We included the results of studies on MAT and telehealth conducted during the COVID-19 pandemic, when the Drug Enforcement Agency (DEA) relaxed rules on MAT to enable people with opioid use disorder (OUD) to access MAT services in the context of the various public health safety measures implemented to slow the spread of COVID before scientists developed an effective vaccine.

To learn the details from that study, please navigate to the blog on our website and read:

New Developments in Medication-Assisted Treatment (MAT): The Role of Telehealth

The primary takeaway from that article is that MAT via telehealth works.

Patients approve, providers approve, and expanded access means more people who need treatment can get the treatment they need when they need it. Some patients and providers prefer in-person treatment, but patients who experience significant structural barriers to care benefit most from MAT via telehealth. In some cases, lifesaving treatment with MAT would be close to impossible without some provision for using telehealth in place of in-person visits, especially with regards to initiating treatment.

The Benefits of Telehealth

Before COVID, most of us knew about telehealth and/or video visits with healthcare providers. The benefits of telehealth/video consultations are obvious. While nothing is better than an in-person visit with a real human, we all recognize that, compared to in-person visits, remote visits can be:

• More efficient
• More convenient
• Less expensive

In addition, telehealth/video consultations increase access to vital care for:

• People in rural areas
• People with mobility issues
• Patients with severe health conditions
• Immunocompromised patients

Telehealth and video care works for anything that doesn’t require a lab test or a direct physical exam. Patients can access appropriate care for common physical ailments, ask providers general non-emergency questions, refill prescriptions, and participate in therapy or counseling for mental health, substance use, and/or behavioral disorders.

This article will discuss the role of telehealth and video care in one specific area: medication-assisted treatment (MAT) with buprenorphine for people diagnosed with opioid use disorder (OUD). We want to know what kind of data the DEA and other policymakers are using to decide the long-term fate of MAT

Medication-Assisted Treatment: The Most Effective Available Treatment OUD

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as:

“The use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

There are three medications for opioid use disorder (MOUD) approved by the Food and Drug Administration (FDA) for MAT: buprenorphine, methadone, and naltrexone. Research shows that treatment with MOUD for people with OUD can:

• Mitigate discomfort associated withdrawal symptoms
• Decrease cravings for opioids during withdrawal and recovery
• Block the action of opioids in the brain

Research also shows the overall benefits of MAT for people with OUD include:

• Reduced risk of overdose
• Reduced overall mortality
• Improved treatment retention, a.k.a. time-in-treatment
• Decreased illicit drug use
• Decreased criminal activity/involvement with criminal justice system
• Improvements in employment
• Improvements in relationships with family and peers

Those benefits explain why MAT is known as the gold-standard treatment for people with OUD. When people with OUD engage – and stay engaged – in MAT programs, virtually everything improves. The most important metric, however, is the fact that MAT reduces risk of overdose and death by overdose: this approach to treatment saves lives.

When COVID arrived, many SUD treatment providers worried that public health measures such as shelter-in-place orders and social distancing would have a negative impact on people in MAT programs, particularly those initiating treatment for OUD. Before COVID, federal regulations required the initiation of any MAT program – whether methadone, buprenorphine, or naltrexone – to occur in-person only. In addition, other rules required in-person counseling, therapy, and medication management.

Thankfully, however, federal authorities heard and understood the warnings issued by treatment providers, and eased restrictions around MAT for OUD. The new COVID policies significantly expanded access to care by changing rules around the use of telehealth.

Let’s take a look at those changes.

Changes to MAT and Telehealth During COVID-19

During the pandemic, federal authorities eased restrictions around MAT. We’ll focus on the changes directly related to telehealth, beginning with methadone.

Methadone

COVID-era regulations allowed clinicians to:

• Treat existing methadone patients via telehealth/video visits
• Renew prescriptions for existing patients via telehealth/ video visits
• Offer counseling and therapy via telehealth/video visits
• Initiate MAT with methadone via telehealth/video visits

Now let’s look at the changes related to buprenorphine.

Buprenorphine

COVID-era regulations allowed clinicians to:

• Initiate OUD treatment with buprenorphine via telehealth/video visits
• Continue to treat existing buprenorphine patients via telehealth/video visits
• Renew prescriptions for existing buprenorphine patients via telehealth/ video visits
• Offer MAT-related counseling, therapy, and support via telehealth/ video visits

In 2024, the pandemic is in the rear-view window. With vaccines readily available, tailored to each new strain of the virus, it’s now moving toward the status of yearly flu. It’s dangerous and even deadly for some people, but for most people, it’s now – more or less – another a respiratory illness that disrupts our lives for anywhere from a couple of day to a couple of weeks.

No fun, but no longer an acute public health crisis.

In light of this, federal regulators are in the process of reviewing the changes they made to MAT rules made during COVID. As we mention in the beginning of this article, the DEA officially made an important announcement in March 2024:

The COVID-era rules are now permanent for patients with OUD using MAT with methadone or buprenorphine in opioid treatment programs (OTPs).

However, they did not make the rules permanent for office-based opioid treatment programs, called OBOTs, where a large proportion of people with OUD engage in MAT with buprenorphine.

The people these rules impact directly – people with OUD, their families, and the providers show treat them – are now waiting to learn to know if federal regulators will make these rules permanent for OBOTs as well as OTPs, create a new set of rules for OBOTs, or decide to revert to the restrictions in place before the pandemic.

What Will Happen if We Don’t Make Rule Changes Permanent for OBOTs?

In our next article, we’ll review new research related to MAT with buprenorphine among a nationally representative sample of veterans engaged in MAT through the Veterans Administration. The research we’ll discuss addresses this question:

Among Veterans Health Administration patients receiving buprenorphine for opioid use disorder in the year following implementation of COVID-19–related telehealth policies, did patient characteristics and retention differ across treatment modalities?

Those are things providers who work in SUD treatment needs to know, because the data – and data from other studies like it – will likely shape how providers deliver MAT-associated care in the years to come.

We’ll do anything we can do to reduce the harm caused by the opioid epidemic. If the data indicate the benefits of using telehealth for MAT outweigh the risks, then we’ll advocate for leaving the new rules in place for OBOTs and look for ways we can increase the use of telehealth in our MAT programs for people with OUD.

The post Medication-Assisted Treatment (MAT) and Telehealth: What COVID-era Rules Did DEA Make Permanent? appeared first on Pinnacle Treatment Centers.

That may come as a shock to many people, who likely first heard about the opioid crisis between 2015 and 2017, a period that began when leaders at the state level – in Ohio and California, for instance – began implementing policies to reduce the harm caused by opioid addiction and overdose, and ended when former President Trump announced a nationwide strategy that followed the template created by local and state leaders.

The first phase of the crisis began in the late 1990s. Experts indicate overprescribing of opioid pain medication led to a drastic increase in opioid use disorder (OUD) – a.k.a. opioid addiction – and opioid overdose around the country.

The second phase began around 2007. Experts indicate the prescription to addiction pathway drove this phase. Many people developed OUD when using prescription opioids. Then, when prescribing practices changed, reducing access to prescription opioids, many people turned to illicit opioids such as heroin, which led to another spike in opioid overdose.

The third phase began around 2013. Experts indicate the influx of illicit fentanyl and other synthetic opioids drove this phase. Fentanyl is 50 times stronger than heroin and 100 times stronger than morphine. This extreme potency drove another spike in OUD and fatal opioid overdose.

The fourth phase – driven by the presence of fentanyl in non-opioid drugs of misuse and exacerbated by the COVID-19 pandemic – began around 2019 and continues to cause significant harm around the country today.

Phase Four: Increased Opioid Overdose Risk in Rural Areas

In the study “Geographic Trends in Opioid Overdoses in the US From 1999 to 2020” research scientists use twenty-one years of data on the opioid crisis to predict – and warn the general public – the direction the fourth phase of the crisis is likely to take.

The research team defines the goal of their work as follows:

“To inform prevention and mitigation strategies, this cross-sectional study examined trends in OOD rates in urban and rural US counties during the 4 waves.”

To that end, they took a unique perspective: they examined the crisis using geographic criteria. While most studies on the crisis focus on rates of OUD, rates of fatal and nonfatal overdose, and the results of various treatment and prevention strategies, this study focused on comparing overdose rates between urban and rural areas. The goal – as implied by the statement “to inform prevention and mitigation strategies” is to help policymakers at the local, state, and federal level anticipate where the greatest level of need will be in the upcoming months and years.

The adage preparation is prevention applies here. If we understand where the next spike in OUD and opioid overdose might occur, we can allocate resources to offer support in those specific areas before the spikes appear – and we may be able to reduce their magnitude and impact.

The Geography of the Opioid Overdose Crisis

Let’s look at how the three waves opioid crisis occurred, with respect to geography, as determined by the research team after analyzing two decades of publicly available data published by the Centers for Disease Control (CDC) in the WONDER Database.

Researchers divided data into four categories:

• Large central metro: Urban areas with over 1,000,000 residents
• Large fringe metro: Suburbs of large central metro areas
• Medium metro: Midsize cities with 250,000-999,999 residents
• Small metro: Towns in rural areas with fewer than 250,000 residents
• Micropolitan: Areas close to towns considered small metro
• Noncore: Rural areas unrelated to any metro area

Within this system and these categories, large central metro corresponds to the most urban areas, while noncore corresponds to the most rural areas.

Here’s what they found:

First Phase, Late 90s – 2007

• In this phase, noncore and large central metro areas showed the highest rates of opioid overdose (OOD)
• Rates of OOD increased most rapidly in noncore and micropolitan areas

Second Phase, 2007 – 2013

• In this phase, all areas – urban and rural – showed parallel and similar linear increases in OOD
• OOD in noncore areas was highest – and higher than all other areas – around 2010
• OOD rates in noncore areas declined from 2010-2012, but increased again beginning in late 2012
• Rates of OOD in large fringe metro areas – i.e. the suburbs of big cities – were higher than all other areas in 2011-2012, but increased again in late 2012

Third Phase, 2013 – 2019

• In this phase, OOD rates in noncore areas remained relatively stable
• Between 2016-2017, OOD rates in large central metro and large fringe metro areas were higher than all other areas.
• OOD rates in all areas dropped between late 2017 and early 2018, but began to increase again in late 2019 and early 2020

Fourth Phase, 2019 – Present

The two years of available data for the report indicate that rates of OOD increased across all geographic areas between 2019 and 2020. The greatest acceleration of OOD rates in noncore areas, followed by medium metro, small metro, and micropolitan areas. Areas classified as large fringe metro showed the slowest increases in this phase of the crisis.

Data from the Centers for Disease Control (CDC) show an increase in overdose fatalities between 2020 and 2022, with noncore areas showing the largest increases. Between 2022 and 2023, total overdose rates decreased nationwide for the first time since 2018. However, with regards to rural areas, results varied. Some rural states reported significant decreases, while other rural states reported significant increases. To learn in-depth details on the state-by-state increases and decreases in, please read  this CDC report, published in May 2024.

How This Research Helps

This research tells us that we need to target our prevention and treatment efforts in rural areas – noncore areas, according to the classification system in the study we discuss – and that we need to target those prevention and treatment effort to the population in most need.

Here’s how Dr. Lori Post of Northwestern University, a lead author on the study interviewed in the online magazine Science Daily, views the data:

“I’m sounding the alarm because, for the first time, there is a convergence and escalation of acceleration rates for every type of rural and urban county. Not only is the death rate from an opioid at an all-time high, but the acceleration of that death rate signals explosive exponential growth that is even larger than an already historic high.”

In both rural and urban areas, that means increasing access to care, increasing harm reduction programs such as mobile medication-assisted treatment (MAT) units, needle exchange programs, Narcan training and distribution programs, and MAT programs in rural community clinics and health centers.

Evidence shows that harm reduction strategies can reduce rated of relapse, overdose, and death related to opioid use and misuse. If we follow the data and expand our level of commitment and support for the people with OUD in rural and urban areas, we can save lives in the years to come

The post Does Geographical Location Increase Risk of Opioid Overdose? appeared first on Pinnacle Treatment Centers.

Researchers identified the need for a review of the effectiveness of MAT via telehealth due to the increases in use during COVID. Before we get into the details of the report, let’s define the terms we’ll use throughout this article: telebehavioral health (TBH), medication-assisted treatment (MAT), and opioid use disorder (OUD).

Telebehavioral Health (TBH)

• TBH is defined as behavioral health treatment delivered via video or audio communication technology. It’s distinct from text-based interventions or other treatment methods that do not used video or audio.
• Within various video or audio formats, TBH treatment can be delivered in one of two ways:
  • Synchronously: This refers to live, simultaneous, real-time interaction between treatment recipient and treatment provide. Phone calls or video conferences/meetings are examples of synchronous
  • Asynchronously: This refers to treatment wherein the provider and treatment recipient can exchange information – i.e. engage in a treatment session – independent of time. A video or audio message and a video or audio reply – a therapeutic exchange – between treatment recipient and provider is an example of asynchronous treatment.

Medication-Assisted Treatment (MAT)

• MAT is an evidence-based therapeutic approach used for opioid use disorder (OUD) and/or alcohol use disorder (AUD) that includes the prescription of Food and Drug Administration (FDA) approved medication – buprenorphine, methadone, or naltrexone – in combination with therapy, counseling, lifestyle changes, and social support.
• Benefits of MAT include:
  • Reduced withdrawal symptoms
  • Reduced cravings
  • Decreased euphoric/sedative effect of opioids
  • Reduced overdose rate
  • Reduced relapse rate
  • Decreased infectious disease transmission
  • Increased time-in-treatment

Opioid Use Disorder (OUD)

• The Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5), defines OUD as a substance use disorder with the substance or substances of disordered use specified as an opioid or opioids.

For the rest of this article, we’ll refer to medication-assisted treatment delivered via telehealth as tele-MAT, where MAT is an acronym for medication-assisted treatment.

Tele-MAT for People With OUD: Can It Help?

Here’s how the authors of the study introduce their work:

“Telehealth-delivered medication-assisted treatment for opioid use disorder (tele-MOUD) has received increased attention, with the intersection of the opioid epidemic and COVID-19 pandemic, but research on recent developments is scattered.”

To rectify the situation and bring a level of consistency and reliability to the fragmented, “scattered” nature of the existing data on tele-MAT, the research team searched for any and all peer-reviewed journal articles on the topics “MAT,” “OUD,” and “telehealth.” They identified over 900 possible titles and found 30 that met their criteria for inclusion in the study.

Of the 30 studies that met their criteria, they evaluated tele-MAT across four categories:

1. Clinical effectiveness, as measured by rates of treatment retention and abstinence.
2. Non-clinical effectiveness, as measured by non-clinical criteria such as access to care and practical implementation for both treatment providers and treatment recipients.
3. Perceptions, as reported by treatment providers and treatment recipients.
4. Regulations, as reported by treatment providers and insurance providers.

We’ll now share what they found, one category at a time, in the order we list above.

Clinical Effectiveness

Reminder: researchers defined the metrics for clinical effectiveness as treatment retention rates and abstinence rates related to medication-assisted treatment via telehealth.

The majority of studies reviewed showed:

• Improved retention rates
• Improved abstinence rates
• Comparable rates for pregnant women with OUD as measured by:
  • Improved treatment retention
  • Decreased rates of neonatal abstinence syndrome (NAS)

Non-Clinical Effectiveness

Reminder: researchers defined the metrics for non-clinical effectiveness as access to care and practical implementation for both treatment providers and medication-assisted treatment via telehealth recipients.

Studies showed:

• Improved access to care for:
  • Recipients in rural areas
  • Recipients with mobility challenges
  • Disadvantaged demographics
• Reduced wait times
• Treatment recipients reported tele-MAT helped mitigate challenges caused by:
  • Work
  • Childcare
  • Transportation
  • Stigma
• Treatment providers reported tele-MAT improved treatment in the following areas:
  • Increased capacity
  • Reduced need for outgoing referrals
  • Continuity of integrated care
  • Consistency in record-keeping
• Treatment providers also reported:
  • Increased patient demand for treatment
  • Increased duration of buprenorphine prescriptions
  • Improved ease in retaining patients

Perceptions

Researchers collected data on perceptions from treatment providers and treatment recipients through online and in-person surveys. Researchers received most of the perception data via personal anecdotes conveyed by providers and recipients of medication.

Surveys and anecdotes indicated the following:

• Clinician perceptions:
  • Clinicians reported tele-MAT was more effective than other telemedicine therapies, including remote psychotherapy
  • Many clinicians reported a need for access to affordable technology that complies with standards established by the Health Insurance Portability and Accountability Act (HIPAA).
  • Many clinicians prefer patients to also have access to in-person, local therapist/counselor, in addition to a tele-MAT provider
  • Clinicians identified a need for solutions with regard to urine screens:
    • Screening for substances of misuse is part of MAT, but requiring a patient to travel to a site for screening recapitulates the challenges that led to the need for tele-MOUD
  • 62% of physicians surveyed across studies indicated willingness to provide tele-MOUD, but only 38% provided tele-MAT
  • 82% of physicians reported satisfaction with tele-MAT
• Treatment recipient perceptions:
  • Recipients reported satisfaction with:
    • Ease of access
    • Scheduling flexibility
    • The feeling of a less “formal or medicalized” treatment context
  • Recipients reported dissatisfaction with:
    • Technical glitches
    • Isolation
    • Lack of face-to-face contact
    • Lack of group counseling session
  • Compared to in-person MAT, recipients reported:
    • Feeling safer
    • Feeling less stigmatized
    • Satisfaction with access to 24/7 hotlines related to tele-MAT

Regulations

Researchers studied the impact of regulations on tele-MOUD by noting the policy changes around MAT directly related to the pandemic, and by collecting data from the Center for Medicare and Medicaid Services (CMS).

Here’s what they found:

• Before the federal government declared COVID-19 a public health emergency (PHE), clinicians and patients identified the following regulatory barriers to care:
  • Restrictions related to prescribing and dispensing methadone, buprenorphine, and naltrexone
  • Restrictions related to reimbursement from public and private insurers
  • Significant variation in regulations and implementation of regulations from state to state
• After the declaration of COVID-19 as a PHE, the Drug Enforcement Agency (DEA) lifted restrictions related to:
  • Initiating buprenorphine-based MAT: initiating buprenorphine-based MAT via telehealth allowed during the PHE
  • Continuing buprenorphine-based MAT: ongoing buprenorphine-based MAT via telehealth allowed during the PHE
  • Take home doses of buprenorphine: allowed increases in take-home doses
• The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS):
  • Allowed reimbursement for tele-MOUD
  • Relaxed HIPPA requirements for tele-MOUD sessions
  • Increased number of MAT patients for providers
• Regulatory easing resulted in:
  • Increase in telehealth visits for Medicare recipients:
    • 1% of behavioral health visits in 2019
    • 38% of behavioral health visits in 2020
  • By the end of 2020, 50% of behavioral health visits for Medicare recipients occurred via telehealth
  • For recipients with OUD, CMS reports:
    • 2% participation in telehealth in 2019
    • 39% participation in telehealth in 2020

That’s the data – and it’s a mixed bag.

