How to Win America’s Fight Against the Opioid Epidemic

Every day, an astonishing 115 Americans die from opioid overdoses, according to a 2017 report from the Center for Disease Control and Prevention. Approximately half of these deaths are due to the misuse or abuse of prescription opioid painkillers (such as Vicodin, Oxycontin, and morphine). Beyond that, increasingly, deaths come from overdoses of the illicit drugs heroin and fentanyl, which are often used after people become addicted to or misuse prescription opioids.

Each day, more than 1000 people are sent to the emergency room for prescription opioid misuse. In many of these cases, opioids were used along with alcohol or medications meant to treat anxiety or seizures (such as Xanax, Ativan, and Valium). When people ingest such mixtures, they face a heightened risk of injury or death as their breathing slows or stops.

Effective treatments exist. But as treatment for over-dosing is increasingly available, treatment for addiction is still not accessible to many of those who need it. Access to effective treatments for opioid addiction is the missing piece in America’s unsteady fight against the opioid epidemic.

Success in Fighting the Opioid Epidemic

Gains in the fight against the opioid epidemic have been made on several fronts. The physicians and nurse practitioners who prescribe America’s medications are being trained to be more judicious in their use of opioids to treat pain. They are also learning to consider, whenever possible, non-opioid medications and other treatments that don’t come from a pharmacy at all. National guidelines have been established for methods of relieving surgical, cancer-related, and chronic pain without opioids. Taken together, all these efforts are saving lives and reducing the volume of prescription opioids that can be diverted to illicit uses.

Similarly, emergency first responders and trained laypeople now have tools to help prevent deaths from opioid overdoses. Lives have been saved in many communities by the administration of naloxone – a medication which blocks the effects of opioids on breathing centers and reverses overdoses.

But what happens after emergencies – or to prevent them? Treatments for addiction can reduce the likelihood that people addicted to opioids will overdose and die. And such treatments are vital because, like any other chronic illness such as diabetes or heart disease, untreated addiction becomes more severe and resistant to treatment over time.

The Missing Piece – Access

What most of America is sorely missing, however, is sufficient access to the addiction treatments that are the most effective – and not enough efforts are currently underway to increase such access. Currently, the best estimates suggest that only one out of every ten patients seeking drug abuse treatment can actually get into a program. To sharply reduce U.S. opioid deaths, proven forms of treatment should be readily available, on demand, to all who need them. Policymakers, civic leaders, patient advocates, and journalists, should consider the following steps:

  • Treatment and reimbursements should be evidence-based. Research shows that the most effective approach is medication-assisted therapy (MAT), where patients are given methadone, buprenorphine, or naltrexone, alongside therapy to combat addiction. Too many private payers pay for treatments based on mistaken ideas. For example, detoxification is known to be highly ineffective against opioid addiction, yet it is widely practiced and reimbursed.
  • Insurance and other reimbursement systems need to acknowledge that addiction is a chronic disease that almost never goes into remission after a one-time treatment. Treatment for addiction needs to be ongoing and long-term, just like treatments for diabetes or heart disease. But currently most health insurance companies will only cover one treatment episode or a fixed number of treatment days per year.
  • Early, intensive treatment is the most effective and less costly over time. Currently, most insurance companies will only cover outpatient treatment for opioid addiction, and will only reimburse intensive inpatient treatment if the first effort fails. Evidence shows that in many cases, the opposite approach would work better: start with intensive treatment rather than with minor steps that allow time for the disease to progress.
  • Many opioid addicts could be treated within America’s current primary care systems. Two effective medications, buprenorphine and naltrexone, can be prescribed by primary care providers. With appropriate waivers, for instance, a physician can treat up to 100 patients with buprenorphine.
  • Medications need to be supplemented with therapy. Because most primary care clinicians do not have the resources or practice partners to provide the therapies patients need in addition to medications, they often limit the number of addicts they treat or avoid treating them altogether. The answer lies in making behavioral health providers more readily available to work with primary care providers, who could then prescribe effective medications more readily.
  • Patients brought to hospitals for opioid addiction and overdose should be enrolled in therapy and other treatment on the spot. Many patients with opioid addiction end up in hospitals and emergency rooms. The current approach is to stabilize them medically and then tell them, as they are discharged, to seek further treatments. But many do not follow up or have adequate access to the help they need. A better approach would be to start treatment while addicts in crisis are at the hospital – and directly transfer them to an addiction treatment facility upon discharge.
  • Jails and prisons are other places where opioid addicts need treatment. Efforts to bring medication-assisted therapy to the incarcerated could mitigate the larger opioid crisis – and also reduce the rate at which ex-inmates commit new offenses and cycle back to prison.

