 Yes, I am licensed to treat clients who want to get off opioids (heroin, fentanyl, oxycodone, etc.). There are a few options but the most common and comfortable way to transition off regular opioid use is to prescribe buprenorphine (Suboxone). Suboxone is a combination of drugs that prevent severe withdrawal and promote transition to a safer, more regulated opioid.
That’s right. Buprenorphine (Suboxone) is an opioid. A much less potent one than heroin or fentanyl. Yes, it sounds counterproductive and there have been criticisms of opioid replacement therapy. However, the benefits of switching to buprenorphine have been proven, especially in people who have difficulty stopping regular use. One of the best benefits of buprenorphine treatment is that it prevents full blown withdrawal and reduces cravings (Mosel, 2022). Due to its chemical makeup, it is unable to produce the euphoric feeling that illicit opioids produce (Grinspoon, 2021; SAMHSA, 2023). Like needle exchanges, buprenorphine is not a magic bullet. It is considered a tool for harm reduction, meaning, less overdoses and blood borne diseases from sharing needles. So will I have to wean off buprenorphine? Ideally, yes, eventually. Many clinicians suggest treatment for at least a year, some think even longer use is best (Grinspoon, 2021). This gives clients time to reflect, create better coping skills, return to work, repair relationships and make new ones apart from old friends they associate with drug use. What are some tools or resources to help me? SMART Recovery is a good resource for people who are turned off by the religious aspect of groups like Alcoholics Anonymous. They provide free meetings online and in person. Their website also has videos and other tools to explain the cycle of addiction and introduce better coping skills. https://www.smartrecovery.org/ This article from Harvard Medical School is also great at addressing some of the myths about Suboxone and opioid replacement therapy. https://www.health.harvard.edu/blog/5-myths-about-using-suboxone-to-treat-opiate-addiction-2018032014496 References:
 Because of the overprescription of ADHD medication during the Covid lockdown by companies like Cerebral and Done, who are now under investigation by the DEA and FDA, there is a shortage of Adderall. This has had a cascading effect onto the other ADHD medications such as the methylphenidate class, as providers try to find alternatives for their clients. A report from Carlat Psychiatry projects the adderall shortage to last until March 2023, perhaps longer (Aiken & Newsome, 2023). In addition to this, the Wall Street Journal has reported the American Professional Society of ADHD and Related Disorders is working with the American Psychiatric Association to provide official guidelines for diagnosis and treatment of ADHD in adults (2022). Up to this point, guidelines have only been for children up to the age of 18. Adult guidelines are slated for release sometime in 2023. I expect more stingent guidelines will be provided in order to protect the public from overprescription of stimulants. The article in The WSJ quoted a concerned provider stating this may be another opioid epidemic. Resources:
 First, the diagnosis of ADHD can be somewhat of a lengthy process. There are many factors that can lead to difficulty in concentration and impulsivity. At the time of this writing, the criteria for ADHD diagnosis is only outlined for children up to the age of 18.
So one of the first questions I ask clients who think they may have ADHD is: Have you been diagnosed or treated for ADHD as a child or teen?
Another line of questioning is: Could your difficulty focusing be attributed to something else? Are you experiencing depression or anxiety? Have you been tested for a hearing, reading or comprehension difficulty? Has there been exposure to toxins like lead? How much screen time do you have in a day? Are you experiencing more than one of these factors?
Short answer: it depends. To set realistic expectations, it may take a few sessions to figure out whether ADHD is the appropriate diagnosis. In accordance with guidelines, other factors previously mentioned like anxiety and processing difficulties must be investigated and treated first before considering ADHD diagnosis. References:
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