What Does The Latest Research Tell Us About Addiction?

Over the last couple of decades, there have been many advancements in the field of drug addiction research.

What We Already Know About The Brain And Addiction

Research already tells us much about addiction and the brain. The initial binding sites of drugs such as cocaine, heroin, nicotine, and amphetamine and their involvement with the brain’s reward system have been studied. This reward system also ties these drugs to chemical signals such as dopamine and to areas of the brain involved in emotion and motivation. In addition, the effects of chronic drug abuse have also been identified to contribute to a decline in mental ­­performance and brain activity. Continuous drug abuse, specifically cocaine addiction, has also shown to create long-term behavioral and genetic changes that could be passed on to following generations. Because these are all established findings from the past, this article will be focusing on current advancements being made about understanding drug addiction and finding better, more effective ways of treatment.

Future Treatment For Cravings

There has been a lot of current research done on other factors that could contribute to an individual’s vulnerability to drug addiction. A study conducted by the Behavioral and Clinical Neuroscience Institute in Cambridge, focuses on the role of drug addiction in habit-learning areas of the brain. This study is researching the influence of memories on drug cravings. They hypothesize that some drug cravings may arise because of past memories that have become associated with drugs. These memories then trigger a craving for the drug whenever an individual is in the same situation as their memory. With memory-based addiction research, the goal is to selectively disrupt the formation of such memories and hopefully break the cycle of addiction. Other studies are focusing on the genetic component of drug addiction. There have been current findings that suggest there are genetic factors that could predict whether or not a person may be more vulnerable to addiction. Lastly, more research is being done to understand the relationship between stress and drug addiction.

Research On Recovery

Due to the increase in other variables that may be contributing to addiction, there are five major studies being conducted to advance addiction treatment techniques. In a study being done by Johns Hopkins University, researchers explored the rate of relapse in addicts. According to their study, the average length patients would take buprenorphine, medication prescribed to addicts to help them ween off of opioids, only lasted about 55 days. This is alarming when the recommended length of medically assisted treatment is months to years for patients who are trying to successfully overcome their addiction. Also, after the 55 days, a vast majority of the patients admitted to relapsing. This study is highlighting the importance for patients prescribed medication, such as buprenorphine or Suboxone, to continue with their prescription for the amount of time originally prescribed so they could have a real chance at recovery.

The second study, completed by Scripps Research Institute, tested heroin addicted rats and showed that these rats are less likely to increase their use of heroin if they receive electrical stimulation. The implications of the study, in regard to humans, can lead to the eventual application of this technique to human addicts to help treat heroin addiction. However, more research needs to be done to see if this is a viable technique for human subjects.

Another study conducted by Yale, researched patients who ended up in the emergency room of a hospital for detox treatment. Their findings showed that patients who were given medication to reduce drug cravings were increasingly likely to seek help after leaving the hospital. The researchers of this study compared recovering addicts who had been given a referral to addiction treatment services, with those who underwent an interview for discussing treatment options, and those who received a referral for medication. Patients who were given medicated assistance, were more likely to be a part of an addiction treatment program and had a greater reduction in opioid use. This study helps to support the need for medications that reduce cravings when treating opioid addiction.

A fourth study, compiled by the Journal of Substance Abuse Treatment, explains the new treatment program, known as contingency management (CM). In CM, patients are given rewards as they complete different steps in their recovery process. A good thing about CM treatment is that it has spread to many outreach outlets such as smart phone apps and web-based platforms. However, this treatment has proven to be most successful in individuals with positive drug urine tests because they were more receptive than those with negative tests.

Transitioning To Home From Treatment

A final study, completed by the Services for the UnderServed, addresses the issues patients have to face when moving from inpatient or residential treatment back into their community. According to their research, 37-56% of patients who had residential treatment relapsed within their first year out of the program. This percentage can be drastically reduced if the patient continues to seek help, but less than half actually continued. The study also found that there were three common barriers faced by inpatient/residential treatment patients. About 62.5% experienced issues with meeting basic needs either financially or in their living situation. 46.9% felt they had no support network back inside of their communities, with an additional 40.6% stating that their friends at home were also struggling from addiction. And finally, 34.4% of patients complained that facilities lacked aftercare services, which are necessary for successful recovery. This research brings to light the necessity of aftercare assistance for patients who are leaving their inpatient programs to return back into their homes.

