Assignment: Substance Abuse And Mental Health Services Administration (SAMSHA)

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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.

Expectation:

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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.”

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