Category Archives: Opiate Addiction

Medication-Assisted Treatment for Teens and Young Adults

Posted on February 7, 2014 | Comments Off on Medication-Assisted Treatment for Teens and Young Adults

opioid-addiction-childrenThere is increasing momentum building for opioid addiction treatment in response to the growing opioid addiction problem in the United States. Many teenagers and young adults who are being introduced to prescription opiates are at risk for developing a crippling drug dependency. The risk is increased as these youth discover that heroin is a relatively cheaper alternative than pain pills purchased on the street.

The Partnership at DrugFree.org has published a 36 page guide outlining opioid addiction and the therapeutic role that medication-assisted treatment can have even for teens and young adults. Methadone, suboxone, buprenorphine, and naltrexone are highlighted in the guide with an accompanying description of each medication and its use in opioid treatment.

Opioid replacement therapy has historically been used as a treatment of last resort in adult populations. The dilemma is that a high percentage of opioid addicted individuals are unable to remain drug free with traditional models of treatment that do not include medication assistance of some variety like naltrexone, buprenorphine, or methadone. Overcoming opioid withdrawal without effective symptom relief presents a serious obstacle in the recovery process.

The Partnership at DrugFree.org recognizes that the wave of opioid addiction in America is mounting. The news media have been covering this issue too with some regularity over the past year. Effective remedies need to be in place as all ages seek help for opiate addiction. If we are to save lives, the stigma of medication-assisted therapy and the misunderstanding around it must be finally removed.

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Posted in Buprenorphine, Medication Assisted Treatment, Methadone, Methadone Blog, Methadone Clinics, Naltrexone, Opiate Addiction, Suboxone

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New York City’s Black Market for Painkillers

Posted on February 6, 2014 | Comments Off on New York City’s Black Market for Painkillers

pain-pill-scheme-new-yorkA Reuter’s story was just released highlighting a large drug bust in New York City in which 25 people were indicted on drug charges including two physicians. The charges stem from evidence that a healthcare clinic called Astramed dumped $500 million in prescription opioids into New York City’s black market from 2011 through 2014. It is reported that a total of 5.5 million oxycodone pills were sold to local drug dealers via phony prescriptions. The Reuter’s article reports a federal indictment was issued in which 24 defendants were charged with conspiracy to distribute narcotics.

This story is especially disturbing and comes on the heels of other recent stories in the news like the overdose death of Philip Seymour Hoffman and the death of 17 people in Pennsylvania who had used the deadly heroin and fentanyl mixture only weeks ago.

The opioid abuse problem in the United States is reaching unprecedented levels and is causing concern in segments of society that had previously never thought much about addiction-related issues.

As addicted individuals come to grips with the reality of their illness, it will be imperative that they have ready access to detoxification and treatment services.

As a clinician of 25 years in North Carolina, I have witnessed a gradual and steady reduction in both substance abuse and mental health funding over the last decade. When rehabilitation services become no longer available to help people, the vast majority of them either remain in active addiction and die prematurely, or wind up incarcerated for committing crimes in desperation.

Stiff penalties for drug dealers are obviously merited. But treatment is the answer for those with addictive disease. We must also do something about our culture which far too often glorifies drug abuse and partying among the younger generation in our society. Opiates are seriously powerful and potentially dangerous medications. America needs to revisit the necessity of increasing funding for drug education & prevention as well as evidenced-based treatment for opioid addiction. That includes life saving medications like methadone and suboxone administered professionally, ethically, and responsibly.

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Posted in Methadone, Opiate Addiction, Opiate Prescription, Prescription Monitoring, Suboxone

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Benzodiazepines in the Methadone Program

Posted on February 3, 2014 | Comments Off on 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. Take care with how long you take , it might be way more difficult to detoxify if you take up the habit. It’s even more difficult than with other less socially acceptable drugs. Also, never exceed the dose. By the example of a friend of mine I learned that your withdrawal syndrome could last for months.

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.

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Posted in Addiction Recovery, Benzodiazepine, Drug Safety, Drug Treatment, Methadone, Methadone Clinics, Opiate Addiction, Suboxone

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Opioid Addiction in the United States

Posted on November 22, 2013 | Comments Off on Opioid Addiction in the United States

methadone-counselingThe U.S. has experienced a steady rise in the number of people being prescribed opioids and in the number of individuals becoming physically addicted to these medications. In the 1970’s and 1980’s, the typical methadone program client was someone who had graduated to daily IV heroin use.

