opioid-addiction

The Prevalence of Substance Misuse and Addiction in Sports

Posted on by Christy Weeks

Jessica Joiner, LCSW, LAC, has over a decade of experience working with those suffering from addiction, complex trauma, and co-occurring disorders. She uses her experience along with the extensive skills gained to address the many issues that arise for athletes.

In her workshop hosted by Harmony Foundation, Joiner discussed the prevalence of substance misuse among athletes, various ways of identifying “red flags,” and evidence-based interventions that can be helpful in combating the misuse of drugs and alcohol.

As Joiner explained, there are three main reasons athletes misuse substances: pain resulting from injuries, stress from incessant pressure to win, and the desire to enhance performance artificially. Over the years and decades, these reasons have stayed the same but the drugs involved are now more sophisticated than ever, with more options.

The statistics paint a grim picture. Substance misuse is prevalent in high school: approximately 19 percent of males and 14 percent of females binge drink in high school. 21 percent of teens use marijuana and up to 6.6 percent have used performance-enhancing drugs (PEDs).

It gets worse in college where 42 percent of students admit to binge drinking, 28 percent use cannabis, and around 11,000 NCAA athletes admit to taking PEDs. There is a strong correlation between concussions and alcohol use. “Having a concussion is actually predictive for alcohol use,” said Joiner. “If a high school student is entering college with a history of concussion, and we know about the correlation, we could put some measure in place to intervene before things get out of control. We don’t want them to get overwhelmed by the pressure of performing and the grades required to continue.” It’s much better to support them on the front end before things get out of hand.

Should players get drafted into the National Football League, the pain from injuries, the pressure to win, and the temptation to use PEDs get even worse. In the NFL, 51 percent of players use opioids and 71 percent of those athletes admit to misusing them. Many of the pills are not prescribed by medical doctors: 68 percent say they got them from other sources.

It takes only a few days to get addicted to opioids, Joiner warned, and professional athletes have easy access. Professional athletes tend to play through the pain and then “fix it” with opioids and other substances after the game, putting themselves at risk for greater injury and addiction.

Joiner then went over the possible consequences of such risky behavior, which include the impact on performance, health, relationships, and career—and in the worst-case scenario, death.

While substances were initially taken to enhance or maintain performance, escalating use will eventually compromise performance and wreak havoc with the athlete’s health. As is the case for all people with substance use disorder, addiction has “a definite negative impact on relationships.” If there is no intervention and treatment, players may end up with legal problems, a league suspension, or just get kicked off their team.

There are many examples of athletes falling into this trap. Former Boston Celtic Chris Herren struggled with substance misuse for much of his NBA career. While playing for the Celtics, Herren started to use opioid painkillers. In December 2007, he was charged with possession of heroin in Rhode Island and in the following June, Herren overdosed on heroin in Fall River, Massachusetts. According to the attending paramedics, he was clinically dead for 30 seconds.

Abby Wambach—widely considered the best female soccer player ever—was arrested for driving under the influence in 2016. Following the incident, Wambach published an autobiography revealing that she had misused prescription drugs and alcohol for many years.

After going into recovery, Herren started raising awareness of drug addiction and has now spoken to over one million students, athletes, and community members, promoting frank discussions about substance use disorder and wellness.

In the webinar, Joiner, too, stressed the importance of prevention and early intervention to attack this problem. Prevention should include educating everybody involved to raise awareness of mental health issues that often drive substance misuse, so parents, teachers, and coaches learn to recognize red flags. “From the outside, it often looks like they have everything”, explained Joiner. That’s why depression and anxiety disorders are often overlooked. Testing, screening and other interventions should be used in a supportive, not punitive way.

“We should stop just being reactive and be more proactive,” Joiner said. Coaches and trainers of athletes should not wait for a crisis to unfold and athletic programs should provide adequate mental health services for players (and other students). Treatment should not be perceived as punishment for bad behavior but as a concerted effort to heal psychological problems. “We need effective collaboration between therapists, doctors, school departments, and the community that facilitates integrated care,” Joiner said. Currently, too many people fall through the cracks because many athletic departments don’t provide nearly enough mental health professionals. Ultimately, a culture shift is required: our society’s approach to athletic injuries and mental illness needs to change significantly and we need more trauma-informed and stigma-free care—and not only for athletes.

Harmony Fights Opioid Epidemic with HOPE

Posted on by Christy Weeks

More than two-thirds of drug overdose deaths in the United States in 2017 involved opioids, according to the Centers for Disease Control and Prevention, escalating an epidemic the CDC says “continues to worsen and evolve.” From 2016 to 2017, opioid-related overdose deaths increased 12 percent overall, surging among all age groups 15 and older.

