MedNOW Clinics has placed over ten probuphine implants to patients. Probuphine implants are used to treat opiate use disorder in patients who have been stabilized on 8 mg or less of buprenorphine for at least three months. The probuphine implant has the advantage over oral buprenorphine in that it is always at a consistent level in the body, does not require daily dosing and lasts for at least six months. According to Dr. Moore, "Our patients with the implant are doing extremely well with no side effects. The implant is very easy to insert here in the clinic. Patients tolerate the procedure well and really love the implant."
ARCH Detox has successfully implanted its first probuphine implant in a patient with opiate use disorder. It is the first such procedure done in Denver. Probuphine implants contain buprenorphine which is used to treat adults who are addicted to opioid drugs. The implant is inserted into the skin of the upper arm and remains in place for 6 months, at which time it needs to be replaced. Probuphine implants have an advantage over traditional medical treatment of opiate use disorders in that the implant is in place for six months during which time there is no need to take an oral medication. The implant offers better compliance with the treatment program and less risk of lost, stolen or mis-used oral medication.
Historically, the addictive process has gained increasing professional and public awareness as do many matters of public health and safety by the outcry of mothers. A great example of this is MADD (Mothers Against Drunk Driving) whose organization and efforts successfully challenged legislatures and courts to address the irresponsibility and illness long unrecognized in society resulting in damage, harm and fatality. The criminalization of driving under the influence of alcohol, or other substances as the legislation naturally evolved, setting the stage for mandated treatment alongside penalties determined by repetition and severity.
Prevention, intervention and treatment for drug use has followed woefully behind in those matters concerning alcohol. Drug users are clearly stigmatized as “something worse” than alcohol users, and deserving less attention due to the “moral deficiency” and waste of funds and resources implicit in that dispute. Again mothers are those who lead the charge for reform and balance in modern society. Illicit drug use and social response its corresponding irresponsibility and illness is rallying mothers whose kid’s lives have been lost or compromised by drugs. Moms United to End the War on Drugs is one of many. A recent article about them published by NPR (National Public Radio) may be found at their website (URL = http://n.pr/1S7fbAX)
Org: Moms United to End the War on Drugs.
URL to NPR Article: http://n.pr/1S7fbAX
In April 2015, Colorado passed a new law, Senate Bill 15-053, expanding access to the life-saving drug naloxone, which is used to reverse overdoses to narcotic drugs, such as certain prescription medications and heroin. As a result of the new law, a physician — or any medical professional with prescriptive authority— can write a standing order for naloxone that can be dispensed by other designated individuals (such as pharmacists and harm reduction organizations. More information can be found at Intranasal Naloxone.
Dr. Moore and his staff believe that patients suffering from opiate addiction who are untreated or who are in recovery but have a high risk of relapse should have easy access to intranasal naloxone. Our high risk patients are given a prescription for this life-saving medication and given instructions on how to use it.
There is an increasing, systemic awareness of how opiates (opium, heroin & other organic derivatives) and opioids (synthetic, similar acting pharmaceutical compounds) are being used in unhealthy ways with poor to tragic outcomes. Overdoses, from the streets to upper-margin America, mark the darkest points of this phenomena.
At the national level, the Center for Disease Control & Prevention (CDC) has recently published guidelines for prescribers of painkillers to respond to the increasing epidemic. The story (http://nyti.ms/1RnywfV) explaining rationale cites nationwide overdose rates that would still surprise most consumers and patients who appear to be more in tune with what is happening among the more educated, informed among the global community.
In my clinical collaboration with Dr. Nathaniel Moore and the Addiction Recovery Center for Healing (ARCHdetox.com) in Aurora, Colorado, he and I are exercising the voluntary prescription guidelines coming forward from the national public health community whenever they are appropriate. Guidelines such as these are made effective in practice delivery points where prescribers are philosophically open in practice and procedure such as Doctor Moore.
Two systemic venues for increasing awareness not only of the risks inherent with opiates and opioids but actions to be taken remain surprisingly small. High schools that are frequently the ‘grieving grounds’ for overdose battle to moderate and respond to all levels of illicit drug use. From the declining academic performance of high school marijuana use and conflicted disciplinary policy that expedites student expulsions to overdose, awareness has been fairly well achieved. Guidance on active response is the necessary next step.
Families are the other systemic venue requiring a combined approach. A surprising number of them also react in disbelief when they discover their sons or daughters compromised, let alone deceased, from substance use of any sort including heroin. Methamphetamine and cocaine remain frequent compatriots to heroin in the triumvirate of “real” drugs that many youngsters regard as different from marijuana. The parents and other loved ones are a system with the potential to empower kids beyond awareness into action.
I am a clinical interventionist designing and offering public “Primers” – brief talks and open discussions on illicit drug use for schools and families, respectively. Educators are hungry, ambitious to develop techniques and tactics to respond to student drug use in inclusive & proactive ways. So, too, are families who have moved from “why our kid?” to “what can we do about it?” I encourage and applaud any other clinical specialists with substance use knowledge to act in the same public health manner. It is time for the behavioral health community to fully assume its role in helping schools and families take effective action.
