*Adapted from information provided by Reckitt-Benckiser, manufacturer of SUBOXONE® (buprenorphine HCl/naloxone HCl dihydrate) sublingual tablet

Opioid dependence is a disease in which there are biological or physical, psychological, and social changes. Some of the physical changes include the need for increasing amounts of an opioid to produce the same effect, symptoms of withdrawal, feelings of craving, and changes in sleep patterns. Psychological components of opioid dependence include a reliance on heroin or other drugs to help you cope with everyday problems or the inability to feel good or celebrate without using heroin or opioids. The social components of opioid dependence include less frequent contact with important people in your life, and an inability to participate in important events due to drug use. In extreme cases, there may even be criminal and legal implications 

The hallmarks of opioid dependence are the continued use of drugs despite their negative affect, the need for increasing amounts of opioids to have the same effect and the development of withdrawal symptoms upon cessation.

There are a variety of factors that can contribute to the continued use of opioids. Among these are the use of heroin to escape from or cope with problems, the need to use increasing amounts of heroin to achieve the same effect, and the need for a “high.”


Treatment for opioid dependence is best considered a long-term process.

Recovery from opioid dependence is not an easy or painless process, as it involves changes in drug use and lifestyle, such as adopting new coping skills. Recovery can involve hard work, commitment, discipline, and a willingness to examine the effects of opioid dependence on your life. At first, it isn’t unusual to feel impatient, angry, or frustrated.

The changes you need to make will depend on how opioid dependence has specifically affected your life. The following are some of the common areas of change to think about when developing your specific recovery plan:

Physical – good nutrition, exercise, sleep, and relaxation.

Emotional – learning to cope with feelings, problems, stresses and negative thinking without relying on opioids.

Social – developing relationships with sober people, learning to resist pressures from others to use or misuse substances, and developing healthy social and leisure interests to occupy your time and give you a sense of satisfaction and pleasure.

Family – examining the impact opioid dependence has had on your family, encouraging them to get involved in your treatment, mending relationships with family members, and working hard to have mutually satisfying relationships with family members.

Spiritual – learning to listen to your inner voice for support and strength, and using that voice to guide you in developing a renewed sense of purpose and meaning.

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My First Blog Post

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Be yourself; Everyone else is already taken.

— Oscar Wilde.

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An OUD news story


Mental Health and Addictions

As most of us realize by now, addiction, being a brain disorder of re-wired neural connections which predispose to “addictive behavior”, is a mental health issue. As a mental health disorder/issue, it is interwoven with our underlying mental state or health whether or not we have (or think we don’t have) other documented mental health maladies or diagnoses.

Here’s a blog(re)post from the folks at Grammarly, whose employees are just like us. They present some helpful tips on how to safeguard our mental health in these challenging times.

How Grammarly Team Members Look After Their Mental Health

GrammarlyUpdated on
May 27, 2020COMPANYHow Grammarly Team Members Look After Their Mental Health

Good mental health is not one-size-fits-all—every person needs to approach the subject in their own way and find the methods that work for them. Right now, when life around the world has been dramatically altered due to the pandemic, these methods seem even more crucial to consider closely. 

As Mental Health Awareness Month draws to a close, we thought we’d speak to a few Grammarly team members about their own views and practices. What do they do to make sure they are supporting their own mental wellness?

Defining mental health for themselves

Members of the Grammarly team come from many different backgrounds and have had a diverse set of experiences—so it’s only fitting each person we spoke to should offer a unique personal definition of mental health.

Finding a balance

“Mental health means finding the right balance in life and staying calm even when dealing with obstacles,” says Katia Chystiakova, a member of our Communications team. 

Jessica Mordo, who works on our Content Marketing team, also seeks “equanimity in the face of challenges.” She points to a particular difficulty in achieving that needed balance: “Stress might express itself physically rather than emotionally or mentally (feelings can be sneaky!), so it’s about noticing the signals and taking a time-out to alleviate them.” 

