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Author: Justin Mckibben
Addiction is not an easy problem to address. It is a complex issue with many variables, so of course there is no simple answer to fix it. There is no one-size-fits-all solution; no monopoly on the right kind of treatment. It is understandable that there is a degree of effectiveness with utilizing any medical means available to try and address addiction, but are maintenance drugs really the answer?
Surely medication assisted treatment is useful, and it helps a lot of people. Most inpatient treatment programs utilize some form of medication to ease withdrawal symptoms and other side-effects of long-term drug use. The detox period of treatment usually focuses on medically assisting someone struggling with drugs in this transition.
However, is getting people off of one drug by making them dependent on another really the best case scenario? It seems now insurance companies are putting more effort into using maintenance drugs to treat addiction. Is this really a better strategy?
Firstly, let us make a clear definition of what maintenance drugs are. Typically, the definition of maintenance drugs is along the lines of prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines.
Examples of common maintenance drugs are medications such as:
- Fluticasone and salmeterol (Advair Diskus) which is used to treat asthma
- Insulin glargine (Lantus) used to treat diabetes
If you consider these examples the point is that people use these medications to “manage” their illness, not to overcome or remedy it. So looking at the issue of addiction, there are some well-known maintenance drugs, specifically concerning opioid addiction.
These medications can be effective, but they also present a level of danger themselves. Even though doctors prescribe them to combat withdrawals, they actually can create their own devastating withdrawals, especially with long term use.
Aetna Aims for Maintenance Drugs
Aetna is one of the nation’s largest insurance companies. In a recent Aetna report, the company is prepared to remove a major restriction for patients seeking maintenance drugs for opioid addiction. The change is set to begin this coming March. Aetna is the third major health insurer to announce such a shift in policy in recent months, now in league with Anthem and Cigna insurers.
To be more specific, this insurance company will stop requiring doctors to seek approval before they prescribe particular medications that are used to combat withdrawal symptoms. One of these medications is suboxone, a well-known medication that many people use to fight opiate addiction.
The common insurance practice is known as “prior authorization”. The reason they are seeking to eliminate this policy is because it sometimes results in delays of hours to days before a patient can get the medications.
This new approach to regulation of maintenance drugs impacts all its private insurance plans, an Aetna spokeswoman confirmed.
Advocates of Maintenance Drugs
Addiction treatment advocates to support having expanded access to maintenance drugs. Dr. Corey Waller, an emergency physician who chairs the American Society of Addiction Medicine’s legislative advocacy committee, states:
“It’s a first-line, Food and Drug Administration-approved therapy for a disease with a known mortality. [For] every other disease with a known mortality, the first-line drugs are available right away.”
Essentially, the idea that parity laws require insurers to cover addiction treatments at the same level as other kinds of healthcare means these kinds of medication should be available for immediate access. This should be the same for all forms of addiction treatment.
Opinion: Treatment over Maintenance
While many would argue that maintenance drugs are a form of treatment, it is still a relevant argument that maintenance drugs are also imperfect and could actually be harmful if they become the cookie-cutter answer implemented by most insurers.
While harm reduction is understandable, and maintenance drugs can help people struggling with heroin or other dangerous opioids avoid other serious risks, the fact is many maintenance drugs include their own side-effects. Some often become subject to abuse themselves.
For instance, suboxone can be useful as a harm reduction tactic, but it can also be abused. Many people who have used suboxone as a long-term solution have found themselves battling suboxone withdrawal symptoms. The dangers of suboxone are very relevant.
The same, if not worse, has often been said about methadone maintenance drugs. While they may keep someone alive to get treatment, there should still be a strong emphasis on treatment itself. Maintenance drugs are most effective when part of a program. They are not a substitute for a treatment program.
Treatment should focus on finding solutions, not prolonging the suffering. Drug and alcohol addiction treatment should come from a holistic approach that addresses more than just physical ailments. Holistic treatment focuses on providing extensive and personalized therapy, combined with physical and emotional heal. If insurance companies want to focus on combining rational medical resources with comprehensive treatment, then this could be a great thing. However, if the focus becomes a quick-fix drug option opposing a full recovery through treatment, it only adds to the danger.
Maintenance drugs have support from the recovery community, but typically they must be accompanied by therapy and other means of treatment. Maintenance drugs are just that- drugs. They are often powerful narcotics, and are true to their title- “maintenance,” not a permanent solution.
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Author: Shernide Delva
Canada has taken a controversial approach to fighting heroin addiction. The Canadian government has just quietly approved a new drug regulation that will permit doctors to prescribe pharmaceutical-grade heroin to severe addicts. Essentially, Canada’s strategy for treating addicts resistant to other forms of treatment is simple: let them have heroin.
