Download Hazelden`s response to opioid addiction

Hazelden’s response to opioid addiction
In response to the nation’s epidemic of prescription painkiller addiction and rising death toll from
accidental overdose of opioids, Hazelden formed a cross-disciplinary team of medical, clinical,
research, administrative and communications professionals to research, study and implement
solutions to the problem. To give its patients the best chances of long-term recovery from opioid
addiction, Hazelden has enhanced treatment programming to include new tracks for those with
opioid dependence. The innovative programming includes alterations to group therapy and lectures
as well as use of extended, adjunctive medication assisted treatment as a means to assist people to
a stable, Twelve Step-based recovery lifestyle and ultimate abstinence from opioids. Here are some
frequently asked questions about Hazelden’s response to the epidemic:
Q: Why is Hazelden enhancing the treatment of opioid dependence?
A: Hazelden is responding to the national epidemic 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.
Hazelden facilities have seen an increase in the number of patients seeking treatment for opioid
addiction. In Center City, Minn., for example, those seeking treatment for opioid addiction rose
from 19 percent of patients in 2001 to 30 percent of patients in 2011. A more dramatic jump was
seen at Hazelden’s facility for young adults and adolescents in Plymouth, Minn., from 15 percent of
patients in 2001 to 41 percent of patients in 2011.
Those who are addicted to opioids are highly vulnerable, at-risk patients. They are:
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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 from opioid addiction increases after a person withdraws and remains
abstinent for a period of time, losing tolerance they had established to opioids. 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 or abusing prescription painkillers; and the
death toll from prescription painkiller overdose has increased more than fivefold in the past decade
across 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 abuse, now
outnumber those caused by car accidents.
Q: What is Comprehensive Opioid Response with the Twelve Steps (COR-12) treatment at Hazelden?
A: COR-12 is 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 who have the
disease of addiction to achieve long-term recovery.
Q: Which medications will Hazelden be using, and what are the relative benefits and risks?
A: To assist in abstinence from opioids and to give patients the best chance at long-term recovery,
Hazelden will be using two medicines:
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Naltrexone. Extended-release naltrexone (which has been used at Hazelden since 2006 for
alcohol dependence) is an opioid receptor blocker (opioid antagonist). When used for opioid
addiction, 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.
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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 dependence in the United States. It has been shown to improve self‐help group
attendance and to be effective for both youths and adults.
Medication assisted treatment for opioid dependence 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 administering these medications, Hazelden will work to ensure that patients will have access
to adequate continuing care, including doctors who are licensed to administer these medications and
Twelve Step groups that are receptive to those who are using them.
Q: Does this contradict Hazelden’s Twelve Step, abstinence-based treatment philosophy?
A: COR-12 will only be employed as an adjunct to, and never as a substitute for, Twelve Step,
evidence-based 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 will always be abstinence.
Q: How will Hazelden define abstinence for someone on buprenorphine/naloxone?
A: A person who has the disease of addiction 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 treatment protocols will Hazelden initiate?
A: Other clinical protocols will include opioid dependent specific groups, lectures and individual
therapy. The features of opioid dependence, opioid withdrawal and recovery will be incorporated
into all aspects of treatment. These treatment protocols will 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, will be integral parts
of the treatment protocols initiated.
Q: Is Hazelden the only Twelve Step based treatment facility to offer
buprenorphine/naloxone?
A: Hazelden will be a leader in the treatment and recovery field to combine COR-12 within an
abstinence-based Twelve Step recovery program. Hazelden’s Butler Center for Research will study
the results of these new treatment protocols and will disseminate findings.
Q: When will Hazelden implement the new plan?
A: It will begin implementing the plan at its Center City and St. Paul, Minn. facilities by the end of
2012, and broaden the option to its other residential and outpatient facilities in 2013.