Harmony Fights Opioid Epidemic with HOPE

More than two-thirds of drug overdose deaths in the United States in 2017 involved opioids, according to the Centers for Disease Control and Prevention, escalating an epidemic the CDC says “continues to worsen and evolve.” From 2016 to 2017, opioid-related overdose deaths increased 12 percent overall, surging among all age groups 15 and older.

The CDC report’s recommendations for curbing opioid-related overdose deaths include “increasing naloxone availability, expanding access to medication-assisted treatment, enhancing public health and public safety partnerships, and maximizing the ability of health systems to link persons to treatment and harm-reduction services.”

Naloxone is a medication often used by first responders because it can rapidly reverse opioid overdose. It is an opioid antagonist—it binds to opioid receptors and can reverse and block the effects of other opioids. It can quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain relievers.

Medication-assisted treatment (MAT) is used to decrease opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission. Medications used for the treatment of opioid use disorder are buprenorphine (Suboxone, Subutex), methadone, and extended release naltrexone (Vivitrol). Some of these drugs are controversial in the recovery community because they are themselves opioids.

The National Institute on Drug Abuse, a US government research institute, clarifies that contrary to what some critics say, “methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for an opioid addiction, the dosage of medication used does not get them high–it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery.”

The use of these medications should always be combined with behavioral counseling with the ultimate aim of ceasing all substance misuse.

HOPE – Harmony’s Opioid Programming Experience

Harmony has provided all clients with medication-assisted treatment for many years. This combination of education, counseling, and the use of medication in early recovery is part of the Harmony philosophy. HOPE expands MAT to include medications that alter the physical response to opioids, reduce cravings, and give the patient time to heal from the psychological, social, and spiritual wounds of addiction.

“It’s important to remember that MAT is only a small part of the picture,” says Harmony’s medical director Christopher Reveley. “That is why we call it ‘medication-assisted’ treatment, because by itself it is not the treatment. Used alone it has a low probability of being successful.”

At Harmony, HOPE begins with thorough medical and psychological evaluations. Collaboration with the patient, members of the interdisciplinary team and, when appropriate, family and referral sources, determine the most effective treatment plan. All HOPE clients are invited to participate in weekly support groups led by a professional addiction counselor. These groups address the unique challenges of early opioid recovery, including uncomfortable physical and psychological symptoms, cravings, and strategies to avoid relapse. In this setting, clients support each other and are educated about the process of recovery.

Medication-assisted therapy may help stabilize the patient for these challenges in early recovery. “It gives people an opportunity to step out of the chaos of addiction and consider other ways of being,” says Dr. Reveley. “I never felt that buprenorphine was meant as a lifelong or even long-term solution.” Although there may be exceptions. It all depends on the individual needs of the patient. Reveley remembers a patient who had been on methadone for 46 years. “He tried to taper off a dozen times and relapsed to heroin use every single time. His family was initially very opposed to him being on methadone but eventually they told him ‘this is working, your life depends on it.’ So there are people on either end of the bell curve but in most cases buprenorphine is only a small but important part of the solution.”

Buprenorphine can be an important tool, especially in early recovery from opioid use disorder. The medication offers patients the opportunity to start living a “normal” life, far removed from the drug culture lifestyle they may have been immersed in while using heroin and other opioids. People are dying every day from opioid overdoses, especially in the age of the fentanyl scourge. Buprenorphine may provide the buffer that enables them to launch into sustained recovery. It is a buffer that can save people with addiction from a potentially lethal overdose.

Harmony has been treating addiction for 49 years and HOPE is now offered to all Harmony clients with opioid use disorders. The program involves enhanced medical, counseling, and case management services specifically tailored to meet these clients’ unique needs.

The Harmony care team works closely with clients who choose to include buprenorphine in their treatment strategy. This will typically involve full participation in HOPE and a recommendation for participation in Harmony’s Transitional Care Program (TCP), an intensive, 90 day intensive outpatient program coupled with monitored sober living and medication management by Harmony providers. When clinically indicated or to accommodate client preference, Harmony’s case managers may refer clients to other programs with similar services.

If you or someone you know is struggling with opioid use disorder and needs help, call Harmony at 970-432-8075 and one of our admissions specialists can discuss next steps.

Harmony Foundation Responds to the Opioid Epidemic with HOPE

by Christopher Reveley, MD, and Annie Peters, PhD, LP

The Opioid Epidemic

According to the National Institute on Drug Abuse (NIDA), nearly 100 people die from opioid overdose in the United States every day, and 2.6 million Americans struggle with opioid addiction. The prescribing of opioid pain relievers became much more common in the late 1990s, and it soon became evident that these medications were powerfully addictive. Opioid overdose deaths have increased significantly in the years since. Many of those addicted to heroin started with the abuse of prescription opioids.