Addiction research has increased over the last few years because of the opioid epidemic that is rising throughout the United States. These current studies are helping to add more and more layers, investigating the causes of drug addiction so as to get a better understanding of why an individual becomes addicted and what is the best way of helping them recover. Research on drug addiction is vital in finally bringing an end to the opioid crisis; the more we understand the issue, the better we can fight it.

 

 

Is Addiction A Disease?

Don’t people choose to drink or do drugs? How can addiction be a disease?

Addiction is much more than a few bad choices. It disrupts the areas of the brain that are involved in reward, motivation, learning, judgement, and memory. Not only can it damage brain and body functions, but it can also damage relationships, families, and workplaces. As defined by both the American Medical Association and the American Society of Addiction Medicine, addiction is absolutely a chronic brain disease.

So what causes addiction?

Once though to be a moral failing, it’s now understood that addiction is caused by a mixture of behavioral, environmental, and biological factors. It isn’t an indication of weak willpower. Biological risk factors alone can account for almost half of the likelihood that a person will become an addict.

Anyone who knows someone struggling with addiction, or anyone who has struggled with addiction themselves, understands that it drastically changes you as a person. This is because it’s a complex disease involving functional changes of the brain and body which result in the compulsive use of substances despite any consequences. If left untreated, addiction can lead to physical/mental disorders becoming even more severe and life threatening over time. As with other serious diseases, the ultimate consequence of addiction can be death.

How does addiction change the brain?

Addictive substances cause high secretion levels of the chemicals used in different reward pathways. When a person feels pleasure, the feelings are caused through the secretion of certain chemicals in the brain. Most addictive substances are used to mimic these feelings so they help to release higher levels of those chemicals.

As the new release of the chemicals occurs continuously over time, an individual may need the substance in order to feel normal. This could cause intense experiences of cravings or desires for the substance and even an overall loss of interest in normal life activities or healthy pleasures. These changes in the brain can remain with a person throughout the course of their life, long after a person stops using the substance. Those recovering from addiction can be more vulnerable to physical and environmental cues they associate with the substance, known as triggers, that can lead to a greater risk of relapse. Those in recovery can learn their triggers, and this awareness can prevent relapse.

Learn More: This Is Your Brain On Opioids

Addiction is a chronic disease.

We now understand that addiction is a chronic disease. A chronic disease is a long-lasting ailment that can not be cured, so it’s controlled or maintained. We wish there was a magic pill or a simple solution to fix addiction, but there isn’t. The good news? Only around 20-25% of individuals who suffer from substance use have a severe, chronic disorder. These individuals are more prone to relapse and require intensive treatments, continuous aftercare, and peer support. In spite of this, even the most severe case of the chronic form of addiction can be reversed with long term treatment and support. Recovery is possible.

So why can some people recover so easily?

But recovery itself can cause confusion. Because some individuals can recover without treatment, many people find it hard to understand that addiction is a disease. Why do some people seem to give up problem drinking or drug use on their own without issue, while others can’t? Individuals who struggle with a mild substance use disorder do have the ability to recover by themselves. However, most individuals with severe addiction require intensive treatment and continuous support. The need for treatment is based off the severity of the addiction and an individual’s own determination to recover.

There’s also that element of choice. “Why can’t you just choose to stop drinking or doing drugs?” People ask. Choosing to do something can’t undermine the validity of the disease. Other diseases involve some level of personal choice. Personal choices like diet and exercise can lead to diseases such as diabetes and heart problems, but these diseases are never questioned.

Addiction is a disease that causes change in the brain. It causes changes in neural networks that can lead to an individual’s inability to make good decisions. The difficulty to act normally when suffering from addiction explains why addicts can’t be entirely blamed for their actions.

With treatment, people can and do recover.

