Answer Addiction

Tag: methadone

  • Inside The Methadone Clinic Boom

    Inside The Methadone Clinic Boom

    “We haven’t seen such a dramatic increase in the industry since the 1970s,” says one expert.

    The methadone treatment industry has exploded from 2014 to 2018, growing more in those four years than in the past two decades, the Boston Globe reports. 

    In the past four years, according to Drug Enforcement Administration (DEA) data, the industry has added 254 new clinics. The clinics allow for the administration of methadone, which is a type of long-acting opioid that can help short-acting opioid users manage withdrawals and allow them more time to detox, WebMD states.

    “We haven’t seen such a dramatic increase in the industry since the 1970s,” Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, told the Globe. 

    Critics of methadone treatment say it is just replacing one substance for another. Yngvild Olsen, an addiction doctor in Baltimore and board member of the American Society of Addiction Medicine, tells the Globe that needs to change.

    “There has been an underlying stigma against methadone for so many years that the industry naturally maintains a low profile,” she said. “Even now, access to methadone is highly geographic. It depends on where you live.”

    Indiana, Maryland, and New York have been at the forefront of states with access to methadone treatment, implementing dozens of new clinics in the past two years alone. Ohio and Florida plan to follow suit with expansions in the works.

    There are some states where laws limit the availability of such clinics. These include Georgia, Indiana, Louisiana, Mississippi, West Virginia, and Wyoming. 

    Even so, the clinics are becoming more common, as in the past four years Medicaid has expanded its coverage and reimbursement for such services for low-income adults. And, in 2020, Medicare coverage of the treatment for those 65 and older will begin as part of the Opioid Crisis Response Act, meaning the need could become even greater. 

    If a state wishes to open such a clinic, they must apply for a license, Parrino tells the Globe.

    While there are other medications to assist in curbing opioid withdrawals, such as buprenorphine, methadone is the most highly regulated. 

    The Globe reports that often, patients are given methadone through a plexiglass shield. Patients are often screened to make sure they are not combining methadone with other drugs. At first, they are only given the medication in the clinic, under the watch of a professional. Eventually, some patients are allowed take-home doses. 

    In contrast, buprenorphine can be prescribed for 30 days at a time by doctors, nurse practitioners, and physician assistants and is viewed as the more obvious treatment by some. 

    “There’s no question that better access to methadone maintenance would save lives,” Andrew Kolodny, co-director of opioid treatment research at Brandeis University, told the Globe. “But for an addiction epidemic that is disproportionately rural and suburban, an intervention that relies on people visiting a clinic every day isn’t the best option. Buprenorphine would be better, but it’s not growing quickly enough.”

    View the original article at thefix.com

  • Promising New Treatments for Opioid-Dependent Babies

    Promising New Treatments for Opioid-Dependent Babies

    Compassionate care for the mothers was crucial to positive outcomes for opioid-dependent babies.

    I gave birth to my daughter in late January of 2014. It was the kind of birth you see in the movies—the contractions started hard and grew closer together within moments. By the time I realized I was in labor, I was already in too much pain to walk. I began needing to push while my husband was on the phone calling for an ambulance. The 911 operator had to walk him through the beginning of my daughter’s delivery. Luckily, paramedics showed up to take over while she was still crowning. The lieutenant who delivered her said it was her first completed childbirth. I will never forget holding my newborn daughter in the elevator while we rode down to the ambulance, or how the entire labor and delivery staff burst into applause when we wheeled into the hospital. But the joy and pride of my wild, badass childbirth was quickly replaced by a deep sense of guilt.

    Within hours, my daughter began showing symptoms of opioid withdrawal—symptoms like rigid limbs, sneezing, and a sharp, screeching cry that burrowed into my belly and filled me with self-loathing. The withdrawal was from methadone, which I was prescribed and taking under a doctor’s supervision. Methadone has been the gold standard of care for pregnant people with opioid dependencies since the 1960s. I did the right thing. Still, watching my newborn daughter go through withdrawal was excruciating. Unfortunately, the treatment she and I received at the hospital—after that initial congratulatory applause—did not make the experience easier.

