This section outlines the structure of the essay. This applied essay is focused on promoting harm reduction by destigmatise the current dispensing process of methadone in the community pharmacies. The essay consists of following five parts.
Harm Reduction in Opioid Substitution Therapy,Improving outcomes of Opioid Substitution, Therapy by dstigmatisation of supervised dispensing of Methadone, Discussion and Conclusion. Last but not the least it is necessary to note that there is insufficient done in New Zealand. Henceforth, essay, discussion and conclusion (recommendations) is based on the work done in the UK, Australia and USA.
Harm Reduction in Opioid Substitution Therapy
Historical Background
Opioid Substitution Treatment approach from 1970 to mid-1990s. In early 1970s Opioid Substitution Therapy was started in New Zealand in Auckland and Christchurch by Dr Fraser McDonald and Dr John Dobson respectively. (Deering, Sellman, & Adamson, July 2014). Until the 1980s, New Zealand Opioid substitution treatment was based on treating opioid substitution as a medical condition based on abstinence approach with an expectation of prescribing sub –therapeutic doses of methadone. Clinicians choose to practice narrow approach focused on client’s substance rather than client centric approach. (Deering, Sellman, & Adamson, July 2014).
Harm reduction as one of the objectives of New Zealand OST programme was introduced in early 1980s to retain and recruit more opioid injecting
In October of 2002, the Food and Drug Administration (FDA) approved the use of Suboxone for the treatment in the United States of opiate addiction (Mintzer, 2007). It is a medication-assisted treatment; however it “does not require participation in a highly-regulated federal program such as a methadone clinic” (Stuckert, 2013). It does not cause the high or euphoria feeling associated with opiate dependency. In fact many patients that have taken the treatment have said that they have felt little more than having more energy and no real high at all (Thompson-Gargano, 2004).
As previously discussed, the program the author would choose to evaluate is MAT treatment programs. This population consists of individuals that have been diagnosed with opiate use disorder, and receive opiate-substitution medications, such as Methadone or Suboxone. These program evaluations would be consumer-centered, performed in the clinics they receive services. Interested stakeholders would include the treatment center where the participants receive services, as well as other MAT service providers. Additionally, the funding sources for these individuals and program centers, such as county, state, and federal agencies, along with medical insurers, would also gain value from the program evaluation research.
Out of the 60 participants 14 were women, 42 came from treatment settings, 18 came from criminal justice settings and 5 did not attend the follow-up 6-month interview. During the 6-month treatment trial, 95% of the participants used opioids on one or more occasions while the other 5% reported completely refraining from using opioids during treatment. The average frequency of opioid use was 24 days during the entire 6-month period. The overall frequency of opioid use was reduced from an average of 2.4 (using the 0-3 frequency scale) before Naltrexone implantation to 0.9 after 6 months of treatment. Heroin was the most commonly used opioid among the 60
In the video Opiate Addiction: Understanding Replacement Therapy, Scott Farnum talks about methadone replacement therapy. There were many topics covered in this video and the topics were introduced in a psychoeducational format. The topics covered included a brief history opioids, brain chemistry, post acute withdrawal syndrome, abstinence based treatment programs verses harm reduction, and how an individual asses the damages of opioids on the brain. As a counselor in training, I found all the information useful because I have not studied methadone replacement therapy in detail.
Medication assistant treatment also known as (MAT) is when a person has presented with an opioid addiction and have challenges stopping and/or abstaining from opioid use and they are prescribed either Methadone, Suboxone, or Vivitrol. Those who are in support for MAT is that this a better alternative to having individuals addicted to illicit substances. The other side to MAT is that this is way to keep individuals addicted to drugs, legally. I do not support MAT treatment as a form of long term treatment and not as the solution for opioid addiction. Serving as an Addiction Counselor and working with individuals who are addicted to opioids, I encounter many individuals who are or at one point utilized
Dr. Perry Kendall’s stated in a report that the mortality rate for people in opioid substitution treatment is about half of what it is for those using street heroin. (“globeandmail”) Another doctor, who has been administering the program as part of his family practice for several years states the rate of success is poor, the nature of the work often frustrating and the paperwork required under new rules is daunting. But the reward is the amazing transformation of those who are helped by methadone, says Dr. Jeff White. (“thetelegram”) Equally, a confident experience is expressed from a recovering addict himself, Jared stated to a Newfoundland based newspaper, The Compass that the methadone program had a super positive impact on his life. Going on to say in a separate interview with The Advertiser, that the first year everything went as well as it could have with him not doing any drugs. (“Advertiser”) This is just a few examples on how the methadone program has continued to play a positive impact on lives when given the
America has a major problem with opioid addicts, and many facilities are helping the addicts by providing safer options to taking the drugs their bodies crave. Methadone clinics are places where people addicted to opioids can receive medicine-based therapy. Opioid use, drugs such as heroin, morphine, and prescribed painkillers, has increased in the US with all age groups and incomes. People become addicted to these drugs when they are prescribed, recreationally used with other addicts, or they are born addicted. Many health institutions are addressing this issue with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted
