|Posted on January 10, 2018 at 10:40 AM||comments (0)|
There are three things that you can do to help prevent opioid drug abuse and addiction:
1. Proactively educate your family on the dangers of drugs and opioids.
Prevention starts early and is proactive. Parents who spend time with their children and take time to connect as a family are more likely to notice changes in behavior earlier to help intervene and address potential substance use issues. Adolescents and teens are a particularly vulnerable group because the earlier an individual starts smoking, drinking or using other drugs, the greater the likelihood of developing an addiction. Studies show that 9 in 10 people with substance problems started using by age 18.
Following are resources to help you talk to you family:
• Facts and Recommendations for Individuals and Families from the Surgeon General
• Signs of Drug Use in Adolescents and Teens
• Medications in Your Home
• Video “Chasing the Dragon” educates teens and young adults about the dangers of opioid abuse
2. Ensure proper usage of prescription opioids under the guidance of a physician.
• Verify proper usage by following prescription directions as explained by the doctor, pharmacist and shown on the prescription label
• Keep notes on interactions of the prescription with other medications and alcohol so that you are able to make choices that keep you in optimal health
• Do not increase frequency or amount of prescribed medication. Consult with your doctor to discuss any changes with your prescription.
• Store prescriptions safely and out of reach from other family members, children or visitors.
• Do not use other people’s prescriptions or give your prescriptions to others
3. Safely dispose of unused or expired prescriptions in the home including common opioid prescriptions.
Educate yourself and other members of your family through resources like this instructional video, how to properly dispose of prescription drugs.
Examples of prescription opioid medications include:
• Codeine – an ingredient in some cough syrups and in one Tylenol® product
• Hydrocodone – Vicodin®, Lortab®, or Lorcet®
• Oxycodone – Percocet®, OxyContin®, or Percodan®
• Hyrdromorphone – Dilaudid®
• Morphine – MSContin®, MSIR®, Avinza®, or Kadian®
• Propxyphene – Darvocet® or Darvon®
• Fentanyl – Duragesic®
|Posted on December 2, 2017 at 3:10 PM||comments (0)|
April 6, 2016
It's a life of justifications, covering up, pretending. It's a life of inconsistency.
I could hear my husband open our front door as I prepped dinner in the kitchen. Except I knew it wasn't really my husband, not the same guy I married over five years ago. Not the same man who held my sobbing body as a positive pregnancy test sat on our bathroom sink, six years ago. Not the man who promised we'd be OK. That we could do this. That he would always stay by my side. And, technically, he did stay by my side. Technically.
He limps into the room: skinnier, snifflier, dead in the eyes. We had a few good weeks going as husband and wife. I actually thought he might be coming back to me after a near-death scare, a promise to get clean, a few sessions on a therapist's couch, but it's all back again.
The consecutive ATM withdrawals and sneaky deception. The coldness in his words, the preoccupation behind his eyes, the sound of his struggling lungs whistling as I try to sleep next to him.
Today it's Vicodin, before that it was Methadone, before that it was Heroin, and before that it was an OxyContin prescription from his doctor, hoping to ease a gnawing pain in his leg. The doctor didn't ask if he had a deeper pain, an emotional pain that this prescription might temporarily patch.
The doctor didn't ask if he had a history of addiction in his family or at what age, exactly, he started self-medicating the anxiety that plagued his childhood. (That age was nine.)
Not like my husband would have been honest, of course, because addicts aren't honest with anyone, especially themselves.
When signs of my husband's dependence became obvious to the doctor — and to several doctors afterward — there was no acknowledgment, no understanding, no effort to help a man struggling with a coping strategy that turned self-destructive. There was simply a phone call from a receptionist: "We can't see you anymore." Dropped from care. So he went to the streets, which is where so many addicts go when their prescription is yanked from their hands. He wasn't looking for a high; he needed to feel normal, to not be in constant pain.
And so the cycle starts: Disappearing money. Lies. Falling asleep at the dinner table. Denial. ER visits. Broken promises. His life is chaotic, consuming, no matter how or why it is.
He shuffles past me; I hold my breath. Everything in me wants to scream.