Inner peace, individually 

For Christina Khrapach, a member of our Support team, mental health requires an “inner sense of calm, first and foremost.” It’s important, too, that this calm is truly felt and not just projected outwardly: “Some people may feel extremely stressed out and do not show it, but that doesn’t necessarily indicate good mental health.” 

Alignment is also important to Iaroslav Karkunov, an engineer on our Core Language team. Mental health “feels like integrity,” he says. It requires you “to be in sync with your body and the world around you.”

Self-care in order to care for others

For Laura Rue, who oversees Grammarly’s internal communications, a major aspect of good mental health is “respecting my needs and boundaries so I can give to others.” For her work, which is often deeply interpersonal, creating healthy boundaries helps her “hold non-judgmental space to explore and work through challenging emotions.” 

Denys Kulyk, a product manager, also likes to be sure that he is at his interactive best. He believes that when his “mental clarity” is low, he is “hesitant to move forward” and fears missing out on essential details. But having better mental wellness means feeling more like himself: “personally more engaged and proactive.” 

Maintaining a practice that works

From definitions flow action: the tactics that will help one find balance and practice self-care. There are untold resources and methods to achieve this—here are some that Grammarly team members find useful for themselves. 

Mindfulness and meditation

“When you wash the cup, think about the cup.” That’s advice Liza Skryabina received from her therapist for concentrating on the present moment. “What do you like about it? How do you feel?” Liza, who coordinates events for our Kyiv office, also likes an exercise that asks her to look at a lamp, jacket, or other object and then appreciate at least three characteristics—shape, color, material, or anything else. “This helps me find beauty in small details,” she says.

Iaroslav meditates, too. He first created his own mediation practice from instinct while stressed out at his first job. Since then he has studied various methods and now meditates every day. He likes to start with body-scan meditation, then tries to remember something “lovely or warm” and concentrate at the feeling it induces. When something distracts—noise, itching, pain, thoughts, emotions—he tries to relax it mentally and return to the warm feeling.

Seeking counsel and support

Beyond meditation, Iaroslav also values psychotherapy, which he thinks of as an “exercise for reflection.” Consulting with someone else took some getting used to. “I thought that I could do everything by myself,” he admits. “But now I believe that is not true. Other people can show you something about yourself that you’ve been ignorant about for a long time.”

The value of a good support system is something Julie Long, who works on our Lifecycle Marketing team, believes in strongly. “In a world where mental health isn’t understood or a transparent subject,” she says, “it’s been really important to have confidantes who can truly empathize with my experience.” 

Her inner circle helped her explore various tactics to lessen her anxiety. She tried meditation, yoga, changing her diet, massage, and cross-country running—but didn’t find relief. “For me, these modalities alone won’t keep me well,” she says. “Connecting with the right doctor and receiving medication has been a game-changer for my quality of life. I have no shame in sharing that and believe it’s important we destigmatize treatment.”

Getting some device-free space 

Denys appreciates the advice he has learned from the classic self-care book Managing Your Mind, by Tony Hope, Gillian Butler, and Nick Grey. He has taken many useful practices from it, including finding healthy distance from a screen. “As with many people who work with technology,” he says, “I find it necessary to have an analog hobby, such as cooking, drawing, or putting together puzzles.” 

In a similar spirit, Jessica likes walking meditations to clear her mind after being still all day. “I take a walk around the block (leaving the phone behind is important) and tune into my movements and the sensations I experience internally and externally,” she says.  “Lately I’ve been delighting in hearing all the birdsong in my urban neighborhood on these walks; it’s extremely soothing and uplifting.”

Channeling energy

In less socially distant times, Christina liked to focus her energy into physical activity. “After all,” she says, “being an office worker does take its toll at some point.” She started doing TRX training (a form of suspension training) and then progressed to lifting weights. “Persistent feelings of anxiety, anger, and irritation” all “dissipate after my workout sessions.”

