Category Archives: Treatment

ERs Are Stepping Up to Help With Addiction

Addiction Treatment Centers

 

Leave it to California to take the lead when it comes to a group of hospitals trying a new way of helping those addicted to opioids—having ERs administer buprenorphine (aka Suboxone) when someone enters in the throes of withdrawal. (Lest anyone forget, buprenorphine is weaker than other opioids. It activates “the same receptors as other opioids, but doesn’t cause a high if taken as prescribed,” says the article in The New York Times.) A 2015 study by researchers at Yale-New Haven Hospital found that when ERs have done this, the people who get the buprenorphine are more likely (twice as likely, in fact) to be in treatment after a month than people who were only given an informational packet that included phone numbers related to treatment. As a result of the study, an ER specialist who heads the buprenorphine program at Highland Hospital in Oakland convinced the California Health Care Foundation to give his hospital a grant to try the novel method.

 

ER Departments

Out of the box idea? Sure. But it seems to be working. Now ER doctors are calling the lead author of the study every week, she said in August, and ER departments in Camden, NJ, Brunswick, Maine, Philadelphia, New York, Syracuse, and Boston are also offering buprenorphine.The doctors need training to prescribe the medication, as well as a license from the DEA to prescribe it unless someone is in withdrawal, so ER doctors are in a good position to treat those patients. “I think we’re at the stage now where emergency docs are saying, ‘I’ve got to do something,’” the lead author of the study said. “They’re beyond thinking they can just be a revolving door.”

 

Detox Centers in Northern California

 

Treatment in the ER

It’s a rare opportunity to meet people where they need help and get them started on medication for their addiction, the article notes. In some places of the country, it’s not easy to find a doctor who takes insurance AND prescribes buprenorphine. After their ER visit, ideally a person will follow a “wheel and spoke” approach, where they first go to a treatment clinic (the hub), adjust to the medication, and then see a doctor in a primary practice (the spoke). Treatment in the ER involves buprenorphine under the tongue, and usually, a prescription for Suboxone, in the form of strips that will dissolve in the mouth and thus are harder to abuse. Then the person is directed to meet with the head of the addiction program in his clinic, where he’s available one day a week.

 

Detox Centers

 

Even signs posted in the waiting area of Highland ER reaching out to those suffering from opioid use disorder are helping. A woman there for a respiratory infection saw one and told her brother about the signs, and he decided to enter the program. Recently released from prison, he was hoping to stay clean, especially because he had a job offer. Now he had “a stable source of treatment.” California was willing to provide the grants to have this program flourish. Two-thirds of Highland Hospital’s 375 patients in withdrawal accepted the medication and had an initial appointment at its addiction clinic. Not only that, but California has started to require detox centers and residential centers to allow residents to take either buprenorphine or methadone, medication-assisted treatment, which has had a history of controversy. That’s also ground-breaking.

 

For more information or to contact our Detox Centers in the Bay Area call (866) 596-9391.

 

Substance Abuse and the Legal System

How Many Chances Should a Drug User Get?

Recently, a letter to the editor in a newspaper from the managing director for policy at the Drug Policy Alliance asked the rhetorical question above. He’s a psychiatrist with a background in public policy and bioethics, and he wrote to the paper after reading that a patient with endocarditis was denied necessary surgery because of intravenous drug use. He called it abandoning a patient. Endocarditis, an infection of the heart, is life-threatening but treatable. Just as drug use has been compared to having cancer—a disease that we treat even if the person has smoked, when smoking is a known carcinogen—the psychiatrist argues that a known drug user shouldn’t be denied care. Should someone with a second heart attack be sent to hospice instead of being treated, just because he didn’t take his medication after the first one, he asks? He notes that several illnesses are accompanied by behavior that is self-destructive. And when the writer asks about how many chances drug users should get, he answers his own question: “The same number as a smoker with cancer, a drunken driver in an accident, and a father after a heart attack. The same number you would want for your loved one.”

Felons Becoming Lawyers

There’s one area in which the legal system is surprising a number of people—allowing former drug addicts who have been incarcerated to become lawyers. Yes, you read that right. If you watch 60 Minutes, you may have seen the segment where a man robbed banks, spent years in prison and went on to become one when he was released. But Tara Simmons seems to be one of the first people suffering from substance use disorder to get her law license. As an article about felons becoming lawyers explains, “Whether people like Ms. Simmons should be allowed to practice law is a hot question these days. Acceptance for those with less-than-impeccable pedigrees seems to be rising.” Ms. Simmons had to appeal after her application to even take the bar exam was rejected. And even if you pass in a similar situation, it may be difficult to be sworn into the bar. A former cocaine trafficker who did time spent $25,000 “going through the process.”

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Relapsing Shouldn’t Be a Crime

Along these same lines, an editorial in The New York Times used the case of Julie Eldred to discuss the argument noted above—sending people to jail for relapsing because she broke her probation when she tested positive for fentanyl. That’s what often happens in the U.S. justice system, the paper noted. But her case is now being heard by the Massachusetts Supreme Court. Wil it change drug policy? That remains to be seen. Her lawyer is challenging the notion that it’s OK to require people with a substance use disorder not to use drugs while on probation, and of sending them to jail if they do. The prosecution rebutted the disease model of addiction as her defense. Using that very disease model, the editorial goes on to give a cogent argument for keeping addicts who relapse out of jail. The argument in favor is that those who suffer from a substance use disorder cannot choose rationally and consistently because their ability not to relapse is impaired by brain changes due to chronic drug use and the colossal force of addiction. Policies like the one that caught Julie Eldred in their net are part and parcel of the criminalization policy. While not everyone suffering from substance use disorder should be freed from all consequences, the consequences should be fair, says a professor of public policy.

