Opioid Addiction - Episode 13

Episode Transcript

(00:06):
Welcome to psychobabl dash Me. I'myour host Daniel Barley along with mehor Mar
Weeks. Today we're going to talkabout opioid use disorder. This is a
huge crisis, right but before westart, let's put out a disclaimer that
this episode may be triggering for somepeople and is in no way meant to
replace mental health treatment. So mayormar is going to start with the ever

(00:28):
wonder statatistics. Okay, So,according to the World Health Organization, sixty
million people use opioids, three pointnine to five million live with drug use
disorders, and according to the NationalCenter for Drug Abuse Statistics, ninety six
thousand people die from drug overdoses everyyear. Seven out of every ten deaths

(00:49):
are related to opioids, and opioidrelated deaths are responsible for one hundred and
thirty six Americans die every year.They estimate that the death rate from overdose
rose two hundred and fifty five betweentwo thousand and twenty nineteen, with heroin
overdose death rates increasing fifty five percentevery year. And that's that's incredible,

(01:14):
yes, And like so before weget into more information, let's just kind
of break down what the different opiatesare. So the only natural occurring opiates
are morphine and coding. Yeah,and so Mey or Mart what tell the

(01:34):
people what opioid medications do or treatwell? They were originally developed by the
pharmaceutical companies to treat cancer. Andthen in like nineteen ninety, big pharma
started trying to push opioids for whatthey called underrated pain in the fifth vital

(01:56):
sign. So they they have acampaign to get doctors to prescribe more and
more opiates for just regular pains,saying that they were not addictive. And
they actually manipulated the data which hasbeen shown in you know, recent movies
and court cases and stuff, hugecourt cases. And then obviously as time

(02:21):
went on, it was clear thatthese meds caused opio and abuse and putting
patients at risk and people at riskfor overdose. Absolutely. And I have
to say, like when I wasstill practicing, and we had an intensive
outpatient program for drugs and alcohol,and I would see those patients for med

(02:42):
checks and I at least seven outof ten of the patients that I had
who were addicted to opiates had originallybeen prescribed opiates legitimately by a doctor.
Yeah, I mean most of themdid not just start you know, shooting
heroin or yeah, because nobody islike I'm going to exactly. I mean,
I remember when my daughter was inhigh school, she had to have

(03:02):
her wisdom teeth taken out and thedoctor prescribed her twenty vicoin for her wisdom
teeth extraction, and I'm like,fuck, no, you can take some
ibuprofen. You don't need vico infor that. Yeah. So, anyway,
from the natural opioids, and thenthey came up with a synthetic which

(03:22):
were the fetanyl your methodone, yourheroin, and then your semisynthetic oxycodone,
hydrocodone, hydromorphine, oxy morphine.And the scary thing is today is that
these people who were addicted to thesedrugs are now fetanyl is so cheap and
it's you know what, one hundredtimes stronger and it's killing. So it's

(03:43):
killing people. I mean, theyjust had an alert in the town we
live in two days ago about anoverdose alert because the drugs were being what's
the word I want, They werebeing not spiked, but they had fetanyl
in it. People are thinking they'retaking heroin and it has fentyl in it,
and they take the normal amount andthen they overdose. Yeah because what
did they say, like the tiniestlittle piece of fat. Okay, yeah,
it's like a hundred times strong orsomething like that. Right, So,

(04:09):
misuse of these medications, the patientare unable to stop it or decrease
their their does so the opioid painmeds and then the things that happen,
it interferes with people's lives, right, so their work ability, school,
everyday tasks, right, they spendSo the criteria is basically which is what

(04:32):
we're talking about from ds M fiveis about the same as what we talked
about in alcohol abuse. Right,So they take larger amounts over time because
the same amount doesn't cause the samekind of high. They spend a lot
of time seeking those drugs, stealing, stealing, avoiding, avoiding, social

(04:53):
gatherings, work, whatever, becausethey want to get high. They continue
to use as DANIELLSA despite their problems. They developed tolerance. They use in
situations that are hazardous, such asdriving. They crave the drugs and I
had I remember I had a conversationwith another nurse when I was a professor,

(05:17):
and I told her that addiction anddependence were two different things, and
she got in a huge argument withme about it, and I'm like,
so your grandma who takes oxy codobecause she has cancer can become dependent upon
it. Yes, an addict isa person who meets these criterias, who
is drugs seeking, craving the drugrugs. Right, Yeah, so there's

(05:41):
a big difference. So some ofthe signs and symptoms of if boid to
be would be obviously craving their drugs, feeling drowsy, changing sleea patterns.
Often they have flu like symptoms,weight loss, You see a huge thing
with weight loss, changing eating habits, They start to isolate from friends and
family, poor hygiene, frequent moodchanges. Right, and then some of

(06:04):
the symptoms of opiate withdrawal are nauseaand vomiting, muscle aches, sweating,
restlessness, diarrhea, watery eyes,abdominal cramping, increase in heart rate,
insomnia, and tremors. Unlike alcoholabuse, which will kill you, you
we're going to feel like you wantto die when you were drawing from opiates,