The CDC report’s recommendations for curbing opioid-related overdose deaths include “increasing naloxone availability, expanding access to medication-assisted treatment, enhancing public health and public safety partnerships, and maximizing the ability of health systems to link persons to treatment and harm-reduction services.”

Naloxone is a medication often used by first responders because it can rapidly reverse opioid overdose. It is an opioid antagonist—it binds to opioid receptors and can reverse and block the effects of other opioids. It can quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain relievers.

Medication-assisted treatment (MAT) is used to decrease opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission. Medications used for the treatment of opioid use disorder are buprenorphine (Suboxone, Subutex), methadone, and extended release naltrexone (Vivitrol). Some of these drugs are controversial in the recovery community because they are themselves opioids.

The National Institute on Drug Abuse, a US government research institute, clarifies that contrary to what some critics say, “methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for an opioid addiction, the dosage of medication used does not get them high–it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery.”

The use of these medications should always be combined with behavioral counseling with the ultimate aim of ceasing all substance misuse.

HOPE – Harmony’s Opioid Programming Experience

Harmony has provided all clients with medication-assisted treatment for many years. This combination of education, counseling, and the use of medication in early recovery is part of the Harmony philosophy. HOPE expands MAT to include medications that alter the physical response to opioids, reduce cravings, and give the patient time to heal from the psychological, social, and spiritual wounds of addiction.

“It’s important to remember that MAT is only a small part of the picture,” says Harmony’s medical director Christopher Reveley. “That is why we call it ‘medication-assisted’ treatment, because by itself it is not the treatment. Used alone it has a low probability of being successful.”

At Harmony, HOPE begins with thorough medical and psychological evaluations. Collaboration with the patient, members of the interdisciplinary team and, when appropriate, family and referral sources, determine the most effective treatment plan. All HOPE clients are invited to participate in weekly support groups led by a professional addiction counselor. These groups address the unique challenges of early opioid recovery, including uncomfortable physical and psychological symptoms, cravings, and strategies to avoid relapse. In this setting, clients support each other and are educated about the process of recovery.

Medication-assisted therapy may help stabilize the patient for these challenges in early recovery. “It gives people an opportunity to step out of the chaos of addiction and consider other ways of being,” says Dr. Reveley. “I never felt that buprenorphine was meant as a lifelong or even long-term solution.” Although there may be exceptions. It all depends on the individual needs of the patient. Reveley remembers a patient who had been on methadone for 46 years. “He tried to taper off a dozen times and relapsed to heroin use every single time. His family was initially very opposed to him being on methadone but eventually they told him ‘this is working, your life depends on it.’ So there are people on either end of the bell curve but in most cases buprenorphine is only a small but important part of the solution.”

Buprenorphine can be an important tool, especially in early recovery from opioid use disorder. The medication offers patients the opportunity to start living a “normal” life, far removed from the drug culture lifestyle they may have been immersed in while using heroin and other opioids. People are dying every day from opioid overdoses, especially in the age of the fentanyl scourge. Buprenorphine may provide the buffer that enables them to launch into sustained recovery. It is a buffer that can save people with addiction from a potentially lethal overdose.

Harmony has been treating addiction for 49 years and HOPE is now offered to all Harmony clients with opioid use disorders. The program involves enhanced medical, counseling, and case management services specifically tailored to meet these clients’ unique needs.

The Harmony care team works closely with clients who choose to include buprenorphine in their treatment strategy. This will typically involve full participation in HOPE and a recommendation for participation in Harmony’s Transitional Care Program (TCP), an intensive, 90 day intensive outpatient program coupled with monitored sober living and medication management by Harmony providers. When clinically indicated or to accommodate client preference, Harmony’s case managers may refer clients to other programs with similar services.

If you or someone you know is struggling with opioid use disorder and needs help, call Harmony at 970-432-8075 and one of our admissions specialists can discuss next steps.

The Insurance Dance with Recovery in Mind by Jim Geckler

Posted on by Christy Weeks
Collaboration

We recently received a Facebook post regarding frustration over Harmony’s handling of payments made through insurance. I wanted to use this opportunity to discuss questions and concerns about our partnerships with insurance partners and how we believe it helps benefit access to treatment.

First and foremost, insurance companies make it easier for us to cover some of the cost of treatment, a service that many of us do not plan for when the time requires it. When we consider our personal relationships with insurance partners, how many of us would be able to have yearly physicals, emergency procedures, or access to treatment? As a provider, Harmony works with our insurance partners to provide the appropriate level of care for the appropriate period of time.

