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The Florida House of Representatives unanimously voted on a bill to extend workers’ compensation benefits for firefighters, police officers and other first responders suffering from post-traumatic stress disorder.
Gov. Rick Scott approved the legislation, SB 376, on March 27.
Before the bill was approved, workers’ compensation did not cover any form of PTSD treatment under Florida law. It covered only physical injury sustained on the job.
Once implemented, the law will allow first responders who have witnessed the death of a minor or a death involving bodily harm to the extent that it caused them significant psychological distress to file workers’ compensation claims.
Dr. Kevin Wandler, chief medical officer at Advanced Recovery Systems, said that Scott is setting a new standard for PTSD support that all states should follow.
“This bill, along with support from the International Association of Fire Fighters, will allow more of our first responders to get treatment for PTSD, which is highly prevalent and can have traumatic consequences,” Wandler told DrugRehab.com.
Under this law, first responders must show clear evidence that their PTSD was caused by a traumatic event on the job. The legislation also requires agencies to provide education on mental health awareness.
The law will go into effect Oct. 1, 2018.
PTSD Treatment Could Prevent Addiction
First responders often brave harrowing situations and unsafe environments that result in mental health problems.
85 percent of first responders have experienced symptoms related to mental health problems.
84 percent have witnessed a traumatic event on the job.
34 percent have received a formal diagnosis of a mental health disorder.
10 percent of responders have been diagnosed with PTSD.
75 percent of those diagnosed with PTSD have received treatment.
Tragedies like the one that occurred at Marjory Stoneman Douglas High School in Parkland, Florida, can cause severe mental distress in those who respond to the situation. In some instances, it can lead to suicidal ideations or substance use disorders.
For example, a 2002 study published in the American Journal of Psychiatry found that alcohol use disorders were common among first responders of the 1995 Oklahoma City Bombing. The report showed that 24 percent of rescue workers developed an alcohol use disorder soon after the attack and 47 percent developed a drinking problem at some point in their lives.
In a Facebook Live video last month, Jimmy Patronis, Florida’s chief financial officer and state fire marshal, said these tragedies are traumatic for first responders. But rescue workers don’t always talk about their emotional anguish.
“This profession is a very proud profession. It’s pretty intimate,” said Patronis. “You don’t see first responders going onto social media and explaining the challenging day they had. They don’t go onto social media or share the horrific experience they had.”
Patronis went on to explain that some first responders may turn to alcohol or other drugs to self-medicate symptoms of PTSD or other mental health disorders. This can result in dependence or addiction. Treating PTSD in first responders could potentially prevent substance use disorders.
Treatment Options for First Responders
Many first responders can receive psychological assistance through employee assistance programs. Fire departments enlist counselors who provide support and resources to firefighters with PTSD and substance use issues. These resources often include a limited number of counseling sessions.
However, counseling might not be enough for a person struggling with severe symptoms of PTSD.
“Society is now more accepting of the realities of PTSD in the military veteran population, but first responders are exposed to harrowing incidents every single day and need the same type of support and coverage for mental health treatment,” she said.
The new law in Florida might help rescue workers receive this support. And it could encourage more first responders to seek assistance for their psychological problems.
“The passage of this bill and the recognition that, just as physical injuries, these are conditions acquired on the job are a great start to helping first responders in Florida have greater access to the comprehensive treatment they need and deserve,” said Morris.
On good days, Samantha Carter can almost block out the burning sensations that occur in her arms, legs, hands
and feet. She homeschools her daughter and blogs about her life to inspire others who deal with pain daily.
She tries to enjoy time with family. She strives to live a normal life.
On bad days, Carter can’t get out of bed. She attempts to numb persistent aches caused by fibromyalgia with heating
pads, Biofreeze and compression gloves. When the pain flares, her goal is to be as comfortable as possible.
Relief isn’t realistic.
“I’ve tried a lot of different methods,” Carter told DrugRehab.com. “There were periods where I would get regular
massages. I’ve done three or four rounds of physical therapy. I do a lot of hot and cold therapy. I’ve used
essential oils. I’ve used Biofreeze and random bracelets. I’ve tried anything that I can get my hands on
that is legal and safe.”
For 16 years, doctors declined to prescribe opioids, such as
Vicodin, Lortab or Percocet, to Carter for long-term pain relief. She’s received opioids after major
surgeries or tests, but the prescriptions lasted less than a week.
Carter refuses to turn to alcohol or illicit drugs for relief. She’s spent hours researching her health conditions.
She’s delved through studies for answers. And she’s come to the conclusion that opioids are her best option.
“The more that I research, the more that I feel like I’ve been treated inhumanely for the past seven years,”
Carter said. “I’m an adult. I have no history of addiction. I have no history of substance abuse. I have
never tried any recreational drug. I don’t drink much. I’m in a stable home. There are no visible risk factors
Photo: Samantha Carter
Like many other people living in pain, Carter believes that opioids may be the only medications that help her
find relief. She’s run out of other options. But the drugs are becoming more difficult to access.
The more that I research, the more that I feel like I’ve been treated inhumanely for the past seven years. I’m an adult.
I have no history of addiction. I have no history of substance abuse.
— Samantha Carter
Increasing rates of
prescription drug addiction and opioid overdose deaths have put pressure on doctors to reduce prescriptions
for opioids. New guidelines urge doctors to be cautious when prescribing the medications for chronic pain.
A 2016 survey of long-term prescription opioid users conducted by the Washington Post and the Kaiser
Family Foundation found that two-thirds of participants were concerned that efforts to combat opioid addiction
would make the medications more difficult to access for people in chronic pain.
About 57 percent of people with chronic pain who responded to the Kaiser Family Foundation survey said prescription
opioids made their quality of life better. But 16 percent said the medications made their quality of life
worse. One-third reported being physically dependent or addicted to opioids.
