2018 Anti-Addiction Bill Signed into Law
BARRIERS TO NALOXONE
SPECIALIZING IN ADDICTIONRECOVERY
3617 Falls Road Baltimore, MD 21211 Phone: 410-366-1380
7229 Ritchie Hwy. Glen Burnie, MD 21061 Phone: 410-320-9967
410-320-9967
www.kpcounselingservices.org
the life
Renew you have been given...
Let us show you how: KP Counseling Services is a State of Maryland certified program with a staff of certified counelors with many years of experience in the field of substance abuse. We offer treatment in a group setting to individuals who are suffering from the disease of addiction. The goal of KP Counseling Services is to serve those persons addicted to drugs who are over the age of 18 that reside in the Anne Arundel County and surrounding area. Our mission is to support the recovery, health and wellbeing of our clients. We want to enhance the quality of life of our clients through a reduction or elimination of substance abuse. Human beings have the capacity to take responsibility for their actions once they learn the skills to change. KP Counseling Services will service those individuals according to state and federal laws and regulations. We feel that these goals can best be accomplished with an outpatient counseling program that exists in the community allowing our clients to maintain employment, family support and continuity in their lives without the use of illicit drugs.
The ultimate goal of this Program is to assist clients in becoming abstinent from all illicit substances, and to teach them how to maintain a healthy lifestyle through recovery. We support and encourage the client in their pursuit of a better quality of life. Until this goal is reached, the Program is committed to providing an array of services or referrals to address the needs of the client and their families. It is our hope that each client will be discharged with the skills to maintain abstinence from illicit substances, and the knowledge to build stable family relationships and reintegrate into the community in a positive way.
“The goal of KPCounseling Services is to serve those persons addicted to drugs who are over the age of 18 that reside in the Anne Arundel County and surrounding area.”
What lies behind us
and what lies before us are tiny matters compared to what lies within us. - Ralph Waldo Emerson
A GOOD L I FE I S within reach A GOOD LIFE IS within reach
GLEN BURNIE LOCATION 7229 Ritchie Hwy Glen Burnie, MD 21061
HAMPDEN LOCATION 3617 Falls Road Baltimore, MD 21211
New anti-addiction bill signed into law Packages more than 70 bills
On October 24, 2018... President Trump signed a new, bipartisan bill to combat the opioid addiction epidemic. Politicians are hailing it as a major step forward, while addiction and treatment experts say it falls far short of providing enough resources – particularly funding – to have a significant impact on the problem.
A package of more than 70 bills introduced targeting the opioid crisis, the Support for Patients & Communities Act:
• Reauthorizes funding from the Cures Act, which put $500 million a year toward the opioid crisis, and makes some policy changes intended to give states more flexibility in using the funding. • Creates a grant program for “Comprehensive Opioid Recovery Centers,” which will attempt to serve the addiction treatment and recovery needs of their communities (in part by using what’s known as an ECHO model). • Removes restrictions on medications for opioid addiction, allowing more types of health care practitioners to prescribe the drugs.
• Expands an existing program that attempts to get more first responders, such as police and firefighters, to carry and use naloxone, a medication that reverses opioid overdoses. • Allows federal agencies to pursue more research projects related to addiction and pain. • Makes several changes to Medicare and Medicaid to attempt to limit the over-prescription of opioid painkillers within the programs and expand access to addiction treatment, including lifting some of the current restrictions that make it harder for Medicare and Medicaid to pay for addiction treatment.
• Advances new initiatives to educate and raise awareness about proper pain treatment among health care providers. • Attempts to improve coordination between different federal agencies to stop illicit drugs like fentanyl at the border, and gives agencies more tools to improve detection and testing at border checks. • Increases penalties for drug manufacturers and distributors related to the over-prescribing of opioids.
