escalate. Stronger opioids are already requiring stronger antidotes.

    With this approach, we may win a few battles, but we will lose the war. You can’t win when you see this as a war to begin with. Because you can’t force someone out of addiction any more than you can force them to stay alive. Force is what causes addiction.

    In 2015, Victoria Siegel, 18, died of a methadone overdose precipitated by cyberbullying. We worry about bullying in schools. What about parental bullying — or governmental? Some of us are aware of the alarming incidence of domestic violence. How many of us recognize how our culture is inherently abusive, our very way of life?

    Sometimes we forget that we are treating people, not diseases. We are bio-psycho-social beings. We have feelings. If addiction comes from pain, and pain comes from hurt, then we need to reduce hurt, not just harm.

    A Dying Shame

    You cannot be lonely if you like the person you’re alone with.

    Wayne Dyer

    We will not end drug abuse until we end human abuse. We will not end human abuse until we end abusive thinking, because violence starts with what you think. A saying often attributed to Martin Luther King Jr. is that “you can have no influence over those for whom you have underlying contempt.” As long as I think, “you’re not good enough; this is all your fault,” or I say that to myself, addiction has a foothold.

    The blame game has no winners. “We’ve lost what it means to just be ourselves and for that to be ok and for that to be enough. So we find ways to self-medicate,” says Rev. Shannon Spencer. People will use painkillers as long as the pain is killing them, for there are few emotions more agonizing than shame.

    We Are Faminy

    I don’t remember now how many days we stayed—long enough to hear David sing often and tease us about white people’s music, which, according to him, is only about “love.” He observed that the Hopi have many songs about water, which they consider the rarest and most precious of resources, and then asked, with feigned innocence, if white people sang so often about love because it was equally rare in our world.

    Peter Coyote

    To many, opioids feel like the opposite of shame. One user describes the feeling as “like being hugged by Jesus.” Indeed, “the very essence of the opiate high,” according to Gabor Mate, is that it feels “like a warm soft hug.” This is the feeling of unconditional acceptance and support, or love.

    We live in a culture where love is the one thing we sorely lack. Millions of people are starving for just a few drops of it. If only for a few moments, we desperately need to feel like we’re OK, that someone wants us to be here, as we truly are. Like they say, it is rain that grows flowers, not thunder.

    Inside, we know we’re not just here to feed The System. We know it should be feeding us. We should not be starving. We should not have to be forced, or force ourselves, to do anything. People need to be supported to decide for themselves what healing looks like for them and to approach it in their own time.

    The Emperor in the Room

    Opioids are like guns handed out in a suicide ward; they have certainly made the total epidemic much worse, but they are not the cause of the underlying depression.

    Anne Case and Angus Deaton

    To solve the drug problem, we need to focus on more than drugs. Otherwise, we are shooting the messenger. Drugs are like the emperor’s clothes; it’s time to look at who’s wearing them.

    Like Dr. Jekyll and Mr. Hyde, opioids and their antagonists are two sides of the same coin. Focusing on either is like looking for your keys under the streetlamp when you know you dropped them further up the street. There is an “upstream” issue here. That issue is our domination-based, “have to” culture. If we stick to our guns, if we continue to be violent, inside and out, we will continue to die.

    Whether we kill another person, the planet, or ourselves, we are a culture committing suicide. We are overdosing on “progress.” We are addicted to things far more insidious than opioids; you’re looking at one.

    Progress isn’t progress when it’s in the wrong direction. The direction we’re going is apart. The direction we need to go is back together.

    Only the Lonely

    Humanity’s current crisis may not, at its root, be an economic crisis or an environmental crisis. It may well be a crisis of consciousness, a crisis in how see ourselves and the world around.

    Peter Russell

    If you’re in the right place at the right time, armed with enough naloxone, you can save a life. But what about an hour later, or the next day? You might get someone into treatment, but what about after that? A person that susceptible to overdose can scarcely be left alone. And that aloneness is the real problem. In fact, it’s how addiction starts.

    The connection between social isolation and addiction shows up on many levels, from treatment to prevention. The most obvious is that you can get naloxone into the hands of every drug user, but it will do them no good if they overdose alone.

    Human beings may be the most social animals on earth. Social isolation can drive us to despair, addiction, and even suicide. Loneliness is self-reinforcing and can lead to shame, for it can mean “I don’t deserve to be loved.” This can be the underlying emotional pain that comes back during withdrawal, whether from an opioid or from someone withholding their affection. And that lack of affection could be the primary cause of addiction.

    Fatal Attraction

    If one has a friend, what need has one of medicines?

    Bhartrihari

    There can be no healing without community. “This unique American moment asks not for a call to arms, but for a call to neighborliness.” (Francie Hart Broghammer)

    No amount of “care” can substitute for the watchful eye of loving family, friends, or neighbors. No amount of “treatment” can make up for how we treat each other. It truly takes a village.

    Ultimately, it’s not drugs that are killing us; they are just finishing us off. Whether or not we beat the horse, we’re already practically dead. Something has weakened us enough to succumb to drugs. It’s the same thing that allows dealers to intentionally make some of their merchandise deadly, or if it’s naloxone, to jack up their prices.

    What our culture is most addicted to is exploitation. It’s what the system is set up for. It compels us not to care. As Ken Eisold says, “The loss of community is not a problem that can be dealt with through psychotherapy,” for what needs rehabilitation is our society. There’s something wrong “with the village.”