These diverse experiences exemplify the arguments for and against the use of opioids for the treatment of chronic
Mixed Messages on Safety and Efficacy
Throughout the 1990s, pain management advocates and pharmaceutical companies publically supported increased access
to opioids. Some advocates claimed that opioids were safe for long-term use and that the risk of addiction
The federal government encouraged doctors to check for pain and treat it adequately. Several organizations called
pain the fifth vital sign.
Many of the safety claims were based on faulty science. Hundreds of thousands of people became addicted to opioids
as access to the drugs increased. Drug overdose deaths skyrocketed. Access to prescription opioids also facilitated
an increase in heroin use, according to a 2012 study published in the International Journal on Drug Policy.
“For most types of chronic pain, opioids are inappropriate,” Dr. Chris Johnson told DrugRehab.com. “There have
been no studies showing that opioids are effective for long-term management of back pain, fibromyalgia, headaches
or arthritis. That has always been true.”
Photo: Dr. Chris Johnson
Johnson serves on the boards of Physicians for Responsible Opioid Prescribing and the Steve Rummler HOPE Network.
Both nonprofit groups advocate for cautious and responsible opioid prescribing practices to reduce the prevalence
of opioid-related deaths.
The groups have lobbied Congress, the Food and Drug Administration, the Centers for Disease Control and Prevention
and other major health organizations.
“The CDC, the American Medical Association and all of these great medical bodies should come out and say that
due to the clear evidence of harm of chronic opioid therapy and lack of any proven benefit for most chronic
pain conditions, these drugs should not be initiated any longer for these conditions,” Johnson said.
A 2015 study funded by the Agency for Healthcare Research and Quality searched for studies on opioid therapy
lasting more than three months. The researchers concluded that evidence was “insufficient to determine the
effectiveness of long-term opioid therapy for improving chronic pain and function.”
Are you or someone you know struggling with opioids?
When the CDC announced new guidelines for opioid prescribing in 2016, the agency reported that no studies lasting
at least one year had measured the effectiveness of opioids in improving pain, function or quality of life.
Despite zero evidence of effectiveness, the agency released guidelines for treating chronic pain with opioids
The CDC does recommend prescribing opioids when all other methods have been exhausted. The agency says doctors
should closely monitor patients, use the lowest effective dose and combine opioid treatment with other therapies.
Living in Pain Without Opioids
For decades, opioids were loosely prescribed by many doctors. But Carter’s doctors were cautious. She’s lived
in pain for 16 years, and she’s never been prescribed opioids for long-term pain relief.
When she was 13, doctors told her she had a condition called reflex sympathetic dystrophy, also known as complex
regional pain syndrome. The condition usually occurs after an injury damages nerves, but Carter said no event
caused her condition. RSD causes a burning sensation that feels like sunburn on different parts of her body.
It can also cause swelling, joint stiffness and muscle spasms.
As a teen, Carter’s doctors were hesitant to prescribe opioids. Illicit drug use was a major problem when she
was growing up in Tennessee. They didn’t want to give an adolescent powerful narcotics. She was eventually
prescribed a short-term dosage of an opioid — she can’t remember which one — to help her sleep. She took
the medication only at night.
“I was always kept on a strict regimen,” Carter said. “They were never used off-label or anything like that.
There were never any feelings of loopiness or a high or anything like that.”
After three months, the opioids were replaced by an antidepressant called amitriptyline that’s sometimes prescribed
to treat nerve pain. One side effect of the drug is drowsiness, which helped Carter sleep. It was one of
the few medications that gave her some relief, but the pain never fully dissipated.
She went to physical therapy and a psychologist for about six weeks, but she was discharged from both treatments
when her pain didn’t improve. She tried a variety of nonopioid medications, but amitriptyline was the only
one that had an effect.
At 21, Carter was diagnosed with fibromyalgia. She’s also been diagnosed with vaginal, bladder and groin conditions.
For those conditions, physical therapy provided some relief. But once again, the pain never completely went
“There are a lot of different types of pain that my doctors are trying to treat,” Carter said. “Throughout all
of it, being able to get pain medicine has been a huge fight. It’s been something that they resist because
they want to rule out everything they can.”
Carter’s experience is representative of the research on interactions between doctors and patients in chronic
You don’t want to get into the argument about what type of pain is legitimate or illegitimate. If a person feels pain, it’s
legitimate. The question is, is it still appropriate for opioids?
— Dr. Chris Johnson,
Physicians for Responsible Opioid Prescribing
A 2007 review of studies on patient-provider interactions published in the journal Pain Medicine found that people
in chronic pain want to be understood. They want doctors to feel that their pain is legitimate. Doctors are
more likely to focus on diagnosing and treating conditions than addressing quality of life issues, according
to the review.
Johnson said that physicians must recognize that patients are in pain and that no expressions of pain are illegitimate.
“You don’t want to get into the argument about what type of pain is legitimate or illegitimate,” Johnson said.
“If a person feels pain, it’s legitimate. The question is, is it still appropriate for opioids?”
The Doctor’s Perspective
On paper, adhering to prescribing guidelines seems simple. In reality, deciding whether to tell patients in pain
that they can’t have medications that may provide temporary relief is difficult.
Writing for STAT, Dr. Jay Baruch described the mental anguish he felt when trying to determine whether a patient
with severe tooth decay was
doctor shopping for opioid prescriptions and whether opioids were appropriate or not.
“Prescribing guidelines … are well-intentioned and necessary. But they do little to address the central anxiety
that makes this decision a source of distress for physicians like me,” Baruch wrote.
Doctors have to think about the short- and long-term interests of their patients, but they also have to protect
themselves from legal liability. Numerous doctors have been arrested for prescribing opioids recklessly.