“This bill is a major victory for Ohio and for the country because it will strengthen the federal government’s response to the opioid crisis,” Sen. Rob Portman (R-OH), who helped put together the legislation, said in a statement after the Senate vote. “Importantly, this bill will increase access to long-term treatment and recovery while also helping stop the flow of deadly synthetic drugs like fentanyl from being shipped into the United States through our own Postal Service.” On the other side of the debate, Leana Wen, M.D., the former health commissioner of Baltimore (and incoming president of Planned Parenthood), said that the legislation “is simply tinkering around the edges.” Daniel Raymond, director of policy and planning for the Harm Reduction Coalition, said the bill is a case of too little, too late. “This is an election year bill to show they are doing something.That’s not always a bad thing, but I do think to some degree it’s a political document,” Raymond told the Washington Post. “When you drill down into it, it’s not that there aren’t good ideas, but it doesn’t reach the level of, this is what our nation needs right now.” The act authorizes a grant program through the Substance Abuse and Mental Health Services Administration (SAMHSA) to allow organizations to develop opioid recovery centers in a community. It also requires the Department of Health and Human Services to determine best practices and then create a grant program implementing those policies or procedures, such as the use of recovery coaches, which has proven effective in Massachusetts.
It also authorizes HHS to develop grants to support people who are in recovery transition to independent living and jobs, as well as develop a pilot program to provide temporary housing for those recovering from substance abuse. One of the most significant parts of the bill provides measures to prevent synthetic opioids like fentanyl from entering the U.S. According to the Centers for Disease Control, total opioid deaths did not increase in 2017, but deaths due to fentanyl overdoses did. Data shows the drug, which is about 50 times more potent than heroin, caused nearly 30,000 fatal overdoses last year. The bill also takes steps to increase access to medication-assisted treatment. It removes the cap on the number of patients to whom a qualified doctor can prescribe drugs like buprenorphine, a drug proven effective at limiting opioid cravings and easing withdrawal, from 100 to 275, and expands a grant program allowing first responders to administer medication-assisted treatments.
POWER OF ATTRACTION
Recent research indicates that magnetic stimulation to the brain may work to curb addictive tendencies in humans, according to research covered in a recent Smithsonian.com article. Researchers tested transcranial magnetic stimulation (TMS) in humans in an attempt to curb cocaine addiction. The treatment used magnets on cocaine addicts for ve consecutive days, followed by once-a-week treatments for three weeks. The number of participants was only 29, but the ndings were still encouraging: Of the 13 people who received an all-TMS protocol, 10 exhibited what researchers determined to be substantial improvement in controlling cocaine cravings. “I have met with these patients, I have seen them, I have seen their families,” says Antonello Bonci, a neuropsychopharmacologist and National Institute on Drugs researcher who co-authored the study, to Smithsonian.com. “They are alive, they are well . . . something has clearly happened to these people.” Researchers Think Magnets Can Help With Drug Addiction Impulses
Magnetic Stimulation
The Mayo Clinic de nes TMS as “a noninvasive procedure that uses magnetic elds to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatment hasn’t been effective.” It works through an electromagnetic coil that is placed directly on a person’s head, near the forehead. The electromagnetic simulation painlessly delivers a magnetic pulse that stimulates nerves in the PFC—the part of the brain also involved with mood control and depression, as well as addiction. “We know that addictive drugs change many, many brain regions, as many as 90 or more, and these regions are organized into overlapping circuits. We have no idea how, given this enormous complexity, just shutting down or tuning up one single region can produce such profound effects,” Bonci says, adding that drug addicts “are often unable to switch from a counterproductive behavior to another, more bene cial, one. They get stuck in repetitive, compulsive behaviors, such as using drugs.” Bonci tells Smithsonian.com that he is currently in the process of launching a larger, placebo-controlled, double-blind study of cocaine addicts. “This is a pilot study—we have a lot of work to do,” says Bonci. “I think that we will know, in just a few years, if this will become an accepted treatment.”
