Friday, April 13, 2018

Long-term opioid use is down among vets, study finds

opioid-use-vetsA study found that efforts by the U.S. Veterans Health Administration (VHA) to promote safer prescribing practices of opioids appear to be effective.

According to research published in the Journal of General Internal Medicine, opioid prescriptions by the VHA have been on the decline after peaking in 2012. The drop-off in prescriptions is primarily due to a decrease in long-term opioid prescriptions, which pose a higher risk of addiction and overdose compared to short-term prescriptions, said Katherine Hadlandsmyth, Ph.D., lead author and professor at the University of Iowa.

The study analyzed VHA prescription data from 2010 to 2016, which included more than 4 million veterans each year.

According to that data, in 2010 opioids were prescribed at least once to 20.8% of veterans (962,193 out of approximately 4.63 million). The opioid prescription rate dropped in 2016 to 16.1% of veterans (803,888 out of 4.99 million) who received new prescriptions for opioids including oxycodone, hydrocodone and fentanyl.

Researchers also looked into long-term opioid use, which accounted for around 90% of VHA opioid prescriptions during the 6-year period. The percentage of veterans receiving long-term opioid treatment went from 9.5% in 2012 to 6.2% in 2016.

According to Hadlandsmyth, this is because fewer veterans receiving new prescriptions for opioids became long-term opioid users. The probability of a veteran becoming a new long-term opioid user decreased from 2.8% in 2011 to 1.1% in 2016.

Hadlandsmyth believes that the improvement in prescribing practices could be the result of recent VHA initiatives that call for opioid safety and opioid alternatives in chronic pain treatment. Since 2010 the VHA has provided clinical practice guidelines to health care professionals about how to safely and effectively use opioids to manage chronic pain, as well as how to select and monitor patients and wean patients off of opioids if desired treatment outcomes are not met.

The VHA also offers guidelines for complementary treatment and multidisciplinary therapy to manage pain, which include behavioral, chiropractic and stepped treatment, or delivering the most effective, least intensive treatment first, and “stepping up” to more intensive treatment as required.

“Future work to understand precisely which initiatives have most positively impacted opioid prescribing would be necessary to maintain effective approaches within VHA,” said Hadlandsmyth.

In the meantime, the VHA’s example could be valuable for other health care organizations. Prescription opioids are not the only way to manage chronic pain. At Hemet Valley Recovery Center, our Chronic Pain Program and First Responders Program have effectively helped hundreds of clients find relief from chronic pain without opioids and address the physical and mental aspects of addiction as they relate to military trauma. For more information about our addiction recovery services, please contact a Hemet Valley Recovery Specialist at 866-273-0868.

Wednesday, April 11, 2018

Opioid Prescribing Guidelines Work

opioid use disorder
Over the last few years, the death rate from opioids fell by an astonishing 25 percent in Oregon; unfortunately, the same cannot be said for most of the country. Before we get to how such a feat was made possible, let’s discuss some of the ways the nation found itself in the midst of an epidemic. Remember, over two-million Americans are struggling with and opioid use disorder, fewer than 1 in 5 receive any treatment, and over a hundred people die each day from an overdose.

Most individuals are privy to the fact that prescription opioid addiction epidemic and heroin scourge is the result of severe over-prescribing. Doctors are not solely responsible, but they play a significant role. It is worth noting that the job of a physician, among other things, is to provide relief whenever possible. A patient is in pain, and a doctor can help ease their discomfort with the aid of opiate painkillers. In most cases, the practice of prescribing opioids in low doses for short durations does not lead to patient problems; however, when doctors prescribe opioids in high doses for months on end, dependence is almost guaranteed.

Despite the writing on the wall, many primary care physicians (PCPs) continue to prescribe in manners what experts can only describe as reckless. To be sure, doctors must consider and treat patient pain, and if they do so at risk of harming their patients, it is problematic. What’s more, merely turning off the fountain is not the solution; instead, primary care physicians must prescribe responsibly, have knowledge about alternative forms of pain management, be able to identify patients with use disorders and refer them to treatment centers. Any failures to provide that kind of support can lead patients to the street in search of illicit drugs.

