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The Difference between a Drug and a Medication

People who are committed to treatment and recovery learn that there are many differences between substances used to get high and medications used to get well. The following chart lists examples of these differences.

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In summary, drugs are what people use to get high. Medications are what people take to get well under a physician’s care. Because people taking them will not feel or act high on appropriate doses, medications do not compromise people’s recovery.

*      Language in chart adapted from William L. White, Narcotics Anonymous and the Pharmacotherapeutic Treatment of Opioid Addiction in the United States (Philadelphia: Philadelphia Department of Behavioral Health and Intellectual Disability Services /Great Lakes Addiction Technology Transfer Center, 2011), 35, which cites Robert L. DuPont and Mark S. Gold, “Comorbidity and ‘Self-Medication’,” Journal of Addictive Diseases 26, no. 1 (2007): 13–27. Permission pending.

HOW OPIOID USE CAN LEAD TO ADDICTION

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Joseph B Stringer, MA, LPC, CAP, MAC

The media are all awash in the current opioid epidemic. Throughout our country people are dying due to opioid overdoses. This seems to be the result of several issues. Number one is that many so-called “dealer/distributors” are cutting their opioid products with anything from other opioid medications to drain cleaner. Another issue is that some people have had previous experience with opioid use, then went through the detoxification/withdrawal process and have been clean. Going back to using again, many people mistakenly believe that they can just pick up where they left off. What these people don’t understand, is that the body has been off this drug long enough that re-introducing this drug after detox cannot begin with the same amount and strength as before – the body is learning about this foreign substance again; therefore, overdose and often death accompany this situation.

Let’s look at the various opioids, how they affect the body and how they come to be dangerous.

In an article written by Doctors Kosten and George in “Addiction Science and Clinical Practice in July of 2002, they state that, “Opioid tolerance, dependence and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part of a struggle to overcome the effects of these changes.  Medications such as: methadone, LAAM*, buprenorphine and naltrexone act on the same brain structures (and receptor sites) and processes as addictive opiates, but with protective or normalizing effects. Despite the effectiveness of medications, they must be used in conjunction with appropriate psychosocial treatments.” This means individual counseling therapy with a professional, licensed clinician or addiction specialist. I mention to patients that just doing one without the other only gets you half way to recovery. Using both on the other hand, provide a complete treatment.

In treating opioid abuse, the focus of treatment is on the patient rather than his/her disease.  A clinician’s understanding of neurobiology of dependence a d addiction is invaluable to the patient’s treatment and recovery. Identifying realistic expectations of the patient is a key to successful treatment, methods and goals. Additionally, informed patients of brain origins of addiction can also benefit from understanding that the illness they have has a biological basis and doesn’t mean that the patient(s) are bad, weak or undisciplined.

Tolerance and/or dependence occurs when the brain cells that have opioid receptors on them gradually become less responsive to the opioid stimulation, requiring more of the opioid in order to achieve the same effects. When I worked in a Methadone Clinic in Ft. Collins, CO, we had a poster on the wall that said, “When you want to stop using, but your brain won’t let you…”. Amazing what one can learn from a poster!

Once the brain gets used to a substance, it wants it more and more, creating a “brain struggle” as it now begins to go through Opioid withdrawal and unpleasant withdrawal symptoms. By the way, these symptoms include restlessness, nausea, vomiting, diarrhea, shortness of breath, drowsiness (the “nods”), runny nose (rhinitis), irritability, and even death!

The parts of the brain that struggles with the opioid withdrawal include the “locus coeruleus” or the LC and the mesolimbic reward system. The LC produces a chemical called noradrenaline that sends its chemical signal to the part of the brain (brain stem) that stimulates wakefulness, breathing, blood pressure, and alertness among other functions. Basically, when these functions are suppressed, the patient begins to experience drowsiness, slowed respiration, low blood pressure (common effects of opioid intoxication). No wonder that extensive use of opioids leads to unconsciousness, lethargy and death!

