The Presidential Election and Addiction

Presidential election and addictionI would like to think that whoever becomes our next President will have a good understanding of our nation’s problem with addiction, but I haven’t heard much at all about the subject from the candidates — they appear to have lots of other things on their minds. I’m not convinced the solution to addiction problems, such as the nation’s heroin epidemic, must necessarily come from government, and I tend to think that local communities might find better solutions than top down federal government solutions, but it’d be good if representatives making all the funding decisions in DC really understood addiction.

So much could be done to save lives if only government officials would handle fundamental problems with fundamental solutions rather than wasting money applying symptomatic solutions to symptomatic problems. It appears that most efforts to deal with addiction have created unintended consequences, like the War on Drugs. After decades of treating drug addiction as if it’s a part of an enemy plot to destroy America, the problem is arguably worse than when the “war” started. Locking up drug users along with drug dealers has only ruined the lives of many good people who could have received treatment and gone on to live productive lives. The money it costs to house drug users in prison where they learn criminal behavior is mind-blowing.

I don’t have much hope that the next President will do much that’s different from what other Presidents have done, but it doesn’t hurt to hope. Drug court programs are successful government efforts, although it’s more of a local solution. As middle class and upper class mothers and fathers lose children to heroin overdose, maybe the nation will wake up and pay attention to addiction in general, thus creating a path to apply fundamental solutions. We’ve wasted enough time, money, effort and lives battling drugs as if we can make an imaginary Drug Invader surrender. As along as the demand for drugs grows, the supply will follow. We need innovation, creativity and perseverance to find true, lasting solutions

From Heroin to Fentanyl

Fentanyl and heroin

Opioid Addiction

You might get confused over terms as you read about opium, opiates and opioids. Heroin, morphine, opium and codeine are opiates produced from the opium poppy plant. The other painkillers you read or hear about or ones prescribed usually by a doctor, such as Percocet, Demerol, Oxycodone, etc., are likely opioid pain killers – opioids are synthetic drugs. So, opium has to do with the poppy plant, opiates are produced from opium and opioids are synthetic, opiate-like drugs. As bad as opiates are for those who become addicted, opioids like Fentanyl are becoming worse.

The drug Fentanyl is an opioid, a synthetic, opiate-like drug that is 50 times more potent than heroin and 100 times more potent than morphine. In some areas of the US, Fentanyl is now a larger problem than heroin. According to this NY Times article, in certain New England areas, illicit Fentanyl is coming from Mexico. Although Fentanyl is great for pain relief if applied properly by medical professionals, it’s high risk to buy it off the street because it’s so potent.

The strange part is that when addicts hear about someone overdosing from a strong drug like Fentanyl, they’ll seek it out, thinking they won’t use so much as to kill them, but knowing they’ll get what they consider good product. Addiction and thrill seeking override good judgement. This is from the article:

“It’s just everywhere,” Heather Sartori, 38, a former nurse who is on methadone after years of shooting up heroin, said as she sat at a busy McDonald’s here. “It would be really hard to navigate through this city without being touched by it.”

She said she had lost several friends to fentanyl and called Lawrence’s drug-infested landscape “the treacherous terrain where the ghosts of the fallen linger.”

“It’s cheaper, and the high is better, so more addicts will go to a dealer to get that quality and grade,” she said, even if it means they could die.

“That is the phenomenon of the addicted mind,” she said. “It’s beyond the scope of a rational thinker to understand.”

Hopefully, as the opiate/opioid problem spreads, more resources will arise to intervene, educate and provide treatment. This is not a new problem – opium, opiates and opiate-like drugs have been a problem since opium poppy plants were first discovered thousands of years ago. Today, though, in the 21st century, there are answers to the problem. Also, opiate/opioid addiction should always be considered in the context of addiction in general — still, alcoholism does far more damage to society than opiate/opioid addiction. We’ve come a long way treating addiction, but there’s still a lot that needs to be done.

 

Opiate Addiction 2015

Suboxone

Opiate addiction

Unfortunately, statistics on opiate addiction and abuse are not current, but the American Society of Addiction Medicine, ASAM, has collected information from the most recent studies. What the information shows is disturbing. At NewDay Counseling, we see the reality of opiate addiction on a regular basis. When we decided to manage Suboxone clients, the decision was made not to get more people hooked on Suboxone, but to guide people through the withdrawal and recovery phase in order for the person to become drug free. Most people come to us already taking Suboxone. Too many people are taking Suboxone, then going back to Oxycodone or heroin, then back to Suboxone, seemingly with no end in sight. At NewDay Counseling we’re incorporating counseling, and group therapy if needed, in order to treat problems related to the chronic brain disease of addiction. We treat addiction, whether the addiction is to alcohol, cocaine, pot or opiates.

