Posted on 07/30/2011 6:45:21 AM PDT by DBCJR
We are facing a tsunami of painkiller addiction that will flood our criminal justice, health care, behavioral health, and social services resources. Illicit online pharmacies have made prescriptions cheap and easy to acquire, fueling a massive wave of addiction that we actually have not seen yet. SAMHSA estimates that over 5% of the nations population, 12 years and older, are using painkillers, nowhere more prevalent than the heartland with Oklahoma leading the nation at 6.7%.
Opioid addiction used to be thought of as primarily heroin addiction, but that is changing rapidly. The masses currently addicted to prescription painkillers have conveniently been able to manage their addiction and manage other aspects of their lives like job and family. However, the Senate passed the Ryan Haight Online Pharmacy Act and the DEA is closing down those cheap and easy suppliers of prescription drugs.
When that happens this mass of addiction will suddenly become sick and desperate, and a foreseeable progression of consequences will follow. That means increased criminal activity, loss of jobs, which leads to loss of housing, which leads to the break-up of families and increased utilization of social services. 5.5% to 6.7% of the population 12 years and older may be headed toward this foreseeable progression of consequences.
Traditional approaches to substance abuse treatment have proven ineffective in treating opioid addiction, with high relapse rates. These approaches start with inpatient detox. In Oklahoma, according to ODMHSAS, there is a waiting list of 1,000-1,300 for residential substance abuse treatment. Detox and residential treatment are huge bottlenecks to an ineffective approach. Is there anything to stop this tidal wave of destruction?
SAMHSA has identified the evidence-based best practice, Medication Assisted Treatment, Treatment Improvement Protocol 43, as having the best outcomes for opioid addicts. Even better, in most cases, active opioid abusers can be taken directly into outpatient treatment, skipping inpatient detox and preserving jobs, housing, and families. While new generation drugs have been developed, they are very expensive and are not covered by Medicaid and Medicare, and many private health plans.
Methadone has been around for over thirty years in the treatment of opiate dependency and it is a rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and dependence. Opiates like heroin and prescription painkillers release an excess of dopamine in the body and causes users to need an opiate continuously occupying the opioid receptor in the brain. Methadone occupies this receptor and is the stabilizing factor that permits addicts on methadone to change their behavior and to discontinue heroin use.
Taken orally once a day, usually in the morning, methadone suppresses narcotic withdrawal for between 24 and 36 hours. Its effectiveness in eliminating withdrawal symptoms makes methadone useful in detoxifying opiate addicts. Methadone has not been proven effective in cases of addiction to other drugs, however, clinical trials are underway.
Methadone reduces the cravings associated with heroin use and blocks the high from heroin, but it does not provide the euphoric rush because of the longer half-life of the drug in the blood system. Consequently, methadone patients do not experience the extreme highs and lows that result from the waxing and waning of heroin and painkillers in blood levels. Ultimately, the patient remains physically dependent on the opioid, but is freed from the uncontrolled, compulsive, and disruptive behavior seen in heroin addicts. Lifestyle changes can be made that support the maintenance of healthy and responsible living.
The Oklahoma Department of Mental Health and Substance Abuse Services reports that heroin accounts for only 5% of substance abuse treatment admissions. Yet nearly 26% of those involved with the criminal justice system have addictions to heroin. Addiction to heroin is highly correlated to criminal activity. That type environment affects many areas of living in a manner that is detrimental to the addict and society as a whole. By removing the need to access that element in order to obtain drugs, whether heroin or diverted prescription painkillers, allows the opiate addict to pursue a different course of life that benefits the addict, their families, and society at large.
The rapid reduction in the supply of prescription painkillers, due to recent legislation and DEA and OBNDD initiatives, is occurring simultaneously with an increase in the prevalence and purity, and a reduction in the price, of heroin. This context is ripe for a conversion from prescription painkiller addiction to heroin addiction – and all the social and criminal ramifications of it. Withdrawal from methadone is much slower than that from heroin. As a result, it is possible to maintain an addict on methadone without harsh side effects, including the impulsive and compulsive behavior associated with extreme highs and lows.
Methadone maintenance treatment (MMT) provides the heroin addict with individualized health care and medically prescribed methadone to relieve withdrawal symptoms, reduces the opiate craving, and bring about a biochemical balance in the body. Important elements in heroin treatment include comprehensive social and rehabilitation services.
