Opiod Replacement Pain Medicines in Pipeline..?: Will we get ’em? Do they want us to get ‘well’?

Chickencoop

So much is being made on black marketed prescription drugs like oxy and ‘the box’ that you gotta wonder The FDA and DEA are at cross purposes because pain advocates are pushing back, assisted by big pharma. Why not, right? The CNN Story with Anderson Cooper distorted it further. So much confusion we’re not entitled to ‘straight dope’ on this issue. I recently learned IBUPROFEN and Tylenol, my first line “go tos” destroy a digestive enzyme, furthering the constipation problem I suffer with it. hey, someone’s gotta speak up.

So, here’s holistic hope to hold onto, sorta..this will be a pricey pharmaceutical too: Hot off Press this week-Duke University Study isolated pain receptors TRPV4 and TRPAI and have a way to activate them; releasing natural endocannibinoids (not endorphine..that was debunke4d ages ago) to secrete natural painkillers for our comfort.

Organic stuff, sad to say, like MS contin, which I took for sixteen years, are actually better for your overall systemic health than NSAIDs which harm the liver and destroy digestive enzymes. Whoops I’m repeating myself. I just wanted you to know the knews. \

And I have yet another natural way of dealing with chronic pain in this article. A click is all it takes to make my day. At least you aren’t making Mark Zuckerberg of Facebook richer. If you click this, you are helping me and my platform. Am I going about this the wrong way? I should be listening to your aches and pains and I promise to do more of that. It, too, is a natural painkiller, releasing a substance called Oxytocin, the ‘love’ hormone begotten of human interaction with those you care about even if you’re separated by miles and held together by broadband.

Here I am: http://www.bphope.com/blog/bipolar-mood-cycles-stop-fighting-and-win/

 

2 trusted shrink/internist of 17 years re chronic pain, bipolar, side effects, Stanford Tardive & Ali

 

DSC01512DSC01510

Thanks to former BFF outta cash and cut outta the will. Dad can’t understand stuff like how  25 years psych meds and side effects, meds for the side effects for the side effects etc. It really DOES happen and according to him, it’s all my fault.  She didn’t understand either, thought the salads for the prediabetic condition side effect and my compulsive carrying of back issues of the new York times to read in waiting rooms was ‘crazy.’ as she built her case about me in silence, totally two faced, she caused more harm than she’ll ever know. She relayed she thought her friendship was a ‘gift’ to me. It was. It keeps on giving, too. I’m still picking up the pieces!!!!!!!!

w/Stanford Volleyball and exercise bulimia the combination of tardive dyskinesia and my annular tear, three herniated discs, spinal stenosis and psoriatic arthritis…well most people would have offed themselves by now.

Dear Reader. If you’re still here the following is actually interesting reading.

And if I may say so myself, I’m published in the local tribune outlet, Meloday maker UK, Hits mag, The Album Network, Arizona Republic, Bipolar Magazine, NAMI and International Bipolar Disorder Foundation (IBPF) in San Diego, the city I grew up in. I am working on a piece on tardive dyskinesia, also called “Extrapyramidal symptoms” for Neurology today for their next issue. My current publisher reached our with both hands; requesting a movement disorder piece when their sole source of income is from a drug company. Tardive is rarer than ever but still, mighty white of them.

This is pursuant to the crisis caused by former bff  projecting her 3 attempts going on a fourth suicidality on me, calling the cops and my father about my deteriorating state. He’s tried his best to help me financially in every way possible but….not have anything to do with the family. He just can’t figure out, understand how someone can possibly have so many problems. But then he’s never been on an MAOI or Clozaril or an antipsychotic causing tardive dyskinesia and a spiral of unending spasms and pain.

