Progressive therapies

Detoxification involves clearing the body of opioids, or any drug for that matter. The process is often extremely mentally taxing and physically painful. Because of this, some people pair detoxification with medicine to help cope with the pain (Goodman, n.d.). Detoxification should not be confused with treatment, as it only addresses the physical side of opioid addiction (National Institute on Drug Abuse, 2018).

Naloxone or Naltrexone Therapy

Naltrexone is a once monthly injection form of Naloxone. Naloxone and Naltrexone are opioid antagonists, meaning they bind to the receptors in the brain where opioids do damage and block the activity of the drug (The National Alliance of Advocates for Buprenorphine Treatment, n.d.). Naloxone and Naltrexone are very attractive, and they bind to the receptors so strongly that they remove the opioid and block it from re-binding (Bloom, 2018). This is why Naloxone works in an overdose (Harm Reduction Coalition, n.d.). If an addict tries to use heroin, fentanyl, or prescription pain relievers, they will not work if Naltrexone is in his or her system (Tate, 2018). Naloxone or Naltrexone Therapy are only successful in very motivated individuals who have a lot to lose if they continue to use or work in sectors where other Medically Assisted Treatment modalities are not acceptable, such as pilots or physicians (National Institute on Drug Abuse, 2018).

Methadone

Methadone, at its core, is really just a substitution of one opioid for another in a controlled, safe, and monitored environment. Methadone is a long-acting opioid agonist. Because of its long duration of action, it doesn’t produce the same high and euphoria as heroin, oxycodone, fentanyl, etc. The goal is to give it at a dose that keeps the patient from feeling withdrawal and craving, but still allows them to function, hold a job, etc (Ambardekar, 2017).

The danger of the drug is that Methadone can be abused. For example, it can be crushed and injected. It doesn’t relieve the patient of their addiction, but refocuses their addiction on something less destructive (National Institute on Drug Abuse, 2018). Methadone maintenance therapy can be quite effective. It decreases homelessness and joblessness among users, as well as decreases the spread of HIV and Hepatitis C (Ambardekar, 2017).

Buprenorphine

Buprenorphine is commonly known as Suboxone. It binds the same receptors as other opioid and has some opioid properties; however, it produces about half the effect of other opioids. Buprenorphine is an opioid agonist-antagonist, as it binds the opioid receptors very strongly and out-competes the pure opioids. This provides some safety if a person with opioid use disorder tries to use heroin, fentanyl, or prescription pain relievers while on buprenorphine (National Institute on Drug Abuse, 2018). Also, buprenorphine does not have the same risk of respiratory depression that come with other drugs. People don’t seem to stop breathing when they misuse the buprenorphine, which is what kills almost all people who overdose (The National Alliance of Advocates for Buprenorphine Treatment, n.d.).

Suboxone is a formulation buprenorphine that contains a small amount of naloxone. Naloxone has no, or very little, activity when taken orally. However, if the patient tries to melt the suboxone and inject it to get high, the naloxone is active and prevents the user from feeling any rush, making it less likely to be used inappropriately. Buprenorphine has less abuse potential than methadone, but there have been cases of illicit use now that it is being used more frequently (The National Alliance of Advocates for Buprenorphine Treatment, n.d.).

Narcotics Anonymous

Almost all addicts have done better when prescribed drugs are combined with psychological and social counseling. Narcotics Anonymous is one of the biggest support groups in the nation. It was inspired by the success of Alcoholics Anonymous. Anyone is able to join a group, meaning it is accessible to anyone who believes they need it (Addiction Center, 2018).

Narcotics Anonymous has two meeting styles, including discussion meetings or speaker meetings (National Institute on Drug Abuse, 2018). Discussion meetings model a group discussion, while speaker meetings typically only have one speaker sharing. While sharing is encouraged, it is not enforced. In addition, addicts are encouraged to rely on a higher power to go through recovery with. A higher power can be anything the addict wants it to be; many people say theirs is God (Addiction Center, 2018).

Types of Non-Traditional Treatments

Equine Assisted Psychotherapy

Equine Assisted Psychotherapy has proven effective in addicts, especially youth and adolescent addicts. Addiction affects more than just the body, and in adolescents especially, has major effects on emotional health (National Institute on Drug Abuse, n.d.).

Equine Assisted Psychotherapy focuses heavily on social development, as many adolescents who struggle with drug addiction also struggle with self confidence (Bennington-Castro, 2014). In addition to social development, Equine Assisted Psychotherapy teaches responsibility. Therapists often allow the client to take care of the basic needs of horses, including grooming and feeding. Taking care of something bigger than themself is often both calming and rewarding for clients (Filippides, 2016).

Because it is often difficult for adolescents to bond with a therapist, due to either distrust or defiance, the presence of the horse allows them to connect with the animal in the presence of the therapist (Filippides, 2016). According to the theories of Ivan Pavlov, a physiologist and psychologist widely known for his work in classical conditioning, when the good thoughts are associated with the horse, they will also be associated with the therapist (The Nobel Prize, n.d.). This allows for a connection with both the animal and the person.

