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individuals can become addicted even after only taking opioid pain meds for a few days. One study found that one in five people given a 10-day supply of opioid painkillers became long-term users. More M.D. Education Needed Don Teater, M.D., medical adviser of the non-profit National Safety Council, says doctors need more education to understand the draw- backs of prescribing opioids. “Doctors get a lot of training in the physical aspects of health, but not the mental aspects,” says Teater, a family physician in North Carolina whose practice focuses on treatment of pain and the treatment of opioid use disorder. “We don’t get training in addiction. Often, a doctor will start a patient on opioid pain med- ication and continue it for awhile. Then if the doctor feels the patient is asking for too much medication, the doctor will cut them off, and abandon them. There needs to be a greater understanding of the emotional component to pain. We also need to have a better under- standing of the disease of addiction.” According to a white paper from the Council, there is little evidence that opioids are helpful when used for chronic pain.

four groups – and by similar levels: 4.3 points in the ibuprofen/acetaminophen group, 4.4 points in the oxycodone/acetaminophen group, 3.5 in the hydrocodone/acetaminophen group and 3.9 in the codeine/acetaminophen group. The researchers said the major limitation of the study is that it had the patients assess their pain only while they were in the emergency department. The study did not evaluate how the ibuprofen/acetaminophen combination would work in comparison to opioids once the patients went home. Also, the participants had a specific type of acute pain – from sprained or broken arms and legs. “Preventing new patients from becoming addicted to opioids may have a greater effect on the opioid epidemic than providing sus- tained treatment to patients already addicted to opioids, in whom it may take many years to achieve recovery,” Demetrio Kyriacou, M.D., a senior editor at JAMA and a professor of emer- gency medicine at Northwestern University, wrote in an accompanying editorial. Yet, as Kyriacou also acknowledges, “stemming the opioid addiction crisis will … require reex- amination of the long-standing assumptions that opioids are superior to

Trial evaluated effectiveness for common injuries

Four Groups of Patients The patients were randomly assigned to one of four groups. One group received a pill for their acute pain that contained a combination of ibu- profen and acetaminophen, the ingredients in Advil and Tylenol. The other groups were given a pill for their pain that contained a prescription opioid as well as acetaminophen, either oxyco- done and acetaminophen (Percocet), hydroco- done and acetaminophen (Vicodin), or codeine and acetaminophen (Tylenol No. 3). All the patients were asked to rate their pain immediately before taking the pain medication and again both one and two hours afterward (before they left the emergency department). The assessments were done using an 11-point scale (0 = no pain; 10 = worst possible pain). The study found that the intensity of pain was similar among all four groups before they took the medication, with a mean score of 8.7 on the scale. The pain then declined over time in all

As the over prescribing of opioid pain medications has become a major public health concern, health care providers have been paying more attention to over-the count- er-drugs that could be used instead, without the risk of addiction. A recent study published in the Journal of the American Medical Association (JAMA) has confirmed that OTC meds ibuprofen and acet- aminophen are just as effective as prescription opioids at reducing acute pain caused by com- mon injuries.It is one of the few “real world” studies that has made the comparison. A team of researchers led by Andrew Chang, M.D. of Albany Medical College, studied 411 patients (aged 21 to 64) who had sought med- ical care at two urban emergency departments after having sprained, strained or broken an arm or leg. (About 20 percent of the patients had fractures.)

non-opioids in most clinical situations requiring man- agement of moderate to severe pain.” Studies have shown that nearly one-third of adult patients seeking care at U.S. hospital emergency departments are given prescriptions for opioid painkillers, even if their visit was not pain-relat- ed. That is a dangerous practice, since some

“In fact, some evidence shows they may be detri- mental and increase risk of addiction and premature death,” the paper says.

There is little evidence that opioids are helpful when used for chronic pain.

