Answer Addiction

Tag: Suboxone

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • 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

  • New Dosage Strength Of Opioid Addiction Drug Approved By FDA

    New Dosage Strength Of Opioid Addiction Drug Approved By FDA

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • A Practical and Comprehensive Guide to Finding a Suboxone Clinic

    A Practical and Comprehensive Guide to Finding a Suboxone Clinic

    It took me 10 hours of phone calls, 20 voicemails, 3 chewed fingernails, and many packs of cigarettes before I found a Suboxone provider in my new town. This is the list I wish I had then.

    When I pulled a “geographic” a few years ago, leaving Portland for my home state of North Dakota, I underestimated the stress of starting over. In fact, stress isn’t a strong enough word to describe driving 1,300 miles with my recent ex-boyfriend in the passenger seat and the fear of restarting life without heroin; not to mention I had no full-time job prospect, no health insurance, no apartment, and very few of my possessions. I also had a unique fear that loomed over me like an ominous storm cloud: trying to find a new Suboxone* provider in a rural state. 

    It took me almost ten hours of phone calls, twenty voicemails, ten games of phone tag, three chewed fingernails, and many packs of cigarettes to find a clinic that would dispense the medicine I take to maintain my recovery. 

    Unfortunately, my situation is a common one. Despite our nation being in the throes of an opioid epidemic, finding a Suboxone provider is a widespread problem; only about one-third of addiction rehabilitation programs offer long-term use of methadone or buprenorphine (the active ingredient in Suboxone). And according to the National Alliance of Advocates for Buprenorphine Treatment (NAABT), only about half of all Suboxone providers are accepting new patients.

    Finding this life-saving medication shouldn’t be so hard. When you are committed to getting better, you shouldn’t have to worry about whether or not you’ll be able to find a clinic to dispense your medicine. A person with diabetes wouldn’t have to search hard to find insulin. So I’ve compiled a round-up of tips and suggestions. 

    This is the list I wish I’d had in early recovery:

    1. Find friends and family who are supportive of your Suboxone journey.

    2. Remember that your form of treatment is just as valid as all other types of treatment and recovery.

    Although Suboxone is a widely stigmatized and divisive medication in the recovery community, it has been shown to reduce opioid overdose death rates by 40 percent.

    3. Join online support groups and forums for people on Suboxone.

    Since I lived in a rural area, I couldn’t find any in person groups. So I joined secret social media Suboxone support groups on Facebook, recovery Reddit threads, and peer-support forums such as the Addiction Survivors website and Suboxone Talk Zone.

    4. Allow Plenty of Time to Research, Call, and Locate Providers.

    This was the most daunting and lengthy part of finding a new provider. Dr. Bruce Seligsohn has been a board-certified internist in Southern California for 30 years and practicing addiction medicine for 10 years. Dr. Seligsohn advises: “Patients really need to be very careful selecting a doctor if they have a choice. I would suggest that a patient looking for a new doctor do their due diligence and see what comes up online about the doctor.”

    I have compiled the most current resources available as of August 2018. See the sidebar for a sample phone script for calling providers.  

    Pros: Convenience, ease of navigation. You will be able to easily search for a provider based upon zip code, state, and the distance that you’re able to travel for a clinic.

    Cons: Out of date, inaccurate, not comprehensive. Be prepared for hours of phone calls depending on your location and financial situation. Not all providers are listed on the site. I also found that some of the clinics listed were not accepting new patients, had been closed, or had their numbers disconnected.

    Pros: Ease of navigation, instant results. Similar to the Suboxone manufacturer’s website, this is a good launching point for starting your search based upon zip code, state, and the distance that you’re able to travel. 

    Cons:  Not comprehensive and despite being a government resource, it is not up-to-date.

    Pros: Easy to use, more accurate. Treatment Match only connects you with providers in your area who are accepting new patients, reducing dead ends and calls to providers who aren’t accepting new patients or insurance. 

    Cons: Wait time/ lack of timeliness, not as many provider connections. This is not a straightforward directory and while it’s easy to sign up, you have to wait for a provider to respond to your email. The site claims that doctors respond 24/7, including weekends and holidays, but I only heard from them during normal business hours.

    • Yelp Reviews of Clinics

    Pros: Hearing directly from other patients about their experiences, easy to use, instantaneous, accessible.

    Cons: Questionable trustworthiness. Dr Seligsohn said: “Patient reviews can sometimes be very misleading.”

    • Calling Your Insurance Company

    Note: Insurance companies vary widely, so I can only speak from my experience. For example, in Oregon I was easily able to locate a Suboxone provider through my insurance company, but my North Dakota insurance did not provide referrals. They stated that their preferred addiction treatment was therapy and 12-step based treatment programs rather than medication.  

