What are the Different Drugs Used for Heroin and Opioid Detox?
Understanding Heroin and Opioid Detox When someone is struggling with addiction to heroin or opioids, it can be almost impossible to quit cold turkey. This is due to unpleasant withdrawal symptoms, as well as intense drug cravings. When someone quits cold turkey, they will have to experience all these debilitating withdrawal symptoms and manage strong cravings on their own. This is extremely hard to do without the assistance of medication during heroin and opioid detox. According to Medline, about 948,000 people used heroin during the past year. In the same year, about 11.5 million people were nonmedical users of narcotic ...
Source: Cliffside Malibu - May 8, 2019 Category: Addiction Authors: Jaclyn Uloth Tags: Addiction Addiction Recovery Addiction Treatment and Program Resources Detox Resources for Alcohol and Drugs/Opiates Painkiller Substance Abuse drug detox heroin heroin addiction heroin users luxury heroin rehab medical medical det Source Type: blogs

Libertarians and Harm Reduction
Last week we held a day-long  conference at the Cato Institute devoted to exploring the strategy known as “harm reduction” to address the rising rate of drug overdose deaths and the spread of infectious diseases, such as hepatitis and HIV.  In my remarks at the beginning and at the conclusion of the conference, I pointed out that the harms afflicting the drug-using community and their intimate contacts are the direct result of drug prohibition. Cato ’s Jeffrey Miron emphasized that point in a key presentation and discussed the success Portugal has had in reducing overdose deaths, HIV, hepat...
Source: Cato-at-liberty - March 26, 2019 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs

For Those Who Are Serious About Increasing Access to MAT for Opioid Use Disorder …
The synthetic opioid methadone, developed in Germany in the 1930s for the treatment of severe pain, has been employed for the Medication Assisted Treatment (MAT) of heroin addiction and opioid use disorder since the 1960s. In the US, methadone clinics are tightly regulated by the Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration.  Patients receiving methadone to treat their addiction must ingest it under the observation and supervision of clinic staff, who keep it in a lock box. Eventually, patients are permitted to take a few doses home with them for use over the weeken...
Source: Cato-at-liberty - February 25, 2019 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs

Sometimes, the biggest challenge to eliminate health disparities is geography
Driving north in a snowstorm Tuesday of Thanksgiving week I certainly took my time. I left after our Suboxone clinic wrap-up conference, around 7:30 p.m., and arrived at my unplowed driveway in Caribou about 1 a.m. On the way up, I saw two ambulances, one from Caribou and one from Presque Isle, on their way […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - January 29, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > Hans Duvefelt, MD < /a > < /span > Tags: Physician Primary Care Source Type: blogs

Can exercise help conquer addiction?
As an athlete, I think regularly about the potential health benefits of exercise for my patients. Every week, I treat patients hospitalized at Brigham and Women’s Hospital with significant medical problems that are a direct result of severe addiction, ranging from seizures and strokes to heart valve and joint infections. I also care for outpatients at the Brigham and Women’s Faulkner Hospital Addiction Recovery Program. In both settings, I provide medication-assisted treatment (MAT) such as buprenorphine-naloxone for opioid use disorder, and extended-release naltrexone for both alcohol use disorder and opioid u...
Source: Harvard Health Blog - December 26, 2018 Category: Consumer Health News Authors: Claire Twark, MD Tags: Addiction Exercise and Fitness Health Source Type: blogs

Creating recovery-friendly workplaces
People who work in manual labor have higher rates of injury and overdose Our country’s ongoing opioid crisis has many faces, from teenagers on Cape Cod to middle-aged parents in West Virginia. A recent report from the Massachusetts Department of Public Health provides another demographic affected by opioids: people who work in the trade industries, namely construction. The report broke down overdose deaths by industry, and construction workers were involved in almost a quarter of overdose deaths recorded in the state over five years. Farming, forestry, and hunting, along with fishing, are the next most dangerous indu...
Source: Harvard Health Blog - December 6, 2018 Category: Consumer Health News Authors: Zev Schuman-Olivier, MD Tags: Addiction Source Type: blogs

