NO WRONG DOOR

Have you heard of this term? I hope so. It is a policy that is being pushed through to all community agencies and professions in the field of community health, public health, mental health and substance misuse. It means that no matter what agency you call or go to, no matter what type of professional you see for an appointment of any kind, they are expected to hook you up with resources and help you even if it is not their specialty. So, if you go to your medical doctor for anything and you mention difficulty with mental health or substance use, they are bound to discuss options to help you and give you resources to call or go to in person....even make the call with you at that moment IF that is what you want. Yes, it is true. That is how bad this opioid crisis is and that is how tragic our numbers of suicides are; not accidental overdoses, I am talking actual suicides. This policy varies from state to state or region to region. If you bravely speak about your difficulty with mental health OR substance misuse OR are experiencing grief from losing someone from an overdose or suicide then whoever you confide in should offer to help you right then. What type of help and how you want to proceed is up to you. If you just want a phone number or website then that is it. Maybe ask for a brochure if available. If you want them to help you make the phone call, they should do that with you or hand you over to the RN nursing coordinator to help you right away. You must speak up and tell us your needs! We are eliminating the stigma to mental health, suicide, and substance use. We want to help but we need to know if you need help and what kind of help you want.

Spiritual Self Care

Spiritual self care is the feel good self care. It is NOT religious unless you want to make it that way. I am talking about doing what makes you feel good right down to your toes! It means different things to different people. Whatever it is...it must give you great joy and make you feel connected to yourself and others including feeling connected to something greater than yourself. This is the easiest self care because it makes you feel so good... who wouldn't want to practice it? So what makes people feel connected and full of joy? For some it is deep serious self reflection. Maybe reading a spiritual or prayer book and reflecting. For others it is meditation, Yoga, or practicing energy work by aligning their Chakras or receiving Reiki from a professional practitioner. Others go out in Nature such as sitting on the beach watching the waves, hearing the tides and smelling the salt air with the Sun shining on them. Adventurous people might climb a mountain then sit  at the top and admire the view in wonder of the beauty. It doesn't have to be out in nature. Play with small children or a dog or cat. Sit at the local park and watch kids play. Volunteer your time and effort at a place where it makes you feel awesome! Go out in the community and see what is going on. Maybe join the festivities. Get up early to watch the sunrise or go somewhere special for a spectacular sunset. Go to a Church of your choice. Pass on your knowledge and talent by teaching someone something in your area of interest and watch the joy as they learn. Maybe you need to connect with others struggling with substance use disorder, so go to a Peer group to support and inspire others. If home alone, blast some music and sing your heart out! Dance! Whatever it is, feel the joy! Be grateful for the gift of life!

Mental & Emotional Self Care

I already talked about physical self care in a previous post. Mental and emotional health self care is even more important. Why? Because if you are a person with a substance use disorder then this part of you is very unbalanced and has contributed to your disorder. Sometimes it is the root cause of substance misuse. Since we are body, mind, spirit, all aspects of ourselves must be treated at the same time. This area might need a little more work to become balanced and whole. 

Again, it starts with you...the real you. Not the person you pretend to be at school, work or even home. The real you without any masks. Some people don't really know who they are since they have pretended and used substances for so long. So, the first step is to acknowledge your feelings. This takes time. What you feel is NOT who you are. It is a temporary uncomfortable place. Maybe you are angry or bitter that life dealt you so many difficulties. Maybe you are scared to get help; fear of the unknown. Perhaps you think it means being judged. It could be that you don't like or love yourself. You have self blame and guilt for getting into this situation and having this disorder. Well all that can get better and those feelings can go away! How? First, make the phone call for help. Entire cities are getting together and each agency near you may have a common goal of supporting you, guiding you towards treatment and recovery, and being there for you every step of the way. Gone are the days of going at it alone! Even if your family and friends are not supportive, these agencies are being taught on how to manage your care according to all your specific needs and be your support system. If this is not the case, then find an area that is adopting this type of care. It will be well worth it.

After you start treatment and feel safe and supported, let all those negative feelings melt away. Cry if you need to....it is therapeutic. Then it is time to get to know yourself. Self reflection is needed. Counseling is recommended. In most treatment programs it is mandatory since it is so crucial to success. Also do things on your own such as taking a walk every day and think about yourself: your dislikes, what you like about yourself such as your positive qualities. Think about happy times in your past and what you can do to make happy memories in the future.  Make an appointment for a Reiki session which is energy work that facilitates balancing and healing all aspects of you. Reflect while you paint or do color therapy. Besides walking, it is one of the best activities for self reflection and it can be fun! Work on a jigsaw puzzle. Go out and sit in nature without distractions. Listen to a  guided meditation in a place where you won't be disturbed. Sit in the Sun. Do some gardening or get some houseplants and take care of them (yes talk to them!). Listen to meaningful music. Journal by writing or drawing every day. Join a peer support group. Recovery is successful when you have multiple support sources. Plus you might make a friend or two.

Now that you know yourself a little it is time to love yourself and express who you are. Forgive yourself.  No more self blame!  Do one thing for yourself  EVERY day. It is so important to love yourself and to show yourself that love. Practice positive affirmations every day and say them out loud. Learn a new hobby that always intrigued you. Dance while no on is looking! Hug a pet or a friend and share your love. Watch a comedy and engage in laughter which is very therapeutic. Read a self help or spiritual book. Go out and listen to live music. Join a social club of some sort. There is a social club for every type of interest such as sports, art & culture, photography, book club, dinner & movie, dog walkers, singles, chess, cribbage, billiards, gaming , arts and crafts, etc...

As I said before, it starts with balancing the physical, mental/emotional and spiritual aspects of yourself. All this is needed for a successful recovery.

Physical Self Care

Self care is #1 priority for everyone! To be truly happy and feeling well, people must take care of themselves physically, mentally, emotionally and spiritually. A person can't be the best they can be if one of these areas is unbalanced. Dissatisfaction with life, unhappiness, and negativity can be the result from the lack of self care. Let's talk about physical self care.

Sleep. Without enough sleep a person can feel cranky and be irritable. This affects those around you and all your relationships with people at home, at work and when you are out with the public. It sets you up for a negative day. Also, it affects your coping skills. For example: dealing with traffic in a healthy manner is much more difficult when deprived of rest and sleep!

Food. Not eating healthy can make you feel sluggish. Your brain might not be getting the protein and nutrients it needs to function at top level. Trouble concentrating at school or work can result. Long term results could be the development and susceptibility to disease.

Exercise. Not exercising can also make you feel sluggish, easily fatigued with loss of muscle tone and strength. All your tissues are getting the minimum amount of oxygen needed. Your heart needs to be exercised. Studies show that cardiac problems such as high blood pressure can be improved by exercising. If  you are not active physically, stress builds up within you since there is no energy release from daily stress and negative emotions. As stress levels increase, anxiety can result. Blood pressure and blood sugar go up. All of that contributes to the development of diseases.

What can you do for physical self care?

Stick to a bedtime routine. Relax for an hour before trying to sleep. Don't eat too late in the evening since that can contribute to insomnia. Read a book. Take a hot bath and unwind. Shut off your cell phone early or program it to ring for certain numbers only after a certain time of night.

Eat healthy. I am not talking about being a fanatic unless that is what you want. Logically, choose foods with less salt and sodium and don't use the salt shaker. Choose foods lower in sugar and limit sweets to fresh fruit. Use fresh or frozen vegetables instead of canned. Have fun with new recipes! Choose heart healthy options on the restaurant menu.