First order of business to take care of myself. Because of certain choices, side xfx,  not all my fault. I’m not a bad person. Dad thinks so. I can’t afford to think that way. I make bad choices and things get worse! Physical, ongoing mental health still paramount. Pain, bowel still problematic. Still needing 290 mg (top) Linzess and once weekly emergency injections of Relistor, an 80.00 copayment even within catastrophic period. I’m still looking for a healthier way. 16.00 copay to see original pain specialist of three years, still picking people’s brains. Followed through w/appt.  Saw a new, likely temporary pain doc (anti narc) studying to be an All Cash “Functional” (read: Holistic)  Medicine”specialist. For a less toxic, least constipating solution, she wrote 7.5 Microgram Butrans patch, still a narc. She gets it. Copy Enclosed.  Of course I didn’t fill it. I was just picking her brain for free, like I did when I first got Tardive Dyskinesia and  saw 15 doctors who weren’t able to treat me and couldn’t admit it. They said ‘psychsomatic’ (Cleveland clinic female doc) were sexist, stigmatizing and didn’t want anything to do with me.. afraid I’d sue them which I never would. I just want to get well.

Still journaling the box, diet and exercise changes, trying to make it work. I’m in more pain but that’s not THE most pressing I hurt too much to exercise the way I used to– partially a good thing. Spine mindfulness, so to speak.  Gentle walks, stretching and at home mat pilates swimming for now. Discontinuing Y membership and beloved NYT. 100.00 Savings. First Haircut in a year. Thanks, Clair. I don’t think you meant well. I think you need help for your brain tumor, beneign as it may be, it’s interfering with your decision making process. I feel for ya. I don’t feel so well myself. But we’re not good for each other and never will be.

More Shark Week Shit

sharkmhammerhead

I swim in ocean. For a long time, over an hour.  I see sharks. This is a Hammerhead. Perfect for Shark Week. Attacks in Florida are on the rise but something else will kill me first. (Statistically speaking).

I love to swim. If I were to die of a shark attack I’d at least of died doing something I love. And I love swimming. I can crawl a mile between 1:10 and 1:45 minutes and that’s in the ocean. It is aggravating to my back but all exercise seems to be. I come outta the florida ocean a brand new woman, filled to the brim with the euphoria caused by endocannabiniods, not endorphins, which are too large a molecule to pass the blood brain barrier and get you high. Can you believe we thought that bit with the endorphins all those years?

Anyhow, I’m at the store today and see a magazine with a big picture of a hammerhead with it’s mouth, it’s cavernous jaw wide open, teeth long, many and sharp. Ok, fine. Do you want me to buy this? I look at price. It’s over 11 bucks, with tax.

What is it about Sharks that gives us that shivery feeling and made Steven Speilberg of Jaws an overnight sensation. We’re scared but we still go in the water.

When I first moved here, I saw a shark in pursuit of an ailing Mantaray. He was black and white, a round body of contrasts, sort of like the high contrast Kosher black and white cookie you get at a deli. (I do miss Nate and Al’s in Beverly Hills and their tongue sandwich with Russian and Cole Slaw on Rye bread).  You could see the two beasts going at each other in the clear water of the breaking surf, you know, when the wave is at its’ peak. They shut down the beach. More recently I ran across a four foot spinner shark. He saw me and quickly reversed direction and ran away.

 

Suicidal Bipolar Projects ‘Plan,’ and I’m in Hospital?

How else can I say it, title it?

allicat

You are my people. My resource.

You hear it first.

My life is messy.

It’s not the worst.

My BFF turned my life upside down.

You guys know I have chronic pain and was looking for a way out. I went Cold turkey for over a week. The worst pain I’ve ever had except for the 60 day flare in reaction to an ‘interventional pain management’ pain doc. Yeah, ‘interventional’ all right. Between me and my life. Between me and my pocketbook. Once back on, thought I could not get off. But I’ve been sick ever since. Hey, you play you pay.

Weak and sick I wanted to go to the ER and check for an obstruction. On the way gonna stop by my BFF’s. I’d packed my low sugar high fiber foods and protein Shakes with Pomegranate in them and Off I was gonna go. Except for one hitch. She’d called the cops and said I was suicidal. Cuffed and dragged off to the psych ward. Then she called my father and told him private stuff. She’s always hated my husband. Partly because he doesn’t have money and she thinks I could do so much better.

