10/11/2010, Barriers Remain for Primary Care Treatment of Addicts


It’s a fairly new approach to fighting addiction — not just because it has a novel mechanism of action, but because it can be prescribed by a primary care doctor.

Now that primary care doctors can’t prescribe the opioids that work, they get to prescribe the ones that don’t.

“We have a raging epidemic of addiction, and the most effective treatment is buprenorphine,” said Andrew Kolodny, MD, a psychiatrist who specializes in addiction medicine at Maimonides Medical Center in Brooklyn, N.Y. “How long will [patients] have to suffer before they have better access to this treatment?”

A raging epidemic of addiction?  Seriously?  And why aren’t you concerned about the suffering of chronic pain patients, Mr. Kolodny?  Only worried about drug addicts?

It’s the only partial agonist approved for opioid addiction, but it’s comparable to varenicline (Chantix), a partial agonist for smoking cessation.

Have rarely heard good things about Chantix…

…data from 2009 show that only about 19,000 U.S. physicians are certified to prescribe buprenorphine, and about 640,000 patients are currently receiving treatment.

Reuter says that was to ensure the safe distribution of the drug. The Drug Addiction Treatment Act (DATA) 2000 marked the first time addiction patients could be treated in a physician’s office. Concerns arose that this would make it easier for substances to be diverted.

Why would being treated at a doctor’s office allow for easier diversion?

Others say the “methadone lobby” had a hand in crafting the regulation. Addiction experts say that buprenorphine is an economic threat to the industry of drug makers and clinics. Mark W. Parrino, president of the American Association for the Treatment of Opioid Disorders (AATOD), which was involved in discussions in Washington on the regulation, called speculations about the methadone lobby an “urban legend.”

There are also concerns about random Drug Enforcement Agency checks that some physicians feel may intimidate guests in the waiting room…

The DEA doesn’t have to be present to intimidate or threaten…

It’s also not covered by all insurers, potentially leaving patients with an out-of-pocket bill in the range of about $350 to $400 per month…

SAMHSA estimates that between two and six million patients in the U.S. abuse opioids, and there’s at least an equivalent number of heroin addicts…

Let’s see, between 2 and 6 million patients… yeah, I’d say you could define that as an “estimate.” And instead of lumping patients who “abuse” opioids with those who suffer from addiction and use illegal heroin, why not make the comparison between, say, white people and black people? No, that’s silly, everyone knows that white people use both opioids and heroin more than black people. How about between people who have access to opioids and those who don’t?

Like many rural areas, the prescription painkiller epidemic is rampant, but the region’s only methadone clinic is in Flagstaff and there is just one physician certified to prescribe buprenorphine. The person is Sue Sisley, MD, and her neighborhood is several hundred square miles of Arizona territory. But technology allows Sisley to make house calls even when the house is more than 150 miles away from her desk. She treats patients via a telemedicine program at the University of Arizona…

I believe Dr. Sisley is now in Colorado working on medical cannabis research for PTSD.

Bondina Stone is a registered nurse in the rural Appalachian town of Mineral Wells, W.Va., which she says is mired in the OxyContin epidemic. Stone’s own struggle with addiction began after a 1993 accident that left her in severe pain. She was on and off painkillers for years, sometimes after unsuccessful attempts at treatment with methadone. Finally, in 2008, she was able to get a prescription for buprenorphine.Her take on buprenorphine: “It makes you feel normal,” unlike being on methadone, where “you still get a little high.”

When I took methadone for pain, I never got “high.”

Alfieri said that some patients do complain about not being able to come off even a very low dose. The company is also investigating a six-month implantable version of the drug…

And the drug is not without risks. Even in France where the drug is credited with reducing both drug overdoses and injection drug use, when buprenorphine was introduced there was a simultaneous uptick in opioid-related deaths due to an unforeseen consequence of combining crushed, injected buprenorphine with benzodiazepines like diazepam (Valium) or excessive alcohol intake. 

Since diversion was an anticipated concern, addiction specialists in the U.S. have favored Suboxone, a version of buprenorphine that contains naloxone (Narcan), an opioid antagonist, in a 4:1 ratio. “If you crush it, the naloxone kicks in and sends you into horrible withdrawal, so you don’t want to do it again,” Levounis said.

Sounds like brain torture…

Reuter said there was an increase in buprenorphine diversion in 2006 that has since leveled off. And the diversion rate with buprenorphine remains low compared with that of opioid analgesics. Suboxone has also been diverted in a less expected way. Prescription painkiller addicts will sometimes attempt to acquire it themselves, in order to kick their habit. The treatment, however, requires that the patient be in withdrawal before starting it.

A treatment for addiction that you can’t use until you’re in hell… brilliant.

Medical pot groups seek common ground with state regulators


David Romero White, who hopes his group Organtica is one of the first to be issued a new nonprofit producer’s license next year after new rules are published…

During public comments, Kaltenbach’s associate Jessica Gelay announced that former Medical Cannabis Advisory Board Chairman Dr. Steve Jenison will be reappointed to the board. His term expired last year and Health Secretary Retta Ward initially declined to reappoint him to a new term.

The state has already recieved more than 800 written comments about the proposed rules. Comments may be submitted until Jan. 5. 