Harmony has a 49 year history of providing a residential level of care; this is the highest level of care for people suffering from substance use disorder. We have a responsibility to our clients to stabilize them medically, assess their conditions, provide them with a diagnosis, work with them to create a foundation for sustained recovery, and construct a comprehensive continuing care plan which will support their recovery. The relationships we have fostered with insurance partners has allowed us to work collaboratively to support access to care along the continuum. Under the umbrella of the American Society of Addiction Medicine (ASAM), together, insurance companies and treatment providers alike are held to the highest standards of care for addiction treatment. This common language, reviewed in tandem with insurance providers determines what level of care an individual requires.

Sometimes there is disagreement.  For example, when Harmony feels that a client would be better served by remaining at a residential level of care and an insurance provider feels they would be successful at the next level.  Other times, a client would like to remain in treatment, however our expert clinical and medical staff believe they are ready to move toward self-management of their own recovery at a level of care which empowers them to practice the early skills of recovery they learned here. In most cases, to arrive at a decision to move a client to the next level of care, involves a conversation with our Medical Director and a physician reviewing the case for the insurance company. We work to keep people at the appropriate level of care indicated by our clinical staff recommendations based on the client’s progress.

Harmony has a dedicated utilization review team, clinical professionals who work with our insurance partners, staff, and clients to keep people at the level of care which will provide them the greatest opportunities for success. When it is determined that funding for residential care has ended, we work to inform the client as quickly as we are able. Unfortunately in this situation the determination for a shift in levels of care is immediate, funding ceases that day. In order to ease the transition for clients and families, Harmony is committed to absorbing the expense of an additional night’s stay for clients. This is not common practice and comes at a fair cost. For example, in the month of July, we provided $28,000 in housing and care at no additional expense to clients. We are able to continue to do this through the generosity of our donors. We recognize the challenge and frustration of learning at 4 pm that one no longer has financing for treatment, however we are dedicated to continue to support our clients during this transition period.

There is nothing magical about 28 days of treatment. We have heard the 28 day timeframe used for many years, growing in public awareness with the Sandra Bullock film. The reality is that proven success is driven by long term engagement in treatment within a full continuum of care, at multiple levels  increasing the opportunity  for self-management.

We will always remain committed to providing access to treatment whenever possible, using all means necessary to help individuals receive treatment that can build an early foundation of recovery.  This could look like something as short as a few days or as long as 4 months.  Either way, our partnerships with insurance and our recommendations for treatment will always be the focus in providing individualized care for clients.

Jim Geckler is the Chief Executive Officer for Harmony Foundation.

Harmony Foundation Responds to the Opioid Epidemic with HOPE

Posted on by Christy Weeks

by Christopher Reveley, MD, and Annie Peters, PhD, LP

The Opioid Epidemic

According to the National Institute on Drug Abuse (NIDA), nearly 100 people die from opioid overdose in the United States every day, and 2.6 million Americans struggle with opioid addiction. The prescribing of opioid pain relievers became much more common in the late 1990s, and it soon became evident that these medications were powerfully addictive. Opioid overdose deaths have increased significantly in the years since. Many of those addicted to heroin started with the abuse of prescription opioids.

Overdose along with the spread of HIV, hepatitis C, and withdrawal syndromes in babies born to addicted mothers constitute a nationwide crisis that has overwhelmed the resources of state and local health care delivery services. Recently, the White House identified the opioid epidemic as a national public health emergency.

How is Harmony Responding to Opioid Epidemic?

Harmony Foundation in Estes Park, CO, has been treating addiction for 48 years and has fostered a generation of long-term recovery support for individuals and families. Harmony’s mission is to provide the foundation for sustained recovery from the diseases of drug and alcohol addiction. Harmony staff is committed to continuous improvement and closely monitors a client experience, treatment response, and the research literature on addiction treatment. In the field of opioid addiction research, advances in behavioral treatment, neurobiology, and brain imaging have given treatment programs guidance in developing better services. Harmony now offers HOPE – Harmony’s Opioid Programming Experience. HOPE is offered to all Harmony clients with opioid use disorders. The program involves enhanced medical, counseling, and case management services specifically tailored to meet these clients’ unique needs.

HOPE: Medical and Clinical Approaches

HOPE begins with thorough medical and psychological evaluations. Collaboration with the client, members of the interdisciplinary team and, when appropriate, family and referral sources, determine the most effective treatment plan. All HOPE clients are invited to participate in weekly Opiate Support Groups led by a professional addiction counselor. This group addresses the unique challenges of early opioid recovery, including uncomfortable physical and psychological symptoms, cravings, and strategies to avoid rapid relapse. In this setting, clients support each other and are educated about the process of recovery.

