Corey’s Haims death – One Among Many..

Prescribed medicines: Killers from the chemist

They are behind a string of celebrity deaths. But these legal drugs also blight thousands of more ordinary lives, says Phil Boucher

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Corey Haim in 2007: he is thought to have died due to an overdose of prescription drugs

Colleges faced with misuse of stimulants Prevalence draws increased attention

By Eleanor Yang Su, UNION-TRIBUNE STAFF WRITER

Monday, February 15, 2010 .

San Diego State University senior Chris Kershaw first used Adderall two years ago to help cram for a final exam.

The economics major doesn’t have attention-deficit disorder, which the drug is most commonly prescribed to treat. But Kershaw, like many college students, occasionally buys the drug from friends to help him study.

“It’s like steroids for the brain,” said Kershaw, 22, of Agoura Hills. “It helped me focus. I was able to stay up until 4 or 5 a.m. studying.”

The drug misuse isn’t new — educators say prescription stimulants like Adderall and Ritalin have been growing in prevalence on college campuses for a decade. Between 5 percent and 25 percent of students admit abuse of the drugs, depending on the college and survey.

What’s changing is the way students are using the drugs, and the increasing attention colleges are devoting to the matter. SDSU’s coordinator of alcohol and drug initiatives is spending his sabbatical this year devising a program to address abuse of prescription drugs ranging from stimulants to painkillers.

It won’t be an easy task, considering there are few, if any, college drug programs that have been proved to work.

And yet, colleges try to address the problem because unprescribed drug use is illegal and causes health risks. Users have suffered from convulsions, seizures, irregular heart rates and impaired judgment.

What’s more, students appear to be finding more ways of using the stimulants.

Initially, college and high school students used the medications to boost their awareness and help them focus on academics. But now students are taking them to suppress appetite or to lift their mood before a rave or party, said Richard F. Clark, director of medical toxicology at the University of California San Diego.

“I think it’s a huge problem,” Clark said. “It think it’s far more widespread than studies suggest today because the drugs work and because it’s so easy for people to get the drugs in this country.”

Students said in interviews that the drugs are simple to find on campus, typically from friends with prescriptions. Pills run $2 or $3 each and $5 to $10 during final exams, when demand is higher.

“It seems socially acceptable. There’s no stigma at all with using them,” said Branden Bueno, an SDSU junior from Monterey. “In the circles I’ve been in, it’s like getting a cup of coffee.”

Students’ attitude toward the drugs is just one of the many challenges colleges face.

Use of the stimulants is difficult to detect. Unlike alcohol and marijuana, which leave an odor and have telltale symptoms, Ritalin and Adderall are virtually untraceable. Students often get the drugs through friends or acquaintances, not large networks of dealers, which makes it harder for police to track, said James Lange, SDSU’s coordinator for drug and alcohol initiatives.

Lange has been searching for programs around the country that have proved to reduce prescription drug abuse, but he hasn’t found any.

“A good chunk of college drug-prevention programs don’t actually do any good,” Lange said. “Teaching someone about risks has been tried on a number of levels and it doesn’t cause any reduction. Inspirational speakers don’t tend to change actual behavior. So we’re in a stage that doesn’t allow us to quickly say, ‘We should be doing this to address the problem.’ ”

At SDSU, campus officials have made modest progress in cutting abuse, though the results may have little to do with drug-intervention programs.

A survey last spring of SDSU undergraduates showed 8 percent illicitly use stimulants such as Ritalin or Adderall. That’s down from nearly 12 percent two years ago.

Lange said he believes the drop was triggered by two factors.

Funding issues prompted the campus health service center to stop diagnosing attention-deficit disorders about a year ago, which meant the end of providing prescriptions for drugs like Adderall and Ritalin on campus. While the decision was mostly financially driven, Lange said, it helped reduce the number of students who may have been giving away or selling their pills.

The other factor, Lange said, has been ramped-up efforts to reduce binge drinking. Many stimulant users tend to be alcohol abusers, Lange said, so cutting back one often has affected the other.

Other San Diego colleges say they are aware of unprescribed stimulant use and are doing their best to address it with counseling and education.

“We certainly know that some students do use it as a study enhancement, and we’re trying to get more information out there that it’s not a good thing to do,” said Debbie Pino-Saballett, director of health promotions at UCSD. The campus began surveying students about amphetamine use in 2008, when nearly 5 percent of students admitted use.

At the University of San Diego, officials say unprescribed stimulant use is on par with the national college average of 6 percent.

“We identify it as a very significant concern,” said Melissa Halter, director of USD’s Center for Health and Wellness Promotion. “Considering the pressures students feel today, it makes sense they’re looking for ways to enhance their cognition.”

Halter said the campus started surveying students about prescription stimulant use four years ago. It provides counseling to students to find out what’s motivating their drug use, and then suggests healthier alternatives.

“If they want to focus better, maybe they can go to the library to study instead of being in the residence hall room,” Halter said. “Or maybe they can turn off music while they’re studying. Maybe they need to spread out their studying to a few one-hour slots instead of trying to study for four hours in a row.”

But the real challenge, Halter acknowledged, is reaching students who aren’t motivated to change because they don’t perceive the drug use as a problem.

