addiction

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The Face Of Opioid Addiction: Vinnie, A ‘Regular’ Guy From Revere

In this 2013 file photo, a recovering heroin addict holds a demonstration dose of the medication Suboxone. (M. Spencer Green/AP)

In this 2013 file photo, a recovering heroin addict holds a demonstration dose of the medication Suboxone. (M. Spencer Green/AP)

By Dr. Annie Brewster
Guest Contributor

Want a glimpse of what opioid addiction really looks like?

Meet Vinnie: a self-described “regular” guy from Revere, Mass., and a recovering drug addict.

Toothless, and 60, Vinnie was prescribed opioids — Oxycodone, Oxycontin, Dilaudid, among others — for a chronic pain condition. Though he says he never intended to abuse these medications, Vinnie became an addict, taking painkillers for 28 years as his doctors kept prescribing higher and higher doses to manage his pain. Listen to his story here:

Vinnie stopped caring about anything except opioids, and finding his next dose of medication.

Vinnie, from Revere, is a recovering drug addict.

Vinnie, from Revere, is a recovering drug addict.

His marriage fell apart. He missed opportunities to spend time with his only daughter as she grew up. He became estranged from friends. He stopped taking care of his body and lost his teeth, gained 100 pounds, and developed diabetes, heart disease and arthritis. He fundamentally lost his will to live and contemplated suicide.

Ultimately, it was a pharmacist who put a stop to Vinnie’s opioid use by refusing to fill his prescription. After his initial panic, this abrupt end to the drugs led Vinnie to connect to a new doctor, an addiction specialist. His new regimen included a slow tapering of the narcotics and the initiation of Suboxone therapy.

The state and nation are in the midst of an escalating opioid crisis — it’s estimated that 100 Americans died each day from opioid overdoses in 2013, and the number of deaths from drug overdoses was three times that of the combined deaths from car accidents and homicides in that same year.

Just this week Massachusetts Gov. Charlie Baker enlisted medical schools to provide more addiction-related training to medical students. Against this backdrop, Vinnie’s story shows the harsh reality of addiction as well as a path to recovery.

How to fix it? It’s clear that a multifaceted approach is needed, as outlined in an extensive report put out by Gov. Baker’s Opioid Working Group in June.

One element, relevant to Vinnie, is consideration of one of several medications available to treat opioid addiction, including methadone, buprenorphine and naltrexone. Currently, these medications are underused, partly because they are controversial. Continue reading

Opinion: It’s Time To Screen Teenagers At School For Risky Substance Use

By Dr. Eugene Beresin
Guest Contributor

Hearings are being held in the Massachusetts State House on a bill that would enable public school nurses to screen teens for the risk of substance use. This practice is strongly supported by the Children’s Mental Health Campaign and the Addiction Free Future Project, and part of a mission in five states to promote screening for teenagers at risk of substance use problems.

We favor broad screening as a way to reduce death and disability due to substance use that typically starts in the teen years. We understand that this screening will be totally confidential — like all substance use screening and discussions between teens and health care providers. However, parents are free to oppose the screening of their children just as they may prevent their children from receiving vaccinations.

The downside to screening raised by some is that it will bring additional costs to the state, including extra time for training and to administer the tests. In addition, some kids may feel discomfort being asked sensitive questions. However, the overall reduced costs of treatment are great. And most kids really are open to talking about substance use in a confidential setting.

There are certainly some people who do not feel school is a place for screening of any kind. But after looking at research on substance use disorder prevention, professionals at The MGH Clay Center for Young Healthy Minds, The MGH Recovery Research Institute and the Massachusetts Children’s Mental Health Campaign feel that the benefits of early screening far outweigh the financial cost and time factors involved. The risks of excessive substance use in teenage years is very dangerous to brain development and social functioning.

A new blog post by screening advocates John F. Kelly, Ph.D., founder and director of the Recovery Research Institute and associate director of the Center for Addiction Medicine at Massachusetts General Hospital, and Courtney Chelo, behavioral health project manager at the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC) lays out the details: Continue reading

Related:

What If Your Doctor Really Listened Instead Of Just Telling You What To Do?

(Alex Proimos/Flickr)

(Alex Proimos/Flickr)

On many a Friday, Dr. Joji Suzuki goes trawling through the medical wards of Brigham and Women’s Hospital with trainees in tow, looking for smokers.

One recent Friday, he finds Thrasher West, a patient who’d had trouble breathing but now is about to go home, where a tempting half-a-pack of cigarettes awaits her.

Dragging in the smoke, blowing it out — smoking feels good to her, West tells Suzuki. But then, she thinks, “Damn. Why’d I do that? Because it’s not good for me –” (Here, her deep cough adds emphasis.) “It’s bad for my health…Aw, I’ll give it up when I finish the pack.”