Physicians also feel emotional attachments to their patients, and they don’t want to see them suffer.
“You want them to feel good about their visits,” Johnson said. “They’re in a system that is charging them so
much money and doesn’t really give them other good options. To say, ‘I just can’t do that,’ is a real challenge.”
He said doctors know that health care is expensive, and a lot of patients are paying out of pocket for appointments.
Many of them don’t have access to alternative therapies to treat pain.
“How do you tell them no if they tell you they want this drug?” Johnson asked. “You’ve only had a few minutes
to see the patient. You can’t give them intensive chronic pain therapy because that’s not invested in [by
the health care system]. You have to give them some satisfaction from their meeting. It’s really hard to
Searching for Solutions
Carter has been in and out of doctor offices in the past two years. She was tested for autoimmune diseases. She
had three biopsies. She had a cystoscopy, a procedure that allows doctors to examine the bladder. She received
stem cell injections to attempt to heal nerves. She searched for answers on her own, and she kept reading
that opioids worked for other people.
She found a study that showed that fibromyalgia pain can be relieved by tramadol, an opioid, when used in combination
with acetaminophen, the generic name for Tylenol. The 2003 study published in the American Journal of Medicine
followed 313 patients for 91 days and found no serious adverse effects associated with the treatment. She
told her doctor about the study during her next appointment.
“I just started bawling and telling him, ‘I can’t handle this anymore. I only need enough for the days that I
can’t move.’ And I said, ‘Honestly, even 10 a month would help.’ So that’s what he gave me,” Carter said.
Her doctor wrote a prescription for 30 tramadol pills for three months with no refills. To relieve pain around-the-clock
for one month, she’d need at least 120 tramadol pills. She was given an average of 10 per month.
Tramadol is less potent than hydrocodone,
oxycodone and many other opioid pain relievers, but Carter said she was scared to ask for anything stronger.
On bad days, the tramadol doesn’t do much to relieve pain, she said. Sometimes she chooses not use the medication
when the pain is bad because the effect is so minimal. She’d rather save it for good days when the medication
can provide some relief and she can almost experience a day without pain.
Mandated Limits on Opioid Prescribing
Despite increased awareness about the risks of prescribing opioids, some doctors still overprescribe. Opioid
prescriptions peaked in 2010 before decreasing each year through 2015, according to a
2017 CDC report. But prescription rates are far from where they were in the early 1990s.
One solution to reduce overprescribing is to mandate limits on the duration and dosage of opioid prescriptions.
In 2017, Maine limited physicians to prescribing the equivalent of 100 milligrams of morphine per day to
most patients being treated with opioids.
Morphine is the standard that other opioids are compared to.
Other states have limited prescriptions to a week or less. In September 2017, the governor of Florida proposed
three-day limit for opioid prescriptions in most situations and a seven-day restriction for rare circumstances.
CVS Health has also announced that it will fill opioid prescriptions only for seven days when the drugs are prescribed
to treat short-term pain.
The limits have outraged people who experience chronic pain. Many believe that restrictions to treatments for
acute conditions are a stepping stone toward restrictions for long-term conditions.
“It scares the crap out of me,” Carter said. “The discussions right now are geared more towards acute conditions.
… But I think it’s unnecessary. I think it’s ill-advised, and I think it’s going to make life more difficult
for people like me.”
But physicians who advocate for responsible opioid prescribing believe the limits don’t go far enough
“Seven days is still about 56 tablets,” said Johnson, who is the chair of the Minnesota Department of Human Services’
Opioid Prescribing Work Group. “That’s a lot of opioids. Our recommendations are going to be to limit acute
opioid prescriptions to less than 100 milliequivalents. That’s like 20 tablets of Vicodin.”
Seven years ago, a British woman named Emily Robinson decided to give up drinking for the month of January as she trained for a half-marathon.
Much to her delight, her month of abstinence made a huge difference in how she felt. Not only did she have more energy to run, Robinson was also sleeping better and shedding pounds — and everyone she knew wanted to talk about her month-long break from alcohol.
A year later, Robinson decided to take a vacation from drinking once again. By this time, she was working for Alcohol Concern, a London-based charity organization that strives to reduce alcohol harm in Great Britain. The organization decided it was time to spread the word about her simple idea — and boy, did it spread.
In 2018, more than 5 million people in the U.K. are expected to take part in Dry January.
In 2013, approximately 4,300 people participated in Alcohol Concern’s inaugural Dry January campaign. More than 5 million people in the U.K. are expected to take part in the no-drinking challenge in 2018, and the health-conscious trend has made its way across the pond.
Instagram, Facebook and Twitter were flooded with #DryJanuary and #Drynuary posts during early January, and the mainstream media has also discovered the phenomenon. The Washington Post, ABC News, CBS News, Fox News and NPR are among the many media outlets reporting on the trend.
For some, the impact has been life-changing.
Rumer Willis, actress and daughter of actors Demi Moore and Bruce Willis, was so pleased by the results of going dry in January of 2017 that the actress decided not to go back to drinking at all.
“My decision to become sober wasn’t out of a need necessarily, it was more just that I did ‘sober January,’ and I just decided to keep it going,’” she told People magazine.
Health Benefits of a One-Month Alcohol Hiatus
You may be wondering whether the benefits of a sober January will live up to the hype. After all, how much could a 31-day sober stretch really change a person?
Quite a bit, it turns out.
Dr. Rajiv Jalan, a professor of hepatology and the head of the liver failure group at UCL Medical School in London, told NPR that he found significant health impacts in a study of 80 hospital volunteers who decided to give up drinking for a month. In the end, about half of the volunteers were successful in maintaining their sobriety, and those who did experienced better liver function and improvements in their skin and overall appearance.
