He supports these non-disciplinary programs, in which doctors and nurses enroll for a number of years and are closely monitored by addiction specialists and state authorities as they seek to maintain or restore their medical licenses. But, he said, he is perplexed as to why these programs and other efforts to help health care providers generally do not stress a recovery method that has long been shown to be effective: the use of drugs like buprenorphine and methadone, known as opioid agonists, to relieve cravings.

“Obviously the data are clear that medication-assisted treatment is the best course of action,” said Boyd, who worked for Massachusetts’ Physician Health Services (previously known as the Society to Help Physicians) from 2004 to 2010. “Whether they’re doctors, nurses or anybody else, [they] can function perfectly well at work and in their lives generally while they’re using medication-assisted treatment.”

Furthermore, he said, “the odds that they’re going to stay clean and sober while using medications for treatment are better.”

show significantly more than other interventions alone. Most advocates advise using it in conjunction with regular therapy or counseling. Legal and medical researchers also made this point in the last month, calling it “ironic that clinicians, who are better positioned than most people to acquire and afford opioid-agonist therapy, are often denied it.”

But some health care professionals believe opioid agonists are just a substitute for the drugs a doctor is addicted to, and, since they bind to the same brain receptors as opioids, may affect providers’ ability to do their jobs. The opioid agonists help reduce relapses and cravings by stimulating the same pathways opioids do, but in a controlled manner that prevents a person from feeling high.

Non-Disciplinary Treatment Programs For AddictionÌý

Non-disciplinary treatment programs have been operating in most states since the 1970s to help health professionals overcome their addiction. Instead of revoking the license of an individual who is found to be impaired on the job, these peer-run programs try to get participants back to work with mandated treatment plans that include intensive therapy, monitoring their behavior in and out of the workplace and, of course, drug testing. Throughout treatment, participants are actively discouraged, if not outright banned from, using opioid agonists that could aid their recovery.

Members of the non-disciplinary program may advocate for a participant’s return to work when they believe the individual is ready, but, ultimately, it is the state board that determines when an individual is fit to care for patients.

Bill Kinkle, a registered nurse in Pennsylvania, developed an addiction to opioids more than a decade ago and lost his license. He tried several recovery programs but relapsed and overdosed several times.

He has been working with the state’s Peer Nurse Assistance Program to get his license back. When he asked if he could use Suboxone, a brand name for a combination of buprenorphine and naloxone, he was told that the nurse assistance program would not allow it unless he had a detailed plan for tapering off the drug.

So he is treating his addiction through the state program without the medication. He was required to participate in a 30-day inpatient program, undergo partial hospitalization (in which a participant is treated for several hours a day but can go home in the evenings) for an additional three weeks, receive three months of intensive outpatient therapy, attend Alcoholics Anonymous meetings three to five times a week and pay for expensive random urine screenings.

The Peer Nurse Assistance Program did not respond to requests for comment.

Some state officials are beginning to consider the use of drugs like methadone and buprenorphine. The North Carolina Medical Board, which handles physician licensing and discipline, is encouraging the state program for doctors with opioid addictions to consider introducing these medications.

Critics argue that the non-disciplinary programs can, in fact, feel more disciplinary than supportive and don’t help as many people as they could if opioid agonists were made available.

The programs “have no independent oversight and patients don’t have a recourse,” said Dr. Peter Grinspoon, an internist in Boston who had an opioid addiction and was both a participant in, and eventually a board member of, Massachusetts’ Physician Health Services program for addicted doctors.

Grinspoon, who also teaches at Harvard, said that although he was unaware of any formal state policy against medication-assisted treatments, none of the program’s participants with opioid addictions used opioid agonists while he served.

Impairment in Safety-Sensitive Positions

Scott Teitelbaum, medical director at the University of Florida Recovery Center, which treats health care professionals from all over the country, said he sometimes prescribes the medicines to the half of his patients who don’t work in “safety-sensitive positions.”

But, he said, it makes sense to have a different strategy for patients in those positions. When the programs ask him if a person should return to practice, they’re not asking what’s best for the individual; they’re asking whether it’s safe for the public. And when patients are using agonist therapies, Teitelbaum, who also was treated for cocaine and marijuana use, said he isn’t sure it is.

A in Mayo Clinic Proceedings of several studies in 2012 showed small effects of both methadone and suboxone on performance in measures such as reaction time and memory. The for and a lack of appropriate control groups.