Doctors Combating Opioid Use Disorder

Health and addiction experts understand how dangerous long-term opioid prescriptions are for patients. The same professionals also know, thanks to tireless research, that drugs like OxyContin are not adequate for treating chronic pain and can worsen one’s symptoms, lead to addiction, and cause an overdose. With that in mind, perhaps you remember the Centers for Disease Control and Prevention (CDC) issuing new prescribing guidelines in 2016? The suggestions were optional, but a vast number of doctors vehemently opposed the guidelines; their argument, primarily, was that they didn’t need instructions and such rules could keep patients from accessing pain care.

Well, it’s now 2018, and not much has changed nationally regarding prescribing practices, except for in a few places, Oregon is one such state. Instead of ignoring the CDC guidelines, a task force came about to put the suggestions into practice with vigor. Doctors in Oregon are using the prescription drug monitoring database which has curbed over-prescribing and doctor shopping. Better educating physicians on pain management has led to relying on opioids less, according to Oregon Public Broadcasting. PCP’s are introducing people to alternative pain treatments like acupuncture, sleep, and physical therapy. Teaching patients about proper prescription drug disposal is beneficial, as well.

“There’s this report that says that the average time that it takes guidelines to turn into clinical practice is 17 years. That’s from the Institutes of Medicine,” said Dr. Cat Livingston, a family physician at OHSU’s Richmond Clinic in Portland. 

With so many people dying each day, seventeen years is not a realistic time-frame. Livingston says the task force came about to lessen that time. It appears to have worked; a 25 percent reduction is worth taking notice; hopefully, other states will make adjustments.

Opioid Use Disorder Treatment

If you are struggling with opioid addiction, please contact Hemet Valley Recovery Center and Sage Retreat. With the assistance of our Chronic Pain and Addiction Treatment Program, you can begin the life-saving journey of lasting recovery, so that you may lead a fulfilling and productive life.

Thursday, March 29, 2018

5 Ways to Manage Chronic Pain Without Opioids

manage-chronic-pain-opioid-alternativesIf you’ve ever dealt with pain, especially chronic pain, then you know how hard it is to think about or do anything else. You just want to make the pain go away as quickly as possible so you can finally get relief.

This approach--pain relief as quickly as possible--can lead to an unhealthy reliance on pain medications such as opioids, which can lead to tolerance and addiction. But there are other ways to cope with chronic pain than just taking a pill. These opioid alternatives might require a bit more effort, but they can bring relief without unpleasant side effects or the risk of addiction.

1. Acupuncture

This form of traditional Chinese medicine involves the insertion of very thin, sterile needles into certain pressure points in the body, which stimulates nerve fibers and signals the central nervous system to release natural chemicals that relieve pain. According to traditional Chinese medicine, energy, or chi, flows through specific pathways in the body. When illness, pain or inflammation are present, they block energy flow. Acupuncture helps to restore the flow of energy and relieve pain.

Clinical studies have shown it’s useful in treating a multitude of symptoms, conditions and diseases, including:

  • Headaches
  • Sciatica
  • Joint pain
  • Neck pain
  • Low back pain
  • Sprain
  • Tennis elbow
  • Rheumatoid arthritis
  • Post-operative pain

2. Chiropractic Treatment

Chiropractic is a common alternative treatment for back pain, though it can be used throughout the body. Hands-on spinal manipulation aligns the body’s musculoskeletal structure and helps the body heal itself without medication or surgery. There is substantial evidence that supports chiropractic as an effective treatment for low back pain or disability.

Manipulations help to restore mobility to joints damaged by a tissue injury caused by a fall or repetitive stress, such as tension or sitting at a desk with poor posture. It’s commonly used to relieve pain in the bones, joints, muscles and connective tissues, such as cartilage, tendons and ligaments.

3. Yoga

Chronic pain triggers changes in the brain that are linked to anxiety, depression and impaired cognitive function, but research has shown that yoga has the opposite effect on the brain and can actually relieve chronic pain.

Studies have found that chronic pain leads to changes in the volume of gray matter and the integrity of white matter connectivity. Gray matter consists of neurons and is abundant in the cerebrum, cerebellum and brainstem. White matter is the filaments that extend from gray matter and create communications pathways between various regions of the brain.

