Drugs and Treatment in New York City, New York
Like so many other major American cities, the City that Never Sleeps has a heroin problem. Heroin seems to be the number one cause of death in larger East Coast cities, outstripping both car accidents and gun violence as the biggest threat to citizens. In fact, in 2017, more New Yorkers died of drug overdoses than car accidents, homicide, and suicide combined.
This epidemic has been caused by a confluence of several factors. Firstly, the prevalence of pain medication prescriptions has led to widespread opioid addiction. Many of the doctors that are issuing these prescriptions are not pain management doctors. Most are general practitioners who are providing pain relief for their patients after accidents or surgeries.
Meanwhile, some pain management doctors have found themselves under the scrutiny of law enforcement officers further scaring off those that would be interested in pursuing pain management as a specialty.
General practitioners themselves may be great doctors but are mostly under-trained to deal with short term and long term needs of those that suffer from temporary or permanent pain disorders. This has led to considerable backlash against the doctors themselves and the pharmaceutical companies that are manufacturing these drugs since many of those who find themselves in drug rehab got their start with prescribed pain management meds.
Still, heroin accounts for 55% of all drug overdoses in New York. It’s debatable the extent to which prescription pain management meds have factored into the rise of what the media has termed the “opioid epidemic”. Certainly, with more scrutiny on doctors than ever before, many legislators and health officials are coming up with various initiatives to stop the carnage. To date, their efforts have proven largely unsuccessful.
Cities like New York have always been vulnerable to the black market drug trade being situated on the coast. New Jersey too has suffered a similar situation with heroin and opioid abuse in the state exceeding the national average. But fighting the traffickers on multiple fronts has locked law enforcement in a stalemate against an unrelenting force. Today, more initiatives are being put in place to fight the addiction.
New York City Drug Addiction by the Numbers
The data shows that all over the country the number of deaths caused by unintentional overdoses is rising. In 2016, more 1300 New Yorkers died of drug-related overdoses. In 2015 that number was under 1000. To put that in perspective, there were 4 deaths a day in the Big Apple, and the majority of those (73%) were caused by opioids with heroin accounting for 55%.
One of the major players causing a rising death toll is fentanyl which can now be made on the street. Fentanyl is a synthetic opioid which is more than 50 times stronger than morphine. Deaths due to fentanyl have risen each quarter as access to the drug has increased exponentially. In addition, fentanyl is being used to cut other drugs like cocaine and heroin. Many of those who end up purchasing fentanyl aren’t aware that the drug is cutting whatever they’re buying. This further complicates things for emergency medical technicians. Fentanyl, due to its potency, may require a higher dose of the anti-opiate drug Naloxone in order to prevent an overdose.
One statistic that many will find surprising is that nearly half (49%) of all unintentional overdose deaths recorded in 2016 were of individuals between the ages of 45 and 64. The image of a disaffected musician junkie is a thing of the past.
The climate that has produced these kinds of numbers is the subject of a great deal of scrutiny. Clearly, pain management meds are essential to certain individuals. But if these individuals are prone to abusing them and not following the instructions on taking them properly, then this sort of addiction is inevitable. It puts doctors in an awkward position because traditionally, these meds have been used for pain management without issue, but today there appears to be a major problem. There may not be one obvious cause that everyone can point to. Nonetheless, the severity of the problem is real.
Treatment: How it Works
If you or your loved one is suffering from addiction, you are not alone. Treatments for all addictions are out there. There is a path to a normal life. The journey won’t be easy, but it is worth it.
You might be wondering what precisely that process entails. Whether you’re seeking treatment or treatment for addiction to pain medication, the process is roughly the same. It entails
- Post-Acute Treatment
- Continued Management
The process of going from a full-fledged addiction to recovery generally lasts about a year. It may only take a couple of weeks to get the drugs out of your system, but the damage it does to the brain chemistry takes about a year to completely fix. The period in between is not easy, but it gets easier as one goes along.
The first step in that journey is an assessment.
