Social POTWR 2019 Vol 3: Examining Opioid Addiction In America

[nhbbear]

I'm a cop in NJ.

I grew up with a kick-ass cousin named Marc. He was 3 years younger than me, and we lived across the street from each other during elementary school and junior high. In high school my aunt and uncle moved about 30 mins away, but I still stayed as close as I could with them.

Me and Marc worked together at 2 different jobs, Chick Fil-A, and then with a tile company. I still remember being on a tile job with him and competing to see who could break the most tiles over our heads. He knocked himself out trying to bust 3.

I was going to college and Marc stayed as a full time tile guy. Eventually he started to change. He moved out of my aunt's house and got a place with his buddies. He skipped out on work and I saw him less and less on those weekends I was still doing tile. He started getting into weed and boozing. He was always a little "nutty", but fun. I met him at a midnight bowling place on night and saw he was fucked up - black eyed, and a bad attitude. He started a fight with guys in the next lane over nothing. I saved him from a beating and we went our separate ways for a while. I graduated and found a part time cop job that took me across state, and only saw Marc on occasion.

I get a phone call from my aunt that Marc got locked up for a DWI. I made a couple calls and found out he had active warrants for possession too. Long story short, Marc graduated from weed and booze to heroin.

Marc tried rehab, halfway houses, and the whole program, but wound up getting rolled a couple times in shithole Newark, NJ. I visited him a couple times, and what was once that fun, nutty kid was a shell of himself. Broken teeth, open sores, and some weird rash on his arms are what I remember most. I'd just had a kid and he wanted to hold my son. I wouldn't let him because I was worried about this unknown infection getting onto my kid. He was such a good hearted dude, and I wouldn't let him hold my kid....

Fast forward through more rehabs, getting kicked out of my aunt's house, moving in with MY parents, and getting kicked out of there for stealing, me looking for possible solutions for him , and boom - he moved to the west coast with his sister. I talked to him a bunch, he seemed to be cleaning up. The rashes and boils apparently were healing and he was doing great. I was so fucking proud of him.

His body washed up on a riverbank in Portland.

Wow, that’s fucked up. Growing up, I had two best friends and we were inseparable until we went to different high schools. I remember the three of us having a conversation about smoking pot. My buddy, Jason, was pushing us to try it with him. We refused. He started smoking pot, and by the end of high school, he was hooked on pills way before they were popular-this was the early nineties. He had a kid and seemingly got clean for a while, then got hooked on gambling and then into heroin. Rather than continue to live as such a serious addict, he swallowed a bottle of Tylenol pm and died in 2004. As a cop at his funeral, I remember most of his friends being addict types and his mom actually blamed me and my other friend for the way he turned out. I didn’t have the heart to tell her.

 

[nhbbear]

We have a huge addiction problem in our society (not just opioids) and very few places for treatment. I have been told that 80% of our prison population ran into legal trouble partially because of a substance abuse problem. Instead of spending money to lock these people up we should be spending money on better and more treatment facilities.

The trick is to work with the children and young adults. This sounds simple but it's really true: If you can keep a person off drugs/alcohol/tobacco until they are 26 years old there is almost no chance they will develop a substance abuse problem. If they dive in to substance use before 26 it changes the brains chemistry and makes them susceptible to addiction.

As far as opioid go I think the research is pretty clear, it began with pills for many people. Much more could be done by states and insurance companies/health plans to combat bad prescribing practices. Most people fill their prescriptions via their health insurance so these companies know how many scrips these patients are getting. Also many states have a database for all opioids prescribed so they know who the doctor is, how many pills and who the patient is. It would be not too difficult to crunch the numbers and intervene on the heavy prescribers.

There are a lot of interventions available to insurance companies and governments but they are not doing a huge amount until the last few years.

I think a lot of the issue is still chronic pain. Now, the crackdown took place a bit too late, and heroin and fentanyl are much easier to get. And the crackdown on doctors is only increasing, and people with legitimate pain issues are the victim, even though they would continue to take these pills as long as possible. But when you cut them off, do they go searching for something else?

 

[nhbbear]

Rehab. There's no other answer. You can't just cold-turkey this stuff because you'll literally kill yourself. You need to be sedated for days and wake up when the worst of the detox is over. From there it's rewiring your head to understand what you lost and what you're looking for.