Regardless of the intensity of addiction, people can and do recover. Depending on the amount of treatment they need and with the right conditions, the recovery process is possible. Most effective programs include a focus on the underlying issues that caused the addictive behavior. Programs will also usually include mental health assessments and trauma treatment to help individuals who are suffering from addiction rooted in these issues. Some recovered addicts have also found help through spirituality and a focus on their mind/body. Workit Health offers an online treatment program to help you recover from addiction, anywhere, anytime.

To sum it up? Addiction is a disease, not a choice or a moral failing. It’s a disease that causes changes in the brain. The good news, is that it’s possible to recover from the disease of addiction. We need to shift our mindset, shed stigma, and focus on treatment options for those still struggling.

 

What Do The New Opioid Laws In Michigan Mean For You?

New laws have been implemented in Michigan to combat the opioid crisis. How will they affect your care?

The opioid epidemic has grown to impact nearly every community in the state of Michigan and the need for addiction prevention resources has amplified. Lieutenant Governor Brian Calley, Governor Snyder, and a group of bipartisan legislators have passed new legislation this past year to combat the opioid epidemic in Michigan. This legislation implements recommendations give by the Prescription Drug and Opioid Abuse Task Force.

Here is a breakdown of the new opioid laws in Michigan:

Public Act 246 (House Bill 4408)

  • Requires a prescriber to fully inform the parents/guardians of the risks a minor (anyone under the age of 18) may face with an opioid prescription. The parents/guardians must sign a consent form that outlines any risks and acknowledges that the patients and their parents/guardians understand these implications. The bill includes various punishments if there is failure to comply.
  • This bill is meant to reduce the risk of minors from becoming addicted to opioids and other pain killers.
  • The bill also emphasizes the need for both the patients and the parents/guardians to understand the exact implications and risks of the medications prescribed including:
    • the dangers of opioid addiction,
    • properly disposing expired, unused, or unwanted prescriptions,
    • the fact that delivery of controlled substances is a felony under Michigan law,
    • and the effects of reproduction, specifically exposing a fetus to a controlled substance.

The bottom line: Parents and guardians of minors will be more educated regarding opioid risks and effects.

An infographic explaining the new opioid laws in Michigan

Public Act 247 (Senate Bill 270)

Prescribers must have a bona fide physician-patient relationship before any controlled substances prescriptions.

Bona Fide includes:

  • a hands-on physician-patient relationship,
  • a full assessment and recording of patient’s medical history,
  • any relevant physical examinations,
  • a full review of previous examinations, treatments, and treatment responses especially any substance abuse history,
  • thorough discussion of all the advantages, disadvantages, risks, effects, and alternatives of the prescribed medication,
  • the development of a plan with set goals in response to the treatment,
  • full documentation of the new treatment and the patient’s response,
  • and communication with any other physicians seen by the patient.

The bottom line: Any doctor that prescribes you opioids will need to have more than just a casual relationship with you. If you’re struggling with opioid use, the team at Workit Health can help.

Public Act 248 & 249 (Senate Bills 166 & 167)

  • A patient’s history of prescriptions must be checked in the Michigan Automated Prescription System (MAPS) BEFORE providing any controlled substances to the patient. The bill also includes disciplinary action against prescribers who do not use MAPS before prescribing opioids to a patient.
  • This bill is meant to reduce the amount of patients that could become addicted to prescribed opioids and other painkillers, specifically drugs that are subject to abuse.
  • By checking previous prescriptions, it will screen for patients who may be more at risk of abuse and it will verify that the new prescriptions do not counteract previous medications or that they do not result in any unforeseen risks.

The bottom line: Even if you don’t disclose all the treatment you are receiving to your newest doctor, they’ll be able to see the medications you get through Michigan’s prescription monitoring program.

Public Act 250 (Senate Bill 273)

  •  The Public Health Code has now been amended to include that all prescribers must provide patients who have experienced an overdose with information on substance use disorder services.
  • This bill will increase prevention methods by informing patients of services right after being treated for overdose. These services are meant to reduce the consequences of substance use disorders by preventing or at least by delaying the progression of substance use disorder.
  • Prevention methods will focus on the individual, support resilience and recovery, prevent any mental/behavioral disorders, and reinforce treatment to prevent relapse.
  • Information of identifiable recovery-oriented services, such as early intervention and crisis intervention, referral services, and treatment services will be given to any current or former patients with substance use disorder.

