Brain Science and Updates From the Field

Overdose drug gains attention, saves lives

Monday, January 30, 2017
For many people in the throes of an opioid-induced overdose, a chance at survival can come in the form of an injection or a spray to the nose.

Such is the philosophy of naloxone, an anti-overdose drug that has become widely used at hospitals, schools and treatment centers, including Stairways Behavioral Health.

“Having Narcan available at these locations is an important safety precaution in the event of an overdose”, said Erin Mrenek, Director of Stairways Dual Outpatient Clinic.

Naloxone, known by its trade name Narcan or referred to as a “save shot,” is a medication used the block the effects of an overdose that has enjoyed increased prominence as the nationwide opioid epidemic continues to escalate.

The emergency drug works by binding to the same receptors in the brain that are occupied by the chemical the individual has consumed, essentially overtaking the opioids and reversing its effects. For someone who has overdosed, this means the ability to begin breathing normally after a stoppage of respiration. Because of its mechanisms, naloxone causes those who have overdosed to go into withdrawal, prompting them to feel the classic symptoms associated with the condition.

“Narcan is a very effective and fast-acting medication for most types of opioids,” said Mrenak, who added that the drug’s effectiveness is at its peak during the time that follows an overdose and precedes medical attention.

“Our policy at Stairways is always to call 911 in addition to administering Narcan, as it is not a substitute for medical attention. It is a way to improve functioning until emergency medical personnel arrive,” she said

Mrenak noted that people should follow up with medical attention after receiving naloxone, as it is possible to have overdose symptoms resume once the medication wears off.

Deaths from opioids, a drug class that includes heroin and prescription pain medications like oxycodone, morphine and fentanyl, have climbed dramatically in recent years.

The epidemic can trace its roots to more than a decade ago, when pain medicines became more readily available, as opioid overdose deaths have increased from just over 9,000 in 2000 to more than 33,000 in 2015, according to the most recent statistics by the Center for Disease Control. The trend’s dramatic rise is reflected at a local level, as heroin and fentanyl were responsible for the vast majority of nearly 100 drug-related deaths – a number that nearly doubled 2015’s total — in Erie County in 2016, according to an Erie Times-News report.

“At our D and A treatment programs, we have seen an increase in individuals with opioids as their primary drug of choice,” Mrenak said. “There has also been an increase in the use of heroin, specifically with IV use.”

Mrenak added that it has become more difficult to locate inpatient beds for clients in need of services, and Stairways has noticed an increase in individuals using medication-assisted treatment, such as methadone, suboxone or Vivitrol, to treat addictions.

As localities across the country take steps to respond to the opioid epidemic, many have turned to naloxone.

In 2014, Pennsylvania enacted legislation designed to make the drug more readily available when Gov. Tom Wolf signed a standing order making naloxone available to laypeople at pharmacies. In Erie County, overdose victims have benefitted from a new “warm handoff” program that ensures people who have overdosed are considered into substance abuse treatment. The warm handoff, a program run by Safe Harbor Behavioral Health and Gaudenzia covering local hospitals, was an initiative the county’s Heroin Overdose Community Awareness Task Force pursued.

Despite the measures, at least locally, overdoses continue and naloxone is being administered at an alarming rate.

According to the Times-News, naloxone usage among EmergyCare paramedics more than doubled in 2016 — from 39 in 2015 to more than 80 uses last year. First responders also have reported having to use more naloxone as opioid drugs continue to grow in strength. Sadly, many of those who have been saved using naloxone have been revived by the antidote before, underscoring the cruel and unrelenting nature of addiction.

“Opioid addiction is very challenging to overcome because the body becomes physically dependent on these substances and it creates significant changes in the functioning of the brain,” Mrenak said. “Individuals working toward recovery from opioid addiction often struggle with impulse control, recognizing and managing emotions, feelings of depression and managing pain.”

Tangled in the Web

Tuesday, January 20, 2015

The teen who spends hours upon hours engaged in an online role-playing game each day. The husband who can’t stop downloading pornography at home and work. The mother who neglects her kids and maxes out several credit cards surfing the web for items she doesn’t need.

While the internet has been successful in connecting people across the world, relaying information at the click of a button and even changing the way we interact, the aforementioned scenarios represent the ugly side of the web: addiction and abuse.

For Dr. Kimberly Young, Ph.D., a member of the board of directors at Beacon Light Behavioral Health, a Bradford-based outfit with whom Stairways Behavioral Health recently affiliated, these situations arise all too often. Young is also a psychologist noted for her research and treatment of internet addiction disorders and founder of the Center for Internet Addiction.

