Medication Treatments Led to 80 Percent Lower Risk of Fatal Opioid Overdose for Patients

Patients with opioid use disorder (OUD) receiving treatment with opioid agonists (medications such as methadone or buprenorphine) had an 80 percent lower risk of dying from an opioid overdose compared to patients in treatment without the use of medications.

The new findings, published online February 25 in the journal Addiction, are a collaboration between researchers at NYU Grossman School of Medicine, Johns Hopkins Bloomberg School of Public Health, the Maryland Department of Health, and multiple Maryland State agencies.

The majority of research examining the effectiveness of medication treatment for OUD in population-based studies has been conducted outside of the U.S. and compares patients receiving treatment to those receiving no treatment. This is one of the first U.S. population-based studies, the researchers say, to compare overdose risk among two patient populations across an entire state—one whose treatment includes agonist medications, and a control group receiving psychosocial interventions without agonist medication.

The team of researchers additionally found that being in any kind of treatment for OUD (with or without medication) is protective against overdose compared to not being in treatment at all. However, neither treatment type offers any additional protections against lethal overdose once patients leave treatment.

Nationally, approximately 60 percent of patients entering specialty treatment for OUD do not receive medication, and many patients with access to medication treatment prematurely discontinue care. This is often due to persisting stigma around the use of medication to treat OUD along with logistical barriers involved in accessing medication treatment, which can, in turn, lead to relapse and overdose.

The researchers also found that taking medication while in treatment offered no protection against fatal opioid overdose once patients left treatment. “This lack of post-treatment protection highlights the need to promote better retention strategies so that patients can remain in treatment as long as it continues to help them,” said Noa Krawczyk, PhD, assistant professor, Center for Opioid Epidemiology and Policy in the Department of Population Health at NYU Langone Health, and lead author of the study.

They also found that overdose risk was highest in the first month after leaving treatment, for both medication and non-medication treatment groups.

How the Study Was Conducted

Krawczyk and colleagues examined administrative claims records for publicly-funded outpatient specialty treatment programs in 2015 to 2016 for 48,274 patients with primary diagnosis of opioid use disorder. The research team then linked these claims to mortality data provided from Maryland’s Office of the Chief Medical Examiner. Seventy-two percent of the patients in treatment received medication during the study period, while 28 percent did not (a breakdown that differs significantly from the national landscape, where less than 40 percent of patients in treatment receive medication for OUD).

Accounting for time, the researchers compared four distinct groups: people receiving non-medication treatment, people receiving treatment with medication, people no longer in treatment but who left non-medication treatment, and people who left medication treatment.

“Getting people in the door and started on medication treatment is a great first step, but retention in treatment is equally important,” says Krawczyk. “Because of this, we need to remove barriers to continuation of care, adopt more harm reduction approaches and employ better strategies to encourage and enable people to stay in treatment.”

Study Limitations 

Krawczyk and colleagues identify a number of study limitations. Findings relied on administrative data used for payment and not research, which limits clinical information available. The investigators also clustered all types of non-medication treatment together and were unable, for example, to distinguish between specific non-medication treatment types such as counseling relative to detox. Similarly, they grouped buprenorphine and methadone together; they did not compare patients using different opioid agonists. Finally, the study focuses only on patients receiving outpatient specialty treatment and does assess overdose risk among patients receiving buprenorphine in primary care settings.

In addition to Krawczyk, study co-authors from Johns Hopkins Bloomberg School of Public Health Public and Johns Hopkins School of Medicine include Ramin Mojtabai, PhD, Elizabeth Stuart, PhD, Michael Fingerhood, MD, Deborah Agus, JD, Jonathan Weiner, DrPH, and Brendan Saloner, PhD. Co-authors from the Maryland Department of Health include Casey Lyons, MPH.

Funding for the study was supported by Grant No. 2015-PM-BX-K002 awarded to the Maryland Department of Health by the Bureau of Justice Assistance of the U.S. Department of Justice. This research was also supported by the National Institute on Drug Abuse (F31DA047021, NK supported).