Every sober day is hard for these guys. The allure of the way it made them feel is always there. The drawback of this whole mess is they WILL replace one addiction for another. You just have to hope the new addiction is benign.

I guess my question is does it ever get better for these people?

 

[nhbbear]

I was a union rep for a while, and had to deal with my co-worker's addictions. Part of my job was getting help, and running interference with the administration to make sure they didn't lose their jobs.

One case in particular was rough. I got hired the same day as XX and we became fast friends. XX was a maniac from day 1. Fun as hell, crazy, and a TERRIFIC cop. He obviously had a checkered past, which gave him a leg up on me when it came to cop stuff. He'd seen and experienced a lot, that I was completely naive to. He was an awesome cop, but he's also an enabler.

We were hanging off duty one day and went to Pathmark. He ran inside and came out with a case of whipped cream. I was like WTF are you doing with that? I hope you don't think we're going to lick that shit off each other. He's like, "no, asshole. We're gonna do whippets." So he opens the case and starts pounding can after can. I wasn't interested in that, as I'd never done it, didn't want to do it, and it was like 3 in the afternoon - too early to get fucked up imo.

Years go by and XX started doing other shit. ALLEGEDLY coke off the dashboard while on duty, smoking weed now and then off-duty, and boozing it up whenever, also off-duty. Still a great guy, and still a fucking awesome cop even with all that going on. So he gets hurt chasing some asshole and fucks up his back.

He was put on light duty for over a year and had multiple operations. Well, what comes with back surgery? Pills, and lots of them (early 2000's btw.)

10+ years of pounding pills, and eventually XX becomes reckless. He realizes he has an issue and tried to get help. How'd they help? With DIFFERENT pills. So now he starts mixing. The feds crack down on pill doctors, and now it's a scramble to try to make the pain go away by any means possible. Oxys and percs turned into gabapentin, suboxone, and some others I can't remember. He gets wasted day after day, at work, and I cover for him. I drive him home, make excuses, whatever I needed to do as his friend. After 3 times of putting my own ass on the line, I take him home and his wife is there. She's wondering why we're in the living room at 1 in the afternoon instead of at work. I laid it out to her and told her we have to get him help. to this day it was one of the most gut wrenching conversations I had to have. One of my best friends is all fucked up with nowhere to go but dead. He'd hit rock bottom.

We get him set up with a rehab and send him off. He called me 3-4x a week over the 2 months he was there, crying and begging me to get him out of there. His wife was thinking of leaving him because of the timing of this mess - XX was going to miss his only kid's 1st Thanksgiving and Christmas.

XX put me in a bad fucking spot. I ran interference for him at work, played peacemaker with his wife, and tried to keep him sane.

He's still married, has a great little kid, and been straight for a number of years now.

Unfortunately, he's not the only addict I had to help at my PD. Some fare better than others, but I'm proud to say none of them got fired under my watch.

I have a different respect for those coping with heroin addiction. At some point it is no longer a choice. Yes it was their choice to take the shit in the first place, but this stuff really rewires your brain and body. Locking them up isn't the answer.

It’s so tough to get hurt like that. I never had one specific injury. I remember in my third year having really bad calf cramps. I started eating bananas and had my favorite curbs in the city that I would stretch my calves on. My partner thought I was nuts. Then one day while I was doing standing curls, my back went out for the first time. Bad spasms that dropped me to the ground and one of the dumbbells smashed my foot. I ended up in the er and I remember screaming in pain for the first time in my adult life. They gave me dilauded and I remember getting real scared as it started creeping up my face. I kept saying “something’s wrong” and I remember the look on my wife’s face, then it hit and I melted. I would have an attack like that every other month, which led me to my first of four mri’s, and all kinds of therapy. Then, after losing one baby, we were waiting for the dr visit where we would get to see our baby(my oldest) and i sneezed. My back went out really bad and I ended up in the er again, missing the appointment. I was crying and felt so guilty. Then I was started on a bunch of medication and I probably only had one or two times that my back went out that bad. Today was a bad back day, my right hip and lumbar area has been kicking like a mule. And that’s with the pain meds.

