Benzodiazepine Withdrawal is Treatable with NAD+ Therapy
I know a secret that other physicians don’t seem to know. Benzo withdrawal sucks! And lasts a long, long time.
Benzo withdrawal can last for months, even years. Patients feel depressed, anxious, and can’t sleep. Worse yet is that not sleeping and feeling terrible makes it all that much worse. Because you didn’t sleep you’re now more tired and depressed.
Your doctor didn’t think that keeping you on Klonopin, Valium or Xanax was a big deal; until you tried to stop. Benzos cause some serious and lasting changes to the central nervous system. But with time, nutritional support, medication and education patients can and do recover.
There is a lot of interest in using NAD+ for benzo recovery. We have quite a bit of experience in this field. NAD+ works for benzo detox, but often needs to be used differently when used for alcohol or opiate withdrawal. For both alcohol and opiate withdrawal, patients can stop their drug of choice and detox. With benzos that doesn’t always work. Basically, benzos are stickier, and the repair process is slower.
Here are 3 examples of how to use NAD+ to detox off benzodiazepines
The Test Dose
One option I like to employ when I have the luxury is the test dose. I offer patients a couple of days of IV NAD while they continue their regular benzo dose. I want to know if they’re going to respond and how it makes them feel. Patients really like this option because they don’t need to invest a considerable amount of money and time into a program not knowing if it’s going to work. Patients can come up for as little as 2-3 days for IV NAD+ and discover for themselves if that limited amount of NAD+ will alleviate any withdrawal symptoms or have a positive effect on their current condition. An ultra short course of NAD is not a substitute for a program, but it’s a good introduction for patients. We can get an early view of who is going to respond. For those patients who feel better, I can confidently recommend a full NAD Program to completely detox. That means 10-14 days of IV NAD+.
Another option that I’ve learned over the years is using the NAD+ Infusion to alleviate the withdrawal symptoms during an outpatient detox. What does that mean? Most patients at this point are doing a slow and gradual outpatient taper. Many hit a wall. At a certain dose they just can’t get below that amount. I’ll have patients come in to the clinic and do NAD infusions until they stabilize at that dose and feel good. Patients usually need less than a week to push past their previous limit. In this case, we’re not using NAD to completely detox off opiates rather we’re using it to help stick the landing on the last benzo dose reduction. Patients can stay on this lower dose during the infusion days. This is a successful technique which is great for patients. They’ve accomplished a dose reduction and only have to come into our clinic for a week or less.
If patients are on a low dose of benzo but just can’t get through that last little bump we can stop the benzo and drip IV NAD+. In this situation patients stop their benzo and we detox them. The NAD does the heavy lifting but we’ll use amino acids, and calming IV nutritional infusions. These infusions may contain taurine, magnesium and other ingredients the body seems to like during this period. We’ll also send patients across the road for a few days of HOCAT treatment. Most patients need at least 10-14 days of IV NAD to comfortably and effectively detox of benzodiazepine medications.
Every patient has a unique genetic blueprint in this constellation of benzo dependence which will determine how they respond to different therapies.
If you or someone you know is struggling with benzos and is ready to be done. Have them give us a call. We have answers.
Ken Starr MD
Board Certified Addiction Medicine
A while ago I wrote a blog about Lofexidine ( Lucemyra). I basically said that there’s not a ton of data but what seemed clear is that it’s crazy ridiculous expensive and really not any better than Clonidine. At a 1000X higher price. Well, I proved to be right.
Dr. David Juurlink MD Ph.D. from Sunnybrook Health Sciences in Toronto, Canda wrote a terrific summary of the most complete, robust up to date study on lofexidine. Just published in the May/June 2019 edition of the Journal of Addiction Medicine. ” Safety and Efficacy of Lofexidine for Medically Managed Opioid Withdrawal: A Randomized Controlled Clinical Trial” Fishman MD, Tirado MD, Alam MD.etc. al.
This was a multicenter Double-blind placebo-controlled study of 603 patients at 18 different US Centers. Keep in mind two of the authors are paid consultants to the manufacturer of Lofexidine. What did we learn?
