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Friday, June 22, 2018

Polysubstance Epidemic in Rural America

methamphetamine
Recently, NPR pulled up the shades on the opioid epidemic in rural America; specifically Vinton County, Ohio. While the opioid epidemic is not unique to rural America, something is changing in places like McArthur, Ohio (pop. about 2,000) the county seat of Vinton. Even though many opioid addicts can access addiction treatment services to address opioid use disorders, in many cases relying on controversial medication-assisted treatment (MAT) drugs like Vivitrol (naltrexone)—which blocks the euphoria and sedation that central nervous system depressants cause, specifically alcohol and opioids—the medication has no effect on other dangerous substances.

Certain medications like Suboxone (buprenorphine/naloxone) and Vivitrol can help people break the cycle of addiction. However, without cognitive behavioral therapy(CBT) and some sort of program of recovery, the prospects of continued progress is unlikely. Removing drugs like OxyContin and heroin from the picture is excellent, but something needs to fill the void that people formerly attempted to fill with drugs and alcohol.

Back in Vinton County, many opioid addicts are receiving some form of treatment at one of the three rehab centers in the one-traffic-light-town of McArthur. Amanda Lee, a counselor at one the treatment centers tells NPR that in the last 4 to 5 months the threat to the residents of the small village which she compares to a drug-laden version of Mayberry, is methamphetamine.


Methamphetamine Complicates the Opioid Epidemic



Amanda Lee points out that patients began abusing the Suboxone that they were receiving for opioid use disorder; this resulted in a more significant push to provide opiate addicts monthly Vivitrol injection which is not susceptible to abuse like buprenorphine drugs. While Vivitrol efficacy shows promise, especially in the right setting with concurrent therapy, it is not a panacea; the drug, as Lee correctly points out, does not work on the receptors in the brain that meth targets. People still have cravings to get high, Lee says, and Vivitrol doesn’t block the effects of methamphetamine.

Andy Chambers, an addiction psychiatrist and researcher at the Indiana University School of Medicine in Indianapolis, tells NPR that Vivitrol is not responsible for the surge in meth use; he believes that people’s meth addiction isn’t addressed when they receive opioid use disorder treatment. We could argue that in places like Vinton County and other parts of rural America contending with opioids and meth—when it comes to treating addiction they are failing to see the forest for the trees.

"The reality is meth has been with us for many years," Chambers says. He says that there is an advantage to no longer saying we have an "opioid crisis" or a "meth crisis," when in fact the crisis is "polysubstance epidemic." Chambers adds that in rural America there are severe mental health provider shortages. 

"I'm concerned about the ongoing shortages," Chambers said. "If you want decent mental healthcare in the U.S. you better live in the big cities."


Opioid Use Disorder Treatment



If you are struggling with opioid use disorder or methamphetamine addiction, please contact Celebrate Hope at Hope by the Sea. We can show what is needed for achieving lasting recovery and give you the tools for everlasting progress.

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