Treatment and Addiction

y Dr. Nora Volkow

Such experiences contribute to a feeling that research is a one-way transaction benefiting scientists but giving little back to the community. Lack of meaningful community engagement also compromises the quality of the science by not incorporating the valuable ideas and insights of people who use drugs.

NIDA is committed to improving community engagement in all parts of the research process. For that reason, we have asked the National Advisory Council on Drug Abuse (NACDA)—the body of experts that advises on NIDA’s scientific research priorities—to convene a working group to recommend ways to enhance the meaningful engagement of people who have experience with drug use in the research our Institute funds. The workgroup will inform the creation of resources that outline NIDA’s expectations regarding community engagement and help both applicants and community partners navigate this critical work.

NIDA has long encouraged community-engaged research, and it is required element in various NIDA research funding opportunities, including those supported through our Racial Equity Initiative. The evolving opioid overdose crisis has underscored the importance of ensuring that people’s lived experience of substance use is centered in the science we support. For example, one of the pillars of the NIH Helping to End Addiction Long-term (HEAL) Initiative is that research must be relevant and responsive to the individuals, families, and communities it aims to help. One way HEAL studies are doing this is by drawing on the input of community advisory boards to ensure that the research is best tailored to the needs of the people most impacted by it.

The NIDA-funded Harm Reduction Research Network is a nationwide set of projects to enhance the impact of harm-reduction efforts, and its community advisory boards have already helped shape some of the studies. One project involves the development of a survey instrument to capture experiences of people who use drugs, and advisory board members helped tailor the wording of the instrument so that it reflected language more likely to be used by people who use drugs. Another study aimed at reducing overdose and increasing engagement in harm reduction and treatment services had originally been limited to people who use methamphetamine. Based on the input of advisors with more up-to-date knowledge of drug-use in their community, the study was broadened to include people who use cocaine, as that was identified as an emerging stimulant in their area.

The Integrative Management of Chronic Pain and OUD for Whole Recovery (IMPOWR) project is addressing the needs of people with substance use disorders and pain via a network of multidisciplinary team science collaborations. Its community advisory boards weigh in on funding decisions for pilot studies, and some of these studies have included a community partner as a co-investigator. Based on community input about the important role of PTSD and discrimination in healthcare settings in pain and opioid misuse and addiction, IMPOWR researchers added PTSD and stigma/discrimination items to their common data elements (the standardized questions that facilitate data-sharing across studies).

The Native Collective Research Effort to Enhance Wellness (NCREW) Initiative is partnering with Tribal organizations to support community-driven research projects that address opioid misuse and pain in Native communities. By providing needed training, technical assistance, and tools, the NCREW project is building capacity within Native communities to conduct locally prioritized research that incorporates indigenous knowledge and lived experience, with the aim of building effective, sustainable, and strengths-based interventions.

As outlined in NIDA’s Strategic Plan, NIDA is committed to partnering with people with lived and living experience in the development of new treatments for substance use disorder. Consistent with that goal, NIDA is funding four Patient Engagement Resource Centers (PERCs) to test various models of patient engagement that can inform research on SUD treatment services. Each PERC will recruit members of a particular patient population to understand what prevents them from finding or receiving evidence-based treatment services. This information will be used to pilot test patient-informed solutions to these challenges that can ultimately serve as models for the development of interventions in other settings.

There are many other ways that partnering with people with living experience of substance use could benefit both science and the community. Surveillance is one example. The drug market is rapidly changing, and people who actively use drugs and live this reality are best poised to provide information on the drug supply and its effects. And through their engagement in surveillance efforts, participants could gain information on new adulterants and contaminants that could help inform their own decisions.

In these, as with other research efforts, people who use drugs need to be treated with respect, and their confidentiality must be protected. They must also be compensated fairly for their time, their input, and their commuting and childcare costs.

Including people with experience of substance use and addiction in the scientific workforce—and making sure they feel safe and recognized as valuable members of the research team—must also become a priority for our science. As some of my colleagues at NIDA’s Intramural Research Program argued two years ago in the Journal of Addiction Medicine, people with lived and living experience of substance use disorders have unique perspectives that are invaluable in making sure that the right research questions are asked.

These are just some of the possible topics that may be discussed in the new NACDA workgroup. For that group, we are seeking individuals who identify as having experience with substance use or a substance use disorder or as a family or caregiver of someone who does. Participants will meet virtually three or four times during 2025 and potentially early 2026 and will be compensated for their time during the meetings. If you are interested in participating, further information is available on the Council Workgroups page. We are accepting application statements through January 10, 2025.

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Source: Forwarding Agency:

Herschel Baker, International Liaison Director & Queensland Director

Drug Free Australia

Web: https://drugfree.org.au/

mailto:drugfreeaust@drugfree.org.au

mailto:drugfree@org.au

Filed under: Addiction,Drug use-various effects,Education,Latest News,Prevention and Intervention,Treatment and Addiction,USA :

Illegal drugs are the source of immense human suffering. Those most vulnerable, especially young people, bear the brunt of this crisis. People who use drugs and those struggling with addiction face a multitude of challenges: the harmful effects of the drugs themselves, the stigma and discrimination they endure, and often, harsh and ineffective responses to their situation.

The global drug problem is a complex challenge affecting millions of people worldwide. According to the World Drug Report, there are nearly 300 million drug users globally.

The issue spans from individuals with substance use disorders to communities affected by drug trafficking and organized crime. The drug problem is deeply connected to organized crime, corruption, economic crime, and terrorism. To effectively address this challenge, it is crucial to adopt a science-based, evidence-driven approach that prioritizes prevention and treatment.

The drug trade problem was recognized early in the 20th century, leading to the first international conference on narcotic drugs in Shanghai in 1909. In the decades that followed, a multilateral system was established to control the production, trafficking, and abuse of drugs.

Evidence-based drug prevention programmes can safeguard individuals and communities. By reducing drug use, these programmes can also weaken the illicit economies that exploit human misery.

Types of Illegal Drugs

Drugs are chemical substances that affect the normal functioning of the body or brain. They can be legal, like caffeine, nicotine, and alcohol, or illegal. Legal drugs, such as medicines, help with recovery from illness but can also be abused. Illegal drugs are considered so harmful that international laws, under United Nations conventions, regulate their use, making it unlawful to possess, use, or sell them.

Illegal drugs often have various street names that can vary by region and change over time. Their effects include immediate physical harm and long-term impacts on psychological and emotional development, especially for young people. Drugs can impair natural coping mechanisms and potential, and mixing them can result in unpredictable and severe consequences.

Additionally, drug use can impair judgment, leading users to take risks such as unsafe sex, which increases the risk of contracting hepatitis, HIV, and other sexually transmitted diseases.

Most common illegal drugs include:

  • Cannabis;
  • Cocaine;
  • Ecstasy;
  • Heroin;
  • LSD (D-Lysergic Acid Diethylamide); and
  • Methamphetamine.

In recent years, New Psychoactive Substances (NPS) have become a global phenomenon. NPS are substances of abuse not controlled under international drug conventions, but may pose public health risks. The term “new” refers to substances recently introduced to the market, not necessarily newly invented.

Known as “designer drugs,” “legal highs,” or “bath salts,” NPS often mimic the effects of illicit or prescription drugs. They are created by modifying the chemical structures of controlled substances to bypass legal restrictions.

The rapid appearance of diverse NPS on the global market poses public health risks and challenges for drug policy. Limited knowledge about their effects complicates prevention and treatment efforts, while their chemical diversity makes identification and analysis difficult. Effective monitoring, information sharing, and early warning systems are critical for addressing these challenges.

UN Action

Since its founding, the United Nations has been tackling the global drug problem in a systematic manner.

The United Nations Commission on Narcotic Drugs (CND) was established in 1946 by the Economic and Social Council (ECOSOC) through resolution 9(I). Its purpose is to assist ECOSOC in overseeing the implementation of international drug control treaties.

Three drug control conventions were adopted under the auspices of the United Nations (in 1961, 1971 and 1988). Adherence is now almost universal.

The International Narcotics Control Board (INCB) is an independent, quasi-judicial expert body established under the 1961 Single Convention on Narcotic Drugs. It was formed by merging two earlier organizations: the Permanent Central Narcotics Board, created by the 1925 International Opium Convention, and the Drug Supervisory Body, established under the 1931 Convention for Limiting the Manufacture and Regulating the Distribution of Narcotic Drugs. The INCB monitors and assists governments in complying with international drug control treaties.

The World Health Organization (WHO) is a key player in the United Nations’ efforts to combat the global drug problem. Sustainable Development Goal 3, specifically Target 3.5, calls on governments to enhance prevention and treatment programs for substance abuse. WHO’s approach to addressing the global drug problem focuses on five key areas: prevention, treatment, harm reduction, access to controlled medicines, and monitoring and evaluation.

The United Nations Office on Drugs and Crime (UNODC) supports governments in implementing a balanced, health- and evidence-based approach to the world drug problem that addresses both supply and demand and is guided by human rights and the agreed international drug control framework. This approach involves: treatment, support, and rehabilitation; ensuring access to controlled substances for medical purposes; working with farmers who previously cultivated illicit drug crops to develop alternative sustainable livelihoods for them; and establishing adequate legal and institutional frameworks for drug control through using international conventions. UNODC works in all regions through balanced, evidence-based responses to address drug abuse and drug use disorders, as well as the production and trafficking of illicit drugs.

Recent Milestones

In 2009, governments adopted the Political Declaration and Plan of Action on International Cooperation Towards an Integrated and Balanced Strategy to Counter the World Drug Problem, which includes goals and targets for drug control.

Progress towards addressing the world drug problem and related issues is assessed at the United Nations General Assembly Special Session (UNGASS). All nations are encouraged to keep in mind the key principles of the 2030 Agenda for Sustainable Development and to leave no one behind. The Special Session in 2016 resulted in an outcome document, Our joint commitment to effectively addressing and countering the world drug problem.

In 2019, the Commission on Narcotic Drugs adopted the Ministerial Declaration on Strengthening actions at the national, regional and international levels to accelerate the implementation of joint commitments made to jointly address and counter the world drug problem. In the Declaration, governments reaffirmed their determination “to address and counter the world drug problem and to actively promote a society free of drug abuse in order to help ensure that all people can live in health, dignity and peace, with security and prosperity, and reaffirm our determination to address public health, safety and social problems resulting from drug abuse.” They also decided to review the progress made in implementing the policy commitments in 2029.

Global Response

National legislative frameworks govern the responses of criminal justice systems to the world drug problem. In the vast majority of countries, illicit cultivation of drug crops, diversion of precursors and drug trafficking are criminal offences, but the criminal nature of drug use or possession for use varies across countries and regions.

Drug use or possession is considered a criminal offence in about 40 per cent of the 94 countries where data are available, representing a significant proportion of the global population. Available data indicate that more punitive measures are imposed for drug use or possession in Asia compared with other regions, while the Americas and Asia are the most punitive regions for drug trafficking.

Long-term efforts to dismantle drug economies must focus on providing socioeconomic opportunities and alternatives that address the root causes of illicit crop cultivation, such as poverty, underdevelopment, and insecurity. These efforts should go beyond simply replacing illicit crops or incomes. Additionally, they must address the factors that lead to the recruitment of young people into the drug trade, as they are particularly vulnerable to synthetic drug use.

According to newly available estimates, in 2022 only about 1 in 11 people with drug use disorders received drug treatment globally. It is recommended that all individuals affected by the world drug problem, including women, who face disproportionate stigma and discrimination, are ensured their universal right to health. To achieve this, drug treatment, care, and services must be comprehensive, effective, voluntary, and accessible to everyone without discrimination. These services should be designed to uphold and preserve the dignity of all individuals, including those who use drugs, as well as their communities.

Role of Civil Society

The United Nations acknowledges the importance of fostering strong partnerships with civil society organizations to address the complex challenges of drug abuse and crime, which weaken the fabric of society. Active participation from civil society— non-governmental organizations, community groups, labour unions, indigenous groups, charitable organizations, faith-based groups, professional associations, and foundations — is crucial in supporting the UN’s efforts to fulfill its global mandates effectively.

UNODC supports NGOs participation in relevant drug-related policy discussions and meetings, particularly the CND regular and intersessional meetings and encourages the increased dialogue between NGOs, member states and UN entities, through the Vienna NGO Committee on Drugs (VNGOC).

Youth Engagement

Recognizing that youth are a vulnerable population, it is essential for the international community to address the issue of substance abuse effectively. Through the Youth Initiative, the UN provides opportunities for youth to actively participate in efforts to prevent substance use. This programme enables young people to join a community of peers committed to promoting health and well-being.

The Youth Forum is an annual event organized by the UNODC Youth Initiative as part of the broader framework of the Commission on Narcotic Drugs. It brings together young people from around the world, nominated by governments, who are actively engaged in drug use prevention, health promotion, and youth empowerment.

The forum provides a platform for participants to exchange ideas, share visions, and explore diverse perspectives on enhancing the health and well-being of their peers. Additionally, it offers an opportunity for youth to present their collective message to global policymakers, contributing their voices to international discussions and decisions.

Resources

 

Source: https://www.un.org/en/global-issues/drugs

Filed under: Global Drug Legalisation Efforts,Latest News,Others (International News),Prevalence,Prevention and Intervention,Treatment and Addiction,Youth :

Cultural, systemic and historical factors have converged to create the perfect storm when it comes to Black overdose deaths.

      By Liz Tung – June 14, 2024 Reporter at The Pulse

In this Jan. 23, 2018 photo, Leah Hill, a behavioral health fellow with the Baltimore City Health Department, displays a sample of Narcan nasal spray in Baltimore. The overdose-reversal drug is a critical tool to easing America’s coast-to-coast opioid epidemic. (AP Photo/Patrick Semansky)

From Philly and the Pa. suburbs to South Jersey and Delaware, what would you like WHYY News to cover? Let us know!

A recent study from the Pennsylvania Department of Health has found that Black people who died from opioid overdoses were half as likely as white people to receive the life-saving drug naloxone, otherwise known as Narcan. The study also found that Black overdose deaths in Pennsylvania increased by more than 50% between 2019 and 2021, compared with no change in white overdose deaths.

In an email, a representative with the Department of Health said that similar rises in overdose deaths are being seen across the country, especially among Black, American Indian and Alaska Native populations. But researchers are still investigating what’s behind the spike.

“There does not appear to be a single reason why rates are increasing for Black populations and holding steady among white populations,” the statement reads. “The volatile and rapidly changing drug supply certainly has been a challenge as fentanyl is now found in every type of drug. Inequities in terms of treatment for substance use disorder may also play a factor as white people are more likely to have better access to the most evidence-based treatments and are more likely to stay in treatment.”

Fear of arrest

Abenaa Jones, an epidemiologist and assistant professor of human development and family studies at Penn State who was not involved in the study, has conducted similar research in Baltimore. She agreed that fentanyl-contaminated drugs — which are more common in lower-income neighborhoods — and less access to health care are likely factors in the growing number of overdose deaths among Black populations.

Jones said the criminal justice system, and its unequal treatment of Black people, also plays a role.

“We know that the intersection of criminal justice and substance use, and criminalization of drug use and how that disproportionately impacts minorities, can limit the accessibility of harm reduction services to racial-ethnic minorities for fear of harassment by police for drug paraphernalia,” Jones said, adding that even syringes obtained through needle-exchange programs can be considered illegal paraphernalia.

Fear of arrest, in turn, leads more people to using drugs in isolation.

“That may protect you from criminal legal involvement, but then in the event of an overdose, you may not have someone to help you,” Jones said. “So it could be that by the time the EMS come, it’s been too long for them to even consider administering naloxone.”

Contaminated drug supplies

An unexpected observation that Jones made in the course of her research could also be a factor in rising death rates — the fact that many of the Black people dying of opioid overdoses are older.

“For any other racial groups, overdose deaths peak around midlife — 35, 45,” she said. “For Black individuals, it’s more like 55, 64, and we were wondering what was going on with that.”

After investigating that question, Jones and her colleagues formulated a working theory.

“The running hypothesis for us is that this is a cohort effect,” she said. “Individuals who’ve been using drugs over time, particularly Black individuals back from the ‘80s and ‘90s with the cocaine epidemic, never stopped using.”

Those individuals may have remained relatively stable until fentanyl began to contaminate their drug supply without them knowing.

“So whatever harm reduction tools that you were using for so many years that’s been helping you, when fentanyl’s involved, it’s a different game,” Jones said. “You have to use less, but you have to also know that you have fentanyl in your drugs, right?

It’s a problem that Marcia Tucker, the program director of Pathways to Recovery — a partial hospitalization program focused on co-occurring substance use and mental health challenges — sees frequently among their mostly Black clients.

“If you come into treatment saying that I’m a cocaine user, or I’m a crack cocaine user, or I use marijuana, you’re not even thinking that an opioid overdose or fentanyl overdose could possibly happen to you,” Tucker said. “And it does happen.”

Fear, stigma and miseducation

In fact, Tucker said, she’s seen more of these kinds of overdoses over the past two years than in the three decades she’s spent working in addiction treatment. Despite that, there’s still a lack of education — and even stigma — surrounding both medication-assisted treatments (MATs) for opioid addiction, and the use of naloxone.

“I think sometimes culturally with the African American community, as far as MATs are concerned, there are some taboos about getting that extra help when they decide to come into treatment and get clean,” she said. “A lot of people feel like they want to do it from the muscle. They see it as another form of using.”

She said others may not know how to use naloxone, what kinds of effects it has or how to get it.

“I think a lot of folks don’t even know that they can walk into a pharmacy and get naloxone — you don’t have to have a prescription for that,” Tucker said. “And I think that information is just not always presented to communities, especially poor communities that don’t have a lot of resources.”

Other sources of hesitation are more immediate. Aaron Rice, a therapist at Pathways to Recovery, said that many of their clients fear naloxone because of its physical effects.

“I think they associate it with precipitated withdrawal at times,” Rice said, referring to the rapid-onset withdrawal that can cause symptoms including anxiety, pain, seating, nausea, vomiting and diarrhea.

“The only thing they’re thinking about is feeling better. And that feeling is going to supersede logic at that moment. It always does.”

Overcoming disparities in health care and mistrust of the system

The Department of Health acknowledged that the study only paints a partial picture, as it doesn’t include individuals whose overdoses were reversed by naloxone, and added that during the years of the study (2019–2021), naloxone was available by prescription only — a fact that likely played into the race-based disparity.

“There are recognized inequities in access to health care among persons of color, the concept of which likely extends to access to naloxone,” the Department of Health statement reads. “Historically, many public health materials and messaging more narrowly focused on persons using opioids. With people now taking two or more drugs together (whether intentionally or unintentionally), public health materials and messaging need to be more inclusive of all persons using drugs, regardless of the type.”

The study, researcher Abenaa Jones, Marcia Tucker and Aaron Rice all agreed on at least one intervention that could increase Black people’s access to naloxone — relying on trusted community leaders and institutions, like churches, to help educate residents and distribute the overdose-reversing drug.

“I just can’t stress enough how it’s a lifesaver — it’s the difference between life and death,” Tucker said. “I think people who aren’t medical professionals and find themselves in a situation where it might need to be used would probably be a little fearful — fearful about how to use it or how the person is going to react or whether it’s really going to work — just know that you’re better off with it and trying it. You don’t want to have to second guess yourself later and say, ‘I wish we had it. I wish we had gotten it,’ or, ‘I wish we had used it.’”

Source: https://whyy.org/articles/black-pennsylvanians-overdoses-naloxone-less-likely-to-receive/

Filed under: Drug use-various effects,Latest News,Prevalence,Prevention and Intervention,Social Affairs,Treatment and Addiction,USA :

Even as officials hope tech can stem the tide of solitary drug fatalities, they know deploying these warning strategies could face obstacles.

By    and   

They die alone in bedrooms, bathroom stalls and cars. Each year in the United States, tens of thousands of fatal overdoses unfold as tragedies of solitude — with no one close enough to call 911 or deliver a lifesaving antidote.

Technology new and old might save some of those lives.

Motion detectors blare alarms when someone collapses inside a bathroom at a shelter or clinic. Biosensors detect slowed breathing triggered by an overdose and one day may be capable of automatically injecting overdose reversal medication. Simpler approaches — chat apps and hotlines — keep users connected to help if drugs prove too potent.

Source: https://www.washingtonpost.com/health/2024/10/19/fatal-drug-overdoses-alarms-sensors/
Filed under: Drug use-various effects,Latest News,Prevalence,Treatment and Addiction,USA :

Washington, D.C. – Today, White House Office of National Drug Control Policy (ONDCP) Director Dr. Rahul Gupta released the following statement on the latest provisional data from the Centers for Disease Control and Prevention (CDC), showing drug overdose deaths decreased by 12.7% year-over-year (in the 12-months ending May 2024). This is the largest recorded reduction in overdose deaths, and the sixth consecutive month of reported decreases in predicted 12-month total numbers of drug overdose deaths.

“When President Biden and Vice President Harris took office, the number of drug overdose deaths was increasing 31% year-over-year. They immediately took action: making beating the overdose epidemic a key pillar of their Unity Agenda for the Nation and taking a comprehensive, evidence-based approach to strengthening public health and public safety. As an Administration, we have removed more barriers to treatment for substance use disorder than ever before and invested historic levels of funding to help crack down on illicit drug trafficking at the border. Life-saving opioid overdose reversal medications like naloxone are now available over-the-counter and at lower prices. We are at a critical inflection point. For the sixth month in a row, we are continuing to see a steady decline in drug overdose deaths nationwide. This new data shows there is hope, there is progress, and there is an urgent call to action for us all to continue working together across all of society to reduce drug overdose deaths and save even more lives.”

Source: https://www.whitehouse.gov/ondcp/briefing-room/2024/10/16/white-house-drug-policy-director-statement-on-latest-drug-overdose-death-data/

Filed under: Drug use-various effects,Health,Latest News,Treatment and Addiction,USA :

At a glance

  • Cherokee Nation Action Network is using culture as prevention for youth substance use in Oklahoma.
  • The leading principle is “Walking in Balance,” which emphasizes balancing traditional Cherokee culture with modern contemporary culture in their everyday lives.

Cherokee Nation Community Action Network

The Cherokee Nation Community Action Network (CAN) coalition was originally developed in 2006 and became a Drug-Free Community coalition in 2018. The CAN uses culture as a strategy to prevent and reduce substance use in Cherokee communities. They partner with Sequoyah School, a tribal school in Tahlequah that young people can attend from anywhere within the reservation. The reservation includes some very rural and isolated communities with limited resources.

To increase community connectedness, the coalition teaches a National Association for Addiction Professionals-certified curriculum based on the book Walking in Balance by Abraham Bearpaw. Bearpaw was raised in one of the Cherokee Nation communities and, after coping with alcohol use for several years, decided it was time for a change. He reconnected with his culture by prioritizing mindfulness, health, and trust and has been in recovery for 12 years. He partners with different communities to teach his curriculum to young people in hopes of reducing the likelihood of them engaging in substance use. The curriculum includes 12 weekly lessons that teach students how to reconnect with culture, manage stress, and care for themselves. The leading principle is “Walking in Balance,” which emphasizes balancing traditional Cherokee culture with modern contemporary culture in their everyday lives.

The CAN coalition initially faced challenges with young people’s willingness to return to the ceremonial grounds. Due to some forbidden traditional practices, they felt they were too far removed. However, the coalition encouraged them to attend to learn and reconnect with their roots. Of the 100 young people living in the current town they serve, 75 showed up to participate in the curriculum. The day-to-day traditional and cultural activities include the making of clay beads, ribbon skirts, corn-bead necklaces, basket weaving, and stickball. The community activities are a source of Cherokee knowledge-building, sharing, and resiliency that helps build a culture of connectedness. The instructor teaches ceremonial values of youth and elder interaction, respect for ancestors, and the importance of taking care of the land. One community member said, “Our tribe has long known that building a sense of belonging, helping youth grow a connection to community, and cultural identity helps them grow into healthy adults.” The Cherokee Nation CAN will continue to foster safe and healthy environmental conditions, providing social support, encouraging school connectedness, and creating safe and caring communities on the reservation to improve the lives of those living there.

Source: https://www.cdc.gov/overdose-prevention/php/drug-free-communities/cherokee-nation.html

Filed under: Culture,Drug use-various effects,Mental Health,Prevention and Intervention,Social Affairs,Treatment and Addiction,USA,Youth :

Manuel Balce Ceneta/Associated Press by CARMEN PAUN – 10/27/2024 04:00 PM EDT

 

Traffickers are to blame, the candidates say. Virtually no one’s talking about treatment.

The Harris and Trump campaigns said the presidential candidates are talking about drug treatment, albeit more quietly than they are border security. |

There’s a rare point of agreement among Republican and Democratic candidates this election year: America has a drug problem and it’s fentanyl traffickers’ fault.

Republicans, including former President Donald Trump, are hammering Democrats over border policies they say have allowed fentanyl to surge into the country. Democrats, including Vice President Kamala Harris, respond that they, too, have cracked down on traffickers and want stricter border enforcement.

The consensus reflects the resonance of border control among voters — most of the country’s fentanyl comes from Mexico — and a hardening of the nation’s attitude toward addiction. Troubled by drug use, homelessness and crime, voters even in the country’s most progressive states favor cracking down. Politicians from Trump and Harris on down the ballot say they will.

“It’s one of those things that people don’t want in their community,” said Rep. Jahana Hayes, a Democrat running for a fourth term representing a district including suburbs of Hartford, Connecticut, and rural areas to their west, of illicit drugs. “They want a tough-on-crime stance on it. They want it to go away. They’re afraid for their families, they’re afraid for their children.”

That view worries public health experts and treatment advocates, who see a backsliding toward the law enforcement focus that once looked futile in the face of Americans’ insatiable appetite for drugs. They fear it bodes ill for additional efforts from Washington to expand addiction care.

“There are a lot of things that both parties can point to, as far as progress that’s been made in addressing overdoses: We’ve seen bipartisan efforts to expand access to treatment, to expand access to health services for people who use drugs, and I wish they would talk about that more,” said Maritza Perez Medina, federal affairs director at Drug Policy Action, an advocacy group that opposes the law enforcement-first approach.

Six years ago, when a bipartisan majority in Congress passed the SUPPORT Act to inject billions of dollars into treatment and recovery services, and then-President Trump signed it, the vibes in Washington around drug use were more empathetic.

President Donald Trump declared the opioid crisis a nationwide public health emergency in October 2017. | Brendan Smialowski/AFP via Getty Images But after it passed, fatal drug overdoses driven by illicit fentanyl skyrocketed, hitting a record 111,451 in the 12 months ending in August 2023 before starting to recede. Homelessness, sometimes tied to drug addiction, also spiked.

When the SUPPORT Act came up for renewal last year, Congress wasn’t as motivated. The Democratic Senate hasn’t voted on a bill, while a House-passed measure from the chamber’s GOP majority offers few new initiatives and no new money.

Attitudes are similar in the states. Oregon, where voters legalized drugs for personal use in 2020, reimposed criminal penalties this year after its largest city, Portland, was overrun with homeless drug users. Polls indicate California voters, frustrated, too, by homelessness and crime, are likely to boost penalties for drug users by ballot initiative next month.

Candidates aim to prove they share voters’ frustration.

Republicans have spent more than $11 million on TV ads in the past month attacking Democratic opponents on fentanyl trafficking, according to a tally by tracking firm AdImpact. And Democrats have spent nearly $18 million defending themselves, mostly by highlighting their efforts or plans to provide more resources and personnel to combat trafficking.

“It’s an easy shortcut in a 30-second commercial to tie a broader issue to one that has an easy explanation,” said Erika Franklin Fowler, a professor of government at Wesleyan University who directs a project analyzing political advertising.

Trump’s not talking about the SUPPORT Act, one of his most consequential legislative successes. Vice President Kamala Harris is not touting the treatment policies of the president she serves, Joe Biden, who expanded access to medications that help people addicted to fentanyl, as well as to drugs that can reverse overdoses. Some public health specialists credit increased access to the drugs with reducing overdose death rates in the past 12 months after years of grim ascent.

Trump used his first anti-Harris ad this summer to blame her for the more than 250,000 deaths from fentanyl during the Biden-Harris administration.

Vice President Kamala Harris met state attorneys general in July 2023 to discuss possible actions against fentanyl. | Saul Loeb/AFP via Getty Images Harris responded by touting her prosecution of drug traffickers when she was California’s attorney general and a promise to strengthen the border.

“Here’s her plan,” a deep-voiced narrator intoned in Harris’ ad: “Hire thousands more border agents, enforce the law and step up technology — and stop fentanyl smuggling.”

‘A political cudgel’

Similar attacks and responses have played out in Senate and House races across the country.

In the tight Arizona race to replace Sen. Kirsten Synema (I-Ariz.), Republican Kari Lake has accused her opponent, Democratic Rep. Ruben Gallego, of empowering drug cartels to import fentanyl by supporting Biden-Harris administration border policies.

“We’re losing an entire generation of people, and you should know better, Ruben,” Lake told Gallego in a debate earlier this month, referencing the deaths of teens who took counterfeit pills laced with fentanyl.

Gallego, who was elected to Congress in 2014 as a progressive but has shied from that label in his Senate run, responded by touting bills he’s supported or introduced to fund more technology at the border and track fentanyl money flows across Mexico and China, where chemicals to make the drug are manufactured.

A mother visit her son’s grave, who died of a fentanyl overdose at 15. | Jae C. Hong/AP In Colorado’s hotly contested 8th congressional district, which encompasses Denver suburbs and rural areas to the north, Republican state Rep. Gabe Evans has blamed the incumbent, Democrat Yadira Caraveo, for the fentanyl crisis.

“This is our reality now: a 100 percent increase in fentanyl deaths because liberals open the border, legalize fentanyl and let criminals out of jail,” says a police officer in an ad for Evans. “And Yadira Caraveo voted for it all,” Evans adds.

Caraveo defended herself in a debate with Evans earlier this month, noting the bill he’s referring to was state legislation that “tried to balance the need to punish drug dealers and cartels but not incarcerate every single person that is addicted.”

In Connecticut, the National Republican Congressional Committee attacked Hayes for voting against a bill to permanently subject fentanyl to the strictest government regulation, reserved for those drugs with high likelihood of abuse and no medical uses.

Hayes said she opposed the bill because it included mandatory minimum prison sentences for people caught with drugs and no provisions supporting prevention, treatment or harm reduction.

“I hate that this is being used as a political cudgel because we’re missing out on an opportunity to say: ‘How do we address the root causes?’” Hayes said in an interview.

Hayes said she has responded to the attacks on the campaign trail and talked to constituents about the need for treatment, despite some advice to the contrary.

“Even amongst Democrats, there were people who were like: ‘You don’t want the headache, you don’t want people to think that you’re soft on crime or soft on drugs.’ And I was like: ‘This has to be about more than optics if we truly are trying to save people’s lives,’” Hayes said. ‘If we don’t keep the momentum going’

Oregon, where voters legalized drugs for personal use in 2020, reimposed criminal penalties this year after its largest city, Portland, was overrun with homeless drug users. | Patrick T. Fallon/AFP via Getty Images The lesson the Drug Policy Action’s Medina takes from the campaigns is that talking about drug treatment doesn’t sell in American politics.

“People are struggling. Social services aren’t where they need to be, health services aren’t where they need to be,” she said. “It’s easier to run a fear-based campaign rather than talking about really tough issues,” like breaking the cycle of addiction.

Ironically, the tough talk on the border comes as policymakers, for the first time in years, have evidence that the tide of fatal drug overdoses is receding.

The CDC estimates that overdose deaths, most caused by fentanyl, declined by nearly 13 percent between May 2023 and May 2024, to just under 100,000.

Harris’ running mate, Tim Walz, mentioned the dip during his debate with Trump’s vice-presidential pick, JD Vance, earlier this month.

The number is now about where it was when Biden took office, though still 50 percent higher than when Trump did in January 2017.

Expanding access to treatment, the Food and Drug Administration’s decision to make the opioid-overdose-reversal medication naloxone available over the counter last year, increased fentanyl seizures at the border, and the arrest and sanctioning of Mexican drug cartel leaders have contributed to the recent drop, Biden said last month.

Advocates for drug treatment say that’s all good cause for candidates to tout their access-to-treatment efforts and promise to expand them.

“The worst outcome for overdose prevention coming out of this election would be if we don’t keep the momentum going,” said Libby Jones, who leads the Overdose Prevention Initiative, an advocacy group.

But there’s not the groundswell of interest on Capitol Hill that there was in 2018, when Congress passed the SUPPORT Act.

Congress has continued to fund opioid treatment authorized in that law, but it mostly hasn’t taken the law’s 2023 expiration as an opportunity to increase funding or try big new ideas.

The Food and Drug Administration decision to make the opioid-overdose-reversal medication naloxone available over the counter last year has contributed to a drop in fatal overdoses over the past year, President Joe Biden said last month. | Diane Bondareff/AP The 2024 federal funding law Congress passed in March included some minor changes in the form of bipartisan legislation to require state Medicaid plans to cover medication-assisted treatment for substance use disorder. It also created a permanent state Medicaid option allowing treatment of substance use disorder at institutions that treat mental illness, in an effort to expand access to care.

But bipartisan legislation approved by the Senate committee responsible for health care to make it easier for others to gain access to methadone, a drug effective in helping fentanyl users, hasn’t gone to the floor and faces opposition from key Republicans in the House.

The Harris and Trump campaigns said the presidential candidates are talking about drug treatment, albeit more quietly than they are border security.

Vice President Harris’ campaign pointed to her web site, where she touts her prosecution of drug traffickers and the Biden-Harris administration’s investment in “lifesaving programs.”

Republican National Committee spokesperson Anna Kelly said “President Trump is uniquely able to connect with families combating addiction,” pointing to times when he’s talked about his brother’s struggles with alcohol use disorder and to his administration’s efforts to contain the opioid crisis.

But she added that the tough talk on the border is relevant: “Combating fentanyl is a public health issue and stopping it begins with securing the border.”

 

Source: https://www.politico.com/news/2024/10/27/fentanyl-drugs-elections-00185576

Filed under: Drug use-various effects,Economic,Health,Political Sector,Prevention and Intervention,Treatment and Addiction,USA :

MEDICINAL cannabis has been the hottest of hot-button issues in medicine for some years now. It’s one the few medications where media hype and patient demand seem to have moulded – some would say muddied – the regulatory framework in a way that has troubled many clinicians.

In Australia, there are now three different pathways to legally accessing medicinal cannabis. The Category A Special Access Scheme (SAS) allows the importation of unregistered products on compassionate grounds, but requires import licences and customs clearance, while Category B SAS gives access to locally stored medicinal cannabis, but requires TGA and state review and approval. Specialists can also obtain an Authorised Prescriber status to prescribe cannabis – these will usually be either oncologists for cancer-related pain, or paediatric neurologists for the control of severe epilepsy in children.

But what is the evidence for medicinal cannabis, and is it sufficient for clinicians to feel comfortable prescribing it? These issues are explored in two articles published in the MJA, one a Perspective from the Royal Australasian College of Physicians (RACP) and the other a Narrative Review on the challenges of prescribing cannabis for paediatric epilepsy, authored by researchers from the Sydney Children’s Hospital.

The RACP comes down on the side of caution. It notes that Australia, along with the rest of the world, is “navigating unchartered waters with pharmaceutical grade cannabinoids”, and that more research is needed before we can say whether or not cannabis has a place in contemporary medical practice.

In paediatric epilepsy, some of that research seems to be coming into focus. Last May, a randomised, double-blind trial of cannabidiol, a cannabis derivative that does not contain the psychoactive ingredient tetrahydrocannabinol, provided hard data for the first time that the treatment may work in children with Dravet syndrome – a severe form of childhood epilepsy with often drug-resistant seizures. This was followed by another trial, published last month in the Lancet, that showed similar efficacy of cannabidiol in Lennox–Gastaut syndrome, another form of paediatric epilepsy characterised by multiple seizure types.

Laureate Professor Ingrid Scheffer, who is Chair of Paediatric Neurology Research at The University of Melbourne and co-author of the trial of cannabadiol in Dravet syndrome, says that although her study does provide solid evidence for the drug’s efficacy, it should in no way be considered a miracle cure.

“It’s been sold as a magic bullet by the media. And you have families who are on a terrible rollercoaster, they’re vulnerable and medicinal cannabis is being cast as this drug that may save their child. And the answer is that it often does not. It may help, and in our study cannabidiol had a 43% responder rate, defined as at least a 50% reduction in the seizure frequency. But that’s exactly the same as some of the other drugs we use.”

But she says that doesn’t mean it shouldn’t be prescribed.

“Dravet syndrome is usually drug-resistant and you don’t know which drugs will work, so it could be worth trying if others have failed. But the families should be aware of its chances of success and the fact that it can have side effects.”

She says the key is more research.

“What people are accessing is very variable. They’re importing it from all over the place, they may even be getting friends to grow it in their backyard, so we do not know what they’re giving their child. What we need to do is go forward with more trials in different populations and with different formulations. If we’re going to invest in this, we need to know it works and we’re not wasting our health dollar on it.”

Professor Scheffer says that another drug currently being trialled, fenfluramine, may end up the more successful treatment. Trial results have yet to be published, but interim findings suggest that fenfluramine may have a dramatically higher responder rate of up to 70%.

Dr John Lawson, a Sydney-based paediatric neurologist and co-author of the Narrative Review on cannabis and childhood epilepsy, agrees that cannabidiol, though worth trying in some children, is no wonder drug.

“I’m not hanging my hopes on cannabidiol,” he says in an exclusive podcast for MJA Insight.

“I came in as quite a sceptic, but my attitude has changed. I now believe that it is an antiepileptic, but I’m not sure what place it has. It’s the early stages of development, and there are other compounds that haven’t been looked at.”

Dr Lawson says that he wouldn’t suggest it to a family until many other antiepileptics had already failed, and the chances of the next drug working were already low.

“I’ve come around to bringing it up in conversation because everyone knows about it, and families know I’ve prescribed it. But the biggest reason to not prescribe is cost. For a small child, it will cost over $1000 every couple of weeks to give a Therapeutics Goods Administration-approved product. Almost the only people I have prescribed it for are those who have an absolute ‘bucketload’ of money. Or I form a contract with them, and I say look, this will cost you $3000, but all the trials say you will know very quickly if it’s working or not.”

He says that in the patients who are helped by cannabidiol, the effect is still relatively modest.

“Patients are very rarely seizure-free. It may have a role in the future, once the hype has died down, but it will be a very low [on a list of preferred antiepileptics].”

 

Source:  https://www.doctorportal.com.au/mjainsight/2018/6/medicinal-cannabis-miracle-cure-or-media-hype/

Filed under: Australia,Cannabis/Marijuana,Drug use-various effects,Marijuana and Medicine,Treatment and Addiction :
Marsha F. Lopez, Ph.D., M.H.S. marsha.lopez@nih.gov, 
MeLisa R. Creamer, Ph.D., M.P.H., and 
Erin M. Parker, Ph.D.Authors Info & Affiliations
In the 50 years since its establishment, the National Institute on Drug Abuse has made significant investment and strides toward improving individual and public health. Epidemiology serves as the foundation for understanding the how many, why, how, where, and who of drug use and its consequences, and effective epidemiology research and training are geared toward actionable findings that can inform real-world responses. Epidemiologic findings enhance clinicians’ ability to provide ongoing care by incorporating information about the patterns and outcomes of drug use that their patients may experience. The goal of this article is to provide a context for epidemiology of substance use as a foundation for prevention, with examples of how epidemiology can provide targets for prevention, and to set the stage for addressing the importance of prevention in clinical settings.
Source: https://psychiatryonline.org/doi/10.1176/appi.focus.20240018 
Filed under: Addiction,Brain and Behaviour,Mental Health,Treatment and Addiction,USA :
Tulsa World
Aug 25, 2024

The Cherokee Nation’s approach to substance abuse recovery is harm reduction, which has drawn criticism from some who work in addiction recovery.

“Harm reduction is a pretty controversial topic. A lot of people feel it can be enabling drug users. It can feel counterproductive and counter intuitive,” said Jennifer Steward, director of the University of Tulsa’s Behavioral Health Clinic.

In a Tulsa World interview, Steward said the controversial aspect comes from the fact that harm reduction does not encourage abstinence from drug use, which makes it different from traditional substance abuse rehabilitation programs. Harm reduction instead focuses on keeping active drug users alive, with considerations for their health and safety.

The Cherokee Nation harm reduction program utilizes a mobile unit that brings supplies to drug-users on the streets: clean needles, cotton swabs and Narcan, which can reduce cravings and combat a potentially fatal overdose.

Steward said many harm reduction programs also provide a safe, clean environment to partake in drug use, free of disease such as HIV or hepatitis C, with staff ready to assist in case of overdose.

Cherokee Nation prevention specialist Coleman Cox said that his tribe recognized the potential for addiction among the Cherokee people after being exposed to the opioid epidemic is “far reaching and the latest in a long line of injustices brought upon indigenous peoples.”

According to the Centers for Disease Control, in 2021 the highest rate of drug overdose deaths was in American Indian and Alaskan Native individuals. Data from the Substance Abuse and Mental Health Services Administration indicates 5.1% of Natives have misused opioids, which can include prescribed pain-relief medications, hydrocodone, oxycodone, fentanyl and heroin.

“We bent the opioid industry to a settlement for the harm it inflicted, and we are making the opioid industry help pay for every single penny of this facility,” said Cherokee Nation Chief Chuck Hoskin Jr. in reference to their treatment facility they broke ground for Thursday morning.

The Cherokee Nation received a Substance Abuse and Mental Health Services Administration grant last year for harm-reduction services. They now operate a storefront at 214 N. Bliss Ave. in Tahlequah. It is open not only to tribal members but also to the public, and all participants can remain anonymous.

The new facility that the tribe broke ground on this week is a $25 million dollar addiction treatment center just outside of Tahlequah.

The Cherokee Nation’s Public Health and Wellness Fund Act of 2021 dedicated $100 million in settlement funds from opioid and e-cigarette lawsuits for a variety of public health programs.

Cox said harm reduction meets people where they are at in their addiction. This means that if the user does not want to seek rehabilitative services, they do not have to. Rehabilitation services may be recommended, but they are not a requirement.

“Harm reduction is more than Narcan and clean needles. It’s treating others how they want to be treated — with dignity, respect and value, without conditions,” said Cox.

Evan White, a member of the Absentee Shawnee tribe, is the director of Native American research at Laureate Institute for Brain Research in Tulsa. He has worked with various tribal behavioral health programs through his research.

“Harm reduction is a model that has a strong evidence base for good outcomes,” he said, “especially in substance use disorders.”

White believes harm reduction could be attractive to Native communities as it values a person’s autonomy.

“I see a consistent value of a person as an individual within Native communities. Healing is an important part of the process in these cultural spaces, even though there is a lot of stigma around substance abuse in our broader society,” he said.

For Native individuals with substance abuse issues, White said participating in cultural activities may enhance self-control and mindfulness.

The Cherokee Nation’s program provides opportunities for Native people in recovery to partake in cultural activities.

“We planted a Three Sisters Garden: corn, beans and gourds,” said Cox. “Corn provides the bean a pathway for growth. Beans give back by imparting nitrogen to the soil. Gourd provides protection and covers the ground. Three different things working in harmony. Body, mind and spirit.”

Members of the program get to adopt a plant, name it and tend to it. Cox said the vegetables are not for eating, however.

“They are meant to harvest seeds for the future bounty, beyond what we can see now. Just like when our members come to us for whatever kind of help, we plant a seed that one day they will harvest a healthier life,” he said.

Cox said the harm reduction staff launched a new chapter of “wellbriety movement” that they call “recovery rez.” It’s a cultural approach to the traditional 12-step recovery plan.

“At Recovery Rez they begin with prayer and fellowship meal, then smudge and hold a talking circle guided by the passing of an eagle feather from speaker to speaker. They close out the evening with a drum circle and singing. All are welcome, and citizens don’t need to be in recovery to benefit from the cultural protective factors,” said Cox.

Steward said it can be difficult to view harm reduction as a substance abuse program because harm reduction focuses on the long-term.

“The goal is to help someone be ready to engage in rehabilitation later on, but in order to do that, they have to be alive,” she said.

According to Cherokee Nation spokeswoman Julie Hubbard, the tribe’s harm reduction program has had 3,099 encounters for service, and it has 1,049 members currently. The number of people who still inject drugs within the program is 743. The amount of lives saved at the program from Narcan distribution is 44.

Source: https://tulsaworld.com/news/local/indigenous/cherokee-nation-takes-long-term-approach-to-substance-abuse-recovery-via-harm-reduction/article_290c6be4-60a1-11ef-ab14-934bc604a21b.html
Filed under: Addiction,Drug use-various effects,Harm Reduction including HIV (Papers),Needle Exchange,Treatment and Addiction,USA :

TogetherWeCan_InternationalOverdoseAwarenessLogo

Perhaps we’re finally turning a corner when it comes to lowering overdose deaths. While the number of people dying as a result of an overdose remains frighteningly high, a new report signals modest progress in efforts to reduce fatalities.

Updated figures from the Centers for Disease Control and Prevention (CDC) found fatal drug overdoses fell 2.4% from 2022 to 2023. The toll from the overdose crisis reached 108,317 lives last year, according to data the CDC posted Aug. 4. While that’s lower than the 111,029 overdose deaths in 2022, it still represents a massive number of preventable deaths, and there’s yet more we can do to ensure that fatalities continue to decline.

That is one of the goals of International Overdose Awareness Day, observed on August 31.

In recognition of the day, the National Council has created an informative new video to help people understand how to administer naloxone. Naloxone (often known by the brand name Narcan) is a medication that reverses opioid overdoses. It is quite literally a lifesaver.

The lower number of overdose fatalities in 2023 may be related to the Food and Drug Administration’s March 2023 decision to make naloxone available over the counter, a decision we applauded. But having naloxone available doesn’t mean everyone who may need it has access to the drug. And it doesn’t mean that everyone knows how to administer naloxone.

Let’s hope the modest drop in overdose fatalities last year was an early indication that we’re finally flattening the curve of overdose deaths.

That’s exactly why we made this video.

Everyone should carry naloxone, especially those who work with the public — whether as a teacher, ambulance driver, librarian, coach or in some other capacity.

The Substance Abuse and Mental Health Services Administration (SAMHSA) continues to promote naloxone distribution through state opioid response (SOR) grants. Naloxone distribution and saturation planning is a federal-state partnership (of sorts) to optimize naloxone distribution.

States are required to create distribution and saturation plans as part of their SOR grant; every state is required to make one. The purpose is for states to meaningfully plan and coordinate their naloxone distribution based on data and input from impacted community partners so they optimize reach, including focusing distribution efforts to those most likely to experience and/or witness an overdose.

Substance use isn’t going away anytime soon. July’s release of the 2023 National Survey on Drug Use and Health provides important new data about substance use challenges and the nature of substance use among people of all ages. For instance:

70.5 million

Among people aged 12 or older in 2023, 70.5 million people (24.9%) had used illicit drugs in the past year, up from 70.3 million people in 2022 and 61.2 million in 2021.

48.5 million

In 2023, 48.5 million people 12 or older (17.1%) had a substance use disorder in the past year, down slightly from 48.7 million in 2022.

8.9 million

In 2023, 8.9 million people 12 and older (3.1%) used opioids in a non-prescribed way in the past year, compared to 8.9 million in 2022 and 9.4 million in 2021.

This data shows us that no one is immune from a substance use challenge.

We can’t turn our backs on people with a substance use disorder or ignore the tragic consequences of substances, whether they’re considered illicit or socially acceptable, like alcohol. To support people with a substance use disorder or their loved ones, the Start With Hope project also recently published many new resources, including:

The Start With Hope project was started in November 2023 by The Ad Council, in partnership with the CDC, the National Council and Shatterproof to deliver a message of hope to those living with substance use disorders as well as those at risk of developing one.

Let’s hope the modest drop in overdose fatalities last year was an early indication that we’re finally flattening the curve of overdose deaths. When it comes to lives lost, we can’t be satisfied with modest improvements. Let’s ensure continued progress by spreading the word about lifesaving resources.

Check out our new video, and let us know what you’re doing in your communities to reduce overdose deaths and provide resources to those with a substance use disorder.

We can and will learn from one another on how to best support people and communities.

Author

Charles Ingoglia, MSW
(he/him/his) President and CEO
National Council for Mental Wellbeing
 
Source:  https://www.thenationalcouncil.org/lowering-overdose-deaths-naxolone-how-to/
Filed under: Drug use-various effects,Prevention and Intervention,Treatment and Addiction,USA,Youth :

DENVER (AP) — Simon Rubick had lost almost everything to decades of alcoholism and drug addiction.

In 2022, he found himself without a vehicle and without a home, which forced his two teenage children to move in with friends. He had burned bridges with friends and family and it took a drug-induced stint in the hospital for him to realize his cocaine addiction was going to be a “death sentence.”

Rubick, who lives in the Denver suburb of Arvada, Colorado, knew he needed help. But first he had to figure out what to do with one of the only sources of unconditional love and support he had left: his beloved German shepherd rescue, Tonks.

Most residential rehab centers in the United States don’t allow patients to bring their pets along, said Rubick, 51. So when his brother could no longer help care for the dog, Rubick thought he would have to make the excruciating decision to give up Tonks.

“It basically came down to being able to take care of my dog or being able to take care of myself,” he said.

Rubick — who has been sober for more than two years and is now an addiction recovery coach — was connected to the group PAWsitive Recovery, which fosters animals while their owners receive treatment for drug and alcohol abuse, and for people dealing with domestic violence or mental health crises.

“People that are trying to get into recovery sometimes have lost their families, their children, any kind of support system that they have had,” said Serena Saunders, the organization’s program manager. “You’re not going to compound trauma that you’ve already had by giving up the one thing that hasn’t given up on you, and that’s people’s animals.”

Saunders founded PAWsitive Recovery in Denver three years ago. Since then, it’s helped more than 180 people and their pets, and Saunders said the group has looked to expand nationally after it became a part of the Society for the Prevention of Cruelty to Animals International. The organization, whose largest foster network is in Colorado but accepts applications nationwide, is one of just a few programs in the U.S. that cares for the pets of people seeking treatment for substance abuse.

Saunders’ own experience with drug and alcohol addiction has helped her tailor the program. She said she had a “pretty broken childhood,” with her mother being schizophrenic and addicted to methamphetamine and her father also struggling with addiction. She sought comfort in alcohol when she was about 12 and was using hard drugs by the time she was 14.

“Addiction just gave me trauma after trauma,” said Saunders, now 41.

Saunders was seeing a therapist for her depression and PTSD when a fortuitous session planted the seed of PAWsitive Recovery. With a background in veterinary and shelter medicine, which focuses on caring for homeless animals, she told her therapist she wanted to incorporate her love of dogs in her recovery.

“And that’s what we did,” said Saunders, who fostered Tonks for several months while Rubick was in treatment and facilitated visits between the two best friends.

“To see a broken person when we’re meeting them in a parking lot, when they have nothing left to live for but their animal. And to see how broken and how desperate they are in that moment, and then to circle back around six months later and see them completely turn their lives around is just so special. It’s amazing,” said Saunders, who has been sober for 3 1/2 years.

That sentiment is echoed by the organization’s volunteer foster families, some of whom are drawn to the program because of their own experiences with addiction.

Denver resident Ben Cochell, 41, who has been sober from alcohol for more than seven years, has two dogs of his own and has fostered several more.

“One of my favorite parts about fostering in this program is the ability to teach my kids some life lessons in how to help others and how to care for animals and be kind, be loving. And to just give of yourself,” he said. “That’s what you have. Your time and your energy. And you can give that away freely.”

If not for PAWsitive Recovery, Rubick said he probably would have ended up living on the streets with his dog and trying to figure out recovery on his own. But as it turned out, by being able to keep his rescue dog, Tonks ended up rescuing Rubick, he said.

“It’s that connection, caring for another creature and having something else care for you the way that animals do,” Rubick said. “It’s just unconditional, and sometimes that’s one of the things that people in recovery really need to be able to feel.”

Associated Press writer Colleen Slevin contributed to this report.

Source:  https://www.seattletimes.com/seattle-news/health/giving-up-pets-to-seek-rehab-can-worsen-trauma-a-colorado-group-intends-to-end-that/
Filed under: Animals,Treatment and Addiction,USA :

By  Charlotte Caldwell

September 6, 2024

LIMA — The Lima Police Department recently posted on its Facebook page about an increase in overdoses in Lima over the past few weeks.

With September being National Recovery Month, where organizations try to increase public awareness about mental health and addiction recovery, local organizations and law enforcement agencies shared their experiences with addiction and overdoses and the help that is available.

The problem

Lima Fire Chief Andy Heffner said his department responded to 85 overdoses so far this year. He said the overdose numbers have risen and fallen throughout the year, with about one-week breaks in between. He believed the numbers were based on the drugs available in the area.

Project Auglaize County Addiction Response Team Project Coordinator/Peer Support Specialist Brittany Boneta spoke on the reason for the overdose spikes.

“When it comes to overdoses, one is too many,” Boneta said. “I think the number of overdoses comes in waves. There could be a really bad batch of heroin or fentanyl that gets distributed throughout the county that could lead to a spike in overdoses.”

Heffner cited the Drug Enforcement Administration’s website, which said seven out of every 10 pills seized by the DEA contain a lethal dose of fentanyl. The website also said 2 milligrams of fentanyl can be enough to kill someone.

“It only takes one time when Narcan is not available that you could lose your life. If you get clean, you will never have to worry about an overdose, and neither will the people that love you,” Heffner said.

Bath Township Fire Chief Joe Kitchen said his department used Narcan 21 times on patients from August 2023 to August 2024. The department also distributes Narcan to families just in case an overdose occurs.

“Although we have only left behind a few kits so far, I think it gives the family of a known addict some peace of mind that they could assist them in the event of an OD prior to EMS arrival,” Kitchen said.

Another problem is a tranquilizer called Xylazine is being mixed with fentanyl, which does not respond to the usual methods of reversal.

“There are always new drugs/drug combinations being introduced on the streets that make it difficult for those in the treatment world to keep up with and know how to effectively treat,” said Jamie Declercq, the vice president of clinical operations for Lighthouse Behavioral Health Solutions. “Right now, we are seeing an increase in substances (such as Xylazine) across the county which does not respond to Narcan, so that is likely one reason for the increase in overdose deaths.”

Their stories

Boneta was addicted to opiates and crack cocaine over a seven-year period, and her addiction journey started when she was prescribed Percocet by a cardiologist for a heart condition when she was 18.

“There wasn’t a drug I wouldn’t use,” Boneta said. “I was an honor roll student in high school with more trauma than almost anyone I know, and when I went off to college I wasn’t educated on the true dangers of drugs, the thirst to fit in, and all of my trauma stuffed down.”

When her doctor stopped prescribing Percocet, she bought them from drug dealers, not knowing they were laced with heroin.

“When the drug supply of the fake Percocet ran out, I was just buying actual heroin. The heroin was starting to have fentanyl added to it, and before long that was all I was consuming,” Boneta said.

Boneta was eventually sent to prison for drugs, and during that time her 6-year-old son was involved in a house fire and suffered serious injuries.

“I was transported from the prison, in my orange jumpsuit and shackles on my wrists and ankles, to say my goodbyes to my son. I think seeing him lying there in a coma covered in bandages was something so soul-shaking that I knew this was my rock bottom,” Boneta said.

“My son had countless surgeries and was getting better and stronger as the months went by, so I decided I was going to completely reset my life and work my butt off just as hard,” Boneta continued. “I completed as many recovery groups and classes as possible and started learning coping skills and tools to use when I was released from prison. I knew that I wanted to help other people like me and show them that people can understand what they are going through and not have judgment towards them.”

Diane Urban, of Delphos, the founder/president of the Association of People Against Lethal Drugs, started APALD because her youngest son died from a fentanyl overdose. Her older son is also a former addict, and her niece is in active addiction.

“He was clean for the last nine months of his life, he came to live with me, and he relapsed due to an ingrown wisdom tooth that was coming in, his face was swelling up, and because he had Medicaid, we couldn’t find him any help anywhere except for a place in Van Wert, and it was a two-week out appointment. Unfortunately, unbeknownst to me, he relapsed, and I found him dead in his bedroom from a fentanyl overdose,” Urban said.

Challenges to get help

Transportation, not enough of a variety of local recovery options available and financial barriers were all cited as issues addicts face when they decide to get help.

“For peers that are needing inpatient treatment or sober living, we have to send them to other counties for help,” Boneta said. “There is definitely a need for more substance abuse treatment in our county.”

Declercq said Allen County also has a need for inpatient or residential treatment, and people who need that care have to go to one of the major cities nearby.

Urban dealt with having to go outside the area when her son got help.

“Seven years ago when I had to get help for my son, we had to go to Columbus. There was no help to get in right away because (Coleman Health Services) was so backed up,” Urban said. “There can never be enough resources because what happens is all these resource centers and rehabilitation centers, they keep you for a period of time then they release you, and a lot of people when they get released like that, they don’t have adequate support for more of a long-term stay, more of them tend to relapse.”

Urban said her son got treatment for free with Medicaid, but in her experience, organizations prioritize people who have insurance.

Auglaize County Sheriff Mike Vorhees also mentioned a challenge with people not having a way to get to treatment.

“We don’t provide transportation yet, but that’s something that we’re working on,” Vorhees said in regard to the services Project ACART provides. “It depends on who it is. If it’s an elderly person, we can work with the Council on Aging; if it’s a veteran we go through Veterans Services.”

Financially, Declercq said Lighthouse Behavioral Health Solutions’ case managers help people apply for Medicaid, or the local mental health board has options for those who don’t qualify for Medicaid.

“One of the most frustrating barriers for seeking treatment is those with commercial insurance or Medicare, as those companies only pay for very limited services,” Declercq said. “Commercial plans typically pay for a short detox stay and limited individual/group counseling sessions, but do not pay for the intensive level of treatment that a program like Lighthouse offers.”

“Thirty days of treatment and/or 10 individual counseling sessions are not enough to truly treat a person who has been in active addiction for years,” Declercq continued. “Oftentimes even one year of intense treatment only touches the surface of the issues that someone in addiction needs to address.”

Available help

Project ACART has only been around about a year, and Boneta is working part-time and is the only employee. She has reached out to 19 people so far, and only two have denied treatment. She put together a resource guide in 2023 including mental health and substance abuse centers; residential detox treatment centers; 24/7 support services; substance use support groups; where to find Narcan; food pantries, hot meals and clothing; housing assistance and shelters; and low income and subsidized housing.

Boneta received help from peer support specialists through Coleman Health Services during her addiction. Now, as a peer support specialist, she uses a combination of her own experiences and formal training. She equated her role to being like a cheerleader. She is available to clients day and night to connect them to agencies to get help or just talk about their struggles.

“I meet people where they’re at and treat every situation differently. Some of the things I do are assessing needs and struggles, setting goals, advocating for my peers, giving resources, facilitating engagement with my peers and their families or service providers, and encouraging and uplifting them,” Boneta said.

Project ACART’s services are also free because of an Ohio grant.

“Many people in active addiction do not have housing, food, clothing, money or insurance, but they should still have the opportunity to get the help they need,” Boneta said.

Declercq said Lighthouse Behavioral Health Solutions also recently opened a peer support center in Lima for clients to have a place to go for sober activities.

“Downtime/boredom is often a trigger for people who are early in recovery, so this gives them a place to fill that time in a positive way,” Declercq said. “Our peer supporters offer a unique support system to our clients because they are people with past lived experience in addiction who are able to show them that life beyond addiction is achievable and fulfilling.”

