specializing in addiction recovery
1601 Congress Street Portland ME 04102
Services I treat all substance abuse disorders, including alcohol dependence, opiate, cocaine, benzodiazepine, stimulant and cannabis addictions. • Buprenorphine treatment • Medication-assisted treatment addiction medicines • Medically managed withdrawal from pain medication • Conversion of methadone maintenance to buprenorphine • Assessment of pain and addiction • Adolescent substance abuse • Pregnancy and addiction treatment • Treatment of medical practitioners, attorneys and other professionals • Outpatient Detoxification • Interventions of alcohol dependence • Vivitrol and other anti-
I have practiced Addiction Medicine for more than three decades. I am the Past President of the Northern New England Society of Addiction Medicine and Past President of both the Virginia and Pennsylvania Societies of Addiction Medicine. I am also a Fellow of the American Society of American Medicine and a Diplomate of the American Board of Addiction Medicine. I serve as the Editor- in-Chief of the American Society of Addiction Medicine Magazine. I am currently working with the Lunder-Dineen Health Education Alliance to develop and disseminate evidence-based education about substance abuse and addiction. Lunder-Dineen is a collaboration between the Lunder Foundation and Massachusetts General Hospital. I am a passionate advocate for addiction treatment and a nationally known educator and have taught addiction medicine in China and helped develop a treatment program for drug-addicted homeless boys in Turkey. In 2009, I was named “Caregiver of the Year” by the Maine Hospital Association and Down East Magazine named me Maine’s “Top Doctor in Addiction Medicine” in 2014 and 2015. I have just been awarded the American Society of Addiction Medicine’s 2017 Achievement Award. Specializing in the Medical Treatment of Addictions
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“ Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention. “
Talkin’ ‘Bout My Generation
NIDA Researchers Develop Screening Tool for Teen Substance Use This article is a condensed version of a piece that originally appeared on the National Institute on Drug Abuse (NIDA) website.
-Dr. Sharon Kelly, Friends Research Institute
Analysis of the data showed that almost all teens who reported on the BSTAD that they had consumed an alcoholic beverage on two or more days during the past year had an AUD. Conversely, teens who reported drinking on fewer than two days were unlikely to have this disorder.The corresponding BSTAD cut point for an NUD was nicotine use on two or more days during the past year and for a CUD was marijuana use on two or more days. BSTAD enables early detection Using these cut points, the researchers found that the BSTAD was highly sensitive. Ninety-six percent of teens with an AUD, 95 percent with an NUD, and 80 percent with a CUD would be flagged as likely in need of further assessment for a brief intervention or referral to treatment. BSTAD’s specificity was also high: 85 percent of teens without an AUD, 97 percent without an NUD, and 93 percent without a CUD reported use below the cut points, and so would be correctly classified. “Very low substance use frequencies were found to be optimal in identifying these disorders,” Dr. Kelly comments. The BSTAD does not distinguish
Researchers encourage regular screening Both the World Health Organization and the American Academy of Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Still, many providers do not regularly screen their patients for substance abuse. “Providers are extremely busy and need a quick and valid screening measure for identifying teens who use substances,” says Dr. Kelly. She and colleagues developed the BSTAD in response to a NIDA call for new tools to fill this need. To create the BSTAD, Dr. Kelly and colleagues added the questions about tobacco and marijuana to the widely disseminated National Institute on Alcohol Abuse and Alcoholism screen for youth alcohol use. In the validation study, the FRI research team administered the BSTAD in person to half of the participants, and the rest of the participants self-administered the instrument on an iPad. The teens reported a strong preference for the iPad. The iPad version offers the potential extra convenience that results can be automatically transferred into a teen’s electronic medical record.
Teens’ use of addictive substances often goes undetected by health care providers. But NIDA-supported researchers have developed a Brief Screener for Tobacco, Alcohol and other Drugs (BSTAD), to help spot teens’ problematic habits. In a recent study, BSTAD developers Dr. Sharon Kelly and colleagues at the Friends Research Institute in Baltimore examined the frequencies of use likely to qualify a teen for a diagnosis of an alcohol use disorder (AUD), nicotine use disorder (NUD), or cannabis use disorder (CUD). The frequencies proved to be surprisingly low, according to the researchers.
