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 Post subject: Hazelden and Suboxone
PostPosted: Wed Dec 02, 2015 8:35 pm 
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This was a fantastic article from 2 years ago detailing the shift in attitude towards maintenance that's happened over at Hazelden.

Now (in 2015) it seems a lot of the 12-step inpatient rehabs are under fire due to Obamacare requiring treatment be "evidence based" in order to qualify for insurance cover. And given 12-step groups reluctance to be studied by the scientific community, they no longer can claim to be evidence based.

It seems we're going through a historical shift away from the archaic 12-step based treatment for addiction!

http://healthland.time.com/2012/11/05/hazelden-introduces-antiaddiction-medications-in-recovery-for-first-time/

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Founded on the idea that abstinence is the bedrock of any recovery from drug or alcohol addiction, Hazelden will now incorporate anti-addiction medications in its rehabilitation programs.

Treating drug addiction is as much about addressing why people become hooked on substances like alcohol, painkillers or illegal drugs as it is about weaning them off of their habit— at least that’s the core of the Hazelden recovery approach. From its founding in a Minnesota farmhouse in 1949, the program has championed the 12-step method, with its roots in the principles of Alcoholics Anonymous. That philosophy is anchored by the belief that true recovery can only start with addicts admitting they need help from others. Abstinence from all potentially addictive substances has always been the cornerstone of this strategy, which has become known as the “Minnesota Model.” Some 90% of American addiction counselors rely on Minnesota Model principles.

But for the first time, Hazelden will begin providing medication-assisted treatment for people hooked on heroin or opioid painkillers, starting at its Center City, Minnesota facility and expanding across its treatment network in five states in 2013. This so-called maintenance therapy differs from simply detoxifying addicts until they are completely abstinent. Instead, it acknowledges that continued treatment with certain medications, which can include some of the very opioid drugs that people are misusing, could be required for years.

“This is a huge shift for our culture and organization,” said Dr. Marvin Seppala, Hazelden’s chief medical officer, who pushed for the new practice. As the program’s first adolescent patient, and someone who has been in recovery from multiple drug addictions for 37 years, Seppala is keenly aware of how dramatic this decision is for the organization, which once debated whether or not coffee was acceptable in its abstinence-based program. “We believe it’s the responsible thing to do,” he says.

Driving the need for change is the sobering reality of what happens to patients addicted to prescription pain relievers— a growing segment of those in need of drug recovery— once they leave the Hazelden program. Within days of leaving the residential treatment facility, most were relapsing— and at least half a dozen have died from overdoses in recent years. It was time, Seppala argued, for a radical change.

In the coming months, Hazelden will begin to prescribe the drug buprenorphine (Suboxone) for some people addicted to opioids — the class of drugs that includes prescription pain relievers like Oxycontin and Vicodin, as well as heroin. At low doses, buprenorphine acts like methadone or heroin, which helps addicts to avoid severe withdrawal. But at higher doses it prevents opioids from working. That means it’s much harder to misuse or to overdose on buprenorphine, making it safer than methadone, the other commonly used anti-addiction medication.

Making The Case

Using the appropriate medication to treat addiction is an idea whose time has certainly come, at least according to the latest research, which has documented the effectiveness of such strategies for decades. But it’s taken longer for the leading treatment providers in the community, including Hazelden and Betty Ford, to accept the idea that giving drug addicts medications similar to those to which they were addicted can be part of recovery.

The science, however, is getting harder to ignore. Studies show that people addicted to opioids more than halve their risk of dying due to their habit if they stay on maintenance medication. They also dramatically lower their risk of contracting HIV, are far less likely to commit crime and are more likely to stay away from their drug of choice if they continue maintenance than if they become completely abstinent.

The first maintenance drug, methadone, was introduced in 1964 after studies supported its effectiveness in fighting heroin addiction. Based on that data, leading health organizations — including the Institute of Medicine (an independent U.S. body of experts authorized by Congress to study health-related issues), the World Health Organization and the U.S. “drug czar’s” office — recognized the importance of medication-assisted treatment for opioid addiction.

