Category Archives: Addiction

The Scary Truth About Lomotil Abuse

Approved by the U.S. Food and Drug Administration (FDA) in 1960, Lomotil is a brand name for the generic drug diphenoxylate and atropine. Each Lomotil tablet contains 2.5 mg diphenoxylate hydrochloride and .025 mg atropine sulfate. Diphenoxylate hydrochloride is an antidiarrheal drug. A small amount of the anticholinergic atropine sulfate is added to discourage deliberate abuse. Atropine sulfate causes unpleasant side effects like rapid heart rate, dry mouth and blurry vision, however, a significantly high dose is required to produce these intolerable side effects.

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Utah Prescription Drug Abuse Statistics

In 2016, more than 40% of all U.S. opioid overdose deaths involved a prescription opioid. The most common drugs involved in these overdoses were methadone, oxycodone (e.g. OxyContin) and hydrocodone (e.g. Vicodin®). From 2000 to 2015, Utah experienced a nearly 400% spike in deaths from the misuse and abuse of prescription drugs. Utah had the seventh highest drug overdose rate in the U.S. in 2016, with 635 deaths. Of the 10 Utahns who died every week from drug overdoses in 2016, 60% were attributed to prescription opioids. The current Utah budget is about $7 million, which helps only 27% of drug abusers eligible for Medicaid. Mirroring the rest of the nation, the majority of prescription opioid deaths in Utah involved concurrent use of other drugs.

  • On average, 7,000 opioid prescriptions are filled every day in Utah.
  • Although 2015 was the first decrease in the rate of prescription opioid deaths in Utah since 2009, 24 individuals still died every month from a prescription opioid overdose.
  • Of 357 prescription drug overdose deaths in 2015, 282 were attributed to opioids.
  • Deaths from oxycodone drugs (e.g. OxyContin and Percocet) accounted for 55.0% of all prescription opioid deaths in 2015, while hydrocodone accounted for 17.7% of deaths.
  • Individuals aged 45-54 had the highest prescription opioid overdose deaths rates, with no major gender differences.
  • The highest rates of Utah ER visits for prescription opioid overdoses were in individuals aged 25-34.

Prescription Drug Overdose Deaths in Utah

In Utah, the following percentages provide a picture of the most serious co-occurring problems in individuals who died from prescription drug overdoses.

  • Substance abuse (e.g. illegal drugs, abuse of prescription medications or regular use of inhalants): 65%
  • Mental illness diagnosis: 62%
  • Physical health problems: 61%
  • History of alcohol dependence or problematic use: 16%
  • Past suicide attempt: 10%

The Path to Heroin Abuse

A study by the Kaiser Family Foundation indicates heroin overdose deaths have soared in Utah, more than tripling since 2007. In 2016, 166 Utah residents fatally overdosed on heroin compared to 127 the prior year. “When they get to a point where they can’t get prescription opioids, where they can’t afford them, then they’re turning to heroin because it’s cheaper to get,” said Jenny Johnson, Utah Department of Health (UDOH) spokeswoman. “We’re seeing a decrease in our prescription opioid deaths,” said Anna Fondario, UDOH epidemiology manager. “But in our illicit opioid deaths, we are seeing increases.”

  • In 2014-2015, about 5,000 individuals aged 12 or older in Utah used heroin in the past year, which is in line with the national average.
  • In a single-day count in 2015, 2,459 and 790 individuals received methadone and buprenorphine, respectively, in Utah opioid treatment programs as part of their substance use treatment.
  • The highest rates of Utah ER visits for heroin were in individuals aged 18-24.

Efforts to Curb Abuse

On May 31, 2018, Utah filed a lawsuit against Purdue Pharma, accusing the manufacturer of OxyContin of creating a drug epidemic in the state. In the court filing, the state claimed Purdue waged an aggressive marketing campaign for its drugs that relied on deception, exaggeration and flawed science. The lawsuit stated Purdue’s actions amounted to fraud, negligence, nuisance and a violation of state consumer sales law. In filing the lawsuit, Utah joined other attorneys general who filed their own lawsuits against Purdue, Johnson & Johnson and opioid distributor McKesson Corp. Separately, more than 700 cities and counties have sued the drug manufacturers and distributors in cases consolidated before a federal judge in Cleveland, with the first trial scheduled for March 2019.

