Opioids derive either from nature (inside the pods of poppy seed plants) or are produced in laboratories. They fall into three categories: prescription pain relievers; synthetic opioids such as fentanyl or methadone; and heroin. Originally intended to reduce acute or chronic pain, such as from traumatic muscle injury or recovery after surgery, all opioids interact with opioid receptors on the nerve cells in the body and reduce the perception of pain. They also induce drowsiness, euphoria, confusion, nausea and constipation.
Of course, as stated above, opioids can be highly addictive.
How do you know if you have a problem?
Like any addiction, if your substance use continues despite bad decisions and consequences (loss of job, estrangement from family, homelessness), if it takes more frequent or higher doses of drugs to feel “high” (tolerance), if you experience cravings or intense desires to use again and/or painful withdrawal symptoms (cravings/ withdrawal) after a period of abstinence, you may have developed an OUD.
One other key fact to know is that the often-hidden addition of fentanyl into synthetic or even prescription drugs such as oxycodone or even Adderall, can be nearly instantly fatal. Fentanyl is 50 times more potent than heroin and 100 times more than morphine. Carfentanyl is 10,000 times more potent than morphine. All can result in respiratory failure in literally minutes and these impacts have spiked the number of overdose deaths in Ohio and elsewhere.
One hundred thirty-six people die every day from drug overdose. If you or someone you love is actively using and not ready to enter treatment, be sure to keep Narcan kits nearby to resuscitate in case of overdose and/or fentanyl test strips to check drugs before consumption.
What Can Treatment Do for You?
The Diagnostic Statistical Manual (DSM) defines various mental health and addiction disorders and the recommended treatment protocols behavioral health clinicians should follow. Use Disorders constitute a category of diseases within the DSM. They are further classified by the substance of choice for the primary addiction, such as Alcohol Use Disorder (AUD) or Opioid Use Disorder (OUD).
Many people with addictions may consume a variety of substances when actively using. Maryhaven will work closely with every client to identify the substances involved in the addiction and provide appropriate, compassionate and respectful treatment.
Our team may initially focus on the primary drug of choice, but we will still look holistically at all issues, including mental health concerns such as depression and anxiety. As much as half of all people with addictions also cope with a co-occurring disorder.
While AUDS are the most common, marijuana, cocaine, crystal methamphetamine and heroin also are very prevalent addiction triggers. A 2017 report from the Ohio Substance abuse Monitoring Network, found that crack cocaine, heroin, marijuana, methamphetamine and Suboxone remain highly available in Central Ohio.
Before entering any treatment, it is imperative that client’s detox, or purge their body of any addictive substances. Maryhaven will help you decide whether this can be done more safely and comfortably as an inpatient (usually the case for people with AUD) or as an outpatient (typically best for those with OUD).
The process can take up to seven days and should be carefully monitored by Maryhaven clinical staff. Medications may be prescribed to help ease what can be painful withdrawal symptoms. Clients should not hesitate to connect with Maryhaven for help during this very vulnerable period. Our team will endeavor to make every client as comfortable as possible and, most importantly help ensure clients transition into treatment once detox is complete.
It is very important to enter treatment as soon as possible post detox to avoid relapse and to continue monitoring overall health. Every client should work with Maryhaven’s staff to determine what approach best serves their needs.
Treatment Choices include:
Inpatient/Residential – Clients may dedicate up to 28 days or four weeks in residential care. This highly structured, safe environment prioritizes physical health and initiates the process of acquiring new skills that promote mental wellness. It also may include medications to help clients get past cravings that can lead to relapse. The majority of our clients transition from detox into our residential care facility.
Outpatient – Sometimes client heal and rebuild best from home or another sober living arrangement that facilitates work and other daily routines. Again, Maryhaven experts can help every client choose the best setting for their recovery and then set up monitoring systems, provide medications, and integrate counseling sessions to ensure the best possible outcome.
Medications – Maryhaven’s Opioid Treatment Program (OTP) offers Medication-Assisted Services, including Methadone, Suboxone and Vivitrol. See more below under “Detox/Withdrawal Management” for how we work with each client to develop a highly individualized withdrawal management strategy.
Therapy – Our counselors and coaches are trained and skilled in a number of DSM-recognized treatment protocols. Most often, they rely upon either Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT).
CBT is one of the most commonly practiced treatment protocols. It helps people examine and re-evaluate how negative thinking patterns and behaviors impair their ability to make good life choices. Clients uncover their negative thoughts, practice new coping skills to deal with those emotions, set goals, find new ways to solve problems and develop a system to quickly recognize and respond to difficult emotions.
DBT is a specialized form of CBT that incorporates many of the same steps as CBT but also adds in practices such as mindfulness, meditation or prayer, all of which can strengthen a client’s ability to rise above trauma, anger and related emotions.