“The evidence shows much, much better outcomes,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse.

But to a treatment program based on the 12-steps of Alcoholics Anonymous—whose first step involves admitting “powerlessness” over one’s addiction— the idea of maintenance on a potentially mood-altering drug has always been suspect. For an alcoholic, substituting vodka for gin or even beer for wine wouldn’t really represent progress: so why would replacing an illegal opioid like heroin or non-prescribed painkillers with a legal one be better for recovery?

The answer lies in the different ways that opioids and alcohol act on the brain. In alcoholism and other addictions, pleasure areas in the brain get misdirected as addicts continue to chemically activate the system in order to achieve greater “highs.” The repeated behavior leads to tolerance, and over time, larger and larger doses are needed just to feel normal, let alone “high.”

But where drinking alcohol is always accompanied by some degree of physical impairment— like loss of motor coordination and reduced cognitive ability, with opioids, there is no significant mental, emotional or physical impairment if someone regularly takes the exact same dose. In fact, research shows that patients addicted to opioids who are on maintenance doses of anti-addiction drugs like buprenorphine can drive safely, work productively and engage emotionally like those who aren’t addicted.

“For most people using opioids daily, they are no longer getting high, even when they are still using. It’s just become maintenance,” Seppala says. The effect is similar to the tolerance people experience with caffeine. “If you drink caffeine on a daily basis, after a while, you don’t notice the effect of one cup of coffee,” he says, “But if you drank two, you would.”

New Beginnings

Still it wasn’t until the FDA approved buprenorphine in 2002 that Hazelden even began considering lifting its ban on medication-assisted recovery. Unlike methadone, buprenorphine can be prescribed by family doctors (although there are still some limits on the number of prescriptions physicians are allowed, in an attempt to prevent “pill mills” from dispensing the drug without proper supervision). Like other medications, it can be picked up monthly at pharmacies, not daily at clinics.

Watching many Hazelden patients leave the facility only to overdose soon afterwards, Seppala realized change was needed. “This is a place of healing,” he says, “To have people die after treatment is just horrible.” Buprenorphine, he realized, might help to avoid some of those deaths.

To his surprise, he found far less resistance than he expected when he approached Hazelden officials to consider using buprenorphine. Over a period of 10 months, the facility’s experts analyzed the available data and in September, the group’s full board approved a plan for change, which involved integrating medication-assisted therapy thoroughly into treatment, not just handing out drugs.

Hazelden will start using buprenorphine maintenance cautiously at first. The drug will not be provided to people who have been addicted to opioids for less than a year and complete abstinence will remain the ultimate goal for most patients, even as the program recognizes that years or even lifetime maintenance on the drug may sometimes be needed. And the rehab will now consider people who are taking maintenance medications in their program as being “in recovery” from the day they start these drugs and stop taking non-prescribed drugs. The program will define relapse as any drug use outside that provided by medical advice. Those changes will be integrated into the counseling and even the 12-step meetings offered onsite.

And because clinicians expect that a single treatment strategy won’t be enough to address the recovery needs of all of those addicted to opiates, for some patients the program will also provide Vivitrol, a time-release injection of naltrexone that prevents opioids from from being effective for about a month. Although this approach may seem like a better option than maintaining people on an opioid medication indefinitely, studies so far have not shown that naltrexone reduces mortality in opioid addiction in the same way that maintenance drugs like methadone and buprenorphine do. The National Institute on Drug Abuse is currently conducting the first trial to compare Vivitrol directly with opioid maintenance to determine its long term effectiveness.

As for Hazelden, “We will never change from being a solid, 12-step based program,” Seppala says. “But I am a physician and we look at the research and want to use evidence-based treatment.”

The reaction among academic addiction experts to the change has been, not surprisingly, positive. “I was delighted,” says Volkow of Hazelden’s decision. “This was a change that I’ve been waiting for. I would predict that as data emerges as to how this change improves the outcome of their patients, then others may realize that this is beneficial for patients and not harming them in any way.”

