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Stop Addiction In Its Tracks

 

Choose the following links to navigate among the questions and answers on this page.



1a. What are opioids?

Opioids are powerful prescription medications used to relieve pain. They are most commonly prescribed to treat pain associated with injuries, surgeries, dental procedures and long-term (chronic) medical conditions. Individuals should discuss alternatives to opioids with their prescribing provider when seeking pain relief, as these medications are known to present a risk for misuse or addiction, as well as other side effects such as nausea or constipation.

Commonly prescribed opioids include:



1b. What is opioid addiction?

Opioid addiction is a physical addiction that often starts with prescription painkillers. Not everyone who uses opioids will become addicted and develop an opioid use disorder. Opioid use, especially misuse, can cause long-term changes in the structure and function of the brain, leading to addiction. These changes may make opioid addiction a chronic condition that is not easy to eliminate. Much like diabetes, hypertension or any other chronic disease, opioid addiction requires ongoing treatment, maintenance, and support.



1c. Why am I hearing so much about opioid addiction?

Opioid use disorder affects many families in the United States, regardless of race, ethnicity, economic status, or where you live. Today, approximately 2.5 million Americans are addicted to opioids. As a result, more people are dying from opioid overdoses. In Massachusetts, opioids kill close to three times as many people as do car accidents. In addition, when prescription opioids become less available or unavailable, more people are turning to heroin. The Centers for Disease Control report found that those who misuse prescription opioids are 40 times more likely to become dependent on heroin.



1d. Where are these drugs coming from?

There are many sources of opioids – street and illegal sources are unfortunately prominent in society today. Opioid drugs can also come from perceived safe sources, such as provider-prescribed pain medications.



2a. What are the warning signs that someone may have an opioid use disorder? (signs are things you can see)



2b. What are the symptoms of opioid addiction? (symptoms are things you feel)



2c. What are the symptoms of withdrawal?

Withdrawal is the process of decreasing or stopping the use of the drug. Symptoms of opioid withdrawal vary depending on the type of opioid, the amount being taken, and the length of time the individual has been dependent on the drug. Common withdrawal symptoms include:



3a. What is being done to control access and misuse?

Government, health care, law enforcement and community leaders from across Massachusetts are working both together and independently to address and end opioid substance use disorders.

In June 2015, Governor Charlie Baker’s office formed a working group that conducted “listening tours” across the state, and submitted a statewide strategy to combat opioid addiction and curb overdose deaths. Hospitals and providers have formed dedicated task forces that have issued recommended guidelines on how prescribing providers and hospitals can screen patients, limit over-prescribing, and provide treatment services when needed. And insurers are offering extensive public education to their members to help them identify, prevent, and find treatment for opioid addiction and substance use disorders. These groups are also working together to combat the problem.

In addition, numerous local and state public safety organizations such as police and public health departments are hard at work to address the crisis in their own communities.

You can read more about the different efforts by clicking on any of the following:



3b. Where can I find help?

If you think you or a family member may be misusing opioids, have an opioid use disorder, or are using drugs again after having stopped before, you should talk to a health care professional immediately about how to access appropriate care and support.

Your health plan can help you find treatment for you or your family member. For assistance, please call:

The Commonwealth has also set up a toll-free hotline where you can speak with a referral specialist. The service is free and anonymous, and interpreter services are available in over 140 languages for non-English speaking callers.



3c: What should I do if I have a drug-related emergency?

As in any acute emergency, call 911 or get to a hospital emergency department immediately. Hospitals across the Commonwealth are prepared 24/7 for any medical emergency. They are also well-trained in the current opioid crisis environment to be your best recourse for immediate and life-saving treatment.

After calling 911, if you have a naloxone rescue kit and you think you or someone else is overdosing, you should use it immediately. Please read section 5 for more detailed information on naloxone.



3d. What are the different types of treatment?

Like any other chronic disease, people with opioid addiction will often require long-term treatment and support, and there are a number of treatment approaches. Current guidelines recommend that each individual’s treatment plan should be created specifically for his or her needs. In addition, treatment should take place in the least restrictive setting.

Medication-Assisted Treatment may be an appropriate option for some people. There are a number of medications, such as Methadone, Suboxone and Vivitrol, that may be used to help lessen cravings, get through withdrawal, and prevent relapse. Patients stabilized on these medications can also engage more readily in counseling and other behavioral interventions essential to recovery.

For others, a period of detoxing to get the drugs out of their system is the best option. This may occur in an outpatient setting, or inpatient setting if the patient is dependent on other drugs. It is important that following any detoxification, a comprehensive treatment plan should be put in place.

With any treatment course, long-term recovery strategies are important, including counseling and behavioral therapies. This can include one-on-one counseling, group therapy, and family counseling. These sessions can motivate people to participate in drug treatment, offer strategies for coping with drug cravings, teach ways to avoid drugs and prevent relapse, and help individuals deal with relapse if it occurs. Counseling and behavioral therapies generally appear to be more effective when combined with medication-assisted treatment than when used alone.

When determining how to treat opioid addiction, there are a number of factors to consider including current level of intoxication; existing medical conditions and complications; emotional, behavioral and cognitive conditions; readiness to change; history of relapse, continued use, or continued problem potential; and recovery and living environment.



3e. What are the different types of Medication-Assisted Treatment (MAT)?

MAT lessens opioid cravings, reduces signs and symptoms of withdrawal, and prevents relapse. It also reestablishes normal function of the body, allowing those who suffer from addiction the ability to resume functional lives.

