Tag: opioid use disorder

Opioid Crisis “More Deadly” Than AIDS Epidemic, CDC Director Says

CDC director Dr. Robert Redfield discussed the parallels between the crises and his plans to combat opioids during a recent interview.

Robert Redfield has only been the director of the Centers for Disease Control and Prevention (CDC) since March, but in that time he has made his stance on the opioid crisis known.

Redfield, 66, tells The Washington Times that the opioid crisis will be worse than the HIV/AIDS epidemic of the 1980s, which he was also involved in fighting. “I would say the opioids-fueled epidemic is clearly already more deadly than the AIDS epidemic ever was,” he told the Times.

According to Redfield, the CDC is working with pharmacies and states to keep up with the opioid epidemic in real time and collect overdose death data as quickly as possible. He says the goal is to release the figures for 2017 in the fall of 2018.

The most recent data, from 2016, has overdose deaths at 42,000. The Times notes that some researchers predict that the newest data will show that overdose deaths have passed the 48,000 HIV/AIDS deaths in 1995 which was the most fatal year of that epidemic.

Redfield says that when it comes to annual rates, drug overdose deaths have already overtaken those of the HIV/AIDS crisis. “If you look at all overdose deaths, not just opioids deaths, we’re over 60,000 now,” he told the Times.

The number of deaths isn’t the only similarity Redfield sees between the two epidemics. He tells the Times that with both, there have been empathy gaps, meaning people initially saw the diseases as something that happened because of dangerous behavior.

“It’s a medical condition. It’s not a moral choice,” Redfield told the Times. He added that as with the HIV/AIDS crisis, combating the opioid crisis will take new scientific innovations and “public health efforts.”

In June, Redfield told the Wall Street Journal that the CDC would be increasing efforts to fight the opioid crisis. He stated the organization would be developing new guidelines for opioid prescriptions for acute pain, as well as introducing a new system to track emergency department data.

Redfield also told the Wall Street Journal that he has personal experience with the opioid crisis, as a close family member had struggled with opioid use. “I think part of my understanding of the epidemic has come from seeing it not just as a public-health person and not just as a doctor,” he told the Wall Street Journal. “It is something that has impacted me also at a personal level.”

Redfield also called stigma the “enemy of public health” and stated that it’s vital to find “a path to destigmatize” opioid use.

“We were able to do it to some degree for HIV, and I think pretty successfully, but it’s not over,” he said.

View the original article at thefix.com

10 July 2018
Kids, Parents & Grandparents All Face Strain Of Opioid Crisis

One expert estimates that for every child in foster care due to a parent’s addiction there are 18 to 20 children who have been informally taken in by family members.

When parents are living with opioid addiction—or even trying to establish their lives in recovery—it can take a toll on the whole family, from kids to grandparents, as roles are redefined.

Donna Butts, the executive director of Generations United, a Washington, D.C.-based organization, has seen how families have coped with drug epidemics fueled by cocaine or meth. This time, she told CBS News, feels different.

“With the opioid epidemic, it seems so much more severe and, in some ways, more hopeless,” she said. “Which is why I think the grandparents and other relatives that are stepping forward are playing such a critical role because the hope is with the children.”

Oftentimes family members will step up to care for the children of people who are addicted without going through the formal foster care system, making it difficult to get an estimate on how many families have been rearranged because opioid addiction.

The foster care statistics themselves are overwhelming; Butts estimates that for every child in foster care because of a parent’s addiction there are 18 to 20 children who have been informally taken in by family members.

This has financial implications for the family member taking responsibility for the children, usually the grandparents. Twenty percent of grandparents raising grandchildren are living in poverty, and 40% are older than 60, which often means they are retired or semi-retired and living on a fixed income.

In addition, many children have been exposed to trauma, and their grandparents have been through their own traumatic experiences in seeing their child battle addiction.

“What they really need is to understand the impact of trauma on the children and try to help support them as they deal with that. Also, they need to have access to trauma-informed services, the services that can really help them to overcome what they’ve experienced,” Butts said.

However, she noted that having stable grandparents can really help children overcome the harms of having a parent battling addiction.

Even for parents who are working to get clean, keeping custody of the children can be challenging.

Jillian Broomstein, of New Hampshire, was in a methadone program when her son was born. Because the baby tested positive for opioids, he was taken by the Division for Children, Youth and Families. Broomstein had just one year to be off opioids and in a stable housing situation, or she would risk losing custody permanently, according to WGBH.

