ALLIED Health clinic llc
summer 2017 issue
TODAY VIVITROL THE OPIATE EPIDEMIC
ALLIED Getting to know HEALTH Clinic OPIATE
MARIJUANA WHAT IS MEDICAL
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WE CAN HELP YOU GET OVER IT SOYOU CANGET BACK TO WHAT MATTERS IN LIFE.
(617) 302-3343 info@alliedhealthclinicllc.com To nd out more please contact us 21 School Street, Suite #1 Quincy, MA 02169
Allied Health Clinic Kicking an addictive habit isn’t easy. Allied Health Clinic can help. We have a holistic approach to treating the disease of addiction, and bringing people back to health. This means giving you the medical and emotional support needed for you to succeed. Our proven treatment involves medically assisted opioid withdrawal using the prescription drug Suboxone. This keeps you sober and helps you get your life under control. About Allied Health Clinic Our Opioid Addiction Services • We design an individual treatment program for you. • We give you a full medical workup and any necessary specialty referrals. • We coordinate your treatment with your other medical and psychological practitioners. • We use the prescription drugs Suboxone and Vivitrol as a bridge to help opioid addicts get stabilized and sober.
• We use Vivitrol as a bridge to help alcoholics become sober. • We have qualied and caring medical and counseling personnel. • We have a full medical lab onsite for testing. • We work with your support network of family and friends. Our Other Services • We provide treatment for alcoholism and other addictions. • We prescribe medical marijuana for pain management in certain medical conditions. Our Story e Allied Health Clinic was organized by Victor Torosyan, a successful Torosyan is trained in physics, mathematics, and computer engineering, and also has a bachelor’s degree in
businessman who came to the United States 17 years ago with, he says, “$365 in my pocket.”Torosyan was motivated to become involved with treatment for addiction after the overdose deaths of two close friends who had been successful professionals before they became addicts. He also was concerned at the rapid growth of opioid addiction in Massachusetts. “It’s destroying lives, destroying families, and destroying communities,”Torosyan said.
economics. Before he got involved in the clinic, he researched addiction treatment and Suboxone for one and half years.en he hired three professional consulting rms to help plan and organize the clinic. In less than a year, the Allied Health Clinic in Quincy has had enough success in helping its clients get “clean,” to move forward with expanded medical services. e clinic plans to open a primary care physician (PCP) and counseling oce next door to the current facility at 21 School Street.
Dr. Jessica Harrington MD Dr. Jessica Harrington is a Family Physician who has been practicing medicine since 1994. She is a graduate of the University of Massachusetts Medical School and completed her Family Medicine Residency at Memorial Hospital of Rhode Island/Brown School of Medicine. Dr. Harrington practiced primary care medicine for children and adults for many years before specializing in addiction medicine at Allied Health Clinic.
Dr. Susan Johnson MD
Dr. Lawrence Litman MD Bachelor of Science, Queens
College 1958 MD State University of New York, college medicine 1962 Intern in medicine – Kings county hospital 1962-1963 Resident in psychiatry, Harvard service psychiatry – Boston Medical Center 1963-1966 Resident in child psychiatry – Mass General hospital 1966-68 Associate & assistant in clinical psychiatry, department of psychiatry –Harvard medical school 1966-1974 Co director, psychiatry service, noble hospital 1983-1986 Diplomat in cognitive therapy, center for cognitive therapy, university of Pennsylvania 1984-1986 Private practice; psychiatry, child psychiatry, cognitive therapy, addiction psychiatry -1968 – present Addiction psychiatry, Suboxone treatment 2011-present
Dr. Theodore Treibick MD
A Dedicated Staff Clinic owner Victor Torosyan attributes the clinic’s progress to the dedication sta has to their patients and their holistic approach to treatment.e administrative team includes administrative director Kenton Fabrick, who has 20-plus years of clinical experience, and CFO Levon Gyulnazaryan, who has a degree in chemistry. “We are not a pill dispensary, as some so-called clinics are,”Torosyan said. “We are totally dedicated to giving people the full services–medical and psychological–they need to get their life back. Every patient receives a full medical workup and treatment or referrals for special health problems,” he said. Torosyan successfully pursued tAmerican Dream, and now wants to return something to the community. “e people who come to our clinic are ordinary people, who were in the wrong place at the wrong time,”Torosyan said. “Our mission is to give them hope, to work with them to get their lives back. Together, we can succeed. We already have some success stories.”