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Preventing mental health disorders may be key to thwarting the opioid crisis

What constitutes mental illness is widely misunderstood. Many people immediately think of schizophrenia or other forms of psychotic or dissociative diseases (e.g., multiple personality disorder), as portrayed in the movies. Sufferers of these illnesses are relatively easy to detect, given obvious alterations in thinking, emotion and behavior. Other disorders such as depression and anxiety, however, are not often readily apparent, even though they are much more common.

Regardless, the opioid crisis has raised our consciousness about the role of these disorders in addiction; science tells us that one begets the other. Given that there are more overdose deaths each year than the number of homicides and suicides combined, we must invest in policies that promise to prevent addiction, not simply treat it after it rears its ugly head. Prevention policies imbedded into national strategies promise to ensure that these problems do not continue to become entrenched, unabated, costing countless lives and precious dollars.

I grew up in a low-income neighborhood outside of Washington, D.C., that was riddled with child abuse, violence, and crime.

I watched as my best friend, Gloria, was beaten down by both physical abuse and neglect by her parents. In her mind, Gloria believed she was defective, unworthy of her parents’ love. She was confused and angry. She was severely depressed. As a teenager, she turned to drugs to cope and alleviate her pain. Eventually, Gloria became addicted and, in adulthood, overdosed.

Gloria is representative of just one of the many people I knew who traveled along a pathway from trauma to depression, including subsequent attempts to stem the pain through drug use, and in far too many cases — debilitating addiction. And because it was so clear to me that these pathways to addiction could be avoided, I decided to devote my career to the field of prevention, which has documented the ability to avert these pathways toward more positive outcomes using science-informed strategies

Today, it is well established that adverse childhood experiences, such as those Gloria endured, significantly increase the likelihood of a person developing mental illness, addiction, or both. People exposed to early adversity such as child abuse, poverty, or caregiver addiction disproportionately develop opiate use problems at a rate twice that found in the general population.

The use of painkillers is 50 percent higher in middle and high school students who grow up in toxic environments. And once teens start misusing prescription painkillers (oxycodone and morphine), approximately 80 percent will transition to opiate dependence.

Although a healthy mix of both prevention and treatment has been recommended by scientific experts to tackle the opioid crisis, treatment has been vastly underfunded and prevention has been virtually ignored.

Scientific evidence from prevention science, amassed over the past 50 years, shows that the most effective approach to promoting behavioral and mental health is comprehensive, and involves a collaboration between child- and family-serving agencies, community organizations, health care providers, and schools.

Effective prevention practices are substantially more cost-beneficial than treatment alone over the long haul. Economic studies consistently report the cost-effectiveness of early, sustained prevention efforts embedded in public health systems.

Noteworthy examples include PROSPER (middle school programs in rural Pennsylvania) shown to reduce opioid use by 10-35 percent, suicide prevention programs targeting Native American Youth (for every dollar spent, $10.67 are saved), and programs to reduce youth risk factors for mental illness such as the Good Behavior Game (for every dollar spent, $81 are saved) by addressing underlying problems before it is too late.

Current policies, however, prioritize the treatment of mental disorders after they have taken root. An example of this reactive policy-driven approach is that insurance coverage is not generally provided until the individual qualifies for a specific diagnosis.

Our health care systems are geared towards medical models of diagnosing “diseases” and only treating them after they manifest as full-blow disorders.

Courtesy of TheHill.com

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Addiction Treatment for Couples

Call Turning Point Treatment Center’s at 949-383-4439 #CouplesDrugRehab

Seeking addiction treatment together in a rehab for couples can be beneficial for a number of reasons, especially when both partners are committed to the relationship and to becoming clean and sober. Providing that both partners are willing to start the recovery process, couples rehab can help not only break the cycle of addiction, but also fortify the relationship by helping the couple examine and change the issues that led to their addiction in the first place.

Turning Point Treatment Center is Pet Friendly

Couples who are addicted to drugs or alcohol often experience difficulties with setting boundaries, expressing feelings, making decisions, parenting, and handling finances. Couples rehab provides education, skills, training, and counseling to help partners achieve improved ways of handling these difficulties. Even if just one partner has an addiction, the other partner can benefit from couples rehab by learning to manage specific triggers and helping the other stay sober. Whether one or both partners require addiction treatment, specialized couples rehab teaches the tools needed to overcome obstacles, prevent relapse, and achieve long-term recovery.

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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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