  GENERAL
FREQUENTLY ASKED QUESTIONS
AIDS
AND HIV TESTING FOR HEROIN ADDICTS
HEPATITIS
IN ADDICTS
 TREATMENT
OF OPIATE DEPENDENCE
TREATMENT OF OPIATE
DEPENDENCE
ALCOHOL TREATMENT
SERVICES DETOXIFICATION AND ANTABUSE®
METHADONE DETOXIFICATION
TREATMENT FOR HEROIN ADDICTION
TREATMENT OF OPIATE
DEPENDENCE
INTRODUCTION
Thank you for visiting Aegis Medical Systems.
Inc., Whether you are a potential patient
or have a friend or family member addicted
to drugs, we can assist you. The following
information may be helpful.
The focus of this information
is the treatment of patients with opiate
dependence
(i.e. heroin addiction). This disease affects
0.7% of the adult population with a male
to female ratio of 3 - 1. In addition, the
use of unclean needles may lead to many
medical complications, such as HIV, Hepatitis
C and abscesses; while poor self care can
lead to tuberculosis, malnutrition, and
other diseases.
Co-existing psychiatric conditions, (i.e.
depression and anxiety) may complicate the
disease. Needless to say, many opiate dependent
patients may also abuse alcohol,
cocaine and benzodiazepines (i.e. Valium,
Klonopin) in an attempt to self medicate
and subsequently develop dependence to these
drugs as well.
Finally opiate dependence
is associated with a high death rate generally
due to overdose, injuries, or other general
medical complications.
Aegis Medical Systems.
Inc., however believes that this disease
is TREATABLE and the above complications
AVOIDABLE. (Back)
DIAGNOSIS
Aegis Medical Systems. Inc., bases its treatment
on the Disease Model of addiction. We understand
that this disease has biological, psychological
and sociological origins; therefore a team
approach is employed in each patient’s
care. The potential patient is evaluated
by a physician and the appropriateness of
the medical treatment determined by history,
physical exam and urine/laboratory analysis.
An Addiction Severity Index (ASI) assessment
by trained counselors compliments the evaluation
and helps the patient to formulate an individual
treatment plan, which includes medication
compliance. (Back)
TREATMENT
Currently, Aegis Medical Systems offers
2 approaches to opioid addiction. Detox
(a medically supervised withdrawal) and
Methadone Maintenance Therapy, also called
Opioid Treatment Medication. A 3rd approach
using a narcotic blocking agent (Naltrexone)
is available for you (discuss with the Aegis
Physician). (See below)
Detoxification is the first
step:
Detox Treatment (methadone)
is an individually customized program (from
21 days up to 180 days) with the intent
of stabilizing the patient followed by a
supervised withdrawal. Doses and rates of
withdrawal are determined by the physician
in compliance Federal and State Regulations.
Continuity of care is crucial in ensuring
favorable outcomes. The most common follow-up
treatments are:
- The decision to begin Opioid
Treatment Medication (i.e. Methadone or
LAAM maintenance).
- Referral to residential
treatment or other treatment modalities.
- Initiate a narcotic antagonist
such as Naltrexone.
Naltrexone is a narcotic (opiate)
receptor blocker, which has been in use
in the United States for more than 20 years.
It is itself non-narcotic and non-addictive,
but effectively blocks the effects of all
opiates including heroin. Physicians prescribe
Naltrexone to prevent patients from relapsing
to heroin. When taken as directed Naltrexone
is the most effective treatment for preventing
relapse to opiates.
Please feel free to pick-up
any of the brochures, which are available
in the clinic and direct any questions you
have to our clinic staff. They will assist
you with knowledge and compassion. (Back)
ALCOHOL TREATMENT
SERVICES DETOXIFICATION AND ANTABUSE®
Detoxification
Over
a one to two-week period, we provide outpatient,
alcohol detoxification. Patients attend
daily, if necessary. Medications and nutrients
are given to prevent seizures, delirium
tremens (DT’s), and to make the patient
comfortable. Breath and urine alcohol levels
are monitored to document that detoxification
is complete. (Back)
What is
Antabuse®?
Antabuse®
is a medication that blocks the effects
of alcohol causing very unpleasant, sometimes
severe symptoms, should the patient drink
alcohol after taking the medication.
(Back)
How does Antabuse® work?
Antabuse®
acts on the enzymes of the body in such
a way that it prevents alcohol from acting
on the nervous system and producing its
effects. If a person drinks alcohol after
they have taken Antabuse®, they will
experience a negative reaction. Fear of
this reaction prevents drinking.