An addiction assessment is designed to determine what the best course of action for the patient would be. It’s also designed to predict any complications that might arise as a result of detoxification. The process of detoxing can take a large physical toll on the body, even for those who are only addicted to pain medication. Heroin addiction treatment and pain medication addiction treatment is not at all dissimilar.
On the other hand, those who are addicted to heroin tend to have other physical issues that concern their health. These can include numerous blood infections, skin infections, and collapsed veins from injection. The assessment process also must determine the extent of the damage the addiction has caused to the patient’s body. This helps the doctor ensure that there are no complications to the treatment process.
It also allows the doctor to treat any other infections that may have been caused during the course of addiction. This goes without saying, but addicts tend not to have the best immune response. Heroin and opioid addicts are especially vulnerable to respiratory infection. Since all opioids are respiratory depressants, the risk that a patient will suddenly stop breathing is always present.
Beyond that, the doctor will want to take a patient history. This not only includes the history of the patient’s addiction but any other surgeries the patient has had. This also includes a family history to determine if heart disease or other ailments may have been genetically passed to the patient. Usually, this information isn’t critical, but having more information is always better.
Lastly, the doctor will want to determine the patient’s attitude toward their drug abuse. This can also include a mental health examination to determine if the patient has any other co-occurring mental health issues that have gone untreated. For those plagued by drug addiction, this is very often the case. Anxiety, depression, and mood disorders are quite common among addicts. Treating the underlying cause of the addiction can go a long way toward curbing a future relapse.
There are two main ways that doctors can detox a patient from opioids. The first is traditional detox that occurs over the course of a couple weeks. The second is rapid detox which is advertised as a way to get off opiates without withdrawal.
Heroin detox centers that offer rapid detox claim that it is a way to avoid opioid withdrawal symptoms. The process involves being hospitalized for 4 days during which the patient is heavily sedated. The patient is given the drug Naloxone, an opiate blocker, which flushes the opioids out of their system. When the patient wakes up, they are said to be detoxed.
There is a great deal of controversy involving this method. Many patients do not wake up from the procedure fully detoxed. Some experience a worsening of mental health symptoms. Others have died.
The CDC conducted a study in 2006 that indicated that there was no benefit to rapid detox over traditional forms of detox. Many clinics refuse to perform the procedure.
In addition, the procedure generally costs more money than traditional forms of detox. It may or may not be covered by most kinds of health insurance.
Detox itself is not a cure for opioid addiction. The addition still remains and those who have made the journey through the process of fighting addiction, battle that addiction every day. The extent to which it will work as advertised may differ from person to person. Naloxone successfully can block opiates in the body, but some forms of opioids are stronger than others.
In addition, there is a risk of a cardiac or pulmonary event. Individuals that are going through heroin or opioid withdrawal routinely suffer hallucinations and psychosis. If the patient is suffering from other mental health issues, rapid detox may intensify them.
By comparison, traditional detox attempts to alleviate the symptoms of opioid withdrawal by supplementing the drug of choice with a lower dose of a drug like methadone or suboxone. The drugs can take the edge off many of the worst symptoms of heroin withdrawal, but can’t make the process completely comfortable.
Cold turkey opioid withdrawal is extraordinarily painful. The most common opioid withdrawal symptoms include:
- Abdominal pain
- Muscle cramping
- Rapid heart rate
- Increased sweating
- Runny nose
- Muscle pain
- Drug craving
Nonetheless, most doctors consider traditional detox to be the best detox method for heroin and pain medication addicts. Detoxing off opiates is not easy. It’s a difficult and uncomfortable process. And it’s only the first step in a journey that will last several months and beyond.
Post-Acute Treatment Options
After detox has completed either at a rapid detox center or through traditional detox methods, the journey has only just begun. While the physical addiction has been kicked, patients will still find themselves craving the drug. On top of that, they’ll be fighting off the part of the addiction that still lingers even when the drug is gone. That is the psychological addiction.
