Category Archives: MAT

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Drug Rehabs West Palm Beach Options

Drug rehabs West Palm Beach options are plentiful when seeking inpatient, substance abuse intensive outpatient treatment ( IOP ), or opiate detox. Finding a rehab center near you starts with recognizing that you have a problem and seeking out effective addiction treatment options. Finding the best opiate detox centers and drug and alcohol addiction treatment programs in West Palm Beach, Ft Lauderdale, and Miami can influence your treatment process and outcome.

How to Find the Best Drug Rehabs West Palm Beach

researching best drug rehabs west palm beachYou want to check the addiction recovery centers online reviews and ratings when searching the best drug rehabs West Palm Beach. There are also qualified physicians and Doctors that provide more individualized care over the drug and alcohol addiction treatment centers West Palm Beach. There are only a few qualified physicians that can offer outpatient opiate detox, medication assisted treatment and opiate treatment for pregnant women. Treating opioid addiction with medications such as buprenorphine (Suboxone, Zubsolv, Bunavail) drastically reduces the risk of opioid overdose death by 40-60%.  MAT (medication assisted treatment) medications allow a patient suffering from opioid use disorder to stabilize, stop obsessing over their drug of choice, quell unbearable withdrawal symptoms, assist with craving reduction, and greatly enhances the patient’s retention in treatment. These drug addiction treatments such as partial hospitalization program ( PHP ) and intensive outpatient program ( IOP ) and MAT, alongside effective therapy at a quality treatment center and ongoing work such as attending N.A., A.A. and “working the steps” is the best chance a patient has at achieving and maintaining long-lasting sobriety.

Opiate Drug Detox, Prescription Medications and Alcohol Detox Options from the Best Drug Rehabs West Palm Beach

You can start your recovery from the use of alcohol, opiate drugs, and prescription drugs by searching for the best substance abuse detoxification programs. Drug rehabs West Palm Beach have inpatient and outpatient detox options for alcohol and drugs. Whether you are seeking a detox from prescription drugs, heroin or alcohol there are many options available in West Palm Beach. However, a medically supervised detox and possibly the provision of ongoing MAT medications by a qualified physician is the best option when trying to overcome substance abuse.

Inpatient Opiate Detox West Palm Beach Options

Get educated on what you need to know about inpatient opiate detox programs. Be prepared and understand the drug and alcohol detoxification process. The best drug rehabs West Palm Beach provide a variety of substance abuse treatment programs. Inpatient and oftentimes out-patient detox. These drug rehabilitation centers work with Doctors and private clinicians to provide the safest medically assisted detox and drug rehabilitation treatment programs.

Inpatient opiate detox has advantages but also has dis-advantages. One advantage is that patients live at the center with 24-hour care. This care provides qualified medical staff that cares for patients’ immediate needs especially from withdrawal. However, this individualized medical care comes at a much higher cost of ridding your body of alcohol or drugs. Another advantage is that individuals are unable to leave the detox center and do not have access to seek drugs or alcohol.  Lastly, at times in-patient detox is the only safe alternative for a patient.  This is often the case if the patient is addicted and dependent upon alcohol and benzodiazepine type sedatives.

Outpatient Opiate Detox West Palm Beach Options

outpatient-opiate-detox-west-palm-beach-addiction-treatment-optionsWhether you’re seeking outpatient opiate detox West Palm Beach or outpatient alcohol detox there are many options in South Florida. Outpatient opiate detox is an excellent and safe option for some to start their recovery journey. The National Institute on Drug Abuse performed a study “Patients Addicted to Opioid Painkillers Achieve Good Results With Outpatient Detoxification.” Other options also include rapid outpatient detox and a virtually painless 5-day outpatient opiate detox option with the Bridge Device. This option is far less expensive than a tradition detox.

Only a qualified physician, after a complete examination, should determine if and what outpatient detox program or an inpatient detox program needs to be administered. The individualized care by a qualified physician is the best option for you or a loved one. Qualified physicians, in order to perform outpatient detox, must have specialized training and DEA authorization. This is even more important for pregnant women seeking opiate detox and prescription drug detox.

There are a limited number of qualified physicians that have these appropriate credentials. The Drug Addiction Treatment Act (DATA) credential enables private physicians to provide an outpatient detox and outpatient-based treatment. This option gives hope and care to thousands of individuals suffering from drug addiction. You can learn the DATA legislation, regulations, and guidelines on SAMSHA’s (Substance Abuse and Mental Health Services Administration) website. This is vital information when seeking the best drug rehabs West Palm Beach. This information will allow you to ask more informed questions to ensure you are going to get the best treatment option available for your individual circumstances.

Residential Inpatient Drug Rehabs West Palm Beach Options

residential-drug-rehabs-west-palm-beachTrying to find the best residential inpatient drug rehabs in West Palm Beach, Ft Lauderdale, and Miami? One of the most popular search terms is Drug Rehabs Near Me. However, you must find out if residential addiction treatment or inpatient drug rehabs are the options you need. This level of care provides medical supervision 24 hours a day.

Residential rehab is needed in severe cases of drug and alcohol addiction. Often, addiction is associated with other mental and behavioral health issues. When this occurs, it is known as “dual-diagnosis”. Residential rehabilitation services strive to provide enough time for individuals to learn long-term recovery strategies. Residential Inpatient Addiction Treatment Centers provide tools and coping skills that become their clients’ new lifestyle. Here is what you can expect while attending a residential inpatient addiction treatment center.

