Your Brain on Opioids, Part 4: Self-Care is Brain Repair

Recovering from opioid addiction? Heal your brain with self-care.

The first three parts of this series focused on our brains – how we start to heal them in recovery. Equally important are the ways we can take care of our bodies in recovery, ways that also support our efforts to heal our brains and maintain their neuroplasticity. Just tuning in? Get the scoop on how opioids change our brains, and how we can work to change them back, starting with the first part in this series: This Is Your Brain On Opioids.

Exercise

Our bodies go through a lot when we’re using. Helping them recover is daunting, but moving our bodies is essential to both physical and mental health. Studies have shown how exercise can improve our moods, sleep and concentration, as well as reduce anxiety and stress. Exercise is also how we re-train our brains to release and recognize our natural endorphins. We don’t have to run marathons. We can start with some gentle yoga or even a ten-minute walk. The point is to get our bodies moving again. And, as with everything we’ve been discussing, we want to create a habit, a new neuropathway, so that exercise becomes part of our everyday lives and our recovery.

Meditation

Some of us may be as intimidated by the idea of mediating as we are by the idea of exercising regularly. We tend to over-complicate the simple idea of sitting quietly and being mindful. Research shows that meditation changes the way our brains work for the better, and some studies are focusing on how it aids specifically with addiction recovery. Don’t be afraid of it. There are tons of resources online, including some great apps, to help you get started. Or check to see if there are any meditation classes offered in your area.

Cognitive Behavior Therapy

Cognitive behavior therapy is a therapy modality that’s been around since the late 1960s. Under the guidance of a qualified therapist, it helps us recognize the patterns of behavior we need to change and gives us the support to make those changes. Which, as you know all too well by now, helps create and maintain positive neuropathways in our brains. CBT has been proven to be a very useful tool in recovery addiction and relapse prevention by helping us understand how we act and react, why we do so and what we can do differently in the present.

Nutrition

Almost all of us neglected self-care while we were actively using, especially when it came to eating right, creating nutritional and vitamin deficits that make it harder for the brain to do its work. Eating well helps heal both our bodies and our minds. (Nutrition is becoming an increasing focus for rehab centers, and a study by the National Center for Biotechnology Information found that rectifying nutritional deficiencies in opiate addicts increased the effectiveness of methadone intervention.)

But it doesn’t take a brain scientist to recognize how we should be eating in recovery: less sugar and processed carbohydrates, more protein, and more fresh fruits and vegetables. By eating properly and eating regularly, we are redeveloping the habits (hello, neuropathways!) of self-care that get so easily lost in the chaos of addiction.

Sleep

We all know how much addiction messes with our sleep patterns and in early recovery, establishing normal sleeping cycles may be as frustrating as searching for a pot of gold at the end of a rainbow. Still, it’s crucial that we try to re-establish good sleep habits and retrain our brains. Setting a regular bedtime and adhering to it is a great start. Don’t get too frustrated if sleep seems elusive at first. As with all things in recovery, it takes time and effort to establish good habits.

Play

Now for the fun stuff! A healthy brain depends on neuroplasticity and we’re both relying on it and improving it with the new habits we’re creating in recovery. It’s also essential to keep our brains on their proverbial toes with some fun approaches. Doing crossword puzzles or Sudoku, playing trivia games, learning a new language or taking up a new hobby are all great ways to support our newly alert, newly recovering brains on their journey back to health.

 

Your Brain on Opioids, Part 3: Yes, Your Brain Can Change

After opioid addiction, your brain can recover and repair.

Now that we’re all well on our way to becoming brain scientists, let’s focus a little bit on how, exactly, we heal our minds by building new neuropathways. Like a lot of things in recovery, it’s simple enough in theory, but challenging in practice.

(Read Your Brain on Opioids, Part 2: Walking on the Wild Side With Neuropathways)

In a nutshell, we create new neuropathways by establishing and practicing new habits. The more we repeat them, the more ingrained those neuropathways become.

Here are four key elements of the process.

1. Motivation and intention

It all starts here, with our motivation for getting clean and our intentions and goals. Motivation is a powerful thing – without it, none of our recovery efforts can find footing. At the outset, we have to prep our brains for change by spending some time identifying what it is we want to do. It’s essential that we’re really clear with ourselves about our goals and that we acknowledge and harness all the motivation we can for kicking opioids in the rear.

