Lucas County

SUMMER 2017 ISSUE

FRONT COVER Lucas County Magazine Urban Minority Alcoholism & Drug Abuse Outreach Program

Executive Director John L. Edwards Sr. addresses the ght on the opioid epidemic

Soaring Recovery A housing program that helps women to reconnect with society

Reentry program looks to rebuild lives

nding Peace UMADAOP client achieves contentment in sobriety

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36 MORETHAN SKINDEEP Implant represents

18 JOHN EDWARDS UMADAOP Lucas County CEO speaks about the fight against the opioid epidemic 12 TREATMENT CHOICES INOPIOID ADDICTION Dr. Islam on different methods of recovery 16 GEOF ALLAN Prevention education becomes a life’s mission 20 FINDING PEACE UMADAOP client achieves contentment in sobriety 24 STARTINGOVER Reentry program looks to rebuild lives, strengthen communities 28 PROLONGING THE PAIN Study suggests painkillers may be having the opposite effect in the long run 30 GROWING CONCERNOVER HEROIN USE The dangers that heroin use

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revolutionary approach to treating opioid addiction 38 COPINGWITH DISCRIMINATION Discrimination remains largely ignored as a cause of substance abuse 42 BEND BUT DON’T BREAK Yoga is being used to help people maintain recovery and avoid relapse 46 TURNING POINT Law enforcement changes their approach to prevent overdoses 50 SOARING RECOVERY Housing program helps women reconnect with society 52 HAVEN FOR SUCCESS Women’s program offers strength through community 54 STARQUEST YOUTH PREVENTION Program strives to assist the youth of high poverty neighborhoods

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poses to the country 32 BOOM, BUST, ANDDRUGS

Study says economic downturn leads to increase in substance use disorders

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Opioid epidemic presents new challenges for treatment providers UMADAOP Lucas County provides a litany of services to help clients in all aspects of their lives. But these days there seems to be one issue taking precedence above all others...opioids. “Everything is overshadowed nowadays by the opioid epidemic,” says John L. Edwards Sr., , executive director of the UMADAOP Lucas County. “The spread of this epidemic is something that just hasn’t been seen before.” Edwards has been in the business of recovery a long time and has seen waves of drug use adversely impact the community. But he says the opioid epidemic is different because of the availability of prescription drugs, social media, and because people have more transportation options than they used to in the past. He says these factors make the situation unique and have required treatment providers to develop new ways to help clients. A Unique Fight

John L. Edwards

“We’ve had to shift our attention away from other areas in large part to develop strategies and program services to help fight the epidemic,” Edwards says. “That’s always a matter of concern because those other issues haven’t gone away and we will most likely find ourselves grappling with those issues again at some point.”

“The spread of this epidemic is something that just hasn’t been seen before.” -John L. Edwards Sr. , executive director, UMADAOP Lucas County

Staying current While maintaining their commitment to treating alcoholism and other issues, UMADAOP staff have also had to fully immerse themselves in the fight against opioid abuse. In order to meet the needs of clients, staff have put in countless hours both during and after work, studying the epidemic and learning about new treatment methods. Edwards says he is extremely proud of the way his staff have dedicated themselves to the cause, and says their commitment will ensure that UMADAOP Lucas County offers clients the best possible treatment modalities. “We’re trying to make certain that we use the most up-to-date, evidence-based programming that’s available to address the issue,” Edwards says. “That requires ongoing training and education among staff to avoid being blindsided by issues that are still emerging.” Community collaboration

“We think that an effective substance abuse organization has to provide the full continuum of services.” -John L. Edwards Sr.

As much as UMADAOP Lucas County staff have dedicated themselves to the opioid issue, they know it’s a battle they can’t win on their own. Edwards says collaboration and community involvement between government and community service agencies is critical to provide the services needed to tackle the epidemic. As a result, UMADAOP Lucas County has increased its educational outreach efforts to bring community members into the fold in the fight against opioid abuse. “We think that’s of critical importance in terms of being able to inform the general public about the dangers posed by these drugs, but also inform them of ways that they can become involved in helping to prevent the drug situation that impacts our communities,” Edwards says. Moving forward