Nearly everyone in the study lost weight. Blood sugar levels declined, as did levels of blood markers associated with cancer.
In a study with mice in a laboratory, British scientists have discovered that a chemical called acetaldehyde that’s produced when the body breaks down alcohol snaps the DNA in blood stem cells, resulting in the rearrangement of chromosomes.
“Some cancers develop due to DNA damage in stem cells,” Ketan Patel, a professor at the Medical Research Council Laboratory of Molecular Biology and lead author of the study, said in a press release. “While some damage occurs by chance, our findings suggest that drinking alcohol can increase the risk of this damage.”
Other Benefits of Sobriety
Cancer risk reduction aside, the participants in Jalan’s study also slept better and had better sexual function.
Ditching a drinking habit is also easier on the wallet, and not just because you’re saving on your bar tab.
Kate Beavis, a mother of two from Bedfordshire, England, told the Daily Mail that she never went back to drinking after committing to Dry January in 2015. Quitting her habit of drinking three glasses of wine per night, she says, cured her allergies, got rid of her back pain and gave her a “clearer head to focus on her business.”
Beavis says her income has increased fivefold as a result.
She’s not the only one drinking less in the long-term after completing her Dry January challenge.
Jalan says the 80 individuals from his study reported “significantly lower drinking” episodes in the six months following the Dry January challenge. While the sample size was small in Jalan’s study, a subsequent study of 857 British adults yielded similar findings, with 72 percent of participants drinking less six months after completing Dry January.
More interesting, perhaps, is the fact that even those who didn’t complete the challenge had tempered their drinking habits over the next six months.
Not for Everyone
A word of caution: the Dry January ritual isn’t intended for heavy drinkers.
Dr. Ramon Bataller, associate director of the Pittsburgh Liver Research Center told the Los Angeles Times that heavy chronic drinkers can “go into a coma, have a stroke or experience withdrawal symptoms” if they stop drinking suddenly.
If you are a heavy drinker and want to stop, don’t attempt to go cold turkey at home. Instead, consult with a physician or alcohol treatment center to see if you need medically monitored detox.
Alcohol withdrawal can began as soon as two hours after people who are dependent on alcohol have had their last drink. Symptoms may range from sweating, shaking, nausea and vomiting to high fever, seizures, hallucinations and even death. Withdrawal symptoms usual peak within one to three days, and they may last for weeks.
Every year, Ohio’s drug crisis grows. Between 2007 and 2016, drug overdoses killed more Ohioans than any other accidental cause.
The main reason for this awful, fatal health crisis is opioids. Opioids are involved in the vast majority of drug deaths in Ohio. In 2016, a total of 4,050 Ohioans died of drug overdoses. Of those, 3,495 — 86.3 percent — died from opioid overdoses.
Heroin is the most notorious opioid. Its bad reputation is well deserved. However, the main culprits for the opioid addiction boom are legal drugs prescribed every day in Ohio by the thousands.
Prescription painkillers are often the first opioid drug used by Ohioans who struggle with opioid addiction. According to the National Institute on Drug Abuse, approximately three in four U.S. heroin users reported misusing prescription opioids prior to their heroin use.
Ohio’s Prescription Opioid Supply
Prescription opioids are marketed as painkillers under familiar brand names such as Vicodin, OxyContin, and Percocet by companies such as Merck, Perdue, and Johnson & Johnson. They’re everywhere — which wasn’t normal until the 1990s.
In the ’90s, pharmaceutical companies worked aggressively to change the way chronic and acute pain is treated in the United States. Pharma companies wanted doctors to prescribe more opioids. They successfully convinced doctors to prescribe large quantities of opioids using a flawed study.
Ohio is no exception to the trend. On average, between 2011 and 2013, Ohio pharmacists gave patients 784 million doses of prescription opioids every year. That’s enough to give every Ohioan 67 doses.
Opioid painkillers are not as safe as the pharmaceutical industry claimed in the ’90s. They are just as addictive as their street drug counterparts, so they can ensnare people who would have never considered buying drugs on the black market. Some medical patients develop opioid dependence after taking the drugs during the course of treatment.
Ohio resident Traci Andrus was prescribed opioids after a medical procedure. The former social worker for the city of Chillicothe developed an addiction to her medication while recuperating from the procedure.
When she started using, Andrus says, “I had a home. I had a brand-new car. I had a life.”
She lost the first two as she slipped further into addiction. Eventually, she started using heroin.
In 2016, a total of 3,495 Ohioans died from opioid overdoses.
Street opioids such as heroin are easier and cheaper to buy than prescription opioids. Opioid painkillers have to be prescribed by doctors and distributed by pharmacists. When someone starts asking for large quantities of pills, caregivers get suspicious and eventually cut them off.
Even if that doesn’t happen, a prescription opioid habit becomes too expensive for most people struggling with addiction to maintain. Heroin is less expensive, and because it is illegal, sales and usage aren’t monitored.
According to Ohio Attorney General Mike DeWine, there is a direct connection between the opioid epidemic and the prescription painkiller boom. In 2017, his office filed a lawsuit against five pharmaceutical companies. The suit accused the companies of lying to doctors and patients to sell more pills and ignoring or changing prescription opioid safety standards.
“[The companies] knew all of it was wrong and they did it anyway, unleashing a health care crisis that has unfurled far-reaching financial, social and deadly consequences for the people and families of the state of Ohio,” DeWine said. The pharmaceutical companies want the lawsuit dismissed. They argue that they aren’t directly responsible for the crisis.
What caused the crisis is a question for history. If Ohio wins the lawsuit, the state may use the settlement to pay for education and treatment programs. Only treatment for everyone who developed an addiction can repair the damage that prescription opioids have done to the people of Ohio.