The bottom line is clear: Increasing access to proven treatments for all addicts who need them would save and improve countless lives, and effectively counter America’s current opioid crisis.

How to Support Someone Going Through Heroin Detox

Going through heroin detox can be a grueling experience. Before the individual enters a heroin detox treatment program, they have already started going through some horrible withdrawal symptoms. By the time they are ready to enter a treatment program, their body has endured a tremendous amount of strain and pain, and their psyche has taken a toil making them very vulnerable to relapse if not cared for appropriately.

Not only is their detox treatment vital; so too is the support from their loved ones, and this can be challenging especially for those who don’t understand what heroin is, what it does, and what heroin detox treatments consist of. If you have a loved one who is fighting for his or her life by trying to get off drugs and enter a heroin detox program, you can best support them by understanding what they are going through. Some basic education will help you be a great support system, and help your loved one get back onto a path of normalcy and healthy living.

What does Heroin do to the Human Body?

The impact heroin has on the human body depends on how much is injected, where the drug binds in the body (or brain), how long it sticks, how strong it is, the rate of speed it takes to bind, and what happens afterward. When heroin is used it clings to certain receptors in the brain called mu-opioids. Once it affixes, it activates these receptors causing a massive sensation of pleasure.

The human brain contains naturally produced chemicals called neurotransmitters that fuse receptors that regulate hormone-release and pain. This all takes place in “the reward center” of the brain, where dopamine is released. When natural dopamine is mixed with external opioids like heroin, that high a person experiences is amplified by massive proportions. According to the National Institute on Drug Abuse, the greatest increase in heroin use is seen in young people aged 18-25. Unfortunately, many young adults can see themselves as invincible and don’t consider the various consequences heroin can have on their health, their life, or on their mortality. When a person takes heroin, their breathing and heart rate slows down–in some cases to the point it can be life-threatening.

What Makes Heroin So Addictive?

Heroin is a very addictive opiate because it actually changes the neurochemical activity in the brain which alters the state of one’s sensation and overall feeling while creating profound degrees of physical dependence and tolerance. Opiates cause pleasure by targeting various regions of the brain and nervous system–giving instant pleasure, both physically and emotionally, on tap. An opioid like heroin alters activity in the limbic system–a part of the brain that controls emotion. Pile this on top of the fact it blocks pain signals being delivered through the spinal cord, and one experiences a state of pleasure that becomes instantly addictive.

Your Loved One’s Behavior is Still Obnoxious after Heroin Use

Supporting a loved one going through heroin detox can be challenging, as much of their bad, obnoxious behavior can still be present. Here are some things to keep in mind: repeated use of heroin causes long-term imbalances that are very difficult to reverse because of the brain’s physiology and physical structure changes.

According to a study on white matter impairment in chronic heroin dependence, W. Li and others discovered that the brain’s white matter deteriorates due to heroin use, and that one’s decision-making abilities, the capacity to regulate behavior, and how one responds to stress is affected. Therefore, if your loved one is having massive mood-swings, says inappropriate things, and acts irrationally, know that the aftermath of this drug has simply dug its talons this deep into the user, and now it is up to a heroin detox treatment to gently and lovingly reverse as much damage done as possible by bringing the person back to their normal self.

Give Support by Finding a Heroin Detox Treatment Program

One way you can support your loved one going through heroin detox treatment is to do some research in looking for the best programs available. You simply can’t lock someone in a room and slide food and water through a window, as movies like ‘Trainspotting’ would like you to think. Coming off heroin can be life-threatening and extremely painful, which is why finding the best heroin detox program is vital to your loved one’s ability to have a happy and healthy future.