Coleman’s seemed to be the go-to choice for law enforcement referrals, and Urban also directs people to the organization.

“My oldest son was a success story, he went to Coleman’s, got treatment, got on the MAT (medication-assisted treatment) program, Suboxone, and he’s thriving today. Owns his own house, owns his own business, married, doing absolutely wonderful. He’s like eight years clean,” Urban said.

Ohio Department of Commerce Division of Securities Recovery Within Reach program also provides a list of recovery resources and offers ways to pay for treatment.

 

Source: https://www.limaohio.com/top-stories/2024/09/06/local-organizations-share-addiction-experiences-challenges-resources/

Filed under: Addiction,Crime/Violence/Prison,Drug use-various effects,Fentanyl,Prevalence,Treatment and Addiction,USA :

Methods: We recruited 58 MA-dependent young adult females from a compulsory isolation drug rehabilitation center in Sichuan Province and randomly divided them into an MBRP group (n = 29) and a control group (n = 29) according to their degree of psychological craving. The MBRP group received 2 hours of MBRP training twice a week for 4 weeks, alongside routine treatment at the drug rehabilitation center. Meanwhile, the control group solely received routine treatment at the drug rehabilitation center without any additional interventions. The assessment was conducted before and immediately after the intervention, with the Compulsive Drug Use Scale (OCDUS) used to assess craving and the Five-Factor Mindfulness Scale (FFMQ) used to assess trait mindfulness. Also, a “mental feedback monitoring balance” instrument was used to assess concentration and relaxation during some training sessions. This randomized trial was conducted to evaluate the effectiveness of decreasing psychological craving and increasing trait mindfulness.

Results: At baseline, there were no significant differences in total or dimension scores for FFMQ or OCDUS between the two groups (all P > 0.05). After the intervention, the repeated measures ANOVA showed a significant time main effect on changes in observing, non-judging, and non-reacting scores (all P < 0.05), and a significant interaction effect between time and group on both FFMQ total score and OCDUS score (P < 0.01 or P < 0.05). Mental feedback monitoring indicated significant improvement in concentration and relaxation after breath meditation exercises (P < 0.05 or P < 0.001). Additionally, the MBRP group showed improved relaxation during the body scan exercise (P < 0.01).

Conclusion: MBRP training can improve the trait mindfulness of MA addicts and reduce psychological cravings effectively.

The full article can be accessed via the source link below:

Source: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1339517/full

Filed under: Addiction,Mental Health,Methamphetamine/GHB/Hallucinogens/Oxycodone,Others (International News),Prevention and Intervention,Treatment and Addiction :

Overview

In recent years, police forces in England and Wales have worked more closely with health, education and other local partners to address social issues, such as drug use, youth violence and people in mental health crisis.[1] This aims to ensure that vulnerable people are supported by the most appropriate professional, and that certain complex social issues are not automatically met with a criminal justice response.

These initiatives are sometimes referred to as public health approaches to policing.[2] They can include interventions aimed at preventing offending altogether (for example, early years school-based programmes), as well as ones covering offenders or people coming into contact with the police.[3]

In 2018, organisations representing public health bodies, health services, voluntary organisations and police forces signed an agreement to work more closely together to prevent crime and protect the most vulnerable people in England.[4] Public Health Scotland and Police Scotland announced a formal collaboration in 2021.[5] In 2019, Public Health England and the College of Policing published a discussion paper on public health approaches to policing,[6] and the Association of Police and Crime Commissioners issued guidance in 2023 to support implementation of such approaches.3

Research has found that cooperation between police and health services can help to improve social outcomes. For example:

  • a 2017 study in the USA suggested that health services and police forces have worked effectively together to improve police responses to mental health-related encounters[7]
  • research in 2017 highlighted international examples of how formal collaboration between criminal justice and public health agencies helped to reduce youth violence[8]
  • a 2022 study found that nurses and police officers could develop collaborative teamwork practices in police custody suites in England[9] [10]

There are examples of police forces working with health partners and other agencies to improve responses to vulnerable people in England and Wales:

  • Under drug diversion schemes, police refer people caught in possession of small quantities to voluntary sector treatment services, rather than prosecute for a possession offence. As of 2024, diversion schemes were operating in Thames Valley,[11] West Midlands,[12] and Durham police force areas.[13] The College of Policing and the University of Kent have received funding to evaluate these schemes, which is expected to be completed in 2025.[14]
  • The Right Care, Right Person model aims to reduce the deployment of police to incidents related to mental health and concern for welfare, and instead ensure that people receive support from the most appropriate health or social care professional. Humberside Police developed the model, which includes training for police staff and partnership agreements between police, health and social services.[15] From 2023, police forces nationally were beginning to adopt it, with support from the National Police Chiefs’ Council and the College of Policing.[16]
  • Violence Reduction Units (VRUs) bring together police, local government, health and education professionals, community groups and other stakeholders to provide a joint response to serious violence, including knife crime. The London Mayor’s Office for Policing and Crime established the first VRU in England and Wales in 2019. It states that it takes a public health approach to violence prevention,[17] including deploying youth workers in hospitals and police custody suites.[18] Between 2019 and 2022, the government funded 20 VRUs across England and Wales.[19] In 2019, the government provided funding for the Youth Endowment Fund, which funds and evaluates programmes in England and Wales that aim to prevent children and young people from becoming involved in violence.[20]

Since 2020, Scotland has seen increasing use of diversion from prosecution schemes.[21] In October 2024, the UK’s first official consumption facility for illegal drugs, including heroin and cocaine, was opened in Glasgow.[22]

Challenges and opportunities

In 2023, HM Inspectorate of Constabulary and Fire & Rescue Services noted how police forces were often the “service of last resort” doing the work of other public services, especially with regards to mental ill health.[23] For some vulnerable people, police custody may provide their only space for healthcare interventions.10 Both police forces and voluntary organisations suggest that, at a time when police capacity is under pressure, public health approaches can reduce the amount of time police officers spend dealing with people with complex health needs, who may be referred to other health, care or support services.[24],[25] However, this can also lead to demand and capacity pressures being displaced onto these services.

For example, drug diversion schemes may increase the demand on local drug treatment services, which themselves are facing significant pressures. In her independent review of drugs for the government in 2021, Dame Carol Black raised significant concerns about the capacity and resourcing of drug treatment services in England, and the impact of funding reductions.[26] The Criminal Justice Alliance has called for increased funding for local drug services, to accommodate people being diverted away from the criminal justice system.[27]

The government’s 10-year drug strategy (2021) committed to invest £533 million into local authority commissioned substance misuse treatment services in England from 2022/23 to 2024/25, as part of its aim to “rebuild local authority commissioned substance misuse treatment services in England”.[28] In 2023, the Home Affairs Committee called for all police forces in England and Wales to adopt drug diversion schemes.[29] It also expressed concern about the long-term sustainability and security of funding for the drug treatment and recovery sector.26

Similar pressures in mental health services have led to concerns about the safety of the national rollout of Right Care, Right Person. In November 2023, the Health and Social Care Committee identified urgent questions around the available funding for health services, and the lack of evaluation, in the rollout of the scheme[30] The Royal College of Psychiatrists and the Royal College of Nurses agreed that people with mental illness should be seen as quickly as possible by a mental health professional.[31],[32] However, they and other health, local government, and mental health charities, have expressed several concerns about the programme. These include: the speed and consistency of implementation, lack of funding, the potential for gaps in provision, and increased welfare risks.[33],[34],[35],[36]

Key uncertainties/unknowns

Outside the UK, some public health approaches have involved a significant shift away from enforcing drug possession for personal use through the criminal justice system.[37] For example:

  • Portugal decriminalised possession of drugs for personal use in 2001 and instead refers drug users to support and treatment.[38] Analysis of these measures from researchers and policy experts suggests decriminalisation led to reductions in problematic use, drug-related harms and criminal justice overcrowding.38,[39]
  • In the USA, Oregon trialled a policy in 2020 making drug possession a fineable offence.[40]
  • In Canada, British Columbia trialled an approach in 2023 that decriminalised possession of small amounts of certain drugs for personal use in specific non-public locations.[41]

Citing international examples, some drug policy experts have called on the government to go further in its adoption of a public health approach to drug use.37 The Home Affairs Committee stated in 2023 that the government’s drug strategy should have adopted a broader public health approach, and called for responsibility for misuse of drugs to be jointly owned by the Home Office and Department of Health and Social Care.26 In 2019, the Health and Social Care Committee recommended the government shift responsibility for drugs policy from the Home Office to the Department of Health and Social Care, and for the government to “look closely” at the Portugal model for decriminalisation of drug possession for personal use.[42]

However, Portugal’s approach has also faced criticism. For example, a research review in 2021 highlighted continued social and political resistance to some of the measures 20 years after being introduced.[43] A 2023 editorial in the Lancet highlighted how a recent rise in the use of illicit drugs in Portugal had led to renewed criticism of the policy.[44] More recently, some states in North America have reversed decriminalisation policies, reportedly due to adverse consequences of drug decriminalisation.33,[45], [46]

This points to a mixed evidence base internationally for a fully public health approach to drug use. However, it may be difficult to compare international examples, given the different models of decriminalisation that have been adopted, and in a variety of social, economic, political and legal systems.[47]

Key questions for Parliament

  • Should the government do more to support the implementation of public health approaches to policing across England and Wales, considering both the police, and health, care and other local services?
  • Should the police continue to implement the Right Care, Right Person model? Do mental health services have sufficient resource and capacity to bridge the gap?
  • Should drug diversion schemes be rolled out across England and Wales? Do drug treatment services have sufficient capacity and resource to respond to increased demand on services?
  • Should the government go further in taking a public health approach to drugs by decriminalising drug possession for personal use?
  • How effective have government measures to reduce youth violence been?
  • What international comparisons are useful for implementation of public health approaches to policing?

 

Source: DOI: https://doi.org/10.58248/HS62

Filed under: Crime/Violence/Prison,Health,Mental Health,Prevention and Intervention,Social Affairs,Treatment and Addiction,UK :
Dr. Robert DuPont (NIDA, USA) shifted the paradigm from demonization to treatment of users.

Key points

  • In the 1970s, people addicted to opioids were demonized, considered hopeless. Some still believe this.
  • Setting high standards and following addicted patients for five years helps doctors know what treatments work.
  • Prevention is key to success in substance abuse, and it’s important to encourage non-use among teens.
In the United States, people addicted to opioids were once demonized as hopelessly bad, and treatment was virtually nonexistent. No one may have done more to change both matters than psychiatrist Robert DuPont, M.D, who, in 1969, during an unexplained surge in crime in the nation’s capital, was working with prisoners in the District of Columbia Department of Corrections. DuPont decided to test incoming inmates for drugs and was shocked to learn that nearly half (45%) were addicted to heroin. Desperate for heroin, they turned to crime for money.

At the behest of the district’s mayor, DuPont developed a D.C.-based clinic, the Narcotics Treatment Administration. It treated more than 15,000 heroin addicts over the next three years, and the D.C. crime rate plummeted by 50%, in a direct correlation.

Helping Medical Professionals Do Better

Robert L. “Bob” DuPont, born in 1936, graduated from Emory University and Harvard Medical School and completed his psychiatric training at the National Institutes of Health. He became the first director of the newly-created National Institute on Drug Abuse (NIDA), where he created a first-of-its-kind comprehensive training program for doctors, nurses, and counselors working in addiction treatment programs. Drug overdose deaths began declining, from from 6,413 to 2,492 by 1980.

In 1978, DuPont left government service to create the Institute for Behavior and Health (IBH), a think tank focusing on drug policy. Dupont has published more than 400 journal articles and 15 books, most recently Chemical Slavery: Understanding Addictions and Stopping the Drug Epidemic (2018).

The IBH conducted the first national study of doctors dependent on drugs and alcohol, their treatment, and five-year outcomes. “Physicians are given a comprehensive assessment by a team of professionals and get treatment for comorbidities, but the focus is on their addictions. They typically attend a month or more of residential treatment and, as outpatients, are monitored for five years with random drug and alcohol testing. If they miss a scheduled test or test positive for any drug, including alcohol, they are taken out of their practice again, assessed, and sent back to treatment.”

DuPont points out that many doctors who entered the program were initially resentful because they didn’t think there was anything wrong with them—typical of individuals with substance use disorder from all walks of life. Yet, most physicians greatly value their medical license, and the overwhelming majority cooperated because participation and success meant they could continue to practice medicine.

His study of nearly 1,000 drug-addicted physicians closely monitored for five years showed what is possible for the rest of the population. Seventy-eight percent never tested positive for drugs or alcohol, an excellent record. In addition, of those who did have a positive or missed drug test, nearly two-thirds never had a second positive test.

A follow-up study of physicians who successfully completed treatment and monitoring contracts five or more years ago showed that more than 95% were still in recovery. Physicians rated the treatment they had received as important to their recovery but said the most valued part of their care was involvement in the 12 steps.

Lessons Learned About Substance Abuse

DuPont says many people don’t realize that it’s rarely just one drug abused by most problematic substance users. And that is particularly true of individuals who die from drug overdoses, in whom two or more drugs are often identified post-mortem.

He also notes that many drugs used today are not in their natural forms but instead are ultra-potent synthetics, like fentanyl. In 2022, about 111,000 people died, and in 2023, about 108,300 people died of drug overdose. .

Early diagnosis and treatment is key

The earlier patients are diagnosed and treated, the better their chances of achieving and sustaining recovery, says DuPont. Many people can stop using substances for some period. However, the real problem is not drug withdrawal, as many people believe, but, instead, the repeated relapses. Yet he has known many individuals with seemingly hopeless drug or alcohol issues who emerged sober and productive. He largely credits organizations like Alcoholics Anonymous and Narcotics Anonymous.

Prevention is best

Whenever possible, prevention of drug use is best, particularly among young people. Not only is adolescence a time when most addictions begin, it’s also a time when the brain is uniquely vulnerable..

DuPont now focuses on youth substance-use prevention: no alcohol, nicotine, marijuana/THC, or other drugs by those under age 21. He notes that the percentage of 12th graders who report never using in their lifetime has increased from around 26% in 2018 to 32% in 2023. The trend is also evident in younger students. DuPont emphasizes, “This trend is key to reversing decades of pain, suffering, and addictions.“

At age 88, Robert DuPont, M.D., advocates for treatment research, long-term treatment with outcome reporting, mental health treatment parity (as important as physical health), and prevention. Recovery, he insists, is possible.

About the Author

Mark S. Gold, M.D., is a pioneering researcher, professor, and chairman of psychiatry at Yale, the University of Florida, and Washington University in St Louis. His theories have changed the field, stimulated additional research, and led to new understanding and treatments for opioid use disorders, cocaine use disorders, overeating, smoking, and depression.

Source: https://www.psychologytoday.com/gb/blog/addiction-outlook/202408/a-front-row-change-agent-of-the-drug-epidemic
Filed under: Addiction,Prevention and Intervention,Treatment and Addiction,USA :

Tuesday, July 30, 2024

Today, the U.S. Department of Health and Human Services’ (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of the 2023 National Survey on Drug Use and Health (NSDUH), which shows how people living in United States reported their experience with mental health conditions, substance use and pursuit of treatment. The 2023 NSDUH report includes selected estimates by race, ethnicity and age group. The report is accompanied by two infographics offering visually packaged highlight data as well as visual data by race and ethnicity.

“Each year, data from the annual NSDUH provides an opportunity to identify and address unmet healthcare needs across America. We’re pleased to see that more people received mental health treatment in 2023 than the previous year,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “Also, to build upon increasing accessibility to data, this year’s release features two infographic reports: one focusing on race and ethnicity and one highlighting selected overall data.”

The 2023 NSDUH Report includes the following selected key findings.

Mental Health:

  • Among adults aged 18 or older in 2023, 22.8% (or 58.7 million people) had any mental illness (AMI) in the past year.
  • 4.5 million youth (ages 12 to 17) had a major depressive episode in the past year, of which nearly 1 in 5 also had a substance use disorder.
  • Among adults aged 18 or older in 2023, 5.0% (or 12.8 million people) had serious thoughts of suicide, 1.4% (or 3.7 million people) made a suicide plan, and 0.6% (or 1.5 million people) attempted suicide in the past year.
  • Multiracial adults aged 18 or older were more likely than adults in most other racial or ethnic groups to have AMI, serious mental illness (SMI), and serious thoughts of suicide.
  • Estimates of suicidal thoughts and behaviors among adults in 2023 were comparable to 2022 and 2021.

Substance Use:

  • In 2023, 3.1% of people (8.9 million) misused opioids in the past year, which is similar to 2022 and 2021 (3.2% and 8.9 million, 3.4% and 9.4 million respectively).
  • Among the 134.7 million people aged 12 or older who currently used alcohol in 2023, 61.4 million people (or 45.6%) had engaged in binge drinking in the past month.
  • Marijuana was the most commonly used illicit drug, with 21.8% of people aged 12 or older (or 61.8 million people) using it in the past year.
  • American Indian or Alaska Native and Multiracial people were more likely than most other racial or ethnic groups to have used substances or to have had an SUD in the past year.
  • In 2023, 9.4% of people aged 12 or older vaped nicotine in the past month, up from 8.3% in 2022.
    • In the past year, more people initiated vaping (5.9 million people) compared to any other substance.
    • Nicotine vaping estimates from 2021 are not comparable with estimates from 2022 and 2023.

Services and Recovery:

  • 31.9% of adolescents aged 12 to 17 (or 8.3 million people) received mental health treatment in the past year, an increase of more than 500,000 from 2022.
  • 23.0% of adults aged 18 or older (or 59.2 million people) received mental health treatment in the past year, an increase of 3.4 million from 2022.
  • Among people aged 12 or older in 2023 who were classified as needing substance use treatment in the past year, about 1 in 4 (23.6% or 12.8 million people) received substance use treatment in the past year. People were classified as needing substance use treatment in the past year if they had a substance use disorder (SUD) or received substance use treatment in the past year.
  • 30.5 million adults aged 18 or older (or 12.0%) perceived that they ever had a substance use problem. Among these adults, 73.1% (or 22.2 million people) considered themselves to be in recovery or to have recovered.
  • 64.4 million adults aged 18 or older (or 25.3%) perceived that they ever had a mental health issue. Among these adults, 66.6% (or 42.7 million people) considered themselves to be in recovery or to have recovered.
  • There were no racial ethnic differences among adults aged 18 or older in 2023 who perceived that they ever had a substance use problem or problem with their mental health who considered themselves to be in recovery or to have recovered from their drug or alcohol use problem or mental health issue.

About the National Survey on Drug Use and Health

Conducted by the federal government since 1971, the NSDUH is a primary source of statistical information on self-reported substance use and mental health of the U.S. civilian, noninstitutionalized population 12 or older. For the 2023 NSDUH national tables and some reports, statistical testing was conducted between estimates from different years (e.g., past month alcohol use in 2023 vs. the estimate in 2022). Where testing involved 3 years of comparable data for 2021 to 2023, pairwise testing was conducted between estimates in these years (i.e., 2021 vs. 2022, 2021 vs. 2023, and 2022 vs. 2023). Statistical tests for overall trends from the baseline year to the current year will not be conducted until four comparable NSDUH data points are available. The NSDUH measures include:

  • Use of illegal drugs, prescription drugs, alcohol, and tobacco,
  • Substance use disorder and substance use treatment,
  • Major depressive episodes, suicidal thoughts and behaviors, and other symptoms of mental illness, mental health care, and
  • Recovery from substance use and mental health disorders.

Addressing the nation’s mental health crisis and drug overdose epidemic is a top priority of the Biden-Harris Administration and are core pillars of the Administration’s Unity Agenda. The President’s Unity Agenda is operationalized through the HHS Overdose Prevention Strategy, the HHS Roadmap for Behavioral Health Integration, and the National Strategy for Suicide Prevention.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To learn how to get support for mental health, drug or alcohol issues, visit FindSupport.gov. If ready to locate a treatment facility or provider, go directly to FindTreatment.gov or call 800-662-HELP (4357).

 

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (HHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes.

Last Updated:
Source: https://www.samhsa.gov/newsroom/press-announcements/20240730/samhsa-releases-annual-national-survey-drug-use-and-health
Filed under: Addiction,Alcohol,Cannabis/Marijuana,Cocaine,Heroin/Methadone,Mental Health,Treatment and Addiction,USA :
Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies. On this page, you can find the latest analysis of harm reduction interventions in Europe, including key data on opioid agonist treatment, naloxone programmes, drug consumption rooms and more. 

This page is part of the European Drug Report 2024, the EMCDDA’s annual overview of the drug situation in Europe.

Evolving drug problems pose a broader set of challenges for harm reduction

The use of illicit drugs is a recognised contributor to the global burden of disease. Interventions designed to reduce this burden include prevention activities, intended to reduce or slow the rate at which drug use may be initiated, and the offer of treatment to those who have developed drug problems. A complementary set of approaches goes under the general heading of harm reduction. Here the emphasis is on working non-judgementally with people who use drugs in order to reduce the risks associated with behaviours that are mostly associated with adverse health outcomes, and more generally to promote health and well-being. Probably the best known of these is the provision of sterile injecting equipment to people who inject drugs, with the aim of reducing the risk of contracting an infectious disease. Over time these sorts of approaches appear to have contributed to the relatively low rate, by international standards, of new HIV infections now associated with injecting drug use in Europe. Over the last decade, as patterns of drug use have changed and the characteristics of those who use drugs have also evolved, to some extent, harm reduction interventions have also needed to adapt to address a broader set of health outcomes and risk behaviours. Prominent among these are reducing the risk of drug overdose and addressing the often-considerable and complex health and social problems faced by people who use drugs in more marginalised and socially excluded populations.

A spectrum of responses is needed to reduce changing drug-related harms

Chronic and acute health problems are associated with the use of illicit drugs, and these can be compounded by factors such as the properties of the substances, the route of administration, individual vulnerability and the social context in which drugs are consumed. Chronic problems include dependence and drug-related infectious disease, while there is a range of acute harms, of which drug overdose is perhaps the best documented. Although relatively rare at the population level, the use of opioids still accounts for much of the morbidity and mortality associated with drug use. Injecting drug use also increases risks. Correspondingly, working with opioid users and those who inject drugs has been historically an important target for harm reduction interventions and also the area where service delivery models are most developed and evaluated.

Reflecting this, some harm reduction services have become increasingly integrated into the mainstream of healthcare provision for people who use drugs in Europe over the last three decades. Initially, the focus was on expanding access to opioid agonist treatment and needle and syringe programmes as a part of the response to high-risk drug use, primarily targeting injecting use of heroin and the HIV/AIDS epidemic. Recent joint EMCDDA-ECDC guidance on the prevention and control of infectious diseases among people who inject drugs recommends providing opioid agonist treatment to prevent hepatitis C and HIV, as well as to reduce injecting risk behaviours and injecting frequency, in both the community and prison settings. The guidelines also recommend the provision of sterile injecting equipment alongside opioid agonist treatment to maximise the coverage and effectiveness of the interventions among people who inject opioids.

 

To access the full report, please click on the link below:

Source: https://www.euda.europa.eu/publications/european-drug-report/2024/harm-reduction_en

Filed under: Drug use-various effects,Europe,Prevention and Intervention,Treatment and Addiction :

The European Drug Report 2024: Trends and Developments presents the EMCDDA’s latest analysis of the drug situation in Europe. Focusing on illicit drug use, related harms and drug supply, the report provides a comprehensive set of national data across these themes, as well as on specialist drug treatment and key harm reduction interventions.

This report is based on information provided to the EMCDDA by the EU Member States, the candidate country Türkiye, and Norway, in an annual reporting process.

The purpose of the current report is to provide an overview and summary of the European drug situation up to the end of 2023. All grouping, aggregates and labels therefore reflect the situation based on the available data in 2023 in respect to the composition of the European Union and the countries participating in EMCDDA reporting exercises. However, not all data will cover the full period. Due to the time needed to compile and submit data, many of the annual national data sets included here are from the reference year January to December 2022. Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour such as drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Although considerable improvements can be noted, both nationally and in respect to what is possible to achieve in a European-level analysis, the methodological difficulties in this area must be acknowledged. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Caveats relating to the data are to be found in the online Statistical Bulletin 2024, which contains detailed information on methodology, qualifications on analysis and comments on the limitations in the information set available. Information is also available there on the methods and data used for European-level estimates, where interpolation may be used.

Content

The drug situation in Europe up to 2024

This page draws on the latest data available to provide an overview of the current situation and emerging drug issues affecting Europe, with a focus on the year up to the end of 2023. The analysis presented here highlights some developments that may have important implications for drug policy and practitioners in Europe.
Understanding Europe’s drug situation in 2024 – key developments

Drug supply, production and precursors

Analysis of the supply-related indicators for commonly used illicit drugs in the European Union suggests that availability remains high across all substance types. On this page, you can find an overview of drug supply in Europe based on the latest data, supported by the latest time trends in drug seizures and drug law offences, together with 2022 data on drug production and precursor seizures.
Drug supply, production and precursors – the current situation in Europe 

Cannabis

Cannabis remains by far the most commonly consumed illicit drug in Europe. On this page, you can find the latest analysis of the drug situation for cannabis in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more.
Cannabis – the current situation in Europe 

Cocaine

Cocaine is, after cannabis, the second most commonly used illicit drug in Europe, although prevalence levels and patterns of use differ considerably between countries. On this page, you can find the latest analysis of the drug situation for cocaine in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more.
Cocaine – the current situation in Europe 

Synthetic stimulants

Amphetamine, methamphetamine and, more recently, synthetic cathinones are all synthetic central nervous system stimulants available on the drug market in Europe. On this page, you can find the latest analysis of the drug situation for synthetic stimulants in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more
Synthetic stimulants – the current situation in Europe 

MDMA

MDMA is a synthetic drug chemically related to the amphetamines, but with somewhat different effects. In Europe, MDMA use has generally been associated with episodic patterns of consumption in the context of nightlife and entertainment settings. On this page, you can find the latest analysis of the drug situation for MDMA in Europe, including prevalence of use, seizures, price and purity and more.
MDMA – the current situation in Europe 

Heroin and other opioids

Heroin remains Europe’s most commonly used illicit opioid and is responsible for a large share of the health burden attributed to illicit drug consumption. Europe’s opioid problem, however, continues to evolve in ways that are likely to have important implications for how we address issues in this area. On this page, you can find the latest analysis of the drug situation for heroin and other opioids in Europe, including prevalence of use, treatment demand, seizures, price and purity, harms and more.
Heroin and other opioids – the current situation in Europe 

New psychoactive substances

The market for new psychoactive substances is characterised by the large number of substances that have emerged, with new ones being detected each year. On this page, you can find an overview of the drug situation for new psychoactive substances in Europe, supported by information from the EU Early Warning System on seizures and substances detected for the first time in Europe. New substances covered include synthetic and semi-synthetic cannabinoids, synthetic cathinones, new synthetic opioids and nitazenes.
New psychoactive substances – the current situation in Europe 

Other drugs

Alongside the more well-known substances available on illicit drug markets, a number of other substances with hallucinogenic, anaesthetic, dissociative or depressant properties are used in Europe: these include LSD, hallucinogenic mushrooms, ketamine, GHB and nitrous oxide. On this page, you can find the latest analysis of the situation regarding these substances in Europe, including seizures, prevalence and patterns of use, treatment entry, harms and more.
Other drugs – the current situation in Europe 

Injecting drug use

Despite a continued decline in injecting drug use over the past decade in the European Union, this behaviour is still responsible for a disproportionate level of both acute and chronic health harms associated with the consumption of illicit drugs. On this page, you can find the latest analysis of injecting drug use in Europe, including key data on prevalence at national level and among clients entering specialist treatment, as well as insights from studies on syringe residue analysis and more.
Injecting drug use – the current situation in Europe 

Drug-related infectious diseases

People who inject drugs are at risk of contracting infections through the sharing of drug use paraphernalia. On this page, you can find the latest analysis of drug-related infectious diseases in Europe, including key data on infections with HIV and hepatitis B and C viruses.
Drug-related infectious diseases – the current situation in Europe 

Drug-induced deaths

Estimating the mortality attributable to drug use is critical for understanding the public health impact of drug use and how this may be changing over time. On this page, you can find the latest analysis of drug-induced deaths in Europe, including key data on overdose deaths, substances implicated and more.
Drug-induced deaths – the current situation in Europe 

Opioid agonist treatment

Opioid users represent the largest group undergoing specialised drug treatment, mainly in the form of opioid agonist treatment. On this page, you can find the latest analysis of the provision of opioid agonist treatment in Europe, including key data on coverage, the number of people in treatment, pathways to treatment and more.
Opioid agonist treatment – the current situation in Europe 

Harm reduction

Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies. On this page, you can find the latest analysis of harm reduction interventions in Europe, including key data on opioid agonist treatment, naloxone programmes, drug consumption rooms and more.
Harm reduction – the current situation in Europe 

PDF version of full report

The European Drug Report 2024 was designed as a digital-first product, structured by modules, and optimised for online reading. Within each chapter, you may download a PDF version of the page. We are also making available here  a PDF version of the full report (all modules and annex tables combined). Please note that some errors may have occurred during the transformation process and that it is possible that this version does not contain all corrections made since the report was first published (please check the last updated date).

Download full PDF version of the European Drug Report 2024 (16 MB, last updated 14.06.2024)

Source: https://www.euda.europa.eu/publications/european-drug-report/2024_en

Filed under: Drug use-various effects,Europe,Prevention and Intervention,Treatment and Addiction :
Open Access: https://en.wikipedia.org/wiki/Open_access
Published:July 25, 2024 DOI:https://doi.org/10.1016/S2666-7568(24)00108-9
The article as uploaded shows link to tables e.g.(Table X) which, for brevity, have been deleted. Please therefore ignore these links!

Summary

Background

Cancer, coronary heart disease, dementia, and stroke are major contributors to morbidity and mortality in England. We aimed to assess the economic burden (including health-care, social care, and informal care costs, as well as productivity losses) of these four conditions in England in 2018, and forecast this cost to 2050 using population projections.

Methods

We used individual patient-level data from the Clinical Practice Research Datalink (CPRD) Aurum, which contains primary care electronic health records of patients from 738 general practices in England, to calculate health-care and residential and nursing home resource use, and data from the English Longitudinal Study on Ageing (ELSA) to calculate informal and formal care costs. From CPRD Aurum, we included patients registered on Jan 1, 2018, in a CPRD general practice with Hospital Episode Statistics (HES)-linked records, omitting all children younger than 1 year. From ELSA, we included data collected from wave 9 (2018–19). Aggregate English resource use data on morbidity, mortality, and health-care, social care, and informal care were obtained and apportioned, using multivariable regression analyses, to cancer, coronary heart disease, dementia, and stroke.

Findings

We included 4 161 558 patients from CPRD Aurum with HES-linked data (mean age 41 years [SD 23], with 2 079 679 [50·0%] men and 2 081 879 [50·0%] women) and 8736 patients in ELSA (68 years [11], with 4882 [55·9 %] men and 3854 [44·1%] women). In 2018, the total cost was £18·9 billion (95% CI 18·4–19·4) for cancer, £12·7 billion (12·3–13·0) for coronary heart disease, £11·7 billion (9·6–12·7) for dementia, and £8·6 billion (8·2–9·0) for stroke. Using 2050 English population projections, we estimated that costs would rise by 40% (39–41) for cancer, 54% (53–55) for coronary heart disease, 100% (97–102) for dementia, and 85% (84–86) for stroke, for a total of £26·5 billion (25·7–27·3), £19·6 billion (18·9–20·2), £23·5 billion (19·3–25·3), and £16·0 billion (15·3–16·6), respectively.

Interpretation

This study provides contemporary estimates of the wide-ranging impact of the most important chronic conditions on all aspects of the economy in England. The data will help to inform evidence-based polices to reduce the impact of chronic disease, promoting care access, better health outcomes, and economic sustainability.

Introduction

Public health initiatives and the development of cardioprotective medications have led to an increase in life expectancy in the past six decades, giving rise to an ageing population.

This ageing population is suffering from a different set of medical issues than the population a century ago, with cancer, coronary heart disease, dementia, and stroke being the four leading causes for mortality and morbidity in England.

In 2019, these four conditions accounted for 59% of all deaths and 5·1 million disability-adjusted life-years in England.

Research investment is essential to combat major public health challenges, facilitating the development of new treatments and interventions that can improve rates of prevention, treatment, or management of diseases, enhancing quality of life and reducing their economic burden. However, it is important that the distribution of research funding across diseases is proportionate to their respective impact on society. In 2008, a UK study (Dementia 2010) evaluated the economic costs of, and research investment into dementia, and compared these costs and investments with those for cancer, coronary heart disease, and stroke.

Such estimates are important to inform health policy and identify diseases in need of greater investment,

with successive UK Governments having placed a greater priority for research funding in dementia.

However, previous studies that quantified the costs of these four chronic conditions had several important limitations, including that care resource use for each of the four conditions was apportioned based on assumptions and estimates from the literature, with methods differing between conditions. With representative cohorts from England, we are now able to estimate the economic burden of these conditions using individual patient-level data and a consistent methodology across conditions. Therefore, we aimed to estimate the economic burden of cancer, coronary heart disease, dementia, and stroke in England in 2018, and forecast this cost to 2050 using population projections.
Research in context
Evidence before this study
We conducted a systematic review of the literature to identify studies evaluating the costs of dementia. We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, EconLit, Cost-Effectiveness Analysis Registry, Turning Research Into Practice, NHS Economic Evaluation Database, Science Citation Index, Research Papers in Economics, and OpenGrey Repository from Jan 1, 2000, to Aug 31, 2023. Search terms included “dementia”, “Alzheimer’s disease”, “cognitive impairment”, “costs”, and “resources”, among others. Except for one study conducted for the year 2008, we did not find any current study evaluating and contrasting the costs of the four chronic conditions with the highest mortality and morbidity burden in England—namely, cancer, coronary heart disease, dementia, and stroke. This study found that the total costs of dementia in England were £23·4 billion, followed by cancer (£12·0 billion), coronary heart disease (£7·8 billion), and stroke (£5·0 billion). However, these estimates were not estimated concurrently, with methodologies and sources of data varying considerably across conditions, including from generally small studies, which did not capture the impact of comorbidities on the levels of care provided. Therefore, results for each of the four conditions are probably not comparable.
Added value of this study
Our study assesses the total costs of cancer, coronary heart disease, dementia, and stroke, concurrently using patient-level data from two representative English cohorts: the Clinical Practice Research Datalink Aurum and the English Longitudinal Study on Ageing. We show that cancer, coronary heart disease, and dementia had similar overall health-care and social care costs, but when other costs were included, cancer had the highest overall economic burden. Using age-specific and gender-specific population projections to 2050, we found that the costs of the four conditions increased by 64% due to population ageing alone, with social care costs increasing by 104% between 2018 and 2050.
Implications of all the available evidence
Our study sheds light on the significant consequences of the four most important chronic conditions in terms of mortality and morbidity in England on various sectors of the economy. The data we present not only emphasise the magnitude of the economic burden caused by cancer, coronary heart disease, dementia, and stroke but also provide valuable insights for public health decision makers. By identifying the specific areas that require targeted interventions, our findings can guide policy makers in implementing strategic measures to alleviate the economic burden of these four conditions. With a projected increase in costs of 64% by 2050, our research findings can aid in directing governmental research expenditure to areas that hold the greatest potential for advancing the prevention, diagnosis, and treatment of disease, further reducing its economic impact on England.

Methods

Analysis framework and data sources

We adopted a societal perspective for our analyses, with inclusion of the following costs: health care, social care (defined as residential and nursing home, and formal care costs), informal care, and productivity losses. We used an annual timeframe that included all costs for 2018, irrespective of the time of disease onset. We obtained England-specific aggregate resource use data on health and social care, mortality, morbidity, and prevalence of disease. To apportion aggregate data on health, and residential and nursing home resource use to each of the four conditions, we analysed individual patient-level data from the Clinical Practice Research Datalink (CPRD) Aurum linked to National Health Service Hospital Episode Statistics (HES).

CPRD Aurum is a large database of routinely recorded primary care electronic health records of patients from 738 general practices in England (10% of practices), covering 13% of the population.

The database contains information on symptoms, diagnoses, prescriptions, referrals, tests, immunisation, and medical staff. Primary care and secondary care diagnosis codes were used to identify the four conditions of interest. CPRD Aurum codes used to diagnose patients in primary care are reported in the appendix (pp 2–55). CPRD records were then linked to secondary care records contained in HES using Aurum (version 2.3) from August, 2019. In secondary care records, cancer was defined by ICD-10 category codes I00–I99, coronary heart disease by codes I20–I25, dementia by codes F00–F03 and G30, and stroke by codes I60–I69. The use of CPRD Aurum for this study was approved by the independent scientific advisory committee for CPRD research (protocol reference CPRD00120051). CPRD obtains annual research ethics approval from the UK’s Health Research Authority Research Ethics Committee (05/MRE04/87) to receive and supply patient data for public health research. No further ethical permissions were required for the analyses of these anonymised patient-level data. The analysis was based on 4 161 588 patients registered on Jan 1, 2018, in a CPRD general practice with HES-linked records, omitting all children younger than 1 year (appendix pp 56–57).

Informal and formal care information was obtained from the English Longitudinal Study on Ageing (ELSA).

ELSA collects data from people older than 50 years, with spouses from age 40 years also included, to understand all aspects of ageing in England. More than 18 000 people have taken part in the study since it started in 2002, with the same people re-interviewed every 2 years. For this study, we used information on wave 9 (2018–19; appendix pp 58–59). Access to ELSA, through the UK Data Service, was obtained as part of the UK Access Management Federation. ELSA has been approved by the National Research Ethics Service (London Multicentre Research Ethics Committee [MREC/01/2/91]).

Health-care resource costs

Primary care consisted of visits with general practitioners and practice nurses in health-care facilities or in patients’ homes. Accident and emergency care consisted of all hospital emergency visits. Outpatient care consisted of specialist consultations and treatments in outpatient wards, clinics, or patients’ homes. Hospital care consisted of hospital admissions, including day cases and inpatient stays. Pharmaceutical expenditure included the costs of all prescriptions dispensed in the community (eg, pharmacies), but excluded costs of medications administered in secondary care settings, which were included in the costs of inpatient care.
We obtained the overall total number of all-cause health-care contacts with each type of service and medication expenditure in England (table 1; appendix p 60). Patient-level data from CPRD Aurum with HES linkage were then used to apportion all-cause health-care contacts and pharmaceutical expenditure in England to cancer, coronary heart disease, dementia, and stroke. All resource use was valued using relevant unit costs.

Nursing and residential care home costs

We included resources associated with living in a nursing home (requiring 24 h nursing care) or residential home (accommodation supporting people who are not able to manage everyday tasks).

Of the more than 10 million people in England aged 65 years or older in 2018, 5% were living in a nursing or residential care home.

Using patient-level data from CPRD Aurum, we apportioned the proportion of people living in a nursing or residential care home in England due to cancer, coronary heart disease, dementia, and stroke (table 1; appendix pp 65–66). Nursing and residential home care home cost was valued at £837 per week,

taking into account the relative proportions of people living in nursing and residential homes,

and the local authority, not-for profit, and profit sector provision case mix.

Informal and formal care

Informal care costs were equivalent to the opportunity cost of unpaid care (ie, the time [work, leisure, or both] that carers forgo), valued in monetary terms, to provide unpaid care for relatives or friends with cancer, coronary heart disease, dementia, or stroke, and based on the conservative assumption that only patients limited in daily activities received care. We valued informal care using the proxy good method, in which an hour of informal care provided was valued using the labour market price of a close market substitute

(i,e. the mean hourly wage for a home care assistant [£7·85]).

Hence, for informal care, we multiplied the age-specific and gender-specific products of age-specific and gender-specific prevalence of cancer, coronary heart disease, dementia, and stroke in England;

the probability of living in the community (appendix p 66); the probability of being severely limited in daily activities as a result of each of the four conditions under study (appendix p 67); the probability of receiving informal care conditional on being limited in daily activities (appendix p 67); and the hours of informal care received, conditional on being limited in daily activities and receiving informal care (appendix p 67).

Formal care costs included the costs associated with paid care for patients living in the community, which was valued at £27·00 per h.

For formal care, we multiplied the age-specific and gender-specific products of age-specific and gender-specific prevalence of cancer, coronary heart disease, dementia, and stroke in England;

the probability of living in the community (appendix p 66); the probability of receiving formal care (appendix p 68); and the hours of formal care received, conditional on receiving formal care (appendix p 68).

Given that ELSA had no participants younger than 40 years, care was only estimated for those aged 40 years or older.

Morbidity losses

Morbidity losses were determined to be the cost associated with temporary or permanent absence from work in patients with cancer, coronary heart disease, dementia, or stroke.

Annual days off sick were obtained from the European Working Conditions Surveys.

To the total number of days of work due to sickness, we applied the proportion of absence that was attributable to cancer, coronary heart disease, dementia, and stroke, which was obtained from the UK Department of Works and Pensions (personal communication).

To calculate permanent absence from work due to sickness or disability, information on the numbers of working-age individuals receiving incapacity or disability benefits and not being able to work was obtained, including recipients of the disability living allowance, employment support allowance (ESA), and incapacity benefit by condition.

Given that recipients of ESA can work up to 45·82% of their time, we only included the proportion of time that was not worked.

Days of absence from work due to sickness or disability were multiplied by mean daily earnings.

Furthermore, for permanent absence, we used the friction period approach because absent workers are likely to be replaced, whereby only the first 90 days of work absence were counted.

Mortality losses

We assumed an initial working age of 15 years and a maximum age of retirement of 79 years. Age-specific and gender-specific deaths due to cancer, coronary heart disease, dementia, and stroke were obtained.

The number of potential working years lost was then estimated as the difference between the age at death and maximum age of retirement. Each lost year of working life was valued using average annual earnings.

However, not all of the population is economically active until age 79 years; hence, age-specific and gender-specific unemployment and activity rates

were applied to the potential foregone earnings. Following UK-recommended guidelines, future earnings lost due to mortality were discounted to present values using a 3·5% annual rate.

Statistical analysis

CPRD Aurum data analyses informed the age-specific and gender-specific health-care resource use and nursing or residential care home use associated with cancer, coronary heart disease, dementia, and stroke. ELSA data analyses were used to derive the age-specific and gender-specific estimates needed to inform the calculations of informal and formal care received associated with the four conditions. To achieve this, we used regression analyses (Poisson, logistic, and generalised linear models) for each type of resource use, adjusting for history of cancer, coronary heart disease, dementia, or stroke; Elixhauser comorbidity index; age; and gender. Together with data on disease prevalence, we used the derived models to estimate the total costs associated with each condition. For more details, see the appendix (pp 60–68).

Finally, we projected the costs estimated for 2018 to 2050 based on future projections of the population alone,

excluding other factors such as epidemiological trends of the four conditions under investigation, risk factor prevalence rates, and life expectancy.

For this, we applied age-specific and gender-specific rates of resource use, prevalence, mortality, and disability observed in 2018 to the predicted distribution of the population in 2050. We valued resource use in 2050 using 2018 costs. For more details, see the appendix (pp 69–71).

Total resource use estimates and costs are reported alongside 95% CIs, which were derived using 1000 bootstrap estimates of all resource use regressions undertaken in CPRD Aurum and ELSA. Given that country-wide productivity loss estimates were obtained (eg, disease-specific working days lost, disability claims, and deaths), sampling uncertainty was not required, and these cost estimates are provided as point estimates. Population projections were not provided with uncertainty levels so these are also treated as point estimates. Significance was set at a p value of less than 0·05.
All analyses were conducted in STATA (version 15, 64-bit).

Role of the funding source

The funder of the study had no role in the study design; the collection, analysis, and interpretation of data; the writing of the report; or in the decision to submit the paper for publication.

Results

The analyses to apportion total all-cause health-care and nursing and residential care home resource use in England to cancer, coronary heart disease, dementia, and stroke was based on 4 161 558 patients in CPRD Aurum with linked HES data (mean age 41 years [SD 23]), with 2 079 679 (50·0%) men and 2 081 879 (50·0%) women. Of these patients, 174 942 (4·2%) had a history of cancer either in primary or secondary care records, 191 603 (4·6%) of coronary heart disease, 52 862 (1·3%) of dementia, and 61 509 (1·5%) of stroke (appendix p 56).
To estimate total hours of formal and informal care in England due to cancer, coronary heart disease, dementia, and stroke, analyses were based on 8736 patients in ELSA (mean age 68 years [SD 11]), with 4882 (55·9%) men and 3854 (44·1%) women. Of these patients, 744 (8·5%) had a history of cancer, 423 (4·8%) of coronary heart disease, 211 (2·4%) of dementia, and 313 (3·6%) of stroke (appendix p 58).
Of all admissions to hospitals (including day cases and inpatient stays) in 2018, 2 164 000 (95% CI 2 083 000–2 243 000) admissions were found to be associated with patients with cancer, followed by coronary heart disease (1 081 000 [1 053 000–1 110 000]), stroke (517 000 [497 000–535 000]), and dementia (234 000 [224 000–244 000]; table 2). The condition with the highest prescribed pharmaceutical expenditure was coronary heart disease (£982 million [95% CI 968–998]), followed by cancer (£925 million [909–940]), stroke (£451 million [437–464]), and dementia (£277 million [269–285]). Overall, the health-care costs associated with these conditions in England were £8·1 billion (95% CI 8·0–8·2) for cancer, £6·7 billion (6·6–6·7) for coronary heart disease, £1·5 billion (1·5–1·6) for dementia, and £3·4 billion (3·4–3·5) for stroke.
About 133 000 (95% CI 126 000–141 000) people older than 65 years with dementia were living in residential or nursing homes in 2018. This estimate was higher than for stroke (75 000 [95% CI 70 000–80 000]), coronary heart disease (52 000 [49 000–54 000]), and cancer (33 000 [31 000–35 000]). Living in residential or nursing homes accounted for costs of £5·8 billion (95% CI 5·5–6·1) for dementia, £3·2 billion (3·1–3·4) for stroke, £2·2 billion (2·1–2·4) for coronary heart disease, and £1·4 billion (1·4–1·5) for cancer (table 2).
Overall health-care and social care costs were £9·7 billion (95% CI 9·5–9·9) for cancer, £8·9 billion (8·8–9·0) for coronary heart disease, £8·0 billion (7·3–8·6) for dementia, and £6·9 billion (6·6–7·1) for stroke (table 2). This resulted in costs of £174 (95% CI 171–178) per capita for cancer, £162 (158–164) for coronary heart disease, £144 (132–155) for dementia, and £124 (120–129) for stroke (appendix p 72). Per person with the condition, the highest health-care and social care costs were associated with stroke at £12 923 (95% CI 12 491–13 399), followed by dementia at £11 641 (10 680–12 558), cancer at £6660 (6526–6803), and coronary heart disease at £5530 (5437–5625).
Friends and family spent a total of 115 million h (95% CI 62–175) providing informal care for patients with cancer; 95 million h (46–137) for those with coronary heart disease, 461 million h (224–561) for those with dementia, and 75 million h (37–110) for those with stroke (table 2). Total informal care costs were £905 million (95% CI 486–1374) for cancer, £748 million (365–1758) for coronary heart disease, £3619 million (1758–4405) for dementia, and £587 million (291–865) for stroke.
More than 271 000 working years were lost due to cancer, 80 000 due to coronary heart disease, 3000 due to dementia, and 37 000 due to stroke, with corresponding mortality losses of £7·8 billion, £2·6 billion, £0·1 billion, and £0·8 billion, respectively (table 2). Losses due to temporary and permanent absence from work due to illness and disability for the conditions under study were £497 million for cancer, £378 million for coronary heart disease, £49 million for dementia, and £362 million for stroke. Overall, productivity losses were highest for cancer (£8·3 billion), followed by coronary heart disease (£3·0 billion), stroke (£1·2 billion), and dementia (£0·1 billion).
The overall costs in England in 2018 were £18·9 billion (95% CI 18·4–19·4) for cancer, £12·7 billion (12·3–13·0) for coronary heart disease, £11·7 billion (9·6–12·7) for dementia, and £8·6 billion (8·2–9·0) for stroke (table 2). Per case, patients with dementia had the highest costs at £17 145 (95% CI 13 998–18 604), followed by stroke at £16 224 (15 482–16 954), cancer at £13 031 (12 681–13 393), and coronary heart disease at £7857 (7599–8068; appendix p 72).
The way costs were distributed among cost categories varied considerably by condition (table 2; figure 1). The proportion of total costs due to health care varied from 52% (£6·7 billion) for coronary heart disease to 13% (£1·5 billion) for dementia. Although productivity losses accounted for 44% (£8·3 billion) of the total costs for cancer, for dementia these accounted for 1% (£145 million) of total costs.
Figure 1 – Distribution of total costs in patients with cancer, coronary heart disease, dementia, and stroke in England in 2018

 

The population of England, excluding those younger than 1 year, is expected to increase from 55 million in 2018 to 65 million in 2050 (18% increase), with the population aged 65 years or older projected to increase by 49% (from 10 million to 15 million).

Assuming no changes in age-specific and gender-specific prevalence rates, this population increase will increase the number of people with cancer by 39% (2·0 million), coronary heart disease by 45% (2·3 million), dementia by 81% (1·2 million), and stroke by 41% (0·8 million; appendix p 69).

These increases in the overall disease prevalence will result in cost increases between 2018 and 2050 of 40% (95% CI 39–41) to £26·5 billion (25·7–27·3) for cancer, 54% (53–55) to £19·6 billion (18·9–20·2) for coronary heart disease, 100% (97–102) to £23·5 billion (19·3–25·3) for dementia, and 85% (84–86) to £16·0 billion (15·3–16·6) for stroke (table 3). Costs with the highest increases are those related to social care, which are projected to rise between 2018 and 2050 by 88% (95% CI 86–90) to £2·9 billion (2·7–3·3) for cancer, 91% (90–92) to £4·4 billion (4·1–4·6) for coronary heart disease, 110% (109–111) to £13·5 billion (12·1–14·8) for dementia, and 109% (107–108) to £7·1 billion (6·6–7·5) for stroke (figure 2).

Figure 2 – Total costs of cancer, coronary heart disease, dementia, and stroke in England in 2018 and the projected costs in 2050 due to demographic change alone

Discussion

Whereas a previous study has assessed the overall costs of chronic conditions, our study made use of individual patient-level data to generate more precise cost estimates for cancer, coronary heart disease, dementia, and stroke, using the same methodology and sources across conditions. Previously the total costs of dementia in the UK were calculated as £23·4 billion, followed by cancer (£12·0 billion), coronary heart disease (£7·8 billion), and stroke (£5·0 billion).

These estimates are not comparable with the findings in this study, possibly due to methodologies and sources of data varying considerably across conditions.

Our results show that the areas of the economy bearing these costs differed substantially by disease area. For example, health-care costs of dementia accounted for 13% (£1·5 billion) of the total, with most costs being borne by the social care system (£6·4 billion, 55% of total costs). By contrast, in cancer, the majority of costs were borne by the labour market, with £8·3 billion in lost productivity (44% of total costs). These findings are notable in that they further emphasise the need for interventions designed to prevent or screen for early-stage disease. For cancer and, to a lesser extent, coronary heart disease, with so much of the cost borne by the labour market, interventions that prevent the disease will not only increase the health of the population and reduce health-care costs, but also improve labour productivity. However, these findings also raise important questions about perceived fairness and equality.

In the UK, about 90% of hospital cases, which according to our findings is where most of the care of patients with cancer or coronary heart disease takes place, is funded by the government (data are from the Eurostat database). By contrast, for dementia and, to a lesser extent, stroke, most of the care takes place in either the social care system, of which 60% is funded by the government, or by relatives and friends through informal care (data are from the Eurostat database). Therefore, patients with dementia and stroke are substantially at higher risk of having to fund their care themselves than those with cancer or coronary heart disease.

Our study also shows the effect of the projected population ageing over the coming decades. On the basis of demographic change alone, we project that the costs of cancer will increase by 40%, those of coronary heart disease by 54%, those of dementia by 100%, and those of stroke by 85%. With the population aged 65 years or older projected to increase by 49%, the costs with the fastest projected rise will be, averaged across all four conditions, for social care, with a 104% projected increase in costs, and informal care, with a projected increase of 78%. Therefore, research funding into interventions aimed to prevent, treat, and care for disease are required as a way to help to reduce or mitigate this projected increase in costs and improve health, especially in those conditions—ie, stroke and dementia—seeing the fastest increase in costs, and that historically have received the lowest levels of research funding.

The limitations of this study should be noted. Our results are based on diagnostic coding from both primary and secondary care records, rather than on careful ascertainment of patients through multiple and overlapping methods such as in population-based cohort studies. Therefore, our results might not reflect the absolute prevalence and costs of disease. Given that there is no single and simple diagnostic test for dementia, this under-ascertainment of disease in routinely collected health data or surveys might be most prevalent in dementia.

The failure to identify these undiagnosed cases might explain the relatively low levels of health-care resource use identified in CPRD Aurum due to dementia.

For diseases affecting cognitive ability, such as dementia and stroke, supervision will be a major component of any informal care provided.

However, in ELSA, respondents were not explicitly asked for supervisory activities received, with our results likely to be an underestimate. We were unable to quantify the costs of formal and informal care in people younger than 40 years. This will, inevitably, have reduced our total estimates of costs, especially for cancer and stroke, where people younger than 40 years account for 6% (110 000) and 8% (60 000) of cases, respectively, compared with 2% (41 000) for coronary heart disease and less than 1% (5000) for dementia.

Finally, our projection of costs from 2018 to 2050 was based on future projections of the population alone, and might be considered simplistic. Our projections did not include other factors, such as epidemiological trends of the four conditions under investigation or the predicted rise in comorbidities predicted for England.

For example, analyses based on ELSA have projected the costs of dementia in the future based on current trends in cardiovascular disease incidence rates.

In addition, new treatments that prevent, slow progression, or successfully treat the four conditions under study, will undoubtedly affect the projected costs estimated in this study.

In conclusion, our study sheds light on the substantial consequences of the four most important chronic conditions in terms of mortality and morbidity in England on various sectors of the economy. These data not only emphasise the magnitude of the economic burden but also provide valuable insights for public health decision makers. By identifying the specific areas that require targeted interventions, our findings can guide policy makers in implementing strategic measures to alleviate the economic burden of these four conditions and improve patient health outcomes. With a projected increase in costs of more than 60% across the four conditions by 2050, our research findings can aid in directing governmental research expenditure in areas that hold the greatest potential for advancing the prevention, diagnosis, and treatment of disease, further reducing its economic impact.

Source: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00108-9/fulltext

Filed under: Drug use-various effects,Economic,Europe,Treatment and Addiction :

Key topics

 

Overdose prevention services should be offered through HIV care

National Institute on Drug Abuse Director Nora Volkow explains the need to leverage the successes of HIV care to prevent overdose deaths. HIV and substance use are inextricably linked. An analysis of the New York City HIV surveillance registry found that in 2017, rates of overdose deaths for people with HIV were more than double overall overdose death rates for the city, but that 98% of those who died of overdose had been linked to HIV care after their HIV diagnosis and that more than three-quarters had been retained in care. This highlights an overlooked opportunity to save lives. Drug overdose claims more lives of people with HIV than HIV-related illness. Volkow says 81% of people who received an HIV diagnosis in 2019 in the U.S. were linked to HIV care within a month, 66% received care and 50% were retained in care. It is sometimes hard to reach people who use drugs with substance use treatment or harm reduction, but when people with HIV seek and receive treatment for HIV, it presents a promising opportunity to deliver addiction services. Delivering naloxone and overdose education in HIV care settings is a relatively easy way to prevent overdose deaths.

Source: We should leverage the successes of HIV care to prevent overdose mortality (National Institute on Drug Abuse)

 

Hemp legalization opened the door to intoxicating products

Lawmakers who backed hemp legalization in the 2018 Farm Bill expected the plant to be used for textiles and nonintoxicating supplements. They did not realize that, with some chemistry, hemp can get you high. People anywhere in the U.S. can use hemp-derived THC without breaking federal law. Hemp and marijuana are varieties of the same plant species. Marijuana is defined by its high content of delta-9 THC. Hemp contains very little delta-9 THC but can contain a large amount of CBD, a cannabinoid that does not get you high. The Controlled Substances Act explicitly outlawed both hemp and marijuana. The Farm Bill defines hemp in a way that allows the plant and products made with it as long as they contain less than 0.3% delta-9 THC, making it seemingly legal to convert CBD into delta-8 THC as long as the process started with a plant that contained less than 0.3% delta-9 THC. The Farm Bill also appears to authorize the creation of hemp-based delta-9 THC products as long as the total delta-9 content is 0.3% or less of the product’s dry weight. The hemp-derived cannabinoid industry is now worth billions of dollars, and hemp-derived intoxicants are available at vape shops and gas stations, but they are not regulated.

Source: Congress Accidentally Legalized Weed Six Years Ago (The Atlantic)

 

Federal news

 

Expanded access to methadone is needed

National Institute on Drug Abuse Director Nora Volkow highlights the need to expand access to methadone. Only a fraction of people who could benefit from medications for opioid use disorder receive them, due to a combination of structural and attitudinal barriers. In 2023, the federal government eliminated the waiver requirement for buprenorphine. This year, it changed methadone regulations to make permanent the increased take-home doses of methadone established during the COVID emergency, along with other provisions aimed to broaden access. Changes implemented during COVID have not been associated with adverse outcomes, and patients reported significant benefits. Recent trials of models of methadone dispensing in settings other than methadone clinics have not supported concerns that making methadone more widely available will lead to harms. Data suggest that counseling is not essential for reducing overdoses or retaining patients in care, though it can be beneficial for some. It will also be critical to pursue other ways that methadone can safely be made more available to a wider range of patients.

Source: Guest Editorial: To Address the Fentanyl Crisis, Greater Access to Methadone Is Needed (American Society of Addiction Medicine)

 

CDC defends overdose prevention work before House committee

Several top Centers for Disease Control and Prevention (CDC) officials testified before the House Energy and Commerce Committee to defend their agency’s programs. The hearing comes after House Republicans passed a budget that would cut CDC funding by 22%. Republicans claimed the agency has failed to fulfill its responsibilities and lost the public’s trust. Republicans accused the CDC of straying from its core mission of keeping the public healthy and said the agency is spending too much time on programs some GOP lawmakers deemed unnecessary or duplicative. The CDC program directors pushed back, citing work they deemed critical to public health. They emphasized three areas of focus – improving readiness and response to disease outbreaks, improving mental health and supporting young families. Allison Arwady, director of the National Center for Injury Prevention and Control, which would be eliminated under the proposed funding bill, spoke about why the center’s work on overdose prevention is necessary.

Source: CDC Defense (Politico); CDC fields GOP criticism at E&C hearing (Politico)

 

Task force releases recommendations to protect youth from social media harms

The federal Kids Online Health and Safety Task Force released a report with recommendations and best practices for safer social media and online platform use for youth. The report provides a summary of the risks and benefits of social media on the health, safety and privacy of young people; best practices for parents and caregivers; recommended practices for industry; a research agenda; and suggested future work, including for the federal government. In collaboration with the Task Force, the Center of Excellence on Social Media and Youth Mental Health is launching a variety of new web content, including best practices resources; age-based handouts for parents that pediatricians and others can distribute at well-check visits; new clinical case examples for pediatricians and other clinicians demonstrating how to integrate conversations about media use into health consultations with teens; and expanded content for teens. The report outlines 10 recommended practices for online service providers.