I’ll really miss her. Foreign films, world affairs, someone intellectual, worldly and brainy to be around and another former disc jockey.

I think it’s a marketable story. What can I call it in seven words or less so that betrayal and paradox jump right off the page; promising a publisher clicks? Can I Sell it to Buzzfeed? Vice? Gawker? Who?  It’s got to be a rebellious type of publication. One that questions the system a tad.

The two publications I write for probably wouldn’t appreciate my caustic tone when I describe yanking the warden’s chains; claiming I’m a nationally published writer who is also in their daily newspaper, a mantle of credibility which happens to be true. People get starstruck.

The puzzlement on their faces was precious. Priceless.   Maybe it’s true. Maybe she’s here by mistake. Our mistake.

Where does this story of one friendship (probably a sick, codependant attachment) end and a new life of healthier pursuits and a more balanced set of associates begin?

Because it’s not really about what she did to me, it’s about why I attract people to my life sicker than I am. That’s what’s nuts.  Then I share my intimacies. Totally Bonkers.

All along I assumed she understood and she’d just been laying in wait to get me locked up somewhere.  She’s disapproved of my level of care and self care all along, right down to the cooler full of raw foods, low sugar fruit, protein and water I carry around.

Suicidal BFF with ‘Plan’ Projects; I land in Lockdown?

aquanotext

Cuffed and Dragged off thanks to my best friend. She’s the one with 200 tegretol to try to take her life a fourth time…but I’m the one carried away. So uncool.

I was sick. She called the cops to have me shoved into involuntary psych eval. I find out later that the cooler of fresh healthy raw foods I carry around as I’m prediabetic she calls that ‘crazy.’ My stomach problems are evidence of ‘crazy.’ My BFF NO LONGER IN MY LIFE. Sad. But she’s gotta go.

Suicidal Bipolar Projects ‘Plan,’ and I’m in Hospital?

How else can I say it, title it?

allicat

You are my people. My resource.

You hear it first.

My life is messy.

It’s not the worst.

My BFF turned my life upside down.

You guys know I have chronic pain and was looking for a way out. I went Cold turkey for over a week. The worst pain I’ve ever had except for the 60 day flare in reaction to an ‘interventional pain management’ pain doc. Yeah, ‘interventional’ all right. Between me and my life. Between me and my pocketbook. Once back on, thought I could not get off. But I’ve been sick ever since. Hey, you play you pay.

Weak and sick I wanted to go to the ER and check for an obstruction. On the way gonna stop by my BFF’s. I’d packed my low sugar high fiber foods and protein Shakes with Pomegranate in them and Off I was gonna go. Except for one hitch. She’d called the cops and said I was suicidal. Cuffed and dragged off to the psych ward. Then she called my father and told him private stuff. She’s always hated my husband. Partly because he doesn’t have money and she thinks I could do so much better.

I’ll really miss her. Foreign films, world affairs, someone intellectual, worldly and brainy to be around and another former disc jockey.

I think it’s a marketable story. What can I call it in seven words or less so that betrayal and paradox jump right off the page; promising a publisher clicks? Can I Sell it to Buzzfeed? Vice? Gawker? Who?  It’s got to be a rebellious type of publication. One that questions the system a tad.

The two publications I write for probably wouldn’t appreciate my caustic tone when I describe yanking the warden’s chains; claiming I’m a nationally published writer who is also in their daily newspaper, a mantle of credibility which happens to be true. People get starstruck.

The puzzlement on their faces was precious. Priceless.   Maybe it’s true. Maybe she’s here by mistake. Our mistake.

Where does this story of one friendship (probably a sick, codependant attachment) end and a new life of healthier pursuits and a more balanced set of associates begin?

Because it’s not really about what she did to me, it’s about why I attract people to my life sicker than I am. That’s what’s nuts.  Then I share my intimacies. Totally Bonkers.