- Lofexidine does slightly reduce withdrawal compared to placebo.
- As mentioned in my previous blog, Lofexidine and Clonidine are pharmacologically and structurally similar
- A review of all randomized trials comparing lofexidine with clonidine in patients suffering opioid withdrawal have shown the reduction of withdrawal symptoms are the same.
- The benefit of lofexidine on withdrawal is maximal by day 2. No difference from placebo is evident by day 7.
- Clonidine has slightly more side effects such as light-headed, dizzy and drowsy.
- 7 days of Lofexidine in the US is about $1700 compared to $1 for Clonidine
” In short, lofexidine can be viewed as a slightly safer version of clonidine that offers patients with opioid withdrawal marginal clinical benefit for perhaps a few days, at a cost of more than $3000o over a typical 2 week treatment period.”.
Drug company price gouging for a “me too” drug for the most desperate and vulnerable of patients.
Ken Starr MD
This weeks post is from our guest contributor Bethany Hatton. PreventAddiction.info
Helping Your Loved One Through Addiction
It’s difficult watching a loved one suffering from addiction. While you want to reach out and help them, you must make sure that you are reaching them in the right way. It’s also critical to take care of yourself and remember that the road to recovery lies in their hands. Let’s discover what practical steps you can take.
Before Approaching Your Loved One
You may know for certain that your loved one has a substance use problem or you may just suspect it. Before approaching him, be sure that you are on the right track and that there is not another issue that should be addressed. Check out the signs of alcoholism from Healthline.
Mental health issues such as anxiety, trauma and depression can co-occur with drug and alcohol addiction. Each of these should be treated. Read more about other conditions that can co-occur with addiction in this guide from the National Institute on Drug Abuse.
You may also have been told to avoid your addicted loved one. While that is appropriate in certain situations, it might not be the entire story. Psychology Today explores how having compassion doesn’t mean you are “codependent” or “enabling.” The author instead sees compassion as a way to empower you to help your loved one. Only you know the right answer to this question but certainly get away if your life or health is at risk.
How To Approach Your Loved One
Once you are certain there is a problem, it’s time to decide how to approach them. Very Well Mind has a detailed article on steps to take, including:
- Establishing trust,
- Communicating the problem, and
- Getting them into the treatment process.
You should also expect to experience difficulties. The person might be resistant to admitting they have a problem or to getting help but you also shouldn’t wait until they “hit bottom.” Read more guidelines on helping someone you love from the National Council on Alcoholism and Drug Addiction.
Finally, be careful of how you talk to this person. Express love and concern, not condemnation. Here are 11 things you should not to say to an addict from The Fix.
Taking Care of Yourself
It’s important that while you are seeking help for your loved one, you are also taking care of yourself. Encounters can be strained and stressful, even as he moves into and through recovery. You may experience resentment and hostility. Read these top 10 survival tips for loving an addicted person from a registered clinical counselor.
Depending on your relationship, you might also want to seek counseling for yourself to make sure you are practicing and managing your own self-care.
Programs For Addiction Treatment
Today, there are numerous treatment programs available to help your loved one. Each will appeal to someone different. They include:
- 12-step programs, such as AA and NA, which have the longest history of treatment.
- Religious-based treatment, such as the Teen Challenge, which is Christian-based, or Buddhist Recovery.
- Holistic programs that emphasize treating the mind, body, and spirit. These can include therapy, fitness, nutrition, mindfulness and more.
- Secular programs that focus on self-empowerment such as SMART Recovery and Moderation Management.
- Evidence-based programs like Cognitive Behavioral Therapy.
Learn more about finding the right program from this post at the New York Times.
You also might want to consider a program called Community Reinforcement and Family Training (CRAFT). According to the Center for Motivation and Change’s website, this program “teaches family and friends effective strategies for helping their loved one to change and for feeling better themselves. CRAFT works to affect the loved one’s behavior by changing the way the family interacts with him or her.” This is a recovery route that supports the whole family.
Helping a loved through addiction is a compassionate response to a difficult problem. Be sure to take the right steps and take care of yourself as you do.