Treatment of Opioid Use is Not a Mystery

In response to the editorial mentioned previously, a clinical professor of population health felt the need to point out a few facts about the fight against the opioid epidemic. People with opioid use disorder who are successful in overcoming it take methadone or buprenorphine and undergo behavioral therapy and counseling, he says. And sometimes it doesn’t even take doing both for them to succeed. He, too, complains that we criminalize the patient, the disease, and the treatment when we don’t have to. The writer is also the former chief of addiction medicine at the notorious Rikers Island prison, by the way, which was a big part of the movie “The Night Of.” Another writer, a director of the Program in Addiction Medicine at the Yale School of Medicine, had a great thought: “We need to teach addiction with the same attention to genes, physiology, cells receptors, transmitters and scientific evidence as we do cancer to try to capture trainees’ interest.” For more information or to find a Rehab in California, please contact Summit Estate at (866) 569-9391.

 

Autism, Asperger’s and Addiction in the High-Tech Industry

 Illustration with word cloud on disease AutismIllustration with word cloud on disease AutismA February post postulated that substance abuse may be more prevalent in the high-tech industry in Silicon Valley than is generally known. Anecdotal evidence from Silicon Valley addiction experts who treat a number of clients from the industry suggested that this is true. Why? The stress involved in working in such a competitive environment — trying to be the first to launch a product.

Those with normal and above-average intelligence are said to have high-functioning autism. Asperger’s syndrome is closely related.” The Autism Society explains that people with Asperger’s exhibit “less severe symptoms and the absence of language delays [in childhood]”. WebMD also holds that high-functioning autistic people as well as people with Asperger’s are “good fits for technically demanding jobs. Not only does the internet downplay autistic social deficits, but the language of computers also allows some people with autism to give full expression to their exceptional abilities.”

Perhaps you’ve known or seen someone on the spectrum who seems intensely interested in how things work. One of the experts WebMD quoted said that these people’s brains are wired differently. They “pick out patterns in information and to discern the logical rules that govern systems. That means people with Asperger’s and high-functioning autism often have great talents for creating and analyzing mechanical systems, such as engines, or abstract systems, like mathematics and computer programs.” Gawker reported that “cases of Asperger’s and autism … exploded in Silicon Valley over the past 20 years, according to state-funded outreach workers — an assertion that will come as no shock to users familiar with pedantic, apathetic, tight-lipped and self-serving tech companies.”

To be fair, Silicon Valley isn’t the only area cited as having a high incidence of these conditions. There’s Redmond, Washington, where Microsoft is located, and the northwest Rochester, where IBM is located, is also mentioned as a possibility. Gawker also noted that there are no statistics surrounding the number of programmers and engineers, for example, that are on the spectrum, but “popular belief holds that places like NASA and Silicon Valley are havens for them.” Even Computerworld, one of the industry bibles, has weighed in, with an article titled “Asperger’s: the IT industry’s dark secret,” in which several techies on the spectrum commented. Temple Grandin, who has Asperger’s, says we wouldn’t even have computers without techies with Asperger’s. So where does substance abuse and recovery come in, you might ask. Do people on the spectrum have substance abuse problems like others?

Maia Szalivitz, a “neuroscience journalist” who often writes about addiction, details her thoughts in an article in The Atlantic (which originally appeared in a publication called Spectrum). It opens with the story of a man addicted to heroin who finally got clean. Afterward he was diagnosed with autism, although the signs were there all along. Szalivitz says that for years, the commonly held belief was that addiction among people with autism is rare, since they follow rules and are usually isolated from their peers, for example. But a study in Sweden found the opposite to be true — people on the higher end of the spectrum are “more than twice as likely to become addicted,” and it’s worse if they also have ADHA. Experts in the article say that people on the spectrum find that alcohol eases social anxiety, and they may become addicted. The same holds true of marijuana. Impulsive behaviors in this population are also a problem and can lead to gambling or internet shopping addiction. An article about autism and addiction in Psychology Today by a person who runs a California treatment center included research from the Washington University School of Medicine, where experts studied Australian twins. The findings were that “people with autistic traits were no more likely to drink or use marijuana than people without these traits, but that people with autistic traits who drank or smoked pot were more likely to become addicted to or otherwise abuse these substances.” The writer noted the difference between a person exhibiting autistic symptoms and actually having a diagnosis, however. He posits that “a diagnosis is likely to accompany a more extreme form of the disorder. And it seems from this research as if a more extreme form of the disorder may keep autistic people from even experimenting with substances.” A psychiatrist he interviewed said “it could be that some traits related to autism are protective, while others elevate the risk for alcohol and substance-abuse problems.” If anything, the information in these articles shows a need for more study between autism and addiction.

Healthcare Insurance: What’s Our Future?

health insurance claim form

Pity the average citizen trying to figure out what’s going to happen with healthcare.  During the week of July 9, proposed legislation changed in a day.

Before July 13, this is where things stood:

BCRA—the Better Care Reconciliation Act of 2017, released on June 22—was still waiting to be approved by the Senate before being sent to the president’s for signing. More than a few people were worried, especially those concerned about healthcare coverage for those suffering from addiction. Ask anyone—those working in addiction and recovery, to families of loved ones caught up in the disease, to anyone who has been through an insurance coverage nightmare or who has heard tales from friends—how difficult it can be to navigate the system when the problem is addiction and mental health, it hasn’t been easy.

For years, a number of people had been working for parity in coverage for mental health and addiction disorders, and Obamacare —the Affordable Care Act —achieved that, according to The Fix.  The ACA was passed in 2008 and by 2014, what so many people dreamed about came into being, starting with increased access to healthcare for many “by expanding Medicaid and offering low-cost insurance through the ‘Health Insurance Marketplaces’.” The law also stopped insurers from denying coverage because of pre-existing conditions, such as substance abuse.