We’ll explain.

Medication-Assisted Treatment via Telehealth is Effective and Feasible, But Providers and Patients See Room for Improvement

The results of this study tell us that tele-MOUD has distinct advantages over traditional MAT in specific categories related to treatment delivery and effectiveness. With the easing of regulations during COVID-19, tele-MOUD removed barriers to care and improved access for individuals in rural areas and in economically disadvantaged areas. It helped people on MAT manage transportation issues, work schedules, and childcare coverage without interrupting or preventing access to care. When these barriers fall, treatment retention increase, and treatment outcomes improve.

Clinicians reported increases in treatment capacity, increase in demand for treatment, increase in patient retention, and an increased ability to maintain continuity of care and deliver integrated treatment in a person-first, holistic manner. Improvements in all these areas translate to improvements in treatment outcomes for people with OUD.

Researchers identified disadvantages, too:

• Some treatment recipients preferred in-person treatment, in order to reduce feelings of isolation and loneliness
• Some treatment recipients reported missing group counseling sessions and contact with recovery peers
• Treatment providers identified the need for affordable, HIPPA-compliant technology
• Some treatment providers preferred their patients to have access to an in=person counselor, in addition to a tele-MOUD provider

In light of the advantages and disadvantages, the study authors compiled a list of ways to improve and expand “this effective method for delivering MAT for OUD.” Here’s the list of improvements they offer, based on the data collected in the study.

Tele-MOUD Needs Moving Forward

1. Funding Increases

• • Tele-MAT works, but needs comprehensive funding to implement at the national scale

2. Solutions to Logistical Challenges

• • Providers need HIPPA-compliant technology that’s easy to acquire and implement
  • Providers need solutions to the problem of urine screens for recipients

3. Programs to Identify Appropriate Patients

• • Funding should include outreach efforts to find and initiate treatment for patients in need, particularly patients in rural areas with limited infrastructure

4. Programs to Expand Awareness and Reduce Stigma

• • Funding should include education campaigns in schools and communities, particularly in rural areas

5. Expand Training for Clinicians and Staff at Treatment Centers

• • All treatment center staff need expanded education and training to implement programs in a manner that’s safe, private, and practical

6. Expand Telehealth Infrastructure

• • Funding should include improving internet infrastructure in rural areas
  • Funding should help providers expand office infrastructure to enable new programs

7. Regulatory Reforms

• • The changes in regulations made during COVID-19 should be made permanent, if evidence indicates they reduce harm

There’s something we need to say about these recommendations: they’re in process. Currently, the plan is to keep the COVID-era changes in place and implement these recommendations as soon as possible. That’s very good news for people with OUD and for the treatment providers who support them.

When we add another component to our treatment options, such as MAT via telephone, we can only see it helping us achieve our overall mission, which is to provide the best evidence-based addiction treatment available to anyone and everyone who needs it.

The post New Developments in Medication-Assisted Treatment (MAT): The Role of Telehealth appeared first on Pinnacle Treatment Centers.

• Methadone
• Buprenorphine
• Naltrexone

MAT programs with methadone are part of a harm-reduction approach to fentanyl addiction treatment. Programs with MAT prioritize treating the whole person in a collaborative, patient-centered environment. In MAT programs, mutual cooperation between patient and provider is essential. These programs stress individual input, personalized treatment based on self-identified goals, and an effort to help each patient to improve overall health and wellbeing by facilitating engagement in significant lifestyle changes and accessing all possible avenues of social support services available.

People in comprehensive, harm-reduction oriented, whole-person MAT programs experience:

• Reduction in opioid use
• Reduction overdose fatality
• Improved treatment retention/adherence
• Increased social and family function
• Increased work and school function
• Decreased rates of relapse
• Decreased rates of criminal behavior

That’s why it’s called the gold standard treatment for OUD. We know from firsthand observation that methadone:

• Stabilizes brain chemistry
• Eases physiological cravings
• Normalizes physiological functioning
• Allows a person to successfully initiate and engage in counseling/therapy

Opioid use disorder (OUD) appears in many forms. People may develop addiction to illicit opioids like heroin, prescription medications that contain opioids, and other street drugs and/or illicitly manufactured drugs designed to look like legitimate prescription medication. In recent years, a dramatic influx of an opioid called fentanyl has complicated efforts to mitigate the harm caused by the ongoing opioid crisis in the U.S.

To learn more about the risks associated with fentanyl, please read this article on our blog:

Why is Fentanyl So Dangerous?

Spoiler alert: fentanyl is 50 times stronger than heroin, 100 times stronger than morphine, and so powerful that a single dose of only 2 mg can cause fatal overdose.

Methadone Treatment: More Effective Than Other MOUDs for Fentanyl Addiction

There are two primary reasons methadone treatment works best or fentanyl addiction:

1. The strength of fentanyl
2. The way methadone works

We mention above that fentanyl is a powerful opioid, significantly stronger than heroin, morphine, and all the common prescription opioids that carry risk of misuse, disordered use, and addiction, such as oxycontin, Percocet, Vicodin, and others.

What we don’t mention above is that among the FDA-approved medications for opioid used disorder (MOUD), methadone is a full opioid receptor agonist. Opioids achieve their effect by binding to opioid receptors in the brain, which results in significant pain reduction and euphoria, among other effects. When a person stops taking opioids, withdrawal symptoms appear within hours, including:

• Nausea
• Chills
• Sweating
• Vomiting
• Agitation
• Cravings for opioids
• Insomnia
• Anxiety

Among the opioids of misuse and disordered use driving the opioid crisis, fentanyl – aside from a far less common variation, carfentanil – is the most powerful. Treatment professionals and addiction scientists now know that because of its increased strength, withdrawal from fentanyl is more intense and severe than withdrawal from other opioids.

This brings us to why methadone works best for fentanyl addiction.

As we mention above, methadone is a full opioid agonist, meaning it binds fully to and completely occupies opioid receptors in the human body. On the other hand, buprenorphine – a MOUD currently in widespread use for people with OUD – is a partial opioid agonist. This means it binds to and partially – but not completely – occupies opioid receptors in the human body.

For patients with a history of high dose, chronic fentanyl use with severe fentanyl addiction, the difference in the effectiveness between methadone and buprenorphine can be the difference between a successful recovery and relapse.

Many patients with severe fentanyl addiction report methadone is more effective at reducing the symptoms of withdrawal compared to buprenorphine, and is particularly effective in reducing opioid cravings, compared to buprenorphine.

Methadone: The Gold Standard for Fentanyl Addiction

Evidence published in a report called Methadone Treatment for People Who Use Fentanyl shows people on methadone with OUD had a lower risk of opioid related mortality compared to patient with OUD on buprenorphine:

• Methadone treatment: adjusted hazard rate (AHR) of 0.41
• Buprenorphine treatment: AHR of 0.61

Evidence from the same report shows that patients on methadone stay in treatment longer, compared to patients on buprenorphine. The longer a person stays in treatment, the lower their risk of relapse, complications associated with fentanyl use and accidental overdose.

Researchers and treatment professionals indicate that both methadone are first-line options for people with OUD. However, people with OUD who may benefit from methadone rather than buprenorphine include:

• New patients at high risk of early treatment drop-out
  • All patients with a history of severe/high fentanyl use are at increased risk of early treatment drop-out
• Patients at high risk of relapse
  • All patients with a history of severe/high fentanyl use are at increased risk of relapse
• Patients who’ve had success with methadone in the past
• New patients who do not want buprenorphine
• Patients who have had no success in previous treatment with buprenorphine

There’s another danger associated with fentanyl we haven’t addressed yet: its presence in illicit, non-opioid drugs. The DEA reports the presence of fentanyl in drugs such as methamphetamine, cocaine, and Adderall. A person taking these drugs – and the people around them – may not recognize the signs of opioid overdose because they don’t know they – and the people around them – may not be aware they ingested an opioid.

Signs of fentanyl overdose include:

• Slow breathing/no breathing
• Slow heartbeat/no heartbeat
• Loss of consciousness/unresponsive to attempts to waken
• Pale, clammy face/skin
• Blue/purple lips or fingernails
• Vomiting
• Trouble breathing/gurgling noises while breathing

If you observe these signs in someone, don’t wait to see what happens, think about it, or worry you’ll get in trouble. Administer naloxone immediately, if on hand, and call 911. Good Samaritan laws protect people who administer naloxone in an overdose emergency.

Advice for Patients Considering Methadone Treatment for Fentanyl Addiction

First, it’s important to understand that methadone treatment is one component part of a harm reduction approach to addiction treatment. Other components include therapy, counseling, lifestyle changes community support, and accessing social services to support improvements in all areas of life.

Second, it’s important to understand that any kind of MAT – including methadone treatment for fentanyl addiction – is not simply trading one addiction for another. It’s an evidence-based approach to addiction treatment that increases overall chances at long-term, sustainable recovery.

Third, new rules around methadone treatment instituted during COVID may soon become permanent, which means the barriers to access to methadone may soon be a thing of the past, increasing the availability of methadone for patients who need it most.

Finally, understand that methadone is the first and most widely studied form of MAT known. The first methadone clinic opened in New York City in 1964. Over the past 60 – yes, sixty years – countless studies demonstrate that MAT with methadone is safe and effective.

Treatment and Support for Fentanyl Addiction

If you or someone you love needs professional support for fentanyl addiction, evidence-based support –is available now. Treatment professionals committed to a compassionate, empathetic, harm reduction approach can help, no matter who you are. We understand taking the first step is often the most difficult, and we’re here to help as soon as you’re ready to ask for help.

We commit to helping you through your entire treatment journey. Our nationwide alumni network is strong, and our case management and peer support specialists can help you manage your recovery, keep you on track, and give you the best possible chance of sustainable, long-term recovery.

Remember: the earlier a person who need professional addiction treatment gets the treatment they need, the better the outcome.

The post Why Does Methadone Treatment Work Best for Fentanyl Addiction? appeared first on Pinnacle Treatment Centers.

Bebe Moore Campbell is a renowned advocate and author whose best-selling books on mental health topics among African Americans are standard reading for anyone interested in the subject. But she’s best known for creating MHAM.

When Congress made MMAM official, Bebe Moore Campbell opened up about her personal, family connection to the issue of mental health:

“Once my loved ones accepted the diagnosis, healing began for the entire family, but it took too long. It took years. Can’t we, as a nation, begin to speed up that process? We need a national campaign to destigmatize mental illness, especially one targeted toward African Americans…It’s not shameful to have a mental illness. Get treatment. Recovery is possible.”

Mental Health America (MHA) typically chooses a basic theme for the month, which they use as a jumping-off point for their advocacy efforts. Here’s our article on MMHAM 2023, a year with a concise theme:

Minority Mental Health Month 2023: Culture, Connection, Community

MMHAM 2024 is slightly different. Rather than a headline-type theme, organizers chose to focus on raising awareness about the mental health-related challenges common in minority communities. These challenges include:

1. Cultural and social stigma around mental health.
2. Generational differences in understanding of and approach to mental health.
3. Reluctance of people in minority communities to talk about mental health.

Mental Health America provides this free and helpful toolkit to help anyone interested in participating in MMHAM:

BIPOC Mental Health Month Toolkit

In this article, we’ll narrow the scope of our discussion to one section of the toolkit: debunking mental health myths prevalent in minority communities.

Mental Health Mythbusters: Breaking Down Stigma

In the BIPOC toolkit, Mental Health America (MHA) identifies at least six myths about seeking mental health support that persist in minority communities.

Note: BIPOC stands for Black, Indigenous, and People of Color. It’s a relatively recent acronym designed to foreground diversity in minority communities, and counter the idea that minority communities are homogenous, and only exist as the binary opposite of majority communities.

We’ll address these myths one at a time, including how the organizers at MMHAM suggest we can debunk them.

Myth 1:  Asking for help/talking about my feelings is a sign of weakness.

We understand. Everyone wants to feel strong and capable of handling their own problems and managing their own affairs without any outside help. However, evolutionary science teaches us humans evolved in groups, and behavioral science demonstrates that most of us don’t do well in isolation. What that means is that it’s in our nature to rely on the help and support of others.

Showing vulnerability takes courage and is a sign of strength.

Your friends are likely to be willing to help in any way they can. If you can’t talk to your friends or peers, though, consider your close family. If you’re not comfortable doing that, then consider talking to aunts, uncles, or people in the community you trust. For ideas about how to start a conversation, click here.

Myth 2: What happens in the family should stay in the family.

In some minority cultures, the family unit is primary. This is true for many minority communities in the U.S. For a variety of reasons, there’s a powerful tradition of keeping any challenges or problems behind closed doors. The goal is for the family to present a strong, self-sufficient, unified image to the outside world: we can take care of ourselves.

What’s important to understand, from inside of this cultural frame of reference, is that getting support for mental health challenges by any single member of the family benefits the whole family. A person can take the tools they learn in treatment and use them to improve family communication, help keep the family dynamic smooth and balanced, and help other family members overcome the challenges they face.

Myth 3: Therapy is for crazy people.

Here’s what MHA has to say about this:

“Therapy is for everyone.”

It doesn’t matter who you are, how old you are, where you’re from, or whether you have a clinical diagnosis or not. Talking to a trained professional who takes the time to listen, get to know you, and help you overcome obstacles can help improve your life. Consider these BIPOC people who discuss how therapy has helped them:

• Charlamagne tha God
• Halle Berry
• Jay Z
• Simone Biles
• Naomi Osaka

Going to therapy can help you make connections between your emotions, thoughts, and actions, which can help promote productive behavior and reduce counterproductive behavior. In addition, a therapist can teach you practical skill to manage stress and effectively process challenging emotions.

Myth 4: Mental illness is a white people problem.

First, see Myth 3, above.

Second, consider the statistics from the 2022 National Survey on Drug Use and Health (2022 NSDUH), which show the following rates of any mental illness among minority groups for people age 18+:

• Non-Hispanic, Multi-Racial: 35.2%
• Hispanic: 21.4%
• Black: 19.7%
• American/Alaskan Indigenous: 19.6%
• Asian: 16.8%

There’s another factor at work here. Data shows that around 85% of psychologists are white, but that has nothing to do with whether mental illness is exclusive to white people: it means there are more white therapists. This is slowly changing, though, and right now it is possible to find minority therapists and anti-racist therapists.

Myth 5: If you’re struggling, you aren’t praying enough.

Having a relationship with prayer, embracing spiritual traditions, and committing to spiritual development are at the root of many people’s lives. If spirituality, whether informal or organized, is important to you, you can find a therapist who shares your faith. To find counseling that aligns with a specific spiritual tradition, simply search online with terms that match your faith.

Myth 6: My ancestors and family had it worse, so I don’t have a right to feel how I do.

The people at MHA have an excellent take on this: two things can be true at the same time. Yes, your ancestors and family may have experienced racism and discrimination that’s far more extreme than anything you face, and you can feel immense gratitude for the strength and courage it took for them to survive. At the same time, you live in the here and now. It’s not only fine, but it’s beneficial for you, your family, and your descendants to recognize, discuss, and process your emotions in a healthy and productive manner. If you’ve heard of generational trauma, taking steps to heal yourself is the first step toward addressing the consequences of this persistent, damaging phenomenon.

Talking About Mental Health: Minority Mental Health Across the Generations

An important part of MMHAM this year is the fact that it’s relatively inward-directed. In the past, organizers focused on getting the message out to everyone. Minority groups, of course, but also non-minority groups in a position to leverage resources to support the immediate needs related to minority mental health. This year, the organizer target issues relevant to minority communities in general and offer insight and help for specific minority communities.

They also offer valuable resources people can use right away. They provide as tips on how younger and older generations can support one another, help finding BIPOC therapists, suggestions for how to ask for help from friends, and advice about how to get a mental health screening from a licensed, qualified professional – and then seek treatment if a screening indicates a clinical mental health issue.

This year, you can help. First, visit the Mental Health America website. Second, download the free toolkit (link in intro above). Third, share the excellent social media graphics far and wide.

The post Minority Mental Health Awareness Month 2024: Debunking Mental Health Myths appeared first on Pinnacle Treatment Centers.

It’s everywhere, and everyone who develops OUD is at risk of overdose and death. That’s also not an exaggeration.

The opioid crisis touches virtually every community in the U.S and has an adverse impact on virtually every demographic group. Young, old, rich, poor – there are no boundaries. Our old concepts of opioid addiction – which mostly involved heroin users in big cities – are outdated. That means we need to revise our approach to everything related to the crisis. From the treatments we use, to the way we provide treatment, to our overall approach to drug policies, we need a reset. We’re also resetting our language: officially, we now call opioid addiction by a new term: opioid use disorder (OUD), although we use the phrase opioid addiction throughout this article, we’re gradually moving away from that phrase whenever possible.

That’s evidence the reset is not an abstract wish: it’s actually happening.

Around the country, access to treatment is increasing. Federal, state, and local authorities have increased funding for harm reduction initiatives, overdose prevention, addiction awareness, and access to evidence-based treatment.

While we navigate this new treatment landscape, there’s a specific population of individuals to think about that many people never consider: pregnant women with opioid use disorder. A paper published in September 2022 called “Impact Of Prenatal Substance Use Policies on Commercially Insured Pregnant Females with Opioid Use Disorder” focuses on this demographic group, with special attention to two types of public policies related to pregnant women with OUD:

1. Supportive policies that improve access to treatment and support for pregnant women with OUD
2. Punitive policies that criminalize pregnant women with OUD

This article will discuss the consequences of those policies, and offer evidence on the impact of the supportive approach to pregnant women with OUD as compared to the punitive approach to pregnant women with OUD.

Opioid Addiction During Pregnancy: Facts and Figures

The CDC published a report in 2017 describing the rates of opioid addiction during pregnancy and the prevalence of neonatal abstinence syndrome (NAS). Note: NAS occurs when a mother with a substance use disorder (SUD) gives birth, and the newborn develops symptoms of withdrawal related to the substance used by the mother. The following statistics are specific to NAS for children born to mothers with OUD.

Here’s the data:

• Between 1999 and 2014:
  • OUD during pregnancy quadrupled
• Between 2002 and 2009:
  • Neonatal abstinence syndrome (NAS) increased five-fold
• In 2009, one baby was born with NAS every 30 minutes
• In 2018, that number doubled: one baby was born with NAS every 15 minutes

Another study, this one published in January 2021, reported rates of NAS and OUD among pregnant women hospitalized during delivery between 2010 and 2017. Researchers collected data on over 750,000 women, a sample size which enables us to make population-level generalizations on rates of NAS and OUD among pregnant women in the U.S.