The volume of gray matter and the integrity of white matter decrease with age, but yoga has shown to offset the decrease of gray and white matter and reduce the perception of pain by volumizing gray matter and strengthening white matter connectivity.

4. Aromatherapy

Aromatherapy for chronic pain uses essential oils, which are highly concentrated extracts from plants that contain medicinal healing properties. Essential oils offer numerous therapeutic benefits that promote rebalancing and healing for the mind and body. When applied topically, essential oils are delivered to cell membranes and diffuse throughout blood and tissues, increasing immune function and circulation.

Aromatherapy can be delivered in a number of ways, including:

  • Inhalation
  • Massage
  • Baths
  • Diffusers
  • Compresses

Lavender, chamomile, rosemary, peppermint, bergamot and eucalyptus oil can reduce inflammation and stimulate circulation. While aromatherapy isn’t a proven treatment for chronic pain, there is research that supports its efficacy in reducing pain in the low back and knee, as well as chronic pain caused by surgery and multiple sclerosis.

5. Biofeedback

This self-regulatory form of therapy helps to increase awareness of pain and change physiological responses to reduce symptoms. Sensors are placed on a patient’s body while a therapist monitors brain waves, blood pressure, breathing, muscle tension, heart rate and skin temperature on a computer screen in real time. The therapist guides the patient through a series of relaxation exercises that help the patient change and control the things that cause pain. Studies on the efficacy of biofeedback have found that it provides relief for chronic pain conditions, such as:

  • Tension headaches
  • Migraines
  • Temporomandibular joint pain (TMJ disorder)
  • Arthritis

Prescription opioids aren’t the only way to reduce chronic pain. At Hemet Valley Recovery Center, our Chronic Pain Program has helped hundreds of people get relief from pain and recover from addiction. For more information about our holistic therapies and pain management alternatives, contact us at 866.273.0868.

Friday, March 23, 2018

Mental Illness Impacts College Students

mental illness
At HVRC, we treat many young adults struggling with addiction and co-occurring mental health disorders, such as depression, anxiety, and PTSD. Our team of skilled professionals stresses to clients the importance of treating the whole patient, not just the alcohol or substance use disorder. It is of the utmost importance that both conditions receive treatment simultaneously if clients are to achieve successful outcomes in the way of long-term recovery.

There has long been a debate over whether addiction precipitates co-occurring mental illness or if conditions like depression and anxiety bring about self-medication and addiction as a result. The dialectic on the subject will likely persist for decades to come, but it’s likely that both propositions are cogent. With that in mind, ensuring the treatment of mental health disorders is the vital part any discussion.

When pathologies present themselves varies from case to case; however, young adulthood is a time when people most often show signs of illness. College-age men and women regularly struggle with depression, anxiety, and bipolar disorder; and, until recently, most students kept their struggle to them self. Thanks to a significant effort to encourage young people to disregard the stigma of mental illness, a more substantial number of nascent adults are speaking up and seeking assistance. This new-found reality is good news, what isn’t so great is that many institutes of higher learning are woefully unprepared to meet the demand.


Mental Illness In College

Young adults living with mental health conditions are far more likely to resort to self-medication, self-harm, and entertain suicidal ideations. Those who are attending college courses have access to campus resources that can assist young people with their disorders. However, an American College Health Association survey shows that nearly 40 percent of students dealt with symptoms of depression and 61% of students said they had “felt overwhelming anxiety” in the previous year. They also reported that their symptoms made it difficult to function at times, TIME reports. The survey results are alarming, and thankfully there is support to be found on campus. But is it enough?

A 2016 report from the Center for Collegiate Mental Health shows that the number of students seeking support on campus for mental illness rose 30 percent between 2009 and 2015, according to the article. Schools are doing what they can to meet the ever-increasing demand for support, but resources are limited. The Association for University and College Counseling Center Directors Annual Survey shows that the typical American university has a single counselor for every 1,737 students (the recommended minimum is one therapist for every 1,000 to 1,500). What’s more, much of a therapist’s time is devoted to crisis control; students don’t have access to long-term treatment options.

“A lot of schools charge $68,000 a year,” says Dori Hutchinson, director of services at Boston University’s Center for Psychiatric Rehabilitation. “We should be able to figure out how to attend to their whole personhood for that kind of money.”


