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Extended-Release Opioids: Dangers, Differences, Precautions

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Extended-release or sustained-release opioids tend to contain higher doses. They’re formulated to gradually release into the patient’s body over an extended time, typically either a 12-hour or 24-hour period.

However, this time-release mechanism can be bypassed depending on the technology used. Crushing, snorting, and injecting extended-release tablets greatly increases the risk of life-threatening overdose.

The Current Opioid Overdose Crisis

As of 2015, an estimated 1 6 million people worldwide have been affected by opioid use disorders. A majority of heroin users begin taking opioids as legally prescribed pain-relieving tablets. In 2016, the United States recorded over 42,000 deaths due to opioid overdose.

This number grows every year. Many of the deaths are attributed to recreational use. The illegal manufacturing of the potent synthetic opioids like fentanyl are largely to blame. Fentanyl is 80 to 100 times more potent than morphine. It is commonly mixed in illegally pressed pills and sold as Xanax or various other street drugs.

However, many of the deaths are due to recreational users who take legally manufactured synthetic opioids in ways that are not recommended by physicians.

A Safer Extended-Release Oxycodone

Efforts are being made through the coordinated efforts of pharmaceutical companies and the FDA to reformulate extended-release tablets to reduce the likelihood of overdose. Collegium Pharmaceutical’s Xtampza ER is a sustained-release version of oxycodone. Xtampza ER is used to treat moderate to severe chronic pain in opioid-tolerant patients. It’s made in sustained-release capsules of 9 mg, 13.5 mg, 18 mg, 27 mg, and 36 mg. The pills are designed to release a percentage of the drug immediately upon ingestion, with the majority of the drug being released gradually over a 12-hour period.

The patient takes two pills a day for around-the-clock pain relief. Taking more than 36 mg in a single dose or exceeding 72 mg in a 24-hour period dramatically increases the risk of overdose.

According to a recent study presented at PAINWeek 2017 in Las Vegas, Nevada, Xtampza ER’s new formulation has a lower abuse potential than immediate-release oxycodone. Typically, extended-release opioids have a higher abuse potential due to their higher drug content. When crushed, the total drug content is released into the system all at once, increasing the risk of overdose.

The opposite proved to be the case with Xtampza ER. Researchers evaluated the pharmacokinetics of crushed and intact extended-release oxycodone compared to crushed immediate-release oxycodone.

Participants were asked to rank the euphoria of the high along with its pain-relieving effects. Researchers used various metrics, including pupil constriction to determine the strength of the drug’s effects. In general, the smaller the patient’s pupils, the higher the intensity of the effects. When all the numbers were crunched, immediate-release oxycodone had an overall higher risk of drug abuse and overdose.

This is a great accomplishment, considering that sustained-release opioids tend to have a significantly higher abuse potential, especially when crushed.

A Safer Version of Opana ER

In similar fashion, Endo Pharmaceuticals came out with a reformulation of their extended-release oxymorphone hydrochloride tablets in 2012. Opana is derived from morphine but is significantly more potent. Opana ER was first approved in 2006. Just like Xtampza ER, it’s intended for the management of moderate to severe chronic pain that requires 24-hour pain relief.

In 2012, Endo Pharmaceuticals changed the formulation of Opana ER to make it more difficult to manipulate for snorting or injecting. The new formulation met the FDA’s regulatory standards for approval. Following the drug’s release, the FDA determined that the new formulation did not meaningfully reduce Opana ER’s abuse potential.

Endo suggested adding additional warnings to the Opana ER’s label to highlight the potential of drug abuse. However, since the drug’s 2012 release, more evidence has surfaced indicating additional risk factors.

FDA Requests Removal of Opana ER

The 2012 reformulation of Opana ER is significantly more difficult to take via injection. However, taking it through this route is still possible, and severely opioid-dependent users continue to crush, dissolve, and inject the substance.

Common side effects of Opana ER include nausea, vomiting, heart palpitations, sedation, drowsiness, and respiratory depression. When Opana ER is taken intravenously, these adverse effects can become intensified.

Clinically significant respiratory depression is more likely to occur when Opana ER is injected. This can lead to carbon dioxide toxicity, oxygen-deprivation, coma, critical organ failure, irreversible paralysis, brain damage, and death.

In 2015, state officials in Indiana to emergency action following an epidemic of HIV in Austin, Indiana. The epidemic was spread primarily by drug users who were injecting oxymorphone intravenously. This event was one of the final strikes against extended-release oxymorphone tablets like Opana ER. Following this event, the FDA formally recommended the removal of Opana ER from the market.