JB is a 27 yr old male patient of mine who had a deep and insightful experience with ketamine. I invited him to share this with our readers
My First Ketamine Experience
I’m writing this excerpt on my experience with my first ketamine infusion therapy treatment in hopes of helping someone else out there that may find my background to resonate with them. For those of you that are reading this, you likely share some similar life challenges that I’ve endured. To give you a brief summary, I was diagnosed with a very misunderstood “autoimmune disease” before my Sophomore year of college which likely triggered my diagnosed adult ADD, depression, anxiety, and poor coping mechanisms by using narcotics to escape. Treatment lasted a year and a half for this autoimmune disease but it changed my personality, cognitive function, and overall homeostasis completely. It’s been almost 10 years since then and I can happily say I’ve been a patient of Dr. Starr’s for about a year and a half. I trust him, his staff, and I’ve always felt he has had my best interest in mind. I have been on antidepressants for 9 years and my body has been flooded with a cocktail of prescribed (and eventually non-prescribed) anti-anxiety meds and narcotic painkillers. Over the last two years, I had decided to pursue my dream of having a career in healthcare. Being the science nerd that I am, it was only natural that I asked Dr. Starr about this new ketamine infusion therapy when I first heard he had been offering it. I even wrote an extensive research paper on Ketamine HCL as my topic for my pharmacology course (which I got a 100% on) so it’s safe to say that I did my fair share of research on this drug. In the last few months, I’ve done well in all areas of my life except for the constant background noise of anxiety and depression that rarely leave me alone. The stress from this often goes to my stomach, causing unbearable pains. I isolate when I’m in pain and my life is put on halt. Overall, I’m a young person living a healthy lifestyle, has had success in going back to school while running a business, and done well with managing my medications from my doctors so why was I still finding myself not leaving my bed due to depression for days at a time? I wish I had the answer for you but I can tell you that I am 100% confident that those days will be over if I continue with ketamine infusion therapy.
I have not had any aches or pains in my body since my treatment, experienced very little to no anxiety, and am sleeping better at night. I’ve continued my regimen of lowering my doses of medications that I’d like to get off of with ease and am actually hopeful for the future. The most important thing I got out of my experience was a true love for myself. This treatment varies for everyone and is a tool that I chose to use to look introspectively. I feel there’s a common theme with others who have had this treatment done and that it can be self-guided. I chose to ask whatever Higher Power there is questions during the treatment and I found answers. It’s also pretty dang cool that this drug actually creates a something called “synaptic plasticity” in your brain. This basically means that it helps regenerate neurons that have the potential to release the chemicals that a depressed person may be lacking. Goodbye antidepressants! No…it’s important that I work with my team of physicians and slowly taper but yes, that is my goal and I have faith with the right amount of ketamine infusion treatments, I can be med free and HAPPY. The true value in this treatment is that it’s experiential. I suggest that if you decide to do it, get your money’s worth and look deep inside to find where the pain (physical, emotional, or traumatic) lies to address it. There is no negative experience with this drug (from what I’ve found) and simply an overall sense of acceptance, positivity, and serenity. It’s been 5 days since my infusion and while I do feel that the level of happiness I had the first few days after has dwindled, I find happiness knowing that I can constantly remind myself of my experience with my journal and this blog entry. I sincerely hope that this blog entry gives at least one person hope, courage, and desire to make a change and take the chance I had. It was the best experience in my life and pray that it continued to researched, recognized and ultimately approved by the FDA so the millions of Americans out there suffering can have access to alternative treatment with ketamine.
This weeks blog comes to us from our guest Bethany at Preventaddiction.info
Anyone who’s ever struggled with a drug or alcohol problem knows that checking yourself into rehab and maintaining sobriety is only half the battle. Getting your life back on track can be even more daunting. But before getting started, it’s important to release the shame of the addiction itself, or it can be impossible to have the confidence and fortitude to move forward. Once you let go of shame, it’s time to focus on repairing your life. Here are the key things that should be on every recovery survivor’s to-do list.
