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Posts Tagged ‘heroin’

About Addiction: School, prescriptions, heroin and morality

July 16th, 2012

It’s Monday and you get another great summary of news and research about addiction that have been making noise this week. If you care about addiction and about recovery, you know you want to stay abreast of what’s important and A3 wants to give you just that! So read on..

Recovery High: A new kind of high school: Across the country, new kinds of high schools are popping up called “recovery high schools”. At these schools kids and teachers aren’t just focused on grades, they are helping the students recover from their drug addiction and alcohol addiction. For teens entering addiction treatment, 75 percent relapse within the first year, often due to the return to the environment that facilitated the use in the first place. While the long-term effectiveness of these schools is still being evaluated, they are showing promise; and with the recent passage of the Affordable Care Act allowing for increased options for recovery, don’t be surprised to see these kind of high schools becoming more and more common. To see the video check out this link.

Prescription Painkillers leading teens to Heroin: According to national data from the Centers for Disease Control and Prevention, the number of deaths from prescription drug overdose tripled between 2000 and 2008. Experts point to the ease of access teens have to prescription pills, such as Percocet’s and Vicodin, from emergency rooms, dentist offices, and especially unfinished prescriptions in household medicine cabinets as one of the main reasons for the increase. These drugs have been found to at times lead teens to heroin, which provides a more intense version of the same high for a fraction of the price. As a result, in the decade from 1999 through 2009, the yearly deaths of people aged 15 to 24 from heroin overdose shot up from 198 to 510.

Heroin abuse becoming a national epidemic: Heroin use and death is still on the rise, exploding in use over the last couple years, fueled by the Baby Boomers. The Boomers increased use of prescription drugs can quickly lead down a road to heroin; once the prescription runs out or the cost gets too high, the more available, cheaper heroin becomes an attractive option. While its use has been increasing nationwide, the statistics from Oregon this past year give an example of the entire nation’s problem. Last year alone, there were 143 heroin-related deaths in Oregon, a 59 percent increase from the year before and almost the entire nation’s total from a decade ago! Marion County, in particular, has already seen more deaths so far this year than in all of 2011. Heroin is on the rebound, no longer a “dormant drug”, and, with its drastic increases recently, should be addressed sooner rather than later.

Addiction: Disease or moral failing? One of the most common questions regarding addiction is the debate on whether it is a disease or a moral failing.  A recent article by Dr. Marc Lewis addresses the question from both sides. He starts by pointing out the common critiques that “you don’t ‘catch’ addiction”, “you don’t treat addiction with medications or expect a cure”, and “you don’t ‘have’ addiction” like you would “have” a cold or other disease, in order to show why addiction should not be considered a disease. However, he then counters with the comparison to type II diabetes, which fits the mold of the earlier critiques, yet is never questioned as being a disease. In fact, having type II diabetes is not seen as a “moral failing” and it seems addiction is following this path and becoming more frequently seen as a disease rather than a moral failing. Truth is, addiction is likely going to continue being seen as straddling these two domains.

A cautionary tale of Fentanyl addiction: Fentanyl, a new painkiller, is becoming the next in a line of destructive and deadly prescription drugs. According to Dr. Michelle Arnot, Fentanyl is 100 times stronger than morphine and 750 more potent than codeine. The article tells the tale of a man who lost his “perfect wife” to Fentanyl addiction. Prescribed as patches to be sucked on, addicts soon learn to smoke them in order to get a greater effect. Shortly after her abuse began, the “perfect wife” was going through a month’s supply in under a week. This led to pawning her children’s and family’s belongings, turning her into someone no one recognized. One day, her husband came home from work to find her dead. Now, her husband wants her story to serve as a warning to anyone else becoming entangled with Fentanyl.

Helping siblings of addicts: When addiction leads to a fatality, almost everyone who knew the victim is affected. However, they are affected and handle it in different ways. Most people know about the grief parents feel when losing a child, and they are given support and programs to help deal with it. Siblings, on the other hand, have often gone overlooked in the coping process, largely because they do not grieve in the same way as parents. The emotional needs, and even physical needs, of addicts’ siblings can often be neglected in favor of the addict while they’re still alive and in favor of the parents needs after an addict’s passing. Now, programs such as GRASP (Grief Recovery After a Substance Passing) are popping up with the goal of helping these siblings cope.


Posted in:  Education
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Is opiate pain medication safe for addicts? Part I

May 30th, 2012

A recent user question on VYou (see my response here) addressed the issue of prescribing addicts with opioid pain medication. Since prescription medication abuse and addiction is on the rise and getting more and more attention in the media every year, the question of whether addicts in recovery, or people who have dealt with substance abuse and addiction problems in the past, should be prescribed these medications is a very relevant one.