Opiate addiction is one of the most difficult addictions to treat. It’s very painful for a person to go through withdrawal from opiates without professional help. As a side note, even though opiate addiction is painful, unlike withdrawal from late stage alcohol addiction, it’s not life-threatening in and of itself. Methadone clinics are a testament to how difficult it is to treat opiate addiction — the clinics are basically a management of the addiction, not recovery from addiction. Suboxone is often a better alternative, but even Suboxone can be used as a maintenance drug and the person is not drug free, although Suboxone doesn’t produce the debilitating euphoric state of mind as opiates like heroin, morphine and Oxycontin produce, and the person taking Suboxone can take prescriptions home and not be chained to a regular visit to a clinic.

The goal of addiction treatment should be to become drug-free as soon as possible and to learn how to live well without drugs. Here is some information on opiates from ASAM:

National Opioid Overdose Epidemic

Over 100 Americans died from overdose deaths each day in 2013vi

46 Americans die each day from prescription opioid overdoses; two deaths an hour, 17,000 annuallyvii

While illicit opioid heroin poisonings increased by 12.4% from 1999 to 2002, the number of prescription opioid analgesic poisonings in the United States increased by 91.2% during that same time periodviii

Drug overdose was the leading cause of injury death in 2013, greater than car accidents and homicideix

About 8,200 Americans die annually from heroin overdosesx

About 75% of opioid addiction disease patients switch to heroin as a cheaper opioid sourcexi

In 2012, 259 million opioid pain medication prescriptions were written, enough for every adult in America to have a bottle of pillsxii

If a vulnerable group of Americans were killed at this rate annually by any other means, there would probably be a great outcry, but we hear next to nothing about this problem in media.

Medically-assisted treatment for opiate addiction

Suboxone

Medically-assisted treatment

As it stands right now there are restrictions on medically-assisted treatment for opiate addiction. Doctors who prescribe Suboxone and similar drugs are limited to a certain number of patients. There is legislation, though, presented by Sen. Edward Markey and Sen. Rand Paul to loosen these restrictions. Because heroin use is on the rise, this is needed regulation.

Suboxone along with counseling and addiction treatment has proved to be an effective treatment for opiate addiction. Opiate addiction is a serious healthcare problem, and in some communities opiate addicts have a difficult time finding a doctor to provide medically-assisted treatment because of restrictive regulations.

This is from Huff Post:

The legislation, known as the Recovery Enhancement for Addiction Treatment Act, would loosen restrictions on the number of patients a doctor could treat with buprenorphine for opioid addiction.

The consensus among the medical establishment is that medically assisted treatments such as buprenorphine (and methadone), along with counseling, represent the best chance for addicts to gain a foothold on sobriety. Both medications can make withdrawal less painful and can significantly diminish further cravings for opioids — greatly reducing the chance of relapse.

The Food and Drug Administration approved using buprenorphine to treat opioid addicts more than a decade ago. But federal regulations placed limits on how many patients a doctor could treat. After getting certified to prescribe buprenorphine, which is sold under the brand name Suboxone, doctors can only treat 30 patients at a time in the first year, and 100 the following year.

In areas hit hardest by the opioid epidemic, those limits have maxed out doctors and created lengthy waiting lists for prescriptions. The legislation would raise the first-year cap from 30 patients to 100 and allow qualified nurse practitioners and physician assistants to prescribe the medication. It also would give doctors the chance to remove the patient cap after one year.

Hopefully this legislation will pass. It’s very difficult to abuse Buprenorphine, and when someone tries they are easily caught. The small risk of abuse is worth taking for the huge benefit to opiate addicts wanting addiction treatment.

Recovery from Opiate Addiction

heroin addiction

Recovery from opiate addiction

What I’m seeing with Suboxone and other opiate withdrawal medications is both encouraging and worrisome. Suboxone is certainly a great drug to medically treat opiate addiction, but Suboxone is so effective with withdrawal it gives the false impression that addiction is solved by simply taking the medicine. Recovery from opiate addiction is more than taking Suboxone.

At NewDay Counseling we’re seeing more and more people who’ve relapsed after being on a Suboxone treatment regimen and wanting to get back on it because they’re back on the street buying heroin. If an opiate addict never treats the fundamental problem of addiction, and if the addict believes they can go out and use heroin or Oxycontin when they choose, then get back on the Suboxone when the addiction rages out of control again, the addiction will continue to get worse and Suboxone will only act as a substitute when the opiate addict is taking a breather. I suppose it’s best to take a breather than to die in the streets, but there’s another way.

Unless opiate addicts are receiving some sort of addiction treatment to deal with the psychological, behavioral, emotional and spiritual aspects of recovery from opiate addiction, nothing much has changed. Many things can happen, but one is that the addict still associates with other addicts and they’re getting high while the addict on Suboxone is not getting high. The addict on Suboxone might be physically comfortable because of the effects of Suboxone on the opiate receptors in the brain, but if the addict hasn’t come to terms with addiction and learned different ways to deal with life other than use drugs, he/she will become bored, restless, dissatisfied with dull, un-sexy Suboxone and will begin to psychologically crave the high of strong opiates.

