The opioid epidemic has likely affected someone you love in a negative way. If you have never experienced addiction grabbing a hold of a close friend or family member- consider yourself fortunate. While you have avoided this in your personal life, my guess is in your professional life you have not been so lucky. We are now several years removed from the peak of the crisis where drug overdoses and drug overdose deaths were really getting out of hand, and it certainly took a toll of Fire/EMS personnel just like you and led to lots of compassion fatigue. This begs the question, what happened after the call - what does long-term treatment look like? What goes into the medical decision making? In this week's blog, we will explore some of the most popular treatment regimens that are trying to curb the crisis and get people back on their feet so they can begin to both function + contribute positively to society once more.
RECOVERY STARTS WITH DETOXIFICATION
Methadone has been a mainstay for quite some time, initially as an American maintenance medication 50+ years ago. Methadone is a true opioid agonist, and it is long acting, so unlike heroin, it doesn't require frequent "uses" or dose escalations. When part of medically supervised treatment at certified clinics, it works fairly well. It helps prevent deaths and reduces the spread of communicable/infectious diseases -- this secondary benefit does not get talked about much but is it crucial in public health arenas. Methadone isn't perfect though. It has to be given the right way. If the patients are under-dosed, they will likely keep abusing drugs to get the same level of euphoria as before. If the dose is too high, you can actually overdose on Methadone - remember it's an opioid agonist. Some patients are only Methadone for a short period of time, while others may be on it for the rest of their lives.
Additionally, in recent years Suboxone (Buprenorphine + Naloxone) has also entered the discussion as another effective maintenance option towards the final goal of sobriety. Suboxone is a little different in its formulation in that it is an agonist/antagonist. It is new and improved and comes with less side effects and negative consequences like abuse potential. The expectations with this drug are vastly different. From the outset, the goal is to "graduate" and eventually get off Suboxone all together. The path to obtaining this drug is much simpler. It can be picked up at a local pharmacy -- as you can ascertain, it is not as tightly regulated
The treatment modalities both exist to reduce cravings and withdrawal symptoms which can be pretty significant and debilitating. The image below is an over simplified representation of how they accomplish similar patient outcomes all while employing different pharmacokinetics. It is important to note these treatments cannot be combined -- it is one or the other, you can switch, but you can't overlap and take them concurrently.
Source: Symetria Recovery
One good start to reduce the stigma and open the doors of compassion again would be to re-train your mind to ask a different question. Instead of saying, "What's wrong with that person", try saying, "What's happened to that person" instead. They likely have battles and demons that we know nothing about. I am sure the patient feels worthless and isolated already, you may be quite surprised what one positive encounter can do for that individual. A needed stimulus that makes them feel worthy enough for help. I have seen one random act of kindness by law enforcement or even EMS professionals return folks to become the pillar of society on many occasions.
ADDICTION ENDS WITH SUSTAINABLE AND MEANINGFUL CONNECTIONS
Some argue addiction is not about chemical hooks, but rather it's about bonding. Humans are social creatures, and they want to feel connection to something. When we are happy and healthy we will bond and connect with each other, but we you can't do that because you're traumatized or isolated or beaten down by life you will bond with anything that gives you some sense of relief. It may not be heroin at all, it could be gambling or a host of other things.
You can't incarcerate the problem away unfortunately. Punishing addicts doesn't deter them and it certainly doesn't provide them with an incentive to stop using. Wouldn't you want a second chance?
July 22, 2024
Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP
Pass with PASS, LLC
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