Being a drug addict's wife is lonely and painful. It's a life of justifications, covering up, pretending. It's a life of inconsistency.
Being a drug addict's wife means understanding the whys and seeing the humanity behind the label. He's not a drug addict; he's a good man suffering through an addiction. Not because I'm in denial, but because I know the full story.
It's trying to love away the hate he feels toward himself, to ease the self-inflicted shame and guilt he carries around, as if it's my duty. It's faithfully being there for someone who repeatedly hurts me, even if it's not with his hands or his words. It's upholding my promise to love him through sickness — except this particular sickness is one of denial, deception, and manipulation.
This sickness changes the people we love into strangers. Is that the vow I made?
Being a drug addict's wife is erupting into tears when a doctor asks, "So how are you?" It's searching the self-help bookshelves for some kind of insight or support, wondering why no one saw the "strong" wife quickly deteriorating.
Being a drug addict's wife means having my quality of life depend on someone else. It's believing I'll only be OK once he changes. It's waiting, worrying, crying. It's Googling, "When is it time to leave a marriage?" It's living with uncertainty. It's mentally preparing his funeral and how I'll explain his death to our son.
It's finally reaching out to a few close friends, then his family, and feeling a cathartic release. (And then wondering what the hell took me so long.)
Being a drug addict's wife means enduring more pain and lies than any healthy person should ever put up with, and one day realizing that the most loving thing I can do — for myself, my child, and also my husband — is to leave.
Because if I keep making it easy for him to spin this cycle, I'll die. We'll die.
It's been six months since I discovered my codependency issues and started therapy. Six months since I took control of my life. I wish I had answers for other wives of addicts, or some sort of timeline to offer, but some days are still really hard.
Even though my husband started his recovery, I still have looming issues: trust, respect, honesty, and a backlog of pent-up anger. And yet I can finally see some value in our pain.
On good days, I have a deeper compassion for the human spirit and the human struggle. On good days, I have a better understanding of all the reasons we put on blinders, escape reality, and numb the pain. And yet my own pain led me to a profound understanding of myself, my fears, my hang-ups, my codependent patterns.
Because of this experience, I understand forgiveness. I understand boundaries. I understand love, including self-love.
On bad days, I can still be gripped with anxiety, anger, fear of what might happen, a fear that's temporary, but powerful.
As of today, I hope that we make it through, but I just can't be sure. I know without a shred of doubt that I'll be a better, stronger, smarter woman because I once loved a man who had an addiction, and my life unraveled.
|Posted on August 2, 2017 at 12:25 AM||comments (0)|
No, medication-assisted treatment is absolutely not substituting one addiction for another.
People may view addiction medication this way because some MAT medications are opioid-based. People who take them are physically dependent on them and will experience withdrawal symptoms if they discontinue use. An important point to remember is that there is a huge difference between physical dependence on a medication that helps a person live a normal, healthy life and addiction to a harmful drug that diminishes a person’s health and well-being and carries a high risk of criminal justice involvement or death.
Addiction medications are fundamentally different from short-acting opioids such as heroin and prescription painkillers. The latter go right to the brain and narcotize the individual, causing sedation and the euphoria known as a “high.” In contrast, addiction medications like methadone and buprenorphine, when properly prescribed, reduce drug cravings and prevent relapse without causing a “high.”
All three FDA-approved medications can help patients disengage from drug-seeking and crime and become more receptive to behavioral treatments. One of the three, Vivitrol, blocks the brain’s opioid receptors and does not cause physical dependence at all.
Why do you think the public looks at methadone treatment programs negatively?
I’d like to amend the premise. While there are certainly members of the public who view methadone negatively, there are also substantial numbers of people who understand the decades of science proving the effectiveness of methadone maintenance therapy. Unfortunately, too many people have seen firsthand the devastation that opioid addiction can cause, but they have also seen the chance for recovery that methadone and other medications can offer.
With respect to the negative perceptions out there, to the extent people believe that methadone is substituting one drug for another, they may view methadone treatment programs as part of the problem, not the solution. People who hold these views are likely unfamiliar with the science behind methadone and other medications. For example, many do not know that continuous methadone maintenance therapy has been associated with drops in heroin use of over 80%.