So what scares me about your stories is that I could see myself in that situation. I do all I can to stay active, which helps with the pain, but without medications, I would not be able to do much of anything. And I am scheduled for shoulder surgery on Thursday (tackled some punk ass kid during a fight at work), and I will no doubt be on something much stronger than my usual meds. Scares me a good bit

 

[BudKing8806]

I am sure you and I have some of the same feelings about suboxone/methadone/subutex. Kind of like a quickly adhered bandaid that acts like an insurance policy for those that have no intention of getting clean.

Yes, I do believe that program only trades one addiction for another. From my experience, the percentage of people who actually succeed in the program and not relapse are rare, very rare. I have seen more abuse of the program than success stories by far. Some of the participants try to get the medication from our facility and sneak it out with them to sell. Most also continue to use even when in the program. I could not tell you how many people have been booted from the program for continued substance use while being in the MAT program. Some of course do complete the program. However, the majority relapse within a few months and come right back to us. In my opinion, a detox followed by continued outpatient treatment services are necessary. Addiction consumes people. This includes daily living habits, relationships, hobbies, etc. Say for example, someone always gets high and cleans house. Every time that person goes to clean house, they are going to associate that activity with drug use. Another example would be the cigarette smoker who always has a smoke with their morning coffee. Having a morning coffee will be associated with having that smoke for years, if not forever. This association will likely cause a craving for that cigarette. So for someone to battle addiction, multiple facets of their lives must change. They need to really make lifestyle changes from relationships to the hobbies they enjoy if they associate them with substance use. That is a lot to ask of someone who is trying to get clean. Imagine trying to stop using, change friends, and change your habits all at once. Addicts need a support system in place to keep them from falling right back into old habits. Anyways, my mind is about shot from a long day lol, was up at 4:15 this morning. I will try to follow up with more in the next few days. I'm really enjoying the thread so far by the way.

 

[nhbbear]

Yes, I do believe that program only trades one addiction for another. From my experience, the percentage of people who actually succeed in the program and not relapse are rare, very rare. I have seen more abuse of the program than success stories by far. Some of the participants try to get the medication from our facility and sneak it out with them to sell. Most also continue to use even when in the program. I could not tell you how many people have been booted from the program for continued substance use while being in the MAT program. Some of course do complete the program. However, the majority relapse within a few months and come right back to us. In my opinion, a detox followed by continued outpatient treatment services are necessary. Addiction consumes people. This includes daily living habits, relationships, hobbies, etc. Say for example, someone always gets high and cleans house. Every time that person goes to clean house, they are going to associate that activity with drug use. Another example would be the cigarette smoker who always has a smoke with their morning coffee. Having a morning coffee will be associated with having that smoke for years, if not forever. This association will likely cause a craving for that cigarette. So for someone to battle addiction, multiple facets of their lives must change. They need to really make lifestyle changes from relationships to the hobbies they enjoy if they associate them with substance use. That is a lot to ask of someone who is trying to get clean. Imagine trying to stop using, change friends, and change your habits all at once. Addicts need a support system in place to keep them from falling right back into old habits. Anyways, my mind is about shot from a long day lol, was up at 4:15 this morning. I will try to follow up with more in the next few days. I'm really enjoying the thread so far by the way.

Yeah, that association that attaches to simple activities, such as a movie. I watched a movie while high, and will always associate that movie with that feeing, which can be enough to cause a severe craving

 

[abiG]

I was asked to join this thread based on a post I made regarding the supply side and why it is seemingly impossible to affect true change in this realm

It went some thing like this.

If you believe there is a solution, you don't know the problem. This whole thing ties into why we went into Afghanistan. It wasn't about freedom or tracking Saudi terrorists. It was about the global heroin market (along with securing the pipelines). Osama, remember had eradicated nearly all the poppies and had been planting food all over the country where the poppies had grown. The country was eating, life was better. But, for those funding black ops with untraceable money, this was too much to handle.

Source: https://www.unodc.org/pdf/publications/afg_opium_economy_www.pdf

Long story short, the food was destroyed, the poppies replanted, and the global heroin trade was back under full control of US military personnel.

I have posted the pictures, you can also find them yourselves.

For further background, here is Ron Paul back in 1988:



Here is a report from ABC with all the spin you'd expect after this was first exposed. They make it seem like the US soldiers aren't running shit as they leave out the whole part about how they burnt the crops to the ground to plant the very crop you are seeing harvested by the locals who have no other source of possible income, but to harvest the crops for the very regime who bombed the shit out them.



