Answer Addiction

Tag: medication-assisted treatment

  • Suboxone: A Tool for Recovery

    Suboxone: A Tool for Recovery

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • More ERs Are Providing Withdrawal Meds As First Step To Recovery

    More ERs Are Providing Withdrawal Meds As First Step To Recovery

    Patients in need are receiving buprenorphine to address their withdrawal symptoms. 

    Kicking an opioid habit comes with a host of physical withdrawal symptoms so severe that people often end up in the emergency room.

    There, they are usually treated for diarrhea or vomiting, but not the underlying issue. Now, however, more emergency rooms around the county are providing buprenorphine to help ease withdrawal and get more people into treatment. 

    “With a single ER visit we can provide 24 to 48 hours of withdrawal suppression, as well as suppression of cravings,” Dr. Andrew Herring, an emergency medicine specialist at Highland Hospital in Oakland, California, told The New York Times. 

    At Highland, people who come in presenting with withdrawal symptoms are given a dose of buprenorphine, also known as Suboxone, and are told to follow up with Herring, who runs the hospital’s buprenorphine program. 

    “It can be this revelatory moment for people—even in the depth of crisis, in the middle of the night,” Herring said. “It shows them there’s a pathway back to feeling normal.”

    Although the Drug Enforcement Administration (DEA) requires doctors to receive special training and a license to prescribe buprenorphine, doctors in the ER can provide the medication without this training. Still, Herring said, many healthcare providers hesitate to provide the first step toward medication-assisted treatment (MAT). 

    “At first it seemed so alien and far-fetched,” he said. 

    Yet, research into the practice is promising. A 2015 study showed that people who were given buprenorphine in the ER were twice as likely to be in treatment 30 days later than those who were not given medication to help with withdrawal.  

    “I think we’re at the stage now where emergency docs are saying, ‘I’ve got to do something,’” said Dr. Gail D’Onofrio, lead study author. “They’re beyond thinking they can just be a revolving door.”

    California has plans to expand treatment for withdrawal in emergency rooms, using $78 million in federal funding to establish a hub-and-spoke system where people would get their first dose of medication in the emergency room before being connected with ongoing services.

    Dr. Kelly Pfeifer, director of high-value care at the California Health Care Foundation, said this is the next step in providing quality care for people fighting addiction. 

    “We don’t think twice about someone having a heart attack, getting stabilized in the emergency department, and then getting ongoing care from the cardiologist,” she said. “And the risk of death within a year after an overdose is greater than it is for a heart attack.”

    View the original article at thefix.com

  • Addiction Medicine Coming To San Francisco's Homeless Community

    Addiction Medicine Coming To San Francisco's Homeless Community

    The outreach program is a response to the “striking increase” in the number of people who inject drugs in public spaces.

    The city of San Francisco is rolling out a program that will bring buprenorphine, a medication used to treat opioid use disorder, to its homeless community. City officials say it’s time to start meeting this community where they’re at.

    Back in May when the outreach program was introduced, Mayor Mark Farrell told the San Francisco Chronicle, “The consequences of standing still on this issue are unacceptable. Drug abuse is rampant on our streets, and the recipe of waiting for addicts to come into a clinic voluntarily is not working. Plain and simple. So we’re going to take a different approach.”

    Dr. Barry Zevin, medical director for Street Medicine and Shelter Health, who has provided medical care to the city’s homeless community since 1991, echoed the mayor’s sentiment.

    In a new interview with the New York Times, Zevin explained that meeting the homeless where they’re at may expedite the healing process, rather than waiting for them to seek help. He noted that this population, in particular, has a dire need for mental health and substance abuse services, as well as medical care.

    “On the street there are no appointments, and no penalties or judgments for missing appointments,” said Zevin.

    Following a yearlong pilot program, 20 out of the 95 participants were still using buprenorphine under the care of the city’s Street Medicine Team, the NYT noted.

    With a two-year budget of $6 million, the program is setting out with a goal of providing buprenorphine to 250 more people—just a fraction of the estimated 22,500 injection drug users in San Francisco, but a start.

    Zevin noted that there is a concern that the same-day buprenorphine prescriptions may end up being abused, but said that the city is prepared to deal with it on a case by case basis.

    “I do have to worry about diversion, but I want to individualize care for each person and not say that the worry is more important than my patient in front of me, whose life is at stake,” he told the NYT.