    The greatest tool I know for rebuilding community is Nonviolent Communication (NVC). The best approach I’ve encountered for addressing the disconnection inherent in addiction is SeekHealing.

    We are the Medicine

    At the root of the opioid epidemic are deeper questions that we have to ask about society. What kind of society do we want to live in? Do we want to live in a society where we believe every life truly matters? Do we want to live in a society where we all chip in, recognizing that we are vulnerable in some way, whether it’s to addiction or loneliness or other conditions, and that we are stronger when we come together, when we recognize our interdependence, and when we help each other?

    As tragic as the opioid epidemic is, if it can move us in a direction of shared understanding about our interdependence, if it can help us address these deeper social roots of disease, then I believe that we will have used it ultimately to improve ourselves to become stronger as a country.

    Vivek Murthy

    To make it out of this crisis, we need to look at the big picture. As writer David Dobbs puts it, “trying to understand mental illness without accounting for the power of social connection is like studying planetary motion without accounting for gravity.” If we only look at addiction on an individual level, we are missing the forest for the trees. If you don’t heal the forest, it gets harder and harder to heal each tree.

    It’s especially hard to heal when you’re continually cut down. In this culture of mutual exploitation, we treat each other like truffula trees. We factory-farm humans and clear-cut them for fuel. We do it to each other and we do it to ourselves. All to feed the machine, the matrix. To race into space, we’re melting our wings.

    Saving lives, then, is only the beginning. It’s the tip of the iceberg. Because it is we, not “they,” who have an addiction. This isn’t about how we use drugs; it’s about how we use each other. Because ultimately, there are no others. We are not just a bunch of individuals. We are one, interdependent whole. Our greatest public health crisis is that we’ve forgotten who we are.

    The Opposite of Addiction

    Sometimes out of really horrible things come really beautiful things.

    Anthony Kiedis

    This crisis is an opportunity, a wake-up call. If we take responsibility for it, there’s no limit to what we can do. It’s said that anything is possible if it doesn’t matter who gets credit for it. The same is true of blame.

    We are all in this together. That’s the bottom line. There is but one answer to this crisis, and we each carry it at the bottom of our heart.

    View the original article at thefix.com

  • How Should The Money From The Opioid Settlement Be Spent?

    How Should The Money From The Opioid Settlement Be Spent?

    Tight controls will be needed to guarantee that all funds support evidence-based methods of prevention and treatment.

    The opioid lawsuits and multi-billion dollar settlements that are being negotiated may seem like one-of-a-kind, but the U.S. has dealt with settlements of this magnitude before—in the 1990s, when Big Tobacco companies agreed to pay about $246 billion in damages over 25 years. 

    That money was intended to prevent people from smoking, and to help people stop if they were already addicted. And yet, just 2.4% of the settlement funds have gone toward cessation and prevention efforts. 

    Leana S. Wen, former Baltimore health commissioner and current visiting professor at George Washington University Milken Institute School of Public Health, says that we need to proceed carefully to ensure that the opioid settlements aren’t squandered in the same way. 

    Supporting Evidence-Based Methods of Prevention and Treatment

    Writing for The Washington Post, Wen says, “To prevent a similarly egregious diversion, today’s policymakers should commit—at the outset—to a strong public health framing for the opioid settlement. This starts with tight controls to guarantee that all funds support evidence-based methods of prevention and treatment.”

    Wen outlines a series of steps to ensure that the opioid funding is distributed fairly and used effectively. First, she says, the government needs to stop supporting out-of-date detox programs that do not result in long-term sobriety. Instead, she says, the funds should be used to fund medication-assisted treatment, the gold standard for treating opioid use disorder. 

    “Rapid ‘detox’ programs do not work, and, in fact, lead to higher rates of overdose deaths,” Wen writes. “Yet, these detox programs still get government funding, and many states force people to comply with these methods. That needs to change.”

    Racial Disparities in Fund Distribution

    Next, Wen suggests that the funds be distributed to areas most affected by opioid addiction. This could be done using a model similar to the one that the Ryan White HIV/AIDS Program uses to distribute money to areas hardest hit by HIV/AIDS outbreaks. 

    It’s important, Wen notes, that the funds be sent not just to areas with the highest prescription rates, but also to places where heroin and street drugs have been devastating. This is crucial in order to ensure that there are no racial gaps in who benefits from the settlement funds. 

    “A funding distribution that focuses only on one face of the disease would violate public health best practices,” she writes. “It would also worsen racial disparities. Already, many in my city and around the country are angry that opioid addiction was not deemed an epidemic until decades after it claimed the lives of countless people in minority communities.”

    Wen continues, “When the face of addiction was black and brown—and associated with heroin—addiction was seen as a crime and a moral failing; when it became white and associated with pills, addiction became understood as a disease. To be sure, it is an important development that much-needed resources are finally coming to address this crisis. But unless street drugs are given equal weight to prescription opioids, the response will not only be ineffective, it will perpetuate systemic injustice and structural racism that have long undergirded opioid addiction.”

    View the original article at thefix.com

  • We Need Harm Reduction for All Drugs, Not Just Opioids

    We Need Harm Reduction for All Drugs, Not Just Opioids

    While we’ve made great strides with harm reduction for people who use opioids, we’re slow to provide non-abstinence-based treatment for people who use other drugs.

    A quick glance at the news reveals the catastrophic effects of opioids across the nation: around 120 people a day die from opioid-related overdoses. It’s so devastating that the nation is calling it an opioid epidemic. Yet even as we watch this tragedy unfold, we’re missing the point.