Take a daily walk for 30 minutes. Not motivated to do that? Then adopt a dog from the Humane Society and that will force you to take that walk every day. Take the stairs instead of elevator. Park your car further away from the store entrance. Get a neat bicycle and ride the local trails. Join fundraiser walks for your favorite cause. Be creative and have fun with your partner!

Other ideas: make an appointment for your annual physical or wellness visit. 

Monitor your blood pressure and blood sugar if applicable.

Try something different for your health such as acupuncture, chiropractor, or treat yourself and get a massage monthly. Join the local Y and use their pool. Try something you always thought about, like Tai Chi, gentle Yoga, kickboxing, Judo or Karate. Take a self defense course. Go hiking. Make it fun and challenge someone to do a specific number of trails to try to beat you. Join a local club that does activities together such as dancing of any kind, hiking, nature walks, rollerblading, volleyball, biking, swim racing.

It all starts with taking care of yourself. Start doing this and getting help and staying in recovery will become easier.

Here is how we can make a difference!

I went to a conference where virtually every public and community health agency in the area where I live was represented. There is a change in the wording of the common language being used when speaking about "addiction". I want to talk about this and explain some of the reasons why this is being changed.
When you hear the words "addict", "addiction", "drug abuse", it brings a mental image to whoever hears or reads these terms.....for example, the word abuse brings on the image of someone hurting another person. These words, which depict images when heard, influence a person towards being judgmental of that person or group of people. This could affect the quality of healthcare for that judged person. Maybe that person feels judged and won't go for help. That is a terrible thought! We need to stop judging by changing our language when speaking about or with "people with substance use disorder". Doesn't that sound like we are talking about an everyday person with a diagnosis that needs to be treated? Yes! Let's start using these terms:
substance use disorder, person in recovery, drug misuse, actively using, abstinent, not using.
NO more addiction, addict, drug abuse, former addict, clean, dirty. Let's talk about people as if they ARE people, like you, like me. When people who have a substance use disorder talk about themselves, they also should not use the old terms. Why? Because talking about themselves in a negative way presents a negative self image in their own mind. When they say it over and over again, that negative self image is reinforced over and over. That is enough to make anyone depressed, want to hide and numb those negative feelings! So let's help others talk and feel more positive about themselves. It starts with me and you. Together we can make a difference!

Let's talk about Opiate Use & Drug misuse

Takoda says, "Talk LOUD"

Takoda the rescue dog got a second chance at Life...someone you know might not if they misuse opiates, other drugs, or medications so....talk LOUD

Let's talk about
Opiate
Use &
Drug misuse

with your friends, with your kids, with your parents!

FEAR OF WITHDRAWAL & TREATMENT OPTIONS

Statement from ariticle 
https://www.ndtv.com/health/bidding-goodbye-to-addiction-1662311

"The patient’s fear of withdrawal perpetuates dependency or makes it more permanent. For the late stage opiate addicted individual, fear of the pain from withdrawal can be the single factor that continues their dependency" 

This is so TRUE! That is the biggest excuse of why a person with substance use disorder did not start treatment earlier. The fear of being in withdrawal. Most people with substance use disorder hear horror stories of others who started treatment and were so sick they couldn't work.  Well, that is in the "old days" or maybe at a different type of program where they only detox you, roughly. It is different now. There are new medications and different modes of delivery being used. Plus, with the Opioid Crisis, programs are being scrutinized and held to certain standards. Programs are changing according to the needs of the crisis. Treatment plans are individualized according to the patients needs and the patients goals! Counties and other communities are being given grants to hire more professionals to meet the needs of society and this crisis. So if the program you are looking into is short staffed or is not being somewhat flexible to your needs (within reason) then move on to one who received a grant and is hiring and training more professionals. Not every clinic received a grant. But all must follow the DEA, Federal, State Pharmacy and State rules and regulations according to the type of license they hold. Private companies that did not receive a grant will become more competitive, hire and train staff and find ways to attract and retain their patients; to better meet the patient's needs.

Of course the biggest attraction to a treatment program is the ease of transition due to the fear of withdrawal. Treatment varies according to the treatment program in which you enroll, and that depends on the insurance, funds you have or money you can borrow. There is, Ultra Rapid Opiate Detoxification without Anesthesia where a patient is place under light sedation and rapidly detoxed. Nothing is felt.  Naltrexone, (which is similar to naloxone) is then implanted. Once fully awake, the withdrawal symptoms are gone! Similar to naloxone, Naltrexone blocks any opiates and the implant lasts anywhere from 3-12 months. I am not sure if it takes care of cravings but that is another reason why addiction counseling is so important. It is not offered everywhere and I am not sure of the cost or insurance coverage.

There is Suboxone treatment which can be administered at a clinic or a certified physician's office along with mandatory addiction counseling or groups. With suboxone, a person MUST have very small to no opioids in their system in order to begin (NO use in 24+ hours). You must be in moderate withdrawals before you take your first suboxone dose. It is the nature of the medication. Suboxone's properties are strong, meaning that once taken, it kicks out any opioid you previously took; it kicks it out from the opioid receptor site and takes its place. The first dose of suboxone is not enough to fully fill the receptor site as much as the opioid you had in your system, therefore you are in withdrawals quite quickly. So, it is better to be in withdrawals before your first dose, and within 1-2 hours after a couple small doses of suboxone, you feel fine....normal. That "normal" state will last for 24 hours!  But. if you use 24 hours or less before your first dose of suboxone, then you will make yourself sick and won't feel better until the next day's dose of suboxone. It would work on that second day, since this second day of suboxone would be 24+ hours after your drug use and the opioids would be out of your system. It would be successful and you would feel better within minutes to an hour of that dose and remain symptom free by taking that therapeutic suboxone dose every day to every other day depending on the program. Stay off of any opioids, marijuana, benzodiazepine and alcohol and you could get take home doses and go only once a week for your addiction group and medication and live a normal life!

Methadone treatment can be started right away at a small dose and that dose is slowly increased until you feel normal. This takes some time. I discussed how methadone programs work in previous blogs.  Don't expect to suddenly stop opioids with your first methadone dose. How do you start methadone and not be in withdrawals or sedated? By being honest about your use and listening to the doctor and nurses treating you. Don't go to your admitting appointment sedated or tired looking or you might be denied or started on a smaller than normal dose, for medical safety. The unspoken rule is: Do not use after 8 pm the night before. Go to your admitting appointment in mild to moderate withdrawals. The doctor will do a physical and order your first dose of methadone which is anywhere from 20 mg to 30 mg. Will that be enough? No. But it is the only way to begin. Too large a dose at the beginning could make you sedated. It has to be done slowly. The day before your assessment and increase day (they will remind you), decrease your drug use to prepare for that increase. If you do it that way: slowly cut down your opioid use as your methadone increases, you will slowly transition to only methadone. You will have periods of withdrawal that will lessen and improve as you learn how to cut down your use and time it wisely. Listen to the nurses dispensing your dose. Talk to one with experience, then ask questions! An experienced methadone nurse can tell you exactly how to transition smoothly and can even estimate what dose will have you feeling "normal". Unfortunately, due to the long action of the medication and the potential for overdose with this medication, the rules for methadone take homes are very strict and it takes longer to earn take home medication doses.

There are other medications being trialed for alcohol and cocaine use. So far, for opioid misuse, the Naltrexone implant sounds like the smoothest transition. Hopefully they will make it affordable and more accessible in the near future.

