Opioid Addiction and Treatment



it's important to stress the difference between dependence and addiction dependence is the tolerance one develops over time and withdrawal one suffers after stopping a drug addiction is a behavioural disorder that refers to the desire a person feels for the effects of a drug and the loss of control over their lives that they have in order to obtain it today we'll be looking at the treatment options available to those who are addicted or dependent on opioids this is healthcare triage this episode is brought to you in part with generous support from the National Institute of Healthcare Management a drug-addict unfortunately spends much of their day either high or sick the goal of pharmacotherapy to help with addiction is to reduce the amount of time spent feeling sick without achieving the high unfortunately we don't use this kind of therapy as often as we should part of that is economic we expect insurers and public health groups to fund it but the savings are realized by society at large asking insurers to pay for a program when the goals are a reduction in prison sentences doesn't always make sense the insurers another reason is the therapy isn't well understood some people think that using drugs like methadone or buprenorphine it's just swapping out one addiction for another the media hasn't always helped with this perception the best way to treat addiction is to prevent it we all knew that too many prescriptions for opioid painkillers were being written policies were put in place to try and reduce the number of unnecessary prescriptions in 2012 Blue Cross Blue Shield and Massachusetts started the require prior authorization for more than a one month supply of opioids in a two month period in just a year and a half this cut the number of prescriptions by more than six and a half million pills another issue is that many still feel like drug addiction is a moral failing rather than a personal and public health issue usually treatment begins with detoxification where we try to beat the cycle of withdrawal it often continues with rehab either in the inpatient or outpatient setting often with pharmacotherapy as well as behavioral therapy unfortunately therapy often doesn't stick about half of those in rehab relapse behavioral treatments work to help patients learn to live without drugs to overcome cravings to avoid situations that could make drug use more likely and to deal with relapse the objective of treatment is to reduce dependence on drugs to reduce morbidity and mortality caused by them to improve mental and physical health to prevent illicit behavior and to help people reenter society now trek zone is an antagonist medication which means that it blocks opioid receptors when someone is given now trek zone then the opioids don't really work it can treat both overdoses and addiction although it's not as widely used for addiction as people don't take it consistently or tolerate it well if you stop taking it you can also get high soon after methadone is a synthetic opioid agonist meaning that it works much like opioids do it acts on the same receptors in the brains that the other opioids do and in doing so relieves withdrawal symptoms and reduces cravings for the drugs methadone is one of the most popular forms of treatment for addiction it's been shown in research to reduce hospitalizations and emergency department visits but those are only the direct costs if you also include societal costs like low productivity and crime it's hard to argue that methadone therapy for opioid dependence isn't cost-saving it's a full new opioid receptor agonist it has a slow onset of action and a long elimination half-life something like 24 to 36 hours a longer-acting derivative known as levo methadone acetate or lam exists as well it is only taken three times a week however concerns about cardiac effects has made it less widely used than other drugs buprenorphine is a partial opioid agonist meaning that it works both a bit like an agonist and an antagonist it also reduces cravings and decreases symptoms of withdrawal a number of randomized controlled trials have shown it to be significantly better than placebo it's not clear however if it's superior to methadone buprenorphine is sometimes unfairly characterized like many of these drugs as synthetic heroin but the drug is materially different than illicit opioid one formulation suboxone differs from other buprenorphine regimens and then it combines naloxone in the formulation making a euphoric experience from either the buprenorphine or any other opioid pretty much impossible all of these pharmacotherapy treatments have some problems though demand for treatment programs is very high and many of them have waiting lists access to these programs can be especially difficult in rural areas even after you get in they're also very expensive insurers don't always pay for drug treatment programs and many pharmacotherapy programs don't accept insurance even when it's willing to pay paying for office visits and medication can be a significant financial burden for those in recovery it's important to remember that addiction leads to real changes in the brain withdrawal leads to real symptoms including diarrhea abdominal pain nausea vomiting aches pain and changes in mood those are just words though the agony of withdrawal is very very unpleasant and people will do almost anything to avoid it finishing detox relieves the physical effects of addiction and withdrawal but it's the social factors and psychological effects that lead people to relapse long-term maintenance therapy can help Narcotics Anonymous is a 12-step program with the process to help people overcome addiction it's absent in space which means that it's opposed to the use of drugs and maintenance therapy this can of course be controversial some counseling programs are more compatible with maintenance therapy these can include cognitive behavioral therapies like the smart therapy program motivational interviewing and Family Therapy opioid abuse has become such a big problem the treatment is very very important given the significant relapse rates though we need to continue to look for new and better ways to treat addiction overcoming the stigmas attached to treatment is a good start understanding addiction is a change in brain structure rather than a moral failing is essential we also need further research and improvements in maintenance therapies and improved access to the treatments we have we know we spend a lot of episodes and opioids recently but there are a real problem for too many Americans these powerful drugs have been in use by humans for a long time and they're likely to remain a fixture on the human landscape into the foreseeable future for better and for worse hopefully a better understanding of how these drugs work how they can help people and how they can be dangerous will help us to get to a place where they can be used safely and for a short period of time healthcare triage is supported in part by viewers like you patreon comm the service that allows you to support the show through a monthly we'd especially like to thank our Research Associates Joe sevenson MT and our surgeon Admiral Sam thanks Joe MT and Sam more information can be found at patreon.com slash healthcare triage

