I have seen the show "Intervention" and always thought that the addict being filmed must know what is going on. Though, when you are actively using, you can be pretty hazy about reality, and even when you have cameras following you around, you might even let your narcissistic side win out. Maybe they just want to help, thinking it is a show on the horrors of the disease. Maybe they don't really know anything and think it is cool to be filmed and don't care who sees it. No matter what, they are being exploited, and harmed in ways they, nor the producers, can't even begin to imagine.
How many peoples stories never even make it to television because they overdosed and died, or at the very least had serious complications due to their use and therefore were no longer of "value" to the show? We will never know the answer. It is beyond unethical. But, it sells because everyone likes to watch a "train wreck." People who watch the show who are in recovery should be ashamed of themselves. They remember, or should, what a living hell their drug and alcohol abuse became. People who don't have the disease really don't understand and are arguably excused from culpability, unless they work in the field or have a loved one they tried to help.
The reason I am writing this blog, is because I read an article in the LA Times. It highlights Leif Garrett, the teen idol, who entered "Celebrity Rehab with Dr. Drew". Another unethical show on VH1. It is reprehensible to mix video cameras with people who are actively using, withdrawing from their drug of choice OR in early recovery. These people can't think straight let alone make decisions based on their well being that will be recorded and memorialized forever. You cannot sign your name to a piece of paper in these circumstances and fully understand the ramifications.
As a recovering person, drug counselor and attorney, I know this story from back to front. It stinks to high heaven. I would be happy to start a class action suit against everyone involved in "Intervention" and "Celebrity Rehab with Dr. Drew". These people lack the mental capacity to fully understand their actions, let alone enter into an informed consent agreement and a contract. Money is the final incentive for people to agree to appear on both of these shows. Again, greed takes the prize and people are lulled into a sort of nirvana that money, or the hope of recovery, will solve all of their problems. Recovery, true recovery, without the presence of a financial incentive is the only way it works.
Please fell free to comment on this post, as I am truly interested in finding out what others think.
Saturday, January 15, 2011
Thursday, December 9, 2010
From amoxicillin to Adderall: a child's journey to prescription drug abuse
As a pharmacist, I can't even begin to count the number of prescriptions I filled for amoxicillin. The majority of them were in the form of the familiar pink suspension that kids get for various infections, mostly for colds and ear infections. That is where children are introduced to me, the pharmacist, purveyor of pure drugs. As an attorney, however, I defend clients against charges related to what are called "dangerous drugs." Both are pure, scientifically designed, sterilely prepared, prescription medications. Yes, Rx drugs can be both beneficial and dangerous, depending on the use, and context of the situation they are being referenced. Ever since we heard the phrase "when you have your health, you have everything" Rx drugs have been an integral part of the picture. The potential for abuse is also as old as the first ingestion of the most common drug of all: alcohol.
Prescription drugs offer the user a false sense of safety lead to impunity of use. Rarely do people consider any deleterious side effects, let alone fatal complications when the ingest a substance prescribed by a trusted physician and dispensed by a friendly pharmacist. Unwittingly, these medical professionals are now becoming the new suppliers of substances used to alter peoples minds and moods... really no different than any illicit drug known to man. Teens and young adults are the latest segment of the population being identified as abusers of Rx drugs. In a recent article by Reuters, young people have increased their access to controlled drugs by 50% in the last 15 years. The main Rx drugs being abused are pain relievers in the opiate class (Vicodin- generic name hydrocodone with acetaminophen, Oxycontin - generic name oxycodone, Percocet - generic name oxycodone with acetaminophen). As a matter of fact, generic Vicodin is the number one prescribed drug in the United States! Other drugs being prescribed and abused are the stimulants: mainly Adderall; and, the anti-anxiety meds of the benzodiazepine class: xanax - generic name alprazolam, Valium - generic name diazepam, and Konopin - generic name clonazepam.
Just yesterday I was speaking to my good friend and colleague, Dr. Stephen Sroka, an expert on motivating young people to choose safe alternatives to sex, drugs and violence. Steve was saying that kids aren't using Adderall to get high, but to get higher grades! I have experienced this personally when I was in college. My friends and I used any sort of stimulant, from coffee on up, to stay awake and cram for finals. The Reuters article also cites a survey claiming 36% of college students share their prescription drugs.
The need is plain to see: we must educate health care professionals on drug seeking behavior, substance abuse and addiction. There will always be plenty of business from legitimate patients to make sure these professionals meet their financial needs, and they don't have to resort to supplying kids, or anyone else, with dangerous drugs. Just like amoxicillin overuse has lead to antibiotic resistant bacteria, so too has overprescribing of pain killers, stimulants and benzodiazepines. They need to know the harm they can potentially be causing and that people can fake symptoms very easily. The other key element is that drug treatment must be available on demand. Only about 10% of the people seeking treatment in the US can find a bed in a treatment detox, residential facility or outpatient program. Education and treatment, two things that can't be overused.
