Psychiatrists Can, Should Help Address the Opioid Epidemic

Psychiatrists and mental health professionals have a vital role to play in addressing the national opioid epidemic, according to a viewpoint published in JAMA Psychiatry.

“We believe psychiatrists are uniquely skilled and ideally suited to be leaders in treating this epidemic,” Srinivas B. Muvvala, MD, from Yale School of Medicine, and colleagues wrote.

“Psychiatrists are unique among physicians in having specialty training in treating trauma, depression, and other co-occurring psychiatric disorders and assessing suicidal behavior; increasingly, there is a growing awareness of the association between suicide and opioid use,” they continued. “Psychiatrists can provide integrated mental health care and relapse prevention counseling and therefore are uniquely qualified to provide office-based addiction treatments efficiently.”

In this viewpoint, Muvvala and colleagues argued that all psychiatrists should have training in assessing and treating patients with opioid use disorder. To respond to the epidemic, they recommended more psychiatrists complete the 8-hour training needed to prescribe buprenorphine, psychiatrists include buprenorphine treatment in routine psychiatric practice, and all residency programs require buprenorphine education for physicians in training.


Psychiatrists can incorporate buprenorphine treatment into outpatient practices easily and safely and recent evidence supports the safety and feasibility of physicians initiating buprenorphine treatment at home, according to the viewpoint. Mentoring programs are available to help physicians overcome any concerns when prescribing buprenorphine.

“Psychiatrists are in an excellent position to meet the requirement that buprenorphine be given in conjunction with psychosocial services,” Muvvala and colleagues wrote. “Psychiatrists can provide in-house counseling and also work collaboratively with other disciplines (eg, psychologists, social workers, nurses and counselors).”

In addition, Muvvala and colleagues wrote that U.S. general psychiatry residency programs are lacking in basic areas of training and only require 1 month of addiction treatment experience.

“Training programs need to broaden the exposure of residents to effective treatments in addiction, particularly in outpatient settings that include competency in prescribing medications for [opioid use disorder],” they wrote. “Buprenorphine training should be a required competency of psychiatry training.”

Ensuring that mental health clinicians know resources for training and mentoring psychiatrists to prescribe buprenorphine exist is critical, the authors wrote.

“Addressing the national opioid epidemic is the responsibility of every psychiatrist,” Muvvala and colleagues wrote. “With commitment and a modest investment in further training, the expertise of psychiatrists in treating other psychiatric disorders can be extended to the effective treatment of [opioid use disorder].” – by Savannah Demko

Disclosure: One author reports consulting for Alkermes; no other relevant financial disclosures were reported.

Muvvala SB, et al. JAMA Psychiatry. 2018;doi:10.1001/jamapsychiatry.2018.3123.

Original article here on Healio.com.

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Why Drug Deaths Are Down in Troubled Ohio

DAYTON, Ohio — Dr. Randy Marriott clicked open the daily report he gets on drug overdoses in the county. Only one in the last 24 hours — stunningly low compared to the long lists he used to scroll through last year in a grim morning routine.

“They just began to abruptly drop off,” said Marriott, who oversees the hand off of patients from local rescue squads to Premier Health, the region’s biggest hospital system.

Overdose deaths in Montgomery County, anchored by Dayton, have plunged this year, after a stretch so bad that the coroner’s office kept running out of space and having to rent refrigerated trailers. The county had 548 overdose deaths by Nov. 30 last year; this year there have been 250, a 54 percent decline.

Dayton, a hollowed-out manufacturing center at the juncture of two major interstates, had one of the highest opioid overdose death rates in the nation in 2017 and the worst in Ohio. Now, it may be at the leading edge of a waning phase of an epidemic that has killed hundreds of thousands of people in the United States over the last decade, including nearly 50,000 last year.

For the first time in years, the number of opioid deaths nationwide has begun to dip, according to preliminary data from the Centers for Disease Control and Prevention — with totals for the preceding 12 months falling slightly but steadily between December 2017 and April 2018. The flattening curve — along with declining opioid prescription rates and survey data suggesting far fewer Americans tried heroin last year and more got addiction treatment — is the first encouraging news in a while.

While it’s too soon to know if the improvement is part of a long-term trend, it is clear there are some lessons to be learned from Dayton. The New York Times spent several days here interviewing police and public health officials; doctors, nurses and other treatment providers; people recovering from opioid addiction and people who are still using heroin and other drugs.

They point to a variety of factors they believe have contributed to the sharp drop in mortality.

Medicaid Expansion Hugely Increased Access to Treatment

Mayor Nan Whaley thinks nothing has had as big an impact on overdose deaths as Gov. John Kasich’s decision to expand Medicaid in 2015, a move that gave nearly 700,000 low-income adults access to free addiction and mental health treatment.

