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Inspiring Success on the Road to Recovery

Monday, January 8, 2018

An Integrated Approach to Tackling the Opioid Crisis

By CBI, Inc. staff

CBI knows we have an opioid crisis happening in the United States of America. If you work in the industry or have had a loved one affected by opioid addiction, then you get it. However, there are still many Americans who can’t explain opioids. They aren’t familiar with what they are, the side effects of use, and signs of abuse or withdrawal symptoms. They don’t know the opioid family expands from prescription painkillers (Percocet, Oxycodone, Vicodin, etc.) to the illicit drug of heroin and new forms of street fentanyl, an extremely potent narcotic that can be deadly from one use or exposure. Most people can’t explain the “crisis” component of opioids as many people are still unfamiliar with the addictive nature of all opioids. In community training, we often ask people what the number one cause of death is when abusing opioids and some typical answers are an overdose or heart attack. Yes, one c
an overdose, or take too many, but that doesn’t always mean death. We definitely need our hearts to function, but when it comes to opioids, they tend to act on our respiratory system, slowing our breathing, often resulting in respiratory failure, the number one cause of death. All this is just the start of the opioid epidemic in America.

Substance abuse is cyclical. 

It never ends. Patterns and trends change, but the abuse of drugs is constantly there. Over the years, Americans have seen an increase in drug overdose deaths. In the 1980s many will recall sayings like “the war on drugs” and “just say no” and we got the feeling that drugs were a problem in our communities. In 1980, there were 6,100 American lives lost to drug overdoses. As we approached the new millennium, we saw an increase to almost 17,000 deaths in 1999 and then we changed history when in 2008 there were more deaths from drugs than car crashes. Over 36,500 lives were lost. Sadly, the increase in drug deaths continues to rise. The Centers for Disease Control confirmed 52,404 drug deaths in 2015. Preliminary data suggests that the number of drug overdose deaths will reach over 64,000 for 2016! The deaths are from many substances; however, a majority of the deaths are from opioids. Early estimates claim 15,466 heroin deaths in 2016 and 20,145 deaths due to fentanyl. These numbers alone total 35,611, about 56% of all the deaths that year and we haven’t even factored in prescription pills.

You never know what you are taking. 

A substance that looks like a pill doesn’t mean it is a pharmaceutical grade drug. Anything can be pressed to look like a pill. There have been many cases of heroin and fentanyl showing up as counterfeit prescription meds. One should know that heroin is not only popular, but is the most potent it’s ever been. Today, heroin can be 90% pure, resulting in addiction or death with one time use. Fentanyl is 50 times stronger than heroin and the US has seen an influx of use and availability. Many of these fake pills are trafficked in from China and Mexico. Current trends reflect blue pills stamped to look like oxycodone. Fentanyl can be deadly in as little as 3 milligrams, which looks like 3 grains of salt… nearly undetectable to the human eye.

“The just say no” campaign failed. 

This is why being in the know or knowledgeable is so important. This is where it starts… education. We can’t be afraid to communicate with one another. Ask our doctors questions. Find out the facts. Inquire with loved ones about their habits, genetics, daily environments, etc. We need to prevent the problem before it occurs and start serious life skill conversations with our kids early and often. We can’t stop the efforts or give up hope. We just need to understand the potential for harm and reduce it.
Pain management is a real thing and necessary in some cases, but not all. It’s ok to feel pain and it’s ok to feel happiness. We learn from our life experiences and feelings. It’s all part of human nature to grow and develop. Perhaps we need reminders that drugs, legal and illegal, can hinder that progress. Maybe more importantly, we remember it’s possible to cope without the “pill for every ill” mentality.

Pain is part of life. We need to accept that pain is part of life. Yes, sometimes the pain becomes unmanageable. We may need medications, counseling or other means/skills to assist us in coping. However, it is when we do not accept the pain that we can create suffering for ourselves. When we burn our hand, we want to experience pain so we can treat that wound accordingly. When a loved one passes away, we may feel pain related to the grief of the loss. If we do not allow ourselves to feel the pain and/or process the experience, the pain can turn into suffering. We can store that pain or suffering in our bodies, which can impact our mind, behaviors, emotions and physical reactions.