Are Doctors Too Reluctant to Prescribe Opioids?

Oxycontin Abusers Often Rely on ‘Leftover’ Meds From Friends

By Steven Reinberg
HealthDay Reporter

THURSDAY, Feb. 18 (HealthDay News) — Almost all people who illegally use or abuse opioid painkillers such as Oxycontin or Vicodin get the drugs from a friend or relative who had a prescription, a new report shows. In the study, which involved a 2008 survey of more than 5,300 Utah adults, almost 2 percent of respondents said they had taken an opioid pain medicine not prescribed to them over the past year. Ninety-seven percent of the time, the drug came from a friend or relative, and in most cases the drug was handed over willingly. The study is published in the Feb. 19 issue of the U.S. Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. Many Utah residents do have at least one prescription for opioid painkillers, according to the Utah Department of Health researchers. “We found that one in five patients are prescribed opioids and the majority of those have leftover medication,” said report co-author Erin Johnson, project coodinator for the department’s Pain Medication Management & Education Program. The majority of patients (71 percent) keep their leftover medication, she added. Johnson and her team warned that holding on to unused prescription opioid painkillers can result in fatal overdoses, especially among people who were not prescribed the drugs. According to the report, 85.2 percent of people who used an opioid without a prescription said the drug was given to them by someone who did have a prescription, and 9.8 percent said they took the medication without the knowledge or permission of the owner. Only 4.1 percent said they had bought the drug. “With all these excess pills, there is a great likelihood of misuse and abuse that could result from that,” Johnson said. “So dispose of your leftover pain medication immediately,” she added. From 1999 to 2007, deaths in Utah from poisoning by prescription pain drugs increased almost 600 percent, from 39 in 1999 to 261 in 2007, according to the report. Johnson pointed out that any misuse of a prescription in Utah is a felony. That even includes taking your prescribed medication for an illness or pain episode other than what it was prescribed for. The best thing to do with leftover opioids: throw them out, Johnson said. “The recommended way is to mix the pills with something undesirable in a separate bag and take the bottle and cross out any identifying information and throw that away separately,” she said. Although the U.S. Food and Drug Administration recommends flushing unused prescription drugs, in Utah experts would prefer that people do not dispose of medicines this way, to avoid contaminating the environment, Johnson said. In Utah, police stations also have drop boxes to collect unused medications, she added. Johnson noted that most people are reluctant to get rid of their unused drugs. The main reason: They paid for these drugs and may need them again, she said. Although enforcing drug disposal is hard, Johnson hopes that public awareness of the dangers of keeping unused opioids around will encourage people to dispose of these drugs. In addition, Utah is trying to get doctors to prescribe only the number of pills they think a patient will need to deal with their pain, Johnson said. “It not a big deal for someone to call in and say they are running low,” she said. “The doctors are understanding and they will write more.” Dr. James Garbutt, a professor of psychiatry at the University of North Carolina at Chapel Hill, said that, “increased use and misuse of opioid medication is a significant health problem.” Overdose deaths from opioids have risen significantly over the past 10 years, and “this a particular problem in young people who are not aware of the risks of these medications,” he noted. “The net effect is that more opioid medications are available, and perhaps one consequence of this is that more individuals are getting into trouble with opioid medications,” he said. The Utah report encourages physicians to only use opioids when clearly indicated, not to prescribe excessive quantities, to avoid long-acting opioids such as Oxycontin unless needed, and to encourage patients to discard leftover medication, Garbutt said. “The report is more evidence of the increasing problem of opioid misuse in the United States. This problem is costing lives, including the lives of young healthy people,” he said. “Education of both physicians and the public is needed.”

Superwoman syndrome fuels pill-pop culture: Overwhelmed overachievers turn to prescription drugs for an edge

Popping a couple of pain pills helped Laurie J. Besden study night after night. They helped her pass the Pennsylvania bar exam. They helped her get more done in a day than many of her colleagues. Then they helped her land in jail.

Besden doesn’t seem like any drug addict you’d picture. She’s smart, motivated — and an overachiever. But she’s one of an alarming number of women who have turned to prescription pills to get ahead — or even just to keep up.

Almost 6 percent of American women, that’s 7.5 million adult women, report using prescription medicines for a boost of energy, a dose of calm or other non-medical reasons, according to the latest numbers from the National Institute on Drug Abuse.

“Many may not consider what they’re doing abuse because they’re using a prescribed drug,” says Susan R.B. Weiss, chief of NIDA’s Science Policy Branch. “Many of these medications are being taken as performance-enhancers.”

While street drug use has been declining in recent years, prescription drug abuse has been up since the 1990s.

The trend seems to be partly driven by more and more women popping pills. While men make up the majority of abusers of street drugs, including meth, cocaine and heroin, women are just as likely to abuse prescription pills as men.

Studies show that women are more likely — in some cases, 55 percent more likely — to be prescribed an abusable prescription drug, especially narcotics and anti-anxiety drugs.

“Not surprisingly, availability increases abuse patterns,” Weiss says.

This alarms some drug abuse experts because women also seem to be more vulnerable to addiction to these types of drugs once they start taking them.

