We want to thank Dr. James DiReda for offering another excellent guest post for us! Dr. DiReda has over twenty years experience working with individuals, families, and organizations to address alcohol, drug, and mental health issues. He holds a dual Ph.D. in Sociology and Social Work from Boston University. He is currently Director of Counseling and teaches at Clark University in Worcester, MA.

The Beast We Call Progression

Within the self-help network, the treatment delivery system, and prevention world, addiction is known as a “life-threatening progressive condition” that worsens if it goes untreated. We hear about it, and read about it all the time. However, when it looks you in the eye it becomes so much more real. I attended a function last night, and while there, saw a former client of mine who had “dropped out” of treatment somewhat abruptly about a year ago. When I met him he was employed at a long-held job, had a very charming young wife, and a newborn baby son.

I’ll call this client “Nick,” although not his real name. So Nick came to see me because he was struggling with a Percodan habit that he just couldn’t manage any longer. It was starting to cause real problems for him at his job, at home, financially, and internally. He was caught up in the obsessive aspect of addiction, and couldn’t seem to break free from it.

It clouded and tainted everything good in his life, and he wanted to stop. Ironically, he was one of those individuals that didn’t present with a long history of drug use that grew into a dependence on prescription pain meds. He had injured his back and was prescribed Percodan to alleviate his pain. It doesn’t take long to become addicted to a drug as strong as Percodan, and he was no exception. It soon consumed him and every waking moment of his life was spent thinking about getting more. He was addicted. So I saw him for about six months, and tried to help him to stop using the drug, which he could never seem to do. He could “white-knuckle” out a day or possibly two, but he always relapsed, until he finally disappeared.

Seeing him last night was a total surprise, but felt good. During our conversation he laid out his “progression,” which sounded almost textbook to me. We went right down the line as I asked him about work, he lost the job; wife, she had thrown him out; newborn, he sees him as his former wife allows; living arrangement, he’s back living with Mom and broke. So, that sums up the “progression” of addiction for anyone wondering what that term means.

Basically, it means that a person’s drug or alcohol use will wipe out anything good or positive in that person’s life if their condition goes untreated. Interestingly enough though, Nick had never told me about alcohol being a problem for him while I was seeing him, but last night he told me that he had pretty much stopped using the Percodan but couldn’t stop drinking and relapsing with alcohol. He also said that alcohol had pretty much always been a problem for him, but he never realized it until he quit the prescription drugs and went “crazy” with the drinking.

Nick’s story emphasizes the importance of us being aware that addiction is addiction, and whether it’s addiction to alcohol or Percodan or Cocaine, it is still a “life-threatening, progressive condition” that, if goes untreated, will worsen and take everything a person is willing to give, including their life.

A summary of global drug abuse statistics was released by Australian researchers last week. The report shows the estimated numbers of drug abusers in various areas of the world, and finds that wealthier, more advanced countries are more at risk. Among the study’s findings are estimates of illicit drug abuse throughout the world:

• Between 149 million and 271 million people worldwide used an illicit drug at least once in 2009; which equals 1 in 20 people aged 15 to 64 who have used an illegal drug. (1)
• In North America, nearly 11% of the population aged 15 to 64 used cannabis in 2009. (1)
• Between 14 million and 56 million people aged 15 to 64 worldwide used amphetamine-type stimulants, such as speed and crystal meth. (1)
• Cocaine use was highest in North America in 2009, and it had 14 million to 21 million users worldwide. (1)
• Opioid use, including heroin, had an estimated 12 million to 21 million users globally. The highest rates of use were in the Near and Middle East, where up to 1.4% of the population aged 15 to 64 had tried the drug at least once in 2009. (1)
• There are between 11 million and 21 million people who inject drugs worldwide. (2)

More Drug Abuse in Wealthy Countries

Much of the drug abuse around the world can be found in the wealthiest and most developed countries. This is possibly because residents have more access to drugs, or have the means to buy drugs, or maybe because people in these countries are of the mindset that they deserve what makes them feel the best. The study “serves to confirm something addiction experts have known for some time — that the extent of illicit drug use and abuse in developed countries like the United States has reached epidemic proportions,” said Dr. Jeffrey T. Parsons, a professor in the department of psychology at Hunter College, in New York City. (2)