Source: Kids Online Health and Safety Task Force Announces Recommendations and Best Practices for Safe Internet Use (Substance Abuse and Mental Health Services Administration)

 

FDA allows sale of tobacco-flavored Vuse e-cigarettes

The Food and Drug Administration (FDA) authorized sales of certain tobacco-flavored Vuse Alto e-cigarette products from R.J. Reynolds. Vuse is the top-selling e-cigarette brand in the country, comprising more than 40% of the market. The marketing authorization applies to six tobacco-flavored pods, which are sealed, prefilled and nonrefillable. Last year, the FDA banned the sale of Vuse Alto menthol and fruit-flavored e-cigarettes, citing increasing popularity among kids.

Source: FDA allows sale of best-selling tobacco e-cigarette Vuse (The Hill)

 

State and local news

 

Montana plans to install harm reduction vending machines

Montana health officials are considering a new strategy to make naloxone more accessible. Drawing on a pool of behavioral health funds set aside by lawmakers in 2023, health officials have proposed installing two dozen naloxone and fentanyl test strip vending machines around the state at behavioral health drop-in centers and service locations for homeless people. The $400,000 plan to build, stock and maintain 24 vending machines for a year has not yet been approved by the governor. Different versions of the harm reduction vending machine model are being tried in at least 33 states, becoming increasingly popular especially in places with hard-to-reach populations. Some local public health groups in Montana have already begun using vending machines to distribute free naloxone, drug testing strips and other supplies, using public grants or private philanthropy, but these would be the first vending machines in Montana being directly funded by the state.

Source: Montana’s Plan To Curb Opioid Overdoses Includes Vending Machines (KFF Health News)

 

Iowa providing $13 million to expand addiction treatment and recovery housing

Iowa Governor Reynolds announced that the state’s opioid treatment and recovery providers can begin applying for $13 million in grants to expand or improve facilities or develop sober living housing options. The funding opportunities were announced in May as part of a larger $17.5 million investment to help address the opioid crisis. The $10 million Iowa Opioid Treatment and Recovery Infrastructure Grant will assist opioid treatment and recovery providers with physical infrastructure and capacity building. The Iowa Recovery Housing Fund includes $3 million for grants for nonprofit organizations to develop sober recovery housing. The grants leverage federal American Rescue Plan Act funds. An additional $1.5 million will be used for programs focused on prevention, including a $1 million education initiative for health care providers to support opioid-alternative pain management and $500,000 for a comprehensive multimedia opioid overdose prevention campaign. The remaining $3 million will support the completion of a residential addiction treatment center for adolescents.

Source: Gov. Reynolds announces grant funding, education programs to support opioid prevention, treatment and recovery (Iowa Governor Kim Reynolds)

 

LAPPA releases model state laws to minimize harms of incarceration

The Legislative Analysis and Public Policy Association released two pieces of model state legislation. The first would require a state department of health and human services to apply for a Medicaid Reentry Section 1115 demonstration waiver to allow a state Medicaid program to cover pre-release services for Medicaid-eligible incarcerated individuals for up to 90 days prior to release and to require the department to conduct comprehensive monitoring and evaluation of the demonstration if the waiver is approved. The second is focused on reducing collateral consequences of conviction. It would establish a process for the identification, collection and publication of collateral consequences that impact individuals convicted of crimes; establish a process by which an individual can obtain a certificate of relief from certain collateral consequences before records are eligible to be sealed or expunged; establish mechanisms for the automatic sealing and expungement, as well as a process for petitioning; prohibit certain entities from inquiring into an individual’s criminal history; etc.

Source: Model Medicaid Reentry Section 1115 Demonstration Waiver Act; Model Relief from Collateral Consequences of Conviction Act (Legislative Analysis and Public Policy Association)

 

Other news in addiction policy

 

Mobile treatment vans can help expand methadone access

Some public health experts hope that mobile treatment programs will help increase access to methadone. Addiction experts say methadone is particularly important as the strength of street fentanyl has lessened the effectiveness of other medications and approaches for some. The mobile vans were approved by the federal government in 2021, lifting a moratorium on their use that had been in place since 2007. Their goal is to reach some of the millions of Americans with opioid use disorder that methadone clinics cannot. While the vans make treatment more accessible, the cost and ongoing restrictions limit the number of people that they can help, as well. Constructing and outfitting a methadone van costs about $375,000. They have to replicate the high-security environments of clinics, with a security guard, 360-degree cameras and a safe for the medication. There are now 42 vans registered nationally, though not all are operational yet.

 

Source: https://drugfree.org/drug-and-alcohol-news/policy-news-roundup-july-25-2024/

Filed under: Addiction,Crime/Violence/Prison,Heroin/Methadone,Prevention and Intervention,Treatment and Addiction,USA,Youth :

Biden’s drug czar is in West Virginia this week.

  • By Allen Siegler | Mountain State Stoplight

This story was originally published by Mountain State Spotlight. Get stories like this delivered to your email inbox once a week; sign up for the free newsletter at mountainstatespotlight.org/newsletter

CHARLESTON — Dr. Rahul Gupta is back in West Virginia. The state’s former health officer has ventured west of Washington this week, hosting seven public discussions in Martinsburg and Charleston as part of his new role as White House Office of Drug Control Policy Director.

Over the last three years, Gupta and the Biden administration have taken significant steps to address the country’s devastating overdose crisis. They’ve promoted harm reduction aggressively, even finding ways to test out hard-sell, evidence-based strategies like safe injection sites.

Still, the addiction crisis continues to ravage U.S. families, especially in Gupta’s former state. Last year, about four West Virginians died of a drug overdose every day.

As the nation’s “drug czar,” Gupta is in a better position to advocate for addiction-related changes than just about anyone else.

Here are five steps the federal government could take to help abate West Virginia’s overdose crisis.

Change opioid treatment program restrictions

West Virginia has policies and regulations that restrict access to opioid addiction treatment. The state makes it difficult for some people with opioid use disorders to receive medications like methadone, which is considered a “gold standard” of treatment. Since 2007, West Virginia has limited the number of methadone clinics, the only places methadone can be prescribed to treat addiction, to nine locations.

But while that’s a state law, federal law is the reason methadone can only be prescribed for treating substance use disorder at these clinics.

People who research addiction have called on Congress to change this policy to allow doctors to prescribe methadone for addiction treatment outside of specialized clinics. Because West Virginia’s moratorium is focused on methadone clinics and not the medication itself, that type of change could make the treatment more accessible to state residents.

Last winter, when Gupta was asked in an interview about a federal bill that would accomplish parts of this goal, he stopped short of endorsing the proposed legislation. Instead, he said it’s important for Congress to “let the science and the data guide policy-making.”

Change restrictions on treatment for methamphetamine addiction

A decade ago, less than 5% of West Virginia fatal overdoses were related to methamphetamine. But that’s changed dramatically; last year, more than 50% of the state’s nearly 1,400 drug deaths involved meth.

That presents a difficult public health problem for West Virginia. Scientists have yet to develop reliable medications for treating methamphetamine addiction.

Of the available treatments, the most effective options are behavior training programs, also known as contingency management. These types of programs reward people regularly with money or other incentives for abstaining from a drug.

Dr. Philip Chan, an addiction and infectious disease researcher at Brown University, said if he could provide patients with $400 to $500 every two to three months, it would be more effective at keeping them from using meth. But the federal government caps contingency management payments at $75 a year.

Repeal the federal funding ban for syringes and needles

West Virginia has many restrictions around needle exchanges. In 2021, the Legislature passed a law that forces syringe service programs to offer a variety of other harm reduction services, and it instructs them to deny service to those who don’t have valid state IDs or return their used needles.

The additional requirements led many programs across the state to shutter. For the ones that remain, restrictions at the national level make it even more difficult to operate.

Needle exchanges are already prohibited from using federal funds to purchase clean needles and syringes. And there have been pushes, including from West Virginia Senator Joe Manchin, to extend the prohibition to safe smoking devices as well.

Nikki Dolan, the Greenbrier Health Department administrator, said this policy makes it more difficult to fund her county’s only syringe service program.

“We’ve been doing harm reduction since 2018 and have never been able to purchase needles with grant funding,” she said.

Include West Virginia in the Ending the HIV Epidemic initiative

West Virginia’s recent drug-related HIV outbreaks have been among the worst in the nation. In 2019, the U.S. Centers for Disease Control and Prevention stepped in to help with a Cabell County outbreak. A couple years later, the agency returned to address cases in Kanawha County, with one top health official calling the outbreak the “most concerning in the United States.”

West Virginia HIV cases have decreased over the last two years, but many doctors and researchers worry about undetected spread, especially in rural parts of the state.

Despite the national attention, no West Virginia counties are included in the federal government’s Ending the HIV Epidemic initiative. The program is designed to direct additional funding and resources to communities heavily impacted by the infectious disease.

Gregg Gonsalves, a Yale University School of Public Health professor who studies HIV transmission, said he was surprised to learn West Virginia and its counties weren’t included in the program.

He said Gupta, using his position in the federal government, could ask Health and Human Services Secretary Xavier Becerra and CDC Director Mandy Cohen to include West Virginia or some of its counties in the initiative.

More funding for recovery residences

Even if state residents with addictions find and receive treatment, sustaining recovery can be challenging. West Virginians in recovery can struggle to find places to live where they aren’t around drugs or alcohol.

Recovery residences, also known as sober living houses, can help with that. The state and federal governments have said the housing units can help people in recovery avoid relapsing.

But in West Virginia, recovery residences often face financial barriers. A survey of state sober living homes last year found that the biggest challenge the organizations faced was financial resources, and the surveyed organizations said only 12% of their revenue comes from federal grants.

Jon Dower, the executive director of West Virginia Sober Living, said the federal government could make these grants easier for recovery residences to win, especially for people who are looking to start state-certified homes.

“If we look at what’s most needed in the recovery housing space in West Virginia, in my opinion it’s capacity,” he said.

Reach reporter Allen Siegler at allen@mountainstatespotlight.org

Source: https://www.timeswv.com/news/west_virginia/bidens-drug-czar-is-in-west-virginia-this-week-here-are-five-things-the-federal/article_43e1fe42-4b80-11ef-8ce1-6b4a5826d699.html

Filed under: Addiction,Drug use-various effects,Heroin/Methadone,Prevalence,Prevention and Intervention,Treatment and Addiction,USA :

The number of drug overdoses in this country went down in 2023. But not enough.

Posted July 29, 2024 |  Reviewed by Michelle Quirk

Key points

  • While overdoses from fentanyl went down in 2023, overdoses from cocaine and methamphetamine went up.
  • Increased availability of Narcan, harm-reduction practices, and drug seizures likely decreased deaths.
  • The best way to save lives and end the opioid epidemic is to prevent addiction in the first place.

With this tragic news just in, there are several important things to say about the drug overdose situation in this country.

The first is this: It is important that we don’t talk about the more than 107,000 overdose deaths in the United States last year like it’s just a statistic.

These are people’s lives that ended, people like you and me. People with friends and loved ones who cared about them, and who wanted them to succeed.

Evidence of an ongoing tragedy

This is where we are with the continuing drug epidemic, according to the recently released Centers for Disease Control and Prevention (CDC) data from 2023:

  • 107,543 people died from drug overdose deaths compared to 111,029 in 2022. That is a 3 percent decline.
  • 2023 witnessed the first annual decrease in five years (since 2018).
  • Indiana, Kansas, Maine, and Nebraska each saw overdose deaths decrease by at least 15 percent. Note: We need to determine what’s working in those states, and replicate it elsewhere.
  • Alaska, Oregon, and Washington each saw overdose deaths increase by at least 27 percent. Note: We need to determine what’s not working in those states, and figure out solutions including by sharing best practices from states with lower overdose rates.)
  • While overdoses from fentanyl (the main driver of drug deaths) went down in 2023, overdoses from cocaine and methamphetamine went up.

Three developments that are helping to reduce deaths

1. Greater availability of Narcan: I’m a huge advocate for this overdose reversal drug, which is naloxone in nasal spray form. I have argued often that it should be as ubiquitous as the red-boxed automated external defibrillators (AEDs) you now see in malls, hotel lobbies, schools, airports, and workplaces.

The U.S. Food and Drug Administration (FDA) took a big and meaningful step in that direction when it approved Narcan for over-the-counter use in March 2023. I have no doubt the increased availability of Narcan has helped bring the overdose numbers down, since Narcan targets opioids like fentanyl and heroin.

2. The stepping up of harm-reduction efforts: Harm reduction means reducing the health and safety dangers around drug use. The goal is to save lives and protect the health of people who use drugs through such measures as fentanyl test strips, overdose prevention sites, and sterilized injection equipment and services.

Harm reduction was a key plank of the White House’s 2022 National Drug Control Strategy aimed directly at the overdose epidemic. Countless harm-reduction efforts have gained traction at the local and state level as well. Again, this continued push may have helped bring down the overdose numbers last year.

3. Increased efforts around law enforcement drug seizures: Of the 107,543 people who overdosed in 2023, 74,702 (70 percent) of them did so after using the synthetic opioid fentanyl, which is many times more potent than heroin. For the first time in years, that number of deaths was lower than the year before.

Why? No doubt in part because 115 million pills containing fentanyl were seized by law enforcement in 2023. That compared to 71 million fentanyl-laced pills seized in 2022. These seizure efforts seem to be working, and they need to be stepped up even more.

Drug use prevention efforts must increase also

Ultimately, the best way to save lives, end the opioid epidemic, and halt the spread of substance use disorder is to stop people from becoming addicted in the first place.

The big news: Statistics show that drug use may be trending down among young people. Even delaying the onset of addiction can change the trajectory of the problem, says Nora Volkow, MD, director of the National Institute on Drug Abuse.

When asked recently about the lower number of overdose deaths last year, Volkow said: “Research has shown that delaying the start of substance use among young people, even by one year, can decrease substance use for the rest of their lives. We may be seeing this play out in real time [in 2023]. The trend is reassuring.”

Final thoughts on turning the tide of addiction

As the antismoking campaign that began in the 1960s showed us, massive and well-coordinated public health efforts can work.

Surgeon General warning labels, hard-hitting public service announcements, school-based programs—all of those had a cumulative effect on smoking habits in this country, especially among young people. Those efforts all targeted one thing: prevention.

We need to do much more of that in 2024 around opioids, methamphetamines, cocaine, and other lethal drugs. Lives depend on it.

Source: https://www.psychologytoday.com/us/blog/use-your-brain/202407/a-closer-look-at-107543-lives-lost-to-drug-overdoses

Filed under: Addiction,Cocaine,Drug use-various effects,Fentanyl,Heroin/Methadone,HIV/Injecting-Drug-Users,Prevalence,Prevention and Intervention,Treatment and Addiction,USA :

July 29, 2024

 By Dr. Nora Volkow. Director, NIDA.

This blog was also published in the American Society of Addiction Medicine (ASAM) Weekly on July 24, 2024.

Over the past several years, the increasing prevalence of fentanyl in the drug supply has created an unprecedented overdose death rate and other devastating consequences. People with an opioid use disorder (OUD) urgently need treatment not just to protect them from overdosing but also to help them achieve recovery, but highly effective medications like buprenorphine and methadone remain underused. Amid this crisis, it is critical that methadone, in particular, be made more accessible, as it may hold unique clinical advantages in the age of fentanyl.

Growing evidence suggests that methadone is as safe and effective as buprenorphine for patients who use fentanyl. In a 2020 naturalistic follow-up study, 53% of patients admitted to methadone treatment who tested positive for fentanyl at intake were still in treatment a year later, compared to 47% for patients who tested negative. Almost all (99%) of those retained in treatment achieved remission. An earlier study similarly found that 89% of patients who tested positive for fentanyl at methadone treatment intake and who remained in treatment at 6 months achieved abstinence.

Methadone may even be preferable for patients considered to be at high risk for leaving OUD treatment and overdosing on fentanyl. Comparative effectiveness evidence is emerging which shows that people with OUD in British Columbia given buprenorphine/naloxone when initiating treatment were 60% more likely to discontinue treatment than those who received methadone (1). More research is needed on optimal methadone dosing in patients with high opioid tolerance due to use of fentanyl, as well as on induction protocols for these patients. It is possible that escalation to a therapeutic dose may need to be more rapid.

It remains the case that only a fraction of people who could benefit from medication treatment for OUD (MOUD) receive it, due to a combination of structural and attitudinal barriers. A study using data from the National Survey on Drug Use and Health (NSDUH) from 2019—that is, pre-pandemic—found that only slightly more than a quarter (27.8%) of people who needed OUD treatment in the past year had received medication to treat their disorder. But a year into the pandemic, in 2021, the proportion had dropped to just 1 in 5.

Efforts have been made to expand access to MOUD. For instance, in 2021, the U.S. Department of Health and Human Services (HHS) advanced the most comprehensive Overdose Prevention Strategy to date. Under this strategy, in 2023, HHS eliminated the X-waiver requirement for buprenorphine. But in the fentanyl era, expanded access to methadone too is essential, although there are even greater attitudinal and structural barriers to overcome with this medication. People in methadone treatment, who must regularly visit an opioid treatment program (OTP), face stigma from their community and from providers. People in rural areas may have difficulty accessing or sticking with methadone treatment if they live far from an OTP.

SAMHSA’s changes to 42 CFR Part 8 (“Medications for the Treatment of Opioid Use Disorder”) on January 30, 2024 were another positive step taken under the HHS Overdose Prevention Strategy. The new rule makes permanent the increased take-home doses of methadone established in March 2020 during the COVID pandemic, along with other provisions aimed to broaden access like the ability to initiate methadone treatment via telehealth. Studies show that telehealth is associated with increased likelihood of receiving MOUD and that take-home doses increase treatment retention.

Those changes that were implemented during the COVID pandemic have not been associated with adverse outcomes. An analysis of CDC overdose death data from January 2019 to August 2021 found that the percentage of overdose deaths involving methadone relative to all drug overdose deaths declined from 4.5% to 3.2% in that period. Expanded methadone access also was not associated with significant changes in urine drug test results, emergency department visits, or increases in overdose deaths involving methadone. An analysis of reports to poison control centres found a small increase in intentional methadone exposures in the year following the loosening of federal methadone regulations, but no significant increases in exposure severity, hospitalizations, or deaths.

Patients themselves reported significant benefits from increased take-home methadone and other COVID-19 protocols. Patients at one California OTP in a small qualitative study reported increased autonomy and treatment engagement. Patients at three rural OTPs in Oregon reported increased self-efficacy, strengthened recovery, and reduced interpersonal conflict.

The U.S. still restricts methadone prescribing and dispensing more than most other countries, but worries over methadone’s safety and concerns about diversion have made some physicians and policymakers hesitant about policy changes that would further lower the guardrails around this medication. Methadone treatment, whether for OUD or pain, is not without risks. Some studies have found elevated rates of overdose during the induction and stabilization phase of maintenance treatment, potentially due to starting at too high a dose, escalating too rapidly, or drug interactions.

Although greatly increased prescribing of methadone to treat pain two decades ago was associated with diversion and a rise in methadone overdoses, overdoses declined after 2006, along with methadone’s use as an analgesic, even as its use for OUD increased. Most methadone overdoses are associated with diversion and, less often, prescription for chronic pain; currently, 70 percent of methadone overdoses involve other opioids (like fentanyl) or benzodiazepines.

Recent trials of models of methadone dispensing in pharmacies and models of care based in other settings than OTPs have not supported concerns that making methadone more widely available will lead to harms like overdose. In two feasibility studies, stably maintained patients from OTPs in Baltimore, Maryland and Raleigh, North Carolina who received their methadone from a local pharmacy found this model to be highly satisfactory, with no positive urine screens, adverse events, or safety issues. An older pilot study in New Mexico found that prescribing methadone in a doctor’s office and dispensing in a community pharmacy, as well as methadone treatment delivered by social workers, produced better outcomes than standard care in an OTP for a sample of stably maintained female methadone patients.

Critics of expanded access to methadone outside OTPs sometimes argue that the medication should not be offered without accompanying behavioural treatment. Data suggest that counselling is not essential. In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment. However, counselling may have benefits or even be indispensable for some patients to help them improve their psychosocial functioning and reduce other drug use. How to personalize the intensity and the level of support needed is a question that requires further investigation.

Over the past two decades, the opioid crisis has accelerated the integration of addiction care in the U.S. with mainstream medicine. Yet methadone, the oldest and still one of the most effective medications in our OUD treatment toolkit, remains siloed. In the current era of powerful synthetic opioids like fentanyl dominating the statistics on drug addiction and overdose, it is time to make this effective medication more accessible to all who could benefit. The recent rules making permanent the COVID-19 provisions are an essential step in the right direction, but it will be critical to pursue other ways that methadone can safely be made more available to a wider range of patients with OUD. Although more research would be of value, the initial evidence suggests that providing methadone outside of OTPs is feasible, acceptable, and leads to good outcomes.

Source: https://nida.nih.gov/about-nida/noras-blog/2024/07/to-address-the-fentanyl-crisis-greater-access-to-methadone-is-needed

Filed under: Fentanyl,Heroin/Methadone,Prevention and Intervention,Treatment and Addiction,USA :

Cannabis or more commonly known as marijuana, is one of the most frequently used drugs in the United States. In 2022, marijuana became more popular than alcohol as the preferred daily drug of use among Americans. In the same year, it was found that 30 out of every 100 high school age students reported using the drug within the past 12 months, and 3 of every 50 reported using it daily.

Marijuana is often perceived as harmless, which has influenced its increased use by a factor of 15 within the past three decades, but this substance can have severe physical and mental health effects.

This blog will share the heart-wrenching stories of Brant Clark and Shane Robinson, as told by their families, along with a recent article by Alton Northup editor-in-chief of KentWired. Their lives were tragically cut short by marijuana induced psychosis.

Brant Clark

Ann Clark shares the heartbreaking story of her 17-year-old son, Brant, who experienced cannabis-induced psychosis leading to his tragic suicide. She recounts his rapid descent into hopelessness and the devastating impact on their family to raise awareness about the dangers of marijuana use on mental health.

Ann Clark shares the heartbreaking story of her 17-year-old son, Brant, who experienced cannabis-induced psychosis leading to his tragic suicide. She recounts his rapid descent into hopelessness and the devastating impact on their family to raise awareness about the dangers of marijuana use on mental health.

Brant Clark (pictured) was a happy and bright 17-year-old who reported using marijuana socially. However, during his last high school winter break, after smoking marijuana at a party with friends, he experienced a psychotic break believed to have been triggered by smoking a large amount of potent marijuana.

After the party Brent expressed to his mother his feelings of “emptiness and hopelessness”, and deep regret, lamenting his decision to smoke marijuana. Within two days of the onset of symptoms, Brant was admitted to the ER and psychiatric care unit. Tragically, three weeks later, he ended his own life, leaving behind a note revealing his intense mental anguish and regret.

Brant’s doctor diagnosed him with Cannabis-Induced Psychosis, a condition where marijuana use leads to severe mental disturbances. Brant’s case highlights how this condition can manifest suddenly and with tragic consequences. Ann, Brant’s mother, recalls the happiness her son brought to her life, and the pain that lingers after his loss.

 Shane Robinson

In 2009, Lori Robinson’s son faced a similar fate. Shane, a vibrant 23-year-old, turned to marijuana for pain relief after a knee injury. Despite his parents’ concerns, Shane believed that the drug was a safe alternative to pain medication. However, Shane’s behavior changed drastically. He began to experience hallucinations and delusions. After being hospitalized several times and a prolonged struggle with mental health, Shane took his own life at the age of 25.

Lori, Shane’s mother, shared that the psychologists who treated her son questioned marijuana’s role in Shane’s mental illness, but neither Shane nor Brant had any prior history of mental illness, and their symptoms rapidly emerged after using marijuana.

Cannabis-Induced Psychosis would finally be added as a recognized mental health diagnosis in the year of 2013.

 

Medical and Scientific Insights

Although research still has a long way to go and should continue to examine how mental health disorders are affected by marijuana use independently, it should also focus on understanding the physiological mechanisms, as well as the effects of increased potency and contaminants in marijuana. The progress that has been made is enough to encourage the continuation of this field of research. Recent studies have shown strong associations between cannabis use disorder (CUD) and psychotic episodes. One study showed that 5 out of every 6 teenagers who sought help for a psychotic episode had used marijuana and that they were 11 times more likely to experience psychotic episodes compared to non-users of the drug. Another study showed a 30% increase in schizophrenia cases among men aged 21-30 were associated with CUD.

Dr. David Streem from the Cleveland Clinic shared with the editor of KentWired that he has observed a dramatic increase in psychosis cases over the past decade, which aligns with the increase in marijuana potency from less than 10% in the 90s to 30% or more today.

Advocating for Prevention

Ann Clark and Lori Robinson have become advocates, raising awareness about the dangers of cannabis-induced psychosis. Despite facing skepticism and opposition, they courageously continue to share their son’s stories to educate others about the potential risks of marijuana use.

As marijuana becomes widely legalized, Ann believes that “it only gives our young people a lower perception of harm, and a false sense of security and safety”. However, increased levels of THC and the building body of evidence linking marijuana to mental health conditions, call for greater public health education and regulations.

The tragic stories of Brant and Shane underscore the urgent need for awareness about cannabis-induced psychosis as the use of marijuana becomes more prevalent among younger populations.

Source: https://kentwired.com/120770/news/cannabis-induced-psychosis-cost-their-sons-their-lives-more-could-be-next/

Filed under: Cannabis/Marijuana,Mental Health,Prevention and Intervention,Treatment and Addiction,USA :

Israel, now the largest per capita consumer of opioids, faces a rising crisis. Learn about the challenges, responses from health authorities, and the need for improved treatment and prevention.

By JUDY SIEGEL-ITZKOVICH
When in 2021, the US Centers for Disease Control and Prevention counted the deaths of over a million Americans from overdosing with opioids – synthetic, painkilling prescription drugs including fentanyl (100 times more powerful than morphine), oxycodone, hydrocodone and many others – Israel’s Health Ministry was asked whether it could happen here. No, its spokesperson said, even though nearly every negative and positive phenomenon in North America inevitably arrives here within a couple of years.

The epidemic began about 25 years ago when drug and healthcare companies began to enthusiastically promote these very-addictive chemicals, claiming they were effective in relieving suffering and did not cause dependency.

A study published this past May by researchers at the Johns Hopkins Bloomberg School of Public Health found that one out of every three Americans have lost someone – a relative or a friend – to an opioid or other drug overdose. The US National Institute on Drug Abuse found that more than 320,000 American children have lost parents from overdoses in the past decade, and the annual financial costs to the US of the opioid crisis is $1 trillion.

Largest consumers of opioids per capita

Incredibly, Israelis today are the largest consumers per capita in the world of opioids, and an untold number of them are addicted or have already died. No one knows the fatality figures here, as the causes of death are described as organ failures, seizures, heart attack or stroke – not listed by what really caused them.

Is this another example of a “misconception” – wishful thinking on the scale of the belief by the government, the IDF, and the security forces that Hamas would “behave” if regularly paid off with suitcases full of cash? Is Israel headed to where the US already is? Perhaps. What is clear is that our various health authorities now have to somehow clean up the opioid mess.

The scandal has been indirectly embarrassing for Israel because among the most notorious companies involved in the opioid disaster is the Sackler family, who own the Purdue Pharma company that manufactured and promoted the powerful and addictive opioid OxyContin and who are now drowning in huge lawsuits. Tel Aviv University’s Medical Faculty that was for decades known as the Sackler Faculty has deleted it from its name.

Last year, the Knesset Health Committee met to discuss the rise in opioid consumption here, with testimony from Ben-Gurion University of the Negev School of Public Health dean and leading epidemiologist Prof. Nadav Davidovitch, who is also the principal researcher and chairman of the Taub Center Health Policy Program. He stressed that inappropriate use of strong pain medications leads to addiction and other severe negative consequences and noted that while most of the rise in consumption is among patients of lower socioeconomic status, the well-off are also hooked. Davidovitch called for the launching of serious programs to treat addicted Israelis based on the experiences of other countries with the crisis.

Opioids attach themselves to opioid-receptor proteins on nerve cells in the brain, gut, spinal cord, and other parts of the body. This obstructs pain messages sent from the body through the spinal cord to the brain. While they can effectively relieve pain, they can be very addictive, especially when they are consumed for more than a few months to ease acute pain, out of habit, or from the patients’ feeling of pleasure (they make some users feel “high”). Patients who suddenly stop taking them can sometimes suffer from insomnia or jittery nerves, so it’s important to taper off before ultimately stopping to take them.

The Health Ministry was forced in 2022 to alter the labels on packaging of opioid drugs to warn about the danger of addiction after the High Court of Justice heard a petition by the Physicians for Human Rights-Israel and the patients’ rights organization Le’altar that claimed the ministry came under pressure from the pharmaceutical companies to oppose this. After ministry documents that showed doctors knew little about the addictions caused by opioids were made public by the petitioners, psychiatrist Dr. Paola Rosca – head of the ministry’s addictions department – told the court that the synthetic painkillers cause addiction. She has not denied the claim that the ministry was squeezed by the drug companies to oppose label changes.

No special prescription, no time limit, no supervision

In an interview with The Jerusalem Post, Prof. Pinhas Dannon – chief psychiatrist of the Herzog Medical Center in Jerusalem and a leading expert on opioid addiction – noted that anyone with a medical degree can prescribe synthetic painkillers to patients. “There is no special prescription, no time limit, no supervision,” he said.

“A person who undergoes surgery who might suffer from serious pain is often automatically given prescriptions for opioids – not just one but several,” Dannon revealed. “Nobody checks afterwards whether the patient took them, handed them over to others (for money or not), whether they took several kinds at once, or whether they stopped taking them. They are also prescribed by family physicians, orthopedists treating chronic back pain, urologists, and other doctors, not only by surgeons.”

Dannon, who runs a hospital clinic that tries to cure opioid addiction, said there are only about three psychiatric hospitals around the country that have small in-house departments to treat severely addicted patients. “Not all those addicted need inpatient treatment, but when we build our new psychiatry center, we would be able to provide such a service.”

Since opioids are relatively cheap and included in the basket of health services, the four public health funds that pay for and supply them have not paid much attention. Once a drug is in the basket, it isn’t removed or questioned. Only now, when threatened by lawsuits over dependency, have the health funds begun to take notice and try to promote reductions in use.

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Dannon declared that the health funds, hospitals, and pharmacies must seriously supervise opioid use by tracking and be required by the ministry to report who is taking them, how much, what ages, and for how long. Opioids are meant for acute pain, not for a long period. “The Health Ministry puts out fires but is faulty in prevention and supervision,” he said.

A Canadian research team has just conducted a study at seven hospital emergency departments in Quebec and Ontario to determine the ideal quantity of prescription opioids to control pain in discharged patients and reduce unused opioids available for misuse.

They recommended that doctors could adapt prescribing quantity to the specific condition causing pain, based on estimates to alleviate pain in 80% of patients for two weeks, with the smallest quantity for kidney or abdominal pain (eight tablets) and the highest for back pain (21 tablets) or fractures (24 tablets), and add an expiry date for them. Since half of participants consumed even smaller quantities, pharmacists could provide half this quantity to further reduce unused opioids available for misuse.

No medical instruction on the Issue

Rosca, who was born in Italy where she studied medicine and came on aliyah in 1983, has worked in the ministry since 2000; in 2006, she became head of the addictions department.

“In Italy, every psychiatrist must learn about alcohol and other drug addictions including opioids,” she said. “Here, there is no mandatory course in any medical school on the subject. We tried to persuade the Israel Medical Association and its Scientific Council, which decides on curricula and specializations, but we didn’t succeed. Maybe now, in the face of the crisis, it will change its mind. We run optional courses as continuing medical education for physicians who are interested.”

Her department wanted pharmacists to provide electronic monitoring of opioid purchases, but “the Justice Ministry opposed it on the grounds that it would violate privacy. I wasn’t asked for my opinion.”

She concedes that the ministry lacks statistics on the number of addicted people, and Arabs have been excluded from estimates until now. “We’re doing a study with Jerusalem’s Myers-JDC-Brookdale Institute to find out how many. Some say one percent, some say five percent. We hope that by December, we will get more accurate figures. Before the COVID-19 pandemic, the ministry set up a committee on what to do about opioids, but its recommendations were never published, and there was no campaign,” Rosca recalled.

In 1988, the government established the statutory Anti-Drug Authority that was located in Jerusalem’s Givat Shaul neighborhood. It was active in fighting abuse and shared research with foreign experts, but seven years ago, its name was changed to the National Authority for Community Safety and became part of the Ministry for National Security, losing much of its budgets – and, according to observers, its effectiveness as well.

The Health Ministry used to be responsible for setting up and operating clinics for drug rehabilitation, but it handed this over in 1997 to a non-profit organization called the Israel Public Health Association, which employs numerous former ministry professionals. Its director-general, lawyer Yasmin Nachum, told the Post in an interview that the IPHA is very active in fighting drug addiction.

“Israel can’t deny anymore that we are in a worrisome opioid epidemic like that in the US: We are there,” he said. “We see patients every day. Some used to take heroin and other street drugs, but with the easy access and low price, they have switched to opioids. If they are hospitalized for an operation and don’t use all the prescriptions they are given, they sell them to others. We want to have representation in every hospital to warn doctors and patients.”

Of a staff of 1,100, the IPHA has 170 professionals – narcotics experts, social workers, occupational therapists, and others working with 3,000 addicted patients every day. Its other activities include mental health, ensuring safety of food and water, and rehabilitation.

Stopping after six months

“We work in full cooperation with the ministry,” Nachum said. “Our approach is that when opioids are taken for pain for as long as six months, it’s the time to stop taking them. The doctors provide addicted patients with a drug called buprenorphine, sold under the brand name Subutex, which is used to treat opioid-use disorder, acute pain, and chronic pain.”

Buprenorphine is a mixed opioid agonist and antagonist. That means it has some of the effects of opioids but also blocks some of their effects. Before the patient can take it under direct observation, he must have moderate opioid-withdrawal symptoms. The drug relieves withdrawal symptoms from other opioids and induces some euphoria, but it also blocks the efficacy of many other opioids including heroin, to create an effect.

Buprenorphine levels in the blood stay consistent throughout the month. Nachum said the replacement drug is relatively safe, with some side effects, but fortunately, there is no danger of an overdose.

NARCAN (NALOXDONE) is another prescription drug used by some professionals to fight addiction. Not in Israel’s basket of health services, it blocks the effects of opioids by temporarily reversing them, helping the patient to breathe again and wake up from an overdose. While it has saved countless lives, new and more powerful opioids keep appearing, and first responders are finding it increasingly difficult to revive people with it.

Now, US researchers have found an approach that could extend naloxone’s lifesaving power, even in the face of continually more dangerous opioids by using potential drugs that make naloxone more potent and longer lasting. Naloxone is a lifesaver, but it’s not a miracle drug; it has limitations, the team said.

After the Nova massacre on October 7, when significant numbers of participants who were murdered were high on drugs, the IPHA received a huge number of calls. In December, Nachum decided to open a hotline run by professionals about addiction that has been called monthly by some 300 people. “We also hold lectures for pain doctors, family physicians, and others who are interested, because there has been so little awareness.”

All agree that the opioid crisis has been seriously neglected here and that if it is not dealt with seriously and in joint efforts headed by healthcare authorities, it will snowball and add to Israel’s current physical and psychological damage.

Source: https://www.jpost.com/health-and-wellness/article-811126

Filed under: Heroin/Methadone,Others (International News),Prevention and Intervention,Treatment and Addiction :

By Nora D. Volkow and Tisha Wiley / July 9, 2024

 

Programs across the country are underway to offer naloxone, also sold as Narcan, in jails and prisons, paired with instruction, training, and social support

The overdose crisis is claiming lives across the United States, but it reaches new depths of despair in the criminal justice system. Overdose is the leading cause of death among people returning to their communities after being in jail or prison. Providing addiction treatment in these settings could change that.Roughly 60% of people who are incarcerated have a substance use disorder, in many cases an opioid use disorder. When people with addiction leave prison or jail and return to their communities, they are at very high risk of returning to drug use and overdosing. Their tolerance to drugs has diminished during incarceration, and fentanyl is pervasive in the street drug supply. Even one relapse could be fatal.It remains a common belief that simply stopping someone from taking drugs while in jail or prison is an effective approach to treatment. But that belief is inaccurate and dangerous. As scientists, we look to research to guide us. And when research shows strategies with clear benefits, they should be deployed.The Food and Drug Administration has approved three medications for opioid use disorder: methadone, buprenorphine, and naltrexone. All three are effective, safe, and lifesaving. But they are woefully underused, particularly in criminal justice settings.

Related: Rigid rules at methadone clinics are jeopardizing patients’ path to recovery from opioid addiction

A 2020 study in Rhode Island estimated that overdose deaths could be reduced by 30% in the state if jails and prisons made all three medications available to those who needed them. Studies also show that people who receive these medications while in jail or prison are less likely to return to substance use and more likely to continue with treatment in the community afterward.

Less than half of jails nationwide, and fewer than 10% of state prisons, offer all three medications. While 96% of jails did provide the overdose reversal drug naloxone to staff, only 1 in 3 provided naloxone and training on how to use it to decarcerated citizens during the critical period when they were returning to their communities.

Neglecting to provide access to these lifesaving treatments and harm-reduction measures creates deadly gaps for people when they leave jail or prison. The repercussions reverberate throughout communities and generations. They deepen racial inequities and overrepresentation of communities of color within the criminal justice system. They cause devastation for children and families.

Providing medications for opioid use disorder in jails and prisons benefits public health and public safety. It’s cost–effective. It can help break the cycle of recidivism. It can reduce the burden on the wider health care system, including emergency departments.

Programs across the country are underway to offer naloxone and medications for opioid use disorder in jails and prisons, paired with instruction, training, and social support. Federal agencies have launched programs to help people manage withdrawal in jails and provide financial health care support for people who are about to reenter the community. A recently published revised methadone rule now allows any jail or prison registered as a hospital or clinic to dispense medications for opioid use disorder in certain circumstances.

Law enforcement leaders are starting to see how addiction treatment increases safety for everyone. Chris Donelan, the sheriff of Franklin County, Mass., has partnered with researchers to study what happens when jails offer all three FDA-approved opioid use disorder medications. His jail became one of the few in the nation to be licensed as an opioid treatment program.

Related: Q&A: Nora Volkow on how to get ‘at least 50% less people dying’ from opioid overdose

“When someone is booked into our facility, often we are the first treatment provider the person has seen in years,” Donelan told his University of Massachusetts research partners. “These treatments save lives and help people enter into recovery. Treatment makes the work of our facility much easier. We have less fights, less contraband, and a much safer facility.”

Since 2019, the National Institutes of Health has funded partnerships across the country to figure out how to link people with addiction to care during and after their time in the corrections system. These researchers are poised to share new evidence as it emerges that will help other communities make data-driven changes so they can implement what is most efficient in justice settings.

There is still a long way to go. A dangerous supply of street drugs, fragmented treatment systems, lack of funding, lack of training, pervasive stigma, and complex logistics all work against people with substance use disorders as they work to rebuild their lives after incarceration. Support in recovery and continuity of care are essential during this vulnerable time.

Fundamentally, an individual’s best or only option to receive addiction treatment should not have to be during incarceration. In an ideal world, treatment and prevention systems in the U.S. would proactively address social drivers of health and mental health needs to stop the cycle between addiction and incarceration. Moving away from criminalization of substance use disorders toward a public-health approach would remove a key structural practice that perpetuates inequalities. It would improve lives for people and their families.

The Authors

Nora D. Volkow, M.D., is a psychiatrist, scientist, and director of the National Institute on Drug Abuse, which is part of the National Institutes of Health.
 

Tisha Wiley, Ph.D., is a social psychologist, associate director for justice systems at NIDA, and leads the NIH Justice Community Opioid Innovation Network initiative, which studies approaches to increase high-quality care for people in justice settings with opioid misuse or opioid use disorder.
 

Source: https://www.statnews.com/2024/07/09/providing-addiction-treatment-prisons-jails/

Filed under: Addiction,Crime/Violence/Prison,Treatment and Addiction,USA :

Simantik Dowerah – First Post India• June 26, 2024

Social stigma and low awareness about available treatment options significantly impact treatment-seeking behaviours, professor at the Department of Psychiatry at NIMHANS Bangalore, Dr Prabhat Chand tells Firstpost
(File) Students take part in an awareness march to mark the International Day against Drug Abuse and Illicit Trafficking, in Patna. PTI

The International Day Against Drug Abuse and Illicit Trafficking, observed every year on 26 June, serves as a global reminder of the urgent need to combat the menace of drug abuse and illicit trafficking. This day aims to raise awareness about the severe impact of drug addiction on individuals, families and communities worldwide. It also emphasises the importance of prevention, treatment and rehabilitation efforts to address this complex issue.

Governments, organisations and individuals come together on this day to advocate for policies and actions that promote a drug-free world, supporting those affected by addiction and working towards sustainable development and peace. The day calls for solidarity and collective action to safeguard public health and build healthier, safer societies for all.

On the occasion of the International Day Against Drug Abuse and Illicit Trafficking, Firstpost interviewed Dr Prabhat Chand, professor at the Department of Psychiatry, Centre for Addiction Medicine & NIMHANS Digital Academy VKN ECHO, Bangalore to gain insights into drug abuse trends in India and its broader societal implications.

How grave is drug abuse in India and how have their usage patterns changed over time?

Drug abuse in India is a significant public health challenge affecting diverse populations across the nation. The most abused substances after alcohol are cannabis and opioids. According to national surveys, the prevalence of cannabis users is 3.1 crore and about 72 Lakh are problem users. The opioid use increased significantly from 0.7 per cent to 2.1 per cent (i.e., 2.3 crore) during the same period. Other substances such as sedatives (1.08 per cent), inhalants (0.7 per cent), cocaine (0.10 per cent), amphetamines (0.18 per cent), and hallucinogens (0.12 per cent) also contribute significantly to the drug abuse landscape. The International Day Against Drug Abuse and Illicit Trafficking on June 26th, 2024, with the theme ‘The evidence is clear: invest in prevention,’ underscores the urgency of this issue.

How do socio-economic factors influence vulnerability to substance abuse in India? What are the demographics mostly affected and at high risk?

Socio-economic factors such as peer influence, societal pressures, difficult childhood and lack of access to supportive environments significantly influence vulnerability to substance abuse in India. The demographics mostly affected and at high risk include young male adults aged 18-25, people from low socio-economic backgrounds and those with lower educational attainment. Over the years, the age of onset for first substance use has been decreasing consistently.

What are the primary challenges in accessing addiction treatment facilities across different tiers of cities in India?

Access to treatment facilities varies significantly across different regions and city tiers. The treatment gap for addictive disorders is as high as 75 per cent, as per various national surveys. It means 75 out of 100 people with addictive disorders do not have access to care. The challenge is twofold – 1. Accessibility of care 2. Quality of care. For example, for opioid use disorder, Opioid against treatment (OAT) is evidence-based care across the world. But in India, the supply of OAT is available in very few places. That means people have to travel far to access the care. It is well known that addiction is a chronic brain condition and needs good aftercare. These are compounded by strong social stigma and low awareness. This emphasises the need for significant investments to enhance treatment options and optimise resource allocation based on national survey evidence.

How does stigma impact treatment-seeking behaviours in rural areas compared to urban centres?

Social stigma and low awareness about available treatment options significantly impact treatment-seeking behaviours. This leads people with addictive disorders to seek treatment at the later stage of the addiction cycle. Also, the studies show that more than 50 per cent of patients likely have comorbid psychiatric disorders, which also makes care more challenging. Bridging this gap requires tailored health service information campaigns to inform users and the general population about the available treatment services.

What strategies are recommended to bridge the treatment gaps between urban and rural areas, especially in smaller pockets and villages?

To bridge the treatment gaps – 1. Increase access to care 2. Making knowledge the effective interventions to the health care providers 3. Early identification by physicians, nurses or healthcare providers 4. Identification of high-risk youth and provider of holistic support 5. Integrate common substance use along with routine care like hypertension or diabetes.

Integrated care models and effective coordination between drug supply control and entities focused on demand reduction and harm reduction are crucial. Additionally, targeted outreach and education programmes can help prevent substance abuse and identify people in need of treatment at an earlier stage.

Why is it crucial to address gender disparities in treatment-seeking behaviours?

Addressing gender disparities in treatment-seeking behaviours is crucial because men predominantly access services compared to women. Tailored health service information campaigns are necessary to engage women and marginalised communities effectively, ensuring equitable access to treatment and support services. By promoting inclusivity in treatment access, India can foster a supportive societal framework that empowers people affected by substance abuse.

How can integrated care models improve outcomes for people with co-occurring substance abuse and mental health disorders?

Integrated care models can improve outcomes by providing comprehensive services that address both substance abuse and co-occurring mental health disorders. This necessitates significant investments to enhance treatment options and ensure effective coordination between drug supply control, demand reduction, and harm reduction entities. Such models are essential for addressing the multifaceted nature of substance abuse and its associated mental health issues.

What role do government policies, healthcare providers, NGOs and communities play in tackling the drug abuse crisis in India and how can collaboration be enhanced to achieve better outcomes?

Government policies, healthcare providers, NGOs and communities play a crucial role in tackling the drug abuse crisis in India. Collaboration among these entities can be enhanced by fostering coordination between drug supply control and demand reduction efforts, expanding treatment accessibility, promoting inclusivity in treatment access, and implementing targeted outreach and education programmes. By prioritising evidence-based strategies and fostering a supportive societal framework, India can empower people affected by substance abuse to reclaim their lives and contribute meaningfully to society. Sustained efforts in prevention, treatment infrastructure expansion and effective policy formulation are essential to achieving better outcomes and paving the way towards a healthier, drug-free future for Indian citizens.

Healthcare providers like doctors can use the ‘Addiction Rx mobile app’ as a guidance tool for screening, assessment and intervention in addictive disorders. This app is developed as a part of the standard treatment guidelines by the Ministry of Health and Family Welfare DDAP Addiction Rx app: iOS and Android.

The doctors, counsellors and nurses can discuss the cases and enrol in certificate courses at the NIMHANS Digital Academy ECHO weekly tele-platform to learn best practices.

Source: https://www.firstpost.com/india/international-day-against-drug-abuse-a-significant-public-health-challenge-affecting-india-13786238.html

Filed under: Environment,Mental Health,Others (International News),Prevention and Intervention,Treatment and Addiction :

By Leah Kuntz

Psychiatric Times Vol 41, Issue 6
Review tapering challenges and strategies for benzodiazepines in this Special Report article.

SPECIAL REPORT: ADVANCES IN PSYCHIATRY

Benzodiazepines, a controversial treatment widely prescribed for patients with anxiety and insomnia, carry a considerable risk of abuse. The poster “Mood Over Matter: Literature Review on Benzodiazepine Tapering, Current Practices and Updates on Adjunct Mood Stabilizers,” which was presented at the 2024 APA Annual Meeting, summarized a literature review of current benzodiazepine tapering practices, outpatient detoxification challenges, and potential barriers to discontinuation. The poster presenters also prioritized reviewing literature that highlighted mood stabilizer adjunct use.

Research demonstrates why clinicians should use caution when prescribing benzodiazepines. Results of a recent study revealed that between 2014 and 2016 an estimated 25.3 million (10.4%) adults in the United States reported using benzodiazepines, and approximately 17.2% of these individuals admitted to misuse.

Similarly, the National Institute on Drug Abuse documented that benzodiazepines were implicated in more than 14% of opioid overdose deaths in 2021. Furthermore, a report from the Centers for Disease Control and Prevention pinpointed benzodiazepines as a factor in nearly 7000 overdose deaths across 23 states from January 2019 to June 2020, constituting 17% of all drug overdose deaths. This time frame saw a staggering 520% surge in deaths related to illicit benzodiazepines, and fatalities from prescribed benzodiazepines rose by 22%.

The poster presenters stated that psychiatric and addiction- focused clinicians play an integral role in preventing benzodiazepine misuse and addiction.

To help patients taper benzodiazepines to discontinuation, clinicians must be up-to-date on practices; if clinicians mismanage tapering, sudden withdrawal can prove fatal. Challenges to tapering patients with chronic benzodiazepine use can be found in the Table.

Table. Challenges to Tapering Chronic Benzodiazepine Use

As for tapering strategies, the presenters suggested adjunct mood stabilizers such as carbamazepine and oxcarbazepine. Carbamazepine, when used as an adjunct or prophylactically, can help reduce intense withdrawal symptoms and thus keep patients on track for discontinuation. However, carbamazepine has received criticism regarding its efficacy, and it is well documented to have a series of concerning adverse effects such as skin reactions, agranulocytosis, leukopenia, and significant drug-drug interactions by nature of its metabolism. This makes some clinicians wonder: Are the risks worth the benefit?

Oxcarbazepine has also been proposed as an alternative. Results of some small-scale clinical trials noted moderate efficacy for oxcarbazepine in helping patients with detoxification, and it has fewer adverse effect concerns. The presenters suggested that other mood stabilizers, particularly those with antiepileptic effects, require further research for their potential help with benzodiazepine addiction.

“Through a more current literature review, we hope to increase the tools available to psychiatrists for more success in discontinuation and maintaining sobriety for patients,” the presenters wrote.

In a previous Psychiatric Times article, Steve Adelman, MD, of the University of Massachusetts Medical School in Boston, suggested 8 universal precautions adapted from Gourlay et al for use by psychiatrists who must decide whether to initiate or continue pharmacotherapy with benzodiazepines. They include making a diagnosis with an appropriate differential and creating and ratifying a treatment agreement. However, other clinicians, such as Daniel Morehead, MD, a Psychiatric Times columnist and featured cover author in this issue, suggest that although benzodiazepines carry risks, those risks are exaggerated by government officials, critics, and the public at large.

Source: https://www.psychiatrictimes.com/view/how-to-safely-and-effectively-taper-benzodiazepines

Filed under: Effects of Drugs,Mental Health,Prescription Drugs,Psychiatric drugs,Treatment and Addiction,USA :

By Carole Tanzer Miller HealthDay Reporter

MONDAY, June 10, 2024 (HealthDay News) — Though overdose deaths continue to surge, there is no approved medication to treat methamphetamine use disorder.

Now, an experimental two-drug therapy has yielded promising results, UCLA researchers report.

“These findings have important implications for pharmacological treatment for methamphetamine use disorder,” said researcher Dr. Michael Li, an assistant professor-in-residence of family medicine at the David Geffen School of Medicine at UCLA, adding that methamphetamine-involved overdoses have surged.

His team published its findings June 10 in the journal Addiction.

In urine tests for methamphetamine, drug-free results rose 27% among participants who received a combination of injectable naltrexone plus extended-release oral buproprion. Negative tests rose only 11%, meanwhile, in a control group.

Methamphetamine abuse is a growing problem around the world, with an estimated 34 million users in 2020 compared to 33 million 10 years earlier. In the United States alone, overdose deaths rose fivefold between 2012 and 2018.

The National Institute on Drug Abuse Clinical Trials Network has supported various trials, including this one, to evaluate different treatments for methamphetamine use disorder.

This trial, known as ADAPT-2, ran from May 2017 to July 2019 at eight sites. More than 400 participants were included, including 109 who received the experimental drug therapy in the first phase. That demonstrated that the combo worked at six weeks.

The new findings are from the trial’s second phase, which looked at a longer period. Partipants were drug-tested at weeks seven and 12 and again, after treatment, at 13 and 16 weeks.

While their results were encouraging, researchers said further study is needed to find out if the treatment lasts longer than 12 weeks and leads to further reductions in drug use.

“Prior stimulant use disorder treatment trials suggest that change in use is gradual [consistent with our findings], unlikely to result in sustained abstinence in a typical 12-week trial, and dependent on treatment duration,” the researchers said in a UCLA news release. “This warrants future clinical trials to quantify changes in [methamphetamine] use beyond 12 weeks and to identify the optimal duration of treatment with this medication.”

Source: https://www.medicinenet.com/two_drug_treatment_could_curb_meth_addiction/news.htm

 

Filed under: Drug Specifics,Treatment and Addiction,USA :

Cultural, systemic and historical factors have converged to create the perfect storm when it comes to Black overdose deaths.

By Liz Tung – June 14, 2024

Reporter at The Pulse

WHYY (PBS) 14th June 2024

A recent study from the Pennsylvania Department of Health has found that Black people who died from opioid overdoses were half as likely as white people to receive the life-saving drug naloxone, otherwise known as Narcan. The study also found that Black overdose deaths in Pennsylvania increased by more than 50% between 2019 and 2021, compared with no change in white overdose deaths.

In an email, a representative with the Department of Health said that similar rises in overdose deaths are being seen across the country, especially among Black, American Indian and Alaska Native populations. But researchers are still investigating what’s behind the spike.

“There does not appear to be a single reason why rates are increasing for Black populations and holding steady among white populations,” the statement reads. “The volatile and rapidly changing drug supply certainly has been a challenge as fentanyl is now found in every type of drug. Inequities in terms of treatment for substance use disorder may also play a factor as white people are more likely to have better access to the most evidence-based treatments and are more likely to stay in treatment.”

Fear of arrest

Abenaa Jones, an epidemiologist and assistant professor of human development and family studies at Penn State who was not involved in the study, has conducted similar research in Baltimore. She agreed that fentanyl-contaminated drugs — which are more common in lower-income neighborhoods — and less access to health care are likely factors in the growing number of overdose deaths among Black populations.

Jones said the criminal justice system, and its unequal treatment of Black people, also plays a role.

“We know that the intersection of criminal justice and substance use, and criminalization of drug use and how that disproportionately impacts minorities, can limit the accessibility of harm reduction services to racial-ethnic minorities for fear of harassment by police for drug paraphernalia,” Jones said, adding that even syringes obtained through needle-exchange programs can be considered illegal paraphernalia.

Fear of arrest, in turn, leads more people to using drugs in isolation.

“That may protect you from criminal legal involvement, but then in the event of an overdose, you may not have someone to help you,” Jones said. “So it could be that by the time the EMS come, it’s been too long for them to even consider administering naloxone.”

Contaminated drug supplies

An unexpected observation that Jones made in the course of her research could also be a factor in rising death rates — the fact that many of the Black people dying of opioid overdoses are older.

“For any other racial groups, overdose deaths peak around midlife — 35, 45,” she said. “For Black individuals, it’s more like 55, 64, and we were wondering what was going on with that.”

After investigating that question, Jones and her colleagues formulated a working theory.

“The running hypothesis for us is that this is a cohort effect,” she said. “Individuals who’ve been using drugs over time, particularly Black individuals back from the ‘80s and ‘90s with the cocaine epidemic, never stopped using.”

Those individuals may have remained relatively stable until fentanyl began to contaminate their drug supply without them knowing.

“So whatever harm reduction tools that you were using for so many years that’s been helping you, when fentanyl’s involved, it’s a different game,” Jones said. “You have to use less, but you have to also know that you have fentanyl in your drugs, right?

It’s a problem that Marcia Tucker, the program director of Pathways to Recovery — a partial hospitalization program focused on co-occurring substance use and mental health challenges — sees frequently among their mostly Black clients.

“If you come into treatment saying that I’m a cocaine user, or I’m a crack cocaine user, or I use marijuana, you’re not even thinking that an opioid overdose or fentanyl overdose could possibly happen to you,” Tucker said. “And it does happen.”

Fear, stigma and miseducation

In fact, Tucker said, she’s seen more of these kinds of overdoses over the past two years than in the three decades she’s spent working in addiction treatment. Despite that, there’s still a lack of education — and even stigma — surrounding both medication-assisted treatments (MATs) for opioid addiction, and the use of naloxone.

“I think sometimes culturally with the African American community, as far as MATs are concerned, there are some taboos about getting that extra help when they decide to come into treatment and get clean,” she said. “A lot of people feel like they want to do it from the muscle. They see it as another form of using.”

She said others may not know how to use naloxone, what kinds of effects it has or how to get it.

“I think a lot of folks don’t even know that they can walk into a pharmacy and get naloxone — you don’t have to have a prescription for that,” Tucker said. “And I think that information is just not always presented to communities, especially poor communities that don’t have a lot of resources.”

Other sources of hesitation are more immediate. Aaron Rice, a therapist at Pathways to Recovery, said that many of their clients fear naloxone because of its physical effects.

“I think they associate it with precipitated withdrawal at times,” Rice said, referring to the rapid-onset withdrawal that can cause symptoms including anxiety, pain, seating, nausea, vomiting and diarrhea.

“The only thing they’re thinking about is feeling better. And that feeling is going to supersede logic at that moment. It always does.”

Overcoming disparities in health care and mistrust of the system

The Department of Health acknowledged that the study only paints a partial picture, as it doesn’t include individuals whose overdoses were reversed by naloxone, and added that during the years of the study (2019–2021), naloxone was available by prescription only — a fact that likely played into the race-based disparity.

“There are recognized inequities in access to health care among persons of color, the concept of which likely extends to access to naloxone,” the Department of Health statement reads. “Historically, many public health materials and messaging more narrowly focused on persons using opioids. With people now taking two or more drugs together (whether intentionally or unintentionally), public health materials and messaging need to be more inclusive of all persons using drugs, regardless of the type.”

The study, researcher Abenaa Jones, Marcia Tucker and Aaron Rice all agreed on at least one intervention that could increase Black people’s access to naloxone — relying on trusted community leaders and institutions, like churches, to help educate residents and distribute the overdose-reversing drug.

“I just can’t stress enough how it’s a lifesaver — it’s the difference between life and death,” Tucker said. “I think people who aren’t medical professionals and find themselves in a situation where it might need to be used would probably be a little fearful — fearful about how to use it or how the person is going to react or whether it’s really going to work — just know that you’re better off with it and trying it. You don’t want to have to second guess yourself later and say, ‘I wish we had it. I wish we had gotten it,’ or, ‘I wish we had used it.’”

 

Source: https://whyy.org/articles/black-pennsylvanians-overdoses-naloxone-less-likely-to-receive/

Filed under: Drug Specifics,Prevention and Intervention,Social Affairs,Treatment and Addiction,USA :
Barry Ewing JUNE 23RD, 2024

A friend called me today and informed me the federal Minister for Mental Health and addictions stated the “minister believes fear and stigma are driving criticism of the government’s decision to support prescribing pharmaceuticals to drug users to combat the country’s overdose crisis…”

After reading the article I realized there will be no hope of taking control of this drug crisis while the Liberals are in power, or any other government that supports harm reduction.

The feds have allowed B.C. to experiment with Canadian lives in that province, pushing experimental policies on the population which have failed, increasing fatal overdoses, not reducing them. How many more thousands of people must die before you admit your policies are a failure?

In 2003, due to overdoses from heroin, Vancouver introduced the first safe injection site on the continent, but after 20 years the evidence is clear that harm reduction practices only magnify the issues. Instead of admitting failure, they have blamed many other factors  for why fatal overdoses, the numbers of addicts, mental health issues, crime and homelessness continue to increase. Instead of dramatically increasing mental health and addiction treatment, they pump billions of taxpayer and donor dollars into programs that encourage and enable addicts, and even their safe consumption sites now fail to offer any assistance for treatment. They have decriminalized small amounts of drugs, and hand out prescribed safe supply illegal drugs now made in B.C., such as cocaine, morphine, MDMA (ecstasy) and heroin, and the interview process for these exempted controlled drugs includes minors. 

Minors do not need parental consent and parents will not be informed. This is how insane the federal government has become, allowing B.C. to progress into the abyss with these wild experiments that have taken thousands of lives, with no end in sight as fatal overdoses increase every year.

B.C. has over 32 safe consumption sites (SCS), and with all the radical programs they have been allowed to employ, they still have more fatal overdoses per capita than Alberta, Saskatchewan or Manitoba.