Utah Take Back Program

Data shows nearly 60% of people in Utah prescribed an opioid in the past year had leftover medication and only 27% reported disposing it. A joint effort of the Utah Attorney General’s Office and the U.S. Drug Enforcement Administration, Utah Take Back is a day set aside to collect potentially dangerous expired, unused or unwanted prescription drugs. Last fall, more than 3,800 federal, state and local agencies collected 702,365 pounds of unused, expired, or unwanted medications at more than 5,000 collection sites across the U.S. During the 2017 event, Utah collected more than 33,000 pounds of prescription drugs to dispose of properly. Attorney General Sean D. Reyes issued this statement in April 2018:

“Prescription drug abuse and deaths related to opioids have risen to epidemic levels in Utah and across the country. Opioid addiction has ravaged rural and urban areas as well as uptown and downtown neighborhoods. It has taken far too many lives and ruined countless more. Those who suffer from addiction may be soccer moms or executives. They can be star athletes, high achieving students, popular kids or “loners.” They are our kids, grandkids and kids from the block. And whether we realize it or not, our medicine cabinets might be the very place where they are looking or have already been for their next high or pill party.”

Naloxone Distribution Saves Lives

As a result of a statewide standing order issued by the UDOH on December 8, 2016, pharmacies across the state dispensed 4,275 doses of naloxone in 2017. Naloxone is a rescue medication that can reverse the effects of an opioid overdose. Data indicate 99 naloxone overdose reversals occurred as a direct result of outreach efforts by the UDOH, local agencies and syringe exchange providers across the state. While pharmacies in rural areas of the state only comprise an estimated 30% of all participating pharmacies enrolled through the standing order, they distributed nearly 70% or 2,914 of naloxone doses in 2017.

Pharmacists and healthcare providers can play an integral role in curbing prescription opioid deaths by discussing the risks of opioids, signs of an opioid overdose and the efficacy of naloxone to reverse overdoses. In some cases, it may be more effective for medical professionals to encourage individuals to seek professional treatment for opioid addiction than when family members urge them to do so.

Muscle Relaxers & Drug Abuse

Muscle relaxers or relaxants are medications with sedative and depressant properties used to treat a wide array of musculoskeletal conditions. Typically prescribed in combination with physical therapy, the goal of these medications is to reduce skeletal muscle spasms, alleviate pain and increase mobility of impacted muscles. In addition, many of these drugs are prescribed for fibromyalgia and back pain. Studies have not demonstrated the superiority of these drugs to acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) for low back pain. Systematic reviews and meta-analyses support their use for short-term relief of acute low back pain when nonprescription drugs are poorly tolerated or ineffective. The American Pain Society and the American College of Physicians recommend using acetaminophen and NSAIDs as first-line agents for acute low back pain and reserving skeletal muscle relaxants as an alternative therapy.

Types of Muscle Relaxers

Prescription muscle relaxants are classified into two basic types. Antispasmodics are centrally acting skeletal muscle relaxants (SMRs) and antispastics are drugs that only suppress muscle spasms. Experts theorize antispasmodics help alleviate muscle spasms and associated pain through their sedative properties and/or by preventing nerves from sending pain signals to the brain. Antispastics are typically prescribed for conditions that cause muscle spasticity, including brain injuries, spinal cord injury and multiple sclerosis. Spasticity is clinically defined as “a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon reflexes, resulting from excitability of the stretch reflex.” In lay terms, spasticity is a problem involving excessive permanent increase in muscle tone when a person is at rest.

Muscle Relaxer Names

Perhaps you’re familiar with some of the most common and widely prescribed names of muscle relaxers, such as Valium (diazepam), Soma (carisoprodol) or Flexeril (cyclobenzaprine). These are just a few of the many muscle relaxants available by prescription. Below is a brief description of the most common muscle relaxants, categorized by type, with brand and generic names.

Antispasmodics

Soma (carisoprodol): Physical or psychological dependence is possible with potential withdrawal symptoms after discontinuation. Carisoprodol was found to be superior to diazepam for the short-term treatment of moderately severe low back pain and spasm. Carisoprodol should only be used for short periods (2-3 weeks) due to lack of evidence proving effectiveness with longer use. This drug may cause drowsiness and dizziness, and should not be used in anyone aged 65 and older.