    The outreach program is a response to the “striking increase” in the number of people who inject drugs in public spaces.

    “Ultimately, this is about helping these individuals, but it’s also about improving the conditions of our streets,” said Mayor Farrell.

    View the original article at thefix.com

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

    "Methadone Pope" Dr. Robert Newman Dies At 80

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • Opioid Use Quadrupled Among Pregnant Women

    Opioid Use Quadrupled Among Pregnant Women

    The prevalence of opioid use disorder present at a hospital delivery rose from 1.5 per 1,000 deliveries in 1999 to 6.5 per 1,000 in 2014.

    Opioid use among pregnant women quadrupled between 1999 and 2014, rising alongside the rate at which opioid use disorder has increased in the general population, according to a new report. 

    “When something is so broad and affects all populations, we also see it reflected in the pregnant population,” Dr. Elizabeth E. Krans, an assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the University of Pittsburgh, told CNN Health.

    The Centers for Disease Control and Prevention (CDC) published its report on Friday (August 10). The CDC analysis found that nationally, the prevalence of opioid use disorder present at a hospital delivery rose from 1.5 per 1,000 deliveries in 1999 to 6.5 per 1,000 in 2014.

    However, in some states the problem was much more prevalent. In Vermont, for example, opioids are a factor in 48.6 out of every 1,000 deliveries. 

    Data was only available in 28 states, but indicated that opioid use in pregnant populations varies widely. Washington, D.C. had the lowest prevalence in 2014 at just 0.7 deliveries per 1,000, while Vermont had the highest.

    The increase in the prevalence of opioids was also uneven: California and Hawaii saw relatively small increases, while Maine, New Mexico, Vermont and West Virginia saw large spikes in the reported use of opioids among pregnant women. 

    State policies on drug use during pregnancy can affect reporting, since in 23 states and Washington, D.C., using drugs while pregnant is considered child abuse. This might prevent some women from being honest about their drug use. 

    “Data on the impact of these policies are scarce,” the authors wrote. 

    “Pregnancy is a really important time. Women are often worried that invested in their own health and the health of their baby, but they’re also fearful of judgment,” Krans said. 

    Women who are using opioids when they become pregnant are often told to go on medication-assisted treatment throughout their pregnancies, as that is the safest option for mother and baby. “We have effective treatments that are available during pregnancy, and we want to encourage women to seek early care and engage in treatment as soon as possible,” Krans said. 

    Left untreated, opioid use can lead to a variety of pregnancy complications and negative health effects for the child. 

    “Opioid use by pregnant women represents a significant public health concern given the association of opioid exposure and adverse maternal and neonatal outcomes, including preterm labor, stillbirth, neonatal abstinence syndrome, and maternal mortality,” the authors wrote. 

    View the original article at thefix.com

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

    Too Often, Insurers Cover Opioids But Not Addiction Treatment Meds

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • Clean, Sober And Using Suboxone

    Clean, Sober And Using Suboxone

    Suboxone users deserve a safe space, in and out of the rooms. And we deserve to proudly call ourselves clean and sober.   

    It was pretty apparent when I began taking Vicodin for migraines that I was going to have a problem, but I was too ashamed and afraid to ask for help.

    On the outside, I was a working professional, undergrad student and hands-on mom.

    Beneath the surface I was deteriorating. 

    It wasn’t until my career was in jeopardy and many relationships broken that I finally admitted I was out of control and needed treatment. I learned the hard way: Secrets keep you sick. Addiction grows in the dark. 

    Today, as a nurse in long-term recovery from opiate and alcohol addiction, I’ve made an intentional choice to forgo anonymity and live “Sober Out Loud.” I advocate for everyone in recovery, especially healthcare professionals, using blogging, public speaking, and coaching to do my part to end the stigma.

    My hope is that talking openly will give others the courage to speak up early. That they’ll notice their decline and get help long before their careers and lives are in danger. Choosing to be open about my addiction also supports my healing. I find accountability, connection, and purpose in sharing my experience.

    It wasn’t easy in the beginning – I was terrified of being judged. The opposite has been true – even in the hospital I worked for. Even with colleagues who may have reason to look down on me. I’ve been met with abundant compassion and acceptance. 