As UMADAOP Lucas County staff work tirelessly to address the growing epidemic, the fluid and changing nature of the situation means they’re aiming at a moving target. With some projections suggesting there could be as many as 10,000 overdoses in Ohio this year, Edwards says that those battling the epidemic haven’t turned the tide yet. With increased awareness about the dangers posed by opioids, and more people than ever joining the fight, he feels optimistic they’re moving in the right direction. Whether it’s opioids or any other substance, Edwards says UMADAOP Lucas County will continue to train and develop programming to offer treatment services of the highest possible quality. “We think that an effective substance abuse organization has to provide the full continuum of services,” Edwards says. “Our quest is to provide high quality services for the individuals that we serve and to continually sharpen our skills, creating a place where they can get the treatment they’re seeking in a warm and welcoming environment.”

SERVICES OFFERED • Diagnostic Assesments • Intensive Outpatient Treatment • Group Counseling • Individual Counseling

• Case Management • Crisis Management • Recovery Coaching • Specialized Treatment • Life Skills Training • Drug-Free Social Activities • And More!

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Call us for more information (419) 255-4444 Visit us online to learn more! umadaop.org 10

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Dr. Islam is medical director of UMADAOP of Lucas County and is board-certified in Addiction and Family Medicine. She has over twenty-five years experience in AddictionMedicine and has worked in all phases of treatment, from inpatient to intensive outpatient, residential and ambulatory treatment.

TREATMENT CHOICES IN OPIOID ADDICTION MAHJABEEN ISLAMMD, FAAFP, FASAM

ore than 50,000 people die of opioid overdoses every year and now more people are being killed by opioids than trac accidents or guns. All of us know someone with the disease of opioid addiction and everyday we either personally deal with the devastation that opioids cause, or read or hear about it. Opioids are taking lives the way that the AIDS epidemic did when it was at its peak in the 1980s and early 1990s.We were able to control the AIDS epidemic, and if the government, the health care system, law enforcement and each and every one of us decides that we are going to defeat this epidemic, we will. First things first: it’s a chronic disease A lot of people think that opioid addiction is a weakness, a personal failure or a character aw. Society and people like to feel stronger by making others feel weak. But we know from medical research that opioid use disorder is a chronic disease, much like diabetes, high blood pressure and asthma. And like these diseases, it has no cure, the same relapse rates, and, if you want to follow it, excellent and successful treatment. If you take diabetes as an example you know that some people have a “touch of sugar” and others are insulin dependent diabetics. In mild diabetes, some patients only need to watch their diet and exercise regularly, others take pills to lower their blood sugar, and some have to inject high doses of insulin every day. So, too, everyone who is prescribed or tries an opioid doesn’t get addicted.We have receptors in our brains called mu receptors, which opioids latch onto and we experience an opioid high. Everyone’s brain is dierent and many factors like our genes, the age at which drugs are tried, the dose used, the potency of the drug, whether it is eaten or injected, our social and family condition, and our psychiatric issues all control the mu receptor and whether we don’t get a high, get a bit of a high or a very intense one. Before determining the right treatment for opioid use disorder it is vital to understand that this is a chronic disease. If you don’t understand and accept this, treatment is For any treatment to be successful the patient has to be motivated. Families, courts, jobs or a society pushing a person to get sober doesn’t work.e motivation has to come from within the person. I like to tell patients that I don’t have the motivation pill, and if I did, my face would be on the cover of Time magazine! Patients who have been through treatment multiple times know that when it was successful, they had internal motivation.e times it didn’t they were either half-hearted or had been pushed by other people or factors. As physicians we try to give the best treatment we can for the patient, but we are not always able to judge the strength of a patient’s motivation and dedication towards their recovery. It is very easy to see through the patient who is half hearted and trying to dupe the system. Because of the large number of people that need treatment, we have no patience, or room, for people that are either not ready for recovery, or are trying to use the system, or both.We want to save the life of someone who really wants sobriety, not play games with patients. Counseling is essential/Customizing treatment to each patient With every kind of treatment, patients are more successful with sobriety when they go through group and individual counseling.ese sessions help the patient understand what started their addiction, what their relapse triggers are, what to do in case of a crisis, the importance of sober support and getting back to school or work. How often a patient should get counseling has not been scientically established; all we know is that counseling helps a lot with recovery.We assess each patient and try to determine how severe their addiction is, as well as their family and social situation, and come up with an individualized service plan to best help the patient. Some patients do well with once a week group therapy, while others have to start with three to ve times a week counseling sessions. Yet others need to be in an inpatient facility or in residential treatment. It is important to customize or tailor the treatment to each patient instead of adopting a one-size-ts-all approach. probably not going to work for you. There ain’t no motivation pill