“We were surprised that morphine was able to induce these really long-lasting changes,” says Dr. Peter Grace, the study’s lead author. Dr. Grace says the cause of the chronic pain increase has to do with cells that form part of the immune system. He says if those areas could be isolated or their eects reduced, the resulting pain may not be as great. “If it does turn out to be a relevant issue to patients, then what our study suggests is that targeting the immune system may be the key to avoiding these kinds of eects,” Dr. Grace says. “Opioids could essentially work better if we could shut down the immune system in the spinal cord.” e team’s research only looked at spinal cord injuries and morphine, and did not study other opioids that are commonly prescribed to patients experiencing pain. But he said it’s likely drugs like Vicodin or OxyContin could aect other parts of the body in a similar way. “While we haven't actually tested other opioids in this particular paradigm, we predict that we would see similar eects,” Dr. Grace says.
ain relievers are supposed to relieve pain. It sounds simple enough, but new research suggests a common pain medication may actually be prolonging chronic pain. Morphine is an opioid painkiller commonly prescribed in hospitals and clinics, and while it is eective in the short term, doctors don’t always consider the potential consequences for pain down the road.at’s why a team of researchers based out of the University of Colorado - Boulder set out to study how morphine treatment aects chronic pain, and found some troubling results. e team, which used mice with spinal cord injuries, found that in mice not given morphine, their pain thresholds went back to normal about four to ve weeks after the injury. But mice who were given morphine didn’t see their pain levels return to normal until around 10 to 11 weeks, meaning the use of morphine eectively doubled the length of their chronic pain. P
Chronic problem Chronic pain can be debilitating for many people facing serious health problems, and it can also be a key factor in substance abuse. Many people report developing a dependence on opioids after having them prescribed for an injury. But new research suggests the number of people who develop dependency issues because of chronic pain may be far higher than people realize. A study from researchers at Boston University looked at a group of nearly 600 people who had either used illicit substances or misused prescription drugs.
ey found that 87 percent reported suering from chronic
pain, with 50 percent of those people rating their pain as severe.ey also found that 51 percent of people who had used illicit drugs like marijuana, cocaine and heroin had done so to treat their pain. While many prevention eorts focus on recreational users, the numbers suggest that chronic pain plays just as prominent a role in substance abuse. “Many patients using illicit drugs, misusing prescription drugs and using alcohol reported doing so in order to self-medicate their pain,” the authors of the study wrote. “Pain needs to be addressed when patients are counseled about their substance use.”
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What is medical MARIJUANA ? Two of the main chemicals in marijuana, called cannabinoids, are approved by the Food and Drug Administration as prescription medications. ese are THC and CBD. Allied Health Clinic is able to prescribe these cannabinoids in pill form.
What does medical marijuana do? THC increases appetite and reduces nausea, both of which can be useful for people combatting cancer and other diseases. It may also decrease pain and inammation and aid in muscle control. CBD also may decrease pain and inammation, and may help control epileptic seizures. Research is ongoing into other possible uses for cannabinoids in treating a variety of diseases. Does medical marijuana make you high? ese two cannabinoids do not make you high. What conditions might bene t frommedical marijuana? If you’re undergoing chemotherapy, cannabinoids may help nausea. It can also stimulate appetite in patients who have AIDS-related weight loss. What kinds of research is going on? e FDA is conducting clinical trials on cannabinoid treatment for many dierent diseases. One cannabinoid drug, a CBD, is being investigated to treat childhood epilepsy.
I just don’t know how to describe your services… They are extraordinary! I am quite happy with them! Just keep up going this way! -William Jenkins
THE TODAY OPIATE EPIDEMIC By every measure, the opiate epidemic today is as destructive to American society as any war we have fought abroad. e number of deaths from prescription opioid overdoses has quadrupled since 1999. In 2010, approximately 100 Americans died every day from an opioid overdose.e rate of deaths from drug overdoses has increased by 137 percent since 2000. Almost everyone knows someone who has died or been made dysfunctional because of drugs. In 2014, 47,055 Americans died from drug overdoses. is is 1 1/2 times more than the number of people killed in car crashes that year. About 61 percent of those deaths were from opioids. But the death toll is only part of the story. For each death, there are friends, family members, neighbors, and others who have suered because of that overdose death. What can be done? A rst step is to recognize that drug addiction is a disease, not simply a personality failure of the addict. Once you understand how addiction changes the brain and the addict’s behavior, it becomes possible to nd solutions for the disease.