Tweak your resume so that it only reflects key employment experiences, and don’t feel pressured to tell the truth about a time gap. It’s completely okay to say you had to take time off to deal with a family situation. Craft a strong cover letter that outlines all of your strengths so that these points can be a topic of discussion should you get an interview. Tap local job resources that cater to recovery survivors, as they can provide guidance, education, and placement assistance.
Fixing Financial Ruin
Between losing jobs to spending every last dime to feed an addiction, it’s not uncommon for recovery survivors to struggle with debt long after sobriety. Once you acquire a job, create a plan to pay down your debt. While bankruptcy can relieve this pressure, it should only be a last resort, as it can make it difficult — if not impossible — to rent or buy a car or house. Consider entering a consolidation program and/or speaking with a financial advisor to help lower your interest rates and put things into perspective. You may also want to work with a credit repair specialist, especially if you have a lower credit score than you think you should have. All too often in addiction, people are financially abused while they’re under the influence, and if your credit score suddenly took a plunge, it’s possible someone you once used with stole one of your credit cards or even your identity. A credit repair pro can help remove these errors from your report, thereby boosting your score.
Make an appointment with your doctor before starting any new program, as there may be some underlying conditions (osteoporosis, heart problems, etc.) that occurred during the abuse period. Establish a healthy eating routine that’s void of sugar and junk food, and opt for easily digestible foods (think fruits, vegetables, and rice) to counteract symptoms of withdrawal. Gradually add in lean protein, healthy fats (think salmon and avocados), nuts, and a wide array of veggies. When it comes to exercise, it may be smart to start slowly by walking outdoors to get your body used to functional movement while reaping the benefits from mood- and bone-boosting vitamin D.
Starting a New Hobby — Or Rediscovering an Old One
Considering that you need to occupy your time with something other than an illicit substance, Health News Digest explains that there’s never been a better time to pick up a few new hobbies. However, make sure the activity — and any other individuals participating — won’t trigger a relapse. If venturing to faraway places is your favorite pastime, you’re going to have to learn how to travel without the temptation of margaritas on the beach and drug-infused parties, so consider signing up for a sober vacation where you can learn to have fun without being under the influence. Consider getting a dog, as it’s been proven that hounds can help recovery survivors stay sober by decreasing stress, replacing feelings of emptiness with feelings of love, and promoting activity via daily walks and exercise. Taking care of a dog can actually be a lifesaving hobby.
According to Everyday Health, relationships of all kinds take a toll when one is addicted to drugs and alcohol, yet there’s no one-size-fits-all approach to repairing them once you’re sober. Each relationship needs individualized attention and ample time to heal — this is another reason why it’s so important to let go of feelings of shame first. You’ll have to humble yourself and realize that some relationships may be too damaged to repair.
Getting back on track when suffering from a drug or alcohol addiction is tough — but it’s not impossible. It’s important to get healthy, find a job, and fix any credit you may have damaged as a result of your addiction. While that could take some time, before long, you’ll discover that sobriety is possible and sustainable.
Despite that fact that substance abuse has been defined as a chronic, relapsing disease, we don’t treat it the same as we do other conditions such as diabetes or obesity. And yet the parallels are clear: Imagine for a moment that you are obese. You’ve struggled with it for years, your family and friends give you a hard time about it, your doctor warns you about it. It’s not clear why this is a problem for you— is it genetics? Behavior? Underlying depression? Why is it that other people can eat as much as they want without gaining weight? Physically speaking, you shouldn’t be overweight and yet you are, despite your best efforts otherwise. It’s costing you your health, your happiness, and taking years off your life. Well consider this: how is drug abuse any different? Food addiction is real, just as alcohol addiction and opiate addiction are real.
One of the main differences is that while substance abuse can often be hidden or minimized, it is impossible to hide obesity— it is right there in the open, for all to see. This leads to more judgments and psychological harm, of course; but it also leads to increased visibility in terms of effective, long-term treatments. Imagine if we treated obesity the same way we treat addiction— saying to an overweight person: “Why don’t you go to ‘fat camp’? We’ll send you there for a few weeks and you’ll be fixed. You’ll learn everything you need to know about how to lose weight, eat healthier, exercise and adopt a healthier lifestyle. Then you’ll come home and, bam, you’ll be good.”