The ultimate test, of course, will be with the patients, whom Hazelden will study closely. And already, they have been encouraged by a success story. J, who failed to overcome multiple addictions during seven different attempts at rehab, including at Hazelden, finally took the first steps toward recovery after a doctor prescribed buprenorphine. J’s mother, Cheryl, a former heroin addict who recovered at Hazelden and became a counselor and supervisor there, witnessed the difference that the anti-addiction medication made for her daughter, and realized that recovery, and recovery treatments, have to be flexible.

What worked for her, she now knows, may not work for everyone. Now free of illegal drugs and alcohol for more than a year, J has regained custody of her son, which she had lost due to her addiction. “I’m as proud as I can be of her,” says Cheryl, “She’s responsible and reliable. I don’t get these calls any more where she has frantic mood swings or is feeling so down and desperate that she is threatening suicide. Without that Suboxone, I don’t think my daughter would ever have been able to develop these sober living skills. The oldtimers are just going to have to accept it.”


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PostPosted: Thu Dec 31, 2015 6:44 am 
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What an awesome article, I love that!! I copied the post and saved it in a new doc, but that link wouldn't work. Maybe it's just me..? Thanks for sharing :)


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PostPosted: Thu Dec 31, 2015 2:16 pm 
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Perhaps someone from Hazelden or someone that has gone through treatment can refute this but; what I am seeing is that they are using it for detox and short term. By the time you complete their outpatient program you also complete the weaning process. Last I heard a rep from there it was being used rarely for one year max. We still get calls from people that are being weaned and do not feel ready. But, at least they have started using it.


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PostPosted: Sat Jan 30, 2016 5:30 pm 
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Check out this article Hazelden Betty Ford just released and please save the praise for a treatment center which doesn't lie and spread misinformation. Here's a copy and paste of the article with a link to the original at the end. ADVOCACY
JANUARY 22, 2016 | BY: Frank L. Greenagel Jr., MPAP, MSW, LCSW, LCADC, ACSW, ICADC, CJC, CCS
The Suboxone Problem No One Is Talking About
The key to effective treatment with Suboxone
On October 21, 2015, President Obama met with people in Charleston, West Virginia and talked with them about the opiate and heroin epidemics. While all of America has been devastated by these drug epidemics, they have particularly ravaged Appalachia and Rust Belt cities; wealthier regions of the country have both more access to healthcare and better treatment options.

The President announced a number of initiatives, including the expansion of buprenorphine and naloxone. Buprenorphine is the chemical that is in Suboxone. It is a semi-synthetic opiate that helps reduce the physical and psychological craving that so often leads newly clean opiate users to relapse. Naloxone is a drug that has come to prominence in the last few years—it can reverse the potentially fatal effects of an overdose. Thousands of law enforcement officials and emergency medical technicians around America now carry it with them and have saved thousands upon thousands of lives.

President Obama ordered that all federally employed healthcare providers must undergo best practice training for prescribing, pain management and how to recognize and educate misuse. On the same day as his speech, the White House issued a press release that more than 40 provider groups pledged to:

Have more than 540,000 health care providers complete opioid prescriber training in the next two years;
Double the number of physicians certified to prescribe buprenorphine for opioid use disorder treatment, from 30,000 to 60,000 over the next three years;
Double the number of providers that prescribe naloxone—a drug that can reverse an opioid overdose;
Double the number of health care providers registered with their State Prescription Drug Monitoring Programs in the next two years; and
Reach more than 4 million health care providers with awareness messaging on opioid abuse, appropriate prescribing practices, and actions providers can take to be a part of the solution in the next two years.

These are all plans and initiatives that I approve of, but there is a key problem that has not been addressed. Back in 2000, the Drug Abuse Treatment Act (DATA) was written by Senators Orrin Hatch (R-UT), Carl Levin (D-MI) and Joe Biden (D-DE) and signed into law by President Bill Clinton. The intention of the act was to allow primary care providers to engage in addiction treatment. Physicians were required to take an 8 hour course on addiction treatment. Once completed, they could prescribe up to 30 patients with buprenorphine (this number was later increased to 100 and there are current proposals to increase it to 200). The act suggested that buprenorphine treatment be combined with regular urine screenings and counseling.