There is treatment and support. 

Addiction and/or dependence not only impacts the individual who is addicted or dependent, it impacts families, friends and the community. Community Bridges, Inc. (CBI) provides services throughout the state of Arizona that assist individuals with getting on their own journey to recovery, and services that provide support and education to families, friends, and the community. At CBI, we know the journey to recovery is not always easy and it can look very different for each person. There's a stigma around addiction, which can include blaming the person who's addicted. Addiction does change the brain. As we treat other medical conditions, it's important that we're treating addiction the same way. When a loved one is going through cancer treatments, the family unit needs support as well. It's the same thing with addiction.

Recovery is possible. 

Community Bridges, Inc. (CBI) understands the support that is needed when you or a loved one are going through recovery. Many CBI employees have been through recovery, and are now working to help others realize the light at the end of the tunnel. Over the past 35 years, CBI has helped thousands of men, women, and families from all walks of life, including Veterans, homeless, and those suffering from mental illness and substance use. They offer a variety of programs that are catered towards very specific needs, such as opioid dependency.

CBI’s programs can help. 

UnScript is a program of Community Bridges, Inc.(CBI) which was developed to treat individuals who have become dependent on prescription pain medications due to having a legitimate pain condition and being prescribed medication by a doctor. The program uses medical interventions, along with an addiction-free pain management model to assist individuals in decreasing their dependence on opioid-based interventions and increase their ability to manage their pain in a manner that is less disruptive to their life. The programs assist the individual in making a long-term gain in their ability to manage their pain.

Don’t always believe your doctor. 

People go to the doctor and get a legitimate prescription for pain medication and feel as though they are doing the right thing. Over time, that dependence can build to where we see the need for the Unscript Program because it is that unintentional dependence that was developed due to being prescribed medication that was needed. We have become so used to prescribing these medications, even in large quantities for minor injuries or minor procedures. One may become physically dependent or addicted to these medications in as little as five days.

The original opioids are unheard of. 

The original opioids are naturally occurring substances and come from the opium poppy. Rather than converted into morphine and heroin, they are made into all these synthetic analogs that are meant to be more effective, more powerful pain relief. Then there's the street world of heroin. Physicians and the public have become more aware of the epidemic and physicians are starting to be wary of prescribing. We also have pharmaceutical databases to look at what somebody is being prescribed, and that's driving the move to street drugs.

The face of addiction has changed. 

Addiction no longer looks like the stereotypical homeless person on the side of the street. Most individuals who are dependent on drugs are like most of us, with families, jobs, and children. Substance use is becoming common in the workplace. The philosophy behind chronic pain management is that you'll be able to function until it starts getting out of control and addiction takes over.

Adolescents are becoming addicted to opioids. 

It is not just adults in the workplace becoming addicted to opioids, but it is also our youth. CBI is introducing their new Unscript Adolescent Program in 2018. The program will provide comprehensive, medically integrated behavioral health services that support members in achieving their recovery goals, enhancing health and wellness, and improving the quality of their lives.

Teenage deaths continue to grow due to heroin and other opioids. 

CBI developed an Adolescent Opioid Use Disorder Treatment Program model for those 16 to 18. The program will focus on brief intervention techniques and taper adolescents off opioids by using Medication Assisted Treatment (MAT), individual counseling, and expanded family support. By using a holistic approach and age-specific interventions, CBI will guide and support adolescents in their journey through addiction recovery.

Medically treating opioid dependencies. 

Medication Assisted Treatment (MAT) helps treat opioid dependency by using suboxone. According to studies, suboxone is a medication often prescribed to teens and is used to treat opioid dependence. “One of the advantages to using suboxone is that it can’t be taken to achieve a full opioid effect, making it more difficult to abuse than other forms of medication-assisted treatment, such as methadone. It is designed to assist the youth in slowly coming off opioids by introducing the suboxone and then to taper off suboxone. This transition process is done under the care of both a psychiatric and family practitioner to monitor mental health and physical health issues. CBI currently offers Medication Assisted Treatment services at five of their facilities in Arizona.

