Inside Narcotics Anonymous

“Are we that obvious?” he responded, when I asked if I was in the right place for Monday night’s NA (Narcotics Anonymous) meeting. The young man, who must have been in his early twenties, was reclining on a chair in the front entrance of the Berklee building that serves as the designated location for weekly Narcotics Anonymous meetings. He had three facial piercings and looked like he hadn't slept (or showered) in weeks. I later learned that this was his first meeting ever, and that he was less than two weeks sober.

As people began filing into the building I followed a group into the elevator to a floor that would take us to the meeting room. I took a seat in the back and observed my surroundings. It’s interesting to see who shows up for NA meetings. While some, like my acquaintance in the building entrance, seem like stereotypical characters for substance abuse users, others are your typical hard-working businessmen or women. I paid close attention to the wide assortment of individuals who filed in for the meeting. I realized that I fit in physically with the group, since there was no general typecast for the physical appearance of an NA member.

The meeting began with the introduction of newcomers and proceeded into a role call of members who were celebrating weeks or months of sobriety. One member, Andrew (name changed to protect his identity) was celebrating one full year of sobriety. The entire room clapped and cheered for him as he accepted a ribbon that represented his full year of staying clean. He spoke to the group about the meaning behind his sobriety and how NA played a primary role in encouraging him to stay clean. After he told his story about his struggle with addiction, several members congratulated him on his sobriety. After the meeting I approached Andrew and congratulated him myself. The most genuine smile I’ve ever seen appeared on his face and he said, “I’m really just happy to be alive.”

During the meeting Andrew mentioned his several failed attempts at sobriety. I asked him what finally gave him the push to follow through with staying sober, to which he responded: “When I came back from the half way house just over a year ago I started going to NA meetings around here. I met people and I just fell in love with this meeting. It just meant so much to me to have the support here. People wanted me to be around and they didn’t care what was in my pocket or what I could offer them. All they wanted was to help me. That was one of the most amazing feelings I’d ever felt. Before I’d never really had friends; I had acquaintances, but now I can honestly say that I have friends. I can honestly say that this is my new family.”

But it wasn’t only the NA group that gave Andrew the consistent motivation to stay away from drugs or any dangers that could target his substance abuse. “I never thought I’d tell another man that I loved him, and I tell me sponsor I love him on a daily basis. I call my great-grand sponsor every other day and say ‘you know, I love you. Thank you for being in my life.’ If it wasn’t for those people, I wouldn’t be standing here today.”

Andrew now runs the NA meetings in the local area and loves giving back to the community that has given him so much strength. I asked him how he felt about addiction treatment and what he felt his doctors had done for him. He responded by saying that they had done very minimal. “For the most part I avoided doctors. I felt like they didn’t want to deal with me. That I was just another screw up and that they couldn’t mend the problems that lead me to substance abuse in the first place. The half-way house was helpful but what really helped me was NA. The support and understanding of those who have been in your shoes, and may walk through your shoes again, is inspiring. We all have to help each other."

Integrating Primary Care by Using SBIRT

Very interesting video about how the Institute for Family Health is integrating primary care and substance abuse treatment. A patient speaks about her personal struggle with addiction and how she was able to change her life. A doctor also talks about using buprenorphine on patients fighting opioid addiction and dependence. The VP for Psychological Services and Community Affairs mentions SBIRT several times when talking about the Institute’s mechanism for integration. SBIRT stands for: Screening, Brief Intervention, and Referral to Treatment. Boston Medical Center was part of a grant with the Bureau of Subsidies Services that had doctors from BU train to do SBIRT. The program found several positive outcomes from the integration of primary care into addiction treatment.

Behavioral Health Care Cuts

Massachusetts' Sen. John Kerry, along with 12 other members of Congress, are currently debating a $1.2 trillion spending cut that could possibly include Medicaid. If this were to be the case, thousands of people living in Massachusetts who are currently receiving treatment for mental health or addictions disorder would be affected. Medicaid, which is responsible for paying for these services, has played an extremely important role for millions of Americans by providing critical support for people who suffer from mental illness and addiction. Medicaid allows these individuals the ability to overcome their illnesses and the potential to lead satisfying and productive lives.

The negative impacts that could result from such budget cuts include an increased demand for expensive emergency room care as well as increased strain on the criminal justice and corrections systems which are already overtaxed. In addition, cutting Medicaid just by 5% would result in tens of thousands of job losses and would cost the states $14 billion. The result of such large cuts would be a detriment to the recession we are already dealing with. The ultimate goal of outing inefficiencies that exist in our health care system needs to be done in a cost-effective and successful manner that does not threaten our network of behavioral health care services.

