Category Archives: Drug Treatment

Opioid Addiction Spiking in Guilford County North Carolina

policeGuilford County is the third most populated county in the state of North Carolina. Located within Guilford County are the cities of Greensboro and High Point – both of which are experiencing a surprising increase in opioid addiction and related overdoses.

The High Point Enterprise news reported that the High Point Vice and Narcotics unit has begun to make a favorable impact on the problem with multiple arrests of those trafficking heroin locally. The article documents that 70 reported High Point opioid overdoses have occurred thus far in 2014 with 9 of those ending in death. Six people were arrested the week of July 14 and are being held on multi-million dollar bonds for their roles in selling or trafficking heroin. To emphasize the local impact, the HP Enterprise reported that 7 overdoses occurred within a 24 hour period on May 16, 2014.

Just 15 miles away in the neighboring city of Greensboro, Rhino Times covered the local explosion in heroin addiction much of which has been driven by individuals turning to heroin when they could no longer obtain prescription opioids like oxycodone. Rhino Times interviewed the Director of Guilford County Emergency Services, Jim Albright, who stated that a particularly strong strain of heroin hit the streets of Greensboro in late April, 2014.

Over the weekend of April 25, the Guilford County EMS responded to an avalanche of calls in response to people overdosing on the new potent version of heroin. Mr. Albright is reported to have identified that 21 overdoses and 5 deaths occurred just in that one weekend. Due to the potency of the drugs, some victims were found with a needle still in their arm.

Highlighted in the article was the life saving properties of Narcan, a drug that quickly reverses the dangerous overdose effects of opiates. Narcan can be administered by injection or squirted into the nasal cavity. As it is absorbed into the body, it restores breathing to those that have overdosed. Narcan is now kept in first responder vehicles, firetrucks, and ambulances. Visit Alcohol & Drug Services for more on Narcan and opioid overdose prevention kits.

For information on methadone as a treatment for opioid addiction, click here.

Lifestyle Change and Responsible Behavior

drug-treatment-opiate-addictionPeople facing addictive disease cover a wide variety of maturity levels, individual capabilities, and in their level of desire for sober lives. What I mean is that some are further along in their mindset and are really ready to live drug free. They embrace the challenge, and they recognize that some work lies ahead in order to get their life properly sorted out.

Others are sometimes only motivated by the present crisis. They do the right thing only long enough to avert the crisis, and then they’re back to old behavior and old attitudes like they didn’t miss a beat. They straighten up just long enough to avoid probation revocation. They may stop using and “make nice” with a loved one as long as it takes to get some money or a favor, and then it’s back to addict behavior.

With opiate addiction, people from all walks of life can develop a problem – from the chronic troublemaker to the person who never gave anyone a hard time. Opiate addiction covers the whole spectrum of humanity and knows no boundaries. I have treated doctors, dentists, and lawyers … grandparents … church members … teachers … and teens. This diverse group of people had one thing in common. That’s right. Addiction.

While long term recovery is available to every person, only some get clean & sober. Why is this? The answer has much to do with whether a person has an innate desire to change, whether they are teachable and open, and sometimes whether their conscience is awake. Addiction, and the unique behavioral traits that often surround it, make people resistant to change. They resist doing the things that lead to stability, sobriety, and success. Like a seriously overweight person who keeps overeating or a stage 4 diabetic who won’t leave the doughnuts and cookies alone.

Addicts can cycle in and out of rehabs, in and out of jobs, and in and out of relationships. They become the drama that disrupts family life. The phone call at 3:00 a.m. that wakes the children. The examples are endless and they all lead to the same destination … which is pain, loss, failure. Or, as they say in NA: jails, institutions, or death.

Each addiction is a journey as is each individual recovery. There are bumps in the road and a multitude of wrong turns. But there is learning. Hopefully, humility develops and the willingness to follow a new path that involves the guidance & support of others who know more. Addiction is a cunning illness. Trying to fight addiction alone is not a smart decision. It has been shown repeatedly that those who make it typically seek help. Treatment is help. Treatment provides the needed support, feedback, and essential tools for repairing one’s life. Opiate addiction is a powerful trap. Make no mistake though. People do recover … and go on to exciting and enriched lives. Do not stay stuck. Reach out for help in your local community.

Advocating For Addiction Treatment

recovery-journeyTreatment for addiction is one path which may be taken to help rebuild a person’s life when alcohol or drugs have become a problem. There is a compelling documentary recovery film recently out entitled The Anonymous People. The film is an interesting retrospective on the recovery movement in the United States and how it evolved, beginning with AA in the 1930′s, until present day.

