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In the debate on the use of medically assisted treatment to combat heroin addiction



The detoxification of heroin or opioids without drugs is hell. I should know.

For many users, a full-blown retreat is often anticipated by a yawn or perhaps a runny nose, aching back, sensitive skin, or a restless leg. The tell-tale sign that heroin is abating was a slight tingling sensation to me when I urinated.

These tell-tale signals – minor annoyances in and of themselves – triggered a desperate panic: I should get heroin or a kind of opioid into my body as soon as possible, or I would experience such a terrible disease that I experience so terribly You can do almost anything to prevent this: Cold sweats, nausea, diarrhea and body aches, all mixed in with depression and anxiety that make it impossible for you to do anything other than think about how sick you are.

They are calling for opioids, not because they really want the high, but because they bring immediate relief.

Giving up heroin was my plan every night when I went to sleep. But when morning came, I rarely lasted an hour, let alone the day, before I found a way to get heroin. My first time in a detoxification facility was an hour, if that was the case. As I walked out of the house, one member of staff said something to the effect, "I do not think you would last long."

After my parents had partially moved out of town to get away from me, I would point that out their new home, five hours away, with high hopes of taking the habit and starting a new life. But after a night of no sleep cringing on the floor and writhing in a steel mixing bowl at vomiting, I would ask them for gas money to drive the 300 miles back to my place of residence and a little more money for heroin. I did this so often that my mother once said to me in frustration, "They turn up, vomit and then go back."

A "cold turkey" withdrawal is not surprisingly impossible for many. For this reason, the medical community has widely accepted the use of methadone and buprenorphine ̵

1; medically known as drug-assisted treatment (MAT) – combined with advice as the "gold standard" for the treatment of opioid addiction. As opioids themselves, these drugs reduce craving and stop withdrawal without producing significant highs, and are delivered in a controlled manner.

"Detox alone is often ineffective in people with opioid abuse," said Marlies Perez, chief advocate of substance dependence disorders at the California Department of Health Services, which estimates that this would be a realistic option for only 15 out of 100 people could.

Studies have also shown that MAT reduces the risk of overdose by 50 percent and increases a person's duration of treatment.

But even with strong evidence for MAT, there are discussions about whether MAT will be offered to people who struggle with opioids. Some states, such as California, have significantly expanded their programs: the Department of Health Care Services has 50 MAT expansion programs, including emergency rooms, hospitals, primary care facilities, prisons, courts, tribal areas, and veterans services. The state has received US $ 230 million in grants from the federal government to support this effort. But many states and communities tend to have a abstinence or belief approach and refuse to offer MAT as an option. In 2017, only about 25 percent of the treatment facilities were offered.

Just as the journey is unique to the addiction of each individual, so do different approaches for people trying to find their way. Health experts believe that they should all be on the table.

Diane Woodruff, an Arizona-based writer who became addicted to opioid medications prescribed for a bad back, described the withdrawal as follows: "If you've ever had the flu, it's like that, but sometimes 100." Woodruff experienced the disease month for five days each time until she was able to replenish her prescription for OxyContin.

Other patients described the disease as ants crawling under their skin or injecting acid into their bones. Woodruff could stop after entering the cold turkey. She used kratom and marijuana to help with detoxification.

Noah, a 30-year-old San Francisco man who asked that his last name not be used, said that MAT was a miracle therapy, adding, "It saved my life. "Noah spent five years on Suboxone, a brand-name buprenorphine and naloxone brand, around the time Fentanyl was dying with impunity. Suboxone took away his craving for heroin, but he drank alcohol for a while, injected cocaine, and consumed other drugs until he joined a sobriety community. He finally weaned MAT half a year ago.

"There is no debate that MAT works – the proof is clear," Dr. Kelly Clark, President of the American Society of Addiction Medicine. The use of opioids sometimes changes the chemistry of the brain permanently. Buprenorphine and methadone stop the withdrawal, reduce cravings and, if prescribed, block the high of other opioids. Clark added that these drugs "attenuate and reset the brain" to support the "normalization" of the individual.

In the nine years of my heroin use, I often tried to sober up: detoxification, rehabilitation, and morphine and methadone under the guidance of a health professional. For me, Suboxone has not proved the answer, although I never (under fairness) prescribed it under medical supervision. I was ambivalent and could not follow any instructions, let alone a treatment plan. I did not want to be tied to another opioid, report to a local doctor or counsel every week or every month – even if all of that could have helped me to work better. (A common criticism of methadone or buprenorphine is that it just replaces one drug with another.)

But Suboxone ultimately made me sober. One day in December 2008, I tried again to successfully detoxify heroin in my parents' home. To make things easier, I had a few tablets of Suboxone that were purchased illegally. After the body hurts and this strange feeling started to grow as I peed, the buzzing ball of fear grew in my gut, and when life seemed unbearable, I squeezed one of the Suboxone tablets and snorted mine Dresser Unknown at the time when Suboxone is crushed, a chemical is released from tampering that puts the user in complete withdrawal.

I spent the next three days in a room while my body and mind began to unravel. I hardly slept and there was plenty of diarrhea and vomiting. After the worst was over, I ran apathetically through my parents' house and did not sleep for two weeks. Then I joined a sober community and have not touched opioids for 10 years.

MAT personally was not the escape route to addiction and I have mixed feelings about these drugs. But with tens of thousands of opiate overdose deaths a year, it makes sense that people who struggle with addiction and face the fearsome retreating ghost have every opportunity.

Kaiser Health News (KHN) is a non-profit health news organization. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.


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