Living With Chronic Pain in Recovery
Living with chronic pain in recovery can feel like a minefield, especially if the pain is relatively new and you've experienced it while sober. While many people become addicted to drugs after being exposed medically, others may need pain relief while sober. Taking opioids for more than a day or two is not safe for people in recovery. Yet longer-term pain may remain; it's not something that improves as you stay sober longer. People with chronic illnesses need solutions that help them stay sober and improve their quality of life.
Treating Chronic Pain Without Opioids
Chronic pain typically can come from various conditions, from nerve damage from long-term drug use to pain from injuries, accidents, and illnesses that didn't heal. Many people in recovery live with chronic diseases. Sometimes that means they live with chronic pain, too.
When left untreated, chronic illness can significantly impact the quality of life of an individual. In the past, opioids, such as morphine and oxycodone, were considered the go-to treatment for severe pain. Today, many doctors are better educated and choose a multi-pronged approach to minimize harm.
Here are some potential options:
- Non-Opioid Medications: Various non-opioid medications can treat chronic pain, including nonsteroidal anti-inflammatory drugs such as aspirin, acetaminophen, and certain antidepressants and anticonvulsants. Many of these can be combined to create adequate pain relief options.
- Opioid Rotation or MAT: If a person with addiction is already on opioid medication for chronic pain, their doctor may consider switching them to a different opioid with a lower risk of abuse potential. Often, this means that they can use MAT options such as buprenorphine.
- Behavioral Therapy: Cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) can help individuals with addiction learn new coping mechanisms for managing chronic pain.
- Physical Therapy: Physical therapy can help individuals with chronic pain increase their physical activity, strengthen their muscles, and improve their flexibility, all of which can help reduce pain and improve overall function.
- Complementary and Alternative Therapies: Some people may benefit from complementary and alternative therapies such as acupuncture, massage, and chiropractic care to manage their chronic pain. These treatments can help reduce pain and improve the overall quality of life.
Buprenorphine For Chronic Pain Management
Buprenorphine, while also used in Medication-Assisted Treatment, is a medication that can help with pain management in a few different ways. First, it is a partial opioid agonist, meaning it can produce some pain-relieving effects as other opioids but with a lower risk of addiction and fewer side effects.
Buprenorphine also has a ceiling effect, meaning it cannot produce any additional pain relief after a specific dose, making it safer to use than other opioids. Buprenorphine works as an antagonist at receptor sites in the brain, which means it can block other opioids from binding and therefore reduce the risk of overdose.
Buprenorphine has been shown to positively affect mood, making it helpful to people who live with chronic pain and struggle with depression. A qualified healthcare provider should only prescribe buprenorphine, and patients should follow their provider's treatment plan carefully. Not every health plan will offer it, and you may not qualify for it. Speak with your healthcare providers to learn more.
Low-Dose Naltrexone for Chronic Pain Management
In pain management, low-dose naltrexone (LDN) has been studied as a potential therapy for conditions such as fibromyalgia, neuropathic pain, and chronic fatigue syndrome. It is thought to work by modulating the immune system and reducing inflammation, which may contribute to chronic pain.
Naltrexone is no longer considered experimental. However, not all health insurance companies will cover it, and not all treatment centers offer it. Naltrexone used for chronic pain rather than opioid use disorder is considered off-label and may not covered by health insurance.
In addition to medication-based treatment, integrative approaches like physical therapy, cognitive-behavioral therapy, and mindfulness-based interventions can help reduce chronic pain without relying on opioids.
Sober Living Can Help
People with chronic pain or no pain can become addicted to opioids. If you live with opioid use disorder, and need treatment for chronic pain, work closely with your doctor to try non-addictive treatment options.
On Jan. 30, 2023, the Biden Administration announced it would end the COVID public health emergency, which could mean new issues regarding telehealth and Medication-Assisted Treatment when the order ends in May this year. MAT, especially buprenorphine, was expanded to online access for most people with opioid use disorder, giving greater access to desperately needed treatment for people in rural areas. Now, it appears that access to buprenorphine may be trickier than it seemed before.
