Tag: methadone

Mom Charged with Homicide, Accused of Causing Infant's OD Through Breast Milk

An autopsy found methadone, amphetamine and methamphetamine in the 11-week-old’s system.

A Pennsylvania woman was charged with homicide after her infant son allegedly died of a drug overdose from drinking drugs through his mother’s breast milk.

Samantha Jones was charged Friday and held on $3 million cash bail for the tot’s April death after an autopsy found methadone, amphetamine and methamphetamine in the 11-week-old’s system, according to Bucks Local News.

At the time, the 30-year-old New Britain Township woman was prescribed methadone to help kick a painkiller addiction. She’d been breastfeeding the boy until three days before his death, when she switched to formula, she allegedly told investigators.

But around 3 a.m. the morning of April 2, the baby started crying and Jones decided to breastfeed, according to court records. It was late and she was tired, and she didn’t want to go downstairs for a bottle, she allegedly told investigators.

She wasn’t sure whether the child actually fed at all before she fell back asleep, she said. But when her husband woke up for work three hours later the child was crying, and his mother was in the other room. So he made the boy a bottle of formula, then Jones fed him, putting the child back to bed before falling asleep again herself.

When she woke up an hour later, the child was white, with bloody mucous dripping from his nose.

Jones shouted for her mother, who called 911 and tried saving the child with CPR. First responders rushed the baby to the hospital where he was pronounced dead an hour later in the emergency room.

The jailed mother also has a 2-year-old son, who is with his father, according to Jezebel. Jones is due back in court on July 23, though her lawyer argued for lower bail in the meantime, saying the death was accidental and she’s not a flight risk. Prosecutors asked for no bail at all, citing the possibility of a mandatory life sentence if the charge is upgraded from homicide to murder.

Although prosecutions for drug-laced breast milk appear to be rare, they’re not unprecedented. In 2014, a South Carolina mom was sentenced to 20 years behind bars after her baby girl died of a morphine overdose from breastfeeding.

View the original article at thefix.com

17 July 2018
Dope Sick: Breaking Down Opioid Withdrawal

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

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

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

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

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

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

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

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

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

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

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

View the original article at thefix.com

10 July 2018
Medication-Assisted Treatment Saves Lives But Is Severely Underutilized

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

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

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

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

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

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

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

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

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

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

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

View the original article at thefix.com

22 June 2018
Using Marijuana to Treat Opioid Addiction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

View the original article at thefix.com

12 June 2018
Medical Schools Focus On Addiction Medicine Training In Light Of Opioid Crisis

Medical students are seeking out addiction medicine training and schools are making adjustments to fulfill their needs.

The opioid crisis is changing the way some medical schools are approaching training, according to the San Francisco Chronicle.

At the University of California, San Francisco (UCSF) School of Medicine, this is being done by implementing a yearlong fellowship in addiction medicine, the Chronicle reports.

The fellowship program is funded by the city and county of San Francisco and works to incorporate addiction medicine into overall medical training, rather than just psychiatric medicine.

Dr. Hannah Snyder is one of the fellowship participants and is expected to complete the program this month.

“I started learning about treating addiction and realizing we had highly effective medications to treat addiction,” Snyder told the Chronicle. “I got really excited about that because there’s a way to prevent people from having those complications in the first place.”

According to the Chronicle, Snyder works at Ward 93 as part of the fellowship. Ward 93 is a methadone clinic at San Francisco General Hospital. There, she meets with patients to discuss treatment.

Snyder is also assisting other U.S. hospitals with new protocols for treating those with opioid use disorders. The Chronicle states that this “primarily means getting patients started on buprenorphine or methadone—two long-term prescription medications for opioid-use disorder—when they come to the hospital after overdosing or having severe withdrawal symptoms.”

The fellowship at UCSF School of Medicine isn’t the only one of its kind. In fact, since 2011, 52 U.S. addiction medicine fellowships have been accredited by the Addiction Medicine Foundation.

Fellowships are typically completed by doctors who have already finished their three- to six-year residency in a specific area and wish to take part in more training in a subspecialty, the Chronicle notes. It wasn’t until 2016 that addiction medicine was recognized as a subspecialty.

Dr. Anna Lembke, a psychiatrist at Stanford School of Medicine, is working to add addiction medicine courses to Stanford’s curriculum.

“It’s the dawning awareness within the medical community that addiction in general is a growing problem in our patient population,” she told the Chronicle. “The opioid epidemic has put it front and center in a way that gives people permission to focus on it. Suddenly there are research dollars available to study it, and federal grants. It has momentum it never had before.”

At Stanford specifically, students are the ones pushing for additional education in the area. The Chronicle states that Alexander Ball, a fifth-year medical student, partnered with Lembke to create lectures centered around pain and addiction for first and second-year students. Some were incorporated into courses this year, and more will be next year, the Chronicle notes.

The lectures concentrate on opioid prescribing, administering buprenorphine and other medications and motivational interviewing, which is a counseling technique.

At UCSF, buprenorphine training has been offered as optional for residents and faculty since 2011, the Chronicle reports. Buprenorphine is used to treat opioid dependence and is a Schedule III narcotic, meaning doctors have to complete eight hours of training and get a waiver in order to prescribe it.

According to Dr. Scott Steiger, associate professor of medicine and psychiatry at UCSF, the buprenorphine training is drawing more and more medical professionals.

“Last year, we had to turn people away because we had reached our capacity for the room, which was 77,” Steiger told the Chronicle. “The next one (this spring), we had it in an auditorium to fit all the people. It’s telling that people are trying to get as much training as they can.”

View the original article at thefix.com

5 June 2018