Parafon Forte, Lorzone (chlorzoxazone): This drug acts primarily at the level of the spinal cord and subcortical areas of the brain, where it inhibits reflexes involved in skeletal muscle spasms. The side effects are similar to most muscle relaxants, with the exception of a limited number of reported cases of significant hepatotoxicity. Therefore, it is not recommended for anyone with liver problems.

Fexmid, Flexeril, Amrix (cyclobenzaprine)

This drug is the most widely studied and has been shown to be effective for muscle stiffness and pain. Structurally similar to tricyclic antidepressants, it is believed to impart analgesic effects by interfering with serotonin transmission at the spinal cord. The recommended dose of cyclobenzaprine is 5 or 10 mg three times daily for immediate release tablets or 15 or 30 mg once daily for extended release tablets. As with most drugs, it is possible to overdose on Flexeril. Combining cyclobenzaprine with opioid analgesics or antidepressant medication increases the risk of neuropsychiatric side effects such as psychosis and delirium, as well as spasmodic muscle contractions.

Skelaxin, Metaxall (metaxalone)

Typically well tolerated, this drug is a used in addition to rest, physical therapy and other measures for relief of discomfort associated with acute and painful musculoskeletal conditions. It is commonly prescribed as a muscle relaxant, although it has no direct muscle relaxant effects. Metaxalone overdose can lead to potentially deadly serotonin syndrome, as evidenced by case studies, however, both subjects ingested other medications and one intentionally attempted suicide.

Robaxin (methocarbamol)

An inexpensive and less sedating option than cyclobenzaprine or carisoprodol, this drug has shown efficacy for low back pain. In a recent study, 44% of people achieved complete low back pain relief. Robaxin methocarbamol tablets are a carbamate derivative of guaifenesin, a CNS depressant with sedative and musculoskeletal relaxant properties.

Norflex (orphenadrine)

This drug works by blocking nerve impulses or pain sensations sent to the brain. It is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury.

Zanaflex (tizanidine)

Tizanidine is indicated for the symptomatic treatment of painful muscle spasms due to musculoskeletal disorders and at higher doses for disease-specific spasticity. It is used in adults with multiple sclerosis and spinal cord injury and in children with cerebral palsy. In combination with NSAIDs, it is superior to NSAIDs alone. A 2009 study found it was superior to aceclofenac monotherapy for the treatment of acute low back pain. It should not be used by individuals with liver disease or with the drugs fluvoxamine or ciprofloxacin.

Antispastics

Lioresal, Gablofen, Lioresal (baclofen): Baclofen is chemically related to gamma-aminobutyric acid (GABA), a naturally occurring neurotransmitter in the brain. GABA released by some nerves results in decreased activity of other nerves. It is believed the GABA-like action of baclofen blocks the activity of nerves within the part of the brain controlling the contraction and relaxation of skeletal muscles.

Dantrium (dantrolene)

This drug helps control chronic spasticity related to spinal injuries, stroke, multiple sclerosis and cerebral palsy. Dantrolene is taken as a capsule and can cause liver problems, so regular blood tests are typically required to monitor liver health. Individuals with asthma, emphysema, bronchitis or other lung diseases are more likely to experience serious side effects.

Valium (diazepam)

A benzodiazepine used to treat anxiety, muscle spasms, seizures, insomnia, epilepsy and some effects of alcohol withdrawal, Valium was introduced in 1963 and quickly gained popularity for its sedative effects. Between 1969 and 1982, Valium was the most prescribed drug in the U.S., viewed by clinicians as a worry-free panacea. In 1979, sales reached a peak with more than 2.3 billion pills sold. Diazepam has similar sedative and hypnotic effects as barbiturates, however, it is far less likely to result in lethal overdose and thought to have less abuse potential than newer benzos like Xanax. Although the peak of Valium abuse was decades ago, accounts of epidemic abuse periodically resurface and the drug continues to be sold on the black market. Valium should not be taken with any prescription opioids due to the increased risk of fatal overdose.

