More, Not Less.

photo-7I can say with unusual certainty that at some point in every person’s life he/she will brush against the sordid world of addiction. That is not to say that everyone in existence is or will be an addict, but rather that someone we know will struggle with an addiction. Addictions appear in a variety of ways; there is no one size fits all. Of course, in our society, drugs seem to be the most obvious form. The 2011 National Survey on Drug Use and Health completed by the U.S. Department of Health and Human Services estimated the number of Illicit drug users age 12 and older at 22.5 million people with use among men almost double that of the female population. An additional report done by the same department revealed that 8.3 million children live with at least one parent who suffers from a substance abuse problem. These children are two to three times more likely to be abused and/or neglected leading to long-term placement with a Child Protective Agency. There is also the greater possibility that these children will grow up to suffer from a range of emotional, developmental, and academic problems as well as being at a higher risk of becoming addicts themselves. The American Society of Addiction Medicine (ASAM) states that genetic factors account for fifty percent of the likelihood; the rest are based on environmental factors. A recent survey showed that one in five individuals currently receiving treatment had been introduced to their substance of choice by a parent. How many more are yet to be counted?

Addiction is complicated. At one of its most basic levels there continues to be debate among medical and therapeutic professionals about whether to define addiction as a disease, a mental illness, or a condition. The American Society of Addiction Medicine (ASAM) designates addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry”. It is characterized by the “inability to consistently abstain” due to affects that occur within neurotransmissions and other interactions in the brain’s structures. The disease process “leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.” Addiction essentially boils down to the biology of an individual’s mind (nature). ASAM also cites that how one is nurtured will also impact addiction to a small degree. In comparison to the explanation given by ASAM, Psychology Today has rendered a definition that offers a less specific, more undecided meaning. The publication defines addiction as “a condition that results when a person ingests a substance…or engages in an activity…that can be pleasurable but the continued use of which becomes compulsive and interferes with ordinary life responsibilities”. This definition is by far easier to comprehend and would allow for any reader to acclimate the term to his/her specific notions. To label addiction as a condition permits it to be interpreted as almost anything from a disease to a simple problem. It would seem that Psychology Today sees addiction as the latter. The publication implies that overuse leads to compulsion. It fails to take into account whether addiction is a lifelong pattern or from where it initially stems. Addiction seems to be just a strong need and/or desire for something, another problem which can be fixed with sheer will-power.

Defining addiction is not its only complication. Addiction is deceptive by its nature. It can linger unnoticed by those closest to an addict for long periods of time. Addiction can even obscure itself from the addict’s awareness. For example the lack of recognition appears to be common among those with opiate or narcotic addictions. Opioids are used to control or elevate pain by reducing “the intensity of pain signals” in the brain; they affect the areas of the brain that control emotion.  These drugs are used as a method of treatment typically prescribed for chronic illnesses and certain types of injuries as well as after surgeries. For some individuals the use of opioids will elicit a greater effect than just the relief from the twinges of pain.  The drugs can also induce a euphoric response in regions of the brain. While this affect may seem to be the culprit leading to opiate or narcotic addiction it is important to remember that dependency likely stems from a variety of factors. Moreover, not all individuals who have a euphoric response will become addicted. Still the FDA has placed strict guidelines of the prescribing and distribution of opiate or narcotic drugs due to the high possibility of addiction and misuse.

Over the last decade drug addiction has spiked claiming the greatest number of victims. Although there is an assortment of uppers, downers, and how-did-I-get-heres, the use of heroin – a euphoria producing narcotic – has been on the rise. Across the U.S. entire towns are succumbing to the drug. A town in Washington state has seen a 53.5% increase. And just this week in Ohio, the Attorney General declared his state was facing an epidemic due to the drug.

Coverage regarding heroin have slowly been seeping into the national media since 2011. While the stories often cover the salacious spiral down into addiction and the devastating effects of long-term use there has lately been a trend regarding treatment for heroin addiction. The most recent piece takes a “double-edged” look at Buprenorphine – the newest drug to aid in ending reliance on opioids. The article narratives of recovery and remorse in the midst of weighing its potential benefits against its increasing popularity as a recreational drug. It also deals with potential misuses among our medical community members and inside prison walls. It seems that Inmate holiday cards have been offering more than festive decorations and well wishes. While stamp licking stories are sure to garner more attention it seems more important to recognize those trying to get clean.

According to data released in a 2012 survey conducted by The Partnership at Drugfree.org and The New York State Office of Alcoholism and Substance Abuse Services (OASAS) 23.5 million individuals reported being in treatment for a substance abuse problem. These are the faces who know the ups and downs of addiction, the places it hides, and the damage it has done. Individuals in recovery should be the voices we listen to when deciding what is acceptable treatment. Addiction and treatment share the common factor that there is no one-size-fits-all method. Treatment varies depending on the addiction but most importantly should be tailored to the individual who is seeking help. Successful recovery will often involve multiple on-going treatments that are meant to work together. Commonly known treatments involve in-patient facilities, twelve step groups, and some type of behavioral therapy. In the case of opioid addictions the use of medications are included to help with the withdrawals that occur.