Barry Ewing – Lethbridge Herald

Source: https://lethbridgeherald.com/commentary/letters-to-the-editor/2024/02/28/theres-no-hope-of-fixing-drug-crisis-through-harm-reduction/

 

Filed under: Canada,Drug Specifics,Drugs and Accidents,Mental Health,Political Sector,Social Affairs,Treatment and Addiction :
MURRAY, Ky. — Around 200 people gathered Tuesday in Wrather Hall on the campus of Murray State University for a roundtable discussion about the drug epidemic locally and across the country.

The event was sponsored by the School of Nursing and Health Professions, and featured speakers from the law enforcement, legal, political, and healthcare communities

Jim Carroll is the former director of the White House Office of National Drug Control Policy — informally known as the U.S. Drug Czar — and said the three biggest factors in dealing with the drug epidemic locally and nationally is enforcement, treatment, and prevention.

“It’s the only way to really tackle this issue is one, reducing the availability of drugs in our community, recognizing that there are people who are suffering from addiction and that recovery is possible that if we can get them in to help, that they can recover,” Carroll said. “It’s important to do all three; it’s possible to reduce the number of fatalities.”

Carroll said the issue is getting worse, with the number of fentanyl deaths going up 50% in the last four years, up to around 115,000 from around 70,000 in 2019.

Uttam Dhillon is the former acting director of the Drug Enforcement Agency, and said that the reason the drug epidemic has become such a serious issue is because of the crisis at the southern border.

“The two biggest cartels are the Sinaloa cartel and the…CJNG, and they fight for territory and the ability to bring precursor chemicals in from China to make methamphetamine and fentanyl, and then transport those drugs into the United States,” Dhillon said. “The battle between the cartels is actually escalated and they are now actually using landmines in Mexico… so this is a brutal war in Mexico between the cartels.”

Dhillon said the reason the stakes are so high in Mexico is because the demand for illicit drugs in the United States is so large.

“Basically every state in the union has activity from the drug cartels in Mexico in them, and that’s really important to understand, because that’s why we are being flooded by drugs,” Dhillon said. “We never declared Mexico a narco state during the Trump Administration, but as I stand here today, I would say in my opinion, Mexico is a narco state.”

In terms of dealing with the nation’s drug epidemic, Dhillon said we first have to start by enforcing the law, which in part begins at the southern border.

Increased enforcement at the border, however, does not fully solve America’s drug epidemic. That is where the panel said local partners in prevention and recovery come in.

Kaitlyn Krolikowski is the director of administrative services at the Purchase District Health Department and said that prevention and treatment is about more than keeping people out of jail.

In January and February, there have been four overdoses in west Kentucky, according to the McCracken County coroner.

“Dead people don’t recover,” Krolikowski said. “We are here to help people recover and to help our community.  For our community to prosper, we need healthy community members and the way that we’re going to get that is by offering them treatment, saving lives, and giving them the resources that they need to be members of our community that we’re proud of.”

While many members of the audience were police officers, non-nursing students, and community leaders, the event was designed to help give clinicians more context about the world they will practice in after graduation.

Dina Byers is the dean of the School of Nursing and Health Professions at MSU, and said that its important to hear what is going on at the national, state, and local level when it comes to illicit drugs.

“It was important that they hear what’s going on,” Byers said. “And that was the purpose of this event was to provide a collaborative effort, a collaborative panel discussion around many topics today.”

If you or someone you know is struggling with addiction, you can call the police without fear of being arrested, or call your local health department to get resources that can help saves lives.

Filed under: Drug use-various effects,Prevention and Intervention,Treatment and Addiction,USA :

Why Do People Relapse? Understanding and Overcoming Relapse in Substance Abuse Recovery: Embarking on the journey of addiction recovery is a tough, but worthwhile goal. However, it is not uncommon for you to face setbacks in the form of relapse during your recovery journey.

In this blog post, we will explore the reasons why people relapse in drug addiction, explore the various stages of relapse, and discuss effective strategies for preventing relapse. Understanding these aspects is crucial for you, your family members, and addiction treatment programs to help you best achieve recovery.

Why Relapse Occurs During Drug Abuse Recovery

The biggest stumbling block people face on the path of recovery is when they slip up. Knowing why relapse happens is critical for those working on getting clean and those helping them out. Let’s dive into the four big causes of going back to drugs during recovery – how mental health problems, ineffective ways of dealing with stress or emotions, intense withdrawal symptoms, and not setting solid limits work together to trip people up.

Mental Health Issues Combined With Substance Addiction

Mental health challenges often coexist with substance abuse. Attending a dual diagnosis treatment program, which addresses both mental health issues and substance use disorder, can significantly increase the effectiveness of your recovery efforts.

Your dual diagnosis treatment team understands how substance use disorders are a chronic disease and will work to give you the tools you need to successfully tackle recovery and lay the groundwork for a sober life.

Poor Coping Skills

Many individuals turn to drugs or alcohol as a coping strategy to deal with negative emotions, stress, conflict in relationships, and peer pressure. As the Marlatt and Gordon model establishes, the seeds of relapse are planted in a high-risk scenario and nurtured by unhealthy coping skills.

If you are facing elevated stress levels, coupled with poor coping skills, you are at a much greater risk for addiction relapse. Negative emotions like anger, depression, anxiety, and boredom can also increase your risk for returning to drug and alcohol use for comfort.

Simply put, without effective coping skills, relapse rates drastically increase.

Uncomfortable Withdrawal Symptoms During Detox

The physical discomfort experienced during withdrawal can be overwhelming, leading your to turn to substance use to alleviate these symptoms. All will to stay sober can easily vanish in the face of intense cravings and physical pain, even if you are fully aware of the consequences.

The vulnerability during the withdrawal phase, coupled with the desire to avoid physical and mental distress, underscores the importance of comprehensive support and coping strategies to navigate this critical stage of the recovery journey successfully.

Lack of Healthy Boundaries

A strong contributor to relapse is your social environment- the people you surround yourself with. Having friends or family members who engage in drug abuse and significantly challenge your recovery and your resolve to stay sober. Even just being around them can trigger intense cravings, heightening your risk of relapse.

Establishing and maintaining well-defined boundaries is crucial for preventing relapse. Without clear boundaries, individuals may find themselves in situations that trigger drug use.

The Stages of A Relapse

A relapse can happen in many ways. What is commonly seen as a “traditional” relapse happens when you consciously decide to consume alcohol or use drugs. This might involve choosing to smoke marijuana to reduce stress after a substantial period of sobriety or having a glass of wine with friends, believing you can handle it without spiraling into excessive use.

On the flip side, a “freelapse” is the informal term for an accidental relapse, which occurs when you unintentionally use drugs or alcohol.

This could occur if you mistakenly consume alcohol, thinking it is a non-alcoholic drink at a party.

At times, the path toward a relapse unfolds without you even realizing it, manifesting in actions taken weeks or months before using drugs or alcohol. Specific thoughts, emotions, and events can act as triggers, sparking cravings and urges for drug use. If not effectively addressed, these triggers can significantly elevate the risk of relapse, which is why it is extremely important to proactively manage these risk factors in the recovery process.

Emotional Relapse Stage

The onset of the emotional relapse stage before actually picking up a drug or sipping a drink. In this phase, you may find yourself struggling to manage your negative emotions in a healthy manner. Rather than addressing your feelings openly, there might be a tendency to bottle them up, withdraw from social interactions, deny the existence of problems, and overlook self-care.

Although the thought of drug and alcohol use may not be at the forefront of your mind during this stage, the avoidance of confronting emotional pain and challenging situations sets the stage for potential relapse in the future. Recognizing and addressing these early signs becomes crucial in preventing future relapse and fostering a healthier recovery journey.

Mental Relapse Stage

In the mental relapse phase, you may struggle with conflicting emotions surrounding sobriety. Within this stage, there is an internal struggle: one side strives to remain sober, while the other wrestles with cravings, harboring secret thoughts about a potential relapse.

Mental relapse goes beyond mere internal conflict; it includes romanticizing past drug use, downplaying the negative feelings and consequences, and actively seeking opportunities for using drugs or alcohol. This intricate mental struggle highlights the delicate balance you have to maintain between your substance addiction and your will to recover.

Physical Relapse Stage

The physical relapse stage is where the actual addiction relapse occurs. What starts out as an initial slip, perhaps with just a few sips of a drink or or hit of a drug, can quickly escalate into a full-blown relapse, characterized by a complete loss of control over your actions and total drug dependence.

The importance of recognizing early warning signs and implementing effective strategies to prevent progression towards physical relapse in the ongoing journey of drug recovery.

What To Do If You Relapse

Whether you have relapsed before or not, knowing what to do if you slip back into the throws of drug abuse is critical for getting back on track and preventing future relapse. No relapse is insurmountable and there’s always an opportunity for recovery.
If you have experienced a relapse, quickly follow these proactive steps to minimize the negative effects of drug use and prevent further substance use.

1. Ask for help. Seeking assistance from family members, friends, and other addicts in the recovery process can significantly help you navigate the challenges of relapse. Create a sober support system and immerse yourself in it. The worst thing you can do in early recovery is suffer in silence.

2. Find support groups near you. Both traditional twelve-step support groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), as well as science-based alternatives like SMART Recovery, offer nonjudgmental spaces for you to discuss substance abuse relapses openly. With meetings available on a daily basis, you can quickly find a support group that’s right for you, allowing you to talk about your relapse experiences within 24 hours of it happening.

3. Avoid triggers at all costs. Being around people, places, situations, etc… that are triggering to you, in the aftermath, of a relapse can be detrimental to your recovery, and actually intensify your cravings. By putting distance between yourself and your triggers helps to create an environment ripe for addiction recovery.

4. Establish healthy boundaries. In all stages of substance abuse recovery, but especially shortly after a relapse, it’s vital to set boundaries to protect yourself from threats against your sobriety. A key component to maintaining firm personal boundaries is steering clear of people who are not completely onboard with your choice to be sober. These people will only try to pressure you back into a lifestyle of using drugs or alcohol, so surrounding yourself with your sober support system is the only way to remain sober after a relapse.

5. Prioritize your self-care. Both your mental and physical well-being should be taken care of, especially in the wake of a relapse, and is one of the key components of recovery, and it gives you a way to relieve tension and reduce stress.

6. Self-reflect about why the relapse happened. Rather than seeing a relapse as a setback, you can see it as a learning tool. Dedicate time to reflect on the circumstances leading to the relapse. Explore the events that unfolded before the relapse occurred. Did you try out any other coping mechanisms prior to resorting to substance use? Think about potential alternatives to using or drinking that you could have used.

Asking yourself these questions offers insights into what you can do differently, encouraging a constructive approach to managing challenges that arise along your path to substance use disorder recovery.

7. Come up with a relapse prevention plan. This is a guide designed to be a steadfast companion to help you maintain sobriety. It should be as detailed as possible, and easy to follow when needed.

Acting promptly after a relapse significantly increases your chances of a quick recovery with minimal negative consequences. It is important to remember that recovery is not linear or bound by time constraints. It is never too late to regain control after a relapse.

If early recovery seems too overwhelming, seek drug addiction treatment to help manage the task. Some treatment centers offer an inpatient program with medical detox and behavioral therapies to help you regain your footing and relapse prevention classes to help you assimilate back into your daily life with the help of addiction specialists.

How to Prevent Relapse After Drug Addiction Treatment

Preventing relapse in addiction recovery involves a complex approach that addresses both the physical and psychological aspects of your substance use.

To start off, recognizing the specific situations or emotions that may lead to relapse and developing effective coping strategies, whether through therapy, mindfulness, or healthy activities, is paramount in navigating through moments of weakness. Building and maintaining a strong support system, made up of supportive friends, family, and possibly support groups, provides a crucial safety net.

Additionally, the creation of a personalized relapse prevention plan, including detailed strategies for recognizing and managing triggers, is vital to staying sober. Regular self-reflection and adjustments to the plan over time ensure its continued effectiveness, empowering you to maintain lifelong sobriety.

Compose a Relapse Prevention Plan

Creating a personalized plan to prevent addiction relapse is a crucial component of substance abuse recovery. This plan should include strategies for recognizing triggers and coping with cravings. It should also outline your specific triggers for drug use, as well as at least 3 positive coping skills that work for you.

Additionally, your relapse prevention plan should list specific people who are in your sober support system, with their phone numbers, who you can call for help when you are feeling the urge to use. You should also compile a list of local addiction support groups that can be there for you in your time of need.

Regularly consulting and revising this plan is instrumental, making sure it stay relevant to your evolving life experiences and fortifying your commitment to a sober life.

Build a Supportive, Nurturing Environment

Building a strong support system and fostering a supportive environment are key factors in maintaining long-term sobriety. Creating a nurturing atmosphere involves not only external factors but also the changes you make within yourself.

Most addicts relapse because they do not change both the people they hang around with, as well as the way they approach situations in life after completing an addiction treatment program and in the early stages of recovery. By attending a local support group meeting, you can meet and befriend people who are going through the same things you are and you can be pillars of strength for each other.

Further, you may find it helpful to make a list of fun activities that do not involve drinking alcohol or using drugs. This list may be helpful when you are experiencing cravings and need to divert your attention.

Maintain a Positive Mindset

Cultivating a positive mindset not only enhances your motivation and resilience during challenging times but also reinforces your belief in yourself and your capacity for personal growth and living a fulfilling, sober life. Your positive outlook serves as a powerful ally in overcoming obstacles, nurturing a sustainable foundation for lasting recovery.

Make Your Self Care a Priority

Prioritizing self-care, including healthy habits and activities, contributes to overall well-being and reduces the risk of relapse. Self-care encompasses a range of activities that bring you pleasure without causing harm, including but not limited to yoga, meditation, exercise, reading, journaling, and eating healthy foods.

Why Do People Relapse During the Recovery Process?

Recovery from drug addiction is a complex journey that requires dedication, resilience, and ongoing support. By understanding the reasons behind relapse, implementing effective treatment programs, and adopting preventative strategies, you can increase your chances of achieving and maintaining long-term sobriety.

Remember, relapse does not signify failure but rather serves as an opportunity for growth and reinforcement of your commitment to recovery.

Source:  https://www.hippocraticpost.com/addiction/understanding-and-overcoming-substance-abuse-relapse/

Filed under: Health,Prevention and Intervention,Treatment and Addiction :

Foreword
The National Institute on Drug Abuse (NIDA) is pleased to publish in its Research Monograph series the proceedings of the 48th Annual Scientific Meeting of the Committee on Problems of Drug Dependence, Inc. (CPDD). This meeting was held at Tahoe City, Nevada, in June 1986.

The scientific community working in the drug abuse area was saddened by the untimely death of one of its very productive and active leaders: Joseph Cochin, M.D., Ph.D. Joe was a talented scientist who was greatly admired by his students and colleagues. For the past five years, Joe had served as the Executive Secretary of the CPDD. This monograph includes papers from a symposium on “Mechanisms of Opioid Tolerance and Dependence,” dedicated to his memory. These papers were presented by many of his friends and colleagues, who took the opportunity to express their high esteem for Joe.
The CPDD is an independent organization of internationally recognized experts in a variety of disciplines related to drug addiction. NIDA and the CPDD share many interests and concerns in developing knowledge that will reduce the destructive effects of abused drugs on the individual and society. The CPDD is unique in bringing together annually at a single scientific meeting an outstanding group of basic and clinical investigators working in the field of drug dependence. This year, as usual, the monograph presents an excellent collection of papers. It also contains progress reports of the abuse liability testing program funded by NIDA and carried out in conjunction with the CPDD. 

This program continues to represent an example of a highly successful government/private sector cooperative effort. I am sure that members of the scientific community and other interested readers will find this volume to be a valuable “state-of-the art” summary of the latest research into the biological, behavioral, and chemical bases of drug abuse.

Charles R. Schuster, Ph.D.
Director
National Institute on Drug Abuse

For the full contents, please go to: 

Source: https://babel.hathitrust.org/cgi/pt?id=ien.35557000188076&seq=11 This version September 2023

Filed under: Brain and Behaviour,Heroin/Methadone,Prevention and Intervention,Social Affairs,Treatment and Addiction :

US DRUG CZAR EXPLAINS CAUSES AND RSDT TOOL TO PREVENT TEEN DRUG USE AND OVERDOSE DEATH INTERVIEW WITH U.S. DRUG CZAR JOHN WALTERS

Introduction:  In response to recent news of a huge increase in drug overdose deaths and arrests for drug trafficking among Fairfax County youths, Fox News TV5 reporter Sherri Ly interviewed U.S. Drug Czar John Walters for his expert views on the cause and potential cure for these horrific family tragedies.  Following is a transcript of that half-hour interview with minor editing for clarity and emphasis added.  The full original interview is available through the 11/26/08 Fox5 News broadcast video available at link:

WALTERS:  Well, as this case shows, while we’ve had overall drug use go down, we still have too many young people losing their lives to drugs, either through overdoses, or addiction getting their lives off track.  So there’s a danger.  We’ve made progress, and we have tools in place that can help us make more progress, but we have to use them. 

Q 1:  You meet with some of these parents whose children have overdosed.  What do they tell you, and what do you tell them?

WALTERS:  It’s the hardest part of my job; meeting with parents who’ve lost a child.  Obviously they would give anything to go back, and have a chance to pull that child back from the dangerous path they were on.  There are no words that can ease their grief.  That’s something you just pray that God can give them comfort.  But the most striking thing they say to me though is they want other parents to know, to act.  And I think this is a common thing that these terrible lessons should teach us.

Many times, unfortunately, parents see signs: a change in friends, sometimes they find drugs; sometimes they see their child must be intoxicated in some way or the other.  Because it’s so frightening, because sometimes they’re ashamed – they hope it’s a phase, they hope it goes away – they try to take some half measures.  Sometimes they confront their child, and their child tells them – as believably as they ever can – that it’s the first time.  I think what we need help with is to tell people; one, it’s never the first time.  The probability is low that parents would actually recognize these signs – even when it gets visible enough to them – because children that get involved in drugs do everything they can to hide it.  It’s never the first time.  It’s never the second time.  Parents need to act, and they need to act quickly.  And the sorrow of these grieving parents is, if anything, most frequently focused on telling other parents, “Don’t wait: do anything to get your child back from the drugs.”

Secondly, I think it’s important to remember that one of the forces that are at play here is that it’s their friends.  It’s not some dark, off-putting stranger – it’s boyfriends, girlfriends.  I think that was probably a factor in this case.  And it’s also the power and addictive properties of the drug.  So your love is now being tested, and the things you’ve given your child to live by are being pulled away from them on the basis of young love and some of the most addictive substances on earth.  That’s why you have to act more strongly.  You can’t count on the old forces to bring them back to safety and health.

Q 2:  When we talk about heroin – which is what we saw in this Fairfax County drug ring, alleged drug ring – what are the risks, as far as heroin’s concerned?  I understand it can be more lethal, because a lot of people don’t know what they’re dealing with?

WALTERS:  Well it’s also more lethal because one, the drug obviously can produce cardiac and respiratory arrest.  It’s a toxic substance that is very dangerous.  It’s also the case that narcotics, like heroin – even painkillers like OxyContin, hydrocodone, which have also been a problem – are something that the human body gets used to.  So what you can frequently get on the street is a purity that is really blended for people who are addicted and have been long time addicted.  So a person who is a new user or a naïve user can more easily be overdosed, because the quantities are made for people whose bodies have adjusted to higher purities, and are seeking that effect that only the higher purity will give them in this circumstance.  So it’s particularly dangerous for new users.  But we also have to remember, it almost never starts with heroin.  Heroin is the culmination here.  I think some of the – and I’ve only seen press stories on this — some of these young people may have gotten involved as early as middle school.

We have tools so that we don’t have to lose another young woman like this– or young men.  We now have the ability to use Random Student Drug Testing (RSDT) because the Supreme Court has, in the last five years, made a decision that says it can’t be used to punish.  It’s used confidentially with parents.  We have thousands of schools now doing it since the president announced the federal government’s willingness to fund these programs in 2004.  And many schools are doing it on their own.  Random testing can do for our children what it’s done in the military, what it’s done in the transportation safety industry– significantly reduce drug use.

First, it is a powerful reason not to start.  “I get tested, I don’t have to start.”  We have to remember, it’s for prevention and not a “gotcha!”  But it’s a powerful reason for kids to say, even when a boyfriend or girlfriend says come and do this with me, “I can’t do it, I get tested.  I still like you, I still want to be your friend; I still want you to like me, but I just can’t do this,” which is very, very powerful and important.  And second, if drug use is detected the child can be referred to treatment if needed.

Q 3:  Is the peer pressure just that much that without having an excuse, that kids are using drugs and getting hooked?

WALTERS:  Well one of the other unpleasant parts of my job is I visit a lot of young people in treatment; teenagers, sometimes as young as 14, 15, but also 16, 17, 18.  It is not uncommon for me to hear from them, “I came from a good family.  My parents and my school made clear what the dangers were of drugs.  I was stupid.  I was with my boyfriend (or girlfriend) and somebody said hey, let’s go do this.  And I started, and before I knew it, I was more susceptible.”

We have to also understand the science, which has told us that adolescents continue to have brain development up through age 20-25.  And their brains are more susceptible to changes that we can now image from these drugs.  So it’s not like they’re mini-adults.  They’re not mini-adults.  They’re the particularly fragile and susceptible age group, because they don’t have either the experience or the mental development of adults.  That’s why they get into trouble, that’s why it happens so fast to them, that’s why it’s so hard for them to see the ramifications.

So what does RSDT do?  It finds kids early–­ if prevention fails.  And it allows us to intervene, and it doesn’t make the parent alone in the process.  Sometimes parents don’t confront kids because kids blackmail them and say “I’m going to do it anyway, I’m going to run away from home.”  The testing brings the community together and says we’re not going to lose another child.  We’re going to do the testing in high school – if necessary, in middle school.  We’re going to wrap our community arms around that family, and get those children help.  We’re going to keep them in school, not wait for them to drop out.  And we’re certainly not going to allow this to progress until they die.

Q 4:  And in a sense, if you catch somebody early, since you’re saying the way teenagers seem to get into drug use is a friend introduces it to a friend, and then next thing you know, you have a whole circle of friends doing it.  Are you essentially drying that up at the beginning, before it gets out of hand?

WALTERS:  That is the very critical point.  It’s not only helping every child that gets tested be safer, it means that the number of young people in the peer group, in the school, in the community that can transfer this dangerous behavior to their friends shrinks.  This is communicated like a disease, except it’s not a germ or a bacillus.  It’s one child who’s doing this giving it behaviorally to their friends, and using their friendship as the poison carrier here.  It’s like they’re the apple and the poison is inside the apple.  And they trade on their friendship to get them to use.  They trade on the fact that people want acceptance, especially at the age of adolescence.  So what you do is you break that down, and you make those relationships less prone to have the poison of drugs or even underage drinking linked to them.  And of course we also lose a lot of kids because of impaired driving.

Q 5:  And how does the drug testing program work, then, in schools– the schools that do have it.  Is it completely confidential?  Are you going to call the police the minute you find a student who’s tested positive for heroin or marijuana or any other illicit drug?

WALTERS:  That’s what is great about having a Supreme Court decision.  It is settled – random testing programs cannot be used to punish, to call law enforcement; they have to be confidential.  So we have a uniform law across the land.  And what the schools that are doing RSDT are seeing is that it’s an enormous benefit to schools for a relatively small cost.  Depending on where you are in the country, the screening test is $10-40.  It’s less than what you’re going to pay for music downloads in one month for most teenage kids in most parents’ lives.  And it protects them from some of the worst things that can happen to them during adolescence.  Not only dying behind the wheel, but overdose death and addiction.

 Schools that have done RSDT have faced some controversy; so you have to sit down and talk to people; parents, the media, young people.  You have to engage the community resources.  You’re going to find some kids and families that do have treatment needs.  But with RSDT you bring the needed treatment to the kids.

I tell, a lot of times, community leaders – mayors and superintendents, school board members – that if you want to send less kids into the criminal justice system and the juvenile justice system, drug test — whether you’re in a suburban area or in an urban area.

What does the testing do?  It takes away what we know is an accelerant to self-destructive behavior: crime, fighting in school, bringing a weapon, joining a gang.  We have all kinds of irrefutable evidence now – multiple studies showing drugs and drinking at a young age accelerate those things, make them worse, make them more violent, as well as increasing their risks of overdose deaths and driving under the influence.  So drug testing makes all those things get better.  And it’s a small investment to make everything else we do work better.

Again, drug testing is not a substitute for drug education or good parenting or paying attention to healthy options for your kid.  It just makes all those things work better.

Q 6:  And I know you’ve heard this argument before, but isn’t that big brother?  Aren’t there parents out there who say to you, “I’m the parent: why are you going to test my child for drugs in school; that’s my job?” 

WALTERS:  I think that is the critical misunderstanding that we are slowly beginning to change by the science that tells us substance abuse is a disease.  It’s a disease that gets started by using the drug, and then it becomes a thing that rewires our brain and makes us dependent.  So instead of thinking of this as something that is a moral failing, we have to understand that this is a disease that we can use the kind of tools for public health – screening and interventions – to help reduce it.

Look, let me give you the counter example.  It’s really not big brother.  It’s more like tuberculosis.  Schools in our area require children to be tested for tuberculosis before they come to school.  Why do they do that?  Because we know one, they will get sicker if they have tuberculosis and it’s not treated.  And we can treat them, and we want to treat them.  And two, they will spread that disease to other children because of the nature of the contact they will have with them and spreading the infectious agent.  The same thing happens with substance abuse.  Young people get sicker if they continue to use.  And they spread this to their peers.  They’re not secretive among their peers about it; they encourage them to use them with them.  Again, it’s not spread by a bacillus, but it’s spread by behavior.

If we take seriously the fact that this is a disease and stop thinking of it as something big brother does because it’s a moral decision that somebody else is making, we can save more lives.  And I think the science is slowly telling us that we need to be able to treat this in our families, for adults and young people.  We have public health tools that we’ve used for other diseases that are very powerful here, like screening – and that’s really what the random testing is.  We’re trying to get more screening in the health care system.  So when you get a check up, when you bring your child to a pediatrician, we screen for substance abuse and underage drinking.  Because we know we can treat this, and we know that we can make the whole problem smaller when we do. 

Q 7:  You have said there were about 4,000 schools across the country now that are doing this random drug testing.  What can we see in the numbers since the Supreme Court ruling in 2002, as far as drug use in those schools, and drug use in the general population?

WALTERS:  Well, what a number of those schools have had is of course a look at the harm from student drug and alcohol use.  Some of them have put screening into place, random testing, because they’ve had a terrible accident; an overdose death; death behind the wheel.  What’s great is when school districts do this, or individual schools do this, without having to have a tragedy that triggers it.  But if you have a tragedy, I like to tell people, you don’t have to have another one.  The horrible thing about a tragic event is that most people realize those are not the only kids that are at risk.

There are more kids at risk, obviously, in our communities in the Washington, DC area where this young woman died.  We know there’s obviously more children who are at risk of using in middle school and high school.  The fact is those children don’t have to die.  We cannot bring this young lady back.  Everybody knows that.  But we can make sure others don’t follow her.  And the way we can do that is to find, through screening, who’s really using.  And then let’s get them to stop – let’s work with their families, and let’s make sure we don’t start another generation of death.  So what you see in these areas is an opportunity to really change the dynamic for the better.

Q 8:  Now, although nationally drug use among our youth is going down – what does it say to you – when I look at the numbers specific to Virginia, the most recent that I could find tells me that 3% of 12th graders, over their lifetime, have used a drug like heroin?  What does it say to you?  To me, that sounds like a lot.

WALTERS:  Yeah, and it’s absolutely true.  I think the problem here is that when you tell people we are taking efforts that are making progress nationwide, they jump to the conclusion that that means that we don’t have a problem anymore.  We need to continue to make this disease smaller.  It afflicts our young people.  It obviously also afflicts adults, but this is a problem that starts during adolescence — and pre-adolescence in some cases — in the United States.  We can make this smaller.  We not only have the tools of better prevention but also better awareness and more recognition of addiction as a disease.  We need to make that still broader.  We need to use random testing.  If we want to continue to make this smaller, and make it smaller in a permanent way, random testing is the most powerful tool we can use in schools.

We want screening in the health care system.  We have more of that going on through both insurance company reimbursement and public reimbursement through Medicare and Medicaid for those who come into the public pay system.  That needs to grow.  It needs to grow into Virginia, it’s already being looked at in DC; it needs to grow into Maryland and the other states that don’t have it.  We are pushing that, and it’s relatively new, but it’s consistent with what we’re seeing – the science and the power of screening across the board.

We need to continue to look at this problem in terms of also continuing to push on supply.  We’re working to reduce the poisons coming into our communities, which is not the opposite of demand; that we have to choose one or the other.  They work together.  Keeping kids away from drugs and keeping drugs away from kids work together.  And where we see that working more effectively, we’ll save more lives.  So again, we’ve seen that a balanced approached works, real efforts work, but we need to follow through.  And the fact that you still have too many kids at risk is an urgent need.  Today, you have kids that could be, again, victims that you have to unfortunately tell about on tonight’s news, that we can save.  It’s not a matter we don’t know how to do this.  It’s a matter of we need to take what we know and make it reality as rapidly as possible.

Q 9:  Where are these drugs coming from?  Where’s the heroin that these kids allegedly got coming from?

WALTERS:  We do testing about the drugs to figure out sources for drugs like heroin.  Principally, the heroin in the United States today has come from two sources.  Less of it’s coming out of Colombia.  Colombia used to be a source of supply on the East Coast, but the Colombian government, as a part of our engagement with them on drugs, has radically reduced the cultivation of poppy and the output of heroin.  There still is some, but it’s dramatically down from what it was even about five years ago.  Most of the rest of the heroin in the United States comes from Mexico.  And the Mexican government, of course, is engaged in a historic effort to attack the cartels.  You see this in the violence the cartels have had as a reaction.  So we have promising signs.  There are dangerous and difficult tasks ahead, but we can follow through on that as well.

Most of the heroin in the world comes from Afghanistan; 90% of it.  And we are working there, of course, as a part of our effort against the Taliban and the forces of terror and Al Qaeda, to shrink that.  The good news is that last year we had a 20% decline in cultivation and a 30% decline in output there.  Most of that does not come here, fortunately.  But it has been funding the terrorists.  It’s been drained out of most of the north and the east of the country.  It’s focused on the area where we have the greatest violence today, in the southwest.  We’re working now – you see Secretary Gates talking to the NATO allies about bringing the counter-insurgency effort together with the counter-narcotics effort to attack both of these cancers in Afghanistan.  We have a chance to change heroin availability in the world in a durable way by being successful in Afghanistan.  We’ve started that path in a positive way.  Again, it’s a matter of following through as rapidly as possible.

Q 10:  Greg Lannes, the father of the girl in Fairfax County who died, told me that one of his main efforts, as you imagined, was to let people know that those drugs, they’re coming from where it is produced, outside our country; that they’re getting all the way down to the street level and into our neighborhoods– something that people don’t realize.  So when you hear that they busted a ring of essentially teenagers who have been dealing, using and buying heroin, what does that say to you as the man in charge of combating drugs in our country?

WALTERS:  Well again, we have tools that can make this smaller.  But we have to use those tools.  And we have multiple participants here.  Yes we need to educate.  And we need to make sure that parents know they need to talk to their children, even when their children look healthy and have come from a great home.  Drugs – we’ve learned, I think, over the last 25 years or more, drugs affect everybody; rich or poor, middle class, lower class or upper class.  Every family’s been touched by this, in my experience, by alcohol or drugs.  They know that reality– we don’t need to teach them that.

What we need to teach them is the tools that we have that they can help accelerate use of.  Again, I think – there is no question in my mind that had this young woman been in a school, middle school or high school that had random testing – since that’s where this apparently started, based on the information I’ve seen in the press – she would not be dead today.  So again, we can’t go back and bring her to life.  But we can put into place the kind of screening that makes the good will and obvious love that she got from her parents, the obvious good intentions that I can’t help but believe were a part of what happened in the school, the opportunities that the community has to have a lot of resources that she didn’t get when she needed them.  And now she’s dead.  Again, we can stop this: we just have to make sure we implement that knowledge in the reality of more of our kids as fast as possible.

Q 11:  Should anyone be surprised by this case?  And that such a hardcore drug like heroin is being used by young people?

WALTERS:  We should never stop being surprised when a young person dies.  They shouldn’t die.  They shouldn’t die at that young age, and we should always demand of ourselves, even while we know that’s sometimes going to happen today, that every death is a death too many.  I think that it is very important not to say we’re going to accept a certain level.  Never accept this.  Never!  That’s my attitude, and I know that’s the president’s  attitude as well here.  Never accept that heroin’s going to get into the lives of our teenagers.  Never accept that our children are going to be able to use and not be protected.  It’s our job to protect them.  They have a role, also, obviously in helping to protect themselves.  But we need to give them the tools that will help protect them.

When I talk to children and young adults in high school or college, they know what’s going on among their peers.  And in some ways, when you get them alone and they feel they can talk candidly, they tell us they don’t understand why we, as adults who say this is serious, don’t act.  They know that we see children who are intoxicated; they know that we must see signs of this, because as kid’s lives get more out of control, they show signs of it.  They want to know why we don’t act.

We can use the tools of screening, and we can use the occasion of a horrible event like this to bring the community together and say it’s time for us to use the shock and the sorrow for something positive in the future.  I haven’t met a parent of a child who’s been lost who doesn’t say I just want to use this now for something positive.  And that’s understandable, and I think we ought to honor that wish.

Q 12:  Well, I guess I’m not asking should we accept that this is in our schools, but is it naïve for people not to understand or realize that these hardcore drugs are in our schools, and in our communities, and in our neighborhoods. 

WALTERS:  Yeah.  Where it is naïve, I think, is to not recognize the extent and access that young people have to drugs and alcohol.  I think we sometimes think that because they come from a home where this isn’t a part of their lives now, that it’s not ever going to be part of their lives.  Look, your viewers should go on the computer.  Type marijuana into the Google search engine and see how many sites encourage them to use marijuana, how to get marijuana, how to grow marijuana, the great fun of marijuana.  Go on YouTube and type in marijuana, and see how many videos come up using marijuana, joking around about marijuana.  And then when you start showing one, of course the system is designed to show you similar things.  Type in heroin.  See what kind of sites come up, and see what kind of videos come up on these sites.  Young people spend more time on these sites than they do, frequently, watching television.  Remember, there is somebody telling your children things about drugs.  And if it’s not you, the chances are they’re telling them things that are false and dangerous.  So there is a kind of naiveté about what the young peoples’ world, as it presents itself to them, tells them about these substances.  It minimizes the danger, it suggests that it’s something that you can do to be more independent, not be a kid anymore. 

We, from my generation — because I’m a baby boomer — unfortunately have had an association of growing up in America with the rebellion that’s been associated with drug use.  That’s been very dangerous, and we’ve lost a lot of lives.  We have to remember that it’s alive and well, and has become part of the technological sources of information that young people have.  I also see young people in treatment centers who got in a chat room and somebody offered them drugs or offered them to come and buy them alcohol and flattered them, and got them involved in incredibly self-destructive behavior.  The computer brings every predator and every dangerous influence into your own child’s home – into their bedroom in some cases, if that’s where that computer exists.  You wouldn’t let your kids go out and play in the park with drug dealers.  If you have a computer and it’s not supervised, those drug dealers are in that computer.  Remember that.  And they’re only a couple of keystrokes away from your child.

Q 13:  And you talk about the YouTube and the computers and all those things.  What about just the overall societal image?  Because we have this whole image with heroin, of heroin chic.  How much does that contribute to the drug use, and how difficult does it make your job, when a drug is being made out to be cool in society by famous people?

WALTERS:  There are still some elements of that.  It was more prominent a number of years ago.  I would say you see less of that now glamorized in the entertainment industry, or among people who are celebrities in and out of entertainment.  You see more cases of real harm.  But it’s still out there.  The one place that I think is replacing that, just to get people ahead of the game here, is prescription pharmaceuticals.  Those have been marketed to kids on the internet as a safe high.  They falsely suggest that you can overcome the danger of an overdose because you can predict precisely the dosage of OxyContin, hydrocodone, Vicodin.  And there are sites that suggest what combination of drugs to use.  We’ve seen prescription drug use as the one counter example of a category of drug use going up among teens.  We’re trying to work on that as well, but that’s something that’s in your own home, because many people get these substances for legitimate medical care.  Young people are going to the medicine cabinet of family or friends, taking a few pills out and using those.  And those are as powerful as heroin, they’re synthetic opioids, and they have been a source of overdose deaths. 

So let’s not forget – while this Fairfax example reminds us of the issues of heroin chic and of the heroin that’s in our communities, the new large problem today is a similar dangerous substance in pill form in our own medicine cabinets.  Barrier to access is zero.  They don’t have to find a drug dealer; they just go find the medicine cabinet.  They don’t have to pay a dime for it because they just take it and they share that with their friends.  We need to remember, that’s another dimension here.  Keep these substances out of reach – under our control when we have them in our home.  Throw them away when we’re done with them.  Make sure we talk to kids about pills.  Because people, again, are telling them that’s the place to go to avoid overdose death, is to take a pill.

Q 14:  When you see a lot of these celebrities checking in and out of rehab, does it sort of glamorize it for kids?  And teach them hey, you can use, you can check into rehab, you can come back, you can – you know.  Is there a mixed message there?

WALTERS:  There is.  Some young people interpret it the way you describe; of it’s something you do and you can get away with it by going into rehab.  We do a lot of research on young people’s attitudes for purposes of helping shape prevention programs in the media, as well as in schools and for parents.  We do a lot with providing material to parents.  I would say that compared to where we’ve been in the last 15 or 20 years, there’s less glamorization today.

I think we should also remember the positive, because we reinforce that.  A lot of young people – obviously not all or we wouldn’t have this death – believe that taking drugs makes you a loser.  They’ve seen that a lot of those celebrities are showing their careers going down the toilet because they can’t get away from the pills and the drugs and the alcohol.  And I think they see that even among some of their peers.  That’s a good thing.  We should reinforce that as parents: teaching our kids that drug and alcohol use may be falsely presented to you as something you do that would make you popular, make you seem like you should have more status in society generally.  But actually, look at a lot of these people; they’ve had enormous opportunities, enormous gifts, and they can’t stop themselves from throwing them away.  And they may not stop themselves from throwing away their lives. 

I think you could use these events as a teachable moment.  It can go two ways.  Help your child understand what the truth is here.  And I tell young people – and I think parents have to start this more directly – this is the way this is going to come to you:  Somebody you really, really want to like you; somebody you really, really like; someone you may even love — or think you love — they’re going to say come and do this with me.  If you can’t find any other reason to not do this with them, say, “Before we do this, let’s go to a treatment center.  Let’s go talk to people who stood where we stood and said it’s not going to happen to me.”  If everybody, when they got the chance to start, thought of an addict or somebody who was dead, they wouldn’t start.  The fact is that does not enter their mind. 

Many people in treatment centers understand that part of the task of recovery is helping other people avoid this.  So they’re willing to talk about it.  In fact, that’s part of their path of staying clean and sober, which not many kids are going to be able to do on their own.  But it makes them think that what presents itself as something overwhelmingly attractive has behind it a horrible dimension, for their friends as well as for themselves.  And more and more, I think kids understand this.

We can use the science of this as a disease, and the experience of many families.  Remember, uncle Joe didn’t used to be like this.  Especially Thanksgiving, when we have families getting together and all of a sudden mom’s going to get loaded and become ugly in the corner.  We also have to remember we have an obligation to reach out to those people, and to get them help.  We can treat them.  Nobody gets sober, in my experience, by themselves.  They have to take responsibility.  But you have to overcome the pushback, and addiction and alcoholism have, as a part of the disease, denial.  When you tell somebody they have a problem, they get angry with you.  They don’t say hey thanks, I want your help.  They don’t hit bottom and become nice.  That’s a myth.  They need to be grabbed and encouraged and pushed.  Almost everybody in treatment is coerced – by a family member, by an employer, sometimes by the criminal justice system.

So remember that, when you find your child using and they want to lie to you up down and sideways saying, “It’s the first time I’ve ever done it.”  No, no, no, no, no, that’s the drugs talking.  That shows you, if anything, you have a bigger problem than you realized and you need to reach out, get some professional help.  But don’t wait!

Source:    National Institute of Citizen Anti-drug Policy (NICAP)

DeForest Rathbone, Chairman, Great Falls, Virginia, 703-759-2215, DZR@prodigy.net

Filed under: Alcohol,Brain and Behaviour,Cannabis/Marijuana,Crime/Violence/Prison,Drug use-various effects,Education,Education Sector,Effects of Drugs,Heroin/Methadone,Internet,Political Sector,Prescription Drugs,Prevention and Intervention,Social Affairs,Synthetics,Treatment and Addiction,USA,Youth :
More than 39 million adults with a substance use disorder did not receive treatment in 2022, according to the latest data from the Substance Abuse and Mental Health Services Administration.

Nearly 95% of those not receiving treatment didn’t believe they needed help—but for 1.8 million adults who thought they did, barriers to treatment left them unwilling or unable to get support. Counseling Schools analyzed findings from the 2022 National Survey on Drug Use and Health (the most recent data available), compiled by SAMHSA, to highlight the most common barriers to care for adults seeking substance abuse treatment. Among these obstacles are stigma, a lack of access, various socioeconomic factors and inequities, and a person believing they could handle their disorder on their own.

A substance use disorder is caused by shifts in brain structure and function due to a pattern of substance use (including alcohol) that renders further use compulsive. These chronic conditions range in severity from mild to severe while impacting cognitive, behavioral, and physiological systems and making treatment notoriously difficult. SUDs have enormous potential to cause long-term negative impacts on people’s health, relationships, home lives, careers, and education. Changes in brain chemistry may cause some with SUDs to act out of character by lying, stealing, or showing aggression—actions that can further alienate individuals from loved ones while reinforcing stigmas around substance abuse.

In 2022, the 18- to 25-year-old age group represented the largest percentage of adults who reported having a SUD in the last year, with more than a quarter of people participating in the SAMHSA survey making that claim.

Treating substance use is among the most expensive health issues in the United States. The Biden administration in 2022 budgeted $9.7 billion for SAMHSA—up $3.7 billion the year prior—with $6.6 billion earmarked for substance use prevention and treatment. In 2023, the total budgeted for SAMSHA reached $10.7 billion. Cumulative spending for mental health and SUD treatment from public and private sources was an estimated $280.5 billion in 2020.

The constellation of care options for SUDs can be complicated to navigate, as successful treatment options are often multi-pronged and specific to an individual. Care may include inpatient and outpatient services, medications, individual and group counseling, case management with a social worker, and more.

Research into substance use science and treatment has afforded the medical community a better appreciation for addressing the full breadth of a patient’s needs, such as putting a focus on mental health care and tailoring specific treatment plans and therapy.

A multidisciplinary approach to care is paramount to tackling the complex symptoms of SUDs, while coordination between caregivers ensures any prescribed medications are complementary (especially if comorbidities such as anxiety or depression are present in a patient) and that the care provided by clinical social workers, psychiatrists, and other professionals works together holistically.

Keep reading to learn more about barriers to care for individuals living with SUDs.

Bar chart showing top 4 reasons for not receiving substance-use disorder treatment.

Counseling Schools

78% of adults with SUDs who didn’t get care thought they should handle it on their own

Analysis of the SAMSHA survey shows that more than three-quarters of adults who did not get treatment for SUDs in 2022 thought they should be able to manage their disease without seeking help. Not being ready to start treatment accounted for 61.3% of the top reasons, and 52.9% weren’t prepared to stop or decrease their use. The SAMHSA survey allowed for multiple answers.

People living with SUDs may be unwilling to seek treatment at a detox center or rehab program if they think their SUD isn’t “bad enough” to warrant it or if they think they can manage their disorder themselves.

The cost of care dissuaded about 48% of respondents. The average cost of drug rehabilitation is $13,475 per person, according to the National Center for Drug Abuse Statistics.

Bar chart showing stigma reasons for not receiving substance-use disorder treatment.

Counseling Schools

Stigma remains a major barrier to treatment

Discrimination against and stigmatization of people living with SUDs are still commonplace despite the relaxation of punitive drug policies in the U.S. Forty-six percent of those surveyed by SAMSHA said they did not pursue treatment out of worry over what others might think or say.

People’s attitudes around the cause and controllability of SUDs play into stigmatization, according to an empirical investigation published in 2010 in the Journal of Drug Issues.

How people label the behaviors of those with SUDS—or characterize the individuals themselves—can impact others’ understanding and have a domino effect on a larger scale. Public perception affects how policymakers allocate resources, the willingness of some providers to screen and address SUDs, and the desire for people living with SUDs to seek or accept treatment themselves.

Fear and shame around breaches of confidentiality are also of major concern for people with SUDs who didn’t get treatment: 38% thought that if people knew they were receiving care, negative repercussions would occur up to and including the loss of their job, home, or children. Thirty-five percent were deterred by the idea that people would find out their private information about their SUD treatment.

Stigmas also play heavily into racial inequities when it comes to treatment. Drug policies in the U.S.—such as the War on Drugs in the ’70s and the Anti-Drug Abuse Act of 1986—have historically criminalized Black Americans with substance use, deterring them from getting needed treatment.

Racial bias in the health care system further contributes to treatment gaps. In a study released in 2023 by researchers at Dartmouth’s Geisel School of Medicine and the Harvard T.H. Chan School of Public Health, white patients with opium use disorders who experienced an infection, overdose, or other high-risk event received and filled prescriptions as much as 80% more frequently than Black patients and 25% more than Hispanic patients, among Medicare beneficiaries with active OUD symptoms and disability.

The study’s authors concluded: “These disparities are unlikely to close without the structural barriers and structural racism obstructing equitable access to medications for OUD, such as stigma and geographic maldistribution of relevant providers, being addressed.”

Bar chart showing cost and lack of access reasons for not receiving substance-use disorder treatment.

Counseling Schools

For those seeking treatment, access to care is crucial

Those who do want to seek treatment may face a range of barriers inhibiting access to services, including a lack of capacity to meet demand—or, for 42% of adults living with SUDS, insufficient health insurance to cover it. Nearly 38% of respondents said their health insurance wouldn’t cover enough of the costs to make it feasible.

Treatment can also be logistically unpractical and time-intensive. People needing time off work might experience anxiety over losing their jobs and affording health care, childcare, or housing. Care may also be geographically far—even hours—away, particularly for people living rurally with large service areas. Long distances require even more logistics around transportation, time, and accommodations.

Barriers to receiving care in the U.S. can be high—but so can the toll on those not receiving vital treatment. Emergency department visits for alcohol use disorders and SUDs rose by 30% on average between 2014-2018 in the U.S. while SUDS-related hospitalizations climbed by 57%, according to a study published in the Journal of General Internal Medicine.

At the same time, experts are understanding more about gender- and race-based inequities when it comes to treatment due to a growing body of research that leverages an intersectional approach to the study of SUD treatment. Additional research like this, along with the dismantling of stigmas and increased access to essential care, can begin to remove some of the most common barriers to SUD treatment.

Story editing by Nicole Caldwell. Copy editing by Kristen Wegrzyn.

This story originally appeared on Counseling Schools and was produced and distributed in partnership with Stacker Studio.

Source: https://seattlemedium.com/why-most-americans-who-need-substance-use-disorder-treatment-dont-get-it/

Filed under: Treatment and Addiction,USA :

A CONVERSATION WITH … Dr. Nora Volkow, who leads the National Institutes of Drug Abuse, would like the public to know things are getting better. Mostly. Volkov says:  “People don’t really realize that among young people, particularly teenagers, the rate of drug use is at the lowest risk that we have seen in decades,” 

By Matt Richtel    NYTimes    April 6, 2024

Historically speaking, it’s not a bad time to be the liver of a teenager. Or the lungs.

Regular use of alcohol, tobacco and drugs among high school students has been on a long downward trend.

In 2023, 46 percent of seniors said that they’d had a drink in the year before being interviewed; that is a precipitous drop from 88 percent in 1979, when the behavior peaked, according to the annual Monitoring the Future survey, a closely watched national poll of youth substance use. A similar downward trend was observed among eighth and 10th graders, and for those three age groups when it came to cigarette smoking. In 2023, just 15 percent of seniors said that they had smoked a cigarette in their life, down from a peak of 76 percent in 1977.

Illicit drug use among teens has remained low and fairly steady for the past three decades, with some notable declines during the Covid-19 pandemic.

In 2023, 29 percent of high school seniors reported using marijuana in the previous year — down from 37 percent in 2017, and from a peak of 51 percent in 1979.

Dr. Nora Volkow has devoted her career to studying use of drugs and alcohol. She has been the director of the National Institute on Drug Abuse since 2003. She sat down with The New York Times to discuss changing patterns and the reasons behind shifting drug-use trends.

What’s the big picture on teens and drug use?

People don’t really realize that among young people, particularly teenagers, the rate of drug use is at the lowest risk that we have seen in decades. And that’s worth saying, too, for legal alcohol and tobacco.

What do you credit for the change?

One major factor is education and prevention campaigns. Certainly, the prevention campaign for cigarette smoking has been one of the most effective we’ve ever seen.

Some of the policies that were implemented also significantly helped, not just making the legal age for alcohol and tobacco 21 years, but enforcing those laws. Then you stop the progression from drugs that are more accessible, like tobacco and alcohol, to the illicit ones. And teenagers don’t get exposed to advertisements of legal drugs like they did in the past. All of these policies and interventions have had a downstream impact on the use of illicit drugs.

Does social media use among teens play a role?

Absolutely. Social media has shifted the opportunity of being in the physical space with other teenagers. That reduces the likelihood that they will take drugs. And this became dramatically evident when they closed schools because of Covid-19. You saw a big jump downward in the prevalence of use of many substances during the pandemic. That might be because teenagers could not be with one another.

The issue that’s interesting is that despite the fact schools are back, the prevalence of substance use has not gone up to the prepandemic period. It has remained stable or continued to go down. It was a big jump downward, a shift, and some drug use trends continue to slowly go down.

Is there any thought that the stimulation that comes from using a digital device may satisfy some of the same neurochemical experiences of drugs, or provide some of the escapism?

Yes, that’s possible. There has been a shift in the types of reinforcers available to teenagers. It’s not just social media, it’s video gaming, for example. Video gaming can be very reinforcing, and you can produce patterns of compulsive use. So, you are shifting one reinforcer, one way of escaping, with another one. That may be another factor.

Is it too simplistic to see the decline in drug use as a good news story?

If you look at it in an objective way, yes, it’s very good news. Why? Because we know that the earlier you are using these drugs, the greater the risk of becoming addicted to them. It lowers the risk these drugs will interfere with your mental health, your general health, your ability to complete an education and your future job opportunities. That is absolutely good news.

But we don’t want to become complacent.

The supply of drugs is more dangerous, leading to an increase in overdose deaths. We’re not exaggerating. I mean, taking one of these drugs can kill you.

What about vaping? It has been falling, but use is still considerably higher than for cigarettes: In 2021, about a quarter of high school seniors said that they had vaped nicotine in the preceding year. Why would teens resist cigarettes and flock to vaping?

Most of the toxicity associated with tobacco has been ascribed to the burning of the leaf. The burning of that tobacco was responsible for cancer and for most of the other adverse effects, even though nicotine is the addictive element.

What we’ve come to understand is that nicotine vaping has harms of its own, but this has not been as well understood as was the case with tobacco. The other aspect that made vaping so appealing to teenagers was that it was associated with all sorts of flavors — candy flavors. It was not until the F.D.A. made those flavors illegal that vaping became less accessible.

My argument would be there’s no reason we should be exposing teenagers to nicotine. Because nicotine is very, very addictive.

We also have all of this interest in cannabis and psychedelic drugs. And there’s a lot of interest in the idea that psychedelic drugs may have therapeutic benefits. To prevent these new trends in drug use among teens requires different strategies than those we’ve used for alcohol or nicotine.

For example, we can say that if you take drugs like alcohol or nicotine, that can lead to addiction. That’s supported by extensive research. But warning about addiction for drugs like cannabis and psychedelics may not be as effective.

While cannabis can also be addictive, it’s perhaps less so than nicotine or alcohol, and more research is needed in this area, especially on newer, higher-potency products. Psychedelics don’t usually lead to addiction, but they can produce adverse mental experiences that can put you at risk of psychosis.

Matt Richtel is a health and science reporter for The Times, based in Boulder, Colo. More about Matt Richtel

Filed under: Addiction,Education,Prevention and Intervention,Social Affairs,Treatment and Addiction :

In 2020 Oregon voters approved Measure 110, the nation’s first law decriminalizing possession of small amounts of drugs, including fentanyl, heroin and methamphetamines. Under Measure 110, people cited for drug possession had the option of paying a $100 fine or calling a hotline for treatment. Oregon committed marijuana tax revenue to addiction and recovery services, but in the first year after decriminalization, only 136 people in the state chose to enter treatment. Instead, the state saw a proliferation of open-air drug markets and a rise in crime, homelessness and overdoses.

A public backlash ensued, and last summer a poll of 1,000 registered voters found that two-thirds wanted a major change in the law. A campaign to “fix and improve” Measure 110 has proposed to recriminalize the possession of fentanyl, methamphetamine and cocaine, prohibit the use of these drugs in public, and make drug treatment mandatory.

Popular opinion holds that an addict cannot be helped until he or she wants to quit, and there is overwhelming agreement among experts that it is preferable for people to choose to enter care rather than be forced into it. But research has borne out the conclusion of a 1990 Institute of Medicine report that “criminal justice pressure does not seem to vitiate treatment effectiveness, and it probably improves retention.”

Most people who are addicted do not want to enter a treatment program. Data from the federal Substance Abuse and Mental Health Services Administration show that in 2022, a staggering 94.8% of people with a drug or alcohol use disorder within the past year “did not seek treatment and did not think they should get treatment.” Those who do voluntarily enter treatment usually don’t complete it. About one-third of voluntary patients drop out of treatment before completion, according to government data. Other studies show that up to 80% leave by the end of the first year. Among dropouts, relapse within a year is the rule.

One of the earliest demonstrations of the value of compelled treatment comes from the California Civil Addict program, established in the 1960s for both criminal and non-criminal drug addicts. The program included an average of 18 months in residential treatment. Patients received drug treatment, job training and education with transition services. Upon release, they were to spend up to five additional years being closely monitored and undergoing weekly urine toxicology tests. During the program’s first two years, however, judges and other officials mistakenly released about half the patients from mandatory treatment after only minimal exposure to the initial, residential part of the program.

A natural experiment was born, allowing researchers to compare people who finished treatment with those who were inadvertently released. After reviewing records and interviewing almost 1,000 “out of control” heroin-addicted participants, the researchers found that, seven years after admission to the program, participants who were prematurely released went back to using heroin at more than twice the rate of those who completed 18 months of compulsory residential care.

Today the U.S. has about 4,000 drug courts that offer an alternative to incarceration for addicts who commit nonviolent crimes. Defendants who choose drug court remain in treatment for one to two years under close supervision, including routine urine testing. Once participants complete the treatment program, their record is expunged—a big dangling carrot. A 2002 study in the Journal of Research in Crime and Delinquency looked at 235 arrestees in Baltimore who were randomly assigned to either drug court or typical community supervision, which might include regular meetings with probation officers and referral to drug treatment services. The study found that those in drug court were one-third as likely to be rearrested after a year.

These and other studies show that people who are mandated to undergo addiction treatment fare at least as well as those who volunteer. In the 2000s, a group of Stanford researchers compared a group of patients required by a court attend drug treatment with others who entered care voluntarily. At one year and five years following enrollment, the mandated and voluntary patients made similar improvements in areas such as drug use, criminal activity and employment status. Notably, the groups were equally satisfied with their treatment experience.

Compulsory treatment offers a chance to rescue people earlier in their “careers” of drug addiction, when intervention can produce greater lifetime benefits. And mandated care can ensure that people remain in treatment and don’t drop out, which is consistently shown to be one of the best predictors of a successful outcome. The longer participants stay in care, the more likely they are to internalize the values and goals of recovery.

Some critics say that compelling treatment for addiction is unethical because addiction is a disease. But it is not a classic, involuntary illness; it is a behavior that entails choice and responds to consequences. An approach known as “contingency management” offers people undergoing drug treatment a positive incentive by offering small rewards for meeting expectations; for instance, a negative drug test might earn movie tickets or a gift cards.

As for negative incentives, almost everyone who enrolls in Dr. Satel’s methadone clinic arrives under pressure, whether from a fed-up spouse, an angry boss or a probation officer. And mandatory treatment is far less restrictive than jail, where many addicts end up when they commit drug-related crimes such as theft, child neglect or threatening public safety.

For people who are so chronically intoxicated that they can’t meet their own basic needs, there is also the alternative of civil commitment. In October, California Gov. Gavin Newsom signed a law reforming the state’s conservatorship system to make it easier to compel treatment for people suffering from mental illness or drug addiction.

 PHOTO: MARY HUDETZ/ASSOCIATED PRESS
Workers clear syringes and other drug paraphernalia from a vacant lot in Albuquerque, N.M.,August 2019. Mandatory treatment programs can offer accountability when drug users threaten public safety.

Critics are correct, however, to point to the inconsistent quality of addiction treatment programs. Until relatively recently, many drug courts were reluctant to allow participants to use proven medications such as methadone or buprenorphine for opioid addiction. In Oregon, the effort to expand treatment under Measure 110 failed in part because the infrastructure was not put in place quickly enough. If mandated treatment becomes more common nationwide, services will need to ramp up quickly.

Oregon may no longer incarcerate people solely for possessing a small amount of drugs, but there is still a need for accountability when someone with a substance use disorder threatens public safety. By mandating high-quality treatment programs for offenders, and providing care for those who can’t otherwise maintain their own safety, the state could turn its failed experiment into a valuable lesson.

Dr. Sally Satel is a senior fellow at the American Enterprise Institute and medical director of a methadone clinic in Washington, D.C. Kevin Sabet, Ph.D., is a former White House adviser and President and CEO of the Foundation for Drug Policy Solutions.

Source:  https://www.wsj.com/health/healthcare/addiction-treatment-can-work-even-when-its-not-voluntary-a81f86ac

Filed under: Addiction,Treatment and Addiction :

As with any addiction, alcoholism is closely connected with stress. And while plenty of people first started drinking as a way to cope with stress or even just wind down after a long day, developing an alcohol use disorder can end up causing significant stresses of its own. If you’re thinking about pursuing alcohol use disorder treatment for yourself or for a loved one, it can be helpful to understand how alcohol is connected to stress.

Present Stress That Can Lead to Alcohol Use

While stresses from your past can certainly contribute to alcoholism, plenty of people also start to develop alcohol use disorder as they struggle to cope with current stress. Often, people end up turning to alcohol in order to try to manage the stresses of day-to-day life. These can include pressure at work or at school, marriage, and divorce, moving, and financial issues.

Minority stress is also an important consideration. If you’re a minority (either in terms of race/ethnicity or sexual orientation), you face unique stresses. You might stress about being passed over for a promotion at work, and you also might fear harassment or becoming the victim of a hate crime.

It’s important to note that stress alone typically does not cause a substance use disorder. However, significant stresses may place you at higher risk of developing one, and high stress levels in sobriety can also make relapse more likely. High stress is a risk factor for alcoholism, along with the following:

Past Stress That Can Lead to Alcohol Use

Unfortunately, it isn’t just current stressful events that can predispose you to drink more. Stresses and traumas from your past can also play a role in alcoholism. Several studies point to childhood abuse and neglect as being a significant factor in the development of an alcohol use disorder. One study found that emotional abuse and neglect were most commonly seen in men and women seeking help for alcoholism. The severity of their alcoholism correlated with the severity of the abuse.

