Archive for May, 2016

FDA approves first drug-oozing implant to control addiction

Posted on: May 31st, 2016 by sobrietyresources No Comments

Published May 26, 2016      Associated Press

WASHINGTON (AP) — Federal health officials on Thursday approved an innovative new option for Americans struggling with addiction to heroin and painkillers: a drug-oozing implant that curbs craving and withdrawal symptoms for six months at a time.

The first-of-a-kind device, Probuphine, arrives as communities across the U.S. grapple with a wave of addiction tied to opioids, highly-addictive drugs that include legal pain medications like OxyContin and illegal narcotics like heroin.

The implant from Braeburn Pharmaceuticals is essentially a new delivery system for an established drug, buprenorphine, which has long been used to treat opioid addiction. But its implantable format could help patients avoid relapses that can occur if they miss a medication dose.

Roughly 2.5 million Americans suffer from addiction disorders related to prescription painkillers and heroin, according to federal estimates.

The matchstick-size implant slowly releases a low dose of buprenorphine over six months. Previously the drug was only available as a pill or film that dissolves under the tongue. It is considered a safer, more palatable alternative to methadone, the decades-old standard for controlling opioid addiction.

Probuphine is intended for patients who have already been stabilized on low-to-medium doses of buprenorphine for at least six months. Braeburn estimates that one fourth, or 325,000, of the 1.3 million patients currently taking buprenorphine meet that criterion.

The FDA previously rejected Probuphine in April 2012, judging the drug’s dose was too low to reliably help the broad range of opioid-addicted patients. Braeburn and partner Titan Pharmaceuticals resubmitted the product with additional data and it received a positive endorsement from federal advisers earlier this year.

The FDA said Thursday that Probuphine should be used as part of a multipronged addiction treatment program that includes counseling and other forms of support. Doctors who implant the device must also receive special training to safely insert and remove the device.

FDA officials are spotlighting new treatment options for opioid abuse, after weathering heavy criticism for not acting faster to combat the epidemic of addiction and overdose tied to the drugs.

“We must do everything we can to make new, innovative treatment options available that can help patients regain control over their lives,” said Dr. Robert Califf, who became FDA commissioner in February.

Heroin and opioid painkillers caused 28,650 fatal overdoses in 2014, the highest number on record in the U.S. Despite those numbers, experts say buprenorphine remains underused due to federal limits on how many prescriptions each doctors can write, gaps in insurance and a lack of acceptance by doctors.

Along with increasing compliance, Probuphine has the potential to address other problems associated with the oral buprenorphine, including illegal diversion and accidental poisoning in children.

Braeburn’s CEO Behshad Sheldon says 2,200 doctors have already signed up to take the training course required to administer Probuphine. The company could train as many as 4,000 physicians by the end of the year, she says.

 

http://www.foxnews.com/health/2016/05/26/fda-approves-first-drug-oozing-implant-to-control-addiction.html

Thriving After Opioid Addiction

Posted on: May 31st, 2016 by sobrietyresources No Comments

The empowered patient can do more than survive.

Even those who are not at especially high risk can develop an opioid addiction; no one is immune.

By Suzette Glasner-Edwards May 26, 2016, at 6:00 a.m.

Just a few day ago, sitting across from one of my therapy patients, a former opioid addict now 10 years into recovery, I was reminded, in the midst of all of the bad news about the opioid overdose epidemic, that if the same level of determination that fuels an addict’s pathological pursuit of opioids can be channeled into recovering from the devastating impact of addiction, a life can be transformed – and even the sickest of addicts can be restored to health. This patient, who suffered a severe sports-related back injury in his early 20s and underwent two surgeries to repair the damage, was handed handfuls of prescriptions for opioids to chase his seemingly unending pain after surgery. He tried them all – Vicodin, Norco, Fentanyl and Darvocet – and when they failed, he began supplementing them with Oxycontin he bought on the street. After mixing opioids with downers, he overdosed, just two days prior to his scheduled qualifying exams for graduate school.