All along I assumed she understood and she’d just been laying in wait to get me locked up somewhere.  She’s disapproved of my level of care and self care all along, right down to the cooler full of raw foods, low sugar fruit, protein and water I carry around.

Suicidal Bipolar Projects ‘Plan,’ and I’m in Hospital?

How else can I say it, title it?

allicat

You are my people. My resource.

You hear it first.

My life is messy.

It’s not the worst.

My BFF turned my life upside down.

You guys know I have chronic pain and was looking for a way out. I went Cold turkey for over a week. The worst pain I’ve ever had except for the 60 day flare in reaction to an ‘interventional pain management’ pain doc. Yeah, ‘interventional’ all right. Between me and my life. Between me and my pocketbook. Once back on, thought I could not get off. But I’ve been sick ever since. Hey, you play you pay.

Weak and sick I wanted to go to the ER and check for an obstruction. On the way gonna stop by my BFF’s. I’d packed my low sugar high fiber foods and protein Shakes with Pomegranate in them and Off I was gonna go. Except for one hitch. She’d called the cops and said I was suicidal. Cuffed and dragged off to the psych ward. Then she called my father and told him private stuff. She’s always hated my husband. Partly because he doesn’t have money and she thinks I could do so much better.

I’ll really miss her. Foreign films, world affairs, someone intellectual, worldly and brainy to be around and another former disc jockey.

I think it’s a marketable story. What can I call it in seven words or less so that betrayal and paradox jump right off the page; promising a publisher clicks? Can I Sell it to Buzzfeed? Vice? Gawker? Who?  It’s got to be a rebellious type of publication. One that questions the system a tad.

The two publications I write for probably wouldn’t appreciate my caustic tone when I describe yanking the warden’s chains; claiming I’m a nationally published writer who is also in their daily newspaper, a mantle of credibility which happens to be true. People get starstruck.

The puzzlement on their faces was precious. Priceless.   Maybe it’s true. Maybe she’s here by mistake. Our mistake.

Where does this story of one friendship (probably a sick, codependant attachment) end and a new life of healthier pursuits and a more balanced set of associates begin?

Because it’s not really about what she did to me, it’s about why I attract people to my life sicker than I am. That’s what’s nuts.  Then I share my intimacies. Totally Bonkers.

All along I assumed she understood and she’d just been laying in wait to get me locked up somewhere.  She’s disapproved of my level of care and self care all along, right down to the cooler full of raw foods, low sugar fruit, protein and water I carry around.

New Youtube Channel and uploaded Tardive Dyskinesia Video

 

I have a learning issue. It’s meds, racing thoughts,al in german dress and new earrings adhd and middle age so I have a social media person come over once a week. Some things happened at my magazine, like changing the name of my article and not telling me, which made me feel really sad. I’m just sad today. Anyway, to cheer me up and take back control of my activism and journalism, We created a YouTube Channel and uploaded my tardive dyskinesia videos on there. If you know anyone who has that problem, I learned a lot during my three year

https://www.youtube.com/channel/UCFrrhgSBHa6_4FIw1ydlG7Qarch for treatment.

A pain doc explains how she has to lie to prescribe Buprenorphine

princeThis is from “Under The Influence.” It’s by a doctor who writes prescriptions for buprenorphine. For pain. For addicts temporarily but for pain patients indefinitely. She wanted to speak out.

This practitioner calls Suboxone a ‘stealth’ drug. Read it. You’ll see. There is not a lot of press coverage on the use or lack of use on this drug. There is an alliance organization that matches people up with doctors but it says the limitations on how many patients a doctor can treat at one time…waiting lists, they say it’s easier to just get placed in a research study.

Doc, I need some help getting off this stuff.”

