Science says: Medications prevent opioid addiction relapse

NATIONAL NEWS 11 of 50 prev next May 24, 2017 08:10 AM By CARLA K. JOHNSON AP Medical Writer CHICAGO (AP) - Remarks by a top U.S. health official have reignited a quarrel in the world of addiction and recovery: Does treating opioid addiction with medication save lives? Or does it trade one addiction for another? Health Secretary Tom Price's recent comments - one replying to a reporter's question, the other in a newspaper op-ed - waver between two strongly held views. Medication-assisted treatment, known as MAT, is backed by doctors. Yet it still has skeptics, especially among supporters of 12-step programs like Narcotics Anonymous, because it involves opioid-based medications. Price appeared to side with that camp when he said during a recent visit to Charleston, West Virginia: "If we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven't moved the dial much." But in an opinion piece published last week in the Charleston Gazette-Mail, he twice mentioned his agency's support for medication-assisted treatment. Here's a closer look. HOW MEDICATION CAN TREAT ADDICTION Because of how opioids act on the brain , people dependent on them get sick if they stop using. Withdrawal can feel like a bad flu with cramping, sweating, anxiety and sleeplessness. Cravings for the drug can be so intense that relapse is common. Medication-assisted treatment helps by moving a patient from powerful painkillers or an illicit opioid like heroin to a regular dose of a legal opioid-based medication such as buprenorphine or methadone. The ideal dose is big enough to fend off withdrawal, but too small to produce a euphoric high. Patients can drive, rebuild relationships and get back to work. "They're not walking around high" and it gives them the chance to practice new ways of coping with family and psychological issues, said Dr. Joseph Garbely of Pennsylvania-based Caron Treatment Centers. With counseling and education about addiction, patients can get back on track. They eventually can taper off medications, but some take them for years. WHAT RESEARCH SAYS Researchers studying these treatments use drug screening to see whether patients are staying off illegal drugs. If someone uses heroin while in treatment, it shows up in their urine. A 2014 review of 31 studies found methadone and buprenorphine keep people in treatment and off illicit drugs. The review by the Cochrane Collaboration, an international group of scientists that evaluates research, found each drug worked better than a dummy medication. A side benefit worth noting: Methadone also helps prevent the spread of HIV by reducing needle sharing, a different research review by Cochrane found. Methadone and buprenorphine can be abused and both can cause overdoses, particularly methadone. But researchers have found that methadone prevents more overdose deaths than it causes. For most patients, medication combined with counseling is superior to other strategies, according to the American Society of Addiction Medicine. OTHER OPTIONS "What's right for one person isn't necessarily right for another person," Price said during a May 9 visit to West Virginia. When asked whether he and his team leaned toward medication or faith-based approaches to opioid addiction, his reply lined up with those who favor abstinence. Abstinence-only philosophies "are not scientifically supported," according to the first surgeon general's report on addiction, published in November. Yet people who describe themselves as in recovery consistently say abstinence is important. All told, remission from opioid addiction can take years and multiple tries at treatment. "The public needs to know that there are proven, effective treatments for opioid addiction," former U.S. General Vivek Murthy told The Associated Press. Murthy was fired by the Trump administration after he refused to resign. Price also mentioned a non-opioid alternative - namely an injection of naltrexone called Vivitrol - as "exciting stuff." Vivitrol, a newer drug, can be used only with patients who have completely detoxed and has a limited track record compared to buprenorphine and methadone. Early studies have shown promise, but relapse is a danger after injections stop. Health and Human Services spokeswoman Alleigh Marre told AP that Price's comments don't signal a policy change. Price "has argued that we should be open and supportive to the broadest range of options, from medication-assisted treatments - including methadone, buprenorphine, or naltrexone - to faith-based recovery programs," Marre said. Not informing patients about the effectiveness of treating addiction with medication is like a doctor not telling a cancer patient about chemotherapy, said Dr. Mark Willenbring, a former director of treatment research at the National Institute for Alcohol Abuse and Alcoholism. "Scientifically, this is a settled matter."