Prescription Drug Abuse

Countries like the U.S. have other things to worry about also, besides illicit drugs. Legal prescription painkillers are becoming the most abused substances in our country. Dr. Marc Galanter said, “It is important that we call attention to very serious drug abuse problems that still exist in the United States. For example, we are seeing recent increases in abuse of painkillers in the United States, as well as the abuse of MDMA [Ecstasy] by adolescents and young adults. Abuse of these particular drugs is not prevalent in less industrialized countries.” (2)

Tobacco and Alcohol Are Also Risks

Other substance, like tobacco and alcohol also have a huge impact on countries throughout the world. Although illicit drug use was linked with about 250,000 deaths worldwide in 2004, alcohol claimed roughly 2.25 million lives globally during that same time period, while tobacco use led to an estimated 5.1 million deaths. (1)

Sources

(1) Worldwide illegal drug use estimated at 200 million people a year

(2) Global Study Finds Drug Abuse Highest in Richer Nations

200 Million People Use Illicit Drugs, Study Finds

Suboxone is known for its capabilities to treat someone with a heroin addiction. It is often used in connection with counseling, but users need to stay on it for a long period of time. A recent study shows that this is also true when using Suboxone to treat other opioid addictions, such as prescription painkillers.

Prescription Painkiller Addiction

Prescription painkiller abuse is a big problem in our country today, one that no one expected. The government calls prescription drug abuse a “public health epidemic”. Since 1999, there has been a 300% increase in prescription painkiller sales, and many of those sales go to support addiction. Among the prescription drugs that are abused 55% are obtained from friends and relatives, 17.3% are prescribed from a doctor, 11.4% are bought from a friend or relative, 4.8% are taken from a friend or relative without permission, 4.4% are from a drug dealer or stranger and the remaining 7.1% are from other sources. (1)

According to the NIDA, 5.3 million Americans abuse prescription painkillers, and overdoses from these drugs kill more people than heroin and cocaine combined. (1) It is fitting, therefore, that current studies be based on finding treatment options for prescription painkiller abuse. “What made this study different was the population,” said Dr. Roger Weiss, lead author and chief of the division of alcohol and drug abuse at McLean Hospital. “This is the first study that focused exclusively on people dependent on prescription opioids, not heroin.” (2)

Suboxone Effective in Short Term

The study took 650 people who were addicted to prescription opioids and treated them with Suboxone. Half also received addiction counseling. 49% of participants were able to maintain sobriety during the study, regardless of counseling or not. But, 90% of participants went back to using prescription painkillers once their Suboxone was stopped.

On the one hand, we know that using Suboxone to treat prescription painkillers is effective. However, researchers were unable to find a length of time of Suboxone use that would help the person to stay sober after weaning off of it. “The study suggests that patients addicted to prescription opioid painkillers can be effectively treated in primary care settings using Suboxone,” said NIDA Director Nora D. Volkow, M.D. “However, once the medication was discontinued, patients had a high rate of relapse — so, more research is needed to determine how to sustain recovery among patients addicted to opioid medications.” (3)

The subjects in the McLean Hospital study were what we might consider mild prescription painkiller addicts. “This was an ideal population to treat – short history of opiate use, high employment rate and most [people] had never sought help, so they weren’t dealing with many failed attempts,” said Weiss of the success of Suboxone. (2) Still, the success rate short term was only 49%, and almost no one remained sober after Suboxone was removed. We will need to find better ways to use Suboxone or other ways to treat people, if we are going to be able to reach more “hard core” prescription drug addicts.

Sources

(1) Suboxone Effective, but Not a Cure for Treatment of Prescription Painkiller Addiction

(2) NIH announces results from first large scale study on treatment of prescription opioid addiction

(3) For Painkiller Addicts, Suboxone Means Freedom, Dependence 

Sometimes it is necessary to review history in order to understand just how we got to where we are today. This is true about the history of drug use and abuse; there is so much we can learn from looking at the past.

The history of drug abuse is filled with experimentation, conflict, violence, and successes and failures. The DEA traces illegal drug abuse back to the early 1800s, to the Opium Wars. We’ve become knowledgeable over the years, but we should not forget the past. The Drug Enforcement Administration Museum in Arlington, VA, chronicles the history of drug abuse through exhibits and artifacts.

Museum Exhibits

The Drug Enforcement Administration museum is free and open to the public. Touring through the exhibits, visitors can see advertisements from the 1800s and early 1900s for things like cocaine filled Coca Cola, opiate based children’s cough syrup, and a hypodermic syringe kit for opiate users from the Sears Roebuck catalog. Visitors to the museum can also learn about drug addiction trends, from the anything-goes 1960s and 70s, to the drug problems of the elite upper class of the 80s. The museum displays artifacts from the war on drugs of the 80s and 90s, including the beginnings of the international drug trafficking operations by the Mexican cartels. Guns and other weapons are on display as well as the stories behind the drug conflicts throughout time. Badges, weapons, and protection used by DEA agents can also be viewed at the museum.