Grinspoon noted that doctors could be taking other medications that affect their performance but face no repercussions. For example, he said, they may take benzodiazepines for anxiety or Ambien to help them sleep.

“There are tons of pharmaceuticals that could affect our performance — all of which doctors are allowed to take,” he said. “And it’s just because of the stigma that they’re singling out addiction.”

Success Rates

Critics of medication-assisted treatment often point to the overwhelming five-year success rates reported by the non-disciplinary programs — generally between 70% and 90%.

But Boyd is wary of those rosy statistics. First, he noted, they rarely count people who dropped out of the program or died by suicide. He said some professionals who never suffered from substance use disorder are forced into the program by bad evaluations.

So far, Kinkle, the nurse in Pennsylvania, has stayed on track, “white-knuckling it” without Suboxone. If all goes according to plan, his license will be reinstated in another 13 months.

“My wife found me multiple times after an overdose lying on the floor unconscious,” said Kinkle. “All that could have been prevented had I been offered” Suboxone.

This <a target="_blank" href="/health-industry/doctors-and-nurses-with-addictions-often-denied-a-crucial-recovery-option/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

More than 18 million people abuse or are dependent on alcohol, yet a funded by the federal government reported last year that only 20 percent will ever receive treatment of any kind. In fact, just slightly more than 1 million , ranging from a meeting with a counselor or a doctor to entering a specialized treatment program.

Acknowledging that for many people peer-support programs, such as Alcoholics Anonymous, work well, federal officials also want to encourage physicians to be more involved in identifying and treating alcohol problems and are seeking to increase awareness of drug treatments.

“We want people to understand we think AA is wonderful, but there are other options,” said George Koob, the director of the National Institute of Alcohol Abuse and Alcoholism, a part of the federal National Institutes of Health. “Let a thousand flowers bloom, anything helps.”

The NIAAA has developed a dedicated to development of medications and is supporting trials of drugs to give patients and doctors more options.

NIAAA and the Substance Abuse and Mental Health Services Administration also asked a last summer on drug options.

“Current evidence shows that medications are underused in the treatment of alcohol use disorder, including alcohol abuse and dependence,” the panel reported. It noted that although public health officials and the American Medical Association say dependence on alcohol is a medical problem, there continues to be “considerable resistance” among doctors to this approach.

It is for a person struggling with an alcohol use disorder to even hear that medication therapy exists. That partly reflects the overwhelming tradition to treat alcohol abuse through 12-step programs. It’s also a byproduct of limited promotion by the drugs’ manufacturers and confusion among doctors about how to use them.

and are the two drugs on the market for patients with alcohol cravings.

“They’re very safe medications,” said Koob. “And they’ve shown efficacy.”

A in the Journal of the American Medical Association of past studies found that both drugs “were associated with reduction in return to drinking.”

For one North Carolina woman eager to get sober, naltrexone provided that help. Dede said she went to hundreds of Alcoholics Anonymous meetings. She spent time in two different rehabilitation facilities, one of which cost her $30,000 out of pocket. But she still struggled.

“The self-loathing was the worst thing about it,” she said. “I hated myself as an alcoholic, but I could not stop.”

Eight years ago she decided to try yet another approach — meetings for people who had drinking problems with counselors at the University of North CarolinaÌýatÌýChapel Hill. That’s where she first heard about naltrexone.

One of the counselors mentioned Dr. James C Garbutt, a professor of psychiatry who treats patients with alcohol use disorders, often using naltrexone. She asked to get an appointment with him but was told it would take weeks to fit her in. She wouldn’t wait that long. Instead, she showed up in the doctor’s waiting room and stayed until he was able to see her.

“I begged. I really begged to get to see him,” she explained.

With the help of naltrexone and one-on-one counseling, Dede said she has consumed no more than two sips of wine since that visit. She agreed to be interviewed on the condition that Kaiser Health News use only her nickname because she has tried to keep her alcohol abuse private.

A third drug is also available, but it does not work against alcohol cravings. Disulfiram, also known by the brand name Antabuse, makes people violently ill when they consume alcohol. It has been found to be in helping stem alcohol abuse than the other two drugs.

