We included the results of studies on MAT and telehealth conducted during the COVID-19 pandemic, when the Drug Enforcement Agency (DEA) relaxed rules on MAT to enable people with opioid use disorder (OUD) to access MAT services in the context of the various public health safety measures implemented to slow the spread of COVID before scientists developed an effective vaccine.

To learn the details from that study, please navigate to the blog on our website and read:

New Developments in Medication-Assisted Treatment (MAT): The Role of Telehealth

The primary takeaway from that article is that MAT via telehealth works.

Patients approve, providers approve, and expanded access means more people who need treatment can get the treatment they need when they need it. Some patients and providers prefer in-person treatment, but patients who experience significant structural barriers to care benefit most from MAT via telehealth. In some cases, lifesaving treatment with MAT would be close to impossible without some provision for using telehealth in place of in-person visits, especially with regards to initiating treatment.

The Benefits of Telehealth

Before COVID, most of us knew about telehealth and/or video visits with healthcare providers. The benefits of telehealth/video consultations are obvious. While nothing is better than an in-person visit with a real human, we all recognize that, compared to in-person visits, remote visits can be:

• More efficient
• More convenient
• Less expensive

In addition, telehealth/video consultations increase access to vital care for:

• People in rural areas
• People with mobility issues
• Patients with severe health conditions
• Immunocompromised patients

Telehealth and video care works for anything that doesn’t require a lab test or a direct physical exam. Patients can access appropriate care for common physical ailments, ask providers general non-emergency questions, refill prescriptions, and participate in therapy or counseling for mental health, substance use, and/or behavioral disorders.

This article will discuss the role of telehealth and video care in one specific area: medication-assisted treatment (MAT) with buprenorphine for people diagnosed with opioid use disorder (OUD). We want to know what kind of data the DEA and other policymakers are using to decide the long-term fate of MAT

Medication-Assisted Treatment: The Most Effective Available Treatment OUD

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as:

“The use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

There are three medications for opioid use disorder (MOUD) approved by the Food and Drug Administration (FDA) for MAT: buprenorphine, methadone, and naltrexone. Research shows that treatment with MOUD for people with OUD can:

• Mitigate discomfort associated withdrawal symptoms
• Decrease cravings for opioids during withdrawal and recovery
• Block the action of opioids in the brain

Research also shows the overall benefits of MAT for people with OUD include:

• Reduced risk of overdose
• Reduced overall mortality
• Improved treatment retention, a.k.a. time-in-treatment
• Decreased illicit drug use
• Decreased criminal activity/involvement with criminal justice system
• Improvements in employment
• Improvements in relationships with family and peers

Those benefits explain why MAT is known as the gold-standard treatment for people with OUD. When people with OUD engage – and stay engaged – in MAT programs, virtually everything improves. The most important metric, however, is the fact that MAT reduces risk of overdose and death by overdose: this approach to treatment saves lives.

When COVID arrived, many SUD treatment providers worried that public health measures such as shelter-in-place orders and social distancing would have a negative impact on people in MAT programs, particularly those initiating treatment for OUD. Before COVID, federal regulations required the initiation of any MAT program – whether methadone, buprenorphine, or naltrexone – to occur in-person only. In addition, other rules required in-person counseling, therapy, and medication management.

Thankfully, however, federal authorities heard and understood the warnings issued by treatment providers, and eased restrictions around MAT for OUD. The new COVID policies significantly expanded access to care by changing rules around the use of telehealth.

Let’s take a look at those changes.

Changes to MAT and Telehealth During COVID-19

During the pandemic, federal authorities eased restrictions around MAT. We’ll focus on the changes directly related to telehealth, beginning with methadone.

Methadone

COVID-era regulations allowed clinicians to:

• Treat existing methadone patients via telehealth/video visits
• Renew prescriptions for existing patients via telehealth/ video visits
• Offer counseling and therapy via telehealth/video visits
• Initiate MAT with methadone via telehealth/video visits

Now let’s look at the changes related to buprenorphine.

Buprenorphine

COVID-era regulations allowed clinicians to:

• Initiate OUD treatment with buprenorphine via telehealth/video visits
• Continue to treat existing buprenorphine patients via telehealth/video visits
• Renew prescriptions for existing buprenorphine patients via telehealth/ video visits
• Offer MAT-related counseling, therapy, and support via telehealth/ video visits

In 2024, the pandemic is in the rear-view window. With vaccines readily available, tailored to each new strain of the virus, it’s now moving toward the status of yearly flu. It’s dangerous and even deadly for some people, but for most people, it’s now – more or less – another a respiratory illness that disrupts our lives for anywhere from a couple of day to a couple of weeks.

No fun, but no longer an acute public health crisis.

In light of this, federal regulators are in the process of reviewing the changes they made to MAT rules made during COVID. As we mention in the beginning of this article, the DEA officially made an important announcement in March 2024:

The COVID-era rules are now permanent for patients with OUD using MAT with methadone or buprenorphine in opioid treatment programs (OTPs).

However, they did not make the rules permanent for office-based opioid treatment programs, called OBOTs, where a large proportion of people with OUD engage in MAT with buprenorphine.

The people these rules impact directly – people with OUD, their families, and the providers show treat them – are now waiting to learn to know if federal regulators will make these rules permanent for OBOTs as well as OTPs, create a new set of rules for OBOTs, or decide to revert to the restrictions in place before the pandemic.

What Will Happen if We Don’t Make Rule Changes Permanent for OBOTs?

In our next article, we’ll review new research related to MAT with buprenorphine among a nationally representative sample of veterans engaged in MAT through the Veterans Administration. The research we’ll discuss addresses this question:

Among Veterans Health Administration patients receiving buprenorphine for opioid use disorder in the year following implementation of COVID-19–related telehealth policies, did patient characteristics and retention differ across treatment modalities?

Those are things providers who work in SUD treatment needs to know, because the data – and data from other studies like it – will likely shape how providers deliver MAT-associated care in the years to come.

We’ll do anything we can do to reduce the harm caused by the opioid epidemic. If the data indicate the benefits of using telehealth for MAT outweigh the risks, then we’ll advocate for leaving the new rules in place for OBOTs and look for ways we can increase the use of telehealth in our MAT programs for people with OUD.

The post Medication-Assisted Treatment (MAT) and Telehealth: What COVID-era Rules Did DEA Make Permanent? appeared first on Pinnacle Treatment Centers.

That may come as a shock to many people, who likely first heard about the opioid crisis between 2015 and 2017, a period that began when leaders at the state level – in Ohio and California, for instance – began implementing policies to reduce the harm caused by opioid addiction and overdose, and ended when former President Trump announced a nationwide strategy that followed the template created by local and state leaders.

The first phase of the crisis began in the late 1990s. Experts indicate overprescribing of opioid pain medication led to a drastic increase in opioid use disorder (OUD) – a.k.a. opioid addiction – and opioid overdose around the country.

The second phase began around 2007. Experts indicate the prescription to addiction pathway drove this phase. Many people developed OUD when using prescription opioids. Then, when prescribing practices changed, reducing access to prescription opioids, many people turned to illicit opioids such as heroin, which led to another spike in opioid overdose.

The third phase began around 2013. Experts indicate the influx of illicit fentanyl and other synthetic opioids drove this phase. Fentanyl is 50 times stronger than heroin and 100 times stronger than morphine. This extreme potency drove another spike in OUD and fatal opioid overdose.

The fourth phase – driven by the presence of fentanyl in non-opioid drugs of misuse and exacerbated by the COVID-19 pandemic – began around 2019 and continues to cause significant harm around the country today.

Phase Four: Increased Opioid Overdose Risk in Rural Areas

In the study “Geographic Trends in Opioid Overdoses in the US From 1999 to 2020” research scientists use twenty-one years of data on the opioid crisis to predict – and warn the general public – the direction the fourth phase of the crisis is likely to take.

The research team defines the goal of their work as follows:

“To inform prevention and mitigation strategies, this cross-sectional study examined trends in OOD rates in urban and rural US counties during the 4 waves.”

To that end, they took a unique perspective: they examined the crisis using geographic criteria. While most studies on the crisis focus on rates of OUD, rates of fatal and nonfatal overdose, and the results of various treatment and prevention strategies, this study focused on comparing overdose rates between urban and rural areas. The goal – as implied by the statement “to inform prevention and mitigation strategies” is to help policymakers at the local, state, and federal level anticipate where the greatest level of need will be in the upcoming months and years.

The adage preparation is prevention applies here. If we understand where the next spike in OUD and opioid overdose might occur, we can allocate resources to offer support in those specific areas before the spikes appear – and we may be able to reduce their magnitude and impact.

The Geography of the Opioid Overdose Crisis

Let’s look at how the three waves opioid crisis occurred, with respect to geography, as determined by the research team after analyzing two decades of publicly available data published by the Centers for Disease Control (CDC) in the WONDER Database.

Researchers divided data into four categories:

• Large central metro: Urban areas with over 1,000,000 residents
• Large fringe metro: Suburbs of large central metro areas
• Medium metro: Midsize cities with 250,000-999,999 residents
• Small metro: Towns in rural areas with fewer than 250,000 residents
• Micropolitan: Areas close to towns considered small metro
• Noncore: Rural areas unrelated to any metro area

Within this system and these categories, large central metro corresponds to the most urban areas, while noncore corresponds to the most rural areas.

Here’s what they found:

First Phase, Late 90s – 2007

• In this phase, noncore and large central metro areas showed the highest rates of opioid overdose (OOD)
• Rates of OOD increased most rapidly in noncore and micropolitan areas

Second Phase, 2007 – 2013

• In this phase, all areas – urban and rural – showed parallel and similar linear increases in OOD
• OOD in noncore areas was highest – and higher than all other areas – around 2010
• OOD rates in noncore areas declined from 2010-2012, but increased again beginning in late 2012
• Rates of OOD in large fringe metro areas – i.e. the suburbs of big cities – were higher than all other areas in 2011-2012, but increased again in late 2012

Third Phase, 2013 – 2019

• In this phase, OOD rates in noncore areas remained relatively stable
• Between 2016-2017, OOD rates in large central metro and large fringe metro areas were higher than all other areas.
• OOD rates in all areas dropped between late 2017 and early 2018, but began to increase again in late 2019 and early 2020

Fourth Phase, 2019 – Present

The two years of available data for the report indicate that rates of OOD increased across all geographic areas between 2019 and 2020. The greatest acceleration of OOD rates in noncore areas, followed by medium metro, small metro, and micropolitan areas. Areas classified as large fringe metro showed the slowest increases in this phase of the crisis.

Data from the Centers for Disease Control (CDC) show an increase in overdose fatalities between 2020 and 2022, with noncore areas showing the largest increases. Between 2022 and 2023, total overdose rates decreased nationwide for the first time since 2018. However, with regards to rural areas, results varied. Some rural states reported significant decreases, while other rural states reported significant increases. To learn in-depth details on the state-by-state increases and decreases in, please read  this CDC report, published in May 2024.

How This Research Helps

This research tells us that we need to target our prevention and treatment efforts in rural areas – noncore areas, according to the classification system in the study we discuss – and that we need to target those prevention and treatment effort to the population in most need.

Here’s how Dr. Lori Post of Northwestern University, a lead author on the study interviewed in the online magazine Science Daily, views the data:

“I’m sounding the alarm because, for the first time, there is a convergence and escalation of acceleration rates for every type of rural and urban county. Not only is the death rate from an opioid at an all-time high, but the acceleration of that death rate signals explosive exponential growth that is even larger than an already historic high.”

In both rural and urban areas, that means increasing access to care, increasing harm reduction programs such as mobile medication-assisted treatment (MAT) units, needle exchange programs, Narcan training and distribution programs, and MAT programs in rural community clinics and health centers.

Evidence shows that harm reduction strategies can reduce rated of relapse, overdose, and death related to opioid use and misuse. If we follow the data and expand our level of commitment and support for the people with OUD in rural and urban areas, we can save lives in the years to come

The post Does Geographical Location Increase Risk of Opioid Overdose? appeared first on Pinnacle Treatment Centers.

Addiction treatment experts from the National Institutes of Health (NIH) discuss the history and development of buprenorphine, and its relevance to us, today, as follows:

“The discovery of buprenorphine in 1966 revolutionized care for opioid use disorder. US government and private industry partnership led to buprenorphine-based medications. Confronting barriers to use these medications is critical to address the opioid crisis.”

Buprenorphine is a core component in an approach to opioid addiction treatment called harm reduction. It’s a primary medication used in medication-assisted treatment (MAT), which is considered the gold-standard treatment for opioid addiction, also known as opioid use disorder (OUD).

When the FDA approved buprenorphine, it joined another medication – methadone – approved for treating opioid use disorder. However, because of a higher risk of diversion for illicit use, federal restrictions around methadone made access difficult. In some cases, these rules prevented people who needed treatment from getting the treatment they needed. Upon approval, the federal government placed fewer restrictions around buprenorphine than around methadone for two reasons:

1. It’s a partial opioid agonist, as opposed to a full opioid agonist – like methadone – which means it creates almost no euphoric effect, thereby decreasing risk of diversion.
2. Pharmaceutical companies designed buprenorphine in specific formulations that precipitate withdrawal when altered from their original form and injected intravenously, i.e. diverted from as directed uses to illicit

Here’s how FDA commissioner, Dr. Robert Califf, describes the approval of this new buprenorphine treatment option, called Brixadi:

“Buprenorphine is an important treatment option for opioid use disorder. Today’s approval expands dosing options and provides people with opioid use disorder a greater opportunity to sustain long-term recovery.”

We’ll now discuss what’s new about Brixadi, and why it makes a difference for people seeking evidence -based treatment for opioid use disorder (OUD).

Reducing Barriers to Care: Harm Reduction and New Buprenorphine Treatment Option

Evidence shows medication-assisted treatment (MAT) with methadone, buprenorphine, and/or naltrexone can significantly improve treatment outcomes for people with opioid use disorder (OUD). People on MAT experience:

• Decreased opioid use
• Decreased overdose fatality
• Increased time-in-treatment
• Improved social and family function
• Improved work and school function
• Reduced relapse rates
• Reduced criminal behavior

That’s why it’s called the gold standard treatment for OUD. It works better than anything else we know about. However, as we mention above, there’s risk of diversion for illicit purposes. That’s why both methadone and buprenorphine treatment are highly regulated, with rules around buprenorphine less restrictive than around methadone.

Before COVID, many of the rules around MAT involved who could prescribe and dispense medication, how treatment initiation could occur, how patients could access medication, and how often patients had to show up in person to either receive medication, engage in counseling and therapy, and submit samples for drug testing.

Because of the various public health measures adopted in 2020 to stop the spread of COVID, the federal government temporarily changed the rules so that at-risk patients with OUD could either initiate or continue MAT without increasing risk of contracting COVID. These new rules also protected health care workers from unnecessary exposure to COVID.

To learn about the changes instituted during 2020, please navigate to the blog section of our website and read this article:

The Mainstreaming Addiction Treatment (MAT) Act: Will We Keep COVID-Era Changes?