    By focusing exclusively on opioids, we’re overlooking the harm caused by other deadly drugs. How can we highlight harm reduction resources if we only focus our efforts on people who use one class of drug?

    The Problem with the Opioid “Epidemic”

    According to the Centers for Disease Control and Prevention, more than 700,000 people died from a drug overdose between 1999 and 2017. Sixty-eight percent of those deaths in 2017 involved an opioid — approximately 70,200. However, that’s not the 100 percent that the “epidemic” coverage would have us believe.

    While I’m not arguing that the opioid-related deaths shouldn’t be covered — they should! — I am saying the problem with zeroing in on the opioid epidemic is that we are focusing too narrowly on the harms caused by one drug and are blinding ourselves to the impact of other deadly drugs. We should be reporting on those, too.

    A more accurate picture of drug-related deaths in 2017, according to the CDC, looks like this:

    • Alcohol was responsible for the deaths of 88,000 people
    • Cocaine misuse killed 13,942 people
    • Benzodiazepine misuse was responsible for 11,537 deaths
    • Psychostimulant misuse, including methamphetamines, was responsible for 10,333 deaths.

    Those aren’t insignificant numbers, so why are they being overlooked? I asked recovery activist Brooke Feldman for her perspective.

    “The sensationalized and narrow focus on opioids fails to account for the fact that people who develop an opioid use disorder typically used other drugs before and alongside opioids,” Feldman said. “So, we really have a polysubstance use situation, not merely an opioid use situation.”

    She continues, “Focusing on opioids only had led to the erection of an opioid-only infrastructure that will be useless for the next great drug binge and is barely relevant to address the deadliest drug used, which is alcohol.”

    The Deadliest Drug: Alcohol

    Alcohol is responsible for more deaths than any other drug. But we overlook it for two reasons: because it’s legal, and because it’s a socially acceptable drug. Not only that, but advertising actively promotes its use — you only have to look on Instagram or Etsy to see how widely excessive use of alcohol is normalized — especially among mothers and millennials. These advertisers have been smart to market alcohol as a means of self-care — encouraging drinking to help unwind from the stresses of the week — and as a means of coping with motherhood. 

    Social media reinforces the message that alcohol is a tool to cope with stress and something that should be paired with our favorite stress-relieving activities, like yoga. Captions on Instagram read like “Vino and vinyasa,” “Mommy’s medicine,” “Mommy juice,” “It’s wine o’clock,” “Surviving motherhood one bottle at a time,” and “When being an adult starts to get you down, just remember that now you can buy wine whenever you want.”

    Perhaps what is most insidious about alcohol is that it heavily impacts marginalized and oppressed communities. For example, Black women over 45 are the fastest-growing population with alcohol use disorder. And the LGBTQ+ community is 18 percent more likely to have alcohol use disorder than the general population.

    Alcohol aside, looking at the harm done by other drugs, we can see that opioids are no longer the leading cause of drug-related death in some states. In Oregon, statistics show, deaths related to meth outnumber those that involve one of the most common opioids, heroin. In fact, there has been a threefold increase in meth-related deaths over the last ten years, despite the restriction on pseudoephedrine products, which now require a prescription. 

    Similarly, in Missouri, which was ground zero for home-based meth labs 20 years ago, the recent spotlight on opioids has overshadowed an influx of a stronger, purer kind of methamphetamine. Deaths related to the new and improved drug are on the rise.

    Oregon’s state medical examiner Karen Gunson speaks to this disparity of focusing on opioids over other deaths and the damage that those other drugs cause. “Opioids are pretty lethal and can cause death by themselves, but meth is insidious. It kills you in stages and it affects the fabric of society more than opioids. It just doesn’t kill people. It is chaos itself.”

    Abstinence Is Not Attainable for Everyone

    Our approach to recovery has been too one-dimensional, stating that complete abstinence is the goal. But this perspective is outdated. Abstinence isn’t attainable for everyone. If it were, then more people would be in recovery. However, harm reduction is attainable. It reduces deaths, treats medical conditions related to drug use, reduces the transmission of diseases, and provides options for treatment services. In fact, people who use safe injection sites are four times more likely to access treatment.

    “Whether it is with problematic use of alcohol, tobacco, cocaine, methamphetamine, etc. use, centering harm-reduction principles and practices would likely engage more people than an abysmal 1 out of 10 people who could use but do not receive SUD (Substance Use Disorder) treatment,” Feldman explains. “Requiring immediate and total abstinence rather than seeking to address overall well-being and quality of life concerns is a barrier to engagement — and sadly, it is placing the focus more on symptom reduction than it is on what is causing the symptom of chaotic drug use in the first place.”

    Harm Reduction for All Drugs Means Fewer Deaths

    Our focus on the opioid crisis has helped improve harm reduction resources — like the increased availability of naloxone to reverse overdoses, and the more accepted use of pharmacotherapy and medication-assisted treatment (which has now been endorsed as a primary treatment by the Substance Abuse and Mental Health Services Administration), and some safe injection sites — but it has also meant we aren’t concentrating as much on research, funding, and education devoted to harm reduction practices for other harmful drugs. The result is that we have fewer resources and less awareness when it comes to keeping people who use non-opioid drugs safe.

    We need to look at reducing harm across the spectrum of drug use to reduce all deaths. More safe usage sites, clean tools, safe disposal bins, medical assistance, education, referral to other support services, and access to pharmacotherapy (including drugs to treat or mitigate harms of alcohol use disorder and the development of new medications for help with other substances). Specialized treatment other than abstinence should be accessible for people who use all drugs — not just opioids. 