    Except I still have one secret. There’s one disquieting fact I haven’t told many people. I’m flooded with fear that I’ll be exiled from the recovery community and excluded from meetings. Petrified that my integrity as a coach and writer will be questioned. And if that’s the case, then what’s my value as a sober advocate?

    There are others who have the same fears, and my silence validates the stigma. Recently, I heard on the radio about a young man who committed suicide. He was tortured by internal conflict; he questioned his sobriety. We share the same secret.

    For that struggling human being, and for everyone else struggling – It’s time for me to be completely open.

    “Hello, my name is Tiffany; I’m an addict and an alcoholic. AND I use Suboxone.”

    This isn’t my opening line when I introduce myself at meetings – nobody has to divulge their prescribed medications to the group, right? The answer’s not so clear if you use Medication Assisted Treatment (MAT).

    On one hand, I feel I shouldn’t have to add a qualifier to the already awkward label I use when attending certain groups. (In the program I regularly go to, we don’t use labels at all, but that’s a subject for another time). On the other hand, it feels like I must add the qualifier, otherwise I’m a fraud. I start spiraling: “Am I allowed to share? What’s my ‘real’ clean date? Can I pick up a chip on my birthday month?”

    In my first month of sobriety, newly on Suboxone, I readily shared at meetings and with a few sober friends. Completely unaware of my disgrace, and totally unprepared for the reactions, I wanted to swallow my words as I was assaulted by:

    “Do you think you’ll be on it long?”

    “You’re going to get off of it soon right?”

    ‘You’re still on an opiate.”

    “You’re still getting high though.”

    “You’re not actually clean yet.”

    “Well you’re definitely not sober. Don’t call yourself sober.”

    “Do what you’re gonna do but don’t talk about it here.”

    “You can’t have a sponsor until you’re done with that.”

    “We all did it without. We didn’t need medication to get clean. You’re obviously not serious – not strong – not determined enough. You haven’t done enough steps. You haven’t gone to enough Meetings.”

    “You’re not sober. Come back when you are.”

    I thought I was sharing success and hope. They asserted I was “cheating the system” and “staying in the game.”

    This inhospitable reception is the reason I’ve stayed silent, the reason I haven’t written about it in my own blog. I found myself avoiding meetings altogether, second-guessing my sobriety; debasing my worth and value in the recovery community. 

    Despite the booming increase in patients using Suboxone, popular opinion – especially in traditional 12-step programs – is that Suboxone treatment and “clean and sober” are mutually exclusive. Regardless of research showing decreased morbidity and mortality of medication-supported patients, and the success addicts are seeing as they put their lives back together, the underlying criticism persists:

    “You’re not CLEAN.” 

    If I’m not “clean” I’m still dirty. If I’m dirty, I must be worthless. And if that’s the case, what’s the point of trying to recover?

    It’s abhorrent that leaders in the recovery community perpetuate the degradation. At a local level, meeting facilitators model this disparaging behavior, despite literature clearly stating that a person’s medication is no one else’s business. (Read The A.A. Member – Medications & Other Drugs).

    Even trusted chemical dependency physicians tout their opinions, adding to the universal disapproval. Dr. Drew Pinsky stated on the podcast “Dopey” episode #124  “I’d rather have them on cannabis.” And though he concedes he’d be open to discussing short-term use with patients to “get them in the door”, he says that Suboxone patients  “replace” other opiates and are merely surviving; that they are “not fully recovered” and “still chronically ill.”

    Still chronically ill? Not fully recovered? In the 3 years since I initiated a Suboxone regimen, I’ve worked tirelessly at making amends. I’ve regained my job as an acute care nurse and clinical instructor in a nursing program. I facilitate Recovery Meetings, and I’ve transformed into a certified Life and Recovery Coach. I’ve repaired relationships with family and friends.  I’m traveling, writing, and above all – finding JOY in living. I’m not an outlier. There’s thousands of us. We’re just not  allowed the safe space to share. 

    MAT is NOT perfect. I’m aware of it’s flaws and have experienced some of them myself. Anyone considering it should carefully review all potential side effects with their physician and trusted, non-biased recovery support. Suboxone causes physical dependence, and there’s severe withdrawal if one quits cold turkey. It is, chemically speaking, an “opiate.”