The new medication, Brixadi, addresses one of the most difficult problems to overcome, with regards to MAT: the balance between realistic expectations for what we require of people on MAT and the risk of diversion. Before COVID, rules restricted refills and the amount of medication a person could receive at a time. Here’s how Brixadi makes some of those rules obsolete.

Brixadi: New Buprenorphine Treatment for Opioid Addiction

• It’s an extended-release medication, which reduces barriers to care by mitigating access problems such as:
  • Transportation to office visits
  • Getting time off work for office visits
  • Arranging childcare during office visits
• Various weekly doses can accommodate the severity of the OUD, and help patients who don’t tolerate the higher doses of extended-release buprenorphine currently available. Weekly doses or Brixadi include:
  • 8 mg, 16 mg, 24 mg, and 32 mg
• Various monthly doses also accommodate the severity of OUD and help patients who don’t tolerate high doses of extended-release buprenorphine currently available. Monthly doses of Brixadi include:
  • 64 mg, 96 mg, and 128 mg.

The weekly doses are designed to promote treatment adherence for people new to MAT who need a period of stability on the medication. The monthly doses are designed for people who are already stable on MAT, participating in treatment, and at lower risk of relapse, diversion, or other adverse events associated with MAT.

MAT, Counseling, Therapy, and Patient-Centered Treatment

Reducing barriers to care is a priority in the FDA Overdose Prevention Framework. One issue treatment professionals and regulatory officials have gone back and forth about is the role of counseling and therapy for patients on MAT.

To be clear, MAT is about more than medication. It’s about a whole-person approach to recovery that includes medication, therapy, counseling, and peer support. Counseling and therapy are required for participation in MAT. However, for some patients, two things make participating in counseling and therapy difficult for people on MAT:

1. The in-person requirement for therapy sessions can prevent people without transportation from attending all sessions.
2. Early in recovery, some patients are simply trying to get through the day, and are not in a physical, psychological, or emotional condition where participating in counseling or therapy would be beneficial or possible.

Previously, the inability to participate in therapy or counseling sessions was perceived as a requirement for initiating MAT. In a letter accompanying the approval or Brixadi, federal officials addressed this interpretation of the current regulations:

“This letter serves to clarify the importance of counseling and other services as part of a comprehensive treatment plan, but to also reiterate that the provision of medication should not be made contingent upon participation in such services.”

With regards to counseling and therapy, federal regulators indicate that assessing each individual to identify their current and accurate stage of change is what should determine participation in counseling and therapy, rather than a blanket, one-size-fits-all rule applied upon initiation of treatment.

Some patients are ready to engage in therapy and counseling immediately. Others are better served engaging in therapy and counseling after they make progress in treatment and achieve stability on their medication. These decisions should be the result of a shared decision-making process that includes the patient and the provider.

Treatment With MAT Saves Lives

It’s clear – as indicated in the letter above – that opioid use disorder is often accompanied by serious and complex psychological and social issues that medication cannot resolve on its own. That’s why it’s essential to offer these supports when appropriate, which means when they have the best chance of increasing overall treatment success.

At the same time, MAT – without concurrent therapy or counseling – reduces risk of relapse and reduces rates of fatal overdose.

In other words, it saves lives.

That’s why federal regulators clarified their stance. Evidence shows a combination of medication and therapy leads to the best possible overall outcomes. Evidence also shows that patients can benefit from buprenorphine treatment when counseling/therapy is not available right away. Therefore, in the words of the current Assistant Secretary for Mental Health and Substance Use at the Substance Abuse and Mental Health Services Administration (SAMHSA):

“OUD…treatment…can begin with stabilization on medication.”

That’s the guidance from the very top of our federal regulatory system. We think it’s entirely logical, and aligns with our vision of both harm reduction and integrated, person-first treatment.

The post Is There a New Type of Buprenorphine Treatment for Opioid Addiction? appeared first on Pinnacle Treatment Centers.

One Pill Can Kill

While that statement from the DEA appears, at first blush, like an exaggeration designed to scare people away from fentanyl and illegal drugs in general, it is absolutely not an exaggeration. Yes, it’s meant to scare people away from fentanyl, and for good reason: one pill really can kill.

Why?

Here are the facts on the drug. According to the DEA, fentanyl is:

• 50 times more powerful than heroin
• 100 times more powerful than morphine
• Strong enough to cause death with a dose only 2 milligrams (mg)

To put that last bullet point into perspective, consider these facts:

• A pinch of salt contains 150-300 mg
• 2 mg of fentanyl looks roughly like a sprinkle of powdered sugar
• 2 mg of fentanyl takes up less space than the exposed lead at the end of a pencil

In addition, the DEA warns people that international drug traffickers use illegal pills to manufacture millions off counterfeit pills every year, then distribute the pills to street-level dealers, who sell them as real – but diverted – prescription medication. Traffickers design the pills to look like common medications such as Adderall, Xanax, Vicodin, Percocet, Oxycontin, and various other prescription medications, and sell them both in person and through online sources which makes them easily accessible to anyone with an internet connection.

To learn more about fentanyl from the Centers for Disease Control (CDC) and the DEA, please download these fact sheets:

CDC Fentanyl Fact Sheet

DEA Fentanyl Fact Sheet

Now we’ll share new information, based on a research effort conducted in Switzerland, that offers insight about why fentanyl is so dangerous.

Fentanyl Acts on More Areas of the Brain Than Previously Thought

The fundamental brain processes that lead to the disordered use of substances, such as alcohol use disorder (AUD) or opioid use disorder (OUD) involve what we call the reward network in our brain, also known as the mesolimbic system. Here’s how research published by the National Institutes of Health (NIH) describe the reward system:

“Reward is a natural process during which the brain associates diverse stimuli, [including] substances, situations, events, or activities with a positive or desirable outcome. This results in adjustments of an individual’s behavior, ultimately leading them to search for that particular positive stimulus.”

That’s the positive reinforcement component of the disordered use of substances. The second part of the puzzle revolves around negative reinforcement. Ingesting opioids causes euphoria. However, after an individual develops a physical dependence on a substance and then stops taking the substance, what happens is something most of us know about: withdrawal.

Withdrawal is characterized by uncomfortable physical, psychological, and emotional components. Physical aspects of withdrawal include nausea, chills, sweating, gastrointestinal pain/distress, high blood pressure, muscle/joint pain, and elevated heart rate. Psychological and emotional components of withdrawal include agitation, restlessness, intense cravings for opioids, insomnia, and anxiety.

When a person continues to take opioids to avoid experiencing withdrawal symptoms, that’s the negative reinforcement component of the disordered use of substances.

This new research offers important new information on the positive and negative reinforcement components of addiction. The study authors, in the paper “Distinct µ-Opioid Ensembles Trigger Positive and Negative Fentanyl Reinforcement,” describe the concept behind their research:

“Until now, it was thought that the mechanisms of both positive and negative reinforcements takes place in the same brain area, the mesolimbic system. Conversely, our hypothesis suggests that the origin of negative reinforcement is to be found in cells that express the mu receptor elsewhere in the brain.”

Let’s learn more about what they mean.

The Reward System and the Fear/Anxiety System

Opioid medications and illicit opioids attach to specific receptors in the nervous system in the human body, called mu opioid receptors.

These receptors are common in the mesolimbic system, specifically in the ventral tegmental area (VTA). Researchers know receptors in this area are related to positive reinforcement, because when they eliminated those cells in lab animals, the animals no longer sought opioids in behavioral experiments.

The research team identified a group of brain cells in another brain region, the central amygdala (CeA), that also express mu opioid receptors. This was new information for neuroscientists. What they learned next was more important than that discovery, though. When they eliminated those cells in the CeA in lab animals, the animals no longer showed symptoms of opioid withdrawal in behavioral experiments.

Why is that an important discovery, and how does that help us understand why fentanyl is so dangerous?

Because the central amygdala is the brain area associated with feelings of anxiety and fear.

Therefore, fentanyl – and other opioids – carry a one-two punch that we previously didn’t understand completely. Positive reinforcement originates in the VTA, and negative reinforcement originates in the CeA. We can now say that one reason fentanyl and opioids are so dangerous is because they act on more brain areas than we previously thought.

How Does This Help Us Help People With Fentanyl Addiction?

The current gold-standard treatment for opioid use disorder (OUD) – which includes fentanyl addiction – is medication-assisted treatment (MAT). This approach uses medications directed at mu opioid receptors in the reward system of the brain. This new research indicates that a significant driver of ongoing addiction is the fear/anxiety system in the brain. Here’s how a press release from the University of Geneva, where the research was conducted, describe the results:

“These discoveries will make it possible to refine substitution treatments and advance research into analgesics without addiction liability.”

In plain language, this new knowledge on how opioids act in the brain may help us – in years to come – develop MAT approaches with medications that target brain areas like the VTA not previously implicated in addiction or withdrawal, and help us develop new, non-opioid pain medications that are less likely to involve risk of misuse, disordered use, and addiction.

Keep an eye on this blog for any new information on this topic. As soon as we learn anything new, we’ll report it here.

The post Why is Fentanyl so Dangerous? appeared first on Pinnacle Treatment Centers.

The crisis continues, and last year we got encouraging news. 2023 was the first year we saw a decrease in overdose fatalities since 2018.

That’s a good step in the right direction, but we need to understand it in context.

The context: rates of opioid use disorder (OUD) and fatal overdose have increased dramatically over the past three decades. The COVID-19 pandemic exacerbated the overdose crisis, which has claimed over two hundred fifty thousand lives since 2019, with three quarters of those overdose fatalities attributed to opioids.

Every overdose death is tragic, and the pain experienced by friends and loved ones is foregrounded by the fact that right now, lifesaving, evidence-based treatment for opioid use disorder exists, and is available in every state in the country.

There are two primary evidence-based interventions that can reduce opioid-involved overdose deaths among patients with OUD:

• Initiation of medication-assisted treatment (MAT) with medication for opioid use disorder (MOUD) approved by the Food and Drug Administration (FDA)
• Retention in MAT program with FDA-approved medication for opioid use disorder (MOUD)

For people with OUD, data shows that current participation in MAT programs that use methadone, buprenorphine, and/or naltrexone reduces overall risk of mortality by close to 75 percent, compared to people with OUD who do not currently participate in MAT programs.

That’s why MAT, using FDA-approved medications for opioid use disorder (MOUD), is considered the gold-standard treatment for opioid use disorder. That’s also why researchers want to learn as much as possible about the factors that promote MOUD initiation and MOUD retention. Previous research shows that at least three factors predict successful treatment, reduction of mortality, and reduction of relapse.

Relapse Prevention, Medication-Assisted Treatment, and Outpatient Treatment

1. Initiating treatment within 14 days of diagnosis reduces overdose and relapse risk
2. Participating in at least two outpatient visits within 30 days of initiating treatment reduces overdose and relapse risk
3. Continuous participation in MAT program using MOUD for a minimum of six months reduces overdose and relapse risk

Treatment professionals who work with people with SUD derive those first two factors from a group of health metrics called the Health Effectiveness and Data Information Set (HEDIS), a resource the Centers for Medicare and Medicaid Services (CMS) use to gauge treatment outcomes, monitor treatment progress, and make decisions about reimbursement for various healthcare treatment services. The third factor comes from an extensive evidence base on the use of MAT for treating OUD, as described by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Those three metrics are important not only because they indicate the effectiveness of MAT for OUD  but also because payors – like CMS and private insurers – use them to make decisions about what types of treatment they’ll cover, and for how long. They’re important, but they haven’t been subject to the same type of scrutiny as the metrics used to gauge treatment success – and determine reimbursement – for non-SUD medical conditions.

Earlier this year, a group of researchers decide to fill that gap in our knowledge, and engage in a thorough review of the first two metrics on the list above.

Medication-Assisted Treatment for Opioid Use Disorder: Verifying Our Metrics

In a publication released in October 2022 called “Performance Measurement for Opioid Use Disorder Medication Treatment and Care Retention,” a group of researchers analyzed the three treatment predictors/metrics to ensure they’re accurate and contribute – in a positive way – to our nationwide efforts to mitigate the harm cause by the overdose crisis.

Here’s what they wanted to verify:

• Whether initiating treatment within two weeks of diagnosis predicted treatment outcomes
• Whether participating in at least two outpatient visits within a month of treatment initiation predicted treatment outcomes
• Among people with OUD who met the first two metrics, whether those metrics would predict participation in MAT programs for at least six months
• Among people with OUD who met the first two metrics, whether those metrics would predict participation in MAT programs for longer durations, such as 12 months or 24 months

Let’s quickly review why this research is important. First – pulling no punches, here – close to 200 people in the U.S. die of opioid overdose every day: that’s something we, as a society, need to fix. Second, evidence-based treatment with MAT can prevent relapse and overdose: that’s something we know, but can use more data to support the increased use of MAT nationwide. Third, CMS uses these metrics to make decisions or reimbursement for past care and approval of ongoing care: without access to care, individuals with OUD may not get the treatment they need.

Therefore, in order to keep people with OUD in the treatment programs that can save their lives, we need to know whether our methods for measuring and predicting treatment outcomes are valid, or need further research.

Let’s take a look at what the researchers found.

Medication-Assisted Treatment for Opioid Use Disorder: The Role of Outpatient Engagement

The first thing the researchers wanted to know was the rate of successful treatment initiation among all individuals in the study. Out of the 19,4867 patient records they analyzed, the data indicated the following:

• 16,063 – that’s 82.4% – successfully engaged in care
• 3,424 – that’s 17.6% – did not successfully engage in care

We’ll note that 82.4 percent is a good rate of engagement – and more than we expected. That’s a positive result. It indicates a majority of patients with OUD demonstrate a willingness to participate in MAT. We’ll also note that while that result is encouraging, what we really want to know is whether this level of engagement persisted for at least six months.

One more thing.

In this context, successful engagement means participants started MAT within 14 days of diagnosis and participated in at least two outpatient visits within 30 days of diagnosis.

Next, we’ll look at the key metric that we’re most curious about:

Eight out of ten individuals in the study successfully initiated treatment, but how long did they stay in treatment?

Let’s see.

Among those successfully engaging in care:

• 47% remained in care for a minimum of 6 months
  • 3% did not meet measurement criteria for successful initial engagement, but remained in care for 6 months
• 33% remained in care for a minimum of 12 months
  • 1.5% did not meet measurement criteria for successful initial engagement, but remained in care for 12 months
• 20% remained in care for a minimum of 24 months
  • 0.01% did not meet measurement criteria for successful initial engagement, but remained in care for 24 months

These results, while not inspiring, are also encouraging. They’re not inspiring because a retention rate of 47 percent is not what we want. We prefer that number to be 100 percent. However, we know that’s not realistic. We also know that when we consider relapse rates for OUD, which hover between 30 percent and 70 percent, 47 percent retention is not ideal. However, it is acceptable – and a sign of progress in our efforts to reduce the harm caused by OUD.

Did Early Engagement Predict Treatment Retention After Six Months?

The original goal of the research we discuss in this article was to confirm and validate metrics used by Medicare and Medicaid – via CMS – to determine approval and reimbursement for individuals in medication-assisted treatment programs (MAT) for opioid use disorder (OUD) using MOUD.