Perfection through pharmaceuticals?
To blame may be what some are calling the superwoman syndrome. Overworked, overwhelmed and overscheduled women juggling families, friends and careers are turning to stimulants, painkillers and anti-anxiety meds to help launch them through endless to-do lists.

“Women load their lives with so much that they get in over their heads, and some turn to prescription pills to cope,” says Talia Witkowski, a psychologist in Los Angeles.

Witkowski, 30, began abusing her prescription attention deficit hyperactivity disorder drugs in high school, and has been clean for three years.

“For many women, even those whom you would never suspect, pills offer an escape,” she says. But what many women don’t realize is that they are conducting a dangerous experiment on their health and their mind.

Start of a secret addiction
After graduating from the Dickinson School of Law at Pennsylvania State University in 1999, Laurie Besden felt overwhelmed by the pressure to pass the bar. So she stole a box of Vicoprofen, which contains the narcotic painkiller hydrocodone, from her ex-boyfriend’s father’s house and popped two pills. She had heard the medication could offer a burst of energy and ability to focus.

“I had energy to study for 12 hours and then clean the house like a superwoman,” recalls the 35-year-old from Plymouth Meeting, Pa. Eventually, her two-a-day habit grew to 20 a day.

bar, she tried to quit, but couldn’t. “If I didn’t take them, I was going to be sick,” she says. “I needed the pills to get out of bed so my heart wouldn’t go into palpitations.”

Then she started a prestigious — and demanding — clerkship, and realized she was completely dependent on her secret stash of pills to get through the day.

For years, she hid this addiction from her friends and family. She no longer even tried to imagine life without her little helpers. Then her source — a doctor who prescribed these pills for any phony condition — had his medical license revoked. Besden figured out how to call in her own prescriptions, using false names and impersonating doctors.

In 2002, she was arrested for the first of what would be five times before she was convicted in 2004 for prescription fraud and jailed for almost a year.

Pills all around
Abuse of prescription drugs has risen right along with increases in the number of prescriptions for stimulants and painkillers seen since the early ’90s, experts note. According to IMS Health, a research firm that tracks prescription use, the use of stimulants has nearly tripled over the past decade.

And as the drugs have become more commonplace, our attitude has become increasingly cavalier. After all, if a kid can be given an amphetamine for ADHD, couldn’t Mom benefit from a little extra focus, too?

Women aren’t just abusing their own prescriptions; they’re also dipping into friends’ supplies. In one survey, 29 percent of U.S. women admitted to sharing or borrowing somebody else’s prescription drugs in their lifetime. This study, published in the Journal of Women’s Health, found the rate of borrowing was highest among women ages 18 to 44.

That stat is backed by the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health, which found that the main source of prescription drugs among non-medical users — a whopping 56 percent — was free drugs from friends and family.

The most commonly abused pills are opiod painkillers, stimulants and central nervous depressants, generally used to treat anxiety and sleep disorders. But these drugs are used for specific brain chemical imbalances, and if you are healthy, you risk tweaking your brain’s natural abilities to sleep, focus and calm down.

These pills can also undermine your confidence if you begin relying on a pill versus your own strengths and capabilities to get through the day, Weiss says.

Popping too many pills also can trigger an irregular heartbeat and lead to cardiac arrest — and even death. In fact, there’s been an exponential rise in the number of unintentional drug poisoning deaths, which spiked nationwide by more than 68 percent between 1999 and 2004, according to the Centers for Disease Control and Prevention. Accidental overdose often happens when users build up tolerance to the drugs and must take more and more for the same effect.

Another big worry is that these pills can interact with many other common medications. When combined with over-the-counter cold medicine, for instance, stimulants can drive up blood pressure to dangerously high levels.

But the potential for addiction is the most serious consequence, experts warn.

At age 15, Witkowski, the Los Angeles psychologist, started abusing medications including the Ritalin she’d been prescribed. Once she got into college, she began experimenting with other drugs. “I knew I was living a lie, but I couldn’t stop,” she says. Finally she got help from a treatment program called Heal Your Hunger.

As Witkowski learned, addicts can recover, especially under the guidance of a therapist or program that specializes in addiction.

“An addiction specialist will be able to offer a solid assessment on how much control the addict has lost and what treatment plan is best,” says Dr. Ken Thompson, medical director of Caron, an alcohol and drug addiction treatment center headquartered in Wernersville, Pa. He advises women pursue gender-specific treatment.

“Women often have different motivations than men in abusing prescription drugs, and by being in a women’s-specific program, they’re able to deal with those reasons more effectively,” he says.

“This doesn’t mean they’re always going to suffer or be miserable, but they will have to pay attention to their recovery and do things to support staying clean,” Thompson says. At Caron, for instance, addicted women who are in the process of healing are encouraged to eat healthy, exercise, relax and do mind-body activities like yoga.

Dr. Harold C. Urschel III, co-founder of Enterhealth, an addiction recovery program in Dallas, says these are the same strategies he recommends all women follow, especially if they’re turning to a pill to relieve stress or anxiety, even just once. “You’re cheating yourself when you use a pill,” he says.

That’s a message Besden has come to accept, especially in jail, which she says saved her life. “I was forced to get clean, something I didn’t think would happen until I died,” she says. After jail, she sought treatment at Caron where she learned how to live without drugs. Since then she’s been rebuilding her life.

