Answer Addiction

Tag: medication-assisted treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • Why Hospitals Offer Treatment Referrals In Lieu Of Addiction Services?

    Why Hospitals Offer Treatment Referrals In Lieu Of Addiction Services?

    Only 5% of ER doctors work in hospitals that offer buprenorphine or methadone.

    A recent Huffington Post feature highlights a conundrum within the medical community’s response to the opioid crisis: emergency room patients with opioid use disorder who receive a dose of buprenorphine are twice as likely to continue treatment within the next 30 days than those who were referred to outside treatment facilities.

    Despite those statistics, a survey by the American College of Emergency Physicians (ACEP) found that only 5% of ER doctors work in hospitals that offer buprenorphine or methadone, of which there are less than 100 in the United States.

    The ACEP study, which polled 1,261 emergency physicians in 2017, found that 9 in 10 respondents felt that the number of patients seeking opioids had increased or remained the same during that year. But at many hospitals, patients seeking medical assistance for addiction-related issues are given the phone number for local clinics.

    Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University, cites a number of reasons why this approach might be favored over administering buprenorphine or other opioid treatment drugs.

    Emergency doctors and nurses may have antipathy towards drug users, who are often in their worst possible states when arriving at emergency services, said Kolodny. Hospital administrators, too, may perceive such patients as poor insurance risks, especially those in states that have not expanded Medicaid; offering services beyond treatment referral could take up staff and available beds.

    Prescribing buprenorphine also requires a license from the Drug Enforcement Administration (DEA), and many physicians are not willing to complete the eight hours of clinical training required to receive it.

    But as the Huffington Post feature notes, a number of hospitals across the U.S., including 10 in Maryland and multiple locations in California and South Carolina, do offer addiction services, which typically entail screening by caregivers and an interview with a peer recovery coach to determine if the patient is willing to accept treatment.

    ER doctors and nurses will treat the patient’s most urgent medical needs, and then administer a dose of buprenorphine. 

    A 2017 study by the Yale School of Medicine found that patients with opioid use disorder who receive such a dose in an ER were twice as likely to be involved in some form of treatment a month later, compared to those who were not. Dr. Eric Weintraub, an associate professor of psychiatry at the University of Maryland School of Medicine, is a proponent of addiction services in emergency rooms, and now works to help other hospitals adopt that approach.

    “We’ve learned that certain places are conducive to engaging patients in treatment,” Weintraub told HuffPost. “One of them is the ER. The other is the criminal justice system. We need to grab those opportunities and offer patients effective treatment when they’re ready.”

    Currently, addiction treatment specialists are watching addiction services programs in Maryland and other locations to see if the approach proved effective over long-term periods. “If this movement… is successful and starts to become normalized nationwide, it could change everything,” said Kolodny.

    “If you really want to see overdose deaths come down in the United States, getting treatment with buprenorphine has to be easier and cheaper for people with substance use disorders than getting heroin or other opioids off the street,” he said. “And what could be easier than walking into an ER and getting started on buprenorphine?”

    View the original article at thefix.com

  • Senate Passes Sweeping Opioid Legislation, Treatment Advocates Unimpressed

    Senate Passes Sweeping Opioid Legislation, Treatment Advocates Unimpressed

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • "Dopesick Nation" Chronicles Struggle To Find Addiction Treatment

    "Dopesick Nation" Chronicles Struggle To Find Addiction Treatment

    “TV is typically the domain of heroes and monsters and we don’t believe in either.”

    A new docu-series shows the day-to-day struggle of finding help for people with substance use disorder.

    The first episode of Dopesick Nation, a new 10-part series that premiered on VICELAND last Wednesday (Sept. 12), follows Frankie and Allie as they seek treatment for Nate and Kelly, two drug users in South Florida.

    Frankie and Allie, who are in recovery themselves, explain the root of South Florida’s current heroin and fentanyl crisis—going back to the feds’ crackdown on prescription pills and the subsequent rise of heroin and fentanyl. 

    South Florida’s recovery industry is among the most notorious—people flock there to get help because it is “brimming with treatment centers on every corner,” Allie explains. Many are “predatory” in nature.

    “I have family in South Florida and they started to tell me about this billion dollar rehab industry. It seemed like everyone down there had a finger in that pie. It was a big, dark, open secret,” producer Ian Manheimer told The Fix via email. “In my research, I met a lot of people who were making a piles of fast money in this industry. Their incentives weren’t necessarily aligned with those of their clients and it led to a lot of horrible things happening.”

    The documentary follows Frankie as he tries to get Nate into treatment. He secured a scholarship for Nate, but they must wait for a bed to open up before he can be admitted. Until then, all Nate can do is wait and do his best to survive, one day at a time. “I don’t know if I can make it through another night,” he says as he is forced to wait longer than expected. “I fucking hate everything about what I’m doing.”