People who lose weight and keep it off have adopted a healthier lifestyle. They gradually made better choices and slowly lost the weight. They ate a little better, maybe exercised a little more but it added up. Months later their weight is down. We don’t take obese people who are addicted to food and admit them into 28 day rehab program and expect them to be fixed. We don’t expect them to come out thin. Why do we continue to do this with substance use disorders? We have good evidence that patients with substance abuse disorders show no long-term benefit from completing a residential program compared to an outpatient program. In fact, relapse rates with opiates and alcohol approach 90% within months of leaving such a program.
A chronic disease like obesity can be managed with counseling, education, exercise, accountability, check in’s, peer support, and sometimes medications. I believe drug addiction is no different. The patients who I see doing well are those who have embraced those tools; accountability, education, peer support, drug testing, and have invested in learning the tools of relapse prevention. By no means is this a science-based statement, but of all the patients in the last 6 years who I have treated in the clinic compared to the ones who went to a residential program, the patients who completed an outpatient program and continue to participate in some programming do better by far.
In the same way we don’t think that obese patients can come out of a 28 days residential program and be cured, let’s not think it works for addiction patients. Patients with eating disorders or substance abuse disorders have a lot in common. Patients with serious substance abuse disorders need ongoing treatment. For some, it may begin with a residential program, but for their treatment to continue to be successful it requires ongoing maintenance and accountability.
And with all that said… this doesn’t even get into the moral and legal ramifications of treating substance abuse differently from other chronic medical conditions! Stay tuned as we address this in the next post.
- Finney JW. The effectiveness of inpatient and outpatient treatment for alcohol abuse: the need to focus on mediators and moderators of setting effects. Dec 1996. Addiction. Vol 91, issue 12. Pages 1773-1796.
IF YOU HAVE RECENTLY EXPERIENCED A RELAPSE DURING ADDICTION RECOVERY, YOU MAY BE GOING THROUGH MANY DIFFERENT EMOTIONS. ANGER, CONFUSION, AND DISAPPOINTMENT ARE ALL COMMON WHEN YOU RELAPSE, BUT WHERE DO YOU GO FROM THERE? DEALING WITH A RELAPSE MEANS FINDING WAYS TO GET BACK ON TRACK AND AVOID LETTING THIS DERAIL YOUR RECOVERY.
BELOW ARE SOME POSITIVE STEPS TO HELP MAKE THAT HAPPEN.
KNOW THIS HAPPENS TO EVERYONE
A RELAPSE CAN MAKE YOU FEEL LOST AND ALONE. HOWEVER, YOU SHOULD KNOW THAT MOST PEOPLE EXPERIENCE A RELAPSE AT SOME POINT DURING RECOVERY. MOST EXPERTS CONSIDER RELAPSE A NATURAL PART OF ANY ADDICTION RECOVERY EFFORT. IT’S SUCH A COMMON ISSUE BECAUSE RECOVERING FROM ADDICTION IS A COMPLEX PROCESS. LEARNING NEW HABITS IS MUCH HARDER THAN YOU THINK, SO GIVE YOURSELF SOME TIME TO REALLY GET HEALTHY. USE THIS NEGATIVE EXPERIENCE AS A STEPPING STONE TO IMPROVE YOUR RECOVERY AND FIGURE OUT WHAT YOU CAN DO TO MAKE THINGS BETTER. DON’T ISOLATE YOURSELF OR FEEL LIKE THIS ONE MISTAKE HAS TO THROW ALL YOUR EFFORTS OFF TRACK.