    View the original article at thefix.com

  • My Methadone Pregnancy

    My Methadone Pregnancy

    I listened to what my doctor told me. I did my research and I am at peace with my decision: getting off methadone while I was pregnant just wasn’t an option.

    The last time I stuck a needle in my arm was three whole months before I conceived my son, and I’m grateful that he’s never experienced me in active addiction. I say three whole months as if it were a lifetime, but it really is to anyone in early recovery. I was fortunate, I stopped using heroin before I found out that I was pregnant. I had just turned 29 and was in a stable relationship with my now-husband.

    For many women, getting on methadone doesn’t happen until they find out they’re pregnant. Their options are to either keep using or get into treatment. I started taking methadone five months before I stopped using and faced a bit of a learning curve. It was difficult to separate myself from the lifestyle and the people who I interacted with on a daily basis. I also had a needle addiction, and there’s no maintenance medication for that.

    When I decided to stop getting high, I immediately started trying to fix everything that I had destroyed. I was in a new relationship with someone who understood that I was broken and he took me to the methadone clinic every day. We met shortly after I got clean and he never once judged me for my past actions or made me feel bad for taking methadone during my pregnancy. Every expecting mom who takes opioids knows that if you just stop taking them, there is a high risk you will miscarry. Your baby experiences the withdrawal symptoms more strongly than you and in many cases they just aren’t strong enough to withstand it.

    Making The Best Painful Choice

    I was in a heartbreaking situation, but I needed to do what was best for the baby. I can see the comments already: How could you continue to take a medication like that while pregnant?! How could you do that to a tiny human, he’s going to withdraw! I heard this from my mother and a few other opinionated individuals who believed it was appropriate to weigh in on my treatment. I listened to what my doctor told me. I did my research and I am at peace with my decision: getting off methadone while I was pregnant just wasn’t an option.

    The doctor at the treatment facility gave me a ton of information as to what to expect with my continuing treatment. She told me that as the baby grew, I would most likely need to take more methadone to accommodate the increased blood volume. I needed to pay attention to my symptoms and try to tell the difference between normal pregnancy discomfort and methadone withdrawal. I was really grateful for her kindness and advice, especially in the beginning.

    After I had my baby, I found out that there are many online support groups for pregnant women on maintenance medication. These sites provide information on symptoms, what is normal, the rights you have as someone who has struggled with opioid addiction, and more. It’s especially important to know what your hospital’s protocols are for infants going through opioid withdrawal. I know a lot more after giving birth than I ever did in my pregnancy.

    I Would Judge Me, Too

    I was afraid that Child Protective Services would be getting involved during and after my pregnancy, but I was assured by my OB-GYN and the doctor at the methadone clinic that as long as I stayed clean, I would have nothing to worry about. Still, as someone who has worked in the medical field, I knew the stigma attached to my condition. I worried at every appointment that people would look down on me and talk negatively about me after I left. I mean, I was an ex-heroin addict who was pregnant and who was continuing to put something addictive into my body. I would judge me, too.

    My apprehension was unnecessary, my OB-GYN was very supportive. She referred me to a high risk maternal/fetal medicine doctor who I also saw regularly. I went to every appointment, took my methadone as prescribed, and continued to go to therapy.

    When I was about 10 weeks along, I told my parents I was pregnant. I wish I waited a little longer, but I was so excited to be a mom. Their reaction was concern that once my baby was born, he would go through withdrawal from the methadone. I tried not to take it as criticism and judgement, because their concerns were valid. I felt very guilty and scared that this little soul was going to suffer and it was all my fault.

    My stepmother threw me the biggest, most elaborate baby shower that I had ever been to. She invited all of her friends and they brought me nice gifts and things I didn’t know I needed. I remember eating the cherry cake she’d ordered especially for me and starting to cry. This party was thrown for me by a woman who I’d lied to and stolen from during my addiction but none of that seemed to matter to her. She invited her friends because I only had one or two left. I’d cut contact with everyone from my previous life when I stopped using.

    I chose to not go to meetings or participate in any 12-step activities because I did not want to be around other people who were struggling in the same way I was. I know that NA is a great support system and helps many people stay clean, but it wasn’t the right fit for me. Of all the resources available to me, I was the most successful with just the support of my husband, my parents, and our church.

    Induction

    At my 37-week appointment, the doctor found that I was low on amniotic fluid and decided I should be induced that day. I was ready, even though I was afraid of the pain and even more afraid that the painkillers wouldn’t work due to the methadone.

    My husband and I hustled over to the labor and delivery wing of the hospital, excited and nervous. As expected, when I got there, I was drug tested. It was mandatory since I had a recorded history of heroin use but it still made me sad.

    The induction process was incredibly painful. I remember not wanting to ask for anything to help with the pain because I didn’t want to be judged, but as soon as I felt my cervix start to stretch, I stopped caring what anyone thought. It was brutal. After 18 hours of agony, I received an epidural. I was exhausted and excited and running on encouragement from my husband.

    Before I knew it, I was 10 centimeters dilated and surrounded by doctors who were telling me to push with each contraction. A few minutes after they set up their delivery equipment, he was here! I have never cried harder than the moment they handed me this pink, messy, angry little person. He was gooey and gross and perfect. I felt so much at once; it’s hard to explain those first few moments. He was on my chest for about 45 minutes before they cleaned him up and took him to the NICU because his blood sugar was low.