SAFE STATIONS

I am not sure about other parts of the US or world but here in the State of New Hampshire in USA, a trend started late 2016 where EVERY Fire Station in Manchester, NH and then in Nashua, NH was designated a SAFE STATION. What does that mean? It means that at ANYTIME day or night, if a person goes to the Fire Station they would be assessed by a fire fighter. If their condition warrants medical attention right away then an ambulance is called and that person is brought to the local Emergency Department for urgent medical treatment. If the person is medically stable but needs intervention for substance misuse treatment then the local treatment center on contract is called and that person is brought directly to the treatment center. NO ARRESTS. NO LEGAL IMPLICATIONS. Any drug paraphernalia, drugs or weapons are confiscated, obviously, and handed over to the local police for disposal. NO ARRESTS for amounts that do not implicate an intent to distribute. This was one way to help the opioid crisis since the Emergency Rooms were becoming overwhelmed and unable to handle the volume of people asking for help or needing intervention. Find out where the SAFE STATIONS are near you and take advantage! It is truly one of the best ways to get someone help.

WHAT IS SUBOXONE? WHAT IS SUBUTEX? WHAT IS MAT & OBOT?

Suboxone is the name of a combination medication: buprenorphine and naloxone. I comes in different strengths. It is made into "films" that get absorbed in your cheek or tablets that get absorbed under your tongue. It is confusing to hear since when you hear naloxone, one thinks of the naloxone used to reverse opioid overdose.  It is all in the properties of each medication. When in film or tablet form AND absorbed via cheek or under tongue, the buprenorphine is the stronger of the two medications, when absorbed through the GI tract. The naloxone properties are different and it is weak in the GI tract and doesn't interfere with the buprenorphine combining with the opiate receptor site, in fact it might help it stick better. But, if misused and abused, and given nasally or IV somehow, the naloxone is stronger and prevents the buprenorphine from adhering to the opiate receptor site. The naloxone takes over the site and nothing else can enter since this med is very strong when given through nose or IV. Strange, but that is how it works in a nutshell.  That is why buprenorphine is usually given as a combination medication. To minimize abuse and prevent harm.

Subutex is a brand name for buprenorphine alone without any naloxone. It used to be that pregnant women received Subutex to minimize any chance of miscarriage. But nowadays, since it is only a danger if abused, Suboxone is often given to pregnant woman with the proper education on the chance of miscarriage if abused. Subutex might also be used for those switching from methadone to Suboxone. It makes for a smoother transition. I heard Subutex is becoming a more popular med in general for treatment but I am not certain on the actual facts. If it is true, then the only reason would be to get more people into treatment.

As I said in a previous post, suboxone is good for those with short history of opioid abuse, with the daily use not too great. If you experience cravings despite all else becoming stable then you need methadone.

Besides cravings, the biggest complaints I have heard from those who tried Suboxone Treatment is that they could not fall or stay asleep. Some complain of a constant headache. Others, it was muscle cramps in their thighs and calves. As with all narcotics constipation is the #1 complaint.

With the Opioid Crisis, Suboxone is becoming a focus point for treatment. Doctors take a course and become certified. Medication Assisted Treatment (MAT) or Office Based Opioid Treatment (OBOT) is what it is being called and you will be hearing a lot more about this. They are generally Suboxone Treatment. Some states already have many physicians participating. Physician participation does vary by state or area. All medication is given by an RN and the patient is assessed and progress monitored properly. Since it is office based, the stigma of a clinic is not there to interfere with any progress. It is a great way to help those newly addicted and a great way to get someone in treatment. As with any treatment program, there is drug testing and addiction counseling or group addiction counseling. It won't work unless you change your thinking AND your behaviors. If Suboxone doesn't work, there is methadone. Still treatment just different med for different needs. The downfall of methadone are the rules: so far, only a hospital or clinic setting may dispense methadone for addiction. I feel a change coming in the near future....

WHAT IS BUPRENORPHINE? WHAT IS METHADONE?

Buprenorphine is an "analgesic", aka pain medication, aka narcotic. It is man made from something "natural" and altered chemically to become a semi-synthetic compound. Yes it is considered a narcotic and treated as such by the DEA. It is in the "Opioid" category. When taken, this medication will merge with opioid receptor sites just as morphine, heroin or methadone does. But this med has other slightly different properties. 

Buprenorphine is a partial agonist opioid. Heroin and methadone are full agonists. I mention this since you might hear those terms, not to conduct an opioid course. Because it is a "partial agonist" Buprenorphine can give pain relief same as the other opioids but it doesn't affect your breathing as much as methadone would. It is faster and easier to get stable with this medication and when you are ready, faster and easier to detox off.  It is considered to be less addicting and with fewer side effects. It is shorter acting compared to methadone. You can't be on any benzodiazepine prescriptions (or illicit) such as xanax since it is not medically safe. You must be illicit drug free after you are stabilized or usually you get terminated. Remain illicit drug free and you get "take home" doses for several days or a week so you don't have to go everyday. Some clinics have you go every other day. Of course there is a catch: buprenorphine has what is called a "ceiling" effect. Meaning, once you reach a certain dose, taking additional doses does not give you more pain relief and it is not suppose to get you euphoric or high. Once you reach a certain level, that is it. Okay if your drug use has been 5 years or less or your daily use is not real high. For some people with substance use disorder  this works very well!  If you are taking buprenorphine and still have cravings then you need methadone. With the carfentanil, it is hard to judge if this treatment would work well with heroin users until one tries it. Doesn't hurt to try. 

Heroin users usually need methadone; WHY? Because of the large amount of daily use and recently because of the carfentanil potency. Methadone is a full agonist. It has no ceiling effect. It gives full pain relief but take too much and you will stop breathing and die. Plainly put. It affects your breathing so anyone with a respiratory disease such as asthma or COPD must be monitored and must be very careful in taking this medication. Methadone can also affect your heart rhythm. A very high dose (> 200 mg) or a dose above 80 mg in combination with certain prescribed meds such as clonidine or seroquel can be deadly. That is why methadone clinic patients are monitored so closely. For medical safety. Methadone is dispensed by nurses only (not counselors) and you are assessed before you take that daily dose, for medical safety. Methadone has a very long half life....it lasts for days in your body until it is totally out of your system. When you take it at a methadone clinic daily, as you should, it builds up in your body to a therapeutic level and then it is maintained at that level. A therapeutic level is when you have no physical withdrawal symptoms at all AND no cravings. You almost forget that you take it because you feel "normal". Not high. Not sick. No cravings. Just live and enjoy life. When I say methadone clinic, I mean methadone for addiction NOT pain. Methadone for pain is a totally different program, different approach and different rules. 