e road to recovery for the addict and the addict’s friends and family is not easy. At Allied Health Clinic, we are committed to helping the addict with a medically assisted opioid withdrawal program that combines Suboxone (and later Vivitrol) and counseling. Ours is a holistic program that considers all the addict’s health problems. We have chosen this medical program because it has proven to be successful in getting people o drugs–and keeping them o. It rapidly allows the addict to resume a normal life–working, getting an education, being a parent, and so on. It also helps to prevent overdose deaths and the transmission of infectious diseases like HIV and hepatitis C. If you or a friend or family member is ready to get his or her life back, Allied Health Clinic is ready to help.
For more information Centers for Disease Control and Prevention, Jan. 1, 2016, Increases in Drug and Opioid Overdose Deaths —United States, 2000–2014. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm Oce of National Drug Control Policy, Feb. 11, 2014, Fact Sheet: Opioid Abuse in the United States. Retrieved from https://www.whitehouse.gov/sites/default/les/ondcp/Fact_Sheets/opioids_fa ct_sheet.pdf Rocheleau, M., May 3, 2016. Opioid overdose deaths by Mass. town in 2015. Boston Globe. Retrieved from https://www.bostonglobe.com/metro/2016/05/03/map-opioid-overdose- deaths-mass-town/Ckn7zRuySCj7WYZWKqbvjI/story.html
Sign of the times Experts say the newly approved implant also provides a big boost to the concept of medication-assisted treatment (MAT) in general. For years, the idea that someone could achieve recovery through the use of drugs like methadone and buprenorphine was rejected by many professionals in the eld who saw complete abstinence as the only true sobriety. Many still hold that belief, but attitudes appear to be changing. Top government ocials say they want to increase the amount of MAT taking place at the country’s treatment centers. Several states as well as the federal government have enacted laws making it easier for physicians to prescribe medications like buprenorphine, but they say too few patients receive the medication they need. National Institute on Drug Abuse, in a statement. “is product will expand the treatment alternatives available to people suering from an opioid use disorder.” ] [ "Opioid abuse and addiction have taken a devastating toll on American families.” - Dr. Robert M. Cali , FDA Commissioner “Scientic evidence suggests that maintenance treatment with these medications in the context of behavioral treatment and recovery support are more eective in the treatment of opioid use disorder than short-term detoxication programs aimed at abstinence,” said Dr. Nora Volkow, director of the
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edication-assisted treatment is growing in popularity and acceptance among addiction recovery professionals. And now it’s taken a revolutionary step forward that could oer renewed hope to thousands of people struggling with an addiction to opioids. is summer, the U.S. Food and Drug Administration approved a new buprenorphine implant to treat opioid dependence. Buprenorphine had previously been available only as a pill or a dissolvable lm placed under the tongue. But the new implant, known as Probuphine, can administer a six-month dose of the drug to keep those dependent on opioids from using by reducing cravings and withdrawal symptoms. "Opioid abuse and addiction have taken a devastating toll on American families,” FDA Commissioner Dr. Robert M. Cali said in a statement. “We must do everything we can to make new, innovative treatment options available that can help patients regain control over their lives.” e implant comes in the form of four one-inch rods that are placed under the skin on the upper arm.e implant must be administered surgically and comes with the possibility of certain side eects, but experts say it could be more convenient and more eective for patients.ey say by eliminating the need to take pills, ll prescriptions and generally manage their medication, it makes it easier for people to focus on the other areas of their recovery while making it less likely someone will lapse in their treatment plan.
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Although the implant is certainly a new alternative, it has yet to show any increased success in keeping people from relapsing compared to the pill or lm tablet. In a study of the implant’s eectiveness, they found that 63 percent of people given the implant were free of illicit drugs at six months, compared to 64 percent of people who took buprenorphine by pill. Still, those rates are much higher than the success rates of people who follow abstinence-only treatment plans. And ocials hope the new implant will lead more people to get MAT, increasing the number of successful recoveries across the country.
