Macklemore Dorm Room 2006

Macklemore: Compassion Led Me to Rehab and It Can Help the Country Fight the Opioid Crisis

When I was 25, my dad asked me a simple question that ended up changing my life. He asked me if I was happy. At that point, my drug addiction had led me to a place of deep depression and self-hate. I couldn’t get away from the shadow that opioids had cast over my life. My love for making music was gone. My relationships with friends and family were strained at best, and permanently damaged at worst. I spent most of my time in my room with the blinds drawn. The world that I once loved was going on outside without me.

Macklemore Dorm Room 2006

“Are you happy?” The answer was simple, yet the process to attain this estranged happiness seemed impossible in that moment. It took my dad’s question to make me realize how far gone I really was. That act of love and compassion saved my life. After years of trying to get sober on my own, I went to rehab.

When I went to treatment, I learned about my disease for the first time. Until then I didn’t know that I had a disease. As the weeks went by, I started acquiring tools to stay sober, one day at a time. When I got out I became immersed in a recovery community that I rely on to this day. Without a group of people who share my experience, I start slipping back into old behavior and start thinking I can do this on my own. My experience time and time again is that I can’t. My parents’ willingness to show up for me and offer me the chance to go to rehab came from a place of love rather than judgement. It’s that kind of compassion our country needs to fight the current opioid crisis.

There are a lot of misconceptions about addicts and a lot of stigma surrounding addiction. People ask: Why don’t addicts just stop? Why don’t they just give it up? I certainly asked myself those questions when I was addicted, but this is a disease. I had to educate myself about addiction in order to learn compassion for myself. No one wants to be miserable, depressed, suicidal and slowly killing themselves. That’s not a choice that people make; it’s where drugs lead you.

We’ve been conditioned for so long to think of drug addicts as bad people, that somehow addiction is a moral failing or a personal choice. But the truth is addiction can affect anyone. Almost every family in America has been touched by the disease in some way. Our society is at a crucial point and more people are coming forward and being honest about the disease and how it has impacted their lives. And as we learn more about addiction, the stigma around it is decreasing and giving way to compassion.

That’s an important step forward, because stigma helps perpetuate the problem. It prevents policy makers and those in power from focusing on treatment and solutions, and instead puts the focus on punishment. Rather than punitive laws that don’t address the root of the problem, we need to provide more tools to help people get their lives back together, get their kids back, get jobs, be happy and be functioning members of society.

One way to achieve this is to give addicts and their families a platform to share their stories because that’s how we’ll learn compassion for this issue and each other. We have to have these conversations. We have to discuss these stories. We have to discuss the over-incarceration of addicts and the over-prescription of America. We need to mobilize around recovery and restoration, and find ways to get addicts who want help the resources to do so.

These actions will bring about progress and change how we treat those affected by this disease. Without discussion, it’s too easy to ignore the problem, too easy not to care. If our nation can treat addiction with compassion, I think we’re going to see a beautiful transformation, a reorientation toward recovery.

Signing document

Chelsea doctor’s regrets lead to call to action on opioid patients

The grandmother, tears in her eyes, had to look away as she whispered to her doctor what had happened. She had come across some oxycodone pills and relapsed into opioid use, decades after entering recovery. “I need help,” she said.

But her doctor, internist Audrey M. Provenzano, couldn’t prescribe the addiction treatment the patient wanted to try — buprenorphine — because she had not obtained the necessary federal certification.

Dr Audrey Provenzano

Provenzano was hardly unusual: Few primary care doctors can prescribe buprenorphine, and few feel prepared to treat addiction in their patients.

She referred her patient, whom she calls “Ms. L.,” to a colleague who could prescribe buprenorphine, but the decision seemed to fray the doctor-patient bond. Ms. L. stopped coming to appointments, and a year and a half ago, Provenzano learned that she had died of an overdose.

“Ms. L. and I had had a relationship,” Provenzano wrote. “She had trusted me. And I’d turned her away.”

Saddened and ashamed, Provenzano decided to undergo the eight-hour training that authorizes her to prescribe buprenorphine, best known by the brand name Suboxone. The drug helps to stop cravings and blocks overdoses.

Now working at Massachusetts General Hospital’s Chelsea HealthCare Center, Provenzano treats a small group of patients with opioid use disorder. And she wrote the essay to call on her colleagues to do the same.

It’s a call that has already gone out in Massachusetts. A state commission has been urging primary care practices to take on the challenges of treating addiction, Boston Children’s Hospital is helping community pediatricians embrace addicted adolescents, and many community health centers are starting to integrate addiction treatment into primary care.

“It’s not an easy disease to treat,” said Dr. Marcelo Campos, a rare doctor in private practice who prescribes buprenorphine. “But this is a challenge we are facing right now. I think it is imperative for us to learn.”

While some doctors are stepping up, many hesitate — unschooled in addiction treatment and daunted by the complexities such patients bring.

Buprenorphine is one of three medications that can control the craving for opioids; doctors are permitted to prescribe it only after taking a course. (The other treatments are methadone, which is dispensed at federally regulated clinics, and Vivitrol, a long-lasting injection of naltrexone, which does not require special training.)

Nearly 3,000 doctors, nurse practitioners, and physician assistants in Massachusetts have undergone the buprenorphine training, according to the US Substance Abuse and Mental Health Services Administration. But it’s not known how many work in primary care or are prescribing the medication.

In her essay, titled “Caring for Ms. L. — Overcoming My Fear of Treating Opioid Use Disorder,” Provenzano is frank about why she initially shied away from buprenorphine. She didn’t have the energy for the eight-hour training after her long days at work. But also, she admits, “I did not want to deal with the patients who needed it.”

She had witnessed addicted patients harassing secretaries and nurses and trying to game urine tests for drug use. By definition, addiction impairs behavior in troubling ways.

