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This is a transcript of a recent radio interview Dr Schiesser Performed with Dr Marvin Seppela, relating to the treatment of addictions, specifically opiate dependence and alcohol.

Dr. Michael Schiesser: Good morning, and welcome to Health Dimensions. This is Dr. Michael Schiesser, on AM KPTK in Seattle. This morning we are talking about addiction and addiction to opiates. And these are prescription painkillers, as well as heroin.

 

And we have an addition specialist, Dr. Marvin Seppala, from Beaverton, Oregon who is the Medical Director of Beyond Addiction. And Dr. Seppala is a graduate of the Mayo Medical School, and has completed a psychiatry and addiction medicine fellowship sometime ago, and has been working in the field of addiction medicine for awhile down there in Oregon. Dr. Seppala, welcome to the show.

 

Dr. Marvin Seppala: Thank you very much, Michael.

 

Dr. Schiesser: And tell me a little bit about the kinds of people that you work with and the types of problems that they have with addiction.

 

Dr. Seppala: I work with people who have almost any kind of addiction--drug and alcohol addiction. And right now, in our program, there seems to be a split between those who are alcoholic and those who are using the oral opioids--the Vicodin, OxyContin, and the like.

 

Dr. Schiesser: And, are you seeing that that type of a problem with people being addicted to prescription pain medications is increasing? That's what I've seen. What's your perspective having doing this for awhile?

 

Dr. Seppala: Yeah, I see a dramatic increase in use of prescription pain medications, especially since the mid-90s, partially because of the release of OxyContin at that point. And the way it was marketed directly to primary care physicians, rather than just to pain specialists, which was the case prior to that. And an emphasis in the U.S. on the use of prescription pain medication in the treatment of pain, which was absolutely worth while.

 

I think we had gotten to a point in medicine where we were not adequately addressing pain. And the emphasis on dealing with pain was appropriate. And I think we've now kind of swung to the other extreme.

 

And, in some ways, I compare it to the 1800s when there was no real limits on the use of prescription pain medications in the United States. And there was basically an epidemic of drug addiction associated with those medications.

 

Dr. Schiesser: Is that right? That's quite interesting. I don't think I've really tuned my brain into sort of the history of opiate use prior to the 19th century, but can you talk a little bit more about that era in the 1800s, and what was the supply and use was?

 

Dr. Seppala: Sure. It was primarily in the form of snake oil and other remedies that were being sold. And the two prominent groups that were addicted to these medications, all based on opium, and opium is what was imported, primary from the Far East to the United States. And it was legal to bring it in. There was no laws associated with it.

 

Dr. Schiesser: It's kind of like Starbucks.

 

Dr. Seppala: [laughs] Yes. And the two primary groups were fairly well off women and physicians. Those were the two groups to get really into trouble with addiction to opium at that time in our history.

 

And there was a national debate because the states were supposed to monitor prescribing and have all the laws associated with prescribing. And nationally they didn't feel they could place limitations on it. But the problem became so extreme that there were attempts to do so. And it started with Supreme Court decisions rather than law making to limit the importation of the opium.

 

Dr. Schiesser: You referred to the problems, but what were the problems?

 

Dr. Seppala: Well, they started to see increasing addiction associated with these substances, and an increasing deterioration in peoples' lives as a result, and overdose.

 

Dr. Schiesser: So, not unlike what we see today?

 

Dr. Seppala: Yeah.

 

Dr. Schiesser: Yeah.

 

Dr. Seppala: Exactly the same. And I look at it as though there was very little in the way of any kind of limitation of the use of those substances then. And there's been a distinct reduction in limitation now in that there's a lot more prescribing of pain medication.

 

And with the increase in prescribing there's an increase in problems. We've seen that in an increased number of emergency room admissions from people that have problems related to these medications, increase in treatment center admissions associated with the use these medications, and an increase in the death rate associated with these medications. So, all the indicators of problems now arising.

 

Dr. Schiesser: And, how does one go about identifying themselves as having a problem? I mean, what does it really look like?

 

Dr. Seppala: Well, it's a little bit difficult, primarily because anyone who uses the opioid pain medications, which would include OxyContin, Vicodin, Hydrocodone, Oxycodone--those sorts of things--Morphine. Anyone that uses them will develop tolerance to them very rapidly. So if someone had surgery and they take these for a week, they're lucky that the pain is improving during that same week, because the medicine's ability to deal with that pain is diminishing during that week.

 

But if someone, after surgery, has a wound infection or something, and pain recurs to an extreme degree, they have to increase the medicine, because the initial dose that would have taken care of even worse pain is no longer going to work as well. Tolerance has developed. And anyone who's taken these medicines for more than a couple weeks will experience some form of withdrawal when they stop it.

 

Dr. Schiesser: If you're just turning in, I'm talking to Marvin Seppala. He's the medical director of Beyond Addiction in Beaverton, Oregon. I also want to orient people to the Turn to Help website. We're talking about addiction today, and specifically addiction to prescription pain medications as well as street opiates like heroin. Dr. Seppala, can you tell us a little bit about how treatment has changed over time, especially in the last ten years?

 

Dr. Seppala: The treatment in general has changed in that there's been a remarkable emphasis on research that's proven treatment methods. And that's been helpful. There's been an incorporation of the foundation of treatment based on 12-step programs, but also using formal therapies, cognitive behavioral therapies as well as interpersonal therapies and motivation enhancement therapies.

 

But also, especially, for the treatment of the opiate pain medication, the use of other medications. Methadone historically was used to address heroin addiction, and it is used to some degree to address these prescription pain medications. But more recently, buprenorphine has been released and has been used as a maintenance treatment to help people end the use of illicit substances like heroin as well as prescribed pain medications.

 

Dr. Schiesser: Can you talk a little bit more about the differences in those? You mentioned methadone, and you also mentioned buprenorphine, which is Suboxone. Can you talk a little bit more about what people would experience with those medications?

 

Dr. Seppala: Well, they both would basically do the same thing. If you get methadone, one has to go to a methadone clinic, and buprenorphine, or Suboxone, can be prescribed in the privacy of a physician's office. There's a remarkable difference there. But the medicines themselves are both opioids and they provide a replacement therapy for someone using heroin.

 

Let's say they're using it every three or four hours. They could take methadone once a day or buprenorphine once a day and eliminate the need for that opioid and develop a tolerance to the new medication rather rapidly and not get a high from it, and have relief of the craving for the drug. It will allow them to lead a fairly normal life without this ongoing need to address their addiction.

 

Dr. Schiesser: Isn't that sort of like substituting one dependence for another?

 

Dr. Seppala: Well, it's often seen that way, but from a medical perspective, what we see is a rapid stabilization that people go through from a physiological perspective, in that they no longer have this craving. They don't go in and out of withdrawal, and they don't need to keep addressing the high and the intoxication of addiction.

 

But also from a sociological perspective, they get out of this ongoing need to find more money that would get them more drugs. In the case of, especially, heroin addicts, they can break out of the cycle of illegal activities that can be associated with the need to continue to buy this expensive drug. And for those who are using prescribed pain medications, they can stop going to five or six physicians to try and continue getting their supplies, or get off the Internet, where they often buy these medications.

 

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Dr. Schiesser: You've been listening to Dr. Marvin Seppala, and I want to remind listeners to look at the Turn to Help website. This is Dr. Michael Schiesser on Health Dimensions, and 1090 KPTK in Seattle. We're going to take a short break and come back and listen to more conversation with Dr. Marvin Seppala.

 

For more information on addictions, go to www.turntohelp.com. Turn to Help has resources for people with addictions.