Pain clinics cash in on America’s painkiller addiction.

In 2008, brothers Chris and Jeff George started the first of what would become an “empire” of pain clinics. The Georges are not doctors or even medical professionals.  The brothers were simply looking for a way to get rich quickly. They made $40 million over 2 years, arguably by exploiting a national painkiller addiction.

Jeff George opened South Florida Pain Center north of Fort Lauderdale, Florida and his brother soon got involved in the business. As business grew, they opened pain clinics in West Palm Beach, Hallandale Beach, Boca Raton and Lake Worth, Florida. The clinics relied on doctors who gave quick exams, often neglecting to ask patients relevant questions about current conditions or medical history, and prescribed excessive amounts of popular painkillers. According to the Sun Sentinel, the clinics distributed prescriptions for over 20 million pills, including oxycodone. Prescription drug abuse continues to rise in the United States and oxycodone is one of the most abused drugs.

It is possible that some of the clinics’ clients were visiting for legitimate pain management. However, others were coming to receive what they misconstrued as a “legal” high. Unfortunately, many people perceive painkillers as safer than illicit street drugs because they are prescribed by doctors and sold in pharmacies, which is only true if they are taken as directed. Prescription drug abuse has serious physical and psychological consequences which can lead to addiction. Prescription drug addiction can lead to death, a fate which many of the George’s clients unfortunately suffered. Investigators estimated that drugs administered by the brothers’ clinics played a part in 53 overdose deaths in the state of Florida.

In 2011, the brothers and 31 of their associates were arrested on charges ranging from murder to racketeering. The clinics were shut down, leaving many prescription drug addicts without suppliers. The shutdown of the Georges’ clinics is a step in the right direction, but there are certainly more clinics out there that must be stopped.

Prescription drug abuse is an epidemic in this country. Individuals who are prescribed painkillers and other controlled substances need to be counseled by trustworthy physicians in how to use them properly and need to be monitored on a continual basis. If tolerance and addiction do occur, individuals need to be properly detoxed in prescription drug rehab and treatment should follow in an addiction treatment center. Don’t be fooled, prescription drugs are not safer than street drugs. The George brothers and their clients learned this the hard way.

Young adults have a high rate of alcohol abuse.

Alcohol abuse is higher among college students than non-college students.  A 2009 study found that 12,000 treatment admissions involved college students, but the rate of admissions for the 18-24 year olds varied greatly for other drugs with all categories of drug abuse higher among non students.

Binge drinking and driving while intoxicated have continually increased among college students since 1998. It is estimated that 696,000 students between 18-24 are “assaulted by another student who has been drinking, and more than 97,000 students …are victims of alcohol-related problems on campus.”

Colleges as well as physicians need to engage in better alcohol screening, counseling, and treatment programs.

(Source: adapted from http://www.collegedrinkingprevention.gov/1College_Bulletin-508_361C4E.pdf)

Huffing is a dangerous pastime for teens.

A recent New Zealand article brought disturbing news about solvent abuse, also referred to as “huffing”:  it is a much bigger problem than many people think. Murray Trenberth, chief executive of WellTrust, a service that counsels youth on drugs and alcohol said, “Seven people a year die from simply drinking too much alcohol in one sitting. Five or six a year dies from [solvent] abuse.” Clearly, the dangers of huffing are not to be underestimated.

What is huffing? Huffing is the inhalation of common household or industrial products such as paint, cleaning products and gasoline. Inhalant abuse is especially seen among teenagers. Trenberth said that children as young as ten years old are experimenting with the substances. The effects of huffing include short-term memory loss, disorientation, tremors and loss of senses. In unfortunate cases, people die from inhalant abuse.

Why are teens huffing? Since so many different legal substances can be inhaled to achieve a high, minors have easier access to them than alcohol or illicit drugs. It would be virtually impossible to enact age restrictions on everything from rubber cement to nail polish remover to canned whipped cream to deodorant. Experts suggest that salespeople be mindful of whom they are selling products to that have a potential for inhalant abuse, but this is hardly a solution to a growing problem. It is important to talk to children and teenagers about the dangers of inhalant abuse. They may be under the incorrect assumption that huffing is a safer way to get high than drug abuse or drinking. Communication can help stop kids from experimenting with inhalant abuse and avoid harmful consequences.