40 Comments

  1. https://www.nytimes.com/2019/01/15/health/sacklers-purdue-oxycontin-opioids.html]

  2. kratom got me off of opiates

  3. These junkies simply need to learn how to act socially acceptably, grow some work ethic, grow some balls (or ovaries, as the case may be), stop using dope that likely wasn't their prescription to start with, go through the 3 day headache and get the fuck on with life. I've had to use pain meds for weeks a couple time throughout life and I quit when it was time. Not that it was fun or comfortable but it was time to quit. No big deal. OR do it til you die so the rest of us don't have to trip over your sissy asses anymore and pay for your dope while you're hanging out moaning about the bad hand you were dealt in life. A lot of us got a bad hand and we are not nodding around sniveling about it!

  4. Good afternoon my name is Freddie Rivera and I am Born in New York City in King county hospital raised in the Bronx Cypress Avenue so now here I am on Sebastian now we're through methadone I kick 140 minutes on my own. Off all medication thinking I was adopted call my friend Johnny talk from the top 59 Street if it is I got it I got to Bellevue Hospital now I'm on Suboxone when I first when I first started it I started with two I won the two for now today I took one in the morning and now I took another one I'm breaking it down myself because I don't even want nothing no type of drugs I can't wait to become government and take all drugs and throw them away and now I Surrender so that's why I'm able stickers, monsters in the boat and they could do it too because God is always watching over us like we wash down here television so my brothers and sisters that's on Edition have faith in our father that's in heaven always watching that he will give you the strength and Hope to leave everything alone because he is the cure of all paying down here in this world Freddie Rivera vs Cypress

  5. I had to move to the UK where treatment and methadone is free after 17 years fighting this shit. Had numerous catastrophic relapses when I'd be laid off or something and couldn't make a clinic payment of 95usd weekly. Can't pay, they just admin detox you out which is basically a death sentence when you're on 100mg daily for 5 plus years, and all you've accomplished is washed away.

  6. Does ns or dns fluid use for drug addiction

  7. try this website: themetaphysicsofaddiction.com

  8. Diazepam under supervision of a dokter ONLY for the days the withdrawal last helped allot!!! Yet i relapsed again for the 7th time.. going to detox clinic today verry scared

  9. Was on subs for 3 years I'm 23 now I quit I'm pretty sick but personally I think just quit being on subs and shit isn't the answer it gives you time to relax but you can't move on with life while on it I wish I would have just stopped but I figured I don't wanna stop so I might as week get a little high on subs and do it safely than be sick all the time and get really high and possibly die withdrawl sucks suboxone isn't as bad as dope it lasts twice as long but is half as intense fair trade I think we'll until the second week that is

  10. No suboxone is 24-36 hours methadone has a halflife of 48-72 hours

  11. i find the lack of mentioning of ibogaine disturbing

  12. You didn't mention insomnia!! When you trying to quitt cold turkey , the major pain and suffering let's up in about 2 weeks time ! However one can say good by to sleep for about 6 month ! I once went into the bush whit a tent and some supplies to kick the hobbit . In 4 weeks time I slept maybe 5-6hours ALL TOGETHER ! In the first 2 weeks I didn't sleep a wink ! In the second half I slept an hour here an hour there ! It v was the hardest thing to endure ! I was so exhausted, but it doesn't matter sleep simply won't come ! Finally I came back k to town ,and went to see a doctor. He gave me 30 sleeping pills , I began taking them one by one by the afternoon I popped every one of them ! After that I don't remember much but I know I finally past out near the e evening ! I slept for 15 hours ! When I woke up I felt like a brand new person it was an amazing feeling , but the next night I couldn't sleep again! It took about 5 month for normal sleep to return