Treatment choices 1. Abstinence-based treatment 2. Methadone maintenance 3. Buprenorphine-naloxone: Suboxone, Zubsolv, Bunavail 4. Naltrexone pill 5. Naltrexone injection: Vivitrol Abstinence-based treatment: you’re kinda on your own e phrase “cold-turkey” comes from opioid withdrawal because when opioids are stopped suddenly the person feels cold, has goose bumps, sweating, nausea, vomiting, diarrhea, insomnia, anxiety, irritability and muscle and bone pain.While the patient may feel that they are going to die; opioid withdrawal does not kill and usually after two to ve days, the severe withdrawal symptoms go away and the patient may just be left with some cravings. In the old days, all we could do was help patients through the withdrawal with medications like Zofran for nausea/vomiting, Imodium for diarrhea,Motrin for pain, Flexeril for muscle pain and clonidine for cravings. And we counseled patients and hoped for the best.is form of treatment doesn’t work well for all patients, in fact only a minority maintains sobriety with this and relapse rates are high. It remains a choice for those patients who don’t want any medication-assisted treatment and there are patients that maintain long-term sobriety with this and counseling. Methadone maintenance: e original treatment Methadone is a long-acting opioid and in the 1970s methadone clinics started in cities across the United States.e government tightly regulates methadone clinics because methadone is a very powerful, long acting and dangerous opioid and can kill easily. In a methadone clinic a physician evaluates the patient, and calculates their methadone dose, mainly based on their opioid use. e patient drinks liquid methadone in the presence of a nurse and has to come every day to take the liquid methadone.

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Advantages of methadone maintenance: 1. Potent opioid; takes away all opioid withdrawal symptoms and cravings. 2. Proven to reduce opioid overdose death rates. 3. Very close monitoring of patient, so it is good for complicated patients who have used high dose opioids for a long time with little sobriety. Disadvantages of methadone maintenance: 1. Daily visits to clinic. 2. Dicult to hold down a job or go to school. 3. Unfortunately very high methadone doses are typically used. Some patients are therefore high on methadone. 4. Dicult to wean o as withdrawal from methadone is particularly severe. Buprenorphine-naloxone: Suboxone, Zubsolv, Bunavail (For ease of understanding I will be using Suboxone to represent buprenorphine-naloxone) Active ingredient is buprenorphine and not naloxone: A lot of people think that Suboxone works because it has the opioid blocker, naloxone, in it.is is not true. Suboxone, Zubsolv and Bunavail’s active ingredient is buprenorphine, which is an opioid. Buprenorphine is not a powerful opioid and has just enough of an eect on the mu receptor to treat withdrawal symptoms and take the craving for opioids away. When Suboxone is used under the tongue, the buprenorphine is absorbed and becomes active.e naloxone does not work when it is taken under the tongue. Naloxone only becomes active when it is injected and if Suboxone is liqueed and injected the naloxone in the Suboxone places a patient in immediate and severe withdrawal. So the reason that naloxone is placed in Suboxone is to prevent patients from liquefying Suboxone and injecting it. A great medication: Buprenorphine-naloxone is a great medication and has been successful in turning millions of lives around. Eight to sixteen milligrams per day is a common dose.e lowest dose should be used which keeps the patient’s withdrawal symptoms away, especially the cravings. At sixteen milligrams the mu receptors are saturated and when a higher dose is given it is only the bad side eects that the patient notices, not necessarily an improvement in cravings or withdrawal symptoms. 14

