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.
Monday, April 21, 2014
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
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