********************************

As to a personal solution for those suffering from pain:

NSAIDs are stronger pain medications than opioids
A Summary of Evidence

In an opioid epidemic that currently claims an average of 91 lives per day, there have been many paths to addiction. For some, it started with a fall or a sports injury, a trip to a nearby emergency room and a prescription for a narcotic pain reliever that seemed to work well in the ER.


New research underscores how tragically risky — and unnecessary — such prescribing choices have been.
http://www.latimes.com/science/sciencenow/la-sci-sn-pain-opioids-ibuprofen-20171107-story.html

^^^^^Science

 

[Lubaolong]

HI, I'm Dr. Lubaolong. Among other things, I run an outpatient addiction medicine clinic.

Regarding a couple earlier post, once someone is addicted to heroin, it's unlikely they will be able to stay clean for an extended period of time without replacement therapy. Several studies show relapse rates over 90%.

A fairly recent NIDA study showed that once treatment is initiated, Suboxone (contains partial opioid agonist) and Vivitrol (another approved drug for opioid use disorder, but not an opioid agonist) are similarly effective. I do frequently recommend Vivitrol as an option to people, but because it requires full detoxification first, it's difficult to do with active users. Many will relapse before treatment can be initiated. So for this reason, Suboxone or sometimes Methadone will be the preferred treatment.

Debunking some common myths, 1. MAT is not trading one addiction for another. Taking Suboxone is nothing like shooting up with heroin. Addiction is much more than being dependent on a medication. There's no distress, impairment, and persistent and recurrent interpersonal and occupational problems with Suboxone use. People are not getting high, struggling with constant cravings, losing control, breaking into houses, getting HIV/Hep C from dirty needles. Pretty much none of the hallmarks of addiction. People can take it, feel like their normal selves, and function great in society. 2. Diversion of Suboxone is uncommon (<1% of reported diverted drugs). Diversion of other opioids like oxys/hydrocodone is much more common. And usually when Suboxone diversion does occur, it's primarily used for management of withdrawal symptoms.

 

[Gregolian]

The one argument I see a lot from people is the "don't lock them up give them treatment options" one and for a LOT of these people... if they weren't arrested they'd never have even THOUGHT of going to treatment if they weren't staring an extended sentence in county detention.

Yeah, at least in Washington, your first 5-6 drug arrests you spend time in county jail if you don't take something like a Drug Offender Sentencing Alternative (DOSA) or go into Drug Court.

Now, to qualify for either my understanding is you can't have a violent criminal record (major physical assaults, DV, rape and things like that) on your record and you only get two chances to complete a DOSA in a 10 year span so the chances are limited admittedly.

 

[HomeCheese]

I think a lot of the issue is still chronic pain. Now, the crackdown took place a bit too late, and heroin and fentanyl are much easier to get. And the crackdown on doctors is only increasing, and people with legitimate pain issues are the victim, even though they would continue to take these pills as long as possible. But when you cut them off, do they go searching for something else?

For the most part, my understanding is that chronic pain is poorly treated with high dose opioids. One of the problem the US has run into is that for a long time providers were told that high dose opioids were the standard of care for chronic pain. I don't think there is another country in the world that handed out pain meds like our country, something like 85% of the worlds vicodin was prescribed in the US. There was a time in the 90's that providers were getting in more trouble for under prescribing rather than over prescribing. Much of this can be blamed on the pharmaceutical industry.

Ideally high dose opioid patients would have a compassionate provider who give them a tapering plan rather than just cutting off their supply. However, this is a very time consuming process and the realities of modern medicine and the need to see a high number of patients per day make this kind of treatment difficult.

Yes certainly some patients that are cut off look for pain meds on the black market. They quickly realize that pills are very expensive purchased this way but heroine is much, much cheeper.

 

[Gregolian]

Just took like 3-4 pleas this morning. Everyone got dinged for things like Retail Theft or just straight plain theft but ALL of the people ALSO had drugs on them at the time of arrest. At least 2 defendants admitted "I was stealing to feed myself or get something to pay for my next high"

Ugh

 

[cleetus]

I guess my question is does it ever get better for these people?