According to the American Psychiatric Association opioid addictions are “a condition in which the body must have a drug to avoid physical and psychological withdrawal symptoms”. It is characterized by stages of dependence and tolerance. Once the body is deprived of the drug source is will go through a series of symptoms such as:

“Agitation, Anxiety, Muscle aches, Increased tearing, Insomnia, Runny nose, Sweating, Yawning, Abdominal cramping, Diarrhea, Dilated pupils, Goose bumps, Nausea, and Vomiting

The symptoms generally begin 12 hours after the last drug use and can last up to 30 hours. Although some choose to handle this alone it is best handled under medical supervision as severity of symptoms vary and have led to death. For addicts who seek medical assistance there are a couple of drugs that can help to ease withdrawal and keep them on a steadier path.

Currently there has been talk about the latest opioid treatment drug trend. The newest drug to the American market is known as Buprenorphine. The brand name is Suboxone which is actually the combination of buprenorphine and another drug, naloxone. The dosage of naloxone contained in Suboxone is a smaller amount. It is used to reverse opioid effects. The drug is frequently used in medical facilities to treat overdoses caused by opioids. Some consider it to be the healer that brings Lazarus back from death. Buprenorphine, on the other hand, is the part that affects the brain similar to an opioid. It is customarily marketed as an alternative to the long-standing treatment drug Methadone. Both medications are used to treat opioid-based addictions. These treatments offer individuals a legal method by which to curb their cravings and stave off withdrawal symptoms. The drugs are meant to help ween the addicts’ the physical demands with the ultimate goal being complete freedom from the drug. The primary differences between Buprenorphine and Methadone are the duration of the medications’ affect on the body as well as the level of effectiveness each can achieve. In addition to its longer lasting effects Methadone can create the euphoria similar to an opioid. Buprenorphine should plateau to the point of easing physical discomfort. Buprenorphine is meant to be used as part of a larger treatment program. It gives the addict an chance to clear his/her head and choose a path to recovery. Unlike Methadone, which can only be obtained by traveling to a clinic, Buprenorphine can be prescribed by a physician for at home use. This allows individual’s to achieve a greater sense of self reliance and confidence through independence; they are tied to a specific schedule or a long distance car ride. It also allows individuals to maintain some kind of privacy in their recovery. Admitting that you have an addiction is the first step, the hardest step, so you should have to right to decide who knows.

While there are enormous benefits to drug therapy as part of recovery it also comes with difficulties. Methadone can only be attained at clinics specializing in its distribution. The majority of clinics are found in urban areas. Most of those in need must travel daily to receive their dose which keeps them from maintaining a regular living schedule. Also there are disputes in many communities about allowing such clinics to be opened. This would lead one to assume that Buprenorphine would be more available but this is not the case. The FDA has placed limits on the number of patients for which a physician may prescribe the drug. The limit is capped at 100; it was previously 30. Additionally, the physician must go through specialized training in order to legally proscribe the drug. Physician assistants and Nurse Practitioners are not allowed to prescribe this medication. This ban alone significantly lowers the number of possible prescribers. In the U.S today there are not enough active physicians to adequately care for the entire population and even fewer certified as Buprenorphine proscribers. As if this lack wasn’t enough, cost for the medication is high. A single dose based on the strength (mg) can range from $4 to $19 per day. Individuals without insurance, or whose insure will not cover the drug, spend around $500 per month. And that cost does not include any fees related to doctor visits. Furthermore there is the dilemma of finding a pharmacy that carries the drug. Federal regulations   require businesses that dispense medications such as Buprenorphine to register with the DEA, however they are not required carry every drug on the market even if licensed. Finally there is the fact that buprenorphine, like a multitude of other drugs, is becoming more prevalent as a street-drug. It is the primary suspect in approximately 420 deaths related to drug overdoses; some of which were first-time users. Still, compared to the CDC’s report that 100 people die every day from overdoses caused by prescription drugs, the number is extremely low.

Addicts deserve the opportunity to have a complete and well-rounded recovery. We should be willing to provide all the available meanings that will help to establish a healthier foundation, a better life. Even with problems, allowing the use of a drug such as Buprenorphine can have a positive impact on the future of addicts, their families, friends and our communities. Buprenorphine is an important part of the recovery process that allows individuals to regain a some sense of normalcy in their lives. The use of drugs as part of treatment can make recovery more feasible. It may help to remove the fear and anxiety that keeps some addicts trapped in their addiction. It may just make recovery that which addicts can not live without.

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One Comment to “More, Not Less.”

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