“Motivation is a powerful thing – without it, none of our recovery efforts can find footing.”

2. Get honest

It’s tough, but necessary, to take a good, hard look at our addiction to opioids and what it has done to our lives – how it’s ruined our relationships, finances, health, etc. It’s not enough just to think about it. We have to put pen to paper (or fingers to keyboard) and see it in black and white.

3. Recognize triggers

As we’ve learned, our brains are hardwired to respond to the people, places, and things that we associate with our addiction, triggering our desire to use. No matter how strong-willed or tough we think we are, our brains have other plans. We have to take a good, hard look at the lives we’ve built and identify the specific people, places, and things that are triggers for us. For the road ahead, we’re going to have to be our own trigger cops, staying vigilant and aware at all times. At Workit Health, a big part of early recovery is learning to recognize triggers, and handle the cravings that they cause.

4. Change our responses to addictive thoughts/patterns as they arise

So we acknowledge what triggers us… then what? Instead of using, we… don’t use, right? That’s all there is to it? In some ways, recovery really does boil down to that difference, but it’s so much easier said than done. There’s a saying in recovery circles that the only thing you have to change is everything – which isn’t super comforting, but there is certain amount of truth in there.

“Even the smallest changes help our brains adapt.”

(Read Part 1: This is Your Brain On Opioids)

Unfortunately, we can’t just decide that we’ll avoid triggers and then our addiction will be fixed. The brain doesn’t work that way – nor does the world always cooperate in helping us avoid them. Those old neuropathways associated with using are deep. Again, we have to distract our brains by creating new neuropathways and we do that every time we make a new, healthier choice. Part of the Workit program is learning to kick old auto thoughts to the curb, and welcoming their opposites, called antidotes, into our life.

Paving a new road is exhausting, but it may be less daunting to think of it as laying one little paving stone after another. Even the smallest changes help our brains adapt. If you’re used to getting up and sitting at the counter with a cup of coffee while you take your first pill of the day, do something different in recovery. Sit at your kitchen table and drink milk instead. Or even drink your coffee out of a different mug. Along with big decisions (such as not using), all of these small decisions confuse your brain and help break the connections that trigger cravings. They add up.

Creating new neuropathways is a long process and we have to remind ourselves that we’re actually retraining our brains. That requires care and dedication, plus a fair amount of sweat and tears. There are also other things we can do, healthy habits and supportive activities we can introduce into our lives that help our bodies support these brain changes – and that’s what we’ll look at next time.

Your Brain on Opioids, Part 2: Walking on the Wild Side With Neuropathways

Opioids change the brain, but the good news? Your brain can heal.

Now that we’ve taken a look at how opioids affect the brain in the long run, let’s focus a bit on the good news–we have the ability to help our brains heal and to develop new healthy, habits. It’s time to talk neuroplasticity.

While we might associate the word “plastic” with hardness and durability, in the scientific sense it really means that something has the ability to flex and change. So when scientists talk about neuroplasticity, they’re talking about how much our brain remains changeable. It’s about the flexibility we have to develop new skills, acquire new knowledge, and create new habits. Neuroplasticity is how we learn to speak a new language or play a new instrument–and it’s also what recovery from opioids depends on.

“Neuroplasticity is how we learn to speak a new language or play a new instrument–and it’s also what recovery from opioids depends on. ”

It all comes down to neuropathways, or neural pathways. These are actual trails created in our brain over time by repetition and habit. When we roll out of bed and sleepwalk through our morning routine almost automatically, that’s thanks to the neuropathways we’ve created by doing the same thing every morning.

A common analogy is to think of neuropathways as actual walking paths or hiking trails. It’s easy to imagine how walking the same path over and over becomes so familiar that you can do it with hardly any conscious thought. When we abuse opioids over a period of time, through sustained use, we create a well-worn pathway in our brain so that it becomes almost an unconscious habit to use. Your brain knows this route. It knows the twists and turns. It’s easy to follow.

When we choose recovery, and we choose to do something other than using drugs, we are actually attempting to change our brain structure. Recovery requires us to create new neuropathways in our brain, but the cool thing is we can do it. Just as we changed our brain through the habit of addiction, we can help heal it through sustained and repeated healthy recovery habits. Which, frankly, is about as rad as it gets.