Whether you’re three days clean or three years, it may occasionally be difficult to find things to get excited about in recovery. Obviously it’s exciting to be living a life without drugs or alcohol, but what comes next? What can we work on throughout our recovery that will keep us moving toward a bright, beautiful future?
This journey is more than getting sober — this a journey to discover our potential as human beings. It is an opportunity to grow our spirits, to recognize our strengths and weaknesses, and to gain independence that was previously inconceivable.
Without the motivation to move forward, and without looking to our future, recovery may seem kind of bleak. But no matter how hard our minds try to trick us, there is always something exciting to experience that will make our journey that much more fruitful.
Embracing a Flood of Suppressed Emotions
My favorite part of early recovery was one of the scariest and most beautiful battles I have ever fought. It’s often said that at a certain point in everyone’s journey to become clean or sober, they start to get their emotions back. I had heard this phrase thrown around a thousand times, but it never really hit me until, well, it hit me.
My life was undoubtedly changing after a few months living drug-free. But most noticeable to me was the evolution of my emotions. Thoughts and feelings I had attempted to hide from for so long would bounce about my brain, leaving me suddenly vulnerable and unsure how to process such strong, unfamiliar emotions.
After numbing that side of myself for so long, this evolution was poignant and seemingly never-ending. It scared me terribly at first. Realizing fear was just another way to mask things I was uncomfortable with, I reached out to my therapist and worked though these new emotions with a support network of friends and professionals.
Crossing Emotional Milestones
What was once my greatest fear — coping with emotions I thought impossible to handle — became my biggest success. This experience became something to look forward to.
If a sweeping feeling came over me, I learned how to understand the emotions behind it. I learned how to ask myself the right questions so I could work through that feeling appropriately.
Suddenly I had motivation to understand myself and my mind better than ever before, and this same motivation keeps me going today. Not only am I conquering fears, I’m also learning about myself in the process — developing the person who I want to be, understanding and accepting my mistakes and using them as fuel for a better tomorrow.
As we cross these emotional milestones, we also get to understand who we are as a person and who we want to be. Feeling shame for our past may drive us to do better in the present and the future. Experiencing genuine happiness makes us feel inspired to spread that joy.
As our emotions change, so do our interests. Music we once enjoyed may not be as appealing anymore. Perhaps we were pretty dang lazy when we were using, but now we find value in regular trips to the gym. Not only do these changing emotions benefit us from the beginning, they also benefit us for the rest of our lives.
You will laugh a hundred times louder, cry a hundred times harder and smile a hundred times wider because your mind is no longer in chains.
With changing emotions and interests comes a change in perspective. There will come a day when someone asks you how you’re doing, and you’ll actually believe it when you say you’re doing well.
Social Rewards in Recovery
Emotions aren’t the only thing to look forward to in recovery. However, they play a big part in what comes next. Once we start to become better people, we are ready to take on social challenges.
Through sincere effort, and quite a bit of patience, we have the opportunity to amend our relationships with people we care for. It’s important to remember that we have a lot of ground to cover, and sometimes forgiveness takes time.
But know that continued effort is well worth it. After years of strained relationships, hearing people say they are proud of you and your recovery is a comfort unlike any other.
Earning trust back from family, peers and co-workers is an aspect of amending these relationships. The value of that trust will feel more significant than it ever has before. These social rewards in recovery also build a bigger support network to aid you in continuing your journey to a new life.
For example, I recently drove from central Virginia to visit my mother in South Carolina. Three years ago, if someone told me I’d be driving 400 miles to see my mom for New Year’s Eve, I would have called them a liar.
My mother and I had always had a stressful relationship, and that stress varied directly with my substance abuse. Today, it’s unheard of for us to go weeks without speaking. When I think about her in a positive light, I send her text messages to remind her that I miss her.
Now I get to spend time with her without prioritizing drugs. She trusts me to stay in her home while I’m visiting. She no longer feels the need to lock every door and medicine cabinet. She packs me a lunch for my long drive back home.
That feeling, knowing that I have a relationship with her, is one I never before thought I’d be able to experience.
Be Excited About Your Progress During Recovery
You can build relationships with your family and friends that are stronger than ever before. You can earn trust that you otherwise felt you didn’t deserve, and that trust will help you understand your strength and how far you have come. You can be forgiven and supported throughout your recovery by people who care for you and want to see you succeed.
Each of these events are powerful and, like our emotions, ever-evolving. They contribute to our independence and our growth as a new person. They help us see our potential, including all of the things we may not have been capable of before but we now have the power to do.
It may sound a little over-hyped, but after being sick and tired for so long, we don’t realize all of the things we lose in the process of losing ourselves.
Part of recovery is getting those things back, and once you do, it’s quite easy to get excited about it. Each and every goal you set is something to look forward to — no matter how small the task.
Whether it’s a goal to do yard work next Saturday or a goal to go back to school for your degree, we wouldn’t have these things without our recovery. And that is indeed something to be excited about.
While more than 20 million Americans are suffering from drug or alcohol addiction, it’s estimated that only 11 percent end up receiving treatment for their substance use disorder. Many factors may influence a person’s decision not to seek help, including mistaken notions about the inpatient process itself. With that in mind, here’s a look at five misconceptions about rehab that hold people back.
Myth 1: You Have to Hit Rock Bottom First
The concept of “hitting rock bottom” falsely assumes that a person shouldn’t seek help for their addiction or won’t benefit from rehab until they’ve hit an all-time personal low.
It’s true that some people don’t seek recovery until they’ve experienced a crushing blow: a divorce, a job loss, an overdose, an arrest. But reaching “rock bottom” — whatever that means — is not a prerequisite for getting help. A person can seek treatment in all stages of addiction, and there’s no need to go through additional pain, suffering and loss before pressing the reset button.