Prescription drugs offer the user a false sense of safety lead to impunity of use. Rarely do people consider any deleterious side effects, let alone fatal complications when the ingest a substance prescribed by a trusted physician and dispensed by a friendly pharmacist. Unwittingly, these medical professionals are now becoming the new suppliers of substances used to alter peoples minds and moods... really no different than any illicit drug known to man. Teens and young adults are the latest segment of the population being identified as abusers of Rx drugs. In a recent article by Reuters, young people have increased their access to controlled drugs by 50% in the last 15 years. The main Rx drugs being abused are pain relievers in the opiate class (Vicodin- generic name hydrocodone with acetaminophen, Oxycontin - generic name oxycodone, Percocet - generic name oxycodone with acetaminophen). As a matter of fact, generic Vicodin is the number one prescribed drug in the United States! Other drugs being prescribed and abused are the stimulants: mainly Adderall; and, the anti-anxiety meds of the benzodiazepine class: xanax - generic name alprazolam, Valium - generic name diazepam, and Konopin - generic name clonazepam.
Just yesterday I was speaking to my good friend and colleague, Dr. Stephen Sroka, an expert on motivating young people to choose safe alternatives to sex, drugs and violence. Steve was saying that kids aren't using Adderall to get high, but to get higher grades! I have experienced this personally when I was in college. My friends and I used any sort of stimulant, from coffee on up, to stay awake and cram for finals. The Reuters article also cites a survey claiming 36% of college students share their prescription drugs.
Saturday, December 4, 2010
Marijuana, Mary Jane, Pot... whatever you call it... it means MONEY!
OK, so it was just a matter of time. Marijuana use has been increasing for the last century. Medical marijuana (MM) use has been on the rise and in the news for the last decade. Legalization has been the talk of the town for the last few years. That means the profitability of pot was only a toke away. A new trade group, the National Cannabis Industry Association, will primarily lobby lawmakers, on behalf of MM businesses. The MM field has made its mark and now it will get even bigger with the help of legislatures. Who would have guessed weed would be the new distributor of "green" in Washington and statehouses around the country!? Somebody has to help these money hungry politicians mellow down slow.
Colorado has also decided it wants to be the first state to regulate production. This has been attempted in New Mexico to some degree of success already. Of course, since the drug starts out in the form of a plant, and most of the time is marketed that way (there are other dosage forms: candies, elixirs etc), it is very difficult to determine potency. It could vary widely throughout parts of the same bud or leaf. Arguably, there will have to be ranges of 9-tetrahydrocannabinol (THC), the active ingredient, for various strains and dosage forms. Colorado wants to have inspectors and labeling standards set up by early next year. They obviously want to make John Denver proud and emphasize the "Rocky Mountain High." It makes sense financially. Some state has to be the first and 'go to" place. Might as well be Colorado. California won't be far behind... besides, they grow more - pot is second largest cash crop, right behind grapes - and they have a bigger budget deficit!
Now, as a drug counselor/social worker, I am most concerned about the damage pot will cause to our youth. It is truly a "gateway drug" and many kids I treat talk about it being safe as it is "God's herb." Safe is the last thing I would call it, especially when mixed with other drugs (that includes alcohol, the number one drug of abuse in this country) and/or driving. Once the lobbying groups start putting money in the lawmakers pockets, legalization and low marketing standards are sure to follow. If the legislatures around this country really think long and hard about the damage marijuana can cause and the influence it has on kids, they will need to counteract that effect with taxes on pot, to pay for prevention and treatment programs. The number of people needing help learning about or stopping marijuana abuse will rise exponentially. The beverage alcohol lobby has gotten away with murder for years, by convincing lawmakers to keep alcohol taxes as low as possible to not deter sales. Please, don't let pot lobbyists blow smoke in the eyes of the people who can levy high taxes on a product that does more harm than good.
Colorado has also decided it wants to be the first state to regulate production. This has been attempted in New Mexico to some degree of success already. Of course, since the drug starts out in the form of a plant, and most of the time is marketed that way (there are other dosage forms: candies, elixirs etc), it is very difficult to determine potency. It could vary widely throughout parts of the same bud or leaf. Arguably, there will have to be ranges of 9-tetrahydrocannabinol (THC), the active ingredient, for various strains and dosage forms. Colorado wants to have inspectors and labeling standards set up by early next year. They obviously want to make John Denver proud and emphasize the "Rocky Mountain High." It makes sense financially. Some state has to be the first and 'go to" place. Might as well be Colorado. California won't be far behind... besides, they grow more - pot is second largest cash crop, right behind grapes - and they have a bigger budget deficit!
