Do you have a problem with pain medications?

If so, you are not alone. In 2010 there were reportedly as many as 2.4 million people in the US with an opioid problem1. The majority of opioids used in the US originate from a legal doctor’s prescription, written to treat pain. There are many different types of prescription opioids (eg: oxycontin, percocet, opana), but there are also “street” opioids (eg: heroin) that are not prescribed by a doctor. Opioids are commonly taken orally in pill form but are also snorted and injected intravenously for faster action.

Why is it so difficult to stop using pain pills or other opioids?

Cognitive Psychiatry, Opioid AddictionIf you have used pain pills or other opioids for extended periods of time, your body becomes dependent on the opioids. When you stop using the opioids, your body will start to go through withdrawal and you will start to feel physically sick. Normally withdrawal starts about 24-48 hours after your last opiate use and common symptoms of withdrawal are fatigue, irritability, aches or chills, diarrhea, and insomnia. Opioid withdrawal is not fatal but it can make you extremely sick for days to weeks, and you may be unable to function and home, school, or work. For many people, when they start to feel sick they start to feel desperate and will take opioids just to feel physically better and function again.

 

What is the difference between opiate dependence, abuse, and addiction?

Opioid dependence was defined by the DSM (a handbook used by mental health providers) as 3 or more of the following in 12 month period:

  • Tolerance (marked increase in amount; marked decrease in effect)
  • Characteristic withdrawal symptoms; substance taken to relieve withdrawal
  • Substance taken in larger amount and for longer period than intended
  • Persistent desire or repeated unsuccessful attempt to quit
  • Much time/activity to obtain, use, recover
  • Important social, occupational, or recreational activities given up or reduced
  • Use continues despite knowledge of adverse consequences (e.g., failure to fulfill role obligation, use when physically hazardous)

Opioid abuse was defined in the DSM as one or more in 12 month period:

  • Recurrent use resulting in failure to fulfill major role obligation at work, home or school
  • Recurrent use in physically hazardous situations
  • Recurrent substance related legal problems
  • Continued use despite persistent or recurrent social oar interpersonal problems caused or exacerbated by substance

Opioid addiction is a more complicated term. Most people use it to describe the psychological state of cravings to use opioids and the behaviors the result from opioid abuse or dependence.

While these terms are helpful to understand, it is more important to understand how your life has been affected by opioids and how you can get help with your symptoms. The current DSM-V does not distinguish between “dependence” and “abuse” but views substance problems on a spectrum of “abuse”. When you come to your first appointment, your doctor will talk with you in detail about how opioid use has affected your life and your personal treatment goals.

What are my treatment options for opioid dependence?

Buprenorphine (Suboxone, Zubsolv) is a medication prescribed by specially trained doctors who see patients in their normal office setting. This medication is a replacement therapy, meaning that the buprenorphine acts like an opioid to prevent the physical withdrawal symptoms. Buprenorphine has special properties which make it a good choice for replacement therapy; suboxone is the brand name of a medication which combines buprenorphine with naloxone to improve the safety of the medication and avoid misuse. Cognitive Psychiatry of Chapel Hill (CPCH) has doctors that are qualified to prescribe you this medication if they think it is a good choice for you. For details on how the CPCH suboxone program works, please see the information sheet below.

Methadone is another replacement opioid therapy. It is prescribed through special programs; most are prescribed at clinics which require daily attendance. CPCH does not prescribe methadone.

Naltrexone is a medication which blocks opioids so that if you use an opioid it will have no effect. This medication can be a good choice for someone who has not used opioids for a longer period of time, or for someone who has recently tapered off replacement therapy but wants to reduce their risk of relapse. Naltrexone is available in pill form or as a once-monthly shot. CPCH doctors can prescribe you the pill form or administer the shot form of this medication.

VIVITROL is a new treatment offered at CPCH which helps with opioid dependence and alcohol dependence. Here are some frequently asked questions about our program :

Am I a good candidate for VIVITROL?

You might be a good candidate for VIVITROL injections if you:

  • have been sober from opioids or alcohol but struggle with cravings
  • are recently sober from opioids and worried about impulsive opioid use
  • have been taking naltrexone pills but would like a monthly option
  • have psychological benefit from knowing you are “blocked” from opioids
  • for more information, see www.vivitrol.com

How would I schedule an appointment to discuss VIVTROL at CPCH?

The first step is to call the office at 919-636-5240 and talk to our staff. Tell them about your situation and they can help you schedule an appointment with one of our providers. At the intake appointment, your doctor will review your history to make sure VIVTROL is the right treatment option for you.

What if I have already been taking VIVITROL and need to switch doctors?

Just let our staff know that you have already been taking VIVITROL. To make sure we get your prescription on time, our admin staff may need to talk with your pharmacy and get your prior records.

If I have used opioids recently can I still start VIVITROL?

NO – you must be sober of all opioids for at least one week prior to starting VIVITROL. If you have opioids in your system and get the injection, you could have an extremely unpleasant reaction called “precipitated withdrawal”. Please be honest with your doctor about the last time you used opioids – it is very important!

Can you also prescribe medications for conditions like depression, anxiety, or ADHD?

YES – we are happy to help you with your other psychiatric needs here at CPCH.

Do you also offer counseling for substance abuse or other problems?

YES – we are happy to offer counseling, psychotherapy, CBT, motivational interviewing, or other forms of talk therapy to help you with your substance abuse or other issues.

Inpatient detoxification (detox) programs are designed to help you stop using opioids quickly in a medically supervised setting. In this program, you will stay at a hospital and you will quickly come off of opioids. You will likely have withdrawal symptoms and the staff at the detox can give you medications to help make the withdrawal less uncomfortable.

Rehabilitation (rehab) programs are often recommended after a detox program. At rehab, you live away from home and do not take any opioids. You attend groups and individual therapy sessions to try to better understand your dependence.

 

What will happen if I continue to use opioids?

loss of productivity : if you are unable to get opioids for a period of time you will have physical withdrawal which will likely make it difficult to function at home, work or school, resulting in decreased productivity

financial problems : the cost of illegal opioid use can be very high, most people we see at CPCH estimate that they spend $200-$1000 per week on opioids

physical damage : chronic opioid use puts you at risk for accidental overdose and liver damage; if you snort opioids you can damage your nose, if you inject opioids you are at risk for diseases like hepatitis, HIV, and even death due to air embolism

legal problems : it is illegal to use pain pills that are not prescribed to you, illegal use of opioids can result in fines, court dates, and jail or prison

References:

Results from the 2010 National Survey on Drug Use and Health: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011 (publication no. SMA 11-4658).

If you would like to consult with one of our psychiatrists about treatment options for opioid dependence, please give us a call at 919-636-5240 option #1 or email office@cognitive-psychiatry.com.