According to the New York Times, heroin overdose from opiates is now the No. 1 cause of death in individuals under the age of 50 in the United States. Pain is subjective to each of us individually. There appears to be a social expectation in the United States that experiencing little to no pain is a possibility for everyone and that is simply is not the case. A report from Express Scripts, A Nation in Pain: The Medicaid Opioid Crisis, revealed the United States represents 5 percent of the world population but as a nation, consumes 80 percent of the narcotics.
Dr. Rakesh Chandra, founder of Rassik Complete Recovery Inc. — a substance use treatment center — opened the first location in Carbondale, Ill., March 2016. As a psychiatrist in the community, he worked at a local addiction clinic and decided he could do more to help with the opioid crisis at a medicated treatment center. His second addiction clinic in Springfield, Ill., opened in early 2017.
Chandra shared, “I never thought I would be treating patients with substance use disorder. As I treated patients with psychiatric disorders, I observed that a significant proportion of the patient population had a substance use disorder. I found that when that was treated, the outcomes were significantly better”.
Koffler, senior analyst for Mizuho Securities USA shared that physicians seem to have no difficulty prescribing narcotics. Koffler was quoted on CNBS, “There were about 300 million pain prescriptions written in 2015. When there is limited access to care, opioids may be prescribed at a larger rate to compensate for it. For example, someone who might only experience five days of pain may be prescribed 30 days of pain medication, which can lead to opioid dependence”.
What are opioids?
According to the American Society of Addiction Medicine, heroin and prescription pain relievers’ like oxycodone, hydrocodone, codeine, morphine and fentanyl all fall into class of drugs called opioids. People find opioids in various ways, including the following:
1. Self-treatment hypothesis: Recent findings from the National Center for Biotechnology Information suggest that people with mental illness may be predisposed to addiction. These individuals turn to specific drugs to self-medicate psychiatric disorders. For example, a patient with anxiety may find, by chance, that opioids ease his or her symptoms and temporarily improve function. As this “self-treatment” is used, it becomes noticeable that it is maladaptive and an additional medical problem that needs to be addressed.
2. Prescription narcotics: Narcotics can cause dependence both physically and psychologically. The American Medical Association opioid task force released a fact sheet detailing recommendations for physicians in regards to prescription drug monitoring programs and educating patients about prescription opioids. As noted in the fact sheet, the task force “urges physicians to enhance their education and training about effective pain management and treatment for substance use disorders.”
3. Adverse Childhood Experiences: A child who grows up around dysfunction has a significantly increased chance of developing substance use disorder. Childhood circumstances that involve uncontrolled mental illness, violence, substance use and a lack of basic care are included in the scoring system. As the score goes up, so does the likelihood that child will grow up to use substances as a coping mechanism and develop a maladaptive pattern of use, requiring treatment.
At Rassik Complete Recovery, the majority of patients seek treatment for addiction due to prescription drugs or from adverse childhood experiences.
What are the various methods used with opioid addiction treatment?
Rassik Complete Recovery is a total recovery oriented treatment program. The center treats the whole person from a bio-psycho-social perspective.
1. Biological Health: Part of the program includes supporting a patient with his or her biological health alongside the patient’s primary care provider.
2. Psychological Health: The psychological aspect is a large component of overall health. If someone has depression and is administered buprenorphine, he or she may go back to using because of the disorder. By having well trained and certified psychiatrists available to treat patients, the total program’s effectiveness is greatly increased.
3. Social Health: Drugs are expensive. Patients with substance use disorders spend time, energy and effort into acquiring the substance and, in turn, neglect relationships. Rassik Complete Recovery runs a few group sessions weekly to help with social connections and accountability, and to encourage the rebuilding of healthy relationships with family and friends.
Chandra stated that for patients work can be the best kind of therapy. Not only is it 40 hours out of their weeks that they won’t be using narcotics but working gives them a sense of purpose and helps them feel good about themselves.
How is buprenorphine used in treatment?
Buprenorphine is an opiate and comes in various forms. It is used in medication-assisted treatment (MAT) to help reduce dependence on heroin or other opiates. Buprenorphine has a high affinity and low activation for the receptor. It binds very tightly to the receptor, and an individual may get a slight pleasurable effect, but he or she won’t get the same high as from a drug. Nurse practitioners and physicians assistants now can be licensed to treat substance use disorders with buprenorphine.
The education of a nurse practitioner (NP) to become licensed to prescribe buprenorphine medications is straight forward. NPs must complete a training course, which includes 24 contact hours of continuing education by the American Association of Nurse Practitioners. After completing the course, the NP is required to submit a course certificate and Notification of Intent to treat with buprenorphine. The Substance Abuse and Mental Health Services Administration will contact the applicant via email within 45 days. Once approved, an NP can treat up to 30 patients for one year.
What are some of the signs friends and family members should look for to determine opioid dependence?
There are three signs to consider:
1. Do they appear intoxicated or under the influence of drugs? Check for signs of euphoria, dilated pupils, sedation, nodding off and confusion.
2. Do they showcase signs of withdrawal? An individual in withdrawal will have nausea, vomiting, diarrhea, yawning, irritability, anxiety, restlessness, sweating and insomnia.
3. Do they have drug paraphernalia and show signs of use not while under the influence or withdrawing? Common drug paraphernalia includes needles, burnt spoons, aluminum foil with black streaks and rubber tourniquets. Some less obvious items are extra pill bottles in the trash and soda cans that rattle because of needles in them.
What should patients expect with opioid withdrawal?
Withdrawal can be compared to a severe case of the flu. Nausea, vomiting, diarrhea, sweating, chills, irritability, bone aches, restlessness and insomnia are all common signs of someone going through withdrawals. Not all patients have all the symptoms at the same time. Patients typically can share the timeline of their withdrawal symptoms on an individual basis. At Rassik Complete Recovery, a Clinical Opiate Withdrawal Scale is used to determine the level of withdrawal someone is experiencing before he or she is induced with medicine for the first time.
Can you describe the typical timeline for patient treatment and symptoms at Rassik Complete Recovery?
Buprenorphine is an amazing medication. When patients come in for the first time, it’s generally in a state of mild to moderate withdrawal. The first dose of buprenorphine is administered in house, and within an hour or two, symptoms have decreased significantly for a patient. Patients are requested to come in for a follow-up after a few days, and the vast majority have little to no symptoms. At this point, there is time to work on the underlying issues. It is very difficult to work on underlying issues when cravings, withdrawal and chronic relapses exist.