Tuesday, October 21, 2014
Big Pharma, Opiates, & Physicians
Several months in Boston we had a rally against the new opiate on the market, “Zohydro.” Basically, Medical Grade ‘Heroin.’ We had the head of the Massachusetts AFL-CIO getting the crowd whipped up and chanting “Down with Big Pharma, Down with Big Pharma!”
While well intentioned, it is never going to happen. Big Pharma essentially laughed this off. Why not when you have the power to get the FDA to go against the ruling of its own select committee on the issue.
I see the issue in another way. Ask your Primary Care Physician how much training he or she had in medical school on mental health and addiction. The answer will probably flabbergast you. So this is what all doctors have received regardless of their speciality after med school. With the possible exception of psych.
Yet they can write scripts for opiates and other psycho-active drugs. You have all seen the TV ads for various psycho-active medications with the ending of the ad saying ‘So ask your physician if it might be right for you.’
What my primary care? The ads do not say to see your primary care for a referral to a psycho-pharmacologist. Just go see your doctor (PCP).
To get back to the ‘opiate’ issue however. Why could we not institute a plan such as the following: A primary care physician before writing an opioid script would have the patient submit to a urine tox screen to see what is already on-board. These screens would not only be qualitative, they would also be ‘quantitative.’
This would be done for all regardless if they have a prior history of drug or alcohol abuse/dependence. In this way the issue of discrimination is taken out of the equation right at the get-go. The scripts would be for one month at a time.
Doctors not complying could be held liable in the case of overdose deaths. Which by the way, the number one cause of opiate overdose deaths in the United States is not from illegal opiates such as Heroin, it is from legally prescribed opiates.
We are the number one country in the world for the consumption of opiates. A recent CNN story on prescription drug abuse: (http://www.cnn.com/2012/11/14/health/gupta-accidental-overdose).
In the United States, we now prescribe enough pain pills to give every man, woman and child one pill, every four hours, around the clock, for close to three weeks. For those of you interested, the number is roughly 274,302,000,000.
While Big Pharma is a concern I see the issue as more of a need for true physician education on addiction and mental health. Again, ask your primary care physician how many hours they had in medical school on addiction and mental health. Most of that training is academic, not clinical.
Even well intentioned doctors sometimes inadvertently set people up for addiction such as when they prescribe ninety percocets at a time after a surgery. “Here, take three a day for thirty days then just stop." "Just stop?" Are you kidding me? Why was the person not titrated down over the course of that month? Then when the patient asks for more the physician may think they are med-seeking.
Yea, Big Pharma is a concern, but what about the prescriber…
Monday, April 21, 2014
Zohydro, Overdose Deaths, Chronic Pain...
Let me start this blog with a statement from a recent CNN story on prescription drug abuse (http://www.cnn.com/2012/11/14/health/gupta-accidental-overdose).
In the United States, we now prescribe enough pain pills to give every man, woman and child one pill, every four hours, around the clock, for three weeks. For those of you interested, the number is 274,302,000,000.
Yup, that’s right, over 274 billion pain pills.
The number one cause of accidental death in the United States is “legally” prescribed opiates.
Now we have to deal with Zohydro? A pure, man-made form of hydrocodone.
Things are not bad enough now? Any doctor can prescribe this drug. Not necessarily a doctor that specializes in chronic pain management or pain management for the terminally ill. Your primary care physician can prescribe this highly addictive medication.
I have a major issue with that. Ask your primary care physician how many “hours” they had in medical school on mental health and addiction. I feel confident their response with startle you. Maybe thirty hours at best. Out of that thirty hours maybe four to five hours actually ‘talking’ to those that are afflicted.
I feel compassion for those that want the drug for their terminally ill loved ones. I do, I understand. I was witness to my father’s agonizing death for ten months when pancreatic cancer was ending his life. So I get it. His pain was eased with morphine which has more regulations than Zohydro and is more difficult to find its way to the street.
In this article entitled “Why long term use of opioids is not the answer,” the author explains why trying to manage pain with just opiates is not the answer (http://www.kevinmd.com/blog/2013/03/long-term-opioids-answer.html)
We have an opiate epidemic particularly here in the Northeast. I understand and agree with the stance that my state of Massachusetts took recently when they tried to bar the sale of Zohydro (which was denied).