LIST OF MEDS RECOMMENDED AND OK TO ***FLUSH***

Source is FDA.GOV so this is the official word on this subject! 
As you will see, narcotics of all kinds are on this list along with one benodiazepine:
DIAZEPAM OR VALIUM

WHY FLUSH?
In past the concern was all about the water. Now, with the opioid crisis, it was determined that it doesn't affect the water supply enough to make a difference compared to the lives SAVED by flushing all pain medications. You see, once you cross over from tolerance to dependence to addiction, you are willing to do anything to get your next fix. This includes dumpster diving and trash hunting. Nurses used to crush it and mix with kitty litter and detergent. But even this measure is not good enough. The addiction is stronger than any offense from detergent or garbage! To do this properly it is recommended to crush the tablets then flush them twice. Whether they are capsules or tablets, put them in a bag, put your boots on, and STOMP them to powder then flush them twice. If it is just a couple and you have a pill crusher or hammer then you can use that. **If it is a fentenyl patch then *PUT GLOVES ON*, TAKE THE PATCH APART AND CUT IN TINY PIECES THEN FLUSH MULTIPLE TIMES. A fentenyl patch is made to be absorbed through the skin over a period of time such as 24 hrs or more. If a child, pet or maybe even an adult were to ingest part of this patch by mouth then it would definitely be deadly! Here is the official list from fda.gov., A-Z

"Medicines Recommended for Disposal by Flushing Listed by Medicine and Active Ingredient  There is a small number of medicines that may be especially harmful and, in some cases, fatal with just one dose if they are used by someone other than the person for whom the medicine was prescribed. This list from FDA tells you what expired, unwanted, or unused medicines you should flush down the sink or toilet to help prevent danger to people and pets in the home. 
 [the one with]* These medicines have generic versions available or are only available in generic formulations.
FDA continually evaluates medicines for safety risks and will update the list as needed. Please visit the Disposal of Unused Medicines: What You Should Know page at www.fda.gov for more information.
Medicine Active Ingredient
Abstral (PDF - 1M), tablets (sublingual) Fentanyl
Actiq (PDF - 251KB), oral transmucosal lozenge * Fentanyl Citrate
Avinza (PDF - 51KB), capsules (extended release) Morphine Sulfate
Belbuca (PDF – 44KB), soluble film (buccal) Buprenorphine Hydrochloride
Buprenorphine Hydrochloride, tablets (sublingual) * Buprenorphine Hydrochloride
Buprenorphine Hydrochloride; Naloxone Hydrochloride, tablets (sublingual) *
Buprenorphine Hydrochloride; Naloxone Hydrochloride
Butrans (PDF - 388KB), transdermal patch system Buprenorphine
Daytrana (PDF - 281KB), transdermal patch system Methylphenidate
Demerol, tablets * Meperidine Hydrochloride
Demerol, oral solution * Meperidine Hydrochloride
Diastat/Diastat AcuDial, rectal gel [for disposal instructions: click on link, then go to "Label information" and view current label]
Diazepam
Dilaudid, tablets * Hydromorphone Hydrochloride
Dilaudid, oral liquid * Hydromorphone Hydrochloride
Dolophine Hydrochloride (PDF - 48KB), tablets * Methadone Hydrochloride
Duragesic (PDF - 179KB), patch (extended release) * Fentanyl
Embeda (PDF - 39KB), capsules (extended release) Morphine Sulfate; Naltrexone Hydrochloride
Exalgo (PDF - 83KB), tablets (extended release) Hydromorphone Hydrochloride
Fentora (PDF - 338KB), tablets (buccal) Fentanyl Citrate
Hysingla ER (PDF - 78KB), tablets (extended release) Hydrocodone Bitartrate
Kadian (PDF - 135KB), capsules (extended release) Morphine Sulfate
Methadone Hydrochloride, oral solution * Methadone Hydrochloride
Methadose, tablets * Methadone Hydrochloride
Morphabond (PDF – 162 KB), tablets (extended release) Morphine Sulfate
Morphine Sulfate, tablets (immediate release) * Morphine Sulfate
Morphine Sulfate (PDF - 282KB), oral solution * Morphine Sulfate
MS Contin (PDF - 433KB), tablets (extended release) * Morphine Sulfate
Nucynta ER (PDF - 38KB), tablets (extended release) Tapentadol
Onsolis (PDF - 297KB), soluble film (buccal) Fentanyl Citrate
Opana, tablets (immediate release) Oxymorphone Hydrochloride
Opana ER (PDF - 56KB), tablets (extended release) Oxymorphone Hydrochloride
Oxecta, tablets (immediate release) Oxycodone Hydrochloride
Oxycodone Hydrochloride, capsules Oxycodone Hydrochloride
Oxycodone Hydrochloride (PDF - 100KB), oral solution Oxycodone Hydrochloride
Oxycontin (PDF - 417KB), tablets (extended release) Oxycodone Hydrochloride
Percocet, tablets * Acetaminophen; Oxycodone Hydrochloride
Percodan, tablets * Aspirin; Oxycodone Hydrochloride
Suboxone (PDF - 83KB), film (sublingual) Buprenorphine Hydrochloride; Naloxone Hydrochloride
Targiniq ER (PDF - 48KB), tablets (extended release) Oxycodone Hydrochloride; Naloxone Hydrochloride
Xartemis XR (PDF - 113KB), tablets Oxycodone Hydrochloride; Acetaminophen
Xtampza ER (PDF – 67.6KB), capsules (extended release) Oxyccodone
Xyrem (PDF - 185KB), oral solution Sodium Oxybate
Zohydro ER (PDF - 90KB) capsules (extended release) Hydrocodone Bitartrate
Zubsolv (PDF - 354KB), tablets (sublingual) Buprenorphine Hydrochloride; Naloxone Hydrochloride"

What Are OPIOIDS?

First......From SAMHSA site Opioid Prevention Toolkit:

"WHAT ARE OPIOIDS?
Opioids include illicit drugs such as heroin and prescription medications used to treat pain such as morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, hydromorphone, and buprenorphine. Opioids work by binding to specific receptors in the brain, spinal cord, and gastrointestinal tract. In doing so, they minimize the body’s perception of pain. However, stimulating the opioid receptors or “reward centers” in the brain can also trigger other systems of the body, such as those responsible for regulating mood, breathing, and blood pressure. A variety of effects can occur after a person takes opioids, ranging from pleasure to nausea and vomiting, from severe allergic reactions (anaphylaxis) to overdose, in which breathing and heartbeat slow or even stop. Opioid overdose can occur when a patient misunderstands the directions for use, accidentally takes an extra dose, or deliberately misuses a prescription opioid or an illicit drug such as heroin. Also at risk is the person who takes opioid medications pre- scribed for someone else, as is the individual who combines opioids—prescribed or illicit—with alcohol, certain other medications, and even some over-the-counter products that depress breathing, heart rate, and other functions of the central nervous system5. PREVENTING OVERDOSE If you are concerned about your own use of opioids, don’t wait! Talk with the health care professional(s) who prescribed the medications for you. If you are concerned about a family member or friend, urge him or her to talk to whoever prescribed the medication. Effective treatment of opioid use disorder can reduce the risk of overdose and help a person who is misusing or addicted to opioid medications attain a healthier life. An evidence-based practice for treating opioid addiction is the use of United States Food and Drug Administration (FDA)approved medications, along with counseling and other supportive services. These services are available at SAMHSA-certified and DEAregistered opioid treatment programs (OTPs).28,29 In addition, physicians who are trained to provide treatment for opioid addiction in office-based and other settings with medications such as buprenorphine/naloxone and naltrexone may be available in your community.30
SUMMARY:
HOW TO AVOID OPIOID OVERDOSE
1. Take medicine only if it has been prescribed to you by your doctor. 2. Do not take more medicine or take it more often than instructed. 3. Call a doctor if your pain gets worse. 4. Never mix pain medicines with alcohol, sleeping pills, or any illicit substance. 5. Store your medicine in a safe place where children or pets can- not reach it. 6. Learn the signs of overdose and how to use naloxone to keep it from becoming fatal. 7. Teach your family and friends how to respond to an overdose. 8. Dispose of unused medication properly. "  see htttps://SAMHSA.gov