A special focus in the film is highlighting the message that people do recover from addiction, that there is a solution to this disease – and that solution is the decision to choose recovery. Recovery is a process that changes lives and takes individuals to a new destination in their life. Recovery is the journey that saves & enhances lives. To that end, recovery from addiction is of incomparable value.

In life, bad choices are made every day. As human beings, we learn to make better choices – often through the mistakes we endure as we travel through life one day at a time.

In reviewing the variety of recovery “paths”, there exist several routes by which an addicted person can find hope and direction in learning to live a drug free life. Some find their answers in church-based recovery programs. Churches recognize the reality of substance addictions and many have developed their own spiritual programs for dealing with drug addiction and offering hope for a better future.

12 Step Programs have been in widespread use for a long time and many lost in addiction have found the support, fellowship, and help needed in the rooms of AA, NA and other 12 step based programs. Some people in recovery from opioid addiction may find that their decision to take methadone or buprenorphine (suboxone) is not well-received in 12 step programs. This can make it difficult to feel accepted or supported there. However, not all NA or AA meetings are the same. NA and AA have themselves evolved over time, and some NA and AA members welcome all people suffering from addiction regardless of their drug of choice.

Addiction treatment is yet another path that leads toward recovery and the possibility of positive change. Treatment, like 12 step meetings, can vary considerably from one program to the next. Opioid treatment in particular often uses medication assistance as an additional tool to help people in their recovery journey. While medication assistance is scientifically proven to be beneficial to opioid addicted persons, it has endured some controversy through the years as those on the outside looking in chose judgment & criticism over compassion and understanding. Methadone and suboxone are proven, effective tools for alleviating the suffering that comes from opioid withdrawal.

In The Anonymous People documentary, there is a strong message that addicted people deserve love & support. Addicted people are from all walks of life. If treatment works, then advocating and supporting treatment is just and worthwhile. The film makes a persuasive argument that better advocacy is needed for the funding of addiction treatment services across the country. Addiction treatment advocacy has not been as effective as advocacy for other critical health conditions like HIV/AIDS or cancer.

As more families struggle with addiction and more voices are ultimately heard in their plea for treatment funding & support, we will hopefully see a shift in society whereby recovery is embraced as the answer to addiction.

Why Methadone Is Effective

methadone-researchMany opioid addicted individuals eventually become interested in methadone after hearing others speak of its effectiveness in eliminating opiate withdrawal sickness.

Methadone has been in use for well over 40 years as a leading treatment for opioid addiction. There are now hundreds of methadone clinics in operation across the U.S. The popularity of methadone as an addiction treatment rests in its proven benefit in completely removing withdrawal symptoms and in methadone’s uniquely long half life.

Heroin and most prescription opiates have a quick onset, short duration. In other words, you feel the effect quickly but the effect does not last long. Methadone is designed to remain in an individual’s system for a prolonged period of time thus keeping withdrawal symptoms at bay for a full day or longer.

Someone who is opioid tolerant and adjusted to their daily methadone medication will experience no high whatsoever from the medication. It will not interfere with their daily responsibilities, work, family, or other obligations. Often, families wonder what effect methadone will have on their loved one. Most family members are surprised to see their loved one return to being functional again and able to live a normal daily life.

Methadone is a full opioid agonist and binds very well to the body’s mu opioid receptors. This action causes withdrawal symptoms like nausea, vomiting, chills,  diarrhea, and runny nose to disappear. Once these symptoms are removed, the addicted person can finally resume a full life and refocus themselves on important personal goals.

While the news media have frequently focused on addiction tragedies, the real stories are those in which countless people’s lives have been saved by methadone. In the North Carolina clinic where I have been employed, I have seen enormous numbers of individuals re-engage with their family, their career, their academic pursuits, home ownership, and a rewarding way of life.

There is a considerable amount of misinformation and fear-mongering that goes on around the topic of tapering off of methadone. It is important to emphasize that a patient is physically dependent upon methadone and must take the medication regularly to avoid opioid withdrawal. However, individuals taper off of methadone successfully everyday in programs across the country. Managing your anxiety during the taper process is important because this helps you stay focused and rational as you slowly reduce your methadone dosage.

The key to tapering successfully is to do so gradually and in cooperation with your prescribing physician and methadone clinic medical team. Some people may try to taper off of methadone too quickly and will consequently begin to feel their withdrawal symptoms return. This is most often avoided by simply proceeding slowly with a methadone taper.

