• Opiate Dependence or Addiction?

    Opiate Dependence or Addiction?

    As we close out Recovery Awareness month (September) the need for recovery and addiction treatment persist. Unfortunately, a great deal of stigma remains. Many people complain of “being judged” when presenting prescriptions to pharmacist. This is known to happen when patients present prescriptions for opiates used for pain management and also when being treated with medically assisted therapy for Opiate addiction.

    This “judgment” is unfortunate and aided by confusion between Opiate dependence and addiction. Dependence denotes the patient is requiring opiates and “dependent” on those opiates. It does not indicate the patient is “addicted”. Dependence indicates a physical component including the possibility of tolerance and withdrawal. Addiction is neurological and describes behavior. Addictive behaviors include: being unable to control drug use, destructive behaviors and cravings. Another confusing factor is that one can have addictive behavior without addiction and one may also have dependence without addiction.

    What is not needed is judgment or misuse of terms that deter people from seeking treatment or obtaining prescriptions. Physicians treating patients with opiates monitor for signs of addictive behavior and monitor physical dependence and medication efficacy. It is not within the scope of practice for pharmacist or other non physicians to judge patients or fill prescriptions based solely on a diagnosis. Two different patients may have the same diagnosis but have very different clinical needs. It is the job and clinical assessment of physicians that should be the determining factor in a patient’s medication needs.

    What physicians do need to account for is the availability of other means to treat pain and addiction. At our Opioid Treatment Center in Marietta, GA. We use acupuncture and physiotherapy to avoid the need for opiates. We also treat addiction with (Buprenorphine) in addition to counseling.

    As recovery awareness month closes we should ALL remember to be nonjudgmental and use alternatives to opiates whenever possible. Here at Acupuncture and Injury, our goal is to have our patients “pain free without pillsTM.

  • Can your doctor lead you to recovery from Opiate addiction?

    Can your doctor lead you to recovery from Opiate addiction?

    Medically assisted therapy for opiate addiction has many critics. Some value only specific counseling treatment programs for opiate addiction. Many will criticize medically assisted therapy as simply “substituting one drug for another”. The fact of the matter is, there is no one therapy that works for every patient. One must understand that the term “medically assisted” implies there is more than just the medication being used to help the patient in recovery.

    On the medical side, some facilities will not differentiate between one opiate treatment modality and offer a number of different medications for the treatment of addiction. Unfortunately, the modality chosen is often done for monetary reasons and not the benefit of the patient. As one patient recently lamented: “When I started at the Methadone clinic, another patient told me ‘say goodbye to the next five years of your life’. That was 5 years ago.” The statement depicts the actions of some Opioid Treatment Centers keeping patients on medication for the sake of repeat visits and monetary gain without consideration for weaning the patient off or down from medication. This IS NOT the way we treat patients at our Opioid Treatment Center.

    We have discussed the use of Suboxone (Buprenorphine) as a Methadone alternative in a previous blog. Methadone has a higher risk profile and usually requires more frequent visits. Many patients are prescribed Methadone and kept on it for long periods of time. This is done despite the alternative of Suboxone treatment being available. A Suboxone Treatment Center like our office can provide Suboxone treatment and appropriate referrals to counselors as part of a treatment plan to eventually have the patient completely “opiate free”. As a Subxone treatment doctor, I often tell my patients that: 80% of treating addiction is counseling the other 20% is monitoring and adjusting the medication dosage.

    What often isn’t discussed is: How do patients get into treatment? I have described elsewhere how so few primary care doctors screen for or make referrals for opiate addiction. The more complex part of the problem is how quickly some doctors will prescribe opiates. For example: I once had a patient referred for pain management stating she had Rheumatoid arthritis in her hands. She stated that her primary care doctor told her he could no longer treat her pain and that she had to go to pain management. Strangely, she had no laboratory or X-ray studies done to confirm the Rheumatoid arthritis diagnosis. When X ray studies were performed they only revealed “mild osteoarthritis”. Lab studies were also negative for Rheumatoid arthritis but the patient had already developed addictive behavior! When doctors are cavalier with the prescribing of opiates and neglect to screen for opiate or other addiction, the results are not in the patient’s best interest.

    So the question remains: “Can your doctor lead you to recovery from opiate addiction?” That question should not be confused with “Can a doctor lead you to recovery?” The difference of course is how YOUR doctor handles opiates and addiction. You can simply ask your doctor if they regularly refer patients for addiction treatment. If so, where to? Keep in mind that about one in ten patients in a given primary care waiting room uses opiates. Is YOUR doctor quick to prescribe opiates? Does YOUR doctor routinely refer patients for non opiate-based pain treatment like acupuncture, physical therapy or chiropractic? If not your doctor maybe leading patients toward addiction which is opposite to the road to recovery! In addition, does YOUR doctor advocate for insurance companies providing non opiate based coverage for pain management when it’s denied?

    You can learn about your doctors referral habits by asking a few simple questions:

    • • Where does he/she refer patient for Addiction Treatment in Georgia?
    • • What methadone alternatives does your doctor recommend? Does he/she have a referral relationship with a local Suboxone Treatment Doctor?
    • • Knowing your doctors referral habits can give you insight as to whether or not they can lead you or a loved one to recovery from opiate addiction.