BRCA benefits are listed at https://www.dpc.senate.gov/healthreformbill/healthbill61.pdf and explained at sites like http://www.benefitspro.com/2017/07/12/breaking-down-the-senates-bcra-proposal. (The latter is a resource for benefits professionals.) Even Wikipedia does a good job of explaining them.

Addiction experts were sounding off about what it would mean should BCRA pass. A July 6 opinion column on an independent Park Forest, Illinois website included comments from over 60 experts who opposed the proposed healthcare act. The Senate’s version of healthcare repeal would cripple national efforts to address this public health epidemic, the article said, and the piece backed that statement up with several arguments. Two are below.

1 “Research has clearly shown that substance use disorders are complex, chronic medical conditions, best treated with comprehensive and integrated care” (and we cannot go back to financing them separately and treating them the same way, as before the ACA.)

2 Medicaid reductions and caps in BCRA mean that many substance abusers will lose coverage for treatment designed to save their lives.

On July 13, the Senate introduced a revised plan:  

As CNN reported:

1 The new bill has an amendment allowing inexpensive, deregulated insurance plans

“as long as Obamacare-compliant plans are sold.”

2 States will receive more money for their healthcare initiatives, including $45 billion for fighting drug addiction.

There is more, but those seem to be the changes most important related to addiction treatment.

Two moderate Republicans immediately took issue with the revision, saying that it will “hurt people with pre-existing conditions…who got coverage under Obamacare” and adding that the reductions in Medicare funding will hurt low-income families and others.

The revised bill also increases the number of people who will be left without insurance.

The finishing touches to the plan are due July 17, and now, Senator Lindsey Graham and Senator Bill Cassidy have yet another proposal.

If you’re not following all this, it’s understandable. There will not be a quiz.

Non-Opioid Pain Management

back painThe Human-Opioid Connection

The relationship between humans and opioids goes back thousands of years. From the time we first cultivated Papaver somniferum over 5,000 years ago to the present day, the properties of the opium poppy have been a blessing and a curse. Opioids contain the most powerful pain-relieving molecules known to medical science, but they also carry a heavy, destructive, and deadly potential for addiction and abuse. Blessing and curse dovetail in a quirk of human physiology: the endogenous opioid system present in the human nervous system. Opioids relieve pain by leveraging this naturally occurring system; opioids lead to abuse by hijacking this naturally occurring system. Opioids become problematic because this internal pain-relief network is linked, at the cellular level, to how humans experience feelings of pleasure, satisfaction, and reward. Humans wrestle with this de facto paradox daily. It’s a cruel irony of nature that the most effective pain medication on earth is also the most dangerous; it’s a test of our ingenuity and scientific responsibility to find ways to use opioids without becoming victims to them – and if we can’t, to find alternative methods of managing pain without exposing ourselves to the risks inherent in opioid use. No population has a greater stake in the search for alternative pain management than those who are in recovery from substance abuse disorders. People in recovery work for years to free themselves from cycles of addiction and abuse. Yet when they’re faced with injuries, surgeries minor and major, or develop medical conditions characterized by chronic pain, their options are limited, and they’re often presented with a false dilemma: live with the pain, or risk sabotaging the hard work and progress gained in recovery by ingesting substances that increase risk of relapse or lead to a new substance abuse disorder.

The Problem(s) With Opioids

Long-Term Effectiveness

Setting aside issues related to individuals with a history of addiction and abuse, opioid pain medications have a significant set of limitations and complications that are neither widely known nor publicized. While they’re incredibly effective at relieving acute pain and there are many situations for which opioids are the logical and appropriate choice for pain management, the effectiveness of long term use of opioids for chronic pain management is not supported by medical research. That may come as a surprise to most people, but it’s true. In 2016, the Centers for Disease Control (CDC) released CDC Guideline for Prescribing Opioids for Chronic Pain, a comprehensive and systematic review of existing scientific evidence “to identify the effectiveness, benefits, and harms of long-term opioid therapy for chronic pain.” The study defines long-term as use of opioids for over three months. The conclusion as to the effectiveness and benefits of opioid therapy for chronic pain management is concise and unequivocal:

“…no study of opioid therapy versus placebo…evaluated long-term (≥ 1 year) outcomes related to pain, function, or quality of life. Most placebo-controlled randomized studies were ≤ 6 weeks in duration. The body of evidence…is rated as insufficient.”

Risks and Harms

The absence of clinical support for long-term opioid therapy in chronic pain management may come as a shock, but the complications of long-term opioid use are well-known and broadly publicized in online, print, and television media. The statistics reveal a pattern which, taken at face value, should cause a complete re-evaluation of the long-term use of opioids for chronic pain:

Profit Motive 

Prescription opioids are big business. Experts estimate the value of the North American opioid market at $12.4 billion for 2015, a figure which quadrupled between 1999 – 2014, and is projected to grow to over $17 billion by the year 2024. This enormous increase occurred even though the amount of pain reported by Americans during the same period did not change. In the January 2017 study “What are the advantages of non-opioid analgesic techniques in the management of acute and chronic pain?” published in Expert Opinion on Pharmacology, Dr. Paul F. White, MD, identifies potential explanations for this counter-intuitive phenomenon:

  • Aggressive marketing tactics of the pharmaceutical industry
  • Overstated risks of non-opioid analgesics
  • Reimbursement issues related to alternative pain-management therapies
  • $880 million spent lobbying politicians to block legislation aimed at curtailing the use of opioids.

