Overdose Deaths Soar Among Military Troops

by recoveryhelpdesk on September 8, 2010 · 0 comments

About once every five days an active-duty service member is found dead of an accidental drug overdose, the Army Times reported. 

This number roughly tripled since 2001.  And the number is more than twice as high if you add in intentional (suicide-related) overdoses.

Read more at:

Rx for Death: Troop Deaths Soar with Prescriptions for War Wounded

Military doctors often prescribe both opioids like methadone and oxycodone to treat pain and benzodiazepines like Xanax and Valium to treat trauma-related anxiety.   Use of opioids and benzodiazepines together greatly increased the risk of fatal drug overdose. 

The Army Times article seemed to largely ignore the fact that many service members use pain killers and benzos without a prescription or in excess of prescribed amounts, and often in combination with alcohol.   Use of alcohol on top of these prescribed medications also increases overdose risk.  Instead, the article focused on  one factor that may be contributing to an increase in accidental overdose deaths: prescribing practices by doctors.

Methadone was mentioned as a common factor in accidental overdoses among service members.  Methadone is often prescribed for pain.  Methadone overdose risks and benefits are important to understand since methadone sometimes increases overdose risk and sometimes reduces overdose risk. 

Methadone is a slow-acting opiate.  Those who are seeking to get high from the medication sometimes take more than they can tolerate because they mistakenly think the medication is not “working.”  As the medication begins to act, the body becomes overwhelmed resulting in an overdose.

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Methadone Patient Satisfaction is Linked to Treatment Success

A recent scientific study of methadone patients confirms what common sense suggests: methadone treatment outcomes are related to patient satisfaction.  Methadone patients who are happy with their treatment have better treatment outcomes. 

Satisfied methadone patients stay in treatment longer and are more successful at reducing or eliminating use of heroin or prescription pain killers.  In other words, satisfied methadone patients are successful methadone patients.

This link between patient satisfaction and treatment outcomes has policy implications for methadone clinics and recovery implications for methadone patients.

What This Means for Methadone Patients

Methadone patients should ask themselves, “Am I feeling satisfied with my methadone treatment?” 

Dissatisfaction with methadone treatment  is a red flag that shouldn’t be ignored.  Patients need to understand the source of their dissatisfaction and find a way to improve satisfaction.  Poor treatment satisfaction puts methadone patients at risk for relapse or abandonment of treatment.

For example, a methadone patient who is dissatisfied with treatment because they are continuing to have severe drug cravings is unlikely to be successful at maintaining abstinence from illicit opiates.  Unless the methadone patient and the methadone clinic are able to find an effective methadone dose for the patient, the patient is unlikely to enjoy positive treatment outcomes. 

What This Means for Methadone Clinics

Methadone programs should ask themselves, “Are we doing everything we can to improve patient satisfaction with our program?”

Methadone programs need to assess patient satisfaction as part of treatment.  Poor treatment satisfaction is a barrier to treatment.  It puts methadone patients at risk for relapse or abandonment of treatment.  An effective treatment plan must address patient satisfaction and resolve sources of dissatisfaction.

Too often, methadone treatment programs seem to rely on the medication itself to engage and retain patients.  This isn’t enough.  Patients need a warm and welcoming staff, skilled and respectful counselors, reasonable program policies, and good medical management to succeed. 

Businesses know that poor customer satisfaction leads to lost customers.  When it comes to methadone treatment, the losses can be fatal.

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30 Year Study Confirms Methadone Saves Lives

by recoveryhelpdesk on July 8, 2010 · 4 comments

Edinburgh University researches followed hundreds of people living with addiction to heroin for nearly 30 years.  What did they learn?

Methadone treatment:

  • reduced the frequency of drug use
  • helped people lead more stable lives
  • reduced the risk of death by 13% each year

Why am I not surprised?  Because I’ve seen this with my own eyes.  And these results are consistent with previous research.

Part of what interests me about this study is that researchers followed participants in the research study for decades.  That is very useful.

The study will be published in the British Medical Journal on July 17, 2010.  I will be very interested to read the details of what they found, and will likely comment further in a future post.

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Our Complicated Relationship With Methadone

by recoveryhelpdesk on July 2, 2010 · 1 comment

Relationships are never easy.  When it comes to our relationship with methadone, let’s just say it’s complicated.

Debby, the Mom at the blog How’s My Son?, recently wrote a post updating her readers on her son’s recovery from addiction to OxyContin and other opiates.  Debby is a good Mom and a good person, and I’ve been a fan of her blog for the better part of a year now.

Debby writes:

I was just saying prayers of thanks this morning for my son’s six months of sobriety.  That’s definitely debatable, because some people believe that if you are using methadone you are not sober.  As far as I am concerned, my son is not buying heroin.  He’s using methadone at a clinic that has a good reputation for dispensing this, in liquid form, and adhering to the state of California’s very strict guidelines.

The medication is working and Debby is grateful.  Yet she feels the need to qualify her description of her son as sober.  She recognizes that some people in the recovery community would not agree that her son is sober since he is taking prescribed methadone.

Methadone-assisted recovery is real recovery, but some people in the recovery community have trouble accepting that fact.  When it comes to methadone and the recovery community, the relationship is complicated.

Methadone is strictly regulated in California, which is not necessarily a bad thing –as long as the regulations are based on science and treatment effectiveness.  The problem is, some regulations are based on stigma and politics and nothing more.  In California and everywhere else, our social and political relationship with methadone is complicated.

