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  • The Work We Do.

    We have received many recent inquiries about the nature and importance of our medical practice and treatment methods. In response, we would like to release the following information:

    Recovery Without Walls is a individualized, outpatient clinic that provides treatment for chronic pain, chemical dependency, and prescription medication management issues, as well as problems with alcohol. Founded and directed by Dr. Howard Kornfeld, the practice is based in Mill Valley, CA. We view our work at Recovery Without Walls to be particularly relevant due to the current opiate crisis in the United States. Presently, millions of patients in the United States are dependent on prescription opiates, many at high doses, to treat chronic pain conditions, while countless others in the U.S. and worldwide are suffering from under-treated acute, subacute, and chronic pain.

    Fortunately, there are safe and effective treatment options for opioid dependency and pain. Dr. Kornfeld is a nationally recognized expert in the use of buprenorphine (the active ingredient in Suboxone® or Subutex®), a medication used for opiate detoxification, maintenance therapy, and pain management. When acute detoxification treatment is required, we arrange 24-hour nursing care, supervised by Dr. Kornfeld. Treating addiction and pain with medication is only one component of an integrated program, which can also consist of psychotherapy and lifestyle changes.

    While we face many challenges in treating addiction and chronic pain (both together and separately), we are encouraged by recent developments in national drug policy. Of note is a new bipartisan White House budget commitment of $1.1 billion in funding for drug treatment programs in 2017. It will primarily expand medication-assisted treatment, especially buprenorphine, for prescription opiate and heroin addiction.

    We are grateful to participate in this meaningful dialogue.

    Dr. Kornfeld will be providing additional information on these topics next week with several other medical leaders at the American Pain Society, Symposia, “Using Buprenorphine to Mitigate the Major Hazards of Traditional Opiates.”

  • Positive Move Toward Harm-Reduction Legislation in Kentucky

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    Continuing its theme of covering the heroin epidemic in Kentucky, the Huffington Post recently published this story on new legislation there targeted at helping addicts.

     

     

    The state will now allow local health departments to set up needle exchanges and increase the number of people who can carry naloxone, the drug that paramedics use to save a person suffering an opioid overdose. Addicts who survive an overdose will no longer be charged with a crime after being revived. Instead, they will be connected to treatment services and community mental health workers.

    Good News!

    Read the rest here.

    Find us on Facebook here.

    Posted by Cara Eberhardt, Patient Care Coordinator

  • More Press about Prescription Drugs and the Latest Heroin Epidemic

    The Week is yet another media source bringing attention to an escalating problem of prescription opiate abuse. In this article, it is reported that Purdue Pharma may be charged in a civil suit for misrepresenting the addictive potential of the drug OxyContin.  Read the rest here.

     

    “A pernicious distinction of the first decade of the 21st century was the rise in painkiller abuse, which ultimately led to a catastrophic increase in addicts, fatal overdoses, and blighted communities. But the story of the painkiller epidemic can really be reduced to the story of one powerful, highly addictive drug and its small but ruthlessly enterprising manufacturer.”

     

    Posted by Cara Eberhardt, Patient Care Coordinator

    Find us on Facebook here.

  • NPR Fresh Air Interview with Huffington Post Journalist

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    The author of Huffington Post longform article on Suboxone, medications, oipate addiction and recovery is interviewed on NPR’s Fresh Air.

    “Police and public health officials in the U.S. have been struggling in recent years with the dramatic rise in heroin addiction and fatal overdoses from the drug. The Centers for Disease Control and Prevention reported that more than 8,000 people died from heroin overdoses in 2013 – a 39 percent increase over the year before.”

    Read the transcript or listen to the full interview here.

    Find us on Facebook here.

    Posted by Cara Eberhardt, Patient Care Coordinator

  • Recovery Without Walls & Dr. Kornfeld Respond to Huffington Post’s “Dying to be Free”

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    For those of us touched by the death of a loved one from a drug overdose, I know which option I would choose if given the option of a few years of life on Suboxone* or death.

    In our practice we have seen many individuals in the throes of opiate addiction and withdrawal transform almost overnight after buprenorphine induction. While it is not a magic pill, it can be the first step toward healing from an addiction–giving the patient and their family members time to work on the psychosocial issues that may have precipitated the addiction in the first place. This medication absolutely saves lives. As addiction medicine practitioners, we commend the Huffington Post for bringing up this important topic for discussion. For over a decade, Dr. Kornfeld at Recovery Without Walls has championed the use of buprenorphine and often been met with reluctance from some traditional workers in the addiction treatment community. However, as explained in the article, the statistics show that recovery from opiate addiction is achieved far more often if addicts are given medication assisted therapy.