My new patient Marshall*, a pale 63-year-old man who lugged around a portable oxygen tank for his breathing problems, had been stuck on pain pills for years. Sharp pain from a gruesome factory injury to his shoulder 25 years ago had evolved into a nightmarish, shock-like nerve pain down his arm to his fingertips. A succession of medical treatments culminated eight years ago in prescriptions for daily use of oxycodone.

It had worked well at first. But after a few years, he descended into a continuous state of opioid withdrawal. At best, he felt mildly anxious and tremulous. Two hours after each dose, he would skid into a wretched state of sweats, gut-knots and dread. His whole body screamed with a pain unrelated to his injury. He craved relief from the next dose.

Sometimes, out of desperation, Marshall would take the next dose early. In exchange for the immediate comfort, he would accept a guaranteed anguish starting days before the next refill was due. His previous doctor had attempted to help by increasing his dose. Symptoms would subside for a month or so, then return with a roar, growing ever more intense. His arm pain had been relegated to a minor annoyance.

The best solution to his cyclical torment was clear to me. I would transition him to a medicine called buprenorphine.

Opioid task forces springing up in the US at the local and national level have begun to cast a spotlight on the surging opioid epidemic and its deadly consequences.

Unfortunately, a sharp focus on the target of opioid “abuse”—non-medical use of pain pills that has led to addiction in an estimated 2 million people in the US, and to heroin use in 1 million—misses a fundamental problem of a much larger scale. Roughly 17 million US adults living with chronic pain are prescribed opioids for daily use. Many, perhaps most, are not thriving.

Yet without these pills, many find life intolerable. Neither patients nor doctors know what to do about it.

A readily available solution—buprenorphine—is a secret weapon largely still waiting to be discovered. And President Obama’s strong emphasis this week on medication-assisted treatment—especially buprenorphine—in his announcement of his plan to combat the opioid crisis, is therefore particularly welcome.

As a family physician, I am in the trenches with patients battling chronic pain. I have seen Marshall’s story played out again and again. Sometimes people are referred to me for help after limping along on opioids for years. Buprenorphine is often the best choice.

Some make the transition seamlessly. Others traverse a rocky road that tests their mettle. Ultimately, most arrive at our intended destination, experiencing a calm normalcy they can hardly believe. A tolerable vestige of their original pain is still present. Opioid withdrawal and its accompanying super-pain, sometimes known as “opioid-induced hyperalgesia,” have vanished.

Patients describe a sense of release from a box or a locked cage. One said, “I felt like a little troll trapped inside a bottle, a horrible feeling. And now I’m free. I’m absolutely thrilled.”

Buprenorphine is better known by one of its brand names, Suboxone, an under-the-tongue film laced with naloxone to deter non-prescribed use. In 2002, buprenorphine–alone or combined with naloxone—was approved by the US Food and Drug Administration as a treatment for people like another of my patients, Luke.

A gentle giant in a black leather jacket, Luke is a 20-year-old convenience store employee who casually enjoyed a Percocet now and then while hanging out with friends. Then he began enjoying one for relaxation daily after work, “like having a beer or two.” Eventually he found himself entangled.

To avoid the agonizing withdrawal symptoms, Luke began spending most of his income buying pills illegally. He risked arrest. He arrived late for work. He could not afford to move out of his parents’ home. The drug’s negative impacts on his life landed him the diagnosis of opioid use disorder—the latest medical term for the condition most people recognize as addiction.

Buprenorphine is often, in my experience, like a magical key that frees people from their seemingly inescapable dungeon. It is an opioid medication with a unique profile that fits the lock precisely. It blocks withdrawal symptoms and craving. There is no drug “high.” Patients trade sluggishness for a fresh energy. Best of all, the hovering risk of overdose death vanishes.

Buprenorphine was developed decades ago and approved by the FDA in 2002. Yet it remains nearly invisible, despite its potency against a fiendish trio of adversaries: withdrawal symptoms, craving and overdose death. That’s why I call it the Stealth Medicine. It is hidden behind the term “medication-assisted treatment,” which also includes methadone and naloxone. Buprenorphine is the only one doctors can use to treat opioid use disorder in their patients with chronic pain.