HOW DO YOU KNOW WHAT YOU ARE BUYIG?
 ANYTHING bought on the streets is altered. People already know not to trust the heroin they buy since it is easy to mix some powder with the heroin, work some magic and it looks the same. It is cheaper to sell so the dealer makes more profit. Well, a tablet might look like your previous prescription pill but it could be part pain med and part animal tranquilizer or something else ....cocaine, xanax, baking soda, Comet, insecticide etc...Ingredients are mixed together and placed in a mold to be the color and shape you recognize. If the tablet is without the little numbers and letters you are used to seeing then IT IS FAKE AND DO NOT TAKE! If  it usually has a line in the middle and this tablet doesn't IT IS FAKE AND DO NOT TAKE! Do not trust anyone, even your usual dealer. They don't care. This is just a job; it is an income for them. Last year the blue 1 mg tabs of xanax were being crushed and mixed with a cheap elephant tranquilizer to make more profit. These looked the same at a glance but didn't have the line etc...I am sure some addicts were harmed and some might have died. Tranquilizers for animals are manufactured according to size.....even a baby elephant is huge.... so you see the problem!

What is Naloxone?

This is an excerpt from SAMHSA's Opioid Prevention Toolkit,

*I underlined and did bold on pertinent info. After the SAMHSA paragraphs I summarize it all...

      " Opioid overdose-related deaths can be prevented when naloxone is administered in a timely manner. As a narcotic antagonist, naloxone displaces opiates from receptor sites in the brain and reverses respiratory depression that usually is the cause of overdose deaths.7 On the other hand, naloxone is not effective in treating overdoses of benzodiazepines (such as Valium®, Xanax®, or Klonopin®), barbiturates (Seconal® or Fiorinal®), clonidine, Elavil®, GHB, ketamine, or synthetics. It is also not effective in overdoses with stimulants, such as cocaine and amphetamines (including methamphetamine and Ecstasy). However, if opioids are taken in combination with other sedatives or stimulants, naloxone may be helpful. Naloxone injection has been approved by the United States Food and Drug Administration (FDA) and used for more than 40 years by emergency medical services (EMS) personnel to reverse opioid overdose and resuscitate persons who otherwise might have died in the absence of treatment.8

FACTS FOR COMMUNITY MEMBERS
Naloxone does not have the potential for abuse. It reverses the effects of opioid overdose.9 Injectable naloxone is relatively inexpensive. It typically is supplied as a kit with two syringes10 These kits require training on how to administer naloxone using a syringe. The FDA has also approved an intranasal naloxone product, called Narcan® Nasal Spray, and a naloxone auto-injector, called Evzio®. The intranasal spray is a pre-filled, needle-free device that requires no assembly. The auto-injector can deliver a dose of naloxone through clothing, if necessary, when placed on the outer thigh.  Prior to 2012, just six states had any laws that expanded access to naloxone or limited criminal liability.11 Today, 42 states and the District of Columbia have statutes that provide criminal liability protections to laypersons or first responders who administer naloxone. Thirty-nine states and the District of Columbia have statutes that provide civil liability protections to laypersons or first responders who administer naloxone. Thirty-eight states have statutes that offer criminal liability protections for prescribing or distributing naloxone. Thirty-three states have statutes that offer civil liability protections for prescribing or distributing naloxone. And 42 states have statutes that allow naloxone distribution to third parties or first responders via direct prescription or standing order.

https://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/SMA16-4742

___________________

**What it means:  Naloxone is a medication that is prescribed by a doctor. This medication has been used for many years in hospitals when needed for patients post surgery if having an unfavorable reaction to anesthesia and pain medication. These medications slow down breathing. If your breathing is not providing enough oxygen to your brain and your heart, your brain will be damaged and your heart will stop. Naloxone is a special medication that can instantly reverse this situation! Miracle med!! Before the opioid crisis, this medication was given IV in hospitals. Now, you can get a prescription for naloxone that can be given by spraying in one nostril (close the other one) or by injection *thru the clothes* eliminating precious time unclothing the person (it will even tell you what to do). 42 states allow "third parties" (such as clinics) to give out naloxone by a "standing order", which means you don't need to personally see a doctor to get it. Just show up at the appropriate clinic and ask for it. No questions. 39 states have a law in effect that protects whoever calls 911...no arrests, no searches, if you call 911 to save a life. So please, call 911 for anyone in need. Don't drop someone off at an Emergency Room! Parents, friends, get a prescription for naloxone and carry it with you. No incrimination when asking for a prescription. You CANNOT harm someone if you give it and they don't need it. It just won't do anything. No side effects. But, if they need it...you saved a life and there is no better feeling than making a difference! One thing to remember, once given during an overdose, the person might need a second dose after a 30-60 seconds if no response. Why? It is because of the super duped drugs out there....carfentanil......making the drugs more potent and deadly. That is why naloxone always comes in packages of 2. Like  I said, it can't hurt and if needed will save a life. After receiving naloxone the person will start breathing and then will be in withdrawals. So, give the spray or injection then call 911 right away! Don't wait to see how it works. They will need intervention for their drug use and this is the perfect opportunity. Plus they need a medical evaluation to ensure they do not need any other medical care. 

Personal Power

We all have personal power. Yes, we are made of energy particles therefore we are energy and energy is power. We all have the ability to use our power in amazing ways. We also have Free Will to do what we want with our energy. Have you ever "willed" yourself sick before an event you really did not want to go to...focused intensely on how happy you would feel after passing an exam...visualized yourself excelling in a sports game and actually have these happen, just as you expected? You used your personal power. What would happen if you focused on how to steal some money for the next fix....constantly lied to cover your habit...always thought about your "bad luck"? Your power would start becoming negative and sickly. Once you cross over that line and become addicted to some type of opioid, you give your personal power away to the drug 100%. The drug now controls you. You have allowed the drug to take your personal power. It starts affecting every aspect of your life because you are now the puppet. The drug has taken over your personality. You are negative, irritable and don't care about anything except your next drug use. It ruins your family life, social life, your school and/or your work. On the outside you are the same person, but on the inside you lack personal power because you gave it away. So, TAKE IT BACK! Step 1 in the 12 Steps talks about admitting you are powerless. Any disagreement there? If you are an addict then you are powerless at this time. But you CAN start heading the the direction of getting your power back 100%. It is never too late to begin this process. In order to do this you must begin at a basic level and admit that drugs have your personal power.... temporarily. At the very least, start Addiction Counseling. Maybe you need inpatient or maybe an outpatient clinic fits your needs. See an Addiction professional. They can get your input then tell you which one is best for you. Don't rely strictly on your friends and family unless they have experience and education in Addiction. There are too many myths out there. Family and friends however, can be a great support system if they are interested in becoming educated and involved with your recovery. With the right treatment, with the right professionals, with the right attitude, you CAN take back your personal power 100%. Read about "The Next Step: The Phone Call" and read about being "...nervous about going to a 12 Step Meeting" for more insight.

Nervous about going to a 12 Step Meeting?

For many, a 12 Step Meeting or even the concepts of the 12 Steps is too much to take in all at once. All you want to do is stop using! You might not want to read about the history of AA or NA. You might think all this wording is way too long and it can't hold your interest. You might think the meeting is a bunch of blah, blah, blah. The truth is that you are at the very beginning of recovery or just contemplating recovery. This means you are nervous, anxious, jittery and can hardly tolerate sitting through the meeting itself! Twelve steps will seem like a long list of chores. It is too difficult to focus at the beginning of recovery. Don't over think it! No one will expect anything out of you. If you can't sit through an entire meeting, go outside for a few minutes, then return. Maybe walk off some of that nervous energy or talk to others who are doing the same as you. Try not to smoke. Remember, no war stories! The one rule during conversations: never speak of you amount of use as if it is something to brag about. That is addictive behavior and it could trigger someone beside you to go out and use. Be kind, always.