Rather than collaborate with patients to discover pain-management methods that carry less risk of harm than opioid medications, pharmaceutical companies and groups of vocal physicians did the opposite. White cites an article published in 2007 in which an international group of pain experts advocated for an increase in opioid prescription with this remarkable assertion: “If only we [physicians and nurses] could overcome our ‘opiophobia’, we would improve pain management.” When correlated with CDC data indicating a dramatic surge in opioid prescribing between 2007 – 2012, and the steady increase in abuse, overdose, and opioid-related fatalities since 1999, a clear picture of the past decade and a half emerges. Profit, expediency, and our cultural tendency to trust physicians and the prescriptions they write combined to create a perfect storm in which medication developed to alleviate suffering has arguably done more harm than good, and likely caused more pain than it has relieved.

Chronic Pain Management: Alternatives to Opioids

The Biopsychosocial Model

We’re in the midst of an opioid epidemic – that’s common knowledge. What’s not common knowledge is the existence of safe and effective alternatives for chronic pain management. To date, the most complete and effective approach to the management of chronic pain is the biopsychosocial approach, which entails understanding illness and disease as a result of the active interplay of physiological, psychological, and social factors. In their 2007 article “The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions”, Gatchel, Peng, et al. conclude “the emergence of the biopsychosocial model of chronic pain has led to the development of the most heuristic approach to chronic pain—the interdisciplinary pain management approach.”  The interdisciplinary approach suggests that in order to treat chronic pain effectively, physicians and patients must work together to see the big picture. Since people who suffer from chronic pain show increased risk for a wide range of additional emotional and physical pathologies, treating one symptom in isolation from the others is ineffective. It’s imperative to adopt a multi-modal approach that includes – in addition to physical symptoms – strategies that consider behavior, emotion, cognition, and environment. Viewing chronic pain as more than a physical condition is the first step in managing symptoms without the use of opioids. The second step is the use of non-opioid medications.

Alternative Medications for Chronic Pain

Chronic pain is often the result of poorly managed acute pain, and opioid abuse is often the result of the over-prescription of opioid medications after minor or major surgery. Mounting evidence shows that two widely used oral analgesics, when administered intravenously, are effective for managing acute pain:

  • Intravenous (IV) Acetaminophen decreases post-operative pain scores and post-operative opioid usage.
  • Intravenous (IV) Ibuprofen also decreases post-operative pain scores and post-operative opioid usage.

In addition, several non-opioid pain medications are effective in treating chronic pain, and thus decrease the risks associated with opioids:

  • Anti-convulsant medications such as Gabapentin and pregablin are considered effective, first-line treatments for managing chronic neuropathic (nerve) pain.
  • Antidepressant medications (serotonin and norepinephrine reuptake inhibitors) are approved by the FDA for the treatment of chronic neuropathic conditions such as diabetic nerve pain, fibromyalgia, and chronic musculoskeletal pain.
  • Tricyclic antidepressants can help manage general nerve pain, diabetic nerve pain, and post-stroke pain. Note: because of the side effects of these drugs, they are not typically advised for elderly patients.
  • Topical NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are an effective treatment for chronic musculoskeletal conditions such as osteoarthritis.

After a change in mindset from a strictly material point of view (diagnose-prescribe-take pill) to a holistic one (biopsychosocial), and a shift from opioid medications to non-opioid medications, the third step in managing chronic pain without opioids is the pursuit of complementary and alternative medical therapies.

Complementary Therapies for Chronic Pain Management           

Complementary therapies are defined as treatments that exist outside mainstream medical science but can be effective when used either in place of or in conjunction with traditional therapies. Complementary therapies attract patients struggling with chronic pain who don’t want to use opioid medication for a variety of reasons. Some may avoid opioids because of pre-existing substance abuse disorders; some may have developed substance abuse disorders as a result of prescription opioid use; some may have been unsuccessful managing chronic pain with opioids; some may be averse to physicians and traditional medical science altogether. This list details complementary approaches supported by scientific research for the management of chronic pain:

  • Cognitive Behavioral Therapy (CBT) is a type of talk therapy which helps a patient make connections between emotions, thoughts, and actions. While CBT itself does not relieve pain, it’s considered effective in improving mood and decreasing catastrophizing. Pain management experts recommend CBT to address the psychological component of pain within the biopsychosocial model of chronic pain management.
  • Physical Exercise improves overall quality of life, mood, physical functioning, and reduces risk of developing co-occurring chronic diseases such as cardiovascular disease, type 2 diabetes, osteoporosis, and obesity. Low, moderate, and high-intensity aerobic exercise, strength training, and flexibility training all have positive impacts on the management of chronic pain. Any exercise plan should be tailored to accommodate individual needs and capabilities.
  • Yoga, Tai Chi, and Qigong are low-intensity movement-based physical activities that have positive impacts on chronic pain associated with rheumatoid arthritis and fibromyalgia. Evidence shows these activities also improve strength, balance, flexibility, cognitive function, and help manage symptoms of anxiety and depression.
  • Acupuncture is a traditional Chinese medical technique used to treat a wide range of disease and illness. Research verifies acupuncture as an effective treatment for osteoarthritis, neck pain, back pain, chronic headache, and shoulder pain.
  • Massage is proven effective in reducing chronic musculoskeletal pain and mitigating associated symptoms such as insomnia, depression, anxiety, and stress.
  • Chiropractic therapy – the direct manipulation of the spine – is proven effective for the treatment of chronic spinal pain syndromes.
  • Mindfulness and Meditation practices serve as an effective complement to CBT in managing chronic pain, decreasing stress, and treating opioid misuse. Pain researchers assert that these techniques operate by increasing emotional awareness and intelligence, skills which lead to greater self-efficacy and a subsequent decrease in the subjective experience of pain.