Stages of treatment: 1. Induction 2. Stabilization 3.Maintenance 4.Weaning

How long on Suboxone? Research does not guide us regarding the duration of treatment with Suboxone.To best treat patients I have divided patients into three categories with regard to duration of Suboxone use: 1. Short term treatment 2. Medium term treatment 3. Long-term or indenite treatment Short-term treatment: e patient is on Suboxone for a few weeks and is rapidly weaned to zero and placed on naltrexone. Medium-term treatment: is treatment is for one to two years and ideally I prefer the dose of Suboxone to be eight milligrams or below. Long-term or indefinite treatment: I reserve this for patients who have concurrent psychiatric illnesses, such as not well-controlled bipolar disorder or schizophrenia. If treatment is going to be indenite, I prefer the dose to be eight milligrams or less. We try to use the lowest Suboxone dose possible, as patients themselves realize they do not need more than eight milligrams and some then decide to sell or share it. Transferring Addiction People unfamiliar with current research, those stuck in the abstinence-based model and fans of the 12-step program, claim that treatment with Suboxone is switching heroin for Suboxone, an illegal drug with a legal one.is is entirely untrue. It can be a typical attempt to make oneself look good and the opioid-addicted patients feel badly about themselves.We have research that shows that Suboxone has a healing eect on the brain and is an excellent bridge from opioid addiction to a life of sobriety. Naltrexone pill and injection (Vivitrol) Naltrexone is a long-acting opioid antagonist and it was initially FDA approved in 2006 for the treatment of alcohol use disorder. In 2010 it was approved for opioid use disorder. Unlike Suboxone, naltrexone does not have an opioid in it and can be prescribed by any physician.To prescribe Suboxone, a physician has to be specially trained in prescribing it. Suboxone and methadone have a lot of research data proving great outcomes in maintaining sobriety, and reduction in opioid overdoses. Studies show that naltrexone works well in patients who are very committed toward their sobriety. In maintaining sobriety and preventing opioid overdoses, Suboxone and methadone are far superior to naltrexone.

Induction: is is the rst stage.e patient is requested to present in opioid withdrawal so the Suboxone can be started immediately.e lowest possible dose of Suboxone that will take care of withdrawal is given to the patient and they are rechecked in two to three days. If the urine drug screen in the next visit is negative, and a dose increase is requested, we do raise the dose. Stabilization: In the next few visits we focus on stabilizing the Suboxone dose. Sometimes the dose is too much and the patient feels that they are nodding during the day, and thus the dose is reduced. Others feel that the dose is insucient. If the urine drug screen is negative and the patient is compliant with counseling, the Suboxone dose is increased. Maintenance: is is the phase when the patient is comfortable with their dose and typically is the longest of all the phases of buprenorphine treatment. Weaning: Depending on the dose of Suboxone that the patient is on, it can take one to four months for a patient to be weaned o Suboxone completely.e dose of Suboxone is lowered very gradually and the patient advised that they will feel opioid withdrawal symptoms for two to ve days, and after that, they are pretty much ne. Essentially all patients realize that they had been unnecessarily nervous about dose reduction, and indeed they felt a little achy and have a bit of insomnia for a couple days, but that after that they were ne. Duration of treatment: is is dierent for dierent people and we try to customize the treatment to each patient. Some patients are on Suboxone for a few months, some for a few years and others indenitely. Just like they had with their choice of opioid, patients get very attached to Suboxone and some become very resistant to dose reduction. Patients want to reduce their doses by one-quarter lms and I reassure them that, just the way they had gotten attached to their drug, they have now latched on to Suboxone and we reduce the dose by half a lm, or four milligrams, every two to four weeks (when the patient is on eight to sixteen milligrams of Suboxone). Side effects: Suboxone can cause drowsiness, constipation, weight gain and leg swelling. And of course dependence as it is an opioid.

· After Suboxone has not been taken for one week and the urine drug screen is negative for it, naltrexone can be started. Option 3: · Start on Suboxone · Have regular discussions with your doctor about the duration of treatment and if it is mutually decided that you need to stay on Suboxone indenitely, make sure you are on the lowest dose that would control opioid cravings. Option 4: · Go through opioid withdrawal and go with abstinence-based therapy, meaning no Suboxone and no naltrexone. · I am not in favor of this option as the patient is unprotected in dealing with a disease and because oral naltrexone is cheap and eective in the motivated patient. e lives of millions of opioid addicted patients have been transformed after their entry into programs that treat opioid use disorder. And being the instrument of such a massive change in people’s lives has been, by far, the most humbling and gratifying experience in my life. Dr. Islam is medical director of UMADAOP of Lucas County and is board-certied in Addiction and Family Medicine. She has over twenty-ve years experience in Addiction Medicine and has worked in all phases of treatment, from inpatient to intensive outpatient, residential and ambulatory treatment.