Side Effects of Muscle Relaxers

The side effects of muscle relaxers vary somewhat based on the medication and individual. Serious side effects include breathing problems, lightheadedness or fainting, blurred vision, confusion, nausea and urinary retention. The most common side effects of antispasmodics include:

  • Constipation
  • Drowsiness
  • Dizziness
  • Dry mouth
  • Fatigue
  • Headache
  • Nervousness
  • Reddish-purple or orange urine
  • Lowered blood pressure upon standing

The most common side effects of antispastics include:

  • Drowsiness
  • Dizziness
  • Weakness
  • Fatigue

Special Precautions

Muscle relaxants should not be combined with antihistamines, St. John’s wort or sleep medications. The excessive sedative effect when taken with other central nervous system depressants such as alcohol, opioids, benzodiazepines or barbiturates can result in respiratory depression and death. Dosing timing is important because a muscle relaxant designed to last 12 hours taken at 10 pm can cause impaired driving before 10 am. Gradual tapering off of these drugs is recommend because withdrawal symptoms such as seizures or hallucinations can occur.

Abuse of Muscle Relaxers

Muscle relaxers are prescribed on a short-term basis because they have the potential to be addictive and in that event, require specialized SOMA addiction treatment. Carisoprodol and diazepam are both classified by the U.S. Drug Enforcement Administration as Schedule IV controlled substances due to their potential for abuse and addiction, as evidenced by studies. Literature also suggests abuse potential for baclofen, methocarbamol, orphenadrine and tizanidine, although relatively few animal and human studies have been conducted.

Carisoprodol was originally thought to have a lower potential for abuse and addiction than other muscle-relaxing drugs used in the 1950s-60s. More recent evidence shows it is habit forming, especially when taken in combination with other drugs. In a person who readily metabolizes carisoprodol, large amounts result in a sedative-hypnotic effect that may lead to psychological addiction. The drug intensifies the effects of Xanax, creating a potentially lethal duo when taken together. This drug is intentionally abused to enhance the effectiveness of other drugs, with users creating “cocktails” to simulate the effects of narcotic substances including heroin. Back in 2000, the Drug Abuse Warning Network listed carisoprodol as the 20th most abused drug, ranking higher than oxycodone and methadone.

Abusing any of these muscle relaxers can increase the risk and severity of side effects and possibly lead to dependence. Only use these medications short-term as recommended, and follow all precautions. Don’t abruptly stop taking these drugs and seek professional help if you feel you have become addicted.

Dealing With Anger Toward an Addict

husband pointing and angry at wife

If you love an addict, one emotion you’re sure to feel a lot of is anger. Addiction drives people to cross boundaries. They’ll take, then take some more. They’ll test your patience and your love. They’ll ask for forgiveness and promise not to repeat their mistakes. Then, they’ll do it all over again.  Continue reading

How to Handle (or Survive) Your First 12-Step Meeting

12 step meeting - group of people sitting in a circle

After you’ve made the often very difficult decision to go into rehab and get professional help to overcome your addiction, it’s not the end of the healing path but merely the beginning. Along with detoxifying your body from addictive substances, learning about the disease of addiction, becoming familiar with and practicing coping skills and techniques, and learning how to prevent, deal with and come back from potential relapse, there’s the whole vital element of ongoing support to navigate. While you’ve probably been introduced to 12-step meetings, once you’re back home again you’ll need to figure out how to handle (or survive) your first (post-rehab) 12-step meeting. Continue reading

How to Tell If You’re Addicted to Your ADHD Medication

ADHD Banner with Medication

Attention-deficit hyperactivity disorder (ADHD) is a serious condition that affects adults as well as children and teens. Stimulant medications are effective in treating this condition, but concerns about the potential for abuse of these medications, or even addiction to them, (Focalin addiction, Adderall addiction, and Ritalin addiction) are valid. Let’s take a closer look at how to discern if you are developing an addiction to the medications prescribed for your ADHD.

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911 for First Responders: Resolving Cumulative Trauma by Supporting Each Other

By Mike Pool, Retired Law Enforcement and Peer Coordinator of After Action: Building Resilience Workshop.

First responders are not allowed to show or share our emotions. We shove our reactions as far down as they’ll go so we can cope with the day-to-day corrosive events of our jobs. Most of us come to see that this kind of work found us, and not the other way around, so we plunge head first into trying to do our best. Many of us don’t realize how much our family history may have led us on this path, or the underlying reasons we need to protect and save people. We just get it done. Continue reading