When my friend Joanne Peterson the founder of “Learn to Cope” (http://www.learn2cope.org/) tried to explain her stance on this issue she found herself personally attacked by those in favor of Zohydro. One person when talking of those with terminal illness referred to her as caring too much about “junkies.” Junkies? You mean someone’s son, someone’s daughter, mother, or father? Hey enough of the ‘ad hominem abusive.’ If you want to debate fine, stick with the facts though.
Do you think anyone grows up wanting to be an addict? I have yet to see it on a resume.
How about the well-intentioned doctor that was not taught to titrate a person down when prescribing pain killers after a surgery. ‘Here are ninety Percocet’s, take three a day for thirty days then just stop.' Really? Good luck on that. Even people with no prior addiction history can end up addicted.
Zohydro may legitimately benefit those with terminal illness. However at what price? An increase in the overdose death rate when it inevitably hits the street? Again, the number one cause of accidental death in the United States is overdose death caused by legitimately prescribed opiates. While I agree wholeheartedly agree with those that want Zohydro to be made tamper-proof I see the even bigger issue as regulation on those that prescribe.
Maybe if the physicians prescribing opiates such as Zohydro could be held personally liable for damages due to misuse then maybe they would limit the number they prescribe and the circumstances under which they do prescribe them.
In the United States, we now prescribe enough pain pills to give every man, woman and child one pill, every four hours, around the clock, for three weeks. For those of you interested, the number is 274,302,000,000.
Yup, that’s right, over 274 billion pain pills.
The number one cause of accidental death in the United States is “legally” prescribed opiates.
Now we have to deal with Zohydro? A pure, man-made form of hydrocodone.
Things are not bad enough now? Any doctor can prescribe this drug. Not necessarily a doctor that specializes in chronic pain management or pain management for the terminally ill. Your primary care physician can prescribe this highly addictive medication.
I have a major issue with that. Ask your primary care physician how many “hours” they had in medical school on mental health and addiction. I feel confident their response with startle you. Maybe thirty hours at best. Out of that thirty hours maybe four to five hours actually ‘talking’ to those that are afflicted.
I feel compassion for those that want the drug for their terminally ill loved ones. I do, I understand. I was witness to my father’s agonizing death for ten months when pancreatic cancer was ending his life. So I get it. His pain was eased with morphine which has more regulations than Zohydro and is more difficult to find its way to the street.
In this article entitled “Why long term use of opioids is not the answer,” the author explains why trying to manage pain with just opiates is not the answer (http://www.kevinmd.com/blog/2013/03/long-term-opioids-answer.html)
We have an opiate epidemic particularly here in the Northeast. I understand and agree with the stance that my state of Massachusetts took recently when they tried to bar the sale of Zohydro (which was denied).
When my friend Joanne Peterson the founder of “Learn to Cope” (http://www.learn2cope.org/) tried to explain her stance on this issue she found herself personally attacked by those in favor of Zohydro. One person when talking of those with terminal illness referred to her as caring too much about “junkies.” Junkies? You mean someone’s son, someone’s daughter, mother, or father? Hey enough of the ‘ad hominem abusive.’ If you want to debate fine, stick with the facts though.
Do you think anyone grows up wanting to be an addict? I have yet to see it on a resume.
How about the well-intentioned doctor that was not taught to titrate a person down when prescribing pain killers after a surgery. ‘Here are ninety Percocet’s, take three a day for thirty days then just stop.' Really? Good luck on that. Even people with no prior addiction history can end up addicted.
Zohydro may legitimately benefit those with terminal illness. However at what price? An increase in the overdose death rate when it inevitably hits the street? Again, the number one cause of accidental death in the United States is overdose death caused by legitimately prescribed opiates. While I agree wholeheartedly agree with those that want Zohydro to be made tamper-proof I see the even bigger issue as regulation on those that prescribe.
Maybe if the physicians prescribing opiates such as Zohydro could be held personally liable for damages due to misuse then maybe they would limit the number they prescribe and the circumstances under which they do prescribe them.
Thursday, April 10, 2014
Substance Abuse / Co-Occurring Disorders & 12 Step Programs (Re-post)
When I educate my patients on community resources one of the first statements I make to them is that if you are attending, or, plan to attend traditional 12 Step meetings, please, please, for your own sake do not discuss or talk about any medications that you are prescribed and currently on for a co-occurring disorder.