While Equine Assisted Psychotherapy has been very successful in alleviating the social effects of opioid addiction, it does not address the physical needs of patients (Foundations Recovery Network, n.d.). Because of this, it is often paired with some type of medication (Filippides, 2016). According to an Eagala study in 2013, children/youth ages 10-18 benefited most among each age group from Equine Assisted Psychotherapy (Eagala, n.d.). This set of data implies that Equine Assisted Psychotherapy may not work well for younger children, but mostly middle and high school students.

Eye Movement Desensitization and Reprocessing

Eye Movement Desensitization and Reprocessing is typically used for addicts who started using opioids due to trauma or emotional issues. The process encourages drug addicts to first focus on why they began using drugs (the past), what is causing them to continue to use drugs (the present), and how they can make get out of the situation (the future) (EMDR Institute Inc., n.d.).

Eye Movement Desensitization consists of eight phases per meeting. The beginning phases focus on familiarizing the therapist with the client’s current situation, as well as addressing the stressors that contribute to the situation. The middle phases are when the actual visualizing takes place; the patient focuses on the image, and identifies how it makes them feel both emotionally and physically. The therapist’s job is to assist the patient in creating goals. In the final phases, the client is encouraged to create a log of anything they think might be relevant to the next meeting (EMDR Institute Inc., n.d.).

Eye Movement Desensitization and Reprocessing cannot be successful in just one meeting. The patient must be committed for several months for the treatment to be successful. While Eye Movement Desensitization and Reprocessing helps to calm the patient over issues that caused them to start using drugs in the first place, it does not address the actual addiction; for that reason, Eye Movement Desensitization Reprocessing is often paired with a form of medication (EMDR Institute Inc., n.d.).

Adventure and Wilderness Therapy

Adventure therapy is a method of combining healing exercises with outdoor activities. Each activity is guided by a therapist, and the activities can take place individually or with a group. One of the most popular methods of wilderness therapy is therapeutic camps. Therapeutic camps date back to the 1800s, and have been used ever since. The point is to get away from their everyday life and focus on the nature around them. This is important for addicts, as many of them lead very stressful lifestyles (Learn Through Experience, n.d.)

Much like therapeutic camps, adventure therapy is meant to take the patient out of their comfort zone and bring them somewhere outside of their normal life. Adventure therapy pushes the patient to learn more about both their environment and themself. Leadership is one of the main skills people take away from adventure therapy. There are many different kinds of adventure therapy because different patients have different fears or interests. Some of the most popular methods include rock climbing and ropes courses (Learn Through Experience, n.d.).

Art and Music Therapy

Art therapy has a heavy emphasis on self expression, and is popular throughout each age group. The therapy is guided by a therapist, and it usually takes place one on one. One of the main goals of art therapy is simply relaxation. There are three different types of art therapy, including self-expressive art, art studio, and legacy projects. Self-expressive art and art studio are the more popular types, as they predominantly focus on how the patient is feeling in the moment. Legacy projects, however, focus on memories. The style of art therapy that the patient chooses really just depends on their background and the details of their addiction (Hope Healthcare, n.d.).

Like art therapy, music therapy focuses on relaxation. Patients, accompanied by a therapist, listen to music, and oftentimes are encouraged to create their own. Many patients enjoy writing songs and performing them to the therapist. Music has many physical effects on the brain and releases endorphins when people hear music they enjoy. This is what causes the positive symptoms like relaxation and contentedness. While the meetings with the therapist are critically important to improving, patients are encouraged to listen and create music outside of therapy sessions as well (Hope Healthcare, n.d.).

Virginia Efforts

The state of Virginia has taken several approaches to address opioid addiction in the commonwealth. According to Tina Pullen, the Public Affairs Officer for the Norfolk Field Office of the Federal Bureau of Investigation, Virginia is a leader in addressing the opioid epidemic. From the Governor of Virginia, who is a pediatrician, to the Virginia Attorney General and the United States Attorney, there is a strong sense of urgency at every level of government to address the crisis T. Pullen, personal communication, November 2, 2018).

This is exemplified, for example, by Virginia’s initiative to spearhead statewide change in education curriculum both at the K-12 level and in higher education. More emphasis has been placed on education about opioids and the hazards associated with its use as opposed to focusing on the traditional DARE program. Additionally, there has been an improved response capability by the law enforcement and first responders community. Naloxone is more readily available and coordination in investigations and the responsibilities of the first person to respond to a scene involving opioids are being handled in an unprecedented way. Also, the medical community in Virginia has changed the way they treat pain and has led efforts to incorporate comprehensive opioid education and training for medical and nursing students. Furthermore, the outreach groups have engaged the faith-based community and initiated social media efforts to crowdsource awareness and information sharing (T. Pullen, personal communication, November 2, 2018).

In the Coastal Plain region of Virginia, the Virginia Attorney General and the United States Attorney for the Eastern District of Virginia teamed up in 2016 to form the Hampton Roads Opioid Working Group. The Hampton Roads Opioid Working Group is a community-based group of action oriented members who are dedicated to reducing the number of opioid related deaths by addressing the demand side of the threat through community awareness, medical community innovation and leadership, and through the support of service based organizations and treatment facilities. The group is made up of members of the law enforcement community, educators, medical professionals, peer recovery specialists, and outreach coordinators. Since September 2016, it has met regularly to address all angles of the epidemic (T. Pullen, personal communication, November 2, 2018).

