Opiates: Information and Resources

In recent years, the rising use of opiates in the United States has reached nearly epidemic proportions. According to the Centers for Disease Control and Prevention, in 2016

• 63,600 drug overdose deaths occurred in the United States
• Around 66% of those drug overdose deaths involved an opioid.
• In 2016, the number of overdose deaths involving opioids was 5 times higher than in 1999.
• On average, 115 Americans die every day from an opioid overdose.
As part of our commitment to those we serve, we present the information on these pages to help educate our community and to offer resources for individuals and families struggling with opiate use.

Getting Help

Fortunately, for anyone seeking substance use treatment for themselves or a loved one, there are options available. Howard Center offers multiple recovery supports and services, including outpatient, residential, and medications for opioid use disorder (MOUD). Our medications for opioid use disorder treatment programs are part of the HUB and Spoke model of treatment and provide a high level of care which is regulated by federal guidelines. Through this system, clients receive medication daily and can earn the privilege to take home medication.

To help clarify what some of the terms are that are associated with treatment options, we have included brief descriptions of the most common:

Medications for opioid use disorder include the use of Methadone, buprenorphine and naltrexone. While they all attach to the same receptor sites in the brain as opioids, they work in different ways.

Methadone is an “agonist” medication. This means it binds to the opioid receptor sites in the brain and activates the receptors. It is like turning a dimmer switch fully on. Because methadone is a long lasting medication, people do not experience the “high” of using faster acting opioids.

Buprenorphine is a partial agonist which is like turning the dimmer switch so that the lighting is part way on. This means that there is a maximum, or “ceiling” effect.

Naltrexone is called an antagonist. It binds to the same receptor sites but instead of activating them, or lighting them up to use the dimmer switch metaphor, it turns off the light. This means that any other opioids cannot bind to the receptors. People will have to use large amounts of opioids to get “high.” It is given either orally daily or once a month as a shot in the muscle. It is only appropriate for people who have not taken any opioids in the last 7 days so is often used for people coming out of a residential program, prison, or a hospital setting. It is also effective for people who have an alcohol use disorder.

Once people are stable on their medication they will be able to make behavioral changes that will have a positive impact on their recovery.
Methadone is only prescribed and dispensed in an opiate treatment program (OTP or “hub”) when it is used to treat opioid use disorders, and it may require two months to reach a stable dose.
Buprenorphine is prescribed by physicians in an office-based opioid treatment program (OBOT or “spoke”) as well as being dispensed in OTPs. Forms of buprenorphine include:
• Mono-therapy which contains only buprenorphine, known commercially as Subutex.
• Combo-therapy which contains burprenorphine and naloxone in a 4:1 ratio, commercially known as Suboxone
There are generic versions of both Suboxone and Subutex.

Intensive Outpatient Program

Howard Center’s Intensive Outpatient Program helps individuals who are beginning the recovery process and require an enhanced level of care to achieve or maintain sobriety. The program provides intensive support for anyone who is making the transition from residential or community based treatment or for those who need more than weekly individual and/or group counseling can offer.
Services are provided at two locations:

Burlington: 802-488-6140
St. Albans: 802-524-7265

What are opioids?

Opioids are substances that depress the central nervous system, reduce perception of pain, and in some people, create euphoric effects. The term includes those substances that are derived from opium or those that are produced synthetically.
Many prescribed painkillers are opioids, including methadone, buprenorphine, hydrocodone, and oxycodone. The brand names for some of the more commonly prescribed opioids are Vicodin, OxyContin, Percocet, Kadian, Avinza, and codeine.
Opioids are effective painkillers because they reduce the intensity of pain signals that reach the brain. When taken at low doses, opioids reduce pain without causing intoxication or impairment and may contribute to feelings of joy or contentment.
Heroin, an illegal opioid, is not prescribed to alleviate pain.

What are the side effects associated with opioids?

Although opioids are prescribed legally to reduce pain, they may cause the following side effects:
• Drowsiness
• Mood changes
• Constipation, nausea
• Smaller pupils
• Reduced respiration
• Itching

How are opioids addictive?

When taken for long periods of time, opioids change the way the brain functions. They increase the amount of dopamine–a naturally produced substance present in the brain that signals feelings of well-being. If taken for long periods of time, opiates reduce the brain’s ability to produce dopamine on its own, creating the urge for increased dosages to maintain the feelings of contentment and well-being.
In addition, some individuals do not have as many receptors in the brain for dopamine, and they have a harder time finding pleasure in everyday events and activities. Using a substance that increases dopamine enables them to experience more feelings of pleasure.
Like other substance use disorders, opiate use may affect individuals regardless of age, race, income, or education level. However, there are factors which may put an individual at risk for opiate use. These include:
• Biological disposition
• Genetics
• Psychological depression
• Trauma victimization
• Social influences, such as friends or family
• Social stressors, such as poverty, abuse, and neglect

What is Addiction?

Addiction is characterized by repeated compulsive use of a substance, despite the consequences. Someone is said to have a substance use disorder when:
• They have difficulty controlling how much or how long they use a substance (impaired control)
• They continue to use even though it has negative consequences in their life (risky use).
• Areas of functioning in life are adversely affected (social impairment)

What You Need to Know About Overdoses

If you think somone is experiencing a drug related overdose, contact 911 immediately.
It’s not always easy to tell whether someone is experiencing a drug overdose. However, if you are worried that they are experiencing an overdose, you should
• Stay with the person. Don’t leave them alone.
• Try to keep them awake, and if necessary, help them to walk around.
• Monitor their breathing.