Clean now for six years, Besden’s had her license to practice law in Pennsylvania reinstated. She’s a working attorney in civil law who finds satisfaction in every day activities — like swimming, hanging out with her dog Marcus and helping other lawyers recover from addiction.

Yet she’s also an addict in recovery, attending five support meetings weekly and touching base with her sponsor, and hopes she can inspire other women who have a secret addiction to get help. “Getting clean was the hardest thing I’ve ever done,” she says, “but getting clean and maintaining my sobriety is by far the biggest accomplishment of my life.”

Karen Asp, a freelance journalist who specializes in fitness, health and nutrition, is a contributing editor for Woman’s Day and writes regularly for Self, Prevention, Real Simple, Women’s Health, Shape and Men’s Fitness.

What is Buprenorphine (Suboxone) Treatment Like?

The following article is from the website of The National Alliance of Advocates for Buprenorphine Treatment.)

By Kathleen Thompson-Gargano, RN

Your doctor or his/her staff will instruct you on how to prepare for your first visit. We recommend that you educate yourself as much as possible beforehand.

Time commitment:
You should expect the first day of treatment to take about two hours. It is probably best if you don’t work that day. Your doctor will prescribe approximately 8 mg to 16 mg on the first day.

Withdrawal symptoms:
It is imperative that you be in withdrawal before taking your first dose of buprenorphine (Suboxone). If you are not, you could experience severe withdrawal symptoms. This would cause you to think that the medication doesn’t work.

Why?
Suboxone is much stronger at the brain’s receptor sites than any other opiates – such as heroin, painkillers, or methadone. This means that some Suboxone will be used to throw the other opiates off the sites causing the experience of violent and rapid withdrawal. Then, there may not be enough Suboxone left to re-occupy the opiate receptor sites. This is called precipitated withdrawal. If you are already in mild withdrawal, many receptor sites are empty so most of the buprenorphine can be used for occupying them and little wasted on expelling other opiates.

Do not fool yourself.
There is no way around the fact that you must be in mild to moderate withdrawal before taking buprenorphine for the first time.

Another reason to be in withdrawal is that it is one way for the doctor to determine what your proper dose should be.

Expected doctor visits:
This is up to your doctor. Most doctors will want to see you at least twice in the first week and at least once a week until you are confident in your ability to take the medication correctly, and until your doctor is confident that the right dose has been achieved for you. There are other things that must be accomplished early in treatment such as finding a counselor and doing lab work.

Pharmacy:
Your doctor should know which pharmacy has Suboxone. Some doctors will dispense the medication from their practice. This is a little more complicated for them so not all will be able to do so.

Urine testing:
Urine toxicology will likely be done before you begin treatment to check for all substance use, and then periodically, perhaps randomly, thereafter.

How you will feel during the first week:
It is normal to feel uncertain about whether the medication will really eliminate or at least minimize withdrawal symptoms. You will soon learn that it does work. But there is still work for you to do. Continued drug misuse will mean that you will never feel quite right because your brain receptor sites will not be allowed to fully calm down. They will be tossed in and out of some level of withdrawal. If taken properly, you will feel normal by the end of the first week. Some patients say they feel like they did before they ever did drugs.

When you will be able to work:
To ensure maximum comfort for yourself, try to take the first day of treatment off.  After that, you should be fine to return to work, even if your job is physical in nature.

Sleep:
If you have a history of sleep problems prior to your drug misuse, you may have them again after starting Suboxone treatment. Most patients report that they sleep well almost immediately. If you find that you are wide awake at night, it may be that you are taking your medication too close to bedtime.

Family relationships:
Families are deeply affected by the addicted family member. They find it difficult to trust and believe them. They have often been let down or neglected by the person who was totally fixated on finding, paying for, and misusing drugs. 

Remember; if they are still in your life at this point they have been patient with you.

Most likely they have never stopped loving you, but they have stopped trusting you. It takes time, faithfulness, and patience to regain trust. Give them as much of your patience, time, and honesty as you can and talk about this with your counselor. Remember; if they are still in your life at this point they have been patient with you. You may know you are going to remain abstinent, but they only have past bad experiences to go by so it will take time to rebuild their trust.

Friends:
One of the most important things you will do early in treatment is to distance yourself from any friends that are still misusing substances. Even if you can spend time with them and NOT use, the moment will arrive when you give in. Regardless of how strong you feel you are, the constant temptation keeps your thoughts on drugs. You cannot resist drugs without thinking about them. It is better to be in a situation where the idea of drugs does not even come up. You must put the odds in your favor and eliminate as much risk as possible.

Counseling:
A genetic predisposition to risky behavior does not alone account for drug misuse and addiction. Take advantage of counseling to learn all you can about what makes you tick and what ticks you off.  Develop strategies with your counselor for handling the inevitable stresses of life. Recovery groups call this “learning to live life on life’s terms”.  This is a necessary skill for all human beings.