In 2017, Endo Pharmaceuticals voluntarily removed Opana ER from the market due to the high rates of overdose and risk factors associated with recreational drug use.

How to Take Opioids Safely

All opioids carry with them a high potential for misuse, addiction, and overdose. Substances like oxycodone, oxymorphone, morphine, codeine, and fentanyl are classified as Schedule II controlled substances by the FDA. The manufacturing and distribution of these drugs are tightly regulated. Most have limits as to how much can be produced each year.

The North American opioid overdose epidemic began in the late-1990s and has been growing exponentially ever since. In response, hospitals and physicians have taken the initiative to reduce the rate at which opioids are prescribed.

Patients should only be prescribed opioids when milder, non-opioid pain-relievers are ineffective. The minimum effective dose of opioids should always be prescribed. Doses can be gradually increased every few days until the minimum effective dose is achieved. In general, only opioid-tolerant individuals should be prescribed extended-release versions of opioids.

When it’s time to stop taking opioids, doses should be reduced gradually to minimize symptoms of opioid withdrawal. Discontinuation of opioid use should always be conducted under medical supervision for the best possible outcome.

If you or someone you love is struggling with opioid dependency, Stonewall Institute Treatment Center is more than happy to answer any questions you may have. Call us today at 602-535 6468 or email us at info@stonewallinstitute.com.

Is It Safe To Take SSRIs For Depression While In Recovery?

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Selective Serotonin Reuptake Inhibitors (SSRIs) are one of the most frequently prescribed drugs for Major Depressive Disorder (MDD). Depression is more common among addicts and alcoholics than other groups. During recovery, symptoms can worsen. If you’ve been diagnosed with depression, SSRIs can potentially improve brain chemistry and ease recovery.

SSRIs are in a class of drugs that don’t have the same addictive qualities as opioids and benzodiazepines (Xanax). Their onset is gradual, and the effects can take weeks to take effect. In the rest of this article, we’re going to discuss how SSRIs behave in the brain and how to determine if they’re appropriate for you or your loved one while in recovery.

Many seeking recovery from alcohol and drug use are diagnosed with a co-occuring disorder.  Many times, these co-occuring disorders include anxiety and depression.  Treatment for co-occuring disorders is very common within the realm of addiction recovery.

 

How SSRIs Work

Serotonin is known as the “happy,” “feel-good” neurotransmitter because it increases feelings of general well-being. SSRIs treat depression by temporarily preventing serotonin from being reabsorbed into the bloodstream. When serotonin is absorbed into the bloodstream it gets returned to the inside of your brain’s neurons. To be actively influencing how you feel, serotonin needs to be outside of your brain’s neurons and in the synaptic gap between them. Once here it can get to work at making you feel happy. SSRIs work by allowing serotonin molecules to stay suspended in the synaptic gap for an extended period before reabsorption.

Serotonin has multiple functions in the body and brain, but its main job is to keep you upbeat and content. Folks that have too little serotonin in the synaptic gaps between neurons are more prone to feelings of depression and nervousness.

 

How Depression Influences Addiction

Someone who’s chronically depressed early in life is more likely to self-medicate with drugs and alcohol. This gets the ball rolling, and genetic tendencies for addiction pick up the momentum from there.

Not all people with depression have low serotonin, and not everyone with low serotonin is depressed. Depression can also be caused by imbalances of dopamine and norepinephrine. For people who are both depressed and low in serotonin, SSRIs can be helpful at managing symptoms during alcohol and drug recovery.

 

How Recovery From Addiction Impacts Brain Chemistry

Recovery throws your brain chemistry into chaos. In a state of addiction, the brain relies on substances as an external source of the happy neurotransmitters it would otherwise produce on its own. In the depths of addiction, your brain balances on shaky legs. When you stop taking drugs and alcohol, those legs get kicked out from under you. Recovery is the process of re-establishing healthy brain chemistry that isn’t dependent on substances.

This transitional period can last over a year before your brain returns to its pre-addiction baseline. It’s during this time that untreated depression can create the most risks for recovering addicts.

 

Depression Increases The Risk Of Suicide In Recovering Addicts

One study suggests that the suicides of alcoholics contribute to 25% of the total suicides nationwide. John H. Krystal, M.D. is the chair of the Department of Psychiatry at Yale University School of Medicine. In his opinion, although therapy alone can be helpful, persistent depression is best treated with a combination of therapy and antidepressants.

