Selected References for Treatment of Opioid Use Disorder with Methadone

This is a list of selected references that I have compiled to help those interested in learning more about the evidence base for the treatment of opioid use disorder with methadone.

https://dl.dropboxusercontent.com/u/24514445/Selected%20References.pdf

Celebrate Medication-assisted Recovery

It has been a busy fall and hard to believe 2015 is almost upon us!

There has recently also been a lot of discussion in the media and elsewhere about the treatment of opioid use disorder with medications, or so-called medication-assisted treatment.

I have come to believe that the better term is medication-assisted recovery as recovery is what happens with so many when medications are part of their treatment and recovery regimen.

So this holiday season, I say happy holidays and best wishes for a bright and wonderful 2015 to all of those people around the world living their lives in recovery with medications -- go MAR!

Comment on CNN and addiction treatment

This is from an article by Dr. Sanjay Gupta, CNN's Chief Medical Correspondent, on the transition from prescription opioid misuse and addiction to heroin addiction. 

"We must work to make sure treatment for drug addiction is a pillar of drug policy in the United States. We already know that it can work at levels similar to the effects of treatment of other chronic diseases, such as diabetes, hypertension and asthma."

Interestingly, as a colleague of mine pointed out, by the time Dr. Gupta "got around to writing a 2-sentence paragraph on need for treatment at the end of the article, he already mentioned how some countries are prescribing heroin..... Also unfortunate is that he did not mention how there are three effective, approved medications for treatment, and how stigma reduces their availability."

Decades of collective data and experience demonstrate that medications including methadone, buprenorphine, and the newer naltrexone, can significantly help people achieve and sustain recovery from opioid use disorder and allow them to lead productive lives. But the stigma, misunderstanding, and associated politics that surrounds these medications, especially methadone and buprenorphine, keeps us collectively as a society from making the most out of them. 

We don't need prescription heroin -- we need informed and courageous politicians, healthcare providers, family members, and people in recovery to stand up and support what we already know works.  

For the full story by Dr. Gupta, go to:  http://goo.gl/Lfd8sb

conference announcement

The Maryland Society of Addiction Medicine will be having their annual meeting on Saturday, Sept 13, 2014
from 8:00am to 2:00pm.

The topic is Healthcare Integration in Maryland: How Will It Impact Your Practice?
Keynote speakers include Dr. Joshua Sharfstein, Secretary of Health and Dr. Gayle Jordan-Randolph, Deputy Secretary for Behavioral Health.

In addition, the conference will feature an update on Maryland's Prescription Drug Monitoring Program, an overview of key scientific journals in addiction medicine in the past year, and a distinguished panel discussing their on-the-ground experiences with integrating care from different perspectives, including an Opioid Treatment Program, an Emergency Department, a rural and urban primary care practice, a mental health setting, and an inpatient acute care hospital system.

The conference is free, and you do not have to be a MDSAM member to attend.

Online registration and more information can be found at:
http://goo.gl/4IWTE5

thank you, david z!

In a world where stigma against methadone is rampant, it takes courage to tell your story of recovery. David Z has that courage and hopefully others will feel inspired to do the same -- we need to hear the voices of people who effectively manage their opioid use disorder with methadone.Those stories of recovery are the key to shattering the myths of methadone!

http://goo.gl/WsYTnX

new media campaign in MD

There's a new media campaign in Maryland, focusing on raising public awareness of opioid overdose and what to do when it happens -- how you literally can save a life!

http://goo.gl/vhN55K

The campaign offers great colorful pamphlets and posters for view on the facebook page and links to a number of different relevant resources from across the state. So take a look!

the words we use

Even though many of you may have seen this article on the word "addict" and how we should ban it from our lexicon (particularly for healthcare professionals, in my mind), I came across this article again and had to post it. It's such a great commentary on the effect of the words we use and their impact.

http://goo.gl/ul9S5V

Apology to a young man

I attended a conference in Cecil County last Thursday, and met a courageous young man in recovery. Part of his recovery involves taking methadone daily. He was at the conference to put a face and a voice to what recovery with methadone means.

I want to apologize to this young man as a handful of other conference attendees (who should have known better) behaved so antagonistically that he felt too intimidated to speak. No one should ever feel defined by a medication that they take, as prescribed, for a medical condition that itself shouldn't define who they are as a person. I can't imagine what the young man must have felt as he sat and listened to his treatment process and his recovery being flung in his face as "not treatment" and "not real recovery." And by people who have no healthcare credentials behind their name.

I was so glad when another conference attendee at the end of the day, after the young man had left, stood up and spoke up on behalf of the young man, his recovery, and the impact that the earlier words had had on him.

