BrightView is an outpatient addiction medicine practice based on clinical best practices and outcomes measures. Through the use of medical treatment in conjunction with psychological and social services.
Before Joe Thompson switched treatments for his opioid addiction, he was a devoted stay-at-home father, caring for his infant son after his wife returned to work. His recovery was aided by the anticraving medication buprenorphine. But after over two years free of heroin, Mr. Thompson, a former United Parcel Service worker from Iowa, relapsed and decided to try another kind of treatment program…
By Maia Szalavitz
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My mission is to provide hope. I am just like many of you. I am a person who is healing, and I too have some tough days. I am an overdose survivor. I also know that I had to overdose in order to start my life over again.
The holidays are
both tough and an opportunity for people with the disease to take stock and
Now is the time.
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With drug overdoses now America’s leading accidental killer, cities and states have been struggling to find some way — any way — to curb the loss of life. A handful have found flickers of hope. The common thread? A willingness to try unconventional solutions and the fortitude to handle the political heat that often follows…..
The Editorial Board USA Today Published December 26th 2018
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Ohio has been hit hard by the effects of opioid abuse, ranking as one of the top five states for rates of overdose deaths. The rate dramatically increased over the past few years, far above and beyond the proportions of the increase we’ve seen nationally. Last year Ohio saw more than 4,800 opioid overdose deaths, a record for the state.
But now the numbers are finally going down in some Ohio communities. Dayton has seen a dramatic 54 percent drop in opioid overdose deaths this year. Hamilton County (home of Cincinnati) is seeing a 31 percent drop in overdose deaths this year and on Monday (12/17) was the focus of a CBS report.
It’s had a huge impact. Last year emergency responders in Hamilton County say they responded to eight overdose calls per day. This year that number is five. When a CBS correspondent rode along with paramedics during a visit, they didn’t have any overdose calls at all.
It’s also worth noting the impact on emergency services themselves. The county reported during this time a 42 percent drop in emergency visits and a 37 percent drop in emergency calls to respond to drug overdoses. So while taxpayers are likely shouldering the costs of providing Narcan, it can’t help but be cheaper than the cost of sending out crews to respond to overdoses.
Another benefit is the impact it has had on availability of doctors and nurses in emergency rooms. Watch CBS’s report on Hamilton County’s successes here. The New York Times explored Dayton’s decline in November here. Note in the Times coverage that Dayton’s Police Department and its chief are on board with the pursuit of harm reduction rather than arrests, and that’s been vital to Dayton’s successes.
Holiday parties are fast approaching, that time of the year when my “normie” friends like to throw parties and bring out the booze. I used to think everyone would notice I wasn’t drinking but the truth is, they don’t, but those who do notice are curious. What am I supposed to say to those people? How do I respond to their questions?
Depending on where I was in my sobriety, I handled holiday parties differently. Sometimes I didn’t go, other times just the smell of alcohol had me heading for the door. Now? I’m in a different place today and want to make sure I’m not crowned Ms. Party Pooper because I’m in the corner spewing off a drunk-a-log, ruining everyone’s Christmas buzz.
Should I Mention the Word Alcoholism?
How do I talk about a heavy subject and keep it light? Do I even want to bring it up? I don’t force the topic of alcoholism or addiction, but if it enters into conversation, I talk about it. It can be uncomfortable to start, but the majority of people I’ve spoken to are intrigued, especially if I keep it casual.
Alcoholism and problematic drinking are common. How that came to be is too complex for party chit chat, but to put it simply, it’s a disease. I try to explain that “we” aren’t bad people, just sick, with an illness that centers in our brain.
I’m not programmed like the average joe, and my body (receptors in my brain) responds to addictive substances differently than some folks. And that’s just the way it is. Untreated, chronic addiction can progress to fatal illness.
What Is an Allergy Anyway?
Walnuts. It may sound strange, but that’s how I explain the allergy concept to normal drinkers. My sweet daughter Stella is allergic to walnuts, and sometimes they are in desserts. She knows that if she eats them she’ll break out into a rash, every time. That’s a fact. However, when staring down a delicious looking cookie, there are moments when she isn’t thinking about the allergy or its consequences. She wants the damn cookie, so she’ll eat it. But once she does, she can’t stop what happens next. That rash that breaks up her perfect skin is coming. She can’t pray it away, wash it off, cry, wish, reverse it, nothing.
It’s the same with alcohol. I’m allergic. But in the past, I didn’t think about the consequences of what would happen after I took that first drink. It looked like a good choice in that moment. Sometimes it looked like my only choice. So I’d drink. And the alcohol would hit my bloodstream and work its way up to my brain and trigger the obsession and craving for another. All bets were off. I couldn’t will-power through it, wash it off, beg, cry, reverse it, nothing. It was bigger than me.