It just takes one person to hear what is being said and feel the 'need' to tell the person they are 'chewing' their booze, and that they are not sober.
Before going into more detail and examples, I feel I should state for the record that I am NOT ANTI-12 STEP. As a matter of fact, many people that are 'dual-diagnosed' utilize traditional 12 Step meetings as their base of recovery. Traditional 12 Step meetings can help one to learn again (or for the first time) how to socialize without a drug or drink in their system. Also, people attending these meetings share a common goal, namely, maintaining and fostering sobriety.
Conflicts can arise for the dual-diagnosed person in these meetings with regards to some of the traditionally held sayings and beliefs.
Example: I had a client that was told at a meeting to, “Just go to another meeting.” Well, the fact of the matter was my client had been awake for four days and had attended six meetings. What he really needed was a medication adjustment for his bipolar disorder.
Example: “No one ever died from lack of sleep.” I have never sought research to confirm or deny this statement. I can tell you from working in the psych/addiction field for twenty plus years now, people can become extremely paranoid, psychotic, and suicidal if they have been awake for a number of days (particularly people in a manic episode for instance).
Example: “They broke out because they stopped going to meetings.” This is definitely a blanket statement. What if the person was ‘so depressed’ they could not get out of bed?
I recently had a patient I was working with inform me that his AA sponsor was telling him to ‘get off’ the anti-depressant he is on. He asked me what he should do. I asked him if he felt the anti-depressant was working for him, he said yes. I told him I think you have your answer then.
So what are some of the other support groups? The first one I tell them about is DBSA - Depression Bipolar Support Alliance (www.dbsalliance.org/ ). These are meetings for people that have major depression with or without anxiety, and those with bipolar disorder.
The largest group within these meetings is “Double Trouble.” These are people with substance abuse coupled to the aforementioned above. People who often times were trying to self-medicate. Many of these members also belong to traditional 12 Step groups as well.
In much the same way that 12 Step programs have sponsors, people in “Double Trouble” can find a sponsor that not only has their same addiction, but the other mental health issue as well; “you pace your kitchen at 3am agitated and drinking – I thought I was the only one!”
The reason support groups work for many people is the identification factor. I realize now that I am not the only person that has ever felt or feels the way I do. I am not alone.
Another group is DRA – Dual Recovery Anonymous (http://draonline.org/ ). This is a 12 Step based group. In these meetings people can not only talk about their addiction issues, they can also discuss their other mental health issues as well. In traditional 12 Step if you want to discuss the other mental health issues you do so after the regular meeting (sometimes referred to as the meeting after the meeting).
DRA is relatively young compared to the other support groups; and meetings can be far and few between. Several months ago I had a couple of former patients drop by the program where I work and they were complaining about this very fact.
I told them I had a suggestion. There are two of you, and it only takes two to have a meeting, right? So why don’t you contact DRA to get the materials to start a new meeting group of your own. They liked that idea (Hopefully they have done so).
Until the next blog,
WRD
It just takes one person to hear what is being said and feel the 'need' to tell the person they are 'chewing' their booze, and that they are not sober.
Before going into more detail and examples, I feel I should state for the record that I am NOT ANTI-12 STEP. As a matter of fact, many people that are 'dual-diagnosed' utilize traditional 12 Step meetings as their base of recovery. Traditional 12 Step meetings can help one to learn again (or for the first time) how to socialize without a drug or drink in their system. Also, people attending these meetings share a common goal, namely, maintaining and fostering sobriety.
Conflicts can arise for the dual-diagnosed person in these meetings with regards to some of the traditionally held sayings and beliefs.
Example: I had a client that was told at a meeting to, “Just go to another meeting.” Well, the fact of the matter was my client had been awake for four days and had attended six meetings. What he really needed was a medication adjustment for his bipolar disorder.
Example: “No one ever died from lack of sleep.” I have never sought research to confirm or deny this statement. I can tell you from working in the psych/addiction field for twenty plus years now, people can become extremely paranoid, psychotic, and suicidal if they have been awake for a number of days (particularly people in a manic episode for instance).
Example: “They broke out because they stopped going to meetings.” This is definitely a blanket statement. What if the person was ‘so depressed’ they could not get out of bed?