Based on that goal, the research effort was successful: successful treatment engagement predicted a 47 percent retention rate six months after initiation of care.

That’s what the data we share above mean. There’s something else in the numbers we should mention, though. Three percent of individuals who did not initiate MAT within two weeks of diagnosis and did not participate in at least two outpatient visits within 30 days of diagnosis, did, in fact, remain in care for at least six months. What that means is that for some people – 3 percent, at least – early engagement and participation in outpatient treatment did not predict treatment success. This subgroup stayed in treatment for six months. That means they substantially reduced their risk of relapse and overdose while in a medication-assisted treatment program, compared to people with OUD who don’t stay in treatment for at least six months.

That percentage does appear small. It’s not small, though, when you consider the big-picture numbers. In 2021, over 73,453 people died of opioid-related overdose. Three percent of 73,453 is 2,203. That means over 2,000 people – friends, siblings, parents, children – decreased their likelihood of relapse and fatal overdose. Here’s how study co-author Dr. Robin Williams describes this finding:

“This is critically meaningful and could guide intervention development to prioritize stabilization of high-risk patients early in treatment. Without early engagement, the great majority of patients will be lost to relapse and possible death.”

We agree.

We should not give up on those who don’t immediately engage, but rather, make plans to follow up with them. The results show that even if they don’t seek treatment right away, they may engage in their own way – and find their own path towards treatment success.

Outpatient Visits and Treatment Retention

There’s one more finding to report on the relationship between relapse, medication-assisted treatment, and outpatient therapy. People who did engage in treatment right away – meaning within two weeks of diagnosis of OUD, with at least two outpatient visits within one month – were twenty times more likely to stay in treatment for at least six months.

Study co-author Dr. Stephen Crystal makes this observation:

“Engagement in outpatient visits or professional services appears to be a necessary condition for adequate care retention. Monitoring this engagement may help identify and address barriers and disparities in outcomes.”

This finding is the meat and potatoes of this research. It confirms that early engagement increases likelihood of treatment retention, which does two things. First, it confirms the metrics we introduce in the beginning of this article as valid. Second, it teaches us that we need to redouble our efforts to get people diagnosed with OUD into treatment as soon as possible. Early engagement means longer retention. Longer retention means reduced risk relapse. Reduced risk of relapse means reduced risk of mortality for patients in medication-assisted treatment programs.

In short, what this study tells us is something we tell almost anyone who reaches out to us for support. Tthe sooner a person with OUD initiates evidence-based treatment for OUD, the more likely they are to experience treatment success. Or, in other words, early engagement in MAT treatment and outpatient support can save lives.

That’s something anyone with OUD, or anyone with a friend, family member, or loved one with OUD should know. If you read this article – and know someone who needs help – we encourage you to share this information with them as soon as possible.

The post Does Outpatient Treatment Reduce Risk of Relapse for People on Medication-Assisted Treatment? appeared first on Pinnacle Treatment Centers.

• Opioids, including:
  • Heroin
  • Fentanyl
  • Prescription opioids
• Depressants, including:
  • Alcohol
  • Benzodiazepines
  • Other sedatives
• Psychoactive drugs, including:
  • Cannabis
  • MDMA
  • LSD
• Amphetamines, including:
  • Cocaine
  • Methamphetamine
  • Adderall

Some of those substances belong to more than one category, but they all have one thing in common: they’re associated with a risk of misuse that can escalate to disordered use. Many of our patients meet the clinical criteria for opioid use disorder (OUD), specifically, which is a significant threat to public health in the U.S. right now.

To learn more about this public health threat, known as The Opioid Crisis, please navigate to the blog section of our website and read these articles:

The Opioid Crisis: A New National Strategy

The Opioid Crisis: What is Harm Reduction?

Opioid Crisis: Update on Settlements with Opioid Manufacturers, Distributors, and Retailers

Those articles will give you a good overview of the opioid crisis, where we are now, and where we’re headed. This article will discuss the gold-standard treatment for OUD, medication-assisted treatment, or MAT, which we mention above. When an intake assessment indicates a new patient can benefit from MAT, we offer treatment with MAT with one of the three medications for opioid use disorder (MOUD): buprenorphine, methadone, or Naltrexone.

What is Medication-Assisted Treatment?

In simple terms, medication-assisted treatment is a type of substance use disorder treatment that includes medication as a primary component at some point during the treatment process. MAT can be short-term, used only during the detoxification phase of treatment, as a transition that prepares patients for recovery without medication, or in some cases, as a core component of a long-term recovery plan.

The way MAT is used depends on the individual, the substance of misuse or disordered use, and the goals for treatment as determined by each patient, in collaboration with their treatment team. The type of MAT we discuss in this article is long-term MAT for people with opioid use disorder using the medication buprenorphine.

Before we continue, we’ll share the definition of MAT as published by the Substance Abuse and Mental Health Services Administration (SAMHSA), because two parts of their definition are important to the our discussion:

“Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Medications used in MAT are approved by the Food and Drug Administration (FDA) and MAT programs are clinically driven and tailored to meet each patient’s needs.”

The two parts of this SAMHSA definition relevant to our discussion are in combination with counseling and behavioral therapies and programs are clinically driven and tailored to meet each patient’s needs. They’re important because evidence shows that time-in-treatment – especially MAT program with buprenorphine – has a direct impact on treatment outcomes.

More time-in-treatment typically leads to more favorable outcomes than less time-in-treatment. Tailoring the type and amount of therapy is similar: more immersive therapy and counseling typically lead to more favorable outcomes than less time in treatment.

However, there’s not a wide base of evidence that examines how these components interact in the context of MAT with buprenorphine. That’s why a study published in the Journal of Substance Abuse Treatment in March 2022 got our attention.

The Effect of Therapy on Treatment Adherence: About the Study

The paper “Psychosocial And Behavioral Therapy in Conjunction With Medication For Opioid Use Disorder: Patterns, Predictors, and Association With Buprenorphine Treatment Outcome” fills a void in research on the interaction between psychosocial/behavioral therapy and time-in-treatment for people with OUD in MAT programs with buprenorphine.

Here’s how the research team describes the situation, and the need for their work:

“Current evidence indicates that buprenorphine is a highly effective treatment for opioid use disorder (OUD), though premature medication discontinuation is common. Research on concurrent psychosocial and behavioral therapy services and related outcomes is limited.”

Translation: the research team recognized a need to add to our knowledge about whether therapy – psychotherapy or behavioral therapy – affected time-in-treatment and overall treatment outcomes for people in buprenorphine-based MAT programs. To explore this topic, the research team defined three clear goals for the study. They sought to:

1. Define patterns of psychosocial and behavioral therapy services patients in MAT programs for OUD received in the first 6 months after initiating treatment with buprenorphine
2. Identify the characteristics associated with the patterns defined in goal #1
3. Examine common patterns of buprenorphine treatment, with a focus on the relationship between behavioral and psychosocial therapy and treatment duration

The overall idea here is that the more we know about the factors that keep people in treatment, the better providers can tailor treatment plans to emphasize those factors and improve outcomes.

Let’s take a look at the results.

Did Therapy Increase Time-in-Treatment for Patients on MAT?

After collecting claim information on 61,076 patients 18-64 years old using the database Marketscan Multistate Medicaid Database and applying advanced statistical analysis to the data, researchers reported several findings that confirmed what many treatment professionals know from firsthand experience, with outcomes in one group that were surprising.

Here’s what they found.

Treatment Trajectories, Treatment Adherence, and The Effect of Therapy in MAT

Patients in MAT programs followed three primary trajectories:

• No therapy: 73.8%
• Low-intensity therapy: 17.2%
• High-intensity therapy: 9.0%

Patient characteristics associated with the three trajectories:

• No therapy:
  • Records showed patients in this group had fewer co-occurring mental health disorders
  • Records showed patients in this group had fewer previous claims for overdose-related services
• Low-intensity therapy:
  • Records indicated presence of higher rates of co-occurring disorders in this group, compared to the no therapy group
  • Records indicated a higher rate of claims for overdose-related health services in this group, compared to the no therapy group
• High-intensity therapy:
  • Records indicated higher rates of co-occurring disorders for this group, compared to patients in the no therapy group
    • Records indicated higher rates of claims for overdose-related health services for this group, compared to patients in the no therapy group

Effect on treatment adherence, a.k.a. time-in-treatment:

• Patients who did not engage in therapy had the highest risk of discontinuing treatment before six months
• Among patients who engaged in therapy, those in the low-intensity group showed the lowest risk of discontinuing treatment before six months
• Patients in the high-intensity group showed higher risk of discontinuing treatment than patients in the low-intensity group

Other relevant findings:

• Patients in the high-intensity group showed:
  • Increased risk of opioid-related health care events during treatment
  • Increased risk of opioid overdose during treatment
• Patients in both therapy groups – low- and high-intensity – showed higher rates of polysubstance misuse, including cannabis and stimulants

As we mention above, those results confirm what most treatment professionals know and understand: therapy increases likelihood of treatment retention for people in buprenorphine-based MAT programs.

The Results: Unexpected Outcomes in One Group of Patients

Specifically, we should talk about the results related to patients in the high-intensity therapy group.

These patients had a higher risk of discontinuing treatment, higher risk of opioid-related medical problems during treatment, and higher risk of opioid overdose during treatment. These phenomena are related to another component of the data: the increased prevalence of co-occurring mental health disorders and polysubstance misuse among patients in the high-intensity group. What this data tells us is that patients with this specific array of disorders – OUD, co-occurring mental health disorders, and polysubstance misuse – are at increased risk of adverse events during the course of their MAT program, and therefore may benefit from intentional, targeted therapy and support that follows the integrated treatment model.

That’s important for researchers and treatment professionals to know. For researchers, it can inform future avenues of research. For treatment professionals, it can help tailor treatment programs to meet the specific needs of these high-risk patients. And finally, it reiterates the importance of including counseling, therapy, and other emotional or psychosocial supports for patients with OUD and co-occurring disorders in MAT programs.

The post Mental Health Month: Does Therapy Increase Time in Treatment for People with OUD on MAT? appeared first on Pinnacle Treatment Centers.

I am humbled to have run an organization that is able to help people return to healthy living. Our work is our calling.

We are based in New Jersey and operate in Indiana, Kentucky, Virginia, New Jersey, Ohio, Pennsylvania, North Carolina, Georgia, and California. We are a full continuum of care with 140+ locations and treat 35,000 people daily. This includes residential, outpatient, and transitional living. We believe that people need to enter treatment on their own terms and to a program that accommodates their own life challenges.

Importantly, we also know that treatment must work from the inside out. This means addressing individuals’ emotional, spiritual, physical, and psychological needs. People become healthy once they embrace treatment and are in the care of nurturing and healing professionals. We are that team.

Much is said about addiction these days. It is one of the biggest topics in the media. For us, it is straightforward – addiction is a disease that is afflicting people, families, and communities across America. It does not discriminate. The people we see are black, white, wealthy, poor, educated, struggling, family members, older and young. We see people who simply need vital care. They are people like you and me.

It is our mission to get folks into treatment and to stem the tide on this disease. Where there is treatment, there is hope.

The post Addiction Treatment: Hope as told by Joe Pritchard, former CEO appeared first on Pinnacle Treatment Centers.

The opioid overdose epidemic crisis has claimed over a million lives nationwide since 1999. It’s impacted people from all walks of life. If you live in Brick, NJ, you or someone you love may have experienced the negative effects of the opioid crisis firsthand. The latest statistics – which we’ll share below – show an increase in overdose deaths between 2018 and 2021 in Ocean County, where we own and operate the following methadone clinic:

Ocean Monmouth Care

This increase in overdose fatalities in Ocean County between 2018 and 2021 was followed by a decrease between 2022 and 2023, after the state government expanded funding for treatment services. That’s the primary reason why people in Brick, New Jersey should know that professional support with methadone is available: it works, and it’s close to home.

About Methadone Clinics

In the U.S., treatment for opioid use disorder with methadone occurs at Opioid Treatment Programs (OTPs) that meet the standards created and enforced by the Food and Drug Administration (FDA) and the Drug Enforcement Agency.

Opioid Treatment Programs (OTPs) provide medication assisted treatment (MAT) with a medications for opioid use disorder (MOUD) called methadone. In New Jersey, we offer MAT with MOUD at several locations across the state, including Ocean Monmouth Care, which we mention above. To learn about all of our treatment locations in New Jersey, please visit our New Jersey locations page:

Our Locations: New Jersey

Pinnacle Treatment Centers in Brick, NJ

Our Opioid Treatment Program (OTP) Brick, NJ, provides medication-assisted treatment (MAT) with methadone for patients diagnosed with opioid use disorder, which includes heroin addiction and addiction to prescription pain medications that contain opioids.

Why Methadone? Reducing Harm Caused by Drug Use

It’s best to answer that question by explaining the value of medication assisted treatment (MAT) for opioid use disorder (OUD). MAT for OUD is part of an overall philosophy and approach to drug addiction, drug use, and drug addiction treatment called harm reduction. For an in-depth look at harm reduction, please navigate to the blog section of our website and read this article:

The Opioid Crisis: What is Harm Reduction?

To summarize, harm reduction is an approach that focuses on treatment, support, education, and a holistic approach to recovery. Harm reduction efforts consider the whole person, incorporate knowledge of the impact of social determinants of health (SDOH) on addiction, and work to move a person toward a state of total health and wellbeing. The goal is to meet people where they are and offer them treatment where, when, and how they’ll accept it. Harm reduction is a clear move away from the War on Drugs, which focused on criminalization and incarceration. Harm reduction, in contrast, focuses on rehabilitation and reintegration, reducing stigma, and increasing knowledge and awareness about addiction and addiction treatment. The goal is to reach and help more people through empathy and compassion, as opposed to using punishment/criminality as a primary deterrent.

The Benefits of Methadone Clinics and Harm Reduction

If you don’t know about harm reduction, that’s okay – the principles make sense, and the State Government of New Jersey recognizes the immense value of harm reduction. In fact, policymakers in New Jersey passed a series of laws in 2022 that increase the availability of harm reduction services for all citizens. Jenna Mellor, Executive Director of the New Jersey Harm Reduction Coalition, describes this new legislation:

“This legislation is a game-changer for people who use drugs and people at-risk of a fatal overdose. Harm reduction is the best tool we have to end the overdose crisis, and this legislation will make sure residents in every corner of New Jersey have access to this lifesaving care. The leadership of the Murphy Administration will make New Jersey a national leader in embracing evidence-informed policies to end the overdose crisis – policies that are lifesaving for our family members, loved ones, and neighbors.”

