Our Response to the Opioid Epidemic

Hazelden Betty Ford Foundation uses medications to engage our opioid dependent patients long enough to allow them to complete treatment and become established in solid Twelve Step recovery.

In 2012, prior to the Hazelden and Betty Ford Center merger, Hazelden launched a new treatment protocol designed to address the grim reality that more people were becoming addicted to opioids and dying from overdose. Of particular concern was the risk that patients whose tolerance decreased during abstinence could relapse and easily overdose just by taking the same doses they used to take.

This protocol—called "Comprehensive Opioid Response with Twelve Steps," or COR-12TM—embraced the latest and best research that indicated certain medications could be used to improve recovery outcomes for people with opioid addiction, and integrated those treatments into our world-class Twelve Step Facilitation model to form the foundation of a unique approach.

The Hazelden Betty Ford Foundation's COR-12 cross-disciplinary team consists of medical, clinical and research professionals whose collective goal is to improve the lives of those suffering from opioid addiction. Our program encompasses the whole spectrum of recovery—from pre-recovery, to recovery initiation, to ongoing and lifelong recovery support services.

The COR-12 treatment path includes group therapy and lectures that focus on opioid addiction as well as two extended medication assistance options - 1) use of buprenorphine/naloxone (Suboxone®) or 2) extended release naltrexone (Vivitrol®) - offered and provided under closely supervised care. Patients also can choose to participate in COR-12 without medication assistance.

"We use medications to engage our opioid dependent patients long enough to allow them to complete treatment and become established in solid Twelve Step recovery," said Chief Medical Officer Marvin D. Seppala, M.D. "Our goal will always be to discontinue the medications as our patients become established in long-term recovery."

Here are some frequently asked questions about Hazelden Betty Ford Foundation's response to the opioid epidemic:

Q: Why has the Hazelden Betty Ford Foundation enhanced its treatment of opioid dependence?

A: Those who are addicted to opioids are highly vulnerable, at-risk patients. They are:
  • More likely to leave addiction treatment before it is completed.
  • Hypersensitive to physical and psychic pain, putting them at higher risk of relapse.
  • 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 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.
 
Q: What is Comprehensive Opioid Response with the Twelve Steps (COR-12) treatment at the Hazelden Betty Ford Foundation?

A: COR-12 is the extended, adjunctive use of medicines—in combination with psychological and psychiatric care, Twelve Step based counseling and other therapies—to increase the potential for those who have the disease of addiction to achieve long-term recovery.

Q: Which medications will the Hazelden Betty Ford Foundation be using, and what are the relative benefits and risks?

A: To assist in abstinence from opioids and to give patients the best chance at long-term recovery, the Hazelden Betty Ford Foundation uses two FDA-approved medicines:

  • Naltrexone. Extended-release naltrexone (which has been used at Hazelden since 2006 for alcohol dependence) is an opioid receptor blocker (opioid antagonist). When used for opioid addiction, it is administered as an injection once a month. It 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.
  • Buprenorphine/naloxone. Buprenorphine/naloxone, taken sublingually on a daily basis, is a partial opioid agonist that activates opioid receptors just as morphine, oxycodone and heroin do, but not to the same degree. It has a very high affinity for opioid receptors, thus preventing the effects of other opioids. Buprenorphine/naloxone 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 youths and adults.

Medication assisted treatment for opioid dependence with naltrexone and buprenorphine/naloxone is supported by scientific research and recommended by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA), National Institute on Drug Abuse (NIDA), Washington Circle (a policy group devoted to improving care for substance use disorders) and the Veterans Administration.

Q: Who should get these medications?

A: Anyone who is addicted to opioids and at high risk of relapse could be eligible for these medications. The decision, however, will always be voluntary and based on individualized medical assessments. There are some contraindications, such as significant liver or respiratory disease, and these conditions must be carefully assessed.

Before administering these medications, the Hazelden Betty Ford Foundation 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.

Q: Does this contradict the Hazelden Betty Ford Foundation's Twelve Step, abstinence-based treatment philosophy?

A: COR-12 will only be employed as an adjunct to, and never as a substitute for, 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 but each individuals treatment plan will be determine based on achieving their best outcomes.

Q: How will the Hazelden Betty Ford Foundation define abstinence for someone on buprenorphine/naloxone?

A: A person who has the disease of addiction and is taking medication under the advice and care of a physician to treat the disease is not unlike a post-surgery patient who is using pain medication: if used as directed and not for the purpose of becoming intoxicated, the medication greatly assists in recovery. We can learn from Overeaters Anonymous (OA) and Sex Addicts Anonymous (SAA) to understand how abstinence is defined when the "drug of no choice" or the addictive behavior cannot be entirely eliminated. Those in recovery in these programs specifically define what foods and behaviors constitute recovery and relapse. They continue to eat and to have sex consistent with defined recovery, but not in the same manner as they had during active addiction. Recovery defined by the establishment of new behaviors in this manner is necessary. We view those working a recovery program while using buprenorphine/naloxone as prescribed as being in recovery, and our goal is abstinence.

Q: What other treatment protocols will the Hazelden Betty Ford Foundation initiate?

A: Other clinical protocols will include opioid dependent specific groups, lectures and individual therapy. Other evidence-based treatment modalities such as mindfulness-based cognitive behavioral therapies, neurobiology of recovery and mental wellness, Twelve Step facilitation, emotion regulation and distress tolerance skills training, interpersonal relational approaches to group therapy, and motivational enhancement. The features of opioid dependence, opioid withdrawal and recovery will be incorporated into all aspects of treatment. 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.

Q: Is the Hazelden Betty Ford Foundation the only Twelve Step based treatment facility to offer buprenorphine/naloxone?

A: The Hazelden Betty Ford Foundation is a leader at utilizing emerging best practices in the treatment and recovery field. The Hazelden Betty Ford Foundation's Butler Center for Research will study the results of these new treatment protocols and will disseminate findings.

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