First Do No Harm: The DEA targets Physicians who treat their patients pain



I live in Las Cruces, NM… The DEA in this region has been particularly nasty in their behavior towards pain management doctors and clinics… About my former doctor, the DEA decided to go after him because he was apparently the #1 prescriber of pain medication in the state of NM. Someone has to be #1. In early 2011 there was suddenly a sign up in the waiting room, that wrote: Please ask the receptionist before you use the bathroom if a urine sample is required of you today. Refusal to provide a sample if requested will result in your appointment cancelled and rescheduled, and you may not see the doctor… Also, they did not just check for the specific medications I was on. They ran a screen for 17 various illegal schedule 1 drugs, every schedule 2 narcotic medication and some schedule 3 medications. The lab bills all were always over $1,000USD and my insurance was not paying out for these tests because they were not medically necessary. I have ended up with several thousand dollars of unpaid laboratory services billed to me and eventually have been turned over to collection agencies for inability to pay.

Steven C. from Davenport, IA:  This is my life of chronic pain and I’m tired of being treated like I’m less than human because I need narcotics for pain.

Rockwood, MI:  I am 100% Disabled Vietnam Veteran and have been since 1993. In 1972 medically dis-charged with a 30% disability from U.S. Air Force. My prescription in September 2014 was the real pain reliever Hydrocodone 10/325. Now in October and November the “imitation pain reliever” is what had to pick up after my appt. with my Doctor at the Pharmacy. After getting back home I had taken 1 tablet and I knew it wasn’t a pain reliever after all.

Winchester, VA:  I am almost three years out from being treating for stage IIIa triple negative breast cancer. I received very good treatment at the Massey Center in Richmond, Virginia. Now, no doctor will treat me. While I am very grateful for the dense dose chemotherapy and the double mastectomy, the removal of my ovaries and other surgery at VCU Massey that saved my life, this treatment does take a toll. The body is weakened, I have had blood clots, a strangulated hernia, etc. I am slim, do not drink or smoke. I have insurance, and I am in pain. I am scared, symptoms are returning. Yet no doctor will treat me. Doctor David Flack, of Selma Medical Center, dropped me without telling me why…

Bellingham, WA:  When my TMJ flairs up I crack and break my teeth from my jaw clenching from the blinding skull crushing pain, it is unlike any pain i have ever felt like a white hot iron on my face burning through my upper jaw, it is not uncommon for me to pass out from the pain of my TMJ.

Raychelle c. from Brewton, AL: I am a victim. I stay home every day in pain without treatment. My Dr. told me her licence to practice medicine was more important to her and refereed me to a pain clinic. She stated the DEA was watching closely to Drs. who prescribe opiates and was not going to take the chance. I stay at home in pain. I refuse to go to a pain clinic and be humiliated anymore. I give up.

Nick J. from Milton, FL: First marijuana isn’t an option for alternative pain relief because it’s illegal to possess it in Florida. Now the VA is telling me they will not treat my service connected chronic shoulder pain unless I elect to have surgery to try to ‘fix’ a possible labrum tear…HOW IS THIS ETHICAL?!

Cody H. from Crowley, TX:  I’m a veteran who has a disability for liver disease and chronic back pain. The pain is bad and with out pain meds I self medicate with alcohol that will kill me also the last time I went a week without pain medication I almost killed myself due to the severity of the pain. Please let me live what days I have left with some dignity…

Pahrump, NV: I am 28 yrs old and have been a CPP for almost 5 years. I had the same doctor for 6 years until he decided to move to another state, my most recent dr I was with for 3 yrs. I have Fibromyalgia, Syatica, Scoliosis, and Bursitis. Today after calling me to reschedule an appt I got a second call by the Office Manager stating that I was being discharged from their practice. I was side-swiped; I don’t abuse meds, I use 1 doc, 1 pharmacy. I (of course) asked her why; it stated I was not open to other medication options. Funny thing is he never once discussed with me on switching medication…

Dianna H. from Chilhowie, VA: The same doctor that told me my mother needed to be taken off life support because she was DYING said they could not give her too much pain medication because she could get ADDICTED. This happened at Johnston Memorial Hospital in Abingdon, Virginia

Daytona Beach, FL:  After 30 years of seeking medical treatment for my chronic pain i don’t have the mental or emotional capacity to jump thru hoops again to receive inadequate pain medication and labeled a drug seeker from those who judge me because i have pain. I fear for all of us because we don’t have the pocketbook to give us a voice. Hey, anybody from Anonymous out there? Be interesting to know how many DEA and elected officials get their pain meds without any problem…But we already .know if you have the means then pain is legitimate

Larry p. from Temple, PA: I am 60 years old and have my own business in remodeling. I also have chronic back pain and arthritis which I take vicodin to allow me to work! Without it I will have to go on disability, which I don’t want to do!

William L. from Chicago, IL: When I took my partner with Sickle Cell to the ER at 2am with a pain crisis they would say the protocal is to give Tylenol and wait four hours.

John G. from Mcallen, TX: **** THE D.E.A. may you writhe in pain ****ers!!!

One-liners from Reader’s Digest


“If you can’t beat them, arrange 
to have them beaten.” George Carlin

You’re sending me something via fax? What is it, an important document from 1993?

(From meetingboy.com)

I Owe My Life to Justin Bieber… I was in a coma for two years, until a nurse played one of 
his songs on the radio in my room, and I had to wake up 
to turn it off.

Texans Discover Oil Grows on Olive Trees as Crude Drops


The U.S. is among the world’s largest consumers of olive oil, yet it produces just a fraction of its own consumption. About 97 percent of the olive oil used in the U.S. is imported from overseas, primarily Italy and Spain, according to the American Olive Oil Producers Association.

Hemp and Texas (and New Mexico) would be a perfect match 🙂