the severities of the disorders, she notes, so when it flags a teen, providers need to follow up with questions to determine appropriate interventions or referrals to treatment. Furthermore, Dr. Kelly says, “Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention.” Providers also should rescreen teens regularly, because onset of substance use can occur abruptly during adolescence. Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Both the World Health Organization and the American Academy of
Teen drug substance use revealed For the study, the BSTAD survey employed a few, simple questions about teens’ use of alcohol, tobacco or drugs within the past year.The teens’ BSTAD responses revealed that 22 percent had used alcohol in the past year, 16 percent had used marijuana, 10 percent had used tobacco, and 3 percent had used at least one illicit substance other
than marijuana. (Original article by Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer) 28
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Boom, Bust, and Drugs Study says economic downturn leads to increase in substance use disorders When the economy tanks, drug abuse goes up.That’s the finding of a new study which shows the state of the economy is closely linked with substance abuse disorder rates for a variety of substances. The study, conducted by researchers from Vanderbilt University, the University of Colorado and the Substance Abuse and Mental Health Services Administration (SAMHSA), found the use of substances like ecstasy becomes more prevalent during economic downturns. Researchers also found that other drugs like LSD and PCP see increased use only when the economy is strong. But for overall substance use disorders, the findings were clear.
Slippery slope Despite some lingering questions, researchers were able to show the significance of the economy’s role in problematic substance use.The study showed that even a small change in the unemployment rate can have a tremendous impact on the risks for substance abuse disorders. “For each percentage point increase in the state unemployment rate, these estimates represent about a 6 percent increase in the likelihood of having a disorder involving analgesics and an 11 percent increase in the likelihood of having a disorder involving hallucinogens,” the authors write. Previous studies have focused on the economy’s link to marijuana and alcohol, with many looking at young people in particular.This study is one of the first to highlight illicit drugs, which given the current opioid epidemic, holds important lessons for those working to curb problematic drug use.
“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens,” says Christopher Carpenter, one of the lead researchers. “Our results are more limited in telling us why this happens.” Researchers say it’s possible that people turn to substance use as a means of coping with a job loss or other major life changes caused by economic pressures, but their particular study did not pinpoint an exact cause and effect. Not all drugs are equal The study showed that a downward shift in the economy has the biggest impact on painkillers and hallucinogens. Rates of substance abuse disorders were significantly higher for those two categories than any other class of drug.
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When it’s needed most The study bears significant weight for treatment facilities and public policy makers in particular. During economic downturns, government agencies typically look to cut spending on treatment programs as a way to save money, something researchers say may be more costly in the end. “Our results suggest that this is unwise,” Carpenter says. “Such spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise, at least for disorders involving prescription painkillers and hallucinogens.”
Researchers also found the change in disorder rates was highest for white adult males, a group which was one of the hardest hit during the Great Recession.They say more research is needed to determine exactly how the economy and drug use are related, but they say the study highlighted some key groups for prevention and treatment workers to target during future economic downturns.
“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens.” - Christopher Carpenter, Vanderbilt University
“Spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise.” - Christopher Carpenter, Vanderbilt University
THERE IS LIFE AFTER ADDICTION
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Sign of the times Experts say the newly approved implant also provides a big boost to the concept of medication-assisted treatment (MAT) in general. For years, the idea that someone could achieve recovery through the use of drugs like methadone and buprenorphine was rejected by many professionals in the eld who saw complete abstinence as the only true sobriety. Many still hold that belief, but attitudes appear to be changing. Top government ocials say they want to increase the amount of MAT taking place at the country’s treatment centers. Several states as well as the federal government have enacted laws making it easier for physicians to prescribe medications like buprenorphine, but they say too few patients receive the medication they need. [ "Opioid abuse and addiction have taken a devastating toll on American families.” - Dr. Robert M. Cali, FDA Commissioner “Scientic evidence suggests that maintenance treatment with these medications in the context of behavioral treatment and recovery support are more eective in the treatment of opioid use disorder than short-term detoxication programs aimed at abstinence,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, in a statement. “is product will expand the treatment alternatives available to people suering from an opioid use disorder.” ]
edication-assisted treatment is growing in popularity and acceptance among addiction recovery professionals. And now it’s taken a revolutionary step forward that could oer renewed hope to thousands of people struggling with an addiction to opioids. is summer, the U.S. Food and Drug Administration approved a new buprenorphine implant to treat opioid dependence. Buprenorphine had previously been available only as a pill or a dissolvable lm placed under the tongue. But the new implant, known as Probuphine, can administer a six-month dose of the drug to keep those dependent on opioids from using by reducing cravings and withdrawal symptoms. "Opioid abuse and addiction have taken a devastating toll on American families,” FDA Commissioner Dr. Robert M. Cali said in a statement. “We must do everything we can to make new, innovative treatment options available that can help patients regain control over their lives.” e implant comes in the form of four one-inch rods that are placed under the skin on the upper arm.e implant must be administered surgically and comes with the possibility of certain side eects, but experts say it could be more convenient and more eective for patients.ey say by eliminating the need to take pills, ll prescriptions and generally manage their medication, it makes it easier for people to focus on the other areas of their recovery while making it less likely someone will lapse in their treatment plan.