Here’s the data:

• Prevalence of NAS:
  • 2010: 4.0 per 1,000
  • 2017: 7.3 per 1,000

That’s a relative increase of 82%

• Prevalence of maternal opioid addiction during pregnancy:
  • 2010: 3.5 per 1,000
  • 2017: 8.2 per 1,000

That’s a relative increase of 131%

Those numbers are larger than most people realize – and the increases mirror the trends in the opioid crisis. These trends are a problem, and present a serious health risk for pregnant women with OUD. The paper Opioid Use Disorder in Pregnancy outline the following specific risks of OUD during pregnancy:

• Premature labor
• Fetal convulsions
• Fetal complications related to cycles of opioid use and withdrawal
• Premature birth
• Unhealthy birth weight (low weight)
• Elevated rate of birth defects, including but not limited to:
  • Cardiac defects
  • Spina bifida
  • Gastrointestinal problems
• Neonatal abstinence syndrome (NAS)

The prevalence of maternal OUD and the complications associated with both maternal OUD and NAS mean this is secondary public health crisis. However, evidence shows that there’s a way to help pregnant women with OUD: medication-assisted treatment (MAT).

The Benefits of MAT for Opioid Addiction During Pregnancy

We’ve arrived back at the purpose behind this article.

The title asks the question:

What helps mothers with OUD?

More specifically:

What helps pregnant mothers with OUD?

There’s a clear, evidence-based answer to this question: medication-assisted treatment helps pregnant mothers with OUD. MAT is the use of three specific medications – methadone, buprenorphine, and naltrexone – in combination with therapy and counseling – to mitigate withdrawal symptoms, reduce cravings, and improve treatment outcomes for people with OUD.

The use of these medications for pregnant women is not without controversy. Many people are wary of using opioid-based medications for the treatment of OUD, and outright resistant to their use among pregnant women.

However, The American College of Obstetricians and Gynecologists endorses the use of MAT for pregnant women. Here’s a statement released by ACOD member Dr. Maria Mascola, in which she addresses the hesitancy with regard to MAT among pregnant women with OUD:

“Concern about medication-assisted treatment must be weighed against the negative effects of ongoing misuse of opioids, which can be much more detrimental to mom and baby. Medication-assisted treatment improves adherence to prenatal care and addiction treatment programs and has been shown to reduce the risk of pregnancy complications.”

Properly supervised and managed MAT during pregnancy can:

• Prevent withdrawal symptoms
• Decrease likelihood of relapse
• Decrease infectious disease transmission
• Improve adherence to prenatal care
• Improve adherence to addiction treatment
• Reduce risk of miscarriage
• Reduce risk of premature birth
• Increase birthweight
• Decrease pregnancy related death for mothers
• Decrease severe OUD-related morbidity (disease/illness)

We know what helps pregnant mothers with OUD: medication assisted treatment. Now it’s time to discuss the study that prompted us to explore this topic and pose the question in the first place.

Supportive Policies or Punitive Policies: Which Helps Mothers More?

To recap, the study that has our attention analyzed the impact of two types of State-level, public policies on pregnant women with substance use disorder, specifically policies that impact opioid addiction during pregnancy: supportive policies or punitive policies.

The study, which involved retrospective analysis of commercial insurance records from a thirteen-year period between 2006 and 2019, included:

• A total of 145,538 females between the ages of 18 and 45
• Each participant met clinical criteria for OUD at least once during the study
• 18,920 participants were pregnant at least once during the study period.

In their analysis of the records, researchers evaluated the type of prenatal substance use policies active in the regions where pregnant mothers made insurance claims. These records are available from the Guttmacher Institute publication “Substance Use During Pregnancy.” The types of policies they evaluated included:

1. Punitive PSUPs that criminalize prenatal substance use or defined it as child maltreatment
2. Supportive PSUPs that offered pregnant females priority access to SUD treatment
3. Supportive PSUPs with funding for SUD treatment programs for pregnant females

They cross-referenced these policies with records of engagement in social services by the study participants, which were included with the insurance claim data. Here’s what the researchers found:

The Impact of SUD Policy on Pregnant Women

• Among pregnant participants:
  • 12% received MAT:
    • 11.2% received buprenorphine
    • 0.44% received naltrexone
    • 0.6% received methadone
  • 10.5% received social services for SUD treatment
• Among women who engaged in SUD treatment programs for pregnant women, following supportive PSUP implementation:
  • Opioid overdose decreased by 45%
  • Use of OUD medication increased 11%
    • Buprenorphine was the most common drug used
  • Receipt of psychosocial services increased
• Following punitive PSUP implementation:
  • Participation in psychosocial services for SUD decreased by 12%
  • Receipt of methadone decreased by 30%
  • Receipt of buprenorphine decreased by 9.6%
  • Overall receipt of MAT for OUD decreased by 11.1%
  • Opioid overdoses increased 45%

The last set of statistics comes from states with the most punitive policies around pregnancy and drug use. Those are the states where any substance use by pregnant women in criminalized, meaning the presence of any substance of misuse can result in:

• Charges of maltreatment or neglect
• Termination of parental rights
• Placement of child in protective services

The states with those policies reported the least favorable outcomes for pregnant women diagnosed with OUD. When we look at the most disturbing metric in the study – opioid overdose – and compare outcomes between the states with supportive policies and states with punitive policies:

In states with supportive policies, overdose decreased by 45 percent.

In states with punitive policies, overdose increased by 45 percent.

Based on that metric alone, we have the answer to our question: the statistics indicate punitive PSUPs are associated with negative outcomes, while supportive PSUPs are associated with positive outcomes. In other words, supportive policies help pregnant mothers with OUD, whereas punitive policies often increase the harm experienced by pregnant women with OUD.

Support Means Medication and Social Services

Medication is an important part of MAT, but it’s not the only component. Additional components include therapy, counseling, lifestyle changes, and community support. These additional components fall under the category we identify above as receipt of social services for SUD treatment.

The results tell us that 10.5 percent of pregnant women with OUD received social services, and 12 percent of women with OUD received MAT. Quick math tells us that 87.5 percent of women who received MAT also received social services. Therefore, in the group with the best outcomes – a 45 percent decrease in overdose – all the participants received MAT, and almost all of them received some form of SUD treatment, such as therapy, counseling, or community support.

What that tells us is that in addition to validating the use of MAT for pregnant women with OUD, this study also offers provisional validation for the integrated treatment for pregnant women with OUD. That makes perfect sense to us, because we think a woman who’s pregnant and has clinical OUD needs more than a prescription: she needs a full suite of integrated treatment services. Previous evidence shows that MAT for pregnant women improves outcomes across almost all measures. This study shows that MAT in combination with supportive policies for prenatal SUD not only reduces rates of overdose, but also increases participation in social support services that can be life-changing for the mother.

These life changes can – with commitment and work – allow an expecting mother with OUD to engage in treatment, increase the likelihood of creating a safe, stable, and healthy environment for her child, and increase her own chances of achieving sustainable, lifelong recovery.

The post What Policies Help Mothers With Opioid Addiction During Pregnancy? appeared first on Pinnacle Treatment Centers.

One important part of MOTA is the provision that “Expert clinical discretion would determine the frequency of counseling and drug testing in patient care.” This demonstrates the commitment to the harm reduction approach to treating OUD. The contents of a treatment plan should be individualized, patient-centered, and the result of a dynamic and adaptable collaboration between the clinician and patient.

In this context, the goal of testing is to gauge progress and the effectiveness of the treatment plan, rather than punish someone for relapsing. In addition, the amount and frequency of counseling and therapy should support individual patient needs in the way that best helps them, rather than a series of mandated hoops to jump through in order to access a complete range of evidence-based care.

It’s important to note that a separate bill – the Opioid Treatment Access Act of 2022 – did pass both the House and Senate and is now the law of the land. That law relaxed some restrictions on methadone treatment, but many experts and treatment advocates assert that the new law did not go far enough and left significant barriers to medication-assisted treatment (MAT) in place, specifically those regulating methadone prescribing and dispensing.

What is Methadone Treatment?

Methadone treatment is part of a harm reduction approach to opioid addiction we mention above, called medication-assisted treatment (MAT). It’s the gold-standard treatment for people with opioid use disorder (OUD), alongside buprenorphine and naltrexone. Among these three medications for opioid use disorder (MOUD), methadone is the most effective for severe opioid addiction, although experts agree all three medications can be both life-changing and lifesaving.

However, studies show that fewer patients receive MOUD than need them. Consider these facts, published in the 2022 National Survey on Drug Use and Health (2022 NSDUH):

Medication-Assisted Treatment (MAT) for OUD

• Among all people over age 12, 8.9 million misused opioids
  • 2.4 million received MAT
• Among all people of age 18, 8.5 million misused opioids
  • 2.3 million over age 18 people who misused opioids received MAT for OUD
• Among adults over age 18, 5.3 million people had OUD, including people with heroin use disorder, prescription opioid use disorder, and other opioids
  • 1.2 million people with OUD received treatment for OUD

These figures show that the gap between the number of people who need MAT and the number of people who received MAT for OUD is significant. It’s called the treatment gap. One primary goal of the MOTA is to reduce barriers to care and affect people in methadone treatment in the best way possible.

Although methadone was the first MOUD approved by the FDA, and has been in use since the late 1960s, it’s the most highly controlled MOUD in the U.S. today. Current federal guidelines around methadone treatment:

• Require patients to appear in-person to receive medication
• Restrict methadone dispensation to Opioid Treatment Programs (OTPs)
• Prevent take-home doses for the first 90 days of treatment
• Restrict the initiation of treatment to in-person visits with specifically licensed and trained physicians at OTPs only

Let’s take a look at how the MOTA can reduce these barriers to care and affect people in methadone treatment programs in positive ways.

How MOTA Will Change Methadone Treatment

In 2024, despite the move toward harm reduction and destigmatizing addiction treatment, federally licensed opioid treatment programs (OTPs) – the places people can initiate and receive methadone – operate in three out of every ten counties in the U.S., and the vast majority of those are in urban areas. For instance, there are six OTPs in the state of Nebraska, all in the Omaha/Lincoln areas. In Wyoming, there are no OTPs at all.

This creates problems for people who:

• Live in rural areas with no OTPs nearby
• Don’t have reliable transportation
• Have significant mobility issues
• Have problems reconciling a work schedule with daily med visits

The MOTA can address these barriers to care by:

• Expanding the number of doctors who can prescribe methadone
  • Physicians licensed in addiction medicine may prescribe methadone without being associated with an OTP (2.644 Section 2.A subparagraph B.ii)
  • Psychiatrists licensed addiction psychiatry may prescribe methadone without being associated with an OTP (2.644 Section 2.A subparagraph B.ii)
  • Treatment may be initiated via telehealth (2.644 Section 2.A subparagraph G)
• Expanding the locations where people can access methadone
  • (2.644 Section 2.A subparagraph C.i-iii)

Here’s how Congressman David Trone describes the pending legislation:

“In order to best fight the opioid epidemic in America, we have to meet folks where they are and ensure treatment is both affordable and accessible. MOTA does that by expanding treatment options for those [with] substance use disorder. With so many lives hanging in the balance, we must continue working together to develop innovative solutions to this crisis.”

Support From Addiction Treatment Professionals and Medical Academies

All cards on the table: not everyone is behind the changes in MOTA. One independent organization – the American Association for the Treatment of Opioid Dependence, Inc. – suggests the proposed changes are too lenient, suggesting the changes only increase access to medication, don’t have the proper safeguards, and aren’t evidence-based. It’s worth noting that none of the data in the information in that link was published after 2010.

It’s also worth noting that the Substance Abuse and Mental Health Services Administration (SAMHSA) studied these same changes when in place during the pandemic and found no evidence to suggest the proposed changes will increase harm, but rather, found ample evidence to suggest the changes will reduce harm for people with OUD. Based on those facts – publicly available here, here, here, and here – a total of 34 professional medical academies and advocacy organizations fully endorse the new legislation.

Organizations and Academies in Favor of MOTA

1. Addiction Professionals of North Carolina
2. AIDS United
3. Alabama Society of Addiction Medicine
4. American College of Academic Addiction Medicine (ACAAM)
5. American Osteopathic Academy of Addiction Medicine
6. American Society of Addiction Medicine (ASAM)
7. Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA)
8. Association of Virgin Islands Psychologists
9. Behavioral Health Association of Providers
10. California Consortium of Addiction Programs and Professionals
11. Connecticut Certification Board
12. End Substance Use Disorder
13. Faces and Voices of Recovery
14. Global Health Advocacy Incubator
15. Grayken Center for Addiction at Boston Medical Center
16. Hampshire HOPE
17. Kennedy Forum
18. Massachusetts Health and Hospital Association (MHA)
19. Massachusetts Medical Society
20. National Coalition to Liberate Methadone
21. New Jersey Hospital Association
22. New York Society of Addiction Medicine
23. Northampton, Massachusetts Department of Health and Human Services
24. Opioid Task Force of Franklin County and the North Quabbin Region (MA)
25. Partnership to End Addiction
26. Rhode Island Society of Addiction Medicine
27. Shatterproof
28. SMART Recovery
29. Tapestry Health Systems Inc. (MA)
30. The National Safety Council
31. The Village Virgin Islands Partners in Recovery
32. Young People in Recovery
33. Virgin Islands Board of Pharmacy
34. Oregon Society of Addiction Medicine

We’ll carefully review all sides of this debate. If the endorsement SAMHSA and these professional organizations offer influences congress to pass MOTA, then we’ll follow suit and expand access to the life-changing and lifesaving medication, methadone, while following all applicable rules and regulations established by federal, state, and local lawmakers.

The post How Will the Modernizing Opioid Treatment Access (MOTA) Act Affect People in Methadone Treatment? appeared first on Pinnacle Treatment Centers.

Addiction treatment experts from the National Institutes of Health (NIH) discuss the history and development of buprenorphine, and its relevance to us, today, as follows:

“The discovery of buprenorphine in 1966 revolutionized care for opioid use disorder. US government and private industry partnership led to buprenorphine-based medications. Confronting barriers to use these medications is critical to address the opioid crisis.”

Buprenorphine is a core component in an approach to opioid addiction treatment called harm reduction. It’s a primary medication used in medication-assisted treatment (MAT), which is considered the gold-standard treatment for opioid addiction, also known as opioid use disorder (OUD).

When the FDA approved buprenorphine, it joined another medication – methadone – approved for treating opioid use disorder. However, because of a higher risk of diversion for illicit use, federal restrictions around methadone made access difficult. In some cases, these rules prevented people who needed treatment from getting the treatment they needed. Upon approval, the federal government placed fewer restrictions around buprenorphine than around methadone for two reasons:

1. It’s a partial opioid agonist, as opposed to a full opioid agonist – like methadone – which means it creates almost no euphoric effect, thereby decreasing risk of diversion.
2. Pharmaceutical companies designed buprenorphine in specific formulations that precipitate withdrawal when altered from their original form and injected intravenously, i.e. diverted from as directed uses to illicit

Here’s how FDA commissioner, Dr. Robert Califf, describes the approval of this new buprenorphine treatment option, called Brixadi:

“Buprenorphine is an important treatment option for opioid use disorder. Today’s approval expands dosing options and provides people with opioid use disorder a greater opportunity to sustain long-term recovery.”

We’ll now discuss what’s new about Brixadi, and why it makes a difference for people seeking evidence -based treatment for opioid use disorder (OUD).

Reducing Barriers to Care: Harm Reduction and New Buprenorphine Treatment Option

Evidence shows medication-assisted treatment (MAT) with methadone, buprenorphine, and/or naltrexone can significantly improve treatment outcomes for people with opioid use disorder (OUD). People on MAT experience:

• Decreased opioid use
• Decreased overdose fatality
• Increased time-in-treatment
• Improved social and family function
• Improved work and school function
• Reduced relapse rates
• Reduced criminal behavior

That’s why it’s called the gold standard treatment for OUD. It works better than anything else we know about. However, as we mention above, there’s risk of diversion for illicit purposes. That’s why both methadone and buprenorphine treatment are highly regulated, with rules around buprenorphine less restrictive than around methadone.

Before COVID, many of the rules around MAT involved who could prescribe and dispense medication, how treatment initiation could occur, how patients could access medication, and how often patients had to show up in person to either receive medication, engage in counseling and therapy, and submit samples for drug testing.

Because of the various public health measures adopted in 2020 to stop the spread of COVID, the federal government temporarily changed the rules so that at-risk patients with OUD could either initiate or continue MAT without increasing risk of contracting COVID. These new rules also protected health care workers from unnecessary exposure to COVID.

To learn about the changes instituted during 2020, please navigate to the blog section of our website and read this article:

The Mainstreaming Addiction Treatment (MAT) Act: Will We Keep COVID-Era Changes?

The new medication, Brixadi, addresses one of the most difficult problems to overcome, with regards to MAT: the balance between realistic expectations for what we require of people on MAT and the risk of diversion. Before COVID, rules restricted refills and the amount of medication a person could receive at a time. Here’s how Brixadi makes some of those rules obsolete.

Brixadi: New Buprenorphine Treatment for Opioid Addiction

• It’s an extended-release medication, which reduces barriers to care by mitigating access problems such as:
  • Transportation to office visits
  • Getting time off work for office visits
  • Arranging childcare during office visits
• Various weekly doses can accommodate the severity of the OUD, and help patients who don’t tolerate the higher doses of extended-release buprenorphine currently available. Weekly doses or Brixadi include:
  • 8 mg, 16 mg, 24 mg, and 32 mg
• Various monthly doses also accommodate the severity of OUD and help patients who don’t tolerate high doses of extended-release buprenorphine currently available. Monthly doses of Brixadi include:
  • 64 mg, 96 mg, and 128 mg.

The weekly doses are designed to promote treatment adherence for people new to MAT who need a period of stability on the medication. The monthly doses are designed for people who are already stable on MAT, participating in treatment, and at lower risk of relapse, diversion, or other adverse events associated with MAT.

MAT, Counseling, Therapy, and Patient-Centered Treatment

Reducing barriers to care is a priority in the FDA Overdose Prevention Framework. One issue treatment professionals and regulatory officials have gone back and forth about is the role of counseling and therapy for patients on MAT.

To be clear, MAT is about more than medication. It’s about a whole-person approach to recovery that includes medication, therapy, counseling, and peer support. Counseling and therapy are required for participation in MAT. However, for some patients, two things make participating in counseling and therapy difficult for people on MAT:

1. The in-person requirement for therapy sessions can prevent people without transportation from attending all sessions.
2. Early in recovery, some patients are simply trying to get through the day, and are not in a physical, psychological, or emotional condition where participating in counseling or therapy would be beneficial or possible.

Previously, the inability to participate in therapy or counseling sessions was perceived as a requirement for initiating MAT. In a letter accompanying the approval or Brixadi, federal officials addressed this interpretation of the current regulations:

“This letter serves to clarify the importance of counseling and other services as part of a comprehensive treatment plan, but to also reiterate that the provision of medication should not be made contingent upon participation in such services.”

With regards to counseling and therapy, federal regulators indicate that assessing each individual to identify their current and accurate stage of change is what should determine participation in counseling and therapy, rather than a blanket, one-size-fits-all rule applied upon initiation of treatment.

Some patients are ready to engage in therapy and counseling immediately. Others are better served engaging in therapy and counseling after they make progress in treatment and achieve stability on their medication. These decisions should be the result of a shared decision-making process that includes the patient and the provider.

