Tag Archives: opiate addiction

Attitudes and Stigma Drive Opioid Treatment and Policy, Not Research

Psychiatrist, Sarz Maxwell says that one of the greatest barriers to treatment and effective drug policy are attitudes towards drugs. Addiction is not seen as a disease, but as a moral failing. Methadone and Suboxone are not drugs of choice. They are medicines. Listen in to this opiate support group discuss stigma .

Discussion Guide:

It is said that this opioid epidemic is getting worse and the stigma against opioid abusers is worsening. Why would this be the case?

Dr. Maxwell said "It is not what the person does to the drug, it's what the drug does to the person." What does this mean?

Abstinence is one of the least effective methods of treatment for opioid addiction and has the lowest recovery rate. Have you been successful with long term abstinence without medication such as Methadone and Suboxone?

"Addiction is the only disease where we expect the patient to be immediately symptom and medication free."  Do people have this expectation of you?

In a genetically predisposed addict's brain, there are too many opioid receptors and too few endorphins. This can cause people to use substances in an effort to get normal. Did you feel abnormal without an opioid boost?

 

 

 

Behavioral Addiction vs. Substance Addiction

When we think of addiction, we immediately think of alcohol, drugs and gambling.  Few of us think of sex, social media or spending as addictions. The DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) does not recognize behavioral addictions, other than gambling. Behaviors such as sex, social media and spending are not included in the approved list of addictions. But should they be included? Listen in to this opiate recovery support group as they discuss the similarities and differences between behavioral addictions and substance addictions.

Discussion Guide:

Are you familiar with the terms behavioral addictions, or process addictions? What are they?

Name examples of behavioral addictions.

How are behavioral addictions different than substance addictions?

How are they similar?

Do these two types of addictions have similar or dissimilar outcomes?

Supplemental Reading:

Robert Weiss, Can You Really be Addicted to a Behavior? http://www.huffingtonpost.com/entry/can-you-really-be-addicted-to-a-behavior_us_59938c79e4b0a88ac1bc380e

Marc Lewis, Behavioral Addictions vs. Substance Addictions https://www.psychologytoday.com/blog/addicted-brains/201306/behavioral-addictions-vs-substance-addictions

What’s the Purpose of Support Groups?

Should you talk about your addiction war stories? Some people believe that telling your addiction history is not helpful. They fear that it could cause cravings and relapse to themselves and others. On the other hand, isn't your support group the appropriate place to talk out your trauma? It can be healing. Listen in to this opiate recovery support group as they discuss the rationale and goals of support groups.

Discussion Guide:

Have you felt that some of your group members have glorified their drug related behavior in the past?

If so, has that triggered a craving or relapse for you?

What are the pros and cons of telling your story to other group members?

What do you think the rationale and goals of support groups are?

What is the most helpful thing that you have experienced from your support group?

Supplemental Reading:

Group Interventions for Treatment of Psychological Trauma, http://www.agpa.org/docs/default-source/practice-resources/group-interventions-for-treatment-of-trauma-in-adults.pdf?sfvrsn=2, see page 32-33.

Is It OK to Stay on Maintenance Medication for Life?

A podcast listener asked the group a question. Do any of them want to stay on a maintenance medication indefinitely? He feels a subtle pressure to wean off his medication by his treatment clinic and wonders if this is true for others. Is it OK to stay on Medication Assisted Treatment forever? Listen in to this opiate support group talk about their progress, intentions and hopes for the future.

 

Discussion Guide:

If you are on a maintenance medication for opiate recovery, have you thought about whether you want to wean off your medication?

Have you experienced pressure from your clinic, or others, to either stay in Medication Assisted Treatment, or pressure to wean off?

What is your personal preference for how long you should stay on MAT?

How do you handle the stigma against MAT?

Do you believe there is any long term harm from staying on MAT indefinitely?

Are you familiar with the Tapering Inventory tool? If not, see Tapering From Methadone (below)

 

Supplemental OpiateSupportGroup.Com Podcast Listening on When or Whether You Should Stop MAT:

Ask The Expert: Dr. Mary Wenzel http://www.opiatesupportgroup.com/ask-the-expert-dr-mary-wenzel-addiction-specialist/ 

Should You Stop? Criteria for Ceasing Medication Assisted Treatment http://www.opiatesupportgroup.com/should-you-stop-criteria-for-ceasing-medication-assisted-treatment/

What You Should Know About Methadone http://www.opiatesupportgroup.com/what-you-should-know-about-methadone/

Tapering From Methadone http://www.opiatesupportgroup.com/tapering-from-methadone-2/

Should You Tell Your Doctor That You Are Taking Methadone or Suboxone?

Some people prefer not to tell their doctors that they are on medication, such as Methadone or Suboxone, because they fear discrimination. But they may also believe that coordinating Medication Assisted Treatment services with your physicians is important for adequate care. This is a difficult decision with possible negative repercussions. Listen in to this opiate support group discuss their opinions on this dilemma.

Discussion  Guide:

What are the pros and cons of informing your doctor about MAT (Medication Assisted Treatment)?

If you are taking a medication such as Methadone or Suboxone, have you informed your doctor?

Are you comfortable telling your physician your private matters?

Does your physician treat your addiction as a disease, or a moral condition?

Have you been discriminated against when professionals learned of your recovery treatment? What happened?

