Week 11 discussion response to classmates

Please no plagiarism and make sure you are able to access all resource on your own before you bid. Main references come from Van Wormer, K., & Davis, D. R. (2018) and/or American Psychiatric Association. (2013). You need to have scholarly support for any claim of fact or recommendation regarding treatment. I have also attached my discussion rubric so you can see how to make full points. Please respond to all 3 of my classmates separately with separate references for each response. You need to have scholarly support for any claim of fact or recommendation like peer-reviewed, professional scholarly journals. If you draw from the internet, I encourage you to use websites from the major mental health professional associations (American Counseling Association, American Psychological Association, etc.) or federal agencies (Substance Abuse and Mental Health Services Administration (SAMSHA), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), etc.). I need this completed by 05/10/19 at 6pm.

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Responses to peers. Note that this is measured by both the quantity and quality of your posts. Does your post contribute to continuing the discussion? Are your ideas supported with citations from the learning resources and other scholarly sources? Note that citations are expected for both your main post and your response posts. Note also, that, although it is often helpful and important to provide one or two sentence responses thanking somebody or supporting them or commiserating with them, those types of responses do not always further the discussion as much as they check in with the author. Such responses are appropriate and encouraged; however, they should be considered supplemental to more substantive responses, not sufficient by themselves.

Read a your colleagues’ postings. Respond to your colleagues’ postings.

Respond in one or more of the following ways:

· Ask a probing question.

· Share an insight gained from having read your colleague’s posting.

· Offer and support an opinion.

· Validate an idea with your own experience.

· Make a suggestion.

· Expand on your colleague’s posting.

1. Classmate (D. Ras)

Overview of Public Policy Topic, Trend or Initiative

Harm reduction is a public health strategy that was developed initially for adults with substance abuse problems for whom abstinence was not feasible (Harm reduction, 2008). Harm reduction approaches have been effective in reducing deaths associated with this population. Although it is found to be a controversial issue in the substance abuse treatment arena, harm reduction strategies are being recognized for their benefits with other areas of public health (Van Wormer & Davis, 2018). For example, the reliance on designated drivers, the mandating of labels using warnings on tobacco and all kinds of other potentially harmful products, immunizations, nicotine replacement therapy, and safe havens (anonymous drop-off places for unwanted infants (Van Wormer & Davis, 2018).

For this discussion, I will stick to harm reduction in the substance abuse treatment arena. These strategies include different medications used to treat opioid use at different phases: acute intoxication, acute withdrawal, and abstinence maintenance (Preston et. al., 2017). Buprenorphine is used in the last two phases. This is “a synthetic opioid medication that acts as a partial agonist at opioid receptors, unlike methadone which is a full agonist” (Perry et.al., 2005, p.429). Buprenorphine does not produce the euphoria and sedation caused by heroin or other opioids but is able to reduce or eliminate withdrawal symptoms associated with opioid dependence and carries a low risk of overdose (NIDA, n.d.). Buprenorphine can be prescribed or dispensed since 2002 in physician offices (Nadelman, & LaSalle, 2017). It has largely avoided the popular stigma associated with methadone, no doubt in part because buprenorphine patients are more likely than methadone patients to be white, employed, and college-educated. Governmental support for opioid agonist therapy has never been better. In February 2015, the principal federal substance abuse agency announced that it would no longer provide federal funding to drug courts that deny agonist medications to participants under the care of a physician (Nadelman, & LaSalle, 2017). Later that year, President Obama issued a Presidential Memorandum directing federal agencies to conduct a review to identify barriers to treatment with medications and develop action plans to address these barriers (Nadelman, & LaSalle, 2017).
 

Description of How It Benefits or Hinders Access to Treatment, Motivation for Treatment, & Relapse Prevention for Addiction

Initially, Buprenorphine was used as a “rapid taper” when clients first entered detox, which would allow them more time in treatment without the medication (Beheshti, 2014). The intent was they would begin working on changing the behaviors and thought processes around the substances. However, the challenge was the individual would not have long enough time opioid-free and would then be more susceptible to relapse (Beheshti, 2014). Therefore, the idea of using Buprenorphine as maintenance therapy came about. This is where the controversy lies because many programs and philosophies are abstinence-based, where Buprenorphine maintenance is considered harm-reduction (Beheshti, 2014).  Despite the research findings that Buprenorphine results in positive outcomes, this issue raises some concerns. The Drug Enforcement Agency (DEA) found 10,804 cases of seizures linked to buprenorphine use in 2012 (Beheshti, 2014). Also, it can be abused through intranasal, sublingual, and intravenous routes which cause euphoria (Beheshti, 2014). Because of these risks the recovery community is often against the use of Buprenorphine. 