“I cannot stress enough that 12 months is a really short window for somebody who’s in early recovery,” says Courtney Tanner, who runs a New Hampshire recovery home where pregnant women and new moms can live with their babies while getting sober.

Situations like Broomstein’s are too common, she said.

“Here in New Hampshire what I have seen is a mom can be enrolled in this program and compliant in treatment and they are giving birth to a child and that child is still being removed and put into foster care.”

However, given the right resources, people in recovery are able to be reunited with their children.

“We see a lot of that,” said Dr. Frank Kunkel, the president and chief medical officer of Accessible Recovery Services. “We see a lot of people that spin out of control. They’re involved with the judicial system and all that. And we see grandma have the kids for a while. Then they’ll get back on track with things legally, and they’ll get on our medications, and they’ll get in seeing their therapist, and they’ll turn their life around. We see that every day.”

View the original article at thefix.com

10 July 2018
Colleges Create Opioid Response Plans Amid National Crisis

Even though overdose deaths on college campuses are relatively rare, many schools are still choosing to put a plan in place.

Colleges across the country are focused on responding to the opioid epidemic, even as opioid abuse and overdose deaths remain very rare on campus.

According to the American College Health Association, about 7 to 12% of the college-aged population use opioids for non-medical purposes, and about 2 to 3% use heroin. Comparatively, about 5% of U.S. adults report misusing opioids.

“Colleges definitely have an obligation to address the opioid epidemic as it manifests on their campuses,” Beth DeRicco, director of higher education outreach at Caron Treatment Centers, told Inside Higher Ed. “While a small percentage of students misuse pain relievers, the danger of opioids and the way in which use has risen makes it an incredible concern.”

In 2016, the American College Health Association released guidelines for how colleges can address opioids and opioid misuse.

Since then, campuses around the country have crafted their own responses to the opioid epidemic. At Bridgewater State University in Massachusetts, naloxone is now available in 50 defibrillator boxes around campus, including in all 11 dormitories. Asheville-Buncombe Technical Community College in North Carolina trained staff on how to recognize signs of opioid addiction, changed the locks on single-stall bathrooms and had school security officers begin to carry naloxone.

The University of Wisconsin Madison hired two substance abuse counselors and made an agreement with Walgreens to allow students to purchase naloxone.

At the same time, a 2016 survey of students at the University of Wisconsin Madison found that just 0.8% of the campus population, or 55 students, reported having any issues with substance use disorder. Of those, only 5.4%—less than 3 students—reported opioid misuse.

One reason opioid abuse may be lower on campus is that opioid addiction is most common among people who have less education, fewer job prospects and live in poverty. However, reaching out to students might help those in their personal lives who are not enrolled in college.

For example, Anne Arundel Community College in Maryland has not seen any opioid overdoses, according to Tiffany Boykin, dean of student engagement. However, in the surrounding county 37 people overdosed in the first quarter of this year, she noted.

“It may not be a student who is actively engaged in practicing. They may have a parent or spouse or a friend who is affected,” Boykin said. “The majority of our students are working professionals. When they’re trying to cope with a family member or a loved one who is affected, it’s very difficult for them to be successful.”

View the original article at thefix.com

3 July 2018
Link Between Heroin Addiction And Narcolepsy Examined

Could opiates be the key to treating the chronic sleep disorder?

Heroin could be the next big breakthrough in treating narcolepsy.

That’s one possibility raised in a paper published recently in the journal Science Translational Medicine, detailing new work probing the connection between addiction and the chronic sleep disorder.a

When narcoleptics nod off or lose muscle control, it’s caused by a lack of hypocretin in the brain. But to probe the connection further between the wakefulness-controlling chemical and the sleep disorder linked to it, researchers started studying the brains of dead narcoleptics. In the process, they stumbled across one brain that stood out.

It had a lot more hypocretin-producing cells than the other brains – and then the researchers learned that person had been addicted to heroin. So the scientists decided to start looking at the brains of people who had struggled with opioid use disorder before their deaths.

In the first four samples they studied, researchers found the opioid-addicted brains had an average of 54% more hypocretin-producing cells than regular brains.

“So it was natural to ask if opiates would reverse narcolepsy,” study co-author Jerry Siegel, a neuroscientist at the University of California Los Angeles, told Gizmodo.

The next step, Siegel explained, was trying a study with mice.