“Already overwhelmed, I did not want to take on patients with needs I did not know how to meet,” she writes.

When she did begin treating addicted patients, Provenzano found them challenging and complex, often burdened with other mental and physical illnesses and disrupted families.

The solution, she says, is not for doctors to turn their backs on such patients, but to work to form teams of social workers, psychologists, and others who can support their efforts.

Provenzano’s health center provides such services, and across the state, to varying degrees, other community health centers are taking the lead on integrating addiction treatment, said Kerin O’Toole, spokeswoman for the Massachusetts League of Community Health Centers. Of the 515 physicians who work at the 50 community health centers in Massachusetts, 200 are authorized to prescribe buprenorphine, according to O’Toole.

In contrast, at Atrius Health, a large medical group in Eastern Massachusetts, some 340 physicians work in internal medicine or behavioral health. But only seven of them prescribe buprenorphine.

One of them is Campos, whose office is in Boston’s Post Office Square. Like Provenzano, he was moved by a death. Shortly after Campos started working at Atrius, a 27-year-old patient died of an overdose. He never even knew she had been using drugs.

Campos, who had previously obtained certification to prescribe buprenorphine, started offering it at Atrius and now has about 40 to 50 patients receiving it. He requires them to undergo counseling as part of their treatment.

“I try to see all these patients the same way I see my patients with chronic medical problems,” Campos said. “They are not any different. If you start to have that mind-set . . . you see them with a different set of eyes.”

When Dr. Kate Atkinson started offering buprenorphine in her Amherst family practice a decade ago, patients who needed it “came out of the woodwork,” she said. Some had been afraid to reveal they were addicted and needed help. Some were getting treatment at a clinic but had never told their own doctor.

Signing document

Among her opioid-addicted patients are “lots of VIPs, deans of colleges, heads of departments, people that didn’t want other people to know,” Atkinson said. In the regular doctor’s office, “No one knows why you’re sitting in the waiting room,” she said.

The protocols for buprenorphine, which include urine screening and pill counting to monitor drug use, are no more burdensome than those for diabetes or asthma drugs, she said.

“If every one of us took 50 patients [with opioid addiction] in our private practice, it would not be a big problem,” said Atkinson, who estimates that about 2 percent of her patients have opioid use disorder. “All people in primary care should offer it. . . . We’re saving lives with Suboxone.”

It’s starting to happen in Massachusetts.

The Health Policy Commission, a state agency that monitors medical costs, has pushed primary care practices to offer medication-assisted treatment for opioid use disorder, and 38 groups have done so, although it’s not clear whether all offer buprenorphine.

Boston Children’s Hospital is working with pediatricians to introduce buprenorphine for addicted adolescents; so far two practices are involved and others are waiting in line, said Dr. Sharon Levy, who heads the program.

And Dr. Michael F. Bierer, who has been prescribing buprenorphine since 2002 as part of his internal medicine practice at Massachusetts General Hospital, says he is no longer the only one at his hospital.

“The worry about prescribing is overblown before you kind of take the first plunge and do it,” Bierer said. “Then the rewards are very rich.”

Indeed, Provenzano and others said taking care of people with opioid addiction is meaningful and satisfying work.

Campos describes it this way: “Patients come in here, they are completely destroyed. In a matter of weeks, they are completely transformed. Very few things we do in primary care are this rewarding.”

Original article here by The Boston Globe.

 

Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.

Empty Wine Glass On Fancy Table

8 Women Share What Made Them Finally Decide To Get Sober

“Like many who struggle with addiction, my wake-up call came in the form of a series of unfortunate events, each one a neon sign blinking, ‘this is a problem,’ rather than one single event,” says Dani D., 34, who’s been sober for seven years. Dani’s story echoes that of many alcoholics: The drinking was fun, until it wasn’t. And deciding to get sober? That was hard as hell—but worth it, every day.

“It is so powerful to hear women’s stories of sobriety,” says licensed clinical alcohol and drug counselor Beth Kane-Davidson, director of the Addiction Treatment Center at Suburban Hospital in Bethesda, Maryland. “It’s dealing with a disorder, just as if you were dealing with diabetes or cardiac issues, and people are much more open these days to saying, ‘This is the disorder I had, this is what I did to recover, and this is how my life is now.’” The more women talk about alcoholism, the easier it becomes for women to get the help and support they need, she says. It’s time to end the stigma.Here, eight women reveal their struggles with alcoholism and how they got—and stayed—sober:
 1. ‘IT BEGAN TO FEEL AS IF I WERE LIVING TWO LIVES—ONLY ONE OF WHICH I COULD REMEMBER’

“Throughout my teens and twenties, I’d been drinking recklessly and desperately, trying to viciously combat the social anxiety and despair I frequently felt. Alcohol had become my go-to escape, a ticket to a world where I could be more social, more wild, and less weighed down by anxious thoughts. Of course, the temporary highs that I experienced always left me with a patchwork of clues to put together. I’d wake in the mornings wondering what I’d said or done, baffled by how I’d returned home or where I’d woken.

“For years, after each hazy night filled with poor decisions, I’d wake and think to myself, I have to quit drinking, but I never actually imagined doing it. The errors in decision-making started out harmless enough—a public make-out session with a stranger, a sharp-tongued rebuke of a loved one—but the older I got, the more serious the errors became. Business trips turned boozy. Car keys slipped easily into the ignition. It began to feel as if I were living two lives—only one of which I could remember.

“When my alcohol misuse began to impact my work, I knew things had gone too far. When I couldn’t keep it to the weekends, when I couldn’t keep it to a social activity but instead took to drinking alone to calm my racing mind, I knew I had to seek change. From my doctor, I got the name of a therapist who specialized in addiction issues. It was the first time in my life that a professional had stated clearly—and without an ounce of hesitancy—that I had a problem. Something about that—the expert acknowledging what I’d known to be true for so long—changed the way I saw my alcohol-focused life. Something about the words she used and the hope she had for me made me realize that I didn’t have to keep drinking.