I wouldn't blame the young man if he never wants to attend another conference on substance use disorders ever again or ever utter the word "methadone" to anyone. I hope he doesn't let this episode affect his confidence in his recovery.  But I hope he will continue to show up and speak out since it will take his voice and that of many others to finally drown out those who don't understand, or choose not to understand, the science and the evidence.

Sticks and stones may break bones, but it's words that often cause the most damage. Let's use words to heal, not harm.

Happy Father's Day!

To all those fathers in recovery out there -- Happy Father's Day!

Whether your recovery involves taking a medication or not, I hope you have a wonderful day celebrating your strengths and all that you give to your family and friends!

Thanks on Memorial Day

As Memorial Day winds down, I wanted to share this message I received from a patient of mine who has been in recovery, and on methadone, for "14+ years" as he describes it. He's currently helping older, Russian speaking people at a nursing home. This is how he described the experience -- a fitting note of thanks on Memorial Day.

                 I saw the struggles of not being able to communicate. Many of them being of Jewish decent &        surviving WW2.

I felt an obligation to not only translate, but to help them to be as comfortable/dignified as possible towards the end of their lives.

I told one Gentleman who fought at Stalingrad where 2 million people died fighting the German offensive. 

I told him that I might not exist without his Sacrifice. 

A little kindness can go a long way...

This was the following message I received from someone I saw the other day for 30 minutes who has a long history of trauma and opioid use disorder (with some parts removed to protect confidentiality):

                       Thank you for making time to speak with me. Your demeanor -- open, friendly, not-speaking-                              down-to-me and not passive/aggressively threatening -- and therefore not traumatic -- were A                            VERY BIG DEAL TO PUT ME AT EASE !!!

I think we sometimes forget how much our attitudes and demeanor shine through every interaction we have with people -- and how far we can get with just a little kindness, patience, and a listening ear. 

Inspiration in clinic

Every day after finishing seeing patients in my clinic, I realize just how much I love my work. I get to work with dedicated, fun, compassionate nurses, therapists, counselors, a nurse practitioner, and administrators. But best of all, I get inspiration from my patients -- because they are smart, brave, funny, and most of all survivors.

Today, for example, I saw a young veteran who developed an opioid use disorder after a severe injury from an IED (improvised explosive device) while serving in Iraq. He survived but is now trying to rebuild his life after exposure to prescription opioids triggered a genetic predisposition to opioid addiction. He is now stabilizing on methadone after years of compulsive, uncontrolled, and dangerous use of everything from fentanyl patches to OxyContin to Percocets by the fistfuls. He still has a long way to go since memories of his time as a soldier continue to invade his thoughts and dreams, and his back injury precludes many possible jobs -- but he is determined to manage his addiction, get the memories under control, and return to work.

I can't really imagine what he has gone through or what he has yet to endure, but his fighting spirit makes me hopeful that he, like many others, will find recovery. Our job as a clinical team is to provide care and support through the ups, and downs, of that process. I am honored to serve him as he has served us.

Mother's Day and methadone can go together

Happy Mother's Day! For all those moms, moms-to-be, and women-who-will-be-moms who are managing their opioid use disorder effectively with methadone -- I say congratulations and may you and your families have a wonderful day! Check out this site if you want additional support: http://goo.gl/zbDPN2


I also know that Mother's Day can be very difficult for some moms who have lost children to opioid use disorder -- sometimes that loss has unfortunately involved methadone. These are tragedies, just like losing any child to an illness or unforeseen circumstance is a tragedy. To these moms, I say my thoughts are with you, I grieve with you, and I am so sorry for your loss. Vigils, like the one coming up in Baltimore on May 28th, is a good way for all of us to remember and celebrate their lives: http://goo.gl/D1iGEA

The risks of full opioid agonists, like morphine, oxycodone, hydrocodone, and methadone, are real -- we need to teach our kids that. But as with so many things in medicine and public health,, risks and benefits go together. The benefits of full opioid agonists are real too, for pain and opioid use disorder treatment. We can't lose sight of the thousands of people whose lives have been restored and lengthened with effective treatment including methadone: http://goo.gl/ZyMslR

My hope is that all moms can come together and celebrate ourselves, our kids, and our families -- no matter who we are or the experiences we bring.