When Emotional Pain Fuels Relapse

grief-and-lossPeople in recovery from addiction face very substantial stresses. The stress of trying to cope with cravings & urges, the stress of facing life and trying to resolve problems, and the common pressure of trying to make ends meet when finances are not in good shape.

While many addicted individuals find that they are more resilient than perhaps they ever believed, loss can sometimes be a particularly crippling experience. People from all walks of life suffer and struggle with losses – divorce, the death of a loved one, the loss of a job, income, security, or health.

A recent New York Times article briefly profiled a young woman released from prison who was trying to stay clean from heroin. She really missed her child who had been removed from her custody. While she loved her baby, she also recognized she was not yet ready to resume the pressures and responsibilities of parenting until she got herself on more solid, sober ground.

With the death of a loved one, the feelings run so deep that coping is sometimes beyond one’s inner resources. Grief has a way of overwhelming the senses and the heart such that making rational choices is much harder than would normally be the case. In extreme emotional situations, thoughts can become paralyzed and feelings intensified. Such a combination can make sobriety incredibly challenging.

Emotional pain is part of life. We have all felt it. Recovery teaches many principles that help to make life more manageable and which can help a person to hold on, to survive the lows of life. And for those that slip, life must go on. All is not lost. In 12 step meetings, they say “keep coming back”. In treatment, they say, “don’t give up”. While these may sound like annoying platitudes, they are generally true and correct sentiments that are there to remind us that pain subsides, and the human heart can find a way to survive and to be happy again.

How this happens varies greatly from one person to another. Support from others can make a huge difference. Prayer and connection with the proverbial higher power can make a difference. We are connected (or can be connected) to good people and good things if we try to open ourselves to them. It is not always easy when we are hurting. Therapy and counseling sometimes point us to answers that we didn’t know even existed. Spiritual support can achieve this as well. Whatever life brings us, good or bad, happy or sad, hopefully we can pause for a few moments to reflect on the small blessings that so often go overlooked and underappreciated.

The message for today is to remember that you are worth it! It can get better. Recovery is always here for you.

Benzodiazepines in the Methadone Program

factsBenzodiazepines are a classification of drugs primarily prescribed to treat anxiety and panic attacks. They have been in use for over thirty years and are typically utilized for short term periods from several days to three months maximum.

Benzodiazepines are sometimes administered just prior to medical procedures or surgery to help calm a patient. Common examples include valium, ativan, klonopin, librium, and xanax. These medications have also been used successfully on a short-term basis to help reduce alcohol withdrawal as patients undergo alcohol detoxification.

For opioid treatment programs, benzos present a particular risk due to the higher probability of abuse and overdose death when mixed with methadone, other opioids, or alcohol. Benzodiazepines depress the central nervous system and can shut down respiration when combined with other CNS depressants. This lethal drug combination has resulted in numerous accidental deaths – even among experienced drug users.

While limited and carefully monitored benzodiazepine use can be clinically justified in some cases, prescribing physicians (and methadone clinics) must be vigilant and cautious in their use of these medications due to their risk of abuse and overdose with opioid dependent patients.

Many opioid treatment programs around the country have adopted a no benzodiazepine policy and will not induct a patient with methadone until the patient has successfully detoxed off of any benz medications, and is able to test negative for the drug.

Some prospective patients have been on benzodiazepines for many years – long past any justifiable therapeutic or medical necessity. Several years ago, an OTP was approached by a client seeking admission who had been taking klonopin by prescription for 25 years. She had experienced several overdose episodes during that time period. The prospective patient voluntarily completed a successful detox off the klonopin, and she demonstrated incredible courage in pursuing this goal. She remained benz free and has tested negative for illicit substances for 3 years now. While she was afraid and doubtful that she could complete the benz detox, she surprised herself and the clinic staff in what can only be described as an incredible commitment to change and a new life.

For those patients diagnosed with a severe anxiety disorder, benzodiazepines may be indicated in select cases. Cognitive-behavioral therapy can also be effective in helping individuals learn to cope successfully with anxiety although it will require strong commitment to the therapy process and a considerable degree of work. With benzodiazepine treatment alone, the medication only manages the symptoms … but does not treat the underlying cause of the anxiety. For that reason, treating anxiety exclusively with benzodiazepines (at the exclusion of therapy) can be a disservice to a patient.

Physical dependency on benzodiazepines can be quite powerful and withdrawal from them dangerous. No one should ever try to self-detox from a benzodiazepine addiction due to the risk of seizure and possibly death.