But without access to a gym during the pandemic, she is finding new ways to apply her energy: by revisiting favorite philosophy books from her student days and recording podcasts. “Focusing on that has helped me route my thoughts to something other than my worries, and that positive distraction has been a tremendous help,” she says.

Making goals and allowing for change

While everyone has their own methods for managing mental health, there is something each person shares: the understanding that things change. All team members expressed the need to appreciate how mental wellness needs to be considered moment by moment, day by day.

These things take time

“I remember having my first panic attack during the summer before freshman year of high school,” Julie says. “Since then, managing my anxiety disorder has become a prominent part of my daily life, and I know it’ll continue to be a lifelong, evolving journey.” This evolution is a natural part of the process, Laura believes: “Over time, you learn what truly supports your well-being and what doesn’t.” 

Figuring out what works often takes the form of developing new habits—a process Denys enjoys. “I don’t feel like I even have to practice them for too long before I see some major change,” he says.

For Christina, however, creating healthy new habits requires clearing away old ones that have stopped working. When she felt sad or anxious in the past, she would listen to music and let herself “succumb to the feelings I was feeling to let them take over and pass.” But when that started making her feel worse instead of better, she realized that she needed to be more proactive. “I think that I benefit more from pushing myself,” she says. 

Forming habits is also important for Michelle Geng, who works in business operations—but so is keeping these habits manageable. Trying to do too much can be counterproductive, creating additional stress. “I’m okay if I don’t do all of it every week,” she says, “as long as I have the intention to do the most that I can.”

Learning to appreciate this moment

Liza likes to affirm that finding a healthy balance for one’s mental health isn’t something to put off for tomorrow. “I am someone who tends to think that true happiness will come later, after some of my goals and dreams are realized,” she says. “But the reality is different. If you cannot enjoy your life right now, you won’t enjoy it in the future either.”

That’s not to say all Grammarly team members know exactly what is most effective for them. Developing new attitudes takes work and time, according to Katia. “I’m still in the learning phase,” she admits. 

So what does she do while still figuring out what works for her? She tries to pay attention to herself. “Sometimes, the rhythm of life and work makes you forget that you are not a robot,” she says. “You need a break, or to change what you’re doing.”

And if you can create some space for yourself every once in a while, Katia believes, you might find something surprising about what was concerning you: “Maybe it was not worth your worries at all.”

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Dr. Brad

Reach me at: pcmed07-gen@yahoo.com or drbrad@methadonetreatmentblog.com

Shared post: “As coronavirus rages on, the opioid epidemic does too”


As fears of COVID-19 sweep across the United States, many people have been forced to stay home and isolate for months. Away from jobs, friends and many loved ones, this quarantine has proven mentally challenging for everyone. And for those […]

As coronavirus rages on, the opioid epidemic does too — CHET DAY

Shared post: “Good News: The Federal Government Just Made it A Whole Lot Easier to Access Opioid Addiction Treatment” — Les Vraies Infos

Good News: The Federal Government Just Made It a Whole Lot Easier to Access Opioid Addiction Treatment

Good News: The Federal Government Just Made it A Whole Lot Easier to Access Opioid Addiction Treatment — Les Vraies Infos

Shared post: “What It’s Like to Be on Methadone During a Pandemic”

What It’s Like to Be on Methadone During a Pandemic #Addiction https://t.co/nG8s2QrZ5y — New Horizon (@RehabNewHorizon) April 22, 2020 https://platform.twitter.com/widgets.js Source: @RehabNewHorizon April 22, 2020 at 12:46AM More information New Horizon Drug Rehab

What It’s Like to Be on Methadone During a Pandemic https://t.co/nG8s2QrZ5y — New Horizon Drug Rehab



The First Stage: Intake

At this preliminary stage you will be given a comprehensive substance use disorder/dependence assessment, as well as an evaluation of mental status and physical exam. The pros and cons of the treatment medication chosen will be presented. For opioid agonist treatment (OAT), opioid (“agonist”) medications are used. It will be either Methadone or a Buprenorphine product.  These have an opiate effect similar to that of the opioids to which you have become psychologically dependent. Treatment expectations, compliance, as well as commonly occurring issues involved with maintenance treatment and medically supervised withdrawal (“detox”), will be discussed.