Past traumas, even if they were not experienced in childhood, may also make someone more likely to experience alcoholism. Many people with an alcohol use disorder also have PTSD. As with other mental health diagnoses, the relationship between alcoholism and PTSD becomes a vicious cycle. Alcohol use makes PTSD symptoms worse, and the PTSD symptoms make alcoholism worse.

If you have experienced trauma and are also struggling with alcohol use disorder, it’s easy to feel as though there is no hope. But at Granite Recovery Centers, we offer evidence-based therapies including trauma therapy. In therapy for trauma and PTSD, you will be able to process your trauma and develop healthier coping strategies to help you avoid self-destructive behaviors. With these therapies, you’ll be able to break the cycle of worsening symptoms and experience a greater quality of life.

How Can Alcohol Use Cause Stress?

While it might seem logical that alcohol use can cause stress, there’s also a good bit of biochemical evidence to explain, at least in part, how alcohol shapes your stress response. Even in the short term, alcohol consumption increases levels of cortisol. Cortisol is known as the stress hormone, and your body also releases it during periods of intense anxiety or fear. In the short term, a cortisol release can be helpful — it increases alertness and focus, which was helpful evolutionarily because it helped humans and animals get themselves out of dangerous situations.

However, having elevated cortisol over a long period of time can be detrimental, exhausting, and even dangerous. And in chronic heavy drinkers and those with alcohol use disorder, cortisol isn’t just elevated during intoxication — it stays elevated through withdrawal. In fact, one study even found that cortisol increased as intoxicated people started moving toward withdrawals. If you’ve ever experienced intense anxiety when withdrawing from alcohol, you’ve felt this cortisol surge firsthand.

Because most people with an alcohol use disorder go through a near-constant cycle of intoxication and withdrawal, cortisol can remain elevated for years on end. Chronically elevated cortisol can cause a number of ill health effects:

  • Slow healing (of wounds, broken bones, etc.)
  • Acne
  • Thinning skin
  • Weight gain
  • Extreme fatigue
  • Irritability
  • Trouble focusing
  • Muscle weakness
  • Headaches
  • Elevated blood pressure

Chronically elevated cortisol may cause other health problems as well, but more research is needed to determine exactly what these effects are. Of course, the physical stresses of elevated cortisol combined with chronic heavy drinking can mean your body is put through a lot of physical stress as well as emotional stress.

You already know that plenty of people use alcohol to alleviate stress, but over time, alcohol can cause its own significant stresses. As mentioned above, the elevated cortisol you experience while intoxicated and in withdrawal can cause significant emotional distress. When your body is under stress, and elevated cortisol is effectively causing a constant stress response, it becomes significantly more difficult to handle even everyday stresses.

And in some cases (like when you are intoxicated enough to experience blackouts or respiratory suppression), being intoxicated can be a stressful experience in itself. And for many people with an alcohol use disorder, that stressful experience is something they experience on a daily or near-daily basis. Some of the physical effects of heavy drinking — including dizziness, nausea, headaches, and dehydration — can compound the emotional stress you’re already feeling.

Many people also consciously or unconsciously use alcohol to self-medicate psychiatric disorders, including depression and bipolar disorder. However, in many cases, alcohol use worsens the symptoms of mental health issues, which can cause considerably more emotional distress on a daily basis. In some cases, heavy alcohol use can even contribute to the development of new mental health diagnoses.

If you’ve been using alcohol to help manage a mental health diagnosis (or to help manage a mental health issue that has not yet been diagnosed), Granite Recovery Centers’ dual diagnosis treatment program can help you. With this approach, medical and recovery professionals work with you to find better treatments and coping mechanisms for your mental health diagnosis while also helping you manage your alcohol use disorder. In many cases, this treatment approach will greatly improve your quality of life, as you’ll be much better equipped to manage both diagnoses.

Regardless of whether you have a mental health diagnosis or not, heavy alcohol use can begin to cause stress as it starts to affect the rest of your life. For example, you may constantly worry whether someone will smell alcohol on your breath at work, or you may worry about when you can take another drink. For many people with an alcohol use disorder, it can start to feel like leading a double life, which becomes exhausting and highly stressful over time. And as a person starts to drink more, they often become more socially isolated. Feeling isolated can increase stress, and the person may then continue drinking heavily to cope with that stress.

If you struggle with an alcohol use disorder or other substance use disorder, you already know just how stressful day-to-day life can become. If you have to drink to get rid of withdrawal symptoms and can’t control your drinking once you start, it’s easy to feel trapped, which is, of course, a major stress in itself. If you feel this way, you aren’t alone — taking the first steps to get help can free you from the seemingly unending cycle of alcohol use.

How Do I Know If I’ve Developed an Alcohol Use Disorder?

If you have started using alcohol as a way to cope with stress, it can be difficult to tell whether you have developed an alcohol use disorder or if you are beginning to develop one. While you’ll need to consult a medical professional if you’re looking for a definite diagnosis, you can look for some of the common signs:

  • Spending a lot of time both drinking and recovering from drinking
  • Not being able to control how much you drink once you start
  • Continuing to drink even when you experience negative consequences
  • Giving up on hobbies or responsibilities in order to drink
  • Developing an alcohol tolerance
  • Craving alcohol or becoming preoccupied with drinking when you can’t drink
  • Experiencing withdrawal symptoms when you don’t drink (or drinking to ensure you avoid these symptoms)
  • Using alcohol when it is dangerous to do so (like when you’re driving)

Binge drinking can also be a sign of a developing alcohol use disorder. Binge drinking is defined as consuming five or more standard drinks in two hours for men and consuming four or more standard drinks in two hours for women. On its own, binge drinking doesn’t necessarily indicate an alcohol use disorder, but it could be a sign that one is starting to develop.

It’s important to keep in mind that alcohol use disorders are on a spectrum. Milder cases tend to have fewer symptoms present, while more severe cases have more. Even if you think you only have a mild case, you can still benefit tremendously from treatment. Most cases of alcohol use disorder become progressively worse over time.

How Can Treatment Help?

If you’re unfamiliar with substance use disorder treatment, you may think residential treatment’s only benefit is preventing you from accessing your substance of choice. This couldn’t be further from the truth. A good residential treatment program takes a holistic approach to help you improve your life.

In most cases (and definitely in severe cases), a stay at a residential treatment center begins with a medical detox program. In medical detox, you’ll be supervised by a doctor and likely given medication to prevent seizures and other complications of alcohol withdrawal. Withdrawing from alcohol on your own can be very dangerous, and inpatient detox can ensure that you’re safe. Granite Recovery Centers provides medical detoxification for people who do not need immediate medical intervention, are not a danger to themselves, and are capable of self-evacuation in the event of an emergency.

Once you’re in treatment, you’ll work with counselors and medical professionals to help you identify issues that make you want to drink. These professionals will help you develop healthier coping mechanisms to deal with stress so you’ll be less likely to turn to alcohol in the future. You may get to participate in cognitive behavioral therapy and dialectical behavioral therapy, as well as trauma therapy if needed.

Nutritional deficiencies developed while drinking heavily can add to stress and feeling generally unwell, so residential rehabilitation includes healthy food and ample exercise opportunities. And if you have a co-occurring mental health condition, on-site professionals will help you develop an effective treatment plan.

Ready to Take the Next Step?

Alcohol is an easy answer to stress for many people. But if you have an alcohol use disorder, chances are good that alcohol only causes more stress and worsens the stress you already have. And if the prospect of quitting by yourself seems like too much, don’t worry—the professionals working with Granite Recovery Centers will be helping you every step of the way. If you’re ready to change your life, give us a call at 855-712-7784 today!

Source: https://www.graniterecoverycenters.com/resources/the-connection-between-stress-and-alcoholism/ April 2021

Filed under: Alcohol,Brain and Behaviour,Health,Treatment and Addiction :

The study by Sadananda et al published in the current issue of the IJMR highlights the neurophysiological basis of altered cognition in subjects with opioid addiction. The study demonstrated aberrant network activity between the default mode network (DMN) and fronto-parietal attentional network (FAN) as a major cause for working memory deficits in drug addiction. Working memory is an important to retain the cognitive information essential for goal directed behaviours. Human beings are endowed with an efficient cognitive faculty of working memory, essential for efficient functioning of the executive network system of the brain. As working memory is the key to carry out any cognitive process involving attention, volition, planning, goal directed behaviour, etc., consciousness is linked largely to working memory processing. The importance of integrating neuroscience knowledge especially the executive functions of human brain in leadership has been taught in neuro-leadership programs as a mean to maximize the human capabilities, productivity, creativity, leadership, wellness, positive attitude.

Aberrant network activities and structural deficits in brain areas of executive functioning impede most of our intellect including mental flexibility, novel problem solving, behavioural inhibition, memory, learning, planning, judgement, emotion regulation, self-control and other social functioning. Deficits in working memory and attention owing to reduced fronto-parietal network (FPN) activity is reported in schizophrenia, autism, attention deficit hyperactive disorder (ADHD) and anxiety disorders. Opioid addiction is reported to impede such dynamicity of the executive system leading to a wide range of deficits in cognition. Opioid addiction alters the network integrity between DMN and FPN networks and weakens the cognitive information processing in cognitively challenging paradigms. Dysfunctional dynamics of DMN activity is believed to contribute to impaired self-awareness, negative emotions and addiction related ruminations. Aberrant DMN activity and reduced medial prefrontal cortical functions are common neural phenotypes of cognitive deficits in conditions like mental illness, drug addiction, sleep deprivation and neurodegenerative disorders. People with substance use disorders develop mental illnesses as a serious comorbidity that in turn, leads to severe behavioural impairments at the social, emotional and cognitive domains. Chronic sleep deprivation associated with drug addiction and substance abuse is another predisposing factor that worsen the behavioural impairments. Over all, drug addiction, substance abuse and the subsequent maladaptive behaviours including mental illness and sleep deprivation trigger a complex set of network instability in the domains of cognition and affect. The euphoria and hallucinating experience of drugs of abuse would soon lead to psychological distress and to cognitive and emotional behavioural impairments due to the disruption of various top down and bottom-up network dynamics.

Substance use disorders are an imminent socio-economic burden and have become a major public health concern worldwide. Despite knowing the harmful effects and consequences of drug use, reports say that the youth especially the adolescents have a tendency to continue the habit. There is a need to have effective measures in place such as educational programmes to improve the self-efficacy of parents and family members to help their children to develop the right behavioural attitude, enhance the capacity building in teachers to strengthen the self-esteem and wellness of students to organize substance use control awareness programmes in coordination with NGOs at educational institutions, involvement of television and other visual and social media platforms to organise substance abuse control programmes and for interactive opportunity for children/youth with educators, researchers and professionals, organization of knowledge dissemination programmes to the public/schools/colleges to highlight the adverse effects of drug abuse on mental health and cognition. Introduction to such knowledge sharing platforms such as the Virtual Knowledge Network (VKN) at NIMHANS, Bengaluru, provide interactive skill building opportunities to safeguard them from substance abuse and addiction. People should have easy access to such services and rehabilitation centers. Various behavioural intervention strategies such as cognitive retraining, psychotherapy, yoga therapy, mindfulness-based intervention programmes etc. are reported to improve cognitive abilities, regulation of negative emotions and restoration of motivational behaviours. A study on single night exposure to olfactory aversive conditioning during sleep helped to quit addiction to cigarette smoking temporarily. Such studies highlight the possibility of learning new behaviours during sleep and its positive impact on wake associated behaviours. Such approaches are quite useful, easily testable and cost-effective. Thanks to the incredible phenomenon of adult brain plasticity, it is possible to re-establish social intelligence, prosocial motivation among people with substance abuse.

Source: Drug addiction – How it hijacks our cognition & consciousness – PMC (nih.gov) October 2021

Filed under: Addiction,Brain and Behaviour,Drug use-various effects,Heroin/Methadone,Nicotine,Treatment and Addiction :

Opioids have become a full-blown national crisis of epidemic proportions, killing 130 people each day. Drug overdose is now the number-one cause of death for Americans under 50. One doctor at the top of her game—who knew the risks better than anyone—almost became another statistic.

Alison ran around her palatial six-bedroom house in Georgia on a crisp January night in 2016, preparing to depart the next day for a family ski trip in Colorado. She washed dishes, tidied counters, put in several loads of laundry, and crossed items off her packing list. Whenever she found a moment alone—every 45 minutes or so—she retrieved the syringe containing sufentanil she’d tucked inside the Ugg boots she wore around her house, pulled a makeshift tourniquet out of her hooded sweatshirt, found a usable vein, and plunged the needle into her arm, delivering one tenth of a milliliter of the most powerful opioid available for use in humans.

That night, as Alison hustled her house into order, she shot up in her 13-year-old daughter’s closet (she once used her ballet-shoe laces as a tourniquet), her oldest son’s bathroom (he was away at college), the kitchen pantry (she sometimes kept vials inside boxes of dry pasta), the laundry room (her favorite place to use), the bathroom (her least favorite), and the stairway leading up to the second floor, where she could gauge if family members were getting close.

By the end of the night, she had polished off two milliliters, an amount that could kill an average-size adult if given in a single dose. Sufentanil is an opioid painkiller five to seven times more potent than fentanyl—another powerful opioid—at the time of peak effect and 4,521 times more powerful than morphine, but Alison wasn’t intimidated. As an anesthesiologist, she’d spent her entire professional life delivering such substances to patients during surgery.

What Alison didn’t know then was that in just over two months, her whole world would come crashing down. She had no idea that three nurses would grow wise to the ways she was stealing drugs from the hospital. Or that she’d spend 90 days at an in-treatment center, followed by a five-year monitoring program for physicians. All she was thinking about that night was that her drugs of choice, sufentanil and fentanyl, made her happy at a time when her work demands were overwhelming and her second marriage was falling apart. “It was immediate; everything just chilled out. For me, it felt like when you have a really good glass of wine and you’re like, ‘Ahhh,’ ” says Alison, now 46. “During that time, that was the only thing I looked forward to. That was really the only thing that was good in a day of life for me.”

Before she started abusing opioids six months earlier, Alison had never used a drug recreationally other than a puff of marijuana during high school. (She didn’t like it.) She enjoyed a glass of red wine with dinner once or twice a month but hadn’t ever thought of using the substances she injected into patients all day, every day. “I’d been in anesthesia for 18 years, and it never even tempted me,” she says. “I never wondered what it felt like. It did not enter my mind.”

Alison was raised in a small town in Tennessee, the third youngest of seven children born to strict, conservative Christian parents. Her father is a physicist who liked to pose math questions at the dinner table (“In a group of 27 kids, there are 13 more girls than boys. How many girls and boys are there? Go!”), and her mother is a stay-at-home mom. For vacation, “we didn’t go to the beach or Disney World; we went to a place with a telescope or a planetarium,” says Alison, recalling one trip in which they piled in a station wagon and drove to South Dakota to watch an eclipse.

Today, three siblings are physicians, one worked for the CIA, and another chaired a university department. Alison likes to joke that she’s the underachiever in the family, and though she deserves no such title, the lifelong pressure she felt to outperform her siblings took a toll. “I was raised in a family where the lowest thing that was allowed was perfection,” she says. “I felt like I needed to do more, always. That was a big thing that came up in treatment—that my ‘good enough’ wasn’t good enough.” She had an eating disorder as a young teen and remembers dropping 30 pounds from her petite frame one summer by consuming only iceberg lettuce and fat-free French dressing. She says she felt like a failure because a younger sister weighed 15 pounds less.

One of Alison’s older brothers taught her square roots when she was two years old. (“It was like his little dog and pony trick to show me off to his friends,” says Alison, laughing.) She took up the violin at age four and started piano lessons when she was six. She skipped first and seventh grades and completed high school in three years, graduating days after she turned 16. She finished college in three years too and enrolled in medical school in California at 19. A wunderkind, yes, but she wonders now about the damage racing through her youth caused. “Perfectionism is horrible,” Alison says. “I know that I didn’t develop good coping mechanisms. Some of my treatment team thinks I got stunted.”

Medical school was the first time Alison had to study in her life. She chose to specialize in anesthesia because of how tangible it was. “I liked how when someone’s blood pressure is high, you give them medicine and it goes down,” she says. “That immediate gratification.” She married a man she met while she was in medical school when she was 22 and had her first son one month before graduation. (Her second son was born during her residency.)

Three years of her medical schooling were paid for by the Navy (“With my dad being a teacher and me being one of seven kids, there was no money,” she explains), so after finishing her residency, she paid the military back with three years of service, during which she was stationed at Walter Reed National Military Medical Center in Bethesda, Maryland. True to form, Alison was not just any anesthesiologist in the Navy, she was the one asked to do the anesthesia for a president (“A huge honor,” she says) and a high-ranking senator. (She was called in from maternity leave after giving birth to her daughter at the surgeon’s request.)

Alison left the Navy in 2003 and moved to Georgia, about an hour from where she grew up. She and her husband wanted to raise their kids in the South, and she was eager for a slower pace. The years of schooling and success with three young children had been hard on her marriage. “I fell in love with my kids immediately, and I let the marriage slip,” Alison explains. “I put my kids before my husband.”

Source: An Opioid Addict Who Was Also a Top Doctor Shares Her Story of Recovery | Marie Claire February 2019

Filed under: Heroin/Methadone,HIV/Injecting-Drug-Users,Prescription Drugs,Treatment and Addiction :

Substance use has often been described as “bad learning” linked with impairments in reward processing and decision-making, but there is little substantial research to support this idea. A recent study by Byrne et al. suggests that substance misuse not only promotes harmful habit formation, which might undermine survival, but also makes it difficult to stop using.

Model-free vs. Model-based Learning

The “Dual Systems” theory of reinforcement learning defines two distinct systems:

  1. The model-based, or goal-directed system, where actions are planned and purposeful, and we learn about the connection between actions and outcomes, and how to modify our behavior to achieve the desired outcome. This system requires more cognitive processing and is more flexible and controlled.

  2. The model-free, or habit-based system, where learning is informed by reflexive responses to stimuli – like compulsive substance use and cravings. This system of learning is less flexible and is more controlled by automatic processing.

The differences between the two systems of learning have been highlighted by researchers in relation to harmful habitual behaviors such as substance use. One school of thought suggests that learning informed by the model-free system, with more of a focus on instinctual response to stimuli and less of a focus on conscious and informed decision-making, sets a person up to be more likely to engage in detrimental behaviors like substance use.

There is evidence that progressing from first use to misuse and addiction is paralleled by a shift from planned, purposeful, and goal-directed behavior to behavior that is habitual and reflexive. This progression and subsequent loss of control has been discussed by National Institutes on Drug Abuse Director Dr. Nora Volkow in her keynote speech at the APA and in her blog about free will. Model-free, conditioned learning means it is harder for a person to engage their frontal lobes, the part of the brain that helps us prioritize healthy, long-term and rational decisions. Repeated problematic substance use initiates a process where humans begin to respond more instinctually to the substance, wanting more and more of it over time. Use begets use, which leads to maladaptive behaviors centered around obtaining and using the substance to trigger the very same dopamine response that drives and reinforces model-free, habitual learning.

Substance Use and Reward Devaluation

Reward devaluation is a process that occurs in the brain where the value of a desirable outcome, like singing in a band, mentoring, or maintaining sobriety is reduced significantly. This process plays into why improving treatment outcomes can be so hard – treatment for addiction is not as “reinforcing” in the brain as substance use. Compulsive drug use is considered “highly pleasurable” by the parts of the brain that control decision-making when people are heavily addicted and feel as though they need the substance to survive. But treatment? not so much — long-term treatment is difficult to complete without continual support and a long-term treatment plan. Many patients stop attending treatment and/or support groups, and taking prescribed medications unless they are compelled to follow a set treatment plan and have adequate supports in place to help keep them on track.

Addiction is correlated to a considerable decrease in a person’s ability to devalue or disengage from habits learned through the model-free system. This means that problematic substance use affects our ability to make decisions and as the disorder progresses, we begin to put less value on long-term rewards and more value on immediately satisfying a need. Gradually, short term needs, like substance use, override long-term needs, like maintaining employment or investing in personal relationships.

Goals of Study

  1. To examine the associations between model-based and model-free learning with a wide array of substance use behaviors. The process used to determine this was measuring individual variations in eye-blink rate, an indirect proxy for dopamine functioning, a key neural process related to model-free learning.

  2. To assess whether problematic substance use predicted reward disengagement.

Why is This Important?

Patients with substance use disorders are driven to use despite harmful consequences, and although addiction is understood more and more as an acquired brain disease, many are still mystified as to why those suffering can’t manage to break their “habit.” This study helps foster a greater understanding of the mechanisms that explain why. Use may be thought of as “recreational” by the user, but it poses a challenge to the brain, reinforcement systems, and reward hierarchies, which can change a person quickly and in a way that is hard for those around them to understand. Once reward-outcome associations are well established— i.e., taking drugs makes a person “feel good”— individuals with substance use disorders have changed the most basic mechanisms in their brain, and will have more difficulty disengaging from the habitual tendencies. It is not clear how individual experiences, genetics, trauma, and other factors change the speed of these changes. That said, the results of this study are consistent with previous data depicting how alcohol dependence indicates a greater likelihood that a person has habit-based learning strategies over goal-directed strategies. The results do not, however, provide us with more information about whether biological recovery is possible, and how we could make recovery more likely and sustainable for patients.

Authors state that current findings highlight how problems with substance use go beyond the realms of habit formation: they also influence the process of disengaging or “breaking” habits by making it more difficult for individuals with substance use disorders to stop using substances. A better understanding of the mechanisms in the brain that take over once substance use becomes problematic may help us create more effective prevention campaigns and treatments once substance use progresses to a harmful habit.

Source: Why are habits so hard to break? (addictionpolicy.org) May 2019, updated October 2022

Filed under: Addiction,Brain and Behaviour,Drug use-various effects,Treatment and Addiction :

Abstract

Opioid use disorder is a highly disabling psychiatric disorder, and is associated with both significant functional disruption and risk for negative health outcomes such as infectious disease and fatal overdose. Even among those who receive evidence-based pharmacotherapy for opioid use disorder, many drop out of treatment or relapse, highlighting the importance of novel treatment strategies for this population. Over 60% of those with opioid use disorder also meet diagnostic criteria for an anxiety disorder; however, efficacious treatments for this common co-occurrence have not be established. This manuscript describes the rationale and methods for a behavioral treatment development study designed to develop and test an integrated cognitive-behavioral therapy for those with co-occurring opioid use disorder and anxiety disorders.

The aims of the study are (1) to develop and pilot test a new manualized cognitive behavioral therapy for co-occurring opioid use disorder and anxiety disorders, (2) to test the efficacy of this treatment relative to an active comparison treatment that targets opioid use disorder alone, and (3) to investigate the role of stress reactivity in both prognosis and recovery from opioid use disorder and anxiety disorders. Our overarching aim is to investigate whether this new treatment improves both anxiety and opioid use disorder outcomes relative to standard treatment. Identifying optimal treatment strategies for this population are needed to improve outcomes among those with this highly disabling and life-threatening disorder.

Source: Development of an integrated cognitive behavioral therapy for anxiety and opioid use disorder: Study protocol and methods – PubMed (nih.gov) July 2017

Filed under: Brain and Behaviour,Drug use-various effects,Heroin/Methadone,Treatment and Addiction :

Abstract

Among individuals with substance use disorders (SUDs), comorbidity with other psychiatric disorders is common and often noted as the rule rather than the exception. Standard care that provides integrated treatment for comorbid diagnoses simultaneously has been shown to be effective. Technology-based interventions (TBIs) have the potential to provide a cost-effective platform for, and greater accessibility to, integrated treatments. For the purposes of this review, we defined TBIs as interventions in which the primary targeted aim was delivered by automated computer, Internet, or mobile system with minimal to no live therapist involvement. A search of the literature identified nine distinct TBIs for SUDs and comorbid disorders. An examination of this limited research showed promise, particularly for TBIs that address problematic alcohol use, depression, or anxiety. Additional randomized, controlled trials of TBIs for comorbid SUDs and for anxiety and depression are needed, as is future research developing TBIs that address SUDs and comorbid eating disorders and psychotic disorders. Ways of leveraging the full capabilities of what technology can offer should also be further explored.

Source: Technology-Based Interventions for Substance Use and Comorbid Disorders: An Examination of the Emerging Literature – PubMed (nih.gov) May/June 2017

Filed under: Drug use-various effects,Internet,Treatment and Addiction :
Abstract

Importance  Opioid-dependent patients often use the emergency department (ED) for medical care.

Objective  To test the efficacy of 3 interventions for opioid dependence: (1) screening and referral to treatment (referral); (2) screening, brief intervention, and facilitated referral to community-based treatment services (brief intervention); and (3) screening, brief intervention, ED-initiated treatment with buprenorphine/naloxone, and referral to primary care for 10-week follow-up (buprenorphine).

Design, Setting, and Participants  A randomized clinical trial involving 329 opioid-dependent patients who were treated at an urban teaching hospital ED from April 7, 2009, through June 25, 2013.

Interventions  After screening, 104 patients were randomized to the referral group, 111 to the brief intervention group, and 114 to the buprenorphine treatment group.

Main Outcomes and Measures  Enrollment in and receiving addiction treatment 30 days after randomization was the primary outcome. Self-reported days of illicit opioid use, urine testing for illicit opioids, human immunodeficiency virus (HIV) risk, and use of addiction treatment services were the secondary outcomes.

Results  Seventy-eight percent of patients in the buprenorphine group (89 of 114 [95% CI, 70%-85%]) vs 37% in the referral group (38 of 102 [95% CI, 28%-47%]) and 45% in the brief intervention group (50 of 111 [95% CI, 36%-54%]) were engaged in addiction treatment on the 30th day after randomization (P < .001). The buprenorphine group reduced the number of days of illicit opioid use per week from 5.4 days (95% CI, 5.1-5.7) to 0.9 days (95% CI, 0.5-1.3) vs a reduction from 5.4 days (95% CI, 5.1-5.7) to 2.3 days (95% CI, 1.7-3.0) in the referral group and from 5.6 days (95% CI, 5.3-5.9) to 2.4 days (95% CI, 1.8-3.0) in the brief intervention group (P < .001 for both time and intervention effects; P = .02 for the interaction effect). The rates of urine samples that tested negative for opioids did not differ statistically across groups, with 53.8% (95% CI, 42%-65%) in the referral group, 42.9% (95% CI, 31%-55%) in the brief intervention group, and 57.6% (95% CI, 47%-68%) in the buprenorphine group (P = .17). There were no statistically significant differences in HIV risk across groups (P = .66). Eleven percent of patients in the buprenorphine group (95% CI, 6%-19%) used inpatient addiction treatment services, whereas 37% in the referral group (95% CI, 27%-48%) and 35% in the brief intervention group (95% CI, 25%-37%) used inpatient addiction treatment services (P < .001).

Conclusions and Relevance  Among opioid-dependent patients, ED-initiated buprenorphine treatment vs brief intervention and referral significantly increased engagement in addiction treatment, reduced self-reported illicit opioid use, and decreased use of inpatient addiction treatment services but did not significantly decrease the rates of urine samples that tested positive for opioids or of HIV risk. These findings require replication in other centers before widespread adoption.

Trial Registration  clinicaltrials.gov Identifier: NCT00913770

Source: Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network April 2015

Filed under: Heroin/Methadone,Prevention and Intervention,Treatment and Addiction :

A life-threatening heart infection afflicts a growing number of people who inject opioids or meth. Costly surgery can fix it, but the addiction often goes unaddressed.

Dr. Thomas Pollard, a cardiothoracic surgeon in Knoxville, Tenn., and his team working to replace heart valves that had been damaged from endocarditis, an infection the patient developed from injecting drugs. Shawn Poynter for The New York Times

OAK RIDGE, Tenn. — Jerika Whitefield’s memories of the infection that almost killed her are muddled, except for a few. Her young children peering at her in the hospital bed. Her stepfather wrapping her limp arms around the baby. Her whispered appeal to a skeptical nurse: “Please don’t let me die. I promise, I won’t ever do it again.”

Ms. Whitefield, 28, had developed endocarditis, an infection of the heart valves caused by bacteria that entered her blood when she injected methamphetamine one morning in 2016. Doctors saved her life with open-heart surgery, but before operating, they gave her a jolting warning: If she continued shooting up and got reinfected, they would not operate again.

With meth resurgent and the opioid crisis showing no sign of abating, a growing number of people are getting endocarditis from injecting the drugs — sometimes repeatedly if they continue shooting up. Many are uninsured, and the care they need is expensive, intensive and often lasts months. All of this has doctors grappling with an ethically fraught question: Is a heart ever not worth fixing?

“We’ve literally had some continue using drugs while in the hospital,” said Dr. Thomas Pollard, a veteran cardiothoracic surgeon in Knoxville, Tenn. “That’s like trying to do a liver transplant on someone who’s drinking a fifth of vodka on the stretcher.”

The problem has consumed Dr. Pollard, a calm Texan who got his Tennessee medical license in 1996, just after the widely abused opioid painkiller OxyContin hit the market. He has seen an explosion of endocarditis cases, particularly among poor, young drug users whose hearts can usually be salvaged, but whose addiction goes unaddressed by a medical system that rarely takes responsibility for treating it.

Certain cases haunt him. A little over a year ago, he replaced a heart valve in a 25-year-old man who had injected drugs, only to see him return a few months later. Now two valves, including the new one, were badly infected, and his urine tested positive for illicit drugs. Dr. Pollard declined to operate a second time, and the patient died at a hospice.

“It was one of the hardest things I’ve ever had to do,” he said.

The Treatment Gap

As cases have multiplied around the country, doctors who used to only occasionally encounter endocarditis in patients who injected drugs are hungry for guidance. A recent study found that at two Boston hospitals, only 7 percent of endocarditis patients who were IV drug users survived for a decade without reinfection or other complications, compared with 41 percent of patients who were not IV drug users. Those hospitals are among a small but growing group trying to be more proactive.

Dr. Pollard has been lobbying hospital systems in Knoxville to provide addiction treatment for willing endocarditis patients, at least on a trial basis, after their surgery. If the hospitals offered it, he reasons, doctors would have more justification for turning away patients who refused and in the long run, hospitals would save money.

Addiction has long afflicted rural east Tennessee, where the rolling hills and mountains are woven with small towns suffering from poverty and poor health. Prescribing rates for opioids are still strikingly high, and the overdose death rate in Roane County, where Ms. Whitefield lives, is three times the national average. Jobs go unfilled here because, employers say, applicants often cannot pass a drug test.

Across Tennessee, some 163,000 poor adults remain uninsured after state lawmakers refused to expand Medicaid under the Affordable Care Act. For them, and even for many covered by Medicaid, as Ms. Whitefield is, evidence-based opioid addiction treatment remains meager. More common are cash-only clinics, or abstinence-based programs that bank on willpower instead of the addiction medications that have proved more effective.

Treatment for endocarditis usually involves up to six weeks of intravenous antibiotics, often in the hospital because doctors are wary of sending addicted patients home with IV lines for fear they would use them to inject illicit drugs. Many, like Ms. Whitefield, also need intricate surgery to repair or replace damaged heart valves. The cost can easily top $150,000, Dr. Pollard said.

Advice from specialty groups, like the American Association for Thoracic Surgery and the American College of Cardiology, about when to operate remains vague. For now, “it’s just a lot of anecdote — surgeons talking to each other, trying to determine when we should and when we shouldn’t,” said Dr. Carlo Martinez, who is one of Dr. Pollard’s partners and who operated on Ms. Whitefield at Methodist Medical Center of Oak Ridge.

Their practice, owned by Covenant Health, will almost always operate on someone with a first-time case of endocarditis from injecting drugs, Dr. Pollard said. But repeat infections, when the damage can be more extensive and harder to fix, make it a tougher call. Dr. Mark Browne, Covenant’s senior vice president and chief medical officer, said, “Each patient is evaluated individually and decisions regarding the appropriate course of care are determined by their attending physician.”

In the nearly two years since she got sick, Ms. Whitefield has felt physically diminished and been prone to illness. She also feels harshly judged by a medical system that saved her life but often treats her with suspicion and disdain.

Over the same stretch of time, Dr. Pollard has grown increasingly disillusioned with hospitals that consider addiction treatment beyond their purview, and haunted by the likelihood that many of his drug-addicted patients will die young whether they get heart surgery or not. He set up a task force in 2016 to address the problem but has faced obstacles, especially concerning cost and, he believes, a societal reluctance to spend money on people who abuse drugs.

“Everybody has sympathy for babies and children,” he said. “No one wants to help the adult drug addict because the thought is they did this to themselves.”

Dr. Pollard has been consumed by the problem of endocarditis among drug users whose addiction goes unaddressed. “We’ve literally had some continue using drugs while in the hospital,” he said. Joe Buglewicz for The New York Times

____

Ms. Whitefield, a talkative young woman with brooding eyes, goes by the nickname Shae. She started on opioid painkillers as a teenager suffering from endometriosis, a disorder of the uterine tissue, and interstitial cystitis, a painful bladder condition. She got the opioids from doctors for years, and eventually from friends.

She and her high school boyfriend, Chris Bunch, had three children by the time she was 26. She trained to become a licensed practical nurse but dropped out of the program when her oldest son, Jayden, got seriously ill as a baby. The family lives in a tiny town that Mr. Bunch, now Ms. Whitefield’s husband, described as “country, country, country.”

In 2015, after their daughter, Kyzia, was born, Ms. Whitefield sank into postpartum depression. She was obsessively worried about shielding Kyzia from sexual abuse and other traumas she had experienced as a child. She started injecting crushed opioid pills and occasionally meth, savoring the needle’s sting — she had an old habit of cutting herself to provide relief from emotional pain — at least as much as the high.

After sharing a needle with one of her brothers that day in June 2016, Ms. Whitefield started shivering and sweating. A fever soon followed, and she lay for almost a week on the couch, thinking she had a kidney infection. She was delirious by the time Jayden, then 8, woke her stepfather one morning and told him to call 911.

She arrived at Methodist Medical Center of Oak Ridge with full-blown sepsis, floating in and out of consciousness. Her organs had started to shut down.

At home, she had stared at a picture on the wall of her grandmother faintly smiling, a source of reassurance, for days. When the first nurse leaned over her in the emergency room, she thought she smelled her grandmother’s perfume.

Her stepfather, Brian Mignogna, remembers being stunned when a doctor who initially assessed her said that if it were up to him, he would not go to great lengths to save her.

“He said once someone’s been shooting up, you go through all this money and surgery and they go right back to shooting up again, so it’s not worth it,” Mr. Mignogna recalled. “I was just dumbfounded.”

Dr. Martinez was the on-call heart surgeon a few days later, though, and felt strongly about taking Ms. Whitefield’s case. Her children and stepfather had been constants at her bedside, and unlike some patients he had seen, she had readily admitted to her drug use. He believed her when she said she had not been injecting for long and wanted to stop.

“She was a young mother and her family was involved; her father was there,” he said. “To me, it seemed she had that social support that patients need once they recover from this.”

Ms. Whitefield also had health coverage through Medicaid, the government insurance program for the poor, because she has young children. It paid for her care, whereas if she were uninsured, the hospital would have had to cover the cost.

Antibiotics cleared the infection that initially led her to the hospital, but she ended up needing surgery two months later. Her mitral valve was so damaged that she had begun showing signs of heart failure. Dr. Martinez was compassionate, but he stressed that the surgery would be “a one-time deal,” Mr. Mignogna recalled.

“The way he put it was, ‘You relapse and end up with another infection, we won’t treat you again,’” Mr. Mignogna said.

Dr. Martinez repaired Ms. Whitehead’s mitral valve in a three-hour operation. It involved sawing open her breastbone, connecting her to a bypass machine to keep blood flowing through her body, and then stopping her heart and fixing the valve. He reinforced it with a small plastic ring before restarting her heart and closing her up.

She had written a note to each of her children — wise Jayden, kind Elijah, strong-willed Kyzia — in case she never woke up. Two weeks later, she was well enough to go home. She soon began seeing a counselor at a clinic unaffiliated with the hospital system and taking buprenorphine, a medication that diminishes opioid cravings and has been found to reduce the risk of relapse and fatal overdose.

Ms. Whitefield has had occasional cravings since the surgery but says she has not used drugs again, traumatized by the memory of her ordeal.

“I know next time God might not save me,” she said quietly. “They will not treat me for a second time if I have track marks or anything like that.”

As she recuperated, Ms. Whitefield started thinking about returning to school, aspiring to become a drug and alcohol counselor or real estate agent, or both.

She has also started serving as an advocate of sorts for others in her community who get endocarditis or other infections from injecting, driving them to the emergency room or sharing every detail of the protocol that saved her. She smarts at the thought of providing only “comfort care” — antibiotics but no surgery — even if a patient refuses addiction treatment.

“When do you stop wanting to save a life?” she asked. “If you have that ability, who’s to say you shouldn’t use it? I see it from their standpoint — not wanting to repeat the same game. But it’s hard, you know? This isn’t an easy disease to break away from.”

____

Dr. Pollard, a quietly driven high school valedictorian, used to have no empathy for drug-addicted patients.

“I was like everyone else: ‘They do it to themselves, they deserve what they get,’” he said. “But then when you see their children, and hear about friends my kids went to school with who have died, it’s closer to home.”

When he became president of the Knoxville Academy of Medicine in 2015, he came up with the idea of the city’s hospital systems teaming up to offer addiction treatment to endocarditis patients. He had the perfect platform to push for it, he thought.

So the following year, he set up a task force that included people from each hospital system — his own, Covenant Health; the University of Tennessee Medical Center; and Tennova Healthcare — as well as from two drug treatment centers and some community groups.

At a task force meeting last August, about a year after Ms. Whitefield’s surgery, Dr. Pollard clicked through a PowerPoint presentation full of data a research nurse had compiled. From 2014 through 2016, the three hospital systems in Knoxville had provided valve surgery to 117 patients diagnosed with endocarditis from injecting drugs. Ten had received a second surgery after becoming reinfected; of those, two had received a third.

Just over half the patients were uninsured, and only 1 percent had private coverage. From the data, it was impossible to know if anyone had been reinfected but turned away by doctors. But at least 21 people — 18 percent — had died since their heart surgery, typically from sepsis or respiratory failure, which Dr. Pollard said indicated reinfection.

The group discussed Dr. Pollard’s proposal for Cornerstone of Recovery, an addiction treatment center here, to admit a handful of endocarditis patients as soon as they were cleared for discharge. Cornerstone would provide several months of inpatient treatment and up to a year’s worth of Vivitrol, a monthly $1,000 shot that blocks cravings and helps prevent relapse.

Buprenorphine, the medication Ms. Whitefield takes, is less expensive. But Cornerstone does not provide it because it is an opioid itself and “is trading one for the other,” said Webster Bailey, its executive director of marketing. Many addiction experts have called that view “grossly inaccurate.” They say it is weaker than drugs like oxycodone and heroin, activating the brain’s opioid receptors enough to ease cravings but not enough to provide a high in people who are already dependent on opioids.

Patients would sign an agreement stating that if they returned to abusing drugs after addiction treatment, they might not be considered a candidate for future heart surgery. The total cost per patient: perhaps $55,000, which Dr. Pollard hopes that government and private funding would help cover if the program expanded.

“This should be part of the treatment, just like antibiotics are,” he told the group.

A surgeon from Tennova dryly pointed out: “Not everybody in that group is going to say, ‘This is for me, I’m going to do it.’”

Still, the group decided Dr. Pollard should take the next step, pitching the pilot plan to each system’s top executives.

“We are competing systems, but this is a common enemy that unites us all,” he said afterward. “We need a united policy.”

Source: https://www.nytimes.com/2018/04/29/health/drugs-opioids-addiction-heart-endocarditis.html April 2018

Filed under: Drug use-various effects,Health,Methamphetamine/GHB/Hallucinogens/Oxycodone,Treatment and Addiction :

As in many other jurisdictions, there are no regulations in B.C. for addictions treatment centres, no standards for addictions services and no requirement for outcomes to be reported or monitored.

They operate under the same legislation that regulates daycares and homes for the elderly, which means that only the facilities are inspected, not the programs or services within them.

B.C. recovery homes don’t have to be licensed, although they are required to be registered if they offer three or more beds. Some treatment facilities are accredited by third-party organizations. But, here’s the kicker: “Most homes are often short-lived business operations in rented housing,” according to last week’s report by the Death Review Panel set up to investigate British Columbia’s epidemic of illicit-drug overdoses.

The total amount British Columbia spends on treatment isn’t clear, although it spends $90 million alone on methadone and other pharmaceutical replacement therapies for addicts each year. Beyond what the government spends, hundreds of thousands (if not millions) are spent by individuals, insurance companies or employers at private facilities that charge upwards of $30,000 to $40,000 a month for residential care. (The famous Betty Ford Center costs US$3,300 a week.)

In an interview, the death panel’s chair Michael Egilson said, “Some supportive recovery homes, somebody may have just decided to set up on their own. The exact number and how they are dealing with treatment is hard to say.”

The panel recommends that by September 2019, British Columbia develop or revise regulations for all treatment facilities and services and set standards so that these facilities can be systematically evaluated and monitored.

Egilson contends that what drove this recommendation is “an acute awareness that opioid-abuse disorders best practise is certainly different from some traditional abstinence models … Abstinence is not a desirable treatment. If a person relapses after a quick detox, there’s a greater potential for overdose death.”

This is a harm-reduction model of replacing an illicit drug with a pharmaceutical one such as methadone, suboxone or even prescription heroin — “opioid agonist therapies.”

Egilson referred specifically to Brandon Jansen, a 20-year-old who overdosed on a fentanyl-laced cocktail of illicit drugs in 2016 at the Sunshine Coast Health Centre in Powell River. At the coroner’s inquest, where Egilson presided, evidence indicated that within the past three years, Jansen had spent time “at a minimum of 11 detoxification centres, recovery homes and treatment centres.”

The fact that he relapsed was hardly unique — 40 to 60 per cent of people receiving treatment do, according to the U.S. National Institute on Drug Abuse.

The unspoken suggestion in the death panel’s recommendation is that the government — along with individuals, their families, insurers and employers — is likely throwing money away because most addiction programs are based on Alcoholics Anonymous’s 70-year-old, 12-step program.

But the point is that we don’t know. We don’t have good data because its collection is not required. We don’t even know what kind of snake oil some of these centres are selling because none of them is properly monitored.

You can’t help wonder why something as basic as ensuring that desperate people hoping to finally kick there habit are getting the help they need has been ignored.

This is, after all, a city and a province that for nearly 20 years has been at the forefront of harm-reduction with needle exchange programs, safe injection sites, methadone and suboxone treatment programs, a prescription heroin program and, more recently, free naloxone kits, free-standing naloxone stations and training for first-responders and even teachers in how to use it as an antidote for fentanyl overdoses.

We’ve gone from crisis to crisis, each one sucking up incredible resources. Currently, a quarter of a million dollars a day goes into the Downtown Eastside alone for methadone treatment. This year, the B.C. government expects the number of British Columbians receiving replacement drug therapy to rise to 30,000 and then nearly double to 58,000 by 2020-21.

In 2006 when Vancouver updated its four pillars approach, it noted that there were 8,319 British Columbians being treated with methadone.

By 2020-21, the province also expects to be supplying 55,000 “free” take-home naloxone kits, up from 45,000 this year.

We keep hearing about an overdose crisis, but what we have is an addictions crisis. Solving it will require a lot more than simply reducing harm. The more intractable problems of poverty, homelessness and abuse that are often brought on by depression, despair and other untreated mental health issues need to be addressed.

So, by all means, let’s do what we can to stop the overdoses. Let’s ensure that there is evidence-based treatment available.

But let’s quit pretending that until we deal with the root causes of addictions, harm reduction is little more than an increasingly expensive bandage.

Source: Daphne Bramham: Harm reduction not enough to end B.C. overdose crisis | Vancouver Sun April 2018

Filed under: Needle Exchange,Treatment and Addiction :
Michael Weaver, MD Medical director, Center for Neurobehavioral Research on Addiction Dr. Weaver has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

I first met 32-year-old Miranda after a drug relapse that followed a stay in a residential addiction treatment facility. She had begun experimenting recreationally with prescription opioids in her early 20s, but her use escalated after she was involved in a car accident a few years later and a doctor began prescribing opioids for pain. Because of her increased use, Miranda decided on her own to enter a 28-day detox and rehab, but relapsed immediately upon discharge. Several months later, she made an appointment with me to discuss opioid agonist treatment. I prescribed buprenorphine, and for the first few months of treatment she appeared to be doing well.

Addiction treatment often begins with high hopes and apparent success, but it’s important to remember that addiction is a disease with a relapse rate of 40%–60% (McLellan et al, JAMA 2000;284(13):1689–1695; Dawson DA et al, Alcohol Clin Exp Res 2007;31:2036–2045). Be realistic: Expect that patients will go through cycles of relapse and recovery. Learn the warning signs for relapse, the measures you can take to prevent it, and what to do after it has occurred.

Recognizing relapse

There are a number of clues that someone has relapsed—or may be headed that way:

    • Reduced eye contact during a ­session
    • A more anxious demeanor than usual
    • Less engagement, or a sense of holding back from the treatment process
    • Exacerbated emotional distress or worsening co-anxiety or depression
    • Vague answers to questions
    • Reduced attendance at 12-step programs or therapeutic groups
    • Missed visits with a psychiatrist or other caregiver

None of these red flags individually spell impending relapse—instead, it’s the pattern of behavior that tells the story. Your patient may not actually have used yet, but (wittingly or unwittingly) is starting to go down that road. This is known as desire thinking (Martino F et al, Addict Behav 2017;64:118–122), and in 12-step programs, it’s called “drinking thinking.”

After three months of buprenorphine treatment, I began to notice worrisome signs of potential relapse during one of our sessions. Miranda’s answers to my questions were more vague than usual, her eye contact faltered, and she seemed a little more anxious. Before that session, we had started talking about smoking cessation, but that day she didn’t seem interested.

At that point, I told Miranda I would need a urine sample. She hemmed and hawed for a minute, then admitted that she had started using again within the past few days. She had been spending time with her sister, who also abused a variety of illegal and prescription drugs; while there, her sister had told her, “I know you can’t use opioids, but here are some benzodiazepines. Why don’t you try those?” Miranda acquiesced, and that quickly escalated to use of marijuana and finally opioids.

Miranda’s story is fairly typical. Pressure from peers not in recovery, or simply spending time with old friends not in recovery, is cause for concern. In fact, if a patient divulges spending time with past friends to you, this can be a clue that’s just as telling as poor eye contact or unusual jitteriness.

The marijuana Miranda’s sister provided only complicated things more. For many people, using marijuana or alcohol provides a false sense of confidence. They think, “I can smoke some pot or have a couple of drinks because they aren’t my problems, and I can handle them.” But these substances are called gateway drugs for a reason—they can impair judgment and lead people to the very drugs they want to avoid.

Proactive is better than reactive
It’s much easier to prevent a problem than to treat one, so I spend a lot of time teaching patients how to ­identify their own risk factors for relapse. The key is reminding patients that any unusual event can reduce their resolve because if they are caught off guard, it is hard to stay focused on abstinence goals. Examples of such events include things like visits by a disliked in-law, a chance meeting with someone from the patient’s drug-using past, and waylaid plans for a vacation.

I find it helpful to talk to patients about potential challenges they might face, and then help them cope with the stress of such situations by rehearsing responses and planning tactics. For a troublesome in-law, for example, you can encourage the patient to express concerns to her spouse and to explain the need to keep away for much of the visit. You can do some role-playing to simulate a chance conversation with a past friend who still uses so the patient has a script that will make saying “no” easier and more automatic. Responses can range from, “No thanks, I’ve decided not to use because I don’t want any problems at my new job” to, “Maybe another time,” which is non-judgmental and helps avoid confrontation.

Relapse triggers are often situational. For instance, if everyone from work is going out for a drink, a patient might feel obligated to drink too. Walk the patient through a discussion about whether attending the event but not imbibing alcohol would actually affect his job security. For example, if he nursed a club soda rather than an alcoholic beverage, would anybody really care?

To help patients deal with temptations, I encourage them to write daily in a journal, even if it’s only half a page. This helps them identify what might be troubling them, put the issues in perspective, and work out solutions. (Ed note: For more information about relapse prevention skills based on cognitive behavioral therapy, see Cognitive Behavioral Skills Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence: https://pubs.niaaa.nih.gov/publications/ProjectMatch/match03.pdf.)

If a relapse is already in progress
You can’t always capture the problem before it has occurred. If your patient has relapsed, the most important task is to help minimize the severity of the relapse. Substance-using patients often slip into an all-or-nothing attitude, in which they say to themselves, “I’ve relapsed; I’ve failed treatment. My abstinence is over, so I might as well give in to the drugs and forget about treatment altogether.” (For more information on cognitive distortions in substance use disorder, see Beck A et al, Cognitive Therapy of Substance Abuse. New York: Guilford Press, 1993.)

In such cases, it’s important to reassure patients that a relapse doesn’t mean the end of the world—in fact, it doesn’t even mean the treatment didn’t work. Just like any chronic disease process, addiction treatment involves remissions and exacerbations, and sometimes all that’s needed is a change of approach. I will often give patients the analogy of treating an infection: “Say you have an infection that requires oral antibiotics. If the infection comes back, you don’t decide that the treatment was worthless. Instead, you talk about it with your doctor, who might need to prescribe stronger oral antibiotics, or even recommend a hospital stay for intravenous ­antibiotics. It’s the same thing here. Our first approach to maintaining recovery only worked for so long, so now we’ll try a different approach.”

How do you step up your treatment game to help a relapsing patient? There are many next steps, depending on the circumstances:

    • Seeing the patient more frequently on an outpatient basis
    • Requiring more frequent urine testing to keep the patient accountable and provide an incentive to think twice about using
    • Having the patient go to more 12-step meetings or more group or individual therapy sessions
    • Increasing the dosage of medication-assisted therapy, such as an opioid antagonist
    • Having the patient undergo a brief inpatient stay for detox

After Miranda’s relapse, I increased her dose of buprenorphine/naloxone from 12 mg/3 mg to 16 mg/4 mg daily to help with cravings and prevent any withdrawal from her recent opioid use. I also asked her to commit to seeing her therapist more frequently. We worked on some of the issues that led to the relapse; specifically, I talked with her about avoiding contact with her sister. In this case, I didn’t suggest 12-step meetings, because she wasn’t particularly interested in that approach. However, because her depression had started to worsen, I made an adjustment to her antidepressant medication.

These steps worked. Miranda went to see her therapist more often, and she responded to the adjustments in her buprenorphine dose. She also stayed away from her sister for a while and worked on refusal skills: “I know you’re trying to be helpful, but it’s not what I want or need right now. Please don’t offer me anything.”

Miranda was highly motivated—more than many other patients. But this doesn’t mean she’s immune to problems leading to other relapses (hopefully short-lived ones), even months or years down the road. That’s often part of the process of recovery—it doesn’t always happen in a straight line.

Like what you just read? Dr. Weaver’s new book, Addiction Treatment, is replete with practical tips for helping addicted patients yourself rather than losing them to follow-up when referring them elsewhere. The 14 brief chapters contain detailed instructions on how to frame sensitive questions to elicit honest answers, user-friendly charts to help you describe what drugs to prescribe in which circumstances, and much more. Feel great about helping your patients pull their lives together. Go to https://thecarlatreport.com/AddictionGuide for more information.

Source: Recognizing and Reversing Relapse | 2017-05-01 | CARLAT PUBLISHING (thecarlatreport.com) May 2017
Filed under: Addiction,Prescription Drugs,Treatment and Addiction :

Fentanyl is a synthetic opioid chemically similar to other substances like hydrocodone, oxycodone, heroin, and morphine. In recent years, fentanyl has played an increasingly prominent role in the opioid crisis, alongside other prescription medications like Dilaudid. Synthetic opioids are the most common drugs responsible for overdose deaths. In 2010, fentanyl was involved in 14.3% of drug overdose deaths. However, by 2017, fentanyl use accounted for nearly 59% of opioid-related deaths.

Fentanyl was created in 1959 and began being manufactured and distributed in the United States throughout the 1960s. Its original use was as an intravenous medication to treat cancer pain. According to the Drug Enforcement Administration (DEA), fentanyl’s pain-relieving properties are about 100 times more powerful than morphine’s and 50 times more potent than heroin’s.

Fentanyl as a Prescription Medication

To obtain fentanyl legally, a prescription from a doctor is required. Fentanyl is only prescribed to patients experiencing severe pain from cancer and who have developed a physical tolerance to other opioids. Building a tolerance means that a person’s body has gotten used to the drug and requires higher and/or more frequent doses to relieve the pain.

Fentanyl should not be used to treat any other types of pain, especially pain caused by migraines, headaches, an injury, or pain from a medical or dental procedure. Its primary purpose is to treat sudden episodes of pain that occur despite ongoing continuous pain management with other medications. Prescription fentanyl can be taken as an oral lozenge, sublingual tablet or spray, skin patch, nasal spray, or injection.

Fentanyl as an Illegal Street Drug

Fentanyl sourced on the street is often produced illegally in a lab. However, there have been documented cases of distribution through other pathways, including theft and fraudulent prescriptions. Patients, physicians, and pharmacists have also been complicit in contributing to fentanyl’s unlawful circulation. There are several ways fentanyl is misused.

The gel contents of patches can be removed and injected or ingested. Patches can also be frozen, cut into pieces, and put under the tongue or between the gums and cheek. Street-bought fentanyl is sold in similar forms as its prescription counterpart. However, it can also come as a powder, in eye droppers, on blotter papers, and in pills that look like prescription opioids.

On the street, it may be called:

  • Apache
  • China Girl
  • China Town
  • Dance Fever
  • Friend
  • Goodfellas
  • Great Bear
  • He-Man
  • Jackpot
  • King Ivory
  • Murder 8
  • Tango & Cash

What Effects Does Fentanyl Have? 

Besides being very effective at relieving pain, fentanyl causes sensations similar to those produced by other opioid analgesics like morphine: relaxation and euphoria. These are the effects that individuals who use fentanyl illegally are looking to achieve. Some negative side effects of use can include:

  • Nausea
  • Vomiting
  • Sedation
  • Dizziness
  • Confusion
  • Drowsiness
  • Constipation
  • Urinary retention
  • Unconsciousness
  • Constricted pupils
  • Problems breathing
  • Respiratory depression

What Happens When Fentanyl Is Misused? 

Two key conditions can result from the misuse of fentanyl: overdose and addiction. An overdose can occur when too high of a dose of the drug is taken, resulting in life-threatening symptoms like hypoxia. Hypoxia occurs when the brain does not receive enough oxygen, in this case, because a person’s breathing has slowed down or stopped. Hypoxia can cause a person to fall into a coma, suffer permanent brain damage, and die.

Coma, pinpoint pupils, and respiratory depression are strong indicators that a person may be experiencing an opioid overdose and requires emergency medical care. Other signs and symptoms of a fentanyl overdose can include:

  • Stupor
  • Dizziness
  • Confusion
  • Cold and clammy skin
  • Drowsiness or sleepiness
  • Being unable to respond or wake up
  • Bluish discoloration of the skin

Naloxone, also known as NARCAN®, is used to reverse the effects of opioids and can save a person from dying from an overdose. Because fentanyl is so strong, multiple doses may be required for its lifesaving effects to occur.

What Makes Fentanyl So Dangerous?

Fentanyl is a powerful drug, even in very small quantities. Its potency is what makes the possibility of overdose so high. Another major problem with illegal fentanyl is that it is being mixed with other drugs like cocaine, meth, heroin, and MDMA. A person looking for a party drug might end up using fentanyl for the first time without knowing it and accidentally overdose.

Like other opioid painkillers, a person that misuses fentanyl can become addicted. Fentanyl binds to opioid receptors in the brain that are associated with pain and emotions. The brain quickly becomes used to the drug and requires more to achieve euphoria. Additionally, users will begin to suffer withdrawal effects after their high wears off. Once addicted, an individual becomes consumed with seeking out and using the drug, despite the negative consequences their behavior has on their lives and those around them.

How Is Fentanyl Addiction Treated?

Before entering residential treatment, fentanyl addiction may first require medical detox. After withdrawing safely, addiction therapy will likely include a combination of medication and behavioral therapy.

Three medications commonly used to treat fentanyl addiction are buprenorphine, methadone, and naltrexone. Like fentanyl, buprenorphine and methadone bind to opioid receptors in the brain, but they can be used in therapeutic doses to help reduce cravings and lessen withdrawal symptoms. Naltrexone works differently. Instead of binding to the receptors, it blocks them so fentanyl won’t have any effect.

What Behavioral Therapies Help With Fentanyl Addiction?

Behavioral therapies used to treat fentanyl and other opioid addictions include cognitive behavioral therapy (CBT), contingency management, and motivational interviewing. CBT is based on the idea that one’s thoughts, feelings, and behaviors are connected. CBT can modify distorted thought patterns and improve emotional regulation.

Contingency management is also called the “prize method” or the “carrot and stick method.” This approach to addiction therapy is based on the idea that behavior can be shaped by enforcing consequences. Positive behaviors, like passing drug tests or meeting treatment goals, are reinforced by offering rewards. The goal of contingency management is to encourage healthy living.

Motivational interviewing is a process by which a therapist helps enhance a client’s motivation to change negative behaviors regarding substance use. A vital component of this therapy is that the client must want to want to change and improve their lives.

These behavioral treatment approaches are effective at treating opioid addiction, especially when used in combination with medication. You can learn more about addiction therapies at Laguna Shores here.

Source: America’s Killer New Drug​: A Guide to Fentanyl (lagunashoresrecovery.com) 2019

Filed under: Drug use-various effects,Prescription Drugs,Synthetics,Treatment and Addiction,USA :

Cannabis Use and Health 2014
Introduction

Cannabis is a group of substances from the plant cannabis sativa. Cannabis is used in three main forms: flowering heads, cannabis resin (hashish) and cannabis oil. There are more than 60 psycho-active chemicals in cannabis, including the cannabinoids:
 delta-9 tetrahydrocannabinol (THC), which is found in the resin covering the flowering tops and upper leaves of the female plant and which alters mood and produces the feeling of a ‘high’;
and
 cannabidiol, which can offset the effects of THC.

Cannabis is usually smoked, either in a hand-rolled cigarette (a ‘joint’) containing the leaf, heads or resin of the plant, or through a water-pipe (a ‘bong’) where water is used to cool the smoke before it is inhaled. In Australia, cannabis is also commonly known as gunja, yarndi, weed and dope.

Patterns of Cannabis Use in Australia and its Public Health Impacts

In 2010, cannabis was the most commonly used illicit drug in Australia. Over one third of Australians (35.4%, approximately 6.5 million) aged 14 years and over had used cannabis at least once in their lifetime, and 1.9 million of these had used cannabis recently (i.e., in the last 12
months). Recent cannabis use among those 14 years and older has increased from 9.1% in 2007 to 10.3% in 2010, though daily users decreased from 14.9% in 2007 to 13% in 2010. In 2010, approximately 247,000 Australians 14 years and over used cannabis daily. For most cannabis users, use is relatively light. Most young people have used it once or twice. However, the younger people start using cannabis, and the greater the frequency with which they use it, the greater the risk of harm.
Based on current use patterns, alcohol abuse and tobacco pose much greater harms to individual and public health in Australia than cannabis. Cannabis-related psychosis, suicide, road-traffic crashes and dependence were estimated to account for 0.2% of the total disease burden in Australia in 2003. This compares to 7.8% of the total burden attributable to tobacco use and 2.3% attributable to alcohol use. In 2004-05, the estimated social costs of cannabis use (including health, crime, road crash and labour costs) was $3.1 billion. Ninety percent of this cost was due to dependent cannabis use. In comparison, the health, crime, road-crash and labour costs of alcohol use in 2004-05 are estimated to be more than three times as much ($9.4 billion).

