#Medication For Opioid Use Disorder

[milo-by-the-fishtank]

“You are addicted to not being in pain”

Uh…. Yeah, I think YOU would be too if you constantly hurt and dislocated your joints!

[gxlden-angels]

I don't know entirely how to explain this, but I think an important part of healing from religious trauma is learning about substance use disorders and shifting your views on drugs to neutral

[hopetorun]

my most frequent media-related intrusive thought is that it bothers me that elementary sherlock holmes doesn't ever take medication for his addiction

[sopranoentravesti]

Sorry to be a member of the intelligentsia on main, but I’m really not interested in hearing your takes on psychology or neuroscience when you get all your information from YouTube videos and refuse to read a book or a paper on whatever your chosen topic du jour is

[sumatcenters]

Struggling with addiction & mental health? Sumat Centres in Dundalk offers holistic dual diagnosis treatment tailored to your recovery journey.

[mostlysignssomeportents]

Ad-tech targeting is an existential threat

I'm on a 20+ city book tour for my new novel PICKS AND SHOVELS. Catch me TORONTO on SUNDAY (Feb 23) at Another Story Books, and in NYC on WEDNESDAY (26 Feb) with JOHN HODGMAN. More tour dates here.

The commercial surveillance industry is almost totally unregulated. Data brokers, ad-tech, and everyone in between – they harvest, store, analyze, sell and rent every intimate, sensitive, potentially compromising fact about your life.

Late last year, I testified at a Consumer Finance Protection Bureau hearing about a proposed new rule to kill off data brokers, who are the lynchpin of the industry:

https://pluralistic.net/2023/08/16/the-second-best-time-is-now/#the-point-of-a-system-is-what-it-does

The other witnesses were fascinating – and chilling, There was a lawyer from the AARP who explained how data-brokers would let you target ads to categories like "seniors with dementia." Then there was someone from the Pentagon, discussing how anyone could do an ad-buy targeting "people enlisted in the armed forces who have gambling problems." Sure, I thought, and you don't even need these explicit categories: if you served an ad to "people 25-40 with Ivy League/Big Ten law or political science degrees within 5 miles of Congress," you could serve an ad with a malicious payload to every Congressional staffer.

Now, that's just the data brokers. The real action is in ad-tech, a sector dominated by two giant companies, Meta and Google. These companies claim that they are better than the unregulated data-broker cowboys at the bottom of the food-chain. They say they're responsible wielders of unregulated monopoly surveillance power. Reader, they are not.

Meta has been repeatedly caught offering ad-targeting like "depressed teenagers" (great for your next incel recruiting drive):

https://www.technologyreview.com/2017/05/01/105987/is-facebook-targeting-ads-at-sad-teens/

And Google? They just keep on getting caught with both hands in the creepy commercial surveillance cookie-jar. Today, Wired's Dell Cameron and Dhruv Mehrotra report on a way to use Google to target people with chronic illnesses, people in financial distress, and national security "decision makers":

https://www.wired.com/story/google-dv360-banned-audience-segments-national-security/

Google doesn't offer these categories itself, they just allow data-brokers to assemble them and offer them for sale via Google. Just as it's possible to generate a target of "Congressional staffers" by using location and education data, it's possible to target people with chronic illnesses based on things like whether they regularly travel to clinics that treat HIV, asthma, chronic pain, etc.

Google claims that this violates their policies, and that they have best-of-breed technical measures to prevent this from happening, but when Wired asked how this data-broker was able to sell these audiences – including people in menopause, or with "chronic pain, fibromyalgia, psoriasis, arthritis, high cholesterol, and hypertension" – Google did not reply.

The data broker in the report also sold access to people based on which medications they took (including Ambien), people who abuse opioids or are recovering from opioid addiction, people with endocrine disorders, and "contractors with access to restricted US defense-related technologies."

It's easy to see how these categories could enable blackmail, spear-phishing, scams, malvertising, and many other crimes that threaten individuals, groups, and the nation as a whole. The US Office of Naval Intelligence has already published details of how "anonymous" people targeted by ads can be identified:

https://www.odni.gov/files/ODNI/documents/assessments/ODNI-Declassified-Report-on-CAI-January2022.pdf

The most amazing part is how the 33,000 targeting segments came to public light: an activist just pretended to be an ad buyer, and the data-broker sent him the whole package, no questions asked. Johnny Ryan is a brilliant Irish privacy activist with the Irish Council for Civil Liberties. He created a fake data analytics website for a company that wasn't registered anywhere, then sent out a sales query to a brokerage (the brokerage isn't identified in the piece, to prevent bad actors from using it to attack targeted categories of people).