 

Antidepressants Can Increase The Risk Of Suicide

For some recovering addicts, taking SSRIs can increase the risk of suicide. For others, taking antidepressants can significantly decrease the risk. This makes it critical to work closely with a psychiatrist who’s experienced in dealing with both depression and addiction. The first few weeks of taking SSRIs, and anytime that doses are changed, are high risk periods for suicide. During this time, depression can get worse before it stabilizes. Patients ages 25 and under report the highest occurrences of such episodes.

 

SSRI Side Effects

The biggest risks associated with SSRIs are suicide and decreased sex drive. Aside from these, SSRIs can cause the following side effects: weight gain, nausea, nervousness, dry mouth, fatigue, rash, diarrhea, increased perspiration, trouble sleeping, and headaches.

 

The goal of recovery is to live a long and happy life. For people with depression, taking SSRIs can be lifesaving in its ability to decrease suicidal thoughts. While abstaining from antidepressants may be appropriate for people with mild or intermittent depression, chronically depressed individuals should rely on the opinion of their psychiatrist to help them make the final call. If you or someone you know lives in the Phoenix, AZ area and is in need of treatment for addiction, our 10-week Intensive Outpatient Program is here to help support you through this challenging time.

 

Prescribing SSRIs (How Psychiatrists Evaluate The Need)

Only a psychiatrist can weigh in on the question of whether or not SSRIs are right for your recovery. More likely than not, if you were already taking SSRIs, your doctor will recommend you continue taking them throughout recovery. Discontinuing use will only create further chaos in a brain that’s scrambling to rewire itself post-addiction.

When deciding whether or not to start an SSRI, your doctor will look at your mental health history. If you weren’t consistently depressed leading up to getting clean, your psychiatrist will likely discourage the use of SSRIs.

If you do have a history of chronic depression, your psychiatrist may diagnose you with Major Depressive Disorder. This would warrant getting you started on an SSRI.

Finding Which Antidepressant Works For You

Most antidepressants take several weeks to build up in your system and become effective. This is a long time to be in limbo for someone struggling with depression, thoughts of suicide, and recovery from addiction. It isn’t unusual for a patient to spend an entire year rotating through different medications before finding one the works. The following are antidepressants that your psychiatrist may suggest for you.

Selective Serotonin Reuptake Inhibitors (SSRIs)

These are usually the first types of antidepressants that your psychiatrist will start you on. They tend to have the least side effects and highest success rates. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil, Pexeva), escitalopram (Lexapro), and citalopram (Celexa).

 

Serotonin And Norepinephrine Reuptake Inhibitors (SNRIs)

This class of antidepressants targets the neurotransmitter norepinephrine as well as serotonin. These include venlafaxine (Effexor XR), duloxetine (Cymbalta), levomilnacipran (Fetzima), and desvenlafaxine (Khedezla, Pristiq).

 

Tricyclic Antidepressants

Your psychiatrist will likely try other antidepressants before suggesting tricyclics due to their higher rates of complications. Examples of tricyclics include nortriptyline (Pamelor), imipramine (Tofranil), and desipramine (Norpramin).

 

Atypical Antidepressants

These are antidepressants that don’t fit nicely in any category. They include vilazodone (Viibryd), trazodone, mirtazapine (Remeron), bupropion (Wellbutrin, Aplenzin, Forfivo XL), and vortioxetine (Trintellix).

 

Monoamine Oxidase Inhibitors (MAOIs)

This is another class of antidepressants that your psychiatrist may wait to try. They can have serious side effects and require a strict diet when taking them. MAOIs don’t combine well with SSRIs.

 

SSRIs Don’t Get You “High”

SSRIs are notoriously slow at making an impact on brain chemistry. The best case scenario is that after several weeks the drug will begin positively impacting on how you feel. You never “get high” in the same way that you do with opioids or benzodiazepines. In fact, after being on SSRIs for a while, you probably won’t notice any change until you stop taking them.

 

SSRIs Don’t Cause Withdrawal Symptoms, But You Do Notice When They’re Gone

SSRIs aren’t considered addictive. You will start to feel different, however, if you miss a few doses or if you stop taking them altogether. Stopping SSRIs causes what the doctors call “discontinuation syndrome.” Discontinuation syndrome can result in nausea, dizziness, and flu-like symptoms in addition to feelings of uneasiness. Let your psychiatrist know if you want to stop taking SSRIs. He or she will put together a plan for gradually decreasing your dose in a way that minimizes undesirable symptoms.