THE PHARMACOLOGICAL INTERVENTIONS AND TREATMENT OF OPIOID ADDICTION

If anything you’ve read so far sounds familiar to you or a friend, it’s time to think about treating this addiction so it does not go any farther. I say this so that you can get on top of this. Many people who prolonged their treatment options for too long are no longer with us. Don’t be that person! When a person over-doses on opioids and make it to the ER while they are still alive, the ER physician/staff administer NARCAN, a drug used for emergencies that will take the patient out of their “horror-show” withdrawals. The goal is to get to the ER BEFORE one goes into cardiac arrest….

There are several treatment options open for a patient who is experiencing the symptoms consistent with serious withdrawal or dependence/addiction. Here are a few of the options:

Naltrexone – (known as Vivitrol, ReVia) is medication is used in the ER (NARCAN) to assist with detoxification and relapse.  It impacts the mu receptor site in the brain and  keeps other opioids from attaching to the opioid receptors, so addictive opioids cannot attach to these receptors. Another benefit is that Naltrexone attaches to the receptor sites 100 times more strongly than regular opioids do, essentially blocking opioids from any chance of attaching and essentially blocks the feeling of pleasure that one would get from other opioids. In order to begin this medication, patients must be completely detoxified from ALL opioid medications, including methadone.

Suboxone - it is actually a combination of two drugs nalaxone and buprenorphine.  As a partial opioid agonist, buprenorphine’s job is to deliver very diminished opioid doses to a patient who is addicted to a stronger opioid. It provides a way for the client to be gradually weaned off their pre-existing addiction, while minimizing the opioid withdrawal symptoms that would come from the process.  The other drug in Suboxone is naloxone, a pure opioid antagonist. An agonist excites an opioid receptor; an antagonist shuts it down blocking agonists from reaching the receptor and even reversing the effect of opioid agonists already in the patient’s system by intercepting the signals that the receptors send to the nervous system.

Buprenorphine – It, too reacts to the mu receptors. It has two different effects. One, a low dose of this medication has a similar effect as methadone, while at higher doses behaves as naltrexone.

Methadone – This is one of the synthetic opioids that are long lasting, unlike morphine, heroin and other opioid drugs that remain in the system for a short time. Because methadone has a steadier, long acting influence on mu receptors, it relieves cravings, urges, and compulsive drug use. Some people who enter methadone maintenance programs believe they can still use heroin or other opioids and get high. Methadone is blocking those receptors in the brain and the only thing that can happen to someone determined on still getting high will just…GET DEAD due to an overdose!

LAAM – This medication is a longer acting cousin of methadone, in fact, it is a derivative of methadone (see, there is a genetic- family resemblance!). A patient that opts for LAAM can receive it three times per week. The main concern with this drug comes from recent concerns about heart rhythm problems (it is very limited in use in the US, due to FDA’s 2001 warnings).

While these medications may sounds like a cure all, they work best when combined with individual counseling and therapuetic groups. 

Pingora Behavioral Health currently has funding to help offset the cost of these medications.  

Please contact us at (307) 463.0337 to discuss your options.  

 

*These sublingually administered formulations of the partial opioid agonist buprenorphine were the first medications for opioid dependence since methadone and LAAM.

#Opioids exert their pharmacological actions through three opioid receptors, mu, delta and kappa whose genes have been cloned (Oprm, Oprd1 and Oprk1, respectively). Opioid receptors in the brain are activated by a family of endogenous peptides which are released by neurons.

HOW DO I KNOW IF I HAVE AN OPIOID PROBLEM?

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"I am currently taking an opioid medication prescribed by my doctor. I had surgery on my knee and I am taking the medication as prescribed. How do I know if/when I develop a problem with this medication?”

Every day, many well-meaning doctors and dentists prescribe opioid medications, such as oxycontin, hydromorphone, Percocet, Demerol* and even Fentanyl* for post-surgical pain or for serious, acute pain due to the patient’s treatment needs. The truth about opioid medications is that while they help with pain, the long-term effects of these kinds of medications may cause the patient to develop a tolerance to the prescription dose which may require a higher dose to achieve the same pain-relieving effects. Building a tolerance to the medication isn’t necessarily a bad thing, but recognizing this and talking to one’s physician is imperative for ongoing medication treatment. It is important to talk with your physician about why you might need a refill and to ask about other pain reliving alternatives. 

Developing a tolerance is a normal process. Even coffee drinkers find that it used to take one cup of joe to get started in their day, but soon many begin to require 2, 3 even 4 cups of coffee in order get the same effect! This is tolerance.

