Tag Archives: treatment

Suboxone Being Sold On the Black Market and May be Stopping Drug Overdoses

When you think of “street drugs,” more than likely the first thing that comes to mind is illegal ones such as heroin. These aren’t the only types of drugs being sold by dealers. Prescription drugs are making their way from medicine cabinets to the street, where they are being sold to users who never had a prescription for them initially. This is not an uncommon practice; however, it has now expanded to include medications normally prescribed to treat drug addiction itself.

Buprenorphine on the Streets

Suboxone is a brand name for one of the addiction treatment medicines used to treat patients for opioid abuse. Another brand name is buprenorphine. Both of these medications contain opioids. They are normally given under a doctor’s orders as part of a medication-assisted treatment program (MAT) that includes counseling with a licensed alcohol and drug counselor or a therapist with experience in this area of practice.

Instead, they are being sold along with drugs designed to give users a “high.” Many people are looking for Suboxone through these channels to try to protect themselves from an opioid overdose. They may also be wanting to get off opioids and are looking for Suboxone to make the withdrawal process easier. Some users try to put together enough of the medication so that they can try to treat their substance abuse issue on their own, which is never a good idea.

One of the Worst Opioid Crisis Cities in US

In Philadelphia alone, more than 1,000 people are dying from drug overdoses annually. This figure pushed the City of Brotherly Love into the dubious category of being the large city with the worst opioid crisis in the US.

In response, city and state officials have taken measures to get more people into drug treatment programs. Along with eliminating the requirements for having insurance company pre-authorizations and having identification, they have set up mobile treatment centers where doctors are issuing prescriptions for Suboxone to patients on the street.

Treatment is still an expensive proposition for those who don’t have Medicaid or private health insurance coverage. People who have lost their health insurance due to a job loss may find themselves at a disadvantage. Some of them bought Suboxone on the street to get off heroin on their own. This is a less expensive option than paying to see a doctor and seeking professional help.





New Laws to Get Addicted and Mentally Ill Into Treatment Are Not Being Enforced

Last year, San Francisco decided to expand its ability to force people who are severely mentally ill and those who are addicted to drugs into treatment. The idea behind introducing court-ordered treatment was to stop the cycle of the most severe cases — “the sickest of the sick” — continually moving and out of the city’s Emergency rooms.

San Francisco’s Homeless Population Tops 8,000

There is no question that San Francisco already has a significant problem with homelessness. The city is finding it difficult to provide services for its current homeless population. Most of its homeless are already living with mental health issues and drug addiction.

Legislation Meant to Apply to Few SF Residents

The legislation was expected to apply only to a small segment of the Golden Gate City’s population. Along with the types of patients mentioned above, another 50-100 people representing a small number among the city’s most vulnerable population, were expected to meet the criteria for court-ordered treatment.

The law has been in effect for a year. To date, no one has been considered for the program. Several public agencies are pointing fingers at each other for the delay in implementing it. The coronavirus pandemic has not helped the situation, either.

Public health officials have said they have the names of approximately 10 people who may qualify for conservatorship (court-ordered treatment). They can’t take any further action because the City Attorney’s Office and the Superior Court must agree on the procedure to file a petition under the new legislation. The Department of Health has said it will support those people under other services in the meantime.

Court Says it is Prepared to Accept Petitions for Treatment

Ken Garcia, speaking on behalf of the court, has said it is ready to accept petitions. None have been filed. Mr. Garcia said that the court is ready to process petitions when they are brought to the court office. He explained that it is not the court’s function to start petitions and that it is unable to do anything until a case is brought before it.

The City Attorney’s Office, for its part, said that it is waiting for the court to approve the process. It stated that this effort has been delayed due to the pandemic.

John Coté, the City Attorney’s spokesperson, explained that his office is working with the court to finalize the procedure. He stated that the City Attorney’s office hopes to have it in place “soon.”

New Law Expands Conservatorship Definition

The new laws expand the definition of “conservatorship” to include people who are addicted to drugs. It also includes those who are severely mentally ill. People in the latter category must have been taken to a 5150 hold (emergency crisis hold) a minimum of eight times. Approximately 630 people are currently in this situation in San Francisco. This figure includes those being treated in residential and outpatient treatment programs.

The program’s critics say that the bar for someone to receive court-ordered treatment is still too high. They point out that there are still more people who are too sick to seek help on their own. The critics also point out that the program’s guarantee that participants will receive housing after completing their treatment is inappropriate in a city like San Francisco which already has an issue with limited housing resources.