Foreign states, including China – a favorite boogeyman of the US national security establishment – can buy Google's data and target users based on Google ad-tech stack. In the past, Chinese spies have used malvertising – serving targeted ads loaded with malware – to attack their adversaries. Chinese firms spend billions every year to target ads to Americans:

https://www.nytimes.com/2024/03/06/business/google-meta-temu-shein.html

Google and Meta have no meaningful checks to prevent anyone from establishing a shell company that buys and targets ads with their services, and the data-brokers that feed into those services are even less well-protected against fraud and other malicious act.

All of this is only possible because Congress has failed to act on privacy since 1988. That's the year that Congress passed the Video Privacy Protection Act, which bans video store clerks from telling the newspapers which VHS cassettes you have at home. That's also the last time Congress passed a federal consumer privacy law:

https://en.wikipedia.org/wiki/Video_Privacy_Protection_Act

The legislative history of the VPPA is telling: it was passed after a newspaper published the leaked video-rental history of a far-right judge named Robert Bork, whom Reagan hoped to elevate to the Supreme Court. Bork failed his Senate confirmation hearings, but not because of his video rentals (he actually had pretty good taste in movies). Rather, it was because he was a Nixonite criminal and virulent loudmouth racist whose record was strewn with the most disgusting nonsense imaginable).

But the leak of Bork's video-rental history gave Congress the cold grue. His video rental history wasn't embarrassing, but it sure seemed like Congress had some stuff in its video-rental records that they didn't want voters finding out about. They beat all land-speed records in making it a crime to tell anyone what kind of movies they (and we) were watching.

And that was it. For 37 years, Congress has completely failed to pass another consumer privacy law. Which is how we got here – to this moment where you can target ads to suicidal teens, gambling addicted soldiers in Minuteman silos, grannies with Alzheimer's, and every Congressional staffer on the Hill.

Some people think the problem with mass surveillance is a kind of machine-driven, automated mind-control ray. They believe the self-aggrandizing claims of tech bros to have finally perfected the elusive mind-control ray, using big data and machine learning.

But you don't need to accept these outlandish claims – which come from Big Tech's sales literature, wherein they boast to potential advertisers that surveillance ads are devastatingly effective – to understand how and why this is harmful. If you're struggling with opioid addiction and I target an ad to you for a fake cure or rehab center, I haven't brainwashed you – I've just tricked you. We don't have to believe in mind-control to believe that targeted lies can cause unlimited harms.

And those harms are indeed grave. Stein's Law predicts that "anything that can't go on forever eventually stops." Congress's failure on privacy has put us all at risk – including Congress. It's only a matter of time until the commercial surveillance industry is responsible for a massive leak, targeted phishing campaign, or a ghastly national security incident involving Congress. Perhaps then we will get action.

In the meantime, the coalition of people whose problems can be blamed on the failure to update privacy law continues to grow. That coalition includes protesters whose identities were served up to cops, teenagers who were tracked to out-of-state abortion clinics, people of color who were discriminated against in hiring and lending, and anyone who's been harassed with deepfake porn:

https://pluralistic.net/2023/12/06/privacy-first/#but-not-just-privacy

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2025/02/20/privacy-first-second-third/#malvertising

Image: Cryteria (modified) https://commons.wikimedia.org/wiki/File:HAL9000.svg

CC BY 3.0 https://creativecommons.org/licenses/by/3.0/deed.en

[shedelulululu]

So I've been seeing some theories go around that Langdon is lying about the origin of his addiction, and I'm not saying that's not possible, but it doesn't seem likely with my reading of the show

1. The exact line is "I hurt my back. I told you that. Our own Dr. Hagan prescribed me some pain meds and muscle relaxants."

So he isn't making up this injury, it's something Robby knew about. Could he be lying about still self treating his own back pain? I guess, but idk if you've ever talked to people with chronic pain, especially from back injuries but they're no joke. I'd only wish back pain on my worst enemies.

2. This show seeks to address real world issues. They show us a medical student who is homeless. They show us COVID PTSD in medical workers. They show us violence against nurses. They show us the corporatization of the medical system. All of these are very real and prescient issues in our world and particularly in the US.

One of the most common 'origins' for substance abuse is being prescribed a medication for an injury or other medical condition. Initiation into opioid misuse has three primary sources - family members, personal prescriptions, or friends 1 (I'll address benzos next but let's assume initiation to prescription drug abuse is similar bc I can only give so much of my time to finding info on this topic for a tv show).

All of this to say, I think the show would be more interested in being grounded in this real world issue and bringing light to it and encouraging its audience to become empathetic to those with substance abuse disorder than pulling the rug from under us for drama.

3. If he has back pain why benzos? While yes you would not typically use benzos to treat back pain, it is not unheard of for (self) managing chronic pain. Motivation to use benzodiazepines includes reasons like a sleep aid (if he was using at home this could be a factor), muscle relaxation (this can help back pain and he was prescribed muscle relaxants alongside pain medication), and ability to function during use ("could an addict do what I do?" On benzos yes! Frank is smart, this would've been something he'd take into consideration) 2 .