Many Uses For TMS
Researchers are looking into the potential of TMS as an effective treatment for a number of ailments. The National Center for Biotechnology Information (NCBI) researchers have studied how TMS can be used for obsessive-compulsive disorder, Parkinson’s disease, and epilepsy. The Journal of Headache and Pain published work studying the effects of TMS researchers studying TMS treatment for alcohol craving suppression and addictive behaviors. NCBI also published a study on TMS and binge eating disorder and comorbid depression, and The Journal of Clinical Psychiatry published a story on the effects of high-frequency repetitive TMS stimulation for decreasing cigarette smoking. Research on the effects of TMS aims to not only explore better ways to treat illness, but also to better understand TMS. “Though the biology of why TMS works isn't completely understood, the stimulation appears to affect how this part of the brain is working,” writes Mayo Clinic Staff in their overview of TMS. One of the primary reasons for pursuing TMS as a treatment alternative is that, unlike other medications, it doesn't have signi cant side-effects. “TMS is well-tolerated and associated with few side-effects and only a small percentage of patients discontinue treatment because of these,” write Johns Hopkins Medicine Psychiatry and Behavioral Sciences researchers. treatment on migraines. The journals of Neuroscience Letters and Neuroscience & Biobehavioral Reviews published work by
“We know that addictive drugs change many, many brain regions, as many as 90 or more, and these regions are organized into overlapping circuits. We have no idea how, given this enormous complexity, just shutting down or tuning up one single region can produce such profound effects.”
— Antonello Bonci Neuropsychopharmacologist Director of National Institute on Drug Abuse’s Intramural Research Program
OPIATE + OPIOID ADDICITON What is the difference between Opiates and Opioids?
OPIATES
OPIOIDS
A Natural Pain RemedIES
SYNTHETIC PAIN MEDICATIONS
VS.
Opium
Oxycodone
Thebaine
Hydrocodone
Morphine
Oxymorphone
Codeine
Hydromorphone
Heroin
What Medications Treat Opiate & Opioid Addiction?
Naltrexone
These medications act directly upon the opioid receptors; more speci cally the mu receptors. Because the effects of these medications vary at the receptor level, there can be different clinical effects during treatment.
ReVia | Depade | Vivitrol
Methadone Dolophine
Buprenorphine Suboxone | Subutex
A FULL AGONIST binds to the receptor and activates it by changing its shape - inducing a full receptor response.
A PARTIAL AGONIST binds to the receptor and activates it with a smaller shape change in the receptor that includes a partial receptor response.
Dead people don’t get into recovery
D. Waters Is Suboxone a Reasonable Treatment Option for Opioid Addicts? After twenty years of providing substance abuse treatment I can tell you that the ultimate goal of anyone battling an addiction is total abstinence. Every addict and alcoholic eventually figures out they can not control their usage, and moderation is unrealistic. Learning to live life on life’s terms is part of the process of learning to live abstinent. Self-help programs like Alcoholics Anonymous(AA) and Narcotics Anonymous(NA) do a great job of helping people understand their addiction, themselves, and effective solutions for coping with their disease. Dead people don’t get into recovery Opioid addicts are not terribly different from any other addict or alcoholic, except the risk of death by accidental overdose is huge. People are dying in droves from opioid overdose. The current heroin epidemic is even more dangerous than the pain killer epidemic it replaced. Relapse rates are tremendous. Unfortunately, it may take years before an individual addict is ready to give the 12-Step AA/NA
I’ve truly never seen anything work better, and when it works it’s a beautiful thing.
process the thorough try it requires to be effective. Therefore, Suboxone is a terrific option for chronic relapsers. You can’t generally get high from it, unless you haven’t used in awhile, or never used in the first place. You can’t overdose on it from use or abuse, and any other opioid you take while it’s in your system will be nullified and wasted.
Not the solution, but maybe a good step forward Suboxone is not the solution, but in many cases it’s better than nothing, and a good response for chronic relapsers who are risking death from overdose. At least the addict is getting some exposure to treatment which is more likely to lead to recovery in the long run. Suboxone buys people time and keeps them alive. There are quite a few people who’s funerals I’ve attended that I wish had gotten on Suboxone. You can’t treat the dead.