Naltrexone, which is also used to help treat opiate addiction, comes in both an oral and injectable form and has few side effects. It was approved for use in alcohol addiction in 1994. Acamprosate was approved in 2004 to treat only alcohol problems. It comes as a tablet.

When naltrexone came on the market, sales teams had trouble explaining how the drug worked differently than Antabuse to the non-physician administrators who made treatment decisions in addiction clinics, addiction experts said. Many misunderstood how and for whom the drug worked. Some of that persists today.

“They got three years” of market exclusivity, said Dr. Henry Kranzler, director for the Center for Studies of Addiction at the University of Pennsylvania. “Three years is not a very long time to make a market where there really isn’t much of a market and they didn’t.” The company discontinued its effort to market the drug in 1997.

Many of the same marketing problems also persist for acamprosate.

Some of naltrexone’s history in opioid treatment also hurt its image. The drug blocks the effects of opioid receptors in the brain. So any patients who took it without having completely detoxed from opiates were launched into agonizing withdrawal. The label urged doctors only to prescribe the medication to patients that had already been opiate-free for at least 10 days.

But it doesn’t have the same effect on patients with alcohol use disorders. A patient who drinks while taking naltrexone will get drunk —Ìýand not have those withdrawal symptoms. Yet, when the drug was approved for alcoholÌýuse disorders in 1994, the label still stated patients should be completely sober before using naltrexone.

Often, care providers consider complete abstinence the only successful outcome of treatment, yet patients who drink while taking naltrexone get drunk without the opioid-induced reward to reinforce the behavior. The absence of this reward makes drinking less appealing in the future.

Garbutt, who was on the expert panel last year, encourages complete abstinence for his patients, but also supports patients who would rather set a .

“If we can reduce your intake 80 percent and reduce your heavy drinking days a lot, that’s also very positive,” he said. “Some people just aren’t ready. The idea of sobriety is just too big of a concept for them to wrap their head around.” And naltrexone can help patients with either of these goals — abstinence or reduced drinking.

In fact, explained Garbutt, while naltrexone does help patients remain abstinent, “the effect of reducing heavy drinking is the most prominent effect of naltrexone.”

This <a target="_blank" href="/mental-health/many-doctors-treating-alcohol-problems-overlook-successful-drugs/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

He supports these non-disciplinary programs, in which doctors and nurses enroll for a number of years and are closely monitored by addiction specialists and state authorities as they seek to maintain or restore their medical licenses. But, he said, he is perplexed as to why these programs and other efforts to help health care providers generally do not stress a recovery method that has long been shown to be effective: the use of drugs like buprenorphine and methadone, known as opioid agonists, to relieve cravings.

“Obviously the data are clear that medication-assisted treatment is the best course of action,” said Boyd, who worked for Massachusetts’ Physician Health Services (previously known as the Society to Help Physicians) from 2004 to 2010. “Whether they’re doctors, nurses or anybody else, [they] can function perfectly well at work and in their lives generally while they’re using medication-assisted treatment.”

Furthermore, he said, “the odds that they’re going to stay clean and sober while using medications for treatment are better.”

show significantly more than other interventions alone. Most advocates advise using it in conjunction with regular therapy or counseling. Legal and medical researchers also made this point in the last month, calling it “ironic that clinicians, who are better positioned than most people to acquire and afford opioid-agonist therapy, are often denied it.”

But some health care professionals believe opioid agonists are just a substitute for the drugs a doctor is addicted to, and, since they bind to the same brain receptors as opioids, may affect providers’ ability to do their jobs. The opioid agonists help reduce relapses and cravings by stimulating the same pathways opioids do, but in a controlled manner that prevents a person from feeling high.

Non-Disciplinary Treatment Programs For AddictionÌý

Non-disciplinary treatment programs have been operating in most states since the 1970s to help health professionals overcome their addiction. Instead of revoking the license of an individual who is found to be impaired on the job, these peer-run programs try to get participants back to work with mandated treatment plans that include intensive therapy, monitoring their behavior in and out of the workplace and, of course, drug testing. Throughout treatment, participants are actively discouraged, if not outright banned from, using opioid agonists that could aid their recovery.

Members of the non-disciplinary program may advocate for a participant’s return to work when they believe the individual is ready, but, ultimately, it is the state board that determines when an individual is fit to care for patients.

Bill Kinkle, a registered nurse in Pennsylvania, developed an addiction to opioids more than a decade ago and lost his license. He tried several recovery programs but relapsed and overdosed several times.