In Dayton, that’s drawn more than a dozen new treatment providers in the last year alone, including residential programs and outpatient clinics that dispense methadone, buprenorphine and naltrexone, the three medications approved by the FDA to treat opioid addiction.

“It’s the basis for everything we’ve built regarding treatment,” Whaley said at City Hall. “If you’re a state that does not have Medicaid expansion, you can’t build a system for addressing this disease.”

An event held every other month at a church in Dayton’s East End shows the scope of available options. Called Conversations for Change, it gives people addicted to drugs a chance to have a meal and to meet treatment providers, who on a recent evening had set up more than a dozen tables.

“We have medication-assisted treatment programs, withdrawal management — come see me,” a representative for one program, Project Cure, urged the two dozen people present.

“If you’re interested in Narcan training, we’re going to get started in a few minutes — you can bring your food with you,” offered a representative of another program.

Kasich has said the state is spending $1 billion a year to address the opioid epidemic, and a big chunk of that is Medicaid funds. With Medicaid now paying for nearly all low-income residents who need it to get addiction treatment, Ohio has been able to go beyond the basics in spending its share of several billion dollars in the opioid grant money the Trump administration has been giving to states. One example: paying for people who go to jail and lose their Medicaid coverage to stay in treatment with their regular provider while they’re incarcerated.

Carfentanil, an Incredibly Toxic Fentanyl Analog, Has Faded

It’s entirely possible that the biggest factor in Dayton has been the dwindling presence on the streets of carfentanil — an analog of the synthetic opioid fentanyl that the CDC describes as 10,000 times more powerful than morphine. Ohio was particularly hammered by carfentanil in recent years; according to the CDC, the state had 1,106 carfentanil-related deaths from July 2016 through June 2017, compared with only 130 in nine other hard-hit states combined.

During that period, carfentanil was showing up regularly in Dayton’s street drugs, including methamphetamine, cocaine and fentanyl. Nobody has figured out why Ohio saw more of it than anywhere else, but there’s no question it played a huge role in the explosion of deaths in Dayton early last year.

By mid-2017 carfentanil’s presence was fading — maybe in part because traffickers realized how much of their customer base it was killing, said Timothy Plancon, the Drug Enforcement Administration special agent in charge of Ohio.

The news is not all good. Cocaine and particularly meth use is rising fast in the Dayton area, as it is nationwide. And they’re often mixed with fentanyl; 77 percent of the overdose deaths in Montgomery County from January through April involved fentanyl, roughly the same as during the same period last year. The national data also suggest overdoses involving fentanyl continue to rise, along with those involving cocaine and meth, while deaths involving heroin and prescription drugs are falling slightly.

Since late summer, deaths in Montgomery County have come closer to matching the same period last year — a reminder that the battle is far from over.

“I still go to more wakes than I care to tell you about,” said Lori Erion, founding president of Families of Addicts, a local support group. “Have we got this beat or licked? Absolutely not, on any level.”

Naloxone Is Everywhere

By now, most Americans have heard of naloxone — also known by the brand name Narcan — the medication that reverses opioid overdoses if administered quickly enough, by injection or nasal spray. But few Americans cities have blanketed their neighborhoods with naloxone like Dayton has.

Montgomery County agencies distributed 3,300 naloxone kits last year, and are on course to more than double that number this year, holding trainings at treatment centers and 12-step meetings as well as at local businesses and schools.

Two friends hugging

Starting in 2014, Richard Biehl, the Dayton police chief, directed all his officers to carry naloxone — going against some of his peers in other Ohio cities, including a sheriff in a neighboring county who outright refused to equip his deputies with it. Some in Ohio and elsewhere continue to oppose harm reduction tools like naloxone, saying they enable drug use, but the evidence is overwhelming that they save lives.

“We really jumped on it because we saw it as absolutely consistent with our public mission to save lives,” Biehl said.

Research suggests he was right. A recent study from Stanford estimated that wider availability of naloxone could prevent 21,000 deaths over the next decade — more than expanding access to medications for addiction or reducing painkiller prescriptions could. But as fentanyl analogs — whose chemical structure is slightly different and can be more lethal — started entering the drug supply in Dayton, it became harder to revive overdose victims with the standard dose of naloxone. So the city, with state support, has spent a lot more to provide higher doses — $350,000 last year.

The investment has paid off, said Helen Jones-Kelley, executive director of Alcohol, Drug Addiction and Mental Health Services for Montgomery County. “If nothing else, you get that second chance with them — and in some cases that third or fourth chance,” she said. “It gives people the opportunity to get connected to services, who would not otherwise have had that chance at life.”