People with addictions quickly train themselves to be short-term thinkers. For example they take their needs one day at a time – where to get the drugs, where to get the money for the drugs, and how to prevent withdrawal. Counseling will help you learn to be a long-term thinker again. If your substance misuse began as a teenager or younger, long-term thinking and planning may be a skill you have never fully developed. Thinking in terms of short-term, medium- term and long-term goals is incredibly rewarding.  Ask your counselor to help you develop strategies so that you can do this in your life.

Counseling is about rebuilding your life. It helps give you the tools and strategies you need to remain happy and healthy. When most people finally seek treatment they feel defeated, the addiction has defeated them, not only physically but defeated economically and socially as well. Counseling helps you restore and rebuild.

Meetings:
Some patients find it very helpful to attend AA or NA meetings. This gives them the understanding and support they need. You may find that it is difficult to find the group that will work for you. Go to several meetings until you find the one that will best suit your needs. If they are against the use of medication to maintain sobriety, either find a different group, educate them about the fact that addiction is a brain illness like any other illness, or just don’t share that particular part of your story.

Remember, Suboxone is a new, cutting-edge treatment and not everyone has heard of it yet. The fact that addiction is a brain illness and not necessarily a sign of moral depravity or character weakness is, in itself, a new concept. Many help groups do not modernize their thinking as addiction science progresses.                        

Taking your medication:
In most cases it is best to take your full dose of medication at the same time every day. There are a couple of reasons for this.

1. Soon you will feel so normal that it will be easy to forget to take your medication. Therefore, we recommend that you take your buprenorphine at a time, usually in the morning, when you can have time to be quiet and undistracted. For example, get up in the morning, have a glass of orange juice, take your medication and let it dissolve while you read the paper. The important thing is to do it at the same time, full dose, and do not talk or swallow until it is fully dissolved.
2. Splitting your dose over the course of the day provides more opportunity to forget and reinforces old behaviors.
3. Some people find that they have increased energy after taking buprenorphine. It may last for a couple of hours. This can make it difficult to sleep at night. In that case it is better to take your dose in the morning or mid-day.

The exceptions to this rule may be:
Some patients will be advised to split their dose during the day because it helps them to better manage their symptoms. One of the great things about Suboxone is the ability to customize the dose and administration. Your doctor or nurse will be able to help you find the best answer for you.

Feel:
The first feelings you will have on the first day of treatment will be at least the first three symptoms of withdrawal that are unique to you. They may be sweats, restlessness, anxiety, agitation, chills, stomach cramps, etc. This is good!!  It means you will have a good experience and relief is just around the corner!

Twenty to thirty minutes after your first dose of at least 4 mg you will begin to feel those symptoms go away. You should be given a second dose approximately an hour later.  After another 4 mg to 8 mg you will be very comfortable.  Some doctors dose generously the first day or two.  This will allow you to feel what is often described as “normal” in the first hour or so.

Caution:
Occasionally we see patients who believe that they are completely cured in the first week or so, because for the first time in years they feel normal every day and night. It is the medication that is making it possible to feel this way. Do not be hasty to get off the medication. Opioid addiction is a brain disease. It is manageable because you can make the symptoms go away with Suboxone, but the addiction itself does not go away that fast.

What Can I Expect on Day 1?
You will need to be in at least mild to moderate withdrawal. This means you will have dilated pupils, sweats, chills, nasal stuffiness, watery eyes, irritability and possibly stomach cramps and diarrhea. More specifically, you will have the first few symptoms that are unique to you. Do not take the medication until you are certain you are in at least mild to moderate withdrawal. Tell your doctor what is typical for you when you are experiencing withdrawal.

You will learn how to take sublingual medication, which means medication that is taken under the tongue. There are large blood vessels under the tongue that give direct access to the bloodstream because there is only a very thin layer of skin covering those vessels. Relief of withdrawal symptoms is achieved quickly when this medication is administered under the tongue. It is less than 20% effective when swallowed and may even cause nausea. Take the time to learn how to take it properly. The taste is bitter so it may be useful to have a bottle of juice, soda, or some hard candy available to take after the medication is dissolved.

You will be given pills to take home or a prescription for take-home medication. You will need to take your medication the same time every day, and the full dose each time, unless your doctor has a reason to have you take it differently.

You will probably sleep very well the first night and the nights thereafter. The exception is if you have a history of sleep problems.

You will receive your appointments for subsequent visits. You will be given information to read that is specific to being a patient at our facility.

You will begin to experience increased confidence in how to take your medication and in the ability of buprenorphine to make you feel better.

You should be able to return to work.
 

You will be actively working toward avoiding the people, places, and things that make you think about using.

You will need to continue actively working toward avoiding the people, places, and things that make you think about using.

You will notice the medication is working.

By Day 5, you should feel normal, like you did before you started using drugs.

You may be experiencing the “honeymoon” stage of your recovery. You will have a sense of hopefulness because you feel like you are in control and all is well again.

Do not become so comfortable that you become lax in your routine of medication administration. Take your Suboxone in the fully prescribed dose at the same time every day unless your doctor has instructed you otherwise.

This is often the week some patients test the blocking effect of the Suboxone. They use drugs to see if it really blocks the effects, or just reduce them as with methadone. Whether you test it out yourself or learn from other’s mistakes, the result is the same. The Suboxone completely blocks other opioids and, not only do you relapse, but you receive no high and waste the money spent on drugs. Once you realize this, you find you no longer need to constantly debate between use and sobriety. If you wanted to use, you would have to be off the Suboxone for at least 3 days. Hopefully you would have one strong moment in that time, and take your Suboxone.