Source: https://www.sfchronicle.com/politics/article/Why-SF-s-new-laws-to-force-more-mentally-ill-15318574.php

Food Addictions are Real and More People are at Risk

Compulsive eating can become a dangerous problem in a similar way as abusing alcohol or addictive drugs, according to researchers. In all these instances, the compulsion to use or consume a substance has the potential to become a full-on addiction.

Some Types of Foods Stimulate Brain’s Pleasure Centers

Repeated exposure to sugars, fats, salts, etc., stimulates the brain’s pleasure centers. It creates a feedback loop of craving, indulging, consuming and regretting. This cycle repeats itself the next day, and the next, and so on. If the person continues this cycle in spite of the negative consequences, you have a recipe for addiction.

Research has revealed that approximately 30% of people who try heroin become addicted to the drug. About 16 percent of cocaine users have the same experience. According to a study, when a group of overweight or obese subjects had the definition of addiction explained to them, 29 percent of the subjects said they were addicted to food (Frontiers in Psychiatry).

Over 40% of Americans are obese and 71.5% are considered overweight. These figures suggest an unhealthy relationship with food is common in this country.

No Abstinence Solution for Food Addicts

Food is more subtle than drugs. There is no way that someone with a food addiction can embrace abstinence, since food is essential for life. It would have to be a constant juggling act: Eat a little, without going overboard. Be sure to eat the good stuff and avoid junk food. Sometimes a person will do all the right things, as we all do. There will be days when they binge and make a bad choice about what they eat, just like we all do.

How Dopamine Relates to Pleasure Sensations

Pleasure gets processed in the part of the brain called the striatum. It’s located deep in the midbrain and is rich in D2 receptors, which exist to bind with the feel-good transmitter dopamine. It’s the transmitter that drives the reward system. When a person does something that gives them a sense of satisfaction, dopamine is responsible for the good feeling that follows. It’s also linked to feelings of pleasure around food, intoxication and having sex.

As long as the dopamine levels remain in balance in the striatum, a person’s ability to control their appetite for pleasure will stay in check. They will be able to limit themselves to one piece of cake for dessert or a glass of wine with dinner, for example. If this system starts to blink, such as when too few D2 receptors are in place and too little dopamine is released to engage with them, behavior changes strikingly. It becomes easier to act impulsively, with little thought to the consequences.

Compulsive eaters don’t simply lack willpower or discipline. They have a similar battle on their hands as drug addicts and they need support if they are going to recover.

Opioid Crisis Took a $631B Toll Out of US Economy in Only Four Years: Study

The results of a study conducted by the Society of Actuaries found that the opioid crisis cost the US economy $631 billion from 2015-2018. The largest portion of this cost was attributed to the potential lifetime earnings of people who died due to drugs, with healthcare costs coming in second place.

Governments Suing Drug Companies

More than 2,000 local and state governments have taken drug manufacturers to court over their role in the opioid crisis. They are seeking to recover damages for the cost of first responder services, public health services and more. The results from the report found that the private sector and individuals bear most of the financial cost (more than two-thirds) as opposed to the government (less than one-third).

Financial Costs of Opioid Crisis Difficult to Track

The federal government has been keeping statistics on the number of deaths attributed to opioid abuse. The number has reached 400,000 American lives lost since 2000. Getting a clear figure of the financial cost has been more difficult.

According to a report released by the Centers for Disease Control and Prevention, the cost was $79 billion (2013). This figure is less than half the cost published in the latest report for more recent years. The opioid crisis has also intensified since 2013; fentanyl and carfentanil have contributed to a higher death toll. Opioid-related deaths grew throughout 2017 and stabilized in 2018 at approximately 47,000 lost lives.

According to the actuaries’ report, the opioid crisis will cost approximately $171-$214 billion in 2019. Even the most optimistic prediction puts the cost higher than the 2017 numbers.

Child Welfare, Criminal Justice Costs Up due to Opioids

The new study found that child welfare system and criminal justice costs have increased due to the opioid epidemic. Most of the increased health care costs related to opioid addiction and overdoses were absorbed by Medicaid, Medicare and other types of government programs. The crisis was also responsible for $18 billion in commercial insurance costs in 2018 and lost productivity accounted for an additional $27 billion hit to the economy last year.

New Resource Launched for Recovery Coaches

As more evidence points to long-term engagement being a key factor in permanent recovery rates, people are turning toward outpatient treatment, private therapists, peer support specialists and recovery coaches for help.