There Is More Support for People When Treatment Ends

Even though there are many more treatment options here now, that doesn’t mean people stay in treatment as long as they should. But the city has an unusually large network of recovery support groups, including neighborhood clubs that provide space for Narcotics Anonymous meetings to Erion’s group, which has thousands of members in Montgomery and four surrounding counties.

Dayton is also investing heavily in peer support — training people who are far enough along in their recovery to work as coaches or mentors for others who are trying to stop using, including in emergency rooms. One example is an initiative called GROW — Getting Recovery Options Working — that dispatches teams of social workers, medics, police officers and people in recovery to homes of people who have recently overdosed. The teams offer to help them get into treatment and to drive them to a program. They also supply them and their families with naloxone to have on hand in case it’s needed.

“I just stop and plant a little seed,” said Darcy Shepherd, a peer supporter who went through treatment for opioid addiction almost five years ago. “I will pull up to them, ask how they are doing and if they are ready for treatment, and when they are, to give me a call.”

Joshua Lewis, 37, is among those who have managed to stay alive long enough to benefit from recovery supports. He overdosed repeatedly last year on heroin and fentanyl, while also using meth. His girlfriend found him a bed at a local treatment center, after which he spent three months at Joshua Recovery Ministries, a religious program that provides housing for men recovering from addiction. He learned how to read there, he said, and is now training to become a peer supporter. He doesn’t use medications for addiction but said he would not discourage others from doing so.

“There are more addicts coming out of the shadows,” he said. “The stigma’s being broke.”

Police and Public Health Workers Actually Agree

When Sam Quinones, author of “Dreamland: The True Tale of America’s Opiate Epidemic,” testified before Congress earlier this year, he said that “the more cops and public health nurses go out for a beer, bridge that cultural chasm between them,” the better chance the country had at solving the problem.

Dayton has largely succeeded at bridging that chasm, which too often pits a punitive, abstinence-only approach to addiction against one that seeks to reduce deaths by any means possible. Law enforcement and public health representatives work hand in hand on a two-year-old Community Overdose Action Team, sharing data and strategizing with dozens of local organizations. Biehl was fully supportive of the city’s decision to set up a syringe exchange in 2014. Research has consistently found that such programs, which allow people who inject drugs to trade dirty needles for clean ones, prevent deaths related to infections like HIV, hepatitis C and endocarditis. While other cities, including Charleston, West Virginia, and Santa Ana, California, closed their needle exchanges this year because of opposition, including from the police, Dayton’s program continues to operate at two sites, each open once a week. The needle exchanges also help clients sign up for Medicaid and connect them with addiction treatment.

The city secured a federal grant for a pilot program that distributes fentanyl test strips, which can be used to check street drugs for the presence of various fentanyl analogues. Only a handful of cities are sanctioning the test strips at this point. Sheila Humphrey, the Dayton director for Harm Reduction Ohio, a nonprofit group, has given out thousands of strips, often at parks and community events.

“If it’s about conserving and protecting life,” Biehl said, “it has to be considered as an option.”

Link to the original article here posted on:

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By Abby Goodnough – The New York Times

Person burying hands in face

Overshadowed by Opioids, Meth is Back With a Vengeance

The number of people hospitalized because of amphetamine use is skyrocketing in the United States, but the resurgence of the drug has largely been overshadowed by the nation’s intense focus on opioids.

Amphetamine-related hospitalizations jumped by about 245 percent from 2008 to 2015, according to a study published last month in the Journal of the American Medical Association. That dwarfs the rise in hospitalizations from other drugs, such as opioids, which were up by about 46 percent. The most significant increases were in Western states.

The surge in hospitalizations and deaths due to amphetamines “is just totally off the radar,” said Jane Maxwell, an addiction researcher. “Nobody is paying attention.

Doctors see evidence of the drug’s comeback in emergency departments, where patients arrive agitated, paranoid and aggressive. Paramedics and police officers see it on the streets, where suspects’ heart rates are so high that they need to be taken to the hospital for medical clearance before being booked into jail. And medical examiners see it in the morgue, where in a few states, such as Texas and Colorado, overdoses from meth have surpassed those from the opioid heroin.

Addiction Scrabble

Amphetamines are stimulant drugs, which are both legally prescribed to treat attention deficit hyperactivity disorder and produced illegally into methamphetamine. Most of the hospitalizations in the study are believed to be due to methamphetamine use.

Commonly known as crystal meth, methamphetamine was popular in the 1990s before laws made it more difficult to access the pseudoephedrine, a common cold medicine, needed to produce it. In recent years, law enforcement officials said, there are fewer domestic meth labs and more meth is smuggled in from south of the border.