He has been working with the state’s Peer Nurse Assistance Program to get his license back. When he asked if he could use Suboxone, a brand name for a combination of buprenorphine and naloxone, he was told that the nurse assistance program would not allow it unless he had a detailed plan for tapering off the drug.

So he is treating his addiction through the state program without the medication. He was required to participate in a 30-day inpatient program, undergo partial hospitalization (in which a participant is treated for several hours a day but can go home in the evenings) for an additional three weeks, receive three months of intensive outpatient therapy, attend Alcoholics Anonymous meetings three to five times a week and pay for expensive random urine screenings.

The Peer Nurse Assistance Program did not respond to requests for comment.

Some state officials are beginning to consider the use of drugs like methadone and buprenorphine. The North Carolina Medical Board, which handles physician licensing and discipline, is encouraging the state program for doctors with opioid addictions to consider introducing these medications.

Critics argue that the non-disciplinary programs can, in fact, feel more disciplinary than supportive and don’t help as many people as they could if opioid agonists were made available.

The programs “have no independent oversight and patients don’t have a recourse,” said Dr. Peter Grinspoon, an internist in Boston who had an opioid addiction and was both a participant in, and eventually a board member of, Massachusetts’ Physician Health Services program for addicted doctors.

Grinspoon, who also teaches at Harvard, said that although he was unaware of any formal state policy against medication-assisted treatments, none of the program’s participants with opioid addictions used opioid agonists while he served.

Impairment in Safety-Sensitive Positions

Scott Teitelbaum, medical director at the University of Florida Recovery Center, which treats health care professionals from all over the country, said he sometimes prescribes the medicines to the half of his patients who don’t work in “safety-sensitive positions.”

But, he said, it makes sense to have a different strategy for patients in those positions. When the programs ask him if a person should return to practice, they’re not asking what’s best for the individual; they’re asking whether it’s safe for the public. And when patients are using agonist therapies, Teitelbaum, who also was treated for cocaine and marijuana use, said he isn’t sure it is.

A in Mayo Clinic Proceedings of several studies in 2012 showed small effects of both methadone and suboxone on performance in measures such as reaction time and memory. The for and a lack of appropriate control groups.

Grinspoon noted that doctors could be taking other medications that affect their performance but face no repercussions. For example, he said, they may take benzodiazepines for anxiety or Ambien to help them sleep.

“There are tons of pharmaceuticals that could affect our performance — all of which doctors are allowed to take,” he said. “And it’s just because of the stigma that they’re singling out addiction.”

Success Rates

Critics of medication-assisted treatment often point to the overwhelming five-year success rates reported by the non-disciplinary programs — generally between 70% and 90%.

But Boyd is wary of those rosy statistics. First, he noted, they rarely count people who dropped out of the program or died by suicide. He said some professionals who never suffered from substance use disorder are forced into the program by bad evaluations.

So far, Kinkle, the nurse in Pennsylvania, has stayed on track, “white-knuckling it” without Suboxone. If all goes according to plan, his license will be reinstated in another 13 months.

“My wife found me multiple times after an overdose lying on the floor unconscious,” said Kinkle. “All that could have been prevented had I been offered” Suboxone.

This <a target="_blank" href="/health-industry/doctors-and-nurses-with-addictions-often-denied-a-crucial-recovery-option/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

More than 18 million people abuse or are dependent on alcohol, yet a funded by the federal government reported last year that only 20 percent will ever receive treatment of any kind. In fact, just slightly more than 1 million , ranging from a meeting with a counselor or a doctor to entering a specialized treatment program.

Acknowledging that for many people peer-support programs, such as Alcoholics Anonymous, work well, federal officials also want to encourage physicians to be more involved in identifying and treating alcohol problems and are seeking to increase awareness of drug treatments.

“We want people to understand we think AA is wonderful, but there are other options,” said George Koob, the director of the National Institute of Alcohol Abuse and Alcoholism, a part of the federal National Institutes of Health. “Let a thousand flowers bloom, anything helps.”

The NIAAA has developed a dedicated to development of medications and is supporting trials of drugs to give patients and doctors more options.

NIAAA and the Substance Abuse and Mental Health Services Administration also asked a last summer on drug options.