Addiction is tough to explain. I have the disease, I go to meetings almost every day, and I still have days I’m at a loss for words. Most average people don’t talk about drinking, at least not in the ways that I do. But I’m also fully aware that practically every house in America has had some sort of connection with alcohol or drug abuse, whether through family or friends.
My Love for Cucumbers
More than just a veggie, cucumbers are actually used to make pickles. Not everyone knows that. I didn’t realize that’s what happened down in my grandma’s creepy cellar. I just remember the cucumbers never came back, and my cousins and I would sneak down to stare at the mason jars, expecting to see strange animal parts but only finding pickles and jam.
I also remember being 16 years old, sitting in a speaker meeting with my sober mom on a Friday night. This man talked about being a cucumber himself for 35 years. It was his drinking analogy: one day a switch flipped for him and the way he drank. He became a pickle, and he’ll never be a cucumber again. Damn. I thought about that for years, despite the cheesiness in his analogy because it is easy to digest. There’s no shame in it. So when I’m faced with the daunting task of discussing alcoholism with curious people, this is great. Not everyone is destined to become an alcoholic: some of us stay cucumbers forever, and that’s terrific. You don’t have to hide your drink from me. In fact, I love cucumbers just as much as I love pickles.
But sometimes, for whatever reason, we find ourselves in our own mason jar, stuck in a dark place. That’s okay, too. I’ve had my turn in the cellar, more than once. At the time, I thought my life was over, but now it’s looking delicious.
The Happy Life in Sobriety
I don’t look so great on paper. I’ve got plenty of evidence of what a life wrapped in alcoholism can look like. Do I need to dish that out during casual conversations? Probably not. I’m already up against old images of drunks under bridges with brown paper bags when I bring up the topic.
There are already plenty of warnings out there, whether it be in headlines, statistics, or personal experiences. I’d rather be an example of what recovery can look like.
I’m still out here living life and having a great time doing it. I haven’t joined a cult or started wearing more sensible shoes. Most days don’t turn out exactly as planned, but I show up anyway without needing a drink to do it. I’m even hanging out with friends and family who enjoy my company again.
Sometimes it isn’t what we say through words to others about alcoholism or the disease of addiction, but what we show them about our sobriety. In the end, I never truly know who is listening or watching, but I still remember when I was that middle-of-the-road drinker. Someone over the holidays might be paying attention. What message do I want to carry? I think I’ll keep it simple, spread some cheer, and throw in some hope just in case someone listening needs it.
For adults with chronic pain, opioids offer narrow improvements over a placebo for pain and physical functioning, on average, according to a new analysis published Tuesday. And the majority of patients will experience no meaningful benefit. Those benefits also tend to decrease over time and come with the risk of side effects such as vomiting and constipation, according to the review of nearly 100 randomized trials published in the Journal of the American Medical Association.
Down the line, risks may include physical dependence and overdose.”The benefits of opioids for managing chronic pain tend to be quite modest,” said study author Jason Busse, associate professor in the department of anesthesia at McMaster University’s school of medicine in Ontario, Canada.
Subgroups of the studies included in the analysis suggest that non-opioid alternatives — such as NSAIDs, certain antidepressants and medical cannabis — may offer similar benefits to opioids on average. But the evidence for that is less strong, Busse said. The analysis comes as federal agencies and other officials in recent years have been cracking down on the prescription of opioids, dually recognized as an important tool in the treatment of pain and as a gateway to physical dependence and addiction.
In 2016, the US Centers for Disease Control and Prevention issued guidelines urging doctors to prescribe these drugs more responsibly for people with chronic pain. But Busse said the CDC report set the bar for placebo-controlled studies too high in its analysis; it looked for studies that followed up with patients for at least a year, of which there were none.
“We have looked at a lot of additional evidence that was not considered by the CDC guidelines,” he said.Dr. Jianguo Cheng, president of the American Academy of Pain Medicine, said the new analysis reinforces what’s become conventional wisdom among pain specialists. He was not involved in the study. “We’re going to try the least risky drug first, so therefore opioids [are] not a first line of treatment in most cases,” said Cheng, also the director of director of the Cleveland Clinic Multidisciplinary Pain Medicine Fellowship Program. “It’s not a second line of treatment, and maybe not a third line of treatment.”The CDC describes chronic pain as “lasting longer than 3 months or past the time of normal tissue healing.” It is among the top reasons for seeking medical care in the US, affecting just over 20% of adults — about 50 million people — in 2016, according to one report this year.