The Dedicated Staff

Some patients don’t want to be on an opioid like Suboxone and this is understandable. But it is important to remember that comparing Suboxone to the naltrexone pill or the shot, Vivitrol, is like comparing apples to oranges. Certain professions, like pilots or truck drivers, do not allow Suboxone and in that situation naltrexone is a good choice. Naltrexone cannot be given when an opioid is present in the system, as it will immediately put the patient in severe withdrawal. Naltrexone is started either at the start of addiction treatment or after Suboxone has been weaned down to zero. Naltrexone pill: e naltrexone pill is prescribed at 50mg daily and is inexpensive and approved by essentially all insurance companies. Naltrexone injection/Vivitrol: Vivitrol is a monthly injection and lately has been heavily promoted by its manufacturer Alkermes and its use is skyrocketing across the United States. It costs about $1200 per injection and 380 milligrams is injected once a month intramuscularly. Several court systems across the country are also concentrating on Vivitrol. It is important to understand that both the naltrexone pill and the Vivitrol injection work, the only dierence being that the pill can be stopped by the patient, but once the Vivitrol is injected it obviously cannot be removed, and its eects last one month. And even though use of an opioid while on Vivitrol will place the patient in withdrawal, patients have been known to relapse while on Vivtrol. e intense marketing of Vivitrol has led to its indiscriminate prescribing by physicians and its recommendation by the justice system to those facing court-ordered treatment and this is placing a terrible burden on our health care system. Vivitrol is not a cure-all and the naltrexone pill is just as good as the injection. Side effects of Naltrexone: e main side eects of naltrexone, both oral and injection, are fatigue, headache and nausea. Sowhat should you do? I’ll list out some options of what you can do when you enter a program: Option 1: · If the patient has not used opioids for at least three days and the urine drug screen is negative the naltrexone pill can be started. · If opioids are present in the urine, a return appointment can be made after three days and naltrexone can be started then. · naltrexone pill can be continued indenitely. · If taking the pill everyday is a problem and the insurance company covers Vivitrol, it can be tried. Option 2: · Start on Suboxone. · On return visits, try to stay on the lowest dose of Suboxone that takes care of opioid withdrawal and cravings. · After four to six months of treatment, start weaning process to zero.

Driven Educator Prevention education becomes a life’s mission

Prevention education Allan came to the UMADAOP of Lucas County several years ago while he was finishing his degree. When a grant became available to support prevention and education in the area, Allan was called on to lead the effort. He says he wasn’t all that excited about prevention at first, but quickly came to love the initiative because it gave him a chance to interact with community members on a vitally important topic. “The grant really is an educational outreach initiative where we’re tasked with not just reaching residents in Toledo, but all of Lucas County,” Allan says. “It’s a large task, but one that we’re happy to do and it’s very, very important.”

They say that the best defense is a good offense, and no one has been on the offensive in the fight against opioid abuse like Geof Allan. As coordinator of the Opiate and Heroin Initiative for UMADAOP of Lucas County, Allan has taken a message of prevention to all corners of the county. He’s educated countless families on the dangers of opioids, provided information on Narcan, and has single handedly trained hundreds on how to use Narcan to reverse an overdose. And he’s not done yet.

Cultivating understanding While Allan’s own recovery is strengthened through his work, his focus is always on the community members who attend his trainings, workshops, town hall meetings, and forums. He says people’s experiences with opioids, whether personal or through loved ones, run the gamut from hopeful to devastating, and bring out a litany of emotions as people struggle to manage such a heavy burden. Whether offering possible solutions or just educating people to increase awareness, Allan has made it his life’s mission to take prevention education to anyone willing to listen. He says he has no plans of slowing down anytime soon as he looks to build stronger communities and individuals through education. “I know that I’m getting out important information and I hope that I’m making a difference in the community,” Allan says. “That’s the type of stuff that keeps me coming back.”

