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A Closer Look: Q&A with Marvin Seppala

marvseppala0409Marvin D. Seppala, MD is Chief Medical Officer at HazeldenHe discussed Hazelden’s new treatment protocol for opioid addiction with us.

Why is opioid use so dangerous?

Those who are addicted to opioids are highly vulnerable, at-risk patients. They are: more likely to leave treatment before it is completed; hypersensitive to physical and emotional pain, putting them at higher risk of relapse; and at higher risk of death from accidental overdose during relapse.  Risk of accidental death from opioid addiction increases after a person withdraws and remains abstinent for a period of time, losing tolerance they had previously established to opioids. If they relapse on an opioid dosage they were accustomed to prior to abstinence, when they were highly tolerant, overdose is a likely result. Breathing might be suppressed, resulting in respiratory arrest and death.

How is Hazelden changing its  treatment program for opioid-dependent patients?

In response to the nation’s epidemic of prescription painkiller addiction and rising death toll from overdose of opioids, Hazelden has enhanced its treatment programming to give its patients the best chances of long-term recovery from opioid addiction. The new programming includes opioid dependent specific groups, lectures and individual therapy, as well as the use of extended, adjunctive medication assisted treatment (MAT). These treatment protocols will focus on engagement over a longer period of time. Therefore, family and recovery community support, along with the use of recovery management interventions that provide significant structure and accountability, will be integral parts of the treatment protocols initiated.

What are some practices Hazelden will use to support medication assisted treatment?

The use of certain medications will only be employed as an adjunct to, and never as a substitute for, our Twelve Step, evidence-based recovery programming. The aim is to engage patients for a long enough period of time to allow them to complete treatment, acquire new information, establish new relationships and become solidly involved in recovery. The goal will always be abstinence.

Anyone who is addicted to opioids and at high risk of relapse could be eligible for these medications. There are some contraindications, such as significant liver or respiratory disease, and these conditions must be carefully assessed.  Before administering these medications, Hazelden will work to ensure that patients will have access to adequate continuing care, including doctors who are licensed to administer these medications, and Twelve Step groups that are receptive to those who are using them.

What is the current evidence related to medication assisted treatment?

Hazelden will be using two medicines.  Naltrexone is an extended-release medication administered through injection once a month that prevents the binding of opioids to receptors in the brain, eliminating the drug’s ability to produce intoxication or reward. It has been shown to improve treatment retention and reduce craving and relapse. Naltrexone has no abuse potential. The other medicine is Buprenorphine/naloxone. Taken on a daily basis, Buprenorphine is a partial opioid agonist that activates opioid receptors just as morphine, oxycodone and heroin do, but not to the same degree. It inhibits craving, reduces relapse to opioid use and improves treatment retention. It is becoming the primary treatment for opioid dependence in the United States. It has been shown to improve self‐help group attendance and to be effective for both youth and adults. Treatment for opioid dependence with both these medications is supported by scientific research and recommended by SAMHSA, NIDA, Washington Circle and the VA.

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