    My daughter’s level of discomfort was rated using the same system used by the majority of U.S. hospitals. It’s called the Finnegan Neonatal Abstinence Scoring Tool (though its inventor, Dr. Loretta Finnegan, notes with a laugh that her name was tacked onto it later without her knowledge). It consists of a comprehensive list of observable newborn withdrawal symptoms. Hospital staff, usually treating nurses, observe the babies every four hours and tally up the number of listed symptoms they observe. Each symptom is a point, and the overall score for that observation period is used to determine how to move forward with treatment. Usually a score above eight means the infant should begin an opiate wean, or have his dose raised if he has already been started on medication.

    The scoring system is the product of meticulous observations recorded by Finnegan in the early 1970s, when babies were dying from opioid withdrawal simply because nobody knew how to define and treat it. But in 2014, when my daughter was subject to it, and when her scores caused her to be sent to the Neonatal Intensive Care Unit (NICU) to be medicated with titrated doses of morphine for over a month by staff who were less than welcoming to me, I resented the Finnegan Score. Other methadone and buprenorphine-dependent mothers whom I have spoken with have related similar discontent with the system. Usually, the complaints center around variability between the way that different nurses score the babies, or at having their babies sent to the NICU. It turns out, the way some of these hospitals use the scoring system is not in keeping with best practice, according to its creator.

    Loretta Finnegan, who is now the Executive Officer of the College on Problems of Drug Dependence, says that inter-rater reliability is key to correct usage of the tool, and recommends that hospitals which use it conduct re-orientations “a minimum of every six months.” She also doesn’t believe that the modern NICU set-up is appropriate for babies who are experiencing NAS without other complications. In fact, she says that “the NICU is the worst place for these babies,” because of the overstimulation caused by the noise and bright lights. Finnegan puts out a training manual, and gives recommendations for the care of infants include swaddling, non-nutritive sucking, decreased stimulation, and plenty of access to mom. When she was doing her clinical work in Philadelphia, she says they “had [their] moms come in every day,” and that “compassionate care for the mothers” was crucial to positive outcomes for the babies. If I had received treatment more in line with Finnegan’s protocols, I probably would have resented the scoring system—and my daughter’s extended hospital stay—a lot less, and I suspect that other mothers would agree.

    But besides providing better training to staff who are using the current standard NAS protocol, there are a couple of promising new tools for NAS that could help decrease hospital stays for infants, and promote better trust between parents and hospital staff. One of these tools, developed by Matthew Grossman, M.D., an assistant professor of pediatrics at Yale School of Medicine, is called “Eat, Sleep, Console.”

    Renee Rushka gave birth to her daughter in July 2018, while taking methadone prescribed for opioid addiction. Her daughter was treated for NAS at Danbury Hospital in Connecticut. She says that they used the Finnegan NAS Scoring System to assess her baby, but they also performed another form of assessment. Although she says she never heard the term “Eat, Sleep, Console,” and she can’t remember the exact measures, she describes a protocol that sounds very much like the system first developed and researched by Grossman in 2014.

    Grossman’s system essentially measures exactly what the name implies—whether the baby is eating at least one ounce of milk, whether the baby can sleep for an hour straight, and whether she can be consoled within 10 minutes of becoming fussy. The protocol suggests maternal contact and non-pharmacological approaches whenever possible. Pharmacological intervention is indicated based on the infant’s level of functioning and comfort, rather than with the goal of reducing all withdrawal symptoms. According to Grossman’s trial conducted at Yale New Haven Children’s Hospital, only 12% of infants required morphine therapy, as opposed to 61% using the Finnegan system (though the study does not tell us whether they used it the way Finnegan herself recommends), and it significantly reduced the length of stay for many of the babies.

    Rushka reports that her experience with the combined Finnegan and ESC-like approach was extremely positive. She brought her baby home, healthy, after five days, having required zero medication intervention. She also notes that she did not feel judged by the staff, and even recalls receiving compliments and affirmations about her recovery—pointing toward the compassionate, inclusive approach that both Finnegan and Grossman deem crucial to the care of opioid-dependent infants. Finnegan expresses concerns that inter-rater reliability might also be an issue should ESC become more wide-spread, in part because of the design simplicity. But she’s definitely in favor of various treatments being designed for NAS. “In most diseases there are many ways to treat them,” she notes, adding, “I just need to see more proof [that ESC works.]”