The rock-bottom myth is also a dangerous one. Alcohol and drug addiction are progressive diseases, and waiting to hit rock bottom can result in irreparable bodily injury and even death. Between 2000 and 2015, more than half a million people died from drug overdoses —and a good many of them probably believed that hadn’t hit rock bottom yet.
Waiting to get treatment can also make recovery more difficult in other ways. Addiction puts a terrible strain on relationships, and the longer you have been struggling with drugs or alcohol, the more difficult it can be to repair or rebuild those broken relationships.
You don’t have to wait until you crash to get help. As the saying goes, “you’ll hit rock bottom the moment you stop digging.”
Myth 2: You Can’t Afford Rehab
The perceived cost of rehab is one of the most common deterrents to getting help. In fact, nearly half of all Americans suffering from a substance use disorder decide not to seek treatment because they believe they can’t afford it or because they don’t have health insurance.
While treatment can be expensive, there are more ways available than ever before to help cover the cost of inpatient treatment. Under the Affordable Care Act, or Obamacare as its more commonly known, insurance companies are required to cover mental health and substance abuse services as “essential health benefits.” Many people suffering from an alcohol or drug addiction may also be unaware that Medicaid, which was significantly expanded under ACA, also covers drug treatment.
If you don’t have insurance and don’t qualify for Medicaid, check to see what other payment options treatment facilities might have. Many offer reduced rates to individuals who are paying out of pocket or will arrange for flexible payment plans.
Because the cost of programs can vary widely from facility to facility, it can pay to check with a range of providers. If cost is a factor, you’ll probably want to avoid facilities that tout themselves as “luxury” rehabs, and you may have to skip the private room. You may also want to consider outpatient therapy, which can be much more affordable.
Many programs offer something called partial hospitalization, or day rehab, which provides intensive care and therapy during daytime hours but allows you return home to sleep each evening. There are also numerous free resources available, such as Alcoholics Anonymous and Narcotics Anonymous, that can help you achieve sobriety.
Don’t let the cost of rehab deter you from getting help. Remember that treatment for addiction is a solid investment in yourself that will pay dividends for life.
Myth 3: Rehab Will Make You Sick and Miserable
If you’re considering getting treatment for a drug or alcohol addiction, you may be worried about whether detox is painful. The truth is, recovering from addiction isn’t easy, but a medically supervised detox can ease the side effects of withdrawal.
The detoxification process is usually the first step of addiction recovery and involves the process of clearing drugs or alcohol from your system. While a number of physical side effects may accompany detox, the intensity of withdrawal symptoms and length of the withdrawal process can vary widely from one person to another, depending on the substance abused and other factors.
Individuals going through heroin or opioid withdrawal, for example, may experience sweating, anxiety, muscle aches, diarrhea, vomiting, abdominal cramps, uncontrollable twitching, intense cravings and a host of other symptoms. Fortunately, many of these symptoms and side effects can be managed with medications that will keep you more comfortable.
Because withdrawal can be dangerous — such as when someone is withdrawing from alcohol, opiates or benzodiazepines — detoxing is much safer in the care of trained professionals. Medical staff will be able to monitor your vital signs and provide treatment should any serious complications arise.
The other thing to keep in mind is that the withdrawal phase won’t last forever. The average duration of detox is approximately seven to 10 days — a relatively short period of discomfort that will pave the way for healing and recovery.
Relapse, however, doesn’t mean treatment has failed. Because a substance use disorder is a chronic disease, relapse in a person recovering from addiction is often a signal that “treatment needs to be reinstated or adjusted or that another treatment should be tried.”
Because of the stigma often attached to addiction, many view relapse as a personal failing. Unfortunately, this warped view can cause feelings of shame or guilt, which can intensify a person’s desire to drink or use drugs, thereby sending them into a worsening cycle of abuse.
Breaking this cycle is best accomplished when addiction is treated like other chronic illnesses, which are diseases that can be managed or controlled, but not cured.
In fact, the relapse rates for addiction are similar to the relapse rates for a number of chronic medical conditions, such as diabetes, high blood pressure and asthma. Just as a diabetic with poor glucose control requires renewed intervention, a person with a substance use disorder who has relapsed may need their treatment renewed and modified.
Many people who’ve never been to rehab imagine something akin to jail or a mental institution, where you’re locked away for 30 days, strip-searched and prohibited from seeing your loved ones.
In actuality, most rehab centers go out of their way to make sure residents are comfortable. While all rehabs are different, many offer amenities such as swimming pools, fitness rooms, massage and meditation— and, if appropriate, many will include your family members in your treatment.
That said, the purpose of rehab is to free you from the grips of addiction, and getting you to that place requires structure and supervision.
At most rehabs, you’ll sleep, eat and attend therapy sessions alongside other men and women recovering from addiction, creating an environment similar to camp. You’ll be kept busy with a range of planned activities to help you master your addiction. A typical day might include group therapy sessions, behavioral therapy and life skills training, relapse prevention training, family therapy sessions and recreational activities.
While most rehabs forbid or limit the use of personal cell phones and other electronic devices, the intent is not to cut you off from your friends and family. Rather, it’s to minimize opportunities for relapse and limit distractions, so you stay focused on your recovery.
Remember, going to rehab is a voluntary choice, not a sentence, and you can check yourself out at any time.
If you’ve heard troubling rumors about rehab that are standing in the way of treatment, don’t assume they’re true. Do your homework and check out the facilities for yourself.
As Ohio’s opioid epidemic has grown in scale, it has also become more lethal. Thousands of people die from opioid overdoses every year in Ohio. The 2016 Ohio Drug Overdose Data: General Findings reported that 3,495 people were killed by opioid overdoses in 2016.