Underage Drinking has Consequences

Every high school parent is familiar with the seemingly obligatory talks that take place before certain events. Generations of mothers and fathers have been looking for ways to speak to their teens about drugs, alcohol and driving before important days such as graduation and prom. Of course, the most effective way to reach teens and encourage them to act responsibly varies from individual to individual. A program in Palm Beach County is using scare tactics to try to convince high school students not to drive under the influence after prom.

A Sun Sentinel report last week shows a video clip of teenage girls, covered in dirt, crying and screaming in horror for their friend who has just died in a crash. Any teenage onlooker would be frightened by this scene, certainly enough to think twice before getting behind the wheel after drinking underage, right? This is the idea behind mock crashes like the one above, which was staged and performed by actors. Organizers hope that seeing a “crash” will make teens take the dangers of underage drinking and driving seriously before prom.

The Palm Beach County Fire-Rescue orchestrates such mock crashes several times a year at various schools throughout the county and according to Captain Don. De Lucia their spokesman, “If you save one [student], you[‘ve] accomplished something.” While they are one way of possibly preventing underage drinking and driving and teen drug abuse, mock crashes should not be relied on as a sole line of defense. Teen substance abuse can lead to addiction and even death, so it is important to educate your children about the dangers of drugs and alcohol. It could save their lives.

Nicotine Interferes with Inpatient Drug Detox

New research is revealing links between nicotine use and methadone detoxification. Methadone detox is currently used to wean individuals off of opiates on a taper system before they enter inpatient drug rehab. Findings presented by Dr. Paolo Mannelli at the 43^rd Annual Medical-Scientific Conference of the American Society of Addiction Medicine (ASAM) say that cigarette smoking may interfere with the advantages of interventions for opioid addiction, such as methadone therapy. In this study, opioid addicts with a history of nicotine dependence had better outcomes if they didn’t smoke during methadone detox.

This brings to mind the age-old question of smoking during drug rehab. Some rehabilitation facilities do not permit smoking, mandating that addicts quit cold turkey while also pursuing recovery from their various addictions. Others allow smoking and give individuals the resources necessary to quit during inpatient treatment, if that is something they desire. The issue of cigarette smoking should be something that individuals consider when selecting an inpatient drug rehab facility since it is a personal matter. Quitting smoking while working to get clean and sober may be difficult, but it will have added health benefits for an individual in both the short and long term.

Regardless of whether you want to keep smoking or quit smoking, rest assured that a rehab facility exists that can accommodate your needs. Alcohol and drug addiction can destroy your social life, ability to maintain employment and finances…they can even kill you. Don’t let cigarettes deter you from getting the help you deserve if you are struggling with addiction.

A healthy relationship with the addict can encourage treatment.

When it comes to alcohol and/or drug addiction, there is no quick fix. A lot of time must be invested into the patient to reach the core of their addiction.  Unfortunately, this usually never happens. Nowadays, more focus is put into how many patients can be seen rather than giving the patient the attention they truly need.

Ideally, each patient should go through the patient-centered care model. This holistic health care approach embodies the whole patient and their family. At the core of this model, though not new, is the patient/doctor-health care professional relationship or the quality of communications between the participating parties. The goal is for the physician to provide education about the condition to the patient and family while empowering the patient to make healthy, life-changing choices.

Most of the time a patient won’t make healthy choices unless empowered.  One way to do this is by having the physician ask open-ended questions. By having an empathetic discussion with the patient, the physician may figure out the root of their addiction. Not only that but, these non-judgmental, open-ended questions about alcohol abuse
and drug use can help lead the patient to accept detox and substance abuse treatment.

Part of the problem with communications today is the assumption that the patient can correctly interpret the data. More often than not the patient is usually in an unhealthy mind state to do so. When addiction confronts the addict, especially in this scenario, a likely response is to deny the problem. Fortunately, blood and urine tests can provide the physician with crucial information about the addiction and help put the symptoms in perspective.