As opioids become harder to get, police said, more people have turned to meth, which is inexpensive and readily available.

Lupita Ruiz, 25, started using methamphetamine in her late teens but said she has been clean for about two years. When she was using, she said, her heart beat fast, she would stay up all night and she would forget to eat.

Ruiz, who lives in Spokane, Washington, said she was hospitalized twice after having mental breakdowns related to methamphetamine use, including a monthlong stay in a psychiatric ward in 2016. One time, Ruiz said, she yelled at and kicked police officers after they responded to a call to her apartment. Another time, she started walking on a freeway but doesn’t remember why.

“It just made me go crazy,” she said. “I was all messed up in my head.”

The federal government estimates that more than 10,000 people died of meth-related drug overdoses last year. Deaths from meth overdose generally result from multiple organ failure or heart attacks and strokes, caused by extraordinary pulse rates and skyrocketing blood pressure.

In California, the number of amphetamine-related overdose deaths rose by 127 percent, from 456 in 2008 to 1,036 in 2013. At the same time, the number of opioid-related overdose deaths rose by 8.4 percent, from 1,784 to 1,934, according to the most recent data from the state Department of Public Health.

“It taxes your first responders, your emergency rooms, your coroners,” said Robert Pennal, a retired supervisor with the California Department of Justice. “It’s an incredible burden on the health system.”

Costs also are rising. The JAMA study, based on hospital discharge data, found that the cost of amphetamine-related hospitalizations had jumped from $436 million in 2003 to nearly $2.2 billion by 2015. Medicaid was the primary payer.

“There is not a day that goes by that I don’t see someone acutely intoxicated on methamphetamine,” said Dr. Tarak Trivedi, an emergency room physician in Los Angeles and Santa Clara counties. “It’s a huge problem, and it is 100 percent spilling over into the emergency room.”

Trivedi said many psychiatric patients are also meth users. Some act so dangerously that they require sedation or restraints. He also sees people who have been using the drug for a long time and are dealing with the downstream consequences.

In the short term, the drug can cause a rapid heart rate and dangerously high blood pressure. In the long term, it can cause anxiety, dental problems and weight loss.

“You see people as young as their 30s with congestive heart failure as if they were in their 70s,” he said.

Jon Lopey, the sheriff-coroner of Siskiyou County in rural Northern California, said his officers frequently encounter meth users who are prone to violence and in the midst of what appear to be psychotic episodes. Many are emaciated and have missing teeth, dilated pupils and a tendency to pick at their skin because of a sensation of something beneath it.

“Meth is very, very destructive,” said Lopey, who also sits on the executive board of the California Peace Officers Association. “It is just so debilitating the way it ruins lives and health.”

Nationwide, amphetamine-related hospitalizations were primarily due to mental health or cardiovascular complications of the drug use, the JAMA study found. About half of the amphetamine hospitalizations also involved at least one other drug.

Because there has been so much attention on opioids, “we have not been properly keeping tabs on other substance use trends as robustly as we should,” said study author Dr. Tyler Winkelman, a physician at Hennepin Healthcare in Minneapolis.

Sometimes doctors have trouble distinguishing symptoms of methamphetamine intoxication and underlying mental health conditions, said Dr. Erik Anderson, an emergency room physician at Highland Hospital in Oakland, California. Patients also may be homeless and using other drugs alongside the methamphetamine.

Unlike opioid addiction, meth addiction cannot be treated with medication. Rather, people addicted to the drug rely on counseling through outpatient and residential treatment centers.

The opioid epidemic, which resulted in about 49,000 overdose deaths last year, recently prompted bipartisan federal legislation to improve access to recovery, expand coverage to treatment and combat drugs coming across the border.

There hasn’t been a similar recent legislative focus on methamphetamine or other drugs. And there simply aren’t enough resources devoted to amphetamine addiction to reduce the hospitalizations and deaths, said Maxwell, a researcher at the Addiction Research Institute at the University of Texas at Austin. The number of residential treatment facilities, for example, has continued to decline, she said.

“We have really undercut treatment for methamphetamine,” Maxwell said. “Meth has been completely overshadowed by opioids.”



Original article here featured on:NBC News logo

By Anna Gorman, Kaiser Health News


Colder, Darker Climates Increase Alcohol Consumption and Liver Disease

Where you live could influence how much you drink. According to new research from the University of Pittsburgh Division of Gastroenterology, people living in colder regions with less sunlight drink more alcohol than their warm-weather counterparts.