How can I tell if someone is experiencing an overdose?

Overdose symptoms may include:
• inability to speak
• loss of muscle control
• pale or clammy face
• fingernails and lips may turn blue or dark purple (light-skin people) or gray or ash (dark-skin people)
• slow or erratic pulse or heartbeat
• choking or gurgling sounds
• vomiting
• unconscious
• unresponsive to stimulus

Is it possible to reverse an opiate overdose?

Yes, it is possible to reverse an opiate overdose using naloxone. Naloxone, also known as Narcan is an effective opioid overdose reversal drug available as either an injection or nasal spray. It is used to counteract life threatening effects of an overdose that inhibits the nervous and respiratory systems. The drug is only effective if opioids are in the person’s system. Narcan is effective within minutes, but because the effects wear off within 20-90 minutes, it may be necessary to administer more than one dose in a severe overdose incidence.
For individuals in northwestern Vermont, Narcan reversal kits are available through several sources, including Howard Center’s Safe Recovery Program. The program distributes free, anonymous Narcan kits. It also provides education, information, and support throughout the recovery process. For more information, call 802-488-6067.
Howard Center’s Safe Recovery Program was recently featured in a Seven Days article, “Staying Alive: The Highs and Lows of Overdose-reversing Narcan.”
In addition, first responders in Northwest Vermont also carry Narcan overdose reversal kits.
If you live outside Vermont and are looking for other sites that distribute Narcan overdose reversal kits, click here.

More Resources

Still looking for more information? Here are some helpful local, state, and national resources.
Local and State Resources
Friends of Recovery Vermont
Students First Project
Turning Point Center
Vermont Addiction Services
Vermont Department of Health
Vermont Recovery Network
National Resources
Addictions and Recovery
American Society of Addiction Medicine
Centers for Disease Control and Prevention
Harm Reduction Coalition
National Institute on Drug Abuse
National Institutes of HealthMayo Clinic
Hazelden Betty Ford Foundation
Substance Abuse and Mental Health Services Administration

The Hungry Heart
The trailer for filmmaker Bess O’Brien’s documentary, The Hungry Heart, provides an intimate look at the often hidden world of prescription drug addiction through the world of Vermont Pediatrician Fred Holmes who works with patients struggling with this disease.
The Opiate Effect
When Will Gates died from a heroin overdose in 2009, his father, Skip, began a journey to try and educate as many people as possible of the harm in not only the drug, but how we are dealing with the problem. Through the voices of Skip, his son Sam, former opiate abusers, HowardCenter, Senator Leahy, Tristram Coffin, Attorney General Holder and more; we find ourselves amidst reality.

Aren’t medications for opioid use disorder (MOUD), like methadone or buprenorphine (Suboxone), just replacing one drug with another?
When we say someone is addicted, we are describing a pattern of compulsive drug use in spite of negative consequences. Someone who is taking methadone or buprenorphine as prescribed is not engaging in a compulsive pattern of behavior in spite of negative consequences. Instead, they are taking a medication as prescribed because of positive benefits associated with treatment.
People who are addicted to heroin or other opioids are more likely to experience overdose, homelessness, violence, incarceration, termination of parental rights, and health problems like HIV and hepatitis C.
People who are participating in MOUD treatment with methadone or Suboxone are less likely to experience overdose, homelessness, violence, incarceration, termination of parental rights, and health problems like HIV and hepatitis C.
People are not replacing one problem drug with another, they are replacing addiction with recovery.
The scientific research is clear. MOUD with methadone or buprenorphine is the most effective form of treatment for opioid dependence. MOUD save lives and improves lives.

What’s the best way I can help a loved one who is using opiates?

  • First, do no harm. Do not do anything that is likely to increase instability or cause harm.
  • Be informed. Get educated about addiction, treatment and recovery. Obtain information from trusted professionals and websites.
  • Recognize that you can maintain appropriate personal boundaries and actively help your loved one at the same time. Figure out where that balance is for you.
  • Help your loved one identify their treatment options.
  • Help eliminate barriers to treatment, such as transportation. Encourage progress. Provide consistent support.
  • Recovery is a process that takes place over time. For most people, the process includes periods of use/relapse. Take the long view, be consistent in your support, and don’t give up.
  • Be prepared. Get an overdose rescue kit with naloxone and make sure naloxone is readily available in the event of an overdose. Naloxone is a nasal spray used to reverse an opioid overdose in progress.

Do insurance companies pay for medications for opioid use disorder?
Treatment is often covered by insurance. Talk to your treatment provider to learn more and to find out about options available to people who do not have insurance coverage.

What is the Good Samaritan law and how does it apply to people who may experience a drug overdose?
In Vermont, the Good Samaritan law provides limited immunity from prosecution under state criminal laws to those who seek help in the event of an overdose on alcohol or other drugs. The law prioritizes getting help for someone who is overdosing, and seeks to encourage those present at an overdose to call for help.

In the event of an overdose, if someone calls for help, then the person overdosing, the person calling, and anyone else who is helping cannot be arrested or prosecuted for violation of any drug crime, including possession of any amount, sale of any amount, or delivery of any amount–even if a death results. They cannot be arrested or prosecuted for providing alcohol to a minor. They are protected from violation of probation, FSU/furlough, or conditions of release. They are also protected from violation of a restraining order.