Treatment With MAT Saves Lives

It’s clear – as indicated in the letter above – that opioid use disorder is often accompanied by serious and complex psychological and social issues that medication cannot resolve on its own. That’s why it’s essential to offer these supports when appropriate, which means when they have the best chance of increasing overall treatment success.

At the same time, MAT – without concurrent therapy or counseling – reduces risk of relapse and reduces rates of fatal overdose.

In other words, it saves lives.

That’s why federal regulators clarified their stance. Evidence shows a combination of medication and therapy leads to the best possible overall outcomes. Evidence also shows that patients can benefit from buprenorphine treatment when counseling/therapy is not available right away. Therefore, in the words of the current Assistant Secretary for Mental Health and Substance Use at the Substance Abuse and Mental Health Services Administration (SAMHSA):

“OUD…treatment…can begin with stabilization on medication.”

That’s the guidance from the very top of our federal regulatory system. We think it’s entirely logical, and aligns with our vision of both harm reduction and integrated, person-first treatment.

The post Is There a New Type of Buprenorphine Treatment for Opioid Addiction? appeared first on Pinnacle Treatment Centers.

One Pill Can Kill

While that statement from the DEA appears, at first blush, like an exaggeration designed to scare people away from fentanyl and illegal drugs in general, it is absolutely not an exaggeration. Yes, it’s meant to scare people away from fentanyl, and for good reason: one pill really can kill.

Why?

Here are the facts on the drug. According to the DEA, fentanyl is:

• 50 times more powerful than heroin
• 100 times more powerful than morphine
• Strong enough to cause death with a dose only 2 milligrams (mg)

To put that last bullet point into perspective, consider these facts:

• A pinch of salt contains 150-300 mg
• 2 mg of fentanyl looks roughly like a sprinkle of powdered sugar
• 2 mg of fentanyl takes up less space than the exposed lead at the end of a pencil

In addition, the DEA warns people that international drug traffickers use illegal pills to manufacture millions off counterfeit pills every year, then distribute the pills to street-level dealers, who sell them as real – but diverted – prescription medication. Traffickers design the pills to look like common medications such as Adderall, Xanax, Vicodin, Percocet, Oxycontin, and various other prescription medications, and sell them both in person and through online sources which makes them easily accessible to anyone with an internet connection.

To learn more about fentanyl from the Centers for Disease Control (CDC) and the DEA, please download these fact sheets:

CDC Fentanyl Fact Sheet

DEA Fentanyl Fact Sheet

Now we’ll share new information, based on a research effort conducted in Switzerland, that offers insight about why fentanyl is so dangerous.

Fentanyl Acts on More Areas of the Brain Than Previously Thought

The fundamental brain processes that lead to the disordered use of substances, such as alcohol use disorder (AUD) or opioid use disorder (OUD) involve what we call the reward network in our brain, also known as the mesolimbic system. Here’s how research published by the National Institutes of Health (NIH) describe the reward system:

“Reward is a natural process during which the brain associates diverse stimuli, [including] substances, situations, events, or activities with a positive or desirable outcome. This results in adjustments of an individual’s behavior, ultimately leading them to search for that particular positive stimulus.”

That’s the positive reinforcement component of the disordered use of substances. The second part of the puzzle revolves around negative reinforcement. Ingesting opioids causes euphoria. However, after an individual develops a physical dependence on a substance and then stops taking the substance, what happens is something most of us know about: withdrawal.

Withdrawal is characterized by uncomfortable physical, psychological, and emotional components. Physical aspects of withdrawal include nausea, chills, sweating, gastrointestinal pain/distress, high blood pressure, muscle/joint pain, and elevated heart rate. Psychological and emotional components of withdrawal include agitation, restlessness, intense cravings for opioids, insomnia, and anxiety.

When a person continues to take opioids to avoid experiencing withdrawal symptoms, that’s the negative reinforcement component of the disordered use of substances.

This new research offers important new information on the positive and negative reinforcement components of addiction. The study authors, in the paper “Distinct µ-Opioid Ensembles Trigger Positive and Negative Fentanyl Reinforcement,” describe the concept behind their research:

“Until now, it was thought that the mechanisms of both positive and negative reinforcements takes place in the same brain area, the mesolimbic system. Conversely, our hypothesis suggests that the origin of negative reinforcement is to be found in cells that express the mu receptor elsewhere in the brain.”

Let’s learn more about what they mean.

The Reward System and the Fear/Anxiety System

Opioid medications and illicit opioids attach to specific receptors in the nervous system in the human body, called mu opioid receptors.

These receptors are common in the mesolimbic system, specifically in the ventral tegmental area (VTA). Researchers know receptors in this area are related to positive reinforcement, because when they eliminated those cells in lab animals, the animals no longer sought opioids in behavioral experiments.

The research team identified a group of brain cells in another brain region, the central amygdala (CeA), that also express mu opioid receptors. This was new information for neuroscientists. What they learned next was more important than that discovery, though. When they eliminated those cells in the CeA in lab animals, the animals no longer showed symptoms of opioid withdrawal in behavioral experiments.

Why is that an important discovery, and how does that help us understand why fentanyl is so dangerous?

Because the central amygdala is the brain area associated with feelings of anxiety and fear.

Therefore, fentanyl – and other opioids – carry a one-two punch that we previously didn’t understand completely. Positive reinforcement originates in the VTA, and negative reinforcement originates in the CeA. We can now say that one reason fentanyl and opioids are so dangerous is because they act on more brain areas than we previously thought.

How Does This Help Us Help People With Fentanyl Addiction?

The current gold-standard treatment for opioid use disorder (OUD) – which includes fentanyl addiction – is medication-assisted treatment (MAT). This approach uses medications directed at mu opioid receptors in the reward system of the brain. This new research indicates that a significant driver of ongoing addiction is the fear/anxiety system in the brain. Here’s how a press release from the University of Geneva, where the research was conducted, describe the results:

“These discoveries will make it possible to refine substitution treatments and advance research into analgesics without addiction liability.”

In plain language, this new knowledge on how opioids act in the brain may help us – in years to come – develop MAT approaches with medications that target brain areas like the VTA not previously implicated in addiction or withdrawal, and help us develop new, non-opioid pain medications that are less likely to involve risk of misuse, disordered use, and addiction.

Keep an eye on this blog for any new information on this topic. As soon as we learn anything new, we’ll report it here.

The post Why is Fentanyl so Dangerous? appeared first on Pinnacle Treatment Centers.

We’ll share our next two lists in a moment. First, however, we’ll offer the same advice we offered at the beginning of Part One: the most important part of staying sober all summer having a recovery plan and sticking to it. If you’ve had professional treatment and support, you probably created your recovery plan with your therapist and counselors before discharge. If you haven’t had professional treatment and support, we encourage you to either 1. Seek treatment, or 2. Find a sponsor at a 12-step meeting or similar recovery group to help you create a personalized plan for the summer – and beyond – that increases your likelihood of sustainable, lifelong recovery.

You can also navigate to the blog section of our website and read our previous posts on staying sober in the summertime:

Our Summer Sobriety Tips: A Reading List

Summer Recovery Tips: 8 Ways to Stay Sober During 4th of July

Summer Recovery Tips: The Potluck Picnic (Recipes Included)

Having a plan, having a sponsor, and having a robust support system are core components of a successful recovery. In addition, evidence shows that the earlier a person with an alcohol or substance use disorder (AUD/SUD) receives professional treatment, the better the outcome. Therefore, if you think you need help, we encourage you to contact an experienced mental health provider for a full mental health/addiction assessment.

Remember the Basics

We can’t write an article about staying healthy, happy, and sober in the summer months without saying this:

Stay hydrated!

We know, we know. Everyone says it – but they say it for a reason. You don’t have to carry a fancy water bottle around everywhere you go. Just make sure you drink water throughout the day, because it helps al the cells in your body function smoothly and efficiently. And in the summer, your body loses water while regulating heat – i.e. sweating – so it’s important to drink more water when you do any kind of outdoor activity while it’s hot outside.

With that said, we’ll move to the topic at hand, which is how to fill your summer with activities that are recovery friendly. We’ll share two lists in this article: places to swim and places to escape (in a good way).

Sober Summer: Places to Swim

Public Pools

Most of us lived for the pool when we were kids. But we didn’t think about everything that went into getting to the pool. Was it a public pool? A friend’s pool? Were you a country club kid? Or maybe a swim team kid who went to the YMCA for lessons and then joined a swim club. Whatever you did as a kid, now that you’re an adult, you have to figure it all out for yourself, and the first thing you realize: it’s not free!

That’s why public pools are a blessing. They’re usually inexpensive, if not free, and their goal is your goal: make it possible for everyone to have a good time swimming during the summer. In case you’re skeptical about whether there’s actually a public pool near you, we went ahead and did some research for you. We chose a city/town at random from each of the nine states where we own and operate treatment centers, and found links for the public pools in that city/town. If your town isn’t on the list, then do what we did: google “public pools [enter location]” and you’ll find a pool. Here’s our list of links:

• Bakersfield, California: Bakersfield, CA Public Pools
• Canton, Georgia: Cherokee County Aquatic Center
• Martinsville, Indiana: Martinsville City Pool
• Elizabethtown, Kentucky: American Legion Water Park
• Boone, North Carolina: Watauga County Pools
• Pennsauken, New Jersey: Pennsauken Municipal Pool
• Cincinnati, Ohio: Cincinnati Recreation Commission (25)
• Pittsburgh, Pennsylvania: Citiparks Outdoor Swimming Pools (15)
• Fredericksburg, Virginia: Doris E. Buffet Pool

From small towns like Boone, NC, to larger metro areas like Cincinnati, OH, public pools are there for you. Check the list, or search in your town: you can recreate those awesome summer pool days you may remember from childhood, or make your own memories, starting this summer.

Condo/Apartment/Neighborhood Pools

We don’t have a list of apartment pools near you – all apologies. However – unless you live in an apartment, condo complex, or neighborhood with a free pool, then this suggestion combines two things that can help you stay on track this summer: staying connected to others, and of course, going swimming. Finding a friend with a pool is easy: all you do is ask. Ask coworkers, ask old friends, ask people at 12-step meetings. Better yet, hang around by the coffee after a 12-step meeting and find a small group and organize a sober/recovery friendly pool party. You never know: you might start an annual summer tradition. Sober 4^th of July part, anyone?

Rivers/Lakes

Sometimes a pool won’t cut it. You need to get out in nature and immerse yourself in water that’s not chlorinated, get mud between your toes, and look up and see trees and the sky, rather than a canvas awning. The best way to do this is to find what country folk call a swimming hole. Those might be in rivers, lakes, or even creeks. Local knowledge is best, so you need to ask friends, or think way back and remember any non-pool places you went to swim when you were a kid.

Or you can use this list we compiled to help you find a good ‘ol swimmin’ hole in your state:

• California: Find a California State Park (By Activity and Type)
• Georgia: Swimming in Georgia State Parks
• Indiana: Accessible Beaches/Indiana Department of Natural Resources
• Kentucky: State Parks With Beaches in Kentucky
• North Carolina: Swimming at State and National Parks in North Carolina
• New Jersey: State Parks With Swimming/New Jersey Park Service
• Ohio: Family Friendly Swimming in Ohio
• Pennsylvania: Swimming in Pennsylvania State Parks
• Viriginia: Swimming at Virginia State Parks

Every state where we operate treatment centers has parks where swimming is easily accessible. Check these links and plan a fun swim day, a quick getaway, or – if you have time and can make it happen – and actual vacation.

The Beach!

Who doesn’t love the beach? Well, we suppose some people don’t: that’s okay – there’s plenty for you to do if you don’t like the beach. But we’re beach advocates and think the beach can be a great place to relax and recharge during recovery. If you live near the ocean, you know going to the beach doesn’t have to be a big production: you can just take a day and go for it. If you’re in the middle of the country, though, we have good news: plenty of state parks and rivers have recreational beach areas. Use the list of links above to find a state park on a lake or a river – and make plans to go.

One last thing about swimming, especially in rivers, lakes, and oceans: jumping into ice cold water during the summer feels amazing, and might just be the most refreshing thing, ever.

How to Escape Without Running Away

This list gave us pause, because the idea of escaping or running away/getting away from it all is dangerously close to the reason many people develop an alcohol or substance use disorder: they want to escape. Escaping with alcohol or drugs will backfire over time: we all know that. Nevertheless, we all need to escape sometimes. We all need to get away from it all sometimes. And that’s okay. But if you’re in recovery, escaping and getting away from it all can’t mean you forget or ignore the basic reality of your situation, which is that recovery comes first.

When we’re in recovery, we escape to recharge, rather than deny reality. With that in mind, here’s our next list to help you fill your time with recovery-friendly activities for a sober summer.

Places to Escape (Without Running Away)

Bookstores

Bookstores still exist. They exist in all shapes and sizes. They’re in every big city in the country. You can find them in small towns, too. The gist of what we’re saying here is that although Amazon sells more books than anyone on earth, you can still find a brick-and-mortar bookstore filled with real books on real shelves. Whether it’s a small independent mom and pop or a big chain like Books A Million or Barnes and Noble, bookstores are still out there. If you’ve never escaped in a bookstore before, here’s how:

1. Find store
2. Get a stack of books
3. Find a quiet corner – a chair or a spot on the floor – and lose yourself in those books.

Don’t worry. Anyone who works in a bookstore has done this a thousand times, themselves. They won’t hassle you because this is perfectly acceptable bookstore behavior. Honestly, they’ll be jealous they have to work while you get to read.

Movies

No explanation needed: going to a movie is a great way to escape from reality for a short period of time. Nothing beats sitting back in one of those big comfy movie theater seats, waiting for the lights to go down, and losing yourself in a comedy, romance, or action movie.

Live Theater

When was the last time you went to see a play? If it’s been a while, we encourage you to reconsider. While some theater tickets are pricey, most theaters have discount days or special deals for afternoon performances. There’s something magic about the theater that you don’t get with movies or television. You see real live humans right there in front of you, performing lines from memory with no second takes, no computer effects, and no stunt doubles. A movie or TV show is what it is: it’s fixed forever, frozen in the final edited form. But theater? When a performer steps on the stage, anything can happen. Sure, there’s a script and they’ve rehearsed the scenes, but the potential is there: when the house lights go down and the stage lights come up on a real human, it’s true: anything can happen. That’s where the magic is.

Music

Wherever you want to go, music can take you there. Concerts are great, and if you can afford Taylor Swift or Foo Fighters tickets, go for it. But we suggest finding smaller, less expensive options in your area. Look in your local papers for jazz clubs, outdoor festivals, or small, family friendly venues. Open mic nights and folk nights can be great fun. We advise against the club scene because, well, most aren’t what you’d call recovery friendly. However, we advise for finding any way to experience music as you can. Live music can be transcendental, but so can putting on your headphones, sitting back in your comfortable chair, closing your eyes, and zoning out to your favorite track. That’s a great way to recharge.

Or consider this: remember back when you were a kid and you’d invite friends over just to sit around and listen to records? You can still do that – but now you can make it recovery friendly. We bet there’s a low-key movement for old-school vinyl record enthusiasts in recovery – and if there’s not, it’s time for you to start one.

Staying Sober All Summer

This might be your first summer in recovery. If it is, we encourage you to make a solid plan and follow it. Get help from your treatment team, your sponsor, or recovery peers. Summers can be tough. You may not have realized that in the past, all your free time during the long summer days revolved around alcohol and substance use, and now you need to find a way to fill that free time. You can do it. Use the suggestions in these two Stay Sober All Summer articles, or read the articles and come up a list of recovery friendly summer activities that work for you.

One last thing, in case we forgot: stay hydrated!

The post Stay Sober During Summer Part Two: Places to Swim and Places to Escape (In a Healthy Way) appeared first on Pinnacle Treatment Centers.

Before we get to our top tips, we should note that the most important part of staying sober all summer is sticking to the recovery plan you developed during treatment. And if you’ve never been in treatment, we suggest either 1. Seeking treatment, or 2. Finding a sponsor at a 12-step meeting to help you formulate a recovery plan that gives you the greatest chance of achieving your goals.

If you think you need professional support in getting and staying sober – whether you have an alcohol use disorder (AUD), a substance use disorder (SUD), or co-occurring AUD/SUD and a mental health disorder, please consider seeking professional treatment:

Medically Monitored Detox

Residential Inpatient Treatment

Partial Hospitalization Treatment

Office-Based Opioid Treatment

Medication-Assisted Treatment

Outpatient Treatment

Evidence shows that the earlier a person who needs treatment for an alcohol or substance use disorder gets professional treatment, the better the outcome. Therefore, if you think you need support, then we suggest seeking a full addiction assessment administered by an experienced, qualified professional: they can help you find out what you need – and help you take step to get there.

But if you’re already on your recovery journey and clicked here for the summer tips, read on: we’re ready to share.

Staying Sober All Summer: Keeping it Simple

One thing recovery teaches us is that it’s possible to organize your life around a singular focus – staying sober/staying in recovery – while living a full, rich, and diverse life. Yes, getting and staying sober/in recovery keeps you from doing some things, but it opens an entire world of opportunity that you likely overlooked before you started your recovery journey. You learn how to have fun in simple, wholesome, soul-enriching ways. And when you realize how good it feels to keep things simple, sober, and recovery friendly, we think you’ll feel an overwhelming sense of gratitude – for your life, for your peers, and for your recovery.

Ready for our list?

We actually have four of them. We’ll share two in this article, and the next two in Part Two, coming soon to this blog.

Summer Recovery Ideas: Places to Walk

We truly think taking walks might be one of the secrets to a happy life. And we know taking walks is a recovery-friendly way to get easy exercise, clear your head, and relax. But where can you take these magic walks?

1. Your Neighborhood

This is the first place to start. Urban, suburban, ex-urban, rural – it doesn’t matter. Take a 20-minute stroll – or longer – around your neighborhood. You can make it a workout, a post-dinner stroll, or an early morning wake-up. Neighborhood walks are a great way to meet the people in your neighborhood and feel connected to others, whether you stop and socialize or not: just being out there and seeing people (and their dogs) can lift your spirits right away.

2. Parks

If your neighborhood isn’t great for walking, then find a park. A park can be a destination for a walk, or you can drive to a park in a different part of town for the sole purpose of getting some you-time in accessible greenspace. And yes, city parks count as greenspace, and spending as little as half an hour in a park is as healthy as spending as spending half an hour out in the woods. Read the evidence on the benefits of greenspace on mental health here and here.

3. Downtowns

On the other side of the spectrum, i.e. not nature walks but still walks, we suggest calling a friend and arranging time to go walk around a scenic downtown area in a small town. Everywhere around the country, municipalities are remembering the value of walkable, people-friendly downtown areas, and revitalizing business districts with the goal of attracting people: it’s the comeback of Main Street, USA – and we think you should go find a small town, take a walk, and see what they have to offer.