The Health Effects of Cannabis Use

There is a dose-response relationship between cannabis use and its effects, with stronger effects
expected from larger doses.
 Intoxicating effects occur within seconds to minutes and can last for three hours;
 Effects last longer with larger doses;
 Effects on cognitive function and coordination can last up to 24 hours;
 Short-term memory impairment may last for several weeks; and
 A single dose in a chronic user can take up to 30 days for the metabolites to be excreted.

Short-term effects of small doses
The most common short-term effects of using cannabis are:
 a feeling of euphoria or ‘high’ – with a tendency to talk and laugh more than usual;
 impaired balance, reaction time, information processing, memory retention and retrieval, and perceptual-motor coordination;
 increased heart rate;
 decreased inhibitions such as being more likely to engage in risky behaviour, e.g. unsafe
sexual practice; and
 if smoked, increased respiratory problems including asthma.

Short-term effects of large doses
The most common short-term effects of a large dose can include:
 hallucinations and changed perceptions of time, sound, colour, distance, touch and other sensations;
 panic reactions;
 vomiting;
 loss of consciousness; and
 restlessness and confusion.

The severity of these short-term effects depend on a person’s weight, tolerance to the drug, amount taken, interactions with other drugs, circumstances in which the drug is taken, and the mode of administration.

Long-term effects
The evidence associating regular cannabis use with specific long-term health conditions and adverse effects is of variable quality. Cannabis use is highly correlated with use of alcohol, tobacco and other illicit drugs, all of which have potential adverse health effects. There is sufficient evidence, however, to indicate that cannabis is a risk factor for some chronic health effects and conditions.

Regular and prolonged cannabis use may cause:
 cannabis dependence, characterised by impaired control over its use and difficulties in ceasing use; increased tolerance (meaning more of the drug is needed to produce the same effect) and possible withdrawal symptoms, including anxiety, insomnia, appetite disturbance, and
depression;
 increased risk of myocardial infarction in those who have already had a myocardial infarction;
and
 deficits in verbal learning, memory and attention (in heavy users).

While not conclusive, there is evidence that regular cannabis use can cause chronic bronchitis and impaired immunological competence of the respiratory system. Occasional cannabis use however, is not associated with adverse effects on pulmonary function. Cannabis smoke contains many carcinogens, but there is variable evidence concerning the relationship between cannabis smoking and lung cancer.

Evidence supporting an association between cannabis use and sexual and reproductive effects is weak. However, some studies show an association between cannabis use and increased risk of testicular cancer.
Daily consumption of large quantities of cannabis may lead to the neglect of other important personal and social priorities such as relationships, parenting, careers and community responsibilities.

Pregnant women
Cannabis is the most commonly used illicit drug in women of child-bearing age. Cannabis use during pregnancy has been consistently associated with lower birth-weight babies and pre-term birth, but does not appear to increase the risk of miscarriage or birth abnormalities. Some studies suggest that children exposed to cannabis in utero may have slight impairment in higher cognitive processes such as perceptual organisation and planning. There is insufficient evidence of an association between prenatal cannabis use and postnatal behaviour.

Accidental ingestion by young children
Accidental ingestion of cannabis can cause coma in young children. Cannabis ingestion can be confirmed by positive urine screening for cannabinoids. Cannabis ingestion needs to be considered in toddlers and children with impaired consciousness.

Driving under the influence of cannabis
Cannabis slows reaction time and increases the risk of having a car crash. Other risk factors are blurred vision, poor judgement and drowsiness which can persist for several hours. The effects are increased by alcohol.

Dependence and tolerance
Cannabis dependence is usually defined as impaired control over continued use and difficulty ceasing despite the harms of continued use.19 Dependence can negatively affect personal relationships, education, employment and many other aspects of a person’s life. Data from Australia and other countries indicates that demand for professional help related to cannabis is increasing. Cannabis dependence is the most frequent type of substance-dependence in Australia after alcohol and tobacco. It has been estimated that cannabis dependence will affect around one in ten cannabis users, and around half of those who use it daily. Animal and human studies demonstrate that tolerance to many of the psychological and behavioural responses to cannabis occurs with repeated exposure to the drug. The symptoms of withdrawal from cannabis appear similar to those associated with tobacco, but less severe than withdrawal from alcohol or opiates.

There is a view that the cannabis being used today has a higher THC content and potency than in the past. This may be a perception caused by changes in the mode of use (i.e. through ‘bongs’ rather than ‘joints’, and with more consumption of the heads of the cannabis plant). However, there is some independent evidence that cannabis used today can be of a higher potency. The cannabis in recent street-level seizures in Sydney and the North Coast of NSW has been shown to have a high potency, with around 15% THC, with little or no cannabidiol.

Cannabis as a Gateway Drug
The gateway hypothesis is that cannabis use may act as a causal ‘gateway’ to the use of other illicit drugs such as cocaine and heroin. It is a controversial hypothesis with proponents arguing that because the use of so-called harder drugs is almost always preceded by cannabis use, this means that cannabis use physiologically and/or psychologically causes people to progress to harder drugs. The alternative theory is known as the ‘common cause’ theory whereby a person’s use of cannabis and their later use of other illicit drugs are both seen as effects of common causes such as personal or socio-economic factors, or exposure to illicit drug distribution networks. Evidence for the gateway hypothesis is inconclusive given the difficulties in disentangling the effect of other potential influences in drug use progression. Meta-analyses suggest that the progression in use that has been observed is likely to be due partially to the influence of independent common
causes.

Cannabis and Mental Health

Cannabis and psychosis
Cannabis use is associated with poor outcomes in existing psychosis and is a risk factor for developing psychosis. For those with existing psychosis, using cannabis can trigger further episodes of psychosis, worsen delusions, mood swings, hallucinations and feelings of paranoia, as well as contributing to poor compliance with medication regimes. The research base on cannabis and psychosis has expanded in recent years with studies showing a consistent association between early-aged onset of cannabis use, regular use and a later diagnosis of schizophrenia. Meta-analyses have noted a doubling of the risk of psychotic outcomes in regular cannabis users, and earlier onset (by 2.7 years) among cannabis users who develop psychosis.
There is increasing evidence that the association between cannabis and onset of psychosis is not due to other co-occurring factors. The most plausible view is that cannabis use is a ‘contributory cause’ of psychosis in vulnerable individuals, and that it is one of a number of potential factors that can bring on psychosis (including genetic predisposition)’

Cannabis and depression
The association between cannabis use and depression is weak and insufficient to establish a causal connection. Studies that have found an association are likely to have been affected by confounding variables such as family and personality factors, other drug use and marital status.
There is currently insufficient evidence available to conclude whether cannabis use is associated with suicide. Research is made difficult by confounding factors such as the stresses of an illicit drug-dependent life and pre-existing poor mental health.

Cannabis and anxiety
There is emerging evidence associating cannabis use with anxiety disorders. However, the current level of evidence is not yet sufficient to establish a causal relationship.

Medical Uses Of Cannabis
In addition to psychoactive compounds, cannabis has constituents with other pharmacological effects, including antispastic, analgesic, anti-emetic, and anti-inflammatory actions. These constituents may have therapeutic potential.

Cannabis extracts and synthetic formulations have been licensed for medicinal use in some countries, including Canada, the USA, Great Britain and Germany, for the treatment of severe spasticity in multiple sclerosis, nausea and vomiting due to cytotoxics, and loss of appetite and cachexia associated with AIDS. The synthetic cannabis product Nabiximols (Sativex), which is delivered as a buccal spray and so avoids the harms of cannabis smoke inhalation, is effective in the management of spasticity and pain associated with multiple sclerosis. The psycho-active effects of Nabiximols can also be managed through controlling dosage.

In Australia, the synthetic cannabinoids nabilone and dronabinol are scheduled by authorities for medicinal use. Sativex is also being trialed in Australia for cancer and cannabis withdrawal. Canada has allowed the medical use of smoked cannabis if this is authorised and monitored by a doctor.
There is a growing body of evidence that certain cannabinoids are effective in the treatment of chronic pain, particularly as an alternative or adjunct to the use of opiates, when the development of opiate tolerance and withdrawal can be avoided. Controlled trials have also shown positive effects of cannabis preparations on bladder dysfunction in multiple sclerosis, tics in Tourette syndrome, and involuntary movements associated with Parkinson’s disease. Based on existing data, the adverse events associated with the short-term medicinal use of cannabis are minor.
However, the risks associated with long-term medicinal use are less well understood, particularly the risk of dependence, and any heightened risk of cardiovascular disease. Though there is a growing body of evidence regarding the therapeutic use of cannabinoids, it is still experimental.

Synthetic Cannabis
Synthetic cannabis products have been developed, usually in herbal form for smoking. These products have been marketed in Australia as ‘legal highs’ with product names such as ‘Spice’, ‘K2’, and ‘Kronic’. The psychoactive components are usually THC analogues that bind to cannabinoid receptors in the brain. These analogues are not easily detectable by routine testing, and until recently have not been captured by legislation. These synthetic cannabis products are attractive to their users because they are perceived as safe, are not easily detectable in drug tests, and until recently have not been illegal.
The synthetic cannabis products can not be considered safe given that the synthesized psychoactive substances in them have not been rigorously tested, and little is known about their long or short-term health effects, dependence potential or adverse reactions. Psychotic
symptoms have been associated with use of some synthetic cannabinoids, as well as signs of addiction and withdrawal symptoms similar to those of cannabis. Adverse outcomes have been reported from the use of Kronic in Australia.

The Control of Cannabis Use and Supply

Australian legislation
The possession, cultivation, use, and supply of cannabis is prohibited in all Australian States and Territories. In some Australian jurisdictions there are criminal penalties for the possession, cultivation and use of cannabis, and in others there are less severe civil penalties. Legislation in Australia often distinguishes between possession of small amounts of cannabis (for personal use) possession of larger amounts (trafficable quantities), and possession of even larger “commercially trafficable” quantities. The supplying of cannabis and the possession of large quantities attract criminal penalties in all Australian jurisdictions. All Australian States and Territories have diversionary schemes for minor and early cannabis offenders which require them to undertake educative and treatment programs as an alternative to receiving a criminal penalty.

Criminalisation and health
It is often thought that criminal penalties are a deterrent to cannabis use and, therefore, an effective way to prevent the health impacts and other harms associated with cannabis use. These beliefs have little foundation. A system of criminal prohibition for cannabis use applied in Australia for many years, but the incidence of cannabis use was still significant. The introduction of less serious civil penalties and diversionary alternatives to criminal sanctions did not significantly increase the rates of uptake and use among Australians.

For those who are not deterred from use by criminal penalties, criminalisation can add to the potential health and other risks to which cannabis users are exposed. These include:

 exposure of cannabis users, including teenage and occasional users, to ‘harder drugs’. Those who acquire cannabis from large scale illicit drug distribution networks will also become exposed to more harmful drugs, including the direct marketing of those drugs to them;
 exposure of cannabis users to criminal networks and activity, including exposure to the threat of violence and the risk of taking part in criminal distribution;
 the personal and health-related costs of a criminal conviction. A criminal conviction can negatively impact on a person’s employment prospects and their accommodation and travel opportunities. Limited employment and accommodation prospects can lead to poor health,
including mental health. Individuals with a criminal record are also at a disadvantage in any subsequent criminal proceedings;
 a deterrent to individuals seeking health advice, treatment and support regarding their cannabis use;
 the inability to collect high quality, reliable data regarding patterns of use and harms.

Harm reduction
A harm-reduction approach is defined as policies and initiatives that aim to reduce the adverse health, social and economic consequences of substance use to individual drug users, their families and the community. Harm reduction considers both the potential harms to individuals using substances like cannabis and the potential harms and negative impacts of the different approaches for controlling the use and supply of these substances. When harm reduction is the primary goal, the key policy focus will be on measures to reduce individuals’ harmful levels of cannabis use, or cannabis use among individuals who are most vulnerable to adverse health impacts, or cannabis use in contexts which involve serious risks to users.

Harm-reduction measures include targeted efforts to reduce the supply of cannabis and to reduce demand for it among vulnerable groups. In certain contexts, and with certain groups, measures emphasizing abstinence may also contribute, in a preventive way, to reducing harms. Policy and legislative approaches that do not effectively address cannabis-related harms or create
significant risks and adverse impacts are not consistent with harm-reduction. Prohibition of cannabis use with criminal penalties has the potential to produce harms and risks. The effectiveness of criminal prohibition of cannabis use in reducing the health-related harms
associated with cannabis use is questionable.

Treatment Options
The number of people seeking treatment for cannabis use is increasing, but most of those who experience cannabis dependence do not seek help. Many regular cannabis users do not believe they need treatment, and there is also a low awareness of the treatment options available and how to access them.
There are fewer treatment options for cannabis dependence than for alcohol or opiate dependence, and limited research on the effectiveness of different cannabis treatment options. Treatments for problematic cannabis use include psychological interventions such as cognitive
behavioural therapy and motivational enhancement, and pharmacological interventions with medications to ease the symptoms of withdrawal or block the effects of cannabis. The research on pharmacological interventions for cannabis is in its infancy, with medications still in the experimental stages of development.

Cognitive behavioural therapy helps the cannabis user develop knowledge and skills to identify risk situations when using cannabis and to modify behaviour accordingly. Motivational enhancement techniques build the cannabis user’s desire to address their problematic use. These counseling interventions are increasingly available online as web-based programs, as well as face-to-face with a counselor. Online programs have the advantage of convenience and anonymity, for those who are concerned about possible stigma. Difficulties in maintaining motivation, and limitations in personalising the programs to individual needs, are drawbacks. According to current research, web-based treatment programs may not be as effective as in-person treatment. Some problematic cannabis users have particular treatment needs, including those with cannabis dependence and mental health issues. These individuals require integrated treatment and coordinated care. General practitioners can play an important role in developing a coordinated care plan to suit the needs of these patients.

The Australian Medical Association Position
The AMA acknowledges that cannabis use is harmful and can lead to adverse chronic health outcomes, including dependence, withdrawal symptoms, early onset psychosis and the exacerbation of pre-existing psychotic symptoms. While the absolute risk of these outcomes is low and those who use cannabis occasionally are unlikely to be affected, those who use cannabis frequently and for sustained periods, or who initiate cannabis use at an early age, or who are susceptible to psychosis, are most at risk.
The AMA also recognises that cannabis use has short-term effects on cognitive and perceptual functioning which can present risks to the safety of users and others. The AMA believes that cannabis use should be seen primarily as a health issue and not primarily as a matter for law enforcement. The most appropriate response to cannabis use should give priority to policies, programs and regulatory approaches that reduce the harms potentially associated with cannabis use, and particularly the health-related harms. The positions outlined below should be read in the light of this harm-reduction principle. The AMA believes the following are the important considerations and central elements in an appropriate harm-reduction response to cannabis use.

Prevention and Early Intervention
 As younger people and those who use cannabis frequently are most at risk of harm, prevention and early intervention initiatives to avoid, delay and reduce the frequency of cannabis use in these populations are essential.
 All children should have access to developmentally appropriate school-based life-skills programs to assist in preventing or reducing potential substance use problems.
 Evidence-based information on the potential risks of cannabis use and where to seek further assistance should be widely available, particularly to young people.
 Medical professionals can play an important role in the early identification of patients they believe to be at risk of adverse health outcomes from cannabis use.
 When a cannabis user comes into contact with law enforcement or justice administration agencies this should be used as an opportunity to direct them to education, counseling or treatment. This is particularly important with young and first time or early offenders.

Diagnosis and Treatment
 Medical professionals have the knowledge and opportunity to screen for and diagnose cannabis-related disorders, including dependence, withdrawal symptoms, and cannabis induced psychosis. Referral networks and linkages should be established within regions between primary care and specialist mental health and drug and alcohol services, to ensure integrated and coordinated treatment support for cannabis use problems.
 Medical professionals, particularly general practitioners, have the opportunity to counsel patients who are at risk of cannabis-related harms, and they should be supported to provide education and advice about those potential harms.
 Targeted treatment regimens should be developed and resourced for groups with particular needs, including those with dual diagnoses, multiple drug use, young teenage users and culturally appropriate services for Aboriginal peoples and Torres Strait Islanders. Of particular importance are suitable treatment services for cannabis users with mental health needs.
 Every effort should be made to address the personal and systemic barriers that cannabis users face in seeking treatment and support when they need it. These include barriers associated with perceptions of stigmatisation, users’ and professionals’ awareness of treatment options, and users’ beliefs that they do not have a health problem.
 Doctors should consider accidental cannabis ingestion in the differential diagnosis of children with impaired consciousness.
 Cannabis users should have access to the rehabilitative services and support they require to manage associated disorders and particularly the risk of relapse.

Medical Uses of Cannabis
The Australian Medical Association acknowledges that cannabis has constituents that have potential therapeutic uses.
 Appropriate clinical trials of potentially therapeutic cannabinoid formulations should be conducted to determine their safety and efficacy compared to existing medicines, and whether their long-term use for medical purposes has adverse effects.
 Therapeutic cannabinoids that are deemed safe and effective should be made available to patients for whom existing medications are not as effective.
 Smoking or ingesting a crude plant product is a risky way to deliver cannabinoids for medical purposes. Other appropriate ways of delivering cannabinoids for medical purposes should be developed.
 Any promotion of the medical use of cannabinoids will require extensive education of the public and the profession on the risks of the non-medical use of cannabis.

Law Enforcement, Cannabis Regulation and Health
 In assessing different legislative and policy approaches to the regulation of cannabis use and supply, primary consideration should be given to the impact of such approaches on the health and well-being of cannabis users.
 The AMA does not condone the trafficking or recreational use of cannabis. The AMA believes that there should be vigorous law enforcement and strong criminal penalties for the trafficking of cannabis. The personal recreational use of cannabis should also be
prohibited. However, criminal penalties for personal cannabis use can add to the potential health and other risks to which cannabis users are exposed. The AMA believes that it is consistent with a principle of harm reduction for the possession of cannabis for personal
use to attract civil penalties such as court orders requiring counselling and education (particularly for young and first time offenders), or attendance at ‘drug courts’ which divert users from the criminal justice system into treatment.
 When cannabis users come into contact with the police or courts, the opportunity should be taken to divert those users to preventive, educational and therapeutic options that they would not otherwise access.
 In allocating resources, priority should be given to policies, programs and initiatives that reduce the health-related risks of cannabis use. Law enforcement should be directed primarily at cannabis supply networks.
 The AMA believes that the availability and use of synthetic cannabis products (including herbal forms) poses significant health risks, given that the psychoactive chemical constituents of these products are unknown and unpredictable in their effect. There are
particular challenges in regulating these products, and Australian governments must make a concerted effort to develop consistent and effective legislation which captures current and emerging forms of synthetic cannabis.

Research
 Further research is needed into the relationship between cannabis use and psychosis and other mental health problems, including the identification of those at greatest risk of cannabis-induced psychosis.
 There should be continuing research to identify the risk factors that contribute to individuals developing problematic or early onset cannabis use, and the factors and interventions that can protect against these.
 Australian governments should fund research into best practice treatment methods, including suitable pharmacotherapies, for those who are cannabis-dependent or who wish to reduce or cease their use.
 There should be systematic ongoing monitoring of the different legislative and policy approaches on cannabis operating in overseas jurisdictions to assess their health and harm-related impacts. The evidence obtained should inform critical reviews of the
approaches that operate in Australia.

Source: 1 (ama.com.au) 2014

Filed under: Australia,Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects,Health,Marijuana and Medicine,Prevention and Intervention,Synthetics,Treatment and Addiction :

A pilot programme at Shanghai’s rehab centres taps the technology to measure addiction and determine how to treat it.

In a treatment room at a suburban Shanghai drug rehabilitation centre, “Victor Wu”, a recovering addict, sits in front of a computer screen, viewing assorted scenes through a virtual reality headset.

Wu (not his real name) takes in a lifelike image of a young man and a woman sitting on a sofa drinking a clear liquid through a straw from a small bottle. As he does so, clips attached to three of the fingers on his left hand pick up his physical reactions.

The data reveals to his observers – including police officers who can see on the computer screen what Wu sees – the degree to which this stimulus excites him.

As the woman in this VR-enhanced scene holds her straw out to Wu, enticing him to drink with her and the man, Wu remains captivated for at least 10 seconds – a detail the observers note with interest.

Although he can choose the scenes to view and their duration by using the switch he holds in his right hand, “Wu’s attention is stuck on this scene for a while before [he moves on] to look at other no-drug scenes”, an officer told the South China Morning Post.

“It means he is still a bit interested in having drugs.”

It is all part of a revolutionary effort to use VR technology to reveal the extent of drug users’ addiction – and the type of treatment they need – to help them to turn their lives around.

Clad in the centre’s official inmate uniform of green sleeveless T-shirt, shorts and sandals, Wu and his fellow addicts are part of a trial of VR technology that was expanded this summer to all five of Shanghai’s rehab facilities, from just two in October.

Although the Shanghai centres were not the first in China to begin using VR – some rehab institutes in the eastern province of Zhejiang had employed it last year – their application of the technology is nevertheless distinctive in its application of eyeball movement tracking science.

Being able to read how an inmate’s eyeballs move over certain images gives staff a clearer idea of whether the addict’s gaze is fixed squarely on the repulsive “educational” images of drug addicts he or she must watch.

Tracking eyeball movement also gives staff extra information they can use to gauge the accuracy of the self-evaluations that inmates are required to fill out; many have been known to lie about the degree of their drug dependency in an attempt to speed up their release from the programme.

“In the rehab centre we see those awful pictures of drug addicts through VR helmet several times a month, as part of our education here,” Wu told the Post. “I really abhor drugs now.”

While it is not known how many addicts in China ultimately are to be exposed to the VR programme, the number is expected to be considerable. The five centres in Shanghai and one at Qingdong alone treat 1,800 male addicts.

Xu Ding, a drug rehab veteran from Shanghai Drug Rehabilitation Management Bureau who spearheads the VR project, said the technology’s use has helped alleviate “a major frustration” encountered when trying to treat drug addicts by showing them revolting images of other addicts.

 “In the past, to depress the addicts’ desire for drugs, we let them watch TV or presented them horrible pictures of people whose health was seriously affected after long-term consumption of drugs,” Xu said. “But both TV or pictures on papers don’t look real enough.

“What’s more, we can’t tell if these people are really focusing on our education,” Xu said. “They would look at other places, or just close their eyes.”

In 2015, when the VR industry was beginning to get a lot of attention in China, Xu and his colleagues moved to incorporate it in treating addicts. “VR is a kind of embedded viewing experience and is so real,” Xu said.

The VR system that was first used in two of the city’s rehab centres in October was jointly developed by Shanghai Mental Health Centre, East China Normal University’s School of Psychology and Cognitive Science, eyeball movement tracking company Shanghai Qing Tech and the Shanghai drug rehabilitation authority.

In the system, an instrument to trace eyeball movement is installed in the VR headset along with devices to measure electrodermal activity (EDA) and pulse phase, to make observers aware when addicts refuse to look at what they are supposed to see.

EDA measures the change in the electrical characteristics of a person’s skin in response to sweat secretion.

 “Shanghai is the first in the world to introduce an eyeball-movement tracking machine to drug rehabilitation, according to the literature I can find on the internet,” Xu said.

Cao Lei, director of the psychotherapeutic department of Shanghai Qingdong Drug Rehab Centre, said the reports on addiction level based on inmates’ responses to watching VR scenes “are objective and people can’t fool the system since they can’t control their EDA and pulse speed”.

Previously, inmates could lie when filling out a questionnaire on their drug dependency to get released early, Cao said.

Under mainland law, people caught possessing drugs must spend two years undergoing treatment at a rehab centre. Inmates who “perform very well” in treatment can get out early.

So far, assessing the VR programme’s effectiveness is difficult, given the lack of concrete results.

Last year, however, the Ministry of Justice said many rehab centres across the country were using innovative methods to try to help people kick drug habits, including virtual reality technology, people.com.cn reported.

The measures, which also included Tibetan medicine, traditional Chinese medicine, massage and physical exercise, had achieved good results, according to the ministry.

Some 2.55 million people in China had possessed illegal drugs as of the end of last year, according to the 2017 China Drug Situation Report issued in June by the China National Narcotics Control Commission.

Among them, 321,000 were put in rehab centres across the country, about 2 per cent more than in the previous year. More than 60 per cent of addicts possessed synthetic drugs such as methamphetamine, a central nervous system stimulant known in the illicit drug trade as “ice”.

Wu, 28, said his drug habit began six years ago at a pub where a friend offered him ketamine – a synthetic drug that induces a trancelike state and is usually referred to on the street as “K powder”.

“I knew drugs are bad, but at that time I was confident that I could control myself [and would] not become addicted to drugs,” said Wu, a former sales representative with an insurance company.

But he failed to do that. Last year, police, tipped off by his friend that Wu had illegal drugs at home, raided Wu’s house and took him away.

“I think I will not touch drugs after I get out [of the rehab centre],” Wu said. “I don’t want to come back again. I hate losing my freedom.”

Source: How China is using virtual reality to help drug addicts turn their lives around | South China Morning Post (scmp.com) July 2018

Filed under: Addiction,Ketamine,Methamphetamine/GHB/Hallucinogens/Oxycodone,Treatment and Addiction :

Realizing you have a drinking problem and deciding to quit are the first two steps of recovery, and for some people, they are the hardest. So, if that’s where you are in your journey right now, know you’re not alone and that you can claim your life back from a destructive addiction.

Once you’ve decided to quit drinking, you must commit to staying sober, despite any temptations or triggers you might come across. This is much more practical when you have support from therapy, a church group, friends who don’t drink, and/or any other kind of system that motivates you and helps you to stay accountable.

It’s also essential that you add meaningful and enjoyable things to your life that don’t involve drinking, and that you move your life forward so that you can thrive. This article will provide some tips on how to get on with your life while recovering from alcohol abuse.

Get Car Insurance

One of the first things to get in order will be your car insurance (if you don’t have any), as you won’t be able to legally drive without it. If your policy lapsed due to having your license suspended, try going to your former insurance company for coverage. If they won’t work with you, you will need to look around at other companies. Sometimes, a lapse in coverage means that it’s too high a risk for standard companies to insure you. However, there are companies that specialize in insuring higher-risk drivers, though you can expect higher premiums.

Surround Yourself with Support

One of the most important aspects of staying sober is hanging around people who help you in your mission. While therapy, treatment, and church can prove invaluable, so can spending time with non-drinking friends. This is because it helps to break social connections with alcohol and normalize sobriety, and friends can keep you accountable on your journey. Plus, boredom can easily lead to relapse, and doing things with people will help prevent that from happening.

Improve Your Diet

What you eat obviously has a lot to do with your physical health, which plays a major role in your mental and emotional health. Start being conscious of your diet — maximizing fruits, vegetables, lean proteins, and healthy fats, while limiting sugar, sodium and saturated fats. You should also make mood-boosting foods like kale, eggs, spinach, nuts, and wild salmon a part of your diet. If it’s easier for you, just start by replacing one meal a day with a healthier option than you normally would consider, and build from there.

Get Fit

Physical activity is also important. Not only does regular exercise yield long-term health benefits, but it also provides short-term benefits. The endorphins released during exercise creates a sense of reward in the brain, which can instantly boost your mood, reduce stress, and make you feel productive. Also, exercise is known to reduce anxiety and depression symptoms, as well as promote better sleep.

Set New Goals

Finally, in order to move past your addiction, you have to move forward in your life. Think of where you want to be in the future, and start setting goals. This could include goals to start a new career, progress in your current career, or go back to school. It can also include goals for repairing and developing relationships, learning new activities or skills, or any other number of things. Take advantage of your commitment to change by setting and focusing on new goals.

Recovering from alcohol addiction is not easy, but the rewards far outweigh the struggle. Be sure to look into your car insurance, and start hanging around positive, non-drinking friends. Prioritize your physical health to boost your mental and emotional health, and set new goals for your future. Most importantly, have grace on yourself, and try to maintain a positive outlook throughout your journey through addiction recovery.

Source:  Ryan Randolph   Recovery Proud  November 2019

Filed under: Health,Treatment and Addiction :
A. Benjamin Srivastava, MD
Mark S. Gold, MD

The opioid epidemic is the most important and most serious public health crisis today. The effects are reported in overdose deaths but are also starkly evident in declines in sense of well-being and general health coupled with increasing all-cause mortality, particularly among the middle-aged white population. As exceptionally well described by Rummans et al in this issue of Mayo Clinic Proceedings, the cause of the epidemic is multifactorial, including an overinterpretation of a now infamous New England Journal of Medicine letter describing addiction as a rare occurrence in hospitalized patients treated with opioids, initiatives from the Joint Commission directed toward patient satisfaction and the labeling of pain as the “5th vital sign,” the advent of extended-release oxycodone (OxyContin), an aggressive marketing campaign from Purdue Pharma L.P., and the influx of heroin and fentanyl derivatives.

To date, most initiatives directed toward fighting the opioid initiatives, and the focus of the discussion from Rummans et al, have targeted the “supply side” of the equation. These measures include restricting prescriptions, physician drug monitoring programs, and other regulatory actions. Indeed, although opioid prescriptions have decreased from peak levels, the prevalence of opioid misuse and use disorder remains extremely prevalent (nearly 5%). Further, fatal drug overdoses, to which opioids contribute to a considerable degree, continue to increase, with 63,000 in 2016 alone. Thus, although prescription supply and access are necessary and important, we need to address the problem as a whole. To this point, for example, the ease of importation and synthesis of very cheap and powerful alternatives (eg, fentanyl and heroin) and the lucrative US marketplace have contributed to the replacement pharmacy sales and diversion with widespread street-level distribution of these illicit opioids; opioid-addicted people readily switch to these illicit opioids.

A complementary and necessary approach is to target the “demand” side of opioid use, namely, implementation of preventive measures, educating physicians, requiring physician continuing education for opioid prescribing licensure, and addressing why patients use opioids in the first place. Indeed, prevention of initiation of use is the only 100% safeguard against addiction; however, millions of patients remain addicted, and they need comprehensive, rather than perfunctory, treatment. Rummans and colleagues are absolutely correct in their delineation of the unwitting consequences of a focus on pain, given that a perceived undertreatment of pain fueled the opioid epidemic in the first place. They are correct to point out how effective pain evaluation and treatment are much more than prescribing and should routinely include psychotherapy, interventional procedures, and nonopioid therapies. In addition, we have described the crossroads between pain and addiction as well as successful strategies to manage patients with both chronic pain syndromes and addiction.

Rummans and colleagues also mention much needed dissemination of medication-assisted treatment (MAT; eg, methadone and buprenorphine) and the opioid overdose medication naloxone, and we agree with both of these measures. However, in addressing the demand side of the opioid epidemic, the focus must be much more comprehensive. Viewing opioid addiction as a stand-alone disease without consideration of other substance use or comorbid psychiatric pathology provides only a limited perspective. Rather, dual disorders are the rule and not the exception, and thus addiction evaluation and treatment should also specifically focus on psychiatric symptomatology and comorbidity. Epidemiological evidence indicates that over 50% of individuals with opioid use disorder meet criteria for concurrent major depressive disorder.Recent evidence from Cicero and Ellis indicates that the majority of opioid-addicted individuals seeking treatment indicate that their reasons for use are for purposes of “self-medication” and relief of psychiatric distress. To expand on this concept, we have suggested that drugs, by targeting the nucleus accumbens, alter motivation and reinforcement circuits and change brain reward thresholds; this change results in profound dysphoria and anhedonia, which, in turn, lead to further drug use.

Obviously, then, opioid addiction treatment should focus on diagnosing and assessing psychiatric comorbidity and monitoring of affective states and other depressive symptoms. However, a bigger problem might be the pretreatment phase, considering that, as Rummans et al note, only 10% of patients with opioid use disorder receive any treatment at all. Resources have principally been devoted to mitigating the effects of acute opioid toxicity both before and during intervention in the emergency department. A principal means of medical stabilization has been overdose reversal with the μ-opioid receptor antagonist naloxone, and efforts have been largely focused on dissemination of this agent. However, while increased naloxone use among the lay public, first responders, and medical personnel has been successful in reducing deaths, recidivism is high and increased naloxone use has not affected the problem as a whole. Generally, when patients present to the emergency department, clinical experience dictates that opioid overdoses are considered accidental until proven otherwise, which, after stabilization, allows the physician to discharge the medically stable patient, the hospital to collect reimbursement, and the pharmaceutical company to raise prices (eg, naloxone prices increased by 400% from 2014 to 2016, for autoinjection formulations).

In addition to the substantial costs associated with repeated naloxone administration and emergency department visits, recidivism is inextricably linked with another problem—the reason for overdose in the first place is not addressed. As mentioned earlier in this editorial, depression prevalence is high in patients with opioid use disorders. Strikingly, using nationwide data from US poison control centers, West et al found that over 65% of opioid overdoses reported were indeed suicide attempts, and of completed overdoses, the percent of those characterized as suicides climbed to 75%. Thus, an “inconvenient truth” may be that many of these opioid overdoses presenting to emergency departments may be unrecognized suicide attempts and that many of the over 66,000 deaths may indeed be completed suicides. Thus, comprehensive evaluation and treatment become even more relevant.

Clearly, more thorough evaluations in emergency departments with comprehensive risk assessments are needed, especially given that these patients may be guarded about suicidal ideation in the first place. Indeed, efforts to initiate buprenorphine in the emergency department, which independently is being investigated for its therapeutic effects on suicidal ideation, have spread; however, while abstinence outcomes are favorable at 30 days, the therapeutic benefit seems to disappear at both 6 months and 1 year. This failure of opioid reversal treatment is important, especially given that at 1 year, 15% of patients rescued with naloxone had died. Additionally, lack of psychiatric services and overcrowding at many emergency departments may preclude a comprehensive evaluation; however, target screening of all high-risk patients may identify patients with even hidden suicidal ideation and allow for appropriate triage.

Most addiction treatment today is centered around time-limited settings without adequate follow-up. Although MAT is an important addition to treatment for opioid addicts, it is generally not sufficient for long-term sobriety given (1) the relatively high rates of immediate and short-term treatment discontinuation and (2) that patients rarely are using just opioids. In fact, regarding long-term outcomes, methadone may be the only MAT treatment that demonstrates superior abstinence rates, safety, opioid overdose prevention, and treatment retention. We recommend that future studies include random assignment to different treatment modalities, assessing abstinence with urine testing and other modalities, psychosocial outcomes, and overall level of functioning for 5 years.

In terms of treatment, we suggest a continuing care approach, viewing addiction as a chronic, relapsing disease, but higher quality data are needed. For example, in most states, physicians with substance use disorders who are referred for treatment indeed undergo evaluation and detoxification, but they are also monitored for 5 years with frequent drug testing, contingency management, evaluation and treatment of comorbid psychiatric issues, and mutual support groups. Outcomes are generally superior, with 5-year abstinence and return to work rates approaching 80%. Notably, most of these programs do not allow MAT, yet opioid-addicted physicians do as well in the structured, supportive, long-term care model as physicians addicted to other substances. Obviously, the threat of professional license sanctions may impel physicians to comply with treatment, but many of the aforementioned strategies including contingency management, long-term follow-up, comprehensive psychiatric evaluation, and mutual support have demonstrable evidence for addiction treatment in general.

More resources need to be devoted to addressing the opioid epidemic, particularly on the prevention and also the demand side. Access to treatment is important, but more investment is needed in improving treatment including implementing 5-year comprehensive care programs. Thus, we recommend that future studies involve random assignment to different treatment groups, focusing on urine drug test–confirmed abstinence, psychosocial outcomes, and overall functioning. Additionally, advances in neuroscience may allow for the development of novel therapeutics targeting specific neurocircuitry involved in reward and motivation (ie, moving beyond the single receptor targets). A parallel can be drawn to the AIDS epidemic, in which massive basic science investments yielded novel effective therapies, which have now become standard of care and one of the world’s great public health successes. Resources focused on these interventions and reinvigorating drug education and prevention may prove fruitful in addressing this devastating epidemic. Further, lessons from this epidemic may help us move beyond a specific “one drug, one approach” so that for future epidemics, irrespective of the drug involved, we would already have in place a generalizable framework that utilizes the full repertoire of responses and resources.

Filed under: Health,Heroin/Methadone,Prevention and Intervention,Treatment and Addiction :

The United States is confronting a public health crisis of rising adult drug addiction, most visibly documented by an unprecedented number of opioid overdose deaths. Most of these overdose deaths are not from the use of a single substance – opioids – but rather are underreported polysubstance deaths. This is happening in the context of a swelling national interest in legalizing marijuana use for recreational and/or medical use. As these two epic drug policy developments roil the nation, there is an opportunity to embrace a powerful initiative. Ninety percent of all adult substance use disorders trace back to origins in adolescence. New prevention efforts are needed that inform young people, the age group most at-risk for the onset of substance use problems, of the dangerous minefield of substance use that could have a profound negative impact on their future plans and dreams.

MOVING BEYOND A SUBSTANCE-SPECIFIC APPROACH TO YOUTH PREVENTION

The adolescent brain is uniquely vulnerable to developing substance use disorders because it is actively and rapidly developing until about age 25. This biological fact means that the earlier substance use is initiated the more likely an individual is to develop addiction. Preventing or delaying all adolescent substance use reduces the risk of developing later addiction.

Nationally representative data from the National Survey on Drug Use and Health shows that alcohol, tobacco and marijuana are by far the most widely used drugs among teens. This is no surprise because of the legal status of these entry level, or gateway, drugs for adults and because of their wide availability. Importantly, among American teens age 12 to 17, the use of any one of these three substances is highly correlated with the use of the other two and with the use of other illegal drugs. Similarly for youth, not using any one substance is highly correlated with not using the other two or other illegal drugs.

For example, as shown in Figure 1, teen marijuana users compared to their non-marijuana using peers, are 8.9 times more likely to report smoking cigarettes, 5.6, 7.9 and 15.8 times more likely to report using alcohol, binge drink, and drink heavily, respectively, and 9.9 times more likely to report using other illicit drugs, including opioids. There are similar data for youth who use any alcohol or any cigarettes showing that youth who do not use those drugs are unlikely to use the other two drugs. Together, these data show how closely linked is the use by youth of all three of these commonly used drugs.

Among Americans age 12 and older who meet criteria for substance use disorders specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Marijuana remains illegal under federal law but is legal in some states for recreational use the legal age is 21, and in some states for medical use, the legal age is 18. Nationally the legal age for tobacco products is 18 and for alcohol it is 21.

These findings show that prevention messaging targeting youth must address all of these three substances specifically. Most current prevention efforts are specific to individual substances or kinds and amounts of use of individual drugs (e.g., cigarette smoking, binge drinking, drunk driving, etc.), all of which have value, but miss a vital broader prevention message. What is needed, based on these new data showing the linkage of all drug use by youth, is a comprehensive drug prevention message: One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. This no use prevention message provides clarity for young people, parents, physicians, educators, communities and for policymakers. It is not intended to replace public health prevention messages on specific substances, but enhances them with a clear focus on youth.

Some claim adolescent use of alcohol, cigarettes and marijuana is inevitable, a goal of no use of any drug as unrealistic and that the appropriate goal of youth prevention is to prevent the progression of experimentation to later heavy use or problem-generating use. These opinions are misleading and reflect a poor understanding of neurodevelopment that underpins drug use. Teens are driven to seek new and exciting behaviors which can include substance use if the culture makes them available and promotes them. This need not be the case. New data in Figure 2 (below) show over the last four decades, the percentage of American high school seniors who do not use any alcohol, cigarettes, marijuana or other drugs has increased steadily. In 2014, 52% of high school seniors had not used any alcohol, cigarettes, marijuana or other drugs in the past month and 26% had not used any alcohol, cigarettes, marijuana or other drugs in their lifetimes. Clearly making the choice of no use of any substances is indeed possible – and growing.

 

Key lessons for the future of youth prevention can be learned from the past. Substance use peaked among high school seniors in 1978 when 72% used alcohol, 37% used cigarettes, and 37% used marijuana in the past month. These figures have since dropped significantly (see Figure 3 below). In 2016, 33% of high school seniors used alcohol, 10% used cigarettes and 22% used marijuana in the past month. This impressive public health achievement is largely unrecognized.

Although the use of all substances has declined over the last four decades, their use has not fallen uniformly. The prevalence of alcohol use, illicit drug use and marijuana use took similar trajectories, declining from 1978 to 1992. During this time a grassroots effort known as the Parents’ Movement changed the nation’s thinking about youth marijuana use with the result that youth drug use declined a remarkable 63%. Rates of adolescent alcohol use have continued to decline dramatically as have rates of adolescent cigarette use. Campaigns and corresponding policies focused on reducing alcohol use by teens seem to have made an impact on adolescent drinking behavior. The impressive decline in youth tobacco use has largely been influenced by the Tobacco Master Settlement Agreement which provided funding to anti-smoking advocacy groups and the highly-respected Truth media campaign. The good news from these long-term trends is that alcohol and tobacco use by adolescents now are at historic lows.

It is regrettable but understandable that youth marijuana use, as well as use of the other drugs, has risen since 1991 and now has plateaued. The divergence of marijuana trends from those for alcohol and cigarettes began around the time of the collapse of the Parents’ Movement and the birth of a massive, increasingly well-funded marijuana industry promoting marijuana use. Shifting national attitudes to favor legalizing marijuana sale and use for adults both for medical and for recreational use now are at their highest level and contribute to the use by adolescents. Although overall the national rate of marijuana use for Americans age 12 and older has declined since the late seventies, a greater segment of marijuana users are heavy users (see Figure 4). Notably, from 1992 to 2014, the number of daily or near-daily marijuana uses increased 772%. This trend is particularly ominous considering the breathtaking increase in the potency of today’s marijuana compared to the product consumed in earlier decades. These two factors – higher potency products and more daily use – plus the greater social tolerance of marijuana use make the current marijuana scene far more threatening than was the case four decades ago.

Through the Parents’ Movement, the nation united in its opposition to adolescent marijuana use, driving down the use of all youth drug use. Now is the time for a new movement backed by all concerned citizens to call for One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. This campaign would not be a second iteration of the earlier “Just Say No” campaign. This new no-use message focuses on all of the big three drugs together, not singly and only in certain circumstances such as driving.

We are at a bitterly contentious time in US drug policy, with front page headlines and back page articles about the impact of the rising death rate from opioids, the human impact of these deaths and the addiction itself. At the same time there are frequent heated debates about legalizing adult marijuana and other drug use. Opposing youth substance use as a separate issue is supported by new scientific evidence about the vulnerability of the adolescent brain and is noncontroversial. Even the Drug Policy Alliance, a leading pro-marijuana legalization organization, states “the safest path for teens is to avoid drugs, including alcohol, cigarettes, and prescription drugs outside of a doctor’s recommendations.”

This rare commonality of opinion in an otherwise perfect storm of disagreement provides an opportunity to protect adolescent health and thereby reduce future adult addiction. Young people who do not use substances in their teens are much less likely to use them or other drugs in later decades. The nation is searching for policies to reduce the burden of addiction on our nation’s families, communities and health systems, as well as how to save lives from opioid and other drug overdoses. Now is precisely the time to unite in developing strong, clear public health prevention efforts based on the steady, sound message of no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health.

Robert L. DuPont, MD, President, Institute for Behavior and Health, Inc.

Source: https://www.ibhinc.org/blog/reducing-adult-addiction-youth-prevention  February 2018

Filed under: Cannabis/Marijuana,Global Drug Legalisation Efforts,Heroin/Methadone,Prevention and Intervention,Treatment and Addiction,Youth :

Study drawing on data from the Netherlands is the first to show how admissions to treatment centres rise and fall in line with cannabis strength

Many countries have seen far stronger cannabis come on to the market in the past few decades

Researchers have found fresh evidence to suggest that more potent strains of cannabis are at least partly to blame for the number of people seeking help from drug treatment programmes.

Scientists at King’s College London drew on data from the Netherlands to show that admissions to specialist treatment centres rose when coffee shops sold increasingly more potent cannabis, but fell again when the cannabis weakened.

The work is the first to investigate how admissions to drug treatment programmes rise and fall in line with the strength of cannabis available to users. It found that changes in demand for treatment typically lagged five to seven years behind changes to cannabis strength.

“This is the first study to provide evidence for an association between changes in potency and health-related outcomes,” said Tom Freeman, an addiction scientist at King’s.

The demand for specialist treatment among cannabis users has risen steadily in recent years, with more people now citing the drug on admission than any other illicit substance. In Europe, the number of first-time referrals for cannabis rose 53% from 2006 to 2014.

Cannabis plants produce more than 100 active compounds called cannabinoids but THC, or delta-9 tetrahydrocannabinol, is largely responsible for the drug-related high. A second compound called CBD, or cannabidiol, appears to reduce some of the mental health risks linked to heavy cannabis use by counterbalancing the effects of THC.

In work funded by the Society for the Study of Addiction, Freeman and others studied data gathered by the Trimbos Institute, a non-profit mental health and addiction organisation in the Netherlands. Each year, the institute conducts anonymous tests on cannabis for sale at a random selection of coffee shops in the country.

Writing in the journal, Psychological Medicine, the researchers show that THC levels in cannabis soared from an average of 8.6% to 20.4% from 2000 to 2004, then slowly fell to 15.3% by 2015. When the researchers looked at the impact on drug treatment programmes, they found that first-time cannabis admissions nearly quadrupled from seven to 26 per 100,000 inhabitants from 2000 to 2010, and then dropped to less than 20 per 100,000 inhabitants in 2015. It means that for every 1% increase in THC, about 60 more people entered treatment.

“We see a rapid increase in THC between 2000 and 2004 followed by a slower decline, and then you see a very similar profile in drug treatment admissions,” Freeman said. The rise in cannabis potency was one of a number of factors driving admissions to specialist drug services.

Val Curran, professor of psychopharmacology at UCL, said: “This adds to a growing number of scientific studies which suggest rising THC potency of cannabis is associated with greater incidence of mental health problems including addiction and possibly psychosis.”

But she added that stronger cannabis was not solely responsible for increasing demand for drug treatment. “Other factors include the marked decrease in levels of cannabidiol (CBD) in cannabis. There is evidence that CBD can protect against some mental health harms of THC,” she said.

Ian Hamilton, a mental health lecturer at the University of York, agreed that other factors beyond the potency of the drug were important. “It is possible that seeking help for problems with cannabis has become more acceptable by users and treatment providers. Over the same period that cannabis referrals to treatment have been increasing, referrals for problems with opiates such as heroin have been in decline. So although cannabis has traditionally been viewed as relatively benign by treatment workers they may now be more inclined to offer support,” he said.

Source: https://www.theguardian.com/science/2018/jan/31/stronger-cannabis-linked-to-rise-in-demand-for-drug-treatment-programmes January 2018

Filed under: Cannabis/Marijuana,Treatment and Addiction :
A USA TODAY NETWORK-Wisconsin project

Heroin entered their lives so easily.

For 10 addicts, the hard part is staying clean.

They got the pills from their doctors, then kept using them until they couldn’t stop. They switched to heroin because it was cheaper, because a friend said it was an easier, better way to get high.

They went to parties as teens, took pills, snorted powders. They got bored with the drugs they were doing and then found heroin, the drug they loved the most.

They had faced abuse, poverty, tragedy. Their pain was deep, and psychological, and the drug was an escape.

The stories of 10 recovering heroin addicts from Wisconsin are the stories of millions of Americans who have been hooked on opiates and either died, or lived with the consequences. They’ve lost friends. They’ve been arrested. They’ve lost touch with their family and friends, lost custody of their children.

COUNTY BY COUNTY: Deaths and ODs in Wisconsin.

“It wasn’t what they always told us it was going to be,” said Moriah Rogowski, a 22-year-old recovering addict, about her first time using heroin. She didn’t develop an addiction right away. But somewhere, more gradually than she expected, she lost control.

Like the other nine recovering heroin users profiled in this special report from USA TODAY NETWORK-Wisconsin, Rogowski has taken back control of her life. She’s clean. She lives in a different city, imagines a different future for herself.

Recovery from opiate addiction is hard, filled with setbacks. But these 10 people from across Wisconsin have taken the first steps toward a life after heroin. In photos, in words and in their own voices, these are their stories about how they started on heroin and fought to get off the drug.

‘That was the only way I liked to get high’

Moriah Rogowski, Green Bay

Moriah Rogowski liked the feeling of downers: Percocet, Vicodin, Oxycontin. She and her friends, the summer before high school, would go out to parties and crush pills and snort them.

She and her three siblings lived in a rural home near Mosinee, where she was homeschooled until eighth grade. In high school, she found her place among the stoners. One night she found herself in a drug house in Marshfield with 33-year-olds. She was 15.

That was the day she first tried heroin. She was afraid of needles, so she let someone else shoot the drug into a vein in her arm.

“That was the only way I liked to get high after that,” she said.

Rogowski is now 22. She’s been in and out of programs in Minnesota and Green Bay as she tried to get clean. But she’d come home and hang out with the same friends; each time they led her back to the drug.

She sought treatment at the methadone clinic in Wausau, where she saw others abusing the methadone and still using heroin. She fell into the same pattern.

She mixed heroin, crack, Xanax. There is a week of her life she can’t remember. She took her brother’s car and got an OWI. Her license was suspended.

Then, from somewhere, she found the will to change. She called her mom to come get her because she wanted to get clean. She began to use the methadone program correctly, taking classes and attending therapy sessions.

Rogowski has lived in Green Bay for two years. She hopes to complete her GED. And she’s trying to help others by working toward becoming a recovery coach.

— Laura Schulte, leschulte@gannett.com

A soldier’s widow masks her pain

Sarah Bear, Wausau

Sarah Bear didn’t want to feel anymore.

Her husband, Jordan, was killed in Afghanistan in 2012 during an attack at his base in the Kandahar province. More than a year later, just when she started being able to grieve her husband’s death, her oldest son’s dad died.

Bear’s addiction started in the summer of 2014 with pills — Vicodin, Oxycontin, Percocet. They dampened the pain of her losses. A friend had been prodding her to try heroin: It was cheaper, he said, and she wouldn’t have to use as much. She swore she would never touch it.

One day, Bear couldn’t get any pills. The withdrawals hit. She got sick; she couldn’t take care of her children. Eventually, she called the friend, and within a half hour was snorting heroin for the first time in her Antigo apartment.

Then, she felt nothing, just like she wanted.

“I completely, seriously fell in love with that drug,” she said. “There was nothing that compared to it, honestly. Sadly.”

She did heroin every day, either snorting or smoking it, and eventually injecting it.



Beginning in January 2015, Bear was in and out of jail, and on and off heroin. She tried methadone treatment but it didn’t stick.

In October 2016, Bear’s four children were taken from her. Two went to stay with her mom, and two with her grandmother.

Almost a year later, Bear, 33, found herself in North Central Health Care’s Lakeside Recovery in Wausau, a 21-day medically monitored substance abuse treatment program. She believes she hit rock bottom.

She started the program in mid-September and could feel the change within her as her Oct. 6 graduation approached. She’s determined to get better.

“I remember a time when my life was good, and I know that I can be back there,” she said. “I know that I can have that again.”

— Haley BeMiller, hbemiller@gannett.com

He laughed at the idea he could be saved

Nathan Scheer, Fond du Lac

Nathan Scheer felt the bottom drop out the day before Christmas Eve 2016. His wife and kids watched the cops haul him away.

His probation officer had heard he would test dirty and showed up at his home unannounced.

“On the way to jail I was higher than I’d been in years, but I remember my probation officer telling me she was going to save my life,” he said. “I laughed and told her you can’t save someone who doesn’t want to be saved.”

He first used prescription opiates after a car crash. One day he didn’t have enough money for hydrocodone pills. In their place, he was offered “dog food” —  a street name for heroin.

A decade-long fling with heroin followed, and it turned the 35-year-old factory worker from a regular, middle-class guy into a liar and a thief.


“I once explained to my wife that it (heroin) felt like what I imagine looking into the eyes of God would feel like,” Scheer said. “It’s the most religious experience you could ever imagine.”

But since the day the probation officer showed up a little more than a year ago, Scheer got clean through counseling, group support and a local church. He learned to feed his addictive personality through the gratification that comes with community service.

Today, Scheer and his 4-year-old son, Bentley, have gained recognition in Fond du Lac by cleaning up parks and playgrounds. Giving back is his metaphor for recovery. Father and son call it #cleanstreetforkids.

“I call it my beautiful disaster, because the way everything happened, I was so lucky. I had people who stuck by me while I waged war on myself.”

— Sharon Roznik, sroznik@gannett.com

‘They just kept prescribing pain meds’

Rebecca Palmieri, Wisconsin Rapids

Rebecca Palmieri’s house is quiet now. In August, a court commissioner ordered her to give up her five children. It was the second time in two years that she lost them.

She’s lost everything since she started using heroin. She’s been homeless. She has a record.

Palmieri, 39, had medical complications when she had her fifth child. That was in 2013.

“They just kept prescribing pain meds for five months after I had my son. They did corrective surgery, but, by then, I was hooked.”

She used pills for about two years. In January 2015, a friend came to her Wisconsin Rapids apartment with heroin. He told her to hold out her arm. In the empty bedroom, with her children in another part of the house, he injected her.

Using wasn’t an everyday thing, she said, until it was. She would look around her apartment to see what she could sell or return for money to buy the drug.

The courts put her kids into foster care. She was homeless for about six months. The kids went to live with her husband; they came back to her when he went to prison. She got clean and found a house. But the courts sent the kids back to her husband when he got out.

Palmieri said she has been clean since November 2016. She goes to the YMCA every day to work out; she attends addiction support group meetings. She wants to get her kids back.

“It’s probably the hardest thing I ever had to do,” she said, “to get clean and stay clean.”

— Karen Madden, kmadden@gannett.com

Sacred fire lights a path to recovery

Joey Powless, Oneida

Joey Powless stood by the sacred fire burning under a tepee in the center of Oneida. He busied himself by keeping the fire steady and clean, moving ash and coals out of the flames.

Powless, 36, a member of the Oneida Nation, called it the Grandpa Fire, and without it, he said, he would not have been able to stay clean for the past five years or so.

The sacred fire represents the spirit of native people, a connection to the past and present, a source of strength, a place to pray, a gateway to understanding.

“Without fire, we couldn’t live,” Powless said. “This is what we cooked our food with. This is what gave us life. Gave us heat. So without it we could never live. This is our very first teaching right here.”

His mother abandoned him and his family when he was a kid, and he responded at a young age with anger, he said. He started drinking and smoking pot at age 13. By the time he was in his early 20s, he added opioid medications and cocaine to the mix.



Powless was 28 when he first tried heroin at a party. He was deep into drug culture, and selling drugs to pay for his own drugs. “Cocaine really wasn’t doing nothing for me no more,” he said. Snorting heroin seemed like a natural thing to do.

It made him sick at first, but as that feeling eased, he felt the high. “That’s when the magic happens,” he said. He continued to chase that high. He graduated from snorting heroin to shooting it into his veins.

He was about 31 when he was jailed, and put into solitary confinement. It was there that he decided he didn’t want to be an addict anymore. “Because I have children,” he said. (Powless is the father of two teenagers.) “I didn’t want to be out of their lives no more.”

— Keith Uhlig, kuhlig@gannett.com

Arrests pile up after friend overdoses

Jennifer Solis, Stevens Point

Jennifer Solis was out of pills and already felt sick.

In the bathroom of her friend’s house in Stevens Point, she crushed up a little heroin and snorted it. It was the first time she had tried the drug.

Her friend, close by, was injecting it. They didn’t talk.

Solis, who was in her mid-20s at the time, looked down on people who used needles. She told herself she wouldn’t cross that line. She would.

Solis, now 34, was born in Colorado but moved to Wisconsin as a teenager. She was already using drugs with her friends — first marijuana, then cocaine — by the time she was 16.

“I think I was always looking for the next best thing,” she said. “I didn’t see myself as an addict back then.”

Solis became addicted to pain pills after she suffered a serious back injury as a result of domestic abuse, she said. After her friend introduced her to heroin, she used it every day.

She called paramedics when a friend overdosed a few years ago, then watched as they used the counteracting drug naloxone to revive her. She was charged in that incident, and then arrests piled up quickly.

 

She joined Portage County’s drug court in May and stayed clean for her first three months. Then she relapsed by using heroin and methamphetamine. By October 2017, Solis had again been clean for three months.

Solis has five children but no contact with them. Her three oldest live with a relative and her two youngest were adopted as infants.

She wants to go back to school for interior design. But for now, Solis lives at the Salvation Army in Stevens Point, working to put her life back together.

— Chris Mueller, cmueller@gannett.com

‘I smoked pot with both my parents’

Kevin Williams, Wisconsin Rapids

Kevin Williams is 35 and lives in a Wisconsin Rapids assisted-care facility. His mother and father divorced when he was 8, and, he said, “I basically smoked pot with both my parents by the time I was 15.”
By the time Williams was an adult, he tried every drug he could.

Cocaine: “Why not? I was already stoned on weed.”

Meth: “I tell people I used meth once in my life for eight months.”

Opiates: A friend first gave him an oxycodone pill, “and I was like, ‘Why not?’ I crushed it up and snorted it. … It was like the absolute, most warmest hug I ever felt.”

He can’t remember when he first switched from prescription opiates to heroin. But shooting up the drug, he said, “was like stepping into the perfect temperature of bath water, and (the feeling) would go all the way up, and all the way down.”

Williams is disabled. He walks with a limp and his left arm hangs at his side.



“I went to prison a couple years back. I found out I had a brain tumor. They went in to take it out, and they cut a blood vessel … gave me a stroke.”

One day, two years ago, he ran out of money and got clean. He can’t explain why.

“These days … I feel better about my life than I ever have before. Which sounds pretty crazy, doesn’t it? I only got half a freakin’ body right now. … But I get by. I still joke and love and make it to the Dollar Tree. All my essentials are taken care of.”

— Keith Uhlig, kuhlig@gannett.com

Addiction becomes a legacy of abuse

Jodi Chamberlain, Stevens Point

Jodi Chamberlain couldn’t get pills. They cost too much.

She got heroin from a friend instead. She was alone in her bedroom the first time she snorted the drug.

She didn’t have to think or feel. She didn’t have to deal with anything. But, Chamberlain said, “when it ends, you just crave more.”

She used heroin again within a week.

Chamberlain was living in Stevens Point at the time. She was barely in her 20s, but was already a regular drug user — mostly pain pills, but also cocaine and other stimulants. Her addictions grew out of a turbulent childhood, which, she said, included incidents of sexual abuse by a relative.

“I was taught to lie and to not have feelings,” she said. “I’ve never felt feelings.”

Now 41, Chamberlain has been clean for about eight months. She moved back to Stevens Point late last year after living in Eau Claire. Sometimes she slept in a truck.

Chamberlain was arrested again and again. She was sentenced in May on felony drug charges, but instead of going to prison, a judge allowed her to participate in Portage County’s drug court. She’s never made it through treatment without going back to heroin. If she fails in drug court, she faces a prison sentence.

Chamberlain regrets how many people she hurt with her drug use, particularly her two children, who watched their mother struggle with addiction.

She wants to stay clean, but even she can’t say whether she will make it.

“I can’t make that promise to anyone, not even myself,” she said. “But I choose to have people in my life now who can help me when I am going through rough times.”