Even supportive members of the public often do not realize that methadone programs are subject to extensive regulations that require them to monitor their patients for illicit drug use and provide them counseling and support services. A lot of people may be surprised to learn that many people who attend methadone programs are successful parents and employees. They go straight from their program to their jobs, where no one even knows that they are in recovery from opioid addiction.
How can this opinion be turned around?
More people need to be exposed to the overwhelming evidence supporting the effectiveness and safety of methadone and other medications, the heart-wrenching stories of friends, family members, and neighbors lost to the scourge of opioid addiction, and the incredible stories of lives restored by these powerful treatments. We are losing about 100 people a day to opioid overdoses in our country, more than die in traffic crashes, and these medications can significantly reduce those numbers. When people know that, it’s hard to argue with.
PAUL SAMUELS, LAC
|Posted on May 19, 2017 at 12:50 AM||comments (0)|
No- with successful buprenorphine treatment, the compulsive behavior, the loss of control of drug use, the constant cravings, and all of the other hallmarks of addiction vanish. When all signs and symptoms of the disease of addiction vanish, we call that remission, not switching addictions.
The key to understanding this is knowing the difference between physical dependence and addiction.
Buprenorphine will maintain some of the preexisting physical dependence, but that is easily managed medically and eventually resolved with a slow taper off of the buprenorphine when the patient is ready. Physical dependence, unlike addiction, is not a dangerous medical condition that requires treatment. Addiction is damaging and life-threatening, while physical dependence is an inconvenience, and is normal physiology for anyone taking large doses of opioids for an extended period of time.
It is essential to understand the definition of addiction and know how it differs from physical dependence or tolerance.
The American Academy of Pain Medicine (AAPM), American Pain Society (APS), American Society of Addiction Medicine (ASAM), and (NAABT) National Alliance of Advocates of Buprenorphine Treatment, have recognizes these definitions below.
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.
Physical dependence and tolerance are normal physiology. Addiction is a disorder that is damaging and requires treatment.
When a patient switches from an addictive opioid to successful buprenorphine treatment, the addictive behavior often stops. In part due to buprenorphine's long duration of action, patients do not have physical cravings prior to taking their daily dose. The drug seeking behavior ends. Patients; regain control over drug use, compulsive use ends, they are no longer using despite harm, and many patients report no cravings. Thus all of the hallmarks of addiction disappear with successful buprenorphine treatment.
Therefore, one is not trading one addiction for another addiction. They have traded a life threatening situation (addiction) for a daily inconvenience of needing to take a medication (physical dependence), as some would a vitamin. Yes the physical dependence to opioids still remains, but that is vast improvement over addiction, is not life threatening, and it can easily be managed medically. It's also important to note that the physical depndence pre-existed the buprenorphine treatment and was not caused by it.
Addiction is a brain disease that affects behavior. This addictive behavior can be devastating to the patient and their loved ones. It's not the need to take a medication that is the problem, many people need to take a medication, but rather it is the compulsive addictive behavior to keep taking it despite doing harm to one's self or loved ones that needs to stop. Whether or not the person takes a medication to help achieve this shouldn't matter to anyone. If a medication helps stop the damaging addictive behavior, then that is successful treatment and not switching one addiction for another.
How to find buprenorphine treatment.
The Essence of Drug Addiction- By Alan I. Leshner, Ph.D., Former Director, National Institute of Drug Abuse, National Institutes of Health
What’s in a Word? Addiction Versus Dependence in DSM-V - CHARLES P. O’BRIEN, M.D., PH.D. NORA VOLKOW, M.D.