Managing Chronic Pain Without Opioids

The relationship between humans and opioids goes back thousands of years – but that’s not the whole story. While it’s true that our relationship with exogenous opioids goes back thousands of years, our relationship with endogenous opioids is deeper. It goes back millions of years, to the very origin of our species, because our opioid system evolved as an integral part of our nervous system. We can neither avoid nor ignore its presence and power in our lives. We can, however, identify when this system works against our overall health and well-being, as in the case of opioid medications used for chronic pain. We can mitigate the negative effects of exogenous opioids by pursuing evidence-based therapies which are equally effective, and in some cases, superior to opioids for chronic pain management. Individuals in recovery and treatment for substance abuse disorders can find comfort in the fact that opioids are not their only option and sidestep the potential for relapse and misuse. They no longer have to fear the effect of injuries or surgeries on the recovery process, or operate under the false notion that living a sober life means they don’t have access to effective pain management strategies or medication that works. Holistic, interdisciplinary approaches, paired with non-opioid medications and the right combination of complementary therapies, empower patients – including those in recovery – to take control of their pain experience and improve quality of life without exposure to the preponderance of risks associated with opioids.

Painkillers For Kids: Recent FDA Approval Marks The Latest Step In OxyContin’s Evolution

Painkillers For Kids OxyContin Approved - Summit EstateThe United States has been embroiled in an opioid overdose epidemic for years, resulting in growing public support for stricter prescription practices and more oversight of pharmaceutical manufacturers. One of the most potent opioid painkillers on the market is OxyContin, and that name has been part of the public drug discussion for the past couple of decades for many reasons.

Although OxyContin is one of the most effective medications for treating severe pain for long periods of time, it is also one of the most habit-forming prescription drugs. Last year, the Food and Drug Administration (FDA) approved OxyContin for use for children as young as 11 years old. OxyContin is an incredibly potent and highly habit-forming opioid, and this new approval has drawn no small amount of scrutiny.

For years, OxyContin had only been prescribed to treat chronic and severe pain. The deciding factor for whether the drug can be given to a child is a bit ominous as well: The child must be able to tolerate a 20 mg opioid dose over five consecutive days to qualify for continued use of OxyContin.

OxyContin is a long-acting painkiller that can provide relief for up to 12 hours for even the most serious pain, and pediatric healthcare professionals have argued that this can help ease the suffering of children with terminal or seriously debilitating health problems.

Although the FDA’s decision is not meant to make OxyContin the first choice among opioid painkillers for children, this change has led to significant public debate. Those who support the change say the drug is powerful enough to combat even the most severe pain some children face, namely from cancer or serious invasive surgeries, such as spinal fusions.

OxyContin In The News

OxyContin's Dubious Track Record - Summit EstateOne of the major criticisms of this new approval is that the FDA is acting in the interest of the pharmaceutical company that develops OxyContin: Purdue Pharma. Purdue has a poor public perception, mostly due to the fact it pled guilty in 2007 to charges of misbranding and misleading pharmaceutical regulators about OxyContin’s potential for abuse and risk of addiction.

Purdue aggressively marketed OxyContin after its introduction in 1996. Sales of the drug reached $1 billion that first year, and Purdue was criticized for marketing to general practitioners and other health care professionals that typically are not trained to identify patterns of abuse among patients.

By the year 2000, abuse and crime rates surrounding OxyContin skyrocketed, as the drug is capable of producing a high as powerful as that of heroin. One of the main reasons Purdue has been criticized was that during the course of legal proceedings, internal documents surfaced that proved the manufacturer was well aware of OxyContin’s potential for abuse and addictive properties.

The time-release nature of the drug was inaccurately touted as a deterrent to abuse, and Purdue severely underreported the appearance of withdrawal symptoms in arthritis patients. These are notoriously serious offenses, and it would appear to many that, at least at the time, Purdue was far more concerned with profits than public welfare.

After a guilty plea, Purdue was forced to pay $600 million in criminal and civil penalties – $130 million of which went to civil litigation settlements for patients. Since the incident, OxyContin has been met with no short supply of scrutiny, although American opioid prescription rates have continued to climb.

America’s History With Painkillers

19000 Deaths Prescription Opioid Overdose 2014 - Summit EstatePrescription opioids are some of the most commonly prescribed painkillers in the U.S., despite the fact drug overdose is the leading cause of accidental death in the country. Opioid addiction is the major driving force behind this very serious epidemic. Of the more than 47,000 lethal drug overdoses in 2014, nearly 19,000 were attributed to prescription opioids. Additionally, heroin (an illicit opioid) caused more than 10,000 overdose deaths that year.

One of the biggest issues with the prescription opioid epidemic in the U.S. is that it increases heroin use among the population. Prescription opioids are addictive and carry a high risk for abuse. Without careful, thoughtful instructions, patients can easily overdose or develop dependency. Once their prescription runs out, many patients see heroin as an attractive substitute. This is because “smack” is cheaper than black market opioid pills and far more accessible.

Building A Tolerance

Despite the addictive nature of opioid painkillers, prescription use has continued to climb over the past several decades. Unfortunately, the nature of prescribed medication lends itself to misuse. Many patients simply assume that since their doctors prescribed the medicine, it must be safe to use. Once the drug works itself into the body, one may develop a slight tolerance to the drug, and it may not treat their pain as effectively after some time. Some patients assume it is safe to up their dosage a bit to compensate for their newfound tolerance..

This line of reasoning turns a slight tolerance into a major tolerance, and patients often go through their prescriptions much faster than intended due to their painkillers lessening in potency. By the time they require so much of the drug that addiction has set in, they essentially depend on the opiod to function.

Recent Strides To Combat Abuse

To combat abuse, Purdue recently reformulated OxyContin pills so they could not be as easily crushed into powder. OxyContin abusers would commonly crush the pills so they could snort the powder or mix it into a solution for injecting. Both methods produce a much more potent and faster-acting high than simply ingesting the pills. Hence, Purdue Pharma’s new formula has helped curb overall demand for black market OxyContin.