At the meeting you will see people of all ages, races, job positions. Addiction is not prejudice. Another basic rule is anonymity. Who you see in the meeting never gets acknowledged outside of the meeting. Same with whoever sees you. It is the golden rule and all alcoholics and addicts have honored this for many, many years. If you only follow one thing, this is it. Be kind, always.

Usually at meeting there are pamphlets or books. Often someone further along in recovery will offer you their beginner's book. Don't blow it off entirely. You can get some material and save the reading for when you are at a slightly better place, when you can sit still and focus your energy. When you start some reading, you can divide it up according to your needs. A chapter at a time, a page at a time, a paragraph at a time, or a sentence at a time. No pressure. It is at your own pace. Once you are totally done with a book, pass it on to a newbie. Be kind, always.

After the meeting, the room has to be arranged the way it was before it was prepared for the meeting. The coffee percolator must be emptied and rinsed out. Volunteers are needed. If you have the time and need to use some of that nervous energy, offer to help. Be kind, always.

Congratulations if you made it to your first meeting! Good job!

IF YOU SUSPECT AN OVERDOSE.....

IF YOU SUSPECT AN OVERDOSE  

 An opioid overdose requires immediate medical attention! An essential first step is to get help from some- one with medical expertise as soon as possible.

***Call 911 immediately if you or someone you know exhibits any of the symptoms listed below.
All you have to say: 

“Someone is unresponsive and not breathing.” 
Give a clear address and/or description of your location. 

Signs of OVERDOSE, which is a life threatening emergency, include the following:

 The face is extremely pale and/or clammy to the touch.
 The body is limp.
 Fingernails or lips have a blue or purple cast.
 The person is vomiting or making gurgling noises.
 He or she cannot be awakened from sleep or is unable to speak.
 Breathing is very slow or stopped.
 The heartbeat is very slow or stopped.



Signs of OVER MEDICATION, which may progress to overdose, include:

 Unusual sleepiness or drowsiness.
 Mental confusion, slurred speech, or intoxicated behavior.
 Slow or shallow breathing.
 Extremely small “pinpoint” pupils.
 Slow heartbeat or low blood pressure.
 Difficulty in being awakened from sleep.


Info from website:

https://www.samhsa.gov/  

Article for Parents to Read: Common Ingredients Used for this Dangerous Mix

Parents: 

Read this article on AddictionBlog.Org on Purple Drank made from candy, cough medicine and prescription medications. You might have these ingredients in your medicine cabinet right now!

Kids like to experiment and these ingredients are common but dangerous when mixed together in large amounts. Even cold medicine can affect your liver and/or kidneys and cause damage! Not to mention what can happen when sedated or drowsy from taking this stuff.

http://prescription-drug.addictionblog.org/what-does-purple-drank-do-to-you-how-to-tell-someones-drinking-lean/

Talk LOUD; Don't Die

                                      Takoda the Rescue Dog Says:  Talk LOUD; Don't Die

Let's talk about
Opiate
Use and
Drug abuse

Takoda the Rescue Dog got a second chance at LIFE......YOU Might NOT......Your KIDS MIGHT NOT.......talk LOUD !!!
     with your kids, your parents and your friends!

Kids and Overdose. Alert to Parents and Kids!

Tragically, in the news, you may hear about a child getting hold of an opioid and overdosing (stopped breathing). If the child was very young, then the drug was probably was hanging around, and like kids do, they put it in their mouth or mimic what they see the adults do. If was a preteen or teenager, then most likely they overdosed because they chose to use an opioid of some kind. Once you reach a certain age, it's all about choices. Why would a preteen or teenager decide to use an opiate? The first thing that comes to mind is Peer Pressure. Their friends are doing it and they want to be part of the gang and fit in. OK for maybe one time, but there are root causes for continued opioid use. The one that comes to mind is physical pain: a football injury, cheerleader injury or a sports injury of some kind. Or it could be pain from an accident such as a car accident. So what is the other reason? Emotional pain. Any type of chronic emotional pain such as teasing at school for any reason, poor relationship with parents/siblings, childhood trauma of any kind, ....anything that a kid would consider hurtful that continues on. The kid wouldn't know what to do about it and that could lead to hopelessness. To stop the emotional pain, a kid might drink alcohol or use drugs to temporarily feel better. Dangerous, yes, but kids don't think that far into the future, especially if they are hurting in some way. Now we all have had some childhood issues at one time, but I am talking about months to maybe even years of emotional pain. To a kid that is forever. Parents, what can you do to help prevent your child from falling into this death trap? I call it LOUD. Tell your kids you want to talk LOUD. It stands for:

Let's talk about
Opiate
Use and
Drug abuse

You see, kids like to think they are fooling their parents when taking certain risks. Let your kids and teenagers know that you are AWARE and KNOWLEDGEABLE. It opens the door to drug talk. It is at that time that a kid might say how they are feeling hurt over something in their life or even alert you to the behavior of another kid or teenager. There is a 2017 phrase, "Take 5 to save lives". It is about kids supporting each other to prevent suicide. Well, the same can be done for drug abuse to help prevent overdoses! Parents, tell your kids you want to talk LOUD! Kids, band together and help each other prevent drug use and overdoses. Stay alive, Don't Die! Talk LOUD to your parents! Talk LOUD to your friends! 

My Friends Keep Calling and Stopping By Even Though They Know I Started Recovery!

You will hear about how "friends don't tempt friends when they start a recovery program". Just think about it.....those friends are addicts too! Don't get angry. Addiction likes company. No matter how much a friend wishes you the best in recovery, the addict in them can't leave you alone. If you truly believe that your addiction is a disease then you must believe the friends knocking at your door have a disease also. But, the fact is, you must do what is best for YOURSELF, or recovery will not work for you. You can offer support while they seek treatment but don't put yourself in the position where they are using in your presence. Even if you don't participate in the drug use, the temptation will seep into your brain. You might start dreaming of using or have severe cravings when you are really stressed about something in your life. It will spiral down from there. So don't go there. If a friend is not ready to seek treatment then just let them know that you will be there when they decide to take that first step. Tell your friend that until that happens, they must stay away from you, out of respect of the friendship. No phone calls, no visits. This is the best approach with friends. Anyone else who is not a friend you can just say no and go away! If a person continues to bother you despite your request, say what you must to discourage them. This is your life and you want to live!

Can I die from withdrawal symptoms if they are bad enough? What can I do for withdrawals?