MAT options include the following:



3f. Will my health plan pay for treatment?

Massachusetts insured health plans provide coverage for a broad range of services. This includes medication-assisted treatment, which clinical data has indicated to be an effective form of treatment for many, as well as counseling and support services. Additionally, Massachusetts insured health plans are required to provide coverage for medically necessary emergency treatment and clinical stabilization services for substance misuse for up to a total of 14 days, without preauthorization.

Call your health insurer directly to get the details of coverage with your specific plan.



4a. Prevention: Questions to ask your health care provider

If your health care provider prescribes an opioid for pain, talk about the prescription during your office visit. Below are five questions you can ask your clinician if you or a loved one are prescribed an opioid for pain.

  1. Why are you prescribing an opioid?
  2. Are there other options available to help manage my pain effectively?
  3. What are the risks for me, and are there things that I should look out for to make sure I do not over-medicate?
  4. What is the usual length of treatment, and when can I stop taking this medication?
  5. How can I safely dispose of unused opioids?


4b. Prevention: If opioids are prescribed to you in the hospital

For your safety, Massachusetts hospitals and their Emergency Departments (EDs) conduct routine screening of patients for whom a prescription for opioid medication is being considered. They do not provide prescriptions for controlled substances that were lost, destroyed, or stolen.

Taking opioid medications, even to treat pain, carries risks. You should discuss these risks with your ED care provider and also discuss potential risks and benefits of other alternative treatments or no treatment.



4c. Prevention: How can I talk to my children about the potential dangers of opioids?

The Massachusetts Department of Public Health recommends that you talk to your children early and often about the dangers of opioid misuse. You’ll find tips on how to start the conversation with your middle school or high school aged child at www.mass.gov/stopaddiction.



4d. Prevention: Storing and disposing of opioid prescriptions

You should store opioid medications in a secure location away from family members and others who are in your home. Consider purchasing a box with a lock at your local pharmacy to store medications that can be misused.

If you have unused prescription opioids, you can take them to secure medication drop-off boxes around the state. You can locate a drop-box in your area at www.mass.gov/drugdropbox.

Guidance from federal agencies recommends that patients should not put medication down the drain or toilet unless the label or accompanying information specifically instructs you to do so. It also recommends, if you throw medication in the garbage, that you remove the medicine from its container, crush the pills and mix them with coffee grounds or kitty litter. Place the mixture in an unmarked container, like an empty can or sealable bag, and throw the container in the trash.



4e. Other important resources

The Massachusetts Executive Office of Health and Human Services has a number of resources available for families experiencing substance abuse disorder. You can also call the state’s Stop Addiction Helpline at 1-800-327-5050.

The Substance Abuse and Mental Health Services Administration (SAMHSA) also has a number of resources regarding substance use disorders as does the National Institute of Health.

Peer support groups like alliesinrecovery.net and learn2cope.org can also be helpful.



5a. Intervention: NALOXONE (Narcan)

Naloxone (also known as Narcan) is a medication that can reverse the life-threatening effects of overdose from heroin or opioid painkillers. It has saved thousands of lives in Massachusetts.

Naloxone can be administered as an injection or as a nasal spray. Paramedics and Emergency Department providers have been administering naloxone for overdose emergency response for decades. Now many other first responders (firefighters and police units) also carry naloxone in the event they respond to an overdose.

If you suspect your child or a loved one has an opioid problem, you should have naloxone nearby too.

Naloxone rescue kits are available at many pharmacies under a standing order, so you do not need a prescription. The pharmacist will bill your health insurance when possible. The Department of Public Health also makes naloxone rescue kits available to anyone who is either at high risk of overdose or likely to witness an overdose at substance use disorder treatment programs and other locations. Ask your pharmacist, health care provider, or counselor for details on how to use it and where to get it.



5b. What are the symptoms of overdose?

An overdose can occur minutes to hours after someone takes drugs. Symptoms of opioid overdose include:

If someone you know is experiencing these symptoms, call 911 immediately and perform rescue breathing or mouth-to-mouth resuscitation. Then administer naloxone as directed on the label or by your health care provider. It is important to call 911 as soon as you find a person who is unresponsive, because overdose is a life-threatening emergency. The person needs oxygen to survive so it is very important to continue rescue breathing while you wait for emergency responders to arrive or for the naloxone to take effect. Remember, naloxone only helps those who are overdosing from opioids and will not reverse the effects of other drugs. Calling 911 is especially important because an individual may have other health concerns that you are not aware of, which require continued care.



5c. How does naloxone save lives?

Opioid overdose causes a slowing of breathing to the point where death can occur. Naloxone blocks the opioid receptors and restores breathing. It typically works in 3-5 minutes after being given. Sometimes multiple doses are needed. Perform rescue breathing and wait 3-5 minutes between doses if more doses are needed.



5d. Can I hurt someone by giving them naloxone if they don’t need it?

Giving naloxone to an individual who is not having an opioid overdose is very unlikely to harm them and could save their life.



5e. Will my insurer cover naloxone?

MassHealth and many other insurers provide coverage for naloxone. Commercial insurers may charge a copay or deductible for naloxone, depending on your insurance plan and carrier. Please contact your insurer to ask about how much it might cost.

CVS Caremark, which administers pharmacy benefits for UniCare State Indemnity Plan members, covers naloxone (Narcan) as a Tier 1 drug. Please call CVS Caremark at 877-876-7214 if you have any questions about cost, coverage, or how to obtain naloxone.


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