  • Medically supervised inpatient detox.
  • Medication Assisted Treatment (MAT) options, if necessary.
  • Relapse prevention skills.
  • Individual counseling focusing on the dual diagnosis issues and how to maintain long-term recovery.
  • Family counseling guiding the individual and family members on how to foster an environment to sustain recovery. This counseling also restores the family bond and trust. The disease of addiction is a family disease!
  • Group therapy sessions with others suffering from drug addiction. These groups work best if the participants are in the same age group and have common issues and interests. This is a peer support mechanism where individuals connect with others suffering from drug and alcohol addiction.
  • Building new life skills and education on long-term recovery.
  • An aftercare program for when residential treatment ends.

Outpatient Drug Rehabs West Palm Beach Options

opiate-drug-rehabs-west-palm-beach-stick-to-the-planOutpatient drug rehabs have many loose terms to describe this level of care. It is referred to as Partial Hospitalization Program (PHP) or Day / Night Treatment, IOP (intensive out-patient), or Outpatient (OP). These options can be provided by recovery centers or specialized and credentialed physicians. Unlike drug inpatient programs, it allows those in treatment to live at home or a sober living residence.  The levels of care are moved through at the pace and frequency best-suited to the individual patient. It depends on how well and stable the patient is with regards to his or her recovery from substance abuse. It also takes into account their mental health status.

Typically once a patient reaches the IOP and OP levels of care they can hold down a job, spend time with family and transition back into a less structured and more “normal” lifestyle.  It is of paramount importance, however, that as patients transition out of structured treatment that they continue to treat their chronic disease of addiction!  This addiction treatment usually entails honoring the natural tendency of addiction to recur. It simply cannot be ignored and involves working some type of individual program.  This often involves regularly attending N.A. or A.A. meetings, working the 12 steps, reading the “Big Book’. There are many other supportive strategies such as maintaining a relationship with a quality sponsor or even religious-based activities.

As with all treatment options, a detailed addiction treatment plan should be in place. This substance abuse recovery plan should be put into place by all that are providing care. This should include the physician, counselors, private clinicians, family, aftercare, and if it is a good fit for the patient, 12 step recovery options. The goal is to make sure the individual in treatment can transition back into everyday life without relapsing.  This is best accomplished by not being complacent and remembering that if you do, in fact, elect to ignore this ongoing treatment, your addiction will be doing pushups on your shoulder, getting stronger all the time!  A great majority of relapses occur when patients pretend they never had an addiction, get “too busy”, prioritize other things in life, and generally become lackadaisical about their recovery.  This is exactly when relapse happens!

The Best AA Meetings West Palm Beach Options 

Graph showing the Top 10 best AA Alcoholics Anonymous Meetings West Palm Beach

Top 10 Best AA Alcoholics Anonymous Meetings West Palm Beach

During and after completing drug and alcohol addiction treatment many will seek the best AA meetings in West Palm Beach. South Florida hosts the nation’s best meetings mostly due to the presence of over 600 recovery centers nestled in Florida. It’s not a surprise that Palm Beach County hosts many good AA meetings. Alcoholics Anonymous and Narcotics Anonymous allow membership in a supportive and cohesive brotherhood, as well as an ongoing education providing tools for long-term recovery. With over 2 million members worldwide it is instrumental in providing and sustaining recovery for many individuals.

Consider All the Options When Finding the Best Drug Rehabs West Palm Beach

When seeking the best drug rehabs West Palm Beach consider drug addiction detox, inpatient rehabs, outpatient drug addiction treatment, and medication assisted treatment options. Get educated on all the levels of care. Remember to have a qualified physician perform a complete evaluation and make a detailed substance abuse treatment plan. Many professionals are involved with your recovery and need to be involved in the planning and kept informed every step of the way. Addiction recovery is a life-long process and getting the tools and education is the first step to your new life. Seek help today if you are dependent on opioid drugs, prescription medications or alcohol!

brain-disease-addiction-treatment-west-palm-beach-florida

Disease Models of Opiate Addiction

Addiction treatment Centers West Palm Beach are doing as much as they can in treating drug and alcohol addiction. They are face with difficult barriers from the insurance companies shortening the length of time payable for addiction treatment.

Addiction Treatment Centers West Palm Beach Fighting the Heroin Epidemic

As most of us are aware, the opioid and heroin problem in our country is at epidemic proportions, and I would go so far as to state unequivocally that we are dealing with a magnitude and severity of a situation in addiction medicine that is unprecedented in nature.  Suddenly, relapse isn’t an “oops let me try again”, it is DEATH.

Addiction-treatment-centers-west-palm-beach-florida-fighting-the-heroin-epidemic

A recent CNN article detailed some alarming statistics:  “heroin-related deaths increased 439% from 1999 to 2014. As of 2014, heroin-related deaths had more than tripled in five years and quintupled in 10 years.  In 2014, opioids were involved in 28,647 deaths — 61% of all US drug overdose deaths — and 10,574 were related to heroin, in particular. Data from 2014 reflects “two distinct but interrelated trends,” the CDC notes, a long-term increase in overdose deaths due to prescription opioids and a surge in illicit opioid overdose deaths, mostly related to heroin.”

In my personal addiction treatment medicine practice, I would estimate that approximately 70% or greater of my addiction treatment patients in the West Palm Beach, Florida area are addicted to heroin.  Very clearly, the near-universal mechanism by which we as a country have dealt with substance use disorders to date, namely traditional 12 step rehab, is inadequate in this new and exploding population of opiate use disorder patients.

