Psycho-active Prescriptions & Your Primary Care Physician

I'm Back...

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 every four hours, around the clock, for three weeks.

We have a population of 311 million people – you do the math. (Don’t bother, I already have. The number is: 39,186,000,000 billion).

This is just the pain-killers.

Why? I feel in large part this is due to the limited training our physicians are receiving in medical schools across the country on mental health and particularly with regards to addictions. Having been a preceptor for a medical school in the Boston area I can tell you first hand that the training is roughly thirty hours. Yup, that’s right thirty hours with most of that academic rather than clinical with patients. Ask them the next time you see them. I feel confident their answer will blow you away.

Not to mention the number of patients PCP’s see every day in order for their practice to survive.

Do you really want your PCP to be prescribing you a psycho-active prescription with that limited a background?

The insurers may think this is fine. I mean, after all, the person is an M.D. right? The real reason they do not mind this practice is that it saves them the cost of having the person referred to a specialist, a psychiatrist, a psych nurse practitioner.

Even in the case of say, anti-depressants, are you making sure they are connected to a therapist? It might be nice if they have an unbiased person that can detect changes from appointment to appointment (for better or for worse).

I am sitting in a conference right now being put on by Harvard Medical School in conjunction with the world renowned McLean Hospital and they are espousing the view that PCP’s do not get enough education on addiction and mental health (I’m on my lunch break, don’t worry, lol).

Soooo, what are we going to do about this????

In the case of PCP’s prescribing psycho-active drugs I would like to see an across-the-board policy whereby before writing ‘said script,’ the patient is given a urine tox screen. Does it not make sense to see what if anything is already on board and the amount? By doing this across-the-board one would find it difficult to claim they are being discriminated against due to a past or current addiction history. Scripts would be for one month at a time with a new tox screen being done before a new script is given. Scripts would be for one month at a time.

The prescribing PCP at the time of the first script would provide the patient with numbers and agencies where they can obtain a therapist.

Before the next script could be written (second one) the patient would be required to provide proof they are currently in therapy. The patient would have to have signed releases so both therapist and prescriber can communicate and update each other.

Post Holidays – Welcome 2013

Jeez, the month of December is over and I realized today that I did not write one single blog the whole month.

No excuse other than not making the time to do so.

I let life (particularly work) get in the way. The hospital where I have been working relocated us twice during the month; each move with its own set of nuances and complications (viewed as challenges – not problems by yours truly).

A wonderful, inspirational buddy of mine had made the suggestion prior to these moves to, “get yourself a latte machine or a basket of good teas…” Sue, I took your suggestion and all I have to say is, “Merci beaucoup.” Nothing quite like a good mug of tea with a squirt of lemon and a dollop of honey, eh?

Last evening colleague Vicki Glow and I were on the Jordan Rich Show, WBZ-Boston, 1030AM radio (nice range, 38 states). The topic was ‘prescription drug abuse.’ Of course due to addiction being such a multi-faceted issue the conversation weaved in and out the designated topic. Look for Vicki & me to do more this spring.

This past week found me interviewing with a hospital closer to my home for a position similar to my current one but with more opportunities to grow and develop as a professional. All parties involved are excited about the possibility of my coming on board (patient states, lol). Pending HR approval I should be receiving an offer in the mail this upcoming week (based not on my ego – based on the nurse manager asking me how soon I can start, again, lol).

I start back to teaching the first week in February and really look forward to it as always. I have been researching both the ‘pro’ and ‘con’ side of the “Suboxone” debate. In a future column I will present both sides of this controversial issue with corresponding links to articles that look at both the empirical studies and clinical observations.

This should raise quite a ruckus I imagine.

Well, I need to get back to working on my website and attend to a couple of syllabuses for February.

To my French Canadian Friends, “Jusqu'à ce que nous nous revoyions!

Peace, Out

Willy

“The Whizzinator!”

Man, I have to tell you, what people think they can get away with when they are actively using never ceases to amaze me.

I get a call from a case manager in Boston I have known for quite some time and the second she hears me say “hello,” she literally “loses it” on the phone laughing.

O.k. I think to myself, some people find me funny, but all I said was hello.

Finally she begins to wind-down. I’m like, ‘ah Nancy what is going on that’s so funny,’ and she loses it again!

Now I’m thinking, Nancy has finally gone over the edge; too many days working in our field.

‘Willy, oh my gawd! (Boston accent) You’ll never believe what happened a half an hour ago here! Unbelievable!

She begins to tell me the tale while trying to hold back her laughter. ‘You have heard of Whizzinators, right?

I say ‘yea I know what they are.’

For you un-informed folks, the ‘Whizzinator’ is an item that men can buy when they are trying to beat a urine tox screen test. They are a prosthetic device that looks like real male (ahem) genitals. The person trying to ‘beat’ the test will get a clean urine sample from someone, load the device with the sample, then pack it down the front of their pants prior to taking the test.

The people supervising the test watch them when they are giving the sample (not a job for me, no thank you).

Nancy continues when we were doing the screens this morning this young, freckled, fair skinned kid from ‘Southie’ got bagged using one.

So I say, ‘yea?’

“Willy! It was a black one!! She ‘loses’ it again laughing and this time so do I.

He told us afterwards it was the only one they had left. (raucous laughter)

Nancy, maybe he went ‘tanning?’ (laughter continues!)

Yup, it never ceases to amaze with what people think they can get away with. 

It’s Their Fault!!

It’s his fault, her fault, the boss’s fault, my mother’s fault, my dad, my cousin, my dog…

Stop!! Enough of the ‘blame game.’ What was your role in all of this?

Well, they made me angry and upset. You mean you ‘allowed’ them, gave them ‘permission’ to get you angry and upset?

What is that supposed to mean? Quite frankly, when we say someone made us angry the fact of the matter is we allowed them and gave them permission to press our buttons.

Granted, easier said than done when dealing with family members and friends in particular who usually know all the right things to say (actually, the not so nice things to say) that can (if we allow them to) place us in a state of mind that can turn reactive and emotionally charged.

One healthy option is to utilize ‘positive confrontation’ when a person says something to try and get you to react.

It works like this. A person says something nasty to you. Instead of reacting, you can respond back with, ‘geez, what is going on with you that you would make that kind of a comment to me, I’m concerned about you.’

Or, ‘geez, you say you love me and care about me, then why would you say something like that? What is going on with you, I’m concerned.’

Usually by showing you are concerned rather than reacting back, ‘argument over before it can begin.’

Sometimes when working with people I will hear a client say, “You know, I am the way I am because of the environment I was raised in!”

Congratulations, you are halfway there. When you have that type of realization it gives you one of two choices; continue to ‘use it’ as your excuse for drug and alcohol use and behavior, or, work on those issues so you can come to resolution on them and move forward in a healthy manner.

If you are not quite there yet for ‘positive confrontation,’ then I suggest you just walk away from them and say nothing to fan their fire further.

Usually we do less harm by walking away then by reacting back.