Treating more than just your addiction 

CBI’s specialized programs work through a multidisciplinary team approach to assess biological, medical, psychological, social, and spiritual domains of life to design the most effective treatment modality for each individual and/or family. The model addresses these domains to achieve true wellness and recovery. Family Support Services are used throughout the treatment to engage the family in discussion regarding education, crisis intervention, skills training, management of mental illness, problem-solving, and social and emotional support. CBI believes it is important to not only treat the patient, but their families too.

Your path to recovery. 

Everybody has their own journey through recovery. Every person has their own unique story and path. Community Bridges, Inc. (CBI) acknowledges that and takes every facet of your life into consideration when helping you through your path of recovery. CBI remarkable and talented staff loves people. CBI offers inpatient and outpatient programs that fit all individual needs.

For more information and to learn about our services please visit:
www.communitybridgesAZ.org.





Sierra Tucson celebrates 10 years - Gratitude for Giving

December 1, 2017, marked the 10th annual Sierra Tucson Gratitude for Giving Recognition Award Breakfast. Each year colleagues in the addiction recovery and behavioral health industry vote for their peers for their outstanding work in the community.




This years winners include (from left) Humility Award: Nancy Barto (AZ State Senator), Compassion Award: Valita Warner (Terros Health), Gratitude Award for Lifetime Achievement: Dr. Michael Sucher,  Hope Award: Stephanie Siete (CBI, Inc., Community Bridges), Spirit Award: Terra Schaad (Hunkapi Programs).  Congratulations to all!

AZ Advocacy Day — January 11

By Angie Geren

In the November 2016 edition of Together AZ I wrote, “It is OUR time, we need to be the voice for those with none, we need to be the lighthouse for those searching, we need to be the driving force to change the conversation, we need to stand up and say, “I’m in recovery and I refuse to stay silent anymore.” 

January begins our legislative season, and it’s imperative we come together and advocate for change. Historically, those affected by addiction have not been represented in the legislative process. We were a demographic easily ignored and dismissed. As the opiate crisis continues to expand and overdose deaths continue to rise, we can no longer sit idle. Last year 35 people represented all of us by meeting with legislators and advocating for key legislation at our Addiction and Recovery Advocacy Day. I know we can easily double our attendance this year on January 11, 2018! It was clear we are being heard and have support from many legislators, however, we cannot rest on our laurels. The legislative process is long, arduous and requires diligence and support through the process.

Quick breakdown of bill process: first read, second read, committees, Committee of the Whole, Caucus, third read, vote and on to either Senate or House to repeat the process before being sent to the Governor’s desk for signature and then the law won’t go into effect for another 6-8 months. This allows for bad legislation to get changed and stopped along the way, it requires us to follow the bills and make sure good legislation has support through the entire process.

Many new bills are being introduced that could have a profound impact changing the conversation around recovery and addiction. Some bills directly affect the way addiction treatment works, ie., banning patient brokering, sober living regulations, and a Good Samaritan Bill that would not punish those who call emergency responders in a case of overdose with drug violations. These big changes need our support and voice. Legislators need to see people in recovery, they need our stories to shift their perceptions that we are “junkies” who will never amount to anything.

Advocating takes on many forms, from meeting one on one with your legislators to calling or emailing. The process can seem daunting and for those of us who have been let down by the “system” it can be very scary, however we are here to help shift your perception also! 

We need YOU, please join us at www.addictionhaven.com/arizona-advocacy  to find out how to become involved, read the bills that we are advocating for, and create change in our communities.

Can We Prevent a Suicide?

By Renee Sieradski, EA

Last month, a colleague told me she had lost her son to suicide a few years back, and then another friends daughter had a failed suicide attempt.

If I were to count how many personal friends and family I’ve lost to suicide, it’s 10 people. If I expand to colleagues, acquaintances, and their families, that’s another 10. I don’t know if this is an average statistic or if my count is higher.

As a person who has struggled with suicidal thoughts since pre-teen years, I know the feeling of the deep relentless pain and wanting it to stop. Thankfully I’ve always found the right people and medications to help with those feelings.