Two Addiction Treatment Thought Models Adopted by Addiction Treatment Centers West Palm Beach

There are two prevailing “thought models” which attempt to explain the pathophysiology behind addiction.  The first is termed “the moral model”, which asserts that addiction is entirely a choice and secondary to an individual’s moral decision-making (or lack thereof).  This model presupposes that, if not for one’s dysfunctional values and choices, he or she would not have an addiction problem.  The second model is known as the “disease model”, which categorizes addiction as a chronic disease.  ASAM (the American Society of Addiction Medicine) defines addiction as ”a primary, chronic disease of brain reward, motivation, memory and related circuitry”.

us-sergeon-general-Vivek-H-Murthy-pleading-for-medication-assisted-treatment-by-addiction-treatment-centers-west-palm-beach-floridaAs part of a recent landmark statement, the US Surgeon General, Vivek Murthy, distinctly stated that addiction is “a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”  Furthermore, President Obama’s 2017 fiscal year budget includes $920 million to support cooperative agreements with States to expand access to medication-assisted treatment for opioid use disorders.  All of this did not happen on a whim- these statements and decisions are directly based on clinical evidence that including MAT in the treatment of the chronic disease of addiction increases the likelihood of abstinence from the illicit substance and decreases the probability of overdose and death.

Adopting Medication Assisted Treatment to Save Lives

Accepting addiction as a chronic disease mandates that we, as addiction professionals, view and treat it in the same multi-disciplinary manner in which we treat other chronic diseases. Namely a COMBINATION of medical interventions and behavioral adjustments and modifications.  In other words, we as physicians don’t look at an obese diabetic patient and simply say “lose a hundred pounds and your diabetes will go away” and omit insulin therapy.  Nor do we look at a smoker with emphysema and simply say “stop smoking and you will breathe better” and omit inhalers that improve lung function.  Are the insulin and inhalers, respectively, “crutches” for these patients?

I suppose one could look at it that way, but mainstream medicine, and our society would submit that these medications are imperative to preserve life and improve the quality of one’s life.  So, if the addition of medication is perfectly acceptable, appropriate and the actual standard of care for all these other chronic disease states, why the stigma when discussing medication as it applies to the chronic disease of addiction?   As an addiction medicine physician, I feel that it is imperative to at least consider utilizing all available tools at our disposal, and this includes Medication-Assisted Treatment.

Ensuring Addiction Treatment Clients Get the Correct Care

responsible-medical-care-by-addiction-treatment-centers-west-palm-beach-FloridaHaving said that, medication assisted treatment should also not be used in a cookie-cutter fashion and is not appropriate in all forms for all patients.  The specifics regarding medication assisted treatment medications are beyond the scope of this introductory article, but will be detailed in a future editorial.  However, suffice to say that, when used responsibly and appropriately, MEDICATION ASSISTED TREATMENT saves lives.  Our national academy and addiction authority, ASAM, our surgeon general, our Country’s President and addiction medicine physicians in the trenches with these patients concur that that is, indeed, the case. This goes far beyond addiction treatment centers West Palm Beach and is a serious national problem.

The addiction treatment centers West Palm Beach recovery community cannot continue to treat our current climate of heroin addiction in a rigid, dogmatic fashion, or thousands of more deaths will be left in the wake- guaranteed.  I would submit this question to the recovery community as a whole: given the REALITY that abstinence is only attainable by approximately 10% of our patients addicted to heroin, what should our answer be to the other 90%?  Attain the recovery community’s traditional idea of abstinence or go die?  During the treatment, no other disease would that be the sentiment.

harm-reduction-plan-b-for-addiction-treatment-centers-west-palm-beach-florida-fighting-the-heroin-epidemicThe logical answer is harm reduction.  If a portion of our patients are utilizing some form of medication assisted treatment, yet going to work, having meaningful relationships, and living a fulfilling life devoid of crime and an elevated risk of death and communicable disease, what is wrong with that?  If I could actually attach a title to the current arena of mainstream heroin addiction treatment it might be “Abstinence- worth dying for.”  The unyielding ideals in the context of the current patient population are at the very least antiquated and simplistic, and at the very most, downright dangerous.

In summary, we have an absolute epidemic of opioid/heroin abuse in this country of a never-before-seen magnitude, and our current and historic methods of dealing with alcoholism and other addictions are NOT WORKING.  Traditional 12-step, “abstinence-based”, one-size fits all programs are simply NOT acceptable as a uniform approach to this new and evolving segment of addicts, and these patients are DYING IN RECORD NUMBERS.

not one more addiction treatment centers west palm beach must adopt medication assisted treatmentThe primary difference between heroin and alcohol or other drugs of abuse is that with ANY relapse, just ONE use or momentary lapse in judgment, the heroin addict has a significant rate of sudden death.  Perhaps being dogmatic about traditional, Big Book, 12 step programs is more acceptable when the risk of relapse does not include the very high likelihood of immediate death.  But, because of the totally unknown mixture of drugs in each purchased “bag” or “cap”, including the most potent opioids known to man, namely fentanyl and carfentanyl, a relapse is not necessarily an invitation to “try again”, but is a game of Russian roulette often ending in death.

In my time treating addiction patients with substance use disorders I have often heard the statement “the definition of insanity is doing the same thing over and over again and expecting a different result.”  I think the way we are currently treating our heroin-addicted patients accurately, albeit ironically, fits that definition.   It is time that addiction treatment centers West Palm Beach and nationally stop preaching and demanding that our idea of “abstinence” in the course of addiction treatment is the ONLY acceptable goal.

