Selected Podcast
Opioid Use Disorder And Medication Assisted Treatement
Dr. Greg Swartzentruber discusses treatment for those suffering from opioid use disorder.
Featuring:
Emergency Medicine Physician and Medical Toxicologist.
Greg Swartzentruber, MD, FACEP
Greg Swartzentruber, MD, FACEP is Medical Director, UPMC Center for Addiction RecoveryEmergency Medicine Physician and Medical Toxicologist.
Transcription:
Host: Help is available, recovery is possible for those with an opioid use disorder. The UPMC's Center for Addiction Recovery is there to help through a multi-care team approach through treatment, recovery, and then ongoing support. So let's learn more about opioid use disorder and treatment options with Dr. Greg Swartzentruber, Medical Director of the UPMC Center for Addiction.
This is Healthier You, the podcast from UPMC in Central Pennsylvania. I'm Bill Klaproth. Dr. Swartzentruber, thank you so much for your time. This is such an important topic, and I'm glad we're talking about this today. So, let me ask you this first off. Why is it so easy for people to get addicted to opioids?
Dr. Greg Swartzentrube: So the pharmacology of opioids lends them to very effectively treating not only physical pain, but emotional pain as well. Americans suffer from chronic loneliness and increasing social isolation. And opioids do a remarkable job at filling that void and covering over and treating the emotional pain that comes along with isolation and loneliness and living alone.
Host: Well, that's really interesting you talked about the emotional aspect of it. When I think of opioids, I think of people treating physical pain, but there's a mental aspect to this as well.
Dr. Greg Swartzentrube: Undoubtedly that's true. And a large number of people first start using opioids following some type of physical injury, so they are treating physical pain. And then for whatever reason, the pain continues and so the opioid use continues. And then at some point along there, the pain may be resolved or improves to the point that opioids aren't required. And at that point, the patient is physically dependent and stopping opioids can be very difficult because of the uncomfortable withdrawal symptoms that follow abrupt discontinuation of them.
Host: So it really is a process then when you have to wean yourself off of opioids, it sounds like.
Dr. Greg Swartzentrube: That's correct. And of course, this depends in part on how long a person's been taking them, the dose they've been using and the particular opioid they've been on.
Host: So as you talk about this, I often wonder when does that happen? When does someone go from a normal user to someone who is addicted?
Dr. Greg Swartzentrube: We just mentioned dependence and withdrawal symptoms. And those two criteria alone are not enough to meet the definition of an addiction. If somebody is taking a medication exactly as prescribed every day, never overtaking or misusing in any way, if they abruptly discontinue that opioid, they will have withdrawal symptoms. But that does not mean the person has a use disorder or an addiction.
The best definition of an addiction that I prefer to use is continued compulsive uncontrollable behavior or substance use in spite of negative consequences. So certainly, the person will feel that they can't stop the medication or they can't stop the substance they're using. But in addition to that, they are using the medication in spite of lots of negative consequences in their life. Maybe that's loss of family or friends, loss of job, failing to fulfill their duties at work, home, or maybe even in spite of severe medical complications such as an overdose or an infection on the arm or hepatitis or some other medical complication, that doesn't stop the substance use. And that's where it becomes an addiction.
Host: So you're making it easy to understand how difficult this is for people to break free when they have an opioid use disorder when they continue to do things in spite of negative consequences. So it sounds like it's not easy for someone to get off opioids by themselves, is that correct?
Dr. Greg Swartzentrube: That's correct. Largely, this is because of the withdrawal symptoms that come along with abrupt discontinuation of opioids. And I generally describe opioid withdrawal syndrome as the worst flu of your life. if you can imagine what it feels like or maybe felt like to have influenza or even a viral illness where you have a fever and your bones and your muscles ache, and have a runny nose and watery eyes, and you're just generally miserable, opioid withdrawal is like that, but probably worse.
Host: Right. And no one wants that. So for people that are struggling with an opioid addiction, thankfully we have places like the UPMC Center for Addiction Recovery. Can you talk to us about how you assess patients and then how you go about treating someone with an opioid addcition.
Dr. Greg Swartzentrube: Certainly. The Center for Addiction Recovery is an outpatient addiction medicine treatment clinic. And we utilize two of the three FDA-approved medications for the treatment of opioid use disorder. And those medications are naltrexone and buprenorphine.
Buprenorphine is the one that we most commonly use. It's a long-acting opioid. It very effectively eliminates the withdrawal symptoms from oxycodone, fentanyl or heroin and also reduces and eliminates the cravings that are a part of opioid use disorder. And then in addition to treating the withdrawal, eliminating the cravings, we also work closely with our mental health colleagues to identify and treat and refer if necessary underlying mental health issues, which frequently go along with substance use.
Sometimes these mental health disorders are caused by the substance use. And sometimes the substance use is the result of an untreated mental health disorder or past trauma. So we try to address both the withdrawal, the cravings and the underlying mental health issues.