No Let Up On The Bad News About Overdose Deaths
The National Center for Health Statistics (NCHS) just issued  Data Brief Number 329, entitled “Drug Overdose Deaths in the United States, 1999-2017.” Drug overdose deaths reached a new record high, exceeding 70,000 deaths in 2017, a 9.6 percent increase over 2016. That figure includes all drug overdoses, including those due to cocaine, methamphetamines, and benzodiazepines. The actual breakdown according to drug category will be reported in mid-December. However,  estimates are opioid-related deaths will account for roughly 49,000 of the total overdose deaths. The big takeaways, quoting...
Source: Cato-at-liberty - November 29, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs

Suboxone for pain makes sense. Why don ’t more doctors prescribe it?
Many patients who end up in Suboxone treatment have chronic pain. They were originally prescribed other opiates and ended up addicted to them. Skeptics argue that is just substituting one opiate for another. But that isn ’t quite accurate. More on that in a bit. In my seven years of prescribing Suboxone for opiate addiction, I […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 19, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Meds Pain Management Primary Care Source Type: blogs

What is Detox and How Long Should It Take?
What is detox? Detox is the very first step of recovery once someone enters treatment. When you have been abusing a substance for a period of time, your brain becomes chemically re-wired to depend on this substance. When the substance is no longer in your body, withdrawal symptoms begin. This is also known as being “dope sick” or “hungover”, and a quick way to get rid of those withdrawal symptoms is to provide the body with the substance again. However, instead of providing the body with the substance, detox works to comfortably wean the client from the substance and essentially rewire the brain bac...
Source: Cliffside Malibu - October 29, 2018 Category: Addiction Authors: Jaclyn Uloth Tags: Addiction Addiction Recovery Addiction Stories Detox Resources for Alcohol and Drugs/Opiates Drinking Drug Rehab Information Drug Treatment Medical Substance Abuse anxiety in withdrawal medicated-assisted detox Source Type: blogs

Does addiction last a lifetime?
I am now 11 years into recovery from my battle with opiate addiction, and I have always been fascinated with two related questions: is there truly such a thing as an “addictive personality,” and do people substitute addictions? The myth of the addictive personality The recently deceased writer and television personality Anthony Bourdain was criticized by some for recreationally using alcohol and cannabis, in what was seemingly a very controlled and responsible manner, decades after he quit heroin and cocaine. Was this a valid criticism? Can a person who was addicted to drugs or alcohol in their teens safely hav...
Source: Harvard Health Blog - October 8, 2018 Category: Consumer Health News Authors: Peter Grinspoon, MD Tags: Addiction Alcohol Medical Research Source Type: blogs

Opioid cheating is a billion-dollar industry
If you search for “how to pass a urine drug test” on the internet, you will get several million results. As physicians, we see and manage the national opioid crisis every day. We see the impacts of this in our practices and our lives. The crisis frankly shows no signs of abating or becoming a less critical issue. Unfortunately, one major reason for our inability to control this issue might be in the testing. Most patients in the throes of addiction or recovery require regular urine testing as part of their treatment (which is much more common than blood, hair or saliva) and that has unfortunately led to widespr...
Source: Kevin, M.D. - Medical Weblog - September 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/giri-venkatraman" rel="tag" > Giri Venkatraman, MD, MBA < /a > Tags: Conditions Medications Nephrology Source Type: blogs

What Makes Cliffside Better
Our Approach Cliffside Malibu is a world class luxury drug and alcohol treatment center. We want you to recover for good, and we do that with seven major factors. 1. We Stand By Our Commitment To Your Success. Our main goal is: We only want you to come to treatment once. 2. We Recognize The Root Cause Of Addiction As Pain/Trauma. Most treatment programs are based on the 12 Step Model. While 12 Step programs have largely been the go-to way to recover from addiction for over 75 years, the model does not address the underlying causes of addiction. While we use 12 Steps as an adjunct to other forms of therapy, we work to help ...
Source: Cliffside Malibu - August 25, 2018 Category: Addiction Authors: Jaclyn Uloth Tags: Addiction Addiction Recovery Addiction Treatment and Program Resources Alcohol Rehab Information Complementary Therapies Detox Resources for Alcohol and Drugs/Opiates Drug Rehab Information Drug Treatment Holistic Treatment Protocols Sob Source Type: blogs