While this is a first for Canada, other countries have similar programs. The approved regulation ensures that Canada’s trail-blazing clinic, Crosstown, in Vancouver, will be able to expand their special heroin-maintenance programs. These programs allow addicts to come and go as many as three times a day to receive prescription heroin from a nurse for free.
Back in May 2016, Canada was in the beginning stages of legalizing prescription heroin. Health Canada explained in a news release:
“A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic relapsing opioid dependence,”
Health Canada continued stating they were considering the idea of legalizing prescription heroin since several other countries have used it and found it effective.
“Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine.”
Lowering the Cost of Addiction?
Furthermore, Dr. Scott Macdonald, a physician with Crosstown Clinic, explained that heroin maintenance programs are much cheaper for taxpayers than paying for the cost of drug addiction. A person battling drug addiction can cost the tax base $45,000 Canadian Dollars (around $35,000 in U.S. dollars) per year in crime costs, health care costs and more. On the other hand, prescription heroin in a Vancouver clinic costs around $27,000 or $21,000 in American Dollars.
The government ensures that this type of treatment is for a small minority of users “in cases where traditional options have been tried and proven ineffective.” The purpose is to give health-care providers access to a wide variety of life-saving treatments options.
In 2005, Crosstown Clinic conducted their first clinical trial of prescription heroin and has operated ever since. The clinic provided diacetylmorphine to 52 addicts under a special court-ordered exemption. They expect that number to double over the next year if supplies can be obtained.
The Case for Prescription Heroin
A regulation like this will raise controversy. However, studies in the past argue the benefits of using prescription heroin over harm-reduction treatments such as methadone. The studies found that patients stayed in treatment longer and relapsed less in comparison to those who received methadone.
Furthermore, researchers found that those receiving diacetylmorphine had a longer life expectancy compared to those receiving methadone. When it breaks down to costs, prescription heroin costs society less.
Researchers also found that those receiving diacetylmorphine had a longer life expectancy than who received methadone. Crime costs reductions occur with both options. When it breaks down to costs, methadone therapy costs society $1.14 million, compared with $1.09 million for prescription heroin.
“The question I get most about heroin-assisted therapy is whether we can afford the increased direct costs of the treatment,” co-author Dr. Martin Schechter of the University of British Columbia said in a news release. “What this study shows is that the more appropriate question is whether we can afford not to.”
A Two-Sided Argument
Still, many remain solidly against the option. Collin Carrie, a Conservative member of Parliament, stated that his party adamantly opposes the use of prescription heroin.
“Our policy is to take heroin out of the hands of addicts and not put it in their arms,” he stated.
However, Scott Macdonald reiterated that the patients considered for these treatments are long term users. Typically, they have been on heroin for decades and have tried treatments like methadone with repeated failed attempts.
“Our goal is to get people into care,” he said.
When it comes to addiction, the entire world is seeing an outstanding amount of deaths related to drug overdoses. Treatment options like these are controversial, but unfortunately, they need to be a topic of discussion. Still, the best option remains learning to live a clean, sober life in recovery. Do not let your addiction go on for too long. There is time and hope for you. Do not wait. Call today.
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Suboxone is a popularly approved medication to treat opiate withdrawal. It is one of two forms of the medication buprenorphine, which is an opiate agonist originally developed to treat pain problems. Suboxone works by binding to opiate receptors in the brain, which are the same receptors that morphine, heroin and other opiates bind to.
If you are not familiar with Suboxone, you might be more familiar with Methadone. Methadone was an earlier form of harm reduction treatments used to treat heroin addiction. Although Suboxone has treated thousands of patients struggling with opioid addiction, the drug is not without its risks. Critics continue to express concern over the lasting impact of Suboxone use when it comes to increasing dependency.
One huge concern of Suboxone use is the potential side effects of mixing other drugs with the substance. Suboxone can have dangerous interactions with other substances which pose an immediate risk to Suboxone users.
How Suboxone Works
In order to better understand the risk of combining drugs with Suboxone, it is important to understand how the drug works. Suboxone is a combination of the drugs buprenorphine and naloxone. It functions as a partial opioid agonist and diminishes cravings as well as prevents other opioids from reacting to the brain’s receptors. In other words, even if you try to get high off opioids, you won’t.
Taking other drugs while on Suboxone can be life threatening. If you are on Suboxone, pay very close attention to the following three substances. Combining these drugs with Suboxone can cause a very dangerous, even fatal interaction.