Harm reductions recognizes an individual’s willingness to make a change in their life, there is a wide range that these individuals may be along, from not thinking about change, to contemplating change, to taking action, to maintaining change and the other way around. The method of harm reduction first begins with focusing on what stage the individual is on with their drug use. As earlier stated the active participation of individuals who use drugs is at the heart of harm reduction. These individuals are the best source of information in terms of their own drug use and are determined with the help of other service agencies to determine the best form of intervention. There have been many success stories from having injection sites as a form
There are three predominate forms of Medication Assisted Treatment (MAT) that have proven effective in combating opioid use disorder. Methadone, buprenorphine, and naltrexone have all shown to be effective in the treatment of substance use. When prescribed and monitored properly, MAT has been shown to reduce illicit drug use and reduce the rate of accidental overdose. However, while as many as 2.5 million people are suffering from substance use disorder, less than 40% have access to MAT
Furthermore, in U.S., dealing with opioid addiction with opioid prescriptions is managed by Federal Regulation 42 CFR Part 8, which offers for an authorization and certification-based schemes for opioid treatment agenda. The guideline recognizes that dependence on a drug is a therapeutic disorder that may entail reverse healing procedures for dissimilar patients. The Division of Pharmacologic Therapies, which is an element of the SAMHSA Center for Substance Abuse Treatment, is accountable for managing accreditation principles and official recognition methods. (https://www.samhsa.gov). Dependence to opioids is a mutilation that can harm and considerably spoil the major life activities of people. For this reason, Federal regulations are
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5, opioid use disorder (OUD) is characterized by patterns of opioid use that are problematic and persist for at least one year (American Psychiatric Association, 2013). Evidence of problematic use of opioid is demonstrated through the presence of at least 2 symptoms which include withdrawal, craving, and continued use of opioids despite the disruptions it causes in personal and professional life. The substances used by persons with OUD are heroin and nonmedical pain relievers ([NMPR]; i.e. nonmedical use of opioid pain relievers), and estimates for DSM-5-defined OUD tend to combine the prevalence of use for each of these substances to determine overall
Opioids, a knock off version of meth which is prescribed by doctors, are known for being addictive and have become a major issue in Ontario, especially in cities like Thamesville and Chatham-Kent. With a little population and no promising economy, the only businesses that seem to be prospering are the medical treatment centers. Like much of Ontario, these cities have also seen a rise in misuse of prescription opioids; it is the fourth most commonly used drug. These drugs are prescribed in large bulks of 100 to even seven hundred doses at once instead of smaller doses to see how a person does with it. When people had these large doses at hand they started selling it to make money. This caused teenagers to start using opioids. When the government
The United States is currently under an opioid epidemic where the abuse of opioids has increased significantly within the last 20 years. It is important to understand that relapse for opioid users is common. This problem has been around for a while; studies have shown that “higher recidivism proportions were found for shorter tenure clients” (Joe, Lloyd, Simpson, & Singh, 1982). Specifically, from 2002-2007 “nonmedical use of prescription pain relievers grew from 11.0 million to 12.5 million people in the United States” (Meyer, Patel, Rattana, Quock, & Mody, 2014). This trend shows that opioid abuse is a growing issue and it requires direct action. Research has disclosed that in 2011, 2.2 million Americans were in jail/prison, and “[o]f those
The use of opioids and other drugs continues to gradually increase in the United State. According to Centers for Disease Control and Prevention (CDC), the number of overdose deaths involving opioids has quadrupled since 1999” (CDC website). Individuals are abusing prescription opioids such as oxycodone, hydrocodone, and methadone. Prescriptions opioids that are supposed to be used as pain relievers, cough suppressants and for withdrawal symptoms are being use by individuals in order to feel relaxed or for the overwhelming effect of euphoria. These types of drugs are to be taken orally, but people are snorting, smoking, and injecting them in order to get a better high. I have personal encounters with opioid drugs and opioid abuser on a regular
The United States currently faces an unprecedented epidemic of opioid addiction. This includes painkillers, heroin, and other drugs made from the same base chemical. In the couple of years, approximately one out of twenty Americans reported misuse or abuse of prescriptions painkillers. Heroin abuse and overdoses are on the rise and are the leading cause of injury deaths, surpassing car accidents and gun shots. The current problem differs from the opioid addiction outbreaks of the past in that it is also predominant in the middle and affluent classes. Ultimately, anyone can be fighting a battle with addiction and it is important for family members and loved ones to know the signs. The cause for this epidemic is that the current spike of opioid abuse can be traced to two decades of increased prescription rates for painkillers by well-meaning physicians.