Medically-Assisted Detox with an Onsite Addictionologist
What is Medicated-Assisted Detox? Medicated-Assisted Detox is the use of medications under supervision of an addictionologist to help treat the symptoms of detoxification from substance use disorders including opioids, alcohol abuse and more. Detoxification is often the most uncomfortable and most feared process of recovery. Cliffside Malibu takes great care in ensuring that this process is as comfortable and stress-free as possible. Detoxing is one of the very first steps in the recovery process. Once the body has become dependent on a substance for a long period of time, their brain can become chemically altered to requi...
Source: Cliffside Malibu - August 25, 2018 Category: Addiction Authors: Jaclyn Uloth Tags: Addiction Addiction Recovery Addiction to Pharmaceuticals Addiction Treatment and Program Resources Alcohol Rehab Information Alcoholism Detox Resources for Alcohol and Drugs/Opiates Drinking Drug Rehab Information Drug Treatment Medic Source Type: blogs

Tapering off Buprenorphine or Suboxone, Pt 2
In the last post we discussed some of the misconceptions about tapering off opioids.  Today we will discuss a couple basic principles, and then describe the approach I recommend for my patients tapering off buprenorphine. Opioids act at receptors that normally bind endorphins, which are released by neurons in response to a range of stimuli including trauma and rewarding behaviors such as eating a good meal or using addictive drugs.  Endorphin pathways elevate mood, reduce sensation of pain, and impact urine production, immune function, intestinal motility, and other bodily functions.  Endorphin pathways have...
Source: Suboxone Talk Zone - August 15, 2018 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine pharmacology receptor actions Suboxone Withdrawal opioid tolerance stopping suboxone suboxone detox Suboxone taper tapering off buprenorphine Source Type: blogs

Tapering Off Buprenorphine or Suboxone pt. 1
Many patients taking buprenorphine live in fear of a dark world around the corner where they will have to taper off the medication.  They see horror stories on YouTube posted by people who, for some reason, abruptly stopped the medication and kept a video log of their experiences.   My own patients sometimes ask, nervously, if I plan to retire some day.  Some have asked what they should do if I ever, say, drop dead. It needn’t be all that bad.  Yes, sudden discontinuation of a typical dose of buprenorphine will result in withdrawal symptoms.  But if you taper correctly, your body will sl...
Source: Suboxone Talk Zone - August 8, 2018 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Buprenorphine receptor actions Suboxone Withdrawal buprenorphine treatment opioid taper stopping suboxone Suboxone withdrawal Source Type: blogs

Americans Fighting the Opioid Crisis in Their Own Backyards
Credit: New York Times article, Jan. 19, 2016. The United States is in the midst of an opioid overdose epidemic. The rates of opioid addiction, babies born addicted to opioids, and overdoses have skyrocketed in the past decade. No population has been hit harder than rural communities. Many of these communities are in states with historically low levels of funding from the National Institutes of Health (NIH). NIGMS’ Institutional Development Award (IDeA) program builds research capacities in these states by supporting basic, clinical, and translational research, as well as faculty development and infrastructure impro...
Source: Biomedical Beat Blog - National Institute of General Medical Sciences - August 1, 2018 Category: Research Authors: Chris Palmer Tags: Pharmacology Medicines Opioids Pain Source Type: blogs

The other side of Suboxone
A lot has been written about Suboxone, the buprenorphine treatment drug. For many, Suboxone acts as an effective medication to treat opioid addiction. For others, it’s a highly-valued street drug that is commonly diverted and misused. To understand and acknowledge the darker side of Suboxone we have to look back at its history over the past 16 years. History of Suboxone Suboxone was first approved by the FDA in 2002 to treat opioid addiction in office-based opioid treatment programs. Prior to Suboxone, the only opioid treatment drug available was methadone, which could only be obtained from an opioid treatment progra...
Source: Kevin, M.D. - Medical Weblog - July 29, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/dennis-wichern" rel="tag" > Dennis Wichern < /a > Tags: Meds Pain Management Psychiatry Source Type: blogs

The satisfaction of Suboxone treatment
My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound. Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my medication-assisted treatment (MAT) patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma, and various infectious diseases. Years ago, working in a mental health clinic, we had strict rules to defer everything to each patient’s primary care provider that wasn’t strictly related to Subo...
Source: Kevin, M.D. - Medical Weblog - July 17, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Pain Management Primary Care Psychiatry Source Type: blogs

