A Call From A Rehab

I got a call from a patient at a residential drug treatment center today. He had been using Opana pretty heavily, and decided to go to rehab to get his life back on track. He had broken up with his girlfriend, and his little girl was staying with his mother.

They’ve been giving me a Suboxone taper to help me detox from the OPs, he told me. At first, I felt okay and I had some time to do some thinking. I think I understand why I’ve been using.

It’s the pain and the sadness I feel inside, and it comes out in anger, and it gives me an excuse to use. But they’ve been cutting my dose every day. And now I’m feeling pretty sick, and my mind is foggy and I can’t really focus.

If I keep using, I’m not going to be able to see my daughter. And I’m afraid. I want to be on maintenance. Methadone or Suboxone.

The staff here are pressuring me about it and telling me I don’t need it. I had to use the client phone to call you because my counselor wouldn’t approve.

Why Am I Not Surprised?

I know this rehab well. Like most rehabs, this one doesn’t really offer much rehabilitation.

Like most rehabs, this one offers nothing more than short-term detoxification; and some basic, incomplete and biased recovery education.

Science and practical experience make it clear that even after detox, the addiction itself remains alive and well. For most people, detox alone is not enough to establish a real recovery. So why the hostility toward methadone and Suboxone, two proven treatments that promote conditions of safety and often set the stage for true rehabilitation?

Most rehabs are based on the Alcoholics Anonymous 12-step model. Many rehabs are staffed by people who go to AA and embrace the AA culture.

This isn’t all bad, of course. There is a lot that is good in the 12-step model and culture. But along with the good, sometimes comes some of the less good –like black and white thinking, rigidity of approach, resistance to change based on scientific and medical progress, a visceral animosity toward medication-assisted recovery, and an unexamined affection for dangerous and ineffective tough-love approaches.

No More Business As Usual

We’ve made a lot of progress in our understanding of the brain, addiction and recovery. But most rehabs are still doing business as usual.

It’s time for residential drug treatment programs to integrate medication-assisted treatment into their client education and aftercare plans. The result will be fewer post-discharge relapses, fewer post-discharge overdoses, fewer repeat customers, more reunited families, and more recovery.

Watch this video to learn more:

“Exhausted, confused, sad, angry, hurting and grieving parents of addicts often come to feel powerless,” I wrote.  “It’s no wonder that many parents come to feel powerless.  Addiction is complex and challenging.  On top of that, parents are often told by those they turn to for support or expert advice that they are, in fact, powerless.”

I urged parents to understand that they can “BOTH establish healthy boundaries AND actively support their loved one in establishing the conditions of safety, stability and opportunity necessary to build a lasting recovery.”

I am quite aware that this is no small task.

One parent who is struggling to both establish healthy boundaries and actively support an addicted son put it so well:

“It is a tough choice over and over, because right action simply isn’t easy to define each time.”

It’s so true.

The standard, one-size-fits-all advice to parents to “detach” and let their loved one “hit rock bottom” is seductive in that it offers a clear direction to exhausted parents caught in a confusing whirlwind of devastation.

It is harder, in a way, to suggest to parents that they should struggle on even as they are faced with tough choices over and over, with no clear or easy answers.

Life is messy, as the saying goes, and life with an addict in the family is all the messier.   It’s important to honor the effort.

Parents don’t have the absolute power to stop addiction.  But parents are far from powerless.

Parents who choose to can find opportunities to influence the outcome of their child’s addiction.  However, playing an active role requires a willingness to think things through independently and make tough choices over and over, even when there are no clear or easy answers.  Further, it requires striking a difficult balance between healthy personal boundaries, and healthy recovery support.

It’s not easy.  But the stakes are high, and the potential rewards are worth it.

Overdoses often turn fatal because nobody is around to call 911. Make sure someone is nearby to get help in an emergency. Don’t use it alone!

Look here to learn more about how to prevent or respond to a drug overdose.

“This is what I have been fighting my family about with my son,” the reader wrote.  ” I do not believe the homelessness or incarceration will be the reality slap necessary.”

Part of what I question is the idea that a reality slap is necessary at all.

Of course, by the time family and friends are considering a reality slap, the status quo is clearly not working.  But is a reality slap the answer?

In many cases, the issue is not that an addicted person doesn’t recognize that they have a serious problem.  But rather that the addicted person feels stuck in figuring out how to solve the problem.

This may be because the addicted person has not been able to identify a realistic path to recovery that they believe can work.  It may be because there are real barriers to moving forward such as lack of child care or long waiting lists for treatment.  Or, it just might be because the addicted person has tried and tried to get sober and just doesn’t have the strength to try again just yet.

Even in those relatively rare cases where the issue really is a lack of awareness that there is a problem, there are better ways to raise awareness and build motivation than a so-called reality slap.