The study, recently published online in Hepatology, found that as temperature and sunlight hours dropped, alcohol consumption increased. Climate factors also were tied to binge drinking and the prevalence of alcoholic liver disease, one of the main causes of mortality in patients with prolonged excessive alcohol use.

“It’s something that everyone has assumed for decades, but no one has scientifically demonstrated it. Why do people in Russia drink so much? Why in Wisconsin? Everybody assumes that’s because it’s cold,” said senior author Ramon Bataller, M.D., Ph.D., chief of hepatology at UPMC, professor of medicine at Pitt, and associate director of the Pittsburgh Liver Research Center. “But we couldn’t find a single paper linking climate to alcoholic intake or alcoholic cirrhosis. This is the first study that systematically demonstrates that worldwide and in America, in colder areas and areas with less sun, you have more drinking and more alcoholic cirrhosis.”

Alcohol is a vasodilator — it increases the flow of warm blood to the skin, which is full of temperature sensors — so drinking can increase feelings of warmth. In Siberia that could be pleasant, but not so much in the Sahara.

Drinking also is linked to depression, which tends to be worse when sunlight is scarce and there’s a chill in the air.

Using data from the World Health Organization, the World Meteorological Organization and other large, public data sets, Bataller’s group found a clear negative correlation between climate factors — average temperature and sunlight hours — and alcohol consumption, measured as total alcohol intake per capita, percent of the population that drinks alcohol, and the incidence of binge drinking.

The researchers also found evidence that climate contributed to a higher burden of alcoholic liver disease. These trends were true both when comparing across countries around the world and also when comparing across counties within the United States.

“It’s important to highlight the many confounding factors,” said lead author Meritxell Ventura-Cots, Ph.D., a postdoctoral researcher at the Pittsburgh Liver Research Center. “We tried to control for as many as we could. For instance, we tried to control for religion and how that influences alcohol habits.”

With much of the desert-dwelling Arab world abstaining from alcohol, it was critical to verify that the results would hold up even when excluding these Muslim-majority countries. Likewise, within the U.S., Utah has regulations that limit alcohol intake, which have to be taken into account.

When looking for patterns of cirrhosis, the researchers had to control for health factors that might exacerbate the effects of alcohol on the liver — like viral hepatitis, obesity and smoking.

In addition to settling an age-old debate, this research suggests that policy initiatives aimed at reducing the burden of alcoholism and alcoholic liver disease should target geographic areas where alcohol is more likely to be problematic.

Story Source:

Materials provided by University of Pittsburgh Schools of the Health SciencesNote: Content may be edited for style and length.

Citation of page: University of Pittsburgh Schools of the Health Sciences. “Colder, darker climates increase alcohol consumption and liver disease.” ScienceDaily. ScienceDaily, 14 November 2018. <www.sciencedaily.com/releases/2018/11/181114080917.htm>.

Original article here.

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Downtown Chillicothe

Need drug treatment now in Chillicothe? A new web site can help

CHILLICOTHE – The region has a new tool to connect people seeking immediate drug treatment options more quickly.

FindLocalTreatment.com aims to not only provide people with a list of accredited treatment facilities but encourages those providers to update availability information regularly, verify treatment services offered, and what type of insurance is accepted. The service will be promoted to the community as well as healthcare providers and first responders who often come into contact with those who are addicted.

“As a physician, this would be incredibly helpful for me,” said Dr. John Gabis at a recent Hope Partnership Project meeting.

The treatment finder kicked off earlier this year in the Cincinnati area after Mercy Health Foundation invested in Crosswave Health, the technology company behind the service.

Raj Gupta, co-founder, and CEO of Cincinnati-based Crosswave Health, met with the Hope Partnership Project (formerly the Heroin Partnership Project) last month to outline the service which was prompted in part after his friend’s sister died of a drug overdose two years ago.

Vivitrol injection

His friend shared how difficult it was to find treatment, so Gupta began asking around and discovered many communities struggled with the same issue. However, the problem sometimes was more about being connected to the right service provider who can help rather than a lack of treatment.

“Quickly and accurately pairing individuals with local trusted treatment programs decreases the number of people who fall through the cracks while trying to find help,” Gupta said in a news release. “We can’t expect those suffering from a chronic disease like addiction to sift through lists of phone numbers, hoping the provider they call accepts their insurance and also has capacity.”

In Cincinnati, the “vast majority” of the certified treatment providers are on board – paying an annual fee – and 96 percent are updating information daily, Gupta said. About 10,000 people searched FindLocalTreatment.com in the first months after launch with 45 percent seeking help for heroin addiction and 20 percent for alcohol.