“Recovery requires us to create new neuropathways in our brain, but the cool thing is we can do it.”

Waking up each day and deciding not to use is a brand new way of doing things for your brain. To go back to the walking path analogy, you’re forging a brand new trail in the wilderness. The ground is rocky and uncertain, there are discouraging obstacles in the way, and everything is unfamiliar and uncomfortable.

In short, it’s hard. We’re rewiring our brains and it’s tough work. (Especially when our brains keep reminding us how much easier it would be just to fall back on that old neuropathway of addiction.) It takes time and practice to really form that new path, to make it clearer, more familiar, and less uncomfortable to navigate.

But if we stick with it–especially if we can just get through those first difficult days when our brain is frustrated and confused–it gets easier over time because those recovery neuropathways get stronger and deeper every time we choose not to use.

So how do we do it? How do we start to change our brains? Next time, we’ll take a look at some specific tips and tools that can help us heal our brains and create those neuropathways that can carry us away from opioid addiction and into a new, healthy way of living.

Ready to get building new neuropathways? Check out the rest of this series:

Michigan’s Opioid Epidemic Tackled From All Directions By Detroit FBI

Combatting Michigan’s opioid crisis involves a myriad of efforts and a number of agencies, from law enforcement to health care systems to addiction recovery initiatives.

Working hard among them is the FBI’s Detroit Division.

Maureen Reddy, Assistant Special Agent says the FBI approaches Michigan’s opioid crisis from a few different angles, most of them focused on stemming the supply of opioids to the state’s citizens and beyond.

One key perspective, she says, is the agency’s focus on healthcare fraud. “We look directly at doctors who are unnecessarily providing prescriptions [for opiates],” she says. The agency looks out for “pill mills,” doctors offices, clinics or pharmacies that sell medically unnecessary prescriptions, often for cash.

Reddy points to the agency’s bust earlier this year of the Meghnot Comprehensive Center for Hope in Pittsfield Township. Positioning itself as a pain management clinic, the center generated approximately $4.5 million in revenue from opiate sales between September 2011 and March 2015, according to the Department of Justice. The center was responsible for the dissemination of 1.5 million oxycodone pills, as well as other drugs.

Michigan’s opioid problem doesn’t stay here, either, notes Reddy. She says Michigan plays an important role in the opioid epidemic in other states: “Often times, those opioids are then sold on the street [but] often they’re trafficked down to West Virginia, Ohio and Kentucky.”

“Often times, those opioids are then sold on the street [but] often they’re trafficked down to West Virginia, Ohio and Kentucky.”

Which brings Reddy to another of the FBI’s efforts to end the opioid crisis in Michigan.

“We also look at the street gangs,” she says. “Not only do they traffic opiate pills down to other states, but they also traffic heroin. If there’s money to be made, they’re going to try to make it.” She notes that gangs also are tied to pharmacy burglaries, another way opioids are funneled to the streets.

One more strategy for the FBI is cracking down on foreign sources of drugs. “The heroin generally comes up from Mexico,” she says. In recent years, the agency has also seen an increasing influx of fentanyl and carfentanyl. “The fentanyl is coming in two ways: across the border from Mexico and from China in the mail.”

Reddy says the more the opioid crisis grows, the more it commands a high proportion of the agency’s resources. “We do not have enough resources to address the problem as it is right now because it’s coming from so many different directions,” she says, noting the agency’s concentration has shifted more towards opioids in recent years. “It’s become a main focus. Heroin sort of went away in the 90s when cocaine took over.”  Now, Reddy says, heroin is back and while she doesn’t have an exact timeframe for when the pain pill epidemic hit, she considers it the gateway to the return of heroin.

The epidemic not only changes the FBI’s focus, it also alters the way the agency approaches busts. “It has absolutely changed the way we approach search warrants,” Reddy says. The presence of super strong drugs like fentanyl and carfentanyl require special approaches for agents. “We’ve started to carry Narcan. We carry gloves and masks and if we think there’s fentanyl involved, we don’t open it and test it at that point in time.”

“We’ve started to carry Narcan. We carry gloves and masks and if we think there’s fentanyl involved, we don’t open it and test it at that point in time.”