You will not die from the symptoms of opioid withdrawal, no matter how bad they are. You will feel like you are dying and others looking at you might agree. You will not die, but there is no doubt you are suffering :(     What can happen medically is severe dehydration from the sweating, vomiting and diarrhea. Being badly dehydrated is a feeling of extreme weakness, pale skin, sunken eyes, cracked dry lips, possibly even dizziness. If the person cannot drink a large amount of water and Gatorade or Powerade, then go to an Urgent Care for IV fluids to rehydrate. In a dehydrated state you are at risk for injury from a fall due to weakness. How many of us had a real bad flu and nearly fell in the bathroom from feeling weak and dizzy? Be safe.....getting hydrated is necessary whether it is from drinking lots of fluids or getting IV fluids. Always have some Gatorade or Powerade in addition to water and IV fluids to replenish your electrolytes. It will help bring back your strength. Over the counter products can help with other withdrawal symptoms such as Immodium for diarrhea, I would avoid Kaopectate and Pepto Bismol since it contains a substance similar to aspirin and anyone ages 12-18 should not take aspirin since there is a chance it can cause a disease called Reyes Syndrome (serious/ fatal disease) if conditions are right. Imodium takes a little time to work so take it at the first signs of diarrhea. If you are pregnant, go to the Emergency Room since you don't want to risk taking any medication, and dehydration when pregnant is much more serious! For muscle cramps take ibuprofen or naproxen but don't exceed the max dose recommended or you can damage your kidneys. I would avoid acetaminophen unless you are absolutely sure you do not have Hepatitis C Antibody; it might overload your liver. Over the counter magnesium supplements also may help muscle cramping if taken according to directions and you do not exceed the recommended dose. Need some sleep? Only at night, use generic benadryl (diphenhydramine) 2 caps and try some melantonin: anywhere from 3mg - 5 mg any brand, or a 10 mg time release tab by Natrol. Melantonin is a hormone your own body makes which regulates the wake-sleep cycle. Taking a supplement helps some people with sleep disturbances get a decent night's sleep. If you end up going to Urgent Care it is best to have someone with you who knows about why you are in this condition. If ER staff suspect you are in withdrawals then whoever is with you might find out. If the Emergency Room takes blood...if they draw any blood they might do some drug testing......if they get a urine sample they might do some drug testing.....that is all I will say on that. If you are drug tested in any way and you are on probation then your probation officer might find out and have concrete evidence against you. Be wise. Go for IV fluids and don't ask for any narcotics or benzodiazepines (like xanax or ativan) and you should be treated well, be rehydrated, & released. Simple as that.

The Intake Appointment Final Part 3

You did the business in Part 1. Saw the Addiction Counselor in Part 2. Now the last part is seeing the nurse. It is usually the Nurse Manager, Charge RN or seasoned staff RN who interviews you in this last stretch of the Intake appointment. All this is in preparation to see the doctor for your first medication dose. If you have any prescription medications that ARE PRESCRIBED TO YOU then bring them in for the nurse to log into your chart. Don't bring old bottles from last year and don't dump the new prescription pills into an old prescription bottle to condense it. The nurse needs current prescriptions in the current bottles, if possible. Please don't try to deceive the nurse and bring only some of your medications. Believe me, a nurse just knows! If you doctor shopped, say so. A history of doctor shopping or fraudulent prescription writing will NOT get you rejected from being admitted into the program. This is why you are here, right? Honesty is needed. By the way, programs do NOT report you to the police for such crimes. Consider it in the past. Just don't continue such behavior since it is counterproductive to your recovery and sets a bad example to other patients who are doing their best. Criminal behavior might get you kicked out if you choose to continue and get arrested. It is all about choices. Back to the nurse: the nurse will take a medical history such as diseases, injuries and surgeries. Please be sure to report any heart or respiratory issues, concerns or problems. Detox medications are serious business and the doctor needs to know of any heart or lung problems before prescribing your suboxone or methadone. It is his doctor's license on the line and he deserves to be informed. Methadone in combination with certain medical conditions and medications needs to be given with caution. Methadone and suboxone can affect your breathing and oxygen level in your blood, especially when combined with other prescription medications and medical conditions. If you have a medical history and are followed by a specialist then you will be asked to sign a "release" for that specialist. The same goes for your Primary Medical Doctor, your Psychiatrist and your Pharmacy. Why? It is coordination of medical care. Methadone and suboxone are actual prescriptions and all prescribing doctors need to know what the other doctors are prescribing, for medical safety. You might think it is overboard until something happens, some interaction of medications and medical conditions that go awry, and harms the patient in some way, including death. Most treatment centers also ask you to sign a form saying that you will tell any provider you are on methadone and you agree to use only one pharmacy. That is standard practice. After the medical history the nurse will ask about your mental health history, including asking if  you are suicidal or homicidal. Again, be honest. They are just getting the details to better serve you in your recovery process. Next step is actually seeing the doctor for admission into the recovery program of an outpatient clinic. It could be the same day or most likely it will be a few days later at the next available appointment. Again, do not come in impaired, sedated, drunk or high on anything in any way. **you must be in withdrawal when you see the doctor for admission. Enough withdrawal to make it safe to give you a low dose of methadone (or total withdrawal for suboxone). If it is methadone treatment then be in mild to moderate withdrawals and do not use after 8 pm the night before! Seriously, you might not be medicated if you use too late in the evening the night before. If it is suboxone treatement then you have to be in total withdrawals and not have any opiate of any kind for 2+ days. Sounds terrible, I know, but it is the nature of suboxone. If you do not follow the instructions that the clinic tells you, then you will be putting yourself in the worse withdrawals ever on admission day when you take your first dose of suboxone. You will do it to yourself! It is all about choices.

Recovery: The Intake Appointment Part 2

So you already gave you address, phone numbers, emergency contact, paid your fees and have been told countless of instructions and rules. Don't worry about remembering all that. You can always ask and most likely you will be reminded by both staff and other patients. The mindset of patients in recovery seems to vary according to what state or part of the USA you live. I have been told countless of times by "visiting" patients from other states how this is true. So this is straight from the patients themselves. (By the way, in NH, we are very friendly and helpful to all.)
So the Addiction Counselor is the next professional you will see after the business part. This is a long detailed meeting but it is very important! Please do NOT use right before this Intake appointment and do NOT use in the bathroom in between seeing professionals! You nod off, and you have to reschedule! You are cranked up and can't sit still, you have to reschedule! and that postpones your first medication appointment with the doctor so it is pointless. Now, we don't want you vomiting either so plan accordingly....you know what I mean. The appointment is at least 2 maybe 2 1/2 hours. When you see the Addiction Counselor you will be asked everything from the first day you ever used in your life until present day. Questions about every drug you tested including cigarettes and alcohol. Please be honest but don't embellish. No one will be impressed. They will ask about your childhood, your family, employment, legal stuff etc...all this plays a significant role in your recovery. If Uncle Brian beat you every Christmas morning, we aren't going to ask you how your Christmas was. If your friend overdosed in March, we will be on the alert for depressive behavior and possible alcohol/drug use near springtime. All the questions are for a reason. We don't like paperwork that much. A big thank you for being patient with all the questions! The last professional you will see is the nurse in The Intake appointment part 3.
.

Recovery Program: The "Intake" Appointment part 1

You made the phone call and have your first appointment. It is commonly called the "Intake" appointment. This appointment is the most important! From my experiences, this appointment is where all info on you is gathered by MULTIPLE healthcare/addiction professionals. These professionals have heard every story so don't leave out any details and please BE HONEST & precise. After all, this is YOUR life! First piece of business is getting your address and a reachable phone number such as your cell number. If you give a second phone number, please specify if it is OK to leave a message. Don't worry, no one will call you mindlessly or call to check on you. It is needed in case your counselor has the flu and has to cancel counseling, in case of fire and the place of business is in a temporary location etc....in other words, for something very important. You will also be asked for at least one emergency contact name and phone number. This is in case you have a medical emergency or injury, so someone close to you can be told. Otherwise, an emergency contact is NEVER called. Confidentiality is taken seriously. The other piece of business is the payment. Programs can't run on love and good intentions. There should be an "intake" fee or it could be called an administrative fee for the admission process. You will also be asked for the first week's payment up front. Yes, that is a big blow to someone who spends all their money, and other people's money on drugs. But it is necessary for two reasons: 1) It is common for addicts to act on impulse by being admitted to a program then not showing up or paying. It is a lot of work to admit someone into a program. It is considered a waste of time and money when this happens. Someone else who is ready for recovery could have come to that appointment. and 2) If you pay a week in advance with your money or borrowed money, you will be sure to show up that first week to get your money's worth, right? Commitment it what it is. That commitment of one week in treatment opens the door to maybe another week, maybe even another month and bingo! You are on your way to a BETTER life and loving it!