Harmony has provided all clients with medication-assisted treatment (MAT) for many years. This combination of education, counseling, and the use of medication in early recovery is part of the Harmony philosophy. HOPE expands MAT to include medications that alter the physical response to opioids, reduce craving, and give the individual time to heal from the psychological, social, and spiritual wounds of addiction.

HOPE clients may choose to avoid medications altogether or use only sleep and anxiety-reducing medications during the acute withdrawal period. For others, naltrexone, an opioid receptor blocker, can prevent the euphoria of opioid use and help control cravings, thereby changing the client’s drive to use illicit opioids after treatment.

Buprenorphine

This partial opioid agonist, administered in a tapering protocol, may be chosen by the treatment team and client to ease symptoms of severe opioid withdrawal during detoxification. On an individual basis, this medication may be continued during early recovery, most commonly for those with severe and persistent opioid addiction. Care following residential treatment may include ongoing buprenorphine to provide a craving-free foundation for the client as they rebuild damaged interpersonal and work relationships and regain physical and emotional health. The ultimate goal with all treatment approaches is complete abstinence from all opioids.

While some may question how an opioid medication (buprenorphine) can help someone recover from opioid addiction, this treatment approach is supported by organizations such as the World Health Organization, the American Society of Addiction Medicine, the Substance Abuse and Mental Health Services Administration, NIDA, the Veterans’ Administration, NAADAC – the Association for Addiction Professionals, and the National Association of Addiction Treatment Professionals. Due to the number and quality of research studies that have been completed on the use of buprenorphine in treating opioid use disorders, the level of evidence for the effectiveness of buprenorphine treatment is considered to be high (Thomas et al., 2014). Positive outcomes typically include improving retention in treatment and reducing illicit opioid use.

The Harmony care team works closely with clients who choose to include buprenorphine in their treatment strategy. This will typically involve full participation in HOPE and a recommendation for participation in Harmony’s Transitional Care Program (TCP), an intensive, 90 day intensive outpatient program coupled with monitored sober living and medication management by Harmony providers. When clinically indicated or to accommodate client preference, Harmony’s case managers may refer clients to other programs with similar services.

If you or someone you know is struggling with opiate addiction and needs help right away, Harmony is here to help. Call us at 866-686-7867 and one of our admissions specialists can discuss next steps.

References

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis

Center for Behavioral Health Statistics and Quality (CBHSQ), 2016. 2015 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Thomas, CP, Fullerton, CA, Montejano, L, Lyman, DR, Dougherty, RH, Daniels, HS, Ghose, SS, & Delphin-Rittmon, ME. Medication-assisted treatment with buprenorphine: Assessing the evidence. Psychiatric services, 65(2), 158-170.

Doctors and Pharmacists Fight Against Addiction

Posted on by Christy Weeks
opioid-addiction

It’s no secret that doctors and pharmacists played a large role in the prescription opioid crisis that has been raging in the United States for over a decade. So it stands to reason that the doctors and pharmacists have a responsibility to help correct the problem.

In Massachusetts, a state which has witnessed firsthand the effects of the opioid crisis in America, U.S. Attorney General Loretta Lynch told a group of physicians and pharmacists that their assistance to law enforcement is crucial for curbing prescription opioid and heroin abuse, the Associated Press reports. U.S. Attorney Carmen Ortiz and Massachusetts Attorney General Maura Healey were also in attendance.

On Friday, at the Massachusetts Medical Society, Lynch credited the state’s medical community and commended the efforts of the Department of Justice in the fight against opioid abuse, according to the article. Lynch stated:

“I applaud you for leading a truly comprehensive campaign to reduce prescription drug abuse in the Commonwealth – and I want you to know that the Department of Justice and the entire Obama Administration, is standing with you in this fight. Through the tireless efforts of our Drug Enforcement Administration (DEA) – under the leadership of Acting Administrator [Chuck] Rosenberg – we are making major strides on all four of the action areas identified in the White House Prescription Drug Abuse Prevention Plan, which President Obama discussed in his weekly address just a few days ago: enforcement, disposal, monitoring and education.”

Lynch also spoke on the value of safely disposing of unused or unwanted prescription narcotics. She points out that opioid addiction often originated inside the family medicine cabinet.

“We also know, as you do, that opioid addiction often begins not with a law-breaking doctor, but with a family medicine cabinet. That’s why we are working to ensure that unused, unwanted and expired medications are responsibly discarded and taken out of circulation. In the last five years, the DEA has held ten National Take Back Days – most recently this past Saturday – when the public is encouraged to bring excess prescription drugs to thousands of designated sites across the country for safe and secure disposal.”