Now, as a drug counselor/social worker, I am most concerned about the damage pot will cause to our youth. It is truly a "gateway drug" and many kids I treat talk about it being safe as it is "God's herb." Safe is the last thing I would call it, especially when mixed with other drugs (that includes alcohol, the number one drug of abuse in this country) and/or driving. Once the lobbying groups start putting money in the lawmakers pockets, legalization and low marketing standards are sure to follow. If the legislatures around this country really think long and hard about the damage marijuana can cause and the influence it has on kids, they will need to counteract that effect with taxes on pot, to pay for prevention and treatment programs. The number of people needing help learning about or stopping marijuana abuse will rise exponentially. The beverage alcohol lobby has gotten away with murder for years, by convincing lawmakers to keep alcohol taxes as low as possible to not deter sales. Please, don't let pot lobbyists blow smoke in the eyes of the people who can levy high taxes on a product that does more harm than good.
Wednesday, December 1, 2010
Darvon and Darvocet die a slow death
The prescription drug that comprises Darvon and Darvocet, generic name propoxyphene, has finally been recalled by the brand name and all generic manufacturers. It was a long time coming. Propoxyphene has long been associated with many untoward side effects, the most dangerous of which is liver damage. Additional MINOR side effects include constipation; dizziness; drowsiness; lightheadedness; nausea; vomiting.
SEVERE side effects that occur when using propoxyphene are severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); anxiety; cold or clammy skin; confusion; excessive sweating; hallucinations; loss of appetite; loss of consciousness; mental or mood changes; seizures; severe drowsiness or dizziness; severe or persistent stomach pain; vision changes; weakness; yellowing of the skin or eyes.
These side effects have been known for years since the drugs approval by the Food and Drug Administration (FDA) and introduction to the market by Lilly in 1957. Considered to be in the opioid class of pain relievers, there have been many safer alternatives available, namely aspirin, acetaminophen, codeine, morphine, hydrocodone and the entire class of opioids. Many people who are allergic to some opioids were not allergic to propoxyphene. That spurred its use despite a limited and low therapeutic pain relief index. Most of those people would have found enough pain relief from plain aspirin of acetaminophen, the active ingredient in Tylenol.
The FDA allowed the drug to stay on the market in 2009, despite a panel of experts who conducted a safety review, and voted 14-12 against doing so. In a half-hearted attempt to save face, the FDA required drug-makers to add a warning to packaging, which stated that taking too much of the drug could be fatal. The results of the most stringent testing showed significant changes to the electrical activity of the heart. Those changes are linked to potentially deadly abnormal heart rhythms.
The bottom line is that the FDA does not have the best interests of the public in mind if it continues to allow drugs to be marketed that cause dangerous side effects. One death is too many. The FDA has been a boon to plaintiff lawyers who sue the drug companies for these infractions. Unfortunately, the amount the drug companies pay out to the few plaintiffs who do bring suit is much lower than the money they have made during the lifetime of the drug on the market, and thus people will continue to be harmed needlessly.
SEVERE side effects that occur when using propoxyphene are severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); anxiety; cold or clammy skin; confusion; excessive sweating; hallucinations; loss of appetite; loss of consciousness; mental or mood changes; seizures; severe drowsiness or dizziness; severe or persistent stomach pain; vision changes; weakness; yellowing of the skin or eyes.
These side effects have been known for years since the drugs approval by the Food and Drug Administration (FDA) and introduction to the market by Lilly in 1957. Considered to be in the opioid class of pain relievers, there have been many safer alternatives available, namely aspirin, acetaminophen, codeine, morphine, hydrocodone and the entire class of opioids. Many people who are allergic to some opioids were not allergic to propoxyphene. That spurred its use despite a limited and low therapeutic pain relief index. Most of those people would have found enough pain relief from plain aspirin of acetaminophen, the active ingredient in Tylenol.
The FDA allowed the drug to stay on the market in 2009, despite a panel of experts who conducted a safety review, and voted 14-12 against doing so. In a half-hearted attempt to save face, the FDA required drug-makers to add a warning to packaging, which stated that taking too much of the drug could be fatal. The results of the most stringent testing showed significant changes to the electrical activity of the heart. Those changes are linked to potentially deadly abnormal heart rhythms.