However, while this change helps to actively curb OxyContin abuse, the new formula is a double-edged sword. If doctors believe the potential for abuse has been diminished with the new formula, they may be more liberal in giving prescriptions to patients. This, in turn, could further the prescription opioid epidemic we are seeing today and create more addicts.

OxyContin’s Evolution: Now Available To Adolescents

OxyContin Can Help Children With Cancer Sickle Cell Anemia - Summit EstateThe important thing to remember is that most addicts do not actively choose to abuse their prescriptions. Many are people with legitimate health problems and a genuine need for opioid painkillers who have simply disregarded their doctors’ instructions or were not thoroughly informed about the risks of their prescriptions before obtaining them.

It is an unfortunate reality in our world that children sometimes must contend with life-threatening and incredibly painful health issues too. The recent FDA ruling is aimed at providing these children with an effective pain-management drug formerly reserved strictly for emergency situations at a doctor’s discretion. The ruling is also meant to provide long-term pain relief for conditions that cannot be adequately managed with other, less potent medications.

Purdue has repeatedly insisted that it has no plans whatsoever for active OxyContin marketing to pediatricians, and the company remains committed to opposing and preventing abuse and misuse of the drug. As an additional safety measure, the FDA has required that Purdue perform consistent follow-up studies on how OxyContin is used among younger patients. This is meant to immediately identify any troubling patterns as they emerge.

The FDA has also required that Purdue collate and report nationally representative data concerning OxyContin prescriptions for children under the age of 17. This data must include the conditions it is being prescribed to treat and the types of doctors providing the prescriptions. These additional requirements are meant to be safeguards to ensure OxyContin is used appropriately for minors.

Clearer Directions For Physicians

The FDA has argued that this change was not meant to make OxyContin more available or more widely used, but rather to better educate the health care industry about how to safely use and distribute opioid painkillers in pediatric cases. Doctors are legally permitted to prescribe and administer whatever medications they deem fit for any given scenario, and the FDA claims that this change will provide a better standard of care for children who are fighting serious medical issues.

The new labeling and dosage changes make it much easier for health care professionals to determine which adolescent patients need OxyContin, and it eliminates most of the guesswork about proper dosage. Children that could greatly benefit from this form of consistent pain relief are those who are:

  • Facing aggressive forms of cancer
  • Recovering from invasive surgeries
  • Stricken with sickle cell anemia or another potentially fatal condition

This issue has sparked vehement voices on both sides of the debate. Many of the strongest supporters are pediatricians, pain specialists and parents that all too often have to witness children in severe pain firsthand. Detractors voice their concerns that this change is made in favor of Purdue’s profits and puts children at an unnecessary risk for addiction. The current opioid overdose epidemic certainly has a large part to play in these raised concerns, too.

Patterns Of Addiction In Adolescents

Another major point of contention is that adolescents are more predisposed to forming addictions than adults. Since the adolescent brain is not fully developed, it is much easier to develop addictive patterns and a dependence on an opiate painkiller. Indeed, prescription opioids are responsible for tens of thousands of accidental deaths each year, and it has been widely argued that the FDA’s ruling opens the doors to children being a larger portion of those statistics.

Recent studies have shown that drug abuse among adolescents and teens has declined to the lowest levels seen in years. This trend has continued despite the ongoing national opioid epidemic, so it would be difficult to draw a connection between this new ruling and OxyContin abuse among adolescents. Another safeguard preventing younger patients from forming addictions is the fact children are rarely responsible for their prescriptions.

Parents are most likely the ones to dispense their kids’ medication, and the new FDA ruling specifically requires careful instructions to be included for all adolescent prescriptions. If parents are properly warned about proper dosing and the dangers of addiction present with OxyContin use, adolescent patients will be less likely to develop addiction to the drug and will use them only as intended.

It would seem that though today’s youth are far warier of drug abuse than previous generations. The known effects of drugs, the consequences of addiction, and the fear of legal repercussions are effective deterrents for keeping children disinterested in experimenting with hard drugs.

Time Will Tell If Painkillers For Kids Is The Right Decision

OxyContin For Kids FDA Approval Opioid Epidemic - Summit EstateAt this point, it is difficult to say definitively one way or another if this change is a step in the right direction. The new ruling requires stricter instructions for use and follow-up studies to carefully analyze the effects of OxyContin prescriptions among adolescents, and it aims to curb the opioid epidemic through responsible use. Children who suffer from serious pain are also now afforded a great degree of relief through OxyContin prescriptions.

On the other hand, the opioid epidemic does not seem to be diminishing, and this new ruling could very well result in a spike in youth opioid dependency. However, one must keep in mind that adolescents are not in charge of their medical treatment and prescriptions. They rely on their doctors and parents for treating and managing their conditions.

As long as those individuals have been thoroughly informed about the dangers of opioid addiction and abuse, it stands to reason that there is little reason to fear the FDA’s decision as a dangerous one.

Will Prescriptions Rise?

As stated previously, one detail that will remain to be seen for some time is whether this change and the new perception of OxyContin will result in an increase in prescriptions overall. If doctors are more confident in the efficacy and safety of the drug, then they will naturally be more inclined to prescribe it without reservation.

One of the most important things to keep in mind is that this new ruling is focused on thorough and accurate labeling as well as education for health care professionals about proper prescription practices, safe applications and appropriate doses. With any luck, this new change will highlight the appropriate applications of OxyContin for all patients so they can benefit and experience an enhanced quality of life while dealing with their afflictions.

By thoroughly educating the health care industry and all relevant professionals about the proper applications of this drug, the FDA may actually help curb the current opioid overdose epidemic rather than prolong it.

What Is Cognitive Behavioral Therapy?