Kind of. As I said, my experience is that one addiction is traded for another.

XX was running straight and narrow after rehab. He would go to meetings, tell me about the office visits to the shrink, and be pretty open with me about how he was feeling. Something changed over the last year however. I don't hear about the shrink, I don't know if he goes to meetings, and he lost a ton of weight - which he wasn't ever very heavy to begin with. A couple months ago, I sincerely asked him if everything was ok, and he pretty much cut me off. He requested a shift change, and now I don't see him much. When I do, he's grumpy and developed an angry, fuck everything attitude. I sometimes ask what's going on, and he gets super defensive and complains about how everyone wants to know his fucking business. It's gotten so noticeable that people around town are asking questions about his health. I don't know what the deal is, but it's not the same XX any more. I know I said he's been straight for a number of years now, but that's only because he's not displaying the pinned eyes, drooling on himself, or "drunkenness" he used to, so I can't pin down the problem.

XX has replaced his addiction with busywork. Anything to keep his hands moving.

Another guy was tuned up on pills for a decade+. He was always an asshole, so saying that he's more of an asshole now, after rehab, doesn't do it justice. He's a prick one day, and acts like your best friend the next. But he's still an asshole. He's swapped his pill addiction for God and the job. He's gone so far as to come in on his own time to do ride alongs with other units. Who the fuck comes to work to not get paid, or better yet, who the fuck comes to work when they don't need to?

It seems that those with prolonged addictions NEED to feed something missing inside of them, whether it be with god, busywork, the job, or making model boats.

There are 2 others, one that did pills and another that binge drank, who actually seem to have turned out better after rehab. BOTH of them made a renewed focus on their families. Maybe that's the key.

nhbear, if you start to notice you need more and more pills to function, you need to find a different avenue of therapy. Please don't start mixing and matching scripts or taking more than you're allowed. It will only end in a train wreck.

 

[cornwallis]

Hello,

I am a LPC who has worked in a substance abuse clinic that specialized in co-occurring disorders, and I now work in a large healthcare organization. The current company I work for provides services at nearly every level: detox, inpatient, and outpatient. We have inpatient programs for substance use, and inpatient for children who have emotional/behavioral concerns. Our outpatient programs also include substance use specific outpatient, emotional/behavioral concern outpatient, and a dayhab program for individuals who have a serious mental illness. Within our programs we do offer the option for Suboxone.

What I have seen in the populations that I work with is that opioids have been used as a numbing agent from past traumas; I work primarily with the Alaska Native population, but I do have clients from all backgrounds. I have had clients that became hooked on opioids after having a prescription from their doctor who did not have any past trauma, but these appear to be rare cases and most of the time are far easier to work with to achieve their goals. The most difficult cases that I have worked on are individuals who are referred by the legal system for substance treatment, but do not want to take care of their past trauma.

I am personally not a fan of the use of medication assisted sobriety. I have witness many clients overuse Suboxone, and also sell it on the street. To me this seems like a way to potentially reinforce the principal of using, and criminal behavior.

As for the epidemic as a whole, I do believe that this came about through the liberal use of prescriptions. Once the providers cut the individuals off they started buying on the street, which leads to the use of heroin; it is much cheaper to purchase heroin than prescription drugs.

 

[nhbbear]

HI, I'm Dr. Lubaolong. Among other things, I run an outpatient addiction medicine clinic.

Regarding a couple earlier post, once someone is addicted to heroin, it's unlikely they will be able to stay clean for an extended period of time without replacement therapy. Several studies show relapse rates over 90%.

A fairly recent NIDA study showed that once treatment is initiated, Suboxone (contains partial opioid agonist) and Vivitrol (another approved drug for opioid use disorder, but not an opioid agonist) are similarly effective. I do frequently recommend Vivitrol as an option to people, but because it requires full detoxification first, it's difficult to do with active users. Many will relapse before treatment can be initiated. So for this reason, Suboxone or sometimes Methadone will be the preferred treatment.