    Because I had methadone in my system during my pregnancy, we had to stay for an extra five days so they could monitor my baby for withdrawal symptoms. I spent that time trying to breastfeed, learning to hold a baby properly, and getting sleep.

    My New Baby, in Opioid Withdrawal

    I would like to end this by saying that we went home after the five days and lived happily ever after, but that’s not the whole story. My husband and I went home but our little boy had to stay for an extra two weeks. He started to show signs of methadone withdrawal around day five.

    There are lots of myths about babies in withdrawal and what they look like. Yes, some are inconsolable and have tremors, but that isn’t always the case. I wasn’t able to recognize the symptoms in my baby because he didn’t match the picture in my head of a baby in withdrawal.

    He had a high-pitched cry; I held him against me and nursed him constantly. Sometimes it calmed him down, sometimes it wouldn’t.

    In the hospital, they use a chart called the Finnegan Scale to assess the severity of withdrawal and determine if the infant needs medication, and my son’s symptoms indicated that he needed to be medicated. The doctor in the NICU told us they were going to start my baby on a small amount of morphine to calm him down and make him more comfortable. I didn’t want them to give him morphine, but I felt more strongly that I didn’t want him to suffer.

    Seeing my baby for the first time after he was medicated gave me some peace. I knew that was best for him, just like taking my methadone was best for him during my pregnancy. It’s hard to convince someone unfamiliar to the world of maintenance medications and opioid addiction that I did what was right for my baby, but I know I did.

    He started getting better immediately and every day he received a little less morphine. My husband and I were lucky enough to have a private room in the NICU and be able to be with him 24-7. The most important things I did for his recovery were keeping him close to me (skin to skin contact), keeping the lights low, and the noises to a minimum. They recommended that I breastfeed as often as possible and my baby had an amazing nurse who taught me how to do this. She constantly encouraged me and kept me informed about his treatment.

    A Healthy, Happy Boy

    Per hospital protocol, my husband and I were interviewed by social services. I had to be completely transparent with them and give my doctor at the methadone clinic permission to speak with them. They even came to look at my home to make sure that it was a safe place for my baby to be. I went through a variety of emotions during this time. I felt violated, angry, insulted, and even confused. I had passed every drug test for the past year and my ability to be a good mom was being questioned. The whole process lasted about a week and then we never heard from them again. I was told that the only reason that social services (CPS or DYFS depending on your state) were contacted was because there were traces of methadone in his meconium.

    Our baby boy has been growing and thriving ever since we brought him home. I still have guilt about his first few weeks in the world, but that’s okay. I try to tell myself that he wouldn’t even be here if I didn’t get on methadone in the first place, but that might just be me justifying it. I now have a smart, healthy, beautiful two-year-old little boy who never stops smiling. When he gets older, I will have to explain to him why he got sick right after he was born. I hope he understands and forgives me.

    View the original article at thefix.com

  • Kansas Prisoner To Get Medication-Assisted Treatment, But Others Won’t  

    Kansas Prisoner To Get Medication-Assisted Treatment, But Others Won’t  

    The ACLU was able to reach a settlement on the prisoner’s behalf but were unable to garner widespread policy change.

    A man serving a three-year sentence in a Kansas federal prison will be able to continue his medication-assisted treatment (MAT) program with buprenorphine thanks to a recent court ruling, but other inmates will not have the same option. 

    The American Civil Liberties Union took up the case of Leaman Crews, 45, who has used buprenorphine for 14 months to manage his opioid use disorder. 

    “It is a rare feat for that long a period,” Lauren Bonds, legal director of the ACLU of Kansas, told The New York Times by email. “It was kind of a success story.”

    Tylenol With Codeine For Withdrawal Symptoms

    However, when Crews reported to federal prison in Leavenworth, Kansas last week to serve a three-year sentence, the prison refused to give him buprenorphine. Instead, he was given Tylenol with codeine, an opioid, to help control his withdrawal symptoms. 

    Michael V. Pantalon, a senior research scientist in the Yale School of Medicine, said using codeine was likely to make Crews’ condition worse. 

    “He will have codeine to reinforce his opioid addiction rather than the medications that would treat it,” Pantalon said. 

    The ACLU Takes The Case

    The ACLU took Crews’ case, arguing that he would “inevitably suffer and possibly die” without access to buprenorphine. The organization reached a settlement that will allow Crews to get his medication-assisted treatment. However, the settlement applies only to this case, and will not result in widespread policy changes to allow federal prisoners to receive medication-assisted treatment. 

    Many prisons do not allow inmates to be treated with buprenorphine, arguing that because it is an opioid with potential for abuse it can be diverted to other inmates. However, Bonds pointed out that this is not applied universally—some inmates, including pregnant women, are allowed to have medication-assisted treatment using buprenorphine.

    “We do know that in Leavenworth they offer buprenorphine for inmates in certain situations, usually to help people detox, as opposed to maintaining sobriety,” she said. 

    Taking inmates like Crews off their treatment regimen increases their risk for relapse and overdose, both within prison and when they are released, Pantalon said. 

    “It is not life or death, like you take him off and he dies. It is life or death mainly when he comes out,” he said. 

    Although Crews’ case will not impact inmates more widely, Nadine Johnson, the executive director of ACLU of Kansas, said that more work needs to be done to increase access to medication-assisted treatment in jails and prisons. 