    Another promising new tool for treating NAS takes a surprising form. It’s a crib called SNOO, whose designer was not initially thinking about NAS at all—his goal was to reduce Sudden Infant Death Syndrome (SIDS). Pediatrician Harvey Karp says that the crib can not only sense when a baby is in distress, but also what level of distress he’s experiencing—and will rock and emit soothing sounds to help calm the baby, similar to a human caregiver, but all while the real caregiver gets some much-needed rest. Karp says that “NAS babies are more skewed to the irritable side,” then, “the more sciencey way of saying it is that they have poor state control…basically you take a child with terrible state control and give them the rhythmic stimulation they need to get down to a calmer state…it’s so important to our neurology that even adults calm down this way; it’s not an accident we fall asleep in planes, trains, and cars. It’s an echo to this ancient, ancient response to the normal womb sensation.”

    Currently, Mark Waltzman, Chief of Pediatrics at South Shore Hospital in Boston, is conducting a study to test the efficacy of the SNOO in reducing distress in babies with NAS. He’s also using Grossman’s Eat, Sleep, Console tool to assess the babies’ level of discomfort. Waltzman’s study is still enrolling, so there’s no data available yet, but he is hopeful that SNOO will offer a relatively simple, non-pharmacological approach to treating the discomfort associated with NAS.

    It has been almost five years since my elder daughter was treated for NAS. Mothers across the country still report complaints similar to the ones I had then—but there are also moms like Rushka who are finding community and support in the hospitals where their babies are being treated. Regardless of the outcome of Waltzman’s SNOO trial, or further testing for Grossman’s Eat, Sleep, Console tool, the fact that this kind of diverse attention is being paid toward NAS—and alongside it a resurgence of the compassion toward the mothers that Finnegan first championed in the 70s—gives me a sense of much-needed hope. Maybe attitudes about addiction are making a positive shift within the medical community. Maybe, in the future, experiences like mine will be obsolete, and all opioid-dependent mothers and infants will have the compassionate care and affirmative respect enjoyed by Rushka and her daughter.

    View the original article at thefix.com

  • An Open Letter to Addiction Treatment Providers

    An Open Letter to Addiction Treatment Providers

    There’s something wrong with addiction patients feeling the need to ask for medical advice from their communities because they don’t trust their providers.

    Maybe you’re a psychiatrist. Maybe you’re a dosing nurse at a methadone clinic. Maybe you’re an inpatient counselor. Maybe you work in an emergency department, or you’re an OBGYN; maybe you don’t specialize in addiction at all, but you regularly come into contact with people who are struggling with the condition. If you’re a medical professional, and all or some of your clients have a substance use disorder (SUD) diagnosis, this letter is for you.

    I am a person in remission from a substance use disorder. I’m here to tell you that addiction patients need you to understand our condition. That sounds basic, I know. It is basic. But here’s the thing: too many of you don’t understand. I’m not trying to attack you. I’m not saying you’re all misinformed. There are unquestionably many caring and well-informed providers doing excellent work in this arena. But it’s also true that enough of you are misinformed to be causing major problems for SUD patients. And that needs to change. Like yesterday.

    Right now my husband is white-knuckling his way through methadone withdrawal while his clinic works on getting him safely back on his therapeutic dose after one of you, a behavioral health doctor, rapidly dropped him 100 milligrams without consent, for no medical reason, while he was in the hospital for mental health reasons. And in 2014, my newborn daughter went through over a month of neonatal withdrawal from my prescribed methadone, which could have been prevented or lessened if my pre- and postnatal providers had made a few small changes to their protocols; sadly, this kind of medical treatment is still provided to mothers and infants across the country.

    Every damn day SUD patients crowdsource medical information from social media communities and online forums, often due to mistrust in the medical community when it comes to addiction care.