Chronic pain affects a substantial portion of the population worldwide (as many as 30%, see here). Opiate medications are one of the most commonly used approaches to treating such pain, which if untreated can cause serious disruptions to sufferers’ lives. Even when treated, chronic pain can be pretty debilitating. Some research (1) brings up good questions about the true effectiveness of opiate therapy for chronic pain, especially among long-term opiate users (like heroin and prescription pain medication addicts) but also among other drug using populations.

So how common is the practice? What sort of results do drug addicts usually get from these opiate therapies? And finally, how many of the addicts or drug abusers who receive these therapies end up abusing them and can we identify those people early so we can stop prescribing to them? In this three-part series of articles we’re going to cover these questions in-depth.

Prescription pain medication use in addict populations

Clinicians treating chronic back pain choose from a range of options, including opioid medications, exercise therapy, nonsteroidal anti-inflammatory medications, tricyclic antidepressants, acupuncture, and electrical stimulation. One study (1)  found wide variability in the percent of chronic pain patients prescribed opioids (from 3%-66%) although the studies varied widely in their size and population served – some even looks at general back pain and not chronic pain alone (they tended to have much lower opioid prescription percentages). Among chronic pain clinic patients, chronic opioid pain medication use was estimated at 19% (2).

Among addicted populations, concerns about tolerance, withdrawal, and abuse tend to cut prescription rates for opioid pain medications. However, past drug abuse can exacerbate pain issues, especially for people who abuse, or have abused, opiates in the past. For this reason, it can sometimes be difficult to properly manage pain in people with a history of addiction. One study (3) found that as many as 67% of patients in a Methadone Maintenance Program and 52% of patients in short term residential treatment programs were being prescribed opiates for pain. It’s important to note that these numbers are higher than those reported in other studies but that populations in treatment do generally show prescription rates higher than the general population. A study in Finland (a country that has great medical record data) found that opiate prescription rates in substance abuse populations were equivalent (not higher or lower) to those in the general population. The College of Problems on Drug Dependence itself had released an official statement noting that a balance must be reached between fear of opioid prescriptions for pain and the usefulness of opioid pain medication for chronic and severe pain (4).

Interestingly, it seems that of all opioid pain medication prescriptions, the largest increases in troubling use has been around oxycodone (Oxycontin), which gets mentioned as often in emergency departments (ED) around the country even though it is prescribed about one-third as often as hydrocodone (Vicodin). This is less surprising when you consider the fact that many addicts report using oxycontin in different ways including smoking, snorting, and injecting the stuff, which is stronger and does not have the same amount of fillers as most hydrocodone preparations. The fact that oxycodone is stronger also means it is more effective for pain relief through higher activation of the opioid system that is relevant for addiction.

In our next piece we are going to explore whether opiate pain medication is helpful in controlling pain among addicts and substance abusers, see you then!

Citations:

1. Martell, O’Connor, Kerns, Becker, Morales, Kosten, Fiellin. (2007). Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction. Annals of Internal Medicine, 146, 116-127.

2. Chabal, Erjavec, Jacobson, Mariano, Chaney (1997). Prescription Opiate Abuse in Chronic Pain Patients: Clinical Criteria, Incidence, and Predictors. Clinical Journal of Pain, 13, 150-155.

3. Rosenblum, Joseph, Fong, Kipnis, Cleland, and Portenoy (2003). Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. The Journal of the American Medical Association, 289, 2370-2378.

4. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement.


Posted in:  Education, Opiates, Prescription
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Naltrexone the addiction cure?

January 23rd, 2012

CNN released a news article a little while back titled “With anti-addiction pill, ‘no urge, no craving‘” that seems to suggest that a cure for addiction has been found. As usual, news reporting on these sort of topics revolves around a kernel of truth, with nice window dressing an a serving of embellishment.

While naltrexone, and topiramate, have been shown to improve outcomes in addiction treatment, they have by no means revealed anything that would warrant giving them the title “anti-addiction pills.”

Indeed, there are now a few different preparations of Naltrexone, including a long acting version called Vivitrol that while relatively expensive, has been shown to be relatively effective at cutting relapse rates for both alcoholics AND heroin (or opiate addicts). Note the difference though here between my language and that used by CNN; Naltrexone has been shown to reduce relapse rates, not eliminate them, and current research seems to show that it is most effective only for specific groups of alcoholics who have a specific type of Mu opioid receptor.

As the article points out, a combination of therapies, including behavioral therapies, medications, and social-support, are still the best option when it comes to addiction treatment.

We’re a long way off from finding anything that can be considered a cure for addiction, no matter what some treatment centers like to claim, but these pills should help us stem the tide while we keep looking…


Posted in:  Education, Medications, Opinions, Treatment
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U.S. Drug overdose deaths are increasing

December 4th, 2011

The second leading cause of accidental death in the US is drug overdose (JAMA 2007). Prescription painkiller overdose deaths (opioid analgesics like OxyContin, Vicodin and methadone) account for nearly half of the 36,450 total fatal overdoses with 15,000 deaths that have claimed a number of celebrity lives including famous actor Heath Ledger (CDC 2011).

