Pubdate: Sun, 27 Apr 2014
Source: Worcester Telegram & Gazette (MA)
Copyright: 2014 Worcester Telegram & Gazette
Contact:  http://www.telegram.com/
Details: http://www.mapinc.org/media/509
Author: Susan Spencer

FINDING TREATMENT FOR OPIATE ADDICTION FRAUGHT WITH CHALLENGES

When opiate addiction reaches a crisis point, either through a medical
emergency or a drug user's life falling apart, it can be hard knowing
where to turn.

Matthew Colonna III, a licensed independent clinical social worker and
director of hospital-based psychiatric emergency services with
Riverside Community Care in Milford, coordinates acute evaluations and
referrals for patients who come into the emergency department at
Milford Regional Medical Center with signs of addiction.

Some come by ambulance after an overdose. Others might report
significant pain that doesn't respond to normal doses of medication,
because they've built up a tolerance.

"One common theme I see across patients with prescription opiate
problems is their really strong belief that this isn't a problem: 'I'm
not addicted to this. My doctor's prescribing them,''' Mr. Colonna
said.

"You have to point out to them that, 'Yeah, you're taking it for a
medical problem but you've lost your spouse, your job, your home.' You
go through all of the impact the medications have had. They're a
harder nut to crack to get them even into treatment."

What's more, he said, "The patient's biggest fear is what treatment is
like: 'I don't want to be in a program with people with addiction
problems.' In their minds, there's a huge difference."

Mr. Colonna said that emergency room doctors sometimes show the
patient his or her profile of controlled substance prescriptions
reported to the state Department of Public Health's Prescription
Monitoring Program database. "That's often effective shock treatment,
to show them how much they're using. It has been helpful and we have
caught patients in doctor shopping," he said.

But when the staff makes calls to find detox or treatment, "What we
find are there are no beds available anywhere in the state," he said.

"The patient is left with sitting in the ER or go home and trying to
call from the community. That's unfortunately our default for detox,"
he said.

That delay often results in a relapse.

"In substance abuse admissions, you've got to strike while the iron is
hot," he said.

Sometimes, people get an addicted family member into detox by having
him or her committed by the court under Section 35 to a stay in a
treatment center; or more likely, because beds aren't available in
treatment centers, to Bridgewater State Hospital for men or Framingham
state prison for women. It's often a last-ditch attempt for help.

"It's criminalizing substance abuse and putting family members at the
forefront of forcing treatment," Mr. Colonna said.

Plus, court-ordered treatment is just not that effective.

"Typically, they say they spent the first week or two upset that they
were there. They do not engage with treatment," he continued. "You
want their natural motivation for treatment to build up to the point
that they're ready to change. I don't think people make change when
the gun is held at their head."

Mr. Colonna said the most effective substance abuse referrals are
those to intensive outpatient programs, when the patient doesn't need
detox.

Robin A. Nagle, a licensed clinical social worker, addiction counselor
and clinical supervisor at Spectrum Health Systems in Worcester, said
the quickest way to get someone into Spectrum's outpatient program,
which offers counseling, groups and methadone treatment, is through
same-day admissions.

Early on Monday and Thursday mornings, people seeking treatment come
in on a first-come, first-served basis and see intake staff, meet with
a clinician and see a doctor for an assessment and history. If they're
appropriate for the treatment, they'll often receive methadone the
first day.

"It's an arduous day, but it gets them into treatment right away," Ms.
Nagle said.

She said people come to the program typically through self-referral,
but sometimes are referred by a doctor or agency. Many have been in
treatment before but need the methadone, which blocks the effects of
opiates, to get them off the illicit drugs for a period of time.

"A lot of people are afraid of overdosing and it's a tough situation,"
Ms. Nagle said. "They might have come in with an opiate prescription
that they originally got from a doctor for a medical issue, it could
have been a chronic medical condition, and there's been a
progression.

"Sometimes people don't have an idea how strong it can be or how
dangerous it can be. It seems sometimes they're not very educated, or
had Vicodin because they had their wisdom teeth out and they were,
Wow, using Vicodin more than they thought they'd ever be."

Heroin use is also common because it's so inexpensive, she
said.

Perhaps the most challenging part of recovery, Ms. Nagle said, is
recognizing how much effort it takes to be successful.

"Sometimes I think people come in in denial: 'Just take care of the
medical part and I'll be fine,''' she said. "Building a support
system, finding resources in the community, starting to be honest. I
think those are important."

She said Spectrum is developing a family forum for friends or family
to meet once a month to learn about addiction and recovery. "I think
if the family is on board, that makes a huge difference," she said.
"And sometimes families don't understand. I'm sure sometimes they're
afraid or angry. So we're all about, I think, trying to build a bridge."

Both Ms. Nagle and Mr. Colonna believe underlying mental health issues
need to be addressed as well, for successful opiate addiction recovery.

And they agree that opiate addiction is everywhere.

"We're really talking about ourselves," Ms. Nagle said. "We're all
affected."
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MAP posted-by: Matt