Powerful words from Massachusetts on the Stigma of Opioid Addiction

Thank you, Massachusetts, for a powerful, and empowering, public health message! 

May all of us step up to the challenge of changing our language -- and actions. 

The Stigma of Opioid Addiction

                                   from Massachusetts department of Health and Human Services

It’s a huge public health threat – addiction to powerful opioid painkillers.  But you can help by changing the way you think about, talk about and treat people with addiction. Words like “junkie,” “addict” and “druggie” can hurt and stand in the way of recovery. There are perceptions that addiction is a personal choice (when in fact it’s a disease), that addiction is a sign of human weakness, or a lack of morals or willpower.  While the initial decision to take drugs may be voluntary, neurological changes to the brain restrict a person’s self-control. The disease hinders the ability to resist impulses to take drugs despite harmful consequences.

A stigma is a mark of disgrace that sets a person or a group apart.  Stigmas aimed at people with substance use disorders come from many sources including personal shame and disgust at one’s own appearance, behavior and feelings of being unworthy of help, negative labels from friends or family, negative attitudes from healthcare providers, the media, law enforcement, places of work and government agencies.

We are all affected by the current epidemic of opioid addiction. Many of us know someone who struggles with addiction, or who is in treatment.  What can we do?

• We can take a stand against stigma. 

• We can support treatment opportunities. 

• We can encourage people in recovery.

          We can talk about addiction with our friends and family.

          Each of us can commit to not using hurtful or damaging words about those who struggle with addiction.  

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

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. 

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.