Congress' recommendations for controlling spending and reducing the deficit are due Nov. 23 so now is really the time to contact committee members and show support for preserving Medicaid.

A Conversation with Timothy Lepak, President and Cofounder of NAABT

It wasn't until I read a brief article on silobreaker.com that I learned about treatmentmatch.org. The article talked about how the website is leveraging their technology to help patients left without treatment after all 30 of Preventive Medicine Associates branches closed their doors. I thought it was really amazing to see the growing amount of support for these patients whose road to recovery was halted by a fraudulent act. What I really wanted to know was more about this free, online website that claims to have matched a total of 40,508 patients with 3,300 doctors nationwide as of this past Monday. I was lucky enough to have the opportunity to speak with Timothy Lepak, President and cofounder of the National Alliance of Advocates for Buprenorphine, which is responsible for treatmentmatch.org as well as two other websites

Can you tell me about what motivated you to start NAABT?

I had a friend who was addicted to heroine and opiates and no treatments worked for him; he couldn't quit. In 1999 he became involved in a study at Yale with buprenorphine and in a matter of weeks he went from talking about suicide to talking about starting classes in the fall. His cravings had subsided and he was really focusing on the positive things in his life. It wasn't until 2000 that made it even possible for doctors to prescribe buprenorphine because, since 1914, doctors were not allowed to prescribe any opiate drug to anyone who was addicted to opiates. When buprenorphine got approved, in late 2002, a lot of things started to happen. People were still dying and there were still older methods of treatment taking place there were changes taking place. At first, doctors were only allowed to treat 30 patients their first year and then 100 patients each year after that. We helped to get this rule changed by petitioning and bringing it to congress. It changed to 100 patients each year but that is still a problem. That's when we decided to start the website for people to become better educated on buprenorphine and the concept of addiction. There's a lot of stigma in the medical field in regards to addiction treatment. Many act like it's not as good of a medicine to practice. We try to educate people about addiction so we can get rid of this stigma. Once people understand it's no longer controversial. The question "how can you treat a drug addiction with a drug" slowly disappears and people realize that the medication helps these patients; they aren't just switching one addiction for another. Soon after NAABT began we saw the problem with people not being able to find doctors and we started treatmentmatch.org.

How exactly did treatmentmatch.org come about?

Well we noticed how difficult it is to find an appropriate doctor and one that is available. A good match is very hard to find because you need to consider issues like insurance and whether or not the doctor can treat your other ailments. There are still only 20,000 doctors able to prescribe buprenorphine and they are each limited to 100 patients a year. I've heard stories of doctors who've had patients die on the wait list. Another reason for the website is to encourage the patient to follow through with seeking help. When someone is finally ready to seek treatment they're usually in pretty bad shape and it's not easy to pick up the phone and call up a doctor only to hear a rejection. It's a horrible experience. So the website works like an online dating service except it connects doctors and patients. When patients register they state how far they are willing to travel for treatment. Then emails go out to doctors in those areas notifying them of the new patients seeking treatment. This way the patients are only hearing positive responses. The system works 24/7 so even at two in the morning a patient can get a response. It's like a lifeline going out to the patient.

Click here for a map of patients currently looking for treatment.

What are some problems affecting office-based addiction treatment?

Since the government started limiting and rationing the treatment of buprenorphine prices started going up. Now it's like the highest bigger gets the spot. Doctors can keep raising their prices until they are getting just enough patients. Some doctors are charging up to $400 cash only, instead of going through insurance, because of these limits. Limiting access is what's causing the diversion and the government's answer is to try and limit everything even more. Last year the DEA released a statement that they are going to show up announced to the offices of every buprenorphine doctor in the country. This lead a whole bunch of doctors who were involved in fraud to just up and leave their practices. This has resulted in a decrease in the rate of new doctors practicing and an increase in the rate of patients dropping out.

How do you get doctors to sign up with treatmentmatch.org?

Every month the District Attorney sends me a list of certified doctors. I send the doctors an email about getting on our system. Once they've filled out the paperwork they can select to be on a public locator or they can check a box that allows them to get direct emails notifying them when a patient signs up.

How do you get patients to sign up?

We do public service announcements on the radio, the subway, billboards, online advertisements, and we even display signs in pharmacies. But mostly we get patients through word of mouth. When people first reach out for help that's the time that people need to be there for them. The next time might not happen for months, or years, or it might never happen. This system is 24 hours and they can reach out whenever they want, not just between business hours. As of today we have 40,508 patients and 3,300 doctors nationwide. Just in the past 12 hours there have been 36 patients contacted. We've connected to about 80% of the patients who've signed up. Most of the ones we haven't reached out to yet are in rural areas where there are not as many doctors.

How is primary care being integrated into the addiction treatment offered by treatmentmatch.com?