    Sara E. Gefvert, a certified recovery specialist who runs the Methadone Information Patient and Support Advocacy (MIPSA) Facebook group, says that she created MIPSA because she saw members of other communities receiving unreliable responses to medical questions. “Many MAT sites and groups I saw were not monitored frequently for correct and accurate content or were only adding to the misinformation and stigma that persons in recovery face, especially being on medication-assisted treatment.”

    In just one day, questions asked in five separate addiction treatment-focused Facebook groups included: 

    What kind of pain relief options are available during labor while I’m on buprenorphine?
    Should I raise my methadone dose if I have psychological but not physical cravings?
    Is it normal to lose my sex drive while on methadone?
    Am I still in recovery if I drink alcohol occasionally?
    Can cold-turkey opioid withdrawal kill you?
    Is it safe to detox while pregnant?
    Can you combine buprenorphine and methadone?
    Should my methadone be making me nod out?

    And others along those lines.

    These are all medical questions with real world consequences—some dire. The answers to these questions should be coming from trusted providers with medical expertise. Sure, people crowdsource medical information from the internet all the time, but it’s usually about pretty mild concerns, or trying to squirrel out whether they should go to a doctor. On the other hand, these addiction specific questions are often accompanied by complaints that the patient couldn’t get a straight answer from her treatment provider, or that the information she received was the opposite of what she read in a research study or an online article. There’s nothing wrong with people seeking community input on issues they’re facing, especially when the answers are reviewed by knowledgeable and professionally trained administrators like in the MIPSA group.

    There is, however, something wrong with addiction patients feeling the need to ask for medical advice from their communities because they don’t trust their providers.

    This seems to be an especially prevalent issue for medication-assisted treatment (MAT) patients. I was on methadone for about a year in 2013 and 2014, and on buprenorphine from 2014 to June of 2018 (with a short break of about five months in 2016). Before starting methadone, I was actively addicted to heroin for close to five years. In all of that time, I heard a lot of different things from a lot of different doctors, nurses, counselors and detox staff in virtually every region of the country. For example:

    Buprenorphine is only good as a detox aid.
    Buprenorphine works best as a long-term treatment.

    Methadone is more addictive than heroin.
    Methadone creates a dependency but effectively treats addiction.

    Breastfeeding while on methadone is unsafe.
    Breastfeeding while on methadone can help ease neonatal withdrawal.

    I can’t count myself sober if I take medication
    I’m at an increased risk of relapsing and overdosing if I detox.

    Addiction is a disease.
    Addiction is a spiritual malady.

    How was I supposed to tease out the truth from all that?

    With all the confusing and contradictory information that patients receive about addiction, it would be easy for someone to assume that the medical science is still out. In reality, there’s quite a lot of straightforward, peer-reviewed data about substance use disorders. Frankly, there is no excuse for a medical provider to ignore these facts. For example, decades of research have shown that methadone (a long-acting opioid agonist) and buprenorphine (a partial opioid agonist), help deter opioid misuse, decrease the risk of fatal overdose, and may help to correct neurochemical changes that took place during active addiction.

    To quickly address some of the other misinformation I’ve encountered:

    • Both methadone and buprenorphine treatment are appropriate, and in fact designed, for long-term use. Patients who choose to taper from these medicines can do so safely, but there is no generalized medical reason why someone with an opioid use disorder should be forced off either medication.
    • Breastfeeding while on methadone or buprenorphine is considered safe as long as the mother is not using other substances.
    • If a patient is using these medicines as prescribed and is not using other substances in a compulsive manner, they are in remission from their substance use disorder. In other words, they’re sober (though defining oneself with the term “sober” is a personal choice).
    • Addiction is medically defined as a disease. Which means that the onus is on our medical providers to stay informed about the science of this disease.

    Ultimately, you can’t be held responsible for everything your patient does. But you do have a responsibility as a treatment provider to give your patients accurate and informed medical advice.

    According to the Substance Abuse and Mental Health Administration (SAMHSA), about 20 million adults in the United States have a substance use disorder. So we’re not talking about some rare condition that only a handful of specialists can be reasonably expected to understand. This is a common, treatable disorder with a robust body of solid research behind it. You need to read that research. You need to stay informed. If you don’t have an answer to a patient’s question, you need to refer them to an accessible colleague who will. You took an oath to do no harm. Staying informed about addiction medicine is part of keeping that oath.