Other estimates suggest that the number is twice that.”It’s a very complicated and diverse population of patients,” Cheng said, including those who may have suffered injuries, had multiple surgeries or live with disability.This is differentiated from other kinds of pain, such as acute pain and cancer pain. For the latter, Cheng said, the use of opioids is far less controversial.Just because most of these patients won’t see meaningful improvements, however, is not to ignore the subset that will experience them, Busse said. “A problematic interpretation of [the study findings] would be: Opioids don’t provide any meaningful pain relief,” he said. “The challenge with that interpretation is it assumes that every patient will get the same amount of pain relief.”
His study estimates how many chronic pain patients a doctor would need to treat in order for one to experience meaningful improvements: For pain, it’s roughly eight patients. For physical functioning, it’s 12 patients. For sleep quality, 17 patients. And this is the “best case scenario,” according to an editorial published in the same journal by doctors with the University of Pennsylvania’s Department of Anesthesiology and Critical Care.The studies included in the analysis largely weeded out patients with past or present substance use disorder, which Busse described as “selecting patients that would be prognostically better off.” Nearly half of the studies excluded patients who were diagnosed with or treated for mental illness, as well.
More than three-quarters of studies in the analysis were funded by the pharmaceutical industry, the study points out. Other research has shown that industry-funded studies tend to produce better outcomes across a variety of fields. In recent years, pharmaceutical companies have come under fire for aggressively marketing opioids to doctors. Leading up to the early 2000s, opioids were seen as a wonder drug, and doctors were urged to treat pain more aggressively.
Former Surgeon General Vivek Murthy wrote in an open letter that doctors were taught that these medications were not addictive if patients were in “legitimate pain.” Multiple studies have shown this to be false. A 2013 study estimated that one in five patients who see a doctor for acute or chronic noncancer pain get prescribed opioids. Another study last year supported a push by the CDC and other health experts to taper chronic pain patients off opioids when possible, saying they may have a better quality of life without them.
But Cheng says this should be done carefully and may not work immediately for all patients, adding, “I have seen many patients abandoned by their physicians, and they cannot find the people to manage their pain.” According to Cheng, alternative treatments that may be effective — such as physical and cognitive behavioral therapies — can also be out of reach for many patients, in some cases because insurance doesn’t reimburse these services.However, despite gaps in knowledge of treating chronic pain, experts say opioids are part of that arsenal — even if they come with risks and benefits that need to be better understood.”
For individuals who are suffering with unrelenting chronic pain every day of their lives, if they’ve tried other alternatives that haven’t worked, they may in some cases decide they still want to embark on a trial of [opioid] therapy,” Busse said, “and now they have the evidence to understand what their chances are of achieving meaningful improvement.”
More than 42 000 Americans died of opioid overdoses in 2016, and the fatalities continue to increase. This review analyzes the factors that triggered the opioid crisis and its further evolution, along with the interventions to manage and prevent opioid use disorder (OUD), which are fundamental for curtailing the opioid crisis.
Opioid drugs are among the most powerful analgesics but also among the most addictive. The current opioid crisis, initially triggered by overprescription of opioid analgesics, which facilitated their diversion and misuse, has now expanded to heroin and illicit synthetic opioids (fentanyl and its analogues), the potency of which further increases their addictiveness and lethality. Although there are effective medications to treat OUD (methadone hydrochloride, buprenorphine, and naltrexone hydrochloride), these medications are underused, and the risk of relapse is still high. Strategies to expand medication use and treatment retention include greater involvement of health care professionals (including psychiatrists) and approaches to address comorbidities. In particular, the high prevalence of depression and suicidality among patients with OUD, if untreated, contributes to relapse and increases the risk of overdose fatalities. Prevention interventions include screening and early detection of psychiatric disorders, which increase the risk of substance use disorders, including OUD.
Although overprescription of opioid medications triggered the opioid crisis, improving opioid prescription practices for pain management, although important for addressing the opioid crisis, is no longer sufficient. In parallel, strategies to expand access to medication for OUD and improve treatment retention, including a more active involvement of psychiatrists who are optimally trained to address psychiatric comorbidities, are fundamental to preventing fatalities and achieving recovery. Research into new treatments for OUD, models of care for OUD management that include health care, and interventions to prevent OUD may further help resolve the opioid crisis and prevent it from happening again.
Nora D. Volkow, MD; Emily B. Jones, PhD; Emily B. Einstein, PhD; et alEric M. Wargo, PhD
Author AffiliationsJAMA Psychiatry. Published online December 5, 2018. doi:10.1001/jamapsychiatry.2018.3126
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One of the many painful and challenging aspects of the US opioid crisis is that people abusing opioids often isolate themselves from family and friends, making it difficult for loved ones to help people on a path towards recovery.
Researchers from Arizona State University have identified a region in the brain that may be responsible for opioid-related social isolation, and their work suggests that activating this region could at least partially revive the urge to socialize among opioid addicts.