And although Reddy’s office is in Detroit, she knows the problem is statewide.

“There’s no part of this state that has not been affected,” she says. In terms of areas of Michigan that have been hardest hit, Reddy says it’s usually in keeping with population size. “Generally, the larger places have the larger problem.” But she also acknowledges that some of the smaller areas in the state also are hard hit and notes it’s hard to trust statistics because they’re often incorrect – usage is difficult to rack and overdoses are under-reported.

Still, she says, it’s the end user, the addict, who is affected the most. “We arrest bad people. Our job is to get the bad people off the street, whether it’s a doctor, a Mexican drug dealer or a [drug] courier.” But the agency is also involved in community initiatives aimed at education and prevention. “We deal mainly with the other end, but the DEA has put together this initiative in Wayne, Oakland and Macomb counties with the Detroit Wayne Mental Health Authority.” The effort brings town hall meetings to communities to discuss the epidemic.

In addition, in partnership with the DEA, the FBI produced a short documentary film entitled Chasing the Dragon: the Life of an Opiate Addict, which gives a raw and real look at the impact of opiate addiction on the lives of individuals. “They go to community groups and show this film and then have question and answer sessions.” Reddy says. “People are really concerned….People really want to learn to identify the signs of opioid abuse.”

Reddy hopes the medical community will play an even greater role in combating Michigan’s opioid epidemic.

“I’d like to see the medical community come out and educate people from their vantage points.” She would also like to see the state’s mental health system get better at treating illnesses often associated with addiction. “It’s ground-level stuff,” she says.

“People need to really focus on how do we get it to a point where there is no addict?”

Asked if there is an end in sight for the opioid epidemic in Michigan, Reddy can’t say.

“We need to fix the problem of having an end user,” she asserts. “If that question can be answered, just think how many issues we can solve. People need to really focus on how do we get it to a point where there is no addict?”

 

Washtenaw County Sheriff’s Office Brings Compassion To The Opioid Crisis

Like most Michigan Counties, Washtenaw County has been working hard in recent years to tackle the crisis of the nationwide opioid epidemic.

Also like most counties, Washtenaw has seen an uptick in opioid-related overdoses. According to the Washtenaw County Department of Public Health, the number of weekly opioid-related overdoses has doubled since 2015, from three to seven and 2017 is already on track to see the highest number of overdoses in the county’s history.

Statistics like these are, by necessity, changing what it means to be a first responder in the county. Once, naloxone—a drug, administered as a nasal spray, that reverses the effects of opioids—was strictly the domain of EMTs and doctors. Now it’s in the hands of a variety of citizens, including trained homeless shelter staff, librarians and, of course, police officers.

At the heart of this movement is the Washtenaw County Sheriff’s Office.

Lieutenant Lisa King has been spearheading initiatives to help the department better tackle the growing opioid crisis. Under her guidance, in August 2014, the department partnered with the University of Michigan School of nursing to train all Washtenaw County sheriff’s offices to carry and administer naloxone.

Police Services Commander Marlene Radzik says allowing officers to provide naloxone to opioid overdose victims is crucial. “Many times we would be the first responders and watching someone in an active overdose and we couldn’t do anything about it,” she laments. “To date, we have not only trained Washtenaw County Sheriff’s Office but also all the police departments in Washtenaw County have been trained.” The ultimate goal is to have every officer in Washtenaw County trained.

“Many times we would be the first responders and watching someone in an active overdose and we couldn’t do anything about it…”

Radzik notes that supplying officers with naloxone and training them in its use was only part of the education provided to police officers to best help them deal with opioid addicts. One piece missing was what she calls “the compassion factor” – in other words, the human element of the opioid epidemic. To remedy that, recovering opioid addicts were brought in to help give a human face to the epidemic. “It was very valuable to have someone from Home of New Vision come in and share with the deputies and tell them, ‘I was that person you saved, but now I’m X many years into recovery,’” Radzik says.

Training police officers to administer naloxone isn’t the only initiative the county is undertaking.

Radzik describes the frustration of seeing opioid addicts saved from an overdose then released from the hospital without any follow-up resources for long-term care or treatment. “I was so shocked to see that once they’re vital, stabilized, they just let them go from the hospital. They get a drug test, but what resources have you offered?” she says.