“Current evidence shows that medications are underused in the treatment of alcohol use disorder, including alcohol abuse and dependence,” the panel reported. It noted that although public health officials and the American Medical Association say dependence on alcohol is a medical problem, there continues to be “considerable resistance” among doctors to this approach.

It is for a person struggling with an alcohol use disorder to even hear that medication therapy exists. That partly reflects the overwhelming tradition to treat alcohol abuse through 12-step programs. It’s also a byproduct of limited promotion by the drugs’ manufacturers and confusion among doctors about how to use them.

and are the two drugs on the market for patients with alcohol cravings.

“They’re very safe medications,” said Koob. “And they’ve shown efficacy.”

A in the Journal of the American Medical Association of past studies found that both drugs “were associated with reduction in return to drinking.”

For one North Carolina woman eager to get sober, naltrexone provided that help. Dede said she went to hundreds of Alcoholics Anonymous meetings. She spent time in two different rehabilitation facilities, one of which cost her $30,000 out of pocket. But she still struggled.

“The self-loathing was the worst thing about it,” she said. “I hated myself as an alcoholic, but I could not stop.”

Eight years ago she decided to try yet another approach — meetings for people who had drinking problems with counselors at the University of North CarolinaÌýatÌýChapel Hill. That’s where she first heard about naltrexone.

One of the counselors mentioned Dr. James C Garbutt, a professor of psychiatry who treats patients with alcohol use disorders, often using naltrexone. She asked to get an appointment with him but was told it would take weeks to fit her in. She wouldn’t wait that long. Instead, she showed up in the doctor’s waiting room and stayed until he was able to see her.

“I begged. I really begged to get to see him,” she explained.

With the help of naltrexone and one-on-one counseling, Dede said she has consumed no more than two sips of wine since that visit. She agreed to be interviewed on the condition that Kaiser Health News use only her nickname because she has tried to keep her alcohol abuse private.

A third drug is also available, but it does not work against alcohol cravings. Disulfiram, also known by the brand name Antabuse, makes people violently ill when they consume alcohol. It has been found to be in helping stem alcohol abuse than the other two drugs.

Naltrexone, which is also used to help treat opiate addiction, comes in both an oral and injectable form and has few side effects. It was approved for use in alcohol addiction in 1994. Acamprosate was approved in 2004 to treat only alcohol problems. It comes as a tablet.

When naltrexone came on the market, sales teams had trouble explaining how the drug worked differently than Antabuse to the non-physician administrators who made treatment decisions in addiction clinics, addiction experts said. Many misunderstood how and for whom the drug worked. Some of that persists today.

“They got three years” of market exclusivity, said Dr. Henry Kranzler, director for the Center for Studies of Addiction at the University of Pennsylvania. “Three years is not a very long time to make a market where there really isn’t much of a market and they didn’t.” The company discontinued its effort to market the drug in 1997.

Many of the same marketing problems also persist for acamprosate.

Some of naltrexone’s history in opioid treatment also hurt its image. The drug blocks the effects of opioid receptors in the brain. So any patients who took it without having completely detoxed from opiates were launched into agonizing withdrawal. The label urged doctors only to prescribe the medication to patients that had already been opiate-free for at least 10 days.

But it doesn’t have the same effect on patients with alcohol use disorders. A patient who drinks while taking naltrexone will get drunk —Ìýand not have those withdrawal symptoms. Yet, when the drug was approved for alcoholÌýuse disorders in 1994, the label still stated patients should be completely sober before using naltrexone.

Often, care providers consider complete abstinence the only successful outcome of treatment, yet patients who drink while taking naltrexone get drunk without the opioid-induced reward to reinforce the behavior. The absence of this reward makes drinking less appealing in the future.

Garbutt, who was on the expert panel last year, encourages complete abstinence for his patients, but also supports patients who would rather set a .

“If we can reduce your intake 80 percent and reduce your heavy drinking days a lot, that’s also very positive,” he said. “Some people just aren’t ready. The idea of sobriety is just too big of a concept for them to wrap their head around.” And naltrexone can help patients with either of these goals — abstinence or reduced drinking.

In fact, explained Garbutt, while naltrexone does help patients remain abstinent, “the effect of reducing heavy drinking is the most prominent effect of naltrexone.”

This <a target="_blank" href="/mental-health/many-doctors-treating-alcohol-problems-overlook-successful-drugs/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">