“Every day it’s a choice—and many days it’s not an easy one. But, for me, it’s always proven to be the right one. I never wake up with regret. I never wake up wondering where I am or who I might have been the night before. As I often say to those struggling at the beginning of sobriety: It gets easier, but it’s never easy. Seven years in and there are still difficult days, but I wouldn’t trade them for anything. Sobriety changed every aspect of my life for the better and, had I never given it a try, I never would have known the woman I have come to be.” —Dani D., 34, sober for seven years

  ‘SOBER IS THE NEW COOL’

“After moving from Texas to Florida at age 15, I was naturally searching for new friends. Drinking seemed to be my ticket into the ‘cool kids’ crew. Mixed with just the right amount of curiosity and boredom, this quickly led to binge drinking and using harder drugs. By the time I was 21, I was addicted to alcohol and cocaine.

“As a result of my substance abuse, I developed anxiety disorder. I would drink to manage my anxiety, unknowingly feeding it at the same time. I tried moderation and rules around drinking, but happy hour somehow always turned into sunrise, and back to the bottle I’d go. Meanwhile, I still managed to work, pay my bills, and even go to the gym, which convinced me that it wasn’t a problem. This continued for many years, until one day I reached a breaking point: I was sick and tired of feeling sick and tired. The hangovers. The shame and guilt. The anxiety. It had become too heavy to carry.

“After another bender, I dropped to my knees in prayer. I wasn’t a religious person, but I was desperate for a change, a miracle. From that day forward, I never drank or used cocaine again. I simply became willing to do things differently.

“I made a commitment to try sobriety, developed a strong spiritual practice, and eventually found yoga. I decided not to let my relationship with alcohol affect my ability to be social or have fun. I started feeling and looking better—along with my bank account, might I add. After a year, I accepted sobriety as a lifestyle, and I’ve been on a mission ever since to show people that sober is the new cool.” Carly Benson, 36, sober for nine years

‘I WOULDN’T TRADE ALL THE SHIT I ENDURED OVER THE YEARS FOR WHAT I HAVE TODAY’

“As far back as I can remember, I had two elements of mental illness: a low level of constant anxiety and obsessive compulsive disorder. These chemical imbalances were the perfect breeding ground to foster a binge-drinking problem.

“To quiet my mind and shed my once pervasive ‘nerd’ identity, alcohol was the perfect antidote. I didn’t realize that not everyone partook in underage (and then, of age) drinking—and that my behavior wasn’t considered the norm. As many of my peers in recovery say, first it was fun, then fun with problems, and then just problems. All the ‘peace’ and confidence drinking provided in the moment would be completely erased the next day, as my body and mind would be wrecked by the physical and emotional ravages of the night before. Losing phones, breaking bones, ambulance rides to the hospital for safekeeping. These weren’t normal rites of passage.

“It took a second hospitalization for alcohol poisoning in the course of 1.5 years to finally shake me. I needed help; I needed to get my life on track. But how?

“When I returned to Washington, D.C., after a fateful hospitalization in New York City, I knew I had to reach out for help from a professional. Through my health insurance, I found an intensive outpatient program that I could attend for five weeks, in the evenings, and still work full-time. But I had just turned 24 and didn’t think about quitting in terms of ‘forever.’ Just for now.

“Suffice it to say, ‘just for now’ became months and then years. I learned to face breakups and family deaths and toxic workplaces and falling in love and being an auntie and living on my own without drinking. I wouldn’t trade all the shit I endured over the years for what I have today.” —Laura Silverman, 34, sober for 10 years

‘MY MOM SAID, ‘THERE’S NOTHING WRONG WITH YOU, YOU’RE AN ALCOHOLIC.”

“After college, I moved to Cancun, Mexico, where I found people who drank and used drugs like cocaine, ecstasy, and GHB the same way I did. It got to the point where I would go on days-long cocaine binges, skip work, and barely be able to take care of my day-to-day responsibilities. I even injured myself, breaking my arm and my nose, during blackouts.

“In spring 2012, I met my now-husband, Fernando, and we began dating. He became irritated with my drinking and using habits and was sick of cleaning up after me and taking care of me. He often pointed out that my alcohol issues weren’t normal. In May 2013, I went on a friend’s bachelorette party trip at an all-inclusive resort in Punta Cana, and I promised Fernando I would control my drinking.

“On the second day, I did what I always ended up doing: I blacked out. I woke up to texts from Fernando saying that we were over and he was sick of my behavior. I was devastated and spent the rest of the weekend drinking and crying. In the airport on the way back to Cancun, I had a breakdown. It was my moment of clarity. I was on the phone with my mom crying and telling her that I didn’t know what was wrong with me. My mom said, ‘there’s nothing wrong with you, you’re an alcoholic.’

“That statement hit me like a ton of bricks, and I knew in my heart it was true. I made a decision on that day that I would not drink until further notice. I had no idea at that time how long that would be, but I knew I had to try something I’d never tried before, which was cutting out drugs and alcohol completely from my life.

“When I got back to Cancun, I began reading about alcohol use disorder and educated myself on why I drank. I started a blog about my sobriety and began forming connections with others through the online recovery community. A year into my sobriety, I tried 12-step meetings, and I also found meditation and CrossFit to be helpful. Every good thing I have in my life is a direct result of choosing recovery every single day.” — Kelly F., 32, sober for four years 

‘I AWOKE AFTER ANOTHER BLACKOUT BINGE-DRINKING NIGHT AND REALIZED THAT I’D WRITTEN A SUICIDE LETTER’

“If you’d met me eight years ago, you may not have guessed I was a high-functioning alcoholic. As a lifelong chameleon, I was adept at diverting your attention in order to hide the fact I was living another side of myself in the shadows. I had a husband and children, a nice home, a career, and an engaging manner to distract you. All the while, I was numbing myself by binge drinking and desperately chasing a joy that somehow I’d never actually found. Outwardly, I was vivacious and self-confident, but inside I felt unworthy and hollow as my behaviors blanketed my soul in a shame I fought to ignore.