  13. I can't tell you how to quit opioid cause every person have different senerios and ways to quit it. Some have strong will and can go cold turkey, some needs time to quit by lowering dosage and some might need other form of opioid or substance. But what im going to tell is how to cure what comes next that is withdrawal. Also i strongly recommend psychiatrist after quitting because things i tell you will only help you for physical aspects of withdrawal which are commonly low energy, anxiety, insomnia, hypersensitive sex drive n uncontrollable orgasms, etc
    Basically problem rises by getting too high as in any case. Most of people don't know is that opium (natural form) is very good for patients of diabetes, heart problems, paralysis and epilepsy but very low dosage is enough and by very low i mean low enough that u won't even feel a bit of high if i have to tell u weight than i will say 2-5mg of natural opium daily is more than enough. It will keep blood glucose low, BP normal and blood hemoglobin stable enough for most of above mention diseases. Also it will help nervous signals stable throughout body. To know more consider Ayurvedic studies of opium.

    Now real cure for withdrawal Organic Shilajit will help in all above diseases n withdrawal, it also keep your liver n pancreas fit without any side effect. Shilajit won't make you high so it is not addictive. It will keep your energy optimal. Take it with warm milk daily before sleep. I recommend 300mg to start with and after 1 week 500mg for 3 weeks after that you may stop but you can continue if u want to it don't have side effects.
    I also recommend natural black salt take 1/4 table spoon daily for 15 day with warm water on empty stomach in morning n don't eat or drink anything for 1/2 hour. It will clean your liver, pancreas and intestines of bad deposits and parasites. You can repeat 15 days routine after 4-5 month again.

    To get these things you can locate nearby ayurvedic medical store or order online. Don't buy premade capsules of shilajit like shilajit gold cap or shilajit 150 or shilajit pro. Try buying liquid form or dried form. Black salt is powder. If u are in India best place is Patanjali Ayurveda or divya pharmacies, i think amazon or online stores also have thier products for wolrd wide delivery.

    Btw u can buy organic shilajit at infowarslife.com too it is best organic shilajit i have used im not in anyform associated with them im just infowars fan.

  14. I'm not sure but ,if anyone else wants to learn about can you cure depression try Vaxicorn Depression Remover Guide (just google it ) ? Ive heard some awesome things about it and my friend got amazing success with it.

  15. Tolerance = Addiction ?

  16. Part of the issue is many people simply don't understand just how agonizing opioid withdrawal can be. I wouldn't wish it upon my worst enemy.

  17. Can you quite methadone useing painkillers

  18. People don't have to worry about opium addiction any more – the government stopped selling these drugs so you don't need any treatment .

  19. IBOGAINE!!! KETAMINE!! WTF is funding this?? Perdue??? LOL! CRYING. It isTHE MOST EFFECTIVE DETOX TOOL WITHOUT A RUNNER UP.. Long term recovery… better fall in love with something (not one) and give it your ALL.

  20. QB4U
    2 minutes ago
    Opiates do not stop pain messages. Only NSAID medications actually do that or numbing agents like cocaine or lidocaine. The endorphin system, in it's pain relieving mode, simply covers up bad feelings with good ones and this can be felt in the typical "runner's high." The endorphin system is also important in learning and rewarding organisms for behavior that is good for reproduction (sex) which reinforces that behavior. Because opiates hijack the reward system, addictions can be basically thought of as very strongly learned and reinforced behaviors or habits. I've volunteered working with addicts and I can say that the withdrawals are much worse than a "flew" as many doctors describe it, and I am sure it can kill people who are frail or have extreme tolerances and sensitivities. Some people when they withdraw from opiates go into a horrible psychosis that resembles a nightmarish and painful psychedelic trip (as reported by people i have volunteered helping as i have never done drug). Also it is a myth that all addicts are better off quitting. Only 5 percent of opiate addicts are able to stop, this is because once a person has been addicted to opiates their brain is changed forever and the large majority of them cannot feel normal or any kind of pleasure without these drugs even after quitting for years and will have horrible problems with depression and anxiety.

    A small minority can quit but for most addicts it is unrealistic to expect them to quit and they should be allowed access to opiates or at least drugs like bupresnorphine which only relieve withdrawals but do not get the user high if they have even a slight tolerance. Also many addicts are afraid of buprenorphine programs currently because their names are put on a list and some employers can find these records as well as police so they can never own firearms or be even denied a drivers license. Drug addicts are not second class citizens and the strict control over buprenorphine just means that criminal black market networks are now administering drugs that are strictly medicinal and do not give very much of a recreational high even to users who are opiate naive. And anyway opiate naive users always go for heroin or oxy and it's extremely rare for buprenorphine to be taken recreationally. This is why we need to allow drug addicts to buy buprenorphine anonymously from pharmacies/apothecaries. Even if it's behind the counter like birth control that would be better than now where criminal gangs are profiting from the medical treatment of addicts that are wise about having their name on some goddamn spook list.