[slowburningechoes]

y’all this hyperfixation is getting ridiculous.

smh i’m at a didactic on treating opioid use disorder with medication and therapy but all i can think about is House, M.D. and the Hilson fight in 05x16: The Softer Side when House starts methadone…

[transmutationisms]

I was reading your porn addiction post, and I just wondering what you consider addiction if not some sort of disease? I also think porn addiction and stuff in that vein is fake but I also can’t think that addiction is just people choosing to be that way even though they hate it. I say this as someone who was actually addicted to substances like I feel like there was something going on there that can’t be explained by the idea that addicts just choose to be like that. (I don’t think you think addicts just choose to be like that I just don’t really know any alternative schools of thought lol) I don’t mean this in an accusatory way I’m sorry if it comes off that way, I am genuinely curious what you think cause your posts are always so enlightening.

first of all you have to keep in mind that 'addiction' has no singular meaning. even if we confine ourselves to talking about psychoactive substances, 'addiction' can range from the 'classic' case of increasing, compulsive, self-destructive use, to cases where a person's usage may actually be stable in the long term but they're chemically dependent on the substance (think: the way doctors talk about chronic pain patients who are dependent on opioid painkillers; then compare to how they talk about psychiatric patients who are dependent on SSRIs. for example). you can get dx'd with a 'substance use disorder' purely on the basis of how much you take/consume, even if you don't feel it's causing impairment in your life, particularly if you let slip that someone else in your life has expressed concern or tried to stop you. race and class contribute to distinctions here as well, where certain people have leeway to be seen (even in a psychiatric setting!) as 'experimenting' with substances, or using them 'recreationally', where the same usage pattern in a person who's otherwise marginalised might be flagged as 'addictive' and in need of intervention. all of this gets even messier when psychiatrists and physicians try to justify applying discourses of 'addiction' to eating, gambling, sex, social media, and so forth. recall that 'addiction' in the roman republic and middle ages had contested legal and augural meanings that could be positive as well as negative, and that by the seventeenth century it was largely used as a reflexive verb with a predominantly positive meaning—as in, "we sincerely addict ourselves to almighty god" (thomas fuller, 1655) or, of plato, "he addicted himself to the discipline of pythagoras" (thomas hearne, 1698). it was not until the twentieth century that "addict" came to be widely used as a noun defining people who were passively suffering on a medical model.

i don't mean to be evasive here but to point out that asking "how do we define addiction besides a disease model?" presumes already that the disease model is the singular and inescapable way of understanding addiction in the first place—this is not true historically or presently. addiction is a muddled concept and has always involved moral discourses; attempts to present it as a 'pure' or 'objective' medico-scientific judgment are in fact recent and still unstable.

to the extent that it is useful to talk about addiction as a disease—that is, as a state of suffering that is imposed upon the sufferer, that is a disruption of a desired state of health and well-being—i think it is critical to keep in mind that such a disease is social as much as biological. you can start here by pointing out that substance use is often precipitated by the necessity of withstanding miserable life conditions (ranging from extreme poverty, domestic abuse, social marginalisation, &c, to the 'standard', inherently alienating and miserable conditions anyone endures in capitalist society). but there are other social factors that contribute to the presentation of substance use as compulsive, escalating, and self-endangering. eg, lack of a safe, steady supply is a huge factor here! when people are forced to rely on inconsistent, unregulated supplies to get high, this contributes greatly to drug 'binge' behaviours and endangers users. there is also the fact that drug users are often already marginalised (esp along lines of race, class, ability, &c) and are then further marginalised on the basis of being drug users. what would substance use look like in a society where using didn't relegate people to the social margins, or render them socially disposable? what if people had social supports, and weren't forced to toil away their entire lives at jobs that make them miserable for pay that's barely enough to live on? what sorts of patterns of substance use would we see then? so then, is it the drugs themselves that are the problem here, purely neurobiologically? or is there a larger story to tell about how people come to exist in such a state where substance use is increasingly hard for them to engage in with safeguards; where being a substance user causes them to lose whatever degree of social connection and support they may have had, which was often insufficient already; where they are often unable to integrate substance use into a full and connected life because they are told they must either give up enjoyment of a substance entirely, or be continually branded 'relapsing', 'non-compliant', 'dangerous', &c &c.....?

at the end of the day i don't think it's helpful or accurate to talk about addiction as a disease because it decontextualises drug use from all of these factors: why people do it, why it becomes harmful for some, why it's assumed we must simply 'stop' and 'resist' in order to 'get better'. disease explanations blame the substances themselves on a reductive bio-mechanical level (& again, this becomes especially untenable philosophically when we think at all about 'behavioural addictions'). the point here isn't to say that addicts are just blithely waltzing into addiction—or, indeed, to say that drug use is intrinsically a bad thing that should be avoided! it's a pretty typical feature of human existence that many of us enjoy consuming substances that alter our mental and physical states, and that's not inherently bad. when i push back against a disease model of addiction, i'm not invoking a model of personal responsibility or individual choice. i'm asking how we can understand drug use within a much broader social and historically contextualised frame, and how that can help people who are in many different states wrt drugs, from 'currently engaging in patterns of usage that feel compulsive and terrible' to 'never done a drug in their life'.