New OD Response page on ADAA website

Check out the new page on ADAA's website for Maryland's opioid overdose response program! You'll find information on the program, contact information, and links to the statue and regulations, forms for being an approved training entity along with the core curriculum, a list of approved training entities, and a helpful FAQ. Happy browsing! http://goo.gl/aRn2O4

Opioid OD response trainings in Baltimore City

Following from the Overdose Response law that the Maryland legislature passed last year, implementation of the program is moving forward. Check out this link for details on the 4 trainings so far scheduled in Baltimore City. http://goo.gl/h3eeXv

Upcoming vigil to honor people who have lost their lives to addiction

On Wednesday, May 28th, starting at 7pm at the Kaufman Pavilion outside the Maryland Science Center to honor and remember family, friends, and colleagues who have lost their lives to addiction. While medication-assisted treatment has been shown to prolong the lives of people with opioid use disorder, we know that often lives are tragically cut short for many reasons. Please attend this event and help support life.
http://goo.gl/7Vbenx

Great day in clinic

Had a great day in clinic today, seeing patients in all stages of their recovery from opioid and other substance use disorders.

Saw a young man who has been stable on methadone for 10 years, and is just about to graduate from a higher education professional course. He's looking forward to completing one more specialized course and then working in healthcare. He came in for a stye on his eyelid.

Saw a woman who is finally able to acknowledge, after over a year of ups and downs, that she's depressed, and relapsing to benzodiazepines after detoxification won't make that any better. Getting her on an antidepressant ASAP. Teamwork with counselor and clinical supervisor as part of the visit really made a huge difference.

Saw a pregnant woman who is now stabilized on an effective methadone dose after switching from buprenorphine that wasn't really working for her. She's looking forward to becoming a mom soon and continuing her care with us after her delivery.

With our two amazing nurse care managers, saw a homeless woman with opioid use disorder that is stable with methadone but struggling with alcohol use. When we showed her her abnormal liver function tests from last week, she immediately agreed to alcohol detoxification -- but would like for it be done as an outpatient. Thanks to amazing teamwork, we are starting that tomorrow with gabapentin and careful nursing monitoring.

Saw an older gentleman who has been stable on methadone for 7 years and wants to quit smoking. He's tried nicotine patches in the past but they haven't worked. So we're trying bupropion this time and he's setting himself a quit date. He's going to see our Nurse Care Manager and follow up with his counselor for extra counseling and support.

Each story is unique but at the end of the day, each story is about a person working hard to make a better life for his or herself. That can happen with medication-assisted treatment.

Here are a few of my favorite......articles

Oldies but goodies:

This is Tom McLellan's article on addiction as a chronic disease.

This is Tom McLellan's randomized trial of methadone vs methadone plus counseling and wrap-around services.

This is Annie Umbricht's study of on-site primary care in an opioid treatment program vs referral to a nearby primary care practice.

Enjoy!

Buprenorphine and Overdoses

Does expanding access to buprenorphine treatment for opioid use disorder really reduce overdose deaths?  Absolutely.  Here is a link to our paper on the impact of expanded access to buprenorphine on deaths from heroin overdoses in Baltimore.

Presentation on Medication-Assisted Treatment

I recently gave a presentation to a conference hosted by the Maryland Addiction Directors Council.  Here are my slides on the topic of  "Medication-Assisted Treatment and Recovery with Methadone and Buprenorphine: What really are they?"

New England Journal article on Chronic Pain, Addiction, and Zohydro

Here's a link to our article in the New England Journal of Medicine on chronic pain, addiction, and Zohydro.

JAMA article on stigma

Here's a link to our article on the stigma of opioid use disorder -- and its treatment.

from a local Connecticut paper

from the article:

One treatment, in use since 1964, is medication-assisted therapy with the use of methadone. Used at CCC, it carries with it a series of misunderstandings and stigma, according to Lambert.

"I've heard methadone being referred to as government-subsidized heroin. There is a profound difference between methadone and heroin," Lambert said. "Methadone is an opiate agonist which attaches to the receptor sites in the brain. It doesn't produce the same high. What it does is normalize brain chemistry."

An effective treatment for opioid dependence and addiction includes medication-assisted therapy with the opioid medications methadone or buprenorphine, the only two opioids federally approved for the treatment of these conditions, according to a SAMSHSA National Survey of Substance Abuse Treatment Services April, 2013 report. "Methadone relieves cravings, blocks the euphoric effects associated with heroin and other opioids and prevents withdrawal."

"People need awareness to destigmatize addiction. I think the average person would be shocked to know that we treat folks from all walks of life," Lambert said. "Some of our patients are nurses, school teachers, athletes, successful stockbrokers who work on Wall Street every day. We have multi-generations in treatment here."

Welcome to Update on Opioids, an educational blog from the perspective of a physician taking care of people with opioid use disorder.  I look forward to this project!

Yngvild