For a certain percentage of people struggling with substance use, there will always be a need for residential treatment, and they also still need aftercare programs to help build on the foundation that a treatment program can establish.

Recovery Coaches as a Part of the Continuum of Care

The American Society of Addiction Medicine (ASAM) has various levels of treatment, ranging from high-level medical detoxification to periodic outpatient treatment. People receiving these various levels generally have to meet certain criteria to determine medical necessity, which unfortunately is largely driven by insurance companies. However, there is a greater recognition that continuing on in a setting such as intensive outpatient treatment (IOP) for a period of a few months, then stepping down to regular outpatient for a few more months is improving recovery rates. Other services that improve recovery rates include paraprofessional help through peer recovery support specialists, recovery coaches and sponsors, mentors and support groups. When combined, they add significant value to the overall treatment process.

Now there is a new resource forming just for recovery coaches and these peer support specialists, and its launch coincides with National Recovery Month. Erecoverycoaches.com provides a way for recovery coaches to offer their services directly to people in need, as well as a way for individuals to browse or search for recovery coaches who may be a good fit for them.

It is free to add a listing, and the intent is to grow it into a large, hand-curated resource for recovery coaches nationally.

Ketamine May Help Treat Cocaine Addiction: Study

The results of new research have found that a single ketamine infusion, when combined with mindfulness-based relapse-prevention therapy (MBRP) can be effective in improving abstinence rates in cocaine-addicted adults. This treatment has also been found effective in reducing craving rates.

The results from a randomized control trial conducted by researchers at New York City’s Columbia University Medical Center indicate that abstinence rates were “significantly higher” in patients who received the ketamine infusion and MBRP compared to patients in the control group.

Elias Dakwar, a medical doctor and an associate professor of psychiatry at Columbia University, explained that patients receiving behavioral modification treatment may benefit from certain medications, even if they only receive it one time.

What is Ketamine?

Ketamine is an anesthetic that is used for human and veterinary purposes. It is a dissociative drug, which means its use can cause a distortion of sights, sounds and colors. While under its influence, a person may also misinterpret himself or his environment. Ketamine is used in surgery for general anesthesia and as a pain control drug. Research has shown it may be useful for treating severe depression.

The US Food and Drug Administration (FDA) currently doesn’t approve any medications for treating cocaine use disorder.

Ketamine and Mindfulness Part of Treatment Studied

The researchers pointed out that treating this type of addiction is challenging due to low motivation, high behavioral reactivity and cravings. Ketamine may improve on many of these issues. It may also serve as a stepping stone for mindfulness training for patients.

The researchers assigned 55 participants to two groups in a random manner. All of them were seeking help for cocaine addiction. One group was given a 40-minute ketamine infusion (0.5 mg/kg) or midazolam (an anesthetic used for pre-operative sedation and in surgery) in a five-week trial.

All participants were admitted to a psychiatric research unit for five days. They received an infusion on the second day and MBRP sessions on Days 2-5. After the trial was completed, the participants were referred to follow-up treatment. Six months later, they were interviewed by telephone.

MBRP therapy focused on learning how to be mindful and assimilating this practice into everyday life. It also challenged clients to apply mindfulness when faced with high-risk situations that might trigger a relapse.

Follow-up visits were conducted on a weekly basis starting two weeks after the infusion and ran through the fifth week following the procedure. The participants completed surveys and tests to measure mindfulness, stress sensitivity and cravings.

The researchers found that 92.9 percent of the midazolam group either used cocaine or dropped out, while 57.7 percent of the ketamine group did. At the six-month follow-up interview, none of the participants in the midazolam group had stopped using cocaine. Forty-four percent of the ketamine group were not using cocaine.

The results of the study were published online in the June 24 edition of the American Journal of Psychiatry.


Americans Abusing OTC Meds Along with Opioids: Study

Prescription opioid pain medications aren’t the only drugs being abused by Americans. Over the counter (OTC) preparations are also falling into that category.

The results of a new study conducted by researchers at Boston University School of Health has revealed that close to one in five users of headache remedies like Advil and Aleve doesn’t use the medicine as recommended. They admitted to exceeding the maximum recommended dose during a one-week period.

OTC Medication Use by Consumers Unsafe

People who use too many of these NSAIDs (non-steroidal anti-inflammatory pain relievers) likely won’t be starting on the slippery slope of moving toward heroin use. That doesn’t mean what they are doing is safe.