With so much concern over illegal drugs, it seems silly not to focus on a problem that is at least as deadly but far more accepted.

Drug overdose deaths increasing quickly

Drug overdoses are normally considered accidental and they're on the riseWe’ve reported on this phenomenon before, so for the regular A3 readers this report might not seem new. But what’s staggering is just how quickly these numbers are moving up.

In 2004 there were 19,838 total accidental overdose deaths, with about 9,000 caused by prescribed drugs, and 8,000 more caused by illegal drugs like cocaine, heroin, and methamphetamines (Paulozzi, LJ, Budnitz 2006). That signals a near doubling in about 7 years, and when you look at numbers from 1999, we’re talking about triple the accidental drug overdose deaths in just over a decade! Fastest growing cause of death in our country ladies and gentlemen.

SAMHSA Reports that use of prescription pain relievers (opioid analgesics) have increased since 2002 from 360,000 to 754,000 people in 2010. That means that people are twice as likely to use these drugs now, which would be fine if 5% of the users weren’t dying every year.  A study I talked about on ABC’s Good Morning America earlier this year (see here) reported that people taking heavy doses are especially likely to die and that this might be at least partially due to additional opioid use over and above the prescribed regimen.Time to get this under control prescribers!!!

This increase in usage opioid analgesics like Oxycontin, Vicodin, and methadone has made them the some of the most deadly drugs in the USA (Paulozzi, LJ, Budnitz 2006). In 1999 to 2004 prescription overdose related to opioid analgesics increased from 2,900 to at least 7,500, this equates to 160% increase in just 5 years (Paulozzi).

A JAMA study conducted between 1999 to 2004 reported that white women showed a relative increase in unintentional drug related deaths of 136.5% followed by young adults aged 15-24 years (113.3%). But the latest report from the CDC suggest that Men and middle aged individuals are most likely to be affected by this growing epidemic. The bottom line is this problem is either moving around or is universal enough affect essentially every major group of Americans. One of the scariest findings from this most recent CDC study may be the conclusion that states are generally unprepared to deal with this growing epidemic.

What can we do about overdose deaths?

First of all, it is seriously time that we had more consistent state and federal computer systems keeping track of prescriptions for heavily controlled drugs in this country. We can keep track of packages moving across state lines with no problem, why is it so damn hard to watch pills that lead to 35,000 deaths? Most states have them in place but they’re not heavily used and there’s nothing at all that looks at cross federal prescription patterns.

Second, we wrote about some harm-reduction methods to reduce overdose deaths, things like intranasal naloxone, safe injection sites, and more. As far as I’m concerned, we need to get off our national moral horse and start acting responsibly when it comes to saving lives. If we have simple solutions that have been shown to reduce deaths while not increasing abuse, I say let’s implement!!! Anything else is simply wrong.

Citations:

Paulozzi, LJ, Budnitz, DS, Xi, Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology Drug Safety 2006; 15: 618-627. (originally published in 2006 and recently updated)


Posted in:  Education
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Saving lives made easy – Treating opiate overdose with intranasal naloxone

October 24th, 2011

oxycodone-addiction-big1Contributing co-author: Andrew Chen

Imagine that you and your friend have been using heroin (or another opiate). A few hours go by and you notice your friend is progressively becoming more and more unresponsive. You check on him and find that his breathing is shallow, his skin is cold, and his pupils are constricted. You recognize these as signs of opiate overdose and call for help. Now what?

Well… If you had some naloxone around, you might be able to treat the overdose and save your friend’s life before the paramedics even arrive.

Naloxone hydrochloride (naloxone) is the standard treatment for opioid overdose. Naloxone works by blocking opioid receptors, thereby removing opioid agonists, such as heroin or oxycodone, from those same receptors. As a result, the overdose is reversed and death is prevented.

What makes naloxone great is that it has no potential for abuse. In fact, it makes the user feel pretty crappy.

Naloxone is typically delivered through an injection, which makes it pretty much useless in many situations. However, it can also be delivered using an intranasal spray device. This intranasal form of naloxone is getting lots of attention recently because it is relatively easy to administer.

In 2006, The Boston Public Health Commission (BPHC) implemented an overdose prevention program, providing training and intranasal naloxone to 385 individuals deemed likely to witness an overdose. These individuals were often family members of opiate users or drug-using partners.

15 months later, the BPHC conducted a follow-up:

  • Contact was made with 278 of the original participants.
  • 222 reported witnessing no overdoses during the 15-month span.
  • 7 had their naloxone stolen, lost, or confiscated.
  • 50 reported witnessing at least one overdose during the 15-month span. Together, these 50 individuals reported a total of 74 successful overdose reversals using intranasal naloxone!