    Sincerely,

    Elizabeth Brico

    View the original article at thefix.com

  • 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

  • Should You Breastfeed Your Baby If You're on Methadone?

    Should You Breastfeed Your Baby If You're on Methadone?

    My daughter was born with neonatal abstinence syndrome but I was not allowed to nurse or have her in the room with me; the hospital staff said the methadone in my breast milk could be dangerous. They were wrong.

    Earlier this summer several news outlets reported on the death of an 11-week-old infant in Philadelphia by what appeared to be a drug overdose. The mother, who has been charged with criminal homicide, blamed the drug exposure on her breast milk. Although an autopsy revealed that the infant’s drug exposure also included amphetamine and methamphetamine, many news outlets chose to focus on the fact that the mother was a methadone patient. The death of an infant by drug exposure is unquestionably terrible; unfortunately, misleading articles make what is already a tragedy even worse by insinuating or directly stating that the methadone content in the breast milk was involved in the infant’s death.

    Stigma around methadone use in the United States has a long shadow. Prescribed primarily to treat opioid use disorder (but also sometimes for pain management), methadone is a long acting opioid that builds in the patient’s bloodstream to create a stable, non-euphoric equilibrium when used correctly. It is a highly effective form of both addiction treatment and harm reduction, shown to reduce overdose deaths by 50% or more. Unlike short acting opioids like heroin or morphine, methadone prevents patients from experiencing the physical chaos of sedation and withdrawal, and can help re-balance neurochemical changes that take place during active addiction. For decades, methadone has been considered the gold standard of treatment for opioid use disorder, including during and after pregnancy.

    But in spite of the demonstrated benefits of methadone and its pharmacological differences from commonly misused opioids, it has, for many years, acquired a popular status as “legal heroin.” Social media is flooded with memes mocking methadone patients or complaining that they don’t deserve “free methadone” when other drugs cost money (in fact, methadone has a price tag like any other medication). Even other people in recovery or the throes of active addiction disparage methadone, sometimes referring to it as “liquid handcuffs” because of the stringent regulations requiring daily trips to a clinic during the first several months of treatment.

    This stigma leaks into every aspect of patient care. For me, it prevented me from seeking treatment for years. I was terrified to get on methadone. Who would volunteer to be “handcuffed” by a treatment system? But when I learned I was pregnant, my doctors urged me to get on methadone. They said that attempting to withdraw from heroin would be dangerous for my developing baby, and continuing to use would be even riskier.

    I was reluctant, but I enrolled in a methadone maintenance program as my doctors advised. Because of that, I had a healthy, full-term pregnancy. But at the Florida-based hospital where my daughter was taken after a speedy, unplanned home birth, I was not allowed to breastfeed. My daughter suffered neonatal abstinence syndrome (NAS), a condition caused by opioid withdrawal that occurs in some babies whose mothers used methadone or other opioids while pregnant; she was dosed with morphine to wean her down from the methadone she received in utero, and the hospital staff told me that adding my methadone dose via breast milk could be dangerous. Because of that, my milk production dwindled, and my daughter—who stayed in the hospital over a month—never learned to properly latch. After she came home, she suffered colic, constipation, and sleep disturbances as we worked through various formulas trying to find one that was gentle on her stomach.

    But these negative ideas about methadone distribution in breast milk are flat out wrong. We know that methadone is a highly potent, long-acting opioid that is extremely dangerous if given to infants and children directly. No amount of methadone syrup should be administered to an infant or child by a parent or caregiver without physician approval. But studies have demonstrated that the amount of methadone that gets passed into breast milk is negligible, and will not harm an infant, even a newborn. A 2007 study of methadone-maintained mothers in addiction recovery found that methadone concentrations in breast milk remained minimal in the first four days postpartum, regardless of maternal dose, time of day after dosing, and type of breast milk being expressed. The daily amount of methadone ingestible by the infants did not rise above .09 mg per day. To help prevent even that slight fluctuation, John McCarthy, a practicing and teaching psychiatrist who has treated opioid-dependent pregnant and postpartum women for over 40 years, suggests splitting nursing mothers’ methadone doses in two—a measure that should have begun during pregnancy to help minimize the risk of NAS. “It’s not dangerous to nurse on a once a day dose, but it’s not the best way to give the medication. The baby should be given a smooth level of methadone.”