Having survived the overdose, with recovery or death as his remaining choices, he seized control over his life, seeking out treatment with a medicine known as suboxone for his opioid addiction. Other healthy behaviors and choices followed, including a couple stints in inpatient rehab, treatment by a psychiatrist, involvement in self-help groups and outpatient therapy. Recovery has not been easy, and he continues to work at it, but the payoff has been well worth the struggle. Now, a decade later, with a doctoral degree, a steady job, a wife he loves and plans to start a family, no one would ever guess that he is a former painkiller addict.

In the addiction community, many would say that he “hit rock bottom” before he was able to change. But we know so much more now about the risks of opioid treatments for pain and the potential for fatal overdose. Waiting for a loved one to hit bottom, we risk missing a chance to save a life. As knowledgeable consumers of medicine in the Digital Era, we have the power to make safer and more informed choices about pain treatment, and we can recognize the signs of a plan of pain management that is headed towards addiction and destructive consequences in a loved one.

[See: How to Find the Best Mental Health Professional for You.]

Addiction Medicine: a Tough Pill to Swallow, for Some

The staggering statistics are all over the media. Drug overdoses are claiming more lives than auto accidents, with opioids as the main driver of the climbing death toll. The Centers for Disease Control and Prevention estimate that 78 people die every day from an opioid overdose, an unprecedented toll in the history of the health impact of drug abuse. With proper treatment, however, many recover from opioid addiction. With as much public awareness that has developed about the potential for opioid addiction and overdose, the rates of treatment initiation and recovery ought to increase dramatically, if this information is put to use by consumers of medical care.

Research studies have found medication-assisted treatments for opioid addiction, such as suboxone and methadone, to be highly effective in helping people recover from addiction and preventing overdose deaths. There are many reasons these medication-assisted treatments are underutilized, including limited availability of the medicines and trained prescribers. Perhaps equally problematic is the skepticism that patients and health care providers have about the use of these medicines in treating addiction. Concerns about replacing one addiction with another are all too common, and usually stem from misunderstandings about how these medicines work.

Medicines like suboxone and methadone eliminate the vicious cycle of using increasing doses of opioids and then going into withdrawal when they wear off, a cycle that fuels escalating use of opioids to get rid of the terrible discomfort in withdrawal. The desperation to avoid withdrawal can then contribute to excessive use, overdose and even criminal activities in the pursuit of more of the drug. Medicines that are used to treat opioid addiction stop the cycle of highs and withdrawals by providing a stable dose of a replacement drug that acts on the same area of the brain. This restores the stability of the addict’s brain chemistry, relieves cravings and helps the person become functional again, and to be productive and have meaningful relationships.

[See: How Social Workers Help Your Health.]

If Your Doctor Prescribes Opioids, Ask Why

While once considered a secondary concern in medicine, the idea that pain could be thought of as a “fifth vital sign” to avoid undertreating it emerged over a decade ago, prior to the surge in painkiller prescriptions. Curbing inappropriate and excessive use of opioid treatment while avoiding jeopardizing opioid therapy for individuals who clearly need it is a balancing act that will continue to challenge physicians.

As scientific data concerning chronic pain treatment has accumulated, the benefits of opioids when prescribed for pain that extends beyond three months have been called into question. What’s more, the repeated use of opioids has been found to worsen pain in a sizable group of patients, a condition known as “hyperalgesia.” This can create a vicious cycle in which the pain sufferer takes larger doses of opioids to try and eliminate a pain condition that was itself worsened by opioids in the first place. As the pain progressively intensifies in response to escalating doses of opioids, the risk of addiction and overdose worsens.

More critically, because opioids also affect the respiratory centers in the brain, which regulate breathing, at too high a dose, or when combined with other sedatives, respiratory depression and death can occur. This is now the too-often heard story of a fatal overdose.

New guidelines for opioid prescribers who are treating chronic pain, released in March by the Centers for Disease Control, recommend consideration of alternative treatments to opioids rather than starting with opioids as a “go-to” pain management strategy. As these guidelines are being implemented, we are not powerless against the devastating disease of opioid addiction. If a doctor prescribes opioids for your pain management, make sure you ask questions about the risks – and alternative treatments.