My cousin Becky who took her life at age 18. She had the biggest, most beautiful smile and was always so kind to me.

My husband and I are approaching our 20-year wedding anniversary. As I’ve mentioned in previous articles, he has bipolar disorder. According to the textbooks, he is at a higher risk for suicide than I am because most medications are ineffective for him.

We’ve figured out the secret to him staying stable is a combination of several factors including an obscure medication called Clozaril, not traveling long distances, avoiding crowds if he is in an irritable mood, and going to sleep at the same time every night.

I realize there may come a day when he gives up the fight against bipolar disorder. I, of course, would be devastated. He’s the love of my life. He was my first kiss, taught me how to drive a stick-shift and how to have humor in life. And he makes me laugh so hard my stomach hurts. We’ve been together longer than we’ve been apart and he is an amazing person. I don’t know how I would live without him.

When he first became ill, I used to leave work, run home and check on him almost daily out of the fear of losing him to suicide. I’ve since learned that if he was going to take his life, he would find a way no matter what magical, perfect words I came up with. I’ve learned to let go of the terror of losing him. I would like to think somehow me letting go of controlling whether or not he would take his life has empowered him to think it through for himself.
I have to take life one day at a time
.
I heard the most beautiful quote and wanted to share: “Your heart is full of a new storehouse of love every day that you wake up and if you don't give it away, it's gone forever.”

On to Finances:

On July 1, Arizona instituted a new law requiring employers to give their employees paid sick time. The only exceptions to this law being government employers and sole proprietor employers. It used to be only full-time employees received paid sick time but it now includes part-time, and seasonal or temporary workers. It, however, does not include contract workers.

The new law requires 24 hours of paid sick time per year, per employee for businesses with 14 or fewer workers and 40 hours for businesses with 15 or more people.

Another facet of this law is employees may request to use their sick time for other issues. Sick leave may be taken if an employee is dealing with domestic violence, sexual abuse, stalking issues, or the closing of a child’s school. The time may also be used for meeting with lawyers, arranging housing, or problems within the family.

An employer may only request proof of sick time when an employee has been absent for three consecutive days. Proof may be provided by way of a letter from an attorney, a doctor’s note, a police report, or a statement written by the employee. In the case of a written statement from the employee, he is not required to state why he needed the time off, but the time off was necessary. Employers are generally required to grant requests for sick leave. They are also required to keep records of accrued time off for each employee. These records of paid sick time, whether accrued or used, must be retained for four years. Employee paystubs should show the amount of sick time used and the amount available for use. This new law must also be posted in a conspicuous area where all employees can see it such as the breakroom. Employers should also have a company policy in place that clearly states, in writing, what happens to unused sick time if an employee is fired or quits.


Opioids After Surgery Left Her Addicted. A Medical Error?

By By Martha Bebinger, WBUR


In April 2017, Katie Herzog checked into a Boston teaching hospital for what turned out to be a nine-hour-long back surgery.

The 68-year-old consulting firm president left the hospital with a prescription for Dilaudid, an opioid used to treat severe pain, and instructions to take two pills every four hours as needed. Herzog took close to the full dose for about two weeks.

Then, worried about addiction, she began asking questions. “I said, ‘How do I taper off this? I don’t want to stay on this drug forever, you know? What do I do?'” Herzog said, recalling conversations with her various providers.

She never got a clear answer.

So she turned to Google to try to figure out how to wean herself off the Dilaudid. She eventually found a Canadian Medical Association guide to tapering opioids.

“So I started tapering from 28 [milligrams], to 24 to 16,” Herzog said, scrolling through a pocket diary that she used to keep track.

About a month after surgery, she had a follow-up visit with her surgeon. She had reached the end of her self-imposed tapering path the day before and at the doctor’s, she recalls feeling quite sick.
“I was teary, I had diarrhea, I was vomiting a lot, I had muscle pains, headache, I had a low-grade fever,” Herzog recalled.

The surgeon thought she had a virus and told her to see her internist. Her internist came to the same conclusion.