3 Drugs You Should Never Mix With Suboxone:
- Benzodiazepines (“Benzos”)
Benzodiazepines (Xanax, Valium, Klonopin) are drugs usually prescribed to alleviate anxiety and treat insomnia. They are depressant drugs, or “downers,” because they sedate the central nervous system, which slows the heart rate, lowers blood pressure and depresses breathing. Because Suboxone is also a depressant drug, the two together create a double-whammy effect. The combination can cause a severe lack of coordination, impaired judgment, unconsciousness, respiratory failure, and even death.
The effects of Suboxone and cocaine are extremely dangerous because both drugs are on opposite sides of the spectrum. Cocaine is a stimulant, or “upper,” while Suboxone is a depression, or “downer.” When you combine cocaine with Suboxone, it actually reduces the amount of buprenorphine that is in your bloodstream. When you have less buprenorphine in your body, you start to feel opioid withdrawal symptoms.
Combining cocaine with Suboxone increases the risk of a cocaine overdose. Since Suboxone is a depressant, it counteracts the effects of cocaine. This means users end up taking more and more cocaine because they do not feel the effects they normally would on their regular amount. Typically, users start to believe that can handle more cocaine, even when they cannot. The increase in cocaine used can result in an overdose.
Mixing alcohol with any medication is never a good idea, especially Suboxone. Just like benzos, alcohol is a depressant. Alcohol is even more of a problem than benzos because it is so readily available. An uninformed Suboxone user may not even consider the risks of drinking alcohol. However, combining alcohol and Suboxone can produce the same exacerbated effects such as unconsciousness and respiratory failure. These side effects can be dangerous and even fatal.It is so important to know all the risks you are taking with newly prescribed medication. According to statistics, there were 30,135 buprenorphine-related emergency room visits in 2010. It should come as no surprise that 59 percent of these visits involved additional drugs.
As Suboxone’s popularity increases, it is important to understand the dangers of mixing Suboxone with other substances. If you are taking Suboxone or similar drugs, it might be a good idea for you to consider seeking help on going off those drugs completely. Seeking professional treatment can help you not rely on any drugs in your recovery. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135.
By Cheryl Steinberg
In Bangor, Maine and its surrounding areas, a team has come together with a three-pronged strategy for attacking opiate addiction and one aspect is to get rid of methadone as a maintenance treatment.
The approach, which came together after 6 months of several community members and agencies meeting on the subject of the opioid problem in their state, doesn’t wish to rid addiction treatment of supportive medication, though; they’re looking to shift from the use of methadone to that of Suboxone.
In recent months, there has been much debate about the use of methadone and, specifically, the replacing of methadone with alternatives, such as Suboxone, for opioid dependence and addiction.
Gov. Paul LePage proposed in his two-year budget plan that he would end methadone treatment for recipients of MaineCare, the state- and federally-funded health coverage system for qualifying individuals, and switch their treatment over to Suboxone. There is pushback from many treatment and health care providers in the area, who warn that addiction treatment isn’t as simple as switching one drug for another.
Three-pronged Approach in Maine Rids Methadone from Addiction Treatment
Bangor Sen. Geoff Gratwick has offered a work-around concerning this debate. His proposal is for a pilot program that would test the efficacy of using drug treatments other than methadone to address opioid addiction. In this pilot project, test sites would involve primary care providers outside of Bangor and would also offer peer support. The senator was inspired by the work of a Bangor group that studied, discussed, and scrutinized drug abuse and addiction in the city.
This ‘group’ is a committee made up of residents, medical providers, treatment specialists, and law enforcement officials put in the hard work for a six month period in order to come up with a strategy to address drug abuse and addiction in Bangor.
Theirs is a three-pronged approach, meaning that the plan emphasizes three key focus areas. The first aspect would be to encourage better prescribing practices when it comes to pain medications in order to reduce the supply of opiates. The second aspect is to evaluate how cases of addiction are treated in emergency rooms, specifically in cases of overdose, in which the patient the practice is to merely send them home after being stabilized; the group suggests transitional steps for such cases. And the third aspect – and incentive for the bill – is to look at alternatives to methadone.
Gratwick’s bill is getting some support because it “looks at the whole person,” allows for treatment closer to home, offers a support system to those receiving treatment, as well as holds participants accountable – an important life skill to learn for those who deal with addiction.
The pilot project aims to set up one or two test sites that are at least 30 miles from already-existing methadone clinics. This way, clients can remain close to their families and jobs so that they can reintegrate or continue to be a part of their communities, which is one of the Department of Health and Human Services’ (DHHS) main goals when it comes to substituting in the Suboxone plan. Furthermore, it will save the state monies on transportation for methadone patients, which can instead go toward paying for the pilot project.