The expansion has saved lives, and there have been repeated assurances by HHS, DEA, SAMHSA, and even the Biden Administration that telehealth buprenorphine patients won’t lose access to treatment. The truth, however, is murkier than it seems. It appears the DEA wants to put much stronger limits to telehealth treatment in place, which could cause unsurmountable access barriers for people who can’t go in person to get their meds prescribed.
What Will the Proposed Rules Do for MAT?
The new proposed rules, treatment advocates say, could cause more harm than good. While they say they’re not stripping access to treatment, the rules would make treatment much more difficult for vulnerable demographics. Patients will be required to have in-person exams and will not be able to continue to a fully virtual telemedicine care regimen. Patients already taking MAT will not be exempted; if their care began at a virtual clinic, they now would need to meet a treatment provider in-person to continue their care.
There seems to be little scientific reasoning behind this; unlike other treatment drugs, buprenorphine is a partial opioid agonist. It is less likely to be abused compared to other opioids due to its unique pharmacological properties and the way it is prescribed. Buprenorphine has a "ceiling effect," which means that after a specific dose, taking more medication does not produce any additional effects, making it less likely to be abused.
Increasing MAT Access Can Only Be a Good Thing
Many medical and professional societies have advocated for increased access to MAT, including buprenorphine. The American Society of Addiction Medicine (ASAM), a professional society representing physicians, clinicians, and other healthcare professionals specializing in addiction medicine, has long argued for increased access to MAT to improve treatment for opioid addiction. The American Medical Association (AMA), the largest professional association of physicians in the United States, has supported efforts to expand access to buprenorphine as part of a comprehensive approach to addressing the opioid epidemic.
Other doctor organizations have recognized the importance of increasing access to buprenorphine to help combat the opioid epidemic and improve the treatment of opioid addiction. The American Academy of Family Physicians, American College of Physicians, and American Osteopathic Association have written letters or papers supporting increasing access to buprenorphine.
Hundreds of organizations signed a paper asking the Biden Administration to make the emergency act telehealth provisions permanent last year; however, the DEA seems to have other thoughts about drug and MAT safety and administration.
Hopefully, the DEA will listen to these organizations and create a rule that’s fair and flexible so that patients can get the treatment they need with the fewest barriers possible.
Getting Help for Addiction
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The FDA recently approved a new OTC form of naloxone nasal spray, meant to be available for people to purchase via dispensers and other less conspicuous places without the input of medical professionals. Naloxone is an opioid overdose reversal drug available by prescription and over the counter in certain states. In most localities, a user must take a training class to administer the lifesaving drug. Much debate surrounded removing the training requirements. For the FDA, the discussion centered not on using naloxone but on the importance of fine-tuning its instructions.
Advisory Committee Meetings on OTC Naloxone Nasal Spray
At a meeting involving the Nonprescription Drug Advisory Committee and Anesthetic and Analgesic Drug Products Advisory Committee, pharmaceutical giant Emergent BioSolutions presented data and newly developed labeling for an OTC form of its nasal naloxone spray. (Typically, people who are prescribed naloxone have to take a short training class or meet other requirements.)
New instructions were written to help people without healthcare training in emergency treatment. Still, FDA reviewers cited various issues, ranging from user errors like dialing 911 first (rather than administering a dose) to the possibility that each blister packaging may need to contain instructions should users discard the box.
The FDA will work closely with manufacturers to ensure the design is simple and effective for people who have never used it before. "The design of the entire user interface plays an important role in how effective the product is at reversing opioid-induced respiratory depression and preventing death and other serious outcomes," they wrote briefly before the meeting.
The FDA Committees issue opinions to the FDA, which are usually respected in final decisions. While OTC Naloxone is likely soon to be approved, there will still be barriers to access, such as cost and locality.