__________________________________________________

If you are or a loved one is abusing opioids, please contact Harmony Foundation to begin the journey of recovery. Harmony is a state-of-the-art, affordable, residential addiction treatment program located in the Rocky Mountains.

Addiction and recovery news provided by Harmony Foundation.

Combination of Drugs Could Help SSRI Resistant Depressives

Posted on by Christy Weeks

For the millions of people around the world living with depression the most common form of treatment is medication. While medications, notably selective serotonin re-uptake inhibitors (SSRIs), have proven to be effective in managing the symptoms of depression for many, there are a significant number of people for whom SSRIs do not work. Naturally, the need to create medications for SSRI resistant people is crucial.

Researchers at the University of Bath in England have found that a combination of two drugs often used for treating addiction may lead to a new drug for treating SSRI resistant depressives, MedicalXpress reports. If successful, the 30-50 percent of patients living with depression who do not respond to SSRI treatment may have a remedy in the near future.

“Whilst SSRIs work for a lot of people, they can cause serious side effects and don’t work for everyone,” said Dr Sarah Bailey, senior Lecturer in the Department of Pharmacy & Pharmacology at the University of Bath. “No new drugs for depression have been developed for decades – they all work in a similar way – so there’s an urgent need to develop new treatments for this condition that affects around 4 million adults in the UK.” 

The research team combined buprenorphine with naltrexone and found that it produced antidepressant-like responses in mice, according to the article. Buprenorphine is commonly used in detox and addiction treatment settings to alleviate the severe discomfort and cravings that occur during opioid withdrawal. Naltrexone is used for the treatment of both opioid and alcohol addiction; the drug blocks the euphoric effects of opioids and it has been shown to decrease heavy drinking.

“Our study shows that using a combination of naltrexone and buprenorphine gives an antidepressant effect in mice, but without the problems of addiction that could be caused by using buprenorphine alone,” said Dr Bailey. “Developing new drugs is a lengthy process, with lots of safety tests and trials to go through. These two drugs have already gone through that process individually, so we know they are safe. There still need to be further trials of the combination in humans, but the whole process of developing this as a new treatment would be greatly reduced.” 

The findings were published in the Journal of Psychopharmacology. __________________________________________________

Addiction is often accompanied by various mental illnesses, such as depression. If you are or a loved one is living with a co-occurring disorder, please contact Harmony Foundation to begin the journey of recovery. Harmony is a state-of-the-art, affordable, residential addiction treatment program located in the Rocky Mountains.

Addiction and recovery news provided by Harmony Foundation.

Can a Missing Enzyme Explain Addiction?

Posted on by Christy Weeks

News related to painkiller addiction and opioid overdoses has increased over the past decade alongside the rate of addiction with few tell all explanations as to why. Also mysterious is the rate of relapse among those addicted to opiates compared to other drugs. Painkillers are killing people at an alarming rate and more people are getting hooked everyday. According to the Partnership for a Drug Free America, there are 2,500 teens in the US who try prescription drugs to get high for the first time each day. Many become easily addicted after they experiment with painkillers. A new study published this week by Charles R. Drew University of Medicine and Science in Los Angeles sheds some light on why painkiller addiction may be so hard to kick for some.

The study suggests that a missing brain enzyme makes some people more susceptible to opioid addiction than others. Researchers removed the enzyme called prohormone convertase 2 (PC2) in mice. This enzyme activates otherwise dormant hormones in the brain and these hormones were found to increase after long-term treatment of morphine. When researchers removed this enzyme, concentrations of the opioid receptors increased in the brain regions related to addiction. When this enzyme is present it regulates the addiction response to opioids in the brain. Although these were preliminary studies, researchers like Theodore C. Friedman, MD, PhD who conducted the study will follow up with similar studies in the near future.

While this study may serve as a partial explanation as to how addiction to opiates occurs, it doesn’t answer why the rate of addiction has reached epidemic levels over the last decade. Many say that the access to painkillers is why addiction rates are so high. A study by Richard Miech, Ph.D. of the University of Colorado Denver explains, “From 1997 to today, legal prescriptions for painkillers increased from 20 million to 160 million a year – a fourfold increase.” Greater access combined with other explanations – like the missing PC2 enzyme – answers some the questions concerning the national epidemic. However, as with many aspects related to addiction the “why” or “how” is often elusive. While people search for explanations, addiction treatment and recovery is most important and works without knowing all the facts about why and how people became addicted in the first place.

If you are concerned about opiate abuse, our young adult and adult addiction programs at Harmony Foundation help people recover from painkiller addiction.