Metropolitan Pain Center

PA I N CE NT E R

specializing in addiction recovery

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4063 Salisbury Road North Suite 206 Jacksonville, FL 32216

(904) 296-3611

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Established in 2000, Metropolitan Pain Management Center uses a wide-variety of techniques from physical therapy to medication management to interventional procedures and surgery. Our state-of-the-art facility is located on Salisbury Road in Southpoint – approximately 10 minutes southeast of downtown Jacksonville.We are a full-service pain management center that diagnoses and treats all types of pain including all musculoskeletal conditions, arthritis, cancer, injuries and accidents, and pain caused by chronic diseases.

Dr. Ismail Salahi, DO

Contact Info

4063 Salisbury Rd Suite 206 Jacksonville, FL 32216 (904) 296-3611

Education

Specialties • Mayo School of Graduate Medical Education Residency , Anesthesiology • Virginia Commonwealth University Health System Fellowship , Pain Medicine • St Vincent Hospital Internship , Internal Medicine • University of New England College of Osteopathic Medicine Medical School Pain Medicine Dr. Salahi is a board certi“ed anesthesiologist and pain management specialist. He received his Doctor of Osteopathy degree from the University of New England, his anesthesia residency at Mayo Clinic, and his pain fellowship at the Medical College of Virginia. After working two years in private practice he founded the Metropolitan Pain Management Center in 2000, and is currently its sole practicing physician. Dr. Salahi “rmly believes in a multidisciplinary approach to treating chronic pain, and o”ers a full array of options currently available to pain patients today. His treatments include all types of diagnostic and therapeutic procedures, medications, physical therapy, osteopathic manipulation, and the full complement of interventional techniques and surgical interventions for treating malignant and nonmalignant pain. His philosophy, consistent with all osteopathic physicians today, is to treat the whole patient, not just their complaint or disease. ABOUT

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OPIOID ADDICTION: “LET’S TALK ABOUT IT.” Learn how faith communities can extend COMPASSION & SUPPORT

to people in recovery and to their families

Talkin’ ‘Bout My Generation

NIDA Researchers Develop Screening Tool for Teen Substance Use This article is a condensed version of a piece that originally appeared on the National Institute on Drug Abuse (NIDA) website.

Teens’ use of addictive substances often goes undetected by health care providers. But NIDA-supported researchers have developed a Brief Screener for Tobacco, Alcohol and other Drugs (BSTAD), to help spot teens’ problematic habits. In a recent study, BSTAD developers Dr. Sharon Kelly and colleagues at the Friends Research Institute in Baltimore examined the frequencies of use likely to qualify a teen for a diagnosis of an alcohol use disorder (AUD), nicotine use disorder (NUD), or cannabis use disorder (CUD). The frequencies proved to be surprisingly low, according to the researchers.

Teen drug substance use revealed For the study, the BSTAD survey employed a few, simple questions about teens’ use of alcohol, tobacco or drugs within the past year.The teens’ BSTAD responses revealed that 22 percent had used alcohol in the past year, 16 percent had used marijuana, 10 percent had used tobacco, and 3 percent had used at least one illicit substance other

than marijuana. (Original article by Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer) 28

“ Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention. “

-Dr. Sharon Kelly, Friends Research Institute

Analysis of the data showed that almost all teens who reported on the BSTAD that they had consumed an alcoholic beverage on two or more days during the past year had an AUD. Conversely, teens who reported drinking on fewer than two days were unlikely to have this disorder.The corresponding BSTAD cut point for an NUD was nicotine use on two or more days during the past year and for a CUD was marijuana use on two or more days. BSTAD enables early detection Using these cut points, the researchers found that the BSTAD was highly sensitive. Ninety-six percent of teens with an AUD, 95 percent with an NUD, and 80 percent with a CUD would be flagged as likely in need of further assessment for a brief intervention or referral to treatment. BSTAD’s specificity was also high: 85 percent of teens without an AUD, 97 percent without an NUD, and 93 percent without a CUD reported use below the cut points, and so would be correctly classified. “Very low substance use frequencies were found to be optimal in identifying these disorders,” Dr. Kelly comments. The BSTAD does not distinguish