Aiming to meet that need is the brand new ROOT – Recovery Opiate Overdose Team – a community partnership established this summer as a joint collaboration with the Washtenaw County Sheriff’s office, Washtenaw County Mental Health, Community Mental Health Partnership of Southeast Michigan, and Home of New Vision, all working in cooperation with St. Joseph’s Hospital and the University of Michigan Health System.

According to ROOT program manager Elissa Spangler, the primary goal of this unprecedented collaboration is “to be the first line of response, to meet [people who have overdosed] where they’re at and try to get them into treatment.”

Now, when an overdose occurs in Washtenaw, the sheriff’s office and/or the EMTs notify Spangler, who is on call 24/7, to meet them at the hospital or the site of the overdose. (Radzik says all overdose victims administered naloxone are automatically taken to the hospital.) There, ROOT performs an on-site assessment and works to release overdose survivors into a safe setting that provides them with treatment and support, including access to shelters, treatment centers, withdrawal management and mental health resources.

Radzik says this is all necessary and overdue.

She describes the changes she’s seen working with the Washtenaw County Sheriff’s department for 20 years. “For me, it’s been pretty devastating. When I started working road patrol, I actually did a couple years undercover as a narcotics detective. At that time—1998 to 2000—what I saw then was powder cocaine, crack cocaine, maybe marijuana, not too much heroin. It was probably around 2010, I saw this shift where I was responding to a lot of overdose deaths involving younger kids, I’m talking 15 to 21.”

“It was so disturbing for me, of course, having six girls myself…to see these young kids. You go into the house and there’s nothing you can do, ” Radzik continues. Previously, she says, most of the drug deaths she saw were from long-term users dying as a result of their ongoing, habitual lifestyles.  “So I finally got enough courage to start asking people, ‘How did your 20-year-old turn to heroin?”

“Every single parent said it started when their son or daughter was either in a car accident or had a sports injury. They went to the doctor and were prescribed Vicodin.” Many of these kids, Radzik says, then became addicted and, when their supply ran out, started buying pills from the street. But pills are expensive and heroin offers addicts an even cheaper fix.

“Every single parent said it started when their son or daughter was either in a car accident or had a sports injury. They went to the doctor and were prescribed Vicodin.”

“Time and time again, we’re responding to these younger kids in general. And it doesn’t matter what demographic. This is all over. It’s all over Jackson County. It’s all over Washtenaw County. It doesn’t matter.”

Radzik notes that, in keeping with national trends, she is seeing an uptick in overdoses tied to fentanyl, a synthetic opioid up to 100 times more powerful than heroin. In fact, fentanyl was involved in 2/3 of Washtenaw County’s overdose deaths in 2017. She says the county’s also starting to see carfentanyl (another synthetic opioid, this time 10,000 more times powerful than morphine) creep in over the past five or six months.

“This past March has been the highest overdose deaths ever in Washtenaw County,” Radzik says, pointing to statistics in the August 2017 Opioid Report from Washtenaw County Public Health. The report also states that there were 175 opioid overdoses in 2015 in Washtenaw County, 251 in 2016. And 2017 has already seen 200 overdoses. “And that’s only through July,” Radzik emphasizes. “We’ve never had anything like this. We are at epidemic levels.”

She also notes that cocaine was involved in 27% of the 2017 overdose deaths, and alcohol in 14%.

While the nation’s focus is squarely on the opioid crisis, Radzik says, “It’s really important that we remember that when you combine drugs there’s a higher likelihood of an overdose.”

Despite the statistics pouring in from Washtenaw and other counties in Michigan, Radzik seems heartened by the efforts of the county, its responders and its citizens to tackle the opioid crisis. She points to success stories, lives saved by a wider range of first responders administering naloxone, and secured funding for ROOT to help Michigan’s opioid addicts seek help beyond the doors of the county’s hospitals.

 

Michigan And The Opioid Crisis: The Scope Of An Epidemic

Michigan is in the midst of an opioid epidemic. We look at the statistics behind the staggering crisis.

It’s not news that the United States is in the grips of an opioid epidemic. In fact, it’s almost impossible to avoid reading or hearing about it. In July, a White House panel asked President Trump to declare the epidemic a “national health emergency,” citing the statistic that 142 Americans die every day due to opioid overdoses.