She went home and suffered through five days of what she came to realize was acute withdrawal, and two more weeks of fatigue, nausea and diarrhea.

“I had every single symptom in the book,” Herzog said. “And there was no recognition by these really professional, senior, seasoned doctors at Boston’s finest hospitals that I was going through withdrawal.”

Herzog did not name any of the providers who had something to do with her pain management or missed signs of withdrawal. She said she sees this as a system-wide problem. Herzog did share medical records that support her story. After the withdrawal, she did not crave Dilaudid and she manages any lingering pain with Tylenol. She has since returned to her providers, who’ve acknowledged that she was in withdrawal.

Not An Isolated Incident

Herzog’s story is one doctors are hearing more and more. “We have many clinicians prescribing opioids without any understanding of opioid withdrawal symptoms,” said Dr. Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing and co-director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School. One reason, Kolodny said, is that doctors don’t realize how quickly a patient can become dependent on drugs like Dilaudid.

Sometimes that dependence leads to full-blown addiction. About half of street drug users say they switched to heroin after prescribed painkillers became too expensive.

Now, a handful of doctors and hospital administrators are asking, if an opioid addiction starts with a prescription after surgery or some other hospital-based care, should the hospital be penalized? As in: Is addiction a medical error along the lines of some hospital-acquired infections?
Writing for the blog and journal Health Affairs, three physician-executives with the Hospital Corporation of America argue for calling it just that.

“It arises during a hospitalization, is a high-cost and high-volume condition, and could reasonably have been prevented through the application of evidence-based guidelines,” write Drs. Michael Schlosser, Ravi Chari and Jonathan Perlin.

The authors admit it would be hard for hospitals to monitor all patients given an opioid prescription in the weeks and months after surgery, but they say hospitals need to try.

“Addressing long-term opioid use as a hospital-acquired condition will draw a clear line between appropriate and inappropriate use, and will empower hospitals to develop evidenced-based standards of care for managing post-operative pain adequately while also helping protect the patient from future harm,” said Schlosser in an emailed response to questions.
Kolodny said it’s an idea worth considering.

“We’re in the midst of a severe opioid epidemic, caused by the over-prescribing of opioids,” Kolodny said. “Putting hospitals on the hook for the consequences of aggressive opioid prescribing makes sense to me.”

Potential Addiction vs. Pain Management Awareness

Penalizing hospitals for patients who become addicted to opioids conflicts with payments tied to patient satisfaction surveys. Hospitals that do not adequately address patients’ pain may lose money for low patient satisfaction scores. In response to the opioid epidemic, patient surveys are shifting from questions like, “Did the hospital staff do everything they could to help you with your pain?” to questions that emphasize talking to patients about their pain. But physicians may still prescribe more, rather than fewer, opioids to avoid complaints from dissatisfied patients.
“This is a real concern that patients who may feel that their pain is under-managed may take that out in these patient report cards,” said Dr. Gabriel Brat, a trauma surgeon at Beth Israel Deaconess Medical Center who studies the use of opioids after surgery at Harvard Medical School.
Most patients leave the hospital with more pain meds than they need. Studies show that between 67 and 92 percent of patients have opioid pills left over after common surgical procedures.

One reason that may contribute to over-prescribing is that patients vary a lot. Brat said about 10 percent of patients need intense pain management, but it’s difficult to identify who will be that 10 percent.

“Many surgeons are still prescribing opioids for the subset of patients that have higher requirements, as opposed to for the majority of patients who are taking a very small percentage of the pills that they are prescribed,” Brat explained.

There are no firm guidelines for which opioids to prescribe after surgery, at what dose or for how long. The CDC released opioid prescribing guidelines for chronic pain in 2016, but it included only brief references to acute pain.

Some opioid prescribing guidance for surgeons is emerging. A study published in September reviewed surgical records for 215,140 patients. It found that the optimal opioid prescription following general surgery is between four to nine days.

This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.

Finding Joy

The dictionary defines joy as a deep feeling or condition of happiness or contentment, a source of happiness, an outward show of pleasure or delight; rejoicing.