Researchers encourage regular screening Both the World Health Organization and the American Academy of Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Still, many providers do not regularly screen their patients for substance abuse. “Providers are extremely busy and need a quick and valid screening measure for identifying teens who use substances,” says Dr. Kelly. She and colleagues developed the BSTAD in response to a NIDA call for new tools to fill this need. To create the BSTAD, Dr. Kelly and colleagues added the questions about tobacco and marijuana to the widely disseminated National Institute on Alcohol Abuse and Alcoholism screen for youth alcohol use. In the validation study, the FRI research team administered the BSTAD in person to half of the participants, and the rest of the participants self-administered the instrument on an iPad. The teens reported a strong preference for the iPad. The iPad version offers the potential extra convenience that results can be automatically transferred into a teen’s electronic medical record. 

the severities of the disorders, she notes, so when it flags a teen, providers need to follow up with questions to determine appropriate interventions or referrals to treatment. Furthermore, Dr. Kelly says, “Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention.” Providers also should rescreen teens regularly, because onset of substance use can occur abruptly during adolescence. Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Both the World Health Organization and the American Academy of

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Drugs can lead to a slow and painful death Don’t start in the rst place! metropain.com

The importance of looking after my mental health in recovery

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SAMHSA PUBLISHES BEST PRACTICES ON MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER

Treatment Improvement Protocol 63, “Medications for Opioid Use Disorder,”

reviews the use of methadone, naltrexone, and

buprenorphine, the three FDA-approved medications to treat opioid use disorders.

Data indicate that OUD-treating medications are both cost effective and cost beneficial

The Substance Abuse and Mental Health Services Administration has published new guidance to help health care professionals better understand medications that can be used to treat Americans with opioid use disorder (OUD). Treatment Improvement Protocol (TIP) 63, “Medications for Opioid Use Disorder,” reviews the use of methadone, naltrexone, and buprenorphine, the three FDA-approved medications to treat opioid use disorders. TIP 63 provides guidance for health care professionals and addiction treatment providers on how to appropriately prescribe these medications and effectively support patients using these medications for OUD treatment. “We know that people can and do recover from opioid use disorders when they receive appropriate treatment, and medication-assisted treatment’s success in treating opioid use disorders is well documented,” said Dr. Elinore F. McCance-Katz, assistant secretary for Mental Health and Substance Use. “TIP 63 emphasizes that increasing access to medications to treat opioid use disorder will help more people recover, enabling them to improve their health, living full and productive lives.” TIP 63 is part of SAMHSA’s larger response to the opioid crisis. More access to treatment with OUD medications is critical to closing the gap between treatment need and treatment availability and an important public health strategy. Data indicate that OUD-treating medications are both cost effective and cost beneficial.

BREAK EVERY CHAIN METROPOLITAN PAIN CENTER

ADDICTION TIME WELL. RECOVERY is real, so is It’s to get

We believe in treating people as a whole and look at all aspects of their health while striving to support our patients in an integrative way that considers mental, physical and spiritual health together as one.

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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 oŽcials 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 “Scientic 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 detoxication programs aimed at abstinence,” said Dr. Nora Volkow, director of the

M

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 oŽcials hope the new implant will lead more people to get MAT, increasing the number of successful recoveries across the country.

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Join us in the Fight Against Drug Addiction

904-296-3611

Physical, Emotional and Spiritual Recovery

you might have a chance to use again, but you also might not get a chance to recover again.