The Second Stage: Induction

Now begins the actual process of being switched from your current “street” opioid (heroin, or prescription painkillers) on to the treatment opioid medication. At the time of induction, you will be asked to provide a urine sample to confirm the presence of opioids and possibly other drugs. You should arrive to your first visit experiencing mild to moderate opioid withdrawal symptoms, that way you’ll be suitable to begin taking the treatment medication during this visit. Arrangements will be made for you to receive your first dose in a clinic or your doctor’s office, or in certain cases at home. Your response to the initial dose is usually directly monitored. In some cases you may receive additional medication, if necessary, to reduce severe withdrawal symptoms.  

Since an individual’s tolerances and reactions to the treatment opioid varies, initially daily appointments may be scheduled and the medication adjusted until you no longer experience withdrawal symptoms or cravings. In the clinic setting (methadone), daily dosing appointments are usual and mandatory initially. Urine drug screening is typically required for all patients/clients initially and then randomly once each month.

Intake and Induction usually occurs at the first visit, but not always.

The Third Stage: Stabilization

Once the appropriate dose of treatment medication is established, and you are beginning to feel well throughout the 24-hour dosing interval (period following dosing), you will stay at this dose while stable blood levels of the treatment medication is attained. You and your doctor will discuss your treatment options from this point forward and you will begin to work on your individualized therapeutic treatment plan goals with counselors and therapists.

The Fourth Stage: Maintenance

Treatment adherence, compliance and progress will be monitored. Participation in some form of behavioral counseling is strongly recommended to ensure the best chance of treatment success and long-term sobriety. You are likely to have scheduled office appointments on a weekly or monthly basis. If treatment progress is good and goals are met, office/clinic visits may become less frequent. For clinic patients, by this time you may have become eligible to receive “take-home” doses to self-administer, so that you won’t be coming to the clinic on a daily basis.

The Fifth Stage: Medically supervised withdrawal (MSW) or detox from treatment med

As your treatment progresses, you and your doctor/treatment team may eventually decide that medically supervised withdrawal is now appropriate. In this phase, your doctor will gradually taper your treatment medication dose over time, taking care to see that you do not experience any withdrawal symptoms or cravings. This should be a slow and gradual process taking weeks, to months, to years for some. However long that you think that it may take you, double it, and that will probably be a more realistic time frame! The reason is that your body has become physically, physiologically dependent on the treatment opioid medication to function normally and so it has to be slowly trained to function on less and less of that opioid, which is a slow process.

Aftercare: Medical options

Medication assistance can be continued (indefinitely) after OAT has concluded. This is usually in the form of opioid antagonist therapy using Naltrexone, orally, daily, or by once-monthly injections. This medication is an opioid-blocker, not an opioid, and is not habit-forming/addictive. It blunts the effects of ingesting or using opioids and is successful in preventing relapses to a significant degree.

Another medication that should be in the possession of all recovering opioid dependent persons is Naloxone. Naloxone, like Naltrexone is an opioid-antagonist (opioid-blocker) but it has a very short duration of action and so is used only in emergency scenarios to reverse life-threatening opioid overdoses.

New, long-acting opioid-agonist Buprenorphine products (Probuphine, Subclocade) are now available which allow once monthly administration by injection (subcutaneous implantation).

After you complete MAT, if you feel that a relapse is eminent returning to some form of low-dose MAT is a preferable option to relapse. Addiction has no cure and is a chronic, relapsing, brain disorder. As such, the risk of relapse is never zero and so it is always a possibility, that is why one’s sobriety cannot be taken for granted and recovery has to become a lifestyle that is constantly being supported. Periodically having to return to MAT is not a bad thing, relapse is.

I hope you found this article informative!

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FAQ: What is rapid Opioid tapering? What’s the big deal about quitting opioid use anyway?; why can’t they just stop!?