[sumatcenters]

Why Dual Diagnosis is Key to Treating Mental Health and Addiction?

What Is Dual Diagnosis?

If you or someone you care about is struggling with both mental health issues and substance use, you’re not alone—and there’s a name for what you’re experiencing: dual diagnosis.

Dual diagnosis means a person is dealing with both a mental health condition and a substance use disorder at the same time. For instance, someone might be battling depression while also struggling with alcohol misuse. Or they may have anxiety alongside an addiction to opioids or stimulants. It’s more common than many realize, and yet it’s often misunderstood or overlooked.

At Sumat Centers, we want you to understand: struggling with both challenges doesn’t mean you’re flawed���it simply means you need a treatment plan that addresses your whole self as a person.

The Connection Between Mental Health and Substance Abuse

What comes first is not always clear —the mental health challenge or the substance use. But it’s clear how closely linked they are. 

People living with unresolved trauma, anxiety, PTSD, bipolar disorder, or depression often turn to drugs or alcohol to cope. But these substances often end up worsening the symptoms in the long run. Simultaneously, substance use can also trigger or intensify mental health symptoms. Eventually, it becomes a cycle: stress, fear, sadness, or emotional pain leading to substance use, which further leads to more emotional instability, and so it continues.

Understanding this cycle is the first step toward healing. You're not weak for needing help—you're human.

Why Integrated Treatment Is Essential?

Treating addiction without addressing mental health—or vice versa—is like fixing a leak without turning off the water. If both aren’t treated together, the risk of relapse stays high, and long-term recovery becomes harder.

Dual diagnosis treatment focuses on healing both the mind and the body. At Sumat Centers, our approach to co-occurring disorders treatment is completely integrated. Our mental health professionals and addiction specialists work together to treat both conditions at the same time, not in isolation. This isn’t a one-size-fits-all approach. It’s a compassionate, tailored process devised to meet you exactly where you are.

Signs You May Need Dual Diagnosis Treatment

Many people live with a dual diagnosis without realizing it. You may benefit from this kind of treatment if:

You use substances to manage intense emotions or mental distress.

You've been diagnosed with a mental health condition and also struggle with addiction.

Traditional addiction treatment hasn’t worked for you in the past.

You feel like your emotional pain is fueling your substance use, or the other way around.

You’ve felt misunderstood or unseen in previous care settings.

Acknowledging that you might need dual diagnosis treatment isn’t a weakness—it’s an act of courage.

How Sumat Centers Treats Dual Diagnosis in Dundalk

Located in  Baltimore, Dundalk, Towson, and Elkridge, MD, our centers offer a safe, structured, and nurturing environment where real healing can happen. At Sumat Centers, we believe recovery should be holistic and rooted in trust, understanding, and personal connection.

We provide residential treatment for dual diagnosis, meaning you’ll have round-the-clock care in a community that supports your recovery journey. Our expert clinicians specialize in mental health and addiction treatment, using evidence-based practices like trauma-informed therapy, medication management, cognitive behavioral therapy (CBT), group counseling, and more.

We take the time to understand not just what you’re struggling with, but why. From day one, we work with you to build a personalized care plan focused on your goals and values.

We’re not just one of the dual diagnosis centers in Dundalk. We’re your partners in rebuilding a life that feels like yours again.

Final Thoughts

Asking for help is never easy, especially when it feels like no one really understands what you’re going through. But the truth is, help exists. Real, judgment-free, holistic care that sees all of you.

Dual Diagnosis Treatment in Dundalk isn’t about labeling you. It’s about freeing you from shame, from pain, and from the patterns that have held you back. At Sumat Centers, we’re here to walk with you every step of the way.

Healing starts with one brave choice. Let it begin with you. Sumat Centres. Helping patients in Baltimore, Dundalk, Towson and Elkridge, MD.

[writers-potion]

i was wondering if you could give some points and tips on writing about a character who is suffering from DRUG ABUSE

Writing A Drug Addict Character

Know Your Drugs

Was the drug invented? A scene using insulin set in 1820 is problematic since this treatment wasn’t discovered until the 1900s. Fentanyl shouldn’t be used in a 1930s scene since it wasn’t available for use until the 1960s—opium or morphine would be more accurate choices.