We can continue jumping up and down screaming abstinence-based rhetoric while our patients continue to die, or we can think more pragmatically about the issue and consider the non-judgmental addition and acceptance of appropriate medically-based therapies to the paradigm of addiction treatment.  Our patients’ lives truly depend on our willingness in the recovery community to adapt to this uncharted territory by implementing the same treatment paradigm that we use as a society in any other chronic disease.

 

MAT MEdication Assisted Therapy opiate detox west palm

Medication Assisted Treatment MAT; A New Breed of Drug Addict

Medication Assisted Treatment Disease Models, and Addiction Treatment for Opiates

Medication assisted treatment MAT in West Palm Beach, FL needs to be addressed. At Whole Health outpatient addiction treatment clinic in West Palm Beach, FL., we see 100’s of patients suffering from drug and alcohol addiction. Many do not have a clear understanding on MAT due to bad information on social media. We see many social media posts giving incorrect information, mainly based on personal experience. MAT must be properly diagnosed by a qualified addiction physician.

As most of us are aware, the opioid and heroin problem in our country is at epidemic proportions, and I would go so far as to state unequivocally that we are dealing with a magnitude and severity of a situation in addiction medicine that is unprecedented in nature. Suddenly, relapse isn’t an “oops let me try again,” it is DEATH.

Too Many Deaths from Opiate Epidemic

A recent CNN article detailed some alarming statistics: “heroin-related deaths increased 439% from 1999 to 2014. As of 2014, heroin-related deaths had more than tripled in five years and quintupled in 10 years. In 2014, opioids were involved in 28,647 deaths, 61% of all US drug overdose deaths and 10,574 were related to heroin, in particular.

addiction treatment Fort Lauderdale, West Palm Beach, and Miami Florida

Data from 2014 reflects “two distinct but interrelated trends,” the CDC notes, a long-term increase in overdose deaths due to prescription opioids, and a surge in illicit opioid overdose deaths, mostly related to heroin.” At Whole Health outpatient addiction treatment clinic, 70% or greater of our patients are addicted to heroin. Very clearly, the near-universal mechanism by which we as a country have dealt with substance use disorders to date, namely traditional 12 step rehab, is inadequate in this new and exploding population of opiate use disorder patients.

Addiction is a brain disease opiate addiction treatment west palm

There are two prevailing “thought models” which attempt to explain the pathophysiology behind addiction.

Moral Model of Addiction

The first is termed “the moral model,” which asserts that addiction is entirely a choice and secondary to an individual’s moral decision-making (or lack thereof). This model presupposes that, if not for one’s dysfunctional values and choices, he or she would not have an addiction problem.

Disease Model of Addiction

The second model is known as the “disease model”, which categorizes addiction as a chronic disease. ASAM (the American Society of Addiction Medicine) defines addiction as ”a primary, chronic disease of brain reward, motivation, memory and related circuitry”. And as part of a recent landmark statement, the US Surgeon General, Vivek Murthy, distinctly stated that addiction is “a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer”.

Medication Assisted Treatment MAT Supported

Furthermore, President Obama’s 2017 fiscal year budget includes $1.1 billion to support cooperative agreements with States to expand access to medication-assisted treatment for opioid use disorders. All of this did not happen on a whim. These statements and decisions are directly based on clinical evidence that including MAT in the treatment of the chronic disease of addiction increases the likelihood of abstinence from the illicit substance and decreases the probability of overdose and death.

Medication Assisted Treatment (MAT) Education Needed

Accepting addiction as a chronic disease mandates that we, as addiction professionals, view and treat it in the same multi-disciplinary manner in which we treat other chronic diseases. Namely a COMBINATION of medical interventions and behavioral adjustments and modifications. In other words, we as physicians don’t look at an obese diabetic patient and simply say “lose a hundred pounds and your diabetes will go away” and omit insulin therapy.

Whole Health Primary Care Physician Delray Beach FL

Nor do we look at a smoker with emphysema and simply say “stop smoking and you will breathe better” and omit inhalers that improve lung function. Are the insulin and inhalers, respectively, “crutches” for these patients? I suppose one could look at it that way, but mainstream medicine, and our society as a whole, would submit that these medications are imperative to preserve life and improve the quality of one’s life.

So, if the addition of medication is perfectly acceptable, appropriate and the actual standard of care for all these other chronic disease states, why the stigma when discussing medication assisted treatment MAT, as it applies to the chronic disease of addiction? As an addiction medicine Doctor, I feel that it is imperative to at least consider utilizing any and all available tools at our disposal, and this includes MAT (Medication-Assisted Treatment.)

Medication Assisted Treatment MAT opiate detox west palm

Having said that, medication assisted treatment MAT should also not be used in a cookie-cutter fashion, and is not appropriate in all forms for all patients. The specifics regarding MAT medications are beyond the scope of this introductory article, but will be detailed in a future editorial. However, suffice to say that, when used responsibly and appropriately, MAT saves lives.

Our national academy and addiction authority, ASAM, our surgeon general, our Country’s President, and addiction medicine physicians in the trenches with these patients concur that that is, indeed, the case. The recovery community cannot continue to treat our current climate of heroin addiction in a rigid, dogmatic fashion, or thousands of more deaths will be left in the wake- guaranteed.

Abstinence, or Die (What’s Really Happening in the Recovery Community)

I would submit this question to the recovery community as a whole: given the REALITY that abstinence is only attainable by approximately 10% of our patients addicted to heroin, what should our answer be to the other 90%? Attain the recovery community’s traditional idea of abstinence, or go die?

harm reduction opiate addiction treatment west palm Medication Assisted Treatment MAT

In the course of treating no other disease would that be the sentiment. The logical answer is harm reduction. If a portion of our patients are utilizing some form of medication assisted treatment MAT, yet going to work, having meaningful relationships, and living a fulfilling life devoid of crime and an elevated risk of death and communicable disease, what is wrong with that? If I could actually attach a title to the current arena of mainstream heroin addiction treatment it might be “Abstinence- worth dying for.” The unyielding ideals in the context of the current patient population are at the very least antiquated and simplistic, and at the very most, downright dangerous.