The harm reduction approach to opioid addiction – specifically MAT with MOUD – is considered the gold standard treatment for OUD. With regards to methadone treatment at OTPs, the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates methadone treatment programs:

• Decrease amount of opioid use
• Decrease rates of fatal opioid overdose
• Reduces criminal activity
• Reduces spread of infectious disease
• Increase family, social, vocational, and academic functioning
• Increases time in treatment
• Decreases opioid-related fatalities

Treatment in an OTP is not only about medication. As part of the harm reduction approach to addiction treatment, it’s about improving life in all domains. The absence of drug use is the core of addiction treatment, of course, but helping patients rebuild their family, work, and social support network helps patients and treatment providers achieve this goal. A plan for opioid addiction treatment at  Ocean Monmouth Care will include methadone and most of the following services, depending on individual diagnosis, treatment history, and current needs:

• One-on-one therapy/counseling
• Group therapy/counseling
• Recovery lifestyle coaching:
  • Stress management
  • Healthy eating
  • Exercise/activity
• Group workshops on addiction/recovery
• Complementary support:
  • Mindfulness
  • Meditation
  • Yoga
• Community support:
  • Alcoholics Anonymous (AA)
  • Narcotics Anonymous (NA)
  • SMART Recovery
• Case management/aftercare support

We design each treatment plan to meet the needs of each individual patient. Therefore, the exact makeup of a treatment plan will vary. Each individual responds to treatment in their own way: what works for one person might not work for another. Our clinicians collaborate with patients on an ongoing basis to ensure treatment matches progress, and leads to sustained, long-term recovery.

Finding Treatment in Brick, New Jersey

If you or loved one need addiction treatment at a methadone clinic in Brick, NJ, please call us at Ocean Monmouth Care. We encourage you to find the best possible treatment center – services, location, hours of operation – for immediate needs. Call us today, or use the following resources to help you locate the best possible treatment:

• New Jersey residents: Addiction Treatment Providers -Treatment Directory Application (rutgers.edu)
• New Jersey residents without insurance: 1-844 ReachNJ.GOV at (844) 732-2465
• IME Addiction Access Center: call (844) 276-2777 for 24/7/365 referral support
• The Substance Abuse and Mental Health Services Agency (SAMHSA) online treatment locator

The Opioid Crisis: Overdose Fatalities in Ocean County

In 2001, records from the Centers for Disease Control (CDC) report a total of 19,000 people overdose fatalities in the U.S. Two decades later, in 2022, records from the CDC show almost 110,000 overdose fatalities. That’s an increase approaching 500 percent.

That’s why officials call it both a crisis and an epidemic.

In New Jersey, the state government created the New Jersey Opioid Dashboard and the NJ Cares Opioid-Related Data website to monitor the opioid crisis, and help both public and private citizens and entities track the progress of harm reduction efforts. Here’s the latest data on the opioid crisis in Ocean County, New Jersey:

Fatal Opioid Overdose: Ocean County New Jersey 2018-2023

• 2018: 219
• 2019: 204
• 2020: 245
• 2021: 242
• 2022: 186
• 2023: 168

These figures tell an important story. Before the state of New Jersey embraced the harm reduction approach in 2022, rates of fatal overdose were increasing, as they had been for close to twenty years. However, as the numbers show, overdose fatalities decreased in 2022, and again in 2023, which tells us that this new approach is effective.

At Pinnacle Treatment Centers, we understand that’s an important step in the right direction, and tells us to stay committed to the harm reduction approach, including MAT with methadone, at our methadone clinics in Brick, NJ. We see the overdose fatality numbers decreasing, and we want to help continue that trend, and reduce the harm caused by the opioid crisis to individuals, families, and communities in New Jersey.

The post Finding a Methadone Clinic in Brick, New Jersey appeared first on Pinnacle Treatment Centers.

People with opioid addiction can change their lives with medication-assisted treatment (MAT) with methadone, which is one of three medications approved by the Food and Drug Administration (FDA) as a medication for opioid use disorder (MOUD).

Methadone Clinics: What You Need to Know

Methadone clinics are opioid addiction treatment centers, which are officially classified by the FDA and the Drug Enforcement Agency (DEA) as Opioid Treatment Programs (OTPs). These treatment centers meet all the FDA and DEA requirements to provide patients with MAT with methadone. In New Jersey, we operate opioid addiction and heroin treatment centers at various locations with medications for opioid use disorder (MOUD), like our methadone treatment services at our methadone clinic in Tom’s River, NJ, called Ocean Medical Services.

Our Methadone Clinic in Tom’s River, NJ

At our methadone clinic in Tom’s River, NJ, we offer medication-assisted treatment (MAT) as part of our addiction treatment services, specifically for people diagnosed with opioid use disorder, heroin use disorder, or prescription opioid use disorder.

About Methadone

Methadone was originally developed as an alternative pain reliever to opium during World War II, to prepare for potential opium shortages. It was sold as a cough reliever in the 1940s before doctors began experimenting with it as a treatment for morphine and heroin addiction. Due to the success of these experiments, the first methadone clinic in the United States opened in New York City in 1964.

Since then – 60 years ago – research has confirmed that methadone is a safe, effective, lifesaving medication for opioid addiction. Methadone helps people with opioid or heroin addiction because it’s a full opioid agonist. This means it has complete affinity for opioid receptors in the brain, and can occupy them easily. However – and this is why doctors use methadone to treat addiction – methadone doesn’t cause the same feelings of euphoria associated with other opioids.

Medication-assisted treatment with one of the three FDA-approved MOUDs is widely considered the gold standard treatment for opioid addiction. It’s part of an approach to treatment called harm reduction.

The Harm Reduction Movement: New Legislation in New Jersey

In response to the ongoing opioid crisis in the U.S., which has negatively impacted people around the country and in New Jersey, the state government passed a series of laws in 2022 that prioritize and expand harm reduction services across the state.

The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates methadone treatment programs:

• Reduce frequency of opioid use
• Reduces fatal opioid overdose
• Decreases criminal behavior associated with opioid use
• Decreases spread of disease associated with intravenous drug us
• Improves social, family, academic, and vocational function
• Help people stay in treatment longer
• Reduce premature mortality associated with opioid use

The treatment experts as SAMSHA sum up treatment with methadone as follows:

“Methadone helps individuals achieve and sustain recovery and to reclaim active and meaningful lives.”

When the harm reduction legislation passed in New Jersey, which include the expansion of MAT services and methadone treatment, former New Jersey State Assemblywoman Valerie Vainieri Hurtle released this statement:

“Research has shown time and again that harm reduction measures work. Our state loses thousands of residents each year to overdoses alone. If we want to help our fellow community members avoid these tragic outcomes, we must offer the resources and [treatment] alternatives they need.”

If that person in your immediate circle needs support for opioid use disorder (OUD), or another type of opioid addiction such as heroin addiction, one thing you can advise is to arrange a full addiction screening with a mental health professional. The result of the screening may indicate opioid use disorder. If so, they may receive a referral for MAT. If they’re in near Tom’s River, NJ, they can pursue treatment with methadone at Ocean Medical Services.

Pinnacle Treatment Centers Methadone Clinic in Tom’s River, NJ

It’s important for everyone to understand that a medication-assisted program is about more than the medication. A methadone program is not only about methadone. It’s about a comprehensive approach to addiction treatment. A treatment plan at  Ocean Medical Services may include – in addition to methadone – some, if not all, of the following components:

• Individual counseling/therapy
• Group counseling/therapy
• Coaching on lifestyle changes, including healthy eating, stress management, and daily exercise/activity
• Education on the science of addiction and recovery
• Complementary support, such as mindfulness, meditation, and yoga
• Community support programs like Alcoholics Anonymous (AA), Narcotics Anonymous (NA) SMART Recovery
• Aftercare and case management services

The goal of these services, and the overall goal of harm reduction, is to bring treatment to people in need in the way they’ll accept it, when and how they’re willing to accept it. Not everyone responds to treatment in the same way. Therefore, at Pinnacle Treatment Centers, each treatment plan meets the unique needs of each individual.

Finding Treatment in Tom’s River, NJ

If a friend or loved one seek addiction treatment at a methadone clinic in Tom’s River, NJ, don’t hesitate to call us at Ocean Medical Services. To ensure you find the treatment that best meets your needs or the needs of a friend or loved one, we also encourage you to do your due diligence and research treatment centers independently. These resources can help you as you seek evidence-based treatment:

• For residents of New Jersey: Addiction Treatment Providers -Treatment Directory Application (rutgers.edu)
• For people in New Jersey without insurance: 1-844 ReachNJ.GOV at (844) 732-2465
• IME Addiction Access Center: call (844) 276-2777 for 24/7/365 referral support
• The Substance Abuse and Mental Health Services Agency (SAMHSA) online treatment locator

The Impact of the Opioid Crisis on Ocean County

At the beginning of the opioid crisis, in the year 2001 – before anyone labeled it a crisis – data from Centers for Disease Control (CDC) show that just over 19,000 people died of a fatal drug overdose. The latest complete set of data we have, from 2022 indicates over 108,000 people died of drug overdose – with around ¾ of those deaths attributable to opioids. That’s a staggering increase of almost 460 percent.

In the state of New Jersey, officials created the New Jersey Opioid Dashboard and the NJ Cares Opioid-Related Data website to track overdose deaths. These following figures demonstrate the impact of the crisis on Ocean County, New Jersey

Fatal Opioid Overdose: Six-Year Trend for Ocean County, NJ

• 2018: 219
• 2019: 204
• 2020: 245
• 2021: 242
• 2022: 186
• 2023: 168

Since 2020 – the infamous pandemic year – rates of overdose in Ocean County have decreased, year-over-year. That’s encouraging. It’s important to understand these figures in context, however. This trend in decrease appeared after close to 20 years of increase nationwide. It’s also important to humanize every number we see, and remember that each overdose represents pain, grief, and heartbreak for families and loved ones, and a tragic outcome for the person who overdosed.

At Pinnacle Treatment Centers, we know that each of those overdose deaths was preventable. That’s why we continue to offer harm reduction services, including MAT with methadone, at our methadone clinic in Tom’s River, NJ. We’ll continue to offer our services as long as the need for addiction treatment exists – and we hope to be a big part of the reason this need decreases, rather than increases, over the next several years.

The post How to Find a Methadone Clinic in Toms River, New Jersey appeared first on Pinnacle Treatment Centers.

Many people have never heard of xylazine and have no idea what xylazine is, much less why test strips for xylazine exist.

Xylazine: What You Need to Know

In 2022, the Food and Drug Administration (FDA) published a warning letter which outlined details about the origin of xylazine, its legal uses, its illegal uses, and the negative consequences of the human uses of xylazine.

The goal of the FDA letter was to warn medical providers, emergency room personnel, and people working in drug enforcement or drug addiction treatment about the rapidly increasing presence of xylazine in the supply of illegal drugs in the United States.

Xylazine is a medication approved by the FDA as a veterinary analgesic and sedative. Xylazine is not approved by the FDA for human use for any purpose.

Over the past several years, the Drug Enforcement Agency (DEA) has detected xylazine in the following illicit drugs:

• Heroin
• Fentanyl
• Methamphetamine
• Cocaine

Street names for xylazine include:

• Tranq
• Tranq dope
• Philly dope
• Zombie drug

Drug traffickers add xylazine to the drugs above to increase the volume of the drug – which increase profit – and to increase the euphoric and sedative effects of the drug. However, xylazine is toxic for humans. Negative consequences of ingesting xylazine include:

• Central nervous system depression
• Impaired breathing
• Extremely low blood pressure
• Extremely slow heartbeat
• Dangerously low body temperature
• Elevated blood sugar levels
• Sever, chronic wound infection
• Death

The CDC reports that repeated use/chronic exposure to xylazine can lead to dependence, severe withdrawal symptoms including agitation and anxiety, and intravenous use of xylazine – with heroin, cocaine, methamphetamine, or other injectable drugs – can cause necrotic skin lesions.

Why Are Xylazine Test Strips Important?

The short answer is they’re important because xylazine is toxic and can lead to severe medical complications up to and including death. Risk of toxic consequences and overdose are elevated with xylazine for the following reasons:

• Since it’s not an opioid, the overdose reversal drug Narcan cannot help someone who overdoses
• Common drug tests and screens are not designed to detect xylazine, which means medical personnel – even if they test a person in crisis – may not know the cause of the medical crisis is xylazine
• Since it’s not an opioid, medications for opioid use disorder (MOUD) cannot mitigate withdrawal symptoms or reduce cravings for xylazine

Now let’s take a look at how to use xylazine test strips.

How to Use Xylazine Test Strips

Xylazine-Involved Overdose

Xylazine first appeared in overdose data between 2000 and 2010 in the Northeastern U.S. During the 2010, use of xylazine spread from urban areas in the Northeast to the South, then the Midwest, and then the West.

The overdose data for these regions illustrates the dangerous increase in xylazine use nationwide:

• Northeast: 103% increase from 2020-2021
• South: 1,127% increase from 2020-2021
• Midwest: 516% increase from 2020-2021
• West: 750% increase from 2020-2021

As those numbers clearly demonstrate, the xylazine problem is serious. Xylazine increases the potency of drugs of misuse – particularly opioids – which increases risk of developing addiction, i.e. substance use disorder (SUD)/opioid use disorder (OUD), which then increases risk of fatal overdose.

Xylazine: Additional Resources

To learn more about the threat posed by xylazine, please read this article on our blog:

Emerging National Security Threat: Xylazine Laced With Fentanyl Exacerbates Opioid Crisis

For an in-depth review of the emergence of xylazine as a public health threat, please read this report from the Department of Justice and the DEA:

The Growing Threat of Xylazine and its Mixture with Illicit Drugs

And finally, you can read the full text of the White House proclamation on xylazine:

Biden-⁠Harris Administration Designates Fentanyl Combined with Xylazine as an Emerging Threat to the United States

Xylazine is dangerous. When mixed with common drugs of misuse, it becomes more dangerous. It increases risk of negative physical and psychological consequences, and dramatically increases risk of fatal overdose. If you or someone you love uses opioids mixed with xylazine, or another type of drug mixed with xylazine, please encourage them to seek a full assessment for substance use disorder (SUD) and pursue evidence-based treatment provided by qualified mental health professionals.

Remind them of the truth of this statement:

The sooner a person who needs treatment for substance use disorder gets the treatment they need, the better the outcome.

The post What Are Xylazine Test Strips? appeared first on Pinnacle Treatment Centers.

The ongoing overdose crisis in the U.S. affects people from all walks of life. From construction workers to doctors, movie stars to working moms, no one is immune – and that includes the people of Brick, New Jersey, where Pinnacle Treatment Centers provides addiction treatment services at Ocean Monmouth Care and Suboxone Services of Brick.

Suboxone Clinics and Medication-Assisted Treatment (MAT)

Suboxone clinics are facilities that meet all the government requirements to support patients with opioid use disorder with medication-assisted treatment (MAT). An addiction treatment program that offers MAT may use one of three medications: suboxone, methadone, and naltrexone. A Suboxone clinic uses one of these medications in particular – Suboxone – which is a formulation that includes both buprenorphine and naltrexone. Our Suboxone Clinics in Brick, NJ use this formulation, which evidence shows can dramatically improve the lives of people with heroin addiction, fentanyl addiction, and other types of opioid use disorder.

Suboxone Clinics in Brick, NJ: Medications for Addiction

Suboxone includes two medications: buprenorphine and naltrexone.

What is Buprenorphine?