My Triple Aim of Medication Assisted Treatment for Opioid Addicted Patients
by HANS DUVEFELT, MD My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound: Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my MAT patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma and various infectious diseases. Years ago, working in a mental health clinic, we had strict rules to defer everything to each patient’s primary care provider that wasn’t strictly related to Suboxone treatme...
Source: The Health Care Blog - July 11, 2018 Category: Consumer Health News Authors: matthew holt Tags: Patients Small Practice Opioid Addiction Opioid crisis Treatment Source Type: blogs

ResQ is Using Games to Fight Opioid Addiction: Interview with Dr. Paul Glimcher
Earlier this year at the Health 2.0 WinterTech Conference, the Robert Wood Johnson Foundation (RWJF) and Catalyst @ Health 2.0 launched the RWJF Opioid Challenge, an initiative aimed at bringing together healthcare and technology innovators to solve a growing epidemic of addiction in the United States. A panel of 19 judges evaluated 97 initial submissions based on innovation, scalability, and overall design and intuitiveness of the solution, resulting in five semifinalists. Resilience IQ (ResQ) Hey, Charlie Luceo/Canary App Sober Grid HashTag Preparation for Phase 2 of the competition is underway with final submis...
Source: Medgadget - June 14, 2018 Category: Medical Devices Authors: Michael Batista Tags: Exclusive Medicine Net News Pain Management Psychiatry Public Health Rehab Source Type: blogs

HEAL Initiative | National Institutes of Health (NIH)
In April 2018, NIH launched the HEAL (Helping to End Addiction Long-term) Initiative, an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis. This Initiative will build on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with Medication-Assisted Treatment (MAT) for opioid use disorder (OUD). Successes from this research include the development of the nasal form of naloxo...
Source: Psychology of Pain - June 12, 2018 Category: Anesthesiology Source Type: blogs

Addiction Treatment ‘Science’ and Dead Rats
In my last post I teased that I would write about fake science.  I’ll try to make it interesting. The internet allows everyone to do research about symptoms and treatments for any condition. If not for need for prescriptions, people could act as their own doctors.  But a huge dose of caution is necessary before anyone takes that path. Realize first that doctors don’t treat themselves or even their family members.  The saying that ‘a person representing himself in court has a fool for a lawyer’ applies double in healthcare.  Treating someone close to one’s self introduces a ...
Source: Suboxone Talk Zone - May 23, 2018 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Education Pharma pharmacology Research treatment alcohol treatment fake science FDA approval nutritional supplements Source Type: blogs

PrEP: Protection against HIV in a pill?
HIV (the human immunodeficiency virus) weakens the human immune system and destroys the important cells that fight disease and infection. A person can get HIV when bodily fluids — including blood, semen, pre-seminal fluid, rectal fluids, or vaginal fluids of a person with the virus — come in contact with a mucous membrane or damaged tissue. HIV can be transmitted through breast milk, or when a contaminated needle or syringe comes into direct contact with the bloodstream. There is no cure for HIV, but with proper medical care the virus and its effects can be controlled. HIV transmission can be reduced by consist...
Source: Harvard Health Blog - May 18, 2018 Category: Consumer Health News Authors: Meera Sunder, MBBS, MRCOG Tags: Health HIV Infectious diseases Source Type: blogs

Buprenorphine, Not Subbies
I’ve been writing longer and longer posts on SuboxForum so maybe I need to write more here.  This blog archives twelve years of frustration over the ignorance toward buprenorphine, at least until I ran out of steam a year ago.  I grew used doctors refusing to treat people addicted to heroin and other opioids.  I became used to the growth of abstinence-based treatment programs, even as relapse rates and deaths continued to rise.  It isn’t all bad news; I enjoyed the past couple meetings of AATOD, where people openly spoke about medication-assisted treatments without hushed voices.  ...
Source: Suboxone Talk Zone - April 9, 2018 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine recovery Suboxone treatment addiction treatment stigma subs Source Type: blogs

Help for Heroin Addiction
A couple comments for regular readers…  first, watch for an upcoming change to a new name.  For years I’ve debated whether to adopt a name centered on ‘buprenorphine’, rather than the more-recognizable ‘Suboxone’.  I believe that time has come.   Second, I’m going to ‘reset’ with some introductory comments about the proper approach to treating heroin addiction, intended for those who are seeking help – starting with this post. I’m addicted to heroin.  Which treatment should I use? I’ve treated heroin addiction in a range...
Source: Suboxone Talk Zone - March 27, 2018 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Clean Enough treatment addiction treatment Buprenorphine heroin addiction medication assisted treatment Methadone Source Type: blogs