What Is An Opiate? Opiates are drugs that relieve pain and also produce a sense of well-being and pleasure.e chemicals in opiates attach to particular proteins on the nerve cells of your brain and other organs, such as your spinal cord and gastrointestinal tract.e attached opiate chemicals cut o the feelings of pain.e chemical link with the receptor also triggers the same natural process that rewards you with pleasure when you carry out basic life functions like eating or having sex. Your brain manufactures its own opiate chemicals, for this purpose, although not in large quantities. Legally prescribed opiates are important in medicine because they relieve pain after surgery and other medical and dental procedures.e problem occurs when you take an opiate in the absence of a lot of pain.en you can become used to the feelings of pleasure the drug produces, the “high,” which motivates you to have more of the drug. If you continue to use the drug repeatedly, you can develop a tolerance for it.To get the same “high,” you then need more and more of the drug.is
is the addiction cycle.e need for “more and more” is also what can cause overdoses. Opiates also have physical side eects.ey can make you drowsy, confused, nauseous, or constipated.ey can also slow your breathing, reducing the amount of oxygen that reaches your brain, which can have bad eects such as brain damage. People who take legally prescribed opiates for severe pain for a long time can become dependent on the drug and suer mild withdrawal symptoms when they suddenly stop taking the opiate. For the addict who stops taking opiates, the withdrawal symptoms can be severe. Early symptoms include sweating, insomnia, anxiety, muscle aches. Later symptoms include rapid heartbeat, nausea, cramps, and diarrhea. Legal and Illegal Opiates Opiates have been around for centuries.e opium derived from the seed pod of the poppy plant is the basis for manufacturing opiates, including heroin, morphine, and cocaine.e word opiate is used interchangeably with opioid, although technically the term opioid includes only the more recent synthetic drugs derived from natural opium. Heroin and opium are illegal opiates. Legal opiates available by prescription include Codeine, Fentanyl, morphine, Oxycodone, Hydrocodone and others. Many addictions begin when people
abuse prescription pain killers, using them in higher concentrations than prescribed. Today, illegal heroin is often cheaper to buy than prescription medication, making it possible for people who become accustomed to pain killers to switch to heroin to e Allied Health Clinic uses a medically assisted treatment for opioid withdrawal to safely help addicts return to a normal life.e drugs we use, Suboxone and Vivitrol, are not addictive; they block drug cravings and withdrawal symptoms.is allows people to lead a normal life while withdrawing from their addiction. Formore information: Drugabuse.com, Opiate Abuse. Retrieved from http://drugabuse.com/library/opi ate-abuse/ Kosten,T.R. and George,T.P., (2002, July).e Neurobiology of Opioid Dependence: Implications for Treatment. Science and Practice Perspectives, Vol. 1, No. 1, pp. 13-20. Retrieved from https://www.ncbi.nlm.nih.gov/pm c/articles/PMC2851054/ National Institute on Drug Abuse, How do opioids aect the brain and body? Retrieved from https://www.drugabuse.gov/publi cations/research-reports/prescript ion-drugs/opioids/how-do-opioid s-aect-brain-body feed their addiction. WhatWe Do
National Institute on Drug Abuse, 2014.What are opioids? Retrieved from https://www.drugabuse.gov/pu blications/research-reports/pres cription-drugs/opioids/what-ar e-opioids Opium. Drugs and Controlled Substances: Information for Students. Ed. Stacey L. Blachford and Kristine Krapp. Detroit: Gale, 2010. Science in Context.Web. 25 Oct. 2016. Retrieved from http://ic.galegroup.com/ic/scic/ ReferenceDetailsPage/Docume ntToolsPortletWindow?display GroupName=Reference&jsid= 978b2e8ad2cac431b99b4f143f6 89aa8&action=2&catId=&doc umentId=GALE|CV264500004 1&u=gotitans&zid=0d3ecf8434 0bbf6c2090be0bb345fb7d Testimony of Nora D. Volkow, M.D., National Institute on Drug Abuse (NIDA), to the Senate Judiciary Committee, Jan. 27, 2016 Retrieved from https://www.drugabuse.gov/abo ut-nida/legislative-activities/tes timony-to-congress/2016/what -science-tells-us-about-opioid- abuse-addiction
What is Suboxone? Suboxone is a prescription medication used to treat people addicted to opioid drugs in a treatment program that includes counseling and general healthcare. It suppresses drug cravings and withdrawal symptoms for 24 hours, and does not give you a high. Its generic name is buprenorphine. How does it work? Suboxone is a combination of two drugs, buprenorphine and naloxone. Buprenorphine is a partial opioid. (e technical term is “partial opioid agonist.”) Naloxone is an opioid blocker. Suboxone acts by blocking the opioid receptors in the brain, making the receptors think that they have an opioid. If you take an opioid while you’re on Suboxone, it will not work to make you high. How will I feel on Suboxone? Most people will feel “normal.” If you were addicted to pain killers, Suboxone may give you a little pain relief. How often will I see a doctor? After your initial health screening, you will come to the clinic twice a week, and later once a week. Each time you will have a urine test at our onsite lab. How long will I have to take Suboxone? e usual course of treatment is about one year. You will be tapered o Suboxone, so that you feel “normal.”en we will start a course of Vivitrol for about a year.e goal is to be medication-free and addiction-free in two years. How do I take it? Suboxone comes in a thin strip that you dissolve under your tongue once a day. Your doctor will prescribe the right dose for you.