 

 

Only you and your psychiatrist can decide whether or not taking SSRIs is right for you. For certain individuals, SSRIs can reduce depression and be a critical component of a safe and successful recovery. SSRIs’ lack of addictive properties makes them safe for recovering addicts to take, so long as they meet the right requirements and are closely monitored by health professionals. If you or anyone you love is currently dealing with drug or alcohol addiction, it’s vital to keep an eye out for developing dependence. Stonewall Institute Treatment Center is more than happy to answer any questions you may have. Call us today at 602-535 6468 or email us at info@stonewallinstitute.com.

 

How to Stay Motivated Through Treatment

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More often than not, people check into a treatment facility with the intention of staying for the average rehabilitation length; 28 days. To think that the recovery process only lasts a month is underestimating the journey you’re about to take. Usually, rehabilitation under supervision lasts up to around 90 days. Yet, it continues throughout the rest of your life.

Maybe you have a loved one entering treatment for their addiction. Or maybe you’re addicted yourself and are looking for a way to handle the process. There are three separate factors that all correlate to help influence addicts stay motivated through treatment.

● Individual engagement

● Facility engagement

● Intensive interventions

 

Through these three factors, your treatment process will not only be successful but also reassure the motivation behind such a life changing decision.

 

Individual Engagement

There are instances where addicts are forced into treatment and, in the end, don’t recover. This has much to do with their lack of individual engagement.

One of the most important steps in recovery is an individual making the decision to quit themselves. If you desire to change your life in this regard, there’s more of an inclination to carry out the steps that proceed.

Addicts who find themselves in a full recovery are often self-motivated by their own ambition. This is why individual engagement is so important.

To ensure a successful treatment, here’s a list of some ways in which an individual can stay engaged:

● Support from loved ones

● Motivated to make a change

● Pressures from outside sources (work, relationships, criminal justice system)

 

Facility Engagement

Though an individual can’t necessarily be held responsible for a facility’s engagement, the facility in question is still your choice. This is why it’s vital for you to pick the right facility for your treatment.

Without the right engagement, an addict may lose faith in their abilities and never recover. When deciding upon a facility, look out for these key factors:

● Cooperative treatment plan

● Clear and concise treatment expectations

● Positive and promising therapeutical relationships with the staff

● Professional resources available (medicinal, social service, psychiatric)

 

Intensive Intervention

One of the most difficult aspects of addiction is an individual is forced to change direct areas of their personality. To go from high to sobriety may be a change in itself, but that change carries along with it a load of minor changes. With this, some individuals get unmotivated to make the change and end up dealing with intensive interventions.

When these situations come into play, those around the individual must know to step up and say something. Whether it be a family member, a faculty staff, a friend, a counselor, or even a co-worker, everyone in the individual’s life must remind him/her that he’s/she’s not on this journey alone. This gives off the impression of care in one’s life and care alone has the ability to motivate someone.

There have been instances where addicts attempt to get out of treatment, even if they had put themselves into it. Often, the change seems too radical for them to handle. It is important that we never let an individual feel undetermined about themselves and to lift them up in times of desperation.

 

 

If you or anyone you know has the desire to make this change, please feel free to call Stonewall Institute Treatment Center at 602-535-6468 for more information on treatment. You may also email us at info@stonewallinstitute.com.

DUI Evaluation Scottsdale

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When you drink and drive, you are putting yourself at risk. Many drink drivers are killed because of their poor driving skills. According to the Centers for Disease Control and Prevention, car wrecks are the leading cause of death for people in America who are under the age of 24, and about 40 percent of those deaths are somehow related to alcohol. Many of those in this statistic were the drivers or passengers of drunk drivers, and recent dui statistics are showing increasing trends.

To schedule a DUI-Related Substance Abuse Evaluation, contact Stonewall Institute at 602-535-6468

Alcohol Screening Scottsdale

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Stonewall Institute provides complete drug and alcohol screening scottsdale to court ordered DUI individuals, and any other person in need of a substance abuse evaluation as required by the Arizona MVD and Arizona Department of Transportation (ADOT).

People who abuse alcohol may have many of the same signs and symptoms as people who have full-blown alcoholism. However, if you abuse alcohol but aren’t completely addicted to it, you may not feel as much of a compulsion to drink. You may not have physical withdrawal symptoms when you don’t drink. But alcohol abuse can still cause serious problems. As with alcoholism, you may not be able to quit drinking without help.

The goal of the alcohol screening is to assess the extent of a client’s current and past alcohol abuse and/or dependence.  If you would like to schedule an alcohol screening scottsdale, contact the Stonewall Institute today at 602-535-6468.