A l-Anon teaches that we are power- less over alcoholism and while that may be true to some extent, there are steps we can take that will help an addict in the long-run, and may even lead them to get the help they so desperately need. There’s a widely held belief that people with substance use disorders need to “hit bottom” before they are willing to seek treatment. Unfortunately, loved ones can actually prevent addicts from experiencing the negative consequences necessary for them to reach that point. This is called “enabling” and it can take many forms. If you have found yourself covering for your addicted loved one when they can’t make it into work, or picking them up from the bar when they are too drunk to make it home, or explaining away their behavior to your kids, then you are enabling them to continue using. The good thing about being a loved one in an addict’s life is that you can actually bring their bottom “up” by stepping back and allowing consequences to take their natural course. In the book, “Boundaries” by Dr. Henry Cloud and Dr. John Townsend, there are some ideas which can help you navigate the treacherous waters of truly helping an addict begin their journey toward recovery. Sometimes, experiencing well-deserved karma is a good thing. There is a law of “sowing and reaping” Cloud and Townsend say that all of us live out. It is especially important to allow this sowing and reaping process to be happening in the life of your loved one. Don’t get in the way. If they lose their job for being late or showing up drunk or high, then so be it. Those are consequences that can help that person get in touch with their addiction. If they get drunk at a party, let them know you don’t intend on getting into the car with a drunk person, then take a cab home with their money.

If you have a son or daughter who is using and doesn’t have a job or isn’t paying rent, then it may be time that you show them the door. Give them the addresses of some homeless shelters. This may be the very thing that helps them to sober up. Yes, it is difficult and painful and it may not work, but enabling them to continue in their addiction is worse. We can talk to addicts until we are blue in the face and this will not matter to them, only when they receive some actual negative consequences for their behavior will they wake up and smell the coffee. One of the most loving actions I ever saw a parent take was when this man’s daughter was sent to jail because of drug use. He could easily have bailed her out, but instead, brought her a recovery book and a toothbrush and said, “I love you, but this is the best place for you right now.” She is sober today. One thing you can expect when you allow natural consequences is your loved one’s anger towards you, especially if you have previously been enabling their behavior. This is unfortunate, but normal. The important thing is for you to not retaliate. Otherwise, they will just blame their use on their “crazy” spouse or parent. What you can do is empathize with them that negative consequences are difficult and ask them if they are ready to get help with their problem. Finally, it is important to remember what real love is. Real love is not rescuing the addict from pain if that pain is a natural consequence to their behavior. People learn good life lessons when they reap what they sow. Hitting bottom is possible before that bottom is death, and not getting in the way of that process is the most loving thing you can do for your loved one.

MY LOVED ONE’S DRUG USE?

There is nothing that makes a person feel more helpless than watching a loved one suffer from drug addiction, especially when it seems they don’t want help.

THE GOOD THING ABOUT BEING A LOVED ONE IN AN ADDICT’S LIFE IS THAT YOU CAN ACTUALLY BRING THEIR BOTTOM “UP”

It also authorizes HHS to develop grants to support people who are in recovery transition to independent living and jobs, as well as develop a pilot program to provide temporary housing for those recovering from substance abuse. of the bill provides measures to prevent synthetic opioids like fentanyl from entering the U.S. According to the Centers for Disease Control, total opioid deaths did not increase in 2017, but deaths due to fentanyl overdoses did. Data shows the drug, which is about 50 times more potent than heroin, caused nearly 30,000 fatal overdoses last year. access to medication-assisted treatment. It removes the cap on the number of patients to whom drugs like buprenorphine, a drug cravings and easing withdrawal, from 100 to 275, and expands a grant program allowing medication-assisted treatments.

strengthen the federal government’s response to the opioid crisis,” Sen. Rob Portman (R-OH), who helped put together the legislation, said in a statement after the Senate vote. “Importantly, this bill will increase access to long-term treatment and recovery while also like fentanyl from being shipped into the United States through our own Postal Service.” On the other side of the debate, Leana Wen, M.D., the former health commissioner of Baltimore (and incoming president of Planned Parenthood), said that the legislation “is simply tinkering around the edges.” Daniel Raymond, director of policy and planning for the Harm a bad thing, but I do think to some degree it’s a political document,” Raymond told the Washington Post. “When you drill down into it, it’s not that there aren’t good ideas, but it doesn’t reach the level of, this is what our nation needs right now.” and Mental Health Services Administration (SAMHSA) to allow organizations to develop opioid recovery centers in a community. It also requires the Department of Health and Human Services to determine best practices and then create a grant program implementing those policies or procedures, such as the use of recovery coaches, which has