Medication Assisted Treatment MAT Saves Lives

In summary, we have an absolute epidemic of opioid/heroin abuse in this country of a never-before-seen magnitude, and our current historic methods of dealing with alcoholism and other addictions are NOT WORKING. Traditional 12-step, “abstinence-based”, one-size fits all programs are simply NOT acceptable as a uniform approach to this new and evolving segment of addicts, and these patients are DYING IN RECORD NUMBERS.

one more time could be your last Medication assisted treatment MAT saves lives

One More Time, Could Be Your Last.

The primary difference between heroin and alcohol, or other drugs of abuse, is that with ANY relapse, just ONE use or momentary lapse in judgment, the heroin addict has a significant rate of sudden death. Perhaps being dogmatic about traditional, Big Book, 12 step programs are more acceptable when the risk of relapse does not include the very high likelihood of immediate death. But, because of the totally unknown mixture of drugs in each purchased “bag” or “cap,” including the most potent opioids known to man, namely fentanyl and carfentanil, a relapse is not necessarily an invitation to “try again,” but is a game of Russian roulette often ending in death.

Harm Reduction – Medication Assisted Treatment MAT

In my time treating patients with substance use disorders, I have often heard the statement “the definition of insanity is doing the same thing over and over again and expecting a different result,” I think the way we are currently treating our heroin-addicted patients accurately, albeit ironically, fits that definition.  It’s time that we as a recovery community stop preaching and demanding that our idea of “abstinence” in the course of addiction treatment is the ONLY acceptable goal. We must embrace harm reduction.

not one more suboxone treatment west palm one more time could be your last Medication assisted treatment MAT saves lives

We can continue jumping up and down screaming abstinence-based rhetoric while our patients continue to die, or we can think more pragmatically about the issue and consider the non-judgmental addition and acceptance of appropriate medically-based therapies to the paradigm of addiction treatment. Our patients’ lives truly depend on our willingness in the recovery community to adapt to this uncharted territory by implementing the same treatment paradigm that we use as a society in any other chronic disease.

For more information on Medication Assisted Treatment MAT, or outpatient addiction treatment options in West Palm Beach, Fort Lauderdale, and Miami please visit our website HERE or call 855.365.1626 (majority of medical insurance plans and Medicare, excluding HMOs. Flexible financial arrangements are available to patients unable to afford their entire deductible or who are without insurance and are paying cash.)

More Addiction and Behavioral Health Treatment Options

 

Addiction Treatment Ft Lauderdale Whole Health Facebook Group Addiction and Behavioral Health Options

CLICK HERE to join.

Addiction and Behavioral Health Options

This group is designed to provide a resource for addiction and behavioral health professionals and individuals seeking addiction help, and individuals in recovery. In this group, you can network with professional peers and individuals seeking information on treatment from the specialists, strengthen your position in the treatment field and forge valuable new relationships. This is a place to get information on treatment, search for help, network, give and receive referrals from addiction centers, psychiatrists, psychotherapists, occupational health physicians, practitioners, health counselors, psychologists, social workers, nurses, front-line practitioners, and many other sources. Share current information, interact with each other, meet leaders in the field, and be exposed to the latest research and clinical methods and techniques. Group members can post information on treatment, info about their services, share information about addiction, recovery, holistic treatments, mental health, marketing, social media and business strategies. Group members are encouraged to network and refer each other.
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Welcome 19.500 Addiction Professional Referral Group Members
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Medicated Assisted Recovery is possible. Come share your experience without stigma or judgement. This meeting is a self-support group and is open to all.

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Please SHARE this post, it could bring hope and recovery to those attempting Medicated Assisted Treatment.
Charles Davis shared a link to the group: Addiction and Behavioral Health Options.2 weeks ago
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Medicated Assisted Recovery is possible. Come share your experience without stigma or judgement. This meeting is a self-support group and is open to all.

EVERY Sunday at noon in Santa Ana, CA.

Please SHARE this post, it could bring hope and recovery to those attempting Medicated Assisted Treatment

You may also be interested in some of our other articles on addiction treatment; “Unchecked Addiction Treatment Diseases“, “What Does (MAT) Medication Assisted Therapy Mean for Generation Z?“, and “Narcan Education by Opiate Detox West Palm Doctor“.

MAT Part 2 opiate detox west palm

MAT Part 2: Addiction Antagonist Therapy

MAT part 2 Medication Assisted Treatment a continuation of our last opiate addiction treatment article from Whole Health in West Palm Beach, FL., explained the definition and use of MAT or Medication Assisted Treatment, in addressing patients struggling with particular substance use disorders.

MAT Part 2 opiate detox west palm

The first article examined the use of opiate agonist MAT therapy (i.e. buprenorphine products/”Suboxone” and methadone),) while this installment will examine the utility of opiate antagonist MAT therapy. The principle disorder to be focused upon, primarily because of its ubiquitous nature and the fact that we are predicted to experience greater than 50000 fatalities this year (MORE THAN AUTO ACCIDENT DEATHS,) is opiate use disorder.

What is Medication Assisted Treatment MAT Part 2

First, a very brief and simplistic review of neurobiology as it pertains to addiction. Opiate addiction is all about the reinforcing experience the patient’s behavior has upon the brain’s dopamine levels (the “feel good” neurotransmitter.)