    Viewers can feel the frustration of this waiting game. It’s clear that Nate is sick and tired of feeling sick and tired. He’s ready for change, and to be present for his son.

    Frankie asks him, “Are you tired, and just done man?” Nate says, “It’s more of a mental/emotional thing, not as much of a physical thing like my body’s tired or my arms hurt, or I don’t have any veins left—you know, all those different reasons why people would stop getting high. Just emotionally and mentally drained as fuck, you’re like just done. It’s never been this bad before for some reason. I just want to have my family back.”

    Nate’s experience is like any other individual who is ready to quit, but can’t stop. After using for so long, Nate is physically addicted to heroin. If he can’t get professional help, the only thing that will make him feel better is heroin or Suboxone, a medication for opioid addiction.

    “This is a God-given opportunity. I’m not supposed to have this. And for whatever reason, I got it,” Nate said about the scholarship that Frankie got for him. “I need to take advantage of it because I can’t keep doing this anymore. This can’t define who I am. This isn’t me. Because I have more potential than that,” he says before he hits his pipe.

    At the end of the first episode, Nate is finally admitted to a treatment center, and is out in 30 days. He looks different—healthier and happier.

    Kelly, on the other hand, is harder for Allie to keep track of. She’s enthusiastic about recovery one day, but is no where to be found the next. But Allie, who met Kelly on her path to recovery, isn’t about to let go of her friend. “I’ll never give up on Kelly. Unless Kelly gives up on Kelly,” she says.

    As the series continues, we’ll meet more young men and women at the height of their crisis, Manheimer says. “Maybe they’re prostituting. Maybe they’re stealing. They’re homeless. Allie and Frank will have to convince them, against all odds, to get into detox before someone else takes the scholarship they have lined up.” 

    Dopesick Nation is about showing the raw reality of people’s experiences, without labels or judgment. “We wanted to make something real,” says Manheimer. “TV is typically the domain of heroes and monsters and we don’t believe in either.”

    Watch the first episode of Dopesick Nation here.

    View the original article at thefix.com

  • New Dosage Strength Of Opioid Addiction Drug Approved By FDA

    New Dosage Strength Of Opioid Addiction Drug Approved By FDA

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • Former Purdue Pharma Exec May Profit From Opioid Addiction Drug

    Former Purdue Pharma Exec May Profit From Opioid Addiction Drug

    Richard Sackler’s involvement with a new formulation of buprenorphine has drawn a wave of criticism. 

    A new formulation of buprenorphine, a medication used to treat opioid addiction, is due to hit the market—but some have taken issue with one of the inventors’ ties to Purdue Pharma, the maker of OxyContin.

    Richard Sackler is listed as one of six inventors on a patent for a new formulation of buprenorphine issued in January, the Financial Times reported. Sackler is also the former chairman and president of Purdue Pharma, according to the Washington Post, and the son of Raymond Sackler, one of the company’s founders.

    Purdue Pharma is the target of more than 1,000 lawsuits from cities, states, counties and tribes across the United States. The pharmaceutical giant and maker of OxyContin is accused of exaggerating the benefits and downplaying the risk of the opioid painkiller, and fueling the national opioid addiction epidemic.

    “It’s reprehensible what Purdue Pharma has done to our public health,” says Luke Nasta, director of Camelot, a New York-based treatment center. The Sacklers “shouldn’t be allowed to peddle any more synthetic opiates—and that includes opioid substitutes.”

    According to the patent, unlike the tablet or film formulation that’s currently available, the new drug will come in a fast-dissolving wafer that is placed under the tongue.

    According to the inventors, the fast-dissolving formula will make it less likely for the drug to be abused and sold on the black market.

    Colorado recently added to the mounting lawsuits against Purdue Pharma—accusing the company of playing a “significant role in causing the opioid epidemic.”

    “Purdue’s habit-forming medications coupled with their reckless marketing have robbed children of their parents, families of their sons and daughters, and destroyed the lives of our friends, neighbors, and co-workers,” said state Attorney General Cynthia Coffman in a statement. “While no amount of money can bring back our loved ones, it can compensate for the enormous costs brought about by Purdue’s intentional misconduct.”

    Members of the otherwise little known Sackler family have come to light for their ties to Purdue Pharma.

    This past March, a group of about 50 people came together at the Metropolitan Museum of Art in New York City to protest members of the Sackler family’s alleged involvement in perpetuating opioid abuse. Led by artist Nan Goldin, the protestors threw pill bottles marked “OxyContin” into the reflecting pool in the Sackler Wing of the museum, named for the family’s contributions to the museum.

    The family has donated millions of dollars to arts institutions like the Met over the years.

    View the original article at thefix.com

  • Senate Considers Opioid Crisis Bill, But Critics Say It Isn’t Enough

    Senate Considers Opioid Crisis Bill, But Critics Say It Isn’t Enough

    “A little drama for little substance,” said one addiction advocate familiar with the bill. 

