Tag: medication assisted therapies

Why are Federal Agencies Officially Recommending Suboxone & Methadone?

The New Standard for Treatment

In a move that’s sure to raise more than a few eyebrows, SAMHSA has officially endorsed medication-assisted therapies (also known as opioid replacement therapies).

substance abuse and mental health servies adminstration
via

While they’ve long been supporters of buprenorphine (Suboxone and Subutex) and methadone, the Substance Abuse and Mental Health Services Administration recently added wording to their grant application that strongly encourages treatment centers to make use of these medicines – or else.

This new language can be found in SAMHSA’s 2016-2017 block grant application. If you’re wondering, like I was at first, just how much this comes out to – it’s a lot. They have awarded, or still will, just shy of $2 billion this year.

That astounding sum of money certainly ups the ante for SAMHSA’s recommendation. It also brings them up to speed with the rest of the federal government and the majority of the medical establishment.

White House drug czar Michael Botticelli – a man in long-term recovery himself – has pushed medication-assisted therapies for years. He even hinted earlier this year that SAMHSA would be updating their guidelines to reflect what federal drug courts have in place (an emphasis on using opioid replacement therapies).

Find out exactly what SAMHSA changed their grant language to below!

A TRULY non-addictive painkiller? Sounds like science-fiction…

What SAMHSA is Saying

While it’s a bit long and wordy, the official language of the 2016-2017 block application grant follows. You can also view it directly on the grant portion of SAMHSA’s site.

There is a voluminous literature on the efficacy of [Food and Drug Administration]-approved medications for the treatment of substance use disorders. However, many treatment programs in the U.S. offer only abstinence-based treatment for these conditions. SAMHSA strongly encourages the states to require that treatment facilities providing clinical care to those with substance use disorders be required to either have the capacity and staff expertise to use MAT or have collaborative relationships with other providers such that these MATs can be accessed as clinically indicated for patient need. Individuals with substance use disorders who have a disorder for which there is an FDA-approved medication treatment should have access to those treatments based upon each individual patient’s needs.

It’s important to note a few things before going on to explore just what this means for the future of the addiction treatment industry.

First, as a senior SAMHSA official pointed out, these are recommendations and nothing more. When a state is awarded a federal grant, it’s still up to them to spend it how they want. If Florida, for example, received a 2016-2017 SAMHSA grant, they would be under no obligation to mandate individual treatment centers make use of buprenorphine.

Still, this change in wording makes it appear that SAMHSA’s going to give preference to states that use opioid replacement therapy.

Second, even if federal block grants aren’t directly tied to states using medication-assisted therapies, some discretionary grants are. According to Anne Herron, the senior SAMHSA official mentioned above, the agency has began to include language in their discretionary grants that makes it mandatory for states to use buprenorphine and methadone.

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Does This Mean Everyone in Rehab is Going to Be on Suboxone?

That’s the question that’s being asked by many in the treatment industry. If a national agency like SAMHSA is increasingly making their grants conditional upon opioid replacement therapies – are federal and state funded rehabs going to medicate all their patients?

That answer isn’t as easy as simply saying yes or no, but the short answer is no.

Just because a treatment center makes use of medication-assisted therapy doesn’t mean they’re going to be pumping all their patients full of Suboxone or methadone. While it’s easy to image that as a worst-case scenario, it just isn’t likely to happen.

these pills arent suboxone or methadone but they look like them

Rather, the federal government’s shift towards embracing “science rather than ideology” signals a few things.

First, buprenorphine, methadone, and the like will largely be used during detox. Second, certain patients will likely remain on them throughout treatment and into their long-term recovery. Still, this is probably only going to happen if the patient meets a number of criteria.

In other words – the government isn’t saying that everyone in recovery should be taking buprenorphine. Far from it. They’re encouraging states and treatment centers to embrace what science has shown for some time – that, in certain cases, medication can have a positive impact on an individual’s recovery.

Sounds good to me. What do you think? Let us know on social media!

Are you sober if you take methadone?

Is This the End of the Heroin Epidemic?

Massachusetts Once Again Leads the Charge in Fighting Heroin

Not too long ago, Lighthouse reported an interesting trend in addiction treatment happening in Massachusetts. Well, we’ve actually reported on a lot of interesting treatment initiatives in MA, but this one was a bit larger than the others.