Over a two-week period, researchers drugged up narcoleptic mice with regular doses of morphine. The experiment upped their hypocretin-making cells, and the effect lasted for a few weeks after scientists cut off the dosage.

Basically, the researchers said, the opiates wake up dormant cells that make the necessary chemical.

“Understanding why opiates ‘awaken’ these cells is a task for the future,” Siegel said.

But other scientists voiced reservations about the work. Even if opioids turn out to be an effective treatment in humans, there are practical limitations.

“No mother of a 15-year-old with narcolepsy would sign onto us giving them several doses of morphine a day,” sleep expert Thomas Scammell of Harvard Medical School told Gizmodo.

Yet, the findings could herald new hope for addiction treatment. If opiates users have more neurons that make hypocretin, the researchers suggested, then maybe they need less.

“If chronic use of opioids is increasing hypocretin production—and the authors show that nicely—then that could amplify the rewarding aspects of these drugs, making addiction all that much worse,” Scammell said. “I think that’s actually the most interesting part of their research.”

View the original article at thefix.com

2 July 2018
"Recovery Boys" Doc Candidly Explores Addiction, Trauma & Rehabilitation

The documentary follows 4 young men who find support and relief through delving deep into their emotions in a rehabilitation setting.

The documentary Recovery Boys, which is screening on Netflix as well as in select theaters, focuses on four young men seeking recovery from opioid dependency at a rehabilitation facility in West Virginia.

Directed by Elaine McMillion Sheldon, whose Oscar-nominated short Heroin(e) looked at women on the front lines of the opioid epidemic in the Mountain State, Recovery Boys breaks from what The Guardian calls the established narrative about dependency, with poor people locked in a cycle of use and despair in impoverished areas.

Instead, Sheldon’s camera follows young men who find support and relief through delving deep into their emotions in a rehabilitation setting.

Recovery Boys unfolds over an 18-month period in the lives of four men in treatment at the Jacob’s Ladder rehabilitation program in West Virginia.

Each of the individuals struggled with not only opioid addiction but an array of related wreckage in their lives—Ryan, 35, told The Guardian that he went through “overdoses and car wrecks, and I was jailed a couple of times, but I didn’t want to give up.”

For 26-year-old Rush, his stint at Jacob’s Ladder was his tenth try at rehab. “I know what people want to hear, so it is really easy for me to skate through a program undetected,” he said in the film.

But through a program of long-term residential treatment focused on holistic therapy like meditation and daily responsibilities of farm work, the men learn to speak plainly and honestly about the pain of their emotional lives and the depths of their dependency. The benefits of such work are touched upon by a patient named Jeff, who said in the film, “Now that you’re not high, you come out and listen to all the birds. When you’re high, you don’t focus on shit like that.”

Anchoring the film on a message of hope and not despair was crucial for Sheldon, who said in a statement, “I make this film not to victimize, pity or make excuses for individuals, but to uplift the stories of people who are actively trying to make change, no matter how big or small.”

Her intention resonated with the film’s subjects, whose desire to portray their struggle with equal shades of dark and light has carried forward after the film’s completion. “My hope for this documentary is that it destigmatized the addict,” said Rush. “Everybody thinks of the guy under the bridge with the tattoos, the beard. We’re not just all bad people. We are good people inside.”

View the original article at thefix.com

29 June 2018
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

26 June 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
New York Plans To Allow Medical Marijuana As Opioid Alternative

“We looked at the pros, we looked at the cons, and when we were done, we realized that the pros outweighed the cons,” said one public health official.

The New York Department of Health will now recommend that the state allow adults to legally use medical marijuana instead of an opioid prescription, or if they are struggling with opioid addiction.

According to U.S. News, state commissioner Howard Zucker announced that the Department of Health will create regulations that allow patients who have been prescribed opioids or become addicted to the drug, to instead enroll in the medical marijuana program.

Dr. Zucker proposed that allowing medical marijuana use in place of opioids is backed by research which shows that having access to marijuana reduces opioid use and eliminates the risk of overdose, as well as the risk of addiction for those not dependent on the drug.

The New York Times pointed out that New York Governor Andrew Cuomo referred to marijuana as a “gateway drug” in the past and was not a supporter of its medicinal use.

Howard Zucker noted this change, stating in the NYT, “We looked at the pros, we looked at the cons, and when we were done, we realized that the pros outweighed the cons,” adding, “we have new facts.”