Buprenorphine is called a partial opioid agonist because it can bind with the opioid receptors in the human brain, but not completely. It takes up enough of the receptors to prevent other opioids – heroin and fentanyl, for instance – from occupying the receptors and causing the euphoria associated with opioid use. In addition to blocking this effect, it also reduces cravings for opioids and mitigates the severity of opioid withdrawal symptoms.

What is Naltrexone?

Naltrexone works differently than buprenorphine. Rather than partially binding to the opioid receptors in the human brain, it completely blocks any type of opioid – especially drugs of misuse and disordered use like heroin and fentanyl – from binding to opioid receptors. When a person takes naltrexone, they don’t experience the euphoria associated with opioids, which prevents the misuse of Suboxone. In addition, if a person takes naltrexone while using any opioid, it can cause that person to enter opioid withdrawal. In this way, the naltrexone acts as a deterrent for the use of other opioids, and the diversion or improper use of Suboxone.

Why Suboxone? The Harm Reduction Movement

Harm reduction is an approach to addiction that first appeared in Europe in the 1990s. The success of harm reduction programs like medication-assisted treatment, clean syringe programs, and access to overdose reversal medication convinced authorities in the U.S. to adopt harm reduction measures in response to our opioid and drug overdose crisis.

The state of New Jersey passed a series of laws in 2022 prioritizing harm reduction strategies to mitigate the negative effects of the opioid crisis. New Jersey State Assemblywoman Annette Quijano describes the importance of this new legislation:

“Harm reduction sites provide critical services…while honoring the dignity of those living with a substance use disorder. These programs are staffed by professionals who can help limit the risks of intravenous drug use…while providing a safe, stigma-free environment in which to receive care. This legislation will help make it easier for these programs to be approved and maintained going forward.”

The legislature passed these laws based on an extensive body of evidence that shows harm reduction has the following benefits:

• Connects people to the gold-standard treatment for opioid use disorder (OUD)
• Provides the overdose reversal medication naloxone to first responders, medical personnel, and people at high risk of overdose
• Decreases the risk and transmission of infectious diseases associated with intravenous drug use
• Decreases stigma associated with addiction

In addition, evidence shows medication-assisted treatment with Suboxone can:

• Reduce opioid use
• Increase time-in-treatment
• Decrease all-cause mortality for people with OUD
• Improve family, social, vocational, and academic functioning
• Decrease rates of fatal overdose

If you or a loved one has opioid use disorder and needs heroin addiction treatment, please encourage them to arrange a full screening for addiction, so they can receive an accurate diagnosis and begin effective treatment as soon as possible at a Suboxone Clinic in Brick, NJ.

Comprehensive, Integrated Addiction Treatment at Pinnacle Treatment Centers

Treatment at Ocean Monmouth Care and/or Suboxone Services of Brick is about more than the medication. Our team supports our patients on any level they accept. Options in our treatment plans are varied, and include:

• Counseling, therapy, psychological support
• MAT with Suboxone
• Education on healthy habits that promote recovery
• Recovery education
• Auxiliary support like yoga, meditation, and mindfulness
• Access to peer support, including 12-step programs
• Aftercare/case management

While all these options are available, not every patient engages every single one: the components of a treatment program depend on factors unique to each individual.

Finding Addiction Treatment in Brick, NJ

If you or a loved one need to find a Suboxone Clinic in Brick, NJ, contact out team us Ocean Monmouth Care or Suboxone Services of Brick.

Additional resources for finding high-quality treatment for substance use disorder are available here:

• Addiction Treatment Providers -Treatment Directory Application (rutgers.edu)
• 1-844 ReachNJ.GOV at (844) 732-2465 (for people without insurance)
• Call (844) 276-2777 for 24/7/365 for referral and emergency support from Rutgers University
• SAMHSA treatment finder

If you or a loved one needs help finding a Suboxone Clinic in Brick, NJ, please don’t hesitate. Evidence shows that sooner a person who requires professional support receives that professional support, the greater their chances of a successful treatment and recovery journey.

The Overdose Epidemic: Statistics for the U.S. and Ocean County, NJ

Over the past 25 years, more than a million people have lost their lives to fatal overdose. Close to 75 percent of those deaths included opioids such as heroin, prescription opioids, and fentanyl. As overdose rates increase, so do our efforts to offer more people lifesaving care in the form of MAT with Suboxone at our clinics in Brick, NJ.

To reiterate the need for this gold-standard care for OUD, we’ll review the overdose reports for the last five years. We retrieved this information from the Centers for Disease Control (CDC).

Five-Year Trends in Overdose, United States

• 2018: 67,850
• 2019: 71,130
• 2020: 92,478
• 2021: 106,699
• 2022: 108,388

Over that time period, overdose fatalities rose by 60 percent. To see the data for Brick, where we operate Ocean Monmouth Care and Suboxone Services of Brick, we’ll use the latest reports for Ocean County. You can find more data on Brick and Ocean County via the New Jersey Opioid Dashboard and /or the NJ Cares Opioid-Related Data website.

Six-Year Trends in Opioid Overdose, Ocean County

• 2018: 219
• 2019: 204
• 2020: 245
• 2021: 242
• 2022: 186
• 2023: 168

When we look at numbers in the tens or hundreds of thousands, like the national data, or numbers in the hundreds, like the data from Ocean County, it can be hard to get perspective on what they really mean on a human level. Our perspective is this: any overdose fatality is a tragedy for that individual, their family, and the people who love them.

This report shows us an encouraging downward trend. However, citizens of Brick need the best addiction treatment available. Experts call MAT with Suboxone the gold-standard treatment for opioid use disorder (OUD). Treatment for OUD with Suboxone is available at our Suboxone Clinics in Brick, NJ.

The post How to Find a Suboxone Clinic in Brick, NJ appeared first on Pinnacle Treatment Centers.

In 2024, fentanyl is almost everywhere in the illicit drug supply – not just in illicit opioids. Drugs that may contain fentanyl include, but are not limited to:

• Heroin
• Cocaine
• Methamphetamine
• Adderall (illicit)
• Xanax (illicit)
• Oxycontin (illicit)
• Percocet (illicit)
• Vicodin (illicit)

The presence of fentanyl in any of these drugs significantly increases risk of fatal overdose. Fentanyl test strips allow people who use drugs to test the drugs they may take for the presence of fentanyl. If fentanyl is present, they can prevent overdose by not taking the substance that tested positive for fentanyl.

Where to Find Fentanyl Test Strips

Find information about fentanyl test strips at the CDC Fentanyl Test Strip Page and the Substance Abuse and Mental Health Services Administration (SAMHSA) Fentanyl Test Strip Page.

To find fentanyl test strips to test illicit drugs, use these resources:

• Local Health Departments
• The National Harm Reduction Coalition
• Needle Exchange Program Locations (NASEN)
• Online (Amazon, etc.)
• Local pharmacies

Fentanyl test strips are inexpensive – about a dollar per strip. They’re often sold in packs of 6 or 12, with costs varying by manufacturer and quantity. A pack of six may cost just over six dollars, while a pack of 100 may cost around 85 dollars.

How to Use Fentanyl Test Strips: Video

Using fentanyl strips is simple and easy. If you or someone you love uses opioids or other drugs that may contain fentanyl (see list above), please watch the video below: it may prevent you or a loved one from taking a substance with a very high risk of fatal overdose:

If you have questions or concerns about using fentanyl test strips, please call us at any time, or visit our contact page, fill out our form and we’ll get back to you as soon as possible.

Why is Fentanyl So Dangerous – And How Can Fentanyl Test Strips Help?

The Drug Enforcement Agency (DEA) maintains an online fentanyl facts and awareness resource called One Pill Can Kill. While that name may sound like an inflammatory scare tactic, it’s not. When you read the facts about fentanyl, you understand why they DEA – and anyone working in drug enforcement, drug treatment, or drug use prevention – make such a big deal out of fentanyl.

It’s true: one pill can kill.

How?

Two reasons.

First, its potency:

• 50 times more powerful than heroin
• 100 times more powerful than morphine
• One dose can cause an overdose

Second, where it’s found:

• Drug cartels manufacture counterfeit pills, then sell them as genuine medications
• The fake pills contain fentanyl, and each one has the potential to cause a fatal overdose
• It’s easy to find fake (illicit) prescription medication online
• Cartels design fake pills to look exactly like the real prescription pills

To see side-by-side pictures of real/fake medication, click the DEA “One Pill Can Kill” link. The takeaway from the DEA is clear:

There’s a very real chance of finding fentanyl in any illicitly produced pill available on the black market or through illegal websites – and one pill is enough to cause a fatal overdose. A fentanyl test strip can prevent someone who uses drugs from accidentally ingesting fentanyl. 

That sounds scary and should be. Fentanyl is dangerous. Here’s the latest data from the DEA and the CDC.

Fentanyl Seizures and Fatal Overdose

• 2023 DEA Data:
  • DEA seized over 78 million pills containing fentanyl
  • DEA seized close to 12,000 pounds of fentanyl powder
  • The 2023 seizures contained close to 400 million lethal doses of fentanyl
• CDC Data, Fatal overdose involving synthetic opioids:
• 2017: 28,659
• 2018: 31,525
• 2019: 36,603
• 2020: 56,894
• 2021: 71,143
• 2022: 74,789

That’s a 160 percent increase over six years, with a staggering 55 percent increase identified between 2019 and 2020. The impact of fentanyl on the opioid and overdose crisis has been devastating, and experts consider fentanyl a primary driver of the opioid overdose crisis. If you or someone you love uses opioids, please help them consider treatment, and if they won’t consent to treatment, please encourage them to consider using fentanyl test strips to reduce their chance of fatal drug overdose.

The post What Are Fentanyl Test Strips – And How Do I Use Them? appeared first on Pinnacle Treatment Centers.

That’s why knowing about the latest treatments – and how to find them – is critical for individuals and families who want to move past the harmful cycles of addiction.

What is a Suboxone Clinic?

A Suboxone clinic is an addiction treatment facility that’s fully licensed and approved by the Drug Enforcement Agency (DEA) and the Food and Drug Administration (FDA) to offer treatment for OUD with Suboxone, which is a combination of two medications: buprenorphine and naltrexone. Buprenorphine is a partial opioid agonist. It occupies opioid receptors in the brain without the euphoria associated with opioid use. Naltrexone, on the other hand, is a full opioid antagonist. It prevents any opioid from occupying opioid receptors in the brain, thereby preventing any opioid-related euphoria.

Treatment with Suboxone is part of an approach to heroin treatment and opioid addiction called harm reduction. Harm reduction was fully endorsed by the State Government of New Jersey with legislation passed in 2022.

The Director of Harm Reduction Services for the New Jersey Harm Reduction Coalition, Caitlin O’Neill, offers her opinion on harm reduction efforts in New Jersey:

“Many lives will be saved with the expansion of harm reduction centers…in New Jersey, and many peoples’ inherent value and humanity will be reinforced. This is a vital step towards New Jersey ending the overdose crisis…and finally building the systems of care that will keep all of us alive and safer — no matter where we lay our heads.”

The benefits of treatment with Suboxone include:

• Stopping/preventing the action of opioids on the brain
• Resetting the neurotransmitter system in the brain
• Blocking the euphoria associated with opioid use
• Reducing the severity of cravings for opioids
• Mitigating the most intense symptoms of opioid withdrawal

Suboxone treatment programs also helps:

• Increase the length of time people stay in treatment
• Reduce the use of opioids
• Reduce criminal behavior associated with drug use
• The ability to look for and find a job
• The ability to engage fully in family life
• School and work performance
• Reduce risk of fatal overdose
• Reduce risk of premature mortality (early death)

Evidence-based treatment with Suboxone is accessible in Tom’s River, NJ.

However, if you don’t know what to look for, how do you determine if you, a friend, or a loved one needs treatment?

Warning Signs: Opioid or Heroin Addiction

When a person has a substance use disorder, it’s important to get help sooner than later. Chronic, long-term addiction can create serious physical, psychological, and emotional problems.

If you or a loved one needs MAT treatment at a Suboxone clinic in Tom’s River, NJ, please remember: the earlier a person who needs treatment receives treatment, the better the outcome.

To determine whether someone might have an opioid/heroin addiction, watch for these warning signs:

Opioid Use Disorder: Physical Warning Signs

• Frequent accidents with no explanation
• Tremors/shaking hands
• Reduced attention/care about personal appearance
• Rapid change in weight
• Incoherent speech
• Clammy palms
• Bloodshot eyes
• Wide pupils
• Decreased coordination
• Strange smells: clothes, hair, breath
• Evidence of intravenous injections

Opioid Use Disorder: Behavioral Warning Signs

• Mood swings
• Drastic changes in personality
• Impaired performance at work or school
• Irritability
• Anger
• Problems concentrating
• Inability to fulfill obligations/responsibilities
• Reduced interest in favorite activities
• Lying about drug use
• Stealing to support drug use
• Furtive behavior
• Attempting to hide drug use

When these warning signs appear in someone you love, or you recognize them in yourself, the best first step is a professional evaluation for substance use disorder performed by a mental health professional.  After a full evaluation, a physician, psychiatrist, or therapist can arrive at an accurate diagnosis and provide a referral treatment at a Suboxone Clinic in Tom’s River, NJ.

Pinnacle Treatment Centers: MAT Treatment Follows National Guidelines

The support and care we offer at our Suboxone clinics in Tom’s River, NJ is not just about taking Suboxone every day. Our treatment approach follows guidelines established by the Substance Abuse and Mental Health Services Administration (SAMHSA). After a full biopsychosocial evaluation, our providers at Ocean Medical Services and Suboxone Services of Tom’s River develop a treatment plan with a variety of effective, evidence-based components.

MAT Programs at Pinnacle Suboxone Clinics in Tom’s River, NJ

• Individual counseling and therapy
• Group counseling and therapy
• Medication for opioid use disorder (MOUD): Suboxone
• Changes in daily habits: Healthy food, daily activity, stress management, sleep hygiene
• Enrichment: group classes on the science of addiction and recovery
• Auxiliary approaches: Yoga, Meditation, Mindfulness
• 12-step programs: Alcoholics Anonymous (AA), Narcotics Anonymous (NA) SMART Recovery
• Case management services: help after discharge with accessing social services, accessing recovery housing, and relapse prevention

While therapy, changes in daily habits, and education on addiction and recovery promotes a successful recovery, the inability to participate in these components of treatment does not prevent a person from receiving Suboxone. A core tenet of harm reduction is meeting people where they are, and offering the treatment they’ll accept in the manner they’ll accept it. If medication is where a person needs to start, then that’s where we start.

Finding Addiction Treatment at a Suboxone Clinic in Tom’s River, NJ

To find treatment at a Suboxone Clinic in Tom’s River, NJ, please call us at Ocean Medical Services or Suboxone Services of Tom’s River.

To find evidence-based treatment for addiction, you can also use these online resources:

• Addiction Treatment Providers -Treatment Directory Application (rutgers.edu)
• 1-844 ReachNJ.GOV at (844) 732-2465 (for people without insurance)
• Call (844) 276-2777 for 24/7/365 for referral and emergency support from Rutgers University
• SAMHSA treatment finder

The earlier a person who needs treatment gets the treatment they need, the better the outcome.