Opiate detox West Palm dopamine

All addictions, whether they be substance-based, or behaviorally oriented (such as gambling and sex addiction) are rooted in the basic fact that these activities cause a surge of dopamine in a specific part of the brain known as the nucleus accumbens. This dopamine surge is perceived as the “high.” This feeling is obviously pleasurable, and the patient wants to repeat and repeat the addictive activity, as the dopamine release becomes a positively reinforcing result of the behavior.

Opioids and Medication Assisted Treatment (MAT)

In the case of opioids, when these drugs attach to the brain’s “mu” receptors, the result is a huge surge of dopamine, which floods the nucleus accumbens, resulting in an intense and euphoric “high.” The patient uses again and again to keep experiencing that dopamine high, and if they stop using they get extremely ill with withdrawal symptoms.

Therefore, the actual use of the drug is reinforcing, while cessation of use causes them to feel horrible (i.e. Not using is NEGATIVELY reinforcing.) This “double whammy” almost guarantees that an opioid addict will continue to use and/or chronically relapse (if you recall from the first article, the “success rate” of stand-alone abstinence-based treatment such as various psychotherapy, 12 steps, etc. is only around 10% at best.)

MU Receptors Oral Naltrexone, Vivitrol and Naltrexone Implants

It is at the brain’s mu receptor sites where antagonist MAT therapies exert their effect.  Antagonist MAT therapies include oral naltrexone, intramuscular Vivitrol, and the off-label use of naltrexone implants that typically provide up to three months of medication with each implant. All of these formulations function in the same fashion- they bind to the brain’s mu receptors very strongly (much stronger than opioids,) preventing any opioids from reaching the patient’s brain and causing that euphoric dopamine surge.

Whole Health stops addiction with opiate detox west palm beach

In other words, with antagonists at work the patient will not derive any high from opioids should he or she decide to use them.  Therefore, this breaks the cycle of positive reinforcement and helps patients with opioid cravings because they know if they use they will simply not derive the expected and desired feeling. The various formulations primarily differ amongst one another in how compliant the patient is likely to be on the given therapy.

naltrexone implants opiate detox west palm Whole Health

Generally, the injection, or implant are much more efficacious than the daily oral naltrexone, because the patient can forget or “forget” to take the daily naltrexone, but the injection or implant is in their body for one or three months, respectively.  Incidentally, MAT antagonist therapy (MAT Part 2) helps immensely with alcohol cravings, and there is emerging evidence that they may be useful for other addictions as well, but that is another topic entirely. However, to stay focused on opioids, I think you can see how incredibly useful antagonist MAT can be in extinguishing the Pavlovian behavior of opiate addicts, and really assist them in putting together solid, long-lasting sober time, and often permanent sobriety!

Abstinence for up to Two Weeks (Understanding the Use of Suboxone)

What is the catch? The primary and most frequent and frustrating problem in initiating antagonist therapy is that, depending on what type of opioid the patient was using, we need anywhere between one and two weeks of total avoidance of ALL opioid and opioid-related products. This includes buprenorphine products (i.e. Suboxone) and methadone.  Therefore, for instance, we can’t take a heroin addict, stabilize him or her on Suboxone, and then transfer immediately to naltrexone/Vivitrol/naltrexone implant.

Similarly, we can’t take a patient right out of detox (opioids are actually used to detox opioid addicts) and transfer them to antagonist therapy.  The reason is that, as stated, the antagonist has a much stronger affinity for the brains mu receptors.  If there are any opioids occupying those receptors at the time that antagonists are introduced, they will “kick off” the opioids and result in severe withdrawal for the patient.

Reasons Why Many Do Not Get Antagonist Therapy (Naltrexone and Vivitrol)

So, the primary issue becomes how do we get the patient to be abstinent for the requisite one to two weeks so that we can utilize this effective antagonist therapy? Unfortunately, many addicts are unwilling or unable to be totally devoid of any and all opioids (including Suboxone or methadone) for more than a couple of days before feeling so horrible that they go right back to using. This is, indeed, the eternal challenge of initiating antagonist MAT therapy, and probably the most frequent reason why it is not implemented in more recovering addicts.

It's time for opiate detox Whole Health Delray Beach, FL

There are other reasons as well- not the least of which is a patient who refuses antagonist therapy because they are scared they won’t be able to get high (they are not “ready” to live a sober life.) Other potential downsides to antagonist MAT is that they can cause nausea, occasionally worsen, or cause depression, and can cause liver inflammation (many of our patients have alcoholic, or viral hepatitis, so this is a particularly relevant concern.) Of course all of these potential side-effects are closely monitored and actually different forms of antagonist therapy tend to have more or less of these side-effects, but they are concerns nonetheless.

Antagonist Therapy is Not Habit Forming (Naltrexone and Vivitrol)

In summary of our MAT Part 2 education, antagonist MAT can be incredibly helpful in the treatment of opioid use disorder (and other addictions,) assuming the proper timing of treatment initiation, and appropriate patient selection. Antagonists are not narcotics, are not habit-forming, and have no discontinuation syndromes.

1 year of opiate addiction treatment West Palm Beach, FL Whole Health

I typically shoot for a twelve month period of closely monitored treatment in my opioid addiction treatment protocol at Whole Health in West Palm Beach FL. With the continuation of cognitive based therapies such as structured PHP/IOP/OP programs, NA/AA, 12 step work, spiritually based programs, or whatever positive and helpful course of psychotherapy my patient gravitates towards. Success rates (which I define as prolonged abstinence- greater than one year) utilizing this methodology in my practice have been impressive and encouraging.