“My moment of surrender came when I awoke after another blackout binge-drinking night and realized that I’d written a suicide letter, which I didn’t remember. It hit me like a ton of bricks that I couldn’t predict my drunken behavior anymore. My fear of a life without alcohol and feeling like an outcast was less than my fear of death or harming someone else. Don’t get me wrong—I’d tried many times over the years to moderate or stop drinking, but somehow on February 6, 2010, I was utterly willing to change anything and everything.

“That day, with the support of my husband and sister, I looked up 12-step meetings. Walking through the doors of my first meeting, I began a horrifically difficult journey toward learning to live again. I stepped over the threshold in a cold sweat of fear, with no idea how I’d ever make up for my mistakes or how I’d ever fit in again.

“The good news is that I’ve learned to walk with my chin held high and no secret shadows in my life. I’ve relied upon my family, friends, faith, and that program to help get me where I am today. I now have a flourishing career in a new field and a stronger marriage and friendships, and I found that joy and self-worth I’d been chasing right inside my own self.” —Julie Elsdon-Height, 45, sober for eight years

6 ‘IT’S ABOUT CREATING A LIFE THAT’S SO GOOD, YOU DON’T NEED TO NUMB OUT FROM IT’

“I don’t have a dramatic rock-bottom story. In fact, not having a rock bottom was one of the things that nearly stopped me from getting sober at all. I had a very fixed idea of what a problem drinker looked like, and I wasn’t it. I was convinced that things weren’t ‘bad enough’ for me to have to quit completely.

“Even at the height of my drinking, I worked out. I ran. I got promoted. On the outside, things certainly looked fine. I was succeeding at work and keeping everything together. I wasn’t pouring vodka on my cornflakes or drinking and driving. But every night, I had this irresistible urge to hit the self-destruct button.

“In April 2013, after a particularly brutal hangover, I looked at the calendar and realized I had exactly six months to go until I turned 30. Suddenly, the idea of taking my problem drinking with me into the next decade seemed incredibly sad and depressing.

“In my previous, half-hearted attempts at quitting, I’d always white-knuckled it by myself and spent the whole time feeling miserable, annoyed, and lost in my own head. This time, I spent a lot of time reading books, listening to podcasts, and trying to educate myself about alcohol and addiction. I started writing a blog and reached out to other sober bloggers. Those small steps made such a difference, as I began to meet people who were sober and—shockingly—really enjoying life!

“I’m nearly five years sober now and I couldn’t be happier. I passionately believe that sobriety shouldn’t be about missing out or feeling deprived—it’s about creating a life that’s so good, you don’t need to numb out from it.” — Kate Bee, 34, sober for four years

 7‘ WHO WAS I WHEN I WASN’T GETTING WASTED?’

“I’ve been on a winding journey trying to find my way in the world since I was 17. As a little girl, I felt different from everyone else. In high school, I was sexually abused and picked on. However, I believe I was born an addict. I started experimenting. Not long after, I became part-time student, full-time connoisseur of alcohol and drugs. I had found my niche, my people, and fervor for life.

“I ended up going in and out of some of the finest rehabs in the country, many of which I walked out of. After a missing person’s report was filed and pleading from my family, I decided to try the treatment route again. Give or take a few years, and I had a brief period of sobriety, but I wasn’t completely honest with myself and others around me.

“One day, I woke up in the hospital after a long and drunken stupor across the country. On the outside, I was a compilation of scars, bruises, and crappy CVS makeup. On the inside, I was broken and scared. Who was I when I wasn’t getting wasted? I couldn’t stand to look at myself in the mirror. I was terrified to live and terrified to die. That day, I had my last drink. The emotional bottom that I had hit couldn’t compare to the possessions I had lost and the close calls with death I had encountered. I went to detox and immersed myself into the recovery world that was around me.

“Through time, persistence, and taking a hard look at myself, I have come to find a life that can’t compare to anything I have ever imagined. Today, I have the best of friends and best family, and I’ve had some of the most amazing adventures because I am sober. Unfortunately and fortunately, I’ve had the chance to live two lives, one of deception and one of triumph. Because of that, I have become set free from the chains that once bound me down. I have come to know true happiness, joy, and serenity.” —Tori Skene, 25, sober for one year 

‘HOW COULD I HAVE A PROBLEM IF THINGS WERE GOING SO WELL?’

“At 38, I had what looked like an enviable life. I worked at a prestigious law firm in New York City, lived in a great apartment, and had a tight set of family and friends. But I also had an awful secret—an alcohol and cocaine addiction that had worsened to the point of drinking and using around the clock. I was what’s known as a high-functioning addict, looking like a relatively normal person to the outside world.

“I had been on a downward spiral for 10 years. At first I only drank at night. Then I started drinking at lunch. I swore I would never drink in the morning—that was for ‘real’ alcoholics—until the morning I had to drink to steady myself for work. Ultimately, I added cocaine to keep me awake and what I considered alert.

“Finally, one Monday morning on my way to work, I thought I was having a heart attack. Feeling like I might die, I somehow decided to reach out for help and checked into a detox unit. It saved my life. That day, I admitted to my friends and family the secret I’d been carrying for so many years.