The NYT reported that the New York State Department will now be supporting the legalization of marijuana after the results of their state-sponsored study, backed by Governor Cuomo, were released.

Dr. Zucker was quoted in NYT, noting that the researchers behind the study were “experts from all across the government.” He said that the researchers had surveyed a broad array of issues, including age, and production and distribution, and decided that the legalization of marijuana in New York was workable.

News outlet WHEC noted that as of now, the New York medical marijuana program allows only 12 conditions (which must be certified by a physician) in those who use the program. These conditions included HIV/AIDS, and chronic pain conditions such as arthritis and cancer.

So far the regulations around the program have been strict: no smokeable forms of marijuana are allowed.

Elizabeth Brico wrote in a recent feature for The Fix that medical marijuana was an integral part of her abstinence from opioids.

“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.”

View the original article at thefix.com

20 June 2018
Generic Suboxone Strips Get The Green Light

The FDA’s move could mean wider availability and more competitive pricing for the popular addiction-fighting drug.

The FDA last week sparked a flurry of legal wrangling when it gave the go-ahead for two drugmakers to sell generic versions of Suboxone strips.

Part of an agency push to expand access to medication-assisted treatment, the move could open up the door to more competitive pricing for the popular addiction-fighting drug—but it also turns up the heat in an ongoing battle between drug companies intent on protecting profits.

“The FDA is taking new steps to advance the development of improved treatments for opioid use disorder, and to make sure these medicines are accessible to the patients who need them,” Commissioner Scott Gottlieb said in a statement. “That includes promoting the development of better drugs, and also facilitating market entry of generic versions of approved drugs to help ensure broader access.”

Currently, the brand-name under-the-tongue strips are sold by Indivior and cost around $200 per month without insurance. The British company is already embroiled in litigation over claims that it strategically worked to block competition from generic Suboxone in order to maintain soaring profits. At one point, the drug brought in $2 billion in sales a year, according to FiercePharma.

But now, the Pennsylvania-based drug maker Mylan and the India-based company Dr. Reddy’s both have the green light to bring out generic versions of the drug. Mylan did not immediately comment on the approval or its plans moving ahead, but the Hyderabad competitor issued a statement Friday praising the move and detailing its 2 mg, 4 mg, 8 mg and 12 mg formulations.

“With opioid addiction becoming increasingly prevalent in America, the full approval and launch of our generic equivalent of Suboxone could not have come at a more critical time to help patients,” said Dr. Reddy’s CEO Alok Sonig.

But Indivior took the matter straight to the courthouse and on Friday—just a day after the FDA announcement—the company won a temporary restraining order blocking Dr. Reddy’s from moving forward with its product release in light of ongoing patent litigation. A judge will decide on the path ahead at a June 28 federal court hearing in New Jersey.

Indivior CEO Shaun Thaxter put out a statement expressing surprise at his competitor’s decision to launch the generic drug—and promised to keep up the courtroom fight.

“We will continue to pursue all legal avenues, including an immediate injunction until the legal status of our intellectual property is confirmed by the courts,” he said.

And Mylan won’t necessarily have an easier time pushing out its generic formulation of the medication-assisted treatment, as the company had previously agreed to delay its generic launch until 2023.

Suboxone, which combines naloxone and buprenorphine to ease withdrawal and fight cravings, initially hit the U.S. market in 2002 as a pill. Five years later, Indivior announced plans to launch a sublingual film, a formulation that wouldn’t immediately have a generic alternative.

But in 2016, 35 states joined together to sue the company for anticompetitive practices. The states claimed that Indivior raised unfounded safety concerns to delay the FDA’s approval of the generic Suboxone tablet. Then, the company allegedly used those concerns to push strips over pills, a move that the states alleged was intended to prevent patients from taking generic versions of the pill.

The Federal Trade Commission (FTC) has since been investigating the company over antitrust claims, according to reports.

Whatever the legal drama surrounding the drug approvals, the FDA framed its announcement as an important step toward increasing access to lifesaving treatments and reducing stigma around medication-assisted treatments.

“The FDA is also taking new steps to address the unfortunate stigma that’s sometimes associated with the use of opioid replacement therapy as a means to successfully treat addiction,” Gottlieb said. “When coupled with other social, medical and psychological services, medication-assisted treatments are often the most effective approach for opioid dependence.”

View the original article at thefix.com

18 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