The real question is how to effectively bridge the gap between opioid use and antagonist MAT so that we don’t lose patients to recidivism secondary to severe discomfort.

Comfort Meds and FDA Unapproved Meds

There are some “comfort meds” we use with variable efficacy, such as clonidine, vistaril, baclofen, trazodone, etc., but these are rarely able to accomplish bridging of that gap.  There are other methods of bridging this gap, including plant-based detox regimens (i.e. Ibogaine) that detox the patient without the use of opiates, which are extraordinarily interesting and deserving of further research, but they are currently not legal for use in the US.  There is also a exciting new non-pharmacologic, “non-substance” device called the Bridge device for opiate detox which when installed on the patient’s ear, can significantly or totally ameliorate withdrawal symptoms, also without the use of opiates.

As usual, insurers presently consider this modality experimental and will not reimburse for its use (though I am optimistic that this will and should change.) If we could just bridge that gap we could really get a lot more patients on effective antagonist therapy, and this is where I truly believe that what the recovery community at large deems “true sobriety” can be much more frequently attained. Until then, I will continue to pray for progress and utilize the appropriate available medications to assist my patients in the avoidance of death, and the realization of the most rewarding and fulfilling lives they can possibly experience.

“We,” collectively in the recovery treatment community, owe it to our patients to place whatever personal biases we may possess aside, and make this our unified and uncompromising goal at all times!

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You may also be interested in some of our other articles on addiction treatment; “Unchecked Addiction Treatment Diseases“, “What Does (MAT) Medication Assisted Therapy Mean for Generation Z?“, and “Narcan Education by Opiate Detox West Palm Doctor“.

Generation Z Medication Assisted Treatment in West Palm Beach Florida

What Does (MAT) Medication Assisted Treatment Mean for Generation Z?

MAT Medication Assisted Treatment, in the context of Addiction Medicine, is an acronym that stands for “Medication Assisted Treatment.” It starts with opiate detox and continues with drug and alcohol addiction treatment centers, Suboxone clinics and drug rehabilitation programs. How does this apply to opioid use disorders (addiction to heroin, Dilaudid, Roxicodone, etc.). In our first article introducing the concept of MAT Medication Assisted Treatment, we discussed two different “models” often used to explain an individual’s predilection for addiction- the “moral model” and the “disease model.”

MAT Medication Assisted Treatment using opioid agonist therapy

My contention, reinforced by the vast majority of experts in the field of addiction medicine, was that addiction is, in fact, a chronic brain disease. It should be managed as we would manage other chronic disease states such as diabetes and hypertension. This management of other chronic diseases includes the comprehensive approach of lifestyle modification and medication, when appropriate. We are already aware of the lifestyle component of addiction treatment- namely the various stages of rehabilitation, and then proceeding with 12 step work, attending meetings, etc. But, what about the medication aspect of treating this particular chronic disease? This aspect of treating addiction with medication is known as MAT.

Tools for Drug Addiction Rehabilitation

With respect to opioid use disorder, MAT Medication Assisted Treatment falls into two general categories: opioid agonists, and opioid antagonists. They are used at different times, and in different patient circumstances. Again, like anything in medicine, this a treatment that is individually tailored to each specific patient, and sometimes the patient is simply not a candidate for any MAT at all. In this article I would like to specifically discuss the opioid agonist group of MAT, methadone and buprenorphine products, and address the topic of opioid- antagonists in the next article.

Using opiate agonists and opiate antagonists for drug addiction treatment

The concept behind opioid agonist therapy is straight forward- replace the illicit substance that our patient is addicted to with a similar substance that is more controllable, but effects the brain in a similar fashion. The severe withdrawal symptoms and cravings an addict experiences upon discontinuation of an opioid are essentially due to the relatively sudden absence of the abused opioid on the addict’s brain receptors. Most often, statistically around 90% of the time, this withdrawal and/or craving is severe and uncomfortable enough that the addict relapses on his or her drug of choice. The sudden introduction of the opioid back into the addict’s body and brain brings an immediate halt to withdrawal symptoms and acute cravings.

Fighting Opiate Addiction

The problem is that the opioids most addicts use have an extremely short half-life and must be used several times a day to avoid withdrawal. Maintaining the happiness/euphoria to which they are accustomed (hedonic tone). Also, the chosen method of introduction into the body is typically one that offers the most immediate desired results- specifically intravenous drug use. This method of use is obviously fraught with risks, such as infectious disease transmission (HIV, hepatitis C, among others), and a drastically increased risk of overdose.

High relapse resulting from opiate epidemic

Overdose typically occurs because the addict has no idea what is actually in the “heroin” they are injecting into their veins, or how potent the substance is- it is, quite literally, a game of Russian roulette with a substantial risk of overdose and death with every single self-administration. The urine drug test results on my “heroin addicts” very commonly reflect the unknown presence of numerous substances. They include, cocaine, fentanyl, and most recently carfentanyl (an opioid often used as an elephant tranquilizer that is about 1000 times as potent as morphine).

It is easy to see that the slightest bit too much of any of these uber-potent drugs can, and often does, result in overdose and death. This concept, and the reality of drug dealers mixing their own drug cocktails with these novel drugs (and I assure you that these drug dealers do NOT possess Louis Pasteur’s drug mixing proficiency), is the reason why “heroin overdoses” and deaths have risen to such a stratospheric level.