The research team, led by M. Foster Olive, focused on a brain area called the insula, which has previously been shown to play a role in social, addictive, and empathy-related behaviors. To study its role, the team turned to rats, which like humans are social and enjoy interacting. The researchers paired male rats together and randomly assigned one of each pair to be trapped in a plastic tube in a cage. The other rat in the pair could easily release the trapped animal by pushing on a door. Once a day for three weeks, the rescuer rat had an opportunity to release his trapped cage-mate — and most chose to do so.
The researchers then infused the rescuer rats with a virus that targeted cells in the insula and delivered one of three specialized proteins: one stimulated the cells of the insula; one suppressed those cells’ activity; and one was inactive and served as a control. Then they allowed all groups to self-administer heroin because, like humans, rats can become addicted to opioids and will self-administer if given the opportunity.
Finally, the rescuer rats were given a choice between freeing their cage-mates or administering themselves a dose of heroin. Rats given the virus suppressing the activity of cells in the insula, and those in the control group, more often chose heroin over rescuing. But rats infused with the virus that activated the cells started to rescue their friends again; the rescuing behavior recovered by about 30 percent.
The results suggest that the insula plays a role in the antisocial effects of opioid addiction, and these findings may lead to clinical applications, perhaps an adjunct treatment for opioid addiction in humans.
“A good social network is critical for recovery,” says Olive. “If we can stimulate this area of the brain in humans, you might get people to find social interactions more rewarding again. It would be a way to help jump-start the recovery process. It’s not a cure, it’s just a crutch to help get back on track and give people a better shot a recovery.”
In the midst of what’s considered the nation’s worst public health crisis so far in the 21st century, one Ohio county is dramatically reducing the number of deaths related to opioid overdoses. A new report shows overdose deaths plunged by 31 percent in Hamilton County, which includes Cincinnati. There was also a 42-percent drop in emergency room visits. Health officials credit a new program that gives away the overdose-reversal drug Narcan for free.
One-hundred-fifteen Americans die every day from opioid overdoses. CBS News correspondent Don Dahler and his team went to Hamilton County and spoke to people who are facing the crisis head-on.
“It’s just heartbreaking what’s going on out there, and it’s got to stop… It’s an awful thing for a mom to go through,” Kathie Mead said. She watched her daughter, Amy, struggle with opioid addiction from age 14 to 30.
“Every time my phone would ring, I would think, ‘Is this a coroner’s office calling for me to come and identify her body?'” Mead said.
Mead’s daughter, Amy Parker, even used while pregnant with her daughter, Chloe.
“They finally decided that the right thing for to do and the best thing for her was for me to sign away my parental rights,” Parker said.
Chloe is one of more than 2.5 million children living with grandparents because of a parent’s addiction.
“It makes me feel sad because—that she wasn’t really around for most of my life. And, well, she missed out on important milestones,” Chloe said.
“It’s hard for me to look at photos of her when she was young because I wasn’t there… when she took her first steps. I wasn’t there when she started school,” Parker said.
Ohio had 4,854 accidental drug overdose deaths last year and 444 of those were in Hamilton County. Tim Ingram, the Hamilton County public health commissioner, said opioid addiction is a “huge problem” in the area. “So we started to think about, ‘How are we going to… keep people alive… until they’re ready for treatment?'” Ingram said.
The answer? Narcan, an opioid-reversal drug. It revives the patient within seconds.
Since last October, the Narcan distribution collaborative has handed out more than 37,000 Narcan doses to the public.
“We got this idea… ‘What would happen if we saturated the community, removed the cost, used data to put Narcan out in as many hands as possible?'” Ingram said.
Since the program started, opioid related overdose deaths decreased by 31 percent and emergency runs for overdoses dropped by 37 percent. We saw it first hand when we embedded with a team of first responders in Hamilton County.Last year, they saw at least eight overdose calls a day. This year, it’s about five. And the day we were there: zero. Dr. Shawn Ryan helped institute the Narcan distribution collaborative. Seventy-five percent of his patients with severe opioid use disorder were once revived with Narcan.
“It’s a potential that almost none of those people would have made it to treatment if they hadn’t had Narcan available,” Ryan said.
Narcan gave Parker a second chance at life. She has been sober for more than six years and now helps others in recovery.
“I wonder, you know, ‘Why me? Why did I get to go through all of that? Why did I get to survive?’ And I know that it’s because I have a message,” Parker said. “There is hope through this.”
“If I had to go through that to get to this, I’d do it every day,” Mead said, choking up with emotion. “I just can’t tell you how proud—”
“That overdose saved my life,” Parker said.
“Instead of ending it, it started it,” Mead said.
Narcan contains the medicine naloxone, which works by targeting the brain to reverse and block the effects of opioids — so if there are no opioids in your system, it won’t affect you. Narcan is available at any pharmacy without a prescription.