    Pros: Possible thorough list of doctors certified to prescribe Suboxone. Those Suboxone providers who accept your insurance are required to keep their information listed and up-to-date.

    Cons: Time-consuming and you have to deal with the hurdles of bureaucracy. Plus, some studies have found that only about 50% of eligible Suboxone doctors accept insurance. Some insurance companies like mine will allow you to submit an appeal asking them to cover part of your Suboxone visit or prescription, especially in rural areas. I saved all of my receipts and had my psychiatrist and Suboxone doctors write letters of support. After months of appeals, the insurance company agreed to cover part of each appointment. Each month I sent in a claim and receipt, and then I received a reimbursement check about a month later. 

    • Asking for a referral from your primary care provider, psychiatrist, or hospital.

    Another note: This is also difficult to give specific advice on because they vary depending according to location and providers, among many other factors.

    Pros: In-person support and assistance, more direct medical guidance and advice. 

    Cons: Stigma, lack of education about Suboxone, judgement, lack of timeliness. 

    5. Be Persistent!  

    6. Moving? Set Up an Appointment Months in Advance.

    Dr. Seligsohn advises finding a doctor and setting up an appointment prior to moving. “Patients need to find out as much information about how their perspective new doctor runs his practice…They also need to find out what the doctor’s philosophy is about long-term vs short-term Suboxone. If I was a patient I’d be reluctant to move to an area where there’s a shortage of Suboxone doctors.”


    Sidebar: Sample Phone Script for Calling Suboxone Providers

    I remember being so nervous, overwhelmed, and frustrated while also dealing with the symptoms of opioid withdrawal. Make sure you set aside a few hours for making calls in a quiet, safe place. I know some of these tips might seem like common sense, but when you’re in crisis and everything feels overwhelming, it can be a relief to have a guide.

    1. Introduce yourself and tell them that you’re looking for a suboxone provider.

    2. Where are you located?

    3. Are you accepting new patients?

    • If yes- when is your earliest available appointment?
    • If no- don’t hang up just yet! Ask: do you have a waiting list? Can you give me an estimate for how long it would take me to get an appointment? 
    • Do you have a cancellation list and if so, can you please add me to it?

    4. How often do I need to come to the clinic or office? 

    • Most clinics and offices require monthly or bi-monthly visits, but some require daily visits and dispense suboxone in a similar manner to methadone.

    4. Do you accept my insurance? 

    5. If the clinic does not accept insurance, how much does each appointment cost?

    • How much does the intake appointment/ first visit cost? This is an important question to ask because initial intake appointments can cost anywhere from $100 – $200 more than a regular visit.
    • Some clinics require pre-payment to reserve your appointment and prevent cancellation. Do you require a down payment before the appointment?
    • What forms of payment do you accept? (cash, credit, check?) Note that most clinics do not accept checks.
    • Do you allow payment plans or is payment due on the day of the appointment? A majority of clinics will not allow patients to do a payment plan and payment is due on the day of the appointment.
    • Are there any additional costs or required fees? Some charge additional fees for mandatory counseling, drug screens, etc.

    6. What are the counseling requirements?

    • You may be required to do weekly or monthly therapy groups with others at the clinic, and/or meet with an addiction counselor. This varies depending on how long you’ve been clean and your insurance coverage. (For example, one of my previous clinics had no counseling requirement, but my new clinic requires me to meet with an addiction counselor for one hour each month. Other clinics require weekly or bi-monthly group support meetings.)

    Quick Resource List:

    The Substance Abuse and Mental Health Administration (SAMHSA)’s Buprenorphine Treatment Practitioner Locator

    Suboxone Website’s Treatment Provider Directory

    Buprenorphine Matching System on Treatment Match on The National Alliance of Advocates for Buprenorphine Treatment (NAABT)

    Addiction Survivors

    Suboxone Talk Zone

      

    *(Writer’s Note: Suboxone is the most common brand-name buprenorphine medication, but this article is also applicable for patients seeking any form of buprenorphine treatment including: Subutex, Zubsolv, Bunavail, and Probuphine).  

    View the original article at thefix.com

  • Anatomy of a Relapse

    Anatomy of a Relapse

    When my father died, I hadn’t been to a meeting in over a year. I had no active knowledge of how to apply healthy coping mechanisms to a devastating situation so I just went back to what I knew: opioids and numbness.