— Chris Mueller, cmueller@gannett.com

‘A very functional addict’ awaits prison

Kyle Keding, Wisconsin Rapids

Kyle Keding was 26 years old and had been a heavy user of drugs for years before he tried heroin.

He had been drinking and smoking marijuana for about half his life. He had been dependent on opiate painkillers such as Percodan and Oxycontin for about five years. The pills helped him get through long days as a welder and they helped him forget about the crap life handed him.

Keding was sexually molested when he was about 5 years old, first by a babysitter, then by a relative, he said. Those memories never left him, unless he was high. So he got high. A lot. For him, that was just part of life, in addition to work, being a parent and a husband.

 

“I was what you call ‘a very functional’ addict,” he said.

The heroin was a practical choice. Opiate painkiller manufacturers had changed the formula of their pills, making them more difficult to use to get high, and also created a huge opiate shortage.

“So I couldn’t find what I wanted. I called up my friend, and he was like, ‘Well, I’ve got some ‘ron (heroin). … (I was) kind of skeptical,” Keding said. “I had not done it before.”

He did not feel as if he had stepped over any kind of line. He had already liquefied prescription opiates and shot those up intravenously.

Shooting up, both synthetic opiates and heroin, gave him a stronger high. He chose the needle because his friend and dealer did not have enough pills to get Keding as high as he wanted.

“I can remember the words that came out of my mouth once I released the strap off my arm,” he said. “‘Oh, my God. This is amazing.’ And I knew right there, this is it. I was like, there was no turning back now. But there was.”

He used heroin for five years, until Dec. 2, 2014. That night he was with friends, getting high, and one of the people he was with died. He was charged with first-degree reckless homicide/deliver drugs. He accepted a plea deal on that charge on Dec. 1, 2017. He awaits sentencing in February and could face years in prison.

— Keith Uhlig, kuhlig@gannett.com

‘This is a lifelong battle’

Tommy Casper, Neenah

Tommy Casper said one of the main reasons he has stayed clean for more than seven months is because of his nephew Owen, who has only ever known him sober. Casper sees his sister Carly Fritsch, who overcame her own struggle with addiction, and Owen most days of the week after work. Casper plays on a recreational volleyball team with other recovering addicts and attends Narcotics Anonymous meeting three times a week.

Tommy Casper was alone in the basement of the two-story home where he grew up.

He sat on his bed and opened a small bag of heroin that had been on top of a dresser beside him. He hadn’t used the drug before, but at about $120 a bag, it was cheaper than the pills he used. He snorted it.

He found himself asking one thing as the feeling went away: “What do I need to do in order to feel that way again?” He used heroin again three hours later.

Casper was 21 years old and living in Muskego, a community of fewer than 25,000 people on the outskirts of Milwaukee. His mother had died about six months earlier and he struggled with the loss. His sporadic use of pain pills became an addiction.

“The first time I used (as a way) to cope — rather than using to have fun or go out — was at her funeral,” he said.

After he turned to heroin, Casper told himself he wouldn’t use a needle because “then I wasn’t as bad as other people.” He used a needle for the first time a year later.

After his mother died, Casper moved around — to a house in West Allis, then an apartment in Neenah. He began to steal to support his addiction, but got caught shoplifting at a Walmart in Fond du Lac. He was charged and went to treatment a few days later.

Casper hardly slept or ate for two weeks as he fought through the physical withdrawal from the drug.

 

Casper, now 29, has relapsed twice since going to treatment. He hasn’t used for about the last seven months and attends Narcotics Anonymous meetings three times a week. He has a full-time job at a call center in Appleton and hopes to use his story to help others.

“This is a lifelong battle that we’re going to be in,” he said.

— Chris Mueller, cmueller@gannett.com

About this project

Wisconsin has a heroin problem directly linked to its opioid epidemic. Every corner of the state has been affected, every taxpayer, every school district, every police department, every social service agency, every hospital.

But why do an estimated 6,600 Wisconsin residents regularly snort, inject or smoke heroin? And how do we get our state off this deadly drug?

A team of journalists from USA TODAY NETWORK-Wisconsin went to 10 people who know firsthand how heroin enters a person’s life, and how best to get away from its grip. Their stories are part of a project the news organization will continue in 2018 to investigate Wisconsin’s response to the opioid crisis and the most successful paths to recovery.

All photos and videos by Alexandra Wimley/USA TODAY NETWORK-Wisconsin

Send feedback to Robert Mentzer, project editor: rmentzer@gannett.com

How to get help

For people who want to get help with heroin addiction:

Emergency: In a life-threatening emergency, call 911.

United Way 2-1-1: If it’s not an emergency but you want information over the phone at any hour about local options, call 211.

Narcotics Anonymous: Local meetings can be found online at wisconsinna.org or by calling 1-866-590-2651.

Wisconsin Department of Health Services: Guide to treatment resources statewide, online at dhs.wisconsin.gov/opioids/.

Source: http://www.wisinfo.com/usat/heroin_addiction/?for-guid=7ba874c6-08dd-e611-b81c-90b11c341ce0#start

 

 

Filed under: Heroin/Methadone,Methamphetamine/GHB/Hallucinogens/Oxycodone,Prescription Drugs,Treatment and Addiction :

The Washington County drug court graduation ceremony for Maria Kestner. Photograph: Fred R Conrad

Photographer  visited a Virginia drug court last year and saw how individuals and families had been given a second chance – so when he went back this summer he had a question: did they take it?

“Opioid and methamphetamine abuse tore through this area like a wildfire.”

This is the view of Rebecca Holmes, who is responsible for mental health and drug use outpatient treatment in Abingdon, Washington County, Virginia, as she looks back at the decision to set up a drug court.

Holmes, the medical director of Highlands Community Services, had seen how the growing crisis around opioids had taken such a heavy toll on families in the town, which is home to just over 8,000 people.

 

There was a growing need for a small group of addicts that did not respond to treatment or programs offered by the existing court or probation, she said, so five years ago she applied for a grant to use a federal model for a drug court that had first emerged in 1989.

The county’s drug court has been in place for several years now and Holmes feels that it has never been more needed. Last year in Virginia there were more deaths from heroin and opioids than highway fatalities for the first time, and the governor declared a public health emergency.

Nationally, opioids are said to be killing 90 people a day.

  • The Washington County court house. Inside the county court room where the drug court meets every week.

Judge Lowe presides over the court and the program, which is a year and half long for those who are placed on it. It combines therapy with a structured program of court visits, random drug screens, curfews and full-time employment for participants.

  • Judge Lowe poses with Wayne Smith, who has completed the second phase of the four-phase drug court. Participants are rewarded for good behavior.

There is the ever-present threat of court sanctions if a participant relapses. Lowe says: “The point of drug court is not just to treat the addict, it’s to make that person a model for the rest of their family so that they can break the cycle of drug abuse.”

The Guardian visited last year and again this year in late summer to see how people who had gone through the court – and who worked there – were getting on.

Bubba

  • Bubba and Ginger in their bedroom.

Bubba Rouse started abusing painkillers when he was a young teenager. He then stole various pills he could get his hands on. At 17 Bubba started smoking meth. He also became a father for the first time.

Bubba continued to use drugs and found a new girlfriend, Ginger, whose father had been sent to prison for meth when she was eight years old. Bubba and Ginger were both using meth and heroin when Ginger got pregnant. “The reason I stopped using was because I knew I had a future coming with my baby and I didn’t want to bring a child into a world like the one I grew up in.”

  • Family pictures of the Rouse family are displayed throughout the home where Bubba Rouse grew up.
  • Playing with her Barbie dolls.

Ginger was able to get sober and her baby was born without any complications while Bubba was in prison. While in prison he was offered a place in the Washington County drug court program. Drug court can be very difficult, especially at the beginning. There are mandatory therapy meetings, frequent random drug screens, curfew calls in the middle of the night and you have to have to be employed full time. It was even more difficult for Bubba because he could not legally drive. Ginger became both chauffeur and workmate for Bubba this past year.

  • Bubba with his daughter. 

They have managed to work together in a factory, on a construction crew and now at a fast-food restaurant. Bubba and Ginger moved in with Bubba’s parents where Bubba was able to able to get closer to his oldest daughter. For most of the year his younger daughter, with Ginger, was taken care of by Ginger’s mother.

The family is now reunited and Bubba and Ginger have taken over the payments on a double wide trailer that they hope to move next to Bubba’s parents home. After drug court graduation in six months, Bubba hopes to start working construction with Ginger’s stepfather.

Bubba said: “Drug court has been good for me but there are not many programs in this area and I wish there were more things to help people quit early rather than when things get really bad.”

Chris Brown

  • Maria Kestner is hugged by Chis Brown at her drug court graduation ceremony.

Chris Brown is a retired police officer with nearly 30 years on the job. “As a police officer you get jaded after a while. You go to the same addresses and visit the same families all the time. It hit me when I started arresting the grandchildren of people I arrested when I was a rookie cop. You realize early on that you can’t incarcerate your way out of this drug problem.”

After retiring from the police force, Chris was looking for a job where he could help people. “When the job of drug court coordinator became available, I jumped at the chance.

  • Bubba hands a drug test cup filled with his urine to Chris Brown.

“This is a wonderful way to help people. I found my humanity with this job.” Chris takes his job very seriously. He’s on call 24/7. He handles compliance with spot drug screens, curfew calls as well as issues of transportation, housing and dealing with family issues of those in the program.

You realize early on that you can’t incarcerate your way out of this drug problem

He is not judgmental and he is a good listener. “I remember talking with a drug addict years ago and asking him how he wanted to be treated. He told me he just wanted to be treated like a human being. That’s what I try to do with everyone in the program: treat them like human beings rather than drug addicts.”

Joyce Yarber

  • Joyce Yarber manages a cattle ranch and hay farm with her husband.

Joyce Yarber, age 59, has always walked with a limp. She has suffered with hip dysplasia and osteoarthritis for most of her life. For over 20 years, her doctor had prescribed a painkilling cocktail that included Lortab, Percocet and oxycodone. When her doctor was arrested for over prescribing opiates she became desperate and eventually wrote half a dozen prescriptions for herself. She was arrested and offered drug court. Because she had written scripts in both Virginia and Tennessee, it took two years of legal wrangling before she could start the drug court program in Washington County, Virginia.

Before starting drug court, she was required to get a hip replacement operation, the hope being that the operation would eliminate the pain that caused her to become a drug addict. Determined to stay sober, Joyce refused to take any opiates after the operation. Her only post-operation painkiller was an over-the-counter one. That determination impressed the drug court team. “When I first started drug court, I was a drug snob. I thought that because I got my drugs from a doctor rather than buying them on the street, I was somehow better. It didn’t take long for me to realize I was wrong. I was no better than anyone else in the program. I was just as much an addict as they all were.”

  • The start of a therapy session at Highlands Community Services for drug court participants.

Joyce has been a model client in drug court and because of her age and her outgoing personality, she has become a mother figure for the group. The only time she missed a therapy meeting was when she was trapped in a tree without her cellphone by a young bull on the cattle farm that she and her husband operate. That bull was culled from the herd the next day.

I thought that because I got my drugs from a doctor rather than buying them on the street, I was somehow better. It didn’t take long for me to realize I was wrong

A few months into the drug court program, Joyce went to her doctor and was diagnosed with stage four lung cancer. Because the pain caused by the cancer was so great, she knew that she would have to go back on to opiate pain medication just to get through her chemotherapy. She offered to resign from the program but the team insisted that she stay. Her medication level is monitored by the drug court and she still attends all of the meetings. “I got a call from the probation office in Tennessee and they gave me a date that I need to call them by after I complete drug court. I sure hope I’m around and that I can remember to call. This chemo brain is a real pain.”

Zac Holt

Zac Holt was always a gifted athlete. His goal after graduating from college was to attend seminary and become a Presbyterian minister. Those plans were delayed after Zac fell 45ft while free climbing. He broke a leg and fractured a vertebra. While in hospital, he was given narcotic pain medication. Zac had experimented with marijuana and cocaine in high school and college but drugs were never a major part of his life.

  • Zac trains daily and has competed in two triathlons since beginning drug court

That changed after he was exposed to percocet and oxycodone. After he was released from the hospital, he began doctor shopping and getting multiple prescriptions. He went off to seminary and continued using drugs. “I became a raging drug addict. I would do anything for my drugs. I lied, cheated and stole, mostly from my family. I dropped out of school. I went through therapy several times but always came back to my drugs.” Zac’s drug use went on for nine years.

  • Zac Holt was addicted to opioids for nearly nine years.

When he was arrested for possession and put on probation he continued to use drugs. He confessed this to his probation officer who then sent him to jail. While in jail his jaw was broken in a lunch room fight. He had reached bottom when he was offered drug court earlier this year. “Drug court was the best thing in the world for me. I wanted to change my life and drug court gave me a way to change.” Zac embraced the discipline and structure of drug court. He went back to live with his parents and started reconnecting with his family. He also started training for a triathlon. It seemed like an impossible goal for someone who had never competed in one. The regimen of drug court and constant training fills every waking moment. Zac has 10 more months of drug court before graduating. He is active in his church and is contemplating a return to seminary. He has also completed two triathlons.

  • Zac is thinking about returning to seminary and becoming a Presbyterian minister after he completes drug court.

Drug use in south-western Virginia shows no sign of decline. Use of Suboxone is on the rise and meth is still entrenched in the hills of Appalachia. Brown, the drug coordinator for the Washington County drug court said: “You can’t let yourself get discouraged by the numbers. You just work and fight drug addiction one family at a time.”

Source: https://www.theguardian.com/us-news/2017/oct/23/drug-court-opioids-virginia-second-chance October 2017

Filed under: Addiction,Crime/Violence/Prison,Heroin/Methadone,Prescription Drugs,Social Affairs,Treatment and Addiction :

Christina Brezing, MD, Frances Levin, MD

It is vital that physicians—particularly psychiatrists who are on the frontlines with patients who struggle with cannabis use—are able to identify and characterize cannabis use disorders; provide education; and offer effective, evidence-based treatments. This article provides a brief overview of each of these topics by walking through clinical decision-making with a case vignette that touches on common experiences in treating a patient with cannabis use disorder.

A separate and important issue is screening for emerging drugs of abuse, including synthetic “marijuana” products such as K2 and spice. Although these products are chemically distinct from the psychoactive compounds in the traditional cannabis plant, some cannabis users have tried synthetic “marijuana” products because of their gross physical similarity to cannabis plant matter.

CASE VIGNETTE

Mr. M is a 43-year-old legal clerk who has been working in the same office for 20 years. He presents as a referral from his primary care physician to your outpatient psychiatry office for an initial evaluation regarding “managing some mid-life issues.” He states that while he likes his job, it is the only job he has had since graduating college and he finds the work boring, noting that most of his co-workers have gone on to law school or more senior positions in the firm. When asked what factors have prevented him from seeking different career opportunities, he states that he would “fail a drug test.” Upon further inquiry, Mr. M says he has been smoking 2 or 3 “joints” or taking a few hits off of his “vaping pen” of cannabis daily for many years, for which he spends approximately $70 to $100 a week.

He first used cannabis in college and initially only smoked “a couple hits” in social settings. Over time, he has needed more cannabis to “take the edge off” and has strong cravings to use daily. He reports liking how cannabis decreases his anxiety and helps him fall asleep, although he thinks the cannabis sometimes makes him “paranoid,” which results in his avoidance of family and friends.

More recently, he identifies conflict and regular arguments with his wife over his cannabis use—she feels it prevents him from being present with his family and is a financial burden. He admits missing an important awards ceremony for her work and sporting events for his children, for which he had to “come up with excuses,” but the truth is that he ended up smoking more than he had intended and lost track of the time.

Mr. M reports multiple previous unsuccessful attempts to reduce his use and 2 days when he stopped completely, which resulted in “terrible dreams,” poor sleep, sweating, no appetite, anxiety, irritability, and strong cravings for cannabis. Resumption of his cannabis use relieved these symptoms. He denies tobacco or other drug use, including use of synthetic marijuana products such as K2 or spice, and reports having a glass of wine or champagne once or twice a year for special occasions.

The diagnosis

In the transition from DSM IV-TR to DSM-5, cannabis use disorders, along with all substance use disorders, have been redefined in line with characterizing a spectrum of pathology and impairment. The criteria to qualify for a cannabis use disorder remain the same except for the following:

1. The criterion for recurrent legal problems has been removed.

2. A new criterion for craving or a strong desire or urge to use cannabis has been added, and the terms abuse and dependence were eliminated.

To qualify as having a cannabis use disorder, a threshold of 2 criteria must be met. Severity of the disorder is characterized as “mild” if 2 or 3 criteria are met, “moderate” if 4 or 5 criteria are met, and “severe” if 6 or more criteria are met. Mr. M demonstrates 3 symptoms of impaired control: using longer than intended, unsuccessful efforts to cut back, and craving; 3 symptoms of social impairment: failure to fulfill home obligations, persistent problems with his wife, and reduced pursuit of occupational opportunities; 1 symptom of risky use: continued use despite paranoia; and 2 symptoms of pharmacological properties: tolerance and withdrawal. As such, he meets 9 criteria, which qualify him for a diagnosis of severe cannabis use disorder.

You summarize Mr. M’s 9 symptoms and counsel him about severe cannabis use disorder. He becomes upset and states that he was not aware one could develop an “addiction” to cannabis. He expresses an interest in treatment and asks what options are available.

Treatment options

Psychotherapeutic treatments, including motivational enhancement treatment (MET), cognitive behavioral therapy (CBT), and contingency management (CM), have demonstrated effectiveness in reducing frequency and quantity of cannabis use, but abstinence rates remain modest and decline after treatment. Generally, MET is effective at engaging individuals who are ambivalent about treatment; CM can lead to longer periods of abstinence during treatment by incentivizing abstinence; and CBT can work to enhance abstinence following treatment (preventing relapse). Longer duration of psychotherapy is associated with better outcomes. However, access to evidence-based psychotherapy is frequently limited, and poor adherence to evidence-based psychotherapy is common.

In conjunction with psychotherapy, medication strategies should be considered. Because there are no FDA-approved pharmacological agents for cannabis use disorder, patients should understand during the informed consent process that all pharmacotherapies used to treat this disorder are off-label. A number of clinical trials provide evidence for the off-label use of medications in the treatment of cannabis use disorder. The current strategies for the off-label treatment of cannabis use disorder target withdrawal symptoms, aim to initiate abstinence and prevent relapse or reduce use depending on the patient’s goals, and treat psychiatric comorbidity and symptoms that may be driving cannabis use. Here we focus on the evidence supporting these key strategies.

Targeting withdrawal and craving

Cannabis withdrawal is defined by DSM-5 as having 3 or more of the following signs and symptoms that develop after the cessation of prolonged cannabis use:

• Irritability, anger, or aggression

• Nervousness or anxiety

• Sleep difficulty

• Decreased appetite or weight loss

• Restlessness

• Depressed mood

• At least one of the following physical symptoms that causes discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache

Withdrawal symptoms may be present within the first 24 hours. Overall, they peak within the first week and persist up to 1 month following the last use of cannabis. In the case of Mr. M, insomnia, poor appetite, and irritability as well as sweating are identified, which meet DSM-5 criteria for cannabis withdrawal during the 2 days he abstained from use. He also identifies strong craving and vivid dreams, which are additional withdrawal symptoms included on marijuana withdrawal checklists in research studies, although not included in DSM-5 criteria. These and other symptoms should be considered in clinical treatment.

Medication treatment studies for cannabis withdrawal have hypothesized that if withdrawal symptoms can be reduced or alleviated during cessation from regular cannabis use, people will be less likely to resume cannabis use and will have better treatment outcomes. Studies have shown that dronabinol and nabilone improved multiple withdrawal symptoms, including craving; and quetiapine, zolpidem, and mirtazapine help with withdrawal-induced sleep disturbances.

Combining dronabinol and lofexidine (an alpha-2 agonist) was superior to placebo in reducing craving, withdrawal, and self-administration during abstinence in a laboratory model. However, in a subsequent treatment trial, the combined medication treatment was not superior to placebo in reducing cannabis use or promoting abstinence.

Six double-blind placebo-controlled pharmacotherapy trials in adults with cannabis use disorder have looked at withdrawal as an outcome. Of these studies, only dronabinol, bupropion, and gabapentin reduced withdrawal symptoms. In addition to reducing withdrawal symptoms, nabiximols/Sativex (a combination tetrahydrocannabinol [THC] and cannabidiol nasal spray not available in the US) increased retention (while actively on the medication in an inpatient setting) but did not reduce outpatient cannabis use at follow-up.

All of the medications available for prescription in the US can be monitored reliably with urine drug screening to assess for illicit cannabis use except dronabinol, which will result in a positive screen for cannabis. When using urine drug screening, remember that for heavy cannabis users the qualitative urine drug screen can be positive for cannabis up to a month following cessation. When selecting a medication, take into account the cost of the medication, particularly since insurance will likely not cover THC agonists such as dronabinol for this indication, and possible misuse or diversion of scheduled substances (eg, dronabinol, nabilone). In addition, monitoring for reductions in substance use and withdrawal symptoms is key.

Abstinence initiation and relapse prevention

Other clinical trials have looked at medications to promote abstinence by reducing stress-induced relapse, craving (not as a component of withdrawal), and the reinforcing aspects of cannabis. Of these trials, the following results show potential promise with positive findings: gabapentin reduced quantitative THC urine levels and improved cognitive functioning (in addition to decreasing withdrawal), and buspirone led to more negative urine drug screens for cannabis (although the difference was not significant compared with placebo). However, in a follow-up larger study, no differences were seen compared with placebo and women had worse cannabis use outcomes on buspirone.

N-acetylcysteine resulted in twice the odds of a negative urine drug screen in young adults and adolescents (although there was no difference between adolescent groups in self-report of cannabis use).Gray and colleagues reported that no differences were seen between N-acetylcysteine and placebo (results of the trial are soon to be published). Topiramate resulted in significantly decreased grams of cannabis used but no difference in percent days used or proportion of positive urine drug screens.16 In a recent small clinical trial, reductions in cannabis use were seen with oxytocin in combination with MET.17Studies with nabilone and long-term naltrexone administration reduced relapse and cannabis self-administration and subjective effects, respectively, which suggests promising avenues yet to be explored by clinical trials.

Treatment of psychiatric comorbidity

Other studies have looked at the effects of treating common comorbid psychiatric disorders in adults with cannabis use disorder, postulating that if the psychiatric disorder is treated, the individual may be more likely to abstain or reduce his or her cannabis use. For example, if a person is less depressed, he may better engage in CBT for relapse prevention.

Fluoxetine for depression and cannabis use disorder in adolescents decreased cannabis use and depression, although there was no difference compared with placebo. A trial of venlafaxine for adults with depression and cannabis use disorder demonstrated less abstinence with greater withdrawal-like symptoms compared with placebo. These findings suggest that this antidepressant might not be beneficial for treatment-seeking individuals with cannabis use disorder and may actually negatively affect outcomes.

 

CASE VIGNETTE CONT’D

After discussing and presenting the different psychotherapy and medication treatment options to Mr. M, you and he decide to start CBT to help with abstinence initiation. In addition, you prescribe 20 mg of dronabinol up to 2 times daily in combination with 50 mg of naltrexone daily, to help globally target Mr. M’s withdrawal symptoms and prevent relapse once abstinence is achieved. However, a few days later, Mr. M calls to say that his insurance will not cover the prescription for dronabinol and he cannot afford the high cost. Given his main concerns of cannabis withdrawal symptoms, you select gabapentin up to 400 mg 3 times daily and continue weekly individual CBT.

Mr. M calls back several days later and reports that he has made some improvements in reducing the frequency of his cannabis use, which he attributes to the medication, but he thinks he needs additional assistance. After reviewing the treatment options again, he gives informed consent to start 1200 mg of N-acetylcysteine twice daily. After 10 weeks of this medication, his urine screens are negative.

You continue to provide relapse prevention CBT. He reports to you that his anxiety and insomnia are almost resolved, and you suspect that withdrawal was the cause of these symptoms. He reports significant improvement in his relationship with his family and recently received a promotion at work for “going above and beyond” on a project he was given the lead.

Over the next 6 months, he has 2 relapses that in functional analysis with you are determined to be triggered by unsolicited contact from his former drug dealer. Together, you develop a plan to block any further contact from the drug dealer. After several months, both the gabapentin and N-acetylcysteine are tapered and discontinued. Mr. M continues to see you for biweekly therapy sessions with random drug screens every 4 to 6 weeks.

 

Conclusion

Based on the available evidence, gabapentin, THC agonists, naltrexone, and possibly N-acetylcysteine show the greatest promise in the off-label treatment of cannabis use disorders. System considerations, such as medication cost, need to be factored into the decision-making as well as combination medication and psychotherapy approaches, which—as demonstrated in the case of Mr. M—may ultimately work best. Until further research elucidates the standard of medication practices for cannabis use disorder, the best off-label medication strategy should target any co-occurring disorders as well as any identified problematic symptoms related to cannabis use and cessation of use. When available, referral for evidence-based psychotherapy should be made.

Source: https://www.psychiatrictimes.com/special-reports/treatment-cannabis-use-disorders-case-report/ August 2017

 

Filed under: Brain and Behaviour,Cannabis/Marijuana,Treatment and Addiction :
Tom P. Freeman, Peggy van der Pol, Wil Kuijpers, Jeroen Wisselink,Ravi K. Das, Sander Rigter, Margriet van Laar, Paul Griffiths, Wendy Swift,Raymond Niesink and Michael T. Lynskey

ABSTRACT:

Background

The number of people entering specialist drug treatment for cannabis problems has increased considerably in recent years. The reasons for this are unclear, but rising cannabis potency could be a contributing factor. Methods Cannabis potency data were obtained from an ongoing monitoring programme in the Netherlands. We analysed concentrations of δ -9-tetrahydrocannabinol (THC) from the most popular variety of domestic herbal cannabis sold in each retail outlet (2000–2015). Mixed effects linear regression models examined time-dependent associations between THC and first-time cannabis admissions to specialist drug treatment. Candidate time lags were 0–10 years, based on normative European drug treatment data.

Results

THC increased from a mean (95% CI) of 8.62 (7.97–9.27) to 20.38 (19.09–21.67) from 2000 to 2004 and then decreased to 15.31 (14.24–16.38) in 2015. First-time cannabis admissions (per 100 000 inhabitants) rose from 7.08 to 26.36 from 2000 to 2010, and then decreased to 19.82 in 2015. THC was positively associated with treatment entry at lags of 0–9 years, with the strongest association at 5 years, b = 0.370 (0.317–0.424), p < 0.0001. After adjusting for age, sex and non-cannabis drug treatment admissions, these positive associations were attenuated but remained statistically significant at lags of 5–7 years and were again strongest at 5 years, b = 0.082 (0.052–0.111), p < 0.0001.

Conclusions

In this 16-year observational study, we found positive time-dependent associations between changes in cannabis potency and first-time cannabis admissions to drug treatment. These associations are biologically plausible, but their strength after adjustment suggests that other factors are also important.

Source: https://www.researchgate.net/publication/322830280_Changes_in_cannabis_potency_and_first-time_admissions_to_drug_treatment_A_16-year_study_in_the_Netherlands January 2018

Filed under: Cannabis/Marijuana,Treatment and Addiction :

Featuring Thomas Kosten, MD,
Professor and the Jay H. Waggoner Endowed Chair in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine
Dr. Mark Gold and Dr. Thomas Kosten discuss anti-drug vaccines to treat substance use and addiction.

Q – Congratulations on your career to date and most recent work. Can you explain the idea behind your anti-drug vaccines? Are there any of your papers you’d suggest the reader look at?
A – Abused drugs are far too small to produce antibody responses. The vaccines work by covalently attaching the abused drug to 20 to 30 exposed amino acids on a carrier protein such as tetanus toxoid and then injecting this vaccine into humans to produce antibodies to both the tetanus toxoid and to the abused drug, because the drug now “looks like” part of this toxoid.

Q – Is the idea to block the drug’s reinforcing effects? What about overdose effects? Are each of the vaccines specific to a single drug or class of drugs?
A – Yes, the antibodies block reinforcing effects, but a slower process like overdose is still possible unless the drug is typically taken in very small quantities when abused – such drugs include PCP and fentanyl. These vaccines are highly specific to a class of drugs and have limited cross-reactivity.

Q – What happens if the drug abused is cocaine? Heroin? How would this be preferable to methadone or buprenorphine? Naltrexone?
A – For opiates, naltrexone is a better choice as a broad-spectrum blocker, but it does not effectively block the super-agonists related to fentanyl. However, these high potency agents are ideal targets for vaccine development, which is underway.

Q – How long would a single antidrug vaccine treatment last?
A – These antibodies persist at high levels for about three months and then require a booster vaccination about every three months.

Q – Are there risks that would prevent vaccination of women? Other risks? Adverse effects?
A – There are no specific risks from these tetanus toxoid based vaccines for women, since tetanus vaccine is even given to pregnant women. The antibodies cross over the placenta so that the fetus would also be protected.

Q – Are any approved for use? Why?
A – None are approved for use by the FDA because they have not met the criteria set for efficacy with either cocaine or nicotine. There have been no safety concerns, and a cocaine vaccine, particularly combined with the enhanced cholinesterase, would be the most likely to meet FDA efficacy standards relatively easily.

Q – Many experts think that the current opioid epidemic will be followed by a cocaine epidemic. What treatments exist for a cocaine-dependent patient or those presenting to an ED with a cocaine overdose? Are you developing for cocaine overdose? Cocaine addictions?
A – As suggested above, yes, we have a new and much more potent cocaine vaccine than we previously tested, but we need funds to move it forward. This vaccine combined with the Teva or other enhanced cholinesterases (Indivior also has one) would prevent overdoses.

Q – What about methamphetamine?
A – We have a methamphetamine vaccine and hope to have it in humans within a year or so, if our funding continues from NIDA.

Q – What kinds of studies are you doing right now? Planning?
A – The studies are all in animals with methamphetamine, cocaine, nicotine and fentanyl vaccines using a highly effective new adjuvant that has been used in humans at 50 times the dose needed for raising our antibody levels up to sevenfold higher than our previous cocaine vaccine.

Q – Anything else to add?
A – You covered it all, just send money. This is a difficult area for getting venture capital as well as NIDA funds to manufacture and get initial FDA approval to use these vaccines in humans.

Source: Email from Mark Gold, MD <donotreply@rivermendhealth.com>  September 2017

Filed under: Health,Treatment and Addiction :

Dr. Mark Gold and Dr. Stacy Seikel discuss opioid addiction

Experts have concluded that the opioid crisis started with physicians overprescribing opioid pain medication.

Q – You are one of the few double board certified, pain evaluation and treatment experts, and addiction evaluation and treatment expert. How do you decide who should be given opioids for chronic pain? What are your advantages in patient evaluation and treatment as a clinical expert in having such training?
A – The first thing when you are evaluating a patient who has pain, or pain and addiction, is that all pain is real. The patients who have chronic or intermittent pain have an underlying fear of suffering. They may appear controlling or resistant to treatment, but actually it is this “fear of suffering” that is driving most of their behavior.

Q – If the person in recovery needs opioids for chronic pain or acute pain how do you manage that and prevent abuse and/or addiction?
A – If the person in recovery needs opioids for acute pain, such as due to an injury or surgery, we develop a “Pain Management Relapse Prevention Agreement”. I have the patient, family, surgeon, sponsor, caregivers and anesthesiologist involved in that plan.

Q – You have written about how to get off Suboxone. Why is it so hard to get off Suboxone and how do you get off Suboxone?
A – First of all, the goal of patients on Suboxone is not to get off Suboxone. The goal is to get into recovery. The Suboxone and other buprenorphine formulations is one tool, among many, to help patients have a meaningful self-directed life, and not a drug directed life.

Q – You have run methadone programs, how do you get off methadone?
A – I taper methadone the same way I taper buprenorphine, that is slowly and with the patient able to stop the taper at any time. I would typically start a methadone taper in a motivated patient at about 10% per month if tolerated. Maybe less. As you can see it can take over a year to successfully taper someone.

Q – How do you detox and get on naltrexone or Vivitrol. How do you get off naltrexone?
A – In order to start a patient on Vivitrol, the patient needs to have the opiates out of their system and not have any withdrawal symptoms. Typically a patient must be off short-acting opiates for one week or long-acting opiates for 10 to 14 days. There are rapid induction techniques for Vivitrol, but I do not use those in an outpatient setting.

Q – Do you have any advice on how to use Narcan in a suspected opioid overdose?
A – Georgia has made naloxone for overdose reversal available in pharmacies without a doctor’s prescription. With one person dying of overdose every 15 minutes, I believe every citizen needs to be trained in overdose reversal and carry Narcan.

Q – What makes fentanyl so deadly? How do you reverse the fentanyl overdose? Does the overdose reverse successfully?
A – Fentanyl is a very potent opioid and it is very easy to take too much. Most of my patients do not realize that the heroin that they have been using has fentanyl in it. So as you can see, a person may not even know they are taking fentanyl. They may think they are taking heroin and take too much and overdose.

Q – MAT programs often have too little in the way of behavioral health and psychiatric treatment. You do the opposite, please describe.
A – I provide MAT within a treatment program in an outpatient setting. We provide intensive outpatient (three hours per day) or PHP (six hours per day) of counseling and group therapy. In addition we provide a psychiatric evaluation, weekly physician visits, med management, individual therapy and a very robust family program.

Q – Describe your program. Who benefits from this program?
A – Atlanta Addiction Recovery Center, AARC, our Christian program, combines our scientific evidence-based treatment with Christian principles. Biblical teachings are embedded in all aspects of our programming. Though we welcome patients from all faiths, Christian teachings are utilized.

Q – Do you see an upswing in cannabis addiction?
A – I have seen an increase in cannabis addiction. Typically we see young adults who have not been able to move through “adulting” because their cannabis use got in the way of their school, their relationships, their work and their ability to mature.

Source: Email from Mark Gold, MD <donotreply@rivermendhealth.com>  February 2018

Filed under: Heroin/Methadone,Treatment and Addiction :

By Jason Schwartz

British Columbia has long been cited as a model for North American drug policy and harm reduction implementation.

BC has established a Death Review Panel in response to the overdose crisis. The panel recently issued a report with 3 recommendations. The first recommendation to regulate recovery homes, which currently require only a simple inspection of the facility. (The other 2 were for more maintenance treatments and more harm reduction.)

The chair of the panel cited the abstinence orientation of houses as a concern.

A columnist at the Vancouver Sun pushes back against the argument that BC is suffering from insufficient harm reduction:

This is, after all, a city and a province that for nearly 20 years has been at the forefront of harm-reduction with needle exchange programs, safe injection sites, methadone and suboxone treatment programs, a prescription heroin program and, more recently, free naloxone kits, free-standing naloxone stations and training for first-responders and even teachers in how to use it as an antidote for fentanyl overdoses.

We’ve gone from crisis to crisis, each one sucking up incredible resources. Currently, a quarter of a million dollars a day goes into the Downtown Eastside alone for methadone treatment. This year, the B.C. government expects the number of British Columbians receiving replacement drug therapy to rise to 30,000 and then nearly double to 58,000 by 2020-21.

In 2006 when Vancouver updated its four pillars approach, it noted that there were 8,319 British Columbians being treated with methadone.

By 2020-21, the province also expects to be supplying 55,000 “free” take-home naloxone kits, up from 45,000 this year.

We keep hearing about an overdose crisis, but what we have is an addictions crisis. Solving it will require a lot more than simply reducing harm.

What’s needed is a recovery orientation. (Which does not rule out harm reduction.)

Source: https://addictionandrecoverynews.wordpress.com/2018/04/12/overdose-crisis-or-addiction-crisis/

April 2018

Filed under: Drug use-various effects,Heroin/Methadone,Treatment and Addiction :

Click on the images to enlarge the detail.

Source:

https://www.intervenenow.com/breaking-the-stigma-of-recovery/

Filed under: Alcohol,Cannabis/Marijuana,Nicotine,Prescription Drugs,Treatment and Addiction :

Comments below from David Evans Esq., a lawyer and special adviser to the Drug Free America Foundation, re the suggestion that marijuana could assist in treating opiate addiction.

WHAT ARE THE PHYSICAL AND BEHAVIORAL ADVERSE EFFECTS OF USING “MEDICAL” MARIJUANA WHILE IN OPIATE TREATMENT?

Memory defect (short and long term) – how are they to remember compliance issues and new problem solving? Masks other mental health issues – anxiety, PTSD, Bipolar

Marijuana use impacts the brain, creates a delay in learning skills to NOT have substance use in life.

In order for change to occur, person must acknowledge loss of control – how can someone do this when control is still lost with marijuana?

Changes in coordination, mood swings, memory/learning problems

Marijuana use deters the return to normal brain functioning and the continued drive for more substances and stimuli in the pleasure seeking area of the brain.

Marijuana use is A-motivational – knocks out drive and ambition

Continued use maintains Arrested Development – low emotional maturity – the maturity level is stumped when start using substances

Recovery – means not using drugs

THC suppresses neurons in information processing system of the hippocampus, the part of the brain that is crucial for learning memory and integration of sensory experiences with emotions and motivations. Learned behaviors, which depend on the hippocampus, deteriorate after chronic exposure

· Because marijuana use impacts learning a person falls behind in accumulating intellectual, job, or social skills. This can directly translate to need for more treatment both with intensity and length

Users have trouble sustaining and shifting their attention in and registering, organizing and using information.

Increase risk of motor vehicle/work accidents

For more detailed information log on to a paper in Support of the UN Drug Conventions: The Arguments Against Illicit Drug Legalisation and Harm Reduction also by David Evans.

Source: https://nationalallianceformarijuanaprevention.files.wordpress.com/2011/12/2009-un-drug-conventions-the-argument-against-legaliztion.pdf

Filed under: Brain and Behaviour,Cannabis/Marijuana,Drug use-various effects,Treatment and Addiction :

During the late 1970s, my colleague, Dr. Herb Kleber, and I introduced a novel neuroanatomical model to explain the pathophysiology of opioid withdrawal and put forth our contention that addiction was not simply a matter of avoiding withdrawal. Using what was then a novel new drug, clonidine, we were able to effectively detox heroin and methadone addicts in half the time, and without the surge of norepinephrine release from the locus coeruleus. This minimized the agitation and somatic anxiety that can be unbearable for some patients.

This helped prove our conviction that addictive disease was the result of numerous and largely unknown factors, and not simply to avoid withdrawal. In spite of effectively and humanely withdrawing addicts from opioids, we also discovered that something was clearly different and unique about their brain and behavior. After being clean and sober for 6-8 months in a safe and secure rehab environment, most addicts returned to using heroin as soon as the door was unlocked. This looked like Pavlovian principles on steroids. Although it was not due to avoidance of withdrawal symptoms, the answer remained unclear.

In some ways, we have travelled light years in furthering our understanding of the brain and addictive disease. Yet, relapse remains the norm and not the exception for opioid addicts. The development and use of naltrexone in the 1990s followed by buprenorphine has helped many addicts achieve a better quality of life. Yet, relapse remains the norm.

In a recent placebo-controlled clinical trial by Kowalczyk, et al, participants were given (0.3 mg/d) of clonidine or placebo during 18 weeks of Medication-Assisted Treatment (MAT) with buprenorphine, and documented their mood and activities via a pre-programmed smart phone.

Study participants receiving clonidine in addition to buprenorphine had increased abstinence from opioids and were able to decouple their stress from drug craving. Additionally, participants in the buprenorphine-plus-clonidine group, not only experienced longer periods of abstinence, but were also better in managing, or coping with their “unstructured” time. In other words, clonidine helped persons deal with their boredom and inability to create or engage in healthy activities, which is a strong predictor of relapse.

Why Does This Matter?

The study replicates previous research demonstrating that 1.) unstructured time, especially during early recovery is a trigger and predictor of relapse, 2.) engaging in responsible or helpful activities is associated with better outcomes among patients receiving Medication-Assisted Treatment, and 3.) clonidine helped participants engage in unstructured-time activities with less risk of craving or use than they might otherwise have experienced.

From a personalized-medicine perspective, these data are a good reminder that addiction is a multifaceted disease requiring a multimodal approach. It is not treatable with any singular intervention. At best, psychopharmacology is adjunctive. And remember before any MAT, many addicted persons enjoyed sustained recovery via 12-step programs.

Source: https://www.rivermendhealth.com/resources/clonidine-plus-mat-improves-treatment-outcomes/ November 2017

Filed under: Addiction,Brain and Behaviour,Treatment and Addiction :

The use of buprenorphine and other Medically-Assisted Treatments (MAT) for opioid use disorder has increased rapidly in response to the opioid epidemic in the United States. From the clinician’s perspective, buprenorphine seemed like a panacea. I remember feeling the same way about methadone in the 70s and Naltrexone in the 80s.

Buprenorphine’s unique chemistry, being a partial agonist and antagonist medication, meant patients were able to detox from heroin or powerfully addictive prescription pain medications using Suboxone (a trade name for buprenorphine) and then taper off with relative ease, compared to heroin or oxycodone. In some cases, patients were not able to come off of Suboxone and remained on a small maintenance dose for months, and even years, but had attained a quality of life they never believed was possible when addicted to illicit opioids.

However, a large study by the Johns Hopkins Bloomberg School of Public Health (2017) reports that a significant proportion of patients on Suboxone therapy, or shortly after the conclusion of their therapy, were attaining and filling prescriptions for other opioid medications. Outcome measures matter. Different treatments work if your outcome measure is one month of adherence to the treatment versus five years of drug-free outcome and return to work.

The methodology in the Johns Hopkins study reviewed pharmacy claims for over 38,000 persons who had been prescribed Suboxone between 2006 and 2013. The results were shocking. Two-thirds of these patients had filled a prescription for an opioid painkiller in the first 12 months following Suboxone treatment—while 43 percent had received a prescription for an opioid during Suboxone therapy. In addition, approximately two-thirds of the patients who received Suboxone therapy stopped filling prescriptions for it after just three months.

What These Data Cannot Tell Us

At first glance these data are disappointing. Just looking at patient return to the program over a short time like six months, it is very clear that most methadone patients come back and many Suboxone patients do not. However, there is much the study results don’t tell us.

In a clinical and policy environment where the number of prescribers, the volume and nature of opioid prescriptions, overdoses, prescribing policies, laws and regulations are changing frequently and dramatically, data loses some of their value. In Florida, for example, the legislature, in response to the “Pill Mills,” enacted a monitoring program whereby all prescribed scheduled medications were on a single database, accessible by any licensed physician.

Twelve months after implementation, the outcomes were evaluated. Overall opioid prescriptions decreased by 1.4%. Opioid volume decreased by 2.5%, and a decrease of 5.6% in MME per transaction was observed. These data were limited to prescribers and patients with the highest baseline opioid prescribing and usage. The findings also accounted for potential confounding variables including sensitivity analyses, varying time windows and dynamic enrolment criteria. The opioid landscape in Florida continues to improve, and the pill mills are virtually gone. This is just one example of how a state’s policies impact the data and the outcome in longitudinal research.

In addition, prescription drug monitoring programs (PDMPs) are associated with reductions in all drug use (including opioids). Data culled from adult Medicare beneficiaries in states that utilize PDMPs compared with states that do not have PDMPs show significant reductions in prescription opioid transactions. Moreover, the top treatment centers may prescribe buprenorphine but also set up voluntary drug monitoring and continuing care programs for their patients, much as the programs do for impaired physicians, nurses and pilots who mandate random and for-cause drug testing for five years.

Most heroin addicts have multiple drug dependencies and problems. They also have multiple medical co-morbidities. It is not as simple as switching the patient’s heroin for buprenorphine. But street heroin is more than a drug, it is many drugs and dangerous adulterants. Over 80 percent of the Physician Health Program participants are treated effectively, monitored and never had a positive drug test throughout the five years of post-treatment outpatient monitoring.

Lastly, the Institute of Medicine released their exhaustive report on Pain in America, revealing that 100 million Americans currently suffer from chronic or intractable pain syndromes. The Johns Hopkins study does not indicate what percent of the study participants have a pain syndrome, requiring treatment with opioid medication, hopefully under the supervision of a specialist in pain managements and addiction medicine.

Why Does This Matter?

The findings certainly raise questions about the effectiveness and the appropriateness of Suboxone for addiction treatment. Clearly, if we were to adopt an oncology standard of five years, Suboxone is not likely to be considered an effective treatment. But it is a viable and important option and part of an arsenal of treatment modalities used to individualize treatment for our patients.

The study researchers noted, and I agree, that the continued use of pain medication during and after addiction treatment indicates that too many patients did not receive a multimodal, integrated treatment plan for their addiction or concurrent chronic pain or co-occurring mental illness, which approximately 50-65% of those with Substance Use Disorder (SUD) have.

Dr. Alexander, the lead author of the study noted: “There are high rates of chronic pain among patients receiving opioid agonist therapy, and thus concomitant use of buprenorphine and other opioids may be justified clinically. This is especially true as the absence of pain management among patients with opioid use disorders may result in problematic behaviors such as illicit drug use and misuse of other prescription medications.”

Addicts are quick to discover the probabilities of attaining a “high” from just about any drug they come across. Buprenorphine, while not commonly abused or sold on the streets, can be used to get high or to ease the pangs of withdrawal when heroin and other opioids are scarce.

The efficacy of treatment for SUD, regardless of the drug, is largely dependent upon non-medical factors. Yes, monitoring is important, but only if the potential for losing something one values is at stake. Surrendering, which cannot be described in medical or psychological language, is the single most important factor in determining recovery. Adjunctive treatments such as Suboxone, Methadone, N.A., A.A., CBT, yoga, meditation, diet and exercise can help a highly motivated individual. When treatment is

individualized and a bond of trust is established between a counselor and patient, good and even improbable things happen, and lives are restored.

MATs are not a replacement for the traditional foundations of treatment and recovery. At best, they can provide a specific need for a specific patient. They are not for everyone. When people ask me what the elements of success are in treatment, I often start with long-term. If a person has been abusing and addicted for years, it is difficult to imagine treatment in weeks. But, as a shortcut to what works, I tell them the 3 M’s: treatment that is high-dose, intense multimodal, multidisciplinary and multifaceted, staffed by dedicated professionals who are experienced and really do care about the patients.

Suboxone and the similar medications that will be developed are inherently not good or bad and certainly don’t work for every opioid addict. But I am thankful we have them. I believe they have saved thousands of lives. The real trick of successful treatment is to know your patients and collaborate with him or her in developing a plan that gives them the best shot at recovery.

Source: https://www.rivermendhealth.com/resources/buprenorphine-saves-lives-but-its-far-from-a-panacea/? Author: Mark Gold, MD

Filed under: Addiction,Heroin/Methadone,Treatment and Addiction :

Pain and pleasure rank among nature’s strongest motivators, but when mixed, the two can become irresistible. This is how opioids brew a potent and deadly addiction in the brain. Societies have coveted the euphoria and pain relief provided by opioids since Ancient Sumerians referred to opium poppies as the “joy plant” circa 3400 B.C. But the repercussions of using the drugs were ever present, too. For centuries, Chinese patients swallowed opium cocktails before major surgeries, but by 1500, they described the recreational use of opium pipes as subversive. The Chinese emperor Yung Cheng eventually restricted the use of opium for medical purposes in 1729. Less than 100 years later, a German chemist purified morphine from poppies, creating the go-to pain reliever for anxiety and respiratory conditions. But the Civil War and its many wounds spawned mass addiction to the drugs, a syndrome dubbed Soldier’s Disease. A cough syrup was concocted in the late 1800s — called heroin — to remedy these morphine addictions. Doctors thought the syrup would be “non-addictive.” Instead, it turned into a low-cost habit that spread internationally. More than 70 percent of the world’s opium — 3,410 tons — goes to heroin production, a number that has more than doubled since 1985. Approximately 17 million people around the globe used heroin, opium or morphine in 2016.

Today, prescription and synthetic opioids crowd America’s medicine cabinets and streets, driving a modern crisis that may kill half a million people over the next decade. Opioids claimed 53,000 lives in the U.S. last year, according to preliminary estimates from the Centers for Disease Control and Prevention — more than those killed in motor vehicle accidents.

How did we arrive here? Here’s a look at why our brains get hooked on opioids.

The pain divide

Let’s start with the two types of pain. They go by different names depending on which scientist you ask. Peripheral versus central pain. Nociceptive versus neuropathic pain.

The distinction is the sensation of actual damage to your body versus your mind’s perception of this injury.

Your body quiets your pain nerves through the production of natural opioids called endorphins.

Stuff that damages your skin and muscles — pin pricks and stove burns — is considered peripheral/nociceptive pain.

Pain fibers sense these injuries and pass the signal onto nerve cells — or neurons — in your spine and brain, the duo that makes up your central nervous system.

In a normal situation, your pain fibers work in concert with your central nervous system. Someone punches you, and your brain thinks “ow” and tells your body how to react.

Stress-relieving hormones get released. Your immune system counteracts the inflammation in your wounded arm.

Your body quiets your pain nerves through the production of natural opioids called endorphins. The trouble is when these pain pathways become overloaded or uncoupled.

One receptor to rule them all

Say you have chronic back pain. Your muscles are inflamed, constantly beaming pain signals to your brain. Your natural endorphins aren’t enough and your back won’t let up, so your doctor prescribes an opioid painkiller like oxycodone.

Prescription opioids and natural endorphins both land on tiny docking stations — called receptors — at the ends of your nerves. Most receptors catch chemical messengers — called neurotransmitters — to activate your nerve cells, triggering electric pulses that carry the signal forward.

But opioid receptors do the opposite. They stop electric pulses from traveling through your nerve cells in the first place. To do this, opioids bind to three major receptors, called Mu, Kappa and Delta. But the Mu receptor is the one that really sets everything in motion.

The Mu-opiate receptor is responsible for the major effects of all opiates, whether it’s heroin, prescription pills like oxycodone or synthetic opioids like fentanyl, said Chris Evans, director of Brain Research Institute at UCLA. “The depression, the analgesia [pain numbing], the constipation and the euphoria — if you take away the Mu-opioid receptor, and you give morphine, then you don’t have any of those effects,” Evans said.

Opioids receptors trigger such widespread effects because they govern more than just pain pathways. When opioid drugs infiltrate a part of the brain stem called the locus ceruleus, their receptors slow respiration, cause constipation, lower blood pressure and decrease alertness. Addiction begins in the midbrain, where opioids receptors switch off a batch of nerve cells called GABAergic neurons.

GABAergic neurons are themselves an off-switch for the brain’s euphoria and pleasure networks.

When it comes to addiction, opioids are an off-switch for an off-switch. Opioids hold back GABAergic neurons in the midbrain, which in turn keep another neurotransmitter called dopamine from flooding a brain’s pleasure circuits. Image by Adam Sarraf

Once opioids shut off GABAergic neurons, the pleasure circuits fill with another neurotransmitter called dopamine. At one stop on this pleasure highway — the nucleus accumbens — dopamine triggers a surge of happiness. When the dopamine rolls into amygdala, the brain’s fear center, it relieves anxiety and stress. Both of these events reinforce the idea that opioids are rewarding.

These areas of the brain are constantly communicating with decision-making hubs in the prefrontal cortex, which make value judgments about good and bad. When it hears “This pill feels good. Let’s do more,” the mind begins to develop habits and cravings.

Taking the drug soon becomes second nature or habitual, Evans said, much like when your mind zones out while driving home from work. The decision to seek out the drugs, rather than participate in other life activities, becomes automatic.

The opioid pendulum: When feeling good starts to feel bad

Opioid addiction becomes entrenched after a person’s neurons adapt to the drugs. The GABAergic neurons and other nerves in the brain still want to send messages, so they begin to adjust. They produce three to four times more cyclic AMP, a compound that primes the neuron to fire electric pulses, said Thomas Kosten, director of the division of alcohol and addiction psychiatry at the Baylor College of Medicine.

That means even when you take away the opioids, Kosten says, “the neurons fire extensively.”

The pendulum swings back. Now, rather than causing constipation and slowing respiration, the brain stem triggers diarrhoea and elevates blood pressure. Instead of triggering happiness, the nucleus accumbens and amygdala reinforce feelings of dysphoria and anxiety. All of this negativity feeds into the prefrontal cortex, further pushing a desire for opioids.

While other drugs like cocaine and alcohol can also feed addiction through the brain’s pleasure circuits, it is the surge of withdrawal from opioids that makes the drugs so inescapable.

Could opioid addiction be driven in part by people’s moods?

Cathy Cahill, a pain and addiction researcher at UCLA, said these big swings in emotions likely factor into the learned behaviors of opioid addiction, especially with those with chronic pain. A person with opioid use disorder becomes preoccupied with the search for the drugs. Certain contexts become triggers for their cravings, and those triggers start overlapping in their minds.

“The basic view is some people start with the pain trigger [the chronic back problem], but it gets partially substituted with the negative reinforcement of the opioid withdrawal,” Cahill said.

That’s why Cahill, Evans and other scientists think the opioid addiction epidemic might be driven, in part, by our moods.

Chronic pain patients have a very high risk of becoming addicted to opioids if they are also coping with a mood disorder. A 2017 study found most patients — 81 percent — whose addiction started with a chronic pain problem also had a mental health disorder. Another study found patients on morphine experience 40 percent less pain relief from the drug if they have mood disorder. They need more drugs to get the same benefits.

People with mood disorders alone are also more likely to abuse opioids. A 2012 survey found patients with depression were twice as likely to misuse their opioid medications.

“So, not only does a mood disorder affect a person’s addiction potential, but it also influences if the opioids will successfully treat their pain,” Cahill said.

Meanwhile, the country is living through sad times. Some research suggests social isolation is on the rise. While the opioid epidemic started long before the recession, job loss has been linked to a higher likelihood of addiction, with every 1 percent increase in unemployment linked to a 3.6 percent rise in the opioid-death rate.

Can the brain swing back?

As an opioid disorder progresses, a person needs a higher quantity of the drugs to keep withdrawal at bay. A person typically overdoses when they take so much of the drug that the brain stem slows breathing until it stops, Kosten said.

Many physicians have turned to opioid replacement therapy, a technique that swaps highly potent and addictive drugs like heroin with compounds like methadone or buprenorphine (an ingredient in Suboxone).

These substitutes outcompete heroin when they reach the opioid receptors, but do not activate the receptors to the same degree. By doing so, they reduce a person’s chances for overdosing. These replacement medications also stick to the receptors for a longer period of time, which curtails withdrawal symptoms. Buprenorphine, for instance, binds to a receptor for 80 minutes while morphine only hangs on for a few milliseconds.

For some, this solution is not perfect. The patients need to remain on the replacements for the foreseeable future, and some recovery communities are divided over whether treating opioids with more opioids can solve the crisis. Plus, opioid replacement therapy does not work for fentanyl, the synthetic opioid that now kills more Americans than heroin. Kosten’s lab is one of many working on a opioid vaccine that would direct a person’s immune system to clear drugs like fentanyl before they can enter the brain. But those are years away from use in humans.

And Evans and Cahill said many clinics in Southern California are combining psychological therapy with opioid replacement prescriptions to combat the mood aspects of the epidemic.

“I don’t think there’s going to be a magic bullet on this one,” Evans said. “It’s really an issue of looking after society and looking after of people’s psyches rather than just treatment.

Source: http://www.pbs.org/newshour/updates/brain-gets-hooked-opioids/

Filed under: Addiction,Brain and Behaviour,Heroin/Methadone,Treatment and Addiction :

St. Petersburg, FL – Thursday, August 31, 2017 – Drug Free America Foundation today introduced a first-of-its-kind Opioid Tool Kit in an effort to help address the opioid epidemic gripping the United States.

The Opioid Tool Kit was unveiled in conjunction with International Overdose Awareness Day, a global event held on August 31st each year that aims to raise the awareness of the problem of drug overdose-related deaths.

“With more than 142 people dying each day, drug overdoses are now the leading cause of death for Americans under the age of 50,” according to Calvina Fay, Executive Director of Drug Free America Foundation. “Moreover, deaths from drug overdose are an equal opportunity killer, with no regard to race, religion or economic class,” she said.

“While alcohol and marijuana still remain the most common drugs of abuse, the nonmedical use of prescription painkillers and other opioids has resulted in a crisis-level spike in drug overdose deaths,” said Fay.

The Opioid Tool Kit has been designed to educate people about the opioid epidemic and offer strategies that can be used to address this crisis. “The Tool Kit is also intended to encourage collaboration with different community sectors and stakeholders to make successful and lasting change,” Fay continued.

The Opioid Tool Kit is a comprehensive guide that defines what an opioid is, examines the scope of the problem, and addresses why opioids are a continuing health problem.  The Tool Kit also provides strategies for the prevention of prescription drug misuse and overdose deaths and includes a community advocacy and action plan, as well as additional resources.

Fay emphasized that the best way to prevent opioid and other drug addiction is not to abuse drugs in the first place.  “The chilling reality is that the long-term use and abuse of opioids and other addictive drugs rewire the brain, making recovery a difficult and often a life-long struggle,” she concluded. The Opioid Tool Kit can be found on Drug Free America Foundation’s website at https://dfaf.org/Opioid%20Toolkit.pdf.

Source:   https://dfaf.org/Opioid%20Toolkit.pdf..  August 2017

Filed under: Addiction,Health,Heroin/Methadone,Treatment and Addiction,USA :

In his last article for Pro Talk, Renaming and Rethinking Drug Treatment, psychologist Robert Schwebel, Ph.D., author and developer of The Seven Challenges program, expressed his views about problems in typical drug and alcohol treatment. In this interview, he focuses on changes that he thinks would better meet the needs of individuals with substance problems.

The Seven Challenges Program

The Seven Challenges is described as “a comprehensive counselling program for teens and young adults that incorporates work on alcohol and other drug problems.” The program addresses much more than substance issues because it also helps young people develop better life skills, as well as manage their situational and psychological problems. Although there is an established structure for each session and a framework for decision-making (see website for the youth version of “The Seven Challenges”), it is not pre-scripted as in many traditional programs. Rather it is “exceptionally flexible, in response to the immediate needs of the clients.”

Independent studies funded by The Center for Substance Abuse Treatment and published in peer-reviewed journals have provided evidence that The Seven Challenges significantly decreases substance use of adolescents and greatly improves their overall mental health status. The program has been shown to be especially effective for the many young people with drug problems who also have trauma issues.

Just recently, a new version of The Seven Challenges program was introduced for adults and is being piloted in a research project. Soon, a book geared toward the general public by Dr. Schwebel that incorporates much of the philosophy of the program, as well as many of the decision-making and behavior change strategies, will be available.

Q&A: What Should Treatment Look Like?

Q: In your last article for Pro Talk, you argued strongly against the word “treatment” and suggested that we use the word “counselling” instead. Will you reiterate why you prefer using “counselling” when talking about professional help for people with substance problems?

Dr. S.: Counselling is an active and interactive process that’s responsive to the needs of individuals. It may include education, but it’s more than that because the information is personalized and offered in the context of a discussion about what’s happening in a person’s life. Effective counsellors help clients become aware of their options, expand those options, and make their own informed choices.

Treatment, on the other hand, sounds like something imposed and passive that an authority (say a doctor) does to someone else or tells them to do. It also implies recipients receive a standardized protocol or regime with a preconceived goal, usually abstinence when we’re talking about addiction. It doesn’t suggest autonomy of choice or collaboration.

 

Q: You stress the importance of choice and collaboration, suggesting both are important in addiction counselling. Please tell us more.

Dr. S.: In collaborative counselling that allows choices, clients get to identify the issues they want to work on. They make the decisions. We make it clear that we’re not there to make them quit using drugs…and couldn’t even if we tried. We tell them, “We’re here to support you in working on your issues, things that are important to you; things that are not going well in your life or as well you would like them to be going.”

