OPIATES. What Is The REAL Problem? Is There A Solution?

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1 OPIATES What Is The REAL Problem? Is There A Solution? Russell Ferstandig, M.D. Medical Director and Founder Monmouth Behavioral Medicine Center Manasquan, New Jersey monmouthbehavioralmedicine.com drruss@monmouthbehavioralmedicine.com

2 Why You Should Listen To Me! Psychiatrist For 35 Years! Addiction Specialist For 30 Years! Board Certified In Addiction Medicine (American Board Of Addiction Medicine)! Suboxone Provider For 9 Years With 100 s of Successes! Recovered Cocaine Addict So I Have Lived The Life Of Addiction

3 THIS PRESENTATION IS ABOUT HOPE BECAUSE THERE IS A GUARANTEED SOLUTION FOR ANYONE ADDICTED TO OPIATES!!!!

4 THIS PRESENTATION IS ABOUT HOPE BECAUSE THERE IS A GUARANTEED SOLUTION FOR ANYONE ADDICTED TO OPIATES!!!!

5 In Order To Find An Opiate Solution, You Need To Understand The Opiate Problem

6 The Problem

7 The Problem The problem has two components:

8 The Problem The problem has two components: Lifestyle People feel the need to hide in unreality because reality is uncomfortable.

9 The Problem The problem has two components: Lifestyle People feel the need to hide in unreality because reality is uncomfortable. Physiologic Opiates Addict Everyone

10 The Problem Lifestyle Component

11 The Problem Lifestyle Component! No simple solution

12 The Problem Lifestyle Component! No simple solution! Based on unrealistic goals and expectations about life

13 The Problem Lifestyle Component! No simple solution! Based on unrealistic goals and expectations about life! Young people feel inadequate

14 The Problem Lifestyle Component! No simple solution! Based on unrealistic goals and expectations about life! Young people feel inadequate! A search to feel better NOW

15 The Basic Rule Of Human Behavior People will resist change by maintaining their current behavior until:! The perceived cost of maintaining the behavior exceeds the perceived cost of changing the behavior

16 The Basic Rule Of Human Behavior People will resist change by maintaining their current behavior until:! The perceived cost of maintaining the behavior exceeds the perceived cost of changing the behavior! The perceived benefit from change greatly exceeds the trouble (real and imagined) generated by the change process.

17 The Basic Rule Of Human Behavior Simplified People will change when it hurts too much not to change.

18 The Problem Opiate Physiology No one is protected from opiate addiction.

19 The Problem Opiate Physiology No one is protected from opiate addiction.

20 The Problem Opiate Physiology No one is protected from opiate addiction.

21 The Problem The Brain Does Not Like External Opiates Of Any Sort

22 The Problem The Brain Does Not Like External Opiates Of Any Sort! Heroin especially NJ Heroin

23 The Problem The Brain Does Not Like External Opiates Of Any Sort! Heroin! Opiates (Pills- prescribed and street sourced)

24 The Problem The Brain Does Not Like External Opiates Of Any Sort! Heroin! Opiates (Pills)! Opioids (Opiate-Like Substances)

25 The Problem The Brain Does Not Like External Opiates Of Any Sort! Heroin! Opiates (Pills)! Opioids (Opiate-Like Substances)! Natural Opium

26 The Brain s Natural Opiate System Is Disrupted By External Opiates Of Any Type

27 The Brain s Natural Opiate System Is Disrupted By External Opiates Of Any Type! Natural opiates (endorphins) are secreted by the brain in very small amounts, probably less than 1/1000 th % (0.001%) of external opiates, AND only for seconds or a minute or two

28 The Brain s Natural Opiate System Is Disrupted By External Opiates Of Any Type! Natural opiates (endorphins) are secreted in very small amounts, probably less than 1/1000 th % (0.001%) of external opiates AND only for seconds or a minute or two! External Opiates Are Present In Progressively Large Doses For Hours, Days, Months Or Years

29 The Brain s Natural Opiate System Is Disrupted By External Opiates Of Any Type! Natural opiates (endorphins) are secreted in very small amounts, probably less than 1/1000 th % (0.001%) of external opiates AND only for seconds or a minute or two! External opiates are present in progressively large doses for hours, days, months or years! The Combination Of Excessive Opiates For Long Durations Forces The Brain To ADAPT To Keep The Individual Alive

30 The Stronger The Opiate, The Faster The Individual Becomes Addicted, Their Brain Adapts To The External Opiate And Becomes

31 NJ Heroin Is One Of The Strongest Opiates Available

32 NJ Heroin Is One Of The Strongest Opiates Available NJ Heroin Cut With Fentanyl (Bud Light) Is The Strongest Opiate Available