Host: So you approach this from many angles then. So it sounds like it's really important to get down to any other underlying conditions or issues that could be causing this, is that right?
Dr. Greg Swartzentrube: That's correct. It's unfair to say all people with an opioid use disorder developed it simply by taking medications that were prescribed to them for pain. because lots of people take opioids following a fracture and they stop when the fracture heals and they never take them again. Some people seem to be particularly vulnerable to the development of an addiction and there's likely genetic and environmental factors that play into that.
Host: Wow. That's really interesting. And I think really important for everyone to understand that. And as you talk about the mental aspects of this, you also can connect people to community-based services as well to help them in their recovery.
Dr. Greg Swartzentrube: Certainly. So we can refer to psychiatry, which is often a barrier for many of our patients. We can refer patients for hepatitis C treatment, primary care. We can give them resources for employment, for housing services in the area, for medical insurance coverage. We try to do as much of the mental health treatment in our clinic as we can just to eliminate the need to go to multiple different appointments at different clinics which is a barrier to recovery for many of our patients where maybe transportation or resources are limited and are barriers. We like to try to address as much of that in our clinic as possible.
Host: Yeah. When it comes to barriers for recovery, sometimes it's things like that. "I just couldn't find transportation to get help." So it's good you cover those things as well. So for someone listening to this, how do they get ahold of you? What is that first step in seeking care at the UPMC Center for Addiction Recovery?
Dr. Greg Swartzentrube: So we can be reached at (717) 782-4781. Someone will answer that call and get you scheduled for an outpatient appointment. If something is needed more urgently, then we can see you in the clinic, we can make arrangements for you to have more urgent treatment received if needed.
Host: (717) 782-4781. Write that number down. Call it if you are struggling with this. And then if we can get your final thoughts, Dr. Swartzentruber, and thank you so much for your time, what is your message to someone suffering from an opioid use disorder and just can't break free?
Dr. Greg Swartzentrube: So I would tell them that help is available and recovery is possible. People are finding recovery all the time. And if they could only see somebody who's been in recovery for five, ten years or more, they would realize that they can do it. And with the right resources in place and the right support along the way, recovery is possible.
Host: I love how you put that. Help is available. Recovery is possible. That's a perfect way to wrap this up. Dr. Swartzentruber, thank you so much for your time. This has really been informative. Thank you so much.
Dr. Greg Swartzentrube: Thank you.
Host: That's Dr. Greg Swartzentruber. And for more information, please call (717) 782-4781 or visit upmc.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, the podcast from UPMC. I'm Bill Klaproth. Thanks for listening.
Host: Help is available, recovery is possible for those with an opioid use disorder. The UPMC's Center for Addiction Recovery is there to help through a multi-care team approach through treatment, recovery, and then ongoing support. So let's learn more about opioid use disorder and treatment options with Dr. Greg Swartzentruber, Medical Director of the UPMC Center for Addiction.
This is Healthier You, the podcast from UPMC in Central Pennsylvania. I'm Bill Klaproth. Dr. Swartzentruber, thank you so much for your time. This is such an important topic, and I'm glad we're talking about this today. So, let me ask you this first off. Why is it so easy for people to get addicted to opioids?
Dr. Greg Swartzentrube: So the pharmacology of opioids lends them to very effectively treating not only physical pain, but emotional pain as well. Americans suffer from chronic loneliness and increasing social isolation. And opioids do a remarkable job at filling that void and covering over and treating the emotional pain that comes along with isolation and loneliness and living alone.
Host: Well, that's really interesting you talked about the emotional aspect of it. When I think of opioids, I think of people treating physical pain, but there's a mental aspect to this as well.
Dr. Greg Swartzentrube: Undoubtedly that's true. And a large number of people first start using opioids following some type of physical injury, so they are treating physical pain. And then for whatever reason, the pain continues and so the opioid use continues. And then at some point along there, the pain may be resolved or improves to the point that opioids aren't required. And at that point, the patient is physically dependent and stopping opioids can be very difficult because of the uncomfortable withdrawal symptoms that follow abrupt discontinuation of them.
Host: So it really is a process then when you have to wean yourself off of opioids, it sounds like.
Dr. Greg Swartzentrube: That's correct. And of course, this depends in part on how long a person's been taking them, the dose they've been using and the particular opioid they've been on.
Host: So as you talk about this, I often wonder when does that happen? When does someone go from a normal user to someone who is addicted?
Dr. Greg Swartzentrube: We just mentioned dependence and withdrawal symptoms. And those two criteria alone are not enough to meet the definition of an addiction. If somebody is taking a medication exactly as prescribed every day, never overtaking or misusing in any way, if they abruptly discontinue that opioid, they will have withdrawal symptoms. But that does not mean the person has a use disorder or an addiction.