Benefits of OTC Narcan/Naloxone
Naloxone (brand name Narcan) is a medication used to reverse opioid overdose rapidly. It works by blocking the effects of opioids in the brain and can quickly restore normal breathing in someone who overdosed on opioids. Narcan is typically administered by emergency medical personnel, but in recent years, some jurisdictions have made it available over the counter, meaning that anyone can purchase it without a prescription.
The benefits of Narcan being available over the counter include:
- Increased access: Making Narcan available over the counter can improve access to the medication, especially for those who may not have a prescription. The FDA has pointed out that price can still be a barrier, which must also be addressed through state or federal funding.
- Faster response: In specific environments, when Narcan is available over the counter, people can quickly obtain and administer the medication. This can be especially important when emergency medical services are not immediately available or every minute counts.
- Reduced stigma: Stigma is often a barrier to access. Making Narcan available over the counter can help reduce the stigma and help people understand that opioid addiction is a treatable medical condition.
- Potential to save lives: By making Narcan available over the counter, more people may be able to access the medication and potentially save lives in cases of opioid overdose. Studies have shown that increasing access to Narcan can save lives.
While Narcan can be a lifesaving medication, it is not a substitute for long-term treatment and support for opioid addiction. Most people need additional medical help after an overdose.
If you or someone you know is struggling with opioid addiction, seeking professional help and support is important.
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Many people who get sober rely on Medication-Assisted Treatment as a tool to stay sober long-term. The FDA says that MAT is a “gold standard treatment” that can help people sustain their sobriety and get treatment. Yet there are still some people who view MAT with disdain or suspicion. Some of this is because they’re unfamiliar with it, and some come from beliefs that don’t mesh with the science, such as the idea that MAT is simply “trading one drug for another.”
5 Important Facts About MAT
What myths have you heard about addiction and MAT? Unfortunately, there is a lot of confusing information out there. Here are some of the essential facts to know.
- MAT is an FDA-approved treatment for opioid use disorder. It saves lives by preventing cravings that often lead to relapse and overdose.
- MAT is a superior treatment when it comes to preventing relapse and overdose. People who stay on MAT are less likely to relapse and more likely to complete long-term treatment programs.
- Doctors and other medical professionals decide what dosage of medication is appropriate for people with opioid use disorder. It is a medical decision between the patient and their doctor, not the treatment center or probation officer.
- People who use MAT as a tool for recovery use it alongside other tools. They often go to detox, then treatment, and continue to work on their recovery through peer support groups. Many of them come through the doors of our sober housing programs!
- MAT is a safe medication that has helped millions of people get – and stay – sober from opioids and other drugs. Most people taper off it within a year, but some chronic relapsers may remain on it for years. It does not cause any long-term harm, and dosages only go down, not up, after a patient is stable.
Understanding MAT and Opioid Use Disorder
Opioid use disorder is one of the leading causes of death in the United States. These deaths are tragic and preventable. MAT is an essential tool that can stop people from relapsing and exposing themselves to street drugs laced with fentanyl, the top cause of drug overdose deaths.
MAT can help people stay sober from opioids for years. It can remove the intense cravings that the brain generates when deprived of opioids. Because of this, people can focus on repairing and healing their lives from the havoc caused by addiction. They learn new coping skills and start to live life on its terms.
Consider Sober Housing as a Tool
If you or somebody you love is looking for a living situation after getting sober, we can help! Our sober homes offer structure as well as independence, with a focus on recovery. Our homes provide community, recovery activities, and safety for newly sober people. Learn more about how we can help! Give us a call at 760-216-2077.
Recently, a new law was added to the California books that requires public schools to keep a steady supply of Narcan, also known as Naloxone, in their emergency supplies. The opioid overdose reversal drug has become a vital public health tool as the drug supply has been inundated with fentanyl. However, schools aren’t the only way that Narcan has saved lives. People who don’t use opioids but live in California have begun to take the harm-reducing measure into their own hands. Several community members spoke recently to the LA Times to describe how they have helped save lives by carrying it on them when they’re out in their communities.
What Is Naloxone, And How Can You Carry It?