33 NJ Heroin Is One Of The Strongest Opiates Available NJ Heroin Cut With Fentanyl (Bud Light) Is The Strongest Opiate Available Bud Light Is The Most Addictive Opiate On The Planet

34 Opiates And Opiate Withdrawal

35 Opiates And Opiate Withdrawal! One of the biggest causes of opiate relapse is that promotes and justifies repeat opiate use

36 Opiates And Opiate Withdrawal! One of the biggest causes of opiate relapse is distorted thinking that promotes and justifies repeat opiate use! occurs while using opiates AND/OR when withdrawing from opiates

37 Opiates And Opiate Withdrawal The only way to avoid opiate logic and opiate behaviors is:

38 Opiates And Opiate Withdrawal The only way to avoid opiate logic and opiate behaviors is:! 100% abstaining from opiate use

39 Opiates And Opiate Withdrawal Therefore, the only way to avoid opiate logic and opiate behaviors is:! 100% abstaining from opiate use AND

40 Opiates And Opiate Withdrawal Therefore, the only way to avoid opiate logic and opiate behaviors is:! 100% abstaining from opiate use AND! 100% stop of withdrawal symptoms 24/7 till the brain is 100% healed

41 The Solution

42 The Solution There Are Four Necessary Steps To Produce A Lasting Solution

43 The Four Steps To Becoming Opiate Free 1. Individual must be truly ready to stop using opiates ( should stop without commitment almost never works)

44 The Four Steps To Becoming Opiate Free 1. Individual must be truly ready to stop using opiates ( should stop without commitment almost never works) 2. Withdrawal must be stopped 100% 24/7 until the brain has 100% healed (returned to the pre-opiate state. Said another way the opiate altered state TOTALLY reversed)

45 The Four Steps To Becoming Opiate Free 3. Identify and correct all psychiatric problems that are likely triggers for relapse (anxiety, depression, ADD, etc.)

46 The Four Steps To Becoming Opiate Free 3. Identify and correct all psychiatric problems that are likely triggers for relapse (anxiety, depression, ADD, etc.) 4. Therapy to better identify triggers, modify opiate thinking distortions and learning new coping skills

47 The Four Steps To Becoming Opiate Free

48 The Four Steps To Becoming Opiate Free All Four Steps Are Required For Lasting Success

49 The Four Steps To Becoming Opiate Free 1. Committed to stop Summary

50 The Four Steps To Becoming Opiate Free 1. Committed to stop Summary % Removal of withdrawal symptoms and opiate logic till the brain is recovered

51 The Four Steps To Becoming Opiate Free 1. Committed to stop Summary % Removal of withdrawal symptoms and opiate logic till brain 100% recovered 3. Correct psychiatric triggers

52 The Four Steps To Becoming Opiate Free 1. Committed to stop Summary % Removal of withdrawal symptoms and opiate logic till brain 100% recovered 3. Correct psychiatric triggers 4. Therapy for better life coping skills

53 Four Necessary Steps Options

54 Four Necessary Steps Options There Are Many Options To Treatment Design

55 Four Necessary Steps Options There Are Many Options To Treatment Design Choose The Design That Works Best For You

56 Four Necessary Steps Options There Are Many Options To Treatment Design Choose The Design That Works Best For You

57 Four Necessary Steps Options There Are Many Options To Treatment Design Choose The Design That Works Best For You

58 There Are No Shortcuts

59 There Are No Shortcuts Shortcuts Essentially Guarantee Relapse

60 There Are No Shortcuts Shortcuts Essentially Guarantee Relapse Common Shortcuts That Produce Relapse

61 There Are No Shortcuts Shortcuts Essentially Guarantee Relapse Common Shortcuts That Produce Relapse:! Individual Not Ready To Stop Using Opiates

62 There Are No Shortcuts Shortcuts Essentially Guarantee Relapse Common Shortcuts That Produce Relapse! Individual Not Ready To Stop Using Opiates! Withdrawal NOT Stopped 100% Until The Brain Has 100% Healed (Returned To The Pre-opiate State)

63 How To Feel Good And Be Productive During Recovery From Opiate Use And Abuse

64 How To Feel Good And Be Productive During Recovery From Opiate Use And Abuse! It is impossible to feel good and be productive during active use and/or opiate withdrawal

65 How To Feel Good And Be Productive During Recovery From Opiate Use And Abuse! It is impossible to feel good and be productive during active opiate use and/ or withdrawal