  21. Go Vegan!

  22. i have tramadol dependency i am 6 days clean i will never touch another opiate pill again

  23. Kratom

  24. Its going to take generations to treat the "stigma" of addiction itself before people begin to heal. We need to look to Europe & the UK for 'harm reduction' not as an issue that backs up law enforcement. Portugal it is all legal. The UK will give you heroin. None of these countries would rather imprison there entire population.

  25. i have been on SUBUTEX, SUBOXONE, AND METHADONE, at high doses Methadone is nearly impossible to get high off opioids, not cos it blocks cos it binds so tightly to receptors. SUBOXONE IS A LIE I was on it for around a year and I had 3 Roxicodone 30mg my ex had and I was like fuck it ill try em out, did 3 intranasal and I got soooooo damn high, and I had been taking 16mg/4mg suboxone/naloxone for around a year (I had been in a methadone clinic and weened down to 30 from 120 to switch to subs) and it turns out that suboxone doesn't block shit that is a fact…..even seen someone do Suboxone w/naloxone intravenously and had zero withdrawl or any type of antagonist feelings, he said it felt basically just like heroin So Naloxone is nothing more than a scare tactic and put in it to make more money……all this happened about 10 years ago. The only person I know that ever got sick from suboxone had ran out of methadone and had an 8/2mg suboxone he took it while in withdrawal and it gave him the most intense withdrawals he said, everyone should know you cannot take suboxone or subutex while on methadone the buprenorphine only does this with methadone any other opioid it would have stopped withdrawals .this was a decade ago but this information needs to be shared and known.

  26. The nalaxone in suboxone if taken orally has no real effect since it has very low bioavailability the only time it ever has any effect is if its injected suboxone is its self a partial agonist-antiagonist so it will cause withsrawl itself if opioids are still present in the brain.

  27. Mate the stuff you are going with is out dated. Methadone is a bad, bad alternative to Opioid treatment. Bup. Is easier to get off but, if you got injured and needed pain relief. Your out of luck!
    We need new alternatives where there is a win win situation for all involved. I.e. changing laws to allow maintenance therapy to include reduction therapy of the original Opioid drug of addiction/dependence

  28. Healthcare Triage you should do a series on benzodiazepines, similar to the opioid series.
    Like if u agree

  29. I’ve never liked drugs or drinking alcohol. I had lower back surgery and was prescribed Percocet. I didn’t want to take it but days after the surgery Ibuprofen wasn’t cutting it and the pain was horrific, way worse then pre surgery. So I took a pill and within 30 minutes the edge of the pain subsided and I remember getting very tired. I continued that week to take a pill every 4-6 hours to keep the pain at bay. I then remember how quickly by the next week I needed a pill every 2-4 hours to get the same relief. The tolerance level changed at the speed of light. 3 weeks in i was returning to the doctor for more pain medication and it was easily refilled. Now the fact that the actual surgery caused me an exuberant amount of pain that wasn’t present before the surgery is one big issue that with the pills made a death spiral that I couldn’t control. Fast forward 3 years and here I am in trouble still. I need out and I hear Suboxone is the only way out. I plan to contact a local doctor and hopefully get on the program while continuing to work.

  30. I find that being opioid dependant (complex regional pain syndrome, a chronic pain syndrome) is way worse than addiction. God forbid I start going through withdrawal as I end up in such bad pain I scream, vomit and sometimes pass out from my blood pressure going too high.

  31. 3:03 “Addition” I’m sure you’d like to fix that.

  32. Sorry sir, you don't know what you're talking about : " an addict spend his day either high or in pain".
    Bullshit, when you're hooked on heroin, after a while you must use just to be "normal", getting high is something of the past, so most of the time you're neither high or in pain, you're just not withdrawing.
    I have (unfortunately) 30 years of in and out of heroín use, never injected, i've never been a thief and never stop working, and i am now helping others with these kind of false ideas spread by people who just read about it, mostly doctors of some kind, but don't know the reality of the matter.

  33. Kratom will fix the withdrawal not meds methadone suboxen period!

  34. PAIN. The Only reason that my Doctor Rx Hydrocodon-Acetaminoph for me. I have been taking this medicine for over 20 years with no constipation and no escalation in dose. I take it as prescribed, I use a bottle cap timmer so as not to take it too often. If I didn't have Back and Joint pain, I wouldn't be taking it.

  35. I've been on Methadone for a little over a year and taking it was the smartest decision ever made. I was addicted to pills for 20 years and my life was miserable and the only thing I looked forward to was dying. Methadone treatment has given me my life back and am has allowed me to repair the broken relationships I had with family and friends. I just wish more people could understand how helpful Methadone is.

