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.
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.
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.
Many in the field of addiction are familiar with the term “doctor shopping,” the act of going to multiple doctors to obtain the multiple prescriptions of the same medication – such as OxyContin ® (oxycodone), a highly addictive opioid narcotic. While prescription drug monitoring programs have made it more difficult for addicts to engage in doctor shopping, it is still possible for people to engage in what’s called “pharmacy shopping” – using multiple pharmacies at the same time in order to obtain more medication than a patient needs.
A new study suggests that patients who engage in pharmacy shopping are at an increased risk of opioid overdose deaths, HealthDay reports. The researchers found that patients who used four pharmacies within 90 days had the highest risk of overdosing.
The records of more than 90,000 Medicaid recipients aged 18 to 64, who were long-term users of narcotic painkillers, were analyzed by researchers. The Medicaid patients involved in the research had used three or more narcotic prescriptions for 90 days from 2008 to 2010, according to the article.
The researchers point out that that there are legitimate reasons for using more than one pharmacy, such as:
- Changes in Insurance Coverage
In many states, in order to deter prescription drug abuse, Medicaid programs track the number of pharmacies a patient visits, the article reports. When a patient’s pharmacy records are not tracked, it is possible to fill multiple prescriptions for the same drug. The overlapping of opioid prescriptions was associated with higher overdose rates.
The study authors note that it has not been determined how many pharmacies or how much time should occur between prescriptions, for a patient to be considered a pharmacy shopper.
The study is published in The Journal of Pain.
If you are currently struggling with opioid addiction, such as prescription drugs or heroin, and are in need of help, please do not hesitate to contact Harmony Foundation to begin the journey of recovery. Harmony is a state-of-the-art, affordable, residential addiction treatment program located in the Rocky Mountains.
Addiction and recovery news provided by Harmony Foundation.
A straight-A teenager from Ohio died from ingesting pure caffeine. Currently it’s not closely regulated or banned, but many people want others to know how dangerous it can be.
Logan Steiner, 18 years old, died suddenly days before his graduation from a lethal dose of caffeine powder. His autopsy showed he had more than 70 micrograms of caffeine in his blood.
Superintendent Jay Arbaugh said, “he was just a terrific kid, he was a role model for the Special Olympic athletes, they loved having him there.”
State Senator Gayle Manning said she is looking into if taking steps to regulating caffeine powder would be advantageous.
Only 1 teaspoon of caffeine powder is equivalent to 30 cups of coffee.
Lorain County’s Coroner Stephen Evans, MD. said, “this is news to the coroner’s office; we had never seen this before. What it does is, it leads to cardiac arrhythmias, speeding heart, and it leads into seizures and those two things are what took his life.”
Evans believes caffeine powder should be taken more seriously and closely regulated. He said the powder can be abused just like any other drug.
Many young people, athletes, and students use the caffeine powder to give them more energy. Many do not even know it could be dangerous.
Companies say its powder elevates mood, endurance, and increases focus.
Any substance we put into our bodies should be closely monitored. Many people have no idea anyone could overdose and die from caffeine, but it is possible. It’s also possible to overdose and die from alcohol, or illegal drugs.
Most people who take drugs or drink do not intentionally overdose. Alcohol poisoning happens when there is so much alcohol in the bloodstream, the brain controlling basic life-supporting functions like breathing, temperature control, and heart rate start shutting down.
Symptoms of alcohol poisoning include seizures, difficulty breathing, slow heart rate, dulled responses, and no gag reflex, which prevents people from choking.
Blood alcohol content (BAC) can rise even when a person is unconscious. The alcohol in peoples stomach and intestines continues to travel through the bloodstream and circulate through the body.
Drug overdose can be similar to overdosing on alcohol. Symptoms include abnormalities in vital signs like blood pressure, temperature, heart rate. Skin can be dry and hot or cool and sweaty. They can have abdominal pain, vomiting, or nausea.
California is now following the footsteps of Colorado and other states that allows the use of naloxone or Narcan, an FDA approved, non-addictive drug that prevents heroin overdose.
California Governor Jerry Brown signed Assembly Bill 635 into law, which took effect on January 1st of this year permitting the use of naloxone by non-medical professionals across the state. Just this week, Gil Kerlikowske the White House Director of National Drug Control Policy highlighted the effectiveness of naloxone as one of many attempts to limit the rise of heroin abuse and overdose in the US. Currently, more than 100 overdose deaths occur from heroin abuse in the US each day. The death of Philip Seymour Hoffman last week was one of an estimated 700 that occurred that week.