Is It Safe?
Like any controlled substance, there is a risk of abuse. When used as prescribed and under a physician's care, research and clinical studies suggest that long-term MMT is medically safe (COMPA, 1997). When methadone is taken under medical supervision, long-term maintenance causes no adverse effects to the heart, lungs, liver, kidneys, bones, blood, brain, or other vital body organs. Methadone produces no serious side effects, although some patients experience minor symptoms such as constipation, water retention, drowsiness, skin rash, excessive sweating, and changes in libido. Once methadone dosage is adjusted and stabilized or tolerance increases, these symptoms usually subside.
Methadone is a legal medication, produced by licensed and approved pharmaceutical companies using quality control standards, prescribed by specifically licensed physicians, and administered by specifically licensed clinics, all of which are under close regulatory scrutiny. Under a physician's supervision, and when it is administered orally on a daily basis with strict program conditions and guidelines, methadone can be very safe.
Methadone does not impair cognitive functions. It has no adverse effects on mental capability, intelligence, or employability. In appropriate therapeutic dosing, it is not sedating or intoxicating, nor does it interfere with ordinary activities such as driving a car or operating machinery. Patients are able to feel pain and experience emotional reactions. Most importantly, methadone relieves the craving associated with opiate addiction. For methadone patients, typical street doses of heroin are ineffective at producing euphoria, making the use of heroin less desirable.
However, there are differences among some clinics' internal policies and procedures that can make drastic differences in the safety of the patient. Below are some of the main considerations:
1. Liquid methadone dispensed onsite cannot be cheeked and diverted.
Studies show that diverted methadone often sold on the streets is responsible for the majority of methadone deaths. Daily dosing onsite allows for clinical assessment of speech, gait, eyes, etc., that prompt urine tests. Urine analysis should include a 12 drug panel and test for adulterants, or masking agents, which are used to flush the system of drug traces. The rampant use of such masking agents makes many tests yield false negatives. Unless the program tests for such adulterants, their patients are at risk.
2. Strict and limited carry-home doses prevents misuse. Carrying multiple doses home allows for:
Self administration of the drug which can result in not taking the drug as prescribed, i.e., overdosing.
Diversion of the drug to the street market. Since methadone potentiates many other drugs, it has a street value.
Supplementation of the methadone regimen with other drugs. Since methadone potentiates many other drugs, this represents a serious risk of drug interaction.
3. Mandatory psychotherapeutic treatment of the underlying addiction.
Not treating the underlying addiction places the opiate addict being maintained a significant risk of relapse while on a medication that potentiates other drugs. Likewise, opioid addiction medical management regimens that provide multiple doses, whether multiple carry-home doses of methadone or a 30 day prescription of a drug like Suboxone or buprenorphine, do not provide the accountability framework for psychotherapeutic treatment compliance, nor a safe monitoring system for administering potentially dangerous medications. Given the typical and symptomatic behavioral characteristics of addiction, this is not an optimal situation for treatment outcomes.
4. Accountability to prevent "doctor shopping" and multiple dosing.
Every program should participate in the DEA's Prescription Monitoring Program and fax sole provider letters to all Opioid Treatment Programs in the state to confirm they are, in fact, the sole provider of medication in the Medication Assisted Treatment.
Programs that utilize the above safeguards and accountability protect the addict from him/herself and optimize the treatment outcomes.
Quapaw Counseling Services:
Oklahoma City 405-672-3033
Miami, OK 918-542-1786
Keetoowah Cherokee Treatment Services:
Tulsa 918-835-3017
Serving Native and Non-Native people with clinical excellence and warm tribal tradition.
Methadone has a poor record of getting people off of narcotics. Trading one drug for another isn’t a recipe for success. Total detox then a change of environment/friends when the narcotic addict is clean is a much more sucessful option.
Seems to me that its more of a recipe for funneling tax dollars to methadone producers.
Your observation runs counter to SAMHSA CSAT empirical data. Traditional treatment for opioid addicts, non-medication assisted, has success rates ranging 6-8%. Medication assisted treatment has rates over 70%.
“Seems to me that its more of a recipe for funneling tax dollars to methadone producers.”
That is a very jaded perspective. That is like saying that announcing a study that drinking water is healthy is channeling sales of bottled water. Or that calling for more drilling is channeling more profits for Exxon Mobil.
