All About Medications for Opioid Use Disorder—In One Place

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In the face of our national opioid crisis communities across the United States are taking notice and taking action. They’re proactively addressing opioid misuse, opioid addiction, and overdose deaths by distributing naloxone nasal injectors to counteract overdoses, contriving ways to move individuals treated for overdoses directly into treatment, and making treatment for opioid use disorder (OUD) more accessible. Treatment for OUD has several potential components, one of which is use of three FDA-approved OUD medications: Methadone, buprenorphine, and naltrexone. Use of medication to treat opioid addiction has been controversial since the 1960s when methadone was first shown to help individuals addicted to heroin. But controversy is being replaced with acceptance as OUD medications are increasingly recognized as a potent tool to combat the opioid crisis. Treatment Improvement Protocol (TIP) 63 released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in February 2018, Medications for Opioid Use Disorder, is...
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It’s Not the Rehab—It’s the Relationships!

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Individuals in active addiction sometimes say, “I don’t need another rehab, I could teach those groups.” Outpatient counselors sometimes say, “So-and-so isn’t doing well: S/he needs to go to rehab.” The first position discounts the value of addiction rehabilitation by equating it with the content of psychoeducational groups. The second elevates its value to that of a panacea for faltering recoveries. Rehabs—and, for that matter, outpatient addiction treatment programs that incorporate similar elements—are neither of these. Research has consistently shown that psychoeducation provides little or no benefit to those seeking addiction recovery. But interpersonal connection, such as an alliance with an empathic therapist, provides even more benefit than the actual method of treatment employed by the therapist. The wisdom of spirituality as well as the findings of science indicate that the way of recovery is not alone. Essential tasks for those seeking addiction recovery are to make sufficient lifestyle changes...
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What’s Behind the Addiction Crisis in Rural America?

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People in rural America are dying from drug overdoses at a faster rate than Americans who live in other parts of the country, and opioid poisonings in rural counties are increasing at more than three times the rate of increase in urban counties. Why are rural Americans being hit so hard by the opioid crisis? While many factors contribute to substance misuse and addiction in rural regions of states such as Kentucky, Maine, and West Virginia, several are linked to the recent social and economic decline of rural communities. The dawn of the 21 st century brought dramatic and rapid transformations in American rural life. The Great Recession took a significant toll on rural areas where employment dropped and has not yet returned to pre-recession levels. And rural job growth has lagged well behind urban job growth since 2011. Further, economic globalization and the relocation of production jobs overseas caused...
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In Ontario, Individuals with Alcoholic Liver Disease Will Not Have to Wait Six Months for Liver Transplants

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Ethical principles stand behind healthcare providers who withhold medical treatments that are “futile or pointless.” But withholding treatment can be controversial. For example, the family of a gravely ill patient might not agree with professionals that an unproven treatment is futile. Even when scientific evidence in favor of a treatment accumulates, medical practitioners can be slow to embrace it. In Ontario, Canada, Debra Selkirk combined scientific reports with her powerful personal story, seeking to overturn the rule that individuals with advanced alcoholic liver disease must demonstrate six months of abstinence from alcohol to be eligible for a liver transplant. Debra shares her account of that process below. Mark Selkirk died on November 24, 2010 from liver failure caused by alcohol use disorder.  He was never assessed for a liver transplant because he had not been alcohol-free for 6 months, a restriction placed on alcoholic liver disease patients (ALD) around the world....
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“It all comes down to your choices.”

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“It all comes down to your choices,” said a man in his fifties as he completed treatment following a brief return to drinking lots of alcohol. In the company of supportive peers and an empathic treatment team, this man had immersed himself for three weeks in mindfulness practices structured by Acceptance and Commitment Therapy (ACT). He also maintained connections with his sponsor and Alcoholics Anonymous. The man recounted how an offer of alcohol—made amid physical, interpersonal, and financial stressors—precipitated his most recent drinking episode. Similar situations had instigated previous binges. In the future, he plans to minimize exposure to stressors and drinking opportunities. When stressors or alcohol are unavoidable, he anticipates choosing to notice them without reacting in ways that conflict with his values. “Personal responsibility” for “choices” protects his paramount value, sobriety. Such clarity is too rare. Many others with addiction—and people around them—would do well to adopt this...
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Suffolk County: Highest Rate of Overdose Deaths in New York State