4. Malls

Yes, really! Although The Golden Era of Malls – the 70s and 80s – may be behind us, malls are still there, and you don’t have to spend any money or shop. During the oppressive summer heat, consider taking a walk at a mall. They’re great if you’re not in a physical place where you can take long walks outdoors in the heat. You can sit, rest, and people watch. Then you can walk a little more, and sit, rest, and people watch at the Food Court. We know it may seem unusual, but this summer, to get out of the house – and beat the heat – consider talking a stroll at a nearby mall.

5. Hikes

You can consider hiking advanced walking. There are three things that can make a walk into a hike: location, distance, and time. The location can be a state or national park where you park your car, find the trailhead, and walk a nice loop for a morning, afternoon, or full day. Walking a long distance over a longish period of time – let’s say three miles or more over 2-3 hours – elevates a walk to hike status wherever you choose to do it.

Staying Sober All Summer: Keep Connected

Another thing recovery teaches you is the value of genuine human connection. Most people who have a successful recovery report that they could never do it without the support of their recovery peers. You might meet recovery peers during treatment or you might meet them at 12-step meetings. Here’s something you know already, if you’ve been in recovery for any period of time, and if you’re new to recovery, you’ll learn soon: people in recovery always find each other. Strange but true, and it will happen to you. At work, at play, and out in the world, once you start your journey, you’ll find others walking the path.

We can’t explain it, but believe us, it happens. And when you meet recovery peers, talking with them is invaluable. That’s why we made this second list.

Summer Recovery Ideas: Places to Talk

1. Coffeeshops

Meeting up at a café to catch up with friends is a time-honored recovery tradition that we fully support. You don’t have to drink coffee, of course. Consume any recovery-friendly beverage you like. The benefits of coffeeshops are numerous, including:

• They don’t cost much money. You rent a table for the price of a cup of coffee (or a bagel or a muffin or a juice) and spend as long as you like.
• Lingering is expected. People who work at coffeeshops expect customers to spend time chatting. However, if you stay longer than an hour, buy something else. Remember, it’s like you’re unofficially renting the table, and you always need to stay current on the rent – right?
• Seeing and being a regular. If you meet up with friends at the same place, consistently, over time, then you become regulars. When you become a regular at a coffeeshop, you often meet the other regulars. That means that if you start out going to a place with a group, it can become yours, and you might meet other people that enrich your life. That’s how building community works: slowly, consistently, over time – just like recovery.

2. Restaurants

Another great place to meet up with recovery peers to talk about the ups and downs of recovery is at a restaurant. In this case, we use restaurant in the metaphorical sense. Your restaurant is anywhere – outside of a home – you sit down for a meal with friends. When you’re in recovery, you’ll learn that your social life includes people in recovery and people who are not in recovery. Meals and meet-ups with recovery peers will occupy a special place in your life.

They’re like informal therapy sessions.

They can help keep you on track between meetings or counseling sessions, help you resolve small problems that you don’t need to talk to your sponsor about, or help you start to unravel bigger, life-size challenges. And remember: your peers are there for you, and you’re there for them. Sometimes saying yes to a meal and spending time talking is all the support you need. And when we said we were using restaurant in the metaphorical sense, what we meant is that your restaurant meet-up can be at a hot dog cart downtown, a taco truck any time, or a hot slice somewhere Brooklyn-esque. Meet up, get some food, have a seat, have a chat: that’s how you do it – and it’s a great way to stay connected to your recovery peers.

3. 12-Step Meetings

We think everyone in recovery should experience at least one 12-step meeting. Why? The collective wisdom at every meeting is valuable. At any given meeting in any given town – small or large, morning, noon, or evening meeting – you’ll find people who’ve been through what you’ve been through and can relate to the challenges you face. This is true for all the following:

• Alcoholics Anonymous (AA)
• Narcotics Anonymous (NA)
• Al-Anon (for families of people with addiction issues)
• Alateen (for teens)
• SMART Recovery (a more recent take on the traditional 12-step model)

These meetings are anonymous, which is important. You can go to a meeting, and with the exception of criminal behavior, anything you say in the meeting stays in the meeting.  Some people sit and listen. Others check in about their daily challenges. At some meetings, people celebrate milestones, like a day, a week, a month, a year, or a decade in recovery. Every milestone is notable, because it means that person is doing the work of recovery.

When you go to a 12-step meeting, you have the opportunity to talk to people who’ve been through what you’re going through and can related to you. We say that above, but we want you to think about that. For instance, you might meet someone with 35 years in recovery: hearing their stories might answer questions you never knew you had, and teach you things you absolutely need to know. On the other hand, you might meet someone on their first day of recovery, and you can be part of the community that welcomes them, inspires them, and tells them they are not alone. In other words, these meetings are safe places where you can give and receive support. And over time, you’ll probably realize that giving support can be every bit as important to your recovery as receiving it.

Your Summer in Recovery

If this is your first summer in recovery, we encourage you to think ahead, make a plan, and stick to it. This is most important if it’s been years since you’ve had a sober summer. You may realize all your leisure activities and spare time involved drinking or using drugs, which means you need to find new, recovery friendly activities to pass the long summer days – like the things we mention in the two lists above. Walking, talking, and meeting can help keep you on track, and most definitely help you stay sober all summer.

The post Stay Sober During Summer Part One: Places to Walk and Places to Talk appeared first on Pinnacle Treatment Centers.

• Heroin addiction
• Opioid addiction
• Prescription opioid addiction
• Fentanyl addiction

The opioid overdose crisis in the United States is in its third decade, and no one in our country is immune. Rich, poor, young, old, white, black, Hispanic – this crisis has had a negative impact on every demographic group, with no exceptions. In order to address the crisis and the ongoing yearly increase in opioid overdose deaths, providers offer a life-changing, lifesaving approach to treatment called medication-assisted treatment (MAT) with medications for opioid use disorder (MOUD).

What is a Suboxone Clinic?

A suboxone clinic is a treatment center that’s licensed and approved by the Drug Enforcement Agency (DEA) and the Food and Drug Administration (FDA) to use MAT to treat patients with OUD.

MAT programs use three medications, depending on their licensure and patient needs:

• Buprenorphine
• Methadone
• Naltrexone

Suboxone clinics specialize in treating patients with OUD with Suboxone, a medication that contains buprenorphine and naltrexone. Our Suboxone Clinic in Somerdale, NJ treats patients with Suboxone every day. Data shows MAT with Suboxone is the most effective treatment available for people the lives of people with opioid use disorder.

Suboxone Clinic in Somerdale NJ: Treatment for Heroin Addiction and Fentanyl Addiction

We mention above that the DEA and FDA approved three medications for OUD: methadone, buprenorphine, and naltrexone. Suboxone is a specific formulation of buprenorphine and naltrexone that’s designed to maximize the benefits of treatment and reduce risk of relapse and overdose.

Buprenorphine: What You Need to Know

Buprenorphine works by occupying receptors in our brain called opioid receptors. Because buprenorphine has a partial affinity for opioid receptors, it’s known as a partial opioid agonist. It occupies the receptors, but it’s not a perfect fit. However, it prevents other opioids from binding to the the receptors, which prevents them from causing the euphoria associated with opioid. It not only prevents euphoric effects, but also reduces the intensity of withdrawal symptoms, and decreases the severity of opioid cravings.

Naltrexone: What You Need to Know

Whereas buprenorphine is called a partial opioid receptor agonist because it partially occupies opioid receptors in the brain, naltrexone is called an opioid receptor antagonist because it completely prevents any opioid – illicit, prescription, or other – from occupying opioid receptors. If naltrexone is in the bloodstream, opioids don’t work at all, in any way. In addition, if a person takes naltrexone while using any opioid, it can cause that person to enter opioid withdrawal. In this way, the naltrexone acts as a deterrent for the use of other opioids, and the diversion or improper use of Suboxone.

Why MAT? Harm Reduction Improves Heroin Addiction, Fentanyl Addiction Treatment

The harm reduction approach to addiction treatment is not new, but it wasn’t widely utilized in the U.S. until the 2010s, when policymakers nationwide realized our old approach to drug addiction and treatment – loosely known as The War on Drugs – wasn’t working.

Harm reduction began around thirty years ago in Europe. In countries like Portugal, France, and the Netherlands, several types of programs appeared, including:

• Medication-assisted treatment programs
• Clean syringe programs
• Naloxone access programs

The success of these programs in reducing overdose rates and increasing treatment adherence got the attention of lawmakers in the U.S. While officials implemented the first harm reduction programs in California in 2019 – aside from methadone clinics in New York City – the State of New Jersey approved a group of harm reduction measures in 2022. These new measures allowed state and local providers to initiate programs specifically to reduce harm caused by opioid addiction.

Here’s how New Jersey Governor Phil Murphy described the legislation:

“Harm reduction is a cornerstone of our strategy, and through this legislation, we are paving the way for long-overdue expansion of…critical services to help people with substance use disorders stay healthy, stay alive, and thrive. These bills…will strengthen our ability to save lives and further our commitment to ending the opioid crisis in New Jersey.”

New Jersey passed this legislation based on a continuously growing body of evidence that shows the following benefits of MAT with suboxone. Treatment for heroin or fentanyl addiction with Suboxone can:

Improve treatment adherence:

• Suboxone treatment helps people stay in treatment longer.

Reduce drug use:

• People in treatment with Suboxone take opioids less frequently.

Reduce illegal activity:

• Suboxone treatment is associated with a decrease in criminal behavior.

Help with work:

• Patients in programs at Suboxone clinics have a greater capacity to find and keep a job.

Help with relationships:

• Suboxone treatment allows people to engage in healthy family and peer interactions.

Reduce overdose rates:

• People in suboxone treatment are at reduced risk of overdose.

Save lives:

• People with opioid use disorder (OUD) in MAT programs live longer than people with OUD who do not engage in MAT.

Pinnacle Treatment Centers: Comprehensive Heroin Addiction Treatment

When a patient engages in treatment at Somerdale Treatment Services, they don ‘t just receive medication. Pinnacle clinicians design a treatment plan around what will work best for each patient. In addition to medication, treatment plans at our Suboxone Clinic in Somerdale NJ may include:

• Full clinical evaluation
• Educational workshops
• Individual counseling
• Group counseling
• Family counseling
• Relapse prevention
• Medication management

The specific components of each treatment plan depend on the individual, their treatment history, the outcome of their clinical evaluation, and treatment goals. At Somerdale Treatment Services, we also offer special services for pregnant patients.

Finding Heroin or Fentanyl Addiction Treatment in Somerdale NJ

If you’re seeking treatment at a Suboxone Clinic in Somerdale, NJ, please email of call our providers at  Somerdale Treatment Services.

Additional resources for opioid addiction are available here:

• Addiction Treatment Providers -Treatment Directory Application (rutgers.edu)
• If you don’t have insurance: 1-844 ReachNJ.GOV at (844) 732-2465
• Call Rutgers University for emergency support or referrals to treatment services:
  • Call (844) 276-2777
  • Phones are staffed 24/7/365
• Nationwide Resource: SAMHSA treatment finder

Research over the past several decades tells us that the earlier an individual with opioid use disorder, heroin addiction, or fentanyl addiction receives evidence-based treatment with a gold-standard therapeutic approach like MAT, the better chance they have of achieving long-term, sustainable recovery.

The Opioid Crisis: Facts and Figures for the U.S. and Camden County, NJ

Since the beginning of the opioid overdose crisis in 1999, over a million people in the U.S. have died of fatal drug overdose. Almost ¾ of those fatalities involved opioids. Some fatalities involved illicit opioids like heroin, others involved misuse of prescription opioids, and still others involved synthetic opioids such as fentanyl.

Here’s the big-picture, nationwide data from the past 25 years:

Trends in Overdose Death, 2001-2022

• 2001: 19,394
• 2006: 34,415
• 2011: 41,340
• 2016: 63,632
• 2021: 106,699
• 2022: 108,388

That’s an overall increase of 458 percent, and overdose fatalities from opioids continue to increase. That’s why we remain committed to providing gold-standard, life-changing treatment for OUD at our Suboxone Clinics in Somerdale NJ: MAT with Suboxone.

Now let’s narrow the focus to the past five years. Here’s the latest data on overdose fatalities in the U.S., published by the Centers for Disease Control (CDC).

Overdose Deaths in the United States 2018-2022

• 2018: 67,850
• 2019: 71,130
• 2020: 92,478
• 2021: 106,699
• 2022: 108,388

That’s an increase of 60 percent over five years, which means we still have work to do. The data for Somerdale, where we operate Somerdale Treatment Services, is available online on the New Jersey Opioid Dashboard and /or the NJ Cares Opioid-Related Data website.

Here’s the most recent data, up to May 7^th, 2024:

Need for Suboxone Clinics in Somerdale NJ: Overdose in Camden County 2018-2024

• 2018: 327
• 2019: 340
• 2020: 288
• 2021: 335
• 2022: 354
• 2023: 326
• 2024: 84

This final set of data shows we’re beginning to make progress. We need to qualify that, however. By progress, we mean we’re almost back to where we were pre-pandemic, which is progress, but it’s not enough. One overdose fatality is one too many. At our Suboxone Clinic in Somerdale NJ, we’ll continue to offer MAT with Suboxone, alongside therapy, counseling, peer support, and a range of services designed to promote long-term, sustainable recovery.

The post How Do I Find a Suboxone Clinic in Somerdale NJ? appeared first on Pinnacle Treatment Centers.

We see you and value you.

We celebrate you.

We’re PROUD right alongside you.

The Pride Month tradition began 54 years ago, with Gay Pride Parades in New York City, Chicago, Los Angeles, and Atlanta. Those marches and parades honored the one-year anniversary of the Stonewall Riots. In the year 1999, President Bill Clinton made Gay and Lesbian Pride Month official. And in 2009, President Barack Obama made it more inclusive, recognizing every June as Lesbian, Gay, and Transgender Pride Month.

To read a quick history of Pride Month, please navigate to the blog section of our website and read our article from Pride Month 2023:

June is PRIDE Month at Pinnacle: The LGBTQIA+ Community and Addiction

We’re proud alongside our LGBTQIA+ recovery peers because we know recovery is hard. Add to that the stigma LGBTQIA+ people face every day, and we understand the strength and courage it takes to navigate the world living your true self and embracing your true identity.

That’s why we’re proud, and committed to welcoming members of the LGBTQIA+ community into our treatment family: we’ll meet you where you are and offer the best available addiction treatment in whatever way you’ll accept it.

Our motto is any door is the right door, and we’re ready to open that door wide for LGBTQIA+ people who need evidence-based support for alcohol and substance use disorder (AUD/SUD).

Recognizing Challenges: Alcohol, Substance Use, Mental Health Issues and the LGBTQIA+ Community

The stigma we mention above is real. Evidence shows that 40 percent of LGBTQIA+ adults experience disapproval from family and friends, while 86 percent of LGBTQIA+ youth report experiencing bullying at school.

The discrimination, stigma, and bullying create significant barriers to overall wellbeing for LGBTQIA+ people. And it starts early in life. Here’s how the experts at the Substance Abuse and Mental Health Services Administration (SAMHSA) describe the impact of stigma on LGBTQIA+ youth and teens:

“LGBT youth use alcohol and drugs for many of the same reasons as their heterosexual peers…However, LGBT youth may be more vulnerable as a result of the need to hide their sexual identity and the ensuing social isolation. As a result, they may use alcohol and drugs to deal with stigma and shame, to deny same-sex feelings, or to help them cope with ridicule or antigay violence.”

With that in mind, let’s take a look at the latest facts and figures on alcohol use, addiction, mental health, and suicidality among LGBQIA+ adults, as reported in the SAMHSA publication “Lesbian, Gay and Bisexual Behavioral Health: Results from the 2021 and 2022 National Surveys on Drug Use and Health: Results from the 2021 and 2022 National Surveys on Drug Use and Health.”

LGBTIA+ NSDUH: Alcohol and Opioid Use, Alcohol and Opioid Use Disorder (AUD/OUD)

Alcohol and Substance Use

LGBTQIA+ adults 18+:

• 60% reported past-month alcohol use
  • 52.7% non-LGBTQIA+
• 29.5% reported binge drinking
  • 24.3% non-LGBTQIA+
• 9.1% reported heavy alcohol use
  • 6.3% non-LGBTQIA+
• 47.6% reported using any illicit drug
  • 23.6% non-LGBTQIA+
• 7.1% reported opioid misuse
  • 3.1% non-LGBTQIA+
• 8.4% reported stimulant misuse
  • 3.6% non-LGBTQIA+
• 7.4% reported using hallucinogens
  • 2.8% non-LGBTQIA+
• 4.3% reported misuse of sedatives/tranquilizers
  • 1.7% non-LGBTQIA+

Opioid Use Disorder (OUD), Alcohol Use Disorder (AUD), Substance Use Disorder (SUD)

LGBTQIA+ adults aged 18+:

• 4.3% had opioid use disorder
  • 2% non-LGBTQIA+
• 16.7% had alcohol use disorder
  • 11.3% non-LGBTQIA+
• 30.1% had any substance use disorder
  • 17.2% non-LGBTQIA+

Now let’s look at the mental health data from this latest report.

LGBTIA+ NSDUH: Mental Illness, Major Depressive Episode, Co-Occurring Disorders, Suicidality, Adults 18+

Mental Illness

• Any Mental Illness:
  • 43.4% LGBTQIA+
  • 21.8% non-LGBTQIA+
• Serious Mental Illness:
  • 14% LGBTQIA+
  • 5.1% non-LGBTQIA+

Major Depressive Episode (MDE)

• 18.7% LGBTQIA+
• 7.7% non-LGBTQIA+

Co-Occurring AMI and SUD

• 18.6% LGBTQIA+
• 7.2% non-LGBTQIA

Suicidality

• Thoughts of suicide
  • 12.3% among LGBTQIA+
  • 4.3% non-LGBTQIA
• Made a suicide plan
  • 4% among LGBTQIA+
  • 1.1% non-LGBTQIA+
• Attempted suicide
  • 1.9% among LGBTQIA+
  • 0.5% non-LGBTQIA+

Here’s how the authors of the study characterize this data:

“Results from the 2021 and 2022 NSDUHs indicate that lesbian, gay, and bisexual adults are more likely than straight adults to use substances, experience mental health issues including major depressive episodes, and experience serious thoughts of suicide.”

That’s why we join the Pride Movement every year, and why we make it a point to say it loud. We understand our advocacy for the LGBQIA+ community and our commitment to welcoming members of the LGBQIA+ community into our treatment family makes a difference and has a positive impact.

But how can you be an ally to the LGBTQIA+ community?