Co-Occurring Disorder Treatment

If you are a young adult in college and are struggling with addiction and a co-occurring disorder, please contact Hemet Valley Recovery Center and Sage Retreat. We can help you begin the life-saving journey of lasting recovery, so that you may lead a fulfilling and productive life.

Monday, March 19, 2018

What Is PTSD and How Is It Treated?

Post-traumatic stress is a mental health disorder in which a person has difficulty recovering after experiencing or witnessing a traumatic event. It’s estimated that 7.8% of Americans will experience post-traumatic stress disorder (PTSD) at some point in their lives, and approximately 5.2 million Americans experience PTSD during the course of any given year.

Traumatic events include:

  • Exposure to combat, accidents, or other gruesome scenes
  • Childhood abuse
  • Sexual abuse
  • Assault
  • Being threatened with a weapon
  • An accident

Symptoms of PTSD

Post-traumatic stress disorder is characterized by four types of symptoms:

  • Re-experiencing symptoms: Flashbacks accompanied by a racing heart or sweating, nightmares and frightening thoughts are characteristic of this type of symptom. They can be brought on by a person’s thoughts and feelings or triggered by anything that is a reminder of the traumatic event, such as words, people or objects.
  • Avoidance symptoms: A person may alter his or her routine to avoid particular triggers, such as people, places, objects or situations that serve as reminders of the traumatic event. For example, a veteran may stop watching news coverage of combat scenes.
  • Arousal and reactivity symptoms: Instead of being triggered by something, reactivity symptoms, such as insomnia, hypervigilance and angry outbursts are constant and can make it challenging to function day-to-day.
  • Cognition and mood symptoms: These symptoms can be brought on or made worse by a traumatic event. Having trouble remembering significant details about the traumatic event, negative feelings about oneself and the world, distorted emotions like extreme guilt, and loss of interest can make a person withdraw from family and friends.

Risk Factors for PTSD

Anyone can develop PTSD at any age, but not everyone who lives through a traumatic event develops PTSD. It’s not clear why some people get PTSD and others don’t. According to the National Institute of Mental Health, most people won’t. Like most other mental health problems, however, it is likely caused by a combination of stressful experiences, a person’s temperament, a family history of mental health issues, and how the brain regulates the hormones and chemicals released by the body in response to stress.

Risk factors for PTSD include:

  • Witnessing or personally experiencing a traumatic event
  • Having experienced trauma earlier in life
  • A job that increases your exposure to traumatic events, such as a first responder, member of law enforcement or military personnel
  • Mental health problems, such as depression or anxiety
  • A family history of mental health problems
  • A lack of a stable support system
  • Substance abuse

How PTSD Is Treated

Because PTSD affects everyone differently, the treatment that is effective for one person might not be sufficient for another. The main types of treatment for those with PTSD include medication, psychotherapy or a combination of both.

Psychotherapy, including cognitive behavioral therapy, exposure therapy and eye movement desensitization and reprocessing (EMDR), is the primary form of treatment for PTSD. Antidepressants and anti-anxiety medications are also commonly prescribed.

If you or someone you know is affected by PTSD, it’s crucial that you are treated by a mental health professional who is experienced in treating PTSD. Proper treatment can reduce and even eliminate many symptoms of PTSD. Talk therapy and, if necessary, medication can help you learn how to:

  • Address and manage symptoms
  • Change the way they view themselves, others and the world
  • Treat the other issues associated with traumatic experiences, including anxiety, depression and substance abuse

You can’t forget the memories of a traumatic experience, but effective treatment can help you gain control over your life by eliminating or even reducing the extent to which those memories trigger symptoms.

Hemet Valley Recovery Center’s specialized First Responders Program addresses the effects PTSD has on first responders, firefighters, law enforcement, medical professionals, military personnel and others who have experienced trauma firsthand. Every HVRC client’s treatment plan is designed to address their unique circumstances utilizes a range of therapeutic modalities to help men and women recover and reclaim their lives.

We are also in-network with most major insurance providers, as well as Medicaid and TRICARE. For more information about our First Responders Program, or to verify your insurance coverage, please contact us at 866.273.0868.