Dr. Kittay is certified and federally licensed in the field of Addiction Medicine. What is Addiction? Addiction is defined as a behavioral syndrome characterized by the repeated, compulsive seeking (psychological dependence) or use of a substance despite adverse social, psychological, and/or physical consequences, along with the physical need for an increased amount of a substance as time goes on to achieve the same desired effect.   To understand fully you must be aware of the difference between tolerance, physical dependence, and addiction. As a person takes opioids for an extended period of time, they become less sensitive to it and require more to achieve the same effect. Receptors in the brain become less sensitive. This means they need more and more opioid to achieve the same effect. This is called tolerance. When the body can no longer make enough natural opioids to satisfy the less sensitive receptors, the body becomes dependent on the external source. This is physical dependence.  "Physical Dependence" is a physiological state of adaptation to a substance, the absence of which produces symptoms and signs of withdrawal. It is possible to be physically dependent on a drug without being addicted to it. Physical dependence is the result of physical changes in the brain. It is not a matter of willpower rather it is actual physiology. Definition:  Opiate Addiction Opioid dependence depends on usage level and duration. The first phase is developing tolerance, which means a higher dose must be taken to obtain the same effect. This can happen whether the treatment is legal and necessary or is the result of illegal abuse. Along with tolerance, a person is said to be dependent on opiates when not taking them results in adverse effects (not related to the original condition). Addiction includes the above as well as cravings for the drug. Addiction adds a psychological and social element to the mere physical facts of tolerance and dependence. Because of this, addiction is a more serious erosion of normal life – the drug becomes not just an escape, but a main driver of daily routine. Definition:  Opioids Opioids are a class of drugs derived from the opium poppy. They are primarily used as analgesics which means pain relief. Along with the pain relief, most opiates give a feeling of euphoria and a degree of sedation. These side effects are what make them popular as drugs of abuse.  Other effects are cough suppression and constipation. Along with drugs derived directly from the opium poppy, the term Opioid has come to refer to other, synthetic pain medications that act on the same receptors in the body and cause many of the same effects. While not strictly accurate, synthetic and semi-synthetic drugs will sometimes be referred to as opiates. They are more properly called narcotics, from the root narko, meaning sleep, numbness, or stupor. True Opiates:             Morphine, Codeine Semi-synthetics:        Hydrocodone (Vicodin), Oxycodone (Percocet), Heroin True Synthetics:         Fentanyl, Methadone Opioids are divided into classes based on whether they are straight extracts from the opium poppy, extracts that have been chemically modified, or completely synthetic and unrelated to opium. The effects differ slightly, as does the abuse potential. Opium Alkaloids: Codeine (Tylenol 3®, Tylenol 4®, Fiorinal #3®, Fioricet#3) Morphine (MS Contin®, Roxinal®, Avinza®) Semi-synthetic Hydrocodone (Vicodin®, Vicodin ES®, Vicoprofen®, Lortab®, Lorcet®, Norco®) Hydromorphone (Dilaudid®) Oxycodone (Percocet®, Roxicet®, Endocet®, Percodan®, Oxycontin®) Oxymorphone (Opana®, Opane ER®) Synthetic Propoxyphene (Darvocet®, Darvon®) Methadone (Dolophine®, Methadose®) Meperidine (Demerol®) Fentanyl (Alfenta®, Sufenta®, Ultiva®, Actiq®) Loperamide (Imodium) Some opioids known to be habit forming and with a higher risk of addiction are: Heroin Morphine Codeine and derivatives: oxycodone and hydrocodone Fentanyl Propoxyphene (Darvocet) Meperidine (Demerol) Methadone Opiate Withdrawal Symptoms: Withdrawal symptoms for opioids may vary in intensity by type of drug; most of the drugs in this class have a similar profile. As the body tries to compensate for not having the drug, symptoms of withdrawal start. They are largely the opposite of what the drug did, only in many cases, much worse. So, while opiates can cause constipation in many patients, withdrawal will cause diarrhea. Other symptoms include: Sweating, runny nose and watery eyes Yawning Diarrhea Vomiting and nausea Shivering and goose bumps Muscle aches and cramps Restlessness and insomnia Irritability and anxiety Loss of appetite Drug Cravings Symptoms can last as few as three days up to a week. Serious problems can arise from the effects of withdrawal. For instance, dehydration from a combination of nausea and diarrhea may be life threatening. In all cases, withdrawal should not be attempted without observation, preferably in a medical setting.  Going it alone is also made more difficult when cravings are factored in. From the addict’s perspective, all the symptoms can be treated by taking more of the drug. In the confusion and anxiety of withdrawal, taking ‘just one more dose’ can seem like the right choice.  Of course, this leads right back into the addiction. Dr. Kittay, MD specializes in treating patients with Opioid Addiction Opioid substance use disorders Opioid substance use in combination with psychiatric disorders Multiple substances use if one of the substances is an opioid Our Substance Use Disorders Program provides the following: Personalized opioid use disorders treatment in an office based private medical practice. Care given by Medical Doctors specializing in Psychiatry with training in opioid substance use disorders. Psychological therapy that meets the special needs of opioid substance users. Our Services Includes: Opioid Detoxification using Suboxone Replacement and/or Maintenance treatment with Suboxone Substance use treatment with Vivitrol Substance use counseling Personalized care is the cornerstone of your recovery. Our goal is to provide excellent addiction treatment in the convenience of a traditional office-based medicine. We pay attention to every detail of care, striving to provide a nonjudgmental and nurturing environment where our patients are safe and well cared for. Office-based medicine is supportive, promotes health, and encourages sobriety. It promotes a strong patient orientation in patient/provider relationships. Your needs and concerns drive care, and care is individualized, flexible, and affordable. We treat our patients in the same way we expect to be treated, with trust, listening, empathy, and respect. Please contact us with any questions you may have about our recovery program. All inquires are strictly confidential.  Remember, we are here to help. Definition:  Buprenorphine – Suboxone Suboxone is a combination of Buprenorphine and Naloxone; Is an opioid - narcotic  replacement medication Prevents withdrawal and cravings from drugs such as Heroin, Percocet, and OxyContin At the same time, it blocks the effects of any other opioids taken while on this medication. Depending on how a patient wants to treat their substance use disorder, Suboxone can be used to detoxify or help people get off opioids altogether.  It can also be used as a short or long term opioid substitution (replacement) medication. It is an oral medication that is taken daily. Definition:  Naltrexone - Vivitrol Vivitrol is an opioid - narcotic antagonist; Blocks the effects of any opioids taken while on this medication  Does not act like a narcotic (opioid); it does not prevent withdrawal or directly stop cravings.  Is given to patients who want to treat their addiction without using an opioid replacement medication. Is given monthly by intramuscular injection. Depending on the substance use disorder and a patient’s recovery goals, these medications can be used in various combinations.  Today we understand there is a direct link between 'dependencies' changes in brain functioning.