Talking with CounslerCognitive Behavioral Therapy (CBT) is treatment modality offered within most professional addiction treatment programs. As a research-based treatment, CBT is both problem-focused and goal-oriented to help recovering addicts change harmful thought patterns.

Understanding CBT

How is CBT effective? One of the most common traits in alcoholics and drug addicts is destructive thinking or thought patterns. Without gaining an understanding of these, it’s very difficult to overcome the grip of addiction. Understanding or “cognition” of thought patterns is necessary for healing and overcoming negative thoughts and behaviors. With CBT, individuals work towards understanding patterns of behavior that lead to self-destructive actions and beliefs, as well as developing alternatives thinking processes that can be incorporated into everyday life.

How Is CBT Different Than Traditional Psychotherapy?

Unlike psychodynamic psychotherapy which is focused on working with a therapist to help recovery from a specific mental illness, CBT is problem-focused and goal-oriented to address the symptoms of mental illness. By exploring the thinking behind the self-destructive actions and beliefs, individuals with mental illness can alter thinking patterns to improve behaviors and coping skills. Sitting and ThinkingNegative thinking is a key component of depression and anxiety, as well as addiction. With all three types of mental illness, destructive thoughts are at play causing a sense of powerlessness and a lack of control. CBT works to recognize dysfunctional thinking and alter behaviors as part of a treatment plan.

How CBT Fits In With Addiction Treatment

Cognitive behavioral therapy sessions can be relatively short, especially when compared with psychodynamic psychotherapy. Thus, it can be integrated into an addiction treatment program regardless if its 30 days, 90 days or longer. For many individuals entering treatment, there are underlying co-occurring mental health issues that can be helped by CBT. From the first days of treatment, individuals can start to work on recognizing negative thoughts, cognitive distortions and perceptions. From there, emphasis can be placed on psycho-education, skills training and cognitive restructuring.

The Benefits Of A Professional Treatment Program

One of the primary reasons why a professional addiction treatment program offers substantial benefits over going “cold turkey” is being able to access research-based treatment such as CBT that help support long-term recovery by changing negative thought patterns. Want to learn more about how a professional treatment program can help you or a loved one overcome addiction? Call Summit Estate now to speak with an addiction specialist

Who Is Outpatient Treatment Best For? Revisited: 7 Questions To Ask Yourself

(Part One Here) When you are considering treatment for drug or alcohol addiction, one of the first considerations is whether you should choose inpatient care in an around-the-clock facility or an outpatient treatment program.

Understanding The Difference Between Inpatient And Outpatient Treatment

Summit Estate Recovery Center-LogoBefore you can decide on the right option for addiction treatment for you, it’s important to have an understanding of both inpatient and outpatient treatment programs. In an inpatient program, you will reside in a facility during your treatment. The normal stay is 28 days, but this duration is sometimes longer depending on factors such as the type and severity of your addiction. If you’re voluntarily seeking help for an addiction, yet have day-to-day responsibilities that you cannot let go for any length of time, an outpatient treatment program might be the right choice. This type of treatment program is less structured, but is still focused on providing you with the necessary counseling and therapies you need to support your recovery.

Making The Right Treatment Decision – 7 Questions To Ask Yourself

While both inpatient and outpatient treatment programs help individuals overcome their addiction, there are some considerations worth exploring before you decide on one or the other. The following are some questions to ask yourself before making this very important decision.

1. How Severe Is My Addiction To Drugs Or Alcohol?

How Severe Is My Addiction To Drugs Or Alcohol If you experience withdrawal symptoms when you stop using drugs or drinking, you have a physical addiction that requires detox. You will initially need inpatient treatment. Symptoms of withdrawal can be very unpredictable, and because of this, they need to be managed under the care of professionals who can help you through this early stage in your recovery. On the other hand, if your addiction is moderate and you don’t have withdrawal symptoms, an outpatient program may be an acceptable option for you.

2. Am I Dedicated To Successfully Completing Addiction Treatment?Dedicated To Successfully Completing Addiction Treatment

Yes, you have to be very honest with yourself with this question. Only those who have the determination to overcome their addiction and are willing to do what it takes to stay sober should be entering a more loosely structured, outpatient treatment program.

3. Have I Previously Tried To Stop Using Drugs Or Alcohol?

Summit Estate Recovery-Tried To Stop Using Drugs, Alcohol

A Discussion Inside Summit Estate Recovery Center

If you’ve unsuccessfully attempted to beat your addiction either cold turkey or in another treatment program, you will be better off in an inpatient facility where you can get the dedicated treatment you need. With each relapse, addiction gets harder to treat. So, if you’ve already had several failed attempts, you will need more focused, intense treatment to delve into the underlying causes of your addiction.

4. What Is My Current Situation?

What Is My Current Situation-Is Outpatient RIght For Me In a perfect world, you would be able to overcome your addiction in an environment free from stress, temptation and triggers. However, you may have the challenges of a demanding career, family or school. If you are unable to take time away from these responsibilities, outpatient treatment might be the best option. However, if you are surrounded by negative outside influences that are helping to perpetuate your addiction, you will need to break free from these people or places to get the help that you need. This may only be possible in an inpatient facility.

5. Do I Have Other Mental Health Issues?

Mental Illness And Addiction More than 50 percent of individuals who abuse drugs or alcohol have some form of mental illness. It’s a fact that addiction treatment is more complex when there are underlying mental health issues. If you’ve been diagnosed with a mental health condition or you suspect you have depression, anxiety or some other form of mental illness, you are more likely to sustain long-term recovery if you undergo inpatient treatment that can address your co-occurring disorders.

6. What Is My Support Network?

What Is My Support Network You may have a loving family or close friends that are supportive in you getting treatment and can help you in your recovery. If this is the case, outpatient treatment can be particularly beneficial. However, if you’re surrounded by individuals who are also using drugs or alcohol or are unsupportive of your recovery, you may need time away from them in an inpatient facility to establish the foundation for your recovery.