I recently had a patient I was working with inform me that his AA sponsor was telling him to ‘get off’ the anti-depressant he is on. He asked me what he should do. I asked him if he felt the anti-depressant was working for him, he said yes. I told him I think you have your answer then.
So what are some of the other support groups? The first one I tell them about is DBSA - Depression Bipolar Support Alliance (www.dbsalliance.org/ ). These are meetings for people that have major depression with or without anxiety, and those with bipolar disorder.
The largest group within these meetings is “Double Trouble.” These are people with substance abuse coupled to the aforementioned above. People who often times were trying to self-medicate. Many of these members also belong to traditional 12 Step groups as well.
In much the same way that 12 Step programs have sponsors, people in “Double Trouble” can find a sponsor that not only has their same addiction, but the other mental health issue as well; “you pace your kitchen at 3am agitated and drinking – I thought I was the only one!”
The reason support groups work for many people is the identification factor. I realize now that I am not the only person that has ever felt or feels the way I do. I am not alone.
Another group is DRA – Dual Recovery Anonymous (http://draonline.org/ ). This is a 12 Step based group. In these meetings people can not only talk about their addiction issues, they can also discuss their other mental health issues as well. In traditional 12 Step if you want to discuss the other mental health issues you do so after the regular meeting (sometimes referred to as the meeting after the meeting).
DRA is relatively young compared to the other support groups; and meetings can be far and few between. Several months ago I had a couple of former patients drop by the program where I work and they were complaining about this very fact.
I told them I had a suggestion. There are two of you, and it only takes two to have a meeting, right? So why don’t you contact DRA to get the materials to start a new meeting group of your own. They liked that idea (Hopefully they have done so).
Until the next blog,
WRD
Wednesday, March 12, 2014
Enabling Them to Death
But the fact of the matter is they are actually aiding and abetting their loved ones addiction to continue.
To not allow them to pay the consequences for their actions is to become an accomplice with their addiction.
I remember having to inform a patient in a program I was working in that we were going to have to discharge him due to his urine screen coming back positive for opiates.
The first thing he said after I informed him of the positive screen and that we would be discharging him from the program was, “Why are you throwing me out of the program?!”
I’m throwing you out of the program? You knew what the policy was when you started the program, you chose to use opiates; therefore, you threw yourself out of the program. I had nothing to do with your decision.
If the person can acknowledge that fact, then they have an opportunity to get honest with themselves and move forward.
Co-Dependency can occur when a person with an active addiction begins to manipulate family and friends in order to keep their addiction running. For instance they might say they need money to get to work. Rather than giving them cash you might want to consider purchasing them a transportation pass instead.
I always have a concern when I see the manipulation/enablement dance. It is not healthy for either side nor productive towards truly helping a person to enter recovery.
You do not find a lot of alcoholics nor addicts in long-term mental facilities; this is where you can find their families and friends that have been trying to make sense out of their loved ones actions. They want to believe that this time will be different even though they are downplaying what they are actually experiencing and seeing.
It is so important for families and friends to seek help from addiction professionals and community supports such as Alanon when dealing with a loved one that has addiction issues. (Massachusetts: http://www.ma-al-anon-alateen.org/meetings.html)
In Co-Dependency one plus one equals one, rather than two. “I can’t live without him! I can’t live without her!” You mean you really would not want to, right? “NO, I CAN’T!!!” “They make me happy.” The question is can you be o.k. without being in a relationship? A healthy relationship with 'self' should come first, agree?
Many times I will find couples where one is an earth person (Non abuser of drugs/ alcohol) coupled to a spaceman (Active alcoholic/addict).
In these relationships one finds the Classic Enabler/Manipulator Dance. If the relationship was founded on this dynamic than it may well be over if the ‘spaceman’ gets into recovery.
I have had clients in early recovery tell of their partner getting on their case a couple of weeks into their recovery by saying things like, “All those years you put me through Hell,” “Now you are Captain AA/NA and I’m supposed to just forget the past!” What I have found in this instance often times is what the person is most upset by is the fact they lost their job as the “Enabler” and now they do not know where they stand in the relationship.
If the dynamic began later in a relationship both may decide to work things out and I would definitely refer them to a couples therapist with addiction experience.
Friends and Families at times ‘want’ recovery more than their loved one wants it for themselves. By not enabling them, hopefully, they will ‘want’ it for themselves and become vested in their own recovery.