Naloxone, known chiefly by its brand name, Narcan, is an opioid-overdose reversal tool approved by the FDA. People who want to carry Naloxone on hand or keep it in their homes face few barriers thanks to California legislation.
The Department of Health Services in your county will be able to distribute fentanyl to people who want to carry it. LA County has made it a mission to hand out 50,000 doses in a year, including people living in encampments uniquely positioned to save drug-using peers.
People who don’t use drugs are still often in a position to save lives. Family members often come across an unconscious relative and try to administer CPR. Naloxone is the only thing that can reverse the effects of an overdose. Many parents and spouses of addicted persons now keep Naloxone in their homes in case of emergency.
Fentanyl Is a Public Health Emergency
Fentanyl has caused an uptick in deaths for Californians in the past three years. It's been found as an additive in almost every type of street drug. In 2021, 625 people died of an overdose in San Francisco, an uptick of 41%. So many people in the community see carrying Narcan as a way to help others stay alive long enough to find recovery. EMTs, people in recovery from addiction, and other empathetic people have revived overdose victims and helped them stay alive.
Narcan is just one tool to help fight the fentanyl epidemic. However, it’s a powerful one – saving a life is a priceless task. Once a person has been revived, they still need medical attention. Most likely, they will be given drug treatment options when in the ER. Some of them will take the chance and decide to get sober. Others will take a little longer.
Treatment centers and sober living homes in California stock Narcan as a preventative measure.
When a person is still alive and breathing, the chance for recovery is always there.
Consider Sober Living
If you are looking for a safe and vibrant recovery housing option, look no further! We offer structured living and independence, helping people build a new life in recovery. Learn more about how our community and homes can help you continue your journey in life. Call us at 760-216-2077 to explore your options.
Many people who decide to get sober use tools like Medication-Assisted Treatment to reduce withdrawal symptoms and help them focus on their recovery. Sublocade is a Medication-Assisted Treatment option many people prefer because it’s only administered once a month. It is prescribed and administered by medical professionals for people with opioid use disorder who want to stay sober.
What Is Sublocade?
Sublocade contains the drug buprenorphine and is administered monthly in a medical provider’s office. For many people, it’s a safe and responsible way to go about their lives while getting relief from withdrawal symptoms and opioid cravings.
Sublocade works best when the person taking it also gets counseling via drug treatment or one-on-one therapy. This can help newly sober people gain insight into themselves and understand their addiction. Opioid use disorder is manageable, but Medication-Assisted treatment is only part of managing it. Getting therapy can also help somebody learn new coping skills and learn to live a more authentic, happy life drug-free.
How Often Is Sublocade Needed?
People prescribed Sublocade need to get the injection monthly in a healthcare provider’s office. Most treatment providers will start patients with a 300mg dosage and eventually will be weaned down to a lower dose, usually 100mg. Some people will stay on 300mg longer if their healthcare provider deems it necessary.
People can use Sublocade as MAT for as long as the doctor approves. Some people will get an injection for months, while others may need to stay on it for years.
Sublocade Injections Increase Sobriety Success Rates
According to the manufacturer, in one clinical study, people treated with Sublocade were fourteen times more likely to complete their treatment programs and stay sober. 28% of people who got therapy/treatment alongside their MAT stayed sober for at least 24 months.
In the study, the group that was given a placebo only had a 3% success rate over the same period. While some people did relapse in the more successful group, everyone who stayed sober for at least 80% of those 24 months did so with the help of Sublocade.
Consider Sober Living
If you or somebody you love needs a safe space to lay their head, sober living may be the healthiest choice. Living in an environment where people work toward positive change can be inspiring and help you stay focused on your goals. Learn more about our communities by calling us at 760-216-2077.
Doctors prescribe many medications to help with mental health disorders, including anxiety disorders and PTSD. Some anxiety medications, however, are also highly addictive. People who become dependent on drugs like Xanax or Klonopin may develop a tolerance and need more medication to get the same effects. Some people who have taken these drugs long-term may end up abusing them.