1994's MOST BIZARRE SUICIDE

At the 1994 annual awards dinner given by the American Association for Forensic Science, AAFS President Don Harper Mills astounded his audience in San Diego with the legal complications of a bizarre death. Here is the story. "On 23 March 1994, the medical examiner viewed the body of Ronald Opus and concluded that he died from a shotgun wound of the head. The decedent had jumped from the top of a ten- story building intending to commit suicide (he left a note indicating his despondency). As he fell past the ninth floor, his life was interrupted by a shotgun blast through a window, which killed him instantly. Neither the shooter nor the decedent was aware that a safety net had been erected at the eighth floor level to protect some window washers and that Opus would not have been able to complete his suicide anyway because of this." >>"Ordinarily," Dr. Mills continued, "a person who sets out to commit suicide ultimately succeeds, even though the mechanism might not be what he intended. That Opus was shot on the way to certain death nine stories below probably would not have changed his mode of death from suicide to homicide. But the fact that his suicidal intent would not have been successful caused the medical examiner to feel that he had homicide on his hands. "The room on the ninth floor whence the shotgun blast emanated was occupied by an elderly man and his wife. They were arguing and he was threatening her with the shotgun. He was so upset that, when he pulled the trigger, he completely missed his wife and the pellets went through the a window striking Opus. "When one intends to kill subject A but kills subject B in the attempt, one is guilty of the murder of subject B. When confronted with this charge, the old man and his wife were both adamant that neither knew that the shotgun was loaded. The old man said it was his long-standing habit to threaten his wife with the unloaded shotgun. He had no intention to murder her - therefore, the killing of Opus appeared to be an accident. That is, the gun had been accidentally loaded. "The continuing investigation turned up a witness who saw the old couple's son loading the shotgun approximately six weeks prior to the fatal incident. It transpired that the old lady had cut off her son's financial support and the son, knowing the propensity of his father to use the shotgun threateningly, loaded the gun with the expectation that his father would shoot his mother. The case now becomes one of murder on the part of the son for the death of Ronald Opus. There was an exquisite twist. "Further investigation revealed that the son [Ronald Opus] had become increasingly despondent over the failure of his attempt to engineer his mother's murder. This led him to jump off the ten-story building on March 23, only to be killed by a shotgun blast through a ninth story window. "The medical examiner closed the case as a suicide."

THE NARCOTIC FARM

From its opening in 1935, the United States Narcotic Farm in Lexington, Kentucky, epitomized this country’s ambivalence about how to treat addiction. On the one hand, it was a humane hospital set on 1,000 acres of farmland where drug addicts could recover from their habits. On the other hand, it was an imposing federal prison built to incarcerate convicted addicts.

“Narco,” as it was known locally, was a strange anomaly, a coed institution where convicts did time alongside volunteers who’d checked themselves in for treatment. It became the world’s epicenter for drug treatment and addiction research. For forty years it was the gathering place for this country’s growing drug subculture, a rite of passage that initiated famous jazz musicians, drug-abusing MDs, street hustlers, and drugstore cowboys into the new fraternal order of the American junkie.

But what began as a bold and ambitious public works project was shut down in the 1970s amid changes in drug policy and scandal over its drug program, which recruited hundreds of prisoners to volunteer as human guinea pigs for groundbreaking drug experiments and rewarded them with bonus doses of heroin for their efforts.

The Narcotic Farm – both the documentary and the book - tells the story of this fascinating institution through rare photographs and film, forgotten press clippings, revealing government documents, and historically significant new interviews with prisoners, doctors, and guards who were there. Through their interviews and a wealth of newly collected archival material, The Narcotic Farm traces this federal institution’s rise and tumultuous fall.

Links....

more about the history of the Narcotic Farm and addiction research read Discovering Addiction, by Nancy Campbell For more about the history of women in American discourse on addiction, read Using Women, by Nancy Campbell For more on the history of addiction research including interviews with scientists and doctors who began their careers at The Narcotic Farm, go to: University of Michigan Substance Abuse Research Center website For more about The Narcotic Farm's narrator and composer Wayne Kramer Wayne Kramer's website Former Narcotic Farm inmate William Burroughs reads "The Do-Rights," a poem about the Narcotic Farm The Man with the Golden Arm, a feature film which opens with Frank Sinatra's character returning from the Narcotic Farm Panic in Needle Park, a stunning LIFE photo essay about heroin addiction in the early 1960s by Bill Eppridge that became the basis for the Al Pacino film of the same title National Institute on Drug Abuse website PBS Frontline documentary, Drug Wars, associate produced by Narcotic Farm produce/director, JP Olsen "Prisontown" music video by The Malefactors of Great Wealth

Filling empty spaces

Now that I have gotten off of heroin I have to find something to do with my time. Boardom and complacency are my worst enemies. I love photography. Here are a few shots i took. 

NY Times video about heroin addiction in Maine

https://youtu.be/8rnSsB0vfCQ

My favorate author is Poe. Who was also a Morphine addict....

"I have absolutely no pleasure in the stimulants in which I sometimes so madly indulge.

It has not been in the pursuit of pleasure that I have periled life and reputation and reason.

It has been the desperate attempt to escape from torturing memories, from a sense of insupportable loneliness and a dread of some strange impending doom."

Edgar Allan Poe

Day 4 on 2 days doses

Not as bad as i thought it was going to be but its still damb uncomfortable. Woke up feeling a little jittery. However, the sickness has been staved off pretty well. Today should be interesting though. No matter what, its better then the alternative. Getting up, hustling money for bags, shooting up, fucking up my arms, only to have to shoot up 4 hours later. Thank you #Suboxone.