Personal dedication In long-term recovery himself, Allan says he sees his work as a way to give back to the community. He says the mission has become part of his own recovery as he works to contribute to society and effect positive change in those around him. “It started off as a job, and I don’t want to sound corny, but it’s kind of my identity now,” Allan says. “We have to give back, so yeah it’s a job, it pays bills, but I never lose sight of the fact that this is part of my recovery.” Allan says he’s extremely appreciative of everything UMADAOP has done for him, and credits Executive Director John Edwards with making his career possible. He says his work strengthens his dedication to sobriety and motivates him to keep pushing to help people in need. “It’s been said that you have to give it away to keep it, and it’s very true,” Allan says. “It affects my life in a good way as well.” Allan’s typical day involves going out into the community and talking with people about opioids, including the scope of the epidemic, the associated stigma, the dangers opioids pose, and the treatment options available. Allan says his goal is to achieve over 300,000 contacts every year, and is already personally responsible for over 55 percent of all Narcan trainings in the county. After conducting trainings everywhere from church basements to Applebee’s, he says he’s willing to do whatever it takes to get his message of preventative education out into the community. “I will go anywhere and do anything where there are people who are willing to listen to what I have to say,” Allan says.

“To just be somebody that can listen and maybe offer an idea or two, and to see that comfort people, that’s awesome, it’s very rewarding.” -Geof Allan

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Finding PeaCe UMADAOP client achieves contentment in sobriety

The story of Guspar’s descent into addiction is a familiar one, but his journey to recovery has been nothing short of extraordinary. A lifetime of drug abuse has given way to a bright future thanks to Guspar’s own dedication and help from UMADAOP Lucas County. The struggles of his past now serve merely as the foundation for his newfound life of peace and sobriety.

“They help through support, and that’s almost number one on top of the list, is having support, having people,” Guspar says. “It’s just a good feeling when you see somebody you recognize and you're just talking and sharing experiences. It’s just great.” Achieving contentment After nearly 30 years of chaos, Guspar has found the kind of peace many of us aspire to. He is living in his own apartment with a dog and two parrots, can drive again for the first time in three years, and is focused on maintaining his sobriety. He says he feels accepted again and thanks UMADAOP for giving him the tools to succeed. He now plans to put those tools to good use. “I’m really at the point of contentment. I have everything, I have an apartment, I just got a vehicle,” Guspar says. “I’m content where I’m at. I love myself again and I care about who I am and what I do.”

Searching for answers Guspar grew up in what he describes as a “somewhat dysfunctional” family, which left him without the love and affection he needed. He says once he started finding acceptance in friends, he began to chase that acceptance, giving into peer pressure as a way to stay in the group. Guspar says he started smoking marijuana and drinking wine at a young age, but things escalated dramatically over the years. “I’ve done alcohol and drugs most of my life, since I was 13,” Guspar says. “I was an alcoholic, I drank a lot and when I found heroin, I immediately stopped drinking and started doing this drug, not seeing the consequences.” What started as a search for acceptance became a decades-long addiction marked by arrests, rehab stints, and difficult circumstances. Guspar says a 34-day jail sentence woke him up to the reality of his situation and the need for treatment. That’s when his brother told him about UMADAOP Lucas County. “I finally looked at all the stress and the

chaos in my life and I decided to do something about it,” Guspar says. “I didn’t want anyone to dictate my life, I wanted to do it on my own.” Putting in the work Since coming to UMADAOP Lucas County, Guspar has learned to navigate the complex emotions and mental health issues that contributed to his behavior. He says it didn’t happen quickly, but through group and individual counseling sessions, he learned to open up and be more honest about his life. “I was pushing down a lot of feelings and I wasn’t dealing with life and reality anymore,” Guspar says. “I made up my mind that I wanted to change for the better and I can’t tell you how my life has been, it’s just been wonderful.” Having been to several other treatment facilities in the past, Guspar says UMADAOP Lucas County stands apart because of its dedicated staff. He says they show “a genuine caring” toward clients, and Guspar feels comfortable going to them when he needs their help. He says those connections to others have proved the most vital part of his recovery process.

“I’mcontentwhere I’mat. I love myself again and I care aboutwho I am andwhat I do.” - Guspar

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Faith Keep the Our programming expands access to an array of treatment and support, to include recovery coaching, FAITH-BASED and non-traditional programs.