Another exhibit remembers those who died from drug overdose, including popular musicians and writers, such as Jimi Hendrix and Janis Joplin, as well as not as well known, everyday people. A slide show of people who have died from drugs runs throughout the exhibit, with pictures submitted to the museum by their loved ones.

Good Medicine, Bad Behavior

The DEA museum continues to update its exhibits, and some new displays tell of more current drug events. Good Medicine, Bad Behavior: Drug Diversion in America is an interactive exhibit that highlights the prescription drug abuse problem of America today. Another exhibit talks of how home meth labs have become a problem in recent years.

The DEA museum, in an effort to improve and expand its exhibits, accepts donations of both money and artifacts for display. The museum not only provides visitors with incredible and entertaining stories, but it also illustrates the advances we have made in medicine and in our knowledge of drugs. By looking at the history of drug abuse, we can learn what things we want to avoid doing again, and we can see a broader picture of both where we’ve been and where we are headed.

Sources

Mexico’s Drug Museum

DEA Museum

For the lowdown on getting high, visit the DEA Museum

Along with the rising prescription drug abuse in our country comes another danger – drug addiction among newborns. Drug addicted moms are finding out that no matter what they do, it is very hard to keep their baby from having withdrawal symptoms.

Quitting Cold Turkey

Moms that abuse prescription drugs like OxyContin are more likely to have difficult pregnancies. Some women who find out they are pregnant will quit their drugs cold turkey. While this is not recommended for pregnant women, some moms do it. Not only do the women go through withdrawal symptoms that can be dangerous to their health, but they are also at a much greater risk for miscarrying. Their developing infants can suffer seizures and other serious complications, such as birth defects, glaucoma, spina bifida, and heart defects.

Continuing in Drug Abuse

On the other hand, a mother who continues to abuse prescription drugs while pregnant is also harming her baby. Along with the possibility for birth defects comes withdrawal symptoms after birth. These babies are born needing treatment and sometimes medication for drug addiction, causing their first few days of life to be very distressing. Some of the babies are given small doses of methadone, Phenobarbital, or clonidine to reverse the symptoms of withdrawal, stop seizure activity, and sedate their tiny bodies.

Methadone Treatment

Other pregnant women will seek help from a doctor in order to sober up. This step is also difficult because not many doctors will take on these cases, because of the fear of harming the infant in utero. Still, some women addicted to prescription painkillers do go on methadone therapy to safely relieve withdrawal symptoms. Methadone keeps a small amount of opioids in the recovering body, supposedly with less risk of dependence, in the hopes that the addict can gradually recover and be weaned off. In the case of a pregnant woman, her baby will also be getting the methadone doses, which causes many of these babies to be born addicted to methadone. While the mom may more easily be able to recover, the baby once again suffers withdrawal symptoms in the first few days of life. Babies born with an opioid addiction cry excessively, have stiff limbs, and may suffer from tremors, all of which can keep these newborns in the hospital for weeks, recovering.

It is hard to say what, if any, long term effects will occur because of a newborn’s addiction. Unfortunately, many of these babies are going to continue to suffer at the hands of parents who may or may not still be addicted to drugs, but may also have other issues that limit their ability to parent. “Most of the literature suggests consistently that the drug exposure itself is not the primary concern,” said Karol Kaltenbach, a professor at Jefferson Medical College in Philadelphia who studies addiction in pregnant women. “It’s the cumulative effect of the drug-using lifestyle – poverty, chaos in the home, domestic violence. All those things affect development.” (1)

We as a society need to keep working to curb all kinds of drug addiction. We need to be ready to step in and help these mothers and babies that are in need of strategies to live a drug free life.

Sources

(1) Littlest victims of Rx abuse: Newborns

Opioids 

Opiate withdrawal 

At the 23rd annual Cape Cod Symposium a couple of our great friends, Matthew and Maureen Marifone shared their story of recovery. A family journey, their story shows each and every one of us why we do what we do here at Treatment Solutions Network. We hope this story provides hope to those of you struggling with the difficult disease of addiction.