Opioid tolerance is common among long-term opioid users. The physician will be able to help you in the process called “titration”, which is gradually stepping down one’s dose. Going to quickly can create some awful symptoms, called withdrawal. This can lead to horrible side effects, such as sweats, shaping, seizures, even death.

So how do we know if there’s a problem? And what is the difference between dependence and addiction?

First, dependence tells us that we are becoming so tolerant to the medication that it takes more of the same drug to get the desired effect. Therefore, an open line of communication with our physician is important, so that the titration process can begin safely.

Addiction, on the other hand, is having the dependence to the medication and being willing to go to any lengths to get the medication, use the medication and recover from its effects. Often, people with this problem are willing to commit crimes or to go to ANY length, to obtain the medication! When this occurs, this person will need some immediate medical assistance.

Keeping track of how many days, weeks, etc. is important to avoid serious withdrawals and keeping the dependence from becoming an addiction! Keep your physician aware of any concerns you may have to avoid a serious problem…one that can be deadly!

*Synthetic opioids which are created in a laboratory and used for medical purposes only.

Now, to discuss how we know when we have a problem with opioids – here are some examples:

1.      Using more than prescribed each day/week, resulting in running out of medications before they are ready to be refilled.

2.     Doctor or pharmacy shopping. This entails either attempting to go to several different physicians to get scripts, and/or trying to get those scripts filled at different pharmacies.

3.     Feeling the effects of withdrawals when discontinuing these medications. Examples are: feeling sick, like the flu (symptoms), irritable, runny nose, edgy, feeling cold at the same time you may be wrapped in blanket(s) and sweating, etc.

4.     Selling your left-over medications when you are finished with them. All unused medications should be either flushed or given to the local police department/sheriff’s office for proper disposal.

5.     Purchasing additional medications from “friends” or associates (this is also very illegal!)

6.     Obtaining opioid medication(s) from friends, family or neighbors (“borrowing a few”).

7.     Purchasing and/or consuming illegal opioids (heroin, “Roxy’s1” or any other illegal or legal substances) on the ‘street’.

If you experience any of these behaviors, go to the nearest physician or ER and advise them of your situation, so that you can begin safe detoxification.

Should you have any questions or doubts about the opioid medication or any other medications you’ve been prescribed, talk with your physician so that you can arm yourself with knowledge. It is very easy to become dependent and addicted to the opioid medications. ALWAYS ask before you begin taking medications such things as how habit-forming, or what are the side effects of a specific medication. Being safe is better than being dead! There is no “do over” once you die.

 

1 – “Roxy or Roxy’s” is the street name for a synthetic opiate known as Oxycodone.

 

Joe Stringer is a clinician with Pingora Behavioral Health Clinic. Joe has extensive history and knoweldge of working with individuals strugging with mental health and substance use issues.  

HOW DO I KNOW IF I HAVE AN OPIOID PROBLEM?

Joseph B Stringer, MA, LPC, CAP, MAC

 

“I am currently taking an opioid medication prescribed by my doctor. I had surgery on my knee and I am taking the medication as prescribed. How do I know if/when I develop a problem with this medication?”

Every day, many well-meaning doctors and dentists prescribe opioid medications, such as oxycontin, hydromorphone, Percocet, Demerol* and even Fentanyl* for post-surgical pain or for serious, acute pain due to the patient’s treatment needs. The truth about opioid medications is that while they help with pain, the long-term effects of these kinds of medications may cause the patient to develop a tolerance to the prescription dose which may require a higher dose to achieve the same pain-relieving effects. Building a tolerance to the medication isn’t necessarily a bad thing, but recognizing this and talking to one’s physician is imperative for ongoing medication treatment. It is important to talk with your physician about why you might need a refill and to ask about other pain reliving alternatives. 

Developing a tolerance is a normal process. Even coffee drinkers find that it used to take one cup of joe to get started in their day, but soon many begin to require 2, 3 even 4 cups of coffee in order get the same effect! This is tolerance.

Opioid tolerance is common among long-term opioid users. The physician will be able to help you in the process called “titration”, which is gradually stepping down one’s dose. Going to quickly can create some awful symptoms, called withdrawal. This can lead to horrible side effects, such as sweats, shaping, seizures, even death.