Suzuki, the hospital’s director of addiction psychiatry, does not lecture her about the risks of smoking. He does not suggest nicotine patches or pills or any other aids for quitting. He just mostly listens, and thoughtfully echoes what she says, and draws her out — when, for example, she mentions that she once quit for five years.

Dr. Joji Suzuki (Courtesy)

Dr. Joji Suzuki (Courtesy)

“Something happened, and you made a decision to stop,” he probes.

Her sons begged her, West recalls. One said, “Mommy, please stop smoking, please stop smoking.”

“Pleading with you…” Suzuki reflects.

“He had tears in his eyes. And he’s my baby, that’s my baby boy.” She reassured her son that she would be around for a long time, she remembers, and he answered, “You keep smoking, no, you won’t!”

Suzuki interprets: “They love their mama so much, they don’t want to lose her.”

The conversation, lasting just a few minutes, may sound like a simple chat. But Suzuki is expertly following principles that have been hammered out over decades and studied in copious research. He listens — actively, empathetically — more than he talks. His comments and questions remind West of her reasons to quit, and bolster her confidence that she can do it. They tap into her values and goals — her love for her family, her desire to live.

By the end, West says she wants badly to stop smoking, and she urgently asks Suzuki to write her a prescription for nicotine patches.

She has just experienced the subtle power of a method that’s increasingly popular in medicine: It’s called motivational interviewing, often referred to just by its initials, MI.

“The big shift in the practice of MI for most practitioners is that you go from telling patients why they should change or how they could change to drawing out from the patient their own ideas about why change would be beneficial to them and about how they might be able to do it,” says Dr. Allan Zuckoff of The University of Pittsburgh, a national leader in the field and author of a new self-guided book, “Finding Your Way to Change: How the Power of Motivational Interviewing Can Reveal What You Want and Help You Get There.”

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Motivational interviewing goes back decades in the field of addiction counseling, Zuckoff says, but in medicine, it’s been really taking off in the last few years.

Hundreds of studies have been published on using it in health care, from diabetes control to reducing the risk of heart disease. It’s being tried for patients with incontinence, psoriasis, hepatitis C, Parkinson’s — virtually any disease in which the patient’s behavior — taking medication, choosing food — affects the outcome. And of course, it can be used for the lifestyle issues that are the biggest driver of American chronic illness: overeating, smoking and drinking and drugs, lack of exercise.

Continue reading

Report Finds Stark Gaps In Mass. Addiction Care

The math is simple and starkly clear.

There are 868 detox beds in Massachusetts, where patients go to break the cycle of addiction. They stay on average one week. Coming out, they hit one of the many hurdles explained in a report out this week from the Center for Health Information and Analysis on access to substance abuse treatment in the state.

There are only 297 beds in facilities where patients can have two weeks to become stable. There are 331 beds in four-week programs.

As the table below shows, there are almost four times as many men and women coming out of detox, with its one-week average, as there are from a two- or four-week program.

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

Patients who can’t get into a residential program right away describe a spin cycle, where they detox and relapse, detox and relapse. Some seek programs in other states with shorter wait times.

Continue reading

2014: CommonHealth Year Of The Brain, From Depression To Dyslexia

 

A map of nerve fibers in the human brain (. (Courtesy of Zeynep Saygin/Massachusetts Institute of Technology.)

A map of nerve fibers in the human brain (. (Courtesy of Zeynep Saygin/Massachusetts Institute of Technology.)

Happy almost 2015. Instead of doing our usual “Top 10 CommonHealth stories of the year” post, we’ve decided instead to look back at our tip-top, far-and-away #1 organ of the year for 2014.

Hint: It’s well above the waist. The brain is, to quote Pink Floyd: “All that you touch/All that you see/All that you taste/All you feel./All that you love/All that you hate/All you distrust/All you save.”

Etcetera. The brain is also the focus of some of the most fascinating research in modern-day science.

Our 2014 series, “Brain Matters: Reporting from the Front Lines of Neuroscience,” tried to capture a partial snapshot of this pivotal moment in brain science, a time of new tools and insights so promising that scientists themselves are saying this is the most exciting time ever to work on the brain.

The series included the set of gorgeous images below, compiled by former intern Suzanne E. Jacobs, and a collection of short video interviews with young neuroscientists, produced by WBUR’s Jesse Costa: 11 Young Neuroscientists Share Their Cutting Edge Research.

The individual “Brain Matters” pieces, in reverse chronological order:

Wishing you a wonderful new year. Special thanks to WBUR’s Iris Adler, who supervised the “Brain Matters” series. And now, for your visual pleasure, the wondrous view inside your head: Continue reading

As Mass. Lawmakers Take Up Addiction Bill, What’s Most Effective Treatment?