(06:26):
but it won't. Yeah, it'snot fatal usually, but they do
definitely have a long lasting effect onsomeone's health. It affects everything your brain,
your bouse, your lungs, yourheart, everything, especially when you
know people go from popping pills tosnorting pills to shooting up and then you're

(06:46):
talking about damage to your vessels,infections, communicable diseases, HIV, hepatitis,
you know, all sorts of things. The dangers obviously can lead to
overdose, taking too much of it, because it the person's respiratory drive becomes
severely diminished. And that's where tothe to the overdose. And that's what

(07:12):
UH narcans for which we're gonna talkabout. The treatments. Yeah, sorry,
the head. No, you jump, you jump as as far ahead
as you want. So I thinkwith treatment, the first thing is to
recognize that you do have a problem, which is sometimes hard, you know,
with with these patients. And thenobviously, you know we've talked about

(07:36):
in previous podcast, is that youknow, people sometimes will what is it
medicate you say, self medicate fordepression, anxiety, things like that.
So the treatments for opioid abuse isthe the box in right, which is

(08:01):
the medication assistant treatments, what wecall it the map, right, Yeah,
And what that does is it reducesthe cravings for the opiates and prevents
the withdrawal, which is are thesigns and symptoms that mehror Mar talked about.
And then the now truck zone itblocks the effects of the opiates.
I always think of it as youknow, people that have the addiction have

(08:22):
those pleasure censors and the brain andit kind of puts a cap on it.
And we talked about to the vivitrialin the past, because the vivitrial
helps two things, opioids and alcohol, right, and methodone is what they
first started Uyes. So the differencein all of these So methodone, I
mean, you can get high onmethodone. It's it's easily abusable because it's

(08:43):
another opiate. So box zone isa combination of vie for norphreen and now
treksone. So not to get toyou know, nerdy on you. But
so what that does, it's apartial opioid agonist. And what that means
is that in your brain the opioidscan connect to those receptors in the brain,
so you don't get that high.Now they tell you that you can't

(09:05):
get high on it. It ispossible to get high on these drugs if
you abuse them, but they canalso kill you. If you or not
kill you, but go send youinto withdrawal if you inject it. Because
of the now trexone in the drugsand for you know, all of these
obviously there you have to be insome sort of a program for the suboxia.

(09:26):
Yeah, and especially with the treatmentcenters, they they're checking your levels
of subox and making sure you're nothaving too much, that you don't have
other drugs in your system. Andusually you have to go to so many
meetings or not therapies, yeah,per month to attend these. And then

(09:48):
again we touched on Narcan, whichblocks the effects of the opioids. It's
an FDA approved over the counter.They have a nasal spray. You can
give one spray. If they don'trespond, you can keep giving them every
two to three minutes until the patientresponds, and like Danielle said, it
brings their breathing back because they stoppedbreathing. And then just some I wanted

(10:11):
to shout out some shows that I'veseen for people to understand how this crisis
came about, because as we touchedupon, it really was pushed by the
big pharmaceutical companies and the doctors kindof didn't know what was going on because
the information was incorrect and people werelegitimately being prescribed these. So on Hulu
there's a really good movie called DopeSick with Michael Keaton, who I love.

(10:33):
And then on Netflix there's one calledPainkillers and Pain Hustlers and those are
both about big pharma. And thenthere's one called Heroin with a E and
parentheses at the end, and that'sall about the opioid epidemic here in West
Virginia and Huntington. Oh and justone more thing, can I tell you?
Yeah, yeah, Okay, thisis really good and important information that

(10:54):
she's gonna soak about right now.I just wanted to, like, I
saw this chart, and I hatenot to cite where I saw it,
but I can't remember. I thinkit was on the National Center for Drug
Abuse Statistics, but they said thehighest concentrations to sorry, the highest concentration
of death rates among states. Numberone was Maryland, Number two was California,

(11:16):
and number three was West Virginia,which, you know, we're a
little po dunks. I know,people get mad at me for saying that,
but compared to California, we're very, very small. They said eight
hundred and seventy people die per yearin West Virginia for overdose deaths. It
has one hundred and fifty five percenthigher overdose death rates in the national average,

(11:39):
which is just mind blowing. Yeah. Crazy. And we were talking
before we started the podcast about howyou know, when this all started.
They were saying in West Virginia therewere cities where they were prescribing more drugs
than there were people who lived there. And these were just pill mills were
not very nice. We're prescribing drugsfor the kickback from them. Yeah,

(12:05):
and so we just want to bringout awareness of this and the treatments.
Now, we're gonna have a specialguest on that runs a MAP program that
deals with opioid abuse. So hopefullyshe can help touch on how how people
can seek treatment, who's the whocan be a candidate of it, different