Heroin detoxification treatment centers use specific drugs to shorten the timespan of opiate withdrawal syndrome. Even with these drugs, patients still experience various degrees of pain, and the road to recovery is still harsh and often hard for loved ones to witness. When looking for various heroin detox treatment centers, here are some questions worth asking:

  • What accreditations does the facility hold?
  • Are medical resources immediately available?
  • Is there a pre-admission evaluation focused on protocol?
  • What are the safety standards and guidelines?
  • Are there multiple detox options to accommodate a variety of patients?
  • How long is the inpatient care program?
  • What is the post-detox recovery care?
  • What procedures are used to make the detox more humane?

By investigating programs and learning more about why they are successful, you can be of tremendous support to your loved one by helping him or her get on the best path to a full recovery.

More Ways to Support Someone through Heroin Detox

Love and ongoing support is crucial to recovery. Here are some ways in which you can show your loving support through their journey to a bright, promising future:

Write a Letter – Writing a letter to someone expressing your love and support is good therapy for you, and it is an ideal thing for the patient to have because they can look at it whenever they need some additional motivation to get them through hard times. If the person has wronged you, avoid being judgemental or calling them out in the letter. There will be a time to confront them, but when they are focused on detoxing is not the ideal moment. Once the detox treatment is complete and the person enters the next phase of recovery, you could write a second letter praising them for making it through the detox, and then confront them on the pain they caused. This way they can deal with the reality of what they did in the next step of their treatment plan which often involves coming to terms with the past.

Build Confidence – Be their cheerleader. Let them know how you have always admired them, acknowledge what they are going through must be very difficult, and let them know you recognize their bravery for undertaking the journey. Saying things like, “I am proud of you for embarking this huge step” and “I respect you for wanting to get clean and be the best version of you” will help empower and drive the person to keep up the good work.

Trophy – A trophy is given to someone to acknowledge and honor them for being victorious. You don’t have to go out and get an actual trophy; instead, create your own “trophy concept” by giving the person a special gift as a way to honor them for being victorious thus far in their recovery. For example, if the person loves to write you could get them a fancy pen with an engraved message on it, and a leather-bound journal. Tell them the pen is their trophy for completing phase one of a very challenging task, and the journal is their platform for writing reflections, celebrating the little victories they experience every day, and writing down their game plan and goals for a fruitful future.

Emphasize Self-Care – In many cases people going through certain phases of heroin detox treatment will be so haunted by the pain they caused loved ones that they don’t focus on themselves. Let your loved one know that self-care is crucial to a full recovery. Let them know that putting themselves first is not at all selfish, but healthy and necessary to their recovery. Let them know you are there to give support, but they need to support themselves at the same time.

Supporting a loved one going through heroin detox treatment means you also need to support yourself. If you aren’t getting enough sleep, eating right, or taking care of your own needs, you won’t be at full strength to be a strong pillar of support. Also, if you are worn down your loved one will likely notice, and enhanced guilt on their part may surface thus slowing down their recovery.

Compassion, forgiveness, and understanding–these are the tenants of supporting a loved one going through heroin withdrawal, and these core components can also be used to help you get through the emotional rollercoaster of watching from the sidelines.

The Challenges of Coping with the Addiction of Someone You Love

As I have gone through the drama, tragedy, stress and shame that comes along with watching a loved one battle addiction, I have finally grown to understand that addiction is not merely a lack of willpower accompanied by a series of horrible decisions. I have had such a misunderstanding of addiction that I have needed to educate myself, if only to better understand the affliction. What I learned is that I have work to do in order to learn how to cope with her addiction.

There are many myths about drug addiction. In order to not add to the problem and to help myself make good choices, I dedicated myself to learning about the disease. I discovered that opioid addiction, which my sister suffers from, and it is considered to be one of the 5 largest public health concerns facing our nation. I learned that addiction is not just a weak-willed response to adversity, but a disease that is often developed along with mental health issues.

My learning wasn’t merely acquiring information about addiction. I was forced to confront my inability to cope with my sister’s addiction, and the challenges that it created for me. Most of what I had to understand was counter-intuitive and went against my nature. For example, I found it nearly impossible, at first, to maintain strict boundaries. I have always felt the need to provide and protect this person, and I learned that doing so wasn’t helping. This was a brutal realization. By ‘helping’ I was prolonging the necessary “bottoming out” that is ugly and brutal, but critical.