Fast forward to 2013 and the typical methadone program participant may well be someone who has never used heroin or any kind of injectable drug. With the rise of oxycontin over a decade ago and other popular painkillers, opioid addiction in America moved to unprecedented levels. With this new epidemic level of opiate addiction has come an increasing number of overdose deaths.

Within the last 10 years, Tennessee was for several of those years the nationwide leader in the number of prescribed opioids per resident and the number of opioid overdose deaths. Many of these fatalities were the resulting combination of mixing opioids with benzodiazepines like xanax, klonopin, and ativan. Today, many opioid treatment programs and independent physicians are using much greater caution in prescribing benzodiazepines in their practice, and some have opted out of this completely due to the significant medical risk involved.

As the resulting need for treatment options began to grow, the availability of local methadone programs increased as did the total number of U.S. physicians who were approved to prescribe suboxone. Both methadone and suboxone have been enormously beneficial in helping addicted people gain a new lease on life. These opioid replacement medications, combined with counseling, provided hope for a life after opioid addiction. Unless someone has experienced the ravages of a drug addiction, they may be unable to fully comprehend the benefit provided by opioid treatment using methadone or suboxone.

In the final analysis, we as a nation must guard against the overuse of prescription painkillers. And individuals must exercise due caution and care since there is no substitute for personal responsibility and good personal judgment. As America moves forward in the coming year, we must strive to prevent drug abuse where we can through education and prevention efforts. We must also recognize and support the concept that addiction is a treatable illness, and that methadone and suboxone are an essential element in the opioid addiction solution.

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Posted in Addiction Recovery, Drug Treatment, Methadone, Methadone Blog, Methadone Programs, Methadone Treatment, Opiate Addiction

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Drug Addiction, Methadone, and Suboxone

Posted on November 3, 2013 | Comments Off on Drug Addiction, Methadone, and Suboxone

suboxone-articleAn article was brought to our attention by Dr. Dana Jane Saltzman, a New York City physician who specializes in the treatment of opioid addiction. Dr. Saltzman uses suboxone in her private practice to help those seeking recovery from a severe opioid habit.

The article was posted in The Village Voice and attempted to depict the duality of opioid replacement therapies. This duality stems from the highly therapeutic & legitimate uses of suboxone (buprenorphine) contrasted against the attempts of some addicts to create a black market cottage industry with the medication selling it illegally online via Craigslist, Facebook, and other social media.

In the world of medicine and addiction treatment, selling suboxone is certainly criminal, and also behavior characteristic of someone who is not grounded in recovery. Many medical & clinical treatment professionals across the country have endeavored for decades to provide safe, effective treatment to suffering addicts. When FDA-approved opioid treatment medications are misdirected and sold on the black market, all varieties of abuse and exploitation occur ending in overdoses and a deepening of damaging social stigma about medications such as suboxone and methadone.

The Village Voice article plays it straight up the middle with perhaps some emphasis on the growing underground market for suboxone targeted to those who want to bypass the cost or inconvenience of signing on with a suboxone-approved physician.

Individuals who attempt to treat their own addiction with opioid replacement therapy are going to fail a high percentage of times. First, most  have no medical basis for understanding the complex nature of opioid addiction in the brain, and they can even deepen their addiction through the inappropriate use of opioid replacements. Addicts often go with what feels right opting for their own intuition as opposed to following proven best practice protocols like those employed in structured treatment programs supervised by suboxone-approved doctors.

Addicts who treat themselves with street suboxone or methadone are also completely missing the counseling component of recovery which addresses the underlying psychological factors that drive addiction. Taking street suboxone without counseling is akin to taking diabetes medication while eating doughnuts. In other words, the individual makes their complicated dilemma even worse.

There are some generic equivalents of suboxone in development which may make opioid replacement therapy more accessible to the larger population. Suboxone and methadone have a definite place in addiction treatment. It is critical however that early recovering addicts receive quality counseling so that they can better understand how to cope with relapse patterns and develop the skills necessary to successfully manage the disease of addiction. Addicts treating themselves with medications acquired on the street will remain stuck in a vicious cycle of addiction.

True recovery requires humility and commitment to higher principles. Chasing shortcuts to recovery creates more pain and wastes valuable time that would be better invested in real solutions.

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Posted in Buprenorphine, Drug Treatment, Medication Assisted Treatment, Methadone, Methadone Clinics, Opiate Addiction, Opiate Treatment, Recovery, Suboxone, Suboxone Doctors, Suboxone Physicians

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