Sometimes feeling a sense of joy can come from having a few moments of serenity or during a quiet meditation or reflection. It isn’t always an outward experience; it is also internal and quite personal.

I’ve sensed joy taking my seat in a 12 step meeting,  reaching my hand out to another, smiling at stranger in the grocery store for no reason, and when my cat sits on my lap and snuggles.
I’ve felt sadness, pain and grief through the years, and coupled with fear it can be debilitating. I have learned sometimes you have to dig deep and dive down to find the light and the way up.

A few months back I was exhausted, physically, mentally and spiritually. The first thought that came to mind was, “Well, you’re not 35 anymore.” I realized I couldn’t keep running and doing, it was time to be a human “being.” Just being.

So I took some time off, a few long needed naps on the weekends and asked my Higher Power for guidance. Along with His guidance —  I prayed for patience. Patience with myself, the people and world around me.

Everything really does happen in God’s time.

I wish for you this coming New Year to enjoy all the joy that is around you.


It’s Your Year

By Dr. Dina Evan

No doubt about it, 2017 was a tough year for most. However, the energy of the New Year brings a fresh start, and new hope. One of the greatest gifts we have as human beings, is we get to begin again in each moment, in each day and on each New Year. We get to do that by making a new choice. Nothing you have done in the past can hurt you, the moment you make a new choice. None of the headlines, news reports or the scare tactics can have any effect at all, unless you begin to believe them. The past has no power over you unless you drag it kicking and screaming into this new year.

You are very powerful 

Since you are creating your reality with each new choice, you have an immense impact on creating the life, the body, the joy you want to have, the moment you make that decision. That choice is your first step. It ignites the fire. Believing a new choice is available and claiming it as yours is not always easy. Sometimes what seems to be...can feel overwhelming. Your choices direct the energy in your life to whatever you choose to focus on and we can be inadvertently focused on the strife in life before we realize we are drowning in that energy.
A master is careful about who he or she invites into his or her mind and life. A master knows that choices must be in alignment with integrity, spirit and values because if it is not, the creative force is lessened. For instance, think about the last time you made a half-hearted decision you really didn’t believe in or knew was wrong. What happened? No doubt you spent some time cleaning up the mess because that decision or action wasn’t aligned with your heart and soul. It wasn’t part of your purpose. It’ a little like a sour note in a symphony.
On the other hand, think about the times your made a decision or took an action that your heart and soul just knew was right for you, even if it didn’t seem possible. No doubt it worked for you in some form. If you still have doubt, you have clearly not heard of Ho’oponopono, the Hawaiian healing process used by Dr. Stanley Hew Len. Take a moment to find his story online and read about he healed a ward of mentally ill, criminal patients with Ho’oponopono. Yep, he actually healed a hospital full of murderers and insane patients that were criminals, simply by using directed energy and love. He never even spoke with them personally. The staff thought he was nuts, but after a year, there was no longer any turnover in staff, no need for strait jackets and the place was flourishing with love and healing. The energy there became joyful for both staff and patients.


We have a choice this year. 

We can listen to the rhetoric of division, separation and fear, or we can create life as WE want it to be. We can stop and help another with love, we can encourage someone even if it is just a sweet hello. We can decide what energy we will empower in our lives. I know many people feel this is a bunch of woo-woo nonsense. These are the same people who have never tried it. Sometimes the simplest things in life are also the most effective. So, here is the secret. Think of something you want this year. Every morning when you get up and you are getting ready for your day, look in the mirror and say, “Today I have (you fill in the blank). Don’t say it in a wimpy way. Own it. It’s that simple. The hard part is not allowing doubt and negative energy to seep in and diffuse your directed energy. So, when that happens, and it might because this is a new thought process, just say cancel — cancel and reaffirm your first thought. For some reason, the mind hears a cancel, cancel or erase-erase or delete-delete as an instruction not to retain the last negative thought in mind. What have you got to lose?   

Reaffirming you new thought each day may change your year in wonderful new way. And, it also changes the energy for the rest of us in a positive way. It’s a team effort. We wish you every blessing in 2018.