(12:28):
things that answer some questions, yeah, answer some questions definitely, and what
the program entails and there's many outthere. Yes, Okay, we'll be
right back. Okay. Today wehave a special guest on. Her name

(12:54):
is Courtney bish Hi. Courtney,Hi, just give us a little bit
about yourself. Well, I'm alicensed clinical social worker. I also run
a couple of programs for drug andalcohol. Okay, and that's what our
main thing is that me and mehrMar touched on about the crisis of the

(13:16):
opioid epidemic. So she does theMATH program, the Medication Assistant Therapy.
That's a drug program that we actuallyrun at our facility. But we're going
to talk about just in a generalfocus. So who can be a candidate

(13:37):
Courtney for the MAP program. Well, I'm not a key to treatment.
Most candidates have to have an openoiduse disorder or alcohol use disorder, so
they have a history of using alcoholor heroin set and all those type of
substances. Okay, any restrictions orcontraindications on who can get treatment. Treatment's

(14:01):
open for anybody. But to getthe medication part, most facilities are focused
on, uh, the opioid useor alcohol use. Those are the ones
that are proved through insurance. Yeah, because correctly, okay, And those
are the ones that we touched onwith the vivitrol, which, like I
said, Mia Mehrimar touched on inthe subox zone. Is it covered?

(14:26):
That's another thing covered by insurance andmedicaid Because I know that there are some
programs out there, So this isprobably like a broad thing. There are
some programs out there that are coveredand aren't covered at our facility. I
do believe that the insurance is coveredcorrect, and then other people will go
to different treatment facilities that they payout a pocket. So like I,

(14:52):
like we talked about before, it'sjust whatever probably you can afford and whatever
program you can get into that thatfits your needs. How long would you
say is treatment with an individual?It varies from the individual and the severity
of their substance shoes. For us, it can be a few years,

(15:15):
it can be a few months.I've seen patients go for years and then
decide to taper down and completely getoff of the Medicaid treatment, or I've
seen some stay on it and continueand they go into a maintenance stage.
Yeah, do you think that peoplehave to stay on the medication for the
rest of their lives? If youever, like, how is would you

(15:37):
say your longest treating patient patient wouldbe at this time? I would say
one of ours is about five years, and they've talked about getting onto supplicate,
which is a shot. Okay,that's good. What about abuse?
I know that people can't abuse themedication right correct? Sadly, well,

(16:00):
two of them are shots and twotypes are actually pill formed. So we
have supplicated, we have the boxin, and we have subutex and sadly,
subutext and boxin can be misuge andcan people over reduced? Why taking these
medications? Yes? Yea yeah,unfortunately I knew it's a terrible cycle.

(16:25):
What does our treatment consist of?Treat medication right, and then they have
to do some sort of therapy right, so therapy and groups, group facilities,
group therapy, individual they have todo right? Correct? Okay?

(16:47):
Which is I mean it curtails becausea lot of times patients that are using
are self medicating for other underlying disorders, which I see that on a daily
basis whenever I'm treating the mental illness. A lot of people are you do
see it too, right that they'reself medicating for sure diagnoses? Yes?

(17:10):
What about success rates? So itvaries on the population a lot of you
know, last study that was justrunning twenty twenty one showed about seventy five
percent chance of recovery, but sadlythey're forty to sixty chance of relapse.
Relapse, Yeah, the first yeardo we we see we do see in

(17:36):
our program success rates and relapse.I think definitely, But you know what,
what message would you give the person? Definitely if they relapse, like
you know, just you relapse,you keep on going, you get up.
And I always tell my clients,you know, if you relapse,

(17:57):
come to me. We will comeup with a planned to make sure that
you're safe. You know, alot of times when they relapse, it's
not on one that it's just noton one substance. A lot of things
are least, so we want tomake sure that you know, they know
everything that they possibly ingested. Soyou know, I'm always like, let's
be open, honest, and let'sget through this next step. And they

(18:18):
usually increase their treatment. Yeah,increase their treatment. Send them to the
person that may be prescribing psychiatric medicationsbecause there's probably huge triggers out there,
especially or maybe they they weren't ableto get their psychiatric medications there. I
mean, it's a huge area ofwhy anybody could relapse. You know,

(18:40):
maybe they're hanging out with the wrongpeople, you know, and that's I
think that you hit the nail onthe head whenever you said let's get them
in and get a plan. Theplan is is huge. Yeah, I
try to work with every one ofthem on a plan. When I first
started working with substance use, youknow, they was said, re Lef's

(19:00):
happened before you even think about it. So having plan in place, who's
their support peers, Yes, onehundred percent. Anything else you would like
to add before we get off,just that there are programs out there that
are wonderful. So if in needof any kind of assistance with substance use,

(19:21):
reach out. Yeah, definitely reachout, like Courtney says, and
if one program isn't right for you, maybe the next one is. Thank
you so much Courtney for being on. Thank you You're welcome. Take care,
Remember you're not alone. You liketo blackho not not don't s