The bottom line is that the FDA does not have the best interests of the public in mind if it continues to allow drugs to be marketed that cause dangerous side effects. One death is too many. The FDA has been a boon to plaintiff lawyers who sue the drug companies for these infractions. Unfortunately, the amount the drug companies pay out to the few plaintiffs who do bring suit is much lower than the money they have made during the lifetime of the drug on the market, and thus people will continue to be harmed needlessly.
Thursday, November 18, 2010
Screening and Brief Intervention (SBI)
SBI is roughly considered to be any attempt by a health care professional, not necessarily a drug counselor, to assist a person recognize their patterns of substance abuse. The final result may not be abstinence, but rather any decrease to normal levels, or levels which are not resulting in consequences to the person or his immediate circle of contacts (e'g', family problems work related problems etc, as a result of the substance abuse.) This method of decreased use is sometimes referred to as harm reduction. The main goal is to reduce the level of substance intake and consequently allow the person to lead a relatively normal life. A good example of SBI would be an emergency room nurse or physician discussing the benefits of decreased alcohol consumption to a person recently involved in an accident related to their drinking. The main idea here is the age old "strike while the iron is hot" principle. When the patient is in the ER and feeling remorseful and ashamed, they are more vulnerable to suggestion and insight to the effects of their substance consumption. The intervention may end there, or the nurse may refer the patient to a social worker for another 2 or 3 sessions of anywhere from 5 to 60 minutes each.
SBIRT, on the other hand, adds the treatment component. The intervention is just the beginning and the client is then referred to a drug counselor for a more in-depth assessment and determination of the patients long-term needs regarding formal treatment, education and aftercare. Now, obviously, the main goal is catching a patient in the early stages and preventing long-term damage. This is not always possible and many people ignore repeated warnings from not only family members but professionals alike.
The importance of SBI and SBIRT should not be understated. Many studies indicate they are as effective as long term residential treatment. The main point is to not stop attempting to intervene in a persons substance abuse. They are not the only ones who will suffer. Even innocent bystanders can be affected adversely by a random act under the influence.
Tuesday, November 9, 2010
Alcohol is more dangerous than any other drug
The fact that alcohol was recently tagged as the most dangerous drug by a group of British Scientists, is nothing new (Boston Globe article, 11/1/10). Alcohol, merely by its wide ranging use, has always been the most abused drug known to man. The fact that it is legal certainly helps, but the advertising done by the beverage alcohol companies helps push it far into the lead as the most consumed mind and mood altering substance. Of course, the second and third most dangerous drugs are heroin and crack respectively, but the second most abused drug is marijuana.
Recently, news outlets have been focused on marijuana, whether for medicinal use or outright legalization as was attempted and failed in California (Proposition 19). Marijuana is certainly making a move on alcohol as a highly abused substance, but trails alcohol by about 100 million users each month (NIDA, 2008 report). Marijuana has many excipients that are known carcinogens. Unfortunately, there have been no in-depth studies on these compounds as there is no funding in it because marijuana can't be marketed to make someone a lot of money due to its quasi-illegal status. It will inevitably be legalized and then money can be made, but I still doubt anyone will point out the deleterious effects of the other ingredients in pot. Who wants to cast a shadow over their product? Just take a look at the tobacco companies.
Alcohol on the other hand has been studied and dissected to a great degree, but you never hear about it due to the lobbying of the beverage alcohol companies. We don't see diseased livers as a result of alcohol abuse as predominantly as we did charred lungs from smoking. Alcohol is too accepted and no one suffers from second-hand drinking. They certainly suffer from the behavior of the alcohol abuser, but that gets swept under the rug due to alcohol's venerated status. It will take more exposure by the main stream media regarding the over-arching and devastating effects of alcohol consumption before the alarms will be sounded and alcohol gets taxed more, not prohibited (we tried that), and the money used for treating the disease of alcoholism.
Bottom line is that alcohol is the most dangerous AND expensive drug in the world. Expenses range from: under-production at work due to hangovers, work absences, bankruptcy, divorce, car accidents, theft, assault, sexual assault, liver disease, heart disease, brain disease, to name just a few. Alcohol abuse costs society more than cancer, heart disease and diabetes combined (NIDA, 2008 report). All tolled, these expenses cost more than $400 billion a year. America needs to wake up and increase taxes on beverage alcohol, just like we did to tobacco products, to help pay for the damage that is caused by this drug. We need to stop the beverage alcohol lobbyists from controlling lawmakers at the expense of everyones health and pocketbook. Unfortunately, the legislators may be one of the industries best customers. Call your legislator today and ask him or her to sponsor a bill to double or triple alcohol taxes. You may help save a life.