The BPHC program is not the only example of successful use of naloxone in opiate overdose prevention programs. Similar programs have popped up in Chicago, New York, San Francisco, Baltimore, and New Mexico.

Unlike injections, using a nasal spray isn’t rocket science. All of the participants in the BPHC program were trained by non-medical public health workers, which makes the idea relatively cheap. As the data shows, the participants were able to effectively recognize an opiate overdose and administer intranasal naloxone. By targeting at-risk populations and providing proper training, distribution of intranasal naloxone can help in saving lives.

For more information, check out our post Addiction and the brain part IV – Opiates

Citation:

Doe-Simkins, M., Walley, A.Y., Epstein, A., & Moyer, P. (2009) Saved by the nose: Bystander-administered intranasal naloxone hydrochloride for opiod overdose. American Journal of Public Health. 99(5)


Posted in:  Education, For addicts, For others, Opiates, prevention, Tips, Treatment
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Promising new medical treatment options for drug addiction!!!

October 17th, 2011

Researchers are attacking the issue of drug addiction from multiple angles, and the results seem to be more and more ways to help. Some promising new developments in pharmacological (as in medication) therapies include a new cocaine-vaccine, as well as expanded use of Buprenorphine, for the treatment of opiate (heroin, morphine) addiction.

  • These medications are best used along with behavioral treatment in order to increase to probability of treatment success.
  • By reducing cravings, as well as reducing the effects of the drugs themselves, these medications can increase the length of time that patients will stay in treatment, which is the most reliable way of producing better treatment outcomes.

What else is new aside from medications?

There are also some exciting developments in the behavioral treatment, including Contingency Management (CM), a treatment method that tries to reteach addicts positive, drug-free behaviors by reinforcing those over the use of drugs. While some people still have problems with programs that use CM because of the notion of rewarding drug addicts for not using drugs, I say use whatever works!

Lastly, as early as 2003, researchers have noted that proper drug treatment may take longer than the 14-30 day programs that are currently being offered (1). In fact, while the article I’m referring too speaks specifically about methamphetamine addiction, we now know that the long use of many drugs, including cocaine, leads to long lasting brain changes that can take up to a year to show significant recovery.

I personally think that proper drug treatment for long time addicts (anyone with more than a year or so of heavy use) should take on the order of 6 months to a year, and should be supplemented by some outpatient post-care for an extended period of time (I’m far from the only one calling for this, see article 2). It’s the only sensible thing to do given the long term changes that such drug use creates in the brain…

I think it’s about time that insurance companies step up the plate and recognize that the huge cost of drug problems for our society (estimated at more than $100 billion annually) can be vastly reduced by providing sound, scientifically based, medical treatment options for those who need it.

citations:
(1) Margaret Cretzmeyer M.S.W, Mary Vaughan Sarrazin Ph.D., Diane L. Huber Ph.D., R.N., FAAN, CNAAc, Robert I. Block Ph.D. & James A. Hall Ph.D., LISW( 2003) Treatment of methamphetamine abuse: research findings and clinical directions. Journal of Substance Abuse Treatment Volume 24.
(2)
A. Thomas McLellan, PhD; David C. Lewis, MD; Charles P. O’Brien, MD, PhD; Herbert D. Kleber, MD (2000). Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation. Journal of the American Medical Association, Volume 284, pp. 1689-1695.

Question of the day:
Do you know anyone who’s been through residential drug treatment?
How long were they in for?
How many times?
Did it help?


Posted in:  Drugs, Drugs, Education, Medications, Treatment
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Addiction stories: Hellish Heroin – Bambi’s heroin addiction story

May 14th, 2011

Opiate Addiction can be a horrible thing whether it's to heroin, hydrocodone, oxycontin, or any one of a number of available opiates. This is only the first in a series of addiction stories we will have on the site.Addiction stories seem to have an impact that objective research can never have. This is another in a series of addiction stories submitted by our readers. I hope that everyone will benefit from learning about others’ experiences. There’s no doubt that Bambi’s experience of escalation in use from what seemed initially innocent is a common one. If you, or someone you know, needs help with their opiate addiction, try our rehab-finder for the best way to get reliable, verified, rehab recommendations.

A harrowing tale of heroin addiction:

When most people hear the word heroin, some things come to mind. Those of you who have never even thought of doing a drug like heroin, would never understand. And for those of you who you know who you are, whether you have found your way out, or are slowly still slipping away… Believe me, if you know who you are, then you know how it is. Realizing you’re addicted to something doesn’t hit you, until you mentally find your way out by accepting what has happened and letting go with only one hell of a memory. Read the rest of this entry »


Posted in:  Addiction Stories, Drugs, Opiates
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