The Opioid Crisis in the U.S. and New Jersey: Facts and Figures

Since 1999, a staggering number of people have died of drug overdose in the U.S. Data from the Centers for Disease Control indicate that number exceeds 1,000,000 – and it’s growing every year. The data shows around 75 percent of those overdose deaths involved opioids.

Let’s look at the fatal overdose data from the past several years. These figures are available on the Centers for Disease Control (CDC) website.

Overdose Fatalities, 2018-2023: United States

• 2018: 67,850
• 2019: 71,130
• 2020: 92,478
• 2021: 106,699
• 2022: 108,388

That’s a 60% increase over those seven years – and the national numbers are still rising. To narrow our focus to Tom’s River, where we operate Ocean Medical Services and Suboxone Services of Tom’s River, we’ll look at the data for Ocean County, NJ, where Tom’s River is located. To explore the publicly available data further, please visit the New Jersey Opioid Dashboard and the NJ Cares Opioid-Related Data resource page.

Overdose Fatalities, Opioids, Ocean County 2018-2023

• 2018: 219
• 2019: 204
• 2020: 245
• 2021: 242
• 2022: 186
• 2023: 168

Let’s be clear: one overdose fatality is one too many.

This data shows us that, although the past two years show a downward trend, the residents of Tom’s River need access to treatment for opioid use disorder (OUD), which also includes heroin treatment and treatment for prescription opioid addiction. Experts call MAT with Suboxone the gold-standard treatment for opioid use disorder (OUD). Treatment for OUD with Suboxone is available at our Suboxone Clinics in Tom’s River, NJ.

The post How to Find a Suboxone Clinic in Toms River, NJ appeared first on Pinnacle Treatment Centers.

The Opioid and Overdose Crisis in the U.S. and California

In the United States, the opioid and overdose crisis has claimed over a million lives in the past 25 years, with over 75 percent of those deaths involving opioids. California is not immune to this crisis. The latest data from the California Department of Public Health (CDPH) and the Centers for Disease Control (CDC):

Overdose Fatalities in California: 2019-2022

• 2019: 3,244 opioid-related overdose deaths
  • 5,885 total drug overdose deaths
• 2020: 5,502 opioid-related overdose deaths
  • 6,198 total drug overdose deaths
• 2021: 7,175 opioid-related overdose deaths
  • 9,462 total drug overdose deaths
• 2022: 7,385 opioid-related overdose deaths
  • 11,761 total drug overdose deaths

Figures from the CDPH and CDC aren’t identical, due to differences in vetting procedures, reporting deadlines, and other technical issues. However, the data above offer the best possible record/report of all drug and opioid overdose deaths in California. For a detailed dive into the data, please click the links and explore both the state and national overdose surveillance dashboards.

That’s the current situation in California, where Pinnacle Treatment Centers offers a core element of harm reduction – medication assisted treatment (MAT) – at over 40 locations across California, including these three facilities:

1. Aegis Treatment Centers Modesto in Modesto, CA

2. Aegis Treatment Centers Ontario in Ontaria, CA

3. Aegis Treatment Centers Roseville in Roseville, CA

Those treatment centers serve a clear and demonstrated need for MAT treatment, as illustrated in the data above: a 100.1 percent increase in total drug overdose deaths between 2019, and a 127.6 percent increase in opioid-related overdose deaths.

Pinnacle Treatment Centers and Aegis Treatment Centers support the harm reduction efforts prioritized by the California Harm Reduction Initiative (CHRI), established by the state of California in 2019.

About the California Harm Reduction Initiative

Officials in California allocated 15.2 million dollars to form a partnership with the National Harm Reduction Coalition to create harm reduction programs that address needs unique to the citizens of California under the umbrella of the California Harm Reduction Initiative.

The diversity of California makes implementing any statewide program a challenge, but that challenge also creates an opportunity for the rest of us: programs that succeed in a state as diverse as California can serve as templates for other areas of the country that are just as diverse, and face similar problems with implementation, scale, and access.

If a program succeeds in California, a state which include urban, suburban, exurban, semi-rural, and rural areas, then it’s likely it can succeed anywhere. Since 2019, the CHRI has implemented programs that improve the lives of Californians across the state.

CHRI Programs: Help for California

• Increase programs that prioritize reducing harm
• Expand access to treatment for SUD, especially OUD
• Mitigate the damaging effects of drug use for individuals, families, and communities.

One of the most successful programs launched by the California Harm Reduction Initiative is the California Bridge Program, called CA Bridge. The goal of the bridge program is to allow any person in California to initiate substance use disorder (SUD) treatment in hospitals in California, wherever the hospital is and whenever anyone needs treatment.

That’s a goal we can relate to.

Our goal at Pinnacle Treatment Centers is to bring SUD treatment to anyone who needs it, as quickly as we possibly can.

The CA Bridge program is important because it leverages a specific time – when a person with SUD or OUD visits a hospital for a drug-related reason, including overdose – that evidence shows people who use drugs are most willing to accept and initiate treatment. When a person ends up in the hospital emergency room for drug-related reasons, they often spend the hours re-evaluating their circumstances – and many decide it’s time to make a change.

California Bridge: The Impact

As we mention above, if you can’t measure it, you can’t improve it.

With that in mind, let’s look at the measurable impact of the California Bridge Program on the people of California, as reported on their comprehensive website.

• As of 2023, 83% of California hospitals participate in CA Bridge
  • 25% in 2020
  • 49% in 2021
  • 73% in 2022
• 109,000 patients screened for substance use disorder
• 31,000 patients administered or prescribed buprenorphine, on of the medications for opioid use disorder (MOUD) used in medication-assisted treatment (MAT) programs.
• 37,300 patients made a follow-up appointment for SUD counseling/treatment
• 36,078 patients initiated MAT as the result of CA Bridge
  • 8,544 were in a criminal justice setting
  • 33% were people of color
  • 33% reported housing insecurity
  • 77% were uninsured
  • 70% had co-occurring mental health disorders
• 85% of patients offered MAT accepted MAT
• 40% of patients who initiated treatment in the hospital participate in ongoing care

The heroes of the CA Bridge program are Substance Use Navigators. Substance Use Navigators help connect people in the hospital with MAT services while in the hospital, then connect them to ongoing support after discharge from the hospital. Substance Use Navigators introduce the concept of harm reduction, treat patients with dignity, focus on empathy and understanding, and show patients without support how they can access support and treatment that can change their lives for the better.

Up Next: Harm Reduction in Prisons and Jails in California

The success of these programs in mitigating the harm caused by the opioid crisis is significant. In just over five years, CA Bridge has had a positive impact on the lives of people in California. In that way, California is indeed leading the way in comprehensive harm reduction programs in the U.S. Another area where California is ahead of the rest of the country is in the implementation of SUD treatment with MAT in prisons and jails.

The California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS) created a program called Integrated Substance Use Disorder Treatment (ISUDT)  to offer substance use disorder treatment – including MAT – to incarcerated individuals in California. The goals of ISUDT are in the CDCR are to “reduce SUD-related morbidity and mortality, and recidivism.”

We’ll report on the outcomes of the ISUDT in Part III of our Harm Reduction in California series. We’ll also shine a light on the ongoing work of our Director of Government Relations (California), Javier Moreno. Javier coordinates our effort to bring MAT to prisons and jails in Califiornia. He works closely with the California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS). Together, they manage programs that support incarcerated individuals with opioid use disorder (OUD). Also, whenever possible, Javier works to offer continuing MAT services, counseling, and therapy upon release from incarceration.

We’re committed to the harm reduction effort in California: look for Part III in this series to learn more.

The post Harm Reduction in California Part II: The California Harm Reduction Initiative (CHRI) appeared first on Pinnacle Treatment Centers.

Over 3/4^th of the overdose fatalities we describe above involved opioids. From prescription opioids such as oxycontin to illicit opioids such as heroin, opioid addiction can have a devastating effect on individuals, their families, and the communities in which they live.

Here’s the most recent information on the situation, as published by the Centers for Disease Control (CDC):

Overdose Fatalities: 2019-2022

• 2019:
  • 50,178 opioid-related overdose deaths
  • 67,697 overdose deaths
• 2020:
  • 70,029 opioid-related overdose deaths
  • 93,655 overdose deaths
• 2021:
  • 80,816 opioid-related overdose deaths
  • 107,622 overdose deaths
• 2022:
  • 82,807 opioid-related overdose deaths
  • 109,360 overdose deaths

The steady increase in overdose deaths reflected in these numbers convinced lawmakers to allocate millions of dollars in funding to harm reduction programs. California was one of the first states in the country to commit to harm reduction almost ten years ago.

The Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. indicates that harm reduction services can:

• Help people access addiction treatment
• Increase access to naloxone
• Supply naloxone to first responder
• Decrease transmission of disease
• Decrease overdose fatalities
• Increase access to addiction assessment/treatment in primary care settings
• Increase access to addiction assessment/treatment in emergency room settings
• Decrease stigma around addiction and addiction treatment
• Improve treatment outcomes by including people in recovery to help create and initiate harm reduction programs
• Increase access to social services to improve the lives of people with SUD and/or OUD

This position statement from SAMHSA reinforces the fact that this is an effective, data-driven approach to helping people with substance use disorder (SUD). In fact, harm reduction programs present the best possible way to reverse steady upward trend in drug overdose deaths in the U.S. To learn more about harm reduction, please navigate to the blog section of our website and read the following articles:

Harm Reduction in Addiction Treatment: What You Need to Know, Part One

Harm Reduction in Addiction Treatment: What You Need to Know, Part Two

Now let’s answer a question you may have. We talk about the benefits of harm reduction above, but what is harm reduction?

Harm Reduction: A Basic Definition

For a full review of the principles and practices of harm reduction in the U.S., please read the articles we link to above. We’ll quickly review the essentials here, in order to set the stage for discussing harm reduction initiatives in California.

Here’s how The National Harm Reduction Coalition (NHRC) and the World Health Organization (WHO) define harm reduction:

“Harm reduction is a set of practical strategies and ideas aimed at reducing negative physical and social consequences associated with drug use.”

In addition, the principles of harm reduction include a basic acknowledgment of the direct relationship between harm reduction and foundational human rights:

“Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”

In the United States, one component of this approach is an attempt to correct the mistakes and unintended negative consequences of our previous national strategy to reduce drug use and related problems in the 1980s and 1990s, which we called the war on drugs. This is not news to many of us, but it’s plain to see: the war on drugs didn’t work.

The war-like posture toward drug use included focusing on the criminal component of drug use. Policies focused on increasing arrests for use, possession, and distribution of drugs and establishing policies like mandatory minimum sentences and three-strikes laws. In retrospect, we can see that this approach – while it may have put some violent criminals behind bars – ended up stigmatizing drug use, and by extension. stigmatized treatment for drug use.

Data over the past thirty years show that the best approach to reducing drug use and addiction is harm reduction. In California, Pinnacle Treatment Centers offers a core element of harm reduction – medication assisted treatment (MAT) – at over 40 locations across California, including these five:

1. Aegis Treatment Centers Oxnard in Oxnard, CA

2. Aegis Treatment Centers Stockton 5th Street in Stockton, CA

3. Aegis Treatment Centers Stockton California Street in Stockton, CA

4. Aegis Treatment Centers Stockton Lower Sacramento Rd. in Stockton, CA

5. Aegis Treatment Redlands in Redlands, CA

We’re committed to offering harm reduction services like medication-assisted treatment (MAT) with medications for opioid use disorder (MOUD) to as many people as possible. These locations, along with our additional treatment centers across the state, can help improve the lives of individuals and families living in the communities of Oxnard, Stockton, and Redlands.

Now let’s take a look at the harm reduction initiatives currently in place in the state of California.

California Adopts Harm Reduction Programs

There’s a common adage that appears across a wide range of endeavors we undertake:

If you can’t measure it, you can’t improve it.

To that end – improving the lives of people in California by taking proactive steps to address the opioid crisis, the California Department of Public Health created a public overdose surveillance dashboard to report the latest information on the drug overdose crisis in California. Up-to-date, reliable data is essential for policymakers, treatment providers, and community advocates. It helps them to target underserved communities and allocate resources to where they’re needed most.

Anyone can check the dashboard for the latest information on:

• Overdose deaths
• Hospital visits for opioid overdose
• Opioid prescription rates
• Links to all pubic addiction support programs in California
• Links to harm reduction programs

This public overdose surveillance system exemplifies the potential benefits of getting citizens and leaders on the same page: real change that impacts real people in real ways. California led the way in their response to the opioid crisis in the U.S. In 2014, government officials formed the  Statewide Opioid Safety Workgroup (SOS) that elicited the participation of all stakeholders – public, private, individual – to brainstorm a way to mitigate the significant harm caused by the opioid crisis.

Among other things, the SOS workgroup identified areas where the state could implement harm-reduction programs.

Harm Reduction in California: Current and Future Focus Areas

1. Expanding access to medication-assisted-treatment (MAT)
2. Expanding access to naloxone, an overdose reversal medication
3. Expanding clean and safe syringe service programs (SSPs)
4. Increase support for underserved populations in high-risk settings
5. Expand access to all SUD treatment, including warm handoff programs in emergency rooms
6. Increase treatment support in prisons and jails with the Integrated Substance Use Disorder Treatment (ISUDT) program

We’ll elaborate on the ISUDT effort in a forthcoming article on the use of MAT in prisons and jails in California. We currently support incarcerated patients with medication-assisted treatment (MAT) with methadone in several locations in California. Whenever possible, we also support patients upon release from incarceration with ongoing MAT services, counseling, and therapy.

Our Director of California Government Relations, Javier Moreno, leads the way on our work offering MAT prisons and jails, forging important, long-lasting relationships with key members of the California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS).

We’ll talk more about Javier’s important, lifesaving work with ISUDT in Part III of this Harm Reduction in California series of articles.

In Part II, we’ll review another positive outcome of the SOS workgroup: the California Harm Reduction Initiative (CHRI), a program established by the state in 2019.

The post Harm Reduction in California Part I: The SOS Workgroup appeared first on Pinnacle Treatment Centers.

The HEAL initiative provided 36 million dollars for harm reduction research. This money funds pilot programs related to eight areas key essential to bringing harm reduction services to people in need:

1. Education
2. Overdose prevention/reversal
3. Medication-assisted treatment (MAT)
4. Needle & syringe programs
5. Drug consumptions rooms
6. Drug checking programs
7. Housing support
8. Legal services

We’ll discuss each of the program areas below. We’ll describe how they can help meet the objective that drives all harm reduction programs in the U.S. That objective? Reverse the ongoing, upward trend in drug addiction and overdose called the opioid crisis. Since 1999, the crisis has claimed over a million lives and caused significant harm to millions of others.

Harm Reduction Policies and Programs

We describe the fundamental principles and theoretical foundation for harm reduction in addiction treatment part one of this article. Now we’ll share how we – meaning treatment providers alongside local, state, and federal government entities – plan to apply these principles in public policies and programs with the help of funding provided initiative like HEAL.