I am a person in long-term recovery from substance use disorder (SUD) and for many years was against the use of methadone and buprenorphine. I work a 12-step program and see evidence daily that it works in my life and the lives of millions of others. For a long time, I thought this was the only way to recover from SUD. However, our country is in an epidemic with 192 people dying every day from an opioid overdose (CDC, 2018). Therefore, as a clinician, I have had to look at this from a different perspective and respect the harm reduction stance on treating opioid addiction. With that being said, I don’t think it needs to be long-term maintenance therapy. If the individual as tried all other routes, starting a maintenance therapy treatment plan with the end goal of being tapered off in a certain amount of time (i.e. 3 months or 6 months) while working on the psychosocial aspects of their disease, I am all for this approach. However, if the person is going to just substitute one for another without looking at the root causes of addiction and addressing them through some sort of therapy or self-help group, then I believe these efforts are fruitless. There is a saying in the rooms which is a quote by Courtney C. Stevens, “Nothing Changes if Nothing Changes. If you keep doing what you’re doing, you’re going to keep getting what you’re getting. You want to change, make some.”

Description of Ways Current Policies or Procedures Could Improve & My Role as Advocate & Social Change Agent

           A way I think the current policies could improve would be to put stipulations on how long a person can receive this medication and steps they need to be taking while being weaned off of it in a safe environment. If the end goal is abstinence, I feel that this is a great tool to use to help the chronic relapser. However, I have seen it way too often where people are using this as a crutch, a long-term solution. The policy needs to be improved by promoting the use of Buprenorphine as a temporary tool for those individuals who have tried every other path to recovery and failed. This will provide that individual with just enough time to learn how to live their live without the use of substances. During this 6-month period of taking this medication, the individual needs to be working on the core issues, the reasons why they use substances in the first place. If they don’t do this work, they will never be able to fully recover.

Reference

Beheshti, S., MD, MA. (2014, November 19). Controversies of Using Buprenorphine for Maintenance in Opioid Dependency. Retrieved April 21, 2019, from https://www.psychiatrictimes.com/psychopharmacology/controversies-using-buprenorphine-maintenance-opioid-dependency

Centers for Disease Control and Prevention. (CDC). (2018, December 19). Opioid Overdose. Retrieved April 21, 2019, from https://www.cdc.gov/drugoverdose/epidemic/index.html

Harm reduction: An approach to reducing risky health behaviors in adolescents. (2008). Pediatrics & child health, 13(1), 53–60.

Nadelman, E. & LaSalle, L. (2017). Two steps forward, one step back: current harm reduction policy and politics in the United States. Retrieved fromhttps://doi.org/10.1186/s12954-017-0157-y

Perry, P. J., Alexander, B., Liskow, B. I., & DeVane, C. L. (2007). Psychotropic drug handbook (8th ed.). Baltimore, MD: Lippincott Williams & Wilkins.

Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2017). Handbook of clinical psychopharmacology for therapists (8th ed.). Oakland, CA: New Harbinger.

The National Alliance of Advocates for Buprenorphine Treatment. (NAABT). (n.d.). Retrieved April 21, 2019, from http://www.naabt.org/faq_answers.cfm?ID=5

Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.

2. Classmate (A. Mc)

Marijuana Legalization

An evident trend in public policy today is the legalization of marijuana, whether that be medicinal, recreational, or both. Currently, ten states and Washington D.C. have fully legalized marijuana (“Map of Marijuana Legality by State, 2019). One of the major reasons legalizing marijuana is trendy is because of its economic benefits, as there is a lot of money to be made in the marijuana business. With approximately 3.1 million individuals reporting daily use, marijuana is the most commonly used, illicit drug in the United States (Wilkinson, Yarnell, Radhakrishnan, Ball, & D’Souza, 2016). While legalizing marijuana shows some medical benefits, economic benefits, and reduces the rates of incarceration, it also has harmful effects (Van Wormer & Davis, 2018). For example, purposeful and accidental access to the drug by adolescents increases with legalization. Between the years 2009 and 2011, there were 14 pediatric, unintentional ingestion visits to the ER in Colorado. Prior to legalizing marijuana, there were zero (Wilkinson et al., 2016). Van Wormer and Davis (2018) describe the legalization of marijuana as a major step forward that can be controlled by harm reduction strategies (e.g. education, marketing controls, driving laws, etc.). However, before calling it a major step forward, it is important to consider how this policy might affect addiction treatment and relapse prevention.  