The mountain to be climbed

“Rapid” tapering could mean anything from hours to months. Extremely fast tapering (over (an) hour(s)) is called “ultrarapid” and involves immediate abstinence+general anesthesia/sedation (going to sleep) for treating the ensuing withdrawal symptoms-an hour(s) long process.

Otherwise, “rapid” tapering, might also refer to what’s popularly referred to as “detox(ing)”.  This type of rapid tapering usually occurs over a period of days, like over a weekend, or up to (a few) week(s). Any means of stopping “cold turkey” (abruptly) might be considered “rapid” tapering. That’s an extreme case and so you might not even consider that as a taper. The common feature among all these methods of “rapid tapering” is that it’s accompanied by physical and mental pain. So much so that not too many sufferers of this opioid withdrawal or abstinence syndrome can tolerate it without reverting to using again, just to ameliorate the malaise. It is described as a severe flu-like condition manifested by symptoms such as sweating, nausea, diarrhea, runny nose, yawning, abdominal pain and cramping, restlessness, muscle aches and pain, and the almost irresistible urge to use an opiate. The worst part being that it lasts for days.

A more gradual decrease in the use of the opioid, over a period of days, is more recommendable as a rapid tapering regime and it’s probably what most practitioners would consider as “rapid tapering”.

Depending on how short your “short term use” is, tapering may not even be necessary. Tapering is only necessary/recommended if an intolerable abstinence syndrome (withdrawal) develops after discontinuing opioid use and this is a sign that your body has/had become opioid-dependent. 


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MMT in the Pandemic Era

Photo by Engin Akyurt on Pexels.com

My perspective:

It’s impossible to minimize the disruptiveness and pandemonium created by an event such as a global pandemic but the impact of any disaster, natural or man-made on one’s sobriety and recovery is pretty much similar. Potentially, it’s an existential threat (no sobriety, no life) that one must (at least in part or to some degree) be preparing for (in good times), then weathered in the moment with as much equanimity as one can muster, through strong adherence to core principles of good recovery, higher power, one’s health care team, recovery community and network, family, friends and governmental assistance. And with a  concomitant overriding attitude of flexibility, forgiveness, and patience. Much easier said than done but I think that that is the proper perspective to strive for.

“Success” in this, which could literally mean survival requires pre-emptive consideration of some of life’s nasty vicissitudes and anticipatorily building in/planning/incorporating some resiliency and extra capacity/potential into all dimensions of our lives, in preparation for the proverbial “rainy day”. How that looks or is achieved is different for each individual.  People at various stages in life and recovery have varying resources, family sizes, responsibilities, etc, etc, but everyone must prepare for that proverbial ‘rainy day” ,however and in what ways they can, wherever they are on life’s spectrum. Just thinking about the “what ifs” is a great start!

If that can be followed by some concrete actions then that person is well on their way to becoming/having a less fragile lifestyle, one less susceptible to upheaval and disruption. That said, this is not an easy thing to accomplish or even address. It requires sustained focus and commitment, afterall when there’s no impending dangers so many other things demand our attentions.

Just as recovery covers a multitude of dimensions, resiliency, hardening, inserting protective elements into one’s lifestyle involves considering multiple domains, if we are to be considered even somewhat ready to weather adversity successfully. The impact of adversity is never completely compartmentalized, as we’re experiencing now as a public health disaster creates a financial one. That said, I don’t think anyone can be completely prepared for any eventuality. The goal is to consider it and take at least baby steps towards mitigating the most damaging sequelae on our personal and family lives.

Photo by CDC on Pexels.com

What might this look like for someone in Recovery or MMT?