There is not yet a medicine that cures addiction and there probably never will be a pill that cures addiction. Once the physical craving associated with addiction has been resolved, there’s the damage done to the psyche and relationships that needs healing. If the addict does not treat the disease of addiction properly, and if the addict believes the calm, normal feeling from Suboxone is the total answer, they’re likely in for much more pain and trouble down the road when their minds trick them again and again into going back to the opiates. Recovery from addiction takes lifelong management, psychic change, development of coping skills and support, not just a pill, no matter how effective the medicine is for withdrawal.

Freedom from Opiates

opiate addiction

Freedom in Recovery

“The secret of happiness is freedom, the secret of freedom is courage.”
Carrie Jones, Need    

Addiction is a loss of freedom. Being chained to a drug is more than a metaphor — the chains of addiction are palpable to the person dependent on a drug. In recent years there’s been a huge problem with opiate addiction arising from use/misuse of prescription painkillers like Oxycontin then progressing to heroin. I’ve written about it on this blog several times — here and here. This is about freedom from opiates, the process of addiction and some of the obstacles to dealing with the problem.

First of all, withdrawal from opiates is excruciating. It takes at least three months for the brain to clear up and it can take up to six months to get through post-acute withdrawal symptoms. It takes a long time for the brain to readjust. In the 1950s American healthcare providers started using Methadone, first synthesized by German scientists in WWII, to treat opioid addiction. Methadone was a compromise to achieve harm reduction, not so much to deal with the problem of addiction.

There’s still no freedom from addiction with Methadone maintenance, although it’s better than buying heroin off the streets and taking healthcare risks on a daily basis. Suboxone is getting good results as a withdrawal tool, but a treatment plan is needed along with the Suboxone. In 2015 it’s time to treat opiate addiction with the ultimate goal of abstinence, unless there’s a medical reason to continue opiate use. Most people addicted to opiates don’t need to use opiates long term for medical reasons — some might have become addicted due to taking pain killers for an injury or physical condition, but addiction drives people to use the opiates long after the injury is healed. Even with constant pain, research has discovered opiates aren’t ideal for long term pain management. Just because it’s difficult to treat opiate addiction doesn’t mean that we give up and settle for harm reduction. Many, many opiate addicts have recovered and are living free of drugs.

So far, symptomatic solutions have failed to create freedom from addiction for far too many addicted to opiates. As long as we treat symptomatic problems with symptomatic solutions we’ll never apply fundamental solutions to address the fundamental problem of addiction. When regulators discovered Oxycontin was abused at high rates, they tweaked it to make it harder to abuse, but this just made those addicted to turn to the streets to buy heroin. Pain medication misuse was reduced, but heroin use increased.

Unless the necessary resources are available to support long term recovery, there’ll be little reduction in opiate addiction. Freedom is living fully, improving self esteem, returning to an active social life and re-bonding with family and friends, not maintaining the fog and slow destruction of addiction.

Opiate addiction treatment

opiate addiction treatment

Recovery from Opiate addiction

We’ve written about opiates and how they act in the brain, and we’ve written about mixing opiates with benzodiazepines — this is about opiate addiction treatment, withdrawals and long term recovery. Opiate withdrawal won’t likely kill you, but it might make death seem easier. After a long time of overloading the brain with opiate chemicals, the brain stops producing the natural chemicals that opiates replaced — when the person stops using heroin or morphine or Oxycontin or whatever opiate they’re using the brain doesn’t automatically start producing chemicals — it waits, so to speak, to see if more opiates are coming. This time between stopping the opiate use and the brain producing natural chemicals is the withdrawal time. The absence of these brain chemicals causes all sorts of physical complications, most of them painful. This is from MedlinePlus/ The National Institutes of Health:

Early symptoms of withdrawal include:

  • Agitation
  • Anxiety
  • Muscle aches
  • Increased tearing
  • Insomnia
  • Runny nose
  • Sweating
  • Yawning

Late symptoms of withdrawal include:

  • Abdominal cramping
  • Diarrhea
  • Dilated pupils
  • Goose bumps
  • Nausea
  • Vomiting

Opioid withdrawal reactions are very uncomfortable but are not life-threatening. Symptoms usually start within 12 hours of last heroin usage and within 30 hours of last methadone exposure.

One symptom they left out is craving. They’re listing physical symptoms that are obvious, but craving is hard to describe, and this is the painful sense that something vital is missing — it drives addicts to return to the drug. Although new drugs like Suboxone help with withdrawals and make detox much, much easier, there’s a danger of becoming addicted to the cure. A good plan must be in place to withdraw gradually from the Suboxone at the right time determined by a physician trained in addiction medicine. Too often the person addicted to opiates gets help with the withdrawals but doesn’t receive the treatment necessary to deal with complications of addiction that linger even after  opiates are removed from the body. What usually happens is that later down the road when the ugliness of addiction fades in the person’s mind, the old opiate using mindset takes over for one reason or another and the person returns to opiates. It could be as simple as being with a group of people who use opiates and the person who’s been off opiates for a year is drinking alcohol so her thinking is impaired — someone in the group offers her heroin, and her impaired judgment only allows euphoric recall of how great the heroin felt — this person is at risk of relapse. It can happen in a flash if the person hasn’t received treatment and is not managing their recovery long term.