Brian: What are some of those symptoms?

Neil: Um, they can start as mild as yawning, burning running eyes, running nose, aches and pains all over your body. Muscle spasms, legs with kick a bit and that is why it is called kicking the habit. Feeling like you have the flu. Cold turkey, stopping immediately can truly make someone miserable for three or four days.

Brian: Is that dangerous.

Neil: It is non life threatening, but generally coming of benzos can be.

Brian: I bet there is someone out there wandering while we are talking about symptoms they are thinking of someone they know and have been unaware of withdrawal symptoms. What would you recommend.

Neil: Have them come in for an evaluation to at least check them out and see if it is in their system. One thing I tell parents uh, family members, that the kids might be visiting or around and one thing that is noticed is an increase in younger teenagers are getting these drugs from the parents or the relatives medicine cabinets. Uh, there could be a grandparent recovering from surgery and the family member could be using the left over medication.

Brian: A couple shows back we talked about how parents and grandparents, young kids, teens, are making themselves welcome to left over meds and there could even be friends of the kids they know where to look. We are going to encourage you if you have these medications to secure them and make sure that you know what is going on in your home and remember it is being stolen and sold in the schools and possibly given away to friends.

Neil: It sounds extreme but you know when you have toddlers you cover the electrical outlets so with teens let’s watch the medicine cabinets. Put a key on them.

Brian: What a wonderful suggestion, most of the time we only think of locks when you are in a hospital or out patient but that is a good idea. A lock box for your medications. Now, you mentioned another medication here, and we call it suboxone and I know that seems to be a medication that is now being used as a replacement in many ways for methadone and now what is the difference in some ways between methadone and suboxone and why is it safer.

Neil: Suboxone is the combination of two meds, they are both opiate agonists and that means that they are on the receptor and the brain and have full activity. The only difference between the two is half life, which is how long it takes your body to eliminate half of the dose you have taken. If you took 10 grams and it takes you 6 hours there are only 5 grams left and that is the half life.

Brian: so the longer the half life it stays in the body longer?

Neil: Right, suboxone has an opiate antagonist which means that the receptor does nothing beneficial and with that in there in the suboxone medication it helps prevent addiction. It is not as likely to be addictiond if you take excessive amounts because you have this other drug competing for the receptor sights and preventing them to be filled completely by the opiate agonist.

Brian: That is a lot to chew on but it is very informative because we need to understand what the differences are. We are going to encourage you to call at 770-226-0920 or if you are outside the area, 1-888-920-2665 and we are going to continue the discussion on opiate pain killers and how we can get off of them. We will be right back.

Commercial Break

Brian: Welcome back, my name is Brian Fujii, here with my guest Dr. Neil Johnston, today we are talking about prescription pain pills and opiate addiction and that is the addiction to pain medication and one of the things that we teach at Breakthrough Dr. Johnston, is helping folks to understand how the drugs go through the pleasure pathway of the brain that helps people get the memory the drug memory and we know that as you said before th break that people when they get addicted to prescription pain pills the brain remembers how good that felt and as a result they want to return to that same place and I think that is what happens a lot of times and as you said, that feeling of well being, it is not just the pain reduction, the analgesic reduction but when they get the really great feeling that is what really begins moving people to see that their medication can do more for them than just pain reduction and that is a huge part of why they continue to use even though the pain has stopped. At Breakthrough during our programs, we try to help people develop coping skills so that craving for pleasure the triggering comes on they want to move quickly to get a hold of it and if they are not taught how to use a thought stopping technique or develop coping skills they will use again. A lot of times we do feel that it is important that they have meds and a good psychosocial support. You mentioned about the suboxone in contrast to methadone and I think that you are bringing up ideas of how suboxone is different and we do have a program called Ambulatory Prescription pain pill detox, which means we can help someone prescription pain pill detox off of prescription pain pills and they don’t have to be hospitalized.