Everywhere you look, news stories and headlines announce the latest scandals: pill mills, doctors over-prescribing pain meds, parents overdosing with their children in their car, even veterinarians having to monitor pets’ owners for abuse of pain medication. It’s hard to wrap your head around the scope of it all. And Michigan, like every state, has been hit hard by the epidemic.

First, back to the big picture. The CDC names three main types of opioids currently in use in the United States: prescription opioid painkillers (such as hydrocodone and oxycontin), fentanyl and heroin. Fentanyl is a powerful synthetic opioid: it’s up to 100 times more powerful than morphine. Frighteningly, now emerging are super strong variations, like carfentanil, a lab-created elephant-tranquilizer 100 times more powerful than fentanyl.

Prescription to Addiction

The opioid epidemic differs in one crucial way from other illegal drug epidemics – it often starts with the perfectly legal prescribing of painkillers. So how do we get from legal prescriptions to an all-out epidemic? Well, for starters, it’s a question of volume. The United States makes up about 5% of the world’s population, yet we consume 80 percent of the world’s production of prescription painkillers.

According to the National Institute on Drug Abuse, young adults between the ages of 18 and 25 are the biggest abusers of prescription drugs, including opioids. And a 2016 study indicated that 80 percent of heroin users started out using prescription opioids.

The Crisis in Numbers

 Michigan Opioid Crisis Statistics

Michigan’s Own Opioid Crisis

Michigan is one of the states hardest hit by the opioid epidemic. Like many states, it has seen a huge uptick in recent years in both the number of opioid prescriptions written and the number of overdoses due to opioid abuse and/or heroin use. According to the Michigan Department of Health and Human Services, 1,257 Michiganders lost their lives to opioids in 2015, the most recent year for which comprehensive data is available. Between 2010 and 2015, the counties seeing the highest number of overdoses were Wayne, Macomb, Genessee and Kent.

The numbers alone can’t do justice to the tragedy the community is suffering with each loss. Patrick Steinhebel’s body sat at the Wayne County morgue for a month as his family suffered, without notification of his death by overdose. Only after they filed a missing person’s report did they receive notice that he had passed. In August, police raided a Dearborn pill mill. Before the pill mill was shut down, it acted as a disruptor to the community, with lines out the door and patients coming and going at all hours. It’s estimated that about half of the 500,000 pills prescribed at the mill in January ended up on Michigan streets.

Employers are even being hit by the epidemic, as they struggle to find and keep sober staff. Skilled labor is especially difficult to find, as workers can’t operate heavy machinery while intoxicated. New hires often aren’t able to pass drug tests. Employees may turn to opioids for relief from injuries caused by taxing physical work, only to struggle with addiction once taking powerful narcotics. This results in jobs lost, and the cycle begins again.

A 2012 CDC study placed Michigan 10th in the nation for prescribing opioid pain relievers, at a rate of 107 prescriptions per 100,000 people. And the CDC ranks Michigan 15th in nation for drug overdose deaths. This’ll give you an idea of the epidemic’s growth: according to the Michigan Department of Health and Human Services, in 1999 only 22 percent of the state’s drug overdose deaths were contributed to opioids and heroin abuse. By 2015, it was up to 67 percent.

According to MLive, Michigan’s most populated counties register the highest number of opioid prescriptions, with Wayne, Macomb and Genessee county topping the list. But when we look at the number of prescriptions per capita, the numbers change and smaller counties are harder hit. For example, Bay County is highest with 19,365 prescriptions per 10,000 residents, followed by Iosco and Montmorency counties.

When it comes to opioid deaths, again the numbers are highest in the most densely populated counties – Wayne, Macomb and Genessee. Adjust for population size and the highest percentages are seen in more rural, less populated areas like Muskegon, Shiawassee and Macomb counties. Rural areas often struggle with fewer resources to handle the opioid crisis, as well.

As in other states, the opioid crisis has changed the lives of many, and not just drug users and their families. Doctors, police officers, firefighters, teachers, EMTs and school nurses are all affected and have to be more prepared than before. But this also means that Michigan is poised to serve as proving grounds for change. The voices are ready, people are adapting and rising to the challenge, and in the next three parts of this series we’ll hear from some of the people on the front lines of Michigan’s opioid epidemic.