The Subs knock down the monster cravings almost completely, and people don’t go through the nasty withdrawal that’s so painful. Once dysfunctional people who couldn’t hold a job, or were constantly on the obsessive hunt for the next fix suddenly become much more functional, and the addiction looks like it’s in remission. They can work consistently, they stop chasing the drugs, they have more money and can care for themselves and their families, and their addiction doesn’t seem to be ruling their lives. It seems like magic! Very few people actually wean off Suboxone successfully Suboxone users often wrongly think they’re cured because they look and feel more functional. Then they think all they have to do now is wean down, or taper off the medication, which is what the clinic doctors help them manage over a number of months to years. The problem is they’ve done nothing about the underlying addiction and all the addictive thinking and coping that go along with it that drive the addiction from within. They haven’t developed any social support, or learned anything about themselves and their disease. We like to say that using, or putting some chemical into the body, is only a symptom of the underlying disease. Abusing substances is not the actual disease—just a symptom. As soon as they stop using the Subs the addiction is still there and ready to start expressing itself all over again through the many painful ways it does. Chemically addicted people cope with life stressors with chemicals—that is, unless they make some fairly significant changes. Suboxone changes nothing in the end. Suboxone changes nothing A combination of Suboxone treatment coupled with AA/NA (with Sponsor and Step work) is a great thing. At Crossroads Counseling we require anyone with a substance abuse issue
to attend AA/NA, obtain a Sponsor, and work the 12-steps. If they don’t we won’t sign-off on their program. Most Suboxone clinics require their participants to attend at least one counseling meeting a month. Unfortunately, this is almost completely useless unless the individual engages in a personal program of recovery that addresses not only the biological issues, but the social, psychological, and spiritual issues related to the disease, as well.
Trial evaluated effectiveness for common injuries
Four Groups of Patients The patients were randomly assigned to one of four groups. One group received a pill for their acute pain that contained a combination of ibu- profen and acetaminophen, the ingredients in Advil and Tylenol. The other groups were given a pill for their pain that contained a prescription opioid as well as acetaminophen, either oxyco- done and acetaminophen (Percocet), hydroco- done and acetaminophen (Vicodin), or codeine and acetaminophen (Tylenol No. 3). All the patients were asked to rate their pain immediately before taking the pain medication and again both one and two hours afterward (before they left the emergency department). The assessments were done using an 11-point scale (0 = no pain; 10 = worst possible pain). The study found that the intensity of pain was similar among all four groups before they took the medication, with a mean score of 8.7 on the scale. The pain then declined over time in all
As the over prescribing of opioid pain medications has become a major public health concern, health care providers have been paying more attention to over-the count- er-drugs that could be used instead, without the risk of addiction. A recent study published in the Journal of the American Medical Association (JAMA) has confirmed that OTC meds ibuprofen and acet- aminophen are just as effective as prescription opioids at reducing acute pain caused by com- mon injuries.It is one of the few “real world” studies that has made the comparison. A team of researchers led by Andrew Chang, M.D. of Albany Medical College, studied 411 patients (aged 21 to 64) who had sought med- ical care at two urban emergency departments after having sprained, strained or broken an arm or leg. (About 20 percent of the patients had fractures.)
individuals can become addicted even after only taking opioid pain meds for a few days. One study found that one in five people given a 10-day supply of opioid painkillers became long-term users. More M.D. Education Needed Don Teater, M.D., medical adviser of the non-profit National Safety Council, says doctors need more education to understand the draw- backs of prescribing opioids. “Doctors get a lot of training in the physical aspects of health, but not the mental aspects,” says Teater, a family physician in North Carolina whose practice focuses on treatment of pain and the treatment of opioid use disorder. “We don’t get training in addiction. Often, a doctor will start a patient on opioid pain med- ication and continue it for awhile. Then if the doctor feels the patient is asking for too much medication, the doctor will cut them off, and abandon them. There needs to be a greater understanding of the emotional component to pain. We also need to have a better under- standing of the disease of addiction.” According to a white paper from the Council, there is little evidence that opioids are helpful when used for chronic pain.