Was the method invented? Since insulin must be given as a shot, that scene is even less authentic as the hypodermic needle wasn’t invented until the mid-1800s. Older historical fiction could involve the use of poultices and mustard packs, while skin drug patches (transdermal patches) are only appropriate in more modern scenes.

The most common drugs abused by gangs are: Marijuana, Methamphetamine, Heroin, Cocaine

Or, it can be prescription drugs

Although many medications can be abused, the following three classes are most commonly abused:

Opioids—usually prescribed to treat pain;

Central nervous system (CNS) depressants—used to treat anxiety and sleep disorders; and

Stimulants—most often prescribed to treat attention deficit hyperactivity disorder (ADHD). (common example? caffeine)

Write In Stages

Stage 1: First Use

Some people use a substance for the first time out of curiosity, while others use substances due to peer pressure. People may also be prescribed medication, such as opioids, by their doctor. Individuals may view their first use as a one-time occurrence, but this opens the door for future use. Some people try a substance one time and never use it again. 

You character will feel:

Angry and/or desperate

Miserable

Lonely

Trying to run away from a certain problem

Persuaded into doing drug

Guilty

Stage 2: Regular Use

If a person uses a substance and enjoys how it makes them feel or believes it will improve their life, they may start to use the substance regularly. They may use drugs or drink alcohol on the weekends while at parties or hanging out with friends. Occasional use may become a regular occurrence. It might become a part of a person’s routine.

Your character:

Will start getting in careless activities while doing drugs

Will probably be violent

Won’t think he has any issue whatsoever and shrug it off

Start associating themselves with harder drug users

Have a false sense of security that they’re able to quit whenever they want.

Stage 3: Risky Use

The next stage after regular use is risky use. A person will continue to use a substance despite the physical, mental, legal or social consequences. Their use likely started as a way to escape or have fun with peers but has now taken priority over other aspects of their life.

Your Character will feel:

uncomfortable around family members/friends who start to notice

Exhibit more reckless behavior

Driving under influence, stealing money to finance substance use, etc.

Underperforming at work or school

Experience tension in personal relationships

Stage 4: Dependence

The next stage is a physical, mental and emotional reliance on the substance. The individual is no longer using the substance for medical or recreational purposes. When a person doesn’t use the substance, their body will exhibit withdrawal symptoms, such as tremors, headaches, nausea, anxiety and muscle cramps.

Your Chracter Will:

Develop a sort of rountine/typical place where they abuse

Believe that the substance is essential for survival

Use substance even when it's unnecessary

Stage 5: Substance Use Disorder

While some people use dependency and substance use disorder interchangeably, they’re very different. Once a person develops a substance use disorder, substance misuse becomes a compulsion rather than a conscious choice. They’ll also experience severe physical and mental side effects, depending on the substance they’re using.

Your Character:

Has noe developed a chronic disease with the risk of relapse

Is now incapable of quitting on their own

Feel like life is impossible to deal with without the substance.

Lose their job, fail out of school, become isolated from friends and family or give up their passions or hobbies.

Research the Trends

Medical knowledge changes over time and with it the drugs prescribed. This then impacts the type of prescription drugs available on the streets.

late 1800s: chloral hydrate used for anxiety and insomnia > bromides > 1920s: barbiturates, barbital > benzodiazepines ("benzos") > early 2000s: opiod drugs > opiod drug bans led to growth of black markets: ilicit fentanyl > and so on...

Different countries/locations will have varying trends of drug abuse (depending on laws, availability, costs, etc.)

Research the Slag

look for "[drug name] trip report" on YouTube, etc. to get first-hand accounts of how drug addicts behave.

The main focus should always be to use the words your characters would use in ways that suit the world you have created.

The slang for certain drugs is a difficult vocabulary to maintain as it is ever-changing and varies based on country, region, town, even by streets. Some writers use what they know or have heard locally, others invent their own.

Resources

FDA (Food and Drug Administration) and DEA online databases and drug resources

Social networking groups focusing on related specialty writing topics, such as trauma or emergency medicine

Newspaper articles and medical journals are great places to find real cases.

The US national poison center 

Helpful Vocab:

Addled - sense of confusion + complete lack of mental awareness

Crazed - emotional anguish experienced by the addict

Desperate

Despondent

Erratic

Fidgety

Hopeless

Impressionable

Struggling

[macgyvermedical]

Definitive Care for Writers

The following are things that could be believably taken care of completely outside of a hospital/without a doctor, listed by the caregiver's highest level of medical training:

With a "Lay" caregiver:

OTC Medications with labels that have instructions for use, like acetaminophen and/or ibuprofen for a headache/fever, antihistamines for minor allergies, etc..

