#Medication For Opioid Use Disorder

[patriciafortunato]

I wrote about some personally meaningful topics here and here.

Thank you to wonderful colleagues and friends.

[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

[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

[intheroomblog]

Effective Opioid Addiction Treatment at Fitchburg Center

Discover expert care at Fitchburg Comprehensive Treatment Center, offering specialized opioid addiction treatments. Through a combination of Medication-Assisted Treatment (MAT) and personalized counseling, we help individuals on their path to recovery. Our professional team provides a safe and supportive environment tailored to your needs. Experience transformative care with us today.

[shrinksinsneakers]

I recently had an interesting discussion with one of our residents about the risk of developing schizophrenia after experiencing substance-induced psychosis. 

[macgyvermedical]

Harm Reduction Ideas for Substance Use Disorder

Recently I have been listening to a podcast called The Curbsiders Addiction Medicine. If you are a clinician that works even sometimes with people who use substances (every clinician ever), it is a fantastic look at all the harm reduction practices you can use to make these individuals safer. Plus, you get free CME.

I’m hardly going to do the podcast itself justice with this post, but I wanted to share some things I learned from it:

If the dangers of using substances (social and legal consequences, time commitment, health problems, money problems, etc…) was a deterrent, people wouldn’t be doing it. But it’s not. Because uncontrolled substance use is a chronic disease that generally does not get better without treatment. When people are treated, not only do they generally use less, but they have a much lower chance of death and a much higher chance of a happy, productive life- whatever that means for the patient.

Previously (even a few years ago) we hung such treatment on the requirement that people be abstinent from substances in order to receive help. This works for some people, but far from everyone.

The evidence shows that best thing we can do for many individuals is to make their use safer and less of a burden on their life and health. This is called harm reduction, and it WORKS.

Here are some evidence-based ideas for how to help your patients:

Create a space where you are working together with your patient and following your patient’s lead. Do they want to become abstinent? Great! Do they want to use less or use in a more controlled way? Also great! Do they want to continue use in a safer way? You guessed it, also great! Support them in whatever their goal is

Provide or prescribe safe, clean tools of use. Things like clean needles, Pyrex pipes, and straws. This decreases rates of infection and abscesses

Prescribe medications that reduce cravings or reduce/eliminate withdrawal (methadone, buprenorphine, topiramate, bupropion, naltrexone) without requiring abstinence

Teach people safer use practices and safer routes, such as rectal (booty bumping) or oral (parachuting) instead of injection drug use

Prescribe PrEP if people are at risk of HIV without requiring abstinence

Test for and treat the consequences of substance use (such as HIV and Hep C) without requiring abstinence

Provide fentanyl and xylazine test strips so people know what is in the substances they are using and can adjust doses/use pattern accordingly

Recommend Never Use Alone hotlines to prevent overdose death or better yet, take turns using with a buddy

Prescribe naloxone to anyone who uses any substance- nearly all street drugs are contaminated with synthetic opioids and naloxone is an effective way to prevent deaths

People use substances for a reason, especially early in their journey- pain, coping with depression/other mental illness, ADHD, and social issues like being unhoused. Treat the problem if you can find it, and you can help people significantly decrease use or use in a more controlled way

Be aware that return to use (or return to uncontrolled use) is a thing you can plan for with the patient and manage before it even happens

It’s hard sometimes to change the idea of addiction/substance use disorder as something that can only be treated as a reward for staying sober. But thats why so few people seek treatment for it. The evidence does not equivocate. Harm reduction WORKS.

[allthecanadianpolitics]

A study conducted by the B.C. Centre for Disease Control has found that prescribing medical-grade opioids dramatically reduced the rates of deaths and overdoses for drug users living in B.C. The study, published in the British Medical Journal, is described as "the first known instance of a North American province or state providing clinical guidance to physicians and nurse practitioners for prescribing pharmaceutical alternatives to patients at risk of death from the toxic drug supply." Researchers looked at anonymized health-care data of 5,882 people between March 2020 and August 2021, all of whom had opioid or stimulant use disorder. Those individuals filled a prescription under the B.C. Risk Mitigation Guide — clinical guidance developed in March 2020 to allow for physical distancing during the COVID-19 pandemic, and to reduce deaths through harm reduction.

Continue Reading

Tagging @politicsofcanada

[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'.

[lifewithchronicpain]

Many patients have horror stories to share about their experiences in hospital emergency rooms, where they’ve been treated as drug seekers and denied opioid pain medication.

“I had a broken arm and was given nothing for pain when leaving the emergency room,” one patient told us. “They now treat everyone like a drug seeking addict even if you have legitimate pain!”

“My last ER visit has caused me PTSD. It was awful they put me in a room and turned the light off and left me there for hours,” said another.

“The emergency rooms are horrible,” said a patient with a fractured rib. “I wasn’t even asking the ER for meds. I wanted an x-ray or something because I was in excruciating pain.”

A new study found that the risk of developing addiction or opioid use disorder after being treated with intravenous opioids in the ER is quite low – less than one-tenth of one percent (0.002%).

Out of 506 patients treated with IV opioids in two Bronx emergency rooms, only one met the criteria for long-term or persistent opioid use six months later.

“These data suggest that the use of IV opioids for acute pain among opioid-naive patients is extremely unlikely to result in persistent opioid use,” wrote lead author Eddie Irizarry, MD, an emergency medicine physician at Montefiore Medical Center.

I’ve had many an ER visit in the past where I needed an opioid and they kept refusing until eventually they realize that I really do. It was fucking torture and I’m so glad I don’t have those flares anymore that put me in the ER.

[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

[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.

[intheroomblog]

Medication-Assisted Treatment: Pros And Cons Of MAT For Recovery

Medication-Assisted Treatment (MAT) offers a balanced approach to Medication addiction recovery by combining medications with counseling. MAT can reduce withdrawal symptoms and cravings, helping patients stabilize their recovery journey. However, MAT may not suit everyone, as some fear reliance on medications or potential side effects. Understanding MAT’s advantages and challenges is essential for making an informed choice about addiction treatment.

[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:

CPR for drowning or lightning strike only (other causes generally need medications or surgical procedures to return heart to normal rhythm)

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)