    “We don’t want others to endure the same or similar situations,” she said. “We look forward to seeing a Bureau of Prisons policy that respects what doctors are recommending in these cases.”

    Pantalon said that the government needs to change its thinking about addiction and medication-assisted treatment. 

    “People who stay on it for one consecutive year or longer do far, far better and stay abstinent for longer,” he said. “It is a chronic disease, so it needs chronic treatment just like people with asthma or hypertension,” he added. “We don’t ask people with hypertension, ‘When are you coming off the hypertension medication?’”

    View the original article at thefix.com

  • In Recovery, on Suboxone, and in the Weed Business

    In Recovery, on Suboxone, and in the Weed Business

    In print and online, I preached cannabis. In life, I practiced therapy and Suboxone.

    I had a few days left on my Suboxone script when I interviewed Justin “Bong King.” He was a professional bong-racer and self-described champion of the competitive smoking circuit. An affable guy, nonetheless his was an image of American cannabis long past, pushed aside by marketing grads and stay-at-home moms who sold branded CBD and touted the benefits of micro-dosing. 

    But Justin drew a crowd, and an entourage to boot. And his natural talent for hitting the fastest gram of weed would corner me into compromising my recovery.

    Throughout my career as a cannabis journalist, I’ve kept silent about my sobriety. Finding freelance gigs is hard enough without the added burden of having to be that guy. Besides, if I learned anything from active addiction, it was how to lie at my job.

    Covering Cannabis Events and Lying About My Sobriety

    But as time passed, I felt withdrawn and disconnected. My recovery had no place in the cannabis industry. Moreover, medication-assisted treatment (MAT) seemed anathema to its goals, according to experts and the news. Rep. Matt Gaetz openly questioned whether buprenorphine and methadone are “a more effective offramp [to opioid use disorder] than medical cannabis.” CNN announced that CBD cures heroin addiction. And the editors of Leafly figured out how to combat the opioid crisis with medical cannabis two years prior.

    After 20 years, recovery had finally become routine. As a cannabis journalist; as an editor in chief — so had my lies.

    Some lies were easy. Weekly therapy appointments usually coincided with editorial meetings or deadlines. I worked from home, my boss was lax, and anyway, I kept hours around the clock. Monthly visits to my psych and 30-day Suboxone refills upped the number of undisclosed appointments I logged, but still, no one seemed to care.

    On assignment was a different story. I covered cannabis expos or dispensary openings — events where the drug laws were lax and the supply was liberal. At a hotel in Hell’s Kitchen, I spent three nights alone avoiding networking galas and after-parties hosted by music moguls turned industry entrepreneurs. In the world’s largest dispensary off the Las Vegas strip, I dodged more questions than I asked when leaving empty-handed. With hand waves and head shakes and less-than-assertive no’s, I passed over pot by lying about my sobriety.

    But face to face with Justin “Bong King,” there was nowhere to hide — no hotel room to run to, no door from which to make a quick exit. There was a crowd around us, boxing us in as he finished his gram smoking demonstration. I shook his hand and stumbled over my words as I signed off the segment on camera.

    It was either a contact high or placebo effect, or maybe just panic anticipating the piss test I would take in the next few days.

    Intensive Outpatient: 12 Steps and Scoring Drugs

    When I had about two months left in my treatment program, I walked out of group for good. It was an intensive outpatient program; a six-month IOP run by Philly’s NHS that championed the Big Book and 90 days. For a minute it worked, but it’s drug rehab mired in a puritan past. The 12 steps are great, but they shouldn’t be a front-line defense.

    Besides, all I did there was make friends and score drugs. Thirty addicts in a room is an excellent opportunity to network and learn.

    By Easter Sunday that year, I felt broken. I was in a dirty motel on Route 1, hopped up on Benzedrex cottons and a $60 baggie of hex-en I purchased online from China. After 20 years of addiction, I had no drug of choice, save for anything that made me high.

    My wife and kids back home slept together in one bed, a little less worried than the last time I disappeared. I was out of work and estranged from everyone. My best friend joined AA and realized I was one of his people, places, and things.

    All I had was my family, and I was losing them too.

    One lie allowed my addictions to grow without the worry of what would happen tomorrow. It’s the lie I told myself when I stole my ex-wife’s Dilaudid two days after her shoulder surgery. It’s the lie that made me laugh when I snorted enough Adderall to make my nose blue. And it’s the same lie that made me indignant when my ex-girlfriend’s brother became angry that I was a sloppy drunk in front of his small children.

    On the Monday after Easter, I drove home before sunrise. It was dark and muggy and difficult to see through my tears and dilated pupils. When I got home, I faced my wife and children and ended the lie that had followed me through two decades of addiction.

    “I can’t stop,” I whispered. That week, I discussed MAT options with my doctor. I’ve been in recovery since that day.

    Cannabis as the Magic Bullet for the Opioid Crisis?

    Tyler Sash won the Super Bowl in his rookie year with the New York Giants. At the time, he didn’t know he only had a few years left to live. A sixth-round draft pick out of Iowa, he overdosed on a combination of methadone and hydrocodone at the age of 27.

    “[He] asked if he could smoke marijuana for his pain like the other players,” recalled his one-time girlfriend, former Miss Iowa and reality-show contestant Jessica VerSteeg. I interviewed VerSteeg when she was promoting a new blockchain-bitcoin something-or-other product in the cannabis space. She recounted Sash’s tragic tale during our interview, explaining how it became the backbone of her business.