Naloxone works by preventing both heroin and addictive opiate pills like OxyContin and percocet from binding to receptors that are responsible for recessing breathing. Heroin overdose deaths occur when breathing has slowed down until it has stopped entirely. By injecting patients with naloxone, emergency rooms and emergency workers have reversed an estimated 10,000 overdoses.
Colorado, and now California, have permitted access to naloxone by those most likely to need it where it can prevent overdoses – such as drug users, addiction counselors and family members of addicts. They are allowed to administer the drug without any criminal or civil liability. Colorado Gov. John Hickenlooper signed Colorado’s version of the bill – Senate Bill 14 – into law in May 2013.
Naloxone essentially puts out the fire for those in active addiction on the brink of an overdose. Harmony Foundation’s drug detox and drug rehab program helps heroin and prescription pill addicts extinguish their active addiction in general, so that they no longer live in fear of overdose. If you or a loved one is at risk of an overdose, our Colorado addiction treatment program can help lay the foundation of recovery and abstinence – lowering the risk of overdose or the need for naloxone.
For many recovering addicts, the tragedy of Philip Seymour Hoffman was a humbling reminder that no matter how many years someone has sober, the disease is still there – doing proverbial “pushups” and that relapse is never off the table.
The disease of addiction progresses even when addicts are not using, which is hard for addicts and others to wrap their minds around until they hear real life tales of how this happens. Hoffman’s story is a very real life example of this: police reported to several news agencies they found 5 empty bags and 65 additional bags full of heroin in his apartment the night he died. He got sober in his early 20s, remained sober for 23 years and just a few years later overdosed with heroin in extreme excess. This is a classic case of the disease doing push ups and progressing even after laying dormant for over 20 years.
Sentiments of sadness spread through sober communities across the US after his death along with those of frustration over the varying public opinions on what addiction is, many of which were expressed in a way that suggested addicts purposefully choose their demise. It makes those in recovery want to tell the world how it really is – but then they harness the principals of the program and let the opinions of others live and let live.
Aaron Sorkin who is in recovery from addiction wrote a poetic piece yesterday for Time that shed some light on addiction and relapse in response to varying opinions. He said Hoffman wasn’t acting on choice; “He didn’t die because he was partying too hard or because he was depressed — he died because he was an addict on a day of the week with a y in it” – suggesting that when the disease of addiction is active, it doesn’t matter what day of the week it is or what sentiments surround substance abuse, it just takes over everything, including lives, because it is real.
Because we understand the disease of addiction, its progression and the reality of relapse, Harmony Foundation specializes in relapse prevention and treatment. We help addicts identify the triggers that can lead to a relapse and welcome those who have relapsed back into our care. We try to intervene before tragedy strikes and lay our hearts heavy when it does. Our hearts, thoughts and prayers go out to Philip Seymour Hoffman and his friends and family and all others who have lost their lives to this terrible disease.
|Amy Tryon (USA) on Poggio (Photo credit: LarsAC)|
We have all heard that addiction does not discriminate, or that drugs are “equally opportunity destroyers” and that becomes more evident as breaking news stories reveal the prescription opiate overdoses of many from actors to uniformed professionals to Olympic medalists.
Amy Tryon, who died of an opiate overdose last month, happened to be both a uniformed professional and an Olympic equestrian medalist. Tryon rode for the U.S. Equestrian Team at the 2004 Athens Olympics where the U.S. team won a bronze medal. In 2008, she competed at the Beijing Olympics. When she wasn’t training, she worked for Eastside Fire and Rescue in her hometown near Seattle, WA.
Riding took a toll on Tryon as she suffered knee and back injuries for which she was reportedly prescribed pain medication. The medical examiner’s office in Seattle, WA released a toxicology report yesterday indicating that Tyron died of an acute combined opiate overdose, which included Oxycodone.
The percentage of those addicted to pain medications in the US is soaring and deaths from prescription painkillers have now reached epidemic levels. Nearly 15, 000 people die every year of overdoses involving prescription opiates, making the number of overdose deaths from prescription opiates greater than those from heroin and cocaine combined. Access to prescription opiates contributes to the problem, as reports indicate that in 2010 enough prescription painkillers were prescribed to medicate every American adult around-the-clock for a month.
The access to this highly addictive drug and propensity toward accidental overdoses has resulted in numerous tragic stories like that of Amy Tryon. If you or a loved one is struggling with a prescription opiate addiction, there is help. Since addiction does not discriminate, neither does the ability to overcome addiction through drug treatment.