Although the implant is certainly a new alternative, it has yet to show any increased success in keeping people from relapsing compared to the pill or lm tablet. In a study of the implant’s eectiveness, they found that 63 percent of people given the implant were free of illicit drugs at six months, compared to 64 percent of people who took buprenorphine by pill. Still, those rates are much higher than the success rates of people who follow abstinence-only treatment plans. And ocials hope the new implant will lead more people to get MAT, increasing the number of successful recoveries across the country.
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no one suggested that she should not be treated because she was “getting what she deserved,” he said. “Yet somehow, if it’s heroin or cocaine or alcohol, we say, ‘Ahh, they decided that, they’re getting what they deserve,’” Christie remarked. HOW ADDICTION WORKS After satisfying basic human needs like food, water, sleep and safety, people feel pleasure. That pleasure is brought by chemical releases in the brain. This is according to Columbia researchers, who note that the disease of addiction causes the brain to release high levels of those pleasure chemicals. Over time, brain functions of reward, motivation and memory are altered. After these brain systems are compromised, those with addiction can experience intense cravings for substance use, even in the face of harmful consequences. These changes can stay in the brain long after substance use desists. The changes may leave those struggling with addiction to be vulnerable to “physical and environmental cues they associate with substance use, also known as triggers, which can increase their risk of relapse,” write Columbia researchers. no ne sug ested that she should not be treated because she was “getting what she deserved,” he said. “Yet somehow, if it’s heroin or cocaine or alcohol, we say, ‘Ah , they decided that, they’re getting what hey deserve,’” Christie remarked. HOW AD ICTION WORKS After satisfying basic human e ds like fo d, water, sle p and safety, people fe l pleasure. That pleasure is brought by chemical rel ases in the brain. This is ac ording to Columbia researchers, who note that he disease of ad iction causes the brain to rel ase high levels of those pleasure chemicals. Over time, brain functions of reward, motivation and memory are alter d. After these brain systems are compromised, those with ad iction can experience intense cravings for substance use, even in the face of harmful consequences. These changes can stay in the brain long after substance use desi t . The changes may leave those strug ling with ad iction to be vulnerable to “physical and environmental cues they as ociate with substance use, also known as trig ers, which can increase their isk of relapse,” write Columbia researchers.
not just a bad habit It’s NOT JUSTA BAD HABIT
not just a bad habit treatment and continued monitoring and support or recovery.
THE COLUMBIA RESEARCHERS DO HAVE SOME GOOD NEWS: Even the most severe, chronic form of the disorder can be manageable and reversible, usually with long term
Recent research and dialogue in the political sphere have brought long-simmering questions about addiction to the forefront: Is addiction truly a disease? Do addicts deserve to be treated like people who have a Recent res arch and ialogue in the political spher have brought long-sim ering questions about ad iction to the fore: Is addiction truly a disease? Do addicts deserve to b tr ated like people who hav a dise s that’s outside their control? disease that’s outside their control? While most researchers agree with the so-called disease model of addiction, stereotypes and cultural bias continue to stigmatize those with addiction because they made an initial choice to consume substances. However, Columbia University researchers point out that “choice does not determine whether 34 While most res archers agre with the so-called isease model of ad iction, ster otypes and cultural bias continue to stigmatize those with ad iction because they made an initial choice to consume substances. However, Columbia University res archers point out that “choice does not det rmine whether
something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices.” Experts say that applying the distinction of choice to addiction creates biases that justify inadequate treatment. It begs the question New Jersey Gov. Chris Christie asked during a 2015 town hall meeting in New Hampshire. When Christie’s mother was diagnosed something is a disease. Heart disease, diabet s and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what hap ens in the body as a result of those choices.” Experts ay that ap lying the distinction of choice to ad iction creates biases that justify inadequate treatment. It begs the question New Jersey Gov. Chris Christie asked uring a 2015 town hall me ting in New Hampshire. When Christie’s mother was diagnosed with lung cancer at 71 as a result of addiction to tobacco, he noted that with lung cancer at 71 as a result of ad iction to tobacco, he noted that
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I N AN EFFORT to encourage new treatments for opioid addiction, the Food and Drug Administration plans to begin permitting pharmaceutical companies to sell medications that help temper cravings, even if they don’t fully stop addiction. The change is part of a wider effort to expand access to so-called medication-assisted treatment, or MAT. The agency will issue draft guidelines in the next few weeks. A senior agency official provided details of the proposal to The New York Times. the agency said it would soon publish two guidances, recommendations for drugmakers, on the issue.