Wednesday, February 26, 2014
The Diagnosis Rage
“Oh I’m Bipolar, with Borderline Personality features, severe PTSD, not to mention I also have been diagnosed with bulimia, opioid dependency, etoh abuse, trichotillomania and grief/abandonment issues.”
Really?
“Oh yes, but I am on the right combination of 12 meds now and things are going, well, fairly smoothly. You know, except for the blurred vision, constipation, migraines, low white blood cell count, and occasionally passing out.
How long have you had these diagnoses?
“Since I saw my new doctor last month for the first time. Gosh, he is just the Best!”
Among things I find amazing is when I meet a new client for the first time and I ask them what their diagnosis is. He or she might say for example that they have been diagnosed with Bipolar Disorder. I will then go on to ask them what Type, I or II? They will look at me like I have three heads and usually respond with something to the effect, ‘what do you mean? You know the type that goes up and down.’
So let me get this straight, someone gives you a diagnosis and you don’t ask them what they are basing it on? Again, as I always emphasis just because a person has credentials after their name does not necessarily mean they are skilled. TRUST ME on this one. I have been working in the field for over twenty years and some of the most idiotic, moronic statements I have heard have come from the mouths of the so called “Experts.”
Might be nice if they told you specifically what criteria they were basing the diagnosis on, right? People often times feel intimidated or just leave it in their hands. ‘I can’t question them, after all they are the professional.’
Bullshit. Someone gives you a diagnosis look it up, read about it. Get all the information you can about. Self-Efficacy my friends. Be an informed consumer. You may find, ‘Hey, from my research I can see now that I had a substance induced mood disorder, not Major Depressive Disorder like they said I had, and I have been feeling better more every day since detoxing!’
Most important of all, YOU are not a Diagnosis, a Label. You are a HUMAN BEING with XYZ!
When I worked at the Somerville Hospital Detox (closed in 2009) when we did the “Wrap-Up” group at the end of the day we had four questions each patient would answer.
The first one was, “Tell us something about yourself.” Something other than the obvious. Yes we know you are an alcoholic or an addict or you would not be sitting here.
What else are you? “a Musician, Father, Friend, Caring Person, Dreamer, Plummer, Student, etc, etc, etc.
The addiction is a part of you, not the Totality!
Over twenty years I have seen the times when a certain diagnosis was the “Rage” such as ADD in the nineties and now we appear to be in the “Bipolar” era.
In 1994 people that were receiving disability checks for Chemical Dependency were informed that they would be losing their benefits unless they were diagnosed with another mental disorder.
Hence began the mad dash to the doctor’s office to get said secondary diagnosis. Often times these were established by those all knowledgeable in psychiatry - The Primary Care Physician! (Yea, eight to thirty hours in med school qualifies them right? Idiots).
Currently I am finishing up the book “Anatomy of an Epidemic” by Robert Whitaker. Yea, Psychiatry definitely needs to take a good hard look at itself. Pick up a copy. I am sure you will find it to be an eye opener to the say the least!
Website www.willydrinkwater.com
Twitter https://twitter.com/#!/WillyDrinkwater
LinkedIn http://www.linkedin.com/pub/william-r-drinkwater-m-ed-cadc-ii-ladc-i/16/549/708/
Really?
“Oh yes, but I am on the right combination of 12 meds now and things are going, well, fairly smoothly. You know, except for the blurred vision, constipation, migraines, low white blood cell count, and occasionally passing out.
How long have you had these diagnoses?
“Since I saw my new doctor last month for the first time. Gosh, he is just the Best!”
Among things I find amazing is when I meet a new client for the first time and I ask them what their diagnosis is. He or she might say for example that they have been diagnosed with Bipolar Disorder. I will then go on to ask them what Type, I or II? They will look at me like I have three heads and usually respond with something to the effect, ‘what do you mean? You know the type that goes up and down.’
So let me get this straight, someone gives you a diagnosis and you don’t ask them what they are basing it on? Again, as I always emphasis just because a person has credentials after their name does not necessarily mean they are skilled. TRUST ME on this one. I have been working in the field for over twenty years and some of the most idiotic, moronic statements I have heard have come from the mouths of the so called “Experts.”
