Medically Supervised Detox From Opiates

Many people believe that using medication in the treatment of substance use disorders is trading one addiction for another. However, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), use of FDA-approved medications in combination with evidence-based therapies can be effective in the treatment of addiction and may help recovering users stay in treatment longer, extending periods of sobriety and paving the way for successful recovery.

This combination of therapies is known as medication-assisted treatment, or MAT.

MAT is commonly integrated into treatment for opioid and alcohol substance use disorders.

Medication assisted treatment (MAT) is the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders. A combination of medication and behavioral therapies is effective in the treatment of substance use disorders, and can help some people to sustain recovery.

Buprenorphine

Buprenorphine, which is a partial opioid agonist, is used to treat someone who is addicted to an opioid – whether the substance being abused is heroin or a prescription painkiller, such as OxyContin or Vicodin. Of the few medications used for opioid dependence, buprenorphine is the first that can be prescribed for and obtained directly from the doctor’s office. To date, other drugs used to treat opioid dependency – such as methadone – can only be administered in clinics.

This increased access for buprenorphine reflects a change in the level of urgency that the opioid epidemic presents to the medical community – one that demands broadened patient access to opioid dependency medication and other forms of treatment.

Buprenorphine isn’t prescribed in isolation; it’s one component of a comprehensive recovery program designed to address the patient’s individual needs.

Buprenorphine alone has potential for abuse and prescription diversion due to its opioid effects. However, formulations that contain a combination of buprenorphine and naloxone decrease the potential for abuse because naloxone otherwise blocks a robust opioid effect and, further, will initiate withdrawal symptoms if attempts are made to misuse it via injection.

When used properly, these buprenorphine-containing medications can both alleviate unpleasant opioid withdrawal and decrease associated cravings.

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Helpful Links:

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• From Samsha.gov: Medication-Assisted Treatment for Opioid Addiction – Facts for Families and Friends
• From Nursingworld.org: Medication-Assisted Treatment (MAT) for Opiate Dependence—It’s Not “Giving Drugs to Drug Addicts”
• From VA.org: From VA.org Understanding PTSD and Treatments
• From PsychiatryOnline.org: Anticraving medications for relapse prevention

More Helpful Links Here

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Meth In The Morning, Heroin At Night: Inside The Seesaw Struggle of Dual Addiction

In the 25 years since she snorted her first line of methamphetamine at a club in San Francisco, Kim has redefined “normal” many times. At first, she says, it seemed like meth brought her back to her true self — the person she was before her parents divorced, and before her stepfather moved in.

“I felt normal when I first did it, like, ‘Oh! There I am,’ ” she says.

Kim is 47 now and has been chasing “normal” her entire adult life. That chase has brought her to some dark places, so we agreed not to use her last name, at her request. For a long time, meth, known commonly as speed, was Kim’s drug of choice.

Then she added heroin to the mix. She tried it for the first time while she was in treatment for meth.

Read the complete article at NPR.org here ..

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Scientists Now Know How Sleep Cleans Toxins From the Brain

The synchronized brain waves of non-REM sleep may play a key role in preventing toxins from accumulating in a person’s brain.

Laura Lewis and her team of researchers have been putting in late nights in their Boston University lab. Lewis ran tests until around 3:00 in the morning, then ended up sleeping in the next day. It was like she had jet lag, she says, without changing time zones. It’s not that Lewis doesn’t appreciate the merits of a good night’s sleep. She does. But when you’re trying to map what’s happening in a slumbering human’s brain, you end up making some sacrifices. “It’s this great irony of sleep research,” she says. “You’re constrained by when people sleep.”

Her results, published today in the journal Science, show how our bodies clear toxins out of our brains while we sleep and could open new avenues for treating and preventing neurodegenerative diseases like Alzheimer’s.

When we sleep our brains travel through several phases, from a light slumber to a deep sleep that feels like we’ve fallen unconscious, to rapid eye movement (REM) sleep, when we’re more likely to have dreams. Lewis’ work looks at non-REM sleep, that deep phase which generally happens earlier in the night and which has already been associated with memory retention. One important 2013 study on mice showed that while the rodents slept, toxins like beta amyloid, which can contribute to Alzheimer’s disease, got swept away.