    The Senate is preparing to pass a bill to address the opioid epidemic, but critics say that the legislation skirts around the most important — and contentious — issues that could help change the way that opioid addiction is handled. 

    “A little drama for little substance,” one addiction advocate familiar with the bill told STAT News. 

    The bill addresses treatment and prevention, according to a copy reviewed by STAT. There are provisions that will better equip law enforcement to detect fentanyl being shipped in the mail system and that will help develop a have a better disposal system for unused opioids, in order to reduce the amount of opioids on the street. In addition, there are provisions to expand treatment by easing access to medication-assisted treatment with buprenorphine, training doctors to screen for substance use disorder and increasing access to treatment via telemedicine. 

    However, treatment advocates say that the bill will do little to affect how treatment is delivered because it does not take enough bold steps to change the status quo. 

    “Overdose rates continue to rise, and our response is still falling short given the mammoth size of the problem,” said Andrew Kessler, the founder of Slingshot Solutions, a behavioral health consulting group. “We are in the early phases of our response to this epidemic, and I can only hope that this bill is the first of many we can pass.”

    One big change that has a chance of passing is repealing the IMD exclusion, which prevents treatment centers with more than 16 beds from receiving Medicaid payments.

    An opioid response bill passed in June repealed the exclusion, but only for treatment for opioid and cocaine addiction.

    Despite the fact that the current Senate bill doesn’t mention the exclusion, Ohio Senator Rob Portman said that he is hopeful a repeal will be included in the final bill. He said that leadership has agreed on the repeal, but could not gather enough votes. 

    “We’ve worked out an agreement that I think most leadership on both sides agree with, but we weren’t able to get the signoff from everybody,” Portman said.

    The Senate bill also includes a call for the development of best practices in disclosing a patient’s history with substance abuse. The House bill would allow a history of addiction treatment to be disclosed without a patient’s expressed permission, but Senate lawmakers are concerned that this could lead to breaches of privacy and stigma. 

    With the coming November election, many lawmakers are hesitant to vote on anything controversial, meaning that the bill may languish. However, some Senators are pushing to make sure it gets a vote this month. 

    “As soon as both parties agree, we can have a roll call vote next week. When we do that, it’ll get virtually unanimous support, and then we’ll work with the House and put the bills together,” said Sen. Lamar Alexander (R-Tenn.), who has spearheaded the bill. 

    View the original article at thefix.com

  • Mom Accused Of Accidentally Killing Child With Drug-Tainted Breast Milk

    Mom Accused Of Accidentally Killing Child With Drug-Tainted Breast Milk

    Prosecutors argue that the child died because the mother had used methamphetamine and amphetamine.

    The homicide case against a Pennsylvania mother accused of accidentally killing her baby with drug-tainted breast milk will move forward, a judge ruled last week during an initial court appearance. 

    Samantha Jones was arrested in July after an autopsy found methadone, amphetamine and methamphetamine in the dead 11-week-old’s system. The Bucks County mother was charged with homicide from the start, but on Wednesday, Magisterial District Judge Lisa Gaier upheld the charge after hearing more from defense and prosecutors. 

    “They don’t know what happened here,” defense lawyer Louis Busico said, pointing out that investigators never tested his client’s breast milk. “I’m asking the court not to criminalize the death of this little child.”

    But prosecutors argued that the drugs “had no business being inside that baby,” according to a news release. 

    “We are not alleging that this was an intentional killing of this baby,” prosecutor Kristin McElroy said. “But it certainly was reckless to know these drugs were in your body and continue to breast feed.”

    The New Britain Township woman previously told investigators she was prescribed the methadone and that she’d stopped breastfeeding her boy three days before his death, when she switched to formula.

    But the morning of April 2, the baby started crying and Jones decided to breastfeed because it was late and she was tired, she told police. 

    When her husband woke up for work, the baby was crying, so he made a bottle of formula and Jones fed him. Afterward, she fell asleep—and when she woke up an hour later the baby was white, with blood around his nose. 

    Jones and her mother tried CPR and called 911, but first responders were unable to save the baby, who died that day in the emergency room. 

    In court last week, Jones’ lawyer tried getting the homicide charge dismissed, saying the woman would never have hurt her boy and that the breast milk hadn’t actually tested for drugs.

    “She was a wonderful mother to this little boy. I can tell you she was a loving mother to this little boy, and she was doing everything possible to improve herself and provide both her children and herself with a nice life,” Busico told ABC News. “She has another child who she loves dearly. She has an amazingly close and wonderful relationship with her own mom. But every day is a little piece of hell on earth, make no mistake about it.”

    View the original article at thefix.com

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

    What Sets Suboxone Apart From Other Medication-Assisted Treatments?

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

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

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

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

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

    She raised a skeptical eyebrow.

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

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

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

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

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

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

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

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

    My answer?

    “No.”  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com