Might be nice if they told you specifically what criteria they were basing the diagnosis on, right? People often times feel intimidated or just leave it in their hands. ‘I can’t question them, after all they are the professional.’
Bullshit. Someone gives you a diagnosis look it up, read about it. Get all the information you can about. Self-Efficacy my friends. Be an informed consumer. You may find, ‘Hey, from my research I can see now that I had a substance induced mood disorder, not Major Depressive Disorder like they said I had, and I have been feeling better more every day since detoxing!’
Most important of all, YOU are not a Diagnosis, a Label. You are a HUMAN BEING with XYZ!
When I worked at the Somerville Hospital Detox (closed in 2009) when we did the “Wrap-Up” group at the end of the day we had four questions each patient would answer.
The first one was, “Tell us something about yourself.” Something other than the obvious. Yes we know you are an alcoholic or an addict or you would not be sitting here.
What else are you? “a Musician, Father, Friend, Caring Person, Dreamer, Plummer, Student, etc, etc, etc.
The addiction is a part of you, not the Totality!
Over twenty years I have seen the times when a certain diagnosis was the “Rage” such as ADD in the nineties and now we appear to be in the “Bipolar” era.
In 1994 people that were receiving disability checks for Chemical Dependency were informed that they would be losing their benefits unless they were diagnosed with another mental disorder.
Hence began the mad dash to the doctor’s office to get said secondary diagnosis. Often times these were established by those all knowledgeable in psychiatry - The Primary Care Physician! (Yea, eight to thirty hours in med school qualifies them right? Idiots).
Currently I am finishing up the book “Anatomy of an Epidemic” by Robert Whitaker. Yea, Psychiatry definitely needs to take a good hard look at itself. Pick up a copy. I am sure you will find it to be an eye opener to the say the least!
Website www.willydrinkwater.com
Twitter https://twitter.com/#!/WillyDrinkwater
LinkedIn http://www.linkedin.com/pub/william-r-drinkwater-m-ed-cadc-ii-ladc-i/16/549/708/
Saturday, February 8, 2014
What's Up for the Addiction Field in 2014
Yes, it has been quite a while since I last blogged. Look for this to change starting tonight. Last year saw the beginning of insurance companies 'changing' what they will pay for, or more importantly, NOT pay for.
One of their goals is to make this year be the year that all opiate detoxifications will be done on an outpatient basis - no more medical addiction treatment units. If a person does have concurrent medical issues in addition to their opiate dependency, then yes they can have a medical bed. But that's it, no addiction program. One hospital in the Boston area has an addiction counselor visit them while they are being medically detoxed. They are limited essentially to providing the patient with aftercare information and possibilities.
I guess that is better than nothing though.
As for detoxification from alcohol and benzodiazepines they are thinking along the same line as the opioids. Unless there is an accompanying medical condition they want this to be on an outpatient basis. This may be more difficult to implement due to the seizure risk in these two types of detoxification.
At least with the opiates their rationalization is there are established methadone and suboxone clinics that can provide this service and there is not the seizure risk that the two aforementioned bring to the table. Although from an observational point of view these clinics tend to promote maintenance (form of harm reduction) as opposed to detoxification. I have yet to counsel someone that told me the day they went on suboxone or methadone the clinic discussed a proposed titration date & plan to get them off.
Hey, we're talking big business, right?
Last year saw 'designer' drugs in the news and they are carrying over to this year as well Drugs such as "Mollies" made their appearance on the Club Scene often with disastrous results: (http://blogs.cbn.com/healthyliving/archive/2013/09/05/new-recreational-drug-molly-popular-but-deadly.aspx). Bath Salts, also known as MDPV are still on the scene and can cause serious mental and physical health issues (http://www.abovetheinfluence.com/facts/drugsbathsalts).
Last summer and again recently overdose deaths have occurred due to street heroin being cut with acetyl fentanyl. Rather than decreasing the potency, acetyl fentanyl is five times the strength of heroin (http://www.forbes.com/sites/davidkroll/2013/08/29/cdc-issues-alert-on-deadly-new-designer-drug-acetyl-fentanyl/).
The latest threat is a drug called "Krokodil" which is a form Desomorphine which is a derivative of morphine. Originally started in Russia due to a heroin shortage, this drug 'rots' the body from the inside out. I have read the life expectency of a user of this drug is usually around one year. (http://www.huffingtonpost.com/2013/10/09/krokodil-drug_n_4073417.html?utm_hp_ref=krokodil).