Supplemental Reading:

Karla Lopez, Deborah Reid, Discrimination Against Patients with Substance Use Disorders Remains Prevalent and Harmful, http://healthaffairs.org/blog/2017/04/13/discrimination-against-patients-with-substance-use-disorders-remains-prevalent-and-harmful-the-case-for-42-cfr-part-2/

Staying Clean Is Not Easy: Barriers to Long Term Abstinence

Getting clean may be easier than staying clean. Long-term recovery can be a challenge without the right support. There are many barriers that cause former drug abusers to become discouraged if they are not able to establish a stable life. Examples are lack of housing and employment. Listen to this recovery support group talk about external and internal barriers that might make them give up.

Discussion Guide:

What are the things you need to give up when you begin a recovery program?

What are you adding to your life when you are in recovery?

What are the barriers to maintaining drug abstinence?

Supplementary Reading:

J. Kelly, J. R. McKay, A Plante, The Fix, Remove the Barriers to Addiction Recovery, 

http://www.thefix.com/remove-barriers-addiction-recovery

Addiction, Medical Ethics and Involuntary Commitment

Opioid abuse, involving both prescription pain relievers and heroin, is having a major impact on the US healthcare sector. Expensive treatments, such as replacement of heart valves from endocarditis, are a burden upon medical facilities and insurance systems. How many times should a substance abuser receive these surgeries, assuming that they will continue to abuse drugs? And under what circumstances should a substance abuser be involuntarily committed to treatment if they are a risk to themselves? Listen in to this recovery support group as they discuss this complicated issue.

Discussion Guide:

Have you put yourself at risk of medical problems by misusing needles, or doing other dangerous drug related behaviors?

Have you had expensive medical treatment due to this unsafe drug related behavior?

If so, how much did it cost to you personally, to your insurer and medical facility?

How many times should a medical facility, or insurer, provide expensive treatment to a substance abuser who is not in recovery?

What ethical guidelines do you suggest to make a decision on how many times, and under what conditions, a substance abuser receives expensive treatment?

37 states allow people who are addicted to be involuntarily committed to treatment if they are a danger to themselves or others. In what way are substance abusers a threat to themselves or others? Examples?

What are the benefits of involuntary commitment?

Supplemental Reading:

Jack Rodolica, Doctors Consider Ethics of Costly Heart Surgery for People Addicted to Opioids, http://www.npr.org/sections/health-shots/2017/03/21/520830183/doctors-consider-ethics-of-costly-heart-surgery-for-people-addicted-to-opioids

Kelly Burch, Involuntary Commitments for Addicts Being Considered By More States, http://www.thefix.com/involuntary-commitments-addicts-being-considered-more-states

What’s With the High Cost of Narcan?

Narcan, also known as Naloxone, is a life saver for someone who has overdosed on opioids. The number of deaths has skyrocketed, but so has the cost of Narcan. What's up with that? Listen in to a group of people who are in recovery from opiate addiction discuss this issue.

Discussion Guide:

Have you overdosed? What were the costs associated with it?

Do you have a Narcan kit for emergency purposes?

Can you purchase Narcan from your local pharmacy? How much is it, do you need a prescription and does your insurance cover it?

What is the most expensive Narcan kit available on the market right now?

Why do you think the price of Narcan has increased over the years?

How does the manufacturer justify this cost increase?

Supplemental Reading:

Meg Tirrell, As Opioid Epidemic Worsens, the Cost of Waking Up From an Overdose Soars, http://www.cnbc.com/2017/01/04/as-opioid-epidemic-worsens-the-cost-of-waking-up-from-an-overdose-soars.html

Needle Safety

Needle exchange programs provide a valuable service to IV drug users. They provide sterile needles and syringes which reduces the risk of infectious diseases (HIV, Hep B, Hep C),  and they refer drug users to prevention and treatment programs. There are more of these exchange programs in operation now, but few in rural areas. Listen to an opiate recovery group talk about their experiences with needles.  

Discussion Guide:

Did you inject drugs? Which substances?

Did you share needles? Did you think you were safe in doing so?

What are the risks involved in sharing needles?

If you used needles, did you feel psychologically addicted to the process of preparing the needle?

Have you taken advantage of a needle exchange program?

How did you dispose of your needles?

Where is a safe place to dispose your needles?

Supplemental Reading:

Use of Needle Exchange Programs Up Dramatically in 10 Years, Medical Press, http://medicalxpress.com/news/2016-11-needle-exchange-years-cdc.html

 

Why Isn’t Narcan More Easily Accessed?

Narcan (also known as Naloxone) can be a life saver for someone who has overdosed from an opiate. Given the high number of overdose deaths, lawmakers created a path to make Narcan readily available at pharmacies. For example, California passed a bill that allowed pharmacists to dispense Narcan to people who may be at risk of overdose including their family members and friends. A prescription is not necessary provided the pharmacist completes an hour of training, agrees to train the recipient in its use, briefly mentions drug treatment options, and notifies the recipient's primary care physician. But, the problem is that even two years later, the pharmacies haven't followed through on the plan. It is not available. Listen in to an opiate recovery support group discuss this issue.

Discussion Guide:

Do you have Narcan? Where did you get it? Did your health insurance help pay for it?

Can you get Narcan from your local pharmacy?

What factors do you believe have prevented pharmacies from offering Narcan?

What are your state regulations on accessing Narcan?

I encourage you to contact your local pharmacy to ask if they distribute Narcan, if you need a prescription, and what the cost is.

Supplemental Reading:

Jonathon Sobotor, We Don't Do Narcan Here, http://www.thefix.com/california-overdose-law-two-years-later-narcan-still-scarce