Long-term use, and increased dosages, can create a physical dependence on the drug. A person with a substance use disorder may take larger amounts of the medication than prescribed. It's recommended that people with a substance use disorder steer clear of prescription anxiety medications that are also addictive.
Which Types of Prescription Anxiety Medications Are Addictive?
First of all, benzodiazepines, such as Xanax are highly addictive. Other drugs that are not prescribed as often for anxiety, such as sedatives like Valium, also have the potential for abuse or addiction. These classes of drugs, when taken in large amounts and stopped suddenly, can also cause withdrawal effects like fevers, shaking, or even seizures or heart palpitations.
Many people initially take the prescribed amount of a drug to get help with their anxiety. Drugs like benzos or sedatives can create peaceful or even euphoric feelings in the user. It’s not surprising that these effects can cause a person to take more than prescribed.
Anti-anxiety pills can help people cope with anxiety, but sometimes they become the only coping mechanism. They also stop working so well. Addiction to a drug can cause you to experience intense anxiety when you are in withdrawal. This can create a cycle of substance use that it feels hard to escape.
Alternative Methods For Coping With Anxiety
When a person quits using a benzo or sedative to help with their anxiety, there are other methods for treating their anxiety. Prescription drugs like Lexapro are helpful for anxiety and depression and do not cause any euphoric feelings. A psychiatrist is best qualified to help with medication changes. There are also therapy groups and methods such as mindfulness that can help you begin to work through anxiety.
Getting sober and no longer abusing substances will help you live with less anxiety. In treatment or 12-step groups, you’ll learn new coping skills. Therapy can help you learn more about your anxiety, cope with anxiety and begin to practice more healthy coping skills.
Stay Focused On Sober Living
Many people who want to stay sober find refuge in recovery communities like sober homes. In a sober living situation, you’ll be part of a group of peers on the recovery journey. Structure, camaraderie, and therapy can help you stay on course as you learn to live life substance-free.
Learn more about sober living by calling us at 760-216-2077.
A recent letter to the Acting Director of Health and Human Services in the Biden administration urged action for expanding the availability of Medication-Assisted Treatment through the Office of National Drug Control Policy. This comes on the heels of Biden suspending the former administration's OUD (opioid use disorder) guidelines.
Who Sent the Letter on OUD Treatment?
In response to a recent retraction of Trump guidelines, the letter announced on January 27, 2021, was written by the American Academy of Addiction Psychiatry (AAAP) and signed by representatives from seven representatives with over 150,000 members and 2200 treatment centers. The Biden administration recently decided to withdraw the previous administration's Practicing Guidelines for Administration of Buprenorphine for Treating Opioid Use Disorder to update them and provide better access.
Medication-Assisted Treatment: Science-Based OUD Tools
The letter from AAAP implored the Biden administration to expand access to science-based medication. Buprenorphine, methadone and naltrexone are all medications that have been proven to help people get and stay sober.
Medications that help people addicted to opioids are crucial in assisting them to avoid the compulsion to use. Buprenorphine and methadone help people prevent painful and challenging withdrawal symptoms.
For many treatment programs, the idea of medication carries a stigma. Because of this, it's vitally important that more doctors are educated about how MAT works and how it should be administered. Many medical professionals have felt uncomfortable prescribing it because of a lack of education.
Opioids are notoriously tricky to cease using due to the problematic withdrawal symptoms they cause when a person quits using.
Opioid Prescribing Education and Guidance
The letter for AAAP also says that the Biden administration needs to begin a focus on opioid addiction prevention. They say that this means requiring all prescribers of opioids to be taught about opioids dependence, addiction, and withdrawal.
Preventing opioid addiction is the best long-term strategy for ending the opioid epidemic. It's unclear what path the Biden administration will decide to take regarding new addiction recovery health policies.
Sober Living San Diego
Do you or somebody you love need a space to get back on your feet now that you're sober? Our homes are bright, cheerful, friendly homes with both community and structure to help you stay on your path to recovery. We have a lot to offer our residents! Give us a call at 760-216-2077 to learn more.