(Back)
Why take Antabuse®?
The major
purpose of Antabuse® is to prevent relapse
to alcohol abuse. A very high percentage
of persons relapse who have been dependent
upon alcohol after a period of being alcohol-free.
(Back)
Does it produce a cure?
No, but
experience indicates that many alcohol abusers
can maintain abstinence when they take Antabuse®.
Additionally, Antabuse® gives an abuser
time to make life-style changes to reduce
stress in order to better resist the temptation
of using alcohol.
(Back)
How effective is Antabuse®?
Essentially,
100% effective as long as the correct dosage
is taken.
(Back)
Who is it for?
- Any alcohol abuser who
needs extra help to stay abstinent.
- A person ordered by the
court to refrain from alcohol.
- A person who may lose a
job if drinking continues.
- A person who has just detoxified
from alcoholism. (Back)
Is
Antabuse® addicting?
No.
(Back)
How often is Antabuse® taken?
One tablet
a day.
(Back)
What happens during Antabuse® outpatient
treatment?
- The patient will visit
the clinic twice a week for the first
two weeks. Thereafter,
about once a week for 2 to 12 months.
- Antabuse® will be prescribed.
- General medical treatment
will be provided when necessary.
- An alcohol breath test
will be given.
- Counseling will be provided.
- A referral will be made
to a convenient meeting of Alcoholics
Anonymous.
- Treatment will be provided
by a team of professionals including a
nurse, counselor,
and a physician.
- Spouse or friends are encouraged
to attend. (Back)
What
about relapse?
If drinking
is resumed, the patient should tell a member
of the treatment team immediately so that
additional assistance can be provided. (Back)
What happens if a person drinks with Antabuse®?
An unpleasant
reaction will occur, which will consist
of flushing, nausea, chills, and possibly
vomiting.
(Back)
Is Antabuse® dangerous?
Only
if you drink alcohol with it.
(Back)
Ancillary medication
There are some new medications
that are not abusable or addictive, and
which reduce alcohol craving. We recommend
that every patient on Antabuse® take
one of these.
Also, specific amino acids should be taken
by every alcoholic to curb craving, reduce
post-drinking symptoms such as depression
and insomnia, and help prevent relapse.
(Back)
METHADONE
DETOXIFICATION TREATMENT FOR HEROIN ADDICTION
What is heroin?
Heroin is diacetylmorphine and
it is made by the chemical conversion of
morphine, which is synthesized from opium.
Heroin is classified as an "opioid."
This term is now preferred over "narcotic"
since it is more descriptive in that "narcosis"
refers to sleep and sedation, which is produced
by many drugs rather than specifically relating
to the unique characteristics of an opioid.
An opioid is a drug that:
- Will relieve pain.
- Will produce withdrawal
signs and symptoms when the drug is stopped
after chronic administration.
- Will suppress withdrawal
signs and symptoms, which occur as a result
of stopping chronic opioid administration.
Opioids come from three sources:
- Opium poppy plant, e.g.,
heroin.
- Synthetic manufacture,
e.g., propoxyphene.
- Nervous tissue in human
body, e.g., endorphin. (Back)
How does heroin work?
Heroin is converted to morphine
within about two to three minutes after
it is injected into the bloodstream.
Before total conversion to morphine, heroin
enters the brain and helps produce a brief
intense euphoria called a "rush".
Heroin and morphine attach to small areas
in the body known as receptor sites. Upon
drug use, these sites are triggered to help
produce the following signs and symptoms,
defined as "being under the influence".
- Constricted pupil (less
than 2.9 mm in diameter).
- Muscle relaxation (e.g.,
droopy eyelids, slurred speech, slow gait,
sleepy appearance, etc).
- Decrease in pulse, reflexes,
blood pressure, and respiration rate.
- Non-reactive pupil. (Back)
What is addiction
or dependence?
A modern definition of an addict
or dependent person is someone who desires
to keep a minimal quantity of drugs in the
bloodstream at all times in order to feel
well or normal.
When the quantity of drug
in the bloodstream drops below a critical
level, the addict will automatically take
another dose to raise the blood level. At
usual street quantities of heroin, it will
remain in the bloodstream above the critical
concentration of 5-10 ng/ml for about four
to six hours. The most common example is
the person addicted or dependent on nicotine
who will almost be unconscious of reaching
for another cigarette in order to raise
his or her blood level of nicotine.