If you have a history of addiction, even if unrelated to controlled substances, or if you suffer from a mental health condition like depression, you are more vulnerable to becoming addicted to opioids. Adolescents also have an increased risk. But even those who are not at especially high risk can develop an opioid addiction; no one is immune. As an informed patient, you can ask your doctor to try non-opioid pain treatment strategies first and see how they work before considering a plan of care that could include opioid medications.

Preventing Overdose

As the fight against opioid addiction continues in this nation, spreading awareness of an opioid antidote that is now available for reversing an overdose is critical. The treatment is easy to use, available as an injection into the muscle or a spray into the nose that can and should be carried by individuals who are taking opioids and by their family members. It’s called naloxone, and while a victim of an overdose likely won’t be able to administer it, a bystander can, quickly restoring the victim’s ability to breathe within 2 to 5 minutes.

[See: 8 Things You Didn’t Know About Counseling.]

Ending Addiction

Recovery from both chronic pain and addiction can be achieved through a combination of behavioral therapies and effective medicines. Studies support the use of non-medicinal approaches including psychotherapy, exercise, biofeedback and complementary medicine such as yoga, meditation and acupuncture, to treat certain types of pain. In addition, non-opioid medications may also be useful and can include nonsteroidal anti-inflammatory drugs, anticonvulsants and certain antidepressants.

Addictive behavior can be recognized as a progressive loss of control over drug use, and can be reflected in behaviors such as “doctor shopping,” or seeking multiple prescriptions for opioids from different doctors, difficulty functioning in important life areas such as at work or in important relationships, and escalating use of opioids despite the devastating impacts, both physical and psychological. If you or someone you are close to is suffering from these signs and symptoms, seeking a prompt evaluation by an addiction treatment professional is a good place to start.

Addiction is not a simple problem with a simple solution. My colleagues and I at UCLA Integrated Substance Abuse Programs are conducting ongoing research to better understand and treat this devastating illness. Many have tragically lost the fight, yet I have worked with and heard powerful stories from those who not only survived, but have created rewarding and meaningful lives in the aftermath of their battle with this disease. It is true: Physicians have an essential role in ending the opioid overdose epidemic, by shifting their prescribing practices to avoid unnecessary and excessive use of opioids in pain management. Equally true, however, is the fact that we can be empowered by all that we have learned about pain control, opioid abuse and addiction, and have the courage to face the pain with alternative and safe methods of treatment, or recognize when a loved one needs help. There is help available, and it works.

Suzette Glasner-Edwards, Ph.D., is an associate professor at UCLA Department of Psychiatry and author of “The Addiction Recovery Skills Workbook.”

 

http://health.usnews.com/health-news/patient-advice/articles/2016-05-26/thriving-after-opioid-addiction

FDA approves six month implant for treatment of opioid dependence

Posted on: May 31st, 2016 by sobrietyresources No Comments


May 26, 2016

The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, is pleased to announce that the U.S. Food and Drug Administration (FDA) has approved the first long-acting, subdermal buprenorphine implant for the treatment of opioid dependence. The medicated rods, implanted in a single procedure, are designed to provide an ongoing release of a low dosage of buprenorphine over the span of six months. The implant technology is approved for a specific subset of patients who are already clinically stable for at least six months on other approved buprenorphine delivery systems, including moderate doses of buprenorphine tablets or films.

Buprenorphine is a medicine currently approved to treat opioid use disorder and is available as a buccal tablet or a film placed under the tongue or against the inside of the cheek, both requiring self-administration by patients on a daily basis. The newly approved implantable form of buprenorphine, called Probuphine, is placed under the skin in the upper arm in an out-patient setting, and removed in a similar manner at the end of the treatment period. Other medications for opioid use disorder include methadone and naltrexone.

Medication-assisted treatment (MAT) is cost-effective and has been proven to help patients recover from opioid use disorder, reduce fatal overdoses, improve social functioning, reduce criminal activity, and lessen the risk of transmitting infectious diseases like HIV and Hepatitis C.

Yet, of the 2.2 million Americans 12 years of age or older who abused or were dependent on opioids in 2014, fewer than 1 million received MAT. Also, less than half of private-sector treatment programs have adopted MAT, and even in programs that offer MAT, only 34.4 percent of patients are prescribed them.