- By Philip, Milgram, MD
Worry, fear, boredom, anxiety, loneliness, escapism, insomnia; these are the emotions that plague our society. The plague that is COVID is making these human imperfections more frequent and more pronounced. There are healthy effective ways we can not only deal with these feelings and situations. But it is human tendency to take an immediate and effective way to escape: The Devil’s Drugs. They are readily (too readily) available. There is easy access to someone who can promise you the gates of heaven. You are invincible. And you want it now. From a friend or family member who has some. Or from a prescriber who will prescribe, sometimes inadvertently but often as a legitimate dealer. Hey, maybe it‘s even covered by your insurance. Maybe you know somebody who knows someone who can get it for you in a park or a parking lot. Trust me. You are not invincible. These are not your grandparent’s drugs. These synthetic drugs have a high addiction potential. I don’t think they should have ever been released to the public, like Quaaludes. You give these drugs to a thousand white mice…and a thousand whit mice will be pushing that button for more. Physiologically, we are not dissimilar from a white mouse. They use these same white mice to test the drugs and extrapolate to human consumption. WE WANT MORE OF THAT!!
These drugs cause what is known as hyperalgesia. Let’s say you stroke the hairs on your arm with a feather. These drugs make a stimulus that would be a tickle or an unpleasurable event and convert it to pain. What do you do? I WANT MORE OF THAT!!
Then you develop tolerance to the drug. Until you rapidly, sometimes within days, need more to get you to that place where you want to be. And you then know. I NEED MORE OF THAT!!
We have been very successful treating alcoholism and drug addiction to heroin, opiates with our innovative and experienced team and the magical molecule of NAD+ (Nicotinamide Adenine Dinucleotide), which detoxifies and fixes your brain, relieving withdrawal symptoms and cravings with much greater regularity than your neighborhood rehab center. But these are The Devil’s Drugs. And they require an all out and effective therapeutic approach to avoid the gates of hell; loss of you job, your family, your money, your home. And finally you lose yourself and then you lose hope. Benzodiazepines (Xanax, Klonipen, Ativan, Ambien and the sort) are not a good solution. You solve a problem by creating another problem. But prescribers too readily whip out their prescription pads to give you a stopgap that may be as bad or worse than the original problem. Please don’t take Kratom either. Often the addiction to Kratom is worse than heroin. Unfortunately, it is readily available and touted as “natural”. When you are addicted to Kratom, you may be suffering such terrible withdrawals that you have to use through the night every two hours.
The best way to avoid this whole situation is to not allow these drugs into your body. Avoid them all-knowingly because I have here told you of their power, their danger, and the high percentage for your physiologic tendency as a normal human being to succumb to the power of these drugs. But it is human tendency to think you are different, stronger, better, even invincible. I WANT TO FEEL IT, NOW!!
We have an alternative therapy here in Carlsbad, with the magic molecule (NAD+) that is already present in every living animal and plant cell. And that the body naturally uses to detoxify, heal, pump up immunity, and create new neural pathways that results in less cravings, less withdrawal symptoms and a high degree of long-lasting sobriety, health, longevity and wellness. We help restore restful sleep, use additional therapies, and get you on the road to a new life free from the influence of these drugs.
NAD+ is the magic. There is an art to the administration of it—starting with the best NAD+. Then there are therapies that enhance and propagate the NAD+ effect. Then, once off the drugs, you need to deal with the emotional, physical, depression, anxiety, any underlying mental disease, situation, and establish an ongoing program of healthy nurturing lifestyle.
There is such a thing as recovery, let us show you.
Phillip Milgram MD
Over 1000 meetings. You bump into everyone in recovery from the gas station to the grocery. Is this good?
Well, being alone and isolated leads to the city of no bueno. Accountability, friendship, support and activities will make anyone worried or stress think twice about being lonely.
By the Sea recovery is San Diego's premiere sober living home. Call us for help & answers on how to live in a great sober house.
Here's a list of AA meeting finder as well as sober activities in San Diego.