“In addition to addiction, I was diagnosed with major depressive disorder, which I had been self-medicating with drugs and alcohol. I was prescribed an antidepressant to treat my depression appropriately. After leaving detox, I threw myself into recovery. I took the antidepressant religiously. I went to outpatient rehab and immediately started going to 12-step meetings. I became willing to do whatever it took to not pick up a drink. Part of my recovery included writing a memoir, Girl Walks Out of a Bar, about my struggles and journey in sobriety.

“Still, as a lawyer, I feared telling anyone at work about my struggle or even my recovery because of the stigma surrounding addiction and mental health disorders. However, when my memoir was coming out, I had to come clean at work. I was thrilled by the understanding and compassion I received. The process of telling people made me realize that these issues touch everyone, whether it’s through their own experience or those of family or friends. Now I advocate publicly for smashing the stigma I once feared. Today, sobriety has given me a life beyond my wildest dreams, and I could not be more grateful.” —Lisa Smith, 51, sober for 13 years

Original article here on Women’s Health mag

February 6, 2018 

Implementing MAT in a Statewide Correctional System

As the epidemic of opioid use in the United States continues to shift from prescription opioids to illicit drugs, more people living with opioid use disorder are encountering the criminal justice system. Most US correctional facilities do not continue or initiate medications for addiction treatment (MAT). This is especially unfortunate given the higher rates of opioid overdose immediately after release from incarceration. In July 2016, a new model of screening and protocoled treatment with MAT (including methadone, buprenorphine,or naltrexone) launched at the Rhode Island Department of Corrections (RIDOC), a unified prison/jail. A community vendor with statewide capacity to provide MAT after release was engaged to help run the program in November 2016, and all sites were operational by January 2017. Individuals arriving into RIDOC while receiving MAT were to be maintained on their respective medications regimen without tapering or discontinuing their medications. Contemporaneously, a system of 12 community-located Centers of Excellence in MAT was established to promote transitions and referrals of inmates released from RIDOC. This analysis
examines preliminary association of the program with overall overdose fatalities and deaths from overdose among those individuals who were recently incarcerated.

Methods

We conducted a retrospective cohort analysis linking data from the Rhode Island Office of State Medical Examiners for all unintentional deaths from overdose occurring from January 1 to June 30, 2016, and from January 1 to June 30, 2017, to data from RIDOC inmate releases.
Decedents were defined as individuals who were recently incarcerated if they died within 12 months of release from RIDOC. Descriptive statistics of decedents include summarized
demographics, the status of incarceration, and the number of fentanyl-related overdoses. Aggregate data of inmates released from RIDOC, counts of naloxone provided to inmates after release, and the monthly receipt of MAT were also reported. Risk ratios (RRs) and 95% CIs were used to compare the proportion of decedents who were recently incarcerated in 2017 with those who were incarcerated in 2016, since individual-level MAT program enrollment data were unavailable. The number needed to treat was estimated from the risk difference of recent incarceration between the 2 periods. χ2 Tests compared differences in decedent characteristics between 2016 and 2017. Statistical analysis was performed using SAS program, version 9.3 (SAS Institute Inc) with 2-sided P < .05 considered statistically significant. The Rhode Island Hospital institutional review board approved this protocol with a waiver of written informed consent.

Table 1

Table 2

Results

Statewide in Rhode Island, there were 179 overdose deaths from January 1, 2016, to June 30, 2016, compared with 157 overdose deaths during the same period in 2017, a reduction of 12.3%. Characteristics of decedents included in the 2017 group were generally comparable with those of
decedents in 2016, but the 2017 group was slightly older and less likely to be of white race/ethnicity (Table 1). Most deaths from overdose were fentanyl-related. For decedents
who were recently incarcerated, there were no statistically significant differences in characteristics of those decedents in 2016 vs 2017. The total number of admissions and releases from incarceration were similar over time; however, the provision of naloxone to inmates after release from
incarceration declined, and the monthly receipt of MAT after release from incarceration increased (Table 2). In the 2016 period, 26 of 179 individuals (14.5%) who died of an overdose were recently incarcerated compared with 9 of 157 individuals (5.7%) in the 2017 period, representing
a 60.5% reduction in mortality (RR, 0.4; 95% CI, 18.4%-80.9%; P = .01). The number needed to treat to prevent a death from overdose was 11 (95% CI, 7-43).

Discussion

We observed a large and clinically meaningful reduction in post incarceration deaths from overdose among inmates released from incarceration after implementation of a comprehensive MAT program in a statewide correctional facility—a reduction contributing to overall population-level declines in overdose deaths. Results are consistent with other studies of the provision of MAT during
incarceration,4 yet it is remarkable that the reduction in mortality occurred in the face of a devastating, illicit, fentanyl-driven overdose epidemic.5,6 Alternative explanations
for the observed reductions (eg, differences in population or the provision of naloxone) linked to recent incarceration are unsupported. Limitations of this study include a small sample size, a
lack of MAT data after inmate release, and possible misclassification of program exposure (eg, refusal of MAT, denial of opioid use disorder, and staggered MAT program implementation),
which may have underestimated the association. Additional individual-level and longitudinal analyses are warranted. Identification and treatment of opioid use disorder in
criminal justice settings with a linkage to medication and supportive care after release from incarceration is a promising strategy to rapidly address the high rates of overdose and opioid use disorder in the community.

Posted by: The Jama Network – Jama Psychiatry

Article here. Published online 2/14/2018

WomanComfortingWoman

Why Addicts Need Empathy and Compassion – Not Judgment and Shame

My husband is a physician. Every day at work, he sees devastating illness and death. I don’t know how he does it, to be honest. I’ve always been in awe of the folks who work on the front lines of our health care system. I wonder how they can see the most heartbreaking moments of the human condition, every day, and simply return home to their normal lives.

I was pondering all of this yesterday morning when my spouse walked into the kitchen.

“Honey,” I said. “I have a random question.”

“Okay,” he responded, pouring a cup of coffee.