These eight program areas – while not the sum total of harm reduction efforts nationwide – represent the priorities for effective harm reduction as established by the non-profit advocacy group Harm Reduction International (HRI), endorsed by the Office of National Drug Control Policy (ONDCP) and prioritized in our revised National Drug Control Strategy, developed in 2022.

1. Education and Awareness

Education programs provide people the real information about drugs, drug use, and addiction treatment. In the context of harm reduction in addiction treatment, education classes include specific information on opioid use and opioid use disorder (OUD), including the harms associated with OUD and how to address them. In addition, harm reduction education programs include offering workshops and classes about how to access social services, including vocational programs, housing support, adult education, general health care, and addiction treatment.

Another component of education and awareness around harm reduction is sharing basic information about harm reduction to people with no direct connection to drug use or the opioid crisis. We understand that at first blush, some parts of harm reduction – needle and syringe programs and drug consumption rooms, for instance – may seem unusual, counterproductive, or too progressive. Educating the public about why their tax dollars should go to these programs is important in maintaining support for ongoing funding and commitment to harm reduction.

2. Overdose Prevention and Reversal Programs

Education about drug use and the risks of opioid use and opioid overdose is the best tool we have to prevent overdose, because effective education can prevent the behavior that leads to illicit drug use before it happens.

Harm reduction programs spend significant time and energy on advocating a medication called Narcan, which contains the medication naloxone. When administered correctly and in time, Narcan can reverse an opioid overdose and dramatically reduce the likelihood of death. It’s a lifesaving drug, which, thanks to federal funding and the new national drug control policy, is now readily available nationwide from both pharmacies and public/community health clinics.

Making Narcan easily available to people who use opioids – or their friends or loved ones – means they have access to the same medication emergency medical personnel like paramedics use when they respond to an overdose call. When the Food and Drug Administration (FDA) approved Narcan for over-the-counter sale on March 2023, it was an important step that harm reduction experts have been recommending for years.

Let’s make that clear for anyone reading this who uses opioids or has friends or loved ones who use opioids: you can now get Narcan from a pharmacy without a prescription. Having Narcan on hand can save a life. Therefore, we recommend considering finding Narcan and keeping it close: it saves lives.

3. Medication-Assisted Treatment (MAT) Programs

Medication-assisted treatment (MAT) for opioid use disorder (OUD), also known as opioid agonist therapy, involves the use of three medications for opioid use disorder (MOUD): buprenorphine (Suboxone), Methadone, and Naltrexone.

While Naltrexone completely blocks the action of opioids in the brain and prevents both the analgesic and euphoric properties of opioids, buprenorphine and methadone act in a slightly different manner. They occupy opioid receptors, which reduces cravings, decreases the severity of withdrawal symptoms, and helps people with opioid use disorder (OUD) reach a physical, emotional, and psychological space where they can engage in treatment and start on the road to recovery.

The Substance Abuse and Mental Health Service Administration (SAMHSA) and the World Health Organization (WHO) consider MAT the gold standard treatment for people with opioid use disorder.

For more informant about MAT for OUD, please read these articles on our website:

Medication-Assisted Treatment

Methadone Treatment for Opioid Use Disorder

Suboxone Treatment for Opioid Use Disorder

In addition, there’s an increase in the number of programs that offer MAT to people incarcerated in prisons and jails. To learn more, please read this article by our Medical Director, Dr. Chris Johnston:

The Case for Medication-Assisted (MAT) Treatment in Jails and Prisons

4. Clean Needle/Syringe Programs

These programs can cause significant controversy and often lead to robust resistance from people who haven’t researched how or why they work. Needle and syringe programs provide clean needles/syringes for people who use illicit, intravenous drugs such as heroin. Opponents assert they promote and condone illicit intravenous drug use. However, evidence shows these programs are effective for the following reasons:

• Safe/clean needle/syringe programs prevent the spread of infectious diseases, including hepatitis C and HIV, by offering sterile needles/syringes to people at risk of reusing or sharing share needles/syringes.
• These programs get people who inject drugs off the street and out of unsanitary shooting galleries common to illicit IV drug use. They provide a safe atmosphere where people who use illicit IV drugs can talk about drug use – and the desire to enter treatment – in an atmosphere characterized by openness and understanding.
• Clean needle/syringe sites are most often managed by harm reduction advocates who help connect IV drug users to essential support, such as treatment for OUD, and lifesaving medication like Narcan.

5. Drug Consumption Rooms

This component of harm reduction also receives stiff resistance in the U.S. However, like clean needle/syringe programs, experts on treatment – including the  American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) – fully support their use. A drug consumption room is a safe, clean place where a person can access and utilize safe supplies under direct supervision. Staff in these rooms can help connect IV drug users to treatment programs, offer emergency medical assistance if needed.

Research indicates drug consumption rooms decrease transmission of infectious disease, decrease drug-related criminal activity, crime associated with drug use, and decrease rates of fatal overdose. Data collected at the only two drug consumption sites in the U.S. – both in New York City – report the following data, after two years of operation:

• 4,486 total participants
• 117,559 visits to safe injection rooms
• 1,339 overdose reversals
• Over 2 million units of drug waste (used needles, etc.) collected

6. Fentanyl Testing/Checking Services

Drug testing services are now an integral component of harm reduction services. Over the past several years, the DEA reports an escalating presence of dangerous substances in illicit drugs. These include fentanyl and xylazine, which have been detected in heroin, methamphetamine, cocaine, and others. Drug testing/checking programs individuals to test a substance for the presence of dangerous substances like fentanyl.

7. Housing

Evidence shows that access to safe and stable housing can reduce drug use, drug addiction, and fatal drug overdose. In some cases, housing support for people with substance use disorder (SUD) requires abstinence, but others do not. Research indicates shows that programs like Housing First – a program that has no sobriety or abstinence requirements for access – can help decrease drug consumption and promote overall wellbeing for people in recovery who experience housing instability.

8. Legal Services

In the context of harm reduction, legal services are necessary on at least two levels: the personal and the public. On the individual level, attorneys or legal aid groups support people in the criminal justice system with various needs. They can help them with charges related to drug use, and advocate for access to evidence-based treatment. In the public sphere, attorneys and legal aid groups have work to do. They can help overturn laws, policies, or programs that stigmatize people with substance use disorder. They can also help facilitate the transition from a punitive system to a supportive, reform-based system. A reform-based system is one that provides access to a comprehensive array of harm reduction programs and services.

Reducing Harm: Essential to Our National Drug Control Strategy

The Substance Abuse and Mental Health Services Administration (SAMHSA) is currently in the process of writing a Harm Reduction Framework. The framework will establish a set of best practices to guide harm reduction in addiction treatment around the country. This is a crucial step. It will help implement the harm reduction priorities identified in the National Drug Control Strategy published in 2022 by the Office of National Drug Control Policy.

Harm reduction works. At Pinnacle Treatment Centers, we advocate comprehensive harm reduction services for everyone in need. Keep an eye on our blog for more information, and the next article in our Harm Reduction Series. We’ll discuss the latest harm reduction efforts in California, where we own and operate Aegis Treatment Centers/A Pinnacle Treatment Center Network. Our California locations offer a wide range of SUD treatment services, including medication-assisted treatment (MAT), a core component of the harm reduction approach to opioid addiction.

The post Harm Reduction in Addiction Treatment: What You Need to Know, Part Two appeared first on Pinnacle Treatment Centers.

And here’s our definition of harm reduction: “Harm reduction is a tactic that prioritizes minimizing adverse consequences from drug abuse as a first step before promoting abstinence. It includes measures like education and spreading awareness, supervised consumption sites, naloxone distribution, and needle exchange programs, aiming to reduce overdose deaths, transmission of infections, and associated health issues while encouraging a non-judgmental approach to support individuals on their path to recovery.”

You can see how the SDOH and harm reduction are related. Both approach substance use disorder (SUD) treatment – a.k.a. addiction treatment – from a holistic perspective. Both consider the importance of external factors that impact both the development of and treatment for SUD.

To explore the topic of harm reduction in depth, please navigate to the blog section of our website and read these two articles:

The Opioid Crisis: What is Harm Reduction?

National Harm Reduction Research Effort Could Reduce Overdose Deaths

Harm reduction practices can help us mitigate the damage caused to individuals, families, and communities by the ongoing opioid and overdose crisis in the U.S. Addressing the social determinants of health while pursuing harm reduction efforts is essential: the two ideas go hand in hand, and in tandem, can help expand our concept of holistic, integrated care further, into areas that have proven benefit for people in recovery, but are not yet part of mainstream SUD treatment.

Why the Social Determinants of Health Matter

This statement from the World Health Organization (WHO) summarizes the impact of the SDOH:

“Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDOH account for between 30-55% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.”

This statement also reaffirms the connection between harm reduction and SDOH. With regards to SUD treatment and recovery, it reminds us – or teaches some of us for the first time – factors aside from the substances themselves, abstinence, and the treatment process play a more significant role than most of us realize.

The Department of HHS indicate five primary domains related to the SDOH:

1. Economic Stability
2. Education Access and Quality
3. Health Care Access and Quality
4. Neighborhood and Built Environment
5. Social and Community Context

The SDOH can have either a positive or negative impact on overall health and wellness. Consider the following:

• Positive Impact on Health and Wellness:
  • Safe neighborhoods
  • Access to affordable housing and transportation
  • Access to education and employment opportunities
  • Opportunity to engage in safe, healthy outdoor activities
  • Access to social support programs
• Negative Impact on Health and Wellness:
  • Violence in community
  • Racism/discrimination in community
  • Air and water pollution
  • Reduced access to healthy food
  • Reduced access to health care

Here’s another connection between harm reduction and the SDOH: when we address them, we reduce the amount of harm external, environmental factors might cause people in recovery from SUD. Now let’s look at how we can address and improve the SDOH, with information from an excellent publication from the Kaiser Family Foundation (KFF) called “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity.”

Reducing Harm by Addressing the Social Determinants of Health

KFF defines the SDOH as “the conditions in which people are born, grow, live, work and age,” which is an excellent and concise way to think about them. In contrast to the HHS approach to the SDOH, the KFF report expands them to six domains, as opposed to the five identified by HHS. We’ll use the KFF categories to talk about how we, as a collective working toward a common goal – reducing the harm caused by the opioid and overdose crisis – can help improve the lives of people in treatment for substance use disorder (SUD).

Economic Stability

Improving economic stability means increasing opportunities to seek and gain employment. Having a job allows an individual to make a steady income to cover living expenses, medical bills, education, and recreation.

Neighborhood and Physical Environment

Improving neighborhoods and the physical environment means increasing access to safe housing, expanding public transportation, ensuring physical safety at all times, and expanding the amount of greenspace/recreational space present in each neighborhood, whether urban, suburban, exurban, or rural.

Education

Improving education means starting early with pre-K and kindergarten programs for young kids, ensuring safe elementary, middle, and high schools for school age students, and expanding funding and access to literacy programs, language learning, higher education, and vocational training for adults.

Food

Addressing issues around food and eating means reducing the amount of hunger and hungry people in our communities through expanding existing social support programs that provide resources for adults in the community and children at school, and reducing the phenomenon of food deserts by increasing access to healthy options in traditionally underserved neighborhoods.

Community and Social Context

Improving the community and social context in which people live their lives means increasing funding and access to social support systems and services, increasing community engagement and eliciting the involvement of community members and direct stakeholders, reducing discrimination in underserved neighborhoods, and addressing increasing levels of environmental, interpersonal, and social stress present in each neighborhood, area, or community – rural, urban, or other.

Health Care

Improving health and health care – an area with which we’re familiar – means increasing insurance coverage for people who lack coverage, increasing the amount of providers in underserved areas, expanding and improving access to care, increasing cultural competency among providers, i.e. providing helpful language and cultural liaison services in health care, and finally, improving the overall quality of health care in traditionally underserved communities.

The Role of Communities in the Opioid Crisis and Harm Reduction

The social determinants of health are about improving the default living conditions in underserved communities across the country. When we say underserved, what we mean is communities which, for most of their history, have not experienced equity in domains like basic safety, education, health care, transportation, and access to affordable and healthy food. Deficits in these areas degrade quality of life, and improvements in these areas increase the quality of life.

It’s really that simple. Addressing the social determinants of health, by definition, reduces the chance of health-related harms in a community, including those related to the substance use that drives the opioid and overdose crisis.

The post What are the Social Determinants of Health? appeared first on Pinnacle Treatment Centers.

In this article, we’ll talk about a new drug involved in opioid overdose deaths – ISO – and address the problem of polysubstance misuse. We’ll also talk about how a new generation of designer drugs complicates the efforts of policymakers, treatment providers, and community advocates to help people with substance use disorder (SUD).

What is ISO?

ISO is short for “Isotonitazene,” which is a synthetic opioid recently identified by the Drug Enforcement Agency (DEA) as an emerging threat in the United States. Isotonitazene is one of a class of powerful opioid drugs developed in the 1950s called nitazenes. Here’s how the DEA describes nitazenes:

“Nitazenes are dangerous synthetic opioids that can be as powerful, or even more powerful, than fentanyl. They have no legitimate use.”

To learn more about nitazenes, please navigate to the blog section of our website and read this article:

Nitazenes: A New Factor in the Opioid Crisis

Experts indicate that nitazenes can be up to 10 times as potent as fentanyl, which itself is 50 times more powerful than heroin. That’s why ISO is so dangerous, and that’s why representatives from the DEA warn that ISO may exacerbate the overdose crisis in the U.S.

Designer Molecules Like ISO and Drug Overdose

People familiar with the phrase designer drugs often think of party drugs such as MDMA (ecstasy) popularized during the 1980s and 1990s, associated with all-night dance clubs, alternative lifestyles, the rave culture. What many people don’t know is that the culture of all-night partying and dance parties – with the assistance of various illicit drugs – never went away. In the 80s and 90s – and now – it’s common to mix opioids, stimulants, amphetamines, and alcohol in an ad hoc cocktail designed to reduce inhibitions, increase feelings of connectedness (I love everyone!), induce euphoria, and give people the energy to stay up all night.

That’s a somewhat romantic – and unrealistic – view of designer drugs. It’s particularly off base when we consider the new generation of designer drugs such as fentanyl, carfentanil, xylazine, and nitazenes. There’s nothing fun or party-like about these drugs or their consequences. They do two primary things:

1. Increase profits for drug traffickers
2. Increase risk of overdose and death for people who take them

When we talk about the opioid crisis, we logically focus on opioids. However, since the mid-teens – around 2015 – the opioid crisis has grown complicated, and although opioids are the main driver of the opioid crisis, fatal overdose involving other drugs is part of why the crisis persists.

This is where it gets more complicated. The other drugs contributing to the overdose crisis, such as methamphetamine, amphetamine, and cocaine, are now likely to contain drugs such as fentanyl, carfentanil, xylazine, and nitazenes.

ISO, Fentanyl, and Overdose

Why do drug traffickers put fentanyl and nitazenes in drugs like methamphetamine and others?