The Other Opioid Crisis: Hospital Shortages Lead To Patient Pain, Medical Error
I came across this public-accesss story, and wanted to share the perspective: Pauline Bartolone, Kaiser Health News Even as opioids flood American communities and fuel widespread addiction, hospitals are facing a dangerous shortage of the powerful painkillers needed by patients in acute pain, according to doctors, pharmacists and a coalition of health groups. The shortage, though more significant in some places than others, has left many hospitals and surgical centers scrambling to find enough injectable morphine, Dilaudid and fentanyl — drugs given to patients undergoing surgery, fighting cancer or suffering traumat...
Source: Suboxone Talk Zone - March 26, 2018 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Acute Pain Anesthesia Public policy surgery Chronic pain opioid addiction Source Type: blogs

CARA 2.0 Introduced by Bipartisan Group of Senators
A bipartisan group of senators have introduced legislation framed as a follow-up bill to the Comprehensive Addiction and Recovery Act (CARA) of 2016. Dubbed CARA 2.0, the bill includes a combination of policy changes and increased funding authorizations that seek to restrict access to opioid-based painkillers and boost access to addiction treatment, including establishing a three-day initial prescribing limit on opioids for acute pain and aiming to increase the availability of treatment. The legislation was introduced by Sens. Rob Portman (R-OH), Sheldon Whitehouse (D-RI), Shelley Moore Capito (R-WV), Amy Klobuchar (D-MN),...
Source: Policy and Medicine - March 14, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Politicians Cannot Stop Punishing Patients for the Unintended Consequences of Drug Prohibition
It seems no amount of evidence can make political leaders disabuse themselves of the misguided notion that the nation ’s opioid overdose crisis is caused by doctors getting patients hooked on prescription opioids. A group of eight senatorsunveiled the CARA(Comprehensive Addiction and Recovery Act) 2.0 Act on February 27, targeting the opioid crisis. It would impose a 3-day limit on all opioid prescribing for patients in acute and outpatient postoperative pain.But the movement to restrict prescriptions is not evidence-based, as prominent experts havepointed out. The politicians base their proposal on the 2016 opioidgu...
Source: Cato-at-liberty - February 28, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs

The Agony of Withdrawal
​Part 3 in a Four-Part Series​A 26-year-old man presented with fatigue. He complained of body aches, diarrhea, and nausea. His history was significant for chronic back pain, for which he had been prescribed oxycodone that he has taken daily for three years. He reported that he had stopped taking it two days before his visit.He denied other medication or drug use. He was alert but restless and diaphoretic. His ECG showed sinus tachycardia. His labs included a WBC of 12, Hgb of 12, glucose of 89 mg/dL, creatinine of 1.0 mg/dL, sodium of 140 mEq/L, potassium of 3.8 mEq/L, and CK of 140 U/L. He was experiencing opioid with...
Source: The Tox Cave - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Psychology Around the Net: February 17, 2018
Hello, Psych Central readers. For this week’s Psychology Around the Net, we’re diving into vibes and what causes us to feel them, how we can use our emotions to cause positive environmental change, ways to help children better understand and practice mindfulness, and more. I’ve chosen to not address the school shooting at Marjory Stoneman Douglas High School in Parkland, Florida in this week’s Psychology Around the Net, as many of our Psych Central writers have already and are continuing to do so. I encourage you to browse our latest blog posts for our team’s insights. How Real Are Vibes: Th...
Source: World of Psychology - February 17, 2018 Category: Psychiatry & Psychology Authors: Alicia Sparks Tags: Addiction Children and Teens Depression Disorders Green and Environment Mindfulness Psychology Around the Net Recovery Research Substance Abuse Technology Buprenorphine Environmental Threats language Obsessive Behavior selfie Source Type: blogs