    Some people believe that breastfeeding an infant with NAS while on methadone will help decrease withdrawal symptoms by providing a minute amount of the same drug from which the infant is withdrawing. According to experts like Jana Burson, a doctor specializing in the treatment of opioid addiction, this belief is also false: “some mothers erroneously think their babies won’t withdraw if they breastfeed—that’s wrong. There’s not enough methadone in the breast milk to treat NAS.” Of course, breastfeeding a child who experiences NAS is beneficial, both because of the health benefits of breast milk, and because maternal contact is important for babies in distress. “Breastfeeding will help in the general sense that babies like to breastfeed and it’s calming, but not because babies are getting methadone in the breast milk.”

    Sandi C., a methadone-maintained mother based out of Massachusetts, breastfed her son for two and a half years, and plans on breastfeeding the baby she is currently expecting. Like me, Sandi was addicted to heroin when she learned she was pregnant. She began on buprenorphine, a partial-opioid agonist used similarly to methadone, and switched to methadone partway through her pregnancy. But her postnatal experience was different than mine.

    “I’m really fortunate that my area is really encouraging of breastfeeding,” says Sandi. “Actually, I wasn’t sure if I could breastfeed and [my doctor] said ‘definitely breastfeed, we encourage it.’” Like my daughter, Sandi’s son was diagnosed with NAS. But instead of being sent to the Neonatal Intensive Care Unit (NICU), her son was allowed to be in the hospital room with her, where Sandi could hold and breastfeed him as much as he needed. Her son was released after just two weeks, less than half the time my daughter spent in the NICU at our hospital in Florida. She continued to breastfeed at home until he was over two years old.

    “He never got sedated,” she recalls. “Everything was fine.”

    Just because methadone is safe for breastfeeding moms doesn’t mean the same is true for other drugs. If the Philadelphia baby’s death was in fact caused by what many outlets have called “drug-laced breast milk,” it would have been due to the amphetamines, not the methadone. Methamphetamine breast milk exposure has not been studied as extensively as methadone, but current recommendations are that lactating women should wait 48 hours after their last use of methamphetamine before resuming breastfeeding. Experts like Burson and McCarthy agree that mothers on methadone maintenance who are not using other substances can safely breastfeed. “All of the major medical groups recommend it,” Burson said, adding, “even on higher doses they all recommend that mothers on methadone breastfeed.”

    View the original article at thefix.com

  • 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

  • "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

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

    SAMHSA Voice Awards Honor Walter Ginter’s MARS™ Project

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • Purdue Pharma Reportedly Worried About Losing Money To Rivals Amid Oxy Panic

    Purdue Pharma Reportedly Worried About Losing Money To Rivals Amid Oxy Panic

    A new report details the early rivalry among opioid drug makers who sought to follow in the profitable footsteps of Purdue Pharma.

    As Purdue Pharma came under fire from federal investigators for unscrupulous advertising practices, the company was reportedly concerned about losing market share to other drug manufacturers, according to internal documents. 

    “Market research as well as reports from the sales force indicates that methadone use is increasing in both the management of cancer pain and non-malignant pain due to its low cost,” an internal Purdue memo from 1999 said, according to a report by Kaiser Health News. 

    OxyContin was brought to market in 1996, and by 1999 Purdue was planning to expand sales into the non-cancer market, setting the stage for marketing practices that would later land the company in lawsuits across the country for false and misleading advertising.

    As part of the planned expansion, Purdue reportedly analyzed the market for pain medications in internal documents. 

    According to these internal documents, one competitor that Purdue was most concerned about was Janssen Pharmaceuticals, the maker of Duragesic, a fentanyl patch.

    Purdue noted that Janssen, a part of Johnson & Johnson, was making “slow but steady” progress in marketing the patches.