Is Suboxone addictive? Suboxone is not the same as taking an addictive opioid. Your body will become physically used to Suboxone, which is why you will be tapered o the prescription. But you will not become addicted to it. How successful is the treatment? Studies of Suboxone treatment report a 40 to 60 percent success rate in getting addicts o drugs. How is Suboxone different from Methadone? Methadone is an opioid and has to be given every day at a federally regulated clinic. A major dierence is that because Methadone is an opioid, people can get high or overdose on it. If you take more than your prescribed dose of Suboxone, you will not get high or overdose, because it blocks the opioid receptors in your brain. However, taking more than your prescribed dose can lead to breathing problems. Are there side-effects to Suboxone? Yes, and your doctor will review all your medications to make sure that Suboxone is right for you. For further information: psychcentral.com/lib/how-is-suboxone-treatment-dierent-than-drug-abuse www.fda.gov/downloads/Drugs/DrugSafety/UCM225677.pdf en.wikipedia.org/wiki/Buprenorphine
VIVITROL What is Vivitrol? Vivitrol is an extended-release form of naltrexone, a prescription drug injected once a month in a small amount to block the eects of opioids and alcohol that produce a “high.” the U.S. Food and Drug Administration has approved the use of Vivitrol for treating alcohol dependence in 2006 and opioid drug dependence in 2010.
How does it work with opioid dependence? Vivitrol attaches to the opioid receptors in your brain and completely blocks the pleasurable feelings of taking opioids. Its purpose is to prevent a relapse after you have tapered o suboxone. You must be completely opioid free when you start vivitrol, or you will suer severe withdrawal. Also, you should not take any opioids, including medications that contain opioids, while you are on Vivitrol. You may risk a serious overdose if you do. How does Vivitrol work with alcoholism? It is not known exactly how Vivitrol works to combat alcohol addiction, but it is thought that it blocks the receptors in the brain that cause the pleasurable feelings produced by alcohol. It reduces cravings and helps you abstain from drinking. If you slip up and have a drink, it can curb your desire to drink more. How do I know Vivitrol will help me? Your physician at allied health clinic will discuss whether Vivitrol might help you after you have tapered o suboxone, or as part of your treatment plan for alcoholism. How long will I have to take Vivitrol? Typically we prescribe Vivitrol for about a year after you have tapered o Suboxone.e goal is to be addiction-free and medication-free within two years.e time period for taking Vivitrol varies individually with alcoholism patients. How is Vivitrol? We administer Vivitrol by injection once a month in our clinic.
Are there side e ects to Vivitrol? Yes, a small number of people have a reaction at the skin site where Vivitrol is injected. A small number also have allergic reactions or tiredness, nausea, stomach ache, or headache. Your doctor will review the possible side eects with you, and you should tell your doctor about any changes you notice after the injection. Are there interactions with other drugs? It is dangerous to take any opioids, including those in pain medications, while you are on Vivitrol. You may get a severe overdose reaction. Your doctor will review all of the medications and supplements you may be taking before prescribing Vivitrol. How successful is Vivitrol? e success rate looks good, but more long-term studies are needed.
It is dangerous to take any opioids, including those in pain medications, while you are on vivitrol.
Kicking an addictive habit isn’t easy. Allied Health Clinic can help. Allied Health Clinic
(617) 302-3343 info@alliedhealthclinicllc.com To nd out more please contact us 21 School Street, Suite #1 Quincy, MA 02169
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