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#MentalHealthMatters – Pathways Out of Opioid Use Disorders (OUD) and Addiction

April 1, 2020

Ravenwood Health | Mental Health and Addiction Services(Editor’s note: Every month, the team at Ravenwood Health posts about a mental-health topic. This month, Gerard M. Papp, DO Medication Assisted Treatment (MAT) Physician
at Ravenwood, writes about being present)

Opioid Use Disorder (OUD) is a biological disease characterized by a problematic pattern of continued opioid misuse. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), “an opioid use disorder is defined as the repeated occurrence of two or more of these 11 problems within a 12-month period.” Three severity levels have been identified: mild, moderate and severe. Examples of Opioids include Heroin, Norco, Vicodin, Oxycodone, Percocet, Morphine, Dilaudid, Demerol, Fentanyl and even codeine in cough syrup.

Addiction is a primary, chronic, neuro/chemical/biological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. Opioid Use Disorder is a pathway into addiction. The pathway is subtle and can be deadly, unique to every individual.

There are six recognized pathways out of addiction with varying degrees of success, hopefully leading to sobriety/recovery

  1. No treatment (cold turkey) – most difficult and least successful
  2. Inpatient detoxification or residential treatment – expensive and long duration with low success rate without medication treatment
  3. Intensive behavioral health – cognitive based therapy, extensive duration of time in active treatment
  4. Buprenorphine or Methadone MAT (Medication Assisted Therapy) – most successful in terms of achieving sobriety, no withdrawal, some cravings and 75% success rate over time
  5. Naltrexone (Vivitrol) – designed to be used for alcohol use disorder and now can also be used for OUD.
  6. Non-intensive behavioral health – includes drug counseling, Alcoholics Anonymous, Narcotics Anonymous

Ravenwood Health started a Medication Assisted Therapy (MAT) program four- and one-half years ago using buprenorphine, which is one of the three recognized approved medication assisted therapies. We began these services with one physician providing treatment, now expanding to four physicians and a dedicated MAT counseling staff. Together, we provide MAT for Geauga county residents, and clients living in neighboring communities.

Future blogs will discuss in greater detail the pathways out of addiction and the efficacy of each avenue.

I am currently reading In Her Own Words by Ruth Bader Ginsburg.

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