Tag Archives: opiate addiction

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

Top 11 Reasons for Relapse

There are a million and one reasons why people who struggle with an addiction relapse. They can be categorized into 11 reasons. Listen to a group of people in recovery from opiate addiction discuss their reasons for having relapsed in the past.

Discussion Guidelines:

Here's a list of eleven common reasons for relapsing:

  1. Grief and Loss
  2. Environment (housing, finances, unemployment, drugs)
  3. Reward
  4. Relationships with Drug Users
  5. Overwhelming Stress
  6. Abuse or Trauma
  7. Pain Relief (withdrawal symptoms, emotional or physical pain)
  8. Drinking (can lower inhibitions)
  9. Revenge (oppositional defiance)
  10. Not Being Fully Committed
  11. Self-Sabotage

What were your reasons for relapsing in the past?

What might cause you to relapse in the future?

Do you have a relapse prevention plan?

In what ways can you further develop your prevention plan?

Which of these eleven reasons might cause early relapse and premature drop-out from treatment?

Supplemental Reading:

Common Relapse Triggers, Alcohol Rehab

Terence Gorski, How To Develop A Relapse Prevention Plan

Should You Stop? Criteria for Ceasing Medication Assisted Treatment

The properties of Medication Assisted Treatment are such that they stop withdrawal symptoms, decrease cravings and block the user from getting high if they use opiates. Because of this, MAT is a godsend to opiate addicts. But many hope to stop MAT at some point. Have you thought about tapering off your medication? What do you hope for and what do you fear about ceasing your medication? Listen to a group of opiate addicts discuss their hopes and fears.

Discussion Guide:

Do you intend to stop utilizing medication assisted treatment for your recovery?

How long do you believe one should engage in treatment before tapering off medication?

What are the pros and cons of stopping your medication?

Do you meet the criteria for ceasing medication assisted treatment?

What are your fears of ceasing MAT?

Supplemental Reading:

Centre for Addiction and Mental Health, Client Handbook, Chapter 8 How Long Will I Be On Methadone? http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/methadone/Documents/mmt_client_hndbk.pdf

Socioeconomic Dimensions to Addiction and Recovery

Writer, Maia Szalavitz, states “Addictions are harder to kick when you’re poor”. She makes the point that there is a socio-economic dimension to addiction. Addiction correlates with high unemployment and  lower income. For example, Szalavitz states heroin addiction is more than three times as common in people making less than $20,000 per year compared to those who make $50,000 or more. Higher levels of education are linked with lower rates of addiction. The addiction rate among the unemployed is around twice as high among people who have jobs. She also makes the point that most addiction ends by the age of 30, if they reach certain milestones such as working, getting married and having children. While this may be true of most drugs of abuse, is it different for opiate addictions? Listen to a group of people who were addicted to opiates discuss their opinions of  the socio-economic dimensions to heroin and pain killer addiction.

Discussion Guide:

Do you believe that addiction is influenced by income, education and employment?

Is your addiction influenced by these factors? If so, in what way?

Is opiate addiction different than other substances in terms of being socio-economically influenced?

Do you agree that most people “age out” of addiction by the age of 30?

Are people in late stage addiction to heroin or pain killers as likely to age out of addiction?

Do you find that the national economy directly impacts whether addicts are able to access treatment?

Supplemental Reading:

Szalavtiz, Maia  https://www.theguardian.com/commentisfree/2016/jun/01/drug-addiction-income-inequality-impacts-recovery

Goal Setting

Members who attended our group entitled “Harm Reduction” were asked to set two personal goals after rating what behaviors they would like to change. The first goal was directly related to their substance use. The second goal was related to wellness. Listen to the group members discuss their values, goals and their process of working toward them. Additionally, they were posed several questions that are designed to clarify what is most important to them, and assist in formulating goals.

Discussion Guide:

Have you set action goals toward recovery? Have you been successful in attaining your goals?

The following questions are designed to clarify your goals:

  •  What are 5 things you value the most in life, that you would sacrifice for?
  • What would you do if you won one million dollars, tax free?
  • What would you do and how would you spend your time if you knew that you had only six months to live?
  • What have you always wanted to do but were afraid to attempt?
  • In looking back over all the things you’ve done in your life, what type of activities gives you your greatest feeling of importance?
  • Imagine that you received one magic wish. What one great thing would you dare to dream if you knew it could not fail?

Supplemental Reading:

The Beginner’s Guide to Goal Setting, Michael Hyatt, http://michaelhyatt.com/goal-setting.html