So, that’s the background- 90% of the time the addict picks back up because the withdrawal symptoms and/or cravings are so unbearable that they simply can’t take it any longer. Opioid agonist MAT drugs attach to the opioid receptors in the patient’s brain, and just like they would if they used their opioid of choice, the withdrawal symptoms and cravings abate. When properly prescribed, opioid agonists used for MAT reduce or eliminate drug-seeking behaviors (i.e. stealing, robbing, prostituting, needle-sharing) and do not produce a “high” or impair functioning.

Complicated Addiction Treatment Options

I feel it is also imperative that I comment on an extremely disturbing circumstance that I routinely witness. The simultaneous prescribing of chronic opioid agonist MAT Medication Assisted Treatment (i.e. methadone or buprenorphine/”Suboxone”) and chronic benzodiazepines in an out-patient setting. This combination can cause serious and sometimes FATAL RESPIRATORY DEPRESSION (and this risk is exponentially higher in our opioid use disorder population- if they could take things according to a prescription on a bottle they wouldn’t be addicts!). Any physician prescribing these drugs in combination is truly doing a disservice to his or her patients, and their liability in event of an adverse outcome is absolutely indefensible and unforgivable!

MAT Medication Assisted Therapy and Methadone

Chemical formula of Methadone

Methadone is the oldest example of an opioid agonist used to treat opioid addiction. As described, methadone attaches to the same opiate receptors in the brain that heroin and other opioids do, and attenuates withdrawal symptoms and reduces cravings. The downsides of methadone are that it is only available at specific government-sponsored clinics, the patient has to go to the clinic daily (at least initially) in order to receive their dose for the day, the safety profile of methadone is somewhat problematic (interactions with other drugs, a propensity to cause respiratory depression, a very real risk of overdose if too much is consumed, and cardiotoxicity and “QT prolongation”), and the patient does remain dependent on an opioid. Although methadone has certainly been used successfully for decades in the treatment of opioid use disorder, these limitations make it less desirable, in my opinion, than the newer medication on the market, namely buprenorphine.

MAT Medication Assisted Treatment and Buprenorphine (Suboxone)

Suboxone use for opiate detox in west palm beach by Dr Ligotti

Buprenorphine is sold as a generic and also in the branded combinations Suboxone, Zubsolv, and Bunavail, which contain both buprenorphine and naloxone. With the exception of Probuphine (a new buprenorphine sub-dermal implant), buprenorphine products are dissolved in the mouth (Suboxone and Zubsolv), or applied to the inside of the cheek (Bunavail). Buprenorphine is a partial opioid agonist that has a “ceiling effect”, making overdoses and fatal respiratory depression much less likely than methadone or abused full-agonist opioids like oxycodone, heroin, etc.

Buprenorphine comes alone as a medication, and this form has a higher street value. It has a greater propensity for diversion or misuse (intravenous administration). In my practice, straight buprenorphine is preferred only in our pregnant patients (naloxone is contraindicated in pregnancy.) Naloxone is an opiate “blocker” which is not active or absorbed to any significant extent when administered orally, and there is also a deterrent to diversion and misuse, as the opiate blocker reduces or eliminates any “high” which could be obtained from intravenous use of the product. This is why combination buprenorphine/naloxone products are generally preferable to prescribe.

The DATA 2000 program is a special training course which familiarizes physicians with buprenorphine products and enables certain physicians to prescribe the products for out-patient management of opiate use disorder. This enables patients to live a fairly normal life- going to work, maintaining relationships, etc. Downsides of buprenorphine treatment include the fact that the patient remains dependent on an opioid and cost.

Health Insurance Company’s Delay MAT Medication Assisted Treatment

Unfortunately, many insurances still play the “prior authorization” game with these medications. What this means is that, if I write a prescription at my Suboxone clinic of Suboxone for one of my patients and they take it to the pharmacy, many times the insurance company will ask me to fill out papers and jump through hoops before they will cover the medication. This can take 3-4 days, and in the meantime my patient is either very ill, or already relapsed because of severe withdrawal symptoms. This is very problematic, but I am optimistic that insurers will be forced to increase their coverage for MAT.

opiate dependence treatment offered by Suboxone Clinics West Palm Beach

You may notice that I listed ongoing opiate dependence as a drawback applicable to both medications. It is important here to differentiate between DEPENDENCE and ADDICTION. Dependence is a physiologic phenomenon experienced by any animal given regular opioids, and is characterized by withdrawal symptoms upon sudden discontinuation.

ADDICTION is distinct from dependence in that addiction is defined as compulsive, out-of-control drug use, despite negative consequences. Thus, a patient being treated with buprenorphine is quite naturally DEPENDENT, but generally devoid of harmful addict behaviors and living a normal existence- i.e. he or she is not “addicted”. This ends up being the rationale for the incorporation of MAT into the treatment paradigm of opiate use disorder- the very real concept of harm reduction. We are essentially trading a condition of dependence and addiction for one of solely dependence, and we must at times believe that this is a “win”!

MAT Medication Assisted Treatment Management

We must accept that the outcome REALITY of the majority of our patients is either relapse or death- PERIOD, NOT the all-too-elusive “abstinence”. Given the REALITY that 90% of our opiate use disorder patients will relapse, and the REALITY that the substances our patients are putting in their bodies nowadays are often fatal with a SINGLE USE OF MINUTE AMOUNTS, we as addiction professionals MUST come to grips with the REALITY of considering MAT Medication Assisted Treatment in the management of our opiate use disorder patients. In the final analysis, the REALISTIC question we must ask ourselves for the vast majority of our patients is: “is my patient better off alive and using MAT, or dead because of blind allegiance to our industry’s traditional, draconian ideals”?

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