904.296.3611 | metropain.com

not just a bad habit It’s NOT JUSTA BAD HABIT

Recent research and dialogue in the political sphere have brought long-simmering questions about addiction to the forefront: Is addiction truly a disease? Do addicts deserve to be treated like people who have a Recent res arch and ialogue in the political spher have brought long-sim ering questions about ad iction to the fore: Is addiction truly a disease? Do addicts deserve to b tr ated like people who hav a dise s that’s outside their control? disease that’s outside their control? While most researchers agree with the so-called disease model of addiction, stereotypes and cultural bias continue to stigmatize those with addiction because they made an initial choice to consume substances. However, Columbia University researchers point out that “choice does not determine whether 34 While most res archers agre with the so-called isease model of ad iction, ster otypes and cultural bias continue to stigmatize those with ad iction because they made an initial choice to consume substances. However, Columbia University res archers point out that “choice does not det rmine whether

something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices.” Experts say that applying the distinction of choice to addiction creates biases that justify inadequate treatment. It begs the question New Jersey Gov. Chris Christie asked during a 2015 town hall meeting in New Hampshire. When Christie’s mother was diagnosed something is a disease. Heart disease, diabet s and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what hap ens in the body as a result of those choices.” Experts ay that ap lying the distinction of choice to ad iction creates biases that justify inadequate treatment. It begs the question New Jersey Gov. Chris Christie asked uring a 2015 town hall me ting in New Hampshire. When Christie’s mother was diagnosed with lung cancer at 71 as a result of addiction to tobacco, he noted that with lung cancer at 71 as a result of ad iction to tobacco, he noted that

no one suggested that she should not be treated because she was “getting what she deserved,” he said. “Yet somehow, if it’s heroin or cocaine or alcohol, we say, ‘Ahh, they decided that, they’re getting what they deserve,’” Christie remarked. HOW ADDICTION WORKS After satisfying basic human needs like food, water, sleep and safety, people feel pleasure. That pleasure is brought by chemical releases in the brain. This is according to Columbia researchers, who note that the disease of addiction causes the brain to release high levels of those pleasure chemicals. Over time, brain functions of reward, motivation and memory are altered. After these brain systems are compromised, those with addiction can experience intense cravings for substance use, even in the face of harmful consequences. These changes can stay in the brain long after substance use desists. The changes may leave those struggling with addiction to be vulnerable to “physical and environmental cues they associate with substance use, also known as triggers, which can increase their risk of relapse,” write Columbia researchers.

not just a bad habit treatment and continued monitoring and support or recovery.

THE COLUMBIA RESEARCHERS DO HAVE SOME GOOD NEWS: Even the most severe, chronic form of the disorder can be manageable and reversible, usually with long term

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METROPOLITAN PAIN CENTER 4063 Salisbury Road North Suite 206 Jacksonville, FL 32216 904-296-3611 metropain.com

Believe you can and you’re halfway there.

I N AN EFFORT to encourage new treatments for opioid addiction, the Food and Drug Administration plans to begin permitting pharmaceutical companies to sell medications that help temper cravings, even if they don’t fully stop addiction. The change is part of a wider effort to expand access to so-called medication-assisted treatment, or MAT. The agency will issue draft guidelines in the next few weeks. A senior agency official provided details of the proposal to The New York Times. the agency said it would soon publish two guidances, recommendations for drugmakers, on the issue.

The new approach was signaled Saturday by the health and human services secretary, Alex M. Azar II, in remarks to the National Governors Association. Mr. Azar said the agency intended “to correct a misconception that patients must achieve total abstinence in order for MAT to be considered effective.” While the Trump administration has generally supported medication-assisted treatment, Mr. Azar’s predecessor, Tom Price, was not completely on board with it. Mr. Price caused an uproar among treatment experts when he dismissed some medications that reduce cravings through synthetic opioids last spring as substituting one opioid for another. He subsequently walked back those comments, saying officials should be open to a broad range of treatment options. Mr. Azar, who took office late last month, said he would work to reduce the stigma associated with addiction and addiction therapy, and would not treat it as a moral failing. The opioid epidemic is considered the most unrelenting drug crisis in United States history. In 2016, roughly 64,000 people were killed by drug overdoses, including from prescription opioid painkillers and heroin. to correct a misconception that patients must achieve total abstinence in order for MAT to be considered effective. Noting federal data showing that only one-third of specialty substance abuse treatment programs offer medication-assisted treatment, Mr. Azar said, “We want to raise that number — in fact, it will be nigh impossible to turn the tide on this epidemic without doing so.” Mr. Azar’s comments echo those of the F.D.A. chief, Dr. Scott Gottlieb, who has made battling opioid abuse a priority for his agency. Dr. Gottlieb has moved to reduce opioid prescriptions by doctors and dentists and to promote more medication- assisted treatment, defined as drugs used to stabilize brain chemistry, reduce or block the euphoric effects of opioids, relieve physiological cravings, and normalize body functions. The F.D.A. has approved three drugs for opioid treatment — buprenorphine (often known by the brand name Suboxone), methadone and naltrexone (known by the brand name Vivitrol) — and says they are safe and effective combined with counseling and other support. But the agency said it would soon publish two guidances, recommendations for drugmakers, on the issue.