Probuphine is made and sold by Braeburn Pharmaceuticals who licensed the North American commercialization rights from Titan Pharmaceuticals. NIDA provided funding for early clinical trials to test the safety and efficacy of the drug for the treatment of opioid use disorder. Information about the availability of Probuphine will be made available on the Braeburn Pharmaceuticals website.

https://www.drugabuse.gov/news-events/news-releases/2016/05/fda-approves-six-month-implant-treatment-opioid-dependence

What it's like to love a heroin addict

Posted on: May 24th, 2016 by sobrietyresources No Comments

By DeMarco Morgan, Jonathan Blakely CBS News May 23, 2016, 7:39 PM

In the Shadow of Death: Jason’s Journey is a multi-part “CBS Evening News” series that follows Jason Amaral, a 30-year-old addict living in the Boston area, on his path to recovery.

“I’ll never give up on him. Never ever,” Beth Eagan said. “No matter what.”

Beth Eagan, 59, is the closest living family member to her two nephews, Jason and Andrew Amaral. Both are heroin addicts.

morgan-shadow-of-death-3

 

 

 

 

 

 

 

 

Beth Eagan, or “Auntie Beth,” got emotional while watching a video of her nephew Jason using drugs.  CBS NEWS

“They’re absolutely like my sons. I can’t, and I don’t want to, lose them. Everybody in the family loves them of course, but they keep saying ‘You just gotta walk away, Beth.’ But I can’t.”

Auntie Beth, as they call her, has been looking out for the boys ever since her sister — their mother — died of cancer when Jason was eleven.

“They’re absolutely like my sons. I can’t, and I don’t want to, lose them. Everybody in the family loves them of course, but they keep saying ‘You just gotta walk away, Beth.’ But I can’t.”

Auntie Beth, as they call her, has been looking out for the boys ever since her sister — their mother — died of cancer when Jason was eleven.

Jason has overdosed eight times, and Eagan was there for one of them.

“It was not nice at all. I actually screamed — I got removed from the hospital. But I screamed at him ‘Who do you wanna be buried next to, Mom or Dad?!'”

Jason’s life wasn’t always like that. Until her death, Eagan’s sister, Joanne, raised her boys in a happy home in Needham, Massachusetts. Jason and Andrew then went to live with their father. Jason was a good student, played sports, and went to college.

He made the mistake of trying the opiate pill OxyContin, and got hooked. A few years into his addiction, Jason’s father died of liver failure. By then, Jason had been caught stealing, and went to say goodbye escorted by police.

“So I went to his wake in shackles and handcuffs in like a jumpsuit. My aunt was there with me,” Jason told us.

“We sat there for hours in the prison that day and he kept saying ‘I did that to Dad. I did that to Dad.’ Of course he didn’t,” Eagan said. “He thinks he did stuff that probably added to his dad’s death.”

“Do you think your father had a broken heart?” we asked Jason.

“Absolutely,” Jason said. “Like he didn’t wanna face the fact that both his sons were heroin addicts. I think he kinda gave up a little bit, you know?”

Jason’s brother Andrew is also walking in the shadow of death. He and Jason remain very close, each hoping the other lives to beat their common addiction.

Andrew now has a young son. He and Jason are fighting to live for him.

“I don’t want him to be without a father. That would just suck,” Andrew told us. “But if I keep getting high, I can’t like f—–g see him.”

Andrew is now homeless, an addict who’s had trouble committing to detox. But Jason is now in rehab working hard to stay clean. He wants to show his brother they can do it.

“I have to lead by power of example. I can’t tell him to stay clean.”

He doesn’t want to get the phone call that his brother is dead. “No, absolutely not. That’s the call I’m dreading honestly. I hope that never happens. I get on my knees in the morning and I get on my knees at night.”

“Do you think [God] is looking out for you?” we asked.

“He has to be! You know what I mean? I’d be dead if he wasn’t.”

Jason has now made it through eight weeks of rehab. He was able to get a scholarship to go to Recovery Centers of America, but for most people who are addicted to heroin finding help is not so easy.

In our next report, we’ll explore ways people can find the assistance they need for themselves or their loved ones.