To catch everybody up – Charlie Baker, Governor of Massachusetts, put together a sixteen-person think-tank called the Opioid Addiction Working Group. The job of this group, made up of “private sector experts,” was to come up with a number of recommendations for how MA can more effectively fight the opioid epidemic.

Well, they did just that. The Opioid Working Group came up with sixty-five strategic recommendations about how to fight abuse, addiction, and overdose in Massachusetts.

Sixty-five recommendations! They’re not messing around! More importantly, many of their ideas can be applied across the country to help stem the tide of painkiller and heroin abuse.

Find information on the Group’s key strategies, as well as some of their specific recommendations, below.

12 Key Strategies to Fight Opioid Abuse

The Opioid Addiction Working Group came up with twelve key strategies to help decrease opioid abuse and addiction. They are:

  • 1) Create New Pathways to Treatment – it seems like many struggling addicts use the ER and other cost/time intensive services to get into treatment. These are called ATS or acute treatment services. If those needing treatment had other pathways (less expensive and more personalized), there would be more resources to help others and healthcare professionals would have more time to help others.

 

  • 2) Increase Access to Medication-Assisted Therapies – while drugs like buprenorphine and methadone are controversial, they also help save lives. Both prisons and long-term, step-down levels of care (outpatient programs and sober homes) can implement medication-assisted therapies to help reduce relapse, overdose, and general criminal activity.

 

  • 3) Utilize Data to Identify Hot Spots & Deploy Appropriate Resources – the Working Group suggests that state governments should partner with local police, EMTs, and other emergency service professionals to gather recent and relevant data on substance abuse trends.

 

  • 4) Acknowledge Addiction as a Chronic Medical Condition – if primary care doctors screened and treated addiction like they screen and treat many other diseases, there would be “timely interventions and referrals to treatment.”

 

  • 5) Reduce the Stigma of Substance Use Disorders – the stigma and shame of addiction and drug abuse are often barriers to individuals seeking treatment. This stigma is also associated with other risks, including: subpar mental and physical health, leaving treatment before completion, relapse and recidivism, and others.

 

  • 6) Support Substance Use Prevention Education in Schools – while programs like DARE have only achieved marginal success, fact-based youth education programs can work to stem adolescent drug abuse.

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  • 7) Require All Practitioners to Receive Training about Addiction and Safe Prescribing Practices – if doctors, nurses, and other medical professionals are unaware of the dangers of opioids, they’re more likely to prescribe them. Education on both addiction and effective prescribing of opioids will decrease the number of potentially dangerous prescriptions written each year.

 

  • 8) Improve the Prescription Monitoring Program – while this strategy touches specifically on Massachusetts’ prescription monitoring program, it can be applied nationwide.

 

  • 9) Require Manufactures and Pharmacies to Dispose of Unused Prescription Medication – if unused, expired, or otherwise non-medically needed opioids are left available, they’ll be diverted and misused. If they’re disposed of, they won’t. It’s that simple.

 

  • 10) Acknowledge that Punishment is Not the Appropriate Response to a Substance Use Disorder – Massachusetts has already begun this paradigm shift through the Gloucester Initiative. If this line of thinking can be carried nationwide, those suffering from addiction will be treated as sick rather than criminals.

 

  • 11) Increase Distribution of Naloxone to Prevent Overdose Deaths – Naloxone, widely known by its brand name Narcan, has the potential to save thousands of lives. It’s already made a large impact in states where it’s readily available to addicts, their families, and first responders.

 

  • 12) Eliminate Insurance Barriers to Treatment – many insurance providers will only approve inpatient treatment if an individual first fails outpatient or partial hospitalization. Removing this “fail first” method, as well as prior authorization, will allow more individuals struggling with addiction to receive the treatment they so desperately need.

 

Some Vital & Easy to Implement Recommendations

The above twelve-point strategic model is nothing short of revolutionary in addressing and treating substance abuse. Still, how can the ideas above be implemented across MA and the rest of the country?

That’s where specific recommendations become vital. Find a few of the many recommendations from the Opioid Working Group below. A full report from Gov. Baker’s panel of experts can be found here.

  • Increasing Treatment Access by Matching Demand and Capacity – this would allow anyone in a particular state to search and find addiction treatment that’s best suited for their individualized needs. An ideal way of implementing this is through a “real-time, statewide database of available treatment services.” Help could be as easy as running an internet search.

