CleanSlate Blog

February is National Children’s Dental Health month, an observance sponsored by the American Dental Association (ADA) that brings together healthcare providers and educators to promote the benefits of good oral health to children and their caregivers.

This year, the ADA’s theme is “Brush and clean in between to build a healthy smile!” But for dentists and teens, the most important lesson of children’s dental health could come through increased education about a danger far more serious than plaque: an opioid prescription.

That’s because the first time that many American teens receive a prescription for opioid painkillers is at the dentist’s office. While teens in other countries are rarely prescribed opioids after dental surgeries like wisdom tooth removal, American teens are much more likely to be prescribed highly addictive drugs such as Vicodin.   

And the danger of addiction is real. A majority of all heroin users started by taking prescription painkillers, including oxycodone, hydrocodone, codeine, and morphine.

A 2015 study in the journal Pediatrics found that prescribed opioid use makes teens 33% more likely to abuse opioids later on. A more recent study, published last December in JAMA Internal Medicine by the Stanford University School of Medicine, found that teens and young adults who receive an initial opioid prescription from their dentists or oral surgeons are at increased risk for opioid addiction as soon as the following year.

A new report from the Centers for Disease Control and Prevention (CDC) concludes that while the opioid epidemic has profoundly impacted all parts of the population over the past nearly 20 years, drug overdose rates have dramatically multiplied amongst one group of people in particular. The findings have garnered wide news coverage as “unexpected.”

Why? Because the group in question is middle-aged women.

This may seem like surprising news, but it isn’t. A deeper look shows that this group has long been vulnerable to high rates of overdoses, a fact that has been well documented for years. For example, a study several years ago by Geisinger Health System concluded that white, middle-aged women were most at risk of prescription opioid overdose. If you want to go back further, we can even time travel to the late 1800s, when women made up 60 percent of the population addicted to opium.

There's a very long history here, which we’ll get to in a minute.

February is for the heart.

It’s Valentine’s Day season, when we’re besieged with images of love, cupid’s arrows, and heart-shaped everything. Whether we want to or not, it’s a time when we receive messages about our hearts, in the romantic sense.

So it’s not a coincidence that the Powers That Be who choose seasonal observations picked this month to educate people about our hearts, in the biological sense. February is American Heart Month, and also the month for the American Heart Association’s signature initiative for women’s heart health, “Go Red for Women.”

Heart disease remains the number one killer of American men and women, leading to one in four deaths in the United States. The goal of American Heart Month is to spread awareness about healthy choices that can help prevent heart disease, including smarter food choices and increased physical activity.

But there’s another risk to heart health that has been steadily growing: opioid addiction.

A recent study, 22 years in the making, has found that the opioid epidemic and IV drug use has fueled an alarming rise in strokes. Infections known as bacterial endocarditis can be caused by dirty or shared needles; when injected into the bloodstream they can enter the brain and lead to a massive stroke.

Decades ago, bacterial endocarditis used to be common in patients who had childhood rheumatic fever, a disease that is virtually extinct now.

"It used to be rare that we saw anybody with bacterial endocarditis-related stroke," said Dr. Carl McComas, a neurologist at St. Mary’s Medical Center in West Virginia, to the Charleston Gazette-Mail. "Now we see one at least every week.”

For reasons related largely to stigma and lack of understanding about addiction, the mainstream medical industry has long been reluctant to integrate addiction treatment into the traditional healthcare system.

But as the opioid epidemic grinds on, experts and policymakers are recognizing that the old solutions aren’t working. More people are suggesting that medication-assisted treatment (MAT) should play a significant role in how we help people with addiction, and that this treatment should be approached as part of the standard patient-doctor experience.

Some leaders around the country are acknowledging that one of the best times to engage people in addiction treatment is during a visit to the emergency room, especially during withdrawal or after an overdose. Massachusetts, for example, has now enacted legislation to mandate that all ERs in the state treat addiction patients with medication.

If more widely adopted, this shift could help people who suffer from addiction immediately begin medical treatment and stem withdrawals, thus minimizing or avoiding relapses that might find them back in the ER.

Warsaw, IN  - CleanSlate Centers, a national leader in outpatient addiction medicine, opened its doors to patients in Warsaw, Indiana today with a new outpatient medication-assisted treatment center. Located at 2936 Frontage Road, the physician-led center continues CleanSlate’s push to expand resources for addiction treatment in Indiana, including rural and underserved communities. 

