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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...

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!