David Petersen, LCSW, LAC
Last month we were honored with a feature in the Denver Business Journal on our efforts in finding new ways to fight opiate addiction. To read the full feature visit the link below.
In a recently published article entitled At the Heart of the Tragedy of Addiction, Bioethicist Tadeusz Pacholcyzk* offers two valuable observations on the nature and scope of addiction’s tragic impact on individuals and families. Father Tad, as he is known, writes from a Roman Catholic, spiritual perspective. His message demonstrates what I have come to see as the core of misunderstanding and stigmatization that we face as individuals, families and a community.
“,,,radical loss of freedom lies at the heart of the tragedy of addiction. Because we are creatures of habit, the choices we make, either for good or for evil, form us in one direction or the other, so we become individuals who are either capable or incapable of choosing the good freely.” (article)
It is encouraging to hear from the pastoral realm of human service and care about the spiritually dynamic aspects of addiction and(implicitly) recovery. Where the essence of stigmatization forms, it is in judgement and condemnation for the individual’s perceived rejection of grace and abundance in health and fulfillment.
“…oh well, I am an addict or alcoholic. I therefore do not have any choice but to continue on this path…” (paraphrase)
Father Ted also quotes addicts whose recovery was initiated by intervention after their capacities to choose had diminished – in the sense that is often referred to as “progressive disease” and that a key to recovery becomes personal choice. That personal choice cannot be made, as the quoted recovering persons who are among millions or billions know, alone or in a vacuum of self-direction and self-will.
With the bioethical considerations of addiction, a contrasting set of ethical dilemma appears. Genetic predisposition, gradual decay of healthy neurotransmission in the human brain and a host of other physiopathologies can become the “excuse” to continue using, or enabling addictive use. While our increasing knowledge illuminates the professional treatment community and its patients with their families, the challenge remains to be fully human and humane, respecting the choices of persons compromised by addiction.
A bioethics of intervention brings unique ethical matters into the whole care continuum process. Medically safe detoxification, the safety & well-being of minor dependent children and even public safety are at the front of the gallery of considerations. Every domain of professional care from intervention to transitional therapeutic living requires attention with informed expertise. The bio-psycho-social (or holistic) perspective we practice and preach must include respect for the human dignity and well-being of any and all who are touched by addiction. It must also respect the right of the individual to accept or decline help for the sake of spiritual integrity.
We are now treating patients for kratom addiction and withdrawal. Like many other drugs, the use of kratom can result in cravings that then drive a person to abuse the drug over and over, even when they are suffering from adverse effects of its use. Addiction may be accompanied by loss of sexual desire, weight loss and darkening of the skin on the face and, of course, strong cravings that compel more use of the drug.
Withdrawal symptoms include muscle restlessness, aches and jerking, severe depression, weepiness, diarrhea, panic attacks, irritability, runny nose, and sudden changes of mood. These symptoms are quite similiar to those of opiates. We have a new treatment program which will manage patients through their kratom withdrawals.
Just like other addictive drugs, a person may start out intending to use this drug recreationally from time to time, but the cravings that set in after repeatedly using this drug may cause him to use it daily. Once he is addicted, he will have to go through withdrawal to get clean and sober again.
In 2012, kratom users began to be seen in Colorado emergency rooms of hospitals when they either got too much of the drug or they were going through withdrawal. Because the addictive nature of kratom may not be well known, a person may not realize that he is going through kratom withdrawal when he goes to the hospital.
Denver and Aurora based reports indicate that people running into trouble with kratom use tended to be those who were too young to buy alcohol, so they bought kratom instead.
Dr. Nathan Moore, a well-known Colorado physician, has opened the door to what he predicts will be the first of many addiction treatment centers specializing in rapid addiction detox and recovery for opiate and other harmful addictions. The new treatment center is named the Addiction Recovery Center for Healing aka ARCH Detox, and will open in Aurora, Colo., this month.
“People are dying in record numbers, both on the streets and in their homes of overdoses of prescription painkillers and heroin,” said Dr. Moore. “We need cost-effective and proven treatment options for patients employing leading edge medical protocols to help combat this escalating problem. Opiate abuse is an epidemic that is growing and will not go away.”
The opiate abuse epidemic has garnered national attention in the 2016 presidential campaign by both parties on the election trail. ARCH Detox offers an effective program that provides patients an alternative to a one-to-three month residential treatment program.
“Unfortunately, not all addicts have the luxury of being able to afford a one-to-three month residential treatment program to address their addictions,” said Dr. Moore.
Detoxification from opioid medications and heroin is not cheap. Most detoxification programs are inpatient and require intensive outpatient therapy or inpatient rehab. These programs can easily cost patients $30,000. Many of these programs are not as effective as they claim to be in treating addiction and the value for patients is not there, according to Dr. Moore. He anticipates the cost of his treatment program to be much more affordable for patients, in the $5,000 - $8,000 range, and this would include monthly visits at the Center for a year, as well as thirty visits with a psychologist.
“Our goal is to offer an affordable and effective treatment option for patients.” Dr. Moore said. “This is entirely possible, and we are committed to help with this statewide and national epidemic of opioid abuse.”