 

  • Increase the Number of Post-ATS Beds – this means wider access to post-hospital or inpatient treatment support services. Think things like sober living homes, community outpatient meetings, community twelve-step meetings and support groups, etc. These can be implemented through a community stipend and statewide grants.
new ways to help addicts
image via Mass.gov
  • Promote Integration of Mental Health, Primary Care, and Opioid Treatment – this is basically calling for an “one-stop-shop behavioral and mental health treatment policy.” While that may sound overwhelming, it’s not. Think statewide, uniform behavioral and mental health policies.

 

  • Support the Implementation of Substance Use Prevention Curricula in Schools – this can be accomplished through using evidence-based practices for educating youth. These are programs that are proven to reduce the abuse of opioids. In addition to using these programs in the community-picked appropriate grade levels, screening for at-risk youth and warning signs of adolescent sports injury opioid abuse can also be implemented.

 

  • Community Based Pregnancy Outreach – this would require prenatal and postpartum care providers to receive training about identifying, intervening, and treating pregnant or postpartum women abusing drugs. This can be implemented through adding regulations to individual states’ medical licensure boards.

Remember, these are only a very few of the sixty-five total recommendations from the Opioid Addiction Working Group. While they’re massive in scope, and most likely overwhelming to most, they’re also intensely practical.

States across the country can implement any of the recommendations on a fairly modest budget. Lives can be saved. Addiction can be treated. What are we waiting for?

The Ugly Truth about Methadone

What is Methadone?

Of all the drugs out there, street and prescription, none are as misunderstood as methadone. People, even those who’ve had firsthand experience with this synthetic opioid, simply don’t understand what methadone is, how it works, and the inherent dangers it brings with it.

Lighthouse has written about methadone before and we’ll write about it again. We won’t stop until everyone understands the truth about this chemical! What is that truth, you ask? Simple – methadone pills and liquid are dangerous and potentially deadly.

methadone dosage

Methadone dosage varies widely and overdose isn’t uncommon. This is true even for those who’ve been on the drug for quite some time. Speaking of extended periods taking methadone, there’s a little something called methadone maintenance treatment to be addressed. Add into this already complicated equation the varying opinions on whether taking methadone is “allowed” in recovery and, well, you can see why there’s such fierce misunderstanding.

So, with all the above in mind, let’s see if we can’t shed some light on what this opioid really is. First up, let’s look at methadone dosages.

Learn why methadone withdrawal is so much longer than other opioid withdrawal

Methadone Dosage

Methadone pills and liquids come in a ton of different strengths. These can range from five-milligram pills all the way to 100+ milligram syrups. It’s important to remember that someone’s methadone dosage is dependent on why they’re taking the medication in the first place and their body’s reaction.

Some people are prescribed methadone for pain related issues. Despite being thought of only as a form of medication assisted therapy, methadone has a long history of being used to reduce chronic pain.

In this case, an individual’s methadone dosage is usually much lower than if they were taking the drug as a form of addiction treatment. This is because they probably don’t have an opioid tolerance. Over time, doctors will adjust a patient’s methadone dosage depending on their level of pain and how well they tolerate the various side effects.

The other reason methadone is commonly prescribed is to help individual’s addicted to heroin and other opioids (oxycodone, hydrocodone, etc.). This is also known as methadone maintenance treatment. I’ll explore this in depth below, but first let’s look at dosage.

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Someone’s methadone dosage is, broadly speaking, much higher if they’re on maintenance treatment. This makes sense, as they already have a tolerance to opioids in general. A patient’s methadone dosage while receiving maintenance therapy could be as high as 200 milligrams. However, and here’s where things get controversial, methadone pill overdose is higher in people receiving the drug for maintenance than in those receiving it for chronic pain.

Perhaps this is due to the vastly different ways these populations consume methadone. One takes it to relieve pain, the other takes it so they won’t relapse into active addiction. One has the brain of a “normie,” the other has the brain of an addict.

I hope it doesn’t sound like I’m demonizing those struggling with addiction. I’m simply suggesting some possible reasons that methadone overdose is higher in those receiving medication-assisted therapies.

Having looked at various methadone dosages, and how those dosages vary depending on the reason someone is prescribed the drug, let’s examine closer what methadone maintenance treatment is all about.

What’s ORT and why do some people call it “fake sobriety?”