What ’s our goal with opioid treatment?
When I started treating opioid dependence, I began with high expectations. I was frustrated with what had become a mindless, ineffectual exercise in providing medication for chronic pain. I saw too many patients “circling the drain” on opioids. Most admitted they still had chronic pain despite their high consumption of opioids. Many patients needed their medication just to feel normal and avoid withdrawal. Others wished they could stop taking opioids but were unable to tolerate severe cravings in addition to withdrawal. Getting off opioids seemed impossible. Instead of being part of the solution, I felt like I ...
Source: Kevin, M.D. - Medical Weblog - February 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/layne-kamalu" rel="tag" > Layne Kamalu, MD < /a > Tags: Physician Pain Management Primary Care Source Type: blogs

The ghost in the basement
Follow me on Twitter @BillEduTheater We are fortunate to have a country home in the Catskills where we can escape city life. An eight-year-old neighbor often crosses our meadow or bikes over to stop by for a visit. While I’d like to think I’m the featured attraction, his visits are not just to see me; of much greater interest is our basement with its shelves of toys and games. Particularly appealing to this lad is the sports equipment: hockey sticks, goalie pads, a goal to shoot on, baseball mitts, a batting helmet, a catcher’s mask, soccer balls, and more. Name the sport and it is most likely we have equ...
Source: Harvard Health Blog - January 12, 2018 Category: Consumer Health News Authors: Bill Williams Tags: Addiction Health Source Type: blogs

Stop Calling it an Opioid Crisis--It's a Heroin and Fentanyl Crisis
The National Center for Health Statisticsreported last month that a record 63,600 deaths occurred in 2016 due to overdoses. Diggingdeeper into that number shows over 20,000 of those deaths were due to the powerful drug fentanyl, more than 15,000 were caused by heroin, and roughly 14,500 were caused by prescription opioids, although it has been known for years that, inmost cases of prescription opioid deaths, the victims hadmultiple other potentiating drugs onboard. The rest of the deaths were due to methamphetamines, cocaine, benzodiazepines, and methadone.Drugs Involved in U.S. Overdose Deaths* - Among the more than 64,00...
Source: Cato-at-liberty - January 8, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs

Comparing medications to treat opioid use disorder
This study was widely covered in the press, and many of the sound bites and headlines reporting the two treatments to be equally effective were a bit misleading. The advantages and disadvantages of buprenorphine (Suboxone, Subutex, Zubsolv, Probuphine, Sublocade) Buprenorphine is a partial opioid agonist medication. This medication activates the same receptors in the brain as any opioid, but only partly. Because its effects are long-lasting, it can be taken once a day to relieve cravings, prevent withdrawal, and restore normal functioning in someone with opioid use disorder. Because it is a partial agonist, it has a ceilin...
Source: Harvard Health Blog - January 3, 2018 Category: Consumer Health News Authors: Sarah Wakeman, MD, FASAM, Medical Director, Massachusetts General Hospital Substance Use Disorder Initiative Tags: Addiction Health Source Type: blogs

Narcan or Narcan’t?
​Part 2 in a Four-part Series​A 57-year-old man presented with acute onset altered mental status. His family said he had been behaving normally. Prior to dinner, however, he became difficult to arouse, and was speaking gibberish. He was somnolent but arousable to physical stimuli on arrival in the ED.He answered questions inappropriately and would then go back to sleep. His past medical history was consistent with hypertension, hypercholesterolemia, and spinal fusion a month ago. His medications included lisinopril, atorvastatin, and hydrocodone. His vital signs were a blood pressure of 110/65 mm Hg, heart rate of 90 b...
Source: The Tox Cave - January 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Are family physicians the best weapon against opioid crisis?
As the national opioid crisis takes center stage, I want to make a case for the authority of the family physician in managing and treating this problem. I am a family physician and have been treating patients with opioid dependence and addiction for 12 years. These patients comprise about half of my practice. The other half is representative of a typical primary care practice. I have patients who have been treated at methadone clinics, dedicated buprenorphine clinics and pain clinics. My patients have participated in hospital-based detox programs as well as outpatient and inpatient rehabilitation programs. Most of my patie...
Source: Kevin, M.D. - Medical Weblog - December 31, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/layne-kamalu" rel="tag" > Layne Kamalu, MD < /a > Tags: Physician Pain Management Primary Care Source Type: blogs