Treatment providers in the Chillicothe area have been added to the finder for a free trial and are still in the process of verifying information. Gupta said providers in Cincinnati have been able to justify the fee for the service because of the added volume of patients they’re getting.

“Knowing that FindLocalTreatment members all meet quality criteria such as having evidence-based treatment options gives us confidence in the providers on the platform that didn’t exist before,” Gabis said in a news release.

The new tool comes as Ross County could see another slight decline in fatal unintentional drug overdoses. In 2017, the county had 34 overdose deaths with three ruled as suicide – 10 fewer than 2016. So far this year, there have been 23 confirmed unintentional drug overdose deaths.

Gabis said the availability of the overdose reversal drug naloxone continues to be a significant factor in the decline, but they also believe a shift away from heroin – often spiked with powerful, deadly opiates fentanyl and carfentanil – toward meth plays a factor.

Original article here published on the:

Thanksgiving Spread

3 Tips for Getting Through the Holidays Sober

It’s the most wonderful time of the year…. until it isn’t.

If you’ve walked into any major retailers lately there’s no denying that the holidays are upon us. True, the turkey hasn’t yet been served on Thanksgiving, but the marketing, holiday music and many social engagements are already all around. 
When you were a kid the holidays may have been the most wonderful time of year, filled with gift-giving, family visits and parties. When you’re an adult, however, all of that can seem overwhelming, particularly if you’re trying to go about it sober.

“We hear so often in recovery circles that the holidays are really challenging and difficult,” said Nell Hurley, the executive director of alumni and recovery support at the Hazelden Betty Ford Foundation. “Everything is heightened around the holidays: pressure, expectation, stress and even joy.”

All of that holiday spirit can be overwhelming, so it’s key to have a plan for dealing with holiday stress and coping in a healthy way, rather than turning to drugs or alcohol.

Pensive Woman Christmas Tree.

“At least for me as an addict, I always dealt with any emotion — stress, anxiety, sometimes even joy — by trying to dampen it with the use of alcohol,” said Hurley, who has been in recovery for nearly 20 years.

Here are some tips for staying focused on sobriety this holiday season:

1. Give Yourself The Gift Of Recovery

This holiday season put yourself on the top of your gift-giving list. The most valuable thing that you can give yourself is a continued investment in your recovery. Whether you are newly in recovery or have decades of sobriety under your belt, build in extra support during this busy time of year. Don’t let holiday demands derail you from going to meetings, since you probably need them more than ever this time of year. When you’re not in the rooms, take time for other self-care that keeps you connected to your recovery.

For Hurley, one gift that sobriety brings is the ability to take control of her life.

“That is the thing that I am most grateful for, the ability to make choices,” she said. “In active addiction my brain was always getting hijacked and I didn’t have the ability to make healthy choices. In recovery, we have the freedom and ability to make choices that we never had in active use.”

2. Be Firm With Your Family

Much of the stress around the holidays comes from interactions with family, particularly if you come from a family that is dealing with cycles of addiction.

“So many of us struggle with family and those relationships,” Hurley said.

“Whether we’re in recovery or not, we tend to adopt our parents’ traditions around Christmas, but being in recovery is about being able to finally make choices,” she said.

That includes deciding what you want your holidays to be like and setting firm boundaries when necessary.

“Do that reflection to decide what do you want on Christmas. What does New Years look like to you?” Hurley says. “Do what nurtures you and fills your cup, rather than defaulting to other people’s expectations.”

3. Slow Down

The holiday season can rush by in a blur, leaving us emotionally drained, exhausted and broke come January. Don’t let the holiday madness sweep you away this year. Instead, find quiet time to reflect on what sobriety has meant for you and for your relationships with the people you love.

“For me the whole key to learning how to do things differently has been around slowing down,” Hurley said. “Before getting into recovery, I’ve been on autopilot my whole life, reacting to situations, stress, anxiety and fear with alcohol. Being able to learn how to be present and feel it all, let it all in, and do it sober has been really hard, but also the thing that has allowed me to open up to my experiences.”

During the holiday season that might mean being aware of your discomfort around certain traditions or people.

“Recognize how you feel rather than powering through it,” Hurley said. “Recognize your reaction and your emotions like anxiety or whatever it is that’s going on.”

Then, rather than reverting to old coping mechanisms, decide on a healthier way forward.

“We need to give ourselves permission to do things differently,” Hurley said.

By: The Fix Staff

Link to original article here: 3 Tips for Getting Through the Holidays Sober

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Dr RYan in Front of BV Chillicothe Location

New Chillicothe drug treatment center to boost local options for help

CHILLICOTHE – A new outpatient drug treatment center opening Monday (11/19) has taken some cues from how emergency departments operate – aim to treat anyone regardless of insurance and respond quickly.