In order for an addict to truly take the steps towards recovery, they often need to feel like they have exhausted their options, otherwise, their addiction poisoned mind will continue to manipulate and bargain to maintain substance abuse. This was difficult to accept, because I love my sister and know the part of her who wasn’t manipulative or duplicitous. But that version of my sister was lost in a cocktail of drugs and alcohol that wouldn’t allow her to surface until she had no other choice. I worried that she might die, considering 78 people die every day in America from opioid addiction.

After several stints in rehab centers and the hospital, she is doing much better. She is clean and appears to be committed to her sobriety. But life has a funny way of testing one’s resolve. She just had an MRI and discovered that she has a torn ACL. She will have surgery and the tear, although complete, is repairable. The problem is that it is a significant surgery, which will require pain killers after the surgery is done. This will require her case worker and all of us who care about her to become familiar with the signs and dangers of her using opioids to deal with the pain. There is an array of complex treatments for pain, but the addiction must be constantly and vigilantly monitored, otherwise we risk sending her back into a severe usage spiral.

This is similar to what happened with people like former San Diego Chargers’ quarterback Ryan Leaf, who is now in prison for stealing painkillers because he became addicted due to the violent repercussions of playing football. Then he seemed to have his addiction under control, but needed surgery to remove a tumor. He vowed to have the operation without anesthesia due to his addiction, but now he is doing a seven year sentence as a result of his crimes.

Now my research has pivoted to the topic of helping my sister stay sober, without enabling her and allowing her to have a necessary operation to fix her knee. What the knee surgery seems to do is pile on to the complex and confusing circumstances that accompany addiction. I feel like this is new territory, and I have no experience to draw from.

But, I have learned that I need to keep growing. I now go to Alanon meetings and continue to ask questions because my first instinct is to help which may be the wrong response. There probably are no perfect responses in this complex process, but working to be more effective with the steps I take is critical. Otherwise, I am part of the problem and not the solution.

Addiction: Treat the Parent – Treat the Child

40-years-of-the-war-on-drugs_51fe10028e876_w1500

This past week has seen a report from the London School of Economics that has looked at the impact of the war on drugs. What they found is that it has been a miserable failure around the world. From an economic perspective, the war has cost billions but the supply of drugs is cheaper and better quality while rates of usage has not been impacted. The time for a conversation about drugs as a health problem seems to be at hand.

Addiction is one of the most common problems for families that come to the attention of child protection. The Substance Abuse and Mental Health Service Administration in the United States estimates that about one out of every ten children live with a parent who has a substance abuse or substance dependence problem. Michelle Kelley and her colleagues at Old Dominion University point out that fact in some new research.

We also know that children exposed to greater amounts of chronic substance abuse tend to have more emotional, behavioral, social, academic problems than their non-exposed peers. They also have a 2-4 times greater risk of developing their own substance abuse problems.

This is a major health concern. Yet, it is often not treated as such. The National Academies have just released a report that shows that the United States incarcerates more people for drug offences than any other country in the world. In general, from the 1920’s to the early 1970’s saw stable rates of incarceration. But as the war on drugs began, the rates quadrupled. Drugs became a criminal as opposed to a health issue.

Sadly, many drug users resort to fairly low levels of crime in order to sustain the drug habit. But, they also get caught and end up jailed. Too many of those people are parents. Yes, it is true that drug use exposure for children is negative but so too is the loss of a parent to the prison system.

Knowing the negative impacts on children, when we are able to focus on rehabilitation services for the parents, we can too often ignore the needs of the children. They too need therapy. The research by Kelly and colleagues identified that most parents will consent to their children also getting treatment.

There is a lot of good research that shows addiction is really a family disease. Thus, we should treat the family. A parent entering rehabilitation seems like the perfect opportunity for us to pay attention to the needs of the other family members, including the children.

It might also be remembered that, if the parent is sent to jail, there may be less focus on the health issues, particularly for the children. The research published this last week should allow us to think again. It should also cause child protection to ensure that case planning with these families should have specific treatment objectives for the children.

Exit mobile version