Sunburn

Menstrual cramps

With someone who has first aid training:

Simple choking (Heimlich maneuver believably fixes this)

Small cuts, venous bleeding only (pressure to stop bleeding, washing with water and dressing is believable)

Opioid overdose (single drug, use of nasal naloxone and rescue breathing is believable as long as the person is monitored for several hours)

Heat exhaustion (get them out of the sun, give water)

With an urban EMT or Paramedic:

Uncomplicated childbirth (It's not fun to have a baby out of a hospital, but it can be done)

Uncomplicated seizure for someone who has a known seizure disorder (basically just need to time it and give emergency med if longer than 5 minutes, have it at least stop after the medication)

Fainting (if it's a 1-off thing with no injury)

Low blood sugar (sugar/food with carbohydrates fixes this within about 15 minutes)

With a Wilderness EMT:

Simple fractures, broken ribs, sprains, and strains (as long as the bone ends are well approximated, a splint during the healing process will do a "good enough" job fixing this)

Some dislocations (forward shoulder dislocation, patella dislocation, finger dislocations all can be believably reduced in the field)

Small wound closure (something like a cut or bullet graze that doesn't hit an artery)

Moderately-sized wounds without life-threatening bleeding (can be packed in the field and believably heal with daily care)

Hypothermia (warm the person up and give sweet warm liquids)

With a Registered Nurse:

Uncomplicated concussion (need to do assessments every 2 hours, have them come up normal)

Severe nausea and vomiting (needs timing of medication, sips of water)

Small skin infections and abscesses (treat-able with heat)

Viral Pneumonia (not requiring oxygen)

Malnutrition

Migraines (assessments needed to determine not a stroke)

[patriciafortunato]

In January of 2022, a medical director of government relations partnered with an addiction medicine content manager and medical director, to write a white paper on the importance of expanding access to medication for addiction treatment (MAT). The paper expounded on methadone treatment for opioid use disorder (OUD), racial disparities in access to MAT, the community pharmacist role, and supports H.R.6279: Opioid Treatment Access Act of 2022, introduced by Congressman Donald Norcross in December of 2021.

The Act aims to increase access to and modernize the process of obtaining MAT. This proposed change in federal legislation would decrease barriers to treatment by sustaining relaxed methadone dispensing regulations enacted during the COVID–19 pandemic and making methadone available at pharmacies, enabling ease of patient access to evidence-based treatment and empowering them to spend less time waiting in line for their medication. During the pandemic, federal restrictions have been temporarily lifted and allow patients to take home larger quantities of methadone at a time; preliminary studies have shown that this has increased engagement with treatment. The federal exemption has been extended—however, patients are still required to obtain their medication albeit larger doses from opioid treatment programs (OTP). The bill also calls for research to evaluate the effects that legislative changes have on treatment access and outcomes.

The paper was presented to Senator Joseph F. Vitale and the New Jersey State Legislature, and an iteration abridged summary was published in the New Jersey Medication for Addiction Treatment Centers of Excellence (MATCOE) newsletter. Learn more here.

Recommended citation:

Fortunato P, Haroz R, Baston K. E. Expanding Access to Medication for Addiction Treatment: A White Paper Prepared for the New Jersey State Legislature. Cooper University Health Care Center for Healing, State of New Jersey Medication for Addiction Treatment Center of Excellence. 2022.

[genderqueerdykes]

I'm so glad to hear your surgery went well, lots of good luck for your recovery <333 i'm chronically ill myself and went through the whole being treated like trash by the ER staff song-and-dance too while looking for a diagnosis (i was also on the verge of death), so i was really scared for you when i saw you liveblogging your experience. But again, really happy that everything went well for you in the end ! :)

hello there! thanks for sending such a kind message!

i'm sorry you've been through it too. i totally understand that working in an ER is a horrific job. i know that the nurses and staff have to put up with an insane amount of stress, even from patients who are "well behaved". i understand that there are many people who come into the ER who expect to be treated right away, treated like they're special, or handed all the best medications right away

i saw many people in there who would literally get pissed off when the nurses would bring them tylenol, aspirin or ibuprofen instead of opioids. i watched an older woman literally start SCOWLING and her tone turned completely bitter and hateful once the nurse brought her some aspirin for her pain. a man sitting next to me started grumbling angrily because he overheard the nurse bringing me oxycodone and got pissed off that he wasn't getting any. it bothered me that so many people in there were clearly just trying to get handed opioids despite not being in a lot of pain. i get that there were a lot of people in here who were upset because they weren't getting high and i get how that could be upsetting to the nurses.