The new approach was signaled Saturday by the health and human services secretary, Alex M. Azar II, in remarks to the National Governors Association. Mr. Azar said the agency intended “to correct a misconception that patients must achieve total abstinence in order for MAT to be considered effective.” While the Trump administration has generally supported medication-assisted treatment, Mr. Azar’s predecessor, Tom Price, was not completely on board with it. Mr. Price caused an uproar among treatment experts when he dismissed some medications that reduce cravings through synthetic opioids last spring as substituting one opioid for another. He subsequently walked back those comments, saying officials should be open to a broad range of treatment options. Mr. Azar, who took office late last month, said he would work to reduce the stigma associated with addiction and addiction therapy, and would not treat it as a moral failing. The opioid epidemic is considered the most unrelenting drug crisis in United States history. In 2016, roughly 64,000 people were killed by drug overdoses, including from prescription opioid painkillers and heroin. to correct a misconception that patients must achieve total abstinence in order for MAT to be considered effective. Noting federal data showing that only one-third of specialty substance abuse treatment programs offer medication-assisted treatment, Mr. Azar said, “We want to raise that number — in fact, it will be nigh impossible to turn the tide on this epidemic without doing so.” Mr. Azar’s comments echo those of the F.D.A. chief, Dr. Scott Gottlieb, who has made battling opioid abuse a priority for his agency. Dr. Gottlieb has moved to reduce opioid prescriptions by doctors and dentists and to promote more medication- assisted treatment, defined as drugs used to stabilize brain chemistry, reduce or block the euphoric effects of opioids, relieve physiological cravings, and normalize body functions. The F.D.A. has approved three drugs for opioid treatment — buprenorphine (often known by the brand name Suboxone), methadone and naltrexone (known by the brand name Vivitrol) — and says they are safe and effective combined with counseling and other support. But the agency said it would soon publish two guidances, recommendations for drugmakers, on the issue.
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State legislators focused on opioid addiction treatment and prevention in schools and prisons Thursday while reviewing bills that would both use medications to thwart overdoses and assist in recovery. A bill making its way through the Legislature would require all schools with grades 9 to 12 to have policies for training nurses on how to administer naloxone. The schools would also have to keep a supply of the medication ready. “The harsh reality is that opioids are killing thousands of people in this country, many of them young people,” Assemblyman Vincent Mazzeo, D-Atlantic, bill sponsor, said in a statement. “Narcan has been proven to save lives. Having it readily available in schools can help ensure that our schools are ready to respond in every emergency situation.” Several South Jersey schools, including Millville, Mainland Regional High School, the Egg Harbor Township School District and the Ocean City School District, already have such policies in place. As of 2017, New Jersey ranked eighth in the nation for drug overdose deaths among people ages 12 to 25, according to the national nonprofit Trust for America’s Health. There have been an estimated 654 overdose deaths in New Jersey since Jan. 1, according to the Department of the Attorney General.
The bill would require that nurses be taught how to use the anti-opioid drug and have a prescription standing order for naloxone to keep it in supply. There were more than 14,300 uses of naloxone in the state last year, state data shows. If passed, the law would also provide immunity from liability for school nurses and other employees when an opioid reversal is performed. Nearby, members of the Assembly Health and Human Services Committee reviewed a bill sponsored by Assemblyman Herb Conaway, D-Burlington, that would require state correctional facilities to offer inmates naltrexone and naloxone just before their release. Naltrexone, known by its brand name Vivitrol, is a type of nonopioid medication- assisted treatment (MAT) for a substance-use disorder. Studies have shown medication-assisted treatments like naltrexone, methadone and buprenorphine have successfully been used to reduce relapse rates and help people maintain recovery from opioid addiction. Vivitrol completely blocks the euphoric and sedative effects of opioids. Recipients often need a monthly shot of the medication administered by a medical professional.
At John Brooks Recovery Centers in Atlantic City and Pleasantville, Vivitrol is just one medication-assisted treatment offered to inpatient and outpatient patients, but it is coupled with counseling and other treatment education. Alan Oberman, CEO of John Brooks Recovery Center, said that while the bill looks well intentioned, giving one shot of Vivitrol, which costs about $1,000, to an outgoing inmate without follow-up or counseling only buys that person about three or four weeks of sobriety before they may use again. “It’s more than just giving an injection, which at least requires a nurse to do it, and many outpatient programs in the community don’t have medical staff there to do it regularly,” he said. While methadone and buprenorphine are MATs that have been on the market for some time, Vivitrol is relatively new. John Brooks and the Atlantic County jail teamed up last summer to create the state’s first mobile methadone program for inmates. Oberman said they now offer inmates Vivitrol, but they haven’t yet had any takers.
The harsh reality is that opioids are killing thousands of people in this country, many of them young people
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