There are literally millions of addicted people cycling through the revolving doors of homeless shelters and jails.  Apparently the reality slap hasn’t done the trick for them.

In fact, here is the real reality slap.  Homelessness and incarceration delay and complicate recovery.

So why don’t more people spend time thinking about identifying the prerequisites for recovery success, and about the need to identify and remove barriers to recovery success?  It is a fruitful question to consider as applied to your own situation.

We need to be figuring out ways to help set addicted people up for success, not figuring out ways to set them up for disaster.

It’s a high-risk time for relapse and fatal drug overdose.  And a high-risk time for relapse to criminal behavior and re-incarceration.

Researchers are injecting inmates who were addicted to heroin or prescription pain killers before incarceration with the medication Vivitrol one week prior to release, and again monthly for six months.

The goal is to prevent relapse, overdose, crime and re-incarceration.

Vivitrol is an extended-release form of naltrexone, a medication used to treat addiction.

Naltrexone is not an opiate, but it has the ability to occupy opiate receptor sites in the brain.  This blocks the effects of heroin and other opiates.

Naltrexone is non-narcotic and does not result in physical dependence.

Vivitrol treatment can’t begin until patients have stopped using opiates for 7-10 days.  Detox is a painful process, and the need to detox before starting treatment with Vivitrol can be a barrier to treatment.  Treating people who are incarcerated before they are released helps overcome this barrier.

Even though most inmates have drug problems, most don’t get treatment in jail.  It makes sense to begin treatment in jail and continue the treatment after release.

Maybe we are finally getting smarter in our approach to drugs and crime.

Try This At Home!

Vivitrol was approved by the FDA for the treatment of opiate dependence in 2010 and alcohol dependence in 2006.  This means the U.S. government has already determined this treatment to be safe and effective.  And it means that your doctor can already prescribe Vivitrol to you or your loved one.

You don’t have to wait for this research to be completed to take advantage of this treatment!

Consider scheduling a doctor’s appointment to begin treatment immediately upon release.   Your doctor will help you determine if this treatment is right  for you.

Treatment with Vivitrol may help reduce the risk of:

• relapse
• fatal drug overdose
• resumption of criminal activity
• re-incarceration

Wishing you a safe recovery!

No more little orange pills.

The company will continue to sell Suboxone film (small strips that dissolve under the tongue).

Suboxone is a treatment for opioid dependence.

Reckitt says that the change will likely happen within the next six months.

Issue One: Child Safety

The company says that the move is motivated by a desire to help keep children from gaining access to the medication by mistake.  Children can die from an accidental overdose if they swallow the medication.

Unlike tablets, film or “strips” are individually wrapped, and data from the US Poison Control Centers shows that this has resulted in safety benefits for children.

Maybe I should just thank Reckitt for watching out for America’s children and end this post here.  But I have to admit that I am not feeling that warm and fuzzy about Reckitt’s announcement.

One line in their press release bothered me.  It reads, “The pediatric exposure safety issue is not related to the active ingredients found in both Suboxone Tablets and Suboxone Film.”

Really?

Reckitt is trying to say that the issue is the packaging, not the medication.  And it seems like they may be implying that since Suboxone film is better packaged, it solves the risk to children.

But if the pill bottle was full of Skittles and not Suboxone, we wouldn’t be worried about children overdosing.  And we wouldn’t need to worry about individual, child-resistant wrapping of Suboxone film.

The statement seems a little less than accurate and more than a little self-serving.

Damn skippy the risk to children has to do with what is in the bottle or the wrapper!  We need to be clear about that.  Packaging changes may help reduce the risk, but the switch to film doesn’t solve the problem.

WARNING:  KEEP MEDICATION, INCLUDING SUBOXONE TABLETS AND SUBOXONE FILM OUT OF REACH OF CHILDREN

Reckitt wants to look like the responsible adult in the room by volunteering to discontinue access to Suboxone tablets.  But they have a financial incentive to make that move beyond the altruistic desire to protect children.

Suboxone in tablet form lost patent protection in 2009, but Suboxone in film form is still protected by patent.  If Suboxone film becomes the standard, Reckitt doesn’t have to worry about competition from a generic version of the medication coming into the market.

And even if altruism is part of the motive here, I can’t help but believe that profit motives delayed the decision to pull Suboxone tablets from the market until after Suboxone film was FDA approved, manufactured, marketed and sold well.

Issue Two: Access To Suboxone Treatment

If Reckitt is in an altruistic mood, how about supporting access to generic versions of Suboxone so that more people can afford the treatment?  Instead, Reckitt is working to make it harder for competitors to enter the market.

Now that Reckitt has decided to stop selling tablets, they have submitted a “Citizens Petition” to the FDA asking that the FDA require that anyone who sells a generic version of the medication in tablet form in the future is required to individually package the tablets.  This would increase the cost of the generic tablets and make it harder for the generic maker to compete in the market.