i wasn't getting high- i was in way too much pain and in hysterics. i wasn't having fun. it really upset me to overhear that people near me thought i was having a "good time" or having fun or just there to get high off of pills. like it made me really uncomfortable to hear that people around me were literally getting jealous over me being given oxy for an ungodly amount of pain. i get that many people can be rude and expect special treatment, i'm never going to sit here and say that being an ER staff member is easy by any stretch of the imagination. i DO understand that drug seeking people do exist, and i witnessed a lot of them in that ER, but it doesn't mean that you should treat the drug seeker, or anyone else like shit. drug seeking can still be a sign of a greater problem and people who engage in this type of behavior deserve to be talked to like people instead of treated like absolute shit. even if the behavior was affecting me, personally, i still don't think someone who goes to the ER specifically to seek drugs should be treated in a subhuman manner

but when i told the surgical staff about how i was being treated, they were utterly appalled. one of the nurses told me that she understands that compassion fatigue is a thing, and that burnout happens, but too many ER nurses resort to become so cold and bitter than they're just mean to their patients because they view them as a nuisance, and start viewing everyone as whiny drug seekers or people who are faking for attention. it's not good, i feel like when one gets to that point it's a good idea to switch jobs. being burnt out isn't a sign that you're weak or have bad character, it just means that you're overwhelmed

it really bothers me that ER staff tend to want to look down on patients who are there and assume that they're seeking attention. my best friend told me one of her friends got told it was "faking a stroke" because borderline personality disorders "make us do funny little things for attention." how the hell do you even fake a stroke? you can't fake the entire left side of your body drooping and failing to function

overall i'm sorry that you have received that treatment as well, there's no reason for you to get ignored or treated like garbage for being sick. i didn't want to worry anyone but i wanted to liveblog my experience to show how difficult it can be to be chronically ill, especially in America, and how people do not take health problems seriously-- even certain medical professionals

the fact that a nurse decided to get pissed off at me and berate me for becoming hysterical from pain was just out of this world. i told her that i wasn't sure how much longer i could wait because the ER waiting room was freezing cold and loud as hell (eveveryone either had several people there with them to talk to, were on the phone/facetime or were blasting music or videos from their phones), and that sitting upright in the chairs was making the pressure and pain in my abdomen worse... she decided to snap at me instead of offering even a modicum of comfort

she scoffed and went "well if you leave, and your symptoms come back, WHICH THEY WILL, you're going to have to come right back here and start all over again. we can't make special exceptions just for you, you wouldn't keep your place in line, you'd have to start all over again and wait all over again. you're an adult, you can make your own decisions, but it's just going to be the same thing all over again if you leave."

she could've went "hey, i get it, it's really stressful in here. surgery is busy and we're going to get you in there as soon as we can, it's just very busy right now." or something like that or at least checked to see if i was due for pain medication, but instead she just got mad at me for "whining". i told a member of the surgical staff team about this and her response was "they're completely discompassionate down there- there's no compassion whatsoever, they just don't... care." as much as it was shocking to hear her say that, it was validating, because it was true

i hope you don't have to deal with that again the next time you need help, i hate it when chronically ill people get branded as annoying, drug seekers, fakers, etc. because that's literally what chronic illness is. just because our situations are complicated doesn't mean people should throw their hands up in the air and give up and consider you a burden. you shouldn't have to go through that in the first place

thanks for your kind message i appreciate it! best of luck in your future care as well, it's not right for anyone who's sick to be turned away or treated like garbage. the focus should be on the patient's care, not the ER nurse's feelings or assumptions about that person. yes medical professionals are human and deserve to have their emotions respected, but they should never supersede the safety and well being of someone who is sick, whether or not they're on death's doorstep or not. take care of yourself, thanks for stopping by!

[bethanydelleman]

Trope exploration: Man, usually a war veteran, with PTSD drowns his sorrows in alcohol

I was rewatching one of my favourite shows and I was struck by the fact that the main male character had severe Posttraumatic stress disorder (PTSD)* and yet didn't drink because it seemed like a big trope subversion. This made me wonder about the real world comorbidity** of substance use disorder (SUD) and PTSD, so I could determine if this common association was a reflection of real life or a trope.

PTSD & SUD co-occur at a rate of about 30-55%

(many of these studies are in veterans, source, source, source)

However, this is SUD in general, which means it includes any abuse of a drug, including but not limited to alcohol. The highest rates of PTSD are in cocaine and opiate users. Also, and this is very interesting, the direction of causation is unknown (does the substance or the PTSD come first):

Although PTSD and SUDs appear to be strongly linked, little is known about the nature of their relationship. The most widely held explanation of their frequent co-occurrence is the self-medication hypothesis. This hypothesis is based primarily on clinical observation and posits that traumatized individuals attempt to use substances in order to dampen traumatic memories, or to avoid or “escape” from other painful symptoms of PTSD. A second hypothesis, the high-risk hypothesis, posits that individuals with SUDs, because of high-risk lifestyles, are likely to experience a trauma and are, therefore, more likely than the general population to develop PTSD. Finally, a third hypothesis, known as the susceptibility hypothesis, states that substance use increases an individual's susceptibility to developing PTSD following a trauma. (source)

It was also noted as important that most patients who suffered from PTSD had multiple traumatic events in their lives, beginning in childhood. Also, more men had SUD than women, which holds true in the general population as well.