Between 2016 and 2017, Indiana experienced a 22.5% increase in overdose deaths, the sharpest rise of any state in the country, according to the Center for Disease Control and Prevention. 

“Despite the tremendous need for high-quality, affordable addiction treatment in smaller communities like Warsaw, we have found that many providers are being pulled towards more populous areas in Indiana,” said Rachael Thompson, CleanSlate’s Regional Managing Director. “We at CleanSlate are eager to fill the treatment gaps in Warsaw and join this community’s battle to save lives that hang in the balance.”

Through our work in addiction medicine, the CleanSlate team is on the frontlines of the vast human suffering caused by the opioid epidemic. Some of the most tragic stories we currently encounter involve counterfeit medications.

Last year, at the Healthy Tennessee Opioid Summit, Carrie Luther shared the story of her 29-year-old son, Tosh. After Tosh came down with a case of hives that was keeping him up at night, a friend gave him a Xanax to help him sleep. As instructed, Tosh took one quarter of one pill. Unbeknownst to Tosh or his friend, the Xanax was actually fentanyl. From just a sliver of one pill, Tosh ingested thirteen times the lethal dose of fentanyl and died within 30 minutes from an overdose.

Twenty-eight years after opioid deaths began to rise in tandem with sharp increases in prescriptions for pain treatment, healthcare leaders have long since reached important conclusions about what’s working in stemming the tide of overdose deaths, and what isn’t. The challenge has been to align the actions of individuals, organizations and legislators with the evidence-based data on how to successfully treat opioid use disorder (OUD).

Top on the list of underutilized success stories is medication-assisted treatment (MAT), which combines behavioral therapy with one of three FDA-approved medications: buprenorphine, naltrexone or methadone. A study published last August by the medical journal Annals of Internal Medicine was the first in the U.S. to compare how these three medications are used and how they impact mortality. The conclusions were startlingly clear: overdose survivors who went on to be treated with medication reduced their risk of death by 40 to 60 percent.

Despite the well-documented success rate of MAT, the Annals of Internal Medicine study found that only 30 percent of overdose survivors are given any one of the three FDA-approved medications for their disease.

Salem, WI - CleanSlate Centers, a national leader in outpatient addiction medicine, has opened a new medication-assisted treatment center in Salem, Wisconsin. The center, which will treat patients suffering from opioid or alcohol addiction, is located at 24804 75th St., within the offices of Oakwood Clinical Associates, a behavioral consulting clinic which will serve as a partner with CleanSlate in the Salem community.

“We’re grateful to join hands with Oakwood Clinical Associates to battle the opioid epidemic and the disease of addiction in Kenosha County,” said Dana Thomson, Center Manager for CleanSlate in Salem. “Our partnership with Oakwood Clinical Associates will increase the diversity of care which we can offer patients as they fight to save their lives.”

New Albany, IN - CleanSlate Centers, a national leader in outpatient addiction medicine, continues its expansion in Indiana with the opening of a medication-assisted treatment center in New Albany. Located at 811 Northgate Blvd., theNew Albany center opened its doors to patients last week.

CleanSlate’s decision to open a center in the southern part of Indiana was driven by the outpouring of patients who were traveling across state lines to receive treatment at the company’s center in Louisville, Kentucky. The New Albany center sits on the opposite side of the Ohio River from CleanSlate’s Louisville center.

When people start treatment for a drug or alcohol addiction, they begin to regain control of themselves and their lives. Their newfound mental clarity is an important development in recovery, but it comes with a catch. With a clear view of the wreckage their disease has caused all around them, patients can feel a debilitating sense of shame and guilt.

We see this every day in our work with patients. At CleanSlate, physicians and staff practice medication-assisted treatment (MAT) to help patients suffering from opioid or alcohol addiction. Patients make appointments at one of our outpatient centers, and their experience is similar to a routine visit to any doctor’s office. After beginning treatment with medications such as buprenorphine (Suboxone) or naltrexone (Vivitrol) to ward off cravings and prevent relapse, many of our patients report feeling “normal,” like their former selves, sometimes in a remarkably short amount of time.

But for most patients, medication is only one component of recovery.