“What’s the saddest thing you have to see at work?”

He paused for a moment, and his eyes seemed to search.

“Addiction,” he said. “Without a doubt. Addicts break my heart the most, every day.”

To be honest, I had expected him to respond with car accidents, or child sickness, or cancer. But… addiction?

“Why?” I asked.

He shrugged a little.

“I see people suffering every day. Of course, all of it is horrible,” he said. “But most of those people don’t have to suffer alone–except addicts. When an addict comes in, they are almost always by themselves. You ask if there’s anyone to call, they tell you there isn’t. And they are so ashamed, too. It’s like they believe that suffering alone is something they deserve. Nobody has empathy for these people. That’s what makes addiction so heartbreaking.”

I didn’t agree with him, at first. In fact, my husband’s empathy for addicts was making me feel a little bit squirmy. Perhaps a little conflicted, too.

You see, addiction runs rampant in my family. This disease has affected us in horrible ways. My therapist warned me to establish firm boundaries with my addicted loved ones, but to be honest, despising them was just easier. I believed they chose a substance over me, and instead of dealing with the hurt that their disease was causing, I decided to toss them aside.

I’m ashamed to admit this, but I think it’s important to do. Because I know it’s not just me. Society as a whole seems to struggle with how to respond to addiction. And the sad truth is, this horrible disease isn’t going away any time soon. The suffering part is bad enough. But for people to suffer, be stigmatized, abandoned, and loathed? That is a special torment that no human being should abide.

It is time we move toward empathy for addicts, and this is why:

Addiction is a disease, not a choice.

Like diabetes, cancer and heart disease, addiction can be caused by multiple factors: behavioral, environmental, or biological. According to the National Center of Addiction and Substance Abuse, genetics account for half of the likelihood that an individual will develop a severe dependence. Addiction is very much a disease, and addicts deserve to be treated with compassion.

WomanComfortingWoman

Judging is ineffective, and also cruel.

I understand that relationships with addicts can be complicated. I’ve been there. I know firm boundaries are crucial.

However, when we judge someone for symptoms of a disease they cannot control, we are downplaying their struggle instead of acknowledging what it truly is. Addiction is a brain illness that changes the way people behave. People can’t fix their brain chemistry any easier than someone could fix their own broken leg. By shaming an addict, as if their addiction is a personal choice, you are placing a moral expectation on a purely physical ailment. That is not only ineffective, it is cruel.

Shaming has negative impacts on already suffering humans.

Have you ever heard the saying “don’t beat a horse while it’s down”? Think about that for a second. When someone is suffering from addiction, shaming them is not likely to help. In fact, according to a study published in the Journal of Substance Abuse Treatment, fear of stigma is one of the top two barriers deterring addicts from seeking treatment in the first place. Conversely, social support and inclusion were identified as leading contributors to a successful recovery. It turns out, shame is a very poor motivator, and can also deal a deadly blow for someone who is already self-loathing and abusing substances.

Compassion is always the right response.

I think for the longest time, society has avoided compassionate responses to addiction because empathy was viewed as being permissive. However, the truth is quite the opposite. When you show an addict compassion, you are validating their struggle, and letting them know that you see them as the human being they are. Nobody deserves to be defined or stigmatized by their illness.

After all, a person is never the problem. The problem is the problem. 

 

Original article here by 

How a Police Chief, a Governor and a Sociologist Would Spend $100 Billion to Solve the Opioid Crisis

We asked 30 experts to think big, but realistically, about solutions. Imagine you had $100 billion to spend over five years — a little less than current federal domestic H.I.V./AIDS spending — to address the opioid crisis. Where would you put that money?

Interactive Photo

The consensus of the experts was that any effective strategy should include funding for four major areas: treatment, harm reduction, and both demand- and supply-focused solutions. The answer above is an average, as our panelists disagreed about the best way to divide up the money they were considering.

Our panel spent more money on treatment programs than anything else. (Over two million Americans are estimated to have a problem with opioids.) It was the top priority for more than 20 of the experts.

There was substantial disagreement about whether to focus on treating addiction or on trying to prevent the addiction from forming in the first place by addressing the underlying social issues that allow opioid addiction to thrive.

Our answers also suggest that the severity of the opioid crisis is breaking down longstanding divisions between public health officials and law enforcement, with over two-thirds of our panel including increased funding for law enforcement or international interdiction efforts. (Most of our panelists are public health and policy experts; others are politicians and law enforcement officials who have dealt with the crisis extensively.)

One point of agreement: No panelist spent any of the hypothetical $100 billion on a border wall with Mexico.

 Due to the technical design of the article, to access the rest of it, along with interactive photos, click here: How a Police Chief, a Governor and a Sociologist Would Spend $100 Billion to Solve the Opioid Crisis

Getting the Right Help for Opioid Dependence or Withdrawal

Do you know someone seeking treatment for opioid dependence or withdrawal? If so, it’s important to know this: products that promise miracle cures or fast results can cost precious time and money, lead to relapse, and even be dangerous.

  • Dietary supplements – such as herbal blends, vitamins, and minerals – have not been scientifically proven to ease withdrawal or to treat opioid dependence.
  • Products like Kratom, which some claim can help, are actually not proven treatments, and can be addictive and dangerous to your health.
  • Opioid dependence and withdrawal are serious health issues. You can address them with time, hard work, and help. But there are no quick fixes.

If you or someone you know is considering treatment for opioid dependence or withdrawal, start here:

  • Call SAMHSA’s National Helpline: 1-800-662-HELP (4357) to get live help from this free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for people and families facing substance use disorders.
  • Visit SAMSHA’s confidential treatment locator: https://findtreatment.samhsa.gov
    Find a reputable treatment facility near you in a quick, confidential online search.SAMHSA small logoBefore taking any dietary supplement – for any medical reason – ask a health provider these questions:
  • Is there scientific proof it actually works?
  • How reliable is this brand?
  • How will it interact with other supplements or drugs I take?
  • What are the side effects?
  • If it’s safe to take, what’s the right amount?