 

http://www.cbsnews.com/news/what-its-like-to-love-a-heroin-addict-jasons-journey/

 

Overdoses from legal drugs are exploding — and a new plan to curb the crisis reveals one big flaw in our approach

Posted on: May 23rd, 2016 by sobrietyresources No Comments

By Erin Brodwin May 20, 2016 8:28 PM

Overdoses_from_legal_drugs_are

(Flickr/Be.futureproof)

On Thursday, health-insurance giant Cigna announced it was taking major steps to prevent and treat addiction.

While the company is specifically targeting addiction to opioid painkillers like OxyContin and Vicodin — it highlights a far bigger problem as well.

There are currently no standards of medical care for treating addiction in this country. 

“Unlike what we see in other chronic conditions, such as diabetes and cardiovascular disease, there currently exists no road map of evidence-based best practices for physicians to follow to effectively and efficiently treat substance use disorders like opioid addiction,” Douglas Nemecek, Cigna’s chief medical officer of behavioral health, told Business Insider.

Opioid painkillers kill more Americans than heroin, according to the CDC, and may also have played a role in Prince’s death.

Cigna plans to slash its customers’ opioid-painkiller use by 25% over the next three years. The program would make Cigna one of the largest insurance companies to put such a plan in place.

Still, without a road map like the kind Nemecek described, physicians are powerless to help patients who are struggling with addiction.

Between 2000 and 2014, nearly half a million Americans died from overdoses involving these drugs. And the rates of these deaths jumped 14% from 2013 to 2014, according to the CDC.

Opioid painkillers aren’t the only problem. Studies suggest many prescription-drug users who become addicted switch to the illegal drug heroin because of its cheaper price.

But the issue extends to other perfectly legal drugs like alcohol and nicotine as well. An estimated 7.6 million Americans, or one in every 12 US adults, suffers from alcohol addiction, according to the National Council on Alcoholism and Drug Dependence Inc.

And cigarette smoking kills 480,000 Americans each year, including nearly 42,000 from secondhand-smoke exposure, according to the CDC.

Overdoses_from_legal_drugs_are-chart

(Dragan Radovanovic/Business Insider)

In this vein, Cigna is doing something that few other insurance companies have done, which is trying to come up with a road map for physicians to use to treat addiction to opioid painkillers.

As part of the company’s announcement to curb opioid-painkiller use rates by 25%, Cigna earlier this month announced a new partnership with the American Society of Addiction Medicine (ASAM) to “verify what works in the treatment of patients with addiction, make the medical community aware of proven strategies, and hasten the adoption of these successful methods,” the company wrote in a press release. Cigna will be sharing two years’ worth of insurance-claim data with ASAM covering medical, behavioral, and pharmacy claims.

“We know there are too many prescriptions being written for these drugs today that are not necessary and our goal is really to eliminate those,” said Nemecek.

 

http://finance.yahoo.com/news/giant-insurance-company-plan-fix-174443746.html

 

Macklemore joins Obama to raise addiction awareness

Posted on: May 20th, 2016 by sobrietyresources No Comments

Macklemore joins Obama to raise addiction awareness

President Obama and Seattle hip-hop artist Macklemore discussed the opioid addiction epidemic in America during the president’s weekly address. (WhiteHouse.gov)

Macklemore and President Obama talked about drug addiction during the president’s weekly address. Macklemore has been open about his struggles — being arrested at 15 and ending up in King County Juvenile Drug Court.

Originally published May 14, 2016 at 7:20 pm Updated May 14, 2016 at 7:33 pm

Grammy Award-winning rapper and Seattle native Macklemore joined President Barack Obama in the president’s weekly address to discuss drug addiction and call for politicians to fund recovery programs.

Drug overdoses kill more people each year than traffic accidents, and the number of deaths from opioid overdoses has tripled since 2000, Obama noted, sitting next to Macklemore at the White House. Many times, the drugs are prescribed by a doctor.

“So addiction doesn’t always start in some dark alley — it often starts in a medicine cabinet,” Obama said.

The U.S. House of Representatives passed several bills during the past week to fight opioid addiction, but the Obama administration says the legislation does not provide enough money to expand treatment.

