Wednesday, June 26, 2019

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In the U.S., drug overdoses are the number one killer of people who are 50 years old or younger. Although marijuana, cocaine, and methamphetamines are some of the most commonly abused drugs in the Cobb County region, heroin and other opioids have topped the list. Within recent years, opioids have become the primary cause of death for those 35 or younger. These statistics hit particularly close to home for Georgia residents as opioid overdoses have increased an astonishing 1000% in the last ten years.

Opioid is the blanket term used to describe both opiates derived from the opium poppy (ex. morphine, codeine, heroin, and opium) and synthetic drugs (ex. methadone, oxycodone, Vicodin, Percocet, and Dilaudid). When used responsibly and as prescribed by a physician, opioids attach to receptors in the brain and are meant to assist in pain management. However, the abuse and addiction rate of opioids in the U.S. is far-reaching and growing exponentially. Opioids don’t discriminate by gender, age, race, or socio-economic status, and sadly, it often begins with opioid painkillers.

In 2016, Cobb County had the second highest number of overdose deaths in the entire state, only surpassed by neighboring Fulton County, which has one of the highest opioid overdose rates in the entire nation. In 2014, Cobb County reported 10.1 – 12 drug-related deaths per 100,000 people, only slightly lower than Fulton and Cherokee Counties (12.1 – 14 per 100,000). One culprit to the high rate of opioid overdoses is the recent introduction of the drug Fentanyl to the region. Because it is easier and cheaper to manufacture, opioids are sometimes cut with Fentanyl, which is similar to morphine, but 50 times more potent. For this reason, Georgia has seen a marked spike in both opioid overdoses and deaths. The difficulties of Fulton County and the surrounding metro areas have been chronicled on the A&E show Intervention and provide a glimpse to the rest of the nation of how dire this situation is in the “heroin triangle.” The city of Kennesaw and surrounding neighborhoods of Deerfield, Summerbrooke, and Abington Green haven’t been immune to the devastation that opioids can inflict.

However, the Kennesaw community has been a pioneer in fighting this epidemic. Three years ago, in an effort to minimize the number of deaths from opioid overdoses, Kennesaw State University was the first university in Georgia to arm the campus police force with naloxone, the antidote that reverses the effects of an opioid overdose. Faculty, staff, students, and others affiliated with the campus have also been trained to use this life saving kit. But there is still much work that needs to be done.

If you, your spouse, partner, sibling, child, friend, or co-worker is struggling with addiction, you are not alone. There are resources to help those in need navigate their way through addiction. Here is a snapshot of what to expect in the recovery process:

Initial Assessment and Pre-Intake

The initial assessment begins with a phone call or visit to a treatment facility. Although each treatment program is unique, many facilities use the Addiction Severity Index (ASI) to help determine the need for treatment. Experts are looking for signs of crisis (those who need immediate attention), risk factors, and potential barriers to successful treatment. Additionally, experts help potential patients to make an informed decision about their own treatment. It’s important to note that there may be a waiting period for programs that are currently at-capacity.

Admission and Intake

After the decision is made to enter treatment, patients will go through a formal intake process, which often includes providing a detailed medical and treatment history as well as having physical and psychological evaluations. Patients can expect to provide information about drugs of choice, method of drug use (smoking, snorting, injecting, etc.), frequency of use, and known or potential infectious diseases such as sexually transmitted diseases, tuberculosis, HIV/AIDS, and hepatitis. Often, new patients are required to take a drug test and submit bloodwork. Being armed with this information will help the medical staff suggest the best method of treatment for new patients.

Detoxification

Treatment from addiction involves a detoxification process, which is important for eliminating the harmful chemicals within the body. As with any addiction, there is a withdrawal period as the body detoxifies. After drug use has stopped, patients may initially experience muscle aches, anxiety, sweating, and a rapid pulse. As the withdrawal symptoms peak, patients may experience nausea, stomach issues (ex. cramping, vomiting, and diarrhea), depression, and cravings.

Depending upon the facility and the patient’s needs, there are different methods of detoxification:

  • Medical Detoxification
    Severe withdrawal is often a catalyst for relapse and for this reason, some patients choose to participate in a program that offers medical detoxification. Doctors will prescribe medication to help patients move through painful withdrawal symptoms. With opioid addiction, the most common types of medication used in a medical detox are:
  • Methadone
    This type of method is referred to as Methadone Maintenance Treatment (MMT) where patients are given a daily dose of methadone, a synthetic opioid to help counteract the withdrawal symptoms. Methadone works by linking with opiate receptors in the brain, which lessens withdrawals symptoms without the “high” that opioids create. Unlike heroin or other opioids, the effects of methadone last 24 hours. Over a period of time, the amount of methadone administered is decreased, with the ultimate goal of being opioid-free.
  • Buprenorphine
    Similar to methadone, buprenorphine, commonly known as Suboxone, fits into opiate receptors in the brain, eliminating the withdrawal symptoms without the euphoric high. This prescription medication is administered by pill and dissolved under the tongue. Suboxone also contains the drug naloxone, which is used to prevent abuse of the buprenorphine. When this medication is injected instead of dissolved under the tongue, it creates withdrawal symptoms. Subutex is another form of buprenorphine, but does not contain naloxone, and may be prescribed for those who are pregnant or have an allergy to this particular medication. The effects of buprenorphine are long-lasting and those prescribed this medication will take it daily or once every two days depending on doctor recommendations.