    Two years ago I wrote a controversial feature for The Fix, “I Take Psychedelic Drugs and I’m in Recovery.” It was controversial in the sense that the response from the publication’s readers — many of whom have an obviously vested interest in topics related to addiction recovery — ranged from sarcastic, hyperbolic criticism to open-minded consideration, with some even condoning the perspective I was sharing.

    The reason I chose to write this honest, albeit uncomfortable “Part 2” of sorts, is to do what folks in certain recovery circles do best (when at their best): share experience, strength, and hope, so that whoever may be listening, reading, or watching may, at the very least, relate and ideally, be helped by it.

    Full disclosure: My name is not James Renato. It’s a pseudonym, adopted out of respect for the principle of anonymity in a 12-step offshoot group I am a member of. It’s also, of course, meant to protect myself from facing unnecessary personal backlash merely for engaging in public discourse.

    Now that I’ve successfully buried the lede, in the spirit of qualifying in the style of an Alcoholics Anonymous meeting: “here’s what it was like, what happened, and what it’s like now.”

    Last April, I ended a full-blown relapse of what previously was an opioid use disorder in remission. In other words, I’d started injecting heroin again eight months earlier, for the first time in over six years.

    It was the culmination of a tripartite experiment involving: firstly, a noble attempt to actively practice a program I helped form (namely, Psychedelics in Recovery [PIR]). Secondly, a misguided lack of acknowledgement that I was inviting a serious risk to my life by no longer practicing abstinence (not just from psychedelics). And lastly, a gradual ceasing of the daily commitment to personal growth in the form of meeting attendance, regular contact with a sponsor, associating with peers in recovery, and just continuing to work on improving the overall quality of my life and relationships with others.

    People in recovery continue to regularly engage in their program of choice because life is unpredictable, and the myriad tools we learn are not always the same ones we rely on for every situation. One day a simple phone call can be all that’s necessary to get ourselves out of “a funk.” Another day it’s hitting four meetings, extensively praying and meditating, and taking a newcomer out for coffee because we were just laid off from a full-time job and needed to avoid the danger that can come from “feeding the poor me’s.”

    In my case, when I stopped participating in my ongoing recovery process, I made an inexplicably impulsive decision to reintroduce opioids to my system. When the DEA announced that they were planning to classify kratom as Schedule 1, I purchased a kilogram from an online vendor for literally no good reason. Several weeks after I received the package of high potency kratom leaf powder (of the “super green vein” variety), I conducted a dose-response self-experiment. I have a history of progressing down the road of “continued use [of opioids] despite negative consequences” (the current best definition of addiction), and within a few months I developed a dependency and went through the entire kilo, despite attempts to reassure my partner that the amount I purchased was intended to last for years, and would only be used when absolutely necessary.

    Right around the time my supply ran out, a friend who had no idea of the habitual relationship I had with kratom use told me about another mild opioid sold on the supplement market called tianeptine sulfate. Tianeptine had undergone clinical trials as an opioid-based antidepressant in the 1990s but did not progress past the second of three phases required by the Food and Drug Administration (for unknown reasons). With the drug’s unscheduled status, enterprising entrepreneurs in the unregulated supplement industry capitalized on tianeptine’s acute, short-acting antidepressive effects at low doses, but savvy opioid connoisseurs discovered the euphoric high it brought on (also short-acting) at much larger doses.

    My kratom habit switched to tianeptine, in large part because of how disgusting I found the taste of the tea I made from brewing the leaf powder, and the hassle of masking the taste by encapsulating the amount I needed to take to reach the effects I preferred. In addition to the perfect storm of things perpetuating my now very active addiction, I’d even stopped attending PIR meetings, was becoming increasingly disillusioned with my graduate studies, and was now too ashamed to admit to anyone that I was seriously struggling.

    Then, tragedy struck. My father, a seemingly healthy 64-year-old on the verge of retirement, suffered a sudden, fatal heart attack on a scuba diving trip in the Caribbean. I was already treading on thin ice, and this kind of event is something I’d long heard people in 12-step meetings share reservations over in their commitment to recovery. But I hadn’t been to a meeting in over a year at this point, so I had no active knowledge of how to apply healthy coping mechanisms to a devastating situation. It was a situation that countless people have gone through, relying on their recovery program to help them navigate as safely as possible, but I’d learned from the opioids I’d been relying on that if I could just figure out how to stay numb 24/7, that’s all I needed to do.

    After the standard bereavement rituals of a wake, funeral, and burial at the family cemetery plot, which was actually a very supportive and comforting assemblage of close friends, loved ones, and long-lost acquaintances paying their respects, I ended up alone in a dangerous situation. I called my old dealer, whose number I still had memorized after over six years of no contact, and one night drove out to meet him just like old times. No need to bother snorting or smoking whatever powder he claimed to be heroin; I had already been well reacquainted with the too-mild results of those routes of administration, so I went right back to the needle.