Neil: Well the whole idea that coming off of prescription pain pills is not life threatening uh, there is no absolute need for a hospital. Sometimes the cold turkey is easier and quicker to do in a hospital but that is not necessary and pretty much I think what can be done in the hospital we can do out-patient considering the way we do the ambulatory process having people come in every day being checked on by medical staff and myself, etc., we can provide the full range of services, I want to comment on use for the pleasure. That is definitely probably the thing that begins the addiction. Uh, but that isn’t necessarily the only piece that sustains it. A lot of patients come in and they want off of them and they are sick and tired of being sick and tired. Coming off of prescription pain pills without support is a miserable experience and so often times patients will say they stopped enjoying this a long time ago and to avoid getting sick they keep using, so it is avoidance of pain as much as pleasure seeking that keeps them addicted.

Brian: That is exactly correct and I even see this in my alcohol clients, they drink to wake up and feel normal. This is the same kind of situation and they are so miserable and they want to avoid the pain and that is the challenge.

Neil: Due to complex changes in the brain after months and years of using that we have not completely defined yet. We have some studies that show differences in the brain but there are advanced tests not given at the doctor’s office um, but we can tell that there are major differences in the addictive brain and the non addictive brain.

Brian: Isn’t there a spot that has the ability to remember well? The pleasurable experiences and are used or repeat because the dopamine system especially because it is a survival it wants to repeat pleasurable experiences so that we do them over and over again to feel better and perform better.

Neil: The systems involved and the dopamine for pleasure that you mentioned is also involved in the pleasure of sex, eating and things that are clearly important to the survival of the species and also these drugs go through the same pleasure routes and pleasure pathways and so trying to modify is a indeed difficult task

Brian: A challenge that’s right. As we take a look at suboxone and it is a partial agonist and yet I have had questions raised by some clients that say for example they are on the suboxone and now they have had an accident or injury or possibly surgery, will this prevent them from being able to utilize any other pain meds to help to decrease the pain of their suffering.

Neil: It doesn’t prevent it but it does the doctor treating the pain needs to know that it may require larger doses of meds to essentially out compete the molecules of the ingredients to get out the receptors. So, um through careful control, the doctor knows about the suboxone they can treat the pain and they definitely need to inform their doctors.

Brian: So many times our clients are afraid to tell the doctor, so we are coming to a break and I want to take a look at that cause as a physician how do we help our clients to know that if the doctor doesn’t know what you are on and you are hiding that what kind of effect does that have on your addiction treatment.

Neil: After the break we will talk about suboxone and other doctor visits.

Brian: Give us a call at 770-226-0920 or 1-888-920-2665

Commercial Break

Brian: Welcome back, Breakthrough Addiction Drug addiction recovery Hour, my guest is Dr. Neil Johnston, we are talking about prescription pain pills and pain killer addiction. We were just talking about suboxone, one of the medications we use in our program at Breakthrough Addiction Drug addiction recovery to help people prescription pain pill detox off of prescription pain pills, tell us Dr. Johnston about the process.

Neil: Generally because of the ingredients of suboxone we want patients to be in slight withdrawal before they begin on the medication. We are not

Brian: Slight withdrawal, all of the receptors are not filled with meds

Neil: Right, and I will add that if you are on methadone then we would have to wait a long period of time um, what I often do is switch them to a short acting opiate and keep them on that for a week or so and then put them on suboxone, then what we do is we have them get the prescription for the suboxone and come back the next morning hopefully in withdrawal uh, we have a nice comfortable “quite room” we have blankets, etc., movies, give them their first dose, come back in an hour and they are assessed by a nurse or PA and see if they need the next dose and that continues until they are not having any withdrawal symptoms and that establishes their baseline dose from there we would continue that does daily and sometimes they may need a slight increase or decrease but once that dose is established we continue for several weeks to a month or more and then start slowly tapering that down.