Because of all of these changes, Virginia was able to report that opioid related deaths in Hampton Roads went down 17% in 2017 (T. Pullen, personal communication, November 2, 2018).

United States Efforts. Drug Addiction Treatment Act of 2000

The Drug Addiction Treatment Act of 2000 is the act that allowed certified doctors to prescribe illegal drugs to opioid-dependent patients in order to combat addiction. This was a major act because it popularized the prescription of Buprenorphine, and 18 years later, it is still a top choice for physicians. Buprenorphine is so effective because it has a very low abuse rate due to the presence of Naloxone within it (The National Alliance of Advocates for Buprenorphine Treatment, n.d.). According to a study done by the United States Department of Health and Human Sciences, Buprenorphine saw an 80% success rate in reducing opioid use (Substance Abuse and Mental Health Administration, 2018).

The Support for Patients and Communities Act of 2018

In October 2018, President Donald Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018. The act mainly focuses on hospitals and state health programs, and its goal is to make treatment more accessible throughout the United States. The Act aims to encourage hospitals to be more conservative when prescribing opioids for pain-relief by increasing the number of prescription drug monitoring programs (PDMPs). In addition, the new law will encourage identifying substance abuse by allowing doctors to look for symptoms at regular wellness checkups. Hospitals have been encouraged to view the act in its entirety on order to reach its full potential (The SUPPORT, 2018).

Federal Bureau of Investigation

In addition to outreach and education programs, the Federal Bureau of Investigation addresses the supply of opioids by targeting the violent crime organizations that distribute dangerous narcotics in the community. It is widely acknowledged in law enforcement that putting people in jail is not the only solution to the opioid epidemic. Because the epidemic is rooted in drug abuse and addiction, the demand for the drugs needs to be addressed. They use a task force model, which leverages the strengths of each of the local, state, and federal law enforcement partners who work as a team to investigate violent street gangs and drug related violence. These large FBI sponsored task forces can indict and prosecute using federal and state laws. Their mission is different than the Drug Enforcement Administration in that they target groups based on their level of violence, which is measured by the number murders, assaults, use of weapons, etc. during a drug deal, not simply the distribution. That being said, violence and distribution often go hand in hand, so the Bureau routinely partners with the Drug Enforcement Administration (T. Pullen, personal communication, November 2, 2018).

The Federal Bureau of Investigation has used their national platform to shed light on the dangers of opioid abuse through awareness initiatives such as their video Chasing the Dragon: Life of an Opiate Addict (U.S. Department of Justice, n.d.).

Relapse

Addiction is so complex, and opioid addiction, especially, is really hard to get rid of for good. Many people describe addicts as “once and addict, always an addict.” The initial use of opioids causes a rush, a euphoria, and feeling of wellbeing that is very stimulating the the reward and pleasure center in the brain, causing a physiological addiction. It is very powerful, and begins to change the brain’s neurochemistry from the first use. Over time, that rush and euphoria starts to fade. Users are always trying to recapture their first high, which is why they are constantly increasing their dosage (American Addiction Centers, 2018).

The danger comes when the brain realizes that its normal function is being blunted by the drug, because it increases a number of receptors to include those that sense pain and those that give you energy and motivation. The longer the drug is used, the more these receptors are increased. At this point, the addict is in a situation where they depend on the drug to feel healthy. When they don’t use opioids, those increased receptors are still active; the increased pain receptors make the addict feel pain; the increased energy and motivation receptors make the addict feel agitated, antsy, and shaky. Those biochemical changes take a long time to fully recover, if ever (National Institute on Drug Abuse, 2015).

There is also a psychological component, which can be just as harmful for some addicts. The things that led them to use opioids in the first place can be remain such strong triggers for relapse, such as friends, locations, romantic partners, other psychological diseases or disorders, past trauma, stress, homelessness, joblessness; the list goes on. These can be reminders of why they started in the first place, and make the addict feel the need to go back to the perceived safety or comfort that the drug provided them (Psychology Today, n.d.).

Conclusion

The United States needs to break the stigma that surrounds addiction, particularly opioid addiction. It affects all walks of life, no matter what race, religion, color, creed, sexual orientation, or age. Some start use on the street, but the majority start using from legitimate prescriptions, out of curiosity, or a desire to party. Suddenly, they are hooked and can’t stop. Nobody starts with the desire to completely destroy their lives. These people have a disease, and society needs to treat them the way society would treat somebody with cancer; people need to treat them with support and focused care.

As a country, the United States needs to try to eliminate the illicit drugs from entering the market. Similarly, hospitals and doctors need to be smarter and safer in their prescribing of these drugs. Small amounts of the least potent opioid should be used for the shortest time possible and only when absolutely needed. The United States needs to work on developing better pain medications that are not opioids and that have little to no risk of dependence.