Both of these can be taught or reinforced in individual and group settings, as determined by the client and Maryhaven’s staff.
Other therapeutic approaches used by Maryhaven’s clients include 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous or TSF, Twelve-Step Facilitation. We also encourage a range of healthy habits—proper diet, exercise, personal reflection, positive social support networks—all contribute to long-term recovery and sobriety.
One additional note: Maryhaven knows that individual clients’ recovery and sense of self-worth grows as their lives improve and they have the opportunity to “give back,” sharing their stories of recovery and resiliency with other people on the same path. We proudly welcome back many of our “alumni” to speak to inpatient, outpatient and other groups. Their stories inspire, encourage and even cause a laugh or two to others with addiction. We hope you will join us and share your own “Been There, Done That, Now I’m Doing This.”
Treatment strategies for OUD Used by Maryhaven
Admissions
Most of the clients who turn to Maryhaven live with an opioid use disorder. They may be referred to us by an approved referral partner, such as the Columbus Division of Fire, they may self-admit through our Walk-In Care team located on the fourth floor of 1430 South High Street or the after-hours triage unit found on the ground floor of 1430 South High Street.
No matter how clients find us, our team works with each person. Together, we:
— Screen for critical needs and assess for health risks that could affect the treatment process. If someone has seizure disorders, significant medial issues, or is psychiatrically unstable due to hallucinations or suicide ideation, they may be better served in a different treatment center. We offer every client an array of options to secure a right fit for their care.
— Sign consent forms, verify insurance and/or apply for Medicaid. Though we certainly want to find funding as appropriate, Maryhaven treats everyone, regardless of ability to pay.
— Complete a medical evaluation and assess each client’s ability to provide self-care. A nurse and other health care professional conduct a medical evaluation and physical. Part of this screening determining how much self-care a client can administer. This step results in a personalized treatment regime that will best benefit each client.
Detox/Withdrawal Management
Maryhaven’s treatment specialists work with each client to develop a highly individualized withdrawal management strategy, that typically follows one of the four following protocols:
— Suboxone maintenance protocol (Maryhaven generally uses suboxone only for opioid treatment);
— Vivitrol pills (We typically do not use this approach until residential or outpatient, if at all);
— Observation only protocol
— Outpatient (may or may not include Suboxone)
Some clients will receive just enough suboxone to be relatively comfortable, which generally means approximately 2-4 doses of a maximum of 16 milligrams per day. Once through the detox process, they are generally safe to enter residential care or other treatment options.
Other clients may start with 16 milligram doses of suboxone and then gradually receive less, with the eventual goal of eliminating any suboxone. This approach may work best for those who want to enter a long-term rehabilitation program that doesn’t allow clients to use suboxone.
For the first two treatment paths, Maryhaven relies on the Clinical Opiate Withdrawal Scale, a best practice standard in addiction treatment. This scale, administered every four hours, guides medical professionals to ensure that Suboxone doses are appropriate to keep the client as comfortable as possible.
For observation only clients, Maryhaven oversees a comfort regime using anti-nausea medications or analgesics like Tylenol to help clients move through the worst of their withdrawal symptoms. This approach is often selected by those who want to more quickly move into long-term or residential care without suboxone.
Finally, some patients are best suited to withdraw at home with care from loved ones. Our team can help oversee this process and ensure that patients successfully navigate detox and avoid triggers that lead to relapse.
Next Steps
Clients in detox meet once a day clinical staff once daily to work on an aftercare plan, whether transitioning to an outpatient setting or inpatient residential care. While the average number of days in detox is four, clients could be in for as brief as a 24-hour observation up to a full seven days of suboxone tapering.
Additional Guidelines to Know
Maryhaven currently oversees a total of 57 beds for adults 18 or older in our withdrawal management unit, a co-ed facility located on South High Street in Columbus. We work hard and are proud to share that nearly all clients can enter detox on the same day they sought treatment.
Maryhaven provides clean scrubs and daily meals while in detox. Clients can:
— exit at any point in the process, although those who enter detox under court order must be medically cleared and have an after-care process in place for the court to approve their exit.
— bring medications with them, except the Drug Enforcement Agency will not permit us to hold any scheduled narcotics such as Suboxone.
— pack sweatshirts, undergarments or socks to wear with the scrubs provided by Maryhaven’s team.
— carry up to $30 cash for vending machines for additional food, snacks or beverages.
We can’t allow personal cell phones while in the facility.
Outcomes/Data
Since January 1, 2022 more than two-thirds of Maryhaven detox clients stepped down to less intensive care (either an in- or out-patient treatment program). In 2021, we served 3,800 clients.