Macklemore, 32, whose real name is Ben Haggerty, has been open about his prescription-drug and alcohol addictions. He was first arrested at 15 and ended up in King County Juvenile Drug Court. He entered rehab in 2008. During the Saturday address, he mentioned his friend Kevin, who died at 21 from an overdose of painkillers.

The hip-hop artist is sober, but his struggle with addiction is an ongoing process, he’s said previously.

“Addiction is like any other disease — it doesn’t discriminate,” Macklemore said during the address. “It doesn’t care what color you are, whether you’re a guy or a girl, rich or poor, whether you live in the inner city, a suburb, or rural America. This doesn’t just happen to other people’s kids or in some other neighborhood. It can happen to any of us.”

Macklemore is “an advocate who’s giving voice to a disease we too often whisper about: the disease of addiction,” Obama said.

A conversation between Obama and Macklemore on opioid addiction — and what can be done to address the problem — will air on MTV this summer.

Click the link to watch the video.

http://www.seattletimes.com/seattle-news/health/macklemore-joins-obama-to-raise-addiction-awareness/

 

 

 

 

The Woman Whose Addiction Story Shook Obama Now Has A Bill In Her Name

Posted on: May 11th, 2016 by sobrietyresources No Comments

Jessie’s Law tries to make a patient’s addiction history more widely known to his or her physicians.

04/27/2016 02:20 pm ET | Updated Apr 27, 2016

WASHINGTON — The young woman whose story of heroin addiction and subsequent death compelled President Barack Obama to sharpen his focus on the epidemic has inspired new legislation in Congress.

On Wednesday, Sen. Joe Manchin (D-W.Va.) introduced Jessie’s Law, a bill named after Jessica Grubb and designed to try to prevent the circumstances that led to her death from occurring elsewhere.

The legislation seeks to make it harder for physicians to unknowingly prescribe large quantities of opioid medication to recovering addicts. It does so by expanding the universe of people who can provide consent for a patient’s substance abuse records to be disclosed to their physicians. It also requires the Department of Health and Human Services to develop a standard policy to include a patient’s history of opioid addiction in medical records if that consent has been given.

Manchin touted the merits of the legislation during a press conference on Wednesday, saying it was a “common sense” reform in treatment of opioid addicts. “We are going to eliminate that from ever happening again, when the parents and the person who is being cared for both agree that we want this to be known so that we don’t end up with something we shouldn’t have.” But while the senator said he expected large bipartisan support and quick passage, he also seemed to acknowledge that the bill will be met with skepticism by patient privacy advocates who have long argued that a person’s medical choices and history are proprietary

 

WASHINGTON — The young woman whose story of heroin addiction and subsequent death compelled President Barack Obama to sharpen his focus on the epidemic has inspired new legislation in Congress.

On Wednesday, Sen. Joe Manchin (D-W.Va.) introduced Jessie’s Law, a bill named after Jessica Grubb and designed to try to prevent the circumstances that led to her death from occurring elsewhere.

The legislation seeks to make it harder for physicians to unknowingly prescribe large quantities of opioid medication to recovering addicts. It does so by expanding the universe of people who can provide consent for a patient’s substance abuse records to be disclosed to their physicians. It also requires the Department of Health and Human Services to develop a standard policy to include a patient’s history of opioid addiction in medical records if that consent has been given.

Manchin touted the merits of the legislation during a press conference on Wednesday, saying it was a “common sense” reform in treatment of opioid addicts. “We are going to eliminate that from ever happening again, when the parents and the person who is being cared for both agree that we want this to be known so that we don’t end up with something we shouldn’t have.” But while the senator said he expected large bipartisan support and quick passage, he also seemed to acknowledge that the bill will be met with skepticism by patient privacy advocates who have long argued that a person’s medical choices and history are proprietary.

Manchin’s role in shepherding Jessie’s Law through Congress is multi-faceted. As a senator from one of the states hardest hit by the opioid epidemic, he has been exploring multiple legislative vehicles to reorient how the medical community is treating addiction and addicts. But he also has a personal tie to this specific bill. He served alongside Grubb’s father, David, in the state senate and the two have kept in close touch since Jessica’s death. In mid-April, he spoke on the senate floor about her story and advocated for changes that he has since written into legislative language.