Any doctor can prescribe buprenorphine for opioid use disorder, after undergoing a brief training required for authorization, known as a “waiver,” from the Drug Enforcement Agency. Only a tiny minority obtain the waiver, however. Due to federal rules, the number of patients each one can treat is strictly limited—to 100, although President Obama’s plan will increase that to 200—and other prescribers (nurse practitioners and physicians’ assistants) are not eligible for a waiver.

Ironically, there is no such bottleneck on access to the opioid pain pills involved in the deaths of 19,000 people in the US in 2014.

Read more from The Influence:

Meet the Victims of Russia’s War on Methadone

The Anatomy of a Heroin Relapse

…and follow us on Facebook and Twitter.

There are strict rules constraining use of the waiver. For one thing, the patient has to have a diagnosis of opioid use disorder. This diagnosis implies a stark but false distinction between “legitimate pain patients” like Marshall and “drug abusers” like Luke.  The same dreadful craving afflicted Marshall, who lost his struggle to use pills as prescribed, and Luke, who never had a prescription. Buprenorphine brought relief to both.

“Off-label” prescribing for chronic pain is perfectly legal without a waiver. The limited research available supports this practice: It shows that a switch to buprenorphine improves pain and quality of life.

But here’s the catch: Without a diagnosis of opioid use disorder, buprenorphine is rarely covered by insurance. With the diagnosis, it usually is. Under Obamacare, insurance companies must provide coverage for treatment of substance use disorders. Luke pays roughly $10 per month for this otherwise pricey drug, which can run to hundreds of dollars without insurance.

The case of Marshall, the patient with arm pain, illustrates the awkwardness of this situation. He never once used opioids for euphoria or relaxation. He never committed a crime, never harmed a relationship with family or friends, never even pressured his medical providers to obtain more of his drug. A diagnosis of opioid use disorder was a stretch. But I made the diagnosis based on his unwelcome craving, and his inability to resist taking doses earlier than scheduled despite known consequences. This diagnosis allowed him access to this life-saving treatment.

Other insurance quirks can create frustrating obstacles. Lily is a trim and perky middle-aged homeowner, a responsible caregiver to two grown children with special needs. For years, Lily had been prescribed oxycodone for arthritis in her spine. She described what happened.

“The longer you take them, the more they make you hurt. It creates pain. You get tolerant to it. And then you think, I’ll take just a little more, and then you take a little more, and pretty soon you hurt worse than you did before you started taking them. The brain creates this fake pain, a magnified pain that really isn’t there. In between doses you would get a depressed feeling, because you knew you weren’t supposed to take another dose, but you hurt, and this becomes cyclic. When you take buprenorphine, you get your whole mental stability back. You don’t have to worry about driving or feeling dopey. It gives you your life back on a plate.”

Since starting buprenorphine for opioid use disorder, Lily had begun walking two miles a day. For two years, she often had no pain at all. Insurance coverage was in place.

Then the insurance company discovered she was not enrolled in a chemical dependency program. She was thus deemed noncompliant with their requirements for buprenorphine coverage. Payment for the next refill was denied.

A formal treatment program would be overkill even for a patient like Luke, the convenience store employee, although he could certainly benefit from having a counselor. But what about Lily? Such a program would be an irrelevant intrusion.

I re-prescribed buprenorphine for Lily, this time using a diagnosis of pain. Coverage was denied. I appealed. Ultimately I talked with the medical director. He politely informed me, “Buprenorphine is not a good medicine for chronic pain, so it is not an option for your patient. But we will cover oxycodone.” Lily has since switched to a more flexible insurance company.

Robin, a stylish business executive, got coverage because she met criteria for opioid use disorder; after discovering buprenorphine’s unique effectiveness for her fibromyalgia, but before she found me to prescribe it, she had guiltily resorted to buying it off the street.