BrightView will begin seeing patients on Monday at its newest clinic location at 126 E. Second St. It has six other clinics in southwestern Ohio and plans to open clinics in Columbus and Toledo.

BrightView was founded by 42-year-old Dr. Shawn Ryan who started his career in emergency medicine and has worked for over a decade in the Greater Cincinnati region.

Waiting Room Chillicothe

His shift in focus came about after seeing an increase in drug overdoses and addiction issues in the emergency department coupled with touchstones in his personal life including the loss of a friend and a colleague entering treatment.

“Myself and others were kind of freaking out … In 2013, I said that’s it. I can’t stand around here anymore and watch this collapse,” Ryan said.

Ryan, who also was a hospital administrator for a bit at Mercy Health, worked with a drug treatment agency before opening his first BrightView clinic in 2015. While the clinic uses medications like Vivitrol and Suboxone to aid in treatment plans, they aren’t used with everyone and never done without coordinating counseling, Ryan said.

“We treat it as a chronic relapsing disease,” said Melissa Sahlin, director of clinical operations.

Each person is individually assessed, and success is viewed as “progress not perfection,” Ryan said. For some, the treatment may take several years, Sahlin said. Initially, though, all patients are seen several times a week until they are stabilized.

BrightView has a 24/7 call line, uses telemedicine, and do intake assessments six days a week to get people started with treatment quickly, Ryan said. The Chillicothe location has at least eight clinical and medical staff hired from the area, but Ryan expects staffing and services to grow. “If people want help, we want to see them,” Ryan said, adding they will “ramp up” staffing as needed to meet demand.

Group Counseling Room

Ryan began considering Chillicothe for a new location after Dr. John Gabis, county coroner and director of the PACCAR Medical Education Center, reached out to him and due to the need for more addiction treatment in rural areas.

While providing drug treatment services is BrightView’s top priority, Ryan said they also focus on engaging in the community and will help educate area physicians on identifying addiction issues with patients and how to get them into recovery.

Ryan serves on various regional, state, and national groups focused on developing solutions for the opiate epidemic and is president of the Ohio Society of Addiction Medicine.

“This is a medical problem, and we need to make sure the systems are engaged,” Ryan said.

For more information about BrightView, call 513-834-7063 or go to its website at www.BrightViewHealth.com.

Written by: Jona Ison, Chillicothe Gazette | Chillicothe | The Chillicothe Gazette

Original article here posted on:

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Addiction Recovery Treatment Bill, Sponsored by Rep. Edwards, Passes House

A bill meant to provide easier access to drug addiction recovery treatment, sponsored by Ohio House Representative Jay Edwards (R-Nelsonville), was approved unanimously across party lines by the Ohio House on Wednesday.

House Bill 167, known as Daniel’s Law, allows pharmacists to dispense, and even administer, an emergency refill of naltrexone, known by its brand name Vivitrol, under “limited circumstances,” according to a release from Edwards’ office.

“The drug epidemic is devastating families and communities, and has cost thousands of Ohioans their lives,” Edwards said in a release. “These are not statistics. These are Ohioans, our constituents. We must use every tool we have at our disposal to counter this epidemic and save lives.”

According to the text of the bill, certain conditions must be met for a pharmacist to provide the Vivitrol, which, when combined with counseling and other services, has proven effective in treating individuals who are addicted to opiates. It works by blocking receptors in the brain so users don’t feel cravings and won’t get a high even if they take opioids. It’s administered once a month as a shot.

The bill notes that pharmacists can only provide the Vivitrol if the pharmacist is able to verify a record of a prescription for the drug, and only if the drug is “necessary to continue the patient’s therapy for substance use disorder,” among other requirements.


Edwards said in the release that the bill is named after Daniel Weidle, who suffered a fatal drug overdose after allegedly being unable to access his Vivitrol prescription.  “Daniel had been receiving a monthly Vivitrol injection and had been opioid-free for eight months when a routine doctor’s appointment was cancelled,” the release reads. “He and his father were unable to find another physician to administer Daniel’s Vivitrol injection, and Daniel lost his battle with addiction.”

HB 167 now moves to the Ohio Senate for further consideration.

Athens County Prosecutor Keller Blackburn, whose office has its own Vivitrol treatment program, said Friday that the bill is a step in the right direction.

“Vivitrol coupled with counseling is the best form of medically assisted treatment for opiate addiction,” Blackburn said. “We need to increase access and limit the hurdles to people who are fighting to overcome addiction. This is a positive step to increasing the availability of Vivitrol.”

Original article here.