7. Can I Commit To An Outpatient Program?

Can I Commit To An Outpatient Program

Summit Estate Recovery Center Outpatient Therapy Session

With an outpatient program, you have to make a commitment to attend regular therapy sessions. Both the location and the schedule have to be convenient so that you can fit your treatment program into your daily schedule.

Find Out More About Outpatient Treatment In San Jose

Summit Estate Recovery Facility-Outpatient Treatment In San Jose

Beautiful Acreage View of Summit Estate Recovery Center

If answering these questions is leading you to outpatient treatment, the next step is speaking with an addiction specialist. If you are looking at outpatient treatment options in or around San Jose, California, call Summit Estate today. We offer individualized outpatient treatment programs that help those who are committed to their recovery. This post further expands on the topic we asked previously Who Is Outpatient Treatment Best For?

Who Is Outpatient Treatment Best For?

When you have daily responsibilities such as family, work or school, it’s not always possible to get extended time away for residential drug or alcohol treatment. For many individuals, the right approach is an outpatient treatment program. Of course, in cases of severe addiction, inpatient care is often the only option. However, outpatient treatment provides the right level of care for many plus the flexibility to continue daily life for those with non-severe addictions who live in a stable and safe home, free from significant temptations.Who is Outpatient Treatment Right for

How To Know If Outpatient Treatment Is The Right Option

Is an outpatient program the right choice? This is a common question that is worth carefully exploring. Some considerations that should be discussed with loved ones to determine the right type of treatment are: The Level Of Your Addiction – Outpatient treatment is more effective for those in the early stages of addiction. Family And Friends – Outpatient treatment is particularly effective for those who have healthy support from family and friends. Continuing Care – Outpatient rehabilitation is commonly recommended once you’ve successfully completed an inpatient program. It’s a smart choice for preventing relapse and sustaining recovery. Treatment For Busy Individuals – Many of the individuals who choose outpatient treatment are working parents with children who depend on them for day-to-day care. Throughout the program, the family can stay intact while treatment is provided on an ongoing basis.

Factors To Consider When Choosing An Outpatient Program

So, what should you look for when choosing an outpatient program that will fit you or your love one’s needs? Here are some of the key things to consider: Program Location – An effective outpatient program requires a commitment to regular therapy sessions. The location needs to be convenient enough to your home or work to make it feasible to fit into your daily schedule. Program Schedule – Some programs offer convenient early morning or evening sessions specifically for busy individuals. Staffing – You will want a program that includes experienced medical, counseling and therapy staff. You will also want to ensure that there is an optimal staff-to-patient ratio to enable you get the level of attention you need to support your recovery.

Ready To Find Out More About Outpatient Treatment?

If you are considering your options for outpatient rehab in Saratoga, California, call Summit Estate Recovery Center. With individualized treatment programs for men and women suffering from drug or alcohol addiction, our intensive outpatient program can be an effective option for individuals who are committed to recovery. Now that you have a better understanding of who outpatient treatment is best for, find out who inpatient treatment works best for. Read Our In-depth Post & Ask Yourself 7 Questions To Find Out If Outpatient Is Right For You

Is My Loved One Using Drugs? What Should I Do?

Is My Loved One Using Drug-What Should I Do-Summit EstateDo you suspect that your loved one is using drugs? It can be both incredibly stressful and heartbreaking to be worried that someone you care deeply about is risking their life by abusing drugs.

What To Do If Your Loved One Is Using Drugs

While it can seem like you’re helpless when you witness someone succumb to addiction, there are actually action steps you can take to help them and help yourself during this crisis.

Don’t Blame Yourself

First, it’s important to not blame yourself. Drug addiction is a disease and not something you caused. It’s also vital to learn the warning signs and symptoms of drug abuse. Often, there are physical evidence to look for including:

Watch For Physical And Behavioral Signs Of Drug Addiction

  • Bloodshot eyes
  • Slurred or incoherent speech
  • Unexplained weight loss or weight gain
  • Dramatic shifts in sleep patterns
  • Unusual smells on their breath, body, or clothing
  • Shaking hands
  • Difficulty walking or executing fine motor skills

Along with physical signs a loved one may have an addiction, there are often recognizable behavioral changes:

  • Attendance or performance problems at work or school
  • Stealing or borrowing money
  • Secretive or suspicious behavior
  • Unexplained new friends or activities
  • Run-ins with the law such as DUIs, fights, theft, or other illegal activities

These behaviors are also combined with some notable psychological signs of abuse such as mood swings, irritability, out-bursts of anger, hyperactivity, anxiety, and even paranoia.

Take A Proactive Stance To Address Drug Abuse

When the writing on the wall is indicating a drug problem or even addiction, time is of the essence. This isn’t when a wait and see approach is the right decision. With each passing day, a drug addiction can get more severe, making it more difficult to overcome.

Don’t Delay In Getting Help

Most often, the best approach for addressing a loved one’s drug use is guiding them to professional addiction treatment. Now is the time to stay strong and help lead your loved one to the care they need. Personalized, on-going support is necessary for breaking an addiction and staying clean and sober.

Treatment for drug abuse is multi-layered to treat the mind, body, and soul and usually includes individual therapy, family therapy, 12-step meetings, and a variety of holistic treatments. In some cases, outpatient treatment is sufficient. However, many individuals can benefit from the comprehensive, round-the-clock care that inpatient addiction treatment offers.

Want to learn more about obtaining addiction treatment for a loved one? Contact Northern California’s premier drug and alcohol rehab recovery center – Summit Estate.

Don’t Wait Another Day – Your Loved One Will Thank You Later – Call Us Now.