Things You Can Do as an Ally: Support Your LGBTQIA+ Friends and Family Members

The most important thing you can do is educate yourself about the LGBTQIA+ experience, and understand the significant challenges LGBTQIA+ people face every day, simply because they’re living as their true selves, out in the open. Here’s an outstanding resource – a complete guide, really – for being an LGBTQIA+ ally, published by the non-profit LGBTQIA+ advocacy group, the Human Rights Campaign Foundation:

Report: Being an LGBTQIA+ Ally

In that report, they suggest five simple ways that individuals can, on their own, act as an influential LGBTQIA+ ally:

1. Read a publication by, for, or about LGBTQIA+ issues.
2. Show your support for the LGBTQIA+ community by posting about Pride Month on social media
3. Participate in LGBTQIA+ advocacy efforts, like Pride Month
4. Call or email your elected officials and advocate for LGBTQIA+ rights.
5. Stand up for LGBTQ+ issues in every aspect of your life — even if there are no LGBTQ+ people there to watch.

In addition, you can participate in any of the 30+ Pride Festivals happening this June. For a full list of Pride Month events nationwide, click here.

Find Support, Find Your People: LGBTQIA+ Helpful Resources and Links

The National Alliance for Mental Illness (NAMI) provides this excellent list of LGBTQI friendly mental health resources for you:

• The Association of Gay and Lesbian Psychiatrists provides an updated a directory of LGBTQIA+ friendly therapists.
• The Gay, Lesbian, and Straight Education Network (GLSEN) is a valuable resource for all things LGBTQIA+
• The GLBT National Help Center provides access to a youth chat line, a crisis hotline, and various other helpful resources.
• The Trevor Project provides specialized suicide and crisis intervention support for LGBTQI youth.
• The American Psychological Association (APA) offers resource for a wide range of topics relevant to the LGBTQIA+ community
• The Gay and Lesbian Medical Association’s Provider Directory offers a list of LGBTQIA+ friendly healthcare providers in the U.S.
• The National Center for Transgender Equality provides a list of trans-friendly healthcare providers in the U.S.
• SAGE National LGBT Elder Hotline maintains a hotline for older LGBTQIA+ people who need support with a variety of health, social, and other issues
• Society for Sexual, Affectional, Intersex, and Gender Expansive Identities (SAIGE) provides LGBTQIA+ friendly mental health resources
• Trans Lifeline connects trans people to various resources to help support them fully live their gender identity
• Depression Looks Like Me is a program designed to support members of the LGBTQIA+ community diagnosed with depression

Happy Pride Month!

The post Pride Month at Pinnacle: Recognizing and Celebrating the LGBTQIA+ Community appeared first on Pinnacle Treatment Centers.

If you search the internet, you’ll find various treatment options: inpatient treatment for addiction, residential treatment for addiction, inpatient drug rehab – the list is long.

This article will help you narrow down your choices and understand your options with regards to treatment for alcohol and/or substance use disorder. The first thing we want to tell you is that the phrases you read when you search online – if you did already – refer to levels of care.

The two levels of care we’ll focus on here are inpatient/residential treatment and outpatient treatment.

Before we continue, you should know something else that’s important: inpatient psychiatric hospitalization is not the same thing as inpatient treatment for AUD or SUD. Inpatient psychiatric hospitalization is appropriate if you’re in crisis right now and are at imminent risk or harming yourself or others. Inpatient psychiatric hospitalization is on the treatment continuum, but the priorities are safety and stability.

If you enter emergency psychiatric hospitalization for an alcohol or substance use emergency, the medical staff will discharge when they determine you’re safe and stable. That’s when the real treatment for AUD or SUD begins: when you’re psychologically, emotionally, and physically ready.

Which bring us back to the topic at hand, phrased as a question in the title of this article:

How Do You Know if You Need More than Outpatient Drug Rehab?

Residential, Inpatient, Outpatient Treatment for Addiction: What’s Right for Me?

There’s a saying among people in treatment for alcohol use disorder (AUD) and substance use disorder (SUD):

If you’ve ever thought about cutting back on your alcohol and or drug use, or stopping use altogether, you should take that thought seriously – and consider seeking professional help and support.

We have one serious disclaimer: long-term use of alcohol or drugs changes the body, and if you completely stop, alone, without consulting a physician, you may experience a very uncomfortable phenomenon called withdrawal. For most substances of misuse or disordered use, withdrawal is not life-threatening, but in some cases, it is life-threatening. That’s why we recommend seeking professional support.

What Are Levels of Care?

A level of care refers to the amount, intensity, and level of immersion of your treatment. Generally speaking, a lower level of care means a less intense, less immersive treatment experience and a higher level of care means a more intensive, more immersive treatment experience. Those levels coincide with your treatment needs: if you have a severe AUD or SUD, more immersive and intensive treatment may be appropriate. On the other hand, if you have a moderate or mild AUD or SUD, less immersive and intensive treatment may be appropriate.

Only a mental health professional can determine clinical severity and recommend a level of care. This article is neither a diagnosis nor a referral.

Keep in mind that when we talk about levels of care and the relative levels of intensity and immersion, those things are not related to the quality of care. A lower level of care is not like a less expensive consumer product in a product line, made with lower quality parts or made in a factory as opposed to handcrafted in a workshop.

If you receive a diagnosis for AUD and/or SUD, a referral for treatment, and choose a well-regarded, fully licensed treatment center, then you will receive the latest evidence-based treatment at all levels of care. Again, the level refers to the amount, intensity, and level of immersion – not the quality.

The most common levels of care – excluding inpatient psychiatric hospitalization, for the reasons we mention above – are inpatient/residential treatment and outpatient treatment.

Inpatient and/or residential treatment levels of care include:

Detoxification

• Detox is the process by which your body eliminates the toxic byproducts of chronic alcohol or substance misuse. Depending on the substance and frequency and duration of misuse of disordered use, detox may last from 3-4 days to two weeks.
• During detox, you live onsite at the treatment facility
• You receive around-the-clock monitoring from trained medical staff, including physicians and nurses, who are ready to address any complications related to detox immediately
• When clinicians determine you’re stable physically and psychologically – i.e. past withdrawal – they’ll most likely discharge you to a less immersive level of care, such as residential treatment

Residential/Inpatient Treatment for AUD or SUD

• During residential/inpatient treatment, you live onsite at the treatment facility.
• The typical length of stay in a residential treatment program is 10 days to one month
• You receive 24/7 medical support and care
• Nurses and doctors on call for emergencies
• You participate in a full day of treatment and treatment-related activities (see list below)
• During the evening, you will most likely complete/participate in:
  • Group counseling or educational workshops
  • Peer support groups, such as:
    • Narcotics Anonymous (NA)
    • Alcoholics Anonymous (AA)
  • Recovery homework: journaling or reading
  • Group outings to sober-friendly activities
    • These typically happen on weekends
  • Residential/inpatient treatment may be appropriate if you have a moderate or severe AUD or SUD.
    • Your clinician makes the final determination

The primary thing you need to understand about residential treatment is that you have the time and space to work on yourself and your recovery in a setting designed for your success, among a group of people – recovery peers and clinicians – who are one hundred percent on the same page as you: working toward a life in sustainable recovery. Since you sleep and eat at the treatment center, you don’t have to worry about the details of daily life. You can focus on recovery, and build the skills you need to take your first steps toward independence.

Next, we’ll talk about outpatient levels of care, from the least immersive to the most immersive.

Outpatient levels of care include:

Outpatient Treatment for Addiction: AUD or SUD

• During outpatient treatment, you live at home and participate in treatment once or twice a week for about an hour per session
• Outpatient treatment typically involves visits with a licensed psychotherapist, psychiatrist, or alcohol/substance use counselor
• Your counselor will likely encourage – or require – you to participate in as many community/peer support group meetings as possible each week
  • Many people in outpatient treatment go to a peer support meeting every day
  • Some go to two meetings a day
• Your therapist/counselor/psychiatrist will support you with the same evidence-based techniques used in more immersive levels of care (see list below)

Intensive Outpatient Treatment (IOP) for Addiction: AUD or SUD

• During intensive outpatient treatment, you live at home and participate in treatment for 3-4 hours per day, 3-5 days per week
  • IOP schedules enable you to continue with a typical work or school schedule while engaging in immersive treatment
• IOP programs typically include a wide range of treatment activities, including therapy, counseling, and complementary supports
• During an IOP program, you will most likely be required to participate in as many community/peer support meetings as possible per week
• You receive the same evidence-based techniques used in more immersive levels of care (see list below)

Partial Hospitalization Treatment (PHP) for Addiction:  AUD or SUD

• During partial hospitalization treatment, you live at home and participate in treatment for 5-6hours per day, 5 days per week
  • PHP schedules enable you to commit to intensive, immersive treatment at almost the same level as residential treatment: the difference is that during a PHP program, you do not live on-site at the treatment facility.
  • Many people in PHP programs live in sober homes/sober living facilities
• PHP programs typically include a full range of treatment activities, including therapy, counseling, and complementary supports like educational workshops, stress management, and relapse prevention
• During a PHP program for AUD or SUD, you will most likely be required to participate in as many community/peer support meetings as possible per week
• During a PHP program for AUD or SUD, you receive the same evidence-based techniques used in more immersive levels of care (see list below)

Those are the levels of care you will find when you search online for professional treatment and support for an alcohol or substance use disorder. We can anticipate your next question:

How do I know what level is right for me?

You don’t have to decide alone. In fact, we recommend against deciding alone. Once you decide you want to seek treatment, the most important thing to do is get a comprehensive assessment administered by a mental health professional.

An Accurate Diagnosis Improves Treatment Outcomes

To learn which level of care is best for you – meaning the level of care that increases your likelihood of achieving sustainable, lifelong recovery – the first step is to arrange a full biological, psychological, and social evaluation administered by a licensed and qualified mental health professional. In the context of treatment for mental health disorders and treatment for alcohol and/or substance use disorder (AUD/SUD), clinicians call these evaluations biopsychosocial assessments. A professional mental health or addiction treatment professional uses a biopsychosocial assessment to learn about all the factors in your life related to your alcohol or substance use disorder.

Biopsychosocial assessments allow treatment professionals to arrive at an accurate diagnosis, identify the severity of the alcohol or substance use disorder, and offer a referral for a level of care that indicated by the symptoms and severity of your addiction disorder.

After you receive a comprehensive biopsychosocial assessment, and you receive a diagnosis for AUD/SUD – if you do – then there’s another step: the clinician needs to determine your level of acuity. In other words, they determine – based on the full biopsychosocial evaluation – how serious and disruptive your AUD/SUD is right now.

The Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5) defines three levels of severity for alcohol and substance use disorders: mild, moderate, and severe.

We’ll describe those levels of severity now.

Mild.

Mild symptoms can be disruptive, uncomfortable, and difficult to manage. Despite the problems they cause, the symptoms of a mild AUD or SUD do not prevent your ability to meet your family, work, school, or social responsibilities. If your symptoms are mild, you probably don’t require an inpatient, residential treatment program.

If you receive a diagnosis for a mild AUD or SUD and your symptoms are not extremely disruptive, outpatient treatment may be appropriate.

Moderate.

Moderate symptoms may be more disruptive, uncomfortable, and difficult to manage compared to mild symptoms. In some cases, moderate AUD/SUD symptoms may impair your ability to meet your family, work, school, or social responsibilities. If your symptoms are moderate, you may or may not need residential treatment: you and the assessing clinician will collaborate on that decision. They will most likely refer you to intensive outpatient treatment (IOP) or partial hospitalization treatment (PHP).

In some cases – based on individual needs – residential treatment may be appropriate if you receive a diagnosis for moderate AUD or SUD.

Severe.

Severe symptoms of AUD and SUD are more disruptive and difficult to manage than symptoms considered mild or moderate. In fact, severe symptoms may be unmanageable and make your life unmanageable. In other words, if the symptoms of your AUD or SUD are severe, they most likely prevent you from meeting the bare minimum responsibilities and commitments related to your family, work, school, or social life. Severe symptoms of AUD/SUD typically trigger a referral for residential/inpatient treatment.

If you receive a diagnosis for severe SUD or SUD and you are not currently in crisis, inpatient residential addiction treatment may be appropriate.

Once a treatment professional administers an assessment and arrives at a diagnosis, they will most likely refer you to one of the levels of care we describe above. The levels of care differ in their levels of intensity and immersion, but that all include the same essential components.

We’ll describe those now.

What Happens During Residential/Inpatient Addiction Treatment for AUD and SUD?

The most effective treatment for AUD and SUD follows the integrated treatment model. This is a whole person approach to bot inpatient and outpatient addiction treatment, which means clinicians address any and all the factors in your life that contribute to AUD/SUD. During integrated treatment, clinicians look beyond your symptoms – although treating symptoms is critical, of course – and help you achieve total health and wellness.

We’ll list the most common components of integrated treatment now. When we wrote see list below in the previous section of this article, this is the list we meant.

Integrated, Evidence-Based Treatment for AUD and SUD: Common Elements

• One-on-one psychotherapy
• Group psychotherapy
• Family psychotherapy
• Peer support, such as 12-step or SMART Recovery meetings
• Complementary supports, such as yoga and mindfulness
• Experiential supports, such as exercise
• Expressive supports, such as art, music, and writing
• Medication (if needed)

If you think you have an alcohol or drug use problem and have decided to seek professional support, we commend your strength and bravery. That’s a hard realization and a difficult choice to make. You also need to know something else: you are not alone. There are millions of people across the country in treatment right now, working towards a life without alcohol and drugs.

Evidence shows that if you need treatment for AUD or SUD, the sooner you get treatment, the better the outcome. And if you commit to treatment, sustainable recovery is within your reach: we see people move past the cycles of addiction every day, and create new lives based on their personal vision of wellbeing and happiness.

The strength they show is within you, too.

The post Inpatient Treatment for Addiction: How Do You Know if You Need More than Outpatient Drug Rehab? appeared first on Pinnacle Treatment Centers.

Why?

Because the gold-standard treatment for opioid use disorder (OUD) is medication-assisted treatment (MAT) with one of three medications for opioid use disorder (MOUD): buprenorphine, naltrexone, and methadone, and the most effective medication for fentanyl among those three is methadone.

However, many residential programs treat patients with a hardline abstinence model, and that approach means they will not provide medication-assisted treatment (MAT) with methadone or buprenorphine.

Why?

Because from their point of view, using a full opioid agonist like methadone or a partial opioid agonist like buprenorphine during treatment defeats the point of treatment: their opinion is that recovery requires full abstinence, and that a person using a MOUD is not abstinent.

But there’s a problem with that stance: programs that require full abstinence and prohibit the use of MOUDs are far less effective for opioid use disorder (OUD) – and specifically far less effective for fentanyl addiction – when compared to programs that utilize MOUDs as part of a comprehensive treatment plan for opioid use disorder.

If that’s the case, then that begs a question:

If MAT with methadone is the gold-standard treatment for people with fentanyl addiction, why do some treatment centers require full abstinence, and prohibit MAT with MOUDs?

To be perfectly honest, we understand where they’re coming from, theoretically, but practically speaking, we don’t understand why an addiction treatment center wouldn’t provide the best available treatment for a specific medical condition.

Therefore, the question posed in the title of this article has at least two valid answers:

1. If a residential treatment center for fentanyl addiction doesn’t offer MAT with MOUD, the answer may be clear and simple “No.”
2. If a residential treatment center for fentanyl addiction does offer MAT with MOUD, the answer may be clear and simple “Yes” if you’re okay with using MAT with MOUD as part of your treatment plan.

The Medical Model of Addiction

Let’s back up and explain why this is even a debate in the first place.

The language we use above to describe buprenorphine and methadone – partial and full opioid agonist(s) – mean that those medications occupy the same receptors in the human brain and nervous system that opioids like heroin, fentanyl, and others occupy, but without causing the extreme euphoria and opioid high associated with disordered or recreational use of drugs like heroin or fentanyl.

Providers that adhere to the hardline abstinence-only model of treatment assert the MAT approach is simply replacing one addiction with another. However, addiction science has moved past this relatively narrow view of treatment and recovery, which has its origins in programs such as Alcoholics Anonymous (AA) and a treatment philosophy developed almost a hundred years ago.

In 2024, we understand two things we didn’t in the 20^th century: the medical model of addiction and the harm reduction approach to addiction treatment. The medical model of addiction means that addiction, which we now call substance use disorder (SUD) is a disease with genetic, environmental, biological, and neurological causes that responds well to evidence-based treatment that includes therapy/counseling, lifestyle changes, and – for some diagnoses and disorders – medication. In this way, addiction is remarkably similar to other chronic diseases such as diabetes or hypertension.

If a person diagnosed with one of those conditions stops taking their medication, risk of relapse increases dramatically. In other words, discontinuing medication can force them out of remission and into relapse. That’s the same with OUD during MAT: if a person discontinues medication, it may force their disease out of remission, and their chances of relapse to opioid use increase.

Addiction and Physical Dependence: An Important Distinction

According to our latest understanding of addiction science, there’s a difference between opioid use disorder (OUD) and physical dependence on medication for opioid use disorder (MOUD). The Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5) places OUD under the overall category of substance use disorder (SUD), which is characterized by:

• Compulsion to use opioids
• Cravings for opioids
• Tolerance to opioids
• Loss of control over opioid use
• Withdrawal when discontinuing use
• Continuing use despite significant negative consequences

The authors of the DSM-V separate physical dependence on MOUD from OUD by identifying these differences:

• Tolerance to FDA-approved MOUD does not count as a criterion for OUD
• Withdrawal from FDA-approved MOUD does not count as a criterion for OUD
• A person in treatment with MOUD who shows tolerance, withdrawal, and cravings – but no other criteria for OUD – is considered in remission on medication

Understanding this distinction is critical for people considering MAT with methadone for fentanyl addiction.

Therefore, when someone asks:

“Isn’t someone on methadone (or buprenorphine) just addicted to a different drug?”

The correct, medically accurate answer – following DSM-V criteria – is this:

“No. A person physically dependent on a MOUD is in recovery, and in medical terms, in remission from OUD.”

Methadone: The Most Effective Medication for Fentanyl Addiction

Residential treatment for fentanyl addiction can be effective without MOUD, but denying access to a gold standard medication for a medical condition does not align with the harm reduction approach to addiction treatment we embrace at Pinnacle Treatment Centers. We take an all-of-the-above approach to treating OUD, and in some cases, methadone is part of that approach.

Evidence shows that of the medications available for OUD, methadone is the most effective for fentanyl addiction. There are three reasons for this:

1. According to the DEA, fentanyl is far more powerful than other opioid medications: it’s 100 times more potent than morphine and 50 times more potent than heroin.
2. Methadone is a full opioid agonist, meaning it attaches completely to opioid receptors in the brain, whereas buprenorphine is a partial agonist, meaning it only partially attaches to the opioid receptors in the brain.
3. Because it’s a full agonist, methadone is more effective than buprenorphine in reducing cravings, mitigating withdrawal symptoms, and normalizing brain chemistry for a person addicted to fentanyl, compared to a person addicted to a less potent/powerful opioid.

Methadone is currently available at specialized treatment facilities called Opioid Treatment Programs (OTPs). To locate a Pinnacle facility that prescribes methadone as part of a comprehensive treatment plan including counseling, social support, and other treatment modalities, please navigate to this page:

Where We Are: Methadone Locations

Expanding access to methadone is essential in our nationwide efforts to mitigate the harm caused by the opioid crisis, and a key component in addressing fentanyl addiction and overdose.