Funny, they never did that when they were making the tablets!

It will be interesting and revealing to see if Reckitt will continue to sell Suboxone tablets outside of the US without individually packaging the pills.  Time will tell.

I am not one to bash drug companies just for the hell of it.  I fully recognize the huge benefits many people have experienced from Suboxone treatment.  I see it every day.

That’s why I would like to see generic Suboxone available.

With $1.2 billion US dollars in Suboxone sales in 2011 alone, I think Reckitt has more than recouped their research and development costs and can survive some competition.

If you want to keep generic competition out of the market Reckitt, how about lowering the cost of the medication?  You will allow more people access to Suboxone treatment, and make it less likely that another company will make a generic version of Suboxone to try and compete with you on price.

Win-win!

Pregnant women who are addicted to heroin or prescription pain relievers should be treated with either methadone or buprenorphine (Suboxone, Subutex).

This according to new guidelines recently published by the American Academy of Pediatrics.

I wasn’t surprised by the new guidelines, because similar recommendations have already been made by the U.S. National Institutes of Health and the World Health Organization, among others.  And it is well known that detoxification from opiates during pregnancy is associated with increased risk of fetal harm and may result in loss of the pregnancy.

Medication-assisted treatment with methadone or Suboxone is a responsible choice for pregnant women who are opiate dependent.  Women who make this choice should be praised and supported.

Instead, the opposite often happens.  And pregnant women who follow the scientific evidence and top expert medical advice often face stigma.

Part of this stigma stems from inaccurate claims that babies will be born “addicted.”  The truth is that babies born to women in treatment with methadone or Suboxone are not addicted.

Addiction refers to dysfunctional and compulsive drug use that continues in spite of negative consequences.  Clearly, a newborn baby is not capable of using compulsively, or having a dysfunctional relationship with a substance.  And we should remember that without the methadone or Suboxone, it’s quite possible that there would be no newborn at all.

Labeling an infant born to a mother in treatment with methadone or Suboxone “addicted” is not only inaccurate, it also contributes to stigma.  Such stigma can lead to punitive treatment of the mother and negative consequences for both the mother and child.

Many babies born to mothers in treatment with methadone or Suboxone will experience some symptoms of physical withdrawal after birth, but this results from physical dependence on the medication and not addiction to the medication.

Withdrawal symptoms may be uncomfortable for the baby.  But they are a side effect of a medically necessary medical treatment.  They are temporary, can be treated to limit distress to the baby, and are not known to cause any long term harm.

Mothers who are in treatment with methadone or Suboxone are encouraged to breast feed their babies (unless otherwise contraindicated).  Small amounts of methadone or Suboxone that may be passed to the baby with the breast milk can help reduce any symptoms of withdrawal.

Research shows that women who are pregnant and addicted to opiates have the best outcomes for themselves and their child when they:

• Participate in treatment with methadone or Suboxone while they are pregnant

• Breastfeed their baby

• Continue methadone or Suboxone treatment as needed to successfully initiate and maintain long term recovery

Medication-assisted treatment is responsible for the safe delivery of many healthy babies to mothers who would otherwise still be using, and therefore less able to parent successfully.

Perhaps the Academy of Pediatrics should recommend medication-assisted recovery for expecting fathers who are addicted too.  I know I do.

Essay contest winners described their addiction recovery in their own words, and explained how medications like  methadone, buprenorphine (Suboxone and Probuphine) and naltrexone (Vivitrol) helped them get sober.

Over 125 people from the US and the UK entered the essay contest.

The winners are:

First Prize:  Darlene DeMore of (Pennsylvania, USA)

Darlene wrote about her methadone treatment and 14 years of recovery.

When I became pregnant, I was terrified that I would not be able to take care of my child.  MAT allowed me to become well, function normally and raise a beautiful daughter.

Second Prize:  Louis Buchhold (California, USA)

Louis wrote about his naltrexone treatment and 11 years of recovery.

In 8 long years I had never been able to get longer than 30 days sober, being in/out of AA, therapy and having tried to kill myself…If it wasn’t for MAT I would not be here to tell my story.

Third Prize:  Ian Christenson (Minnesota, USA)

Ian wrote about his Suboxone treatment and 5 years of recovery.

“Suboxone saved my life…I had been attending 12 step groups but after years of heroin and pill addiction, numerous drug treatments, and chronically relapsing I had to do something different…I feared the judgments of others in recovery…MAT is the best decision I made in a long time…Suboxone has stopped my cravings and preoccupation with getting high…I’m 100% committed to my recovery…I now have a good job, a house, and a family…I now have something I never thought I could, sobriety and true happiness.

Congratulations to the winners on both their wonderful essays and their recovery success.

The contest was sponsored by the Addiction Technology Transfer Center (funded by the US government), Faces & Voices of Recovery, and the National Alliance for Medication-Assisted Recovery.