Effects on Treatment

Despite the common notion that marijuana is not addictive, Wilkinson et al. (2016) reports that approximately one in ten adult users develop an addiction to marijuana. Thus, legalization of marijuana is bound to have effects on addiction treatment. Evidence from states who have implemented the legalization of marijuana have seen a reduction in perceived harm and disapproval of marijuana use (Pacula & Smart, 2017). On one hand, this might sound like a good thing; the United States is marching towards destigmatization of a drug that has beneficial properties and is commonly used. However, with an increasing number of people believing there is little-to-no harm in using marijuana and an increasing number of people approving of its use, access to treatment and motivation for treatment might decline. In addition, legalization might prevent black market sales, but it will also allow people to access the drug with ease (Hall & Lynskey, 2016). The accessibility of the drug might prove to be a difficult temptation for those who struggle with addiction and are making efforts to remain sober. Further, even if individuals struggling with an addiction have never touched marijuana, marijuana can be a gateway drug, driving this individual back towards their original substance of choice (Van Wormer & Davis, 2018). In other words, it will be more difficult to protect against relapse.

Improvement and Advocacy

I understand that policy changes are trial and error. Sometimes, policies change that do not align with our political stance, and sometimes, they do. However, when implementing a policy which involves an FDA classified, Schedule 1 drug (high potential for abuse and no evidence of therapeutic use), I think the procedure and spread of the policy needs to happen more slowly (Van Wormer & Davis, 2018). It has been almost six years since Colorado completely legalized marijuana. After thinking about how legalization of marijuana can affect those who struggle with addiction (i.e. treatment and relapse prevention), I don’t believe that six years is a long enough trial period. Enough time has not passed to see any long-term effects from this policy, and that is scary to me. My role in advocating for clients in recovery or struggling with addiction would likely be small-scale, as the legalization of marijuana is happening and unlikely to be stopped. Therefore, I may advocate for this population by proposing early intervention and education about marijuana, the legalization of marijuana, and their effects, both positive and negative, for example.  

References

Hall, W., & Lynskey, M. (2016). Evaluating the public health impacts of legalizing recreational
            cannabis use in the United States. ADDICTION, 111(10), 1764–1773. Retrieved from
            Walden Library Databases.

“Map of Marijuana Legality by State”. (Updated April 2019). Retrieved from
https://disa.com/map-of-marijuana-legality-by-state

Pacula, R. L., & Smart, R. (2017). Medical marijuana and marijuana legalization. Annual
            review of clinical psychology, 13, 397–419. doi:10.1146/annurev-clinpsy-032816-045128

Wilkinson, S. T., Yarnell, S., Radhakrishnan, R., Ball, S. A., & D’Souza, D. C. (2016).
            Marijuana legalization: Impact on physicians and public health. (2016). Annual Review of
            Medicine, 453. Retrieved from Walden Library Databases.

 Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th
            ed.). Boston, MA: Cengage.

3. Classmate (G. Sim)

Legalizing marijuana in the United States is long overdue, in my opinion. Just from a legal standpoint, American courtrooms have been bogged down by silly misdemeanor marijuana possession charges for so many years, and low-level convictions have blighted the criminal records of countless Americans and interfering with their lives. Since the camp film Reefer Madness, fear and loathing of marijuana by conservative family and religious groups have distorted the truth about the harm marijuana actually causes while preventing the medicinal qualities of it for sufferers of conditions like HIV, cancer, glaucoma, and nerve pain. 

The discussion of whether to legalize it or not is a two-pronged issue: legalizing it for medical purposes and legalizing it for recreational use. More than 20 states have already put medical marijuana in circulation for people needing its healing potential. Advocates are pushing harm reduction therapy as a life-changing alternative to deadly opioids for pain relief, hoping that the availability of it will encourage people seeking to get high to choose it over heroin, which is now killing Americans in record numbers (Van Wormer & Davis, 2018). Still, others use the old “gateway drug” argument that using marijuana will encourage users to try increasingly harder drugs. A 2015 study found that three times as many marijuana users as non-users developed a substance use disorder. Additionally, heavy marijuana smoking among young people is associated with brain abnormalities, memory problems, and loss of motivation. But legalization enables the authorities who control it to regulate its potency and mete it out in measured doses. Legalization will also create jobs for farmers and manufacturers, will decriminalize small-time users and free up court and jail space, and scientists will be able to study it more without the onus of Schedule I legislation on it (Van Wormer & Davis, 2018).

For me, improving the ways in which the harm reduction model can be incorporated into treatment is the best outcome of the new mindset and legislation. Practitioners can use marijuana to encourage clients to stop using heroin or methadone and “step down” on their way to full sobriety or a less dangerous drug of choice (Van Wormer & Davis, 2018). It also puts the brakes on the failed and ruinous War On Drugs, which filled up prisons with tragic mandatory minimum sentences given to people who never had any intention of being pushers or corrupting people with it. Enlightenment at last.

Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.

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Required Resources

  • Van      Wormer, K., & Davis, D. R. (2018). Addiction treatment: A      strengths perspective (4th ed.). Boston, MA: Cengage.
    • Chapter       2, “Historical Perspectives” (pp. 51-87)
    • Chapter       13, “Public Policy” (pp.507-532)

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