Fentanyl and the Opioid Crisis

In the report “STREET DEA: State and Territory Report on Enduring and Emerging Threats,” published in January 2024, Drug Enforcement Agency (DEA) officials explain that fentanyl is a significant danger to our national health and wellbeing due to its ongoing role as the primary driver behind the ongoing opioid overdose crisis in the U.S. The Centers for Disease Control and Prevention (CDC) reports the following overdose data for 2022:

• 109,413 total drug overdose deaths
• 82,075 opioid-related overdose deaths
• 74,829 fentanyl-related overdose deaths

That data tells us fentanyl was involved in approximately 68 percent of drug poisoning deaths. In addition, the DEA indicates:

• Fentanyl seizures by the DEA have increased steadily since the mid-2010s
• Rates of fentanyl overdose increased alongside the increase in DEA seizures:
  • 2015: 9,367 fentanyl-related overdose deaths
  • 2022: 74,829 fentanyl-related overdose deaths

That’s an increase of 698 percent.

This data makes increasing access to methadone treatment more important than ever before: in plain language, evidence shows medication is the most effective approach to reducing the negative consequences of fentanyl addiction. MAT with methadone can:

• Decrease opioid use
• Increase time-in-treatment
• Normalize brain chemistry
• Improve social and family functioning
• Improve academic and vocational achievement
• Reduce criminal behavior
• Decrease risk of relapse
• Reduce opioid-related mortality
• Reduce fatal overdose

If you or someone you love is considering residential treatment for fentanyl addiction, please understand that the best available treatment for fentanyl addiction is with the MOUD methadone. While residential treatment plays an important role in the big picture effort to support people with substance use disorder in their long-term recovery journey, it’s critical for people to understand that evidence shows methadone – as part of a comprehensive treatment plan – is the gold standard treatment for OUD, and the most effective known treatment for fentanyl addiction.

The post Do I Need Residential Treatment in a Drug Rehab for Fentanyl Addiction? appeared first on Pinnacle Treatment Centers.

• Opioids, including:
  • Heroin
  • Fentanyl
  • Prescription opioids
• Depressants, including:
  • Alcohol
  • Benzodiazepines
  • Other sedatives
• Psychoactive drugs, including:
  • Cannabis
  • MDMA
  • LSD
• Amphetamines, including:
  • Cocaine
  • Methamphetamine
  • Adderall

Some of those substances belong to more than one category, but they all have one thing in common: they’re associated with a risk of misuse that can escalate to disordered use. Many of our patients meet the clinical criteria for opioid use disorder (OUD), specifically, which is a significant threat to public health in the U.S. right now.

To learn more about this public health threat, known as The Opioid Crisis, please navigate to the blog section of our website and read these articles:

The Opioid Crisis: A New National Strategy

The Opioid Crisis: What is Harm Reduction?

Opioid Crisis: Update on Settlements with Opioid Manufacturers, Distributors, and Retailers

Those articles will give you a good overview of the opioid crisis, where we are now, and where we’re headed. This article will discuss the gold-standard treatment for OUD, medication-assisted treatment, or MAT, which we mention above. When an intake assessment indicates a new patient can benefit from MAT, we offer treatment with MAT with one of the three medications for opioid use disorder (MOUD): buprenorphine, methadone, or Naltrexone.

What is Medication-Assisted Treatment?

In simple terms, medication-assisted treatment is a type of substance use disorder treatment that includes medication as a primary component at some point during the treatment process. MAT can be short-term, used only during the detoxification phase of treatment, as a transition that prepares patients for recovery without medication, or in some cases, as a core component of a long-term recovery plan.

The way MAT is used depends on the individual, the substance of misuse or disordered use, and the goals for treatment as determined by each patient, in collaboration with their treatment team. The type of MAT we discuss in this article is long-term MAT for people with opioid use disorder using the medication buprenorphine.

Before we continue, we’ll share the definition of MAT as published by the Substance Abuse and Mental Health Services Administration (SAMHSA), because two parts of their definition are important to the our discussion:

“Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Medications used in MAT are approved by the Food and Drug Administration (FDA) and MAT programs are clinically driven and tailored to meet each patient’s needs.”

The two parts of this SAMHSA definition relevant to our discussion are in combination with counseling and behavioral therapies and programs are clinically driven and tailored to meet each patient’s needs. They’re important because evidence shows that time-in-treatment – especially MAT program with buprenorphine – has a direct impact on treatment outcomes.

More time-in-treatment typically leads to more favorable outcomes than less time-in-treatment. Tailoring the type and amount of therapy is similar: more immersive therapy and counseling typically lead to more favorable outcomes than less time in treatment.

However, there’s not a wide base of evidence that examines how these components interact in the context of MAT with buprenorphine. That’s why a study published in the Journal of Substance Abuse Treatment in March 2022 got our attention.

The Effect of Therapy on Treatment Adherence: About the Study

The paper “Psychosocial And Behavioral Therapy in Conjunction With Medication For Opioid Use Disorder: Patterns, Predictors, and Association With Buprenorphine Treatment Outcome” fills a void in research on the interaction between psychosocial/behavioral therapy and time-in-treatment for people with OUD in MAT programs with buprenorphine.

Here’s how the research team describes the situation, and the need for their work:

“Current evidence indicates that buprenorphine is a highly effective treatment for opioid use disorder (OUD), though premature medication discontinuation is common. Research on concurrent psychosocial and behavioral therapy services and related outcomes is limited.”

Translation: the research team recognized a need to add to our knowledge about whether therapy – psychotherapy or behavioral therapy – affected time-in-treatment and overall treatment outcomes for people in buprenorphine-based MAT programs. To explore this topic, the research team defined three clear goals for the study. They sought to:

1. Define patterns of psychosocial and behavioral therapy services patients in MAT programs for OUD received in the first 6 months after initiating treatment with buprenorphine
2. Identify the characteristics associated with the patterns defined in goal #1
3. Examine common patterns of buprenorphine treatment, with a focus on the relationship between behavioral and psychosocial therapy and treatment duration

The overall idea here is that the more we know about the factors that keep people in treatment, the better providers can tailor treatment plans to emphasize those factors and improve outcomes.

Let’s take a look at the results.

Did Therapy Increase Time-in-Treatment for Patients on MAT?

After collecting claim information on 61,076 patients 18-64 years old using the database Marketscan Multistate Medicaid Database and applying advanced statistical analysis to the data, researchers reported several findings that confirmed what many treatment professionals know from firsthand experience, with outcomes in one group that were surprising.

Here’s what they found.

Treatment Trajectories, Treatment Adherence, and The Effect of Therapy in MAT

Patients in MAT programs followed three primary trajectories:

• No therapy: 73.8%
• Low-intensity therapy: 17.2%
• High-intensity therapy: 9.0%

Patient characteristics associated with the three trajectories:

• No therapy:
  • Records showed patients in this group had fewer co-occurring mental health disorders
  • Records showed patients in this group had fewer previous claims for overdose-related services
• Low-intensity therapy:
  • Records indicated presence of higher rates of co-occurring disorders in this group, compared to the no therapy group
  • Records indicated a higher rate of claims for overdose-related health services in this group, compared to the no therapy group
• High-intensity therapy:
  • Records indicated higher rates of co-occurring disorders for this group, compared to patients in the no therapy group
    • Records indicated higher rates of claims for overdose-related health services for this group, compared to patients in the no therapy group

Effect on treatment adherence, a.k.a. time-in-treatment:

• Patients who did not engage in therapy had the highest risk of discontinuing treatment before six months
• Among patients who engaged in therapy, those in the low-intensity group showed the lowest risk of discontinuing treatment before six months
• Patients in the high-intensity group showed higher risk of discontinuing treatment than patients in the low-intensity group

Other relevant findings:

• Patients in the high-intensity group showed:
  • Increased risk of opioid-related health care events during treatment
  • Increased risk of opioid overdose during treatment
• Patients in both therapy groups – low- and high-intensity – showed higher rates of polysubstance misuse, including cannabis and stimulants

As we mention above, those results confirm what most treatment professionals know and understand: therapy increases likelihood of treatment retention for people in buprenorphine-based MAT programs.

The Results: Unexpected Outcomes in One Group of Patients

Specifically, we should talk about the results related to patients in the high-intensity therapy group.

These patients had a higher risk of discontinuing treatment, higher risk of opioid-related medical problems during treatment, and higher risk of opioid overdose during treatment. These phenomena are related to another component of the data: the increased prevalence of co-occurring mental health disorders and polysubstance misuse among patients in the high-intensity group. What this data tells us is that patients with this specific array of disorders – OUD, co-occurring mental health disorders, and polysubstance misuse – are at increased risk of adverse events during the course of their MAT program, and therefore may benefit from intentional, targeted therapy and support that follows the integrated treatment model.

That’s important for researchers and treatment professionals to know. For researchers, it can inform future avenues of research. For treatment professionals, it can help tailor treatment programs to meet the specific needs of these high-risk patients. And finally, it reiterates the importance of including counseling, therapy, and other emotional or psychosocial supports for patients with OUD and co-occurring disorders in MAT programs.

The post Mental Health Month: Does Therapy Increase Time in Treatment for People with OUD on MAT? appeared first on Pinnacle Treatment Centers.

Clonazepam is a type of prescription medication called a benzodiazepine. Other benzodiazepine medications include, but are not limited to: alprazolam, chlordiazepoxide, clobazam, clorazepate, diazepam, estazolam, flurazepam, lorazepam, midazolam, oxazepam, quazepam, temazepam, triazolam, remimazolam.

Klonopin acts on the benzodiazepine receptor system in the human central nervous system. Benzodiazepine medications are most often prescribed for the following conditions:

• Insomnia
• Acute status epilepticus (seizures)
• Induction of amnesia
• Agitation
• Anxiety
• Spastic and seizure disorders

Anyone prescribed Klonopin should understand its side effect profile, which we’ll describe now.

Klonopin Side Effects

Klonopin is an effective medication when used as directed, but Klonopin use is accompanied by a wide range of side effects. The most common side effects include:

• Muscle weakness
• Drowsy
• Dizziness
• Fatigue
• Ataxia (loss of control of body movements)
• Slurred speech
• Sedation
• Dyspepsia (indigestion)
• Erectile dysfunction
• Stomach pain
• Cognitive impairment
• Behavioral disorders
• Bronchitis
• Cough
• Diarrhea
• Central nervous system depression
• Pharyngitis (sore throat)

In addition, Klonopin use can be accompanied by serious side effects which require immediate medical attention. These less common, more serious side effects include:

• Confusion
• Problems with memory
• Depressive symptoms
• Suicidality: suicidal ideation or suicide attempts
• Thoughts about engaging in self-harm
• Shallow breathing
• Easy bruising and bleeding
• Infected sores/wounds

Some people have an allergic reaction to Klonopin. Signs of an allergic reaction include rash, itching or swelling, extreme dizziness, and problems breathing. A person taking Klonopin who experiences any of these side effects should seek medical attention immediately.

How Long Does Klonopin Stay in Your System?

Klonopin is a long-lasting benzodiazepine, which means it stays in your body longer than most other benzodiazepine medications. In general, it stays in your bloodstream for anywhere from 5-14 days.

The time it takes your body to process and eliminate the medication depends on the following factors:

Age:

Younger people process benzodiazepines more quickly than older people

Dosage:

The higher the dosage, the longer benzodiazepines will stay in the body

Frequency of Use:

The more often someone takes benzodiazepines, the longer they stay in the body

Duration of Use:

The longer a person uses benzodiazepines, the longer it takes for the body to process them

Overall Health:

A healthy person with a smooth-functioning metabolism will process and eliminate benzodiazepines more quickly than someone with serious chronic health conditions

Liver Function:

A person with a healthy liver will process and eliminate benzodiazepines more quickly than a person with compromised liver function due to pathology/disease

Body Mass Index (BMI):

Klonopin will sequester in fat cells. Therefore, the higher the body mass index, the longer Klonopin stays in the body.

Presence of Other Medications:

In some cases, other medications interact with Klonopin and cause it to stay in the body longer than usual.

Dangers of Klonopin

All benzodiazepine medications have a risk of dependence and addiction. Most people build up a tolerance for Klonopin, which means they need to take more of the medication to achieve the same effect. This happens more often with people who misuse Klonopin for recreational purposes and take more than directed.

When a person with a physical dependence on Klonopin discontinues use, they can go into withdrawal, which is extremely uncomfortable.

Klonopin Withdrawal Symptoms

Common symptoms:

• Anxiety
• Insomnia
• Restlessness
• Agitation
• Irritability
• Difficulty concentrating
• Poor memory
• Muscle tension
• Muscle aches
• Depression

Patients on high doses of Klonopin may experience:

• Psychotic symptoms
• Seizures

Typical Klonopin Withdrawal Timeline

First Phase, Days 1-4:

• Initial withdrawal symptoms appear
• Anxiety and insomnia are the most common initial symptoms

Second Phase, Days 5-9:

• Full range of symptoms appear
• Intensity of withdrawal symptoms is highest

Third Phase, Days 10-14:

• Symptoms begin to fade at around 10 days after discontinuation of use
• Most symptoms fade after two weeks

Day 15 and Beyond:

Around 10%-15% of people who stop use experience a longer withdrawal syndrome, called post-acute withdrawal syndrome (PAWS). Symptoms of PAWS include:

• Depression
• Anxiety
• Paresthesia, or tingling, pins and needles, or numbness in arms and legs
• Restless legs
• Muscle jerking
• Stomach problems

In most cases, people who experience PAWS require professional support in the form of therapy or counseling. However, the best way to manage PAWS is to maintain a healthy, balanced lifestyle, which means eating healthy food, getting plenty of sleep, getting plenty of exercise and activity, and engaging in stress-management and self-care activities.

The Benefits of Klonopin

Klonopin and other similar medications are essential medications for treating seizures. Evidence indicates that 1%-2% of emergency room visits every year are for seizures, and benzodiazepines like Klonopin are a first line medication that are effective in stopping seizures.

In addition, common off-label uses help people manage Tourette syndrome, sleep disorders, and tardive dykinesia (uncontrolled facial movements). In some cases, people in treatment for alcohol use disorder (AUD) will receive a short-term prescription for a benzodiazepine medication in order to prevent the delirium, tremors, and delirium tremens associated with alcohol withdrawal.

Klonopin: Use As Directed

When used as directed, Klonopin is a safe and effective medication. However, anyone who receives a prescription for Klonopin should have a serious conversation with their provider about both the risks and benefits of Klonopin.

The post What is Klonopin? appeared first on Pinnacle Treatment Centers.

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

With regards to substance use and mental health, that means health is more than the absence of substance use or the absence of mental health symptoms. The Centers for Disease Control (CDC) concurs with this definition, and indicates their goals for all people in the U.S.:

• Help people live fulfilling lives, free from preventable disease, disability, injury, and premature death
• Establish health equity, eliminate disparities and barriers to care, and improve the health of all groups
• Promote quality of life, healthy development, and healthy behavior in all areas of life

Integrated treatment acknowledges these definitions and goals for overall health and includes them in treatment for co-occurring disorders. The general idea is that treatment should address not only the SUD or mental health disorders themselves, but all the factors in the life of an individual that may contribute to the SUD or mental health disorder. Addressing and resolving symptoms is important, but the absence of symptoms is not necessarily synonymous with overall health and wellbeing.

That’s the goal of integrated treatment: total health.

We’ll describe how integrated treatment can help patients achieve total health in a moment. Firsts, we’ll take a moment to define what we mean by co-occurring disorders.

What are Co-Occurring Disorders?

When a person receives a diagnosis for one or more substance use disorders and one or more mental health disorders at the same time, they receive a dual diagnosis and have co-occurring disorders. In the context of SUD treatment, this is always what these terms mean. In other areas of healthcare, dual diagnosis may refer to the presence of two conditions or diseases at the same time, but the more appropriate phrase is comorbidity, while co-occurring disorders or dual diagnosis is the preferred term in mental health and SUD treatment.

Co-occurring disorders are far more prevalent than most people realize. In fact, in the introduction to the 2020 Substance Abuse and Mental Health Services Administration (SAMHSA) publication “SAMHSA TIP 42: Substance Use Disorder Treatment for People With Co-Occurring Disorders,” a leading expert on SUD and mental health treatment observes:

“Comorbidity is important because it is the rule rather than the exception with mental health disorders.”

Two years later, the data still supports this observation. The 2022 National Survey on Drug Use and Health (2022 NSDUH) shows:

• 84 million adults in the U.S. had either SUD or any mental health illness (AMI)
  • 25 million adults had SUD but not AMI
  • 59.3 million adults had AMI
  • 37.7 million adults had AMI but not SUD

21.5 million adults had SUD and AMI

• 3 million adults in the U.S. had either SUD or a serious mental health disorder (SMI)
  • 39.1 million adults had SUD but not SMI
  • 15.4 million adults had SMI
  • 8.0 million adults had SMI but not SUD

7.4 million adults had SUD and SMI

Those are the big-picture facts about co-occurring disorders. Millions of people nationwide have co-occurring disorders, and need effective, evidence-based treatment to achieve the best possible outcome.

Let’s look at how integrated treatment can help people with co-occurring substance use disorder and mental illness.

Integrated Treatment for Co-Occurring Disorders: An Overview

Here are the primary elements of the integrated treatment model, as defined by SAMHSA.

Integrated Treatment: Six Core Components

To meet the criteria established by SAMHSA for a fully integrated SUD/Co-Occurring Disorders treatment program, a treatment center:

1. Provides Access

• Access means the process by which an individual first encounters the treatment experience. There are four main types of access:
  • Routine: individuals who are not in crisis seek treatment independently
  • Emergency: individuals who initiate treatment because of a crisis
  • Outreach: individuals in need but do not seek treatment independently
  • Involuntary: individuals who initiate treatment as mandated by an employer, the criminal justice system, or the child welfare system
• No Wrong Door
  • This concept it crucial: it means that an individual should receive access to treatment no matter how they arrive at, initiate, or encounter the opportunity to engage in treatment. If an individual asks for help, help them.
  • Providers can create the right door through outreach

2. Performs a Comprehensive Assessment

• Providers must screen for SUD and mental health disorders immediately
  • Type of SUD/mental health disorder
  • Severity of SUD/mental health disorder
• Providers must assess background:
  • Family history
  • Trauma history
  • Medical history
  • Work history
  • SUD treatment history
• Providers must assess psychosocial factors:
  • Employment status
  • Housing status
  • Food access status
• Assessments must be followed by treatment evaluations during the treatment process:
  • Determine treatment progress
  • Make changes to treatment plan if necessary

3. Determines an Appropriate Level of Care

• Providers use the Level of Care Utilization System (LOCUS) or similar metric to refer an individual to the appropriate level of care. The LOCUS matrix uses six factors to hep clinicians determine a level of care:
  • Risk of Harm: Is the individual a risk to themselves or others?
  • Functional Status: Is the individual impaired with regards to family, work, and school?
  • Medical or Psychiatric Factors: Are there additional conditions or disorders that will impact treatment?
  • Home Environment: Does the individual have a safe, recovery friendly home or family situation?
  • Treatment History: Has the individual been in treatment before?
  • Engagement/Recovery Status: Does the individual understand their disorder? Is the individual committed to treatment?