66 The Only Solution Is 100% Elimination Of Withdrawal

67 The Only Solution Is 100% Elimination Of Withdrawal Currently there are only two ways to eliminate withdrawal symptoms totally:

68 The Only Solution Is 100% Elimination Of Withdrawal Currently there are only two ways to eliminate withdrawal symptoms totally:! Suboxone treatment using the required medication techniques AND proper doses during all phases of treatment, especially the taper phase

69 The Only Solution Is 100% Elimination Of Withdrawal Currently there are only two ways to eliminate withdrawal symptoms totally:! Suboxone treatment using the required medication techniques AND proper doses during all phases of treatment, especially the taper phase! Methadone maintenance, which controls the withdrawal symptoms, does not end use due to the ongoing need for methadone

70 Suboxone Is The Only Option Currently Available To Stop Withdrawal AND Eliminate Opiate Influence

71 Suboxone Is The Only Option Currently Available To Stop Withdrawal AND Eliminate Opiate Influence Methadone Has Problems Because:

72 Suboxone Is The Only Option Currently Available To Stop Withdrawal AND Eliminate Opiate Influence Methadone Has Problems Because:! By virtue of its maintenance approach, methadone maintains some degree of opiate influence 24/7

73 Suboxone Is The Only Option Currently Available To Stop Withdrawal AND Eliminate Opiate Influence Methadone Has Problems Because:! By virtue of its maintenance approach, methadone maintains some degree of opiate influence 24/7! Methadone frequently does not have an exit strategy because of ongoing maintenance

74 Suboxone Is The Only Option Currently Available To Stop Withdrawal AND Eliminate Opiate Influence Methadone Has Problems Because:! By virtue of its maintenance approach, methadone maintains some degree of opiate influence 24/7! Methadone frequently does not have an exit strategy because of ongoing maintenance! When tapered, there is a very high relapse rate

75 Suboxone Fools The Brain Into Acting Like The Changes From Opiate Use Have Totally Healed

76 Suboxone Fools The Brain Into Acting Like The Changes From Opiate Use Have Totally Healed! The patient functions as if they never used opiates

77 Suboxone Fools The Brain Into Acting Like The Changes From Opiate Use Have Totally Healed! The patient functions as if they never used opiates! Opiate induced brain changes are stimulated to heal and revert to the pre-opiate state

78 As The Brain Heals, Less Suboxone Is Needed To Insure Proper Function And No Withdrawal Symptoms

79 As The Brain Heals, Less Suboxone Is Needed To Insure Proper Function And No Withdrawal Symptoms! It is the altered state of the brain that drives opiate withdrawal

80 As The Brain Heals, Less Suboxone Is Needed To Insure Proper Function And No Withdrawal Symptoms! It is the altered state of the brain that drives opiate withdrawal! When the brain has totally recovered from its opiate induced alterations, Suboxone is no longer needed because the withdrawal is over

81 Dr. Russ Suboxone Rule

82 Dr. Russ Suboxone Rule The key to effective Suboxone treatment

83 Dr. Russ Suboxone Rule The key to effective Suboxone treatment! Insure that the Suboxone blood level in the patient is always at the lowest level necessary to insure 100% elimination of withdrawal symptoms 24/7 until the opiate induced brain alterations have 100% healed

84 Dr. Russ Suboxone Rule The key to effective Suboxone treatment! Insure that the Suboxone blood level in the patient is always at the lowest level necessary to insure 100% elimination of withdrawal symptoms 24/7 until the opiate induced brain alterations have 100% healed! This 100% guarantees proper functioning as long as the individual does not ACTIVELY CHOOSE to use opiates

85 Dr. Russ Suboxone Rule Using more Suboxone than the minimum needed causes problems:

86 Dr. Russ Suboxone Rule Using more Suboxone than the minimum needed causes problems:! Generates a mild opiate response than can trigger relapse

87 Dr. Russ Suboxone Rule Using more Suboxone than the minimum needed causes problems:! Generates a mild opiate response than can trigger relapse! Takes energy to fuel the opiate response that could be used for healing

88 Dr. Russ Suboxone Rule Using more Suboxone than the minimum needed causes problems:! Generates a mild opiate response than can trigger relapse! Takes energy to fuel the opiate response that could be used for healing! Inhibits healing because opiates appear to be present, suggesting the need for the brain alteration

89 Ideal Suboxone Blood Level

90 Ideal Suboxone Blood Level

91 Ideal Suboxone Blood Level

92 Low Suboxone Blood Level

93 There Is Life After Opiates!! It Is Wonderful And Available For Everyone

94 For More Information Please Go To monmouthbehavioralmedicine.com Click Resources And Then Addiction Medicine to Call