Overdose along with the spread of HIV, hepatitis C, and withdrawal syndromes in babies born to addicted mothers constitute a nationwide crisis that has overwhelmed the resources of state and local health care delivery services. Recently, the White House identified the opioid epidemic as a national public health emergency.

How is Harmony Responding to Opioid Epidemic?

Harmony Foundation in Estes Park, CO, has been treating addiction for 48 years and has fostered a generation of long-term recovery support for individuals and families. Harmony’s mission is to provide the foundation for sustained recovery from the diseases of drug and alcohol addiction. Harmony staff is committed to continuous improvement and closely monitors a client experience, treatment response, and the research literature on addiction treatment. In the field of opioid addiction research, advances in behavioral treatment, neurobiology, and brain imaging have given treatment programs guidance in developing better services. Harmony now offers HOPE – Harmony’s Opioid Programming Experience. HOPE is offered to all Harmony clients with opioid use disorders. The program involves enhanced medical, counseling, and case management services specifically tailored to meet these clients’ unique needs.

HOPE: Medical and Clinical Approaches

HOPE begins with thorough medical and psychological evaluations. Collaboration with the client, members of the interdisciplinary team and, when appropriate, family and referral sources, determine the most effective treatment plan. All HOPE clients are invited to participate in weekly Opiate Support Groups led by a professional addiction counselor. This group addresses the unique challenges of early opioid recovery, including uncomfortable physical and psychological symptoms, cravings, and strategies to avoid rapid relapse. In this setting, clients support each other and are educated about the process of recovery.

Harmony has provided all clients with medication-assisted treatment (MAT) for many years. This combination of education, counseling, and the use of medication in early recovery is part of the Harmony philosophy. HOPE expands MAT to include medications that alter the physical response to opioids, reduce craving, and give the individual time to heal from the psychological, social, and spiritual wounds of addiction.

HOPE clients may choose to avoid medications altogether or use only sleep and anxiety-reducing medications during the acute withdrawal period. For others, naltrexone, an opioid receptor blocker, can prevent the euphoria of opioid use and help control cravings, thereby changing the client’s drive to use illicit opioids after treatment.

Buprenorphine

This partial opioid agonist, administered in a tapering protocol, may be chosen by the treatment team and client to ease symptoms of severe opioid withdrawal during detoxification. On an individual basis, this medication may be continued during early recovery, most commonly for those with severe and persistent opioid addiction. Care following residential treatment may include ongoing buprenorphine to provide a craving-free foundation for the client as they rebuild damaged interpersonal and work relationships and regain physical and emotional health. The ultimate goal with all treatment approaches is complete abstinence from all opioids.

While some may question how an opioid medication (buprenorphine) can help someone recover from opioid addiction, this treatment approach is supported by organizations such as the World Health Organization, the American Society of Addiction Medicine, the Substance Abuse and Mental Health Services Administration, NIDA, the Veterans’ Administration, NAADAC – the Association for Addiction Professionals, and the National Association of Addiction Treatment Professionals. Due to the number and quality of research studies that have been completed on the use of buprenorphine in treating opioid use disorders, the level of evidence for the effectiveness of buprenorphine treatment is considered to be high (Thomas et al., 2014). Positive outcomes typically include improving retention in treatment and reducing illicit opioid use.

The Harmony care team works closely with clients who choose to include buprenorphine in their treatment strategy. This will typically involve full participation in HOPE and a recommendation for participation in Harmony’s Transitional Care Program (TCP), an intensive, 90 day intensive outpatient program coupled with monitored sober living and medication management by Harmony providers. When clinically indicated or to accommodate client preference, Harmony’s case managers may refer clients to other programs with similar services.

If you or someone you know is struggling with opiate addiction and needs help right away, Harmony is here to help. Call us at 866-686-7867 and one of our admissions specialists can discuss next steps.

References

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis

Center for Behavioral Health Statistics and Quality (CBHSQ), 2016. 2015 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Thomas, CP, Fullerton, CA, Montejano, L, Lyman, DR, Dougherty, RH, Daniels, HS, Ghose, SS, & Delphin-Rittmon, ME. Medication-assisted treatment with buprenorphine: Assessing the evidence. Psychiatric services, 65(2), 158-170.

New FDA Commissioner Supports Abuse-Deterrent Opioids

abuse-deterrent-opioids

It does not matter how someone uses prescription opioids, they can be dangerous and potentially lead to a deadly overdose. However, it could easily be argued that the greatest risk is associated with intravenous (IV) use; opioid addicts will crush their pills, mix the powder with water and inject. In order to combat the use of opioid narcotics in unintended ways, pressure was put on pharmaceutical companies to develop formulations of their painkillers that are harder to abuse – known as abuse-deterrent opioids.

Critics of such efforts argue that harder-to-abuse painkillers are merely a band-aid, and have little effect on the opioid epidemic. While the new formulations are more difficult to use, addicts often find their way around tamper resistors and/or turn heroin as a cheaper, stronger alternative. Nevertheless, such arguments can easily be countered with ‘anything is better than nothing.’