The bottom line: If you overdose, getting you treatment options will be a priority. As we know it should be, overdose can be a catalyst for recovery when options are available.

Public Act 251 (Senate Bill 274)

  • Limits the amount of opioids that can be prescribed for acute pain. It also allows prescribers to partially fill prescriptions in increments.
  • If a patient has acute pain (pain that usually lasts for a limited amount of time), a prescriber can only prescribe an opioid for a maximum of 7 days.
  • Public Act 252 (Senate Bill 47): MAPS must be used to monitor the dispensing of any controlled substances by prescribers.

The bottom line: For acute pain, patients can only receive 7 days of opioids.

Public Act 253 (House Bill 4403)

Allows treatment options for Medicaid beneficiaries who are suffering from substance use disorder. Treatment options now include:

  • inpatient care,
  • clinical stabilization services,
  • and any medically necessary treatment services.

The bottom line: This bill finally allows people with Medicaid to find and pay for treatment of substance abuse.

 Public Act 254 (House Bill 4406)

The Prescription Drug and Opioid Abuse Commission will create recommendations for the Michigan Department of Education to teach students about addiction and substance abuse.

The bottom line: This bill acts as a prevention measure by allowing schools in Michigan to educate students about the dangers of opioid abuse.

Public Act 255 (House Bill 4407)

Requires schools in Michigan to provide education on opioids and the risk of addiction in the curriculum for health education.

The bottom line: It is now required that schools include opioid and opioid addiction information in all health education classes.

The state of Michigan has taken several measures to decrease the prevalence of opioid addiction. These bills are meant to act not only as prevention methods, but also to increase both the patients and the public’s education on the dangers of opioids. By implementing these regulations, Michigan has taken one step forward in curbing the opioid epidemic. What do you think about the new laws? Tell us in the comments.

 

Telehealth Buprenorphine A Solution For Opiate Addiction In Rural Michigan

How Telehealth Treatment Works to End the Opioid Crisis in Michigan

Michigan falls 7th out of the 50 states for the highest amount of drug overdose deaths based on the most recent collected data by the Centers for Disease Control and Prevention in 2016. In 2016, Michigan averaged about 18.5 of opiate deaths per 100,000 people. According to the Kaiser Family Foundation, since 2007 Michigan has tripled their number of opiate-related deaths. Not only does Michigan have an opioid crisis within its own state walls, but also in August 2015 United States Attorney Barbara McQuade called Michigan a “drug pipeline” sending opioids to neighboring states such as Kentucky, Ohio, Pennsylvania, Tennessee, and West Virginia. Despite these overwhelming statistics, in an analysis done by Avalere Health, a healthcare consulting firm, Michigan is in the bottom 10 of U.S. states for their ratio of certified doctors compared to opiate deaths.

“Michigan is in the bottom 10 of U.S. states for their ratio of certified doctors compared to opiate deaths.”

One of the latest advancements in opioid addiction treatment, specifically medication-assisted treatment, is buprenorphine. This medication helps people reduce or all together quit their use of a wide range of opiates including heroin and morphine. Buprenorphine is itself an opioid, however, it results in a less euphoric high, curbs opioid cravings, and creates a gradual weaker effect regardless of dosage. When buprenorphine is taken as prescribed, it proves to be a highly effective and safe method of treatment. According to Michigan state officials, there are about 1,400 certified prescribers of buprenorphine, but the actual amount of active prescribers remains unclear. In another analysis done by Avalere Health, Michigan was the 6th worst state in their ratio of buprenorphine prescribers compared to opiate deaths. Michigan’s ratio is only .39 compared to the national average of 1.6 buprenorphine prescribers per death. Despite its helpful effects, buprenorphine has faced some controversy. Some issues include reports of its sale being rerouted to be used as a street drug and the overall ethical dilemmas faced by some physicians of prescribing a drug that is an opiate itself. Because of this, Dr. Pooja Lagisetty, a University of Michigan health researcher, conducted a study in 2017 that proved that buprenorphine prescriptions combined with counseling are an effective opiate treatment. This study was done in various U.S. states and in seven different countries that all concluded buprenorphine can lead to successful treatment.

