Unintended Consequences: The Potential for Opioid Misprescribing Due to Healthcare Reform and Parity
The Office of National Drug Control Policy (ONDCP) Policy Meeting on Treating Substance Use Disorders addressed access, recovery, and the Affordable Care Act, focusing on the entry of previously uninsured substance abusers into the medical system. It is estimated that approximately 10 million new patients have been added to the healthcare rolls in 2014; about 10% of them are estimated to be substance abusers. One of the unintended consequences of the increased access to the medical system by substance abusers will likely be inadvertent misprescribing of opioids by physicians unfamiliar with addiction assessment. This will escalate the legal debate on [...]
Why We Relapse
Relapse in the treatment of alcoholism is common—but not inevitable—for several reasons, including post-acute withdrawal symptoms, stress, and the fact that recovery programs are voluntary, and most importantly because it is easy to forget that addiction is a fatal disease. Post-Acute Withdrawal When we stop using drugs or alcohol, we enter an acute withdrawal phase of withdrawal, the first stage, if the quantity and frequency of use were sufficient enough to produce symptoms. Acute withdrawal symptoms, which often can last 7 to 10 days, usually not longer than a few weeks, are mostly physical and vary depending on the person and the drug. [...]
Death by Pain Killers: The Government Weighs In
In an effort to respond to this ongoing rise in abuse of opioids, the Substance Abuse and Mental Health Services Administration (SAMHSA) recently published a guide for physicians on medication-assisted treatment for opioid dependence in the outpatient office setting. Many addicted patients are very reluctant to seek inpatient treatment. It is estimated that 80% of patients suffering from an opioid use disorder receive no treatment. The reasons for not getting care for this potentially deadly problem include limited treatment facilities, stigma associated with being “an addict,” and the high cost of detox and rehab treatments. The federal government believes one strategy [...]
What It Means to Trigger Addiction
Certain circumstances, including sights, sounds, tastes, and smells, can trigger our senses and our memory banks to tap into the files in our past and recall those incidences where drugs were used to make us feel a certain way. Enormous happiness, elation, celebration, devastating sadness, isolation and loneliness, anger, and exhaustion—these can trigger our memories and put us in a state of stress. The triggered brain will seek out the old drug, the old behaviors, old friends, and old locations in search of that set of circumstances or substances that will relieve us. Addiction triggers can be very obvious—the sound [...]
Drug Addicts and Their Families Are Showing the Way to a Better National Drug Policy
Drug addicts’ stories are infinitely varied and specific, but they have a near-universal common core. Each addict’s tortured journey begins with “experimenting”—using drugs with friends who use the same drugs. It starts out with no problems. This innocent flirtation progresses, sometimes rapidly, sometimes slowly, into an abusive chemical love affair as drug-caused problems emerge and grow. As dishonesty enters addicts’ lives, they seek to hold onto their abusive chemical lovers without losing their relationships with family members and others who care about them—all of whom, sooner or later, become concerned about the negative changes in the addicts’ lives caused by [...]
How to Live One Day at a Time: Acceptance
In a previous piece I discussed Awareness, being conscious of what is happening around us and inside us. In Twelve-Step recovery, awareness is noticing when our behavior is being driven by a character defect (such as dishonesty) rather than a spiritual principle (such as honesty). When we are aware of our behaviors and the motivations behind them (character defects or spiritual principles), we can make efforts to rectify a situation. We can also make a pretty accurate Tenth step inventory and ask our Higher Power to remove these character defects so we can start the day with a clean slate. [...]
LSD: Bad Trips, Pseudo Hallucinogenic Perception Disorder, Flashbacks
The psychoactive qualities of lysergic acid diethylamide, first synthesized in the 1930s, were first reported by Dr. Albert Hofmann of Sandoz Pharmaceuticals in Switzerland in 1943. Although some psychiatrists initially felt that LSD might have therapeutic value, military and intelligence agencies conducted experiments to determine its potential for more global purposes. Its desirability as a recreational substance came to the forefront in the mid-1960s, leading to its being forced underground as a Schedule I drug. LSD has not gone away, however. Thousands, if not millions, of individuals have used the drug, most prominently the followers of the Grateful Dead and other “jam [...]
How to Live One Day at a Time
Awareness. Awareness is being conscious of what is happening around us and inside us. When we’re walking down the street and are aware of our surroundings, we are conscious of businesses across the street, of the people walking behind us. We’re aware of the expressions on people’s faces, aware of whether it’s sunny or cloudy, warm or cold. On the inside, we are conscious of our feelings. Did something we just think or do, see or hear make us feel shameful, resentful, angry, or hurt? Or do we sense that something we said or did made someone else feel shameful, [...]
Should the Government Repeal Restrictions on Buprenorphine/Naloxone in the Short-Term, Not the Long-Term?
There is a plethora of research indicating opioid dependence can be successfully treated with either buprenorphine alone or with buprenorphine in combination with naloxone (Suboxone®; Subsolve®). However, we encourage caution in long-term maintenance using these drugs, even considering the lack of any other FDA approved opioid maintenance compound to date. Our concern has been supported by severe withdrawal experience by patients from low dose of buprenorphine, alone or with naloxone (even with tapering of the dosage of for example buprenorphine, which is 40 times more potent than morphine). In addition, our findings of a long-term flat affect in chronic Suboxone® [...]
Exercise and Recovery: Stress Reduction
The importance of stress reduction cannot be overstated when addressing the management of these disorders. Stress results from a number of sources and is a bio-psycho-social phenomenon. It can be treated by a number of interventions, including medications, psychotherapy, exercise, meditation, hypnosis, and other nonpharmacologic strategies. A critical stress reduction strategy is sleep. Sleep is essential for normal cognitive functioning. We all know how poorly we feel after a poor night’s sleep. The body cannot function at its highest level without restful sleep. Sleep deprivation leads to psychotic thoughts and significant alteration in our ability to think clearly. It has [...]