Learn more at FTC.gov/DietarySupplements.

This publication is a message from the Federal Trade Commission and the Substance Abuse and Mental Health Services Administration (SAMHSA)

The Substance Abuse and Mental Health Services Administration is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

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Download and Print the PDF by clicking the image above.

Original article here.

 

New treatment guidance issued for pregnant and parenting mothers

Last Wednesday, the Substance Abuse and Mental Health Services Administration (SAMHSA) released new Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants.

SAMHSA’s Clinical Guidance comes at a time of great need for effective opioid use disorder (OUD) treatment.  In 2016, over 20,000 pregnant women reported using heroin or misusing pain relievers in the past month. Newborn babies of mothers who used opioids while pregnant are at risk of neonatal abstinence syndrome–a group of physical and neurobehavioral signs of withdrawal.

“SAMHSA is filling an urgent need for reliable, useful, and accurate information for healthcare professionals working to treat opioid dependent mothers and their children,” said Dr. Elinore F. McCance-Katz, SAMHSA’s Assistant Secretary for Mental Health and Substance Use. “Ultimately, the steps explained in this guidance will help the mother and her infant safely receive treatment for opioid use disorder and neonatal abstinence syndrome.”

SAMHSA Pregnant Women

The Clinical Guidance offers standard approaches to a range of real-world scenarios faced by healthcare professionals working with mothers and infants.  For each scenario, the guidance offers clinical action steps and supporting evidence. The action steps reflect the best available treatment, including medication-assisted treatment for the mother and infant and appropriate types of social supports and follow-up services.

The guidance, which consists of 16 fact sheets on prenatal, infant, and maternal postnatal care, contains four elements: clinical scenario; clinical action steps; supporting evidence and clinical considerations; and web resources. Detailed, evidence-based treatment options for pregnant women with OUD including pharmacotherapy with methadone, buprenorphine, and buprenorphine/naloxone are provided.

The Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants: PDF Version Here (or click image above)

or it is available in the online SAMHSA Store at:                                            https://store.samhsa.gov/product/SMA18-5054

SAMHSA web page link

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (DHHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

NPR: Understanding The Struggle Against Opioid Addiction

NPR’s Rachel Martin talks to Medicaid’s former Chief Medical Officer Andrey Ostrovsky about his uncle’s fatal drug overdose and his efforts to destigmatize opioid addiction.

RACHEL MARTIN, HOST: A couple of years ago, the former chief medical officer at Medicaid, a man named Andrey Ostrovsky, lost his uncle. The family never knew what caused his death, and no one really talked about it. When Ostrovsky visited Florida later, he met up with his uncle’s best friend.

ANDREY OSTROVSKY: He lived in town, so I used that as a chance to hook up with him for what I thought was a quick cup of coffee, and it turned into a over three-hour session where he just unloaded the details of how he and my uncle had used for many years various types of drugs. My uncle’s friend was there when my uncle died, the night he died, and all of the history that my uncle’s friend described, it really did help me understand how, for over a decade, he’s been struggling with addiction and was never able to get help largely because of stigma.

MARTIN: When Ostrovsky found out that his uncle had died because of opioids and other drugs, he started to question a lot of things, including his career. He decided he could do more to address the opioid crisis outside of Medicaid even though he was a top official there. So last December he quit. He now runs a group that tries to focus on the broad causes of opioid addiction and treatments.

In your job at Medicaid, you had a unique vantage point on how this country is grappling with the opioid crisis. And then you’ve had this personal experience, this loss, losing your uncle. How would you characterize the federal government’s response to the opioid epidemic?

Brain With Pills

OSTROVSKY: I think the best answer to your question is summarized by the president’s State of the Union address. He spent, I believe, under a minute addressing what the federal strategies are to address the opioid use disorder crisis. He made reference to two strategies. One is stronger drug enforcement, which has some merit. And then he made a reference to a story about an officer who found a woman who was pregnant…

(SOUNDBITE OF 2018 STATE OF THE UNION ADDRESS)

PRESIDENT DONALD TRUMP: Homeless woman preparing to inject heroin. When Ryan told her she was going to harm her unborn child, she began to weep. She told him she didn’t know where to turn but badly wanted a safe home for her baby.

OSTROVSKY: …And how about officer and his wife adopted the baby.

(SOUNDBITE OF 2018 STATE OF THE UNION ADDRESS)

TRUMP: Ryan and Rebecca, you embody the goodness of our nation. Thank you.

(APPLAUSE)

OSTROVSKY: And that’s it. And then he moved on to some other theme. That to me is a bit terrifying and emblematic of a lot of the policy that’s coming out of the federal government right now, which is largely uninformed and incomplete. Alluding to a woman who’s pregnant that has opioid use disorder and the solution being let’s just take away her baby – not exactly what the evidence suggests we have as an option. There’s actually great medication-assisted treatment that can empower that mom to get into recovery and not be viewed as some addict of, you know, moral failure who doesn’t deserve to keep her child but rather a human that has a chronic condition that can be empowered to address and cope with that chronic condition.

MARTIN: Although the president did talk about the need for treatment. We’ve got a clip of him referencing that. Let’s listen.

(SOUNDBITE OF 2018 STATE OF THE UNION ADDRESS)

TRUMP: My administration is committed to fighting the drug epidemic and helping get treatment for those in need, for those who have been so terribly hurt. The struggle will be long, and it will be difficult, but as Americans always do, in the end, we will succeed. We will prevail.

MARTIN: Was that all encouraging for you to hear?

OSTROVSKY: My nature is to be optimistic just by virtue of what I’ve had to do and more importantly what my family has had to do to get us here. I think that hope is becoming more and more cautious.