Understanding the circumstances of the addiction, whether related to constant pain, trauma, heart and blood pressure problems, mood disorders, and even certain cancers is crucial.

For many years now, patient-physician communications have been emphasized. Research illustrates that without empathetic listening and responding; the patient is unlikely to open up to the physician, accept the diagnosis of addiction, or make any positive changes.

Military Personal Having Issues with Medications

According to U.S. Army’s Surgeon General (LA TIMES), antidepressants, stimulants, narcotics, sedatives, anti-psychotic and anti-anxiety medications were given to over 100,000 troops to take. Nearly 8% of active duty troops were prescribed sedatives with an additional 6% that were prescribed antidepressants. A growing number of these troops are displaying erratic behaviors.

A host of problems are associated with prescribing powerful drugs as troops leave for deployment. Little if any follow up is available in the field, and soldiers go with a supply large enough to last the deployment. Trading drugs is not unusual and poly drug use occurs increasing the number of military personnel who grow addicted.

Several former military psychiatrists are speaking out about the practice of over prescribing powerful medications and then sending people out to work with weapons. Soldiers on multiple deployments are psychologically worn out. More and more cases of psychotic breaks followed with violent breaks are occurring.

While the situation of stress, mental exhaustion, and trauma may be specific to active members of the military, the lessons can be drawn toward the growing number of Americans prescribed these powerful drugs. Addiction and mental health disorders have been found to be correlated. Care in prescribing, full screening, mid treatment assessments, and follow ups are crucial.

(Source: http://www.latimes.com/news/nationworld/nation/la-na-army-medication-20120408,0,1291311.story)

Are Gender Specific Drug Rehab Programs the Way to Go?

A recent study published in January 2012, conducted by Yale School of Medicine, examined differences in men and women who suffer from induced cocaine cravings. The study used brain imaging to map the differences both in men and women and the activation of cravings based upon different cues.

The study found that women experienced stress related drug induced cravings where as men experienced cravings induced by drug cues. The cocaine dependent individuals experienced stimulation to broader portions of the brain linked to cocaine addiction and motivation than those of the control group.

The results further support gender specific treatment as female cocaine addicts would appear to benefit from stress reduction therapies that target cravings, while men would respond best to cognitive behavioral therapies and 12 Step programs to deal with drug induced cravings brought on by drug cues.

Prescription Drug Take Back Day Aims to Fight Drug Abuse

Tomorrow, April 28^th, is the fourth scheduled National Prescription Drug Take-Back Day. The event, sponsored by the US Drug Enforcement Administration (DEA), will take place from 10 am to 2 pm and provide an opportunity for anyone to turn in prescription drugs for safe disposal. Participating police departments and collection sites will be receiving drugs across the country.

DEA administrator Michele M. Leonhart said, “The amount of prescription drugs turned in by the American public during the past three Take-Back Day events speaks volumes about the need to develop a convenient way to rid homes of unwanted or expired prescription drugs.” Furthermore, the event is a great way to keep drugs you may have around the house from being used improperly.

Prescription drug abuse has been on the rise in the United States and involves people misusing medications prescribed to them as well as those not prescribed to them. Regardless of medical need, prescription drug abuse can have dangerous effects on an individual’s health, finances and social life. Even if a medication is prescribed to you, your body can develop dependence and you may find yourself burdened with a prescription drug addiction. If you feel that this may be happening to you or a loved one, consult your doctor or consider medical prescription drug detox and drug rehab. Thousands of people a year turn to these options as ways to break free of prescription drug dependency. Also, consider participating in National Prescription Drug Take-Back Day tomorrow to prevent any old or unwanted drugs you have from falling into the wrong hands….you may be saving someone’s life.

For more information on National Prescription Take-Back Day, including where to find a drop off site near you, visit: http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html.

Substituting Addictions with Buprenorphine Maintenance

Years ago, methadone maintenance therapy was a breakthrough treatment for those suffering from heroin addiction. More recently, the medical community discovered the wonders of buprenorphine.  The drug was first used in France in 1995 and is now approved in 44 countries for the treatment of opioid addiction.