NIDA publication: The Neurobiology of Opioid Dependence: Implications for Treatment Thomas Kosten MD, Tony George MD
The American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine - consensus document – February 2001,
American Academy of Pain Medicine - http://www.painmed.org/
American Pain Society - http://www.ampainsoc.org/
American Society of Addiction Medicine - http://www.asam.org/
|Posted on May 1, 2017 at 3:20 PM||comments (0)|
No matter how many days, months or years go by in stable, medication assisted recovery it’s important to remember that triggers remain & that the underlying temptations and urges resulting from our struggle with opiate use never completely go away. A fight with our husband/wife or partner, a death in the family, stress with our family or kids, frustration dealing with the clinic system — any number of things has the possibility to conjure up old desires to just “make it go away” or long for that “quick fix” that was seemingly able to solve all our problems during our days of active drug use. And it’s easy for us, for me at least, to get lost in a daze of daydreaming about how nice it would be to feel the warmth of that rush as all my problems fade away once again. How nice it would be…
But then more memories come back as well. The days when there was no money, no pills, no heroin, no “friends” to help me out… the days when I was writhing in withdrawals thinking of Heaven in a desperation so great that in those moments it often felt like death might be the only way to escape the misery. I start to remember all the difficult times where my chronic metabolic disorder, my pain killer and heroin addiction, caused me to make choices between honoring a friendship and my word or doing what it took to keep me well. The days where I had to make a choice between paying my phone bill, or even eating, or getting that one pill to try to keep me well. I remember the days when the warm rush and getting high were a thing of the past because my struggle day in and day out was to simply be well, to stay out of withdrawals. Getting high was not even a realistic possibility because my tolerance and opiate use had become so high….
And so I ultimately come back around to my solid ground. I snap out of it and realize that my recovery is one of the most precious things that I have, and I thank God that I walked into the methadone clinic all those years ago - originally for all the wrong reasons - and ended up finding an amazing life of recovery as a result.
But I think it’s important to have these discussion and to not stick our heads in the sand. We need to confront the fact that many of us in long term, stable recovery can still have moments of weakness when we’d like nothing more than a big bag of China White to pump into our veins… That is part of the chronic nature of this disease. We can treat it effectively, and thank God for the research of Doctors Dole, Nyswander and Kreek decades ago, but we can’t cure it. It doesn’t mean I’m weak in my recovery because I have moments of weakness; It shows strength in my recovery that I am able to realize that I’m not a bad person because these thoughts and feelings can still conjure up but that I recognize it is because I’m dealing with a chronic, relapsing disease. We need to be prepared for these thoughts and feelings and desires. We need to know that for some of us, for many of us, they will still come up from time to time when the going gets tough, or maybe for no reason at all, and we need to talk about it and confront it head on.
Living The Methadone Life isn’t always honey and roses. It isn’t always easy. We are still flawed individuals that are struggling with a chronic and relapsing metabolic disorder despite being patients of what the National Institutes of Health (NIH) refers to as the “gold standard treatment.” But a basic understanding of the disease we’re dealing with helps us to know that doesn’t mean we aren’t strong in our recovery or our desire to remain abstinent from illicit drugs. Talking about it helps us know we’re not alone and that there are others dealing with the same thing.
Hang in there, brothers and sisters, and keep on keeping on. While we have an amazing tool and medication to aid our recovery we also still need to realize we’ll never cure this disease, but through peer support, psychosocial support and continuing to take our medication on a daily basis we can keep it at bay and have a life just as amazing as those individuals who were lucky enough to never deal with a chronic relapsing disease of the brain.
8:46PM | URL: https://tmblr.co/ZpbNks1Rw13_2
JUNE 16, 2014
|Posted on November 28, 2016 at 9:55 AM||comments (1)|
by Louis E. Baxter, Sr., MD, FASAM | June 12, 2014
"You're not clean and sober if you keep taking that medication from your doctor!"
"You're just substituting one drug for another."
"You are depressed because you are not grateful enough."
These and other statements are often made to 12-step members who are legitimately prescribed and taking FDA approved medications to treat their addictions and other co-occurring illnesses. Unfortunately, this so- called “advice” from well-intended but misinformed members is not founded in scientific or 12-step philosophy and violates a long held 12- step policy of " AA members should not give medical advice to each other." (Read The AA Member - Medications & Other Drugs).
It is well known that AA supports and encourages its members to "follow doctor's orders." In an article published in AA News in 1999, author Dr. Jacqueline Chang wrote that research regarding short-term abstinence showed "other things besides and in conjunction with AA are helpful. These include therapy, counseling, and others like Valium, Antabuse, Naltrexone, and Acamprosate."