But what about Sally, a sweet 50-year-old lady on opioids for many years after an injury to her lower back? In a classic example of opioid-induced hyperalgesia, she described intolerable shoulder and neck pain after a demanding night at the community center playing bingo. She has always been meticulous about using her pain medicine as instructed, so she doesn’t meet criteria for opioid use disorder. But with exaggerated pain sensitivity, she might still benefit from buprenorphine.

The tides are turning. Many national leaders are now recognizing opioid addiction as a disease and not a crime. Now we need a more nuanced view of the challenge people face when their chronic pain is poorly controlled by opioids. Many struggle to use their prescribed pain pills as directed. Whether they succeed or fail, buprenorphine may improve their quality of life.

A sea change would be possible if millions of patients with chronic pain were switched to buprenorphine from daily pain pills. This would dry up the flood of opioids leaking out to the streets. Fewer young people would find pills and be tempted to try them. Fewer still would graduate to a gritty life of heroin use, or risk a death from overdose.

Doctors, patients, insurers and policy makers: Take note.

*Patients’ names have been changed.


Lucinda Grande, MD is a board-certified family physician who practices in Lacey, Washington. She specializes in chronic pain and addiction medicine. She has prescribed buprenorphine for opioid use disorder for four years, and currently prescribes it to 70 patients.

 

Washington Post re: Prince, Buprenorphrine, barriers to access, stigma

prince

You guys….there’s a story here and it’s bigger than we know. There’s a better drug for pain, and we have no knowledge of it and even less access to it. Prince was going to go all the way to California for it. You know what killed Prince? He ran out of time and stigma. I’m having some of the same problems. The side effects are killing me. I take less than prescribed. Somedays I excruciatingly don’t take any in order to keep my dosage down. But the side effects. Buprenorphrine is cleaner, doesn’t go through your digestive tract, doesn’t burden the kidneys and even has a ceiling on how much it can affect or slow down your respiration, so it’s way safer. What is the deal????????????????? No one is talking.

By Maia Szalavitz

PostEverything

May 9

Maia Szalavitz is a journalist and author, most recently of the forthcoming “Unbroken Brain: A Revolutionary New Way of Understanding Addictions.”

Prince performs at halftime of the Super Bowl in 2007. (JEFF HAYNES AND ROBERTO SCHMIDT/AFP/Getty Images)

Prince’s greatest music hit the radio while I was going off the rails during my own opioid and cocaine addiction. The young man who gave me my first injection was a massive fan and played “Kiss” for me around the same time he introduced me to the needle. I was soon hooked on both Prince and injecting.

That’s why it hit me especially hard when I learned that this musical genius’ overdose death occurred a day before he was due to start treatment. This tragedy makes clear that what likely killed him, and is killing so many others, is not just addiction itself, but the stigma we attach to it and, even worse, to the most effective treatment for it.

If we really want to stop the overdose epidemic, we need to get serious about providing the only treatment known to reduce the death rate by 50 percent to 70 percent or more: indefinite, potentially lifelong, maintenance on a legal opioid drug like methadone or buprenorphine. The data on maintenance is clear. If you increase access to it, death, crime and infectious disease drop; if you cut it short, all of those harms rise.

ADVERTISING

 

 

 

Prince was supposed to see a doctor, known for using buprenorphine to treat addiction, just a day after his death. But most patients — even most celebrity patients — do not actually get this sort of evidence-based care.

Indeed, most people concerned with opioid addiction don’t know that they should be looking for maintenance, or they avoid it thanks to the stigma against long-term medication treatment — research shows that maintenance patients experience prejudice and discrimination from family, friends, health care workers and employers. Even I perpetuated the stigma myself in the past, in an anti-methadone op-ed in the 1990s. At the time, I thought that simply having experienced addiction qualified me as an expert and incorrectly relied on anecdote, not data.

For both methadone and buprenorphine, access is highly limited. Only 30,000 physicians are licensed to prescribe buprenorphine, but most who are licensed don’t prescribe it and each is currently limited to seeing 100 patients. When used for addiction treatment, methadone is regulated to an extraordinary degree — it’s illegal to prescribe outside of those rundown clinics, and NIMBYism keeps them located in poor neighborhoods.