First, it’s currently easy for cartels – such as the Sinaloa Cartel and the Jalisco cartel – to buy the chemical precursors to fentanyl from overseas suppliers. It’s also not hard or too complicated to manufacture fentanyl or nitazenes in illicit laboratories. After manufacture, traffickers mix these chemicals – which they create themselves, and are easier to source than the opium or coca necessary to manufacture heroin or cocaine – with their supply of illicit drugs, which increases volume, thereby increasing their profit, as we mention above.

That’s good for drug traffickers, but a literal recipe for disaster for people who use drugs, especially people who use illicit opioids, illicit/fake prescription medications, methamphetamine, stimulants, or tranquilizers like benzodiazepines.

Here’s the problem, or part of it: a person who uses opioids often understands the warning signs of opioid overdose – and they often also have Narcan on hand in case of an accidental overdose. However, a person who takes an illicit stimulant, like cocaine, or an amphetamine, like methamphetamine, might not be on the lookout for the signs of opioid overdose, since stimulants/amphetamines generally have the opposite effect of opioids.

In other words, they may not know to watch for the warning signs of opioid overdose.

Why?

Because they had no idea they ingested and opioid or opioid-derived medication like fentanyl or a nitazenes like ISO.

Highest Danger: Illicit Opioids, Methamphetamine, Fake Prescription Drugs

Drugs like fentanyl, xylazine, and ISO – a.k.a. nitazenes – make purchasing illicit drugs akin to playing Russian Roulette. Here’s how DEA intelligence analyst Maura Gaffney describes the problem:

“People have to keep in mind, with all the synthetic drugs out there, and the way they’re being mixed together, you never know what you’re actually buying.”

In 2021, over 108,000 people died of drug overdose, with 75 percent of those fatalities involving a synthetic opioid. And, as we mentioned above, in many cases, overdose victims never knew they ingested an opioid.

According to the DEA, synthetic opioids – the new, deadlier designer drugs – are now detected in a variety of illicit and fake prescription drugs:

• Amphetamine
• Methamphetamine
• Cocaine
• Heroin
• Benzodiazepines
• Prescription opioids

Warning signs of a fentanyl or designer opioid overdose include:

• Person is unresponsive
• Irregular breathing
• Gray, pale, bluish skin/lips
• Tiny, pinpoint pupils

If you see these signs in someone, take the following steps:

1. Call 911
2. Administer Narcan, if it’s on hand
3. Administer CPR, if you know it
4. If nothing changes, administer a second dose of Narcan
5. Stay with overdose victim until help arrives

At the moment, there is no way for a regular person to test for or detect ISO in an opioid or another drug. However, fentanyl test strips are readily available and easy to use. To learn more about fentanyl test strips, check the Centers for Disease Control Fentanyl Test Strip Page. Buying fentanyl test strips is easy: simply search ‘fentanyl test strip’ on Amazon. To find free fentanyl test strips in your area, please visit the National Harm Reduction Coalition Fentanyl Page.

The post What is ISO? Illicit Drugs and Opioid Overdose appeared first on Pinnacle Treatment Centers.

By Lori Ryland, Ph.D., LP, CAADC, CCS, BCBA-D, Chief Clinical Officer,

Nitazenes are a class of opioid drug invented in the 1950s so strong scientists determined they had a high potential for misuse/abuse and no real practical medical use or application, but now, close to 75 years later, drug cartels mix nitazenes – known by the street name “iso” – with opioids and other illicit drugs, increasing risk of addiction and driving up the number of fatalities associated with the decades-old, nationwide opioid crisis.

Nitazenes are a stark reminder that the opioid crisis in the U.S. is not going away.

They join fentanyl as the latest complicating factor in the opioid crisis, which is also known as the overdose crisis, partially because illicit opioids like fentanyl are now present in non-opioid drugs, which increases risk of addiction and fatal overdose.

If you’re not familiar with the opioid crisis, please navigate to the blog section of our website and read about the current nationwide efforts underway to mitigate harm, reduce overdose deaths, and offer treatment and support to communities and families impacted by the crisis:

The Opioid Crisis: A New National Strategy

To learn about the impact of opioid derivatives on the opioid crisis, please read this article:

Emerging National Security Threat: Xylazine Laced With Fentanyl Exacerbates Opioid Crisis

If you’re not familiar with the impact of fentanyl on the opioid crisis, or you’ve never heard of fentanyl, please read this article:

Opioid Crisis Report: Need for Fentanyl Detox Increases

Before we discuss nitazenes and their impact on the opioid crisis, we’ll share the final, confirmed statistics on opioid use disorder and opioid fatalities in the U.S., published in the 2022 National Survey on Drug Use and Health (2022 NSDUH) and the Centers for Disease Control (CDC):

Opioid Use Disorder (OUD) and Opioid Overdose Fatalities, 2022

• Opioid use disorder (OUD):
  • Age 12+: 6.1 million
  • 12-17: 265,000
  • 18-25: 424,000
  • 26+: 5.4 million
• Total overdose fatalities:
  • All drugs: 110,757 (DEA)
  • Opioids: 79,770
  • Synthetic opioids (e.g. fentanyl, nitazenes, others): 75,125

That’s the data – and it clearly demonstrates the increasing problems and complications caused by the presence of illicit, synthetic opioids in the illicit drug supply. Let’s take a closer look at the latest drug that threatens the health and well-being of communities and families across the U.S.: nitazenes.

Nitazenes and the Opioid Crisis: What Are Nitazenes?

In a press conference held in October 2023, DEA administrator Anne Milgram made the following comments about the presence of nitazenes in the illicit drug supply in the U.S. She talks about nitazenes and how the joint DEA/Department of Justice (DOJ) taskforce is working to address the problem.

“Nitazenes are dangerous synthetic opioids that can be as powerful, or even more powerful, than fentanyl. They have no legitimate use. Today, we announce 8 indictments, charging 8 companies and 12 individuals, for importing into the United States fentanyl precursors [e.g., nitazenes], xylazine, and other man-made or synthetic chemicals.”

Law enforcement and laboratory analysts report at least ten types of nitazenes found in the drug supply in the U.S. The three most common include:

• Isotonitazene
• Metonitazene
• Etonitazene

To reiterate, these chemicals have no legitimate medical use. Currently, they exist only to increase profits for drug cartels and distributors to maximize profit from the sale of illicit drugs. Several types of illicitly produced drugs may include nitazenes:

• Opioids/opiates:
  • Fake prescription medications such as oxycodone, oxycontin, Vicodin, Percocet, and others
  • Fentanyl and derivatives
  • Heroin
  • Morphine
  • Dilaudid
• Methamphetamine
• Amphetamine
• MDMA, a.k.a. ecstasy
• Cocaine
• Benzodiazepines
• Ketamine
• Synthetic cannabinoids

Nitazenes appear in different forms:

• White, yellow, or brown powder
• White, yellow, or brown crystalline solid
• Liquid form

Ingesting nitazenes causes the following:

• Pain relief
• Euphoria
• Fever
• Sweats
• Nausea/vomiting
• Respiratory depression (slow breathing)

These symptoms/consequences/effects are one reason nitazenes are a real threat. They’re similar to the effects of opioids and other drugs. However, person who takes one of the illicit drugs containing nitazenes may have no idea they ingested nitazenes or a nitazene derivative. It’s similar to the problem posed by fentanyl, carfentanil, and other chemicals drug traffickers use to increase both the volume and potency of their products.

Think of it this way. If a person takes methamphetamine, or something different, like benzodiazepine, they won’t be on the lookout for signs of an opioid overdose. And when they realize what’s happening, it may be too late to administer Narcan. It may also be too late to get to an emergency room for lifesaving medical care.

So what can we do about nitazenes?

Nitazenes, the Opioid Crisis, Law Enforcement, and Evidence-Based Treatment

Here’s what we know, so far, about nitazenes, as reported by the DEA in the press conference we link to above:

• Drug manufacturers in China produce drugs such as xylazine and nitazenes, and sell them to drug traffickers in Mexico and Central America
• The DEA identifies the Sinaloa and Jalisco cartels as primary manufacturers and distributors of the nitazenes that reach the U.S.
• In October 2023, the DEA announced 8 indictments that charged 8 companies and 12 individuals responsible for importing nitazenes, xylazine, and other chemicals related to illicit drug manufacturing into the U.S.
• Chemicals like nitazenes are inexpensive
• It’s relatively easy for chemists working for drug cartels to turn fentanyl precursors into fentanyl. It’s also easy for them to use nitazenes to increase the potency of fentanyl

The first step in mitigating the harm caused by these drugs is awareness. DEA Special Agent Jarod Forget confirms this approach:

“We want to get this info out and warn people. If we can educate and inform our communities about the dangers of taking counterfeit prescription pills or other drugs, we stem the proliferation of these deadly opioids, stop all of these senseless deaths, and help keep our neighbors and loved ones safe.”

Although nitazenes are not yet as prevalent as fentanyl, they present a danger that we need to understand before their prevalence increases, and drives rates of fatal overdose even higher than they are now. It’s also important to understand two more things:

1. Evidence-based treatment for opioid addiction, methamphetamine addiction, cocaine addiction, and tranquilizer addiction – all drugs that may contain illicit nitazenes – is effective. Treatment can decrease risk of overdose and death.
2. Narcan can reverse a nitazenes overdose, but effective reversal may take more than one dose. Scientists currently don’t know enough about nitazenes to offer specific guidance on reversion nitazenes overdose, but they do know that Narcan can reverse a nitazene-related overdose.

We’ll keep any eye on any developments on nitazenes, and report the news on nitazene-related overdose prevention and the opioid crisis here as soon as it appears.

The post Nitazenes: A New Factor in the Opioid Crisis appeared first on Pinnacle Treatment Centers.

Experts on the opioid crisis now indicate we’re in the fourth wave or phase of the crisis, which began in the late 1990s. The fourth wave is characterized by mental health problems and treatment access issues related to the COVID-19 pandemic. In addition, wave four/phase four inlcudes increasing polysubstance misuse, with methamphetamine and the presence of fentanyl in various illicit drugs exacerbating the problem by both increasing overdose fatalities and complicating the assessment, treatment, and recovery process.

To learn more about the opioid crisis in general, please navigate to the blog section of our website and review the articles in this category:

The Opioid Crisis in America

To learn about the latest approaches receiving federal funding and the new innovative approaches we’re implementing nationwide, please read this article:

The Opioid Crisis: A New National Strategy

This article will focus and a study published in the Journal of the American Medical Association called Contingency Management for Patients Receiving Medication for Opioid Use Disorder. The study examined the effect of a drug use prevention/reduction/abstinence approach called – as the title implies – contingency management. Researchers reviewed data on contingency management for various drugs, but prioritized analysis on psychostimulants such as methamphetamine. These drugs currently present a significant challenge: they’re associated with increasing overdose death, and – unlike alcohol or opioid use disorder (AUD/OUD), there are currently no medications available to treat stimulant use disorder.

What is Contingency Management?

Here’s how mental health and addiction treatment experts define contingency management:

“Contingency management (CM) is a behavioral therapy, based on operant conditioning principles, that provides tangible reinforcers for evidence of behavior change. In the case of substance use disorders, it most often involves delivery of monetary-based reinforcers for submission of drug negative urine samples.”

Three decades of research on contingency management confirm the following:

• It improves treatment outcomes for people with substance use disorder (SUD)
• It’s safe to implement simultaneously with psychotherapy or pharmacotherapy
• It works for various SUDs
• Pre-existing conditions don’t impact effectiveness
• It works for a wide variety of patients, regardless of demographic or personal characteristics

However, there’s significant resistance to implementing a CM approach to SUD treatment among policymakers, treatment providers, and insurance companies, including Medicare/Medicaid. The arguments against CM revolve around resistance to paying people not to do drugs and concern that patients will divert money paid to abstain from one drug to purchase other drugs. We won’t get into the reasons for/against or discuss the theoretical pros and cons of contingency management in this article: instead, we’ll review evidence from the study above. The study has a relatively narrow focus and prioritizes the following research goal:

“The overarching aim of this systematic review and meta-analysis is to provide a timely and comprehensive review of contingency management’s efficacy in addressing the public health crisis of psychomotor stimulant use and other common clinical challenges among patients receiving MOUD.”

In other words, the researchers wanted to know whether reimbursing patients with opioid use disorder (OUD) in treatment with medications for opioid use disorder (MOUD) decreased polysubstance use, specifically polysubstance use including stimulants like methamphetamine.

Contingency Management and Polysubstance Use While on MOUD

To answer their research question and determine the effectiveness of contingency management on drug use among people on MOUD, the study team analyzed information from 74 clinical trials including data on 10,444 adult patients currently in treatment for opioid use disorder with MOUD.

Here’s what they found.

Stimulant Use:

• Contingency management associated with medium-large effect size on abstinence, compared to control groups

Polysubstance Use:

• Contingency management associated with small-medium effect size on abstinence, compared to control groups

Illicit Opioid Use:

• Contingency management associated with a medium-large effect size on abstinence, compared to control groups

Tobacco Use:

• Contingency management associated with a medium-large effect size on increased abstinence, compared to control groups

Treatment Attendance:

• Contingency management associated with a small-medium effect size on increasing therapy attendance, compared to control groups

Medication Adherence:

• Contingency management associated with a medium-large effect size, compared with control groups

After collecting and analyzing the data to yield those results, researcher combined all the evidence on abstinence and treatment adherence to identify any big-picture, general trends in the data. Here’s what they found.

Combined Data, Abstinence:

• Contingency management associated with significant increased abstinence, compared to control groups

Combined Data, Treatment Adherence:

• Contingency management associated with increased treatment adherence, compared to control groups

At first glance, this evidence looks overwhelmingly positive. It indicates contingency management may have an important place in SUD treatment moving forward. We’ll discuss these results further, below.

Can Contingency Management Really Work?

The data answer that question with a simple, affirmative “Yes.”

However, perhaps a better question might be:

Contingency management works, but is it an approach we want to pursue?

The answer to that is unclear. It should be obvious: if it works, use it. But there are things to think about, here. For instance, is it sustainable to pay people – indefinitely – to not use drugs? This question is relevant because additional data shows that when providers remove the reinforcement or reward – e.g., the money – the positive effects fade quickly.

That’s something to consider, with very real financial implications. At first blush, ongoing, open-ended contingency management doesn’t seem like a sustainable approach.

However, that fact notwithstanding, we need to consider something else, as elucidated by the study authors:

“…contingency management is the only intervention that has reliably increased abstinence from psychomotor stimulants in randomized clinical trials across more than 30 years of research.”

That’s a powerful argument in favor of finding a realistic way to incorporate contingency management into our long-term approach to SUD treatment. Psychomotor stimulants are a primary driver of the current fourth wave of the overdose fatality crisis. Overdose deaths involving fentanyl-laced methamphetamine are on the rise. With contingency management emerging as an effective approach to increasing abstinence, an expansion of the role of CM is logical.

If we truly want to take an all-of-the-above approach to mitigating harm caused by the opioid and overdose crisis, then we need to consider CM. Further, we need to understand the reasons – beyond cash in pocket – it may be an effective approach for reducing psychomotor stimulant misuse. Stimulant misuse carries a significant risk of serious health complications, including fatal overdose. If it reduces harm, we need to find out why. Then we can learn more about how we to leverage the why to help more people in need.

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