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Opioid misuse and overdose deaths in the United States have been rising for two decades. Between 2000 and 2013, the opioid overdose rate—among all ages, races, genders, and ethnicities—nearly quadrupled, increasing from 0.7 to 2.7 deaths per 100,000 individuals. Drug overdose is now the single greatest cause of unintentional deaths in America. Suffolk County, in downstate New York, has been hit particularly hard. With 337 heroin-related deaths between 2009 and 2013, Suffolk County reported more such deaths than any other county in New York State. And in 2014, the age-adjusted opioid-related death rate in Suffolk County was 12.6 per 100,000, compared to the New York State average of 7.2 per 100,000. This article explores why Suffolk County residents are at greater risk for overdose deaths and, more important, how they are now protecting themselves. The Community Suffolk County occupies the easternmost two-thirds of Long Island. Its population size of 1.5...
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Untreated Early-Life Trauma – Missed Opportunities, Lost Lives

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Several years ago, a colleague asked me what I thought about his “four months and done” buprenorphine treatment program. He believed that virtually all people with opioid use disorders could “learn” how to stay drug-free in that time. All his patients were titrated to an effective dose in the first weeks, maintained for the first two months, and tapered off over the next two months. He offered anecdotal evidence of the success of his approach, but it became clear that most of those he tapered simply disappeared. He had no meaningful data, even in the short term. I asked him whether he took a trauma history when his patients initially presented, and he had no idea what I was talking about. I am an individual in recovery as well as a treatment professional, and I have treated tens of thousands of patients with addiction. Most of those patients, when questioned,...
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Prescription for the Nation

Prescription for the Nation
Most healthcare professionals promote the well-being of one individual at a time. Those who work in public health, however, promote the well-being of groups of individuals. The U.S. Public Health Service and the rest of the U.S. Department of Health and Human Services (HHS) promote the well-being of overlapping groups that taken altogether represent the entire population of the United States. Individuals do not always collaborate with healthcare providers. For example, only about 50 percent of patients with chronic diseases take their medications as prescribed. It remains to be seen whether the population of the United States will collaborate with HHS’s current initiative to protect the well-being of the Nation. In November 2016, HHS released FACING ADDICTION IN AMERICA: The Surgeon General’s Report on Alcohol, Drugs, and Health . Reports from the Surgeon General are not routine government publications. They address serious threats to the health of the population (e.g.,...
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ADHD—Focus on Adults

ADHD—Focus on Adults
Attention Deficit Hyperactivity Disorder (ADHD) is a condition characterized by inattention, disorganization, and/or hyperactivity-impulsivity that consistently disrupt a person’s activities and relationships. According to DSM-5 (p 32), “Inattention and disorganization entail inabil­ity to stay on task, seeming not to listen, and losing materials, at levels that are inconsistent with age or developmental level. Hyperactivity-impulsivity entails overactivity, fidgeting, in­ability to stay seated, intruding into other people's activities, and inability to wait—symptoms that are excessive for age or developmental level.” This conception of ADHD is relatively new, although literature of the past 200 years depicts individuals who might meet current criteria for ADHD. In 1844, for example, German psychiatrist Heinrich Hoffman created a children’s story about Fidgety Phil (“Zappelphilipp”). In 1902, English pediatrician George Still described children with an “exaggeration of excitability” whose behavior was so disruptive that he considered them to have a defect of moral control. In 1937, Rhode Island...
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Hope & Caution – for Happy Holidays

Hope & Caution – for Happy Holidays
Once again, the holiday season is upon us.  The Addiction Medicine Update, Hope & Caution—for Happy Holidays,  originally published in November 2012, receives thousands of views, telling us that it strikes a chord in readers.  With that in mind, we are reprinting it this year.  As we approach the holiday season—the time of year from Thanksgiving through New Years when "joy" is the word but not necessarily the reality—it's worth reflecting on ways we can protect ourselves and those we care about from inconvenience and tragedy due to use of alcohol or other mood-changing substances. Start by believing that some measure of holiday joy and fulfillment, provided we are open to it, is available to us all.  Caution is needed. But the holidays evoke strong feelings, and strong feelings often override caution. Strong feelings could include the stress of keeping up with the seasonal parade of expectations and events such...
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Facing Addiction and The National Council on Alcoholism and Drug Dependence (NCADD) are proud to announce the merger of our organizations – creating a national leader in turning the tide on the addiction epidemic.
The merged organization will be called:

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