If we are serious about addressing the opioid epidemic, this is what we should do
Multiple state leaders, including Maryland Gov. Larry Hogan, and even President Trump have declared states of emergency in response to the opioid epidemic. Policymakers claim to be battling this public health crisis on all fronts, but one arena continues to be conspicuously ignored: our prisons and jails. Roughly half of all incarcerated individuals suffer from addiction. And in the two weeks following their release, former prisoners are 129 times more likely to die from overdose than members of the general population. This is despite the fact that we have robust evidence showing that we can decrease the incidence of relap...
Source: Kevin, M.D. - Medical Weblog - December 1, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/justin-berk" rel="tag" > Justin Berk, MPH, MBA < /a > Tags: Physician Emergency Medicine Primary Care Public Health & Policy Source Type: blogs

Naloxone: An important tool, but not the solution to the opioid crisis
In this study, we aimed to define how many patients who were treated with naloxone by an ambulance crew and initially survived were still alive after one year. Even though these patients are typically just observed in the ED hallway, allowed to sober while the ED staff is busy taking care of other patients with life-threatening emergencies like heart attacks, trauma, and strokes, our team hypothesized that the individual sobering in the hallway bed has perhaps one of the highest one-year mortality rates of anyone seen in the department. Here’s how the study worked — and what we found To perform the study, we to...
Source: Harvard Health Blog - November 30, 2017 Category: Consumer Health News Authors: Scott Weiner, MD Tags: Addiction Health naloxone Source Type: blogs

The Opioid Commission: Ringing The Right Alarm To Respond To The Overdose Epidemic
The 20-year opioid overdose epidemic confronting our nation has continued unabated largely because of an uncoordinated response that has over emphasized supply-side interventions (i.e. prescriber guidelines, Prescription Drug Monitoring Programs, law enforcement) rather than dramatically increasing access to evidence-based treatment as occurred in other Western nations with great success. The White House’s Opioid Commission (chaired by Governor Chris Christie, R-NJ) in declaring a national emergency and breaking with this failed tradition offers much hope for stemming the overdose death rate. The Opioid Commission&rs...
Source: Health Affairs Blog - August 21, 2017 Category: Health Management Authors: Arthur Robin Williams and Adam Bisaga Tags: Featured Public Health Quality Opioid Addiction opioid epidemic Source Type: blogs

Missing the Point of Buprenorphine Treatment
A forum reader wrote about concerns over a partner on buprenorphine.  Her concerns pointed out a common misperception about the goals of treatment of opioid use disorder using buprenorphine, or using methadone for that matter. Her question, amended for privacy: I married the love of my life.  He is still he love of my life but has been an addict for 15 of them. Our children have been greatly affected by his addiction.  He made promise after promise that he was clean, and I dove back in with complete faith time after time only to get burned. His addiction started with recreational pills increasing over time, ...
Source: Suboxone Talk Zone - June 17, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine Suboxone treatment buprenorphine treatment opioid taper rapid detox Suboxone taper Source Type: blogs

Safe injection sites and reducing the stigma of addiction
Imagine a chronic medical condition in which the treatment itself has serious side effects. Examples of this are plentiful in medicine. For example, in diabetes, giving too much insulin can cause hypoglycemia (low blood sugar), a dangerous and potentially life-threatening condition. That doesn’t happen very often, but imagine that it was a common complication of treating diabetes because doctors couldn’t really tell how powerful a given dose of insulin actually was. And suppose that doctors and patient safety experts advocated for places where patients with diabetes could be carefully monitored when taking thei...
Source: Harvard Health Blog - June 2, 2017 Category: Consumer Health News Authors: Scott Weiner, MD Tags: Addiction Behavioral Health Brain and cognitive health Mental Health Pain Management Source Type: blogs

Treating addiction: Rewriting patients ’ country songs
Jimmy spent 10 years on the street chasing oxys and heroin. He lost his family and friends after lying and stealing. He lost his truck when the bank repossessed it. He lost his four-year-old son to the Department of Child Protective services. His life was like a country song. Now a member of our suboxone group, Jimmy has two years of sobriety under his belt, he is enrolled at the local community college, and coaches his son’s soccer team.  It was his turn to check in and share with the group how his week went. “Well,” he began in his calm, melodic voice, staring at his hands as he talked. “Me a...
Source: Kevin, M.D. - Medical Weblog - June 1, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/randi-sokol" rel="tag" > Randi Sokol, MD, MPH < /a > Tags: Physician Pain management Source Type: blogs