Dr. David Kaufman, the lead researcher on the study, and a professor of epidemiology at Boston University’s School of Public Health, explained that these drugs can produce serious side effects when taken. Even though they are readily available, it doesn’t mean that consumers can make up their own dose, no matter what the dosing instructions say on the label.

Consumers Don’t Read Medication Packages When Dosing

Consumers’ attitude that they can choose their own dose, no matter what the label states, along with lack of knowledge about dosing limits, is contributing to exceeding the daily limit, according to Dr. Kaufman.

The study was conducted in 2015-2016 by having 1,326 participants keep drug diaries for a week. Participants were, on average, 45 years of age. The majority of them (75 percent) were white, and 60 percent were women.

Most of the study participants (87 percent) took ibuprofen, which is sold OTC under brands like Motrin or Advil. Thirty-seven percent of the participants reported they took other NSAIDs like Aspirin or naproxen, such as Aleve.

Chronic Pain Patients More Likely to Take Higher Doses

The study results showed more than 15 percent of the study participants took too many of the pills at least one day of the week. Participants who live with chronic pain were even more likely to take more than the recommended dose.

When asked whether non-prescription pill abusers were trying to avoid taking opioids, Dr. Kaufman replied he didn’t think that scenario applied in this instance. He said that avoiding opioids may influence prescribing behavior for physicians, but it may not have a similar effect on consumers.

Appetite May Be Linked to Cocaine Addiction

Scientists are constantly looking at and investigating different areas of the brain that the medical community knows little about. And in a new study, released by researchers at the National Institute on Drug Abuse, shows an interesting area of the brain that may be responsible for cocaine addiction. They found that an area of the brain that is responsible for appetite and alertness, may also be the same mechanism that promotes the urge to use cocaine.

Each part of the brain is responsible for certain functions necessary for life. The hypocretin/orexin (HCRT) system of the brain exists to ensure that a person is driven to eat enough and also stay alert. This same part of the brain may also be compelling cocaine addicts to continue to seek out the dangerous drug.

This phenomenon was discovered after researchers observed rats that were given access to cocaine and how their brain, specifically the HCRT system, reacted. They found that rats who had allowed to self-administer cocaine for an hour (a relatively short amount of time) did not have this part of the brain taking over. However, rats that were allowed to self-administer cocaine for six hours (a relatively long period of time) did display an overreaction of the HCRT. They then administered blocking medication designed to target this part of the brain. The rats who were exposed to cocaine did not have any reaction to the medication, but the rats that been using cocaine for six hours had a positive reaction. These rats stopped compulsively seeking cocaine.

Researchers are hopeful that this study will pave the way for some sort of medication that would target the HCRT system of the brain in long term cocaine addicts and allow them to get some relief from the compulsive drug-seeking behavior that is usually present.

“The results of this study would suggest that the hypocretin system could be considered a pharmacological target, with the hopes that a medication designed to target hypocretin receptors could be used in combination with cognitive behavioral therapies as part of a cocaine abuse treatment strategy,” explained Dr. Schmeichel, lead author of the study.

Study Indicates Racial Disparity in Drug Charges

As part of a continuous effort to increase drug treatment and education and reduce the amount of people incarcerated due to drug offenses, a study was conducted to examine racial disparity among people with drug charges. Performed by the Oregon Criminal Justice Commission, the results show that African-Americans were twice as likely to be convicted of drug charges than white people.

What makes this information interesting is that research shows that black and white people appear to use drugs equally. So, if the same amount of black people and the same amount of white people are using drugs, why are black people more likely to be jailed because of it?

This is a question that Governor Kate Brown wants answered. Requesting the study was the first step in determining how to effectively help addicts, while eliminating the one-sided punishment. Brown has offered a proposal in order to close the race gap and help addicts attain long lasting sobriety. The proposal includes dropping some drug possession felonies to misdemeanors and focusing on treatment rather than incarceration. These policies and interventions are newer to the state of Oregon, but there has been a noticeable shift across the country. More and more people are realizing that treatment is much more effective than jail time.

In agreement with Brown, other public officials are speaking out against the racial disparity uncovered by this recent study. “Everyone who uses or possesses (illicit drugs) has committed that crime. Whether or not they are caught is completely different,” explained State Criminal Justice Commission Director Mike Schmidt. Additionally, the Multnomah County District Attorney is also working to reduce the amount of jail time addicts receive and instead replace the sentence with court-mandated, effective treatment.

As a growing number of public officials understand that prisons are not an effective substitute for quality treatment, it is likely that more substance abusers will get a chance to redeem themselves, and return to their families, jobs, friends and lives.