Internet addiction disorder (IAD) is a compulsive behavior in which online activity interferes with normal life functions.

“It’s not about someone who is in front of their computer at work for most of the day,” she says. “What we’re really talking about is the teen who games for 10 hours a day or the guy who looks at porn or gambles to excess.”

Young, who has studied and treated internet addiction since 1995, created a treatment model called Cognitive-Behavioral Therapy for Internet Addiction (CBTIA) that targets thoughts and feelings associated with IAD.

Internet addiction is a concept that has gained considerable traction in recent years as technology proliferates. As it becomes more available, the internet becomes an accessible place for diversion and refuge from life’s problems, not unlike the role drugs and alcohol play for others, Young said.

“The theme that’s common to the cases I see is escape,” she says. “Like any other addiction, people use the internet to get away from the issues in their lives and they put all their focus and absorb themselves in their computer.”

In addition to escape, those addicted to the internet have the added luxury of remaining completely anonymous to the web community with whom they’re interacting.

“Because they are able to become someone different in the character they become in games or the internet world, it becomes very enticing to take on a position of power, recognition and respect,” she says.

Indeed, many of the changes in brain chemistry that are present in substance abuse also occur in those who are abusive of the internet. For instance, the mesolimbic dopamine pathway—the pleasure center of the brain—becomes active for both drug and internet abusers.

However, unlike chemical dependence, internet use can be difficult to completely eradicate while functioning in an increasingly digital world. That’s why it’s important to assess one’s “digital diet” and establish healthy parameters for more controlled internet use, Young noted.

“I use the analogy of a food addiction,” she says. “It can be harder to treat addiction to food because we all need to eat at some point, whereas you can quit a drug or alcohol and never have the actual need for it again.”

Young stresses that “controlled and moderated” use of is key for anyone.

“For work and some things, you are going to need to use the internet, so moderating it becomes very important,” Young says. “(Internet use) becomes a problem when it is interfering with our everyday lives.”

Dr. Kimberly Young, Ph.D., is a professor at St. Bonaventure University and has been featured in numerous national media outlets including the New York Times, Good Morning America, USA Today, Newsweek and CBS News among others. She has also authored several books on the topic of internet addiction and recently gave a lecture as part of a TEDx event. You can view the lecture here https://www.youtube.com/watch?v=vOSYmLER664

For tips or more information, visit Young’s website http://www,netaddiction.com/

Treatment Court offers an alternative to offenders

Thursday, December 11, 2014

At a site where they might otherwise have been sentenced to incarceration, a group of individuals were recognized for making the most of a second chance Thursday, Dec. 18.

That’s when a handful ex-defendants stood before family, friends and support staff to mark their sobriety and advance to the next stage of recovery by graduating from Erie County Treatment Court.

“It’s usually an emotional time for therapists and families who have invested a great deal in seeing them graduate,” said Autumn McLellan, Stairways Behavioral Health Forensic clinical director.

Treatment court is a court-sponsored program that offers alternative treatment options for non-violent offenders struggling with mental health and substance abuse issues in lieu of jail time.

Treatment court is a model used in place of traditional prosecution for certain offenses in courts across the country and has gained popularity in recent years. In Erie, treatment court is broken down into drug, mental health and family dependency courts, all of which are presided over by Judge William Cunningham.

In March, Erie County President Judge Ernest J. DiSantis Jr. approved a veterans’ court—a program aimed at addressing veterans with addiction and mental health problems. DiSantis assigned Judge John Garhart to head up the court, which became the 18th such program in the state and will operate independently of the other three treatment court programs.

Since its inception in 2000, Erie County treatment court has graduated well over 200 individuals and witnessed on multiple occasions the benefits of using a more supportive and therapeutic approach in place of traditional punishments.

“The courts are more receptive to working with these offenders on issues that may arise because they recognize the mental health component,” said Wayne Sharrow, supervisor of Stairways Behavioral Health’s Drug and Alcohol Clinic.

Stairways has formed a close working partnership with the county in providing mental health services to those involved in treatment court. With the help of Stairways and other providers, treatment courts generally focus on treating the problems that cause the offenders to commit crimes.

Treatment court does have certain eligibility restrictions, Sharrow noted.

“If someone can’t be monitored that would be reason not to include them in treatment court,” he said. “The same is true for if there is a victim who is not welcome to the idea in the victim impact statement.”

Individuals who have applied for and are approved for treatment court attend weekly court hearings that track their adherence to the court’s conditions. Each defendant stands before Cunningham, who evaluates their progress and orders further discipline or treatment.