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Starting Over Reentry program looks to rebuild lives, strengthen communities e stated goal of the Ohio criminal justice and correctional system is to protect public safety by rehabilitating oenders. But more often than not, many oenders fall far short in their pursuit. UMADAOP Lucas County has picked up this mission, oering a variety of programs and services aimed at helping ex-oenders successfully assimilate back into society.rough the Circle for Recovery program, UMADAOP Lucas County’s reentry sta hope to strengthen communities by helping people build better lives. Programming for progress e Circle for Recovery program is provided for 10-20 male participants who meet twice a week to address a range of issues they may be struggling to overcome. Group counseling sessions are conducted to give clients a chance to share their feelings and discuss issues in a setting where they feel understood by those with a similar past. Men’s Program Coordinator John Edwards, Jr. says that by addressing the issues that drove criminal thinking and behavior, participants can reshape their thinking to produce more positive actions. He

Defining success Where the criminal justice system may have failed, the Circle for Recovery program has seen incredible success in helping ex-oenders turn their lives around. Program organizers say they’ve seen participants go back to school, get and hold jobs, and become more dedicated to their family structures and obligations. “You see guys become more self-responsible, and more involved in their children’s lives when it’s allowed,” Edwards, Jr. says. While tackling practical matters like housing and unemployment are critical to nding success, Edwards, Jr. says it’s the emotional change and new thinking patterns that ultimately make the dierence. He says he’s seen clients make amazing strides as they come to terms with the issues that held them back for years, and even decades in some cases. “You see guys become a little bit more humble and realistic in the expectations they hold themselves to,” Edwards, Jr. says. “You see guys get more sincerely involved with the program because they really want the successful outcomes.”

states that many of the clients have never been taught or properly educated about the societal norms that all law abiding individuals are expected to follow. “We have clients that have felony backgrounds, and we help them to deal with some of the underlying issues that lead to criminal behaviors,” Edwards, Jr. says. “We use evidence-based programming to address a lack of education and life skills on everything from housing, education, employment, low self-esteem, criminal behaviors, substance use disorders, child support and domestic violence.” Program sta oer clients the full range of UMADAOP Lucas County services as a way to meet their everyday needs through outpatient treatment and recovery support.e program also features specialized individual counseling sessions to help clients avoid criminal thinking, illegal activity and recidivism. Edwards, Jr. says as clients work through their issues, they slowly begin to understand the motivations behind their behavior and become more self-aware of how to maintain law abiding and productive lifestyles. “Being able to sit down one-on-one with a Circle for Recovery counselor is a big help for them.e specialized individual sessions help them adopt new behaviors and become more comfortable in maintaining law abiding lifestyles,” Edwards, Jr. says. “We try to help them stage their development so that they can see the growth, because it helps build their condence and their self-esteem.”

Communal change As more and more participants nd lasting success, Edwards, Jr. says there’s a ripple eect of inspiration that permeates the group. When new clients see what’s possible, they become more motivated to try to achieve those outcomes for themselves. “It’s rewarding because we witness other guys begin to reap rewards from following the positive examples set by others,” Edwards, Jr. says. “It’s rewarding for the participants and the sta to see the clients succeed in spite of their backgrounds and obstacles.” Edwards, Jr. says by helping to address each client’s specic issues, the clients are enabled to change their thinking and ultimately their behavior. In this way, the Circle for Recovery program benets not only the participant, but society as a whole. “e overall goal for the client is to see them refrain from criminal thinking and behaviors that lead to recidivism so that they can lead successful lives,” Edwards, Jr. says. “e primary purpose is to help those individuals become productive members of society and make communities safer. “If we can help to reduce the recidivism rate, we feel like we’ve done our job.”

“The overall goal for the client is to see them refrain from criminal thinking and behavior and to be successful in their own lives.” - John Edwards, Jr.