    We have long known that the system to treat addiction has been separate from the structure of the medical and scientific community and we are seeing this problem develop as a lethal failure. We hope to see changes within the healthcare system to make this life saving treatment more widely available. More physicians need to obtain certification from the federal government to prescribe Suboxone. State-funded and private health insurance agencies need to make the process of obtaining coverage for these medications easier. Longer office visits with practitioners and psychotherapy sessions needs to be covered by insurance agencies so that the recovering addict can address other stressors that contribute to relapse.

    The Huffington Post article is focused mostly on treatment in Kentucky, however, our own state of California is certainly affected. We would propose that medication based treatment should be part of the standard of care within residential programs. If a practitioner should choose not to treat an opiate addict with a maintenance medication, there should be a justifiable reason for withholding that treatment. Just as if you were to choose not to treat a diabetic, a justifiable reason, such as attempts at dietary change or exercise, must be made clear. This paradigm could apply in the case of opiate addiction, but many of the current methods in treatment centers rely on moralizing and willpower more than what has been scientifically shown to lead to recovery.

    The brain of an opiate addict is often changed by the drug. Cravings are unbearable and the physical and psychological reactions to stress are heightened. Maintenance medications allow recovering addicts the time to slowly regain normal function. Contrary to some individuals quoted in this article, maintenance medication does not necessarily mean forever. Many addicts will take Suboxone for 6 months to several years, but good addiction medicine providers understand that tapering is always the goal.

    When speaking about providing Suboxone to recovering opiate addicts, healthcare providers, individuals in the justice system, and others in the treatment community must set aside the stigmas associated with this illness and embrace this life saving treatment. The greater availability of this medication under the supervision of a physician results in fewer deaths which seems to us to be the truly moral choice.

    *While we use the trade name Suboxone, most of the buprenorphine, including buprenorphine combined with naloxone, is available as a generic medication.

     

    Posted by Cara Eberhardt, Patient Care Coordinator

    Read the Huffington Post article here.

    Find us on Facebook here.

  • Suboxone Works

    Blog Post by: Andrew Kornfeld, B.A., B.S., Director of New Patient Services at Recovery Without Walls

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    The title of the article is as follows:

    Dying To Be Free

    There’s A Treatment For Heroin Addiction That Actually Works.

    Why Aren’t We Using It?

    The front page of the Huffington Post is a beautiful acknowledgment of the power of the most effective tool we have in the treatment of Heroin Addiction. The article (more like that of an essay or short book) stands in stark contrast to the somewhat misleading article by Ms. Deborah Sontag in the New York Times last year.

    Mr. Jason Cherkis in his eight chapters, interviews those with different perspectives – and easily comes to the conclusion that using Suboxone (a combination of both buprenorphine and naloxone) instead of methadone is more than just replacing one opioid with another. We as the medical community have known for a long time the great potential for the safe use of Suboxone given the drugs pharmacology and effects on our patients. There is little to no risk for overdose.

    The replacement theory (that Suboxone does not work) and abstinence only recovery – put forth as the best option by a rural judge in the article, stands anomalous to the evidence and data demonstrated by users. It’s just not what the science says: Suboxone can infact save lives. Heroin addicts who “graduate” from abstinence only programs have nearly a 75% relapse rate – and are put at great risk for overdose upon re-use as their tolerance has decreased. The opioid blocking component of the Suboxone known as naloxone can prevent this.

    This is our initial reaction to what is sure to be a bomb-shell article.  Our Medical Director, Dr. Howard Kornfeld will have his own commentary in the next few days.

    Stay tuned.

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  • Addiction is a Complex Problem

    “The opposite of addiction is not sobriety. It is human connection.”

    Read the rest of this article on Huffington Post.Screen Shot 2015-01-26 at 10.42.15 AM

  • Announcing A Series of Five Free Public Lectures at Recovery Without Walls!

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    Announcing A Series of Five Free Public Lectures
    Thursdays, 5:00 PM, 3 Madrona Street, Downtown Mill Valley
    December 18 and January 8, 15, 22, and 29
    New Methods, New Medications in the Treatment of Chronic Pain

    Street parking available.
    Please walk up the stairs.
    We hope to see you there!

    Dear Patients, Friends, and Colleagues:

    With the holidays ​upon us, it is my pleasure to invite you to our free lecture series and to tell you about some of the new and innovative work happening at our medical practices and at Recovery Without Walls (RWW). The fields of pain and addiction medicine are rapidly evolving. Through our innovative use of lower risk and higher efficacy pharmaceutical tools and other treatment modalities, including those provided by astute clinical psychologists, we endeavor to provide the highest quality of medical care for our patients – both here in Mill Valley in our private practice at 3 Madrona Street – and in Oakland at the pain clinic for lower income residents of Alameda County at Highland Hospital (where I serve as the founding medical director).

    I have continued to advocate for the appropriate use of buprenorphine as a front-line treatment of chronic pain disorders, particularly those associated with prior opiate dependency. Last April, I presented several of our published buprenorphine protocols at the American Society of Addiction Medicine’s annual meeting in Orlando Florida, at the day long Pain and Addiction: Common Threads conference.