Opioid addiction: Long-term treatment for a chronic condition
In 2015, motor vehicle accidents claimed the lives of more than 35,000 Americans. Sadly, the toll exacted by motor vehicle accidents has now been eclipsed. Data from the American Society of Addiction Medicine show that more than 52,000 of we Americans lost our lives to opioid overdose in 2015. Here in the Commonwealth, the story is even more grim; even accounting for differences in average age from community to community — younger people are still more likely to be affected than older people — the opioid overdose death rate has climbed to 23 per 100,000 residents as compared to 9 per 100,000 for the nation as a...
Source: Harvard Health Blog - May 5, 2017 Category: Consumer Health News Authors: Glen Buchberger, MD Tags: Addiction Behavioral Health Brain and cognitive health Drugs and Supplements Source Type: blogs

Brandeis and CDC Wrong on Buprenorphine PDMP Data
I’ll share an interesting story about the data used for the prescription drug database in Wisconsin and other states.  I’ve been holding back on writing about this issue in hopes that the reason for the story would be corrected, and I would have no story to tell.  But that hasn’t happened. A new law in Wisconsin requires all prescribers to check the prescription drug database when prescribing any controlled substance.  I’m surprised that no privacy advocates have complained about the database, which tells prescribers about the controlled substances used by their patients over the past...
Source: Suboxone Talk Zone - April 28, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine pharmacology Public policy risks Brandeis University CDC drug database PDMP Source Type: blogs

Is Suboxone Potent?
We get about 5000 readers of SuboxForum per day who ask question, provide answers, or share their experiences with buprenorphine medications. If you’re a patient on buprenorphine, consider joining us. It is free, and you’ll find help for starting buprenorphine, tapering off the medication, and everything in between.  Or if you’re a buprenorphine prescriber consider joining to see what patients are doing and thinking, and to help answer their questions! Yesterday someone wrote about the high potency of buprenorphine. He also wrote that it is hard to get off buprenorphine medications. I ended up writin...
Source: Suboxone Talk Zone - April 27, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Source Type: blogs

Ten Gripes of Buprenorphine Doctors
I recently gave a lecture to medical students about opioid dependence and medication assisted treatment using buprenorphine, methadone, or naltrexone. I was happy to see their interest in the topic, in contrast to the utter lack of interest in learning about buprenorphine shown by practicing physicians. In case someone from the latter group comes across this page, I’ll list a few things to do or to avoid when caring for someone on buprenorphine (e.g. Suboxone). 1. Buprenorphine does NOT treat acute pain, so don’t assume that it will. Patients are fully tolerant to the mu-opioid effects of buprenorphine, so they...
Source: Suboxone Talk Zone - March 25, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Acute Pain Addiction Buprenorphine Chronic pain Suboxone surgery buprenorphine stigma Source Type: blogs

Where ’s the Buprenorphine asked Mr. Obvious? Thanks, CDC!
A quick note tonight, hopefully with a longer post to follow this weekend… I’ve been frustrated by the people behind the Wisconsin PDMP, or Prescription Drug Monitoring Program, for their mistakes related to buprenorphine. Whoever came up with the numbers made a rookie error when calculating the equivalent morphine dose of patients taking buprenorphine products. The error is easy to notice by anyone who works with the drug, but apparently difficult to grasp by anyone with the power to correct the database figures. Those people include, by the way, the folks at Brandeis University who give the numbers to Wiscon...
Source: Suboxone Talk Zone - March 22, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Benzos Buprenorphine pharmacology Public policy risks benzodiazepines CDC PDMP Source Type: blogs

A primary care doctor delves into the opioid epidemic
Our nephew Christopher died of a heroin overdose in October 2013.1 It had started with pain pills and experimentation, and was fueled by deep grief.2 He was charismatic, lovable, a favorite uncle, and a hero to all the children in his life. His death too young was a huge loss to our family. I have always felt that I didn’t do enough to help prevent it, and perhaps, in a way, even contributed. Good intentions with unintended consequences My medical training took me through several big-city hospitals where addiction and its consequences were commonplace. Throughout all of it, great emphasis was placed on recognizing &l...
Source: Harvard Health Blog - February 20, 2017 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Addiction Behavioral Health Source Type: blogs