Keep your counseling appointments and make the most of them.

Old drug using friends may start to come around thinking that by now you are ready to come back to your old ways. It is important to be strong now, and although it is easier to do so on Suboxone, it still will not be “easy”. Stand firm. When they see your success you may be able to help them to find the same way out. Some people will never quit using. Needless to say, their lives will be shorter than they have to be.

Perhaps it has been difficult for you to get a job or solve a relationship problem. It may become difficult to remain optimistic now that a month has past. Work with your counselor to make small goals and accomplish them so that you don’t lose heart. Many bridges can be burned with prolonged drug use. It may take quite a while to recapture your relationships and financial stability.

You will be comfortable about taking your medication by now. You should expect to have a well-established routine with regard to doctor appointments, counseling appointments and taking your Suboxone at the same time every day.

Like most other patients you will just feel normal.

Problems that came into existence due to drug use may be a tough reality to face. Face them anyway and you will know what it is like to be successful and strong in adversity. This will be a skill you will be glad you have, over and over again.

Due to the 30/100-patient limit and the physicians’ desires to help as many patients as possible, some doctors don’t want to keep patients on maintenance therapy with Suboxone. Studies show that the longer you are on the medication, the better your chance of permanent abstinence.

Patients often know when they are ready to start decreasing their medication dose. It is best to gradually reduce your dose when you are ready to stop Suboxone treatment.  For example, reduce your dose from 16 mg to 14 mg for a month, and then reduce again by 2 mg each month. If you find your symptoms are beginning to return go back up 2 mg.  It is recommended that this gradual reduction should be coordinated with your doctor.

After several months of treatment patients rarely feel a difference when they decrease their dose by a few milligrams.

Am I an Addict

Am I an Addict? What is Addiction?

This is a compicated question with no easy answers. Here are some good quidelines

Social User:

 One who uses alcohol and/or drugs simply to enhance the pleasure of normally pleasurable situations. The social user experiences the following:

• No negative consequences
• No surprises or unpredictability
• No loss of control
• No complaints
• No thoughts of or need for limit setting

 Substance Abuser:

One who uses to enhance pleasure and/or compensate for something negative, such as physical or emotional pain, insecurity, fear, anger, etc. The substance abuser experiences some or all of the following:

• Occasional negative consequences that are not repeated
• Limit setting that is adhered to
• Promises that are made and kept
• Complaints are heard and dealt with

Addict:

One who uses to celebrate, compensate, or for any other reason, legitimate or not. The addict experiences some or all of the following:

• Negative consequences are recycled
• Limit setting & promises to self or others are broken
• Complaints are denied and/or not heard

Reliable symptoms of addictive disease become more evident. Reliable symptoms include those listed under the DSM IV definition of addiction and others, expressed as follows:

• Continued use despite negative consequences
• Loss of control, as in more use than planned (broken limits)
• Unpredictability, as in use despite plan not to use (broken promises)
• Compulsivity/preoccupation in thinking
• Denial; Use of defenses to maintain denial
• Build up of (or “break” in) tolerance
• Remorse & guilt about use or behavior when using
• Memory loss, mental confusion, irrational thinking
• Family history of addictive behavior
• Withdrawal discomfort (physical, mental, emotional, and/or psychological)

 *The DSM-IV TR is published by the American Psychiatric Association (APA) and covers all categories of mental health disorders for both adults and children. The manual is non-theoretical and focused mostly on describing symptoms as well as statistics concerning which gender is most affected by the illness, the typical age of onset, the effects of treatment, and common treatment approaches. The DSM-IV is the current edition of the manual and was first published in 1994. This edition presents nearly 400 disorders. In June 2000, a text revision was published bringing it up to date with current statistics as well as the latest findings in research.

Treating Opioid Dependence with Buprenorphine: How long should teens and young adults stay in treatment?

Carolyn Schuman, M.D., Medical Director

Reliance Center

Opioid agonist therapy was first developed in the mid-1960s when psychiatrist Marie Nyswander and endocrinologist Vincent Dole demonstrated that methadone, a long acting opioid, resulted in dramatic decreases in withdrawal symptoms, craving, and illicit opioid use in heroin addicts.  During two years of follow-up, 90% of patients retained in treatment.  70% of patients in this group became employed, while the remaining 30% showed no evidence of criminal behavior.

Over the next several decades, a growing body of evidence proved that long term treatment was more successful than short term detoxification.  The relapse rate after tapering from methadone was approximately 80% at 12 months, and eventually reached more than 90%.  Patients in long term therapy did much better – they tended to remain in treatment, and demonstrated greater levels of abstinence from illicit drugs with each successive year in treatment.  Opioid dependence became recognized as a chronic disorder which required ongoing treatment.  Open ended methadone treatment, without a fixed duration, gained widespread support within the medical community as the preferred therapy for heroin addiction.

Times have changed.  In the past ten years two major developments have rocked the addiction treatment world.