Debunking some common myths, 1. MAT is not trading one addiction for another. Taking Suboxone is nothing like shooting up with heroin. Addiction is much more than being dependent on a medication. There's no distress, impairment, and persistent and recurrent interpersonal and occupational problems with Suboxone use. People are not getting high, struggling with constant cravings, losing control, breaking into houses, getting HIV/Hep C from dirty needles. Pretty much none of the hallmarks of addiction. People can take it, feel like their normal selves, and function great in society. 2. Diversion of Suboxone is uncommon (<1% of reported diverted drugs). Diversion of other opioids like oxys/hydrocodone is much more common. And usually when Suboxone diversion does occur, it's primarily used for management of withdrawal symptoms.

When used correctly, suboxone works that way, but I have caught people in the act of melting and injecting subs and during an interview with them, said they do this when they can’t get heroin, or they do the heroin early in the day and inject the subs later. I don’t mean to be contrary, you are the expert, but that is what I have experienced and been told on the street.

 

[nhbbear]

For the most part, my understanding is that chronic pain is poorly treated with high dose opioids. One of the problem the US has run into is that for a long time providers were told that high dose opioids were the standard of care for chronic pain. I don't think there is another country in the world that handed out pain meds like our country, something like 85% of the worlds vicodin was prescribed in the US. There was a time in the 90's that providers were getting in more trouble for under prescribing rather than over prescribing. Much of this can be blamed on the pharmaceutical industry.

Ideally high dose opioid patients would have a compassionate provider who give them a tapering plan rather than just cutting off their supply. However, this is a very time consuming process and the realities of modern medicine and the need to see a high number of patients per day make this kind of treatment difficult.

Yes certainly some patients that are cut off look for pain meds on the black market. They quickly realize that pills are very expensive purchased this way but heroine is much, much cheeper.

That 85% is for countries that have health care systems, I am guessing. In countries without a healthcare system, the doctors sell the pills to them on the spot. Again, I may be incorrect, but I thought I read that during my research.

 

[nhbbear]

Kind of. As I said, my experience is that one addiction is traded for another.

XX was running straight and narrow after rehab. He would go to meetings, tell me about the office visits to the shrink, and be pretty open with me about how he was feeling. Something changed over the last year however. I don't hear about the shrink, I don't know if he goes to meetings, and he lost a ton of weight - which he wasn't ever very heavy to begin with. A couple months ago, I sincerely asked him if everything was ok, and he pretty much cut me off. He requested a shift change, and now I don't see him much. When I do, he's grumpy and developed an angry, fuck everything attitude. I sometimes ask what's going on, and he gets super defensive and complains about how everyone wants to know his fucking business. It's gotten so noticeable that people around town are asking questions about his health. I don't know what the deal is, but it's not the same XX any more. I know I said he's been straight for a number of years now, but that's only because he's not displaying the pinned eyes, drooling on himself, or "drunkenness" he used to, so I can't pin down the problem.

XX has replaced his addiction with busywork. Anything to keep his hands moving.

Another guy was tuned up on pills for a decade+. He was always an asshole, so saying that he's more of an asshole now, after rehab, doesn't do it justice. He's a prick one day, and acts like your best friend the next. But he's still an asshole. He's swapped his pill addiction for God and the job. He's gone so far as to come in on his own time to do ride alongs with other units. Who the fuck comes to work to not get paid, or better yet, who the fuck comes to work when they don't need to?

It seems that those with prolonged addictions NEED to feed something missing inside of them, whether it be with god, busywork, the job, or making model boats.

There are 2 others, one that did pills and another that binge drank, who actually seem to have turned out better after rehab. BOTH of them made a renewed focus on their families. Maybe that's the key.

nhbear, if you start to notice you need more and more pills to function, you need to find a different avenue of therapy. Please don't start mixing and matching scripts or taking more than you're allowed. It will only end in a train wreck.

Yeah, I am very cognizant of that. I have tried just about every avenue available, and this combination of physical therapy and medication seems to work best for me, though I still have bad days.

And it seems there are a lot of guys you work with that have serious problems. Do you know if other departments in your area are having similar issues?

I have worked with a few that had a problem, but most left the profession and a few got into some trouble. One guy was a k-9 cop. He started dating a stripper and he fell apart. Granted, he was one of the few obviously dirty cops I worked, but when he started dating that stripper, he became non-functional. His drug kit that you use to train the dogs ended up empty, his stripper got pulled over in another county in his personal car with a bunch of drug dealers from Cleveland, and he got fired for some other shit. He was one of the only cops that I ever witnessed use force when it was simply not necessary-meaning that the guy was cooperating and he used force. I actually shoved him into a store window and it cracked. I told the Lt, but nothing was done because the guy did not want to do anything despite me trying to persuade him to file a complaint.