An opioid addiction is one of the more difficult addictions to overcome. The cravings that individuals feel can be impossible to ignore, and withdrawal symptoms are unpleasant. Detoxing from opiates is not life-threatening, but because it is difficult it takes someone committed to recovering to undergo it. There are ways to recover from opioid addiction, and the most effective way involves treatment with pharmaceuticals and therapy.

We are always looking for ways to make the recovery process easier. The development of new medications, such as methadone, to reduce cravings and withdrawal symptoms, have made recovery easier. Buprenorphine, first used in 2002, has been one of the most common drugs to treat opioid addiction, because it is tolerated by most patients and is available in a pill form for patients to take at home.

Implant Study

Now a new form of buprenorphine has been developed, and its makers released the results of a study today in the Journal of the American Medical Association. Titan Pharmaceuticals, led by Dr. Walter Ling, came up with a buprenorphine implant. The implant is placed just beneath the skin on the patient’s arm, and it slowly releases the medication over the span of 6 months. The study showed the implants were successful; they helped patients make it through the full 6 months of treatment in 37% of cases, compared to only 22% making it through with placebo implants. The makers are excited about the buprenorphine implants because they keep patients in treatment. Instead of opioid addicts losing interest and stopping taking the oral pills, the implants ensure that the patient gets his or her correct dosage. Implants can’t be sold for drug money either, as sometimes happens to buprenorphine pills.

Concerns about Implants

But there are some problems with the implant. Some patients had irritation or other complications with the implant site. With a larger group of people being studied, we could probably expect even more complications, as is common with surgical implants like this. One of the biggest concerns about the implants is the lack of effectiveness that occurred in some of the patients. Many were given supplemental sublingual buprenorphine when their cravings or withdrawal symptoms got bad. Iif we are going to go through the trouble of using implants, they need to work effectively.

In this study, patients also received drug counseling throughout the 6 month period. If these implants are ever used with the public, just as with any addiction treatment, counseling needs to be a big part of it. Patients wishing to be clean need to be committed to a sober lifestyle, which can be developed through hard work and therapy. There is no magic pill or implant that can just take addiction away; sobriety has to be worked for.

Sources

NIDA

Drug Implant for Opioid Addiction Looks Effective

Buprenorphine Implants Curb Opioid Dependence

Some people will do anything to get high, including stealing and taking animal medications. Veterinary clinics have been broken into throughout recent years for their stocks of medications, by desperate people trying to get their hands on some drugs, any drugs. It sometimes doesn’t even matter to an addict what they are injecting or popping – as long as they think it might give them a high, they will try it.

In the last 15 years, vet clinics have had to tighten down their storage practices of controlled substances. Human drugs like Ketamine, Morphine, Buprenorphine, and Diazepam are commonly used also in animal medicine. Addicts have now started to break in and raid the drug cabinets, which, until recently, may not have even been locked up very securely.

Dangers of Animal Drugs

Many of the veterinary controlled substances are exactly the same as the human ones, but there are sometimes differences, which at times can be deadly. The strength is likely to be different – for example, a veterinarian treating a horse or a cow will have stronger meds than human doctors. If a person is searching for drugs to get high on, they aren’t necessarily thinking of their own safety. They are not going to sit and figure out the dosage needed for their body weight. In fact, more is usually better in the mind of someone coming off a high. Mixing drugs can also be common, as well as injecting something they aren’t even familiar with.

Burglaries in the last few weeks have been particularly disturbing and dangerous. Thieves in Calgary last week stole, among other controlled substances, some vials of Euthasol, the drug used to euthanize animals. If someone mistakenly got a hold of it and decided to inject it, it would be immediately fatal. Other medications designed specifically for animals can be just as harmful.

Abusing Veterinary Prescription Pills

Humans also sometimes abuse animal prescription medications. More and more animals are being maintained on things like Valium and Phenobarbital pills to manage pain or seizures, or as a sedative. Just as addicts go from doctor to doctor, requesting more pills, so some people take their pet from vet to vet. Since the animal can’t communicate how much pain they are or are not in, it can become very difficult to prove that a person is just on a pill hunt for themselves.

It is unfortunate that drug addiction has gotten so bad that not even animal medicine is safe from drug abusers or dealers. Many vet clinics have developed stricter ways of recording their controlled substance usage and storage. Many vets have also begun to look more closely at pets that are on prescription pain pills, because the danger of these getting in the wrong hands is real.