Hydrocodone pills, also known as Vicodin. (Toby Talbot/AP)

Hydrocodone pills, also known as Vicodin. (Toby Talbot/AP)

As Massachusetts lawmakers work on differences in the $20 million bill designed to address the state’s opioid crisis, questions remain about which treatments are best.

Several business and insurance leaders have written to Gov. Deval Patrick saying that some parts of the bill may not encourage the most effective addiction treatment. Essentially, they say, more beds may not be the answer, but more medication and longer outpatient care might be better.

The House bill requires insurers to pay for at least 10 inpatient days of addiction treatment if that’s determined to be medically necessary; the Senate bill requires up to 21 days of inpatient coverage.

“We just believe patients should have a choice.”

– Leominster Sen. Jennifer Flanagan

But the American Society of Addiction Medicine estimates that 95 percent of opioid-dependent patients do not need inpatient care, and might be better off with medication maintenance and several months of outpatient therapy. Lawmakers maintain that they do not want to mandate any form of treatment.

“If we have this epidemic that continues to grow, we’re essentially in uncharted territory, and current treatment options aren’t working,” said Leominster Sen. Jennifer Flanagan, one of the bill’s co-sponsors. “If people want inpatient treatment or medication maintenance, they should be able to decide that with their doctors.”

At the same time, a new report contains some surprising findings about medication maintenance addiction treatment. It says that methadone, long used to treat heroin addiction, may be the most effective and cheapest treatment.

The report, from The New England Comparative Effectiveness Public Advisory Council, found that when comparing methadone with suboxone (Buprenorphine) or naltrexone (Vivitrol), more patients stayed in treatment longer if they were taking methadone. Continue reading

Study: Young Adults’ Casual Marijuana Use Causes Brain Changes

(prensa420/Flickr)

(prensa420/Flickr)

A new study by Boston researchers is believed to be the first that shows that young adults who even occasionally smoke marijuana could be damaging their brains.

The study, just published in The Journal of Neuroscience, found abnormalities in areas of the brain related to emotion, motivation and decision-making.

The researchers say the degree of brain changes appeared to be directly related to how frequently the study’s participants smoked pot.

The authors write in their paper:

The results of this study indicate that in young, recreational marijuana users, structural abnormalities in gray matter density, volume, and shape of the nucleus accumbens and amygdala can be observed. Pending confirmation in other cohorts of marijuana users, the present findings suggest that further study of marijuana effects are needed to help inform discussion about the legalization of marijuana.

The study comes with a plurality of Massachusetts residents supporting the legalization of marijuana for recreational use, and as the state is in the process of opening medical marijuana dispensaries.

Here & Now has more on the study this afternoon.

And hat-tip to The Boston Globe, which has more on the findings.

Second Opinion: Doc Says Blue Cross Opioid Policy Is Flawed

Amidst concerns over a massive national increase in the use and abuse of prescription painkillers, health insurer Blue Cross Blue Shield of Massachusetts instituted a new policy to reduce pain medication addiction and misuse.

This week The Boston Globe reports that as a result of the new policy, Blue Cross has cut prescriptions of narcotic painkillers by an estimated 6.6 million pills in 18 months.

But Daniel P. Alford, MD, an associate professor of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program at Boston University School of Medicine and Boston Medical Center, calls the policy “flawed and irresponsible.” Here’s Alford’s response:

By Dr. Daniel P. Alford
Guest Contributor

The Blue Cross Blue Shield of Massachusetts opioid management program was implemented to provide members with “appropriate pain care” and reduce the risk of opioid addiction and diversion.

In a recent Boston Globe report they claim “very significant success” with this program after 18 months because they have cut opioid prescriptions by 6.6 million pills.

Dr. Dan Alford

Dr. Dan Alford

Is this really a measure of success and if so, for whom? It likely saves Blue Cross money but has it successfully achieved their program’s stated goals? Does decreased opioid prescribing mean more appropriate pain care? Does decreased opioid prescribing reduce the risk of addiction or diversion, or does it decrease access to a specific pain medication (opioids) for treating legitimate chronic pain? Is the observed decrease in opioid prescribing evidence that opioids have been overprescribed, as Blue Cross claims, or is it proof that instituting a barrier to opioid prescribing (prior authorization) will decrease prescribing even for legitimate need? Are patients with chronic pain really benefiting from this program? I doubt it.