Dr. Ruth Fox, the Founder of ASAM, supported MAT. It is well known and documented that she regularly prescribed Antabuse to her family, friends, patients and colleagues to assist them in their recovery from alcoholism.
Further, Alcoholics Anonymous and Psychiatric Medication (September 7, 2010) says that "it became clear just as it is wrong to enable or support any alcoholic to become re-addicted to any drug, it equally wrong to deprive any alcoholic of medication which can alleviate or control other disabling physical and or emotional problems."
Although there is no dispute that abstinence from alcohol and other drugs with potential for addiction is the foundation for sustaining recovery in most instances, there are other cases where MAT, especially for persons with co-occurring illnesses, is essential to obtain and sustain term recovery.
In the late 1980's it was discovered by NIH that addiction was a brain disease. Since that time, medications with FDA approval have been developed to target those areas of the brain. These medications have shown great efficacy in assisting patients into and sustaining recovery. Every other chronic medical disease employs and encourages the use of medications in concert with life-style changes. Addiction medicine should examine the benefit of following suit.
MAT in addiction treatment is not required for everyone, but used in conjunction with 12- step programs and other biopsychosocial interventions, for those that need it, has shown to be invaluable in appropriate cases.
Louis E. Baxter, Sr., MD, FASAM
Dr. Baxter is the Immediate Past President of ASAM and Executive Medical Director of the Professional Assistance Program of New Jersey, Inc, located in Princeton, New Jersey and Medical Director, of the Division of Addiction Services for the New Jersey Department of Health and Senior Services. He is also an Instructor in Medicine at the Thomas Jefferson School of Medicine in Philadelphia, Pennsylvania
|Posted on October 17, 2016 at 8:30 PM||comments (3)|
Yes, methadone is generally a safe medication.
When taken as prescribed, methadone is safe and effective. In fact, methadone allows people to recover from addiction and to reclaim active and meaningful lives. Still, there are risks of opiate/opioid overdose that come with using methadone. And some serious side effects can occur.
This article provides you with some basic information about the safe dosage of methadone as well as common side effects people have reported on methadone. Plus, we’ll look into the issue of methadone as safe for long-term treatment. Then, we invite your questions about the safe use of methadone at the end. In fact, we try to answer ALL legitimate questions personally and promptly.
Methadone is used to prevent withdrawal symptoms and minimize cravings in people addicted to opiate or opioid drugs. Methadone is in a class of medications called opiate (narcotic) analgesics. As a maintenance medication, Methadone works to treat opiate addicted individuals by producing similar effects and preventing withdrawal symptoms in people who have stopped using these drugs.
Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives. Methadone has also been shown to reduce addiction-related death, criminal recidivism, and the spread of HIV.
For optimal results, when you take methadone, you should also participate in a comprehensive medication-assisted treatment (MAT) program that includes counseling and social support. Appropriate methadone maintenance treatment (MMT) provides several benefits:
Help Available 24/7
Blocks the effects of other opioids.
Prevents the onset of withdrawal for 24 hours or more.
Promotes increased physical and emotional health.
Raises the overall quality of life of the patient.
Reduces or eliminates craving for opioid drugs.
Can taking methadone cause serious side effects?
Methadone may cause side effects and you should consult your doctor if any of the following symptoms appear and do not go away:
These are some of the serious methadone side effects:
Methadone may cause serious or life-threatening breathing problems, especially during the first 72 hours of your treatment and any time your dose is increased. You should carefully follow doctors orders during your treatment.
How much methadone is safe to take?
Methadone comes as a tablet, a dispersible (can be dissolved in liquid) tablet, a solution (liquid), and a concentrated solution to take by mouth.
When initiating pain management therapy, using oral methadone in non-tolerant people, the usual oral dose starts at 2.5 mg to 10 mg every 8 to 12 hours, slowly tolerated to effect. If you take methadone as part of a treatment program, your doctor will prescribe the dosing schedule that is best for you.