This comprehensive approach is certainly worthy of a look and, moreover, of support. It’s a smart way to plow right on through the competing arguments about what’s the best approach to treatment. Instead of being polarized – and therefore getting nothing done – the plan would be a proactive approach to addressing the opioid epidemic in and around Bangor. Who knows? It may spread to the rest of the state and even to other states.
The project is able to identify what system and supports need to be in place for the best chance of success, which makes it a step in the right direction.
If you or a loved one are struggling with addiction or have become dependent on maintenance drugs, such as methadone or Suboxone, treatment is available for these exact situations. Healing and successful recovery are possible with the right treatment and education. Please call toll-free 1-800-951-6135.
By Cheryl Steinberg
There are two main schools of thought when it comes to addiction and, especially recovery from addiction. One school is driven by the belief that complete abstinence from mood- and mind-altering substances is essential to recovery – the whole idea of “once an addict, always an addict. This is the foundation of such recovery programs as the 12-Step philosophy.
The other school of thought regarding recovery from drug addiction calls for what’s known as Harm Reduction strategies, such as clean needle exchanges and the use of medication.
As it stands, it seems that the approach to recovery is polarized with arguments that it can only be one way (abstinence) or the other (harm reduction i.e. allowing the use of certain drugs).
But it doesn’t have to be so black-and-white. If people could come together with the same mission: that of saving lives, then perhaps the whole opiate epidemic could be stopped in its tracks.
Here are 9 ways to fix the opioid addiction crisis.
#1. Make overdose reversal drugs accessible
Drugs like Naloxone can instantly reverse an opiate overdose, saving many lives. With the heroin epidemic in the north and Midwest, more and more first responders – such as EMTs and police officers, are carrying the drug. It should be made as widely available as possible.
#2. Good Samaritan laws
These laws, which are being accepted more widely, work to protect people from criminal prosecution when they call 911 because somebody is overdosing, leading to the saving of lives. This approach should be the law of the land, rather than only existing in some pockets of the country.
#3. Syringe exchange programs
As mentioned above, a tactic of the harm reduction movement is to provide clean needle exchange programs as well as safe injection sites. This might sound a bit too pro-drug use for some people but, when you consider that IV drug use is a public health concern, it should become clear that these types of programs and services can be a proactive way to approach the opioid addiction epidemic.
#4. Access to evidence-based addiction medicine interventions
This means making sure that all substance abusers seeking help have access to the evidence-based, addiction medicine interventions, referring to such programs as methadone maintenance and Suboxone maintenance. As it stands now, most people who are opioid-dependent are not receiving these kinds of treatment.
This approach is at odds with the abstinence approach of 12 step philosophy but, according to Mark Willenbring, MD., “The main deficiency of current actions to address opioid addiction is the lack of access to prompt, professional opioid maintenance treatment with buprenorphine or methadone. Opioid maintenance therapy is the only proven effective treatment for established opioid addiction, but government and mainstream healthcare organizations have not mobilized to make this life-saving and cost-effective treatment widely accessible and affordable.”
#5. Better training for physicians
Another of the 9 ways to fix the opioid addiction crisis is to improve training for physicians so that they become more adept at screening for, recognizing and treating addiction with the purpose of interrupting the development of an opiate addiction. In this way, the focus is on prevention.
#6. Nationwide Database
Making sure that all physicians with prescribing privileges have access to Prescription Monitoring Programs and that they use them. Although most states now have some type of electronic database that prescribers can consult prior to prescribing opiate painkillers, not all states make it a requirement that they do so.
#7. Make pills difficult to crush
Opioid pain medications should be made in such a way that they cannot be used in ways other than the ways they were intended or prescribed. As examples, we could stop approval of any new opioid painkillers that are not clearly safer than existing ones and remove from the market all high dose opioid analgesics that are easily crushed.
#8. Educate the public
Again, drug abuse and addiction is really a public health concern and thus the public needs to be educated about the risks of prescription pain medications. Young people, especially, begin their opiate drug use by harvesting these types of drugs from their parents’ and/or their grandparents’ medicine cabinets.
#9. Increased access to treatment
Lastly, and certainly of equal importance is that we need to make drug and alcohol treatment more easily accessible so that people suffering from opioid addiction, as with other forms of addiction, have access to the kind of evidence-based psychotherapy that is so conducive to ongoing recovery.
If you or someone you know is abusing prescription painkillers or has turned to heroin because it is a cheaper, more easily accessible form of opiate, help is available. It is important to reach out and call toll-free 1-800-951-6135 to speak with an Addiction Specialist today. Opioid addiction all too often ends with fatal overdose. Please call today.