    I also continue to teach about these methods on a monthly basis as a member of the clinical faculty at the pain fellowship program at UCSF and consult with the Medical Board of California as an expert medical reviewer.

    In particular, our protocol utilizing transdermal buprenrophine (Butrans) has created opportunities to better transition patients from more addictive opiates to sublingual buprenorphine and to help more patients who would otherwise not be able to handle this transition. We continue to be one of the few medical offices with experience in this important method. Buprenorphine has unprecedented potential to stabilize difficult pain syndromes, as compared to other more commonly used medications, and is conducive to low and tapering dose strategies.

    In the pain field, we are also partnering with other pain clinicians who have expertise in regenerative approaches to joint repair, neuroplasticity concepts, innovative headache treatments, high dose CBD (a non-intoxicating derivative of cannabis), and intravenous ketamine.

    Our nurse practitioner, Inna Zelikman, and I will be holding a series of five free lectures for the general public and professional community on chronic pain with a focus on new medications on Thursdays at 5 PM at our office in Mill Valley. The first one will be on December 18 and the following four will be in January on the 8th, 15th, 22nd, and 29th.

    In the addiction field, we continue to partner with Shine A Light Recovery Support Systems, ROC Recovery Services for Women, and Executive Home Detox to provide seasoned sober coaching, companionship, and nursing – as a pillar of the program of Recovery Without Walls. We guide patients to Twelve-Step Recovery as well as to secular and Cognitive Behavioral Therapy (CBT) oriented recovery (SMART and LifeRing Recovery) and Buddhist recovery (Refuge Recovery, Spirit Rock, and San Francisco Zen Center). LifeRing now has a regular meeting at 6:15 PM at our offices on Thursday evenings.

    Our familiarity with Suboxone (a form of buprenorphine) for opiate addiction places us at the top tier of practitioners licensed to prescribe this drug, and we have developed individualized protocols, unavailable elsewhere, for getting patients both on and off of Suboxone.

    We have also extended the work with the established drug, baclofen (a medication with low abuse potential) to a wider variety of alcohol, drug, and medication dependencies, particularly the challenges posed by benzodiazepines and sleeping pill habits. Also, we have been pioneering the use of transdermal selegiline (EMSAM), an energizing compound, in the mood stabilization of patients in recovery and with chronic pain and as an alternative to the more problematic use of stimulant drugs, such as the amphetamines for attention problems.

    To stay up to date in these fields, I maintain current board certifications, recognized by the American Board of Medical Specialties, in both the pain and emergency medicine fields and remain board certified by the American Board of Addiction Medicine. In addition, I retain active medical staff privileges at Marin General Hospital to optimize our patients’ care when acute treatment is needed.

    Our nurse practitioner, Inna, has taken a leadership role in the Diversion Program run by the State of California Board of Registered Nursing, which cares for and monitors registered nurses who have become chemically or psychiatrically impaired.

    In addition to her role as Director of Clinical Psychology at our office in Mill Valley, Janis Phelps, Ph.D., also continues to teach, as a senior faculty, at the California Institute for Integral Studies’ graduate training programs.

    Finally, we have established the Pharmacology Policy Institute, a 501(c)(3) nonprofit, to support public policy work in the drug field independent of both government and industry. This is greatly needed in the addiction, pain, and buprenorphine fields. We look forward to providing further information about our developing programs in forthcoming newsletters.

    Do not hesitate to call us, or attend a lecture, to obtain guidance in these areas. It is a gift and a privilege to have the knowledge and expertise to help and we want to attempt to pass this on to you. If we are unable to help you directly, we will endeavor to assist you in finding appropriate resources.

    With hope for the health of our community.

    Warm Regards,

    Howard Kornfeld, M.D.

  • Enjoy this year’s post of the Serenity Prayer

    No matter what your spiritual belief, everyone can benefit from these wise words. Enjoy this year’s post of the Serenity Prayer.life-quote-151-wallpaper-1

  • American Academy of Neurology takes Firm Stand Against Opioid Pain Medication

    A recent report by the American Academy of Neurology declared that opiates are essentially a poor choice by physicians wishing to manage chronic pain conditions of their patients. The report detailed the risk for dependence, even in cases where the opiates appear to be providing relief. We agree that full agonist opiates like Vicodin and OxyContin are generally not sustainable solutions in the treatment of chronic pain.

    Absent from the report is the emerging use of Buprenorphine in the front-line treatment of chronic pain and the drug’s efficacy to transition patient’s away from more harmful opiates. At Recovery Without Walls we have carefully used Buprenorphine and other innovations in the treatment for chronic pain for many years.

    If you, a friend or a family member are suffering from chronic pain or chemical dependency, please do not hesitate to contact us.
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