“You can’t throw that temptation at an addict,” Manchin said then. “There is no way for them to handle it. It is done. It is over.”

It is in large part because of her father’s ties to the world of West Virginia politics that Jessica’s story had such a profound impact. When Obama visited Charleston, West Virginia last October, David Grubb explained to him in horrifying detail the circumstances that led to his daughter’s fourth stint in rehab.

“We found her in her bedroom, tourniquet on her arm, syringe next to her,” Grubb said at the town hall. “She was already turning blue. My wife administered CPR.  We called 911. While we were waiting, I held her and said, ‘Don’t leave us yet.’”

Aides to Obama subsequently said the president was struck by the fact that the family of an elected official could be afflicted by such an ordeal. It was a lightbulb moment, said one White House official, when the pervasiveness of the heroin problem dawned on him.

He got very emotional,” the official said. “You’re in this deep-red [conservative] environment, but people are just opening up their hearts on this. [The president] sort of was taken aback at how candid people were talking about this.”

 

Jessie only lived to be almost 31 years old. But how many people if they lived to be 100, can actually say that their lives prevented deaths?

David Grubb, Jessica’s father.

 

Jessica Grubb watched that moment on a live stream feed on her laptop. She was in Michigan, where she had moved for a residential drug rehab program. She stayed in the area through the new year. But in the winter of 2016, she developed an infection in her hip bone — a byproduct of her intense jogging — and went in for surgery at St. Joseph Mercy Hospital in Ann Arbor.

When she was discharged, she was given a prescription for 50 pills of Oxycodone, a powerful opioid pain medication, as well as a central catheter port in her arm, to manage her care. She died on March 3 from an Oxycodone overdose. The discharging doctor would later tell David Grubb he did not know about her addiction history.

David Grubb and his wife stood alongside Manchin and fellow West Virginia Senator Shelley Moore Capito (R) on Wednesday at the Capitol Building to introduce the law bearing his daughter’s name.

“The one thing that we have said over and over again is, ‘Okay, Jessie only lived to be almost 31 years old. But how many people, if they lived to be 100, can actually say that their lives prevented deaths? Jessie’s life can have meaning. She can prevent future death,” he said, fighting back tears.

 

http://www.huffingtonpost.com/entry/heroin-epidemic-bill-jessicas-law_us_5720f339e4b0f309baef634a

 

The public scorns the addiction treatment Prince was going to try. They shouldn’t.

Posted on: May 10th, 2016 by sobrietyresources No Comments

Maintenance is the most effective way to treat addiction, but it’s also heavily stigmatized.

 By Maia Szalavitz May 9

Prince’s greatest music hit the radio while I was going off the rails during my own opioid and cocaine addiction. The young man who gave me my first injection was a massive fan and played “Kiss” for me around the same time he introduced me to the needle. I was soon hooked on both Prince and injecting.

That’s why it hit me especially hard when I learned that this musical genius’ overdose death occurred a day before he was due to start treatment. This tragedy makes clear that what likely killed him, and is killing so many others, is not just addiction itself, but the stigma we attach to it and, even worse, to the most effective treatment for it.

If we really want to stop the overdose epidemic, we need to get serious about providing the only treatment known to reduce the death rate by 50 percent to70 percent or more: indefinite, potentially lifelong, maintenance on a legal opioid drug like methadone or buprenorphine. The data on maintenance is clear. If you increase access to it, deathcrime and infectious disease drop; if you cut it short, all of those harms rise.

 

Prince was supposed to see a doctor, known for using buprenorphine to treat addiction, just a day after his death. But most patients — even most celebrity patients — do not actually get this sort of evidence-based care.

Indeed, most people concerned with opioid addiction don’t know that they should be looking for maintenance, or they avoid it thanks to the stigma against long-term medication treatment — research shows that maintenance patients experience prejudice and discrimination from family, friends, health care workers and employers. Even I perpetuated the stigma myself in the past, in an anti-methadone op-ed in the 1990s. At the time, I thought that simply having experienced addiction qualified me as an expert and incorrectly relied on anecdote, not data.