I think one of the best representations in popular media of PTSD might be The Hunger Games. They have SUD/PTSD Haymitch and the Morphling (opioid abuse) victors, but Katniss and Peeta deal with their experience in other ways, as do the others that we see. Also, it's clear that most of the victors have repeated trauma: Katniss's father dying and nearly starving to death; Peeta's childhood abuse; and Haymitch being forced to have a front row seat to subsequent games.

Conclusion: at most, only about 50% of patients with PTSD abuse a drug of any kind, less of them abuse alcohol. So it would be both interesting and scientifically valid to see more characters with PTSD who are not constantly drinking. Men are more likely to have substance use disorders, so the trope is partially supported.***

*Comorbidity is when two disorders happen in the same person at the same time. There are many conditions that are likely to co-occur, like depression and generalized anxiety disorder or Type 2 diabetes and obesity.

**Symptoms of Posttraumatic Stress Disorder, taken from one of the sources above:

The characteristic symptoms of PTSD can be divided into three clusters: avoidant, intrusive, and arousal symptoms. Examples of intrusive symptoms include unwanted thoughts or flashbacks of the event. Avoidant symptoms include, for example, attempts to avoid any thoughts or stimuli that remind one of the event. These symptoms are particularly relevant to this review because substances of abuse are often used by individuals with PTSD in an attempt to avoid or escape memories. Arousal symptoms generally include exaggerated startle reflex, sleep disturbance, and irritability, and are generally associated with hyperactivity of the autonomic nervous system.

***I'm not saying that this trope is bad or that we shouldn't see any people with PTSD resorting to substance abuse in media. Instead, I'm saying that the amount of people with PTSD who use alcohol as a coping mechanism is lower than most people probably think, and it would be interesting to see other representations of PTSD as well. PTSD & SUD are most likely commonly paired together in media because it's an easily visible sign of internal suffering.

Also, varied displays of different disorders are important, in my opinion. We don't want someone thinking they don't have PTSD or that a loved one doesn't have PTSD because they don't also have a problem with alcohol.

[transmutationisms]

like there is a (usually subconscious) perception among medical professionals that any degree of patient self advocacy is a threat to their expert status & simultaneously in psychiatry specifically it's ultra important that everyone toe the line because these aren't diagnoses that you can like physically document even.

hgkgj3m i was diagnosed by a psychiatrist with "cluster b" in the psych emergency for patient self advocacy and not backing down on seeing a pain specialist after years of jumping through hoops to no avail... also said the opioid epidemic was a result of gross medical neglect in overprescribing and was now resulting in gross medical neglect the other way w underprescribing

diagnosed with Extra Not A Disorder, i think they literally couldnt decide which "this person is manipulative and sinister" disorder to give me, for undermining their expert status and that of doctors everywhere by not accepting being patronised and pathologised (tried to blame it on hrt, Maybe i would Change My Mind™) and suggesting doctors could be responsible for causing harm ^_^

this patient thinks she knows so much and is better than Me she must be a narcissist... but shes manipulating me she must be evil hysterical woman... but she's icky trans so maybe she's a sociopath (male coded)... but she's making such a big deal out of this maybe she's histrionic... eh it's not like these disorders have quantifiable symptoms lets just say it's the whole category

alright so i generally think this isn't an issue of overprescribing per se (i think drugs should all be legalised and available lol) but one of lying about the risks—whether or not someone 'needs' opioids for a broken ankle, they do need to be told that opioids have addiction potential, and that is information that the sacklers were massaging out of their trial data and that doctors in turn were not telling their patients, even after it was very obvious to anyone doing followups that the risk existed. & like i say this as someone who did start doing opioids because they were around the house lol. i don't think the answer here is that doctors magically become able to determine with pinpoint accuracy who actually 'needs' the drugs—there is no way to eliminate human error from that process, for one, and anyway i think people should be able to make their own decisions on substance use in general. but you have to be doing that with actual full information. but i do certainly agree the underprescribing is an issue—this has always been a problem for people with chronic pain/illness, and media coverage of the 'opioid epidemic' (scare quotes bc i think the epidemic framing is a bad one) has certainly made this worse.

anyway though. this is funny cause i initially got shuttled to psychiatry because i was trying to get my chronic fatigue diagnosed, and i definitely think asking for pills was a factor in the psych deciding i was bpd or hpd or bipolar or whatever he even said lol. you always have to do this little song and dance with them where you showed up to the office of the prescribing professional but now you have to pretend you're not looking for a prescription becsuse if you want it too much that's Bad obviously. and then because PDs in particular and psych diagnoses in general are vibes based, it's literally just the psych announcing in medicalese that they don't like you. if you look at the criteria for some of the PDs they even explicitly include points for how the patient 'makes' the doctor feel akajaksajs like literally i diagnose you with im doing transmisogyny to you