Myth: Methadone rots your teeth

FALSE. Teeth do not rot within months of starting a methadone program. It takes time, lots of time to have more than one tooth rot enough to be pulled. It is the amount of time you spent using that is the culprit. Years of not eating properly (and not taking vitamins), years of not brushing, years of not seeing a dentist for preventative cleanings will lead to tooth decay. A poor diet for an extended period of time will leave your body deficient in nutrients. Then your body start taking nutrients where it can, at the least vital place...your teeth. Once you are in recovery, you start noticing what you couldn't see or feel while you were using all those years. Your gums are sore, they might bleed easy, you have uncontrolled bad breath. You start taking care of your health and think you escaped any health issues. Then one day you bite into something and start chewing and....snafoo! A broken tooth. It is easy to blame methadone and since there is some amount of sugar in the liquid form. It might sound like a very logical blame to you. But know it takes years to do that kind of damage. Nothing you can do about it now except take care of what is, and do what you can to prevent any further damage. At the first sign (or before) of trouble with teeth or gums, make an appointment with a dentist. Don't wait until you are in pain, have an infection or break a tooth since there will be a period of waiting until an appointment is available. Worst case scenario:  having a legitimate infection with pain and going to the Emergency Room as an addict asking for an antibiotic and pain med. If they don't want to give you pain med, you suffer. If they give you pain med, you should give the med to a family member who can dispense the correct amount of tablets to you during the prescribed time frame. Until you are further along in recovery it is way too tempting to abuse the prescription. You don't want to make your situation worse, make yourself feel worse or lose any ground you gained while in recovery. If you made progress in recovery, be proud and ask someone to help you with your prescribed med!

The First Step: The Phone Call

So you don't want to tell your family or friends you have a problem with misusing substances or medication...OK. It's your life, but if you want to take that next step towards a BETTER life, then you need to talk to professionals who can help you with tackling this disease and head towards recovery. So it is a matter of making that first phone call. NOT always a  simple task!  You might feel a rush of all kinds of feelings that are very uncomfortable. Feelings you have numbed and shoved back inside of you all this time. One way to help minimize this experience is to have someone with you when you make that first call. It can be someone from a recovery group or local community service. Heck it can be a firefighter or a social worker or nurse in the local Emergency Room. All public service professionals will be willing to sit with you for a few minutes as support while you make your first phone call for help with your disease. If you have someone in your personal life with you at the time of the phone call, make sure they are stable, sober, not impaired and have your best interest at heart. FYI:  The first phone call will 1) give you basic info on the service,  2) info on insurances accepted or cash payment and either 3). make your first appointment for an Intake or put your name on a wait list. ***This phone call, entire conversation and any info given is completely confidential.  NO ONE can call and see if you called, NO ONE can check to see if you have appt or are on the wait list. NO ONE, period. Not even your mom! This is the law! A violation of this law can get a person jail time. So congratulations if you made your first phone call :)  I will talk about the first Intake appointment in another section with the word Intake in the title.

Do I have to tell anyone?

Have you ever tried to explain the mechanics of what is wrong with a car and how to fix it to someone who doesn't have a clue?  That is what you will get trying to talk addiction to friends and family who are not educated on the subject. It is a foreign language and a foreign land. Not their fault and not their problem. It's your problem and your recovery. Some family are open to the subject and if they are ....well, you are very lucky!  Not everyone is open to the subject when it comes to family. Could be pride, or maybe they are addicts/alcoholics themselves! Who wants to look in the mirror? If you don't have the support of family and/or friends then there are plenty of support groups and others in recovery you can turn to. If it's one thing I know to be true:  addicts will always accept other addicts and be there for that 2 am phone call when you really want to use. You don't have to be BFF, but some type of support is needed in recovery. Someone who understands exactly what you are going through and can listen without judging. With the opioid crisis going on there are many new hotlines, support groups, treatment centers and professionals in this field. If one doesn't suit you, there are plenty more to try.

"I'm getting clean...now what....I still have problems!"

Problems, problems, problems! You had a problem and turned to drugs/alcohol to fix it, then got addicted. You had a problem and did drugs to distract you or numb you, then got addicted. You did drugs/alcohol, you got addicted, and it caused problems in your life. Addiction ruins every aspect of your life: personal, family, social, employment, legal. It is a vicious cycle: problem....drugs, drugs....problems...back to drugs etc...Your mind makes up excuses and reasons to continue using drugs. In the old day it was called, "Stinkin Thinkin". Your mind wants to win, and your mind is strong! That's where Addiction Counseling comes in with Addiction Focused Problem Solving to break the cycle. It is a specialized approach to .....everyday shit.  You need Addiction Counselor to show you how it works. With focus and 100% effort it can be done!

HOPE

Like the Phoenix, the addict can rise from the ashes of  the old self into the new self!

Misconceptions

"I can detox myself"
If you take another person's methadone or suboxone, you buy it off the street (it is probably diluted or altered somehow). You try detox yourself slowly so you don't go into withdrawals. So, intentions are there...but....can you really do this and wean yourself completely off, and stay off ... off ANY narcotic or alcohol? NO. I know because addiction is an official disease. and even if you don't believe that, think about it: How many addicts have tried but couldn't stop on their own? or if they did, how long could they maintain that? When an addict sees how it destroys their life, they don't WANT to do it but they MUST so they don't get physically ill and can function normally at work, at home etc... and even when an addict physically weans off the drug, there is a psychological component that is not addressed. Therefore the cycle eventually starts over and continues until addressed. That is where outpatient treatment centers come in. Could be methadone or suboxone. The "medication" is an actual prescription by a certified psychiatrist. It is dispensed by Registered Nurses who are trained in Addiction. Yes, you are usually routinely drug tested to check your progress and there is Addiction Counseling. The physical addiction part is easy. It is the psychological component that a person normally cannot do on their own without guidance, monitoring and support. It is the only way to change your thoughts and behaviors long term. Remember, Addiction is a disease and needs to be treated seriously as a disease or it will come back as that awful problem and cause problems.

Recovery CAN be successful!

YES it can work!
But I have often heard these statements:
"i can't"
"I've been doing this for x years, I can't stop...recovery won't work for someone like me...it's my life".
Yes you can!
But don't expect it to happen in 1 day or 5 days. Patience is NOT a virtue of any type of addict!

**So you must PUT IT INTO PERSPECTIVE:
It took ____yrs to become addicted to opiates. It didn't happen overnight. So it will take a little time for recovery. Like something that has been out in the rain for years and has lots of rust....it takes more time to get all that rust off. But if you don't START cleaning it, it will never get clean! So, think about it, and decide what it is you want to do. Everything is a choice that YOU make. Start cleaning or let it rust some more