Tag Archives: Opiate Detox

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.

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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.)

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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“.

60% Intravenous Opiate Detox Drug Users Hep C

Addiction Treatment and Hepatitis C

60% Intravenous Opiate Detox Drug Users Hep C say, “I think I’ve got Hep. C”. It is an all-too-common phrase I hear in my addiction medicine practice (West Palm Beach, FL).  As a matter of fact, I would estimate our patients (60% Intravenous Opiate Detox Drug Users Hep C) who are intravenous drug users are, in fact, positive for the hepatitis C antibody.  According to NIDA (National Institute on Drug Abuse), 2.7–3.9 million people are living with HCV in the United States and, amazingly, deaths from hepatitis C now EXCEED deaths from the HIV/AIDS virus!

This is increasingly common incidence of this disease and its impacting on my patient population as well as the recovery community. We are educating the entire community by discussing symptoms, transmission, diagnosis, and treatment of the hepatitis C virus.

Understanding Hep C and Opiate Addiction Treatment

Opiate Detox Drug Users Hep C education dr ligotti delray beach

Hepatitis C is a viral liver disease, currently the most common blood borne infection in the United States. It is much more contagious and transmissible than other similar infectious agents.  Hepatitis C infection can be either acute or chronic.  Acute hepatitis C is oftentimes without symptoms and patients progress to chronic infection completely unaware of their exposure to the virus.

Therefore, so many patients are surprised when they test positive.  Less commonly, symptoms of acute infection may include jaundice, abdominal pain, nausea and vomiting, and impressively elevated liver function tests on blood work.  After acute exposure to the hepatitis C virus, approximately 75-85% of patients go on to become chronically infected with the virus, and these are the patients for whom treatment is considered.

Detecting Hep C in Opiate Addiction Treatment

Opiate Detox Drug Users Hep C education dr ligotti opiate detox west palm beach

Hepatitis C is extremely contagious and spreads primarily through blood exposure.  This includes our patients who suffer from the disease of addiction and who share needles, spoons, cotton, water, or any other injection equipment. It also includes, those who share other drug paraphernalia such as snorting straws, with a person who has hepatitis C.  Sexual transmission is also possible, but thought to be unusual.

Opiate Detox Drug Users Hep C

Opiate Detox west palm beach stop Hep C dr ligotti

The importance of diagnosing and treating chronic hepatitis C is to hopefully avoid the two most important risks of the disease; cirrhosis/liver failure, and liver cancer (hepatocellular carcinoma).  The diagnosis of hepatitis C is made from bloodwork performed on a patient.  Screening bloodwork to test for hepatitis C detects the body’s immune system’s response to the virus. It is the hepatitis C antibody that is first detected when somebody “tests positive” for hepatitis C.  The test will confirm the fact that the patient’s body has “seen” the hepatitis C virus at some point in the past. The next step is to perform a hepatitis C viral load and genotype test.

A positive viral load confirms the actual presence of hepatitis C virus in the patient’s blood. This quantifies how much virus is present. While the genotype tells us what type of hepatitis C infection we are dealing with (six main types), and this is important for determining the most effective treatment regimen.  It is important to note that most patients whose immune systems naturally “clear” the acute hepatitis C viral infection on their own (15 and 25% of patients) do so within the first six months of infection.

Therefore, physicians will monitor viral loads at six months following first detection to give patients a chance to clear the infection on their own.  If at six months there is still a positive viral load (active infection), treatment is considered.  Again, approximately 75-85% of people will go on to develop chronic infection and will need to consider treatment.

New Hep C Treatment with 90% Success Rates

To date there are several newer oral medications for Opiate Detox Drug Users Hep C, alone and in combination products. The choice of medication depends in part on the genotype of the hepatitis C infection, but the specific details and exact medications are beyond the scope of this article.

Suffice to say, the general advantages of these drugs when compared to older interferon-based regimens include significantly fewer side effects and cure rates well over 90%- very impressive results!  However, one of the primary barriers to these newer hepatitis C treatment regimens is the exorbitant price tag and the cumbersome task of getting insurance companies to pay for the treatment.

Opiate Detox Drug Users Hep C Insurance and Tests

Insurance companies in general require a large battery of tests and information be compiled before they will cover the cost of hepatitis C treatment.  These tests include various blood and urine tests as well as imaging studies and “staging” of the hepatitis C infection (how much damage has been done to the liver).

This staging has traditionally been accomplished by liver biopsy (obviously an invasive and less than desirable procedure).  However, a new technology exists called Fibroscan. We are seeing, insurance companies covering in most cases, all of the costs.

Fibroscan Painless Test Saving Lives from Hep C

New Hep C test drug and alcohol addictin treatment west palm dr Ligotti

Fibroscan is a painless, non-invasive test that simply measures the elasticity of the liver.  This elasticity tells us how much damage has been done to the liver and is sufficient for “staging” the patient’s liver disease.  Fibroscan is an amazing technology that makes invasive biopsy unnecessary in most cases and gives insurers the information they need to pay for these incredible new treatments for hepatitis C!

Helping Opiate Detox Drug Users Hep C

Currently there are very few Fibroscan machines in West Palm Beach area. Many insurers require a Fibroscan diagnostic test to approve treatment coverage. We are seeing insurance companies covering in most cases, all of the costs. The limitation of this test is making it very difficult for our chronic hepatitis C patients in the recovery community to access treatment for their hepatitis C.

Whole-Health is a drug and alcohol addiction treatment practice focused on the comprehensive medical care of our recovery community. Since we have with many patients in the recovery in the West Palm Beach area, it was determined that we really can greatly increase access to hepatitis C treatment.  Therefore, Whole-Health has purchased a Fibroscan machine in our effort to better serve the medical needs of our recovery community.

Opiate Detox West Palm, and Drug and Alcohol Treatment West Palm

Now, instead of inconvenient specialist referrals and dealing with transportation issues, our recovery patients with hepatitis C can be evaluated and treated at our office here in Delray Beach, Fl. We have been providing opiate detox West Palm, and unequalled drug and alcohol addiction treatment West Palm for well over a decade.

We are very proud to add this additional service to our practice. It is just another example of how Whole Health is the premiere leader in comprehensive medical care in the practice of addiction treatment medicine!  We encourage all our at-risk patients to come in to be screened for hepatitis C.

We also hope that patients with known hepatitis C will visit our opiate addiction practice in the West Palm Beach area (855) 965-1626, so we can coordinate testing, assist with insurance requirements, and start these amazing new treatments to help eliminate this virus from our recovery community!

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

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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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