    “I wanted to change the way that other people saw cannabis,” she said.

    VerSteeg’s article drew in readers, as did most CEO and celebrity interviews. Her story reminded me of how lonely my secrecy about my recovery had become. I often wished I could reach out and say that I understood. There are millions of people with substance use disorders, and we’re all so alone.

    But like most of the executive class in the cannabis industry, her hot take on opioids ended up being bullshit. Conventional wisdom in the cannabis industry had run somewhat amok on this topic, and it forced me, I felt, into compromising everything.

    There was the DEA agent who was so disgusted with opioids that he became a cannabis executive. Without irony, he told me that more research would prove the plant’s medicinal value. The head of an “innovation accelerator” in my city held a conference on the role of medical cannabis in the opioid crisis. He quoted research showing that states with medical cannabis laws have lower rates of opioid overdose deaths. Cannabis, they were convinced, would solve the opioid epidemic.

    But Where’s the Evidence?

    “Morphine, when it was introduced, was promised to cure what they called alcoholism at the time,” Dr. Keith Humphreys told me. A professor of psychiatry and behavioral sciences at Stanford University, he’s also worked at the White House Office of National Drug Control Policy under Presidents Bush and Obama. “Then, people got addicted to morphine, and cocaine was introduced.”

    He continued: “In general, there’s been this enthusiasm of if we just add a different class of addictive drug on top then that will drive the other addictions out. Generally, what happens is we get more addiction to that drug, and we still have the original problem.”

    I spoke with Dr. Humphreys after reading his research on cannabis laws and opioid overdose mortality rates. Contrary to conventional wisdom, he found the correlation to be spurious at best. It’s alarming — though not unsurprising — to see the industry ignore his findings. Several states, including Pennsylvania, where I live, approved opioid use disorder as a qualifying condition for medical cannabis.

    “I couldn’t recommend something medically without clinical trials, well-controlled by credible groups [and] checked for safety,” Dr. Humphreys said. He explained that in the case of cannabis, there was little more than these state-level correlational studies. “None of that has been done.”

    “I’m amazed and disappointed that we don’t care more about people who are addicted to heroin [and other] opioids, that we would wave through something like [medical cannabis] without making sure that it will help people, not hurt them,” he continued, noting that cannabis has shown no efficacy as either a replacement for or an adjunct to any MAT therapy.

    Listening to Dr. Humphreys made me realize how little I stand up for what I believe. Sometimes, when you’re an addict and you lie so much, you lose any sense of truth.

    Tyler Sash’s family asked Jessica VerSteeg to stop using his name to promote her business. According to a report in the Des Moines Register, they didn’t want his name associated with drugs anymore, neither opioids nor marijuana. VerSteeg refused, repeating the story she told me to several news outlets.

    For two years, I wrote about and reported on the emerging cannabis industry while hiding my ongoing recovery. In print and online, I preached cannabis while practicing therapy and Suboxone.

    Even in recovery, you can still have regrets.

    View the original article at thefix.com

  • Patients, Psychiatrists Share Their Experience With Treating Depression

    Patients, Psychiatrists Share Their Experience With Treating Depression

    From medication to exercise, patients and psychiatrists get candid about their methods of treating depression. 

    Kelli María Korducki wanted options. While she appreciated the arsenal of medications being offered to treat her depression, she also wanted to explore the emotional, personal side of the disease, not just the chemical imbalance. 

    “A more realistic, nuanced approach to the way we conceive of mental illness would go a long way toward validating the myriad potential causes for human suffering and clearing paths for many more in need,” Korducki wrote in a July 27 editorial for The New York Times. 

    Medication Management

    Korducki argued that psychiatry has become “medication management.” 

    “To be sure, many people need medication, and greatly benefit from it,” she wrote. “The right drugs have made my life better too. But I fantasize about a future in which mental illness is understood less in terms of static diagnoses and psychopharmaceutical stopgaps than each individual’s symptoms and the circumstances that might inform them.”

    In response to Korducki’s editorial, many people—doctors and patients—shared their experience with treating depression. 

    Insurance Changes the Game

    John M. Oldham, chief of staff at the Menninger Clinic and former president of the American Psychiatric Association, said that insurance requirements have transformed psychiatry into short, 20-minute med-check visits that do not have the length or intimacy to address a patient’s underlying concerns. 

    “Don’t get me wrong,” Oldham writes. “Psychiatric medications are valuable components of treatment. But mental illnesses are complicated. Medications can do part of the job, but the rest must be done by a careful partnership between psychiatrist and patient, a thoughtfully crafted treatment plan that includes psychotherapy and/or high-quality psychosocial interventions.” 

    Christopher Lukas, author of Shrink Rap: A Guide to Psychotherapy From a Frequent Flier, shared that his doctor told him that antidepressants weren’t serving him—instead, talk therapy was what really made a difference for Lukas. 

    “My psychotherapist believes in listening,” Lukas writes. 

    Jenny Orme, who has struggled with major depression, said that she refused to believe she was a “victim of her genes” even though her mother died from complications of depression at 45. Orme took her health into her own hands, with what she describes as a “rigorous program of yoga, tai chi, swimming and meditation.” That, combined with Eastern medicine and the support of friends and family, help Orme stay stable. 

    “The epidemic of mental illness and suicide calls for a multifaceted, enlightened approach to the treatment of this serious personal and public health problem,” Orme writes. 

    Like Orme, Kordicki says she now views her depression as more than a biological process, and now treats it as so. 

