Wednesday, November 11, 2009

Private Outpatient for Opiates, Done Right

Prescription drug abuse, especially by young people, is on the rise, and opiates like Vicodin and Oxycontin rank high on the list.  People with chronic pain all too often end up addicted to their medications.  People who got into  heroin or other opiates for recreational use or to self-medicate some psychic hurt frequently find themselves in deeper waters than they ever intended.  We meet all these people, among others, in LifeRing meetings, and one of the big concerns for them is anti-addiction medications.  In the past, the most common medication to treat opiate addiction was methadone.  Methadone continues in use, but buprenorphine (byou-pruh-NOR-feen) is the new kid on the block, and both physicians and patients are picking up on it because it's easier to administer, has fewer side effects, and less potential for abuse than methadone.  Buprenorphine is being used both to detox the person addicted to opiates and in some instances as a maintenance regime.

It isn't easy for the person who wants to address an opiate addiction to find proper care.  Apart from a few outstanding practitioners like Dr. Howard Kornfeld in Mill Valley, the patient who is without Kaiser coverage may not find any place to go.

That's slowly changing, as both physicians and patients become educated about new addiction pharmacology.  One of the bright signs of change in the field is the opening of Reliance Center in San Francisco.  Located on the third floor of the beautiful old 450 Sutter Street building, a block north of Union Square, this new outpatient clinic brings together a very high powered medical and counseling staff in a comfortable, almost living room atmosphere.

Putting physician and counselor on the same team tells me that these folks really "get it."  You need both the medical doctor and the empathetic psychological advisor to deal with an addiction.  I had the opportunity to meet and to look up the resumes of the key staff.  Dr. Carrie Schuman, Medical Director, has treated people with opiate dependence for more than 25 years.  She's a leading member of the California Society of Addiction Medicine and a member of the national addiction medicine group.  This physician knows what she's talking about when it comes to opiate addiction, and she also projects a warm, caring, nonjudgmental attitude.  On the counseling side, there's Lubov Smith, a Licensed Marriage and Family Therapist, who comes to the Reliance Center from years as Executive Director of the Henry Ohloff Centers, one of the oldest addiction treatment programs in the area.  She's bright, funny, and very knowing.  If I had an opiate addiction issue, I'd put myself into the hands of this team without hesitation.  Check them out at http://reliancecenter.com.

Professionals who include pharmacological tools in their recovery approach are often pleasantly surprised to learn that abstinence support groups exist that are open to patients who are taking these medications.  More than ten years ago, the medical director of a local treatment facility complained to me about the "G**damn 12-step sponsors who interfere with my treatment plans."  Although AA co-founder Bill W. was personally very positive about anti-addiction medications, the organization he founded contains a strong streak of anti-medication Luddites, who in many instances tell the recovering person to throw away their anti-depressants and other prescription drugs, or they're not really considered "sober."  That hasn't changed in the past ten years, judging by recent stories I've heard.  And so, when a support group like LifeRing comes along, with a more evidence-based approach, physicians' interest perks up.

In the past few years, LifeRing has mounted exhibit tables at conferences of addiction counselor groups such as NAADAC and CAADAC and at APA events (American Psychological Association).  If we can raise the money -- it costs at least $1000 to exhibit at one of these events -- we hope to exhibit next year also at ASAM and CSAM -- the American and California Societies of Addiction Medicine.  With our evidence-based supportive approach to anti-addiction pharmacology, LifeRing should get a positive reception from these professional groupings.

1 comment:

Sam said...

way to Go Marty! it may take more time for some of the professionals in the field, but we're moving in the right direction with information.
Sam Houx CSAC CDP

ps Im back at Schick woohoo:)