 Sources

Burglar found sleeping inside vet clinic

Police issue warning after euthanasia drug stolen from Calgary vet clinic
Dangerous drugs stolen during vet clinic break-in

Sometimes many of us might feel like we want to do something more for our troops. These people have put their lives on hold, left their families, and risked injury and death to fight for our country. Ask any soldier and they will tell you that it is rewarding when they are applauded by onlookers at an airport, or thanked by civilians at the mall. But it seems that we should be doing more to thank them than a quick hello and thanks when we see them out and about in their uniform, or standing for them when they pass by in a Fourth of July parade.

Soldiers and Substance Abuse

One area that we can help our soldiers with is substance abuse. Soldiers have always struggled with substance abuse. Their tasks are stressful and traumatic, leading to mental illness sometimes, and self-medication with drugs or alcohol other times. There are so many veterans from wars throughout the years that now live lives of addiction and alcoholism. Too many soldiers go on to be homeless or depressed, or plagued by some other addiction or illness, all because of the things they experienced while fighting for our freedom.

Opiate Production in the Middle East

Recent statistics suggest that substance abuse, especially opiate abuse, is rapidly increasing among our soldiers today. The actual numbers state that there was a nearly 500% increase in soldiers enrolled in substance abuse counseling for opiates between 2004 and 2009. It could be that more soldiers are just now reporting substance abuse and getting help for it. But authorities believe that at least part of the jump in recent years is due to an increase in addiction, due to an increase in the availability of opiates.

Afghanistan is the world’s leading opium producer, and our soldiers have at times become their buyers. With an increase of troops in Afghanistan, our soldiers are put right in the middle of the opiate production. Opiate abuse is more common among Afghan forces, but it also affects U.S., Canadian, and NATO troops. Many people who are taking note of this issue are concerned not only about the way opiate abuse affects our soldiers, but also about the way it benefits the Taliban. When Afghans sell their opium, the sales help fund the Taliban’s efforts. This group taxes poppy farmers and the processers of the drugs, giving us another reason to keep our troops away from opiates.

Treatment for Soldiers

We as a country need to set up better prevention techniques, more screening opportunities, more effective treatment programs, and better long-term care for our troops. Every soldier should be screened for substance abuse and mental illness, and be encouraged to come forward and get help for these problems. The sooner after the conflict that a solder gets help, the better the chance at recovery. We need to educate our soldiers more effectively on how to manage stress and avoid drug abuse in the first place. When drug abuse does occur, we need to follow up with treatment designed specifically for soldiers.

Sources

Afghanistan opium harvest a dilemma for Canadian Forces

Army surgeon general notes concern about drugs prescribed to wounded soldiers

Number of Soldiers Seeking Opiate Abuse Treatment Skyrockets

Approved by the Food and Drug Administration (FDA) in August 13, 1947, Methadone is a narcotic pain reliever, analgesic used to treat moderate to severe pain with people who have not responded to pain relievers. Its main uses also include being given to patients who are battling narcotic addiction or in the maintenance treatment of narcotic drug addiction.

The drug targets the central nervous system and opioid-receptors in the brain to provide analgesic relief from pain. Methadone is a Schedule II narcotic under the United States Controlled Substances Act and has been a vehicle for potential drug abuse, addiction and misuse. There is a definite possibility several patients who take Methadone for withdrawal circumstances may develop a dependence which can lead to further abuse.

A Black Box warning was issued in 2006 for methadone, meant to alert healthcare professionals, patients and consumers about the chance of cardiac toxicities that may be associated with the drug.

Side Effects and Information

There can be a chance for developing a physical addiction or abuse when taking methadone. Patients who have a history of addiction or abusing other medications, alcohol, emotional problems may be at a higher risk for this. Different cases may apply to certain individuals, so speak with your personal doctor before stopping the drug.

Several serious side effects may occur when taking the medication. If any of these are experienced, please see a physician as soon as possible:

• Breathing that slows down
• Change in heart beat or chest pain
• Dizziness and confusion
• Drowsiness and faintness
• Hallucinations
• Shallow breathing

Do not combine methadone with any of the following medications, unless you have consulted with a medical doctor: anti-depressants, anxiety medications, muscle relaxers, narcotic pain medications, sedatives and sleeping pills.

By providing FDA alerts, drug information, interactions and drug side effects about prescription and over the counter medications, we can ensure an environment where patients have the best knowledge on their medical treatment and health.

Disclaimer:
This article is for purely informational purposes and does not intend to prevent, treat, or cure any disease. It was not written by a medical professional. If you have any questions about your own methadone use, or are considering using methadone contact your physician.