Lewis was curious how those toxins were cleared out and why that process only happened during sleep. She suspected that cerebrospinal fluid, a clear, water-like liquid that flows around the brain, might be involved. But she wasn’t sure what was unique about sleep. So her lab designed a study that measured several different variables at the same time.

Study participants had to lie down and fall asleep inside an MRI machine. To get realistic sleep cycles, the researchers had to run the tests at midnight, and they even asked subjects to stay up late the night before so people would be primed to drift off once the test began.

Lewis outfitted the participants with an EEG cap so she could look at the electrical currents flowing through their brains. Those currents showed her which stage of sleep the person was in. Meanwhile, the MRI measured the blood oxygen levels in their brains and showed how much cerebrospinal fluid was flowing in and out of the brain. “We had a sense each of these metrics was important, but how they change during sleep and how they relate to each other during sleep was uncharted territory for us,” she says.

What she discovered was that during non-REM sleep, large, slow waves of cerebrospinal fluid were washing over the brain. The EEG readings helped show why. During non-REM sleep, neurons start to synchronize, turning on and off at the same time. “First you would see this electrical wave where all the neurons would go quiet,” says Lewis. Because the neurons had all momentarily stopped firing, they didn’t need as much oxygen. That meant less blood would flow to the brain. But Lewis’s team also observed that cerebrospinal fluid would then rush in, filling in the space left behind.

“It’s a fantastic paper,” says Maiken Nedergaard, a neuroscientist at the University of Rochester who led the 2013 study that first described how sleep can clear out toxins in mice. “I don’t think anybody in their wildest fantasy has really shown that the brain’s electrical activity is moving fluid. So that’s really exciting.”

One big contribution of the paper is it helps show that the systems Nedergaard has been studying in mice are present and hugely important for humans too. “It’s telling you sleep is not just to relax,” says Nedergaard. “Sleep is actually a very distinct function.” Neurons don’t all turn off at the same time when we’re awake. So brain blood levels don’t drop enough to allow substantial waves of cerebrospinal fluid to circulate around the brain and clear out all the metabolic byproducts that accumulate, like beta amyloid.

The study also could have clinical applications for treating Alzheimer’s. Recent attempts at developing medications have targeted beta amyloid. But drugs that looked promising at first all failed once they got into clinical trials. “This opens a new avenue,” says Nedergaard. Instead of trying to act on one particular molecule, new interventions might instead focus on increasing the amount of cerebrospinal fluid that washes over the brain.rain.

Read the complete article at Quartz.com here .. 

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What to know about opiate withdrawal

When a person stops taking opiates, they may experience withdrawal symptoms, such as pain, body aches, fatigue, and nausea. The symptoms will ease up over time, and medical treatments and home remedies can help. The symptoms of opiate withdrawal can be very distressing, but they are rarely life threatening. Withdrawal symptoms can arise hours after the last dose of the drug and may last for a week or more.

Where possible, people should work with a healthcare professional to manage their withdrawal and come off opiates gradually to reduce symptoms. Drug replacement medicines, such as methadone and buprenorphine, can help.

In this article, we provide an overview of opiate withdrawal, including its causes and a timeline of symptoms. We also explain how to treat and manage the symptoms and where to turn for help.

What is opiate withdrawal?

A person with opiate withdrawal may experience anxiety, agitation, or aching muscles.

Opiates are drugs that derive naturally from the opium poppy plant and activate opioid receptors on nerve cells.

Doctors prescribe some opiates, such as codeine, for pain relief. There are also some synthetic substances that bind to the same receptors. These are called opioids.

Some people use opiates and opioids recreationally to produce a high. People can experience opiate withdrawal from both prescription pain relievers and recreational drug use.

Opiates are effective for pain relief, but when a person takes them repeatedly over time, they have a high risk of causing physical dependence and tolerance, which can lead to addiction.

Physical dependence on a drug means that a person’s brain structure and brain chemicals have altered to accommodate the drug. When the person stops using opiates, their body has to adapt to not having the drug in the body, which results in withdrawal symptoms.

Some examples of opiates and opioids include:

• opium
• morphine
• heroin
• codeine
• fentanyl
• oxymorphone

What are the symptoms of opiate withdrawal?

Opiates, including prescription medications and heroin, can cause withdrawal symptoms several hours after the last dose.

The severity of a person’s symptoms will depend on the dosage of opiates that they were using and how suddenly they are coming off the drug.