The key word here is suggested, and it’s a terrible flaw.

Thousands of doctors have undergone the training, and a large number of their practices are primarily in the treatment of opiate addiction. This is despite the fact they are not true specialists, but rather regular doctors who took an eight-to-24-hour course on addiction treatment. Many of these doctors do not drug test their patients, nor do they require them to go to counseling. When the clinical trials of buprenorphine were conducted, the patients were given regular drug screens and counseling. The outcomes of the clients were good and this resulted in the passage of the law and the approval by the FDA. But while these newly trained doctors were prescribing buprenorphine to their patients, they were neither drug-testing them nor making them attend counseling, and the effectiveness of this new drug treatment was greatly diminished.

Regular drug testing through urine screens (blood tests are rare) leads to less drug use. It’s clear and irrefutable. To be effective, drug tests need to be monitored by another person in the room and they need to be regular and random. There are many studies that demonstrate that counseling has some effectiveness (I am a believer in a combination of individual, group and multi-family counseling). Despite the suggestion by DATA, studies and best practice guidelines by the American Society of Addition Medicine (ASAM—full disclosure, I’m a member), many doctors do not require drug screens or counseling when they are treating their opiate addicted patients.

This has led to the misuse, abuse and diversion of buprenorphine (the New York Times reported on these issues in November of 2014). Over the last decade, buprenorphine has become a dirty word in Twelve Step meetings and many treatment programs. AA and NA meetings are often the last place someone can go and be accepted—to be rejected there is not only wrong, but it can be deadly.

A majority of halfway and recovery houses refuse to accept people that are on buprenorphine. As a result, people in early recovery are often faced with the decision to either:
stay on buprenorphine and be homeless or live in a dangerous environment; or,
rapidly or immediately quit buprenorphine in order to live in a safe environment and be accepted in the rooms.

People in Twelve Step programs have reacted negatively to buprenorphine because it has not usually been properly used in treatment. They have seen people use other drugs while on Suboxone or used it as a tool to avoid detox during the week before returning to heroin on the weekends. Their experience with it is almost entirely negative. Thousands of people in recovery have attended my professional trainings, and a majority of them do not believe in the efficacy of buprenorphine. I have had to spend much too much time and energy explaining research studies, the evidence that it is quite effective, anecdotes of clients, and the failure of the DATA act in order for them to even consider changing their minds.

All of this can be fixed with a proposal that no one is talking about. Instead of suggesting regular drug screens and regular counseling, a prescription of buprenorphine (or naltrexone or probuphine for that matter) must be accompanied by regular drug screens and counseling. By regular, I mean weekly drug screens and at least one hour of counseling a week (still too minimal in the beginning).

I have brought this up with both Republican and Democratic members of Congress, and they have all told me that “getting new regulations are tough.” I smile and ask them to take a look at it and do their best.

Inside, I seethe. This is an issue that can be easily improved upon. The data and studies are clear. We need leadership, and I don’t see any politician speaking about this simple measure.

It is time for addiction treatment professionals and advocates to urge politicians to require that drug screens and counseling accompany the prescribing of buprenorphine (and other medication assisted therapies). It will increase the effectiveness of the medication and thereby reduce the stigma associated with it that is rife in the rooms of Twelve Step programs and in treatment centers.

Frank Greenagel is an adjunct professor at the Rutgers School of Social Work. He is also an instructor at the Rutgers Center of Alcohol Studies and a member of the Hazelden in New York Board of Directors. He writes a blog at greenagel.com. He conducts trainings, consults for programs, and delivers keynote speeches around the country. He completed a Masters in Public Affairs and Politics in 2015. He rejoined the Army in 2014 as a Behavioral Science Officer.
http://www.hazeldenbettyford.org/articl ... l-suboxone


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PostPosted: Sat Jan 30, 2016 10:44 pm 
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What an unwitting ass! He has no idea what he is talking about! Weekly drug screens my ass!

Amy

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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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