REASSESS YOUR RECOVERY PLANS
IN MANY WAYS, A RELAPSE OFTEN POINTS TO SOME PROBLEMS IN YOUR TREATMENT PLAN. MAYBE YOU NEED TO ADD SOME THERAPY TO GET TO THE ROOT OF YOUR ADDICTION. OR, MAYBE YOU JUST NEED TO MAKE SOME CHANGES TO COMMIT TO HEALTHY HABITS IN OTHER AREAS OF YOUR LIFE. EXERCISE, FOR EXAMPLE, HAS BEEN SHOWN TO IMPROVE SOBRIETY IN RECOVERING ADDICTS, AND A HEALTHY DIET CAN AID YOUR RECOVERY AS WELL. MORE THAN ANYTHING, HOWEVER, YOU NEED TO FIND POSITIVE WAYS TO RELIEVE STRESS IN YOUR LIFE, ESPECIALLY AT HOME. STRESS IS THE MOST COMMON TRIGGER FOR ADDICTION, SO TRY TO CREATE A STRESS-FREE SANCTUARY IN YOUR HOME TO REDUCE TENSION AND BOOST YOUR MENTAL HEALTH. MANY PEOPLE IN RECOVERY HAVE FOUND IT BENEFICIAL TO ADD MEDITATION TO THEIR OVERALL TREATMENT EFFORTS. SET UP A MEDITATION SPACE IN YOUR HOME SO YOU CAN FOCUS ON POSITIVITY AND PEACE.
REACH OUT FOR PROFESSIONAL HELP
ADDICTION IS A COMPLEX PROBLEM WITH MANY PHYSICAL AND MENTAL ASPECTS, SO YOU CANNOT EXPECT TO RECOVER ALONE. EFFECTIVE TREATMENT REQUIRES THE AID OF EXPERIENCED HEALTH PROFESSIONALS, FROM YOUR PRIMARY HEALTHCARE PROVIDER TO SPECIALIZED COUNSELING. THERAPY CAN BE ESPECIALLY IMPORTANT IN FIGHTING ADDICTION. THE MAJORITY OF ADDICTIONS BEGIN WITH SOME UNRESOLVED MENTAL HEALTH ISSUE OR TRAUMA, AND IT TAKES A SKILLED PROFESSIONAL TO HELP YOU GET TO THE ROOT OF THE PROBLEM. SO, IF YOU HAVE NOT SPOKEN WITH A COUNSELOR, MAKE AN APPOINTMENT AS SOON AS POSSIBLE AND KEEP THE THERAPY GOING TO ADDRESS YOUR MENTAL HEALTH.
BE OPEN WITH LOVED ONES
IT’S NOT EASY TO ADMIT YOUR MISTAKES TO YOUR FAMILY AND FRIENDS. BUT BEING OPEN ABOUT YOUR RELAPSE CAN BE IMPORTANT IN REDUCING THE STIGMA AROUND YOUR RELAPSE. TRY TO PICK A TIME WHEN EVERYONE IS CALM TO ADDRESS YOUR RELAPSE. DEPENDING ON YOUR RELATIONSHIPS AND HISTORY, YOU MAY HAVE TO DEAL WITH SOME ANGER AND OTHER UNPLEASANT EMOTIONS. JUST TRY TO KEEP THE CONVERSATION FOCUSED ON THE POSITIVE AND MAKE IT CLEAR THAT YOU WANT TO SUCCEED. DON’T BE AFRAID TO ASK FOR HELP FROM YOUR LOVED ONES WHEN IT COMES TO GETTING BACK ON TRACK AGAIN.
LEARN TO FORGIVE AND JUST MOVE ON
WE ALL MAKE MISTAKES. SOME ARE HARDER TO RECONCILE THAN OTHERS, BUT IF YOU WANT TO HAVE HOPE OF STAYING SOBER, YOU HAVE TO FORGIVE YOURSELF. ACKNOWLEDGE YOUR MISTAKE AND THE PAIN THAT IT HAS CAUSED. APOLOGIZE IF NECESSARY, ASSESS WHAT WENT WRONG BUT DO NOT DWELL ON THE PAST. AFTER ALL, YOU CANNOT CHANGE IT, AND CONSTANTLY THINKING ABOUT YOUR RELAPSE WILL ONLY CAUSE MORE PROBLEMS FOR YOUR RECOVERY. SO, MAKE AMENDS, ADMIT YOUR MISTAKE, AND MOVE ON TO MORE POSITIVE STEPS.