Naltrexone
Naltrexone also works by blocking opiate receptors in the brain. In addition to counteracting opiate withdrawal symptoms, this medication also helps treat alcohol dependence by reducing the effects normally felt with alcohol. Naltrexone is either administered by pill or an injection of Vivitrol. Naltrexone pills must be taken daily while the injection is time-released and lasts for 30 days.

Medically Supervised Detoxification
Not to be confused with medical detox, medically supervised detox involves licensed medical staff closely monitoring a patient’s detoxification process. Depending on the facility, medically supervised detox programs may employ either natural methods or use prescription medication to alleviate the symptoms of withdrawal while monitoring a patient’s vitals and level of discomfort.

Natural Detoxification
A natural detoxification process, which is supervised by licensed medical professionals, is also considered a type medically supervised detox. Natural detox focuses on allowing the body to go through the withdrawal process naturally. Herbal remedies and over-the-counter, non-addictive medication may be used, but this type of detox doesn’t use any prescription medication. Patients can expect to be closely monitored by doctors and nurses to ensure their vitals are stable and help address any other medical issues that may arise. The philosophy behind this method is that feeling the effects of withdrawal may serve as a deterrent in the future.

Rapid Detoxification
Rapid detoxification involves putting patients into a medically-induced sleep state and administering medication that accelerates the detoxification process while eliminating the awareness of withdrawal symptoms. There is much debate about this type of treatment. Advocates believe that this method helps people move through the most challenging part of withdrawal, while opponents argue that the rate of relapse is greater with rapid detox because there are no negative withdrawal symptoms to serve as a deterrent.

Treatment Options

Think of treatment as a chain – depending on needs, each patient will begin on a certain rung. Each subsequent rung is meant to move patients closer and closer to individually managing their addiction. Treatment falls into three broad categories: inpatient, intensive outpatient, and outpatient. After the intake process, medical professionals will help patients determine the best option.

Inpatient Treatment
Inpatient treatment involves a patient residing in a facility for a specified amount of time, which can range from a few weeks to several months. This occurs in either a residential treatment center, where patients receive psychological, emotional, and medical support to work through their addiction. Patients are often supported by a team of doctors, nurses, therapists, and other trained healthcare professionals. The environment is highly controlled to allow patients to focus on their recovery.

Partial Hospitalization Programs
In some cases, medical personnel may recommend a partial hospitalization program (PHP). A PHP is designed for those that have either completed a residential program or those who have demonstrated they do not need around-the-clock care of a residential program. Those enrolled in PHP participate in highly structured in-house therapies and activities several days during the week, but return home in the evening. PHP provides the high level of support of an in-patient program, but offers the flexibility of an outpatient program. Those enrolled in a PHP can expect to commit approximately five hours five days a week of their time.

Intensive Outpatient Programs
Intensive Outpatient Programs (IOP), similar to PHP, are the intersection of inpatient and outpatient treatment. Those enrolled in intensive outpatient programs will attend in-house sessions, receive one-on-one counseling, and be given medication if needed. IOP participants can expect to commit approximately three hours three days a week, which is less time required than PHP. Those enrolled in an IOP may receive one-on-one counseling sessions from medical professionals in addition to group therapy sessions.

Outpatient Treatment
Outpatient treatment offers the most flexibility of all treatment programs as patients are allowed to continue with their daily responsibilities such as work, but are required to check in at a treatment facility during regularly scheduled times. Outpatient treatment varies greatly, but can include personal counseling, group sessions, medication oversight, and other support.

Aftercare Programs

Aftercare is a term relative to where treatment begins. For example, if a patient begins with inpatient treatment, part of their aftercare may include outpatient treatment. Completing a recommended treatment plan is an important milestone in the recovery process, but patients should also plan for long-term success. Participating in aftercare programs is highly recommended as it reduces the chances for relapse. Those in recovery will work closely with their treatment facility to find an aftercare program that best suits their needs. Aftercare programs vary greatly in time commitment and services, but are often focused on group therapy, individual growth, and self-efficacy. Some types of aftercare programs that patients may consider:

12-Step Programs
12-Step programs such as Narcotics Anonymous and Alcoholics Anonymous provide a safe and supportive environment for those in recovery. These group sessions are confidential and provide participants with the tools to work through “steps” of recovery. Almost 75% of treatment centers utilize 12-step programs in their treatment of patients. To find a meeting near you: https://www.na.org/meetingsearch/.

Individual counseling
Those in recovery may also choose to work with a mental health professional to address any barriers to sobriety. Counseling may be conducted with either a licensed psychologist or psychiatrist, preferably with drug and alcohol counseling experience. Therapists may employ behavioral, cognitive, or a combination of therapeutic approaches during sessions.

Group Therapy and Support Groups
Sharing some of the same components of a 12-step program, group therapy and support groups can help provide emotional support for those in recovery. Participants are placed in a group with others struggling with the same addiction issues and will normally work with a trained therapist leading regularly scheduled sessions.

Sober Living
Sober living facilities are meant to bridge the gap between residential treatment centers to living on one’s own. These substance and alcohol-free homes are shared by individuals who are also in recovery. Those in sober living homes often participate in multiple forms of aftercare such as 12-step programs, group therapy sessions, and individual counseling.