Methadone Maintenance Treatment

Better minds than mine have discussed the in’s and out’s of methadone maintenance treatment, so we won’t beat a dead horse. What Lighthouse offers is a firsthand examination of what methadone maintenance treatment really looks like. That is to say, can you take methadone and be “truly” sober?

Opinions are all over the board on this question. Some say that taking methadone pills is completely acceptable in recovery. Others argue that taking opioids, methadone or otherwise, is a relapse. Some say that because many doctors offer methadone as a first line treatment for heroin addiction, it’s okay to take and call yourself sober. Others disagree.

Unfortunately there simply isn’t an easy answer. Rather, this is a decision that each individual much reach after consulting with their doctor(s), their sober supports (including their sponsor!), their spiritual or religious advisor, and their loved ones. After talking to all those people, it’s up to the individual to make an informed decision about whether methadone maintenance treatment is right for them.

Through our extensive personal experiences, we’ve seen both the good and the bad. While Lighthouse has no opinion on the effectiveness of methadone maintenance treatment, we do strongly encourage everyone to attempt abstinence-based treatment first.

Researchers Think MDMA May Be the “Next Paxil”

Will MDMA Soon Be Prescribed Freely?

While it’s doubtful doctors will be writing scripts for the ubiquitous “molly” anytime soon, there’s mounting evidence of the drug’s positive effects. The latest comes from researchers out of California studying MDMA’s impact on individuals with autism, PTSD, and end of life depression and anxiety.

mdma assisted therapy
pure MDMA via Wikimedia Commons

Although any use of MDMA is strictly banned under federal law, the DEA recently granted permission for a group of scientists to conduct a small-scale study. Researchers from the Los Angeles Biomedical Research Institute and the Santa Cruz Multidisciplinary Association for Psychedelic Studies (MAPS) will team up to see what medical benefits MDMA offers.

This study, set to run in the next year, isn’t without precedent. Since being made illegal in 1985, MDMA’s therapeutic reactions have been studied in over 1,100 patients. There has yet to be any occurrence of an SAE (serious adverse event).

The California team, led by scientist Alicia Danforth, will examine how MDMA impacts anxiety and depression in terminally ill patients and autistic adults. The drug’s effect on social cues as they pertain to autism will also be studied.

According to a report released earlier this year, the need for exploring MDMA’s potential benefits is invaluable. Published in the journal Progress in Neuro-Psychopharmacology & Biological Psychiatry, the report states,

“Researchers gradually and cautiously are exploring a broader range of potential risks and benefits of MDMA-assisted therapies…Informed understanding of the facts about MDMA, a psychotherapeutic compound known to enhance prosocial behaviors, is as relevant to clinicians, researchers, the public, and policymakers now as in any earlier point in its history” (MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults).

Learn strange facts about MDMA!

Are Researchers Just Handing Out Pills?

One of the major concerns raised against medication-assisted therapies, be they opioid, marijuana, or MDMA based, is how secure they are. That is to say, will researchers just start giving away dangerous chemicals to random people?

Of course, this isn’t the case at all. Those selected to participate in medication-assisted therapies are strictly picked. For example, because MDMA raises the heart rate of those who ingest it, individuals with a history of cardiac issues have been excluded from this study.

So, how will it run? Well, according to Brad Burge, the spokesperson for MAPS, there will be eighteen participants. These range from individuals with terminal diagnoses (cancer, etc.) to those on the autism spectrum.

All clinical trials will be double blind and will be conducted by Dr. Philip Wolfson. Participants will either be given a full dose of MDMA (125 milligrams), an active placebo dose (30 milligrams), or a placebo. All participants will then undergo three extended therapy sessions.

To ensure the mental health of all involved, post-study counseling, testing, and resources will be provided.

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Is MDMA Therapy Really a Good Idea?

Well, is it? What are the benefits and drawbacks of giving a powerful psychoactive substance to individuals suffering from various forms of mental illness?

Unfortunately, there’s no definitive answer available yet. The full scope of MDMA assisted therapy remains to be seen. Still, as mentioned above, there is scientific evidence that suggests MDMA can be helpful in certain cases.

While it’s a far cry from “helpful in certain cases” to “the next Paxil,” MDMA does show extraordinary potential. Does this mean the average man or woman should rush out and buy ecstasy or molly on the street? Absolutely not! Let’s see what science has to say first.

What’s the difference between ecstasy and molly?

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