    I’ll spare you all the details of the familiar downward spiral and just hit on the highlights: I depleted all of my savings, misappropriated funds from an award I’d received, stole thousands of dollars from my father’s still active bank account, then my mother’s shared account, totaled my partner’s car from multiple accidents, couldn’t maintain my job, took a leave of absence from school, and wreaked a devastating emotional toll by shattering the trust of my friends and family.

    Miraculously, I was not arrested, did not overdose (though I came close), and was not robbed (although certainly ripped off repeatedly). About six weeks before I was confronted about the missing money, I obtained a 15-day supply of Suboxone from a chemical dependency clinic, but I shelved it, having no intention of taking it. Towards the end of the first week of April, my partner was preparing to go out of town for the weekend, and I had just been asked by my mom if I knew anything about the empty bank accounts.

    I woke up alone on April 5th, a Thursday, and began my morning ritual of taking stock of the heroin I had left, trying to negotiate with myself on how to titrate the remaining amount throughout the day. I always lost these negotiations and usually just did all of it, or the rest soon thereafter. But after I injected the last of it, I didn’t feel the slightest bit high. Instead, I wept. With only the company of my two cats (who avoided me as much as possible), I realized that I could no longer hide. I faced a crossroads: I could escalate my lies and attempt to find another hustle — knowing full well how inept I am when it comes to actual criminal behavior — or, surrender.

    I remembered the Suboxone sublingual film, and without really taking any time to talk myself out of it, I tore open the package and put the film under my tongue — realizing that if I kept it in long enough to absorb the full dose, I’d be inducing opioid withdrawal. I felt incredibly lonely and remorseful, so I begged my partner to come home from work, admitting to her what she had long known but felt powerless to help me with. Then I texted my mom, hinting to her that I was in a desperate state, and needed to spend the weekend at her home or I wouldn’t be able to “see things through.”

    Tears were pouring down my face in these moments, and I was wailing — one of the deepest emotional pits of despair I’ve ever found myself in. I’ve never found the concept of rock bottom useful. Instead of labeling that moment or attempting to explain it, I attribute my actions to grace.

    A New Perspective on an Old Idea

    I’m a wholehearted believer in the potential of psychedelics or plant medicines in recovery. I have heard first-hand tremendously powerful stories from people who have overcome their reluctance and the doubt instilled upon them by their peers, and are actively integrating the spiritual insights from their psychedelic journeys into their lives. PIR continues to meet regularly via an online meeting, twice a month, and our members gather from across whatever time zones they’re in to come together and share experience, strength, and hope with each other. We’ve formulated a list of guiding principles, meant to clarify the scope of our suggested program. I had strayed from those principles and met the predictable outcome we’re hoping to help others avoid.

    There are ongoing FDA-approved clinical trials for the use of psilocybin (the active pro-drug of psilocin, a psychedelic found in several species of mushrooms) for nicotine, cocaine, and alcohol use disorder, as well as a recently approved study in Europe looking at MDMA-assisted psychotherapy for treatment of alcohol use disorder. While these trials are aimed at treatment of an acutely manifesting substance use disorder, one of the primary guidelines for PIR is that our members should have a firmly established foundation of recovery in a primary qualifying recovery fellowship, and are actively working that program as it’s suggested.

    Recently, now just five months out from ending my relapse, I considered having a ceremony with iboga (the alkaloid-containing root bark of a shrub indigenous to western equatorial Africa), as I wanted to commemorate the one-year anniversary of my father’s death. After soliciting the feedback of my support network, none of whom gave me any advice, but instead offered honest and open perspective to help guide me in making a decision, I decided against it. Ultimately, the decision to commemorate the anniversary unaided came during several of my morning sitting meditations, a practice that has become vital to my ongoing recovery.

    Instead, friends, family, and loved ones gathered at our house on the anniversary day, and shared memories, pictures, and videos of my father.

    View the original article at thefix.com

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

    What Sets Suboxone Apart From Other Medication-Assisted Treatments?

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

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

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

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

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

    She raised a skeptical eyebrow.

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

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

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

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

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

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

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

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

    My answer?

    “No.”  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • Suboxone: A Tool for Recovery

    Suboxone: A Tool for Recovery

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

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

    More ERs Are Providing Withdrawal Meds As First Step To Recovery

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

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

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

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

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

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

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

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

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

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

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

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

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

    View the original article at thefix.com

  • 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

  • Dope Sick: Breaking Down Opioid Withdrawal

    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