    Some prescriptions are diverted; I’ve personally cared for patients who admit getting the drug on the street. And with full transparency, I sometimes feel conflicted about using pharmaceuticals to overcome an addiction to pharmaceuticals. I’m not oblivious to the irony. And I strongly assert that any MAT is only truly successful if taken while simultaneously working on recovery of the mind and spirit. 

    But people are dying. We don’t have time to argue over which is the most righteous recovery path.

    After weighing all the pros and cons, searching my soul, and utilizing critical thinking skills I’ve honed in 17 years of working in healthcare, here’s what I’m absolutely sure of:

    Suboxone is right for ME.  I am Clean and Sober. 

    Four years ago I was resigned to being found dead in a bathroom with a needle in my arm. Today, I prove that recovery is possible. I am on a journey toward physical, emotional and mental wellness, and have a quality of life I couldn’t have dreamed up. Suboxone, for now, is a part of my story. As it is for many, in increasing numbers every day.

    Whether I wean off in a month or stay on it forever has no bearing on my credibility.

    It’s likely that someone sitting next to you today in a meeting is on Suboxone. It’s also likely they’re petrified to talk about it, like I was, and might leave the meeting fighting the humiliation of being “unclean.”  

    They might decide that it’s better to go back out and use, since they don’t belong in recovery; or to wean off without a doctor’s supervision, undergoing agonizing withdrawal and back at risk of using street drugs- which is part of my story as well. They might even decide that they don’t belong here – at all. That the only choice is to end their life. 

    What is your role in this? Are you hurting or helping? Consider the language you’re using. Is it pejorative and shame-inducing? Or do you cultivate love and belonging? 

    Those of us in recovery have a responsibility to welcome everyone who is making positive progress towards a sober lifestyle. It’s not our business to take the inventory of someone else’s medication list – it IS our business to eradicate stigma. Offer compassionate acceptance. Keep an open mind. Suboxone users deserve a safe space, in and out of the rooms. And we deserve to proudly call ourselves clean and sober.   

    Next time someone shares with you that they choose to use Suboxone – or any MAT – as part of their journey, don’t criticize. Don’t interrogate or give them a timeline to stop it. Ask how it’s working, and If they’re happy. Ask if they’ve been successful staying off street drugs; if they’ve made strides towards repairing the damage of their past. And when they share with you their clean date, congratulate them on being SOBER. 

    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 reach Tiffany through her blog www.scrubbedcleanrn.com and follow her @scrubbedcleanrn. 

    View the original article at thefix.com

  • Searching For The Next Naloxone

    Searching For The Next Naloxone

    Experts are concerned that naloxone may not be strong enough for synthetic opioids such as fentanyl and carfentanil.

    Naloxone is—at times—a seemingly miraculous drug. Within minutes of naloxone being administered, someone who was unresponsive because of an opioid overdose can start breathing on their own and regain consciousness.

    However, despite its strengths, there are issues with the drug that have left healthcare professionals and policy makers pushing for alternatives. 

    One of the biggest issues with naloxone today is that it is reportedly not as effective at reversing overdoses from powerful synthetic opioids like fentanyl and carfentanil.

    In these cases, a person might need multiple doses of the opioid reversal drug in order to see a benefit. This isn’t just expensive, but can also cost someone their life if there aren’t enough doses immediately available. 

    Another issue is that opioids remain active in the body for longer than naloxone does. Because of this, someone can be revived using the opioid reversal drug, but later slip back into an overdose when the effects of naloxone have worn off. 

    Both of these concerns have led to the search for alternatives to naloxone. 

    “The strategies we’ve done in the past for reversing overdoses may not be sufficient,” Nora Volkow, director of the National Institute on Drug Abuse (NIDA), recently said in a speech at the 2018 National Rx Drug Abuse and Heroin Summit, according to STAT News. “We need to develop alternative solutions to reversing overdoses.”

    Dr. Jay Kuchera, a Florida-based addiction medicine specialist for Resolute Pain Solutions, said that “naloxone is being outgunned” by synthetic opioids that have largely replaced heroin in many areas of the country. 

    “Naloxone seemed to be great for the older opioids,” Kuchera said. “But now that we’re encountering these nonmedical, ungodly [opioids] like carfentanil… we need to get with the times.”

    In 2016, one report found that the market for opioid reversal drugs was valued at nearly $1 billion, so there are good economic incentives for companies to find alternatives to naloxone.