    In fact, Janssen tripled its advertising spending between 1998 and 1999 as regulators and clinicians first became aware of the dangers of OxyContin. Marketing materials from that time included the claims that the patch “has less potential for abuse than other currently available opioids.”

    By 2000, the Food and Drug Administration noted that Janssen had disseminated “false or misleading” advertising, including that safety claim.

    Despite Purdue’s own claims about the safety of its drugs, the company was allegedly quick to acknowledge the trouble that the competition was in. 

    “It has been reported that Janssen sales representatives are using improper techniques to capitalize on the negative press surrounding OxyContin tablets and the issue of abuse and diversion,” Purdue marketing materials noted in 2002. 

    At the same time, Purdue noted that methadone was claiming market share for pain patients, despite the 2006 FDA warning of deaths and dangerous side effects in “newly starting methadone for pain control and in patients who have switched to methadone after being treated for pain with other strong narcotic pain relievers.” 

    In a statement to Kaiser Health News, Janssen said that the marketing procedures for the fentanyl patch were “appropriate and responsible,” and that the company “acted quickly to investigate and successfully resolve FDA’s inquiries.”

    Janssen stopped “actively marketing” Duragesic in 2008. 

    Purdue has also denied false or misleading advertising, telling Kaiser, “We vigorously deny these allegations and look forward to the opportunity to present our defense” in a series of lawsuits. 

    View the original article at thefix.com

  • Man Sues Prison For Addiction Medication Access

    Man Sues Prison For Addiction Medication Access

    The 30-year-old at the center of the suit started using painkillers as a teen and was prescribed Suboxone five years ago.

    Last week, the ACLU sued Maine’s prisons and one county jail over their continued refusal to give addiction medication to inmates.

    Zachary Smith, who is scheduled to go to prison in September, filed a federal lawsuit targeting the Aroostook County Sheriff’s Office and Maine Department of Corrections, claiming violations of the Eighth Amendment’s ban on cruel and unusual punishment and also of the Americans with Disabilities Act. 

    “Denying needed medication to people with opioid use disorders serves absolutely no good purpose, and actually undermines the important goal of keeping people off of opiates,” ACLU of Maine legal director Zachary Heiden said in a statement. “Going to prison shouldn’t be an automatic death sentence, but that is the chance we take when we cut prisoners off from adequate medical care.”

    Failure to provide medication can lead to painful forced withdrawal and increase the risk of overdose. 

    The 30-year-old at the center of the suit started using painkillers as a teen and was prescribed Suboxone five years ago. “If I did not get on buprenorphine I’d probably be dead,” he told the Bangor Daily News. 

    He was denied access to his medication last year during a short stint in the county jail. So, once he knew he had prison time in his future—a nine-month sentence for domestic assault—Smith and the ACLU wrote a letter to the state’s correctional system requesting that he continue to receive his medication behind bars.

    When they got no response, they filed suit.

    Although medication-assisted treatment (MAT) is considered the standard of care on the outside, many county jails and state prisons refuse to provide it. In Maine, according to the Bangor paper, only Knox County Jail provides Suboxone, though the Penobscot County Jail offers another alternative, the injectable treatment Vivitrol. 

    Prison officials declined to comment.

    “If we’re being sued, I can’t speak about that,” Maine Department of Corrections Commissioner Joseph Fitzpatrick told the Press Herald. “Once they’ve filed, I’m not able to comment.”

    Though the legal action could be ground-breaking for Maine prisoners, it’s not the first of its kind. In June, the ACLU of Washington launched a class-action suit against a jail there for denying inmates access to methadone and Suboxone as part of a policy the organization called “harmful, unwise and illegal.” 

    “The ADA prohibits singling out a group of people because of their disability and denying them access to medical services to which they would otherwise be entitled,” the organization wrote at the time. “The Whatcom County Jail has a policy of denying people with (opioid use disorder) the medication they need while providing necessary medication to everyone else, which is discrimination.” 

    Two months earlier, advocates in Massachusetts publicly pondered a lawsuit there, even as federal prosecutors announced an investigation into whether failure to provide addiction medications is a violation of the ADA. 

    View the original article at thefix.com