Buprenorphine is considered a reasonable alternative to methadone as it can enable opioid addicts to discontinue use of their opioid drug of choice. Recently, the Mayo Clinic published a paper concerning healthcare professionals (HCPs) addicted to opioids and the controversy of diversion treatments such as buprenorphine maintenance therapy. The focus of the paper was whether placing HCPs addicted to opioids on buprenorphine maintenance is safe for their patients. Studies have not clearly demonstrated a single definitive answer. In response to the potential harm to patients, the Mayo Clinic writers argued that an abstinence-based model of treatment was still the best approach.

Buprenorphine produces the same effects as other opioids at lower doses and can diminish or remove cravings for the drug of choice. However, it can be abused without proper supervision. Taken in high doses, it will precipitate immediate and intense withdrawal symptoms. The Mayo Clinic report stated that buprenorphine produces “cognitive and psychomotor impairment, memory deficits, respiratory depression, decreased gastrointestinal motility, urinary retention and nausea”.

Researchers studying buprenorphine found that a significant number of poison control hotline calls from 2003 to 2005 were “suggestive of buprenorphine abuse.” They also indicated that “the combination drug of buprenorphine and naloxone or Suboxone had a higher rate of abuse ratio than plain buprenorphine.”

Other studies in the report measured cognitive performance of those on buprenorphine maintenance against those on methadone maintenance. In some of the tests, buprenorphine users fared better than methadone users, while in others, both demonstrated major deficits. Researchers examining cognitive and psychomotor effects of intravenous buprenorphine use found buprenorphine significantly impaired performance in all areas tested.

While the report focused on HCPs, its studies included individuals who were overcoming opioid addiction, others who had not used opioids in a long time, students and healthy volunteers who never used drugs. The Mayo Clinic researchers argued that abstinence-based recovery improves the quality of life of professionals. HCPs in treatment under the abstinence-based model have very high rates of treatment compliance, completion of treatment and long-term recovery. Healthcare professionals typically also have the motivation to maintain licensure and to return to practice driving their recovery from addiction even further.

(Source: Buprenorphine Maintenance Therapy in Opioid-Addicted Health Care Professionals Returning to Clinical Practice: A Hidden Controversy, retrieved from http://www.mayoclinicproceedings.org/article/S0025-6196%2811%2900081-4/fulltext:

Abstinence-Based Substance Abuse Treatment vs. Buprenorphine Maintenance Therapy

Buprenorphine maintenance therapy should not be used as first line treatment for an opioid addict nor has it been shown to be successful for those with an opioid and cocaine addiction. Whether taken as Subutex or Suboxone, buprenorphine is addictive and presents addicts with a harsh, difficult withdrawal process.

Switching from one opioid to a partial opioid agonist doesn’t change the problems of addiction.  Furthermore, buprenorphine maintenance therapy does not allow the brain to heal because it does not allow the receptors to return to normal functioning. It can create another addiction that traps the user into a life of drug-induced slavery.

Generally speaking, buprenorphine is 20-40 times more powerful than morphine. Many doctors are unaware that buprenorphine is powerfully addictive, perhaps due to marketing by pharmaceutical companies. Opiate addicts who are placed on buprenorphine may begin abusing buprenorphine, substituting one addiction for another. Most physicians are not trained in addiction medicine, which can complicate the problem.

Although buprenorphine does have the potential for addiction, it also does provide many with relief during the drug detox process. Indeed, there are many evidence-based, medically monitored, comprehensive drug rehab programs that use buprenorphine for short-term detox. Once that need has been met, there is not a strong argument for maintaining the patient on buprenorphine. After detox, the focus of drug rehabilitation programs shifts to providing someone with the tools necessary to living in abstinence.

If an addict suffers from an underlying mental health disorder that is not properly diagnosed and addressed, there is a greater risk for relapse. Providing someone with a pill to take does not provide him or her with the skills necessary to handle the symptoms of a mental health disorder, minimize the chance of relapse, or avoid misusing drugs to cope with the symptoms. Considering the number of people entering addiction treatment who are suffering from disorders such as depression, anxiety or PTSD, receiving dual diagnosis treatment is crucial to diminishing the risk of relapse whether they are taking buprenorphine or not.