For heroin addicts, this is much worse. Heroin releases is a great deal of dopamine when the user takes the drug. This is what causes the feeling of euphoria that heroin addicts crave. The longer the user is on heroin, the more their brain depends on heroin in order to produce dopamine. Hence why drug rehab includes more than just detox.
It’s important to note that the majority of heroin addicts that relapse do so during this part of their treatment. The reason for this is the impact that the drug has had on their brain chemistry. Heroin addicts struggle to produce dopamine naturally. There is no drug that the doctor can prescribe to combat this. Their brains must relearn how to produce dopamine on their own. This entire process can take up to a year.
Dopamine is the neurotransmitter involved in pleasure and reward. After detox, many heroin addicts report a profound sense of depression, hopelessness, and emptiness. That is due in large part to the fact that their brain is no longer producing dopamine. The medical term for this is anhedonia. It means the inability to experience joy.
Getting through this part of addiction treatment is extremely difficult. Many recovering addicts will tell you that it’s more difficult than detox. While doctors can prescribe antidepressants to help those in recovery through the process, the brain more or less needs to stabilize its own chemistry.
There are a number of ways in which psychotherapists and addiction counselors attack this problem. Some of it involves retraining the addict’s brain to be rewarded by the right things. It’s difficult for those who have not been addicts to imagine, but the things that make you happy and excited like acing a test, getting a promotion, a new relationship, or the birth of a child, have all been replaced by heroin in the psyche of an addict.
How do health professionals manage this process?
Intensive Inpatient Treatment for Addicts
Inpatient treatment generally comes in one of two kinds. 28-day programs help the addict through the period of detox and the early part of the post-acute phase of overcoming addiction. Three-month inpatient programs can also focus more on the post-acute phase during which the majority of addicts are the most vulnerable.
For obvious reasons, inpatient programs have shown the greatest amount of success at preventing relapse, with three-month programs having a slight edge over 28-day programs. The benefit of inpatient programs is that they provide a very restrictive environment. Those recovering from addiction will not be tempted to return to old patterns of behavior while they’re in a restricted facility.
Inpatient programs also provide recovering addicts with a supportive team of professionals who work one on one and in groups to give those in recovery the tools they need to successfully manage their stressors and cravings. Groups are meant to be a place in which addicts talk about their issues, their addiction, their reasons for using, and to talk about issues they may face once they’re released. They can also talk about their hopes for the future and why their recovery is important to them.
Somewhere between an inpatient program and an outpatient program is partial hospitalization. Not all hospitals will offer this as an option, but some will. The patient would spend the day at the hospital meeting in groups and with counselors. The programs usually go from 9 am to 4 pm. They would then be released.
The key to a program like this working is that the individual in recovery has a safe place to return to where they won’t be tempted to use. Many in supportive sober-living situations choose this option after detoxing.
Intensive Outpatient Programs
Intensive outpatient programs are ideal for those who have a safe place to go back to, a job waiting for them, or are highly motivated to kick their habit. Many who are addicted to pain meds choose intensive outpatient programs after detoxing. Follow up care is done around the patient’s schedule. Meetings and tox screens are mandatory, but they can be done at night.
Maintaining Sobriety after Addiction
The majority of those who find themselves in rehab truly do want to break the cycle. The process isn’t easy and it won’t be without its difficulties, but individuals from all walks of life have rebuilt their lives. While their addiction haunts them and that part of their life can’t be erased, they take comfort in the communities that they’ve built for one another. Programs like SOS and Narcotics Anonymous provide individuals in recovery with a community that they can lean on when they’re driven to use again.
Much of the therapy for recovering addicts is centered around understanding what motivates an individual addict to seek refuge in their drug of choice. For many, it’s relationships, job-related stress, family stress, or feelings of insignificance. Unfortunately, a stress-free life is promised to no one. Those who maintain their sobriety learn to manage the stressors that drove them to use in the first place and meetings play a very important role in that process.
While the journey of recovery may never end, lives are saved and rebuilt every day. It’s a difficult choice, but it’s still a choice. It’s not the easier choice, but it is the more rewarding one.