4. Achieves Integration of Treatment

• Providers address SUDs and mental health disorders concurrently, based on symptoms and need
• Clinicians receive training in treating individuals with SUD and mental health disorders
• Treatment occurs in phases that match individual readiness for treatment and engagement
  • Providers use motivational strategies such as motivational interviewing (MI) to facilitate readiness and engagement
• Providers offer substance use and alcohol counseling services
• Providers offer:
  • Individual therapy
  • Group therapy
  • Family therapy
  • Peer support, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA)
  • Medication-assisted treatment when appropriate

5. Provides Comprehensive Services

• In this context, comprehensive means everything not mentioned above. Comprehensive services for people in treatment for co-occurring disorders may include:
  • Vocational support/access to vocational services
  • Housing support/ access to housing services
  • Food support/access to food support services
  • Language support for non-native English speakers

6. Ensures Continuity of Care

• Continuity of care refers to two things:
  • Transitions between levels of care during formal treatment
  • Ongoing care after the completion of a formal treatment program, which is often called aftercare or alumni support
• The goal of continuity of care between levels of care is to facilitate a smooth transition, capitalize on treatment progress, and communicate all relevant details about treatment from one treatment team to the next
• The goals of an aftercare plan – i.e. a plan an individual receives upon completion of a formal treatment program – include, but are not limited to:
  • Sustaining sobriety
  • Continuing recovery
  • Living independently
  • Resolving relationship and family issues
  • Finding employment
  • Continuing healthy, recovery friendly habits, such as health eating and exercising
  • Ongoing engagement with a peer support/recovery community such as AA or NA

The intentional combination of the treatment components above increases the chance of successful recovery for a person diagnosed with co-occurring substance use and mental health disorders. The idea is to treat both disorders simultaneously, and, while doing so, begin to address the psychosocial factors at play that can either promote or impair the recovery process. When a person receives evidence-based treatment for all the disorders for which they receive a diagnosis, and receives support in all the areas of life that impact recovery, then their chances of achieving sustainable, long-term recovery improve.

Treating the Whole Person

The movement toward integrated treatment often involves components which we never would have considered twenty years ago. Lifestyle changes, exercise, diet, meditation, yoga, and stress management – just 20 years ago – may have been considered radical or woo woo or simply ineffective treatments with no evidence to support them.

There is now evidence to support those complementary approaches, and high-quality treatment centers around the country incorporate these components into treatment programs every day.

In addition, treating substance use and mental health disorders at the same time was not common: that’s a new approach, based on evidence – see our SAMSHA link above – that shows treating one without treating the other can impair treatment progress for both.

The final piece of the puzzle, with regards to integrated treatment, is the widespread recognition of the importance of the psychosocial components of recovery, which align with the WHO definition of health and the CDC goals for a healthy society that we list earlier in this article. Health is more than the absence of disease: health is when a person thrives in all areas of life.

The same is true for recovery from SUD and mental health disorders. Health is not simply abstinence from substances or the absence of mental health symptoms, although those are critical elements of health for a person with SUD and a co-occurring disorder. Health is when a person thrives in recovery, maintains positive relationships, meets personal responsibilities, and achieves overall wellbeing and life satisfaction.

That’s what integrated treatment can do for an individual in recovery: create a foundation for long-term health and happiness. It takes work and commitment – and for people new to treatment, those goals can seem a long way off – but it’s important for anyone in treatment to understand this fact:

Those goals are achievable.

Right now, across the country, millions of people are finding hope in treatment, belief in themselves, and creating a positive vision of a better tomorrow.

The post Mental Health Month: What is Integrated Treatment for Co-Occurring Disorders? appeared first on Pinnacle Treatment Centers.

Every year since 1949, local, state, and national organizers work together to host this important awareness movement during the month of May. MHA was founded by Mental Health America (MHA), who now collaborate with the National Alliance on Mental Illness (NAMI), the Substance Abuse and Substance Abuse and Mental Health Service Administration (SAMHSA), and other public and private agencies nationwide.

This year, the theme MHM is one we can relate to:

“Where to Start: Mental Health in a Changing World”

We can relate because with so much going on in the world, and so many new developments in mental health and mental health treatment, sometimes it’s hard – even for treatment professionals – to know exactly where to start.

This year’s theme leads directly to the action steps the organizers at MHA, NAMI, and SAMHSA want us all to take this year to raise awareness around mental health, mental health treatment, and mental health related issues during mental health month:

1. Learn how the various aspects of our daily life affect our mental health
2. Act so we can learn the skills we need to tolerate stress, manage our emotions, and navigate challenging psychological and emotional situations in a healthy and productive manner
3. Advocate for increased awareness about mental health, access to mental health treatment, and reducing stigma in your community

In this article, we’ll talk about how we can all do our part for Mental Health Month 2024. One thing we know is true: when we work together toward a common goal – like raising awareness about mental health – we can accomplish amazing things. Before we talk about how we can all help, though, we’ll take a moment to review the current state of mental health, overall, in the U.S.

Mental Health in the U.S.: The Big Picture

We all understand that since March 2020, mental health has been in the news for many reasons. The obvious thing to mention is the pandemic. In the beginning, every mental health professional in the country warned that worry about getting sick, grief over the death of loved ones, and the consequences of mitigation measures like social distancing, stay-at-home orders, and virtual work and school could have a negative impact.

They expected increases in depression, anxiety, and other mental health disorders, as well as increases in alcohol and substance use disorder (ADU/SUD). And they were right. Data from the Centers for Disease Control and other sources showed increases in mental health diagnoses and AUD/SUD diagnoses in 2020. Mental health diagnoses decreased in 2021, but rates of AUD and SUD continued to increase.

In addition, before the pandemic, two public health issues were front and center: the increase in suicide, particularly among young people, and the opioid crisis, which has claimed over a million lives in the U.S. since 1999.

This is the background context for where we are now – and that’s without mentioning the youth mental health crisis and the loneliness epidemic identified by the Surgeon General of the United States in two consecutive public health advisories: Protecting Youth Mental Health (2021) and Our Epidemic of Loneliness and Isolation (2023).

When the top medical official in the country sees fit to publish two public advisories over as many years, it means we should pay attention – and participate in Mental Health Month to help promote our overall health and wellness nationwide.

Mental Health: How Are We Doing?

Every year the National Institutes of Health, in partnership with the University of Michigan, conduct the National Survey on Drug Use and Health – the NSDUH – to help policymakers, treatment providers, and the general public understand our current situation with regard to mental health disorders, addiction, and various topics related to mental health and addiction.

We retrieved the data below from the 2022 National Survey on Drug Use and Health (2022 NSDUH). We shared the same sets of data from the 2021 NSDUH in our MHA 2023 article. We’ll point out the differences between 2021 and 2022 where we have like data to compare. After we share this information, we’ll talk about the steps we can all take to raise awareness during mental health month.

We’ll start with the latest facts and figures on mental illness.

Any Mental Illness (AMI)

• Adults 18+: 23.1% (59.2 million)
  • Received treatment: 50.6% (29.9 million)
• 18-25: 36.2% (12.5 million)
  • Received treatment: 49.1% (6.1 million)
• 26-49: 29.4% (30.1 million)
  • Received treatment: 50% (15.1 million)
• 50+: 13.9% (16.5 million)
  • Received treatment: 52.7% (8.7 million)

There’s good news here. Rates of mental illness increased by only 0.1 percent from 2021, but overall treatment rates increased by close to 6 percent.

Serious Mental Illness (SMI)

• Adults 18+: 6.0 % (15.3 million)
  • Received treatment: 66.7% (10.2 million)
• 18-25: 11.6 % (4.0 million)
  • Received treatment: 61.4% (2.4 million)
• 26-49: 7.6 % (7.8 million)
  • Received treatment: 4% (5.2 million)
• 50+: 3.0 % (3.5 million)
  • Received treatment: 71.0% (2.5 million)

There’s also good news here. Overall rates of SMI among adults did not increase, but rates of treatment – like rates for AMI – increased by 6 percent.

Next, we’ll look at the data on a phenomenon we encounter every day: co-occurring disorders.

When Mental Health and Alcohol/Substance Use Disorders Meet: Co-Occurring Disorders

If a patient receives a diagnosis for the disordered use of alcohol or substances and a mental health disorder at the same time, they receive a dual diagnosis for co-occurring disorders. It’s common for people with a mental health disorder to self-medicate with alcohol or substances, which can lead to AUD or SUD, and it’s also common for people with AUD or SUD to develop mental health disorders, influenced by chronic, severe alcohol or drug use.

Like the facts and figures above, we retrieved this data from the 2022 NSDUH.

Co-occurring Disorders: Any Mental Illness (AMI), Serious Mental Illness (SMI), and SUD

• Adults with AMI and SUD:
  • 18+: 8.4% (21.5 million people)
  • 18-25: 15.1% (5.2 million people)
  • 26-49: 11.4% (11.6 million people)
  • 50+: 3.9% (4.6 million people)
• Among adults with AMI and SUD:
  • 59.1% received treatment of some kind
  • 37.9% only received mental health treatment
  • 17% received mental health and SUD treatment
  • 41% received no treatment at all
• Adults with SMI and SUD:
  • 18+: 2.9% (7.4 million people)
  • 18-25: 6.0% (2.1 million people)
  • 26-49: 3.7% (3.8 million people)
  • 50+: 1.3% (1.5 million people)
• Among adults with SMI and SUD:
  • 71.2% received treatment of some kind
  • 45% only received mental health treatment
  • 24% received mental health and SUD treatment
  • 28.8% received no treatment at all

There’s also promising news in this data. Across the board, in all categories, the percentage of people with co-occurring mental health and substance use disorder who received treatment increased between 2021 and 2022. That’s an important development – and it’s the reason we do our part to raise awareness about mental health and mental health/addiction treatment during mental health month.

Mental Health, Alcohol Use Disorder, and Suicide

We mention the upward trend in suicide deaths among young people widely reported by media before the pandemic. That’s of significant concern, as is the relationship between suicidality, mental health, and substance use. Combined AUD/SUD and mental health disorders increase suicide risk, and in 2022, the NSDUH survey included questions on the impact of alcohol and substance use on suicidal behavior.

Consider these statistics:

AUD and Suicidality: 2022

• Serious thoughts of suicide, total population: 5.2% (13.2 million)
  • Serious thoughts of suicide, people with AUD: 11.8% (3.4 million)
• Made a suicide plan, total population: 1.5% (3.7 million)
  • Made a suicide plan, people with AUD: 4.1% (1.1 million)
• Attempted suicide, total population: 0.6% (1.6 million)
  • Attempted suicide, people with AUD: 1.8% (518,000)

The data clearly show the presence of AUD increases risk of suicidality. People with AUD had thoughts of suicide at twice the rate of people without AUD, people with AUD made suicide plans at almost three times the rate of people without AUD, and people with AUD attempted suicide at exactly three times the rate of people without AUD.

What We Can Do: Mental Health Month 2024

Let’s revisit the theme for this year:

“Where to Start: Mental Health in a Changing World”

And the goals are to Learn, Act, and Advocate. We’ll review what you can do, starting with advocacy and working back to learning.

Advocate

To advocate for mental health during MHM, please navigate to the Mental Health America website, choose the Mental Health Month page, and download the Where to Start Toolkit. You can share social media posts, encourage your school or workplace to participate, and join the Be Seen in Green Challenge to show your commitment to mental health awareness.

Act

To take care of your own mental health, you need to take proactive steps, i.e. you need to act. First, establish a self-care routine that includes healthy food, adequate sleep, plenty of exercise and activity, and regular social contact with people who help you relax and recharge. Second, check yourself for signs and symptoms of mental health disorders, substance use disorders, or co-occurring disorders. Finally, if you identify symptoms in yourself and think you need professional support, we encourage you to arrange a full mental health/addiction assessment administered by a mental health professional.

Learn

For MHM 2024, the advocates art MHA hope we all take the time to understand the factors in our life – aside from things like genetics, trauma, and relationships – that may have a negative impact on our mental health. These include:

• Current events, which can increase our overall levels of stress and disrupt our wellbeing.
• Technology, which can bring us closer together, but can also degrade overall wellbeing by over-exposure to negative information, unhealthy social media use, and a decrease in real, in-person, face-to-face interaction.
• Loneliness, which is associated with increased rates of anxiety, depression, and AUD/SUD. In addition, recent evidence – in the Surgeon General’s Advisory – indicates loneliness can decrease our life expectancy, and have as significant an impact on our health as smoking a pack of cigarettes a day.
• Social and Environmental Factors, which refer to the social determinants of health (SDOH), a group of factors the S Department of Health and Human Services (HHS) define as “…the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

Resources for Mental Health and Addiction Support

It’s important to remember we are not alone. If any of us – ourselves, friends, loved ones, anyone – has a mental health problem or substance use problem, we need to understand that effective, evidence-based support is available.

People seeking a therapist, counselor, or psychiatrist for an evaluation can use these resources:

• The SAMHSA treatment locator.
• The American Psychological Association (APA) treatment locator
• For opioid use disorder (OUD) treatment:
  • MAT with buprenorphine
  • MAT with methadone

For emergency support – i.e. you or someone you know/love is in crisis right now – these resources are available:

• The 988 emergency line is a 24/7 phone line to call in case of a mental health emergency, including an overdose crisis.
• SAMHSA’s National Helpline at 1-800-662-HELP (4357) supports people in need of addiction treatment resources, and can connect people to support in drug-related emergencies.
• Trevor Project Help Line at 1-866-488-7386 offers specialized support for members of the LGBTQIA+ community.

We’ll end with this reminder: treatment works! The sooner a person with a mental health or alcohol-/substance use disorder gets the help they need, the better the outcome.

The post What is Mental Health Month 2024? Learn, Act, Advocate appeared first on Pinnacle Treatment Centers.

What’s the difference between Suboxone and Subutex?

Suboxone and Subutex are both medications for opioid use disorder (MOUDs) approved by the Food and Drug Administration (FDFA) for the treatment of opioid use disorder (OUD) in federally licensed medication-assisted treatment (MAT) programs.

Understanding the various treatment options available for OUD is important, because in the U.S., drug overdose has claimed over a million lives since 1999, with over 75 percents of those deaths attributable to opioids.

So what’s the difference between Suboxone and Subutex?

Gold Standard Treatment for OUD

We’ll start with the similarities:

1. They’re both medications approved for the treatment for OUD.
2. They both contain the partial opioid agonist buprenorphine.
3. Both medications are core components of medication-assisted treatment (MAT), widely recognized as the gold-standard treatment for OUD.
4. They both mitigate the symptoms of withdrawal, reduce cravings for opioids, normalize brain chemistry, and allow people with OUD to fully engage in all aspects of treatment.
5. Patients who stay in treatment in MAT programs show improved outcomes across multiple life domains, including reduced criminal behavior, increased ability to participate in family life, social life, and health relationships, improved vocational opportunity, and improved overall health.

Now we’ll address the differences.

What is Suboxone?

Suboxone is the brand name of a medication that contains buprenorphine, a partial opioid agonist, and Naloxone, a full opioid antagonist.

Note: Naloxone is the active ingredient in the lifesaving opioid overdose reversal medication, Narcan.

Let’s clarify what we mean by the terms partial opioid agonist and full opioid agonist.

A partial opioid agonist is a chemical that fits into and occupies the opioid receptors in the brain and nervous system, but the fit is not exactly perfect: it’s partial. Therefore, the chemical triggers some, but not all of the same responses in the nervous system as an opioid. In the case of buprenorphine, it occupies receptors enough to reduce the symptoms of withdrawal, reduce cravings for opioids, and normalize brain chemistry, but not enough to cause the euphoria, sedation, and/or high caused by opioids themselves.

A full opioid antagonist, on the other hand, completely occupies the opioid receptors in the brain and nervous system. In the case of the full opioid antagonist Naloxone, it occupies opioid receptors without causing any of the effects associated with opioids or partial opioid agonists. More importantly, it prevents opioids or partial opioid agonists from occupying opioid receptors. That’s the main reason many patients and providers choose Suboxone: the added Naloxone prevents diversion and misuse.

We’ll explain.

When taken as directed – in sublingual (under tongue or inside cheek) tablet or gel, almost no Naloxone makes it into the bloodstream, and therefore, almost no Naloxone makes it to the opioid receptors. However – and this is how the Naloxone + buprenorphine combination prevents diversion or misuse – if a person alters Suboxone in order to inject it for recreational purposes, the Naloxone does make it to the bloodstream, does make it to the opioid receptors.

When it does that, it kicks any opioids or partial opioid agonists – like buprenorphine – off the opioid receptors, which triggers opioid withdrawal. When comparing Suboxone and Subutex, this is often the deciding factor: the potential of withdrawal discourages misuse, which many patients and providers prefer.

What is Subutex?

Subutex is the brand name for sublingual (under the tongue or inside the cheek) form of buprenorphine that comes in 2mg and 8mg doses.

Subutex is a partial opioid agonist used in MAT programs for people with OUD. We’ve mentioned MAT several times, but we’ll elaborate on how MAT works here. When a person develops opioid use disorder, their brain and body changes. With prolonged use, the body achieves homeostasis – a.k.a. balance – in the presence of opioids. When a person stops taking opioids, the body reacts, and temporarily goes far out of balance: this is opioid withdrawal.

Symptoms of opioid withdrawal include:

• Agitation
• Muscle aches
• Respiratory depression
• Restlessness
• Anxiety
• Runny nose
• Excessive sweating
• Insomnia
• Diarrhea
• Abdominal pain
• Nausea/vomiting
• Goose bumps
• Dilated pupils
• Rapid heartbeat
• High blood pressure
• Severe cravings for opioids

It’s easy to see why patients who enter treatment want to avoid experiencing these symptoms as much as possible: they’re miserable. That’s what makes Subutex an effective medication for opioid use disorder: it mitigates the worst of these symptoms. Most importantly, it drastically reduces cravings for opioids, which is one of the primary reasons people with OUD cite for relapse to opioid use after attempting to discontinue use.

Which One Is Best for Me? Suboxone or Subutex?

If you meet the clinical criteria for opioid use disorder (OUD), you’ll make this decision in collaboration with your treatment team. They’ll tell you that the best medication for you depends on factors unique to you. Those factors include:

• Medical history
• Mental health history
• The opioid you use/used
• Frequency and duration of use
• Treatment history/MAT history

The biggest difference between these two medications is the presence of Naloxone. We explain the effect of Naloxone above. It’s a significant deterrent to misuse. The relevance of this is also unique to you, your treatment goals, and the shape you want your treatment plan to take. The best way to decide which is best for you – Suboxone or Subutex – is to have an open, honest, and direct conversation with your treatment team, weigh the alternatives, and make an informed decision that matches your long-term goals.

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