    Opiant Pharmaceuticals, which developed Narcan (the nasal spray version of naloxone), has had early success with a drug that works the same way as naloxone but lasts longer, so that the victim would be less likely to slip into another overdose after administration. 

    “Compounds like fentanyl, carfentanil, and other synthetic opioids act for longer periods of time,” said Dr. Roger Crystal, CEO of Opiant. “The concern is that naloxone’s half-life doesn’t provide sufficient cover to prevailing amounts of fentanyl in the blood.”

    Because many overdose deaths occur when a person stops breathing, scientists are also examining whether they can use drugs to keep a person breathing even while not reversing the overdose itself. For this, researchers are looking at ampakines, a class of drugs that can counteract respiratory depression. 

    Some people argue that funds would be better used to address the causes of addiction or to further study naloxone to see if it is indeed less effective against synthetic opioids, but Volkow said that having new and potentially better options for saving people from overdose is critical.  

    “There are so many people dying that we have to recognize the urgency,” Volkow said. “We obviously value basic science, but at the same time we have to recognize because of the current situation, the development of medication the can help address the crisis has become our top priority.”

    View the original article at thefix.com

  • Medication-Assisted Treatment Options Limited For Medicare Recipients

    Medication-Assisted Treatment Options Limited For Medicare Recipients

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • Buprenorphine Exposure Affects Kids At Alarming Rates

    Buprenorphine Exposure Affects Kids At Alarming Rates

    The number of children exposed to the addiction drug rose 215% over three years. 

    As the opioid crisis continues to grow, some children are being put at risk as they are exposed to buprenorphine, an opioid medication used to treat opioid use disorder. 

    A new study published in the journal Pediatrics found that from 2007 to 2016, more than 11,200 calls were made to poison control centers in the U.S. with concerns about children being exposed to buprenorphine. Of those, 86% were about children under age 6 and 89% were unintentional exposures. 

    “This is never prescribed for children under 6. It is a significant risk to them,” Henry Spiller, director of the Central Ohio Poison Center and an author of the study, told CNN. “We’re not quite sure why it stands out so much. Perhaps the parents who have this may not think it’s as risky as their other opiates because it doesn’t have the big effect that the other opiates do for them.”

    Of the 11,275 children exposed to the medication, the overall exposure rate per 1 million grew by more than 215% from 2007 to 2010. It then decreased 42.6% from 2010 to 2013, before increasing again in 2016 by 8.6%.

    Dr. Jason Kane, an associate professor of pediatrics and critical care at University of Chicago Medicine Comer Children’s Hospital, tells CNN that the increase in exposure has to do with the increase in adults using buprenorphine as a treatment option.

    “This is not the first study to show these data, but it is the latest study to show a medication whose design it is to help adults with narcotic or opioid addiction is ending up poisoning, mostly unintentionally, children and in particular those who are most vulnerable,” Kane said. 

    Buprenorphine is an opioid receptor stimulant as well as a blocker. It is considered an opioid but does not have the same effect as other opioids for adults, thought it can still be habit-forming. For children, however, it can have a stronger effect on the respiratory system.

    “In adults, the respiratory depression, the part that slows the breathing and you stop breathing, is limited, and so there’s a lot less respiratory depression in adults,” Spiller told CNN. “That’s why it was felt to be safer. Unfortunately, in very young children under 5, preschoolers, toddlers, infants… that protection isn’t there, and they do get this respiratory depression. It does affect their breathing.”

    Of adolescent exposures, 77% were intentional and more than one-quarter used the medication with another substance. 

    “It was surprising that adolescents were actually using it for abuse. It’s very specific,” Spiller told CNN. “You have to be in a program to get this. It’s carefully managed. It’s not widely available… It is available on the street, but essentially, the majority of this is from these management programs and someone’s in therapy, someone in the house, them or a family member.”

    According to CNN, study authors expect the number of exposures to continue to increase.

    To limit exposure, Kane recommends disposing unused medications, using child-proof caps and making sure medications are labeled correctly.

    “Seven children under the age of 6 died as a result of an accidental poisoning from this drug, which was present in someone’s home, prescribed with the goal of making someone else better,” Kane said to CNN, adding, “that’s a striking thing for me.”

    View the original article at thefix.com