We set up our system so that primary care is an integral part of treatment. The doctors we are connecting these patients to work in office-based practices. We list clinics as well but we really feel that the office-based environment is so much better. It also takes away the stigma in the sense that you are not standing in line for methadone treatment along with other methadone addicts; that can be very demoralizing. The way the government has treated the delivery system is inefficient. Whereas if you go to a doctor's office and are treated like you would be for any other condition it is much better for the patient and they have a positive experience that way. It makes more sense to go to a doctor who can also refer patients to further counseling or other treatment. Detox places have such poor success rates. It makes sense that detox would be ineffective considering what we now know about addiction; taking the drugs away doesn't help and it certainly explains why relapse rates are so high.

TreatmentMatch.org Reaches Out to Help Displaced Patients

In lieu of Dr. Punyamurtula Kishore's arrest and immediate closure of his dozens of addiction clinics across the state of Massachusetts, online service TreatmentMatch.org extends its services. The website serves as a free online resource to addicts suffering from opioid addiction. According to the website itself, 86 patients have been contacted and matched up with physicians just in the last 72 hours. The website is available 24/7 to connect people seeking treatment for addiction with treatment providers in an anonymous and confidential manner. Certified physicians can go onto the website and draw from patients in their area when they have an opening for an appointment. This eliminates the need for patients to call multiple physicians hoping to simply land one appointment. For patients who may not have access to a computer or to the internet, a counselor or advocate can sign on to the website and submit an application on the patient's behalf.

This list of certified physicians was created by the Substane Abuse and Mental Health Services Administration (SAMHSA). According to a SAMHSA employee, who prefers to remain anonymous, not all of the certified physicians choose to be put on the list; some choose not to because they already have a full load of patients to treat and this can oftentimes be an exhausting process for the patients searching for openings. Click here to view the actual list of certified treating physicians.

According to prnewswire.com, there have been over 40,000 patient-physician connections made by TreatmentMatch.org. The website is run by the National Alliance of Advocates for Buprenorphine Treatment (NAABT), which is a non-profit organization that encourages the use of buprenorphine to treat opioid addiction. The opioid medication is a drug that activates specific receptors in the brain that mimic the full opioid effect commonly associated with heroin, oxycodone, methadone, hydrocodone, and morphine. Buprenorphine also has full properties of an antagonist, which is a drug that blocks opioids by attaching to the receptors themselves without actually activating them. Antagonists block full agonist opioids and do not cause any kind of opioid effect. Acting as a partial agonist while having the full properties of both agonists and antagonists allows buprenorphine to activate the opioid receptors in the brain to a lesser degree. This allows for some of the opioid effect but also suppresses the heavy withdrawal symptoms and cravings.

To learn more about this online source visit www.naabt.org.

New Services Offered to Addicts Affected By Clnic Closings

The closure of the 30 medical branches that make up Preventative Medicine Associates has resulted in Gosnold, a treatment center on Cape Cod, offering services for the patients affected by the closings. Gosnold is the largest provider of addiction and mental health services in the Cape Cod area and offers primary care, inpatient rehabilitation, transitional care, and residential treatment. The treatment became available on October 3rd and since then a Gosnold physician and several counselors are available to see patients in Gosnold's Centerville clinic.

President and CEO of Gosnold, Raymond V. Tamasi, said that the closures have created a state of emergency for addicts in treatment. He hired Dr. Robert Friedman, medical director of the Sandwich branch of Preventative Medicine Associates to work three days a week at first to help the patients displaced by the closures. Interestingly, Friedman's Sandwich clinic was closed back in August, which was 2 whole months before the entire larger organization, Preventative Medicine Associates, collapsed a couple weeks ago. Friedman was interviewed by the Cape Cod Times back in early September on his clinic's reaction to the abrupt shut down of their clinic and how Kishore randomly layed off three employees during their lunch hour.

Tamasi expects over 100 patients from Preventative Medicine Associates to take advantage of the newly available services. Gosnold will also be expanding its services to include the use of the injection drug vivitrol that eases the withdrawal symptoms of patients by blocking opiate receptors in the brain. The drug significantly reduced the craving symptoms associated with drugs like heroin and oxycodone. Gosnold will expand these services to accommodate the new patients permanently, says Tamasi. Gosnold must now find a way to take on these new patients who need counseling and other services which are not easily covered by insurance. Tamasi released a statement to the Cape Cod Times saying, "We do what we can by going to the community (for fundraising) and applying for grants."

The website for Preventative Medicine Associates does not address the organization's current state of affairs and attempts to contact Dr. Kishore were unsuccessful. Patients displaced by the closure of PMA clinics are instructed to call Gosnold at 800-444-1554 for outpatient care.