    “Rather than view my psychological experience as a biologically fated roller coaster, I’ve come to think of my mental health as a reflection of the complex ebbs and flows of life; accordingly, I’ve developed tools to better mitigate that which I can’t control, an agency I once wouldn’t have imagined possible,” she wrote. “I feel, for the first time, like a person who belongs to the world.”

    View the original article at thefix.com

  • Can Medication-Assisted Treatment Repair Damage Caused By Drug Use?

    Can Medication-Assisted Treatment Repair Damage Caused By Drug Use?

    Dr. Nora Volkow is testing this theory by studying the brain scans of people with opioid use disorder. 

    Over the past few years medication-assisted treatment (MAT) has become the standard of care for people with opioid use disorder, helping to cut users’ risk of fatal overdose by as much as half.

    Now, researchers from the National Institute on Drug Abuse (NIDA) are hoping to understand why. 

    NIDA director, Dr. Nora Volkow, has a theory. She believes that medications including methadone, buprenorphine and naltrexone don’t just help people deal with cravings for drugs. She thinks these medications also help repair the damage done to the brain by drug use, the AP reported.

    “Can we completely recover? I do not know that,” she said. However, people on medication-assisted treatment are “creating stability” in their brains, which allows the brains to react more normally to stimuli. 

    The Theory

    Volkow is testing her theory by completing brain scans on people with opioid use disorder. This includes people who are actively using, those in early recovery, and people on established MAT plans. Volkow and her research team are examining how people react to various stimuli—e.g. what reaction does a picture of a cupcake garner, for example, compared to a picture of heroin?

    The researchers are also doing other work to measure people’s impulse control with exercises like offering them $50 now or $100 in a week’s time. 

    “You need to be able to inhibit the urge to get something [to overcome addiction],” Volkow said. “We take for granted that people think about the future. Not when you’re addicted.”

    Volkow also wants to study how each medication affects people differently. For example, she suspects that buprenorphine will have more of an effect on mental and emotional health than methadone. 

    She expects to see big difference in the brain scans of people who use opioids, compared with those who are on medication-assisted treatment. 

    “You should be able to see it with your eyes, without having to be an expert,” she said.

    The Search For Participants

    Unfortunately the research team has struggled to find participants who are healthy enough to be considered. Research subjects cannot be on any medications that affect the brain other than their MAT regimen. 

    Overall, Volkow hopes that by better understanding medication-assisted treatment and how it can help people with opioid use disorder, scientists will dispel some of the myths and misunderstandings about MAT. 

    “People say you’re just changing one drug for another,” she said. “The brain responds differently to these medications than to heroin. It’s not the same.”

    View the original article at thefix.com

  • Autoworkers Union Pushes For Better Opioid Treatment 

    Autoworkers Union Pushes For Better Opioid Treatment 

    “The issue demands that we get involved, and it demands that we set an example of combating it in a positive way,” said the union’s VP.

    The United Automobile Workers union (UAW), which has nearly 400,000 active members, is making access to addiction treatment a priority in negotiations with the major automotive companies this year. 

    “The issue demands that we get involved, and it demands that we set an example of combating it in a positive way—the union and the company,” the union’s Vice President Rory Gamble told Automotive News. “We have to grab this thing and address it now.”

    Like many people in the industry, Gamble has been touched by addiction. His granddaughter died in January of an opioid overdose. For other workers the connection is even more personal, as long days and assembly-line work lead to injuries that are often treated with opioids. 

    Working With The Union

    Scott Masi lost his automotive job after he was found sleeping on the job, a complication from opioid use disorder. Now in recovery, Masi works with the union and employers to help them better integrate employees who need treatment. 

    “If I was struggling with diabetes and I wasn’t getting my medication, and I was sleeping because of that, do you think they would have fired me? No,” he said. “I had no recourse to save my job, get the help that I needed or utilize the insurance that I had worked for.”

    Consultant Pamela Feinberg-Rivkin would like to see automakers be proactive to increase access to treatment for employees. 

    “If one or all three of [the automakers] would invest—not only in recovery; they need to have treatment first—but invest in the detox treatment and then a recovery community where they can live and work and receive that long-term care—that’s a model that should be created in the state,” she said. “Many workers that we have could benefit from having that whole continuum of care.”

    Ford’s Pilot Program

    Ford is leading the way, with an initiative to provide a point-stimulation therapy device that helps people overcome the pain of withdrawal. As part of a pilot program, more than 200 employees and family members will have access to the device. 

    “This device is not a miracle, but it is the next best thing,” said Todd Dunn, president of a local UAW chapter. “It’s a positive, disruptive solution to opioid treatment. I think you’re going to see GM, Chrysler, a lot of companies and organizations look at this device as a game changer.” 

    Jeremy Milloy, a researcher who has studied American workplaces, said that it’s important that employer health plans offered by automotive makers cover devices like this and other medication-assisted treatment. For too long, he said, the companies’ generous health plans contributed to people having easy access to opioids. 

    “It’s a really obvious time for them to say that policies based on surveillance and stigmatization have failed,” he said. “They can’t work in a system where the No. 1 most-abused drug is a licit one being prescribed through company health plans.”

    Gamble, the union’s vice president, said that the union, employers and employees are all willing to work together to help improve access to treatment. However, it’s a matter of finding an option that works for all parties. 

    “I am not against any type of solution that makes sense,” he said. “But when you sit down with a company, you have to craft that where it makes economic sense.”

    View the original article at thefix.com