Tag Archives: addiction

Opioid USE Spurs California to Rethink Medication

Drug treatment providers in California and elsewhere have relied for decades on abstinence and therapy to treat addicts. In recent years, they’ve turned to medication.

Faced with a worsening opiate epidemic and rising numbers of overdose deaths, policymakers are ramping up medication-assisted treatment. California already plans to expand access to medications as it launches an overhaul of the state’s substance abuse treatment system for low-income residents. The state recently embarked on a five-year demonstration project on the premise that addiction is a chronic disease and should be treated as such.

While medication is not for everyone, it can be critical for some people with severe addiction, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services. The medications, she said, “have been proven as the gold standard for really helping people recover.”

The best-known medication, methadone, blocks the effect of certain drugs and lessens withdrawal symptoms. It is highly regulated and can only be prescribed by clinics that have government approval. Buprenorphine, which can be prescribed in doctors’ offices, produces mild opioid effects while also easing withdrawal symptoms. Another medication available by prescription, naltrexone, blocks the effect of opioids.

The medications are available across the country but must be prescribed by physicians with special training. There are only about 30,000 authorized doctors nationwide, and they can only prescribe to a limited number of patients.

The use of medication in treatment conflicts with the 12-step and Narcotics Anonymous philosophy of addiction recovery, which is based on abstinence, experts said. For many, experts said, simple abstinence doesn’t work.

“You would hope that just by talking to somebody, they could get rid of their problem with drugs,” said James Sorensen, a University of California, San Francisco professor and interim director of the substance abuse and addiction medicine program at Zuckerberg San Francisco General Hospital. “The reality is, that is simply not efficient, so we look for other tools.”

Medication is one of the most successful, evidence-based treatments available, and more access should have a big impact on those with substance abuse disorders, said John Connolly, deputy director for substance abuse prevention and control for the Los Angeles County Department of Public Health. But, he cautioned medication should be used alongside more traditional treatment methods.

“The medication has tremendous effect, but it is most impactful when it is prescribed with the necessary counseling and social supports,” he said.

Stephen Kaplan, director of behavioral health and recovery services for San Mateo County, said the county has increased its use of medication. About two years ago, the county began a pilot project to prescribe naltrexone to people with severe alcoholism who hadn’t been successful in traditional treatment.

The medication reduced people’s cravings and drinking, Kaplan said. The county recently began expanding the project to include people with opiate addictions.

Kaplan said he respects providers who believe that replacing one drug with another is not true recovery. But from a policy standpoint, Kaplan said, the medications are effective and should be more integrated into overall recovery for people with substance abuse disorders. “We need to make available to them every possible option,” he said.

Marijuana Addiction in the Age of Legal Weed

Generation X writer Neal Pollack thought he had it all: a good writing career, a strong marriage, even a lucrative 3-day run on “Jeopardy”! That brought him national attention. Like many in his generation, he also smoked a lot of marijuana. He had discovered that food, music and even his beloved yoga was much better when he smoked. In 2014, as several states in the country legalized pot, Pollack scored a writing gig for a marijuana site that provided free weed. He saw his drug use as harmless and joked about it often in his writing. But as more states, including California, began to legalize the drug, Pollack’s life began to fall apart, in part because of his drug use. Both of his parents died and he soon found himself spiraling out of control, sometimes in public. By 2018, Pollack admitted publicly he had a marijuana addiction and set about to conquer it, through honesty . . . and humor. Pollack’s new book, Pothead, is about coming to terms with his marijuana problems just as the country increased its recreational availability. The book is a cautionary and timely tale for those who think the drug isn’t dangerous and can’t cause serious addictive problems. Join us for a special evening program as Pollack discusses his story with Los Angeles novelist Bucky Sinister.