It is necessary for the bloodstream
to maintain a minimal level of drug in order
to saturate target areas of the brain. If
a saturated area suddenly becomes unsaturated,
withdrawal sets in. In the case of opioids,
the target areas are known as receptor sites.
The concepts of physical
and psychological dependence are archaic
in light of new research on blood concentrations,
receptor sites, brain chemistry, and withdrawal
syndromes. All mind-altering drugs, including
nicotine, marijuana, and cocaine, can produce
addiction or dependence; develop tolerance,
alter brain chemicals, and induce a withdrawal
syndrome after cessation of chronic use.
(Back)
How methadone detoxification works
There are two kinds of detoxification
allowed by Federal regulation : Short Term,
or shorter than 30 days and extended, between
30 and 180 days. In California , methadone
detoxification has always been short term,
limited to 21 days until May 18 of 2001,
when by waiver we can now offer extended
detoxification. Along with this new policy,
there is a significant change in avaibility
of detoxification: each patient may only
engage in two detoxification attempts per
year, beginning May 18, 2001. The clinic
physician , based upon a physical examination
and other relevant factors, determines the
patient's daily dosage of medication. The
dosage is tapered downward each day until
zero is reached.
In our program, if a
patient experiences symptoms such as insomnia
or muscle aches that are not relieved by
methadone, we will provide ancillary medication
during the program for symptom relief.
(Back)
Treatment after detoxification
If the patient is unable to remain
abstinent after extended or short term of
detoxification, we recommend that he/she
enter methadone maintenance or Naltrexone
(Trexen) treatment, also insuring that much
needed counseling is continued.
(Back)
Diagnosis of heroin addiction
Heroin addiction can be presumed
if the following are present:
- The individual reports
that heroin is used every four to six
hours or more during a 24-hour period.
- There are recent, fresh
needle marks.
- Morphine is present in
the blood or urine.
- No overt signs of intoxication,
indicating tolerance. (Pupil may, however,
be constricted.) (Back)
Withdrawal
symptoms and signs from heroin addiction
Symptoms – Feelings experienced
by the addict which begin four to six hours
after last heroin use:
- Insomnia
- Muscle aches (myalgia)
- Chills
- Depression
- Loss of Appetite
- Joints ache (arthralgia)
- Nausea
- Sweating or oiling of face
(diaphoresis)
Is usually first
sign to appear
- Gooseflesh (piloerection)
Is usually second
sign to appear
- Hyperactive reflexes
Is usually third
sign to appear
- Yawning
Only occurs with
marked withdrawal
- Tearing (lacrimation)
Only occurs with
marked withdrawal
- Runny nose (rhinorrhea)
Only occurs with
marked withdrawal
- Vomiting
Only occurs with
marked withdrawal
- Diarrhea
Only occurs with
marked withdrawal
- Pupil dilates above 6.5
mm
(Back)
Treatment and
outcome of the heroin addict
Reviews of research studies plus
clinical observation show that only about
10 to 20% of heroin addicts can stop use
and remain abstinent for as long as three
years.
Recent scientific studies
have proven that self administration of
opioids over time change the brain's chemistry
to the point that an opioid must be present
in the body for the brain to function 'normally'.
Weaning the brain off illicit drugs and
into a truly normal state can take months
and even years.
The reasons for the high relapse
rate among heroin addicts is due, in most
cases, to a variety of factors. These factors
may include:
- Brain functioning
- Alteration of the endorphin
system
- Underlying psychiatric
disorders
- Genetic defects
- Becoming conditioned to
the lifestyle of an addict
- Continued contact with
drug abusing peers.
Narcotic Replacement Therapy,
NRT, has been proven to be the most effective
treatment for chronic heroin addiction for
over 30 years. Recent studies suggest that
a period of time in NRT may lead to a healing
or reversal of abnormal, addictive, brain
function.
A narcotic antagonist, naltrexone "Trexan"
when taken orally, will prevent heroin relapse.
However, few addicts are motivated enough
to take it unless mandated to do so by an
employer, family member, or judicial official.
(Back)
Re-admission polic
Often, detoxification is the first
step on the road to recovery. Sometimes
detox must be attempted more than once before
success is attained. Attempted detoxification
without success can be an indication that
a maintenance program is needed. (Back)
Cocaine use by heroin addicts
Many heroin addicts are also addicted to
cocaine. We can provide detoxification medication
for cocaine at the same time methadone is
given. (Back)
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