Of course, methadone producers will be rewarded - for producing a product that works. That is the American way, isn’t it?
Perhaps you should take a look at long-term efficacy of medication-assisted treatment. While methadone will stop withdrawal symptoms, it is way too offten used as a long-term substitute for the drugs. It's like taking a wino and weaning him off with beer and then continuing the beer "therapy". As a recovered alky (23 years) I have frequent contact with folks in other addictions and have seen far too many die from methadone overdose after the treatment being lauded as what saved the person from the addiction. The hard reality is that 8-15% is about the norm for long-term freedom from dependancy, no matter what the treatment. All methadone does is increase the short-term efficacy, then it becomes a similar anchor around the person's neck.
Methadone is paid for by tax dollars - state and fed. I don’t understand why taxpayers have to pay for what amounts to a substitute drug for addicts. This is the part of the ‘legalize drugs’ argument I despise. If someone wants to be addicted to drugs - ok, I guess. But why do taxpayers have to pay for the damage they do to their own lives?
Go up on Netflix and rent a copy of the HBO Documentary from several years ago entitled “Methadonia”. It documents how people addicted to heroin become legally addicted to methadone; along with innumerable other problems....
This article is ridiculous.
Having taxpayers pay for a methadone addiction is oh so much cheaper. LOL
I don't see the incentive for the clinic to "cure" the patient from the addition. The person I know, doesn't know anyone who has permanently broken their addition to drugs.
It is going to be bad when these folks can't get methadone or a substitute.
Lots of people make huge amounts of money off methadone. Though you wouldn’t think it to look at the squalor of an inner city methadone clinic, the money is all behind the scenes and at a much higher level.
And those who make the money lobby hard to keep it that way.
A system that was tried in Europe showed great promise, but was effectively killed. It was a combination of three drugs. The first would put a junkie into a coma for four days. The second would remove the heroin from their system. And the third would block the effect of heroin in their body, so they would get nothing from injecting it.
The end result was that the junkie would go through withdrawl while unconscious, wake up clean, and have enough of the blocking agent in their blood to last them for a month. Then, with counseling, and once a month getting a shot of blocking agent for five more months, the chance of them going back to heroin was significantly reduced. And since the blocking agent is not particularly expensive, if they wanted to continue with it longer, they could.
Because of the debilitated condition of many junkies, and the inherent risk of being put into an artificial coma, there was as high as a 1% risk of death, though in practice much less. This was just a little more than the number of junkies who would typically die in a six months time frame no matter what.
Though such a relatively high rate of death, compared to other procedures, was quite high, this was suitable to bar the procedure from even being tested in the US.
aH yes, the methadonians... We see them a lot in the emergency deparment. I don’t think I can recall a time when I saw a methadonian lower their dosage. It is kinda like the Hotel Califonia, you can check in but you can’t check out.
If someone is taking the same dose of the same drug the physician would have prescribed, but they didn't get it from the pharmacy using a prescription from the doctor, all you've done is make it illegal to attempt to provide medical care for themselves.
There's something very wrong about that idea.
thats not what former addicts tell me. they say that methadone is just exchanging one addiction for another. The fact that its “legal” is no justification for addiction.
“This is the part of the ‘legalize drugs’ argument I despise. If someone wants to be addicted to drugs - ok, I guess. But why do taxpayers have to pay for the damage they do to their own lives?”
I, too, have fear drastic libertarian measures. Not because they are flawed in themselves, but because they wouldn’t exist in a vacuum. It’s the same reason I can’t advocate open borders, despite my sincere belief in them: the welfare state. Can’t very well let foreigners flood in willy-nilly, nor hop-heads roam the streets, so long as we have socialized medicine, socialized housing, socialized transportation, socialized lazing around the house, etc.
Nature has a cure for drug addiction. If you can’t work, you don’t eat. Without anyone subsidizing them, painkiller addicts who weren’t “functional,” as they say, would simply die. And that is the greatest motivator to get well there ever was.
“That is a very jaded perspective. That is like saying that announcing a study that drinking water is healthy is channeling sales of bottled water. Or that calling for more drilling is channeling more profits for Exxon Mobil.”
That’s a really bad analogy, as both mentioned are productive enterprises. No one would use methadone if it wasn’t free.
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