Addiction is not the easiest subject to talk about, however the longer we avoid it, the worse the problem becomes. That’s why today we are headed to New Jersey to talk to Dr. Indra Cidambi and discuss drug dependency in the Garden State. We’ll have a chance ask her about medical marijuana, heroin, fentanyl, meth and much more.
Tell our readers about yourself and exactly what you do?
I am Board Certified in General Psychiatry and Addiction Medicine. After working at inpatient detoxification and rehabilitation centers, I founded the Center for Network Therapy (CNT). in 2011 and was the first to introduce the ambulatory (outpatient) detoxification option for managing withdrawal from alcohol, anesthetics, benzodiazepines, corticosteroids and opiates in New Jersey. CNT offers the most acute level of care, detoxification, on an ambulatory (outpatient) basis and also offers lesser acute levels of care; Partial Care and Intensive Outpatient (IOP). CNT is in-network with most major private health insurance providers. I am an expert in women’s issues and ensure that all programs incorporate the special needs of women. Over the past 8 years Center for Network Therapy’s revenues have grown at a compounded annual rate of 50%.
Tell us a bit about your personal and medical background?
I was born in India and completed her high school and pre-med in southern India. I accepted a scholarship to pursue my medical degree in the former USSR and relocated to Luvov (Ukraine) and subsequently to Tashkent (Uzbekistan). I completed my medical degree there and also obtained certification to act as an official translator of the Russian language. I then moved to New York and was accepted into the psychiatry residency program at Maimonides Medical Center in Brooklyn. Upon completing her residency in psychiatry, I pursued a 2-year Fellowship in Addiction Medicine at New York University/Bellevue Hospital. Before founding CNT, I was the Director of Chemical Dependency at a major inpatient addiction treatment facility in New Jersey. I am fluent in five languages.
Where are your locations?
As of now the Center for Network Therapy has two locations in New Jersey: Middlesex and West Orange. A third location is planned in Freehold, and should open in 2019.
What is the most common addiction that you see daily?
Opiates (opioid pain pills, heroin, fentanyl) is the most common drug of choice for clients treated at the Center for Network Therapy, although it is rarely the only substance individuals are addicted to. Usually individuals abuse a combination of drugs; opiates and alcohol, opiates and benzodiazepines or opiates and cocaine.
What are some of your most popular treatments for addiction?
Since a majority of Center for Network Therapy’s clients abuse opiates, medication assisted treatment utilizing buprenorphine (a partial agonist) to address opiate withdrawal symptoms is the most common treatment. However, other medications are utilized to treat alcohol withdrawal and benzodiazepine withdrawal.
How do you feel medical marijuana / recreational marijuana in New Jersey will play out?
Incentivized by a potentially significant new tax stream, politicians are rallying people to support legalizing marijuana for recreational purposes. If the bill to legalize marijuana use for recreational purposes passes, the people of New Jersey will have to pay the price. Marijuana is addictive, as it increases the level of dopamine in the brain and primes the reward pathways for other drugs. This is a big concern because eventually users will develop tolerance to marijuana and will need more potent substances to release increased amounts of dopamine to get the same effect. It also affects brain development and marijuana use will substantially hurt our teenagers’ and young adults’ ability to achieve their potential at school and in life. It is obvious that the negative consequences outweigh the potential benefits of marijuana, although medical marijuana could help people with cancer related chronic pain.
There are reports that Meth is on the rise in NJ (while this has been the case in South Jersey), have you noticed this trend coming north?
Methamphetamine is on the rise in southern New Jersey. The disturbing thing is the purity, which is 99%, suggesting they are made in Mexico. The rise in methamphetamine is driven by falling prices and its utility in combating opiate withdrawal. While it is not so prevalent in the northern parts of New Jersey currently, it should become more prevalent.
Have you noticed a rise in people becoming addicted to Fentanyl?
Fentanyl is an opioid, much like opioid pain pills or heroin. Fentanyl, though, is 50-100 times stronger than heroin. Addiction to fentanyl is increasing, but overdoses related to fentanyl are often accidental. Drug dealers use fentanyl to spike the potency of heroin, and, sometimes even marijuana. So, oftentimes people do not even realize that they are injecting fentanyl. Indeed fentanyl made up over 28,000 of the 72,000 overdose deaths in 2017.
While I am sure there is no silver bullet for addiction, what have you noticed is working?
The incumbent detoxification and rehab model has been inpatient or residential treatment. But, with the advent of effective medications over the past few years, options to treat addiction have increased. Medication Assisted Treatment (MAT), in conjunction with therapy provided on an outpatient basis, is proving more effective than inpatient treatment. This is beginning to cause a seismic shift in the addiction treatment market and, going forward, inpatient treatment will become marginalized.
What are some efforts that the State of New Jersey could do to ease the addiction/drug problem?
Essentially the state of New Jersey is throwing more money at the problem. Initially the state focused on expanding the availability of inpatient detoxification and rehab beds, but over the couple of years they have been incentivizing programs to move to lower cost outpatient detoxification by making grants available for this modality of care. This is also one factor that is increasing the adoption of the outpatient model more broadly at the expense of inpatient detoxification and rehab.
Do you have any final thoughts about addiction our readers should know?
It has taken some time, but finally addiction has been recognized as a disease, not a behavioral problem, as was assumed previously. Addiction is chronic disease, punctuated by relapses. What has been so different about addiction treatment is that it was always assumed the patient needs to be separated from his home environment and isolated in a facility in order to effect behavioral changes. Over time the incumbent inpatient treatment model has been responsible for attaching stigma to the disease of addiction. Interestingly, other chronic diseases such as diabetes, hypertension or even contagious HIV are treated on an outpatient basis while the patient is living in his home environment. Although better outcomes and lower costs are reasons to adopt outpatient detoxification more widely, a bigger reason is to reduce the stigma associated with addiction.
If you or someone you know is battling addiction in the New Jersey please visit www.recoverycnt.com and get the help you need today.