First, there have been impressive changes in the types of opioids abused and the ages of the users.  Trends over the past ten years showed a decrease in injection heroin use, while the abuse of prescription painkillers skyrocketed.  The average age of people who misused prescription opioids was much younger than the average age of injection heroin users.

Second, buprenorphine, a partial opioid agonist, was approved as a second agent for the treatment of opioid dependence.  Because of its favorable safety profile, buprenorphine became available for treatment by prescription in a physician’s office.

Researchers began to ask an important question about how long treatment should last in this young group of pill using patients.  Could prescription painkiller abusers, who tended to be younger than injection heroin users and had shorter histories of opioid abuse and dependence, successfully undergo a medically supervised withdrawal from opioids and remain drug free after agonist therapy ended?  The hope was that these younger patients with shorter addiction histories could move from illicit pill use to prolonged abstinence with the help of a relatively short term buprenorphine taper.

To test this hypothesis, a group of investigators looked at about 150 teen-agers and young adults, ranging in age from 15 to 21.  These subjects were randomized to two treatment groups.  One group was treated with a two week buprenorphine taper, while the other underwent a three month treatment episode.  Individual and group counseling was offered weekly to both groups.

After four and eight weeks, more than half of the subjects randomized to the two week taper had urines that were positive for opioids, while only about a quarter of the patients randomized to the three month treatment had opioids in their urine.  This result suggested that patients who continued taking buprenorphine were twice as likely to be free of illegal opioids as patients who discontinued buprenorphine.

But even more significantly, at the end of three months, after both groups had completed their tapers, the rate of relapse was just about identical in the two groups, with about half of all subjects in each group giving opioid positive urines.  And further down the line, by 6 to 12 months, the groups continued to look similar, with the rate of relapse ranging from 70% to 80%.  Interestingly, this was similar to the rate of relapse that had been observed previously in older injection heroin users.

The conclusions of this study were that younger opioid users with relatively short periods of addiction did well during treatment with buprenorphine.  However, when the medication was stopped, these young people acted just like older long term injection heroin users.  An accompanying editorial in the Journal of the American Medical Association summarized the study’s conclusions: “The implication is that adolescent opioid-dependent patients, like their adult counterparts, will likely need long-term, rather than short-term, opioid agonist treatment.”

Luckily, times have indeed changed.   Today buprenorphine offers a safe, convenient, and confidential treatment option.  Because buprenorphine is prescribed in an office based practice, similar to medications for hypertension, high cholesterol, diabetes or asthma, people can continue treatment and avoid relapse to illegal opioids while maintaining a productive and fully functional lifestyle.  Over time, working with their physician and their therapist, people can make informed, thoughtful, individualized, and realistic decisions about the duration of their own treatment.

Dole VP, Nyswander ME.  “Heroin Addiction – A Metabolic Disease.”  Arch Intern Med –Vol 120, July 1967.  19-24.

Fiellin D.  “Treatment of Adolescent Opioid Dependence:  No Quick Fix.” JAMA.

Vol. 300, No. 17, November 5, 2008.  Editorial.

Woody GE, et al. “Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth.”  JAMA. Vol. 300 No. 17, November 5, 2008.

Hormone linked to Drug Addiction and Alcholism

New Study identifies hormone linked to drug addiction and alcohol abuse

Chicago 1/13/2010 08:42 PM GMT (TransWorldNews)

A study recently published in The Proceedings of the National Academy of Sciences suggests that the hormone ghrelin may not only be responsible for excessive overindulgence in food but in alcohol as well.

In the study, the mice injected with ghrelin, a hormone known to promote appetite and food intake, were more likely to choose alcohol over water when presented with the two choices. Conversely, the group of mice that were injected with a ghrelin antagonist as well as a control group of mice whose ghrelin receptors were removed, were both resistant to the alcohol.

Professionals at Mountainside Drug Rehab and Addiction Treatment Center commented on the study saying, “if scientists can create a way to block the physical desire for alcohol by decreasing the production of ghrelin without any adverse effects on the human body, not only could we be closer to conquering food addictions but alcohol addictions and possibly other drug addictions as well. “

Mountainside further states “there have been several promising studies that have been published recently which focus on the physiological dependence of drugs and alcohol. There’s no doubt these studies are certainly useful and beneficial to the scientific community, but we also need greater focus on the psychological and social dependence that drugs and alcohol create. While it may be difficult for a non-addicted person to understand these facets of the addiction, they are very powerful and can’t be switched on and off easily. And in order for a person to fully get into recovery, we must address those psychological and social factors. In the future, if we are able to conquer the physiological dependence with a shot or a pill, that will certainly go a long way in a person’s recovery. But, the public must understand that a shot or a pill is not a panacea for alcohol and drug rehab – that an addicted individual needs a personalized, multi-focused drug addiction treatment program as well as continued support in order to conquer his or her addiction.”

Managing Your Pain: How to Use Prescription Drugs Without Becoming Addicted

Michele Braa-Heidner, 47, started taking prescription painkillers in 1995, when she had her wisdom teeth removed. Soon after, she developed a painful spinal condition for which she needed several surgeries–and more medications. The drugs relieved the pain and “made me feel really good,” she says. Soon, she found that she couldn’t get through the day without them. “You’re almost chasing that first high, (but) you never get it anymore unless you take a huge amount,” she says.