Make today be the first day of your new life

Call Now...We Can Help 904.296.3611 Take the first step 4063 Salisbury Road North Suite 206 • Jacksonville, FL 32216 Dr. Salahi firmly believes in a multidisciplinary approach to treating chronic pain, and offers a full array of options currently available to pain patients today.

Feeling Down?

Don’t face opioid addiction alone. Get help today. (904)296-3611

The harsh reality is that opioids are killing thousands of people in this country, many of them young people

State legislators focused on opioid addiction treatment and prevention in schools and prisons Thursday while reviewing bills that would both use medications to thwart overdoses and assist in recovery. A bill making its way through the Legislature would require all schools with grades 9 to 12 to have policies for training nurses on how to administer naloxone. The schools would also have to keep a supply of the medication ready. “The harsh reality is that opioids are killing thousands of people in this country, many of them young people,” Assemblyman Vincent Mazzeo, D-Atlantic, bill sponsor, said in a statement. “Narcan has been proven to save lives. Having it readily available in schools can help ensure that our schools are ready to respond in every emergency situation.” Several South Jersey schools, including Millville, Mainland Regional High School, the Egg Harbor Township School District and the Ocean City School District, already have such policies in place. As of 2017, New Jersey ranked eighth in the nation for drug overdose deaths among people ages 12 to 25, according to the national nonprofit Trust for America’s Health. There have been an estimated 654 overdose deaths in New Jersey since Jan. 1, according to the Department of the Attorney General.

The bill would require that nurses be taught how to use the anti-opioid drug and have a prescription standing order for naloxone to keep it in supply. There were more than 14,300 uses of naloxone in the state last year, state data shows. If passed, the law would also provide immunity from liability for school nurses and other employees when an opioid reversal is performed. Nearby, members of the Assembly Health and Human Services Committee reviewed a bill sponsored by Assemblyman Herb Conaway, D-Burlington, that would require state correctional facilities to offer inmates naltrexone and naloxone just before their release. Naltrexone, known by its brand name Vivitrol, is a type of nonopioid medication- assisted treatment (MAT) for a substance-use disorder. Studies have shown medication-assisted treatments like naltrexone, methadone and buprenorphine have successfully been used to reduce relapse rates and help people maintain recovery from opioid addiction. Vivitrol completely blocks the euphoric and sedative effects of opioids. Recipients often need a monthly shot of the medication administered by a medical professional.

At John Brooks Recovery Centers in Atlantic City and Pleasantville, Vivitrol is just one medication-assisted treatment offered to inpatient and outpatient patients, but it is coupled with counseling and other treatment education. Alan Oberman, CEO of John Brooks Recovery Center, said that while the bill looks well intentioned, giving one shot of Vivitrol, which costs about $1,000, to an outgoing inmate without follow-up or counseling only buys that person about three or four weeks of sobriety before they may use again. “It’s more than just giving an injection, which at least requires a nurse to do it, and many outpatient programs in the community don’t have medical staff there to do it regularly,” he said. While methadone and buprenorphine are MATs that have been on the market for some time, Vivitrol is relatively new. John Brooks and the Atlantic County jail teamed up last summer to create the state’s first mobile methadone program for inmates. Oberman said they now offer inmates Vivitrol, but they haven’t yet had any takers.

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