Brian: What is the maximum that they can be taking in order to prescription pain pill detox. What is the average

Neil: Suboxone, usually around the 8/16 but you can go higher if you need to and again that is all depending on how much opiate drugs someone is using um, I have seen in methadone maintenance clinics now people are up to 160 to 180 mgs. A day which if we split that 3 ways today in the studio you know it’s just amazing, people become more and more tolerant to that. One other thing I want to mention with prescription pain pills they are all deadly when combined with alcohol, benzodiazepines, barbiturates, and people have to be extraordinarily careful, it is not printed as clearly as it should be on the bottle but if you are on an opiate pain killer, make sure your doctor knows what you are on and if you go to another doctor tell them as well because xanax, valium, alcohol, certain preparations for diarrhea all of these you have to be very careful with prescription pain pills.

Brian: Even in our programs, the clients they feel so shameful or so embarrassed or they feel scared in being able to talk with their physicians about what they are struggling with and yet what you said is so important and I am hoping that the audience heard that because if you are using these kinds of medications and then you see your doctor for a procedure it could produce some major issues that could be counter productive for what needs to be done, so I want to help the listening audience with knowing your doctor will not condemn you he is there to help you get through the process and he can’t unless he knows what is in your system.

Neil: Most of these drugs will be used other than the short term for a physical problem should be prescribed by psychiatrist.

Brian: What is psycho-active?

Neil: Anything effective the central nervous system, so I encourage people to see a psychiatrist so if you are on something like xanax and you may really need that and then you are put on suboxone or something else, they may have the knee jerk reaction of not providing anymore so see a psychiatrist or addiction psychiatrist they would work with you more to see if you were adjusted correctly and um administered safely, so while yes, I want you to be honest with the doctors, if your doctor reacts in the way, absolutely not, maybe you should find a specialist

Brian: Give us a call here at 770-226-0920 or if you are outside our area, 1-888-920-2665, again I want to remind our audience we have a wonderful website and you can obtain a lot of information on addiction and the various drugs that are out there and the ones that are used to help in a very unique way in treating people who are struggling with alcohol and cocaine, prescription pain pills we have some very unique ways that we can help individuals to deal with this problem effectively. We also offer a free consultation and so when you call us, we will set up an appointment and any problem you may need to discuss we will sit down and help you. So, give us a call, we are in Norcross, and you can reach our office for that free consultation at 770-734-8091, 770-734-8091, it gives you an opportunity to meet our staff and again it is www.breakthroughaddictiondrug addiction recovery.com

Brian: Welcome back to the Breakthrough Addiction Drug addiction recovery Hour, my name is Brian Fujii, here with my special guest, Dr. Neil Johnston, we are talking about opiate addiction, pain killers and the medications that people are now using to the point where they are becoming addicted. One of the areas we are talking about is how methadone and also like you said, any medication can be done to the extent where they can become fatal. We do know that as you mentioned, this is happening with the younger teens and how they can get hold of this and other medications and in the high schools there is.

Neil: There is increase all across the board with all populations but is particularly alarming in the adolescent and young adult populations as far as deaths that have been related to methadone in some way or the other. Incidentally if there is a parent out there that is concerned or what not, that their child is getting methadone or someone else getting it from a source that is not acceptable, the DEA has set up a new anonymous toll free hotline and the number I don’t have but google DEA hotlines or something of that nature, it should get you to that site. You can also report internet sites that are inappropriately providing this to your loved one and that will help shut down the problem and so the feds are getting more involved and thank goodness.

Brian: We see them getting to this online and people ordering more and more of their pain killers, they can track it at some point and this will be fantastic and doctors and pharmacists will be able to take a look at the amount, quantity and frequency at which it is being ordered. It is interesting to note that 51% of methadone related deaths occurred in people who were not registered in a methadone maintenance program and again, you and I were talking about this at the beginning about how easy it is if someone is not taking this on a regular basis or if they are using methadone for pain how much easier it is for them to maybe overdose on this because they are medicating themselves in contrast in having it regulated by getting the pill once a day.