MARTIN: In the beginning of our conversation, you talked about the stigma that your uncle suffered as a result of his addiction. How did that play out, I mean, in your own family? What did that look like, the stigma?

OSTROVSKY: Well, it didn’t really play out in the sense that we didn’t know until I had this chance conversation with his friend and all of this surfaced, and then I shared it with my family. And I certainly felt guilt that I made judgments about my uncle that in retrospect I shouldn’t have made because I didn’t realize that he had this chronic disease. And that…

MARTIN: Judgments like what?

OSTROVSKY: Judgments like how is it that he couldn’t hold a job? How is it that he was estranged from his wife and his small child? How did he get himself into such a situation that he would be an absentee dad? Like, those are awful things to say about a dear family member that I loved. But my uncle likely had a genetic predisposition to addiction. He certainly, like the rest of my family, had massive stressors of having low socioeconomic status, at least initially, having emigrated from another country, being persecuted for being Jewish – like, lots of stuff that can accumulate and make it difficult for someone to cope and perhaps use substances.

I think even if we as a family didn’t treat addiction with so much stigma and tried to reach out and help, then there’s all the other barriers of, you know, the person themselves being activated enough to try to get into recovery. But we didn’t even give him a shot. My family didn’t even give him a shot. One, we didn’t know, but we – our eyes also weren’t open to thinking, oh, maybe it’s addiction, maybe let’s talk about it. It’s just so stigmatized, and I can’t bear to think that there are families today that have family members that they may actually know that there is addiction at play but are too ashamed to talk about it. And by not talking about it, people will die, and it’s not worth it.

MARTIN: Andrey Ostrovsky is the CEO of Concerted Care Group. It’s a comprehensive opioid addiction program in Baltimore, Md. Thanks so much for talking with us and sharing your story.

OSTROVSKY: Thanks for having me.

(SOUNDBITE OF EPIGRAM’S “WAITING TO WAKE UP”)

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Posted Feb 2 2018

Original article on NPR.org here.

Study: In heroin addiction, glial cells play key roles in regulating the motivation for the drug

Findings suggest these specialized cells help rewire the addicted brain

BUFFALO, N.Y. — Scientists studying addiction know that heroin and other opioids induce plasticity in brain cells. Now, University at Buffalo researchers have made the novel discovery that in certain types of brain cells, drug-induced plasticity can work to reduce, rather than boost, motivation for heroin.

By providing new insights into how addiction changes the brain, the research could lead to novel approaches to treatments and potential new targets besides neurons.

“Most therapies have focused on the blocking or activating of receptors that bind drugs like heroin,” explained David Dietz, PhD, senior author of the paper and associate professor in the Department of Pharmacology and Toxicology in the Jacobs School of Medicine and Biomedical Sciences at UB. “While that approach may be effective in the short-term, it doesn’t get to the fundamental problem of what is addiction and how to prevent it, as well as prevent relapse.”

Published online last month in Neuropsychopharmacology, the paper describes how glial (non-neuronal) cells regulate both cellular and behavioral responses to heroin.

“Not much is known about glial cells in the context of addiction” said Dietz, a faculty member with UB’s neuroscience program. “In the addiction field, most neuroscientists focus on neurons. Very rarely have they studied glial cells in psychiatric diseases. This work demonstrates an essential role of glia in addictive behaviors, and offers us the ability to provide a new set of targets for future therapies toward the treatment of addiction.”

Dietz and his colleagues decided to study the potential role of glial cells in addiction when they found that RNA sequencing of tissue from heroin-addicted animals revealed changes in genes that are traditionally markers for a type of glial stem cell called oligodendrocyte precursor cells or OPCs.

Brain Image

Opiates and the prefrontal cortex

The research is likely the first to investigate how opiates affect adult OPCs in the brain’s prefrontal cortex, which is involved in complex cognitive behaviors and is a main target of addictive drugs.

“We found that many of the genes regulated by heroin aligned with the profile of OPCs, so something was going on with them,” he said.

OPCs, he explained, are cells that often become myelin, which is critical for efficient communication between neurons.

Dietz collaborated with his colleague Fraser Sim, PhD, associate professor in the Department of Pharmacology and Toxicology in the Jacobs School, co-author on the paper. In 2014, Sim identified one of the genes, SOX10, as a “master switch” for the differentiation of these stem cells towards myelination.

To determine what was happening when genes encoding OPCs were exposed to heroin, the scientists overexpressed them in addicted laboratory animals using viral gene therapy.

Compensatory effect

The result was surprising: when either of the two genes, SOX10 or BRG1, was overexpressed, the animals’ motivation to take the drug was reduced.

“To our surprise, it reduced their drug-taking behavior,” said Dietz. “It looks like the brain is trying to reconnect and possibly readapt myelin to normalize function, although that would need to be directly tested in future studies.”

One way to think of what may be happening, he explained, is to imagine that the brain is responding to exposure to drugs of abuse by attempting to reconnect with the brain’s other reward centers.

“As with any part of the body that sustains an insult, it seems that the addicted brain is trying to fix what went wrong,” he said. “Our hypothesis is that after exposure to heroin, the brain starts to upregulate OPCs in an attempt to fix the altered connectivity that occurs in the addicted states. It is possible that when we facilitated OPCs, we may have reversed some of the disconnect between the prefrontal cortex and the brain’s other reward regions.”

The research was funded by the National Institute on Drug Abuse of the National Institutes of Health.

Along with Dietz and Sim, other co-authors are: J.A. Martin, A. Caccamise, C.T. Werner, R. Viswanathan, J.J. Polanco, A.F. Stewart, S.A. Thomas, all of the Department of Pharmacology and Toxicology in the Jacobs School.

Original article here.  Release Date: January 26, 2018