This year should be the year that licensed alcohol drug counselors in the Commonwealth are finally granted their insurance billing rights (projection of December). About time. Those that are licensed as 'Addiction Specialists' (LADC-I) have had to sit on the sidelines while disciplines with minimal (if any) experience have been working with the population. Not a knock on them, at least someone has been working with them. It only makes sense to give the people with addiction issues the option of seeing an addiction specialist among the possible choices.
As far as "Recovery Coaches" I am not too keen on the whole concept for several reasons. I see this as deluding the addiction profession and downplaying the seriousness of addiction. Also, the minimal training required to obtain the designation.
Another issue has been the increase in detoxification beds while transitional programs (usually for thirty days after detox) lagged behind in numbers. Just recently new transitional program starts have been announced. This is a positive note for the longer a person is in treatment, the higher their probability of remaining sober. Prior to these announcements a person could complete detox and not have a transitional bed available to them.
That's it for the episode. Look for this blog to return to a weekly format.
One of their goals is to make this year be the year that all opiate detoxifications will be done on an outpatient basis - no more medical addiction treatment units. If a person does have concurrent medical issues in addition to their opiate dependency, then yes they can have a medical bed. But that's it, no addiction program. One hospital in the Boston area has an addiction counselor visit them while they are being medically detoxed. They are limited essentially to providing the patient with aftercare information and possibilities.
I guess that is better than nothing though.
As for detoxification from alcohol and benzodiazepines they are thinking along the same line as the opioids. Unless there is an accompanying medical condition they want this to be on an outpatient basis. This may be more difficult to implement due to the seizure risk in these two types of detoxification.
At least with the opiates their rationalization is there are established methadone and suboxone clinics that can provide this service and there is not the seizure risk that the two aforementioned bring to the table. Although from an observational point of view these clinics tend to promote maintenance (form of harm reduction) as opposed to detoxification. I have yet to counsel someone that told me the day they went on suboxone or methadone the clinic discussed a proposed titration date & plan to get them off.
Hey, we're talking big business, right?
Last year saw 'designer' drugs in the news and they are carrying over to this year as well Drugs such as "Mollies" made their appearance on the Club Scene often with disastrous results: (http://blogs.cbn.com/healthyliving/archive/2013/09/05/new-recreational-drug-molly-popular-but-deadly.aspx). Bath Salts, also known as MDPV are still on the scene and can cause serious mental and physical health issues (http://www.abovetheinfluence.com/facts/drugsbathsalts).
Last summer and again recently overdose deaths have occurred due to street heroin being cut with acetyl fentanyl. Rather than decreasing the potency, acetyl fentanyl is five times the strength of heroin (http://www.forbes.com/sites/davidkroll/2013/08/29/cdc-issues-alert-on-deadly-new-designer-drug-acetyl-fentanyl/).
The latest threat is a drug called "Krokodil" which is a form Desomorphine which is a derivative of morphine. Originally started in Russia due to a heroin shortage, this drug 'rots' the body from the inside out. I have read the life expectency of a user of this drug is usually around one year. (http://www.huffingtonpost.com/2013/10/09/krokodil-drug_n_4073417.html?utm_hp_ref=krokodil).
This year should be the year that licensed alcohol drug counselors in the Commonwealth are finally granted their insurance billing rights (projection of December). About time. Those that are licensed as 'Addiction Specialists' (LADC-I) have had to sit on the sidelines while disciplines with minimal (if any) experience have been working with the population. Not a knock on them, at least someone has been working with them. It only makes sense to give the people with addiction issues the option of seeing an addiction specialist among the possible choices.
As far as "Recovery Coaches" I am not too keen on the whole concept for several reasons. I see this as deluding the addiction profession and downplaying the seriousness of addiction. Also, the minimal training required to obtain the designation.
Another issue has been the increase in detoxification beds while transitional programs (usually for thirty days after detox) lagged behind in numbers. Just recently new transitional program starts have been announced. This is a positive note for the longer a person is in treatment, the higher their probability of remaining sober. Prior to these announcements a person could complete detox and not have a transitional bed available to them.
That's it for the episode. Look for this blog to return to a weekly format.
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