Debby’s son’s relationship with methadone is complicated too.

He’s been sober for six months.  He was allowed to move home six weeks ago, and Debby says he’s been great.  He’s working two jobs and saving money.

Recently, Debby’s son ran out of gas and missed his appointment at the methadone clinic.  Without his methadone dose, he began to experience withdrawal sickness.  “I hate that poison that’s in his body,” Debby wrote.

Debby’s son bought some methadone from a friend.  He said he had to do it or he would be tempted to use.

Frickin’ poison.  How I pray that my son will finally be able to purge that crap out of his body.  Synthetic opiate or not, how I long for my son to be free of drugs of any kind.  I can only watch, and feel sorrow for what he’s going through.

Debby’s feelings are understandable.  But they reminded me that the complexity of our feelings about methadone is not without consequence.

Ambivalence about methadone can be a barrier to successful treatment.  Methadone treatment requires a strong commitment to recovery. Mixed feelings about methadone can make it more difficult for a methadone patient to sustain the effort it takes to be successful in treatment.

Most methadone patients do have mixed feelings about methadone treatment.  They are grateful for the often dramatic improvement methadone treatment has brought to their lives.  Yet, they wish they didn’t need it.

They wish they didn’t have to rely on a medication.  They struggle with “clinic fatigue” from having to go to the methadone clinic frequently and over extended periods of time.  Some may experience side effects from the medication.  Yet they keep at it because the treatment is working and in the end it is worth it to them.

Those who are part of a methadone patient’s circle of support often have mixed feelings about methadone too.

They are grateful for the benefits of methadone treatment.  Yet they can’t help but wish that their loved one didn’t have an addiction in the first place.

They wish other treatments would have worked.  They wish they didn’t have to worry about whether this treatment is really working or still working.  They wish that their was a cure for addiction and the whole nightmare of addiction could just be over.  They worry about their loved one taking a long term medication (even though research shows that long term methadone use is generally safe).

The problem is that mixed feelings often lead to mixed messages.  If you want someone you care about to succeed in methadone treatment, then you want to make sure that you don’t allow emotionally-driven, negative feelings about methadone treatment to turn into negative messages about methadone treatment.

You can bet that your loved one in methadone treatment is highly tuned to these messages, and they matter.

Sometimes the negative messages are subtle and inadvertent.  Other times the messages are overt and intentional.  Either way, the effect can be disastrous.

The good news is that positive messages have power too.

Messages like:

I support you in your treatment and your recovery.  I admire you for the effort you are putting into your recovery.  I understand how hard it is to do what you are doing.  I support your right to make your own treatment choices.  I support whatever path to recovery works for you.  I want you to stay in methadone treatment as long as you need to.

Methadone patients, and those who care about them should recognize that their feelings of ambivalence are normal.  But they should also monitor their feelings carefully.  Unless managed properly, these feelings can and do effect treatment outcomes.

I appreciate Debby for sharing her feelings openly on her blog.  She is a great example of a Mom who is both honestly expressing her feelings and doing a great job in supporting her son through difficult terrain.  People like Debby and her son are making heroic efforts that I think we can all admire.

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Vivitrol On FDA Fast Track to Treat Heroin Addiction

by recoveryhelpdesk on June 21, 2010 · 1 comment

Vivitrol is on the fast track for approval in the U.S. as a treatment for addiction to heroin, OxyContin and other prescription pain killers.  Here are some facts about Vivitrol:

  • Vivitrol is an extended release formula of the drug naltrexone
  • Vivitrol was approved for treatment of alcohol dependence in 2006
  • Vivitrol was granted priority review status as a treatment for opiate dependence by the U.S. Food and Drug Administration (FDA) in May, 2010
  • FDA is expected to make a decision on approval of Vivitrol as a treatment for opiate dependence in October, 2010
  • Vivitrol is non-narcotic, non-addictive, and a single dose lasts one month
  • Vivitrol is administered by injecting the medication into muscle

Unlike methadone or buprenorphine (brand names Suboxone and Subutex), Vivitrol is not an opiate replacement therapy.  Opiate replacement therapies treat compulsive use of fast acting opiates by prescribing therapeutic doses of longer acting, less euphoric opiates under medical supervision.

Naltrexone is not an opiate, but it has the ability to block the effects of opiates by physically occupying opiate receptor sites in the brain.

Naltrexone is already used to treat addiction to heroin or other pain killers, but usefulness of the treatment is limited by the fact that many patients simply skip doses or stop taking the medication as part of a relapse to opiate use.  A single dose of Vivitrol is active for one month limiting the temptation and opportunity to circumvent the treatment.

Methadone and Suboxone/Subutex (buprenorphine) also have medication adherence issues.  For example, many Suboxone patients in early recovery find it difficult to successfully hold their own medication and take the medication as prescribed.  Without adequate recovery supports, many patients relapse before they have a chance to establish a stable recovery.

A few concerns about Vivitrol:

  • Vivitrol patients must not have used heroin, OxyContin or other prescription pain killers within 7-10 days of taking Vivitrol (this complicates the process of getting an opiate dependent person started on the medication)
  • Patients who try to overcome the blockade effect of Vivitrol or who resume opiate use after discontinuing use of Vivitrol may be at increased risk for fatal drug overdose
  • Vivitrol, like other formulations of naltrexone, can be toxic to the liver (this may limit usefulness for some patients with active liver disease including some patients who became infected with Hepatitis C via injection drug use)

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