Dr. Moore has developed his own proprietary protocol, the “ARCH Detoxification Protocol,” based, in part, on substantial research from his alma mater, Duke University School of Medicine. The ARCH Detoxification Protocol is designed to minimize withdrawal symptoms while flushing opioid drugs out of the patient’s body. The ARCH Detoxification Protocol can be accomplished in an outpatient setting and employs a novel approach with established detoxification medications in a unique manner designed to wean the patient off any opioid drug over a few days. Dr. Moore reports positive results from his ARCH Detoxification Protocol thus far. “Our patients are indicating that they will never go back to opiate abuse. As long as they stick to the protocol, they will do well, ” he said.
“For our patients struggling with opiate addiction, what we’re able to do is get them completely off the addictive substance within a week or with almost zero side-effects. Once the patient is detoxified from their usual opioid drug, our program has hand-selected clinical psychologists who will continue to treat patients with addiction problems to continue in the recovery process.” Moore said, “The recovery component cannot be discounted and is the most important aspect of freeing a patient from addiction. Our program focuses on the individual, and his or her personal history of helplessness, which is what leads many individuals to turn to drugs in the first place.”
Dr. Moore, a member of ASAM, the American Society of Addiction Medicine, became certified to prescribe Suboxone, a synthetic opiate used to treat painkiller and heroin addiction, many years ago after he noticed numerous patients becoming dependent upon opioid painkillers. “I couldn't keep prescribing painkillers to them in good conscience,” he says. “After starting Suboxone, most of my patients come back to see me in tears, saying they have their life back.” Dr. Moore is convinced that there is more that can be done to treat patients that are victimized by this addiction epidemic.
In 2007, Dr. Moore was a recipient of the Ernst & Young Entrepreneur of the Year Award, which he received for the successful launch of his nine-location urgent care and family medicine business, Rocky Mountain Urgent Care and Family Medicine, which he sold in 2013. Dr. Moore was a pioneer in starting the now prolific urgent care industry. Dr. Moore currently is the owner of MedNOW Clinics with two locations in Denver and Aurora. ARCH Detox is a new business venture that will operate separately from his MedNOW Clinics. Dr. Moore expects to open a second ARCH Detox within a year and a third on the west side of town within two years.
Dr. Moore attended Stanford University, obtaining a bachelor of science in 1991, and then Duke University School of Medicine, obtaining his MD in 1995. He also attended the prestigious Woodberry Forest Boarding School in Virginia, graduating summa cum laude in the class of 1987.
Among greater Denver treatment admissions (including alcohol), prescription opioids/opiates other than heroin ranked sixth in the first halves of both 2012 and 2013. Statewide, primary admissions for prescription opioids/opiates other than heroin rose from 2.6 to 7.3 percent of total treatment admissions from 2004 through the first half of 2013. Similarly, in the Denver area, the percentage of primary prescription opioids/opiates other than heroin admissions increased from 3.3 to 6.4 percent of total admissions from 2004 through the first half of 2013. Prescription opioids/opiates other than heroin ranked second in Denver substance abuse-related hospital discharges in 2011, excluding alcohol (n=1,516; rate per 100,000 population=244); both the number and rate of discharges increased in 2012 (n=1,654; rate per 100,000=263).
In the first half of 2013, heroin ranked fourth in statewide treatment admissions (the same as in the first half of 2012) and increased to 9.1 percent of total admissions (including alcohol) from 7.6 percent in the first half of 2012. Denver area primary heroin treatment admissions also increased, from 10.9 percent of the total (including alcohol) in the first half of 2012 to 12.7 percent in the first half of 2013. This increase resulted in a change in rank for heroin from fourth in the first half of 2012 (behind alcohol, marijuana, and methamphetamine) to third in the first half of 2013 (behind alcohol and marijuana but ahead of methamphetamine).
There has been a lot of improvement when it comes to the tools that physicians have for treating opiate addiction. One of the most dependable tools is a drug called naltrexone, which reduces cravings and can make it very difficult for someone to feel the effects of opiates if they do take them. Naloxone is used to alleviate an overdose of opiates, and has saved thousands of lives as it has become more widely available. Suboxone can be an effective way to help someone coming off opiates to break the habits and behaviors associated with addiction, can prevent symptoms of withdrawal, and more. But what if there was a way to vaccinate someone from opiate use? That’s the question scientists at Scripps Research Institute in California have been asking.
So far, experiments have only been done in rats, but preliminary results are promising. Researchers start by providing rats with heroin – a lot of heroin. As much heroin as these rats would like. Then they slowly wean the rats off of it during a four week long detoxification stage, and administer a vaccine to half the rats (while providing a placebo to the other half of the rats). The vaccine literally causes the rats bodies to mount an immune system response against the heroin, attacking it as if it was a disease pathogen and fighting against it. Once heroin is reintroduced to all of the rats’ environment, those that had been provided a placebo start to partake once again. Rats that have taken the vaccine do not.
Clinical trials in humans are currently under way. Which is not to say that if you have a problem, you shouldn’t be looking for a solution that can help today – but it is an exciting proposition.