For both methadone and buprenorphine, access is highly limited. Only 30,000 physicians are licensed to prescribe buprenorphine, but most who are licensed don’t prescribe it and each is currently limited to seeing 100 patients. When used for addiction treatment, methadone is regulated to an extraordinary degree — it’s illegal to prescribe outside of those rundown clinics, and NIMBYism keeps them located in poor neighborhoods.

 

To top it all off, the 12-step support groups that addicted people are urged or even required to attend as part of treatment often see people on maintenance as not “really” in recovery.

These practices are deadly. We’ve got to get over the idea that medication for opioid addiction simply “replaces one addiction with another” and doesn’t count as getting better. To do so, we need a far better understanding of what addiction really means.

In many people’s minds — due to concepts popular in the ’70s and early ’80s — addiction means physically needing a substance to function and becoming physically ill when deprived of it. From this perspective, the biggest barrier to quitting is suffering through the nausea, pain, shaking and diarrhea that accompany withdrawal. And, from this point of view, people who are on maintenance treatments are actually “still addicted.” But this definition of addiction was dropped by experts long ago.

One reason this view fell out of favor was the rise of crack cocaine. Cocaine and stimulants, like methamphetamine, don’t cause physical withdrawal symptoms — if addicted people suddenly stop taking them, they don’t get physically ill. However, they absolutely experience irritability, anxiety and craving that is every bit as intense and likely to lead to relapse as that associated with alcohol or opioids. This makes stimulants like crack highly addictive.

Though we tend to think otherwise, physical withdrawal isn’t the main barrier to abstinence; instead, craving and the sense that drugs are essential for emotional survival are at the core of addiction. In my own case, I put myself through withdrawal from heroin addiction at least six times. Never once during these attempts did I relapse while ill. Instead, I returned to drugs after withdrawal illness had passed — not because I felt physically bad, but because I had convinced myself that “just once” would be okay.

So what is addiction if it isn’t defined by tolerance or withdrawal? Psychiatry, through its diagnostic manual, the DSM, sums it up as compulsive behavior that recurs despite negative consequences. This means that maintenance helps users conquer their addiction by replacing addictive compulsion with physical dependence.

Craving, obsession, intoxication and consequences are gone; tolerance and steady dosing mean that patients are not impaired and can drive, care for families and work. What remains is a physical need for the substance to avoid withdrawal.

And such dependence isn’t harmful, per se: We’re all physically dependent on oxygen, food and water, and some of us (like yours truly) are physically dependent on antidepressants or other types of medication. If the consequences of physical dependence are positive, it’s not addiction. Which is why I don’t sit around dreaming of Prozac, yearning for my next dose, taking more and more and hiding my obsessive behavior.

Of course, like any other addiction treatment, maintenance doesn’t always lead to recovery. Indeed, as with abstinence-only treatment — though at alower rate — relapse is the most common outcome.

Importantly, however, unlike in abstinence-only treatment, patients benefit from maintenance even during relapses. That’s because, whether or not people continue taking other drugs in an addictive fashion, the tolerance provided by maintenance pharmacologically makes overdose death much less likely.

The ongoing use of other drugs during relapse explains why so many people see maintenance as a failure and maintenance patients as being constantly high — but retaining relapsers in treatment is a feature, not a bug. It reduces mortalitydisease and crime and keeps patients in health care.

Unfortunately, most families and friends of addicted people don’t understand this. They tend to seek abstinence-only inpatient rehab because maintenance is stigmatized, and the media rarely highlights its dramatic reduction in mortality. Instead, we hear about relapse or people selling their maintenance medications on the street. Ironically, that street market exists primarily because we don’t make maintenance accessible enough. Maintenance drugs wouldn’t be valuable if people who wanted them could get them, whether or not they are ready for abstinence.

Prince’s death was awful enough. A man lost his life, we lost a great artist — and we also lost the chance for him to model and destigmatize the best treatment we currently have for addiction.

 

https://www.washingtonpost.com/posteverything/wp/2016/05/09/the-public-scorns-the-addiction-treatment-prince-was-going-to-try-they-shouldnt/?postshare=3021462820807541&tid=ss_fb

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