There was another guy that would show up to work with really poor hygiene and was reported to be taking pills on duty. He was also fired.

 

[nhbbear]

Hello,

I am a LPC who has worked in a substance abuse clinic that specialized in co-occurring disorders, and I now work in a large healthcare organization. The current company I work for provides services at nearly every level: detox, inpatient, and outpatient. We have inpatient programs for substance use, and inpatient for children who have emotional/behavioral concerns. Our outpatient programs also include substance use specific outpatient, emotional/behavioral concern outpatient, and a dayhab program for individuals who have a serious mental illness. Within our programs we do offer the option for Suboxone.

What I have seen in the populations that I work with is that opioids have been used as a numbing agent from past traumas; I work primarily with the Alaska Native population, but I do have clients from all backgrounds. I have had clients that became hooked on opioids after having a prescription from their doctor who did not have any past trauma, but these appear to be rare cases and most of the time are far easier to work with to achieve their goals. The most difficult cases that I have worked on are individuals who are referred by the legal system for substance treatment, but do not want to take care of their past trauma.

I am personally not a fan of the use of medication assisted sobriety. I have witness many clients overuse Suboxone, and also sell it on the street. To me this seems like a way to potentially reinforce the principal of using, and criminal behavior.

As for the epidemic as a whole, I do believe that this came about through the liberal use of prescriptions. Once the providers cut the individuals off they started buying on the street, which leads to the use of heroin; it is much cheaper to purchase heroin than prescription drugs.

That has been my experience/observation as well. I would say that many of the people that got started on pain pills started using them with the sole purpose to get high. Then there are those that got hurt on the job, many in the coal mines, that ended up addicts.

I also forgot to mention that during my interviews, I was told that the heroin addicts keep suboxone as a readily available source of narcan.

 

[nhbbear]

I think the solution is a national healthcare plan that is well funded and people can actually get fixed up when they are hurt. That seems to be where the majority of the problems begin and seems to be where the greatest good can be done

I also think that stopping prescribing pills to a long term patient is cruel and if they dont want to come off you are gonna make a heroin addict. If someone has never been on them dont prescribe them but if someone is already on all you can do is ride that wave til you want off or crash

The toothpaste is already out of the tube so to speak with these pain killers and I think the best option right now is to try not to steer people into worse options. @nhbbear said 2 percent of ODs are pills so that is clearly safer than the alternative and fairly affordable if you dont get em off the streets. You cant punish someone into sobriety

What say you guys ?

I like the “toothpaste” analogy. I think at this point, pills have become the least of the problem. Heroin and fentanyl are the real issue. There are still quite a few addicts that will not ever make that transition from pills to heroin because pills seem safer to them, which is true because it is a known amount and always the same amount. And there are some that believe that because it’s medicine, they don’t have a real problem. Wrong

 

[nhbbear]

Dopamine is the neurotransmitter that is associated with addiction as far as I know. This drug can't block those receptors completely I wouldn't think. Dopamine is the neurotransmitter that is released when engaging in enjoyable activities.

Dopamine is the pleasure neurotransmitter. Funny how it has “dope” in its name

 

[Lubaolong]

When used correctly, suboxone works that way, but I have caught people in the act of melting and injecting subs and during an interview with them, said they do this when they can’t get heroin, or they do the heroin early in the day and inject the subs later. I don’t mean to be contrary, you are the expert, but that is what I have experienced and been told on the street.

You can probably easily do this with Subutex, which is straight buphrenorphine. I never prescribe Subutex because of the increased abuse potential. I've only prescribed it to a highly functioning woman who had been stable for years on Suboxone when she became pregnant (Suboxone contains naloxone, which is contraindicated in pregnant women). Naloxone is included in Suboxone as an abuse deterrent. Naloxone doesn't absorb well via the GI tract, so it doesn't do much of anything if taken orally. Intravenous use can give you the same effect as Narcaning someone. It kicks opioids off the receptors and can throw you into withdrawal.

I'm curious if any of the posters here with opioid addictions have tried to inject Suboxone.