The best definition of an addiction that I prefer to use is continued compulsive uncontrollable behavior or substance use in spite of negative consequences. So certainly, the person will feel that they can't stop the medication or they can't stop the substance they're using. But in addition to that, they are using the medication in spite of lots of negative consequences in their life. Maybe that's loss of family or friends, loss of job, failing to fulfill their duties at work, home, or maybe even in spite of severe medical complications such as an overdose or an infection on the arm or hepatitis or some other medical complication, that doesn't stop the substance use. And that's where it becomes an addiction.
Host: So you're making it easy to understand how difficult this is for people to break free when they have an opioid use disorder when they continue to do things in spite of negative consequences. So it sounds like it's not easy for someone to get off opioids by themselves, is that correct?
Dr. Greg Swartzentrube: That's correct. Largely, this is because of the withdrawal symptoms that come along with abrupt discontinuation of opioids. And I generally describe opioid withdrawal syndrome as the worst flu of your life. if you can imagine what it feels like or maybe felt like to have influenza or even a viral illness where you have a fever and your bones and your muscles ache, and have a runny nose and watery eyes, and you're just generally miserable, opioid withdrawal is like that, but probably worse.
Host: Right. And no one wants that. So for people that are struggling with an opioid addiction, thankfully we have places like the UPMC Center for Addiction Recovery. Can you talk to us about how you assess patients and then how you go about treating someone with an opioid addcition.
Dr. Greg Swartzentrube: Certainly. The Center for Addiction Recovery is an outpatient addiction medicine treatment clinic. And we utilize two of the three FDA-approved medications for the treatment of opioid use disorder. And those medications are naltrexone and buprenorphine.
Buprenorphine is the one that we most commonly use. It's a long-acting opioid. It very effectively eliminates the withdrawal symptoms from oxycodone, fentanyl or heroin and also reduces and eliminates the cravings that are a part of opioid use disorder. And then in addition to treating the withdrawal, eliminating the cravings, we also work closely with our mental health colleagues to identify and treat and refer if necessary underlying mental health issues, which frequently go along with substance use.
Sometimes these mental health disorders are caused by the substance use. And sometimes the substance use is the result of an untreated mental health disorder or past trauma. So we try to address both the withdrawal, the cravings and the underlying mental health issues.
Host: So you approach this from many angles then. So it sounds like it's really important to get down to any other underlying conditions or issues that could be causing this, is that right?
Dr. Greg Swartzentrube: That's correct. It's unfair to say all people with an opioid use disorder developed it simply by taking medications that were prescribed to them for pain. because lots of people take opioids following a fracture and they stop when the fracture heals and they never take them again. Some people seem to be particularly vulnerable to the development of an addiction and there's likely genetic and environmental factors that play into that.
Host: Wow. That's really interesting. And I think really important for everyone to understand that. And as you talk about the mental aspects of this, you also can connect people to community-based services as well to help them in their recovery.
Dr. Greg Swartzentrube: Certainly. So we can refer to psychiatry, which is often a barrier for many of our patients. We can refer patients for hepatitis C treatment, primary care. We can give them resources for employment, for housing services in the area, for medical insurance coverage. We try to do as much of the mental health treatment in our clinic as we can just to eliminate the need to go to multiple different appointments at different clinics which is a barrier to recovery for many of our patients where maybe transportation or resources are limited and are barriers. We like to try to address as much of that in our clinic as possible.
Host: Yeah. When it comes to barriers for recovery, sometimes it's things like that. "I just couldn't find transportation to get help." So it's good you cover those things as well. So for someone listening to this, how do they get ahold of you? What is that first step in seeking care at the UPMC Center for Addiction Recovery?
Dr. Greg Swartzentrube: So we can be reached at (717) 782-4781. Someone will answer that call and get you scheduled for an outpatient appointment. If something is needed more urgently, then we can see you in the clinic, we can make arrangements for you to have more urgent treatment received if needed.
Host: (717) 782-4781. Write that number down. Call it if you are struggling with this. And then if we can get your final thoughts, Dr. Swartzentruber, and thank you so much for your time, what is your message to someone suffering from an opioid use disorder and just can't break free?
Dr. Greg Swartzentrube: So I would tell them that help is available and recovery is possible. People are finding recovery all the time. And if they could only see somebody who's been in recovery for five, ten years or more, they would realize that they can do it. And with the right resources in place and the right support along the way, recovery is possible.
Host: I love how you put that. Help is available. Recovery is possible. That's a perfect way to wrap this up. Dr. Swartzentruber, thank you so much for your time. This has really been informative. Thank you so much.
Dr. Greg Swartzentrube: Thank you.
Host: That's Dr. Greg Swartzentruber. And for more information, please call (717) 782-4781 or visit upmc.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, the podcast from UPMC. I'm Bill Klaproth. Thanks for listening.