Infographic from dualdiagnosis.org Infographic from dualdiagnosis.org

An often overlooked issue with buprenorphine treatment is the challenge to provide these types of options, such as medication-assisted treatment, to rural Michigan. Because of the lack of primary care providers in rural Michigan, many different areas rely on physicians that still use abstinence-based care. William Morrone, the chief deputy medical examiner of Bay County, stated that there is “no evidence” that supports the effectiveness of abstinence-based care. Other issues faced by rural populations include a limited number of opioid treatment clinics and large distances between opiate treatment providers. Regardless of the limitations, Kent County’s community health authority, Ross Buitendorp said that, “an individual with severe opiate use disorder, 9 times out of 10 will need to use some form of medication-assisted treatment in order to recover.”

“Issues faced by rural populations include a limited number of opioid treatment clinics and large distances between opiate treatment providers.”

Keeping the benefits and issues of buprenorphine in mind, there seems to be a solution to help rural communities receive access to help stop opioid addiction: telehealth treatment. Telehealth, or telemedicine, is an encompassing term for the ability to help patients through web-based platforms, video conferencing, and messaging in order to increase outreach to patients in rural or remote areas away from hospital or clinical settings. By using telemedicine, people in rural communities have an increase in reliable access to care and privacy. The results of a telemedicine study done in Ontario showed that patients who used telehealth methods had a greater percentage of sessions and stayed in treatment longer than others who did not use telehealth treatment and telemedicine individuals had a decrease in early dropout when in treatment.

The need for telehealth treatment is essential in ending the opioid crisis since it can help increase healthcare access to a wide range of often overlooked communities. One major provider of telehealth treatment for opioid addiction in Michigan is Workit Health. Workit is transforming how recovery and addiction are addressed and treated. We are a licensed opiate addiction treatment program that begins with online basic questions, continues to a visit with a doctor to get the prescription, and ends with continuing care through online therapy methods such as with a phone or computer. The clinic is also conveniently located in Ann Arbor, Michigan. In addition, Workit has a national platform for online addiction treatment that includes fun and engaging science-based lessons in a personalized treatment program and the option to message a peer recovery coach 24/7. These personalized programs take 1-2 hours per week for a flat fee. This fee can also be covered through insurance with a $25 copay. Since Workit Health was made by addicts, for addicts, and backed by experts, we know that affordable treatment anywhere is hard to find. In order to combat this issue, Workit Health provides a sliding scale for anyone who is low-income and who wishes to end their struggle against opioid addiction. As the world’s first online addiction care program, Workit Health takes a uniquely comprehensive and personalized approach that will help patients successfully work through their addictions.

 

The United State’s First Supervised Drug Injection Site in San Francisco

This summer, San Francisco is on track to open two supervised injection sites that will serve around 22,000 people in the Bay Area.

These sites were unanimously voted for by the local Health Commission, whose ultimate goal is to equip these facilities with clean needles, medical staff trained in responding to overdose or other medical emergencies, and resources for people who want treatment: all in order to help end the opioid epidemic. According to the US Center for Disease Control and Prevention, over 63,000 people have died from drug overdose in the United States. Last year alone, over 100 people died in San Francisco from drug overdose.

“Last year alone, over 100 people died in San Francisco from drug overdose.”

The San Francisco Department of Public Health stated that the locations are meant to not only help improve the public health of the residents of San Francisco, but also save the city about $3.5 million annually in drug addiction costs [CNN]. The two locations are set to be open by July, and will be run by a combination of six to eight non-profit organizations that already focus on drug addiction services and needle exchanges in the city.

The facilities will be funded by the private sector so to avoid any liability issues for the city, since intravenous drug use is against both state and federal law. Regardless of state law, San Francisco still plans to open the facilities this summer to help the health and safety of their residents. In addition, the state of California is currently trying to pass legislation to help protect all individuals, drug users, employees, and property owners,  who will deal with these safe injection sites.