So how do we know if there’s a problem? And what is the difference between dependence and addiction?

First, dependence tells us that we are becoming so tolerant to the medication that it takes more of the same drug to get the desired effect. Therefore, an open line of communication with our physician is important, so that the titration process can begin safely.

Addiction, on the other hand, is having the dependence to the medication and being willing to go to any lengths to get the medication, use the medication and recover from its effects. Often, people with this problem are willing to commit crimes or to go to ANY length, to obtain the medication! When this occurs, this person will need some immediate medical assistance.

Keeping track of how many days, weeks, etc. is important to avoid serious withdrawals and keeping the dependence from becoming an addiction! Keep your physician aware of any concerns you may have to avoid a serious problem…one that can be deadly!

*Synthetic opioids which are created in a laboratory and used for medical purposes only.

Now, to discuss how we know when we have a problem with opioids – here are some examples:

1.      Using more than prescribed each day/week, resulting in running out of medications before they are ready to be refilled.

2.     Doctor or pharmacy shopping. This entails either attempting to go to several different physicians to get scripts, and/or trying to get those scripts filled at different pharmacies.

3.     Feeling the effects of withdrawals when discontinuing these medications. Examples are: feeling sick, like the flu (symptoms), irritable, runny nose, edgy, feeling cold at the same time you may be wrapped in blanket(s) and sweating, etc.

4.     Selling your left-over medications when you are finished with them. All unused medications should be either flushed or given to the local police department/sheriff’s office for proper disposal.

5.     Purchasing additional medications from “friends” or associates (this is also very illegal!)

6.     Obtaining opioid medication(s) from friends, family or neighbors (“borrowing a few”).

7.     Purchasing and/or consuming illegal opioids (heroin, “Roxy’s1” or any other illegal or legal substances) on the ‘street’.

If you experience any of these behaviors, go to the nearest physician or ER and advise them of your situation, so that you can begin safe detoxification.

Should you have any questions or doubts about the opioid medication or any other medications you’ve been prescribed, talk with your physician so that you can arm yourself with knowledge. It is very easy to become dependent and addicted to the opioid medications. ALWAYS ask before you begin taking medications such things as how habit-forming, or what are the side effects of a specific medication. Being safe is better than being dead! There is no “do over” once you die.

 

1 – “Roxy or Roxy’s” is the street name for a synthetic opiate known as Oxycodone.

 

Joe Stringer is a clinician with Pingora Behavioral Health Clinic. Joe has extensive history and knoweldge of working with individuals strugging with mental health and substance use issues.  

Holiday induced stress and depression and how to cope:

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With the Holidays fast approaching, it is important to remember that it can be a difficult time of year for some people. Often times the holidays can bring unwanted stress and expectations.   Here are a few coping strategies on how to cope.  

  • Acknowledge your feelings. If someone close to you has recently died or you can't be with loved ones, realize that it's normal to feel sadness and grief. It's OK to take time to cry or express your feelings. You can't force yourself to be happy just because it's the holiday season.
     
  • Reach out. If you feel lonely or isolated, seek out community, religious or other social events. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships.
     
  • Be realistic. The holidays don't have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if your adult children can't come to your house, find new ways to celebrate together, such as sharing pictures, emails or videos.
     
  • Set aside differences. Try to accept family members and friends as they are, even if they don't live up to all of your expectations. Set aside grievances until a more appropriate time for discussion. And be understanding if others get upset or distressed when something goes awry. Chances are they're feeling the effects of holiday stress and depression, too.
     
  • Stick to a budget. Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don't try to buy happiness with an avalanche of gifts.
     
  • Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That'll help prevent last-minute scrambling to buy forgotten ingredients. And make sure to line up help for party prep and cleanup.
     
  • Learn to say no. Saying yes when you should say no can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can't participate in every project or activity. If it's not possible to say no when your boss asks you to work overtime, try to remove something else from your agenda to make up for the lost time.
     
  • Don't abandon healthy habits. Don't let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt.
     
  • Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.
     
  • Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.

 

 (Stress, depression and the holidays: Tips for coping - Mayo Clinic, 2017)