Adding yet more paperwork for physicians will not improve pain care, decrease addiction or the numbers of accidental overdoses from prescription opioids. Those physicians who are unwilling (or ambivalent) to prescribe opioids even when indicated will use the prior authorization requirement as an excuse to continue not prescribing. Those who are overly liberal in prescribing will figure out the most efficient way to satisfy the insurance requirements for approvals. Physicians who responsibly prescribe opioids – that is, prescribing them only when the benefits outweigh any risks — will be saddled with more administrative burdens to justify their well thought-out treatment decisions.

Some physicians may ultimately decide that prescribing opioids isn’t worth the trouble despite known benefits for some patients. Continue reading

In Defense Of 12 Steps: What Science Really Tells Us About Addiction

The chips AA members receive to mark sobriety. (Randy Heinitz/Flickr)

The chips AA members receive to mark sobriety. (Randy Heinitz/Flickr)

Last week, Radio Boston featured an interview with Dr. Lance Dodes, author of “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.” Here, two Harvard Medical School professors of psychiatry respond, arguing that Dr. Dodes misrepresents the evidence and that 12-step programs have among the strongest scientific underpinnings of any addiction treatment.

By John F. Kelly and Gene Beresin
Guest Contributors

In a recent WBUR interview, Dr. Lance Dodes discussed his new book, which attempts to “debunk” the science related to the effectiveness of 12-step mutual-help programs, such as Alcoholics Anonymous, as well as 12-step professional treatment. He claims that these approaches are almost completely ineffective and even harmful in treating substance use disorders.

What he claims has very serious implications because hundreds of Americans are dying every day as a result of addiction. If the science really does demonstrate that the millions of people who attend AA and similar 12-step organizations each week are really deluding themselves as to any benefit they may be getting, then this surely should be stated loud and clear.

In fact, however, rather than support Dr. Dodes’ position, the science actually supports the exact opposite: AA and 12-step treatments are some of the most effective and cost-effective treatment approaches for addiction.

In his book, Dr. Dodes commits the same misguided offenses he condemns. His critique of the science behind treatment of addiction is deeply flawed, and ironically, his own psychoanalytic model of an approach to solve the “problem of addiction” has no independent scientific proof of effectiveness, particularly in comparison to other methods of treatment.

Below, we address some of the specific pronouncements he made on Radio Boston and in his book in order to convey what well-conducted science actually tells us about how to treat addiction.

What he says: 12-Step programs do not work, are not backed by science, and are probably harmful.

The evidence is overwhelming that AA, and treatments that facilitate patients’ engagement with groups like AA, are among the most effective and best studied treatments for helping change addictive behavior. Continue reading

Citing Addiction Fears, Group Asks FDA To Revoke Painkiller Approval

Instant Vantage/flickr

Instant Vantage/flickr

By Judy Foreman
Guest Contributor

In an unusual move, a coalition of activists and physicians, concerned about the problem of prescription pain-reliever abuse, yesterday asked the U.S. Food and Drug Administration to revoke its approval of a new type of opioid called Zohydro. The medication is expected to be on the market soon.

“Too many people have already become addicted to similar opioid medications and too many lives have been lost,” said the Feb. 26 letter to the FDA, signed by a coalition of consumer health advocates, addiction treatment and health care providers.

But that request is provoking outrage and anxiety among chronic pain patients who applauded the FDA’s approval of the new medication last fall and would like to see Zohydro added to the list of prescription pain-relievers now on the market.

Zohydro is a type of opioid called hydrocodone and, in its chemical structure, is similar to morphine, said June Dahl, a professor of neuroscience at the University of Wisconsin School of Medicine and Public Health, in a telephone interview and email conversation.

“It’s an advantage to have another pure opioid agonist on the market and to have that agonist in a controlled release formulation,” said Dahl. She questioned, however, whether it is wise to allow the current formulation of Zohydro on the market right away, instead of waiting a few years for an abuse-deterrent, a formulation specifically designed to thwart abusers.

Until recently, the only hydrocodone-containing products on the market were combination medications such as Vicodin which contains both hydrocodone and acetaminophen. The major concern about Vicodin is actually not the opioid it contains but the acetaminophen (which is also the active ingredient in Tylenol), noted Dahl. (Last fall, the FDA took the first steps toward moving medications like Vicodin to a more restrictive category, which would limit the how easily patients could get refills.)

Zohydro is different from Vicodin in that it contains only hydrocodone, with no other ingredients. The company that makes Zohydro argues that this formulation makes the drug safer than the combination products.

Dr. James Cleary, a palliative care specialist at the University of Wisconsin, said in a telephone interview that “it is reasonable to have this product [Zohydro] out there.” Opioids are defined as “essential medications” by the World Health Organization and several other major groups, he added.

“Therefore we need to make sure they are available to appropriate patients and we need to establish a balanced system that also reduces abuse and diversion. We need to understand the opioid crisis much better.” Continue reading