Download The Hazelden Betty Ford Foundation`s treatment for opioid addiction

The Hazelden Betty Ford Foundation’s treatment for opioid addiction
In response to the nation’s prescription medication crisis and the rising death toll from accidental
overdoses, the Hazelden Betty Ford Foundation formed a cross-disciplinary team of medical,
clinical, research, administrative and communications professionals to research, study and
implement solutions to the problem in 2012. To give our patients the best chance for long-term
recovery, we enhanced treatment programming to include new tracks for those with opioid use
disorders. The innovative programming includes alterations to group therapy and lectures as well as
the use of certain medications to assist people to a stable, Twelve Step-based recovery lifestyle and
ultimate abstinence from opioids. Here are some frequently asked questions about our new
treatment for opioid use disorders.
Q: Why did the Hazelden Betty Ford Foundation enhance its treatment for opioid use
disorders?
A: We responded to the national crisis of addiction to opioids, including prescription painkillers
(OxyContin, Vicodin, Demerol, etc.) and heroin, and a corresponding increase in the number of
accidental deaths related to opioid addiction.
Our facilities were seeing an increase in the number of patients seeking treatment for opioid use
disorders. In Center City, Minn., for example, those seeking treatment for opioid use disorders rose
from 19 percent of patients in 2001 to 30 percent of patients in 2011. A more dramatic jump was
seen at our facility for young adults and adolescents in Plymouth, Minn. – from 15 percent of
patients in 2001 to 41 percent of patients in 2011.
Those with opioid use disorders are highly vulnerable, at-risk patients. They are:
•
•
•
More likely to leave treatment before it is completed.
Hypersensitive to physical and psychic pain, putting them at higher risk of relapse.
At higher risk of death from accidental overdose during relapse.
Risk of accidental death increases after people withdraw from opioids and remain abstinent for a
period of time, losing tolerance they had established. If they relapse on an opioid dosage they were
accustomed to prior to abstinence, when they were highly tolerant, overdose is a likely result.
Breathing might be suppressed, resulting in respiratory arrest and death.
According to the Centers for Disease Control, about 12 million Americans (age 12 or older)
reported nonmedical use of prescription painkillers in 2010; nearly half a million emergency
department visits in 2009 were due to people misusing prescription painkillers; and the death toll
from prescription painkiller overdose increased more than fivefold in the U.S., from 3,000 deaths in
1999 to 15,500 deaths in 2009.
In fact, deaths from drug overdose, driven by the increase in prescription painkiller misuse, now
outnumber those caused by car accidents.
Q: How is the Hazelden Betty Ford Foundation using medications to treat opioid use
disorders?
A: We have implemented the extended, adjunctive use of medicines -- in combination with
psychological and psychiatric care, Twelve Step based counseling and other therapies -- to increase
the potential for those with opioid use disorders to achieve long-term recovery.
Q: Which medications does the Hazelden Betty Ford Foundation use, and what are the
relative benefits and risks?
A: To give patients the best chance at long-term recovery and abstinence, we use two medicines:
•
Naltrexone. Extended-release naltrexone (which has been used at Hazelden Betty Ford
Foundation facilities since 2006 for alcohol dependence) is an opioid receptor blocker
(opioid antagonist). When used in the treatment of opioid use disorders, it is administered as
an injection once a month. It prevents the binding of opioids to receptors in the brain,
eliminating the drug’s ability to produce intoxication or reward. It has been shown to
improve treatment retention and reduce craving and relapse. Naltrexone has no abuse
potential.
•
Buprenorphine/naloxone. Buprenorphine/naloxone, taken sublingually on a daily basis, is
a partial opioid agonist that activates opioid receptors just as morphine, oxycodone and
heroin do, but not to the same degree. It has a very high affinity for opioid receptors, thus
preventing the effects of other opioids. Buprenorphine/naloxone inhibits craving, reduces
relapse to opioid use and improves treatment retention. It is becoming the primary treatment
for opioid use disorders in the United States. It has been shown to improve self‐help group
attendance and to be effective for both youths and adults.
Treating opioid use disorders with naltrexone and buprenorphine/naloxone is supported by
scientific research and recommended by the U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration (SAMHSA), National Institute on
Drug Abuse (NIDA), Washington Circle (a policy group devoted to improving care for substance
use disorders) and the Veterans Administration.
Q: Who should get these medications?
A: Anyone who is addicted to opioids and at high risk of relapse could be eligible for these
medications. The decision, however, will always be voluntary and based on individualized medical
assessments. There are some contraindications, such as significant liver or respiratory disease, and
these conditions must be carefully assessed.
Before using these medications, we work to ensure patients will have access to adequate continuing
care, including doctors who are licensed to administer the medications and Twelve Step groups that
are receptive to those who are using them.
Q: Does this contradict the Hazelden Betty Ford Foundation’s Twelve Step, abstinencebased treatment philosophy?
A: We use medications only as an adjunct to, and never as a substitute for, Twelve Step, evidencebased recovery programming. The aim is to engage patients for a long enough period of time to
allow them to complete treatment, acquire new information, establish new relationships and become
solidly involved in recovery. The goal is always abstinence.
Q: How does the Hazelden Betty Ford Foundation define abstinence for someone on
buprenorphine/naloxone?
A: A person who has an opioid use disorder and is taking medication under the advice and care of a
physician to treat the disease is not unlike a post-surgery patient who is using pain medication. If
used as directed and not for the purpose of becoming intoxicated, the medication greatly assists in
recovery. We can learn from Overeaters Anonymous (OA) and Sex Addicts Anonymous (SAA) to
understand how abstinence is defined when the “drug of no choice” or the addictive behavior
cannot be entirely eliminated. Those in recovery in these programs specifically define what foods
and behaviors constitute recovery and relapse. They continue to eat and to have sex consistent with
defined recovery, but not in the same manner as they had during active addiction. Recovery defined
by the establishment of new behaviors in this manner is necessary. We view those working a
recovery program while using buprenorphine/naloxone as prescribed as being in recovery, and our
goal is abstinence.
Q: What other protocols are included in your treatment for opioid use disorders?
A: Other clinical protocols include opioid-specific groups, lectures and individual therapy. The
features of opioid dependence, opioid withdrawal and recovery are incorporated into all aspects of
treatment. These treatment protocols focus on engagement over a longer period of time. Therefore,
family and recovery community support, along with the use of recovery management interventions
that provide significant structure and accountability, are integral parts of the treatment.
Q: Is the Hazelden Betty Ford Foundation the only Twelve Step based treatment facility to
offer buprenorphine/naloxone?
A: We are a leader in the use of certain medications within an abstinence-based Twelve Step
recovery program. Our Butler Center for Research is studying the results of our new approach and
will disseminate findings.
Q: When did the Hazelden Betty Ford Foundation implement the new treatment?
A: We launched the new programming at the end of 2012.