ONE MISTAKE DOES NOT HAVE TO DEFINE YOUR RECOVERY. YOU CAN LEARN FROM YOUR RELAPSE AND FIGURE OUT BETTER WAYS TO HELP YOU STAY SOBER IN THE FUTURE. TAKE A DEEP BREATH, TAKE SOME TIME, AND THEN GET BACK TO FIGHTING YOUR ADDICTION AGAIN
Courtesy guest post from Bethan Hattan @ Preventaddiction.info
As many of our readers know, I got pretty stirred up earlier this summer when one of our local pharmacies decided to not carry buprenorphine or suboxone products. The pharmacist actually said to me, “these patients never get better and these medications are no better than pain pills. ”
And as of this writing, 1770 people saw my facebook post about this on June 23rd. Well here’s the followup. Let’s see if this district manager cares about this. Here’s the email I just sent him. Let the games begin.
September 18, 2018
Will Henning, Pharmacy District Manager
Albertsons District Manager
1421 S Manhattan Ave.
Fullerton, CA 92838
Dear Mr. Henning
My name is Dr. Ken Starr. I am a Board Certified Addiction Medicine Specialist with a medical practice in Arroyo Grande, CA. My clinic is a state licensed and CARF accredited facility specializing in the treatment of substance use disorders. Many of our patients are treated specifically for opiate use disorders.
As you are well aware, about 100 patients die in our country daily from opiate overdoses. The National Institute on Drug Abuse (NIDA) has officially declared the country to be in an “Opioid Overdose Crisis”. Because of this, both the U.S. Department of Health & Human Services and the National Institute of Health has identified improving access to treatment one of its major priorities.
One of the pivotal steps in reducing overdose deaths, reducing medical complications of addiction, and increasing engagement in recovery has been the implementation of Medication Assisted Treatment (MAT) with medications such as Buprenorphine and Buprenorphine containing products such as Suboxone. There is currently a tremendous effort underway nationally to train more doctors to recognize and treat addiction and to become X-waivered by the DEA to prescribe Buprenorphine products for Opiate Use Disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) considers Buprenorphine to be a Class 1A drug for the treatment of Opiate Use Disorder. Organizations such as the American Academy of Addiction Psychiatry and the American Psychiatric Association have taken a strong stand recommending Buprenorphine products as an integral part of a recovery treatment plan.
I was shocked and disappointed on June 23rd, 2018 when Pharmacist Levan Hoang ( RPH 68310 CA State Pharmacy Board) discussed with me her decision to not stock Buprenorphine products at SAV-On Pharmacy #314 (189 Niblick Road, Paso Robles, CA 93446) was based on her personal belief that “ these patients never get better and these medications are no better than pain pills”.
I think it’s important that you are made keenly aware of this situation. Ms. Hoang is personally taking it upon herself to restrict access to a broad category of medication that is highly recommended as the standard of care for the thousands of patients in this community with an opiate use disorder.
It’s my understanding that the law mandates a pharmacy must provide any medicine legally prescribed unless: it’s not covered by insurance, the patient is unable to pay the cost, or the pharmacist determines doing so would be against the law or potentially harmful to a patients health. In this case, Ms. Hoang was simply portraying the medication as “ not immediately available”. But her statements suggest she wasn’t ordering any Buprenorphine products to stock. She verbally confirmed this with me on the phone at the time.
According to your companies Notice of Nondiscrimination, Albertsons and their subsidiary entities comply “ with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Albertsons Companies does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. “ One could argue in this situation your employee is discriminating against patients with an opiate use disorder by refusing to stock medications directed and solely for their treatment.
Due to the above action, I plan on filing a grievance with Albertsons Companies Chief Compliance Officer as well as a civil rights complaint with the US Department of Health and Human Services Office of Civil Rights.
I pray you feel motivated and take action to remedy this situation. All patients deserve access to life saving medications. Our community does not benefit from a rogue, opinionated, and poorly informed pharmacist dictating what treatments should be available.
Ken Starr MD FACEP ABAM