On October 24, 2018... President Trump signed a new, bipartisan bill to combat the opioid addiction epidemic. Politicians are hailing it as a major step forward, while addiction and treatment experts say it falls far short of

A package of more than 70 bills introduced targeting the opioid crisis, the Support for Patients & Communities Act:

• Reauthorizes funding from the Cures Act, which put $500 million a year toward the opioid crisis, and makes some policy changes intended to give states more • Creates a grant program for “Comprehensive Opioid Recovery Centers,” which will attempt to serve the addiction treatment and recovery needs of their communities (in part by using what’s known as an ECHO model). • Removes restrictions on medications for opioid addiction, allowing more types of health care practitioners to prescribe the drugs.

• Expands an existing program

• Advances new initiatives to educate and raise awareness about proper pain treatment among health care providers. • Attempts to improve coordination between different federal agencies to stop illicit drugs like fentanyl at the border, and gives agencies more tools to improve detection and testing at border checks. • Increases penalties for drug manufacturers and distributors related to the over-prescribing of opioids.

responders, such as police and

naloxone, a medication that reverses opioid overdoses.

• Allows federal agencies to pursue more research projects related to addiction and pain. • Makes several changes to Medicare and Medicaid to attempt to limit the over-prescription of opioid painkillers within the programs and expand access to addiction treatment, including lifting some of the current restrictions that make it harder for Medicare and Medicaid to pay for addiction treatment.

overtly racist or sexist to another person. But less research has been done on what are known as micro-aggressions, small everyday occurrences that can rub a person the wrong way. That research is improving, but there are other factors that need to be more fully explored. While studies have looked at historical trauma in the African-American population, the concept has not been fully investigated with regards to Hispanic and Asian populations. “This notion of historic trauma could be really relevant to other groups, but it hasn't received much attention at all,” Dr. Gilbert says. “This is something we should pay attention to.” All of this adds up to the fact that treatment providers may be missing a key piece of the substance abuse puzzle.

The team found that discrimination did indeed lead to an increase in drinking frequency, quantity of alcohol consumed, and in the risk for alcohol use disorders. Researchers say drinking can represent a coping mechanism in response to the stress caused by discrimination, and several studies showed clients acknowledging this direct link themselves. But when looking at specific populations and types of discrimination, the picture becomes less clear. “The story is that generally there is good scientific support, but the evidence is mixed for different groups and for types of discrimination,” says Dr. Paul Gilbert, the study’s lead author. “We don’t really know comparing one type or one level to another.” For example, much research has been done on interpersonal discrimination where someone is

Discrimination, whether based on race, gender, or sexual orientation, has long been thought to be a contributor to substance abuse. Now a new study has confirmed the relationship between discrimination and addiction, but it’s also brought up many more questions that still need to be answered in order to improve treatment outcomes. Researchers at the University of Iowa recently completed a peer review study in which they looked at 97 previous studies on discrimination and alcohol use. Their goal was to summarize the collective knowledge researchers have uncovered throughout the years, and what they found confirmed in more detail what many had previously suspected.

But just because the intricacies of how discrimination affects drinking aren’t yet fully understood, that doesn’t mean our current knowledge base can’t be helpful. Dr. Gilbert says simply knowing that experiences with discrimination can drive drinking could inform the way treatment providers interact with clients, opening new areas of their lives to explore during treatment. “It can serve as sort of an early warning or indicator,” Dr. Gilbert says. “For treatment providers, it’s worth looking at: is there something that may be keeping folks from accessing services or affecting outcomes?”

Dr. Gilbert says treatment providers should continue to address discrimination as part of a holistic approach to recovery. He says it will be up to researchers to fill

in the gaps to find the precise ways that discrimination affects drinking behavior. “We’ve got good evidence on this level of interpersonal discrimination,” Dr. Gilbert says. “We’ve gotten the low-hanging fruit, now it’s time to start working on the stuff that’s a little further up the tree.”

“It can serve as sort of an early warning or indicator.”

“Generally there is good scientific support, but the evidence is mixed for different groups

and for types of discrimination.” - Dr.Paul Gilbert, University of Iowa

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