News You Can Use














Tidbits From the latest issue of Journal of Addiction Medicine

Don’t Forget the Family

I finished reading the latest issue of the Journal of Addiction Medicine this weekend, and as usual there’s much good stuff in it. One article that captured my interest was about family involvement in substance use disorder treatment.

Family members of patients with substance use disorder can powerfully influence the course of treatment of their loved ones.

I’ve known about the studies that support this for years, yet I must admit I haven’t gone out of my way to involve family members unless my patients request this.

The journal article reminded me we have research that shows family members can help prevent substance use disorder, can halt the development of these disorders, and can affect the prognosis once a substance use disorder is established. This article, by Ventura et al., reminds readers that involving family members in evidence-based interventions can improve health outcomes for the entire family.

That is, not only do these interventions improve the health of the person affected with substance use disorder, but also improve the health of all family members. Family members of affected patients show decreased healthcare expenditures as the patient’s treatment outcome improves.

It’s not fair to blame family members for actions which may worsen the substance use disorder of the affected person. They aren’t professionals. They are trying their best to deal with the insanity brought into the home with substance use disorders. They may not know the best way to support their affected loved one. Instead of judging these family members for their actions, better outcomes are seen when we educate them, and help them get care for themselves.

It’s tough to include families. Sometimes, our patients refuse us to include family in their treatment, and that is their right, and must be honored. Sometimes family members have their own substance use disorder that needs treatment. It’s also time consuming to involve family members, and many treatment professionals already feel their time is stretched. Some families are hostile to medication-assisted treatment of opioid use disorder. Explaining the reason why MAT is not just “substituting one drug for another” takes time and patience.

But if we can overcome these obstacles, involving the family in treatment can make a substantial difference in the lives of all family members, and not just the affected person.


Ondansetron for opioid withdrawal:

An article by Chu et al. described a study that looked to see if ondansetron (often known better under its brand name Zofran) could lessen withdrawal in patients on chronic opioid therapy. Because of previous studies that show some symptoms of opioid withdrawal may be mediated through the serotonin system, the authors hypothesized that ondansetron, as a serotonin receptor antagonist, could reduce opioid withdrawal.

This was a small study, with only 33 subjects, who participated in this double-blind, randomized crossover study. The subjects all had chronic back pain, and were changed from whatever opioid they were on to sustained-release morphine prior to the study. Then precipitated withdrawal was induced in these subjects with intravenous naloxone. Subjects’ withdrawals were treated with either placebo or ondansetron, and then both objective signs and subjective symptoms were measured.

The study showed no difference in withdrawal symptoms when ondansetron was given, compared to placebo.

That’s disappointing, but important to know.

4 responses to this post.

  1. Posted by dbcincsa on November 19, 2017 at 3:51 pm

    Good story. I am slightly perturbed by this policy of the medical field to rename diseases every few years in an attempt to remove stigma. I am sure everyone sees through that. I mean, “Opiod Abuse” is now “Opiod Use Disorder”. Ok, whatever. But wouldn’t education go farther than cosmetic name changes?

    p.s. I swore I would be clean by 40 and have succeeded. 100% clean and free from Suboxone and benzos. I feel better than I have in years. Now, let me tell you, those who say ‘2 weeks and you’ll be fine’ are full of it. I was down for a full 6 weeks. At one point, after 3 weeks of no sleep, I literally wondered if I was still alive and started to have severe psychosis, eventually landing me in the ER, who did more for me than my (new) PCP. I loved my Suboxone doctor, but knew if I stayed with him, I’d stay on the drugs. Little did I realize the stigma I would face, even as I fought. Nobody expects you to win the battle, so you really have to be doing it for yourself. Man, it is nice not to be dependent on something though.


    • Right! So…the question that begs to be asked is: What do you wish your suboxone doctor would have done differently? Pushed you? Forced a mandatory taper? How could he/she have made it successful for you? I would love to hear yiur feed back on this, as I manage a good number of patients who are where u were and I want to help them to the best of my abilities and to learn, I need to hear what is needed from us!

      Thank you
      Dr. Prucha


  2. Couldn’t agree more. I’ve yet to experience a negative impact when I ask patients to bring family or for permission to speak with them. It adds an additional dimension of accountability and credibility when it’s needed. I always say: Your’e with me for 30 minutes and they’re with you for life. I like to hear their side of how things are going if the patient will permit me. They offer me another view of the land that can go a long way in providing depth of field in these patients. Anything to help me reduce complications and challenges is welcomed in my practice so long as it’s agreeable to all parties.


    Joey Prucha


  3. Posted by dominique simon on November 19, 2017 at 7:07 pm

    Ventura has been very supportive of our work with families. We just trained her staff on our approach. The boston medical center will be running hybrid groups for families, using our site as the curriculum. Families deserve evidence based training. We provide it online for pennies, with or without the addition of a live group as bmc has done.


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