  36. to all and any of you that have ever shunned/put down an opiate addict: FUCK you. You are worse than worthless. I have no words that come to mind to help me express how much I dearly wish you could sustain some injury that causes you to have no option but to get on strong opiates, then get cut off and have to "make do" out on the streets. Addicts are not the problem. You are the fucking problem and I wish I could alleviate you as the problem. no….I'll go further… I wish I personally could have the pleasure to free you from the tyranny of physical reality. (in case you're a fucking idiot, that last thought means literally "I wish I could be the one that ends your pathetic fucking life")

  37. I watched all your videos on Opiods, NOT ONCE DID YOU MENTION WHEN THE CHRONIC PAIN IS NOT IN YOUR BRAIN AND IS REAL, YOU HAVE MADE THIS WAR ON OPIATES ABOUT ADDICTIONS, I GO TO MY PAIN MGT DOC, I PEE IN THE BOTTLE NOW TO INSURE I'M A GOOD LITTLE 62 YEAR OLD BOY TAKING MY MEDICATIONS AS PRESCRIBED, I'M POST SURGICAL CERVICAL SCREWED UP PERSON THAT HAS IMPINGEMENT, LOOSE SCREWS IN THE PLATE AND A MYLEOGRAPHAM THAT DOCUMENTS ALL OF THIS, BUT YOU STILL WANT TO TAKE THE ONLY THING THAT GETS ME ANY QUALITY OF LIFE. I SPEND 25 AVERAGE DAYS A MONTH IN BED. AND THIS IS THE REALLY IMPORTANT THING YOU STUPID PEOPLE DON'T GET, 17 YEARS I HAVE BEEN ON SOME LEVEL OF OPIATE THERAPY, THE LAST TIME I ACTUALLY FELT SOME TYPE OF HIGH, WAS ABOUT 17 YEARS AGO, ALL I FEEL IS A RED HOT KNIFE IN MY NECK AND BACK THAT HURTS TEN FOLD TO ANY RELIEF FROM MY CHRONIC PAIN SYNDROME….YOU TAKE THE PAIN AWAY AND YOU CAN HAVE YOUR DRUGS BACK, I WOULD ENJOY BEING ABLE TO HAVE A NORMAL BOWEL MOVEMENT, OH AND BY THE WAY I'VE NEVER HAD ONE INSTANCE OF SIDE AFFECTS THAT ALL YOU THREE LETTER FEDERAL GOVERNMENTS PEOPLE THAT LOOK AT THE BOTTOM LINE OF THE OLE MIGHTY DOLLAR VRS MY NECK FAILURES. YOU SEE, I GOT HURT IN THE LINE OF DUTY AS A POLICE OFFICER PARAMEDIC AND ONCE I WAS NO LONGER ABLE TO RETURN TO DUTY I HAVE DONE NOTHING BUT FIGHT, FIGHT, FIGHT. I HAVE SO MUCH COPIES OF RECORDS AND DOCUMENTED PATHOLOGY, YET EVERY 28 DAYS I HAVE TO GO PEE IN A BOTTLE AND BE A NICE LITTLE 62 YEAR OLD AND HOLD MY BREATH EVERYTIME I DUE, BECAUSE THE STATE INSURANCE CARRIER CONTINUOUSLY SENDS MY PAIN MANAGEMENT TO UTILIAZTION REVIEW AND AS OF LAST FRIDAY COULDN'T GET MY MEDS UNTIL I CALLED THREE PEOPLE, SHORT OF SCREAMING AT THE IDOSY OF THIS SYSTEM. I LAY HERE IN BED TYPING THIS AS THE RED HOT KNIVES ARE SENDING MY BRAIN SIGNALS SAYING I HURT LIKE HELL, MAKE IT STOP. WELL THE PAIN NEVER STOPS BUT IS MEDIATED.
    WE ARE ALL INDIVIDUALS, MY BODY CHEMESTRY IS NOT LIKE ANYONES ELSE…WE OUGHT TO KNOW THIS OF THE COMPLEXITY OF THE DNA SEQUENCY OF THE HUMAN GENOME. STOP YOUR WAR ON ALL OF US THAT HAVE NO LIFE BECAUSE BECAUSE THE PAIN IS REAL, THE PAIN IS REAL, DID I TELL YOU THE PAIN IS REAL?

  38. If you want to quit opiates use Kratom. It will work 100%.

  39. Smoking weed to overcome opioid addiction? What's your opinion on it?

  40. why can't people see if using Herion give clean Herion that is safe and stops crime ect

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