The type of opiate also affects the symptoms that people experience. Short acting opiates, such as heroin, can produce more intense symptoms in a shorter time frame, whereas long acting opiates, such as methadone, can take up to 30 hours from the last dose to cause any symptoms.

Symptoms occur as a result of the body’s detoxification from the drug. Common symptoms include:

• aching muscles
• stomach pain
• anxiety or agitation
• increased heart rate
• fever and chills
• nausea and vomiting
• diarrhea
• tremors
• depression

Symptoms can be mild or severe and can depend on the person’s:

• overall health, including any medical conditions
• drug use, including the extent and duration
• environment, for example, how stressful it is
• family history of addiction

Article courtesy of MedicalNewsToday.com

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Here’s What Happens During a Fentanyl Overdose

Deaths due to opioid overdoses have risen sharply in the past few years, partly due to a particularly potent drug called fentanyl. Fentanyl is between 50 and 100 times more powerful than another opioid, morphine, and its use seems to be on the rise in the U.S.

In Massachusetts, for example, from 2013 to 2014, 32 percent of opioid overdose deaths involved fentanyl. During the first half of 2016, the percentage of fentanyl-related opioid deaths had more than doubled, jumping to 74 percent, according to a new report.

In an effort to better understand the effects of this powerful drug, as well as educate first responders and bystanders on how to best identify and treat people who have overdosed on fentanyl, researchers at the Centers for Disease Control and Prevention interviewed more than 60 people from southeastern Massachusetts, who were recruited from harm-reduction programs. [America’s Opioid-Use Epidemic: 5 Startling Facts]

All of the people in the study had either used the drug in the previous year and survived an overdose in past six months, or had witnessed an overdose between October 2014 and March 2015.The researchers asked them about their experiences, knowledge, attitudes and beliefs about opioid overdoses. In addition, the researchers gathered information from death records to track fatalities that occurred during the same time period.

The interviews shed light on the fast-acting and sometimes gruesome nature of fentanyl overdoses — as well as how widespread the drug has become — according to the report, which the CDC published today (April 13).

When the researchers asked the participants why there had been an increase in opioid overdose deaths in recent years, 88 percent of the respondents placed the blame on fentanyl. (In fact, when the CDC researchers reviewed death records for nearly 200 people who overdosed on opioids during the study period, they found that two-thirds tested positive for fentanyl.)

From pain patch to deadly powder
Fentanyl can be used legally — doctors prescribe the drug for people with chronic pain. The drug comes as a transdermal patch, which slowly releases the drug into the person’s body at a rate that is considered safe.

But the drug can also be found in an illegal, powdered form.

In the interviews, the participants said that fentanyl powder can be purchased on its own or mixed with heroin. They also said that sometimes, people didn’t know if the heroin they had purchased also contained fentanyl.

The death records revealed that 82 percent of the fatalities involved the illegal powdered form of the drug, and just 4 percent involved the prescription patch. In 14 percent of the cases, the form of the drug that the person had used was not known.

The researchers noted that some of the people interviewed said that they specifically sought out fentanyl. Others said they had tried to avoid the drug, but they also said that the possibility that they might wind up with fentanyl, or fentanyl-laced heroin, didn’t stop them from seeking opioids, the researchers found. [10 Interesting Facts About Heroin]

One of the major characteristics that the respondents described was the speed of a fentanyl overdose: Seventy-five percent of the respondents said that the symptoms occurred within seconds to minutes.

When a person overdoses on heroin, he or she may take the drug and then proceed to carry on a conversation for a few moments, one respondent said. Then suddenly, that person stops talking and “you look over and realize that they’re overdosing,” the respondent said.

But with fentanyl, the same respondent said that the effect is immediate: “I would say you notice it [a fentanyl overdose] as soon as they are done [injecting the fentanyl]. They don’t even have time to pull the needle out [of their body] and they’re on the ground.”

Injecting fentanyl was the most common way that a person overdosed on the drug, accounting for 75 percent of the overdoses witnessed, according to the respondents. The remaining 25 percent of the overdoses resulted from people snorting the dug, the researchers said.

Anatomy of an overdose
The researchers asked the respondents to describe what happened during a suspected fentanyl overdose. The most common characteristic, described in 20 percent of the cases, was that the person’s lips immediately turned blue, followed by gurgling sounds with breathing (16 percent of the cases), stiffening of the body or seizure-like activity (13 percent), foaming at the mouth (6 percent) and confusion or strange behavior before the person became unresponsive (6 percent), according to the report.