The U.S. Food and Drug Administration (FDA) has a new commissioner who has vowed to support abuse-deterrent opioid efforts, the Associated Press reports. Dr. Robert Califf told a panel of FDA advisers that he is pledging to do “everything possible under our authority to prevent abuse, save lives and treat dependence.”

The new commissioner’s declaration is just one facet of an interagency effort to end the American opioid epidemic. However, Califf made clear that the FDA alone cannot resolve the current crisis, according to the article. Since 2010, Califf’s agency has approved five abuse-deterrent opioids, and there is reportedly another 20 such drugs in development. FDA Commissioner Califf plans to work with outside advisers and he has a comprehensive plan for addressing the prescription opioid scourge, which claims as many as 44 lives per day.

He stated that the agency will add more cautionary warning labels to the opioid narcotics prescribed the most, the article reports. What’s more, the FDA will encourage the safe disposal of unused medications, which will prevent narcotics from ending up in the wrong hands.

“What we can do is work with prescribers, professional associations, patient advocates and state and local partners — essentially the entire country — to encourage safe use and disposal of opioid medications,” said Califf. 

If you or a loved one struggles with prescription opioid and/or heroin addiction, please contact Harmony Foundation. We have been helping people break the cycle of addiction for decades, teaching people about the resources needed for a living a life on the road of recovery.

Bipartisan Focus on Opioid Overdose Deaths

The rise in drug overdose deaths in America has legislators from both sides turning their attention to the insidious problem. Senate Majority Leader Mitch McConnell of Kentucky (R), and Senator Ed Markey of Massachusetts (D) have called upon the Department of Health and Human Services (HHS) to urge the Surgeon General to issue a report on the problem opioid overdose deaths plaguing the country, The Hill reports.

Since 1999, deaths caused by prescription opioids quadrupled, the article reports. In 2013 alone, 44,000 people lost their lives to opioid overdoses – more than firearms or car crash related deaths.

Addiction to opioids and the overdoses related to abuse does not discriminate, people from all walks of life, both red and blue, have lost their lives to prescription drugs and heroin. Senator Markey says the issue “has to be bipartisan,” according to the article.

“Whether it’s Lexington, Massachusetts or Lexington, Kentucky, this epidemic knows no boundaries,” said Markey. “Senator McConnell and I believed that our response should know no political boundaries.”

Recently, McConnell and Senator Bob Casey of Pennsylvania (D), introduced legislation to the HHS for the development of a plan focusing on neonatal abstinence syndrome (NAS). Pregnant women who use opioids put the baby at risk of developing NAS, which requires weeks of intensive medical attention for several weeks after birth.

“This is a bipartisan issue that members of both parties have come together to fight head on,” McConnell said in a statement to The Hill.

Even democratic presidential candidate Hillary Clinton has set her sights on addressing the problem. In Iowa, Clinton spoke about the issue:

“When I started running, when I started thinking about this campaign, I did not believe I would be standing in your living room talking about the drug abuse problem, the mental health problem, and the suicide problem,” said Clinton. “But I’m now convinced I have to talk about it. I have to do everything I can in this campaign to raise it, to end the stigma against talking about it.”
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Addiction and recovery news provided by Harmony Foundation

Sharp Rise in Tramadol-Related ER Visits

Two new government reports found that there was a sharp increase in emergency room (ER) visits associated with the use of the drug tramadol, HealthDay reports. Tramadol is an opioid narcotic painkiller used for moderate, severe or chronic pain, and is the active ingredient brand-name pain medications, such as Ultram, Ultracet, Conzip and Ryzolt. Between 2005 and 2011, tramadol-related ER visits increased 145 percent.

The drug’s adverse reactions can include seizures and a reaction known as serotonin syndrome, which is potentially fatal, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Mixing tramadol with other drugs can be dangerous as well, especially when used with anti-anxiety medications, alcohol or other narcotic painkillers.

In 2005, there were almost 11,000 ER visits tied to tramadol. In 2009, almost 26,000 people were seen in the ER for tramadol and by 2011 there more than 27,000, according to SAMHSA. The highest increase in ER visits due to tramadol was among adults 55 and older, the article reports. The reports showed that the increase of tramadol-related ER visits was higher among women than among men.

“Tramadol and other pain relievers can help to alleviate pain, but they must be used carefully and in close consultation with a physician,” said SAMHSA Chief Medical Officer, Dr. Elinore McCance-Katz, in an agency news release.

“Like all medications, tramadol can cause adverse reactions, which can be even more severe if the drug is misused. We must all work to lower the risks of taking prescription drugs,” McCance-Katz said.

“Simple steps such as following directions for use, letting your doctor know if you are experiencing a problem, locking up medications for safe storage, and proper disposal of unused medications are easy steps people can take to help reduce potential harm to themselves and others,” she said.