Staff from Stairways, the Erie County Probation and Parole Department, the district attorney’s office, Erie Office of Children and Youth, Erie County Care Management, Erie County Office of Drug and Alcohol, the Public Defender’s office, other service providers and Cunningham meet prior to the weekly hearings to review offenders’ progress and decide on the proper course of action. Should offenders violate the conditions of their treatment-court sentences, they can be sentenced to traditional penalties, such as jail time.

Offenders are monitored by probations and are subject to random drug testing. Additionally, they must comply with the conditions set forth by the court at the weekly hearings, including those relating to work and personal matters.

“If there is a bad living situation, we try to make arrangements to get them in better situations,” McLellan said. “And if the judge says you have to leave (your current living situation), then you have to leave.”

Treatment court’s pragmatic approach to justice has yielded positive results for courts utilizing the program, as national recidivism rates for graduates are regularly lower than offenders who don’t participate.

On Dec. 18, Erie County residents who completed the program’s three requisite phases and appeared before the court for graduation were the latest group to represent the efficiency of treatment court— a means of reintegration and rehabilitation McLellan endorses.

“I’d recommend (treatment court) to anyone because the need to be held accountable is so great and treatment court offers that,” she said. 

A Different Look at Addiction Recovery

Monday, September 08, 2014

Innovative Injectable treats addiction by target brain's receptors

There is no magic pill for addiction, but an innovative treatment method that can eliminate the effects of alcohol and opiates has been an effective tool in the box for those struggling with substance abuse.

Wendy McCullough, director of Stairways Behavioral Health’s Forensic Clinic has witnessed first-hand the positive outcomes Vivitrol, a monthly injectable, can yield in recovering addicts.

“We’ve had good results with it,” McCullough. “The big thing is that it is not a narcotic, so it’s not addictive and it can be given by anyone who can write prescriptions.”

Vivitrol, the trade name for Naltrexone, is an extended-release injection given each month that acts as a blocker by attaching to receptors in the brain, blocking the euphoric feelings associated with opiates and alcohol.

Vivitrol blocks receptors in the brain associated with opioids (above) and alcohol.

In contrast to methadone and buprenorphine (Suboxone), which have been the standard agonist treatments used during recovery, Vivotrol is an antagonist, meaning it blocks the brain’s neurotransmitters. Methadone and buprenorphine, which are opiates, meanwhile, activate the effects of neurotransmitters naturally found in the brain.

Stairways has used Vivitrol with clients for more than two years and has seen its effectiveness on multiple occasions.

Part of the drug’s appeal, noted McCullough, lay in its practicality. Vivitrol gives substance abuse treatment providers and those in treatment an alternative to methadone and buprenorphine, which must be taken daily under the supervision at certified clinics or, in the case of buprenorphine, at home, which can lead to street sales.

Another attractive quality of Vivitrol is its extended-release feature, which can reduce the urge to get high by eliminating the need to take a daily pill. If a dosage of one of the daily drugs is missed, McCullough noted, addicts are susceptible to relapse because they would then be able to feel the effects of the substance they abuse.

“If I wanted to go use heroin tonight, I could stop using Suboxone two days in advance and get high,” McCullough said. “You can’t do that with Vivitrol.”

While oral naltrexone has been a trusted method used to treat substance abuse for nearly 30 years, intramuscular injections of Vivotrol are a relatively new development, having been approved by the Food and Drug Administration in 2010.

An ongoing concern since its introduction has been its steep price tag. Monthly injections sit in the $800-1,200 range, but unlike other treatment options, Vivitrol is now eligible to be covered by insurance.

 “Some people say it is expensive, McCullough said. “But when you factor in that most insurance pays for it, whereas it does not Suboxone, it really isn’t that much more than the other methods of treatment.”

McCullough recalled an instance several years ago when the drug was not yet covered by insurance, when a clients’ parents paid out of pocket for the monthly injections.

Stairways clients undergo a comprehensive process prior to being put on Vivitrol: blood tests are collected to detect the possible presence of liver enzymes and a chart is kept to monitor triggers and urges. McCullough said that the 20 to 25 clients taking Vivitrol at any given time who also undergo treatment in the form of stress and medication management in coordination with their monthly regimen have generally responded well.

“The people we have on it like it,” she said. “They seem more apt to stay on it. They seem not to be using.”

Though Vivitrol has produced positive results in many, McCullough did acknowledge that monthly injectables are not necessarily a fit for all in recovery.

“We realize it isn’t for everybody and not everyone wants to use it.”



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