Minneapolis fans: Prince’s legacy ‘will live on’

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Play Video1:26

One day after music icon Prince was found dead at his suburban Minnesota compound, music fans were still in shock, as memorials grew. (McKenna Ewen/The Washington Post)

To top it all off, the 12-step support groups that addicted people are urged or even required to attend as part of treatment often see people on maintenance as not “really” in recovery.

These practices are deadly. We’ve got to get over the idea that medication for opioid addiction simply “replaces one addiction with another” and doesn’t count as getting better. To do so, we need a far better understanding of what addiction really means.

In many people’s minds — due to concepts popular in the ’70s and early ’80s — addiction means physically needing a substance to function and becoming physically ill when deprived of it. From this perspective, the biggest barrier to quitting is suffering through the nausea, pain, shaking and diarrhea that accompany withdrawal. And, from this point of view, people who are on maintenance treatments are actually “still addicted.” But this definition of addiction was dropped by experts long ago.

One reason this view fell out of favor was the rise of crack cocaine. Cocaine and stimulants, like methamphetamine, don’t cause physical withdrawal symptoms — if addicted people suddenly stop taking them, they don’t get physically ill. However, they absolutely experience irritability, anxiety and craving that is every bit as intense and likely to lead to relapse as that associated with alcohol or opioids. This makes stimulants like crack highly addictive.

Though we tend to think otherwise, physical withdrawal isn’t the main barrier to abstinence; instead, craving and the sense that drugs are essential for emotional survival are at the core of addiction. In my own case, I put myself through withdrawal from heroin addiction at least six times. Never once during these attempts did I relapse while ill. Instead, I returned to drugs after withdrawal illness had passed — not because I felt physically bad, but because I had convinced myself that “just once” would be okay.

So what is addiction if it isn’t defined by tolerance or withdrawal? Psychiatry, through its diagnostic manual, the DSM, sums it up as compulsive behavior that recurs despite negative consequences. This means that maintenance helps users conquer their addiction by replacing addictive compulsion with physical dependence.

Craving, obsession, intoxication and consequences are gone; tolerance and steady dosing mean that patients are not impaired and can drive, care for families and work. What remains is a physical need for the substance to avoid withdrawal.

And such dependence isn’t harmful, per se: We’re all physically dependent on oxygen, food and water, and some of us (like yours truly) are physically dependent on antidepressants or other types of medication. If the consequences of physical dependence are positive, it’s not addiction. Which is why I don’t sit around dreaming of Prozac, yearning for my next dose, taking more and more and hiding my obsessive behavior.

Of course, like any other addiction treatment, maintenance doesn’t always lead to recovery. Indeed, as with abstinence-only treatment — though at a lower rate — relapse is the most common outcome.

Importantly, however, unlike in abstinence-only treatment, patients benefit from maintenance even during relapses. That’s because, whether or not people continue taking other drugs in an addictive fashion, the tolerance provided by maintenance pharmacologically makes overdose death much less likely.

The ongoing use of other drugs during relapse explains why so many people see maintenance as a failure and maintenance patients as being constantly high — but retaining relapsers in treatment is a feature, not a bug. It reduces mortality, disease and crime and keeps patients in health care.

Unfortunately, most families and friends of addicted people don’t understand this. They tend to seek abstinence-only inpatient rehab because maintenance is stigmatized, and the media rarely highlights its dramatic reduction in mortality. Instead, we hear about relapse or people selling their maintenance medications on the street. Ironically, that street market exists primarily because we don’t make maintenance accessible enough. Maintenance drugs wouldn’t be valuable if people who wanted them could get them, whether or not they are ready for abstinence.

Prince’s death was awful enough. A man lost his life, we lost a great artist — and we also lost the chance for him to model and destigmatize the best treatment we currently have for addiction.

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