3,495 people were killed by opioid overdoses in 2016.
As overdoses have increased, so has the use of naloxone. The drug, which is also known by the brand name Narcan, can revive someone overdosing on opioids. It is administered as a nasal spray or an injection.
Naloxone is controversial. Some public officials have even suggested that it has made the opioid epidemic worse.
Naloxone Use in Ohio
Most naloxone is administered by emergency workers. First responders throughout the United States and across Ohio now carry naloxone with them.
Naloxone is also available without a prescription to anyone in Ohio who has been certified to administer it. The certifying course is open to everyone.
In 2013, the department estimated that opioid overdoses cost Ohio $3.5 billion, and required $4.9 million in medical spending.
One overdose survivor, a Zanesville man named Brandon, has been revived more than once with naloxone. He is now in recovery, but it took him a long time to be ready.
“I went to rehab a couple times, went to jail a few times, I was still getting high,” Brandon said. “In August (2016) I went to jail again. I went back to Pickaway to rehab. I’m in Hope Court now. I feel great. I’m doing great.”
Naloxone is also used to revive caregivers and first responders who have been exposed to powerful opioids like fentanyl and carfentanil. Those drugs can cause an overdose if they come into accidental contact with someone’s eyes, nose, or skin. Three nurses at a hospital in Massillon had to be revived with naloxone after they were exposed to opioids in the course of treating an overdose patient.
Naloxone & Harm Reduction
Administering naloxone is a component of harm reduction, a controversial approach to fighting drug epidemics.
Harm reduction is based on the idea that the best way to help people suffering from drug addiction is to keep them as healthy as possible. The aim of harm reduction is to keep drug users alive, and minimize the damage that drug use does to communities. Other harm reduction tactics include needle exchanges, methadone clinics and safe consumption sites.
Studies about naloxone administration show that it “does not encourage opiate users to increase their drug consumption, nor does it increase the likelihood that they will harm themselves or those around them.”
Harm reduction methods are almost always controversial. Some critics react to harm reduction strategies from a moral standpoint. Such critics believe that enacting harm reduction policies gives the impression that a community approves of or even encourages drug use. Indeed, a number of Ohio incidents have caused national debates and scrutiny of naloxone.
In one incident, East Liverpool police officers took photos of two overdose patients, who appeared to be unconscious, in their car. The police published the photos on Facebook, where they went viral. Controversy and national press coverage ensued. The police say that they were trying to promote awareness of the opioid epidemic.
More controversy erupted in June 2017, when Dan Picard, a city council member in Middletown, proposed limiting the amount of times one person can be revived with naloxone by first responders.
“[An opioid user] obviously doesn’t care much about his life, but he’s expending a lot of resources and we can’t afford it,” Picard said. “I want to send a message to the world that you don’t want to come to Middletown to overdose because someone might not come with Narcan and save your life. We need to put a fear about overdosing in Middletown.”
Picard’s proposal drew media attention, and Ohioans had strong reactions. Some people criticized Picard on Facebook:
“These people need HELP not political nonsense,” wrote one man.
Others took Picard’s side. “Personal responsibility and consequences are the only thing that will save these people. It’s not a disease, it’s a bad decision that became an addiction. Stop coddling and making excuses,” wrote another.
“All we’re doing is reviving them, we’re not curing them.” – Sheriff Richard Jones
For some Ohioans, opioid addiction is a moral failing. To people who hold that position, administering naloxone to opioid users is just sustaining and condoning a dangerous mistake.
Other officials are frustrated with naloxone for similar reasons. Butler County Sheriff Richard Jones expressed his frustration with naloxone when he explained to the press why his deputies don’t carry naloxone.
“I just know what we are doing is not working,” Jones said. “My brother died of cirrhosis of the liver and early in his life he had a drug problem. There isn’t somebody out there who doesn’t know somebody who has a drug issue. I am trying to get the point across that we’re just frustrated.”
Jones also stated that his department works closely with the county’s EMS and fire services to administer medical first responder care. He said that he preferred medical caregivers to administer the drug, even though anyone can be trained to use it.
He said that there is a perception among his officers that reviving someone who is overdosing can be dangerous. But, most of all, he was frustrated that naloxone hasn’t made the problem of mass overdoses any better.
“All we’re doing is reviving them, we’re not curing them,” Jones continued. “One person we know has been revived 20 separate times.”
Jones is referencing an incident in Dayton. There, one person has been revived with naloxone more than twenty times by first responders. A Dayton police officer was asked about Picard’s comments in light of the multiple revival story. The officer, Major Brian Johns, had this to say about Picard’s comments:
“I disagree with it. I know Narcan isn’t the answer. But, as law enforcement, we took an oath to protect life and where do you stop?”
In the end, the only way to end the harm of drug addiction is through treatment. The benefit of naloxone, and other harm reduction strategies, is keeping drug users alive long enough to get there.
Fentanyl has killed thousands of people in Ohio. The powerful opioid is responsible for a growing wave of death and harm that has swept over the state during the 2010s. The Ohio Department of Health blames fentanyl and its cousin, carfentanil, for the increasing fatality of the state’s illicit drug supply. Ohio is the epicenter of fentanyl misuse in the United States. In 2016, Ohio’s crime labs detected more fentanyl mixed into illegal drug seizures than in any other state.
In 2015, fentanyl deaths in Ohio more than doubled.
Drug overdose deaths in Ohio went up every year but one between 2004 and 2016. In 2016, 4,050 Ohioans were killed by drug overdose. A large majority of those people — 2,357 people, or 58.1 percent of the Ohioans killed by drugs that year — had overdosed on fentanyl, carfentanil, or fentanyl mixed with other drugs.
