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....

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 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. 

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.

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.