“There are 120 safe injection sites all over the world.”

Other than San Francisco, there are currently over 120 of these sites all over the world [The Fix]. The idea of setting up supervised injection sites has spread to cities such as New York City, Seattle, Philadelphia, Boston, and Denver [Vox]. At the end of January, Philadelphia announced that it will host private companies that are willing to create safe injection facilities.

The goal of these supervised injection sites is to help people safely use drugs while also readily giving them access to treatment, consequently leading to a decrease in drug use. The locations will also contribute to a decrease in outdoor, public use of injections, thus reducing the amount of unsafely discarded syringes in places such as parks and alleys. Individuals, who have obtained their own drugs such as heroin, can visit the facilities to safely inject themselves under the supervision of staff and gain access to other social and health services.

By using these sites for safe injection, there will also be less HIV and hepatitis transmission. Based on a study conducted by David Binder Research, out of 500 registered voters in San Francisco, 67% supported the implementation of these sites while 27% opposed it and 6% abstained. This currently seems to be the most ideal solution to help curb the opioid epidemic until policy interventions are made to increase harm reduction and treatment accessibility in the United States.

At Workit Health, we meet people where they are in recovery. That means helping them moderate or quit, or stop using a drug like heroin while they continue to smoke marijuana. This goes against traditional, abstinence-based models of treatment. But we believe that each person deserves a chance at recovery, and we allow recovery and success to be defined by the individual.

Learn more about Workit Health’s online recovery programs.

Benefits of Safe Injection Sites:

  • These facilities use a harm reduction approach by creating a safe space where individuals can use drugs with supervision.
  • Studies consistently prove that facilities with supervised consumption are effective.
  • The opening of these facilities leads to a decrease in:
    • drug overdose related deaths, up to a 35% drop in a community
    • related emergency care calls
    • HIV transmission
    • Hepatitis C transmission
    • public displays of drug usage
  • Even though law enforcement officials are some of the biggest critics of these sites, they only have sway in locations where the police control most of policy-related public safety. (Read our blog on California’s opiate laws.)
  • Philadelphia was able to gain the support of their Police Commissioner when he switched from “dead-set” against the sites to “keeping an open mind.”
  • Studies show that these supervised injection sites do not relate to an increase in drug use and actually lead to a decrease in drug-related issues.
  • The sites help to make drug addiction treatment more accessible.
  • Areas around the facilities had less public injections and inappropriately discarded syringes.
  • The sites were not linked to any increase in crime in Australia and Canada and even reduced street disorder.
  • In Philadelphia, there was a study that proved that as many as 76 deaths could be prevented with the creation of supervised injection sites.
  • Alongside San Francisco’s saving of $3.5 million annually through the reduction of drug addiction costs with these sites, Philadelphia can save $1.8 million annually in hospitalization.
  • According to a study done by UC San Diego, facilities that have been tested in the U.S. have shown results similar to those in the rest of the world by reducing the harm that comes from drug use and reducing the social nuisance of the drug.
  • The facility in Vancouver, Canada has a record of zero deaths in their location.

So what is the debate surrounding Safe Injection Sites?

  • These facilities face some opposition from the federal government.
  • The idea of not-in-my-backyard (NIMBY) opposes these facilities because individuals are scared of allowing drug usage in their communities since it could attract drug users and increase crime, although the research shows this isn’t true.
  • Critics believe that these sites can lead to an increase in drug usage by removing some of stigma around injecting.
  • The Justice Department has stated that if these facilities operate they may encourage individuals to use opiates and maybe even push people to switch from snorting to injection which has a greater overall risk of overdose.
  • Since addiction and homelessness have a connection, if these sites increase drug usage it may have an indirect effect on an increase in homelessness.
  • The ethical dilemma that doctors have to face by facilitating drug usage on individuals who do not have to commit to detox or treatment.

Regardless of your feelings about Safe Injection Sites, in the midst of the opioid crisis, harm reduction strategies are here to stay. Workit Health will be watching San Francisco and supporting its endeavors to provide safe and humane treatment to drug users in the city.