The Trump Administration declared the opioid epidemic a public health emergency last week. There are millions of people in the U.S. struggling with an opioid-use disorder. Effective treatment can help people with opioid addiction get clean. The Centers for Disease Control and Prevention reports it’s critical to expand access to evidence-based programs that provide behavioral therapy in combination with medication. Reno Public Radio’s Anh Gray explores how that works.
Opioids are substances that can come in natural or synthetic forms. Heroin and fentanyl, a synthetic opioid, are illegal forms of the drug. But legal ones, like oxycodone, hydrocodone and codeine, are commonly prescribed pain killers.
Opiates are habit forming because chemicals in those drugs bind with brain receptors which releases dopamine, creating a sense of euphoria.
Dr. Saide Altinsan is a psychiatrist at Northern Nevada HOPES, a community health center based in Reno.
“I think most people don’t understand that opioid use disorder is a medical disorder, they feel that it’s a character flaw, however, studies show that it’s a genetic, biological disorder,” Altinsan says. “You can compare it with hypertension or diabetes. It’s a chronic, relapsing disorder that needs to be treated.
At HOPES, Altinsan offers her patients with what’s called Medication-Assisted Treatment, or MAT, which combines counseling with medications. In general, MAT programs use one of several FDA approved drugs to control cravings, reducing the risk of relapse and fatal overdose. Altinsan says she’s seen positive outcomes.
“People actually turn their lives back to normal,” Altinsan explains, “and I’ve seen people, initially, I see them homeless, isolated, unemployed, and when they start our program, I see that they become healthier, they get their families back, they start working.
Critics of MAT say that the treatment is merely replacing one drug with another. Using medication can be controversial because drugs like methadone and buprenorphine, used in treatment, are opioids. And, the side effects for some of the treatment medication are similar to opioids and range from nausea, vomiting and irritability.
But many addiction experts and national health agencies support MAT as an effective treatment. They include the Substance Abuse and Mental Health Services Administration, the US Surgeon General, the National Institute on Drug Abuse.
The Life Change Center is an Opioid Treatment Program in Sparks. The facility is busy with about 300 people stopping in each day to pick up meds. John Firestone heads up the center and says relapse is common because withdrawal symptoms are severe.
“At their worst, they’re experiencing a lot of flu-like symptoms, nausea, vomiting perhaps, definitely stomach upset; they’re sweating, hot-and-cold sensations, a lot of nose running, eyes watering,” Firestone explains, “and then the sleeplessness that goes on for quite some time, and it’s tough.”
And remember how the opioids act on brain receptors? Well, treatment medications activate the same ones but take a longer time to be absorbed in the bloodstream and can help people stay in treatment. Other options include non-opioid drugs that also sit on those same receptors and block them.
In Nevada, there are slightly more than just a dozen licensed opioid treatment programs that provide MAT.
“The needs of our patients are fairly high by the time they come to us,” Firestone says. “Their lives have been kind of challenged and they are kind of living day to day. The idea of rehabilitation and recovery is complex and it takes time.”
Firestone says doctors customize care by determining which drugs would be effective and for how long treatment should last for each patient. Under federal law, in addition to medication, programs are required to provide medical assessments, counseling, and other therapies.
The Life Change Center offers a variety of services including group counseling, a gardening program, and music therapy.
In a dimly lit room, music therapist Dr. Dave Kemppainen leads a group playing handmade drums, rainsticks and maracas.
“I think it has, number one, a calming effect; it also has a focus effect, centering effect,” Kemppainen explains. “If you have a little bit of anger or stress going on, it’s a stress release, emotional release.”
Frank Borrelli is part of the group. For maintenance, he comes to the center to pick up a weekly regimen of meds and to participate in therapy sessions.
“I’m from Chicago and I had a drug addiction and I came to Reno to build video poker and Keno and slot machines for my dad and I relapsed and started again,” Borrelli says, “so I came to the Life Change Center and I’ve been here for seven years.”
And Borrelli says he has stayed clean for those seven years.