Construction Industry Ranks Highest for Heroin, Methadone-Related Overdose Deaths: CDC

Construction workers have the highest proportional mortality ratio for heroin- and methadone-related overdose deaths, a Centers for Disease Control and Prevention analysis of 26 occupations shows.

Using 2007 to 2012 data from the National Occupational Mortality Surveillance program, researchers investigated 57,810 drug overdose deaths in 21 states. They found that construction workers had a 1.46 proportional mortality ratio for heroin-related deaths and a 1.34 proportional mortality rate for methadone-related deaths. A proportional mortality ratio greater than 1.0 indicates that the proportion of deaths in that occupation group is greater than the proportion in all other occupations combined.

Construction Workers

Construction also ranked first (1.25) among all occupations in total drug overdose deaths, followed by health care support (1.18), extraction (1.16) and health care practitioners/technical (1.16).

Extraction occupations ranked first among natural and semisynthetic opioid-related overdose deaths (1.39) and prescription opioid-related overdose deaths (1.3). Health care practitioners/technical occupations led all workers in overdose deaths related to synthetic opioids other than methadone (1.81).

The researchers suggest employers implement workplace-specific programs and policies to reduce the impact of the opioid epidemic.

A change in workers’ compensation laws and regulations regarding pain management and the prescribing and distribution of opioids already has made a difference. Since 2009, the study states, opioid use among nonsurgical workers has declined in 26 states, according to workers’ comp claims.

Among all drug overdose deaths, researchers note that the majority were male (61.8 percent), white (89.8) and between that ages of 45 and 54 (30.1).

Original article here.

Simulated Training: Talk About OUD with Your Patients

Talk About Opioid Use Disorder with Your Patients: A Clinical Practice Simulation is a
30-minute interactive case-based training simulation offering best practices and evidence-based communication strategies to better equip primary care providers to address the needs of patients with opioid use disorder (OUD).
This simulation targets primary care clinicians, and will offer information about the opioid crisis, the neurobiology of OUD, the effectiveness of medication, and treating patients with OUD with empathy. The simulation is grounded in real-world experiences and will capture the participant’s decision points and performance; provide real-time feedback to participants on their decisions, errors, and missed steps; and proceed based on decisions by the participant during the simulation.
PCSS has partnered with Kognito, a health simulation company, to make this training available.
Click the blue “Begin Simulation” button below to access the “Clinical Practice Simulation”
Begin Simulation

Assessment Information

In the simulated conversation in this activity, you’ll be asked to make several decisions. You’ll have multiple attempts to make the correct decisions, and will need to retry specific decisions if your choices are not successful. You will be evaluated on your performance as you proceed through the simulation, and you will be able to view a summary of your choices on a performance dashboard. In addition, you will be asked to complete a short online survey about your experience in the training.

Purpose of Activity

As a result of completing this activity, clinicians should be better able to:
  • Recognize people with OUD as patients in need of help.
  • Reject outdated and moralistic beliefs about “addicts” and “addiction.”
  • Understand the medications available to treat OUD and their effectiveness.
  • Use shared decision making and motivational approaches to help people with OUD engage in healthier behavior and begin recovery through treatment
  • Seek a DATA-2000 waiver and/or use buprenorphine to treat patients in an office setting.

Continuing Education Information

Continuing Medical Education
Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of The University of Arizona College of Medicine – Tucson and Kognito Solutions LLC. The University of Arizona College of Medicine at the Arizona Health Sciences Center is accredited by the ACCME to provide continuing medical education for physicians.
Designation Statement
The University of Arizona College of Medicine – Tucson designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
This continuing nursing education activity was approved by Montana Nurses Association, an accredited approver with distinction by the American Nurses Credentialing Center’s Commission on Accreditation. To receive a certificate of completion, users must:
  • Attend the entire activity
  • Complete the activity evaluation form
The Montana Nurses Association designates the activity entitled “Talk about Opioid Use Disorder with Your Patients: A Clinical Practice Simulation” for 0.75 total contact hours of continuing nursing education.
This activity is approved from 10/8/18 – 10/8/20.
This activity was jointly provided with Providers Clinical Support System.
Simulation Acknowledgement:
This simulation course was prepared with support through Contract No. HHSS283201200002I/HHSS28342009T, Reference No. 283-12-0209 with the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Nothing in this simulation constitutes a direct or indirect endorsement by SAMSHA or HHS of any non-federal entity’s products, services, or policies, and any reference to non-federal entity’s products, services, or policies should not be construed as such.
Look for more information about treating chronic pain and opioid use disorder and additional trainings at www.pcssNOW.org.
PCSS Acknowledgement:
Funding for this initiative was made possible (in part) by grant no. 5U79TI026556-03 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
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