four groups – and by similar levels: 4.3 points in the ibuprofen/acetaminophen group, 4.4 points in the oxycodone/acetaminophen group, 3.5 in the hydrocodone/acetaminophen group and 3.9 in the codeine/acetaminophen group. The researchers said the major limitation of the study is that it had the patients assess their pain only while they were in the emergency department. The study did not evaluate how the ibuprofen/acetaminophen combination would work in comparison to opioids once the patients went home. Also, the participants had a specific type of acute pain – from sprained or broken arms and legs. “Preventing new patients from becoming addicted to opioids may have a greater effect on the opioid epidemic than providing sus- tained treatment to patients already addicted to opioids, in whom it may take many years to achieve recovery,” Demetrio Kyriacou, M.D., a senior editor at JAMA and a professor of emer- gency medicine at Northwestern University, wrote in an accompanying editorial. Yet, as Kyriacou also acknowledges, “stemming the opioid addiction crisis will … require reex- amination of the long-standing assumptions that opioids are superior to
non-opioids in most clinical situations requiring man- agement of moderate to severe pain.” Studies have shown that nearly one-third of adult patients seeking care at U.S. hospital emergency departments are given prescriptions for opioid painkillers, even if their visit was not pain-relat- ed. That is a dangerous practice, since some
“In fact, some evidence shows they may be detri- mental and increase risk of addiction and premature death,” the paper says.
There is little evidence that opioids are helpful when used for chronic pain.
GLEN BURNIE LOCATION 7229 Ritchie Hwy. Glen Burnie, MD 21061
3617 Falls Road Baltimore, MD 21211 HAMPDEN LOCATION
NALOXONE WHAT IS N
aloxone is an opioid antagonist that can safely and effectively reverse an opioid-related overdose by quickly restoring breathing and consciousness. Naloxone binds to opioid receptors in the brain, displacing the opioids and temporarily reversing their life-threatening effects. Because naloxone does not affect someone without opioids in their system, it can only reverse overdoses involving opioids like prescription pain medication and heroin. Naloxone is administered intravenously and can be administered one of two ways. One, it can be injected intramuscularly or two, sprayed intranasally. Regardless of how it’s administered, both methods can be easily done by trained laypersons. Naloxone is often dispensed in a rescue kit that includes the delivery device (needle or nasal atomizer and syringe) and items such as alcohol swabs, non-latex gloves, a plastic face shield for rescue breathing and information cards on things such as opioid overdose response and naloxone administration, overdose prevention tips and substance use disorder treatment.
Naloxone has few side effects, is not a controlled substance, and is available only by prescription.
T H E B A R R I E R S TO
OVERDOSE RESPONSE PROGRAM The Department of Health & Mental Hygiene (DHMH) launched Maryland’s Overdose Response Program (ORP) in March 2014 to train and certify quali ed individuals most able to assist someone at risk of dying from an opioid overdose when emergency medical services are not immediately available. Despite stringent guidelines, dispersion protocols, and the training certi cation required with the program, looming controversy surrounds questions of what validates individuals are being “quali ed” in assisting in the Overdose Response Program. Recently, reports have shown that family members, friends and associates of opioid users; treatment program and transitional housing staff; and law enforcement of cers seem to make up the majority of those most able to assist someone at risk of dying from an opioid overdose. Successfully trained individuals will receive a certi cate allowing them to obtain and have lled a prescription for Naloxone, also known as Narcan®, a life-saving medication that can quickly restore the breathing of a person who has overdosed on heroin or prescription opioid pain medication like oxycodone, hydrocodone, morphine, fentanyl or methadone. The DHMH authorizes private or public entities to conduct educational training programs using a core curriculum that includes information about prescription and non-pharmaceutical opioids and
training on how to recognize and respond to an opioid overdose, proper rescue breathing technique, and how to properly administer naloxone and care for the individual until emergency medical help arrives. The training also stresses the importance of calling 911 for the person in distress and reporting the naloxone administration event to the Maryland Poison Center.
Human beings have the capacity to take responsibility for their actions once they learn the skills to change. At KP Counseling Services - wewant to enhance the quality of life of our clients through a reduction or elimination of substance abuse.
7229 Ritchie Hwy. Glen Burnie, MD 21061 Phone: 410-320-9967
3617 Falls Road Baltimore, MD 21211 Phone: 410-366-1380
www.kpcounselingservices.org
It’s time to discover a new you — A new path for yourself — One that reaches beyond the past or present. — It’s time to wake up in a world of character — of determination.
kpcounselingservices.org
410-320-9967
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