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“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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CONCERN OVER HEROIN USE GROWING

New Poll Shows Americans Are Increasingly ConcernedWith

45 percent of Americans think heroin use is a bigger problem in their communities than shows they’re not wrong. According to the Centers for Disease Control, heroin-related overdose deaths nearly quadrupled from 2002 to 2013. Experts fear the numbers will continue to rise, with recent data showing roughly 156,000 Americans began using heroin in 2012 alone. Political Discourse a time when lawmakers and treatment providers are struggling to combat the rise in heroin overdoses. Several states have passed legislation making it legal to purchase Naloxone, a drug that works as an antidote for opiates, and Congress is considering several bills that would change the way federal authorities handle drug issues.

ore and more Americans are feeling the dangers of heroin, with nearly half of adults describing heroin abuse as a very serious problem,

according to a recent poll.

1,000 U.S. adults about heroin abuse, with 49 percent saying they thought it was a very serious problem, and another 38 percent saying they thought it was somewhat serious. heroin epidemic is hitting, with one-third of respondents saying they personally know someone who has become addicted to heroin or another opiate. Numbers Don’t Lie Public perception of heroin use has changed quickly over the last few years. A Rasmussen Reports survey in November of 2015 found

groups to increase understanding of addiction as a disease, 28 percent said those who use heroin are most to blame. Still, the poll showed public opinion remains somewhat balanced, with 48 percent of people saying all groups are equally to blame. A Universal Issue races. Although black and Hispanic Americans were more likely than white respondents to cite heroin as a very serious problem, all three groups had similar views on nearly every other question. across almost every demographic over the past decade, and poll numbers show perception and reality are more in line than most would like to admit.

commander-in-chief have also paid closer attention to the heroin epidemic, with the issue playing a more prominent role in this year’s presidential campaign than it has in

past election cycles. Who’s To Blame?

voters are paying close attention to the problem may come as no surprise considering how much blame the public puts on them. Of those surveyed, 5 percent said the U.S. government and those who decide how heroin users are treated are most to blame for the current heroin problems. In comparison, drug dealers themselves were singled out by only 11 percent of “49 percent of U.S. adults think heroin abuse is a very serious problem, and 38 percent say it’s somewhat serious.” -

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Boom, Bust, and Drugs Study says economic downturn leads to increase in substance use disorders When the economy tanks, drug abuse goes up.That’s the finding of a new study which shows the state of the economy is closely linked with substance abuse disorder rates for a variety of substances. The study, conducted by researchers from Vanderbilt University, the University of Colorado and the Substance Abuse and Mental Health Services Administration (SAMHSA), found the use of substances like ecstasy becomes more prevalent during economic downturns. Researchers also found that other drugs like LSD and PCP see increased use only when the economy is strong. But for overall substance use disorders, the findings were clear.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens,” says Christopher Carpenter, one of the lead researchers. “Our results are more limited in telling us why this happens.” Researchers say it’s possible that people turn to substance use as a means of coping with a job loss or other major life changes caused by economic pressures, but their particular study did not pinpoint an exact cause and effect. Not all drugs are equal The study showed that a downward shift in the economy has the biggest impact on painkillers and hallucinogens. Rates of substance abuse disorders were significantly higher for those two categories than any other class of drug.

Researchers also found the change in disorder rates was highest for white adult males, a group which was one of the hardest hit during the Great Recession.They say more research is needed to determine exactly how the economy and drug use are related, but they say the study highlighted some key groups for prevention and treatment workers to target during future economic downturns.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens.” - Christopher Carpenter, Vanderbilt University

Slippery slope Despite some lingering questions, researchers were able to show the significance of the economy’s role in problematic substance use.The study showed that even a small change in the unemployment rate can have a tremendous impact on the risks for substance abuse disorders. “For each percentage point increase in the state unemployment rate, these estimates represent about a 6 percent increase in the likelihood of having a disorder involving analgesics and an 11 percent increase in the likelihood of having a disorder involving hallucinogens,” the authors write. Previous studies have focused on the economy’s link to marijuana and alcohol, with many looking at young people in particular.This study is one of the first to highlight illicit drugs, which given the current opioid epidemic, holds important lessons for those working to curb problematic drug use.

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When it’s needed most The study bears significant weight for treatment facilities and public policy makers in particular. During economic downturns, government agencies typically look to cut spending on treatment programs as a way to save money, something researchers say may be more costly in the end. “Our results suggest that this is unwise,” Carpenter says. “Such spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise, at least for disorders involving prescription painkillers and hallucinogens.”

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“Spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise.” - Christopher Carpenter, Vanderbilt University

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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 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

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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