-Things to do during “normal” times:

  1. Know your Dr/Clinic’s emergency protocols and plans
  2. Line-up alternative modes of transport to the clinic
  3. Establish an Emergency Fund for Clinic charges and  financial emergencies
  4. Try to earn “Take Home” doses privileges asap or inquire about a 90-day supply of medication
  5. Maintain your recovery network
  6. Develop healthy habits: these will guide and sustain you in stressful times.
  7. Burn all bridges to/disassociate from the drug culture

Clinic-related things to do during “disasters”:

  1. Check-in with the Clinic or your counselor or the website. Get informed of any changes, new rules. Inform them of any new changes with you
  2. Maintain your schedule as much as possible.
  3. Be patient and follow the new rules. Change can be difficult but realize that it’s being implemented for a greater good, not just to irritate you or make your life more difficult.

Photo by Edward Jenner on Pexels.com

Here’s some advice from Dr. Nora Volkow of the NIH:

I hope you found this informative. For any questions please email me. 

Dr. Brad




Prescription Digital Therapy for Opioid Use Disorder

reSET and reSET-O are the first ever FDA-authorized prescription digital therapeutics (PDTs) for Substance use disorder (SUD) and Opioid use disorder (OUD)

ReSET and reSET O are the first, and only, FDA-authorized Prescription Digital Treatments (PDTs).

PDTs, are software-based (digital) disease treatments, such as a smartphone or computer app. PDTs are designed to directly treat disease, tested for safety and efficacy in randomized clinical trials, evaluated by the FDA, and prescribed by healthcare providers.

PDTs are designed and tested much like traditional prescription drugs with one distinction: rather than swallowing a pill or taking an injection, patients are treated with software. patients with substance use disorder (SUD) and opioid use disorder (OUD) with 24/7 access to evidence-based behavioral techniques, such as cognitive-behavioral therapy and fluency training. 2,3 

reSET® and reSET-O® are for patients 18 and older in outpatient treatment under the supervision of a clinician.

These PDTs are adjunctive therapies that have been proven in clinical studies to be effective in helping patients with SUD and OUD. 1,4 

(Providers, please see the Clinician Brief Summary Instructions for reSET and reSET-O.) 


reSET: The first-ever FDA-authorized prescription digital therapeutic for SUD:

· Adding reSET to outpatient therapy significantly improved abstinence and retention in the treatment of patients with SUD in a 12-week study. 2

· The Clinician Dashboard (to be used by the prescribing professional), provides an analysis of patients’ progress, giving the clinician more insight into their patients’ behaviors between in-person visits.2

· Interactive treatment modules deliver cognitive behavioral therapy and fluency training to reinforce proficiency.2

· reSET is for English speaking patients only. reSET is not intended as a stand-alone treatment and does not replace care by a licensed medical practitioner. 

reSET-O: The first ever FDA-authorized prescription digital therapeutic for OUD

· Adding reSET-O to outpatient treatment using buprenorphine increased retention in the treatment of patients with OUD in a 12-week study. 3

· The Clinician Dashboard shows patient-reported buprenorphine adherence, giving the clinician more insight into their patients’ behaviors between in-person visits.3

· Interactive treatment modules deliver cognitive behavioral therapy and fluency training to reinforce proficiency.3

· reSET-O is for English speaking patients only. reSET-O is not intended to be used as a stand-alone therapy for OUD and does not replace care by a licensed medical practitioner. Do not report emergency information via reSET-O.  

Link to site!:           RESETFORRECOVERY.COM

References: 1. Campbell ANC, Nunes E V, Matthews AG, et al. Internet-delivered treatment for substance abuse: a multisite randomized controlled trial. Am J Psychiatry. 2014;171(6):683-690.doi:10.1176/appi.ajp.2014.13081055 2. reSET Clinician directions for use (LBL001.G – 2019-06-20). Pear Therapeutics, Inc; 2019. 3. reSET-O Clinician directions for use (LBL017.B – 2019-06-20). Pear Therapeutics, Inc.; 2019. 4. Christensen DR, Landes RD, Jackson L, et al. Adding an internet-delivered treatment to an efficacious treatment package for opioid dependence. J Consult Clin Psychol. 2014;82(6):964-972.

** Information provided by Pear Therapeutics, developer of these new, innovative medical products.

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