Recently, news outlets have been focused on marijuana, whether for medicinal use or outright legalization as was attempted and failed in California (Proposition 19). Marijuana is certainly making a move on alcohol as a highly abused substance, but trails alcohol by about 100 million users each month (NIDA, 2008 report). Marijuana has many excipients that are known carcinogens. Unfortunately, there have been no in-depth studies on these compounds as there is no funding in it because marijuana can't be marketed to make someone a lot of money due to its quasi-illegal status. It will inevitably be legalized and then money can be made, but I still doubt anyone will point out the deleterious effects of the other ingredients in pot. Who wants to cast a shadow over their product? Just take a look at the tobacco companies.
Alcohol on the other hand has been studied and dissected to a great degree, but you never hear about it due to the lobbying of the beverage alcohol companies. We don't see diseased livers as a result of alcohol abuse as predominantly as we did charred lungs from smoking. Alcohol is too accepted and no one suffers from second-hand drinking. They certainly suffer from the behavior of the alcohol abuser, but that gets swept under the rug due to alcohol's venerated status. It will take more exposure by the main stream media regarding the over-arching and devastating effects of alcohol consumption before the alarms will be sounded and alcohol gets taxed more, not prohibited (we tried that), and the money used for treating the disease of alcoholism.
Bottom line is that alcohol is the most dangerous AND expensive drug in the world. Expenses range from: under-production at work due to hangovers, work absences, bankruptcy, divorce, car accidents, theft, assault, sexual assault, liver disease, heart disease, brain disease, to name just a few. Alcohol abuse costs society more than cancer, heart disease and diabetes combined (NIDA, 2008 report). All tolled, these expenses cost more than $400 billion a year. America needs to wake up and increase taxes on beverage alcohol, just like we did to tobacco products, to help pay for the damage that is caused by this drug. We need to stop the beverage alcohol lobbyists from controlling lawmakers at the expense of everyones health and pocketbook. Unfortunately, the legislators may be one of the industries best customers. Call your legislator today and ask him or her to sponsor a bill to double or triple alcohol taxes. You may help save a life.
Friday, October 29, 2010
HSA hidden fees with hospital clinics
My insurance from my employer changed this year. I went from standard insurance to and HSA, or health savings account. These plans offer the insured to save pre-tax money toward medical expenses. There is no co-pay when you see a medical provider, but rather the costs are run through the insurance company's fee schedule and reduced according to what they would normally pay. Then this is the amount the insured pays.
So, I went to a dermatologist (whom I had seen before when I had traditional insurance with a $20.00 co-pay) to get some of my fair Irish skin treated and the doctor happened to be associated with a hospital, MetroHealth, in Cleveland, Ohio. Her office was in a building across the street from the hospital. I was her office for 15 minutes tops. I received a bill from her for $120.07. No problem with that. Then I received a bill from the hospital for facility services, apparently because they own the building and it was in a treatment room in their building (looked like an ordinary patient exam room seen in any other doctor's office), for $324.00!
The reason I went to this dermatologist again was that she was listed as an in-network provider by my insurance company, Anthem, and she seemed like a good physician. There was no indication from Anthem, on their website listing providers, that there would be an additional fee for seeing a physician who is in a clinic near a hospital. There was no indication at the doctor's office that there would be additional charges. Since I had traditional insurance coverage the first time I saw this doctor, there was no way I could have known if my insurance company was paying a higher fee. This is a hidden fee, and people with HSA's should be aware of it.
If you have an HSA account, I caution you to check with any doctor associated with a hospital, whether there will be additional facility charges prior to making an appointment.
So, I went to a dermatologist (whom I had seen before when I had traditional insurance with a $20.00 co-pay) to get some of my fair Irish skin treated and the doctor happened to be associated with a hospital, MetroHealth, in Cleveland, Ohio. Her office was in a building across the street from the hospital. I was her office for 15 minutes tops. I received a bill from her for $120.07. No problem with that. Then I received a bill from the hospital for facility services, apparently because they own the building and it was in a treatment room in their building (looked like an ordinary patient exam room seen in any other doctor's office), for $324.00!
The reason I went to this dermatologist again was that she was listed as an in-network provider by my insurance company, Anthem, and she seemed like a good physician. There was no indication from Anthem, on their website listing providers, that there would be an additional fee for seeing a physician who is in a clinic near a hospital. There was no indication at the doctor's office that there would be additional charges. Since I had traditional insurance coverage the first time I saw this doctor, there was no way I could have known if my insurance company was paying a higher fee. This is a hidden fee, and people with HSA's should be aware of it.
If you have an HSA account, I caution you to check with any doctor associated with a hospital, whether there will be additional facility charges prior to making an appointment.
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