For safety, your first dose of methadone should be low or moderate. New patients usually start at a dose not higher than 30 to 40 mg. A larger dose of 60 to 120 mg a day may be required during long-term maintenance. In order for the therapy to be effective you should take methadone exactly as your doctor directs.
If you are using the dispersible tablets, do not chew or swallow before mixing the tablet in a liquid. If your doctor has told you to take only part of a tablet, break the tablet carefully along the lines that have been scored into it. Place the tablet or piece of the tablet in at least 120 mL (4 ounces) of water, orange juice, citrus flavors of Kool-Aid, or a citrus fruit drink to dissolve. Drink the entire mixture right away. If some tablet residue remains in the cup after you drink the mixture, add a small amount of liquid to the cup and drink it all.
Your doctor may change your dose of methadone during your treatment. If needed, you may be instructed to decrease your dose or take methadone less often as your treatment continues. On the other hand, if you experience pain during your treatment, your doctor may increase your dose or may prescribe an additional medication to control your pain. Talk to your doctor about how you are feeling during your methadone treatment. Do not take extra doses of methadone or take doses of methadone earlier than they are scheduled even if you experience pain.
Safety recommendations when using methadone
1. Drinking alcohol while taking methadone should be avoided at all means.
2. Do not drive a car or operate machinery until you know how this medication affects you. You should know that this medication may make you drowsy.
3. If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking methadone.
4. Inform your doctor and pharmacist about any allergies to methadone, any other medications, or any of the ingredients in the methadone product you plan to take. Ask your doctor or pharmacist or check the Medication Guide for a list of the ingredients.
5. Methadone can cause life-threatening changes in breathing (it may slow or stop).
6. Methadone can cause life-threatening changes to the heart beat that may not be felt.
7. Methadone stays in your body longer than it’s pain relieving effects last. Therefore, do not to take more methadone than prescribed because methadone could build up in your body and cause death.
8. Pain relief from methadone should last longer after you have taken it for awhile and as treatment continues.
9. Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine.
10. Tell your doctor if you are breastfeeding hence methadone is secreted into human milk. Babies can experience the same serious side effects from methadone as the mother.
11. Tell your doctor if you start or stop taking other medicines. They may interact with methadone and possibly cause death, life threatening side effects, or result in less pain relief from methadone.
12. Women who are pregnant or breastfeeding while on methadone can safely take the medication, but only with a clearance from their doctor.
Is methadone safe for long term use?
Methadone can produce physiological and psychological drug dependence and has the potential for being abused. Thus, it is very important to be used exactly as prescribed.
Methadone withdrawal symptoms are similar to those of other opioids but are less severe, slower in onset, and last longer. Symptoms of methadone dependence include:
The longer you’ve been dependent on opiates or opioids, the more likely you are to benefit from being on methadone. Those who withdraw from methadone after short-term treatment are more likely to return to drug use than those who stay in treatment until they have obtained the optimal treatment and recovery time. But, there is no strict time limit. In fact, you should stay in treatment as long as you are benefiting from it.
How to come off methadone safely
The length of time you stay in methadone maintenance treatment (MMT) is an issue that should be decided solely by you and your doctor. Some people are in methadone maintenance treatment (MMT) only for a few weeks, while others choose to stay in it indefinitely.
It may take from 6 months up to a year before you can completely come off of methadone. You should never set time limitations on yourself – taper off at your own pace in cooperation with your treatment provider.
Throughout treatment and after treatment ends, be sure to maintain and extend your support network. You can request to come back to the program every few weeks for the first year and expect to have the same privileges that you did before tapering off. Should you feel that you may relapse, return to your program immediately for re-dosing. You can always return to treatment. And, keep in mind that returning to treatment is not a failure – it’s a choice about what is best for you.
Methadone safety questions
If you still have questions about methadone safety and its use, please leave them here. We are happy to help answer your questions personally and promptly. If we do not know the answer to your particular question, we will refer you to someone who does.
Reference Sources: SAMHSA: Methadone
NIH National Institute on drug abuse: Methadone – Appropriate Use Provides Valuable Treatment for Pain and Addiction
Medline Plus: Methadone
OASAS Office of alcholism and substance abuse services: Methadone Dosing
Introduction to Methadone