Fentanyl overdoses can be reversed with the same antidote that is used to treat other opioid overdoses — a drug called naloxone, which is sold under the brand name Narcan.

In the report, in 83 percent of the cases when naloxone was used, one dose was not sufficient. Instead, the respondents said that two or more doses of the antidote were needed to revive the person who had overdosed, according to the report.

Indeed, some opioid users are aware of the dangers of both fentanyl and heroin: According to the report, 30 percent of the respondents said that, in order to help protect themselves against a deadly overdose, they don’t use the drugs when they are alone.

Read the entire article at LiveScience.com here 

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Quitting alcohol may improve mental well-being, health-related quality of life

Quitting alcohol may improve health-related quality of life for women, especially their mental well-being, according to a study from Hong Kong published in CMAJ (Canadian Medical Association Journal).

“More evidence suggests caution in recommending moderate drinking as part of a healthy diet,” says Dr. Michael Ni, School of Public Health and The State Key Laboratory of Brain and Cognitive Science, University of Hong Kong (HKU).

The study carried out by Dr. Xiaoxin Yao, Dr. Michael Ni, Dr. Herbert Pang and colleagues at HKU included 10 386 people from the FAMILY Cohort in Hong Kong who were nondrinkers or moderate drinkers (14 drinks or less per week for men and 7 drinks or less per week for women) between 2009 and 2013. The researchers compared their findings with data from the National Epidemiologic Survey on Alcohol and Related Conditions, a representative survey of 31 079 people conducted by the National Institute on Alcohol Abuse and Alcoholism in the United States.

The mean age of participants in the FAMILY Cohort was 49 years and 56% were women. About 64% of men were nondrinkers (abstainers and former drinkers) and almost 88% of women were nondrinkers. Men and women who were lifetime abstainers had the highest level of mental well-being at the start of the study (baseline). For women who were moderate drinkers and quit drinking, quitting was linked to a favourable change in mental well-being in both Chinese and American study populations. These results were apparent after adjusting for sociodemographic characteristics, body mass index, smoking status, and other factors.

“Global alcohol consumption is expected to continue to increase unless effective strategies are employed,” says Dr. Ni. “Our findings suggest caution in recommendations that moderate drinking could improve health-related quality of life. Instead, quitting drinking may be associated with a more favourable change in mental well-being, approaching the level of lifetime abstainers.”

“Change in moderate alcohol consumption and quality of life: evidence from 2 population-based cohorts” is published July 8, 2019.

Read the complete article at MedicalExpress.com here.

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Why are intelligent people more likely to abuse drugs?

The downsides of drug abuse are so clear that one would imagine smarter folks would stay away from them. The research suggests otherwise.

• Numerous studies have confirmed the link between intelligence and substance abuse.
• However, the mechanism for this correlation has been difficult to pin down.
• Why would more intelligent people who should ostensibly know better practice such a risky habit?

No mathematician has ever published more papers than Paul Erdos. The 20^thcentury mathematician was brilliant, eccentric, and prolific, publishing a record 1,525 papers. By the age of four, Erdos could calculate the number of seconds someone had lived if they gave him their age. He contributed to a wide variety of mathematical disciplines, including discrete mathematics, probability theory, Ramsey theory, graph theory, and others. He worked 19-hour days. And he loved amphetamines.

When Ronald Graham, a concerned friend and fellow mathematician, bet him $500 that he couldn’t stay off his drug of choice for a month, Erdos accepted and easily won the challenge. When the 30 days was up, Erdos said to Graham, “You’ve showed me I’m not an addict. But I didn’t get any work done. I’d get up in the morning and stare at a blank piece of paper. I’d have no ideas, just like an ordinary person. You’ve set mathematics back a month.” Erdos resumed taking amphetamines and did so for every day of his life until his death 17 years later.

Numerous studies have documented the relationship between intelligence and substance abuse. This relationship should be a negative one. After all, recreational drugs can damage your health, addiction costs huge amounts of money, and the legal consequences can be dire. But in fact, intelligence and substance abuse have a positive relationship: intelligent individuals are more likely to abuse drugs than less intelligent individuals.

Read the complete article here … 

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