We also support clients in decision-making about drugs. They set their own goals about using. One person might want to quit using, while another might want to set new limits. For those who want to change their drug use behavior, we check in with them about how they’re doing regarding their decision on a session-by-session basis. If they have setbacks, we’ll provide individualized support to help them figure out why, We’re not doubting them or trying to “catch” them. Rather, we’re helping them succeed with their own decisions to change. This type of check-in would not apply to individuals who have not yet decided to make changes.

 

Q: Many addiction programs feel that dealing with addiction should be the first priority and that other issues are secondary. What are your thoughts about this?

Dr. S.: I’ll start by saying that they have equal importance. Drug problems have everything to do with what is going on in a person’s life. And, a person’s life is very much affected by drug problems. I do want to say, however, that not everyone who winds up in an addiction program has an addiction. That’s a ridiculous generalization. They may be having problems with binge drinking, issues with family or jobs because of substance misuse, or legal problems because they were unlucky and got caught. (For instance they got arrested for another crime and tested positive for drugs.) They often wind up in places that require abstinence and wonder, “What am I doing here?” Then they’re told they’re “in denial.”

Traditional treatment tends to focus narrowly on drug problems, usually pushing an agenda of immediate abstinence. However, drug problems – whether or not they qualify as “addiction,” are very much connected to the rest of life. Therefore, clients need comprehensive counselling that addresses what’s happening in their overall lives and helps clients make their lives better. So it’s not all about use of substances and making the individual quit. The goal is to support clients and to help them make their own decisions about life and substance use.

We use the term “issues” – not “problems.” Whatever is most important to the individual that day is what we work on. A client might say, “I have an issue with my mother.” We don’t just want to have a discussion about the issue; we want to set a session goal so that a client gets practical help with an issue each time. Ideally we try to facilitate a next step, some sort of action that can be taken between sessions. We want to support our clients in making their own lives better. We like to reassure clients that we won’t be harping on drugs all the time: At least half of what we do is about everything else besides drugs. This means that counsellors need to know how to help people with their other problems. Unfortunately, many have a narrow background in drug treatment and don’t yet know how to do that.

 

Q: How do you address the issue of “powerlessness” which a number of young people have told me they struggled with in12-step treatment programs they’ve attended? Don’t adolescents by nature resist anything that threatens to take away their autonomy?

Dr. S.: One of our main messages is “You are powerful; people do take control over their drug use. You have that power within you.” We also say, “You don’t need to do it alone. You are entitled to support. We’re behind you. We’re not saying it’s easy and

there won’t be setbacks along the way. If there are, we’ll help you figure out why and how to handle it differently the next time. At the same time we’ll help you with other issues in your life so you’ll have less need for drugs.”

I think there is great harm in the all-or-nothing approach to drug and alcohol problems and that more people would come for help if they were not told that they’re powerless. Also, many more would come if they felt they could make a choice about drugs and did not expect to be coerced.

 

A New Version of The Seven Challenges

Following is the new adult version of Dr. Schwebel’s The Seven Challenges program:

· Challenging Yourself to Make Thoughtful Decisions About Your Life, Including Your Use of Alcohol and Other Drugs

· Challenging Yourself to Look at Your Responsibility and the Responsibility of Others for Your Problems

· Challenging Yourself to Look at What You Like About Alcohol and Other Drugs, and Why You Use Them

· Challenging Yourself to Honestly Look at Your Life, Including Your Use of Alcohol and Other Drugs

· Challenging Yourself to Look at Harm That Has Happened or Could Happen From Your Use of Alcohol and Other Drugs

· Challenging Yourself to Look at Where You Are Headed, Where You Would Like to Go, and What You Would Like to Accomplish

· Challenging Yourself to Take Action and Succeed With Your Decisions About Your Life and Use of Alcohol and Other Drugs

Source:  http://www.rehabs.com/pro-talk-articles/what-drug-and-alcohol-treatment-should-look-like-an-interview-with-dr-robert-schwebel/     17th July 2017

Filed under: Addiction,Addiction (Papers),Health,Treatment and Addiction,Youth :

Medication-assisted treatment is often called the gold standard of addiction care. But much of the country has resisted it.

If you ask Jordan Hansen why he changed his mind on medication-assisted treatment for opioid addiction, this is the bottom line.

Several years ago, Hansen was against the form of treatment. If you asked him back then what he thought about it, he would have told you that it’s ineffective — and even harmful — for drug users. Like other critics, to Hansen, medication-assisted treatment was nothing more than substituting one drug (say, heroin) with another (methadone).

Today, not only does Hansen think this form of treatment is effective, but he readily argues — as the scientific evidence overwhelmingly shows — that it’s the best form of treatment for opioid addiction. He believes this so strongly, in fact, that he now often leads training sessions for medication-assisted treatment across the country.

“It almost hurts to say it out loud now, but it’s the truth,” Hansen told me, describing his previous beliefs. “I was kind of absorbing the collective fear and ignorance from the culture at large within the recovery community.” Hansen is far from alone. Over the past few years, America’s harrowing opioid epidemic — now the deadliest drug overdose crisis in the country’s history — has led to a lot of rethinking about how to deal with addiction. For addiction treatment providers, that’s led to new debates about the merits of the abstinence-only model — many of which essentially consider addiction a failure of willpower — so long supported in the US.

The case for prescription heroin

The Hazelden Betty Ford Foundation, which Hansen works for, exemplifies the debate. As one of the top drug treatment providers in the country, it used to subscribe almost exclusively to the abstinence-only model, based on an interpretation of the 12 steps of Alcoholics Anonymous and Narcotics Anonymous popularized in American addiction treatment in the past several decades. But in 2012, Hazelden announced a big switch: It would provide medication-assisted treatment.

“This is a huge shift for our culture and organization,” Marvin Seppala, chief medical officer of Hazelden, said at the time. “We believe it’s the responsible thing to do.”

From the outside, this might seem like a bizarre debate: Okay, so addiction treatment providers are supporting a form of treatment that has a lot of evidence behind it. So what?

But the growing embrace of medication-assisted treatment is demonstrative of how the opioid epidemic is forcing the country to take another look at its inadequate drug treatment system. With so many people dying from drug overdoses — tens of thousands a year — and hundreds of thousands more expected to die in the next decade, America is finally considering how its response to addiction can be better rooted in science instead of the moralistic stigmatization that’s existed for so long.

The problem is that the moralistic stigmatization is still fairly entrenched in how the US thinks about addiction. But the embrace of medication-assisted treatment shows that may be finally changing — and America may be finally looking at addiction as a medical condition instead of a moral failure.

The research is clear: Medication-assisted treatment works

One of the reasons opioid addiction is so powerful is that users feel like they must keep using the drugs in order to stave off withdrawal. Once a person’s body grows used to opioids but doesn’t get enough of the drugs to satisfy what it’s used to, withdrawal can pop up, causing, among other symptoms, severe nausea and full-body aches. So to avoid suffering through it, drug users often seek out drugs like heroin and opioid painkillers — not necessarily to get a euphoric high, but to feel normal and avoid withdrawal. (In the heroin world, this is often referred to as “getting straight.”)

Medications like methadone and buprenorphine (also known as Suboxone) can stop this cycle. Since they are opioids themselves, they can fulfil a person’s cravings and stop withdrawal symptoms. The key is that they do this in a safe medical setting, and when taken as prescribed do not produce the euphoric high that opioids do when they are misused. By doing this, an opioid user significantly reduces the risk of relapse, since he doesn’t have to worry about avoiding withdrawal anymore. Users can take this for the rest of their lives, or in some cases, doses may be reduced; it varies from patient to patient.

The research backs this up: Various studies, including systemic reviews of the research, have found that medication-assisted treatment can cut the all-cause mortality rate among addiction patients by half or more. Just imagine if a medication came out for any other disease — and, yes, health experts consider addiction a disease — that cuts mortality by half; it would be a momentous discovery.

“That is shown repeatedly,” Maia Szalavitz, a long time addiction journalist and author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, told me. “There’s so much data from so many different places that if you add methadone or Suboxone in, deaths go down, and if you take it away, deaths go up.” That’s why the biggest public health organizations — including the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, and the World Health Organization — all acknowledge medication-assisted treatment’s medical value. And experts often describe it to me as “the gold standard” for opioid addiction care.

The data is what drove Hansen’s change in perspective. “If I wanted to view myself as an ethical practitioner and doing the best that I could for the people I served, I needed to make this change based on the overwhelming evidence,” he said. “And I needed to separate that from my personal recovery experience.”

Medication-assisted treatment is different from traditional forms of dealing with addiction in America, which tend to demand abstinence. The standards in this field are 12-step programs, which combine spiritual and moralistic ideals into a support group for people suffering from addiction. While some 12-step programs allow medication-assisted treatment, others prohibit it as part of their demand for total abstinence. The research shows this is a particularly bad idea for opioids, for which medications are considered the standard of care.

There are different kinds of medications for opioids, which will work better or worse depending on a patient’s circumstances. Methadone, for example, is only administered in a clinic, typically one to four times a day — but that means patients will have to make the trip to a clinic on a fairly regular basis. Buprenorphine is a take-home drug that’s taken once or twice a day, but the at-home access also means it might be easier to misuse and divert to the black market.

One rising medication, known as naltrexone or its brand name Vivitrol, isn’t an opioid — making it less prone to misuse — and only needs to be injected once a month. But it doesn’t work in the same way as methadone or buprenorphine. It requires full detoxification to use (usually three to 10 days of no opioid use), while buprenorphine, for example, only requires a partial detoxification process (usually 12 hours to two days). And instead of preventing withdrawal — indeed, the detox process requires going through withdrawal — it blocks the effects of opioids up to certain doses, making it much harder to get high or overdose on the drugs. It’s also relatively new, so there’s less evidence for its real-world effectiveness.

One catch is that even these medications, though the best forms of opioid treatment, do not work for as much as 40 percent of opioid users. Some patients may prefer not to take any medications because they see any drug use whatsoever as getting in the way of their recovery, in which case total abstinence may be the right answer for them. Others may not respond well physically to the medications, or the medications may for whatever reason fail to keep them from misusing drugs.

This isn’t atypical in medicine. What works for some people, even the majority, isn’t always going to work for everyone. So these are really first-line treatments, but in some cases patients may need alternative therapies if medication-assisted treatment doesn’t work. (That might even involve prescription heroin — which, while it’s perhaps counterintuitive, the research shows it works to mitigate the problems of addiction when provided in tightly controlled, supervised medical settings.)

Medication can also be paired with other kinds of treatment to better results. It can be used in tandem with cognitive behavioral therapy or similar approaches, which teach drug users how to deal with problems or settings that can lead to relapse. All of that can also be paired with 12-step programs like AA and NA or other support groups in which people work together and hold each other accountable in the fight against addiction. It all varies from patient to patient.

It is substituting one drug for another, but that’s okay

The main criticism of medication-assisted treatment is that it’s merely replacing one drug with another. Health and Human Services Secretary Tom Price recently echoed this criticism, saying, “If we’re just substituting one opioid for another, we’re not moving the dial much. Folks need to be cured so they can be productive members of society and realize their dreams.” (A spokesperson for Price later walked back the statement, saying Price supports all kinds of drug treatment.)

On its face, this argument is true. Medication-assisted treatment is replacing one drug, whether it’s opioid painkillers or heroin, with another, such as methadone or buprenorphine.

But this isn’t by itself a bad thing. Under the Diagnostic and Statistical Manual of Mental Disorders, it’s not enough for someone to be using or even physically dependent on drugs to qualify for a substance use disorder, the technical name for addiction. After all, most US adults use drugs — some every day or multiple times a day — without any problems whatsoever. Just think about that next time you sip a beer, glass of wine, coffee, tea, or any other beverage with alcohol or caffeine in it, or any time you use a drug to treat a medical condition.

The qualification for a substance use disorder is that someone is using drugs in a dangerous or risky manner, putting himself or others in danger. So someone with a substance use disorder would not just be using opioids but potentially using these drugs in a way that puts him in danger — perhaps by feeling the need to commit crimes to obtain the drugs or using the drugs so much that he puts himself at risk of overdose and inhibits his day-to-day functioning. Basically, the drug use has to hinder someone from being a healthy, functioning member of society to qualify as addiction.

The key with medication-assisted treatment is that while it does involve continued drug use, it turns that drug use into a much safer habit. So instead of stealing to get heroin or using painkillers so much that he puts his life at risk, a patient on medication-assisted treatment can simply use methadone or buprenorphine to meet his physical cravings and otherwise go about his day — going to school, work, or any other obligations.

Yet this myth of the dangers of medication-assisted treatment remains prevalent — to deadly results.

In 2013, Judge Frank Gulotta Jr. in New York ordered an opioid user arrested for drugs, Robert Lepolszki, off methadone treatment, which he began after his arrest. In January 2014, Lepolszki died of a drug overdose at 28 years old — a direct result, Lepolszki’s parents say, of failing to get the medicine he needed. In his defense,  Gulotta has continued to argue that methadone programs “are crutches — they are substitutes for drugs and drug cravings without enabling the participant to actually rid him or herself of the addiction.”

This is just one case, but it shows the real risk of denying opioid users medication: It can literally get them killed by depriving them of lifesaving medical care.

The myth is also a big reason why there are still restrictions on medication-assisted treatment. For example, the federal government still caps how many patients doctors can prescribe buprenorphine to, with strict rules about raising the cap. This limits how accessible the treatment is. A Huff Post analysis found that even if every doctor who can prescribe buprenorphine did so at the maximum rate in 2012, more than half of Americans with opioid use disorders could not get the medication. That’s on top of barriers to addiction treatment in general. According to a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment. The report attributed the low rate to severe shortages in the supply of care, with some areas of the country, particularly rural counties, lacking affordable options for treatment — which can lead to waiting periods of weeks or even months. Only recently has there been a broader push to fix this gap in care.

The medications used in treatment do carry some risks

None of this is to say that the medications used in these treatments are without any problems whatsoever. Methadone is tied to thousands of deadly overdoses a year, although almost entirely when it’s used for pain, not addiction, treatment — since it’s much more regulated in addiction care. Buprenorphine is safer in that, unlike common painkillers, heroin, and methadone, its effect has a ceiling — meaning it has no significant effect after a certain dose level. But it’s still possible to misuse, particularly for people with lower tolerance levels. And there are some reports of buprenorphine mills, where patients can get buprenorphine for misuse from unscrupulous doctors — similar to how pill mills popped up during the beginning of the opioid epidemic and provided patients easy access to painkillers.

Naltrexone, meanwhile, can heighten the risk of overdose and death in case of full relapse. Overdose and death are risks in any case of relapse, but they’re particularly acute for naltrexone because it requires a full detox process that eliminates prior tolerance. (Although this would typically require someone to stop taking naltrexone, since otherwise it blocks the effects of opioids up to certain doses.)

But when taken as prescribed, the medications are broadly safe and effective for addiction treatment. For regulators, it’s a matter of making sure the drugs aren’t diverted into misuse, while also providing good access to people who genuinely need them.

The fight over medication-assisted treatment is really about how we see addiction

Behind the arguments about medication-assisted treatment is a simple reality of how Americans view addiction: Many still don’t see it, as public health officials and experts do, as a disease.

With other diseases, there is no question that medication can be a legitimate answer. That medication is not viewed as a proper answer by many to addiction shows that people believe addiction is unique in some way — particularly, they view addiction as at least partly a moral failing instead of just a disease.

I get emails all the time to this effect. Here, for example, is a fairly representative reader message: “Darwin’s Theory says ‘survival of the fittest.’ Let these lost souls pay the price of their criminal choices and criminal actions. Society does not owe them multiple medical resuscitations from their own bad judgment, criminal activity, and self-inflicted wounds.”

This contradicts what addiction experts broadly agree on. As Stanford psychiatrist and Drug Dealer, MD author Anna Lembke put it, “If you see somebody who continues to use despite their lives being totally destroyed — losing their jobs, losing loved ones, ending up in jail — nobody would choose that. Nobody anywhere would ever choose that life. So clearly it is beyond this individual’s control on some level.”

Many Americans may understand this with, say, depression and anxiety. We know that people with these types of mental health problems are not in full control of their thoughts and emotions. But many don’t realize that addiction functions in a similar way — only that the thoughts and emotions drive someone to seek out drugs at just about any cost.

Some of the sentiment against medications, as Hansen can testify, is propagated by people suffering from addiction. Some of them believe that any drug use, even to treat addiction, goes against the goal of full sobriety. They may believe that if they got sober without medications, perhaps others should too. Many of them also don’t trust the health care system: If they got addicted to drugs because a doctor prescribed them opioid painkillers, they have a good reason to distrust doctors who are now trying to get them to take another medication — this time for their addiction.

The opioid epidemic, however, has gotten a lot of people in the addiction recovery world to reconsider their past beliefs. Funeral after funeral and awful statistic after awful statistic, there is a sense that there has to be a better way — and by looking at the evidence, many have come to support medication-assisted treatment.

“I remember sitting there,” Hansen said, speaking to his experience at a funeral, as a mother sang her dead son a lullaby, “thinking that we have to do better.”

Source:  German Lopez@germanrlopezgerman.lopez@vox.com  Jul 20, 2017

 

Filed under: Addiction,Addiction (Papers),Heroin/Methadone,Treatment and Addiction :

Residential treatment has received a lot of criticism and scepticism over the last several years, especially for opioid use disorders. (Some of it is deserved. Too many providers are hustlers and others provide little more than detox with inadequate follow-up. Of course, many of the same criticisms have been directed at medication-assisted treatment. But, that’s not what this post is about.)

At any rate, the Recovery Research Institute recently posted about a study looking at completion rates for outpatient and residential treatment.   The study looked at A LOT of treatment admissions, 318,924.  Residential completion rates appear to have surprised a lot of people:

Results: Residential programs reported a 65% completion rate compared to 52% for outpatient settings. After controlling for other confounding factors, clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment.

But, what really surprised some readers was this:

Compared to clients with a primary alcohol use disorder:
Clients with marijuana use disorder were only 74% as likely to complete residential treatment.
Clients with an opioid use disorder were 1.29x MORE likely to complete residential treatment.

So opioid users were much more likely to benefit from residential treatment compared to alcohol users. . . .

We speculate that for opioid abusers, the increased structure and cloistering of residential treatment provide some protection from the environmental and social triggers for relapse or that otherwise lead to the termination of treatment that outpatient treatment settings do not afford. Indeed, environmental risk characteristics in drug abusers’ residential neighbourhoods, such as the presence of liquor stores and indicators of concentrated disadvantage at the neighbourhood level, have been found to be associated with treatment non-continuity and relapse.

Such environmental triggers may play a particularly substantial role for those addicted to opioids compared to those seeking treatment for marijuana abuse. Since opioid users have the lowest raw completion rates in general, this finding that residential treatment makes a greater positive difference for opioid users than it does for any of the other substances represents an important result that merits further investigation. Given the current epidemic of opioid-related overdoses in the U.S., our results suggest that greater use of residential treatment should be explored for opioid users in particular.

For the differences between residential and outpatient, they say the following:

In general, residential treatment completion rates are usually higher compared to outpatient settings, but what is particularly noteworthy is that even after controlling for various client characteristics and state level variations, the likelihood of treatment completion for residential programs was still nearly three times as great as for outpatient settings. Given the more highly structured nature and intensity of services of residential programs compared to outpatient treatment, it is understandable that residential treatment completion rates would be higher. It requires far less effort to end treatment prematurely in outpatient settings com-pared to residential treatment.

Given the strong association between treatment completion and positive post-treatment outcomes such as long term abstinence, the large magnitude of difference between outpatient and residential treatment represents a potentially important consideration for the choice of treatment setting for clients.

Source:  https://addictionandrecoverynews.wordpress.com/2017/07/13/opioid-users-complete-residential-at-higher-rates

Filed under: Addiction,Alcohol,Health,Heroin/Methadone,Treatment and Addiction :

“I wish that all families would at least consider investigating medication-assisted treatment and reading about what’s out there,” says Alicia Murray, DO, Board Certified Addiction Psychiatrist. “I think, unfortunately, there is still stigma about medications. But what we want people to see is that we’re actually changing the functioning of the patient.” Essentially, medication-assisted treatment (MAT) can help get a patient back on track to meeting the demands of life – getting into a healthy routine, showing up for work and being the sibling, spouse or parent that they once were. “If we can change that with medication-assisted treatment and with counselling,” says Murray, “that’s so valuable.” The opioid epidemic is terrifying, especially so for a parent of someone already struggling with prescription pills or heroin use. It’s so important to consider any and all options for helping your child recover from their opioid dependence.

Part of the reason it’s so hard to overcome an opioid addiction is because it rewires your brain to focus almost exclusively on the drug over anything else, and produces extreme cravings and withdrawal symptoms as a result. By helping to reduce those feelings of cravings and withdrawal, medication-assisted treatment can help your son or daughter’s brain stop thinking constantly about the drug and focus on returning to a healthier life.

Medication-assisted treatment is often misunderstood. Many traditional treatment programs and step-based supports may tell you that MAT is simply substituting one addictive drug for another. However, taking medication for opioid addiction is like taking medication for any other chronic disease, such as diabetes or asthma. When it is used according to the doctor’s instructions and in conjunction with therapy, the medication will not create a new addiction, and can help.

As a parent, you want to explore all opportunities to get your child help for his or her opioid addiction, and get them closer and closer to functioning as a healthy adult – holding down a job, keeping a regular schedule and tapering, and eventually, stopping their misuse of opioids. Medication-assisted treatment helps them do that.

“MAT medications are most effective when they are used in conjunction with therapy and recovery work. We would never recommend medication over other forms of treatment. We would recommend it in addition to it.”

The three most-common medications used to treat opioid addiction are:

· Naltrexone (Vivitrol)

· Buprenorphine (Suboxone)

· Methadone

NALTREXONE

Naltrexone, known by its brand-name Vivitrol, is administered by a doctor monthly through an injection. Naltrexone is an opioid antagonist. Antagonists attach themselves to opioid receptors in the brain and prevent other opioids such as heroin or painkillers from exerting the effects of the drug. It has no abuse potential.

BUPRENORPHINE

Buprenorphine, known by its brand-name Suboxone, is an oral tablet or film dissolved under the tongue or in the mouth prescribed by a doctor in an office-based setting. It is taken daily and can be dispensed at a physician’s office or taken at home. Buprenorphine is a partial agonist. Partial agonists attach to the opioid receptors in the brain and activate them, but not to the full degree as agonists. If used against the doctor’s instructions, it has the potential to be abused.

METHADONE

Methadone is dispensed through a certified opioid treatment program (OTP). It’s a liquid and taken orally and usually witnessed at an OTP clinic until the patient receives take-home doses. Methadone is an opioid agonist. Agonists are drugs that activate opioid receptors in the brain, producing an effect. If used against the doctor’s instructions, it has the potential to be abused. There is no “one size fits all” approach to medication-assisted treatment, or even recovery. Recovery is individual.

The most important thing to do is to consider all of your options, and speak to a medical professional to determine the best course of action for your family. The best path is the path that helps and works for your child.

Source:  http://drugfree.org/parent-blog/medication-assisted-treatment/  19th May 2017

Filed under: Addiction,Brain and Behaviour,Heroin/Methadone,Treatment and Addiction,Youth :

Meet Ryan Hampton, 36, recovery advocate, political activist and recovering heroin addict igniting America’s social media feeds with stories of hope, recovery and activism. From his advocacy that led Sephora to take their eyeshadow branded “druggie” off the shelves to the activism that urged an Arizona politician to apologize for a statement stigmatizing addiction, he’s certainly become a social media powerhouse for all things addiction, recovery and policy. And with an estimated 7 out of 10 people on social media platforms, it’s no coincidence he’s found success taking the addiction advocacy fight digital.

Today, more than 22 million people are struggling with addiction, and it’s estimated that as a result, more than 45 million people are affected. But what many people don’t realize is that there are more than 23 million people living in active, long-term recovery today. Yet, because of shame and stigma, many stay silent. To fight this often-lethal silence, Hampton has urged the public to speak up and share personal stories of recovery through his recently launched Voices Project. The project, a collaborative effort to encourage people across the nation to share their story, exists to put real faces and names behind the addiction epidemic.

A Personal Struggle

Before becoming a national recovery advocate and social media powerhouse, Hampton himself faced a personal struggle with addiction. A former staffer in the Clinton White House, Hampton did not appear to be a likely candidate for heroin addiction, or so stigma would say. But after an injury and subsequent prescription for pain medication, Hampton found himself addicted to opiates, eventually leading to a heroin addiction that would span more than a decade.  After a long struggle, Hampton decided to get help.

It was the phone call that started his recovery journey that changed everything – his life and his view on the power of his phone. After getting sober, he began connecting with others in recovery, amazed at the magnitude of the digital community. But still, while uncovering these online stories of recovery, Hampton lost four friends to opioid addiction.

It was a breaking point for Hampton – one that led to the beginning of a movement that would someday reach and impact millions.

A Notable Partner

Hampton began reaching out to others in recovery and started realizing the power of digital tools to connect and build an online recovery community. And as he was slowly networking and meeting others in recovery, on October 4, 2015, Hampton’s advocacy met its catalyst: Facing Addiction.   The non-profit organization hosted a concert at the National Mall in Washington, D.C., an event that drew thousands to the capitol with celebrities, musicians and other well-known names willing to publicly celebrate the reality of recovery and call for reform in the addiction industry. Hampton, a Los Angeles resident, tuned into the event from across the country through Facebook Live and was again inspired by the content delivered through his mobile phone.

After meeting co-founders of Facing Addiction, Jim Hood and Greg Williams, Hampton plugged in, partnered and even joined the Facing Addiction team as a recovery advocate.

The importance of online advocacy aligns with Facing Addictions’ national priorities, shares CEO Jim Hood, “When enough people tell enough stories and the people who are impacted by addiction look like all of us and our kids and neighbors and relatives, the stigma has to start going away. And then we can get to work.”

After partnering with Facing Addiction, Hampton understood the priorities, the strategy and the mechanism. Said by Hampton, “I stand on the shoulders of giants”.

Leveraging the power of the algorithms at his fingertips every day, Hampton has grown his online presence to be one of the most influential in the recovery movement. Digital communication helped him get to treatment, connected him with Facing Addiction, and now is the platform in which he is sharing recovery stories from across the nation.

In just one week, more than 200 stories were submitted to the Voices Project and over 500 people sent in personal messages to express their support. Among those speaking up are notable voices such as pro skateboarder and former Jackass member Brandon Novak;   Grammy Award-winning musician Sirah;  rapper Royce da 5’9’’;   American politician and mental health advocate Patrick Kennedy;  former child actress and now-addiction counselor Mackenzie Phillips, and more.

According to Royce da 5’9’’, “Addiction is a problem that we all have to deal with. It affects us all in one way or another, and having someone giving it a voice, a name and a face not only helps get rid of the stigma regarding addiction, but he’s [Ryan] on the forefront letting people know there are solutions out there and recovery is real.”

Patrick Kennedy shares the importance of building a digital recovery movement to influence and support political reform in the addiction recovery space. “With the push of a button we’ll be able to have others show up to support communities across the nation,” says Kennedy, “because their fight is our fight.”

“The face of addiction is everyone,” Sirah shares. “The Voices Project gives people a voice and a connection to hope.”

The hope offered through open dialogue about addiction and recovery has now grown into a digital movement.

The pages that Hampton started with $20 and an old computer have gained more than 200,000 followers across platforms, reaching nearly 1 million people each week. “We’re the fastest-growing social movement in history – and the funny thing is, we’re a community that nobody ever wanted to be a part of,” Novak says.

“This is the one space where we cannot be ignored. The time has come for us to speak out, and we’re a community that speaks loudly. With addiction, we’re dealing with imminent death every day,” Hampton says. “Through social media, we’ve found an innovative way to communicate with each other and connect with people we haven’t met, and now, we’re having this conversation with the rest of the world.”

Perhaps the most intriguing impact of Hampton’s work is the paradoxical ability to bring the work of addiction recovery advocacy online – only to take it back offline through real-world change in communities across the country. According to Hampton, the work he’s doing shouldn’t stay digital – it should impact community laws, help new non-profits emerge and influence real people to seek treatment and find it.

“No matter if you have social media or not – your way of doing this is talking about addiction at the dinner table, to a parent or a friend or an employer. You should not be afraid to tell your story of recovery or loss and, most importantly, your story of struggle and how you need help. It may not just change your life, it may change someone else’s life,” Hampton says.

At the crux of digital advocacy in the addiction recovery realm are real lives being saved – people finding treatment, families finding hope and those in recovery being freed of stigma that can keep them in shame and silence.  This is the mission that has fuelled Hampton’s work since the beginning. And Hampton’s reason is hard to refute: “My story is powerful, but our stories are powerful beyond measure.”

Source: https://www.forbes.com/sites/toriutley/2017/04/18/the-recovering-heroin-addict-shaking-social-media/2/#273606f0689c

Filed under: Addiction,Heroin/Methadone,Internet,Social Affairs (Papers),Treatment and Addiction :

(Comment by NDPA:  Some shocking figures from the USA in this article)

In 1964 the Surgeon General’s report on smoking and health began a movement to shine the bright light on cigarette smoking and dramatically change individual and societal views. Today, most states ban smoking in public spaces.

Most of us avoid private smoky places and sadly watch as the die-hard huddle 15 feet from the entrance on rainy, snowy or frigid coffee breaks. Employers often charge higher health insurance premiums to employees who smoke, and taxes on cigarettes are nearly triple a gallon of gas. Yet, some heralded progressive states have passed referendums to legalize the recreational use of a different smoked drug.

Now, more than 50 years later, another very profound statement has been made in the introduction to the recent report, “Substance misuse is one of the critical public health problems of our time.”

“Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” was released in November 2016 and is considered to hold the same landmark status as that report from 1964. And maybe, just maybe, it will have the same impact.

Many key findings are included that are critical to garnering support in the health care and substance abuse treatment fields. But the facts are just as important for the general public to know:

— In 2015, substance use disorders affected 20.8 million Americans — almost 8 percent of the adolescent and adult population. That number is similar to the number of people who suffer from diabetes, and more than 1.5 times the annual prevalence of all cancers combined (14 million).

— 12.5 million Americans reported misusing prescription pain relievers in the past year.

— 78 people die every day in the United States from an opioid overdose, nearly quadruple the number in 1999.

— We have treatments we know are effective, yet only 1 in 5 people who currently need treatment for opioid use disorders is actually receiving it.

— It is estimated that the yearly economic impact of misuse and substance use disorders is $249 billion for alcohol misuse and alcohol use disorders and $193 billion for illicit drug use and drug use disorders ($442 billion total).

— Many more people now die from alcohol and drug overdoses each year than are killed in automobile accidents.

— The opioid crisis is fuelling this trend with nearly 30,000 people dying due to an overdose on heroin or prescription opioids in 2014. An additional roughly 20,000 people died as a result of an unintentional overdose of alcohol, cocaine or non-opioid prescription drugs.

Our community has witnessed many of these issues first hand, specifically the impact of the heroin epidemic. The recent Winnebago County Coroner’s report indicated that of 96

overdose deaths in 2016, 42 were a result of heroin, and 23 from a combination of heroin and cocaine.

We know that addiction is a complex brain disease, and that treatment is effective. It can manage symptoms of substance use disorders and prevent relapse. More than 25 million individuals are in recovery and living healthy, productive lives. I, myself, know many. Most of us do.

Locally, the disease of addiction hits very close to many of us. I’ve had the privilege of being part of Rosecrance for over four decades, and I have seen the struggle for individuals and families — the triumphs and the tragedies. Seldom does a client come to us voluntarily and without others who are suffering with them. Through research and evidence-based practices at Rosecrance, I have witnessed the miracle of recovery on a daily basis. Treatment works!

If you believe you need help, or know someone who does, seek help.  Now. Source: http://www.rrstar.com/opinion/20170304/my-view-addiction-is-public-health-issue-treatment-works.  4th March 2017

Filed under: Addiction,Health,Nicotine,Prevention and Intervention,Treatment and Addiction :

National statistics show 2,367 users aged 18 to 24 sought treatment in 2015-16 as drug becomes increasingly unfashionable.   A total of 149,807 opiate addicts came for treatment in England during 2015-16, down 12% on a peak of 170,032 in 2009-10.

The number of 18 to 24-year-olds in England entering treatment for addiction to heroin has plummeted 79% in 10 years, as the stigma surrounding the drug and changing tastes in intoxication have made it increasingly unfashionable.

In the year to March, 2,367 people from that age group presented with heroin and opiate addiction at the approximately 900 drug treatment services in England, compared with 11,351 10 years earlier, according to statistics from the National Drug Treatment Monitoring System (NDTMS).

They constituted a tiny fraction of the 149,807 opiate addicts who came for help to kick their habit throughout the year, a number that is itself 12% down on a peak of 170,032 who came for treatment in 2009-10. The median age of those users was 39, the statistics showed.  Michael Linnell, the coordinator of UK DrugWatch, a network of drug treatment professionals, said many of the heroin users currently accessing treatment would have become addicted during a boom in the drug’s popularity in the late 1980s. Young addicts were “as rare as hen’s teeth”, he said.

Our neglect of ageing heroin users has fuelled the rise of drug-related deaths

“For the Thatcher generation who didn’t see a future and there were no jobs or employment and the rest of it, it was an alternative lifestyle in that you were really, really busy being a heroin user: getting up, scoring, nicking stuff to get the money to score and the rest of it,” Linnell said.

“There was a whole series of factors until you got to that point where people from those communities – the poorest communities – where you were likely to get heroin users, could see the visible stigma of the scarecrow effect, as some people called it.

“They didn’t want to aspire to be a heroin user because a heroin user just had negative connotations, rather than someone who was rebelling against something.”

Overall, 288,843 adults aged 18 to 99 came into contact with structured treatment for drug addiction during 2015-16, 52% of whom were addicted to heroin or some other opiate. Among opiate addicts, 41% were also addicted to crack cocaine, with the next highest adjunctive drugs being alcohol (21%) and cannabis (19%).

About half of those presenting to treatment – 144,908 – had problems with alcohol, a fall of 4% compared with the previous year. Among those, 85,035 were treated for alcohol treatment only and 59,873 for alcohol problems alongside other substances.

The most problematic drug among the 13,231 under-25s who came into contact with drug treatment services in the past year was cannabis, which was cited as a problem by 54%, followed by alcohol (44%) and cocaine (24%).

The numbers from this age group accessing treatment had fallen 37% in 10 years, which the Public Health England report accompanying the statistics said reflected shifts in the patterns of drinking and drug use over that time, with far fewer young people experimenting with drugs than in the past.  Karen Tyrell, the spokeswoman for the drug treatment charity Addaction, said the decline in problem drug use among young people reflected what drugs workers see on a daily basis, and credited evidence-based education, prevention and early intervention programmes for the change.

The shift, though, was precarious, Tyrell said, warning that yearly spending cuts to treatment services risked reversing the gains.

She added: “Of course, what this also means is that we have an ageing population of heroin users, many of whom have been using since the 80s or 90s, and who are now dealing with poor physical health and increasing vulnerability. In an environment of ever rising drug-related deaths, it’s imperative we don’t lose sight of their needs.”

Source:  https://www.theguardian.com/society/2016/nov/03/

Filed under: Addiction,Heroin/Methadone,Social Affairs,Treatment and Addiction,Youth :

Highlights

* •Motives for cannabis use can predict problematic use and use-related problems.

* •A MET/CBT intervention was associated with significant reductions in motives.

* •Reductions in a subset of motives significantly predicted change in outcomes.

Abstract

Background

Heavy cannabis use has been associated with negative outcomes, particularly among individuals who begin use in adolescence. Motives for cannabis use can predict frequency of use and negative use-related problems. The purpose of the current study was to assess change in motives following a motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT) intervention for adolescent users and assess whether change in motives was associated with change in use and self-reported problems negative consequences.

Methods

Participants (n = 252) were non-treatment seeking high school student cannabis users. All participants received two sessions of MET and had check-ins scheduled at 4, 7, and 10 months. Participants were randomized to either a motivational check-in condition or an assessment-only check-in. Participants in both conditions had the option of attending additional CBT sessions. Cannabis use frequency, negative consequences, and motives were assessed at baseline and at 6, 9, 12, and 15 month follow-ups.

Results

There were significant reductions in motives for use following the intervention and reductions in a subset of motives significantly and uniquely predicted change in problematic outcomes beyond current cannabis use frequency. Change in motives was significantly higher among those who utilized the optional CBT sessions.

Conclusions

This study demonstrates that motives can change over the course of treatment and that this change in motives is associated with reductions in use and problematic outcomes. Targeting specific motives in future interventions may improve treatment outcomes.

Source: http://www.drugandalcoholdependence.com/article   1st October 2016

Filed under: Addiction,Cannabis/Marijuana,Treatment and Addiction,Youth :

An intriguing new NIAAA-funded study offers a glimpse at how the adolescent brain responds to the language of therapists. Led by Sarah W. Feldstein Ewing, Ph.D., Professor of Psychiatry and Director of the Adolescent Behavioral Health Clinic at Oregon Health & Science University, the study assessed 17 young people ages 15–19 who were self-reported binge drinkers. Following a psychosocial assessment, the youths received two sessions of motivational interviewing aimed at reducing drinking. Between sessions, the participants underwent a brain scan using functional magnetic resonance imaging, or fMRI.

During the fMRI, the therapist presented two types of statements: one set of “closed questions” based on standard language used within addiction treatment (e.g., “Do your parents know you were drinking?”); the other set included more effortful “complex reflections” (e.g., “You’re worried about your drinking.”)

The youth were re-evaluated one month after treatment. At the follow-up evaluation, the youth showed significant reductions in number of drinking days and binge drinking days. Furthermore, in the fMRI sessions, the researchers observed greater brain activation for complex reflections versus closed questions within the bilateral anterior cingulate gyrus, a brain region associated with decisionmaking, emotions, reward anticipation, and impulse control.

The scientists also noted that greater blood-oxygen level dependent (BOLD) response in the parietal lobe during closed questions was significantly associated with less post-treatment drinking. BOLD response is a way to measure activity in specific brain areas. Previous research has shown that this region’s secondary function is related to a person’s ability to navigate, plan, and make decisions.

The study team also observed lower brain activation in the precuneus was associated with study participants’ post-treatment ratings of the importance of changing their drinking. The precuneus, a subregion of the parietal lobe located inside the fissure that separates the brain’s hemispheres, is related to self-reflection and introspection and is involved in risk behavior. It is considered to be a hub of the brain’s key resting-state network.

The researchers also noted what they did not find from the brain scans—any link between treatment outcome and activation of the frontal lobes, which are a region tied to complex reasoning. The authors commented that this lack of activation might be

because the frontal lobes of the adolescent brain are still developing, making it difficult for teens to bring their frontal lobes “online.”

The study authors note that their findings have important implications for the treatment of addiction in adolescents and can improve our understanding of youth brain systems and inform how to influence mechanisms of behavior change in this population.

Reference:

Feldstein Ewing, S.W.; Houck, J.M.; Yezhuvath, U.; Shokri-Kojori, E.; Truitt, D.; and Filbey, F.M. The impact of therapists’ words on the adolescent brain: In the context of addiction treatment. Behavioural Brain Research 297:359–369, 2016. PMID: 26455873

Source:  http://www.spectrum.niaaa.nih.gov/news-from-the-field/news-from-the-field-01.html  Volume 8 Issue 3  September 2016.

Filed under: Brain and Behaviour,Drug use-various effects on foetus, babies, children and youth,Treatment and Addiction,Youth :

Some cannabis users have developed an “inverted expertise” on the drug – often equipped with more up-to-date knowledge than the people trying to help them, a conference being held at the University of York was told today.

A group of national experts gathered at the University’s King’s Manor to exchange ideas on effective treatment for cannabis users.

There has been a dramatic increase in the number of people seeking treatment for problems related to cannabis use over the last decade. Research has revealed there was a 64% increase in the number of people seeking treatment between 2005 through to 2015 in England. Cannabis has also now overtaken heroin as the drug most likely to prompt calls for help.

The increase in requests for treatment is in contrast with the steady decline in the population’s use of cannabis, delegates were told.

Researchers at the University of York – including Ian Hamilton, Lecturer in Mental Health and Charlie Lloyd, Senior Lecturer in Health Sciences – and the University of Leeds are investigating why so many cannabis users are seeking treatment and how services are responding.

Initial findings suggest that individuals seek help with problems which are not usually associated with cannabis, such as irritability and poor impulse control.

Also, that treatment services are not sufficiently prepared to offer effective interventions, as cannabis is still seen as a benign drug.

Dr Mark Monaghan, a lecturer in Criminology and Social Policy at Loughborough University, told the delegates: “There is this ‘inverted expertise’ around cannabis in which the users have all the up-to-date knowledge of the local markets and the service providers are lagging behind.

“This can have a significant knock-on effect for the kind of services they are providing. Cannabis users are quite knowledgeable in what is going on in terms of the market.

“The providers are slightly lagging behind in terms of their knowledge base. Because they are lagging behind they don’t have intelligence on what the consumers are using; it creates this situation where they don’t really know what to do.”

He added: “We need to know what people are using and we need to offer them evidence-based treatments.

“Treatment across the sector is really variable. We do need more research on the changing nature of the cannabis market. We need to explore the reason why more people are presenting to treatment centres.”

Ian Hamilton, Department of Health Sciences’ Lecturer in Mental Health, who organised the event, said: “This is the first research that has looked at both the demand for cannabis treatment and the reasons why there’s been a significant rise in it. The outcome of the conference today was agreement amongst commissioners, providers and researchers that there is a problem we need to explore, around why people are presenting to treatment services, and how we can offer effective interventions once they are in treatment.”

Source:  https://www.york.ac.uk/news-and-events   7th June 2016

Filed under: Cannabis/Marijuana,Treatment and Addiction :

Hendriks V., van der Schee E., Blanken P.
Drug and Alcohol Dependence: 2011, 119, p. 64–71.

US research led by the programme’s developers has found that a family therapy which intervenes across a child’s social environment is more effective than alternatives for problem substance using teenagers, but this independent European study found individually-focused cognitive-behavioural therapy overall just as effective.

SUMMARY Cognitive-behavioural therapy is a mainstay of addiction treatment, but young problem substance users might benefit more from approaches which intervene with their families and wider environments. The featured study tested this proposition among cannabis users in The Netherlands, pitting multidimensional family therapy against a more conventional, individually-focused cognitive-behavioural therapy.

Key points

Multidimensional family therapy addresses problem drug use and related problems among adolescents not through a set regimen, but by applying principles and a therapeutic framework to the individual seen as situated within a particular set of environmental influences and constraints. What distinguishes it from some other family therapies is that therapists see substance use as potentially a problem in its own right, and that the intervention extends beyond the child and family to all the social systems (school, juvenile justice, etc) in which the child may be involved.

US studies involving young cannabis users have shown promising results, but almost all these were obtained by one research group. Independent replication studies are needed, and it is unclear whether the impacts of multidimensional family therapy observed in the United States can be generalised to a country such as The Netherlands, where attitudes to cannabis use are more permissive.

To answer these questions the featured study compared the effectiveness of multidimensional family therapy and cognitive-behavioural therapy among adolescent cannabis users in The Netherlands. Between 2006 and 2009 it recruited 109 children aged from 13 to 18 diagnosed as experiencing cannabis abuse or dependence within the past year. They were among the intake at two treatment centres for adolescents in The Hague, one specialising in substance use problems, the other in mental and behavioural health. Patients in the study had to have regularly used cannabis in the past three months and have at least one parent figure who agreed to participate in treatment and in study assessments.

Participants averaged just under 17 years of age and 80% were male. According to their own accounts, they had on average been using cannabis for two years and at study entry had averaged 162 ‘joints’ in the past 90 days – equivalent to nearly two a day. Other substances were used relatively little. They reported an average of about six violent or property crimes in the past three months and a substantial minority were diagnosed with a conduct disorder or oppositional defiant disorder. Four in 10 lived in single-parent households and the same proportion had been imprisoned.

They were allocated at random to multidimensional family therapy or cognitive-behavioural therapy, each planned to last five to six months and delivered on an outpatient basis. In weekly one-hour sessions, the cognitive-behavioural option focused on enhancing patients’ motivation to change their addictive behaviour, and then on changing problem behaviours by means of training in self-control, social and coping skills, and relapse prevention. Monthly sessions were also scheduled for the parents to provide information and support, but not to intervene in family dynamics or parenting.

Multidimensional family therapy was more intensive, scheduled to occupy two one-hour sessions a week with the adolescent, parent(s) and/or family, plus contacts with schools and court staff and other people. It was delivered by trained and supervised therapists who followed a manual by the approach’s developers and were trained by the developers, whose unit in the USA was contacted monthly for feedback and consultation.

An attempt was made to reassess patients to track their progress, the final assessment being 12 months after the baseline assessment conducted just before patients were allocated to the treatments. At the final follow-up, just over 94% of patients were reassessed.

Main findings

Though continued cannabis use was the norm, the general picture was of improvements between the 90 days before starting treatment and the 90 days before the final 12-month assessment. However, these improvements were not significantly greater depending on the treatment to which patients had been allocated. This was the case despite multidimensional family therapy being far better attended; 8 in 10 children completed this treatment compared under 3 in 10 allocated to the cognitive-behavioural option, and they attended sessions totalling 35 hours compared to 10. Significant others in the child’s life also spent much more time engaged in the multidimensional than in the cognitive-behavioural programme.

The number of days in which the children had used cannabis fell from 62–63 days out of 90 to 43 with multidimensional family therapy and 47 with cognitive-behavioural therapy, and the number of joints smoked fell respectively by 38% and 46%. In both options a good treatment response – at least 30% fewer cannabis-using days without substantial increases in use of other substances – was recorded by 42–44% of patients. In both options the number of crimes the children said they had committed fell by over a third.

Despite overall near equivalence, there were indications that children with the severest problems reduced their cannabis use more when allocated to multidimensional family therapy. This was the case whether severity was assessed in terms of intensity of cannabis use or substance use in general, criminality, presence of conduct and/or oppositional defiant disorders (among whom the extra reduction in days of cannabis use peaked at 42 days), and whether the child’s family was assessed as dysfunctional. Differential impacts among children with severe substance use or exhibiting conduct and/or oppositional defiant disorders reached statistical significance.

The authors’ conclusions

The study indicates that multidimensional family therapy and cognitive-behavioural therapy are equally effective in reducing cannabis use and delinquency among adolescents with a cannabis use disorder in The Netherlands, though neither was sufficient to eliminate problem substance use altogether among most of the children. Despite some limitations, the results are robust and applicable to most treatment-seeking adolescents with problem cannabis use in The Netherlands. The results are notable given the much higher treatment ‘dose’ – and consequently, higher costs – of multidimensional family therapy. As others have done, the study also found indications that multidimensional family therapy is differentially effective with adolescents and families with more severe problems.

It should be acknowledged that without a no-treatment control group, it cannot be said for certain that the treatments caused the observed improvements. Also the results derived from youngsters who frequently used cannabis, but not other substances, and who often had a history of delinquency and psychiatric treatment, and from a country with a relatively permissive attitude to cannabis.

COMMENTARY This well designed study has considerable clinical relevance since participants were seeking treatment in the normal way and were clearly using cannabis excessively as well as having other serious problems in their lives – the kind of caseload one would expect at substance use and mental health treatment services for young people, and the kind seen in the UK, where among under-18s cannabis is now by far the most common primary drug in relation to which treatment is provided. Numbers in England in 2013/14 continued to increase to a record 13,659, 71% of all young patients in specialist treatment. Forms of cognitive-behavioural therapy are a common component of treatment in Britain, but family-based therapeutic work is surprisingly rare, given that for example in England, over 80% of young patients were living with their families. Based on the evidence, British practice standardsfrom the Royal College of Psychiatrists on the care of young people with substance misuse problems commend family work, but say it is not standard in British services.

The featured study offers some guidance on whether for young, frequent cannabis users, UK services would do better to replace cognitive-behavioural therapies with family work in the form of multidimensional family therapy. Overall the answer is no; this would cost more without substantially improving outcomes. The finding is particularly important since it derives from a rare test conducted with a European caseload and by a research team independent of the developers of the programme. Independence is important because in several social research areas (1 2 3), programme developers and other researchers with an interest in the programme’s success have been found to record more positive findings than fully independent researchers.

Promising as US studies led by the developers of the programme have been (for example, 1 2), an independent US study found multidimensional family therapy slightly (but not significantly) less effective at promoting recovery from substance use problems than two other therapies, and substantially less cost-effective. Like the featured study, the focus was on young problem cannabis users, and cognitive-behavioural therapy featured among the alternatives.

Multidimensional family therapy is one of a similar set of programmes which integrate intervention in to several domains of a child’s life. Such approaches can improve on typically less well organised and less extensive usual practices (1 2), but this is not always the case, and performance against stronger alternative approaches focused on the individual young cannabis user has been equivalent. Evaluations conducted independently of programme developers have usually been unconvincing, and results overall have not been as impressive as investment in these programmes might be seen to require, especially if they supplement rather than replace legally or socially required procedures. A major obstacle to their use is the expensive training and supervision and considerable skills required to implement them in ways which have been associated with good outcomes.

Best for the hardest cases?

Britain’s National Institute for Health and Clinical Excellence (NICE) has recommended the types of programmes exemplified by multidimensional family therapy for problem-drinking children who also have other major problems and/or limited social support, signalling their particular suitability for the most severely affected and multiply problematic youngsters. In line with this recommendation, the featured study and others suggest that investment in multidimensional family therapy might be warranted for more problematic youngsters – particularly in the featured study, those so at odds with families and society that they can be diagnosed as exhibiting these traits to a pathological degree. That suggestion is tentative, however, primarily because these analyses were not planned in advance so may have capitalised on chance variations in outcomes.

The same limitation applies to the US trials which found multidimensional family therapy particularly suitable for high-severity youngsters. Other limitations too make the US findings an unreliable guide to whether multidimensional family therapy really is best for the most severely affected youngsters (details below), though the plausibility of the findings and the similar findings in The Netherlands mean this contention cannot be dismissed.

One of the US studies compared multidimensional family therapy with cognitive-behavioural therapy. In this study the researchers identified a set of youngsters (about 4 in 10 of the sample) initially more strongly engaged with and affected by substance use, and among whom this engagement weakened less over the course of treatment and a 12-month post-treatment follow-up. They also had more psychological problems. Among this sub-sample, engagement with substance use weakened significantly more when they had been allocated to multidimensional family therapy. Less engaged youngsters were affected about equally by both treatments. But these results were extracted only by a complex analysis which divided the sample up based not just on initial severity, but on their progress in and after treatment. The formation of these categories itself partly depended on the effects of the treatments, then the analysis tested whether the treatments affected each class differently – a circularity which complicates assessment of just what the results mean in practice. This analysis also had to contend with the fact that at each follow-up around 40% or more of the sample could not be reassessed, presumably meaning it had to estimate how they would have scored based on the available data. Such estimates can only be relied on if the data is randomly missing – in this case, if the reasons why a young person did not attend for reassessment had nothing to do with the factors which affected their response to treatment, an unlikely assumption.

Less affected by these complications, a simpler analysis of whether youngsters who started treatment with a deeper engagement with substance use became more disengaged when allocated to multidimensional family therapy was negative, as was one which tested initial psychological problems as a predictor of differential response to treatment. Nor were any relationships found between frequency of substance use and differentially benefiting from multidimensional family therapy. In a similar analysis of a second study comparing multidimensional family therapy to usual criminal justice procedures, the reverse was the case; here it was not the more deeply engaged youngsters who benefited more from multidimensional family therapy, but those who used substances most often. Such inconsistency heightens concerns over cherry-picking of results to demonstrate that multidimensional family therapy is best for most severely affected youngsters.

Last First uploaded 18 April 2015

Source:http://findings.org.uk/PHP/dl.php?file=Hendriks_V_2.tx

Revised 27th April 2015

Filed under: Cannabis/Marijuana,Drug use-various effects on foetus, babies, children and youth,Treatment and Addiction :

An interactive mobile texting aftercare program has shown promise as a means to help teens and young adults engage with post-treatment recovery activities and avoid relapse, researchers report. In a NIDA-supported pilot study, the program, called ESQYIR (Educating & Supporting Inquisitive Youth in Recovery), reduced young people’s odds of relapsing by half compared with standard aftercare.

Dr. Rachel Gonzales and colleagues at the University of California, Los Angeles (UCLA), designed ESQYIR to teach and reinforce wellness self-management in a manner that fits young people’s attitudes and communication styles. The researchers cite numerous advantages of the mobile texting approach: It is inexpensive and features personalization of content, convenience of use, ease of assessment and monitoring, and flexibility in the time and location of delivery.

The Need

Many young people comply poorly with aftercare interventions and resist involvement in 12-step programs and other post-treatment recovery activities. Dr. Gonzales says, “Teens and young adults don’t want to be stigmatized as having a disease or as still being in recovery. In their minds, after the primary treatment, they are done.” Young people often don’t view addiction as a disease, she adds. Instead, they regard substance use as a matter of lifestyle and personal choice. As a result, as many as 85 percent of teens and young adults relapse within 1 year.

Dr. Gonzales and her research team reckoned that young people might engage more readily with aftercare built on text messaging. This mode of communication is ubiquitous among young people, surpassing most other forms of social interaction. Messages can be personalized and can be accessed and responded to privately, when and where youths find it convenient or feel a need for help. Text messaging interventions are already used to treat maladies including obesity, sexually transmitted diseases, and tobacco dependence in young adults.

“The most effective programs take into consideration the users, their needs, their desires, and their way of connecting,” Dr. Gonzales says. Accordingly, when she and her team composed the text messages for Project ESQYIR, they solicited input from young people in recovery from substance use disorders (SUDs). “The program’s text messages are based on their voices, parallel their views of recovery, and speak to their recovery needs,” Dr. Gonzales says.

Keeping Tabs With Texts

The participants in the ESQYIR pilot study were 80 volunteers, ages 14 to 26, who had been treated in outpatient and residential community treatment centers in the Los Angeles area. The drugs that had caused them problems included marijuana (55 percent), methamphetamine (30 percent), cocaine (15 percent), heroin (11 percent), prescription drug (6 percent), and other substances including alcohol (4 percent). Half of the participants received the mobile texting ESQYIR program, the other half received the standard aftercare offered by their treatment facilities, which consisted of referral to 12-step programs.

Figure 1. Daily Mobile Texts Prompt Self-Monitoring, Give Recovery Advice and Encouragement

The participants in the text messaging program received daily text messages with tips to self-monitor their recovery- and substance use–related behaviors and with alerts to aftercare services in their community.

Each weekday at 12 noon, the participants in the ESQYIR group received a text that reminded them about being in recovery and provided a wellness tip for the day. The reminder portion of the text said, “Today’s a new day in ur recovery! Think about the change ur working towards.” The wellness tip promoted personal, social, physical, or emotional health. For example, one message read, “Write down the top 3 stressors that u need to avoid or deal with for helping u not use.”

Weekdays at 4 p.m., the participants in the ESQYIR group received a text that prompted them to self-monitor and text back numerical ratings of their abstinence confidence, wellbeing, substance use, and recovery behaviors (see Figure 1). The participants then received a feedback text, automatically selected from more than 600 possible messages, which provided motivational/inspirational encouragement, coping advice, or positive appraisal tailored to the participants’ self-rating. For example, motivational feedback texts encouraged participants to keep on track with recovery and attend therapy or self-help meetings when needed.

Dr. Gonzales says, “The self-monitoring texts helped participants remain mindful and aware of potential relapse triggers, particularly in risky situations.” With that awareness and the feedback provided by the program, the young people were able to generate strategies for coping with such situations without drugs, the researchers suggest.

On weekends, the participants received personalized texts with educational information adapted from NIDA reference materials and resource information on local support services.

Less Relapse, More Engagement

Figure 2. Text-Based Delivery of Aftercare Content Decreases Relapse

Teens and young adults receiving daily text messages had lower relapse rates than peers receiving only standard aftercare.

The UCLA researchers monitored the participants’ urine for alcohol and drugs monthly during the program. The results indicated that with passing time, the text-based aftercare participants’ odds of relapsing to their primary substances rose only half as fast as those of the standard aftercare group. Compared with the participants in standard aftercare, those assigned to the ESQYIR group were less likely to have relapsed 1 month (8.6 percent vs. 30.3 percent), 2 months (3.6 percent vs. 39.3 percent), and 3 months (14.7 percent vs. 62.9 percent) after the end of their substance abuse treatment (see Figure 2).

The researchers followed up with 55 of the original 81 study participants 180 days after the end of treatment (90 days after the end of the aftercare programs). Those who had received the ESQYIR mobile wellness aftercare intervention were still less likely to have relapsed (21.4 percent vs. 59.3 percent).

The ESQYIR and standard aftercare participants both attended on average ten 12-step meetings per month during their last month in substance abuse treatment. Both groups reduced their 12-step attendance in the aftercare period, but the ESQYIR participants did so to a lesser degree (8.9 vs. 2.9 meetings in the final month). The two groups no longer differed significantly in 12-step attendance during the third month post-aftercare (7.0 vs. 4.6 days per month). However, during that month the ESQYIR participants were more involved in other recovery-related extracurricular activities (e.g., exercise, walking, and community/volunteer service) than those who received the standard aftercare.

Text and Thrive

Dr. Gonzales and colleagues are planning a larger, stage II efficacy trial of the mobile-based ESQYIR aftercare wellness intervention. For this trial, they are enhancing the program with new features, including text messages to foster HIV awareness and prevention.

“We look forward to further research in this line of work and to learning more about the efficacy of this intervention,” says Dr. Jessica Campbell Chambers, health science administrator at NIDA’sBehavioral and Integrative Treatment Branch. “This work is extremely important given the high rates of relapse among recovering adolescents.”

Dr. Campbell Chambers concurs with Dr. Gonzales that although the pilot nature of the study and its relatively small cohort size make its results only preliminary, the findings are very promising. The UCLA study team will soon publish a report on the ESQYIR program’s effects at 6- and 9-months post-participation.

This study was supported by NIH grant DA027754.

Source

Gonzales, R.; Ang, A.; Murphy, D.A. et al. Substance use recovery outcomes among a cohort of youth participating in a mobile-based texting aftercare pilot program. Journal of Substance Abuse Treatment 47(1):20-26, 2014.

Filed under: Social Affairs (Papers),Treatment,Treatment and Addiction,Youth :

A woman who was admitted to rehab three times because of her severe drug addiction has turned her life around by becoming an addiction therapist helping others going through what she did.

Vicky, from Hale, Manchester, reveals that her drug addiction started at a young age; she was smoking weed when she was 11 and took acid and mushrooms by the age of 16.

The 49-year-old, who attended Altrincham Grammar School, comes from a wealthy background and was expected to go into medicine or dentistry.

However, her parents split when she was young and she hasn’t seen her biological father since she was seven years old. The breakdown of the family unit, she explains, led her to feel as though there was a deficit in her life.

As a result, she began to use food, substances and sex to fill the void to help her feel better about herself.

Vicky explains that she’s had obsessive behaviours towards food – often bingeing on a whole box of crisps at once – since a young age.

At the age of 11 she moved to Canada for six months to live with relatives where she started smoking cannabis. By 16 she was aware her drinking habits weren’t ‘normal’. Vicky felt she had no cut off point and regularly had memory loss. She also started taking what she considered to be recreational drugs: cannabis, acid and mushrooms.

When she was 17, she was introduced to amphetamine. Looking back, Vicky says she considers that her recreational drug use was about helping her to feel better about herself.