Fentanyl was such an uncommon cause of death that the state department of health didn’t even track fentanyl death statistics until 2007. It killed between 65 and 85 people every year between 2007 and 2013. Then, in 2014, the drug killed more than 500 Ohioans. In 2015, fentanyl deaths in Ohio more than doubled, reaching 1,155. That number doubled again in 2016.
Fentanyl Comes to Ohio
The other opioids behind Ohio’s drug epidemic are well known. Prescription opioid painkillers and heroin have been misused for decades. Fentanyl is much, much more powerful than other opioid painkillers or heroin. It is used to relieve patients’ suffering from extreme pain caused by things like third-degree burns and late-stage cancer. Pure heroin is fatal to most people in a 30 milligram dose. Pure fentanyl kills at 3 milligrams — that’s about one-half of a teaspoon.
Drug dealers introduced fentanyl into the black market opioid trade to cut costs. Fentanyl is cheaper and easier to produce than heroin. Fentanyl is produced legally on an industrial scale for use in hospitals and clinics. Organized crime groups like drug cartels can easily buy processed fentanyl or its ingredients in industrialized developing countries such as China or Mexico. It’s mixed into heroin shipments there, or drug dealers will mix them together closer to the market.
New Dangers to Ohio Residents from Fentanyl and Carfentanil
Ohio’s heroin dealers have started experimenting with other cutting agents for their heroin supply. One is carfentanil, an opioid that is used to subdue large animals, such as horses and elephants.
Carfentanil is even more potent, and therefore more dangerous, than fentanyl. Either drug can cause an overdose if someone so much as touches or inhales it by accident.
That means that carfentanil and fentanyl are dangerous to first responders. Patrolman Chris Green, of East Liverpool, accidentally ingested a small amount of fentanyl after he searched the car of suspected drug dealers. He simply brushed powdered fentanyl off his uniform. He overdosed an hour later. Fortunately, he was at his station when the overdose symptoms started, and his fellow officers were able to revive him with naloxone.
Fentanyl is now a fact of the Ohio drug trade. It is incredibly dangerous. Anyone who takes it regularly is at high risk of overdose and death. The only way to undo some of the damage fentanyl has done is to make treatment available to the people the drug has ensnared.
In 2014, more people died from drug overdoses in Ohio than in any other state. That year, heroin killed 1,196 of the 2,531 Ohioans who died from drug overdoses. The most common cause of drug death in the state in 2014, heroin has killed at least one thousand people every year since 2014.
Remarkably, heroin is no longer the most fatal drug in Ohio. In the same way that heroin supplanted prescription opioids as Ohio’s most common killer, fentanyl has outpaced heroin. To understand the heroin trade and its awful effects, you have to understand the way prescription opioids have entered the black market.
Prescription Opioids and Heroin in Ohio
Heroin attracted a steady following for most of the 20th century. However, in Ohio and elsewhere, its use was mainly limited to big cities like Cleveland and Cincinnati. That started to change in the 2000s, as heroin appeared in small towns across the state where it previously hadn’t been a problem.
The ’90s marked the beginning of the sudden heroin boom. That’s when large pharmaceutical companies convinced the medical profession to prescribe large amounts of prescription opioid painkillers such as Vicodin and Percocet for chronic pain patients.
The companies flooded Ohio and the rest of the United States with prescription pain pills. Ohio pharmacists gave patients 784 million doses of prescription opioids on average every year between 2011 and 2013. That’s enough to give every Ohioan 67 doses.
With such an abundant supply of prescription opioids, it’s no surprise that more and more people misused or became addicted to prescription opioids. Ohioans started to misuse prescription opioids, for example, after an operation or after sampling medication that a patient in their household had left in the medicine cabinet. Over the span of roughly ten years, there was a large pool of people who found themselves suddenly addicted to prescription opioids.
That’s where heroin comes in. Prescription painkillers are very similar chemically to heroin, but they’re much harder to obtain, especially since doctors began cutting back on prescribing opioids for pain management. Many heroin users — as many as three in four — misused prescription painkillers before they started on heroin. Prescription painkillers are expensive, and they’re controlled by doctors and pharmacists.
Heroin and the Ohio Drug Trade Boom
As prescription painkillers became harder to obtain, Ohioans began to switch to heroin. These new heroin users are most likely to live in Southern and Northeast Ohio. Those areas of the state depend economically on industries that require manual labor, such as farming, mining and heavy industry.
Workers in these industries often experience injury and chronic pain, which has led to the large supply of prescription opioids in the area. Use began to expand as heavy industry and mining shut down or became automated. Large-scale unemployment and poverty lead to large-scale drug use. Ohio became trapped in a vicious cycle of economic turbulence and drug use.
The market for opioids was growing. Meanwhile, prescription opioids became harder to obtain legally or illegally. According to those struggling with opioid addiction, drug dealers have met demand. Dealers make trips to shopping centers and motels in small towns. They bring heroin and other drugs, including cocaine and methamphetamine.
Street drugs are extremely dangerous. Heroin for sale in Ohio is mixed, or cut, with all sorts of substances, including baby formula, laxatives and rat poison. Contaminated heroin makes users more likely to overdose or, if they shoot the drug with a syringe, contract bloodborne diseases such as hepatitis or HIV.
Heroin in Ohio is also frequently mixed with fentanyl or carfentanil, some of the most powerful opioids available. Heroin-fentanyl mixtures are even more dangerous than heroin cut with contaminants. Ohio officials blame heroin-fentanyl mixes for the frightening surge in heroin deaths between 2014 and 2017.
Heroin is extremely addictive, and it’s now available in every county in Ohio. Thousands of Ohioans are addicted to heroin. The only way to help the people fighting heroin addiction is to get them into treatment.