Prescription drug abuse has long been a problem for everyday Americans as well as pill-popping celebrities. About 48 million people, or 20 percent of Americans over age 12, have taken prescription medications–often, the painkillers called opioids–for nonmedical reasons, according to the National Institute on Drug Abuse, and seniors are particularly vulnerable since they often juggle many medications.

Those prescription opioids cause more drug overdose deaths than heroin and cocaine combined, according to the Drug Enforcement Administration. (Drowsiness, respiratory depression and arrest, nausea, confusion, constipation, sedation, unconsciousness, and coma are among the potential health consequences of abusing the drugs.) Meantime, painkiller-related admissions to state-licensed treatment centers are on the rise, according to a March report.

But while the stories of current and former prescription opioid addicts are frightening, chronic pain experts note that addiction is relatively rare and that these drugs do offer benefits when they’re properly prescribed and used. And there’s certainly a need for them.

More than a quarter of Americans age 20 or older–more than 76 million people–say they’ve experienced pain that lasted longer than 24 hours, according to the American Pain Foundation, and 42 percent of those sufferers have endured pain lasting longer than a year. For many of these people, prescription opioids like the oxycodone (commonly sold as OxyContin) and hydrocodone (sold most popularly as Vicodin) used by Braa-Heidner, as well as meperidine (sold as Demerol) and others, are very helpful.

“I think the fear can be a huge barrier to proper pain control,” says Paul Christo, director of the multidisciplinary pain fellowship program at Johns Hopkins University School of Medicine (Baltimore, Maryland). So how should you approach using a pain medication to get the relief you need without getting hooked?

First, experts say it’s best to stick with one doctor to coordinate your care; that way, she will keep tabs on all the pain medications you’re taking. She may also be looking for signs of abuse. Pain specialists can monitor pill use and do urine drug testing to ward off addiction in their patients. They may also require patients to sign treatment agreements that give the doctor permission to take certain steps if he or she suspects addiction–including talking to family members about suspected abuse, says Howard Heit, a pain management and addiction medicine specialist based in Fairfax, Virginia.

And there are other systemic measures in place to help curb abuse. By July of this year, 40 states had passed legislation to start prescription drug monitoring programs to keep tabs on when, where, and for whom controlled substances, including opioids, are dispensed. There’s even a push to fund a federal program, approved by Congress but never put into action, to monitor opioid prescriptions from state to state.

Meantime, after being prompted by the U.S. Food and Drug Administration, drug companies are trying to do their part to ease the problem by reformulating drugs to make them more difficult to abuse. An FDA advisory panel recently recommended approving a new formulation of OxyContin that would reduce the amount of medication released when tablets are crushed or chewed–common methods used by abusers to boost the impact of the drug. (The FDA typically follows the advice of its expert panels.)

If your pain isn’t improving, talk to your physician. It’s a bad idea to take medications that haven’t been prescribed for you, so don’t be tempted to use pills intended for a friend or relative. Instead, see if a different medication or dosing schedule might make things better, and be sure to consider alternative ways of managing pain that might work instead of or in tandem with powerful opioids.

Experts say that injections of steroids or other medications, nerve blocks that interrupt pain signals, physical therapy, and psychological interventions such as cognitive behavioral therapy, biofeedback, and guided imagery, as well as other relaxation techniques can all be beneficial.

Acupuncture is another option. It’s thought to ease pain by raising the level of endorphins–the body’s natural pain relievers–in the body, Christo says. “They are released when the body experiences pain, when you sprain your ankle, cut your finger–in response to injury.” The therapy may work for some but isn’t a cure-all; a review of 13 studies published in January in the British Medical Journal found that acupuncture offered only a small level of relief for people with low-back pain, migraines, knee osteoarthritis, and postoperative pain.

And while it may sound counterintuitive, people with chronic pain should try to get exercise, both for the same health reasons as everyone else and, specifically, to avoid muscle atrophy. A 2005 study published in the Annals of Internal Medicine found that a supervised, individually tailored exercise program may help both ease pain and improve function. A physical therapist or personal trainer can help.

If you are using prescription opioids, be aware of the different states that your body may experience. Tolerance occurs when the body adjusts to one dosage and needs increasingly more medication over time to achieve the same result. (This also applies to side effects, so if opioids make you itch, for instance, that feeling may go away as your body adjusts.) People should not be overly concerned about developing tolerance to pain medications, because it’s a part of taking the drugs, experts say.

Users can also experience physical dependence, causing withdrawal symptoms such as diarrhea, perspiration, and abdominal cramping when they abruptly stop taking the medication. It can occur after as few as two days of continuous use; to reduce symptoms, physicians can help you taper off the dosage, says Christo.

Addiction is far more serious. It involves compulsive use of the drug, continued use despite harm to a person or loved ones, and cravings for the substance. Not everyone who takes the medicine will get hooked, even with years of use, and there’s no sure way to predict who will. Wonder if you have a problem?

The hallmarks of addiction are an inability to keep up with work, school, or family matters as a result of drug abuse, and an inability (or refusal) to stop despite those consequences, says Scott Fishman, professor and chief of pain medicine at the University of California- Davis School of Medicine.