Brainy quotes on Circles

“Specialized meaninglessness has come to be regarded, in certain circles, as a kind of hallmark of true science.”  Aldous Huxley

“I started skating and I kind of liked it because I could run circles around the guys that wouldn’t pick me to play baseball.”  Scott Hamilton

“Confining marine animals to tanks and separating them from their families and their natural surroundings, just so people can watch them swim in endless circles, teaches us far more about humans than it does about animals – and the lesson is not a flattering one.”  Pamela Anderson

“It’s not foreign for me to be talking about my problems in circles.”  Matthew Perry

“Blessed is he who talks in circles, for he shall become a big wheel.”  Frank Dane

Seeking the Facts on Medical Marijuana

I think the time has come for us as a global community to agree on what we want to know and then go get it. And our patients need to move away from self-experimenting with substances and derivatives we don’t know about, and move to a situation where we know what they are using and where we can better help them. This isn’t going away.

One of the great things about medical cannabis is that it isn’t necessary for a doctor to be involved with the treatment.  It is easy enough for patients to experiment with different strains; and in more mature cannabis markets, patients have both access and a variety of strains to choose from.  And just like this doctor says:

Interestingly, our patients appeared to actually use very small quantities of the drug to control their symptoms, a lot less than recreational users…

That’s because it’s very easy to take cannabis.  It’s very easy to titrate the dosage based on — at least in the case of smoking it — the immediate effect.  I don’t have a lot of experience with edibles and extracts, but I assume it’s a little more difficult to find the right dosage through those delivery systems.

But once you feel the drug’s effects, you don’t need to keep smoking it.  With good bud, a few puffs is all you need, and you’re good to go.  Unless you’re using a higher dose at night for sleep, smoking more than you need is just a waste.  And as expensive as medical cannabis is in most states, no user wants to waste even a tiny trichome.

In other words, you don’t need the advice of a doctor to be a medical cannabis patient.  Bud can’t hurt you, so feel free to experiment.  New users should, of course, start slow, maybe with a THC level of around 10%, depending on tolerance and pain levels.  Don’t start with a strain that’s over 20% THC unless you know what you’re doing.

Patients in cannabis programs don’t rely on their doctors to tell them how to choose their medicine or navigate their state’s program — patients rely on the information from other patients, which is why it’s so important to spread the word about your own cannabis experiences in your state.

Perhaps those who suffer from schizophrenia or bipolar may want to consult a specialist in THC/CBDs before attempting treatment, but patients have more expertise than doctors when it comes to cannabis.  Heck, the internet has all the information you’ll ever need about marijuana — but it’s only in the experimentation with different products that you’ll find what you need to know.

Robbery Victim Held In Rikers Jail For 2 Years Without Being Convicted Of A Crime

Russell Hernandez was robbed by two gang members in New York City, but he ended up spending more time in jail than his attackers. Hernandez was held for two years on Rikers Island to make sure he testified against the perpetrators. In the end, he didn’t even testify at trial. The two gang members pleaded guilty and received 5 years probation, according to The New York Daily News.  This week, the News reports that Hernandez was awarded a $1 million settlement from the city for his troubles…

The Bronx case is similar to that of Benito Vazquez Hernandez. The Oregon man was held for 900 days in jail because prosecutors wanted him to testify in a murder trial, WWLP reported last week…

Both stories are reminiscent of last year’s New Yorker feature about a 17-year-old who was held at Rikers for three years after he was accused, but never convicted, of stealing a backpack.

Multiple TBIs, Chronic Pain Linked to Increased Risk of Military Suicides (June 2013)

Servicemembers who suffer more than one mild traumatic brain injury (TBI) face a significantly higher risk of suicide, according to research by the National Center for Veterans Studies at the University of Utah…

“That head injury and resulting psychological effects increase the risk of suicide is not new,” Bryan suggested. “But knowing that repetitive TBIs may make patients even more vulnerable provides new insight for attending to military personnel over the long-term, particularly when they are experiencing added emotional distress in their lives.” …

I believe that TBIs also raise the rate of addiction in patients, along with the risk of Alzheimer’s. And I assume that a TBI also means a chronic pain condition.  This is what the military is holding workshops on:

The cognitive-behavioral treatment protocol is adapted from The Pain Survival Guide by Dennis Turk and Frits Winter. All participants receive a copy of this book…

There’s not very much internet activity for this book, which was published in 2005 by the American Psychological Association (APA).  I found one review from a pain patient in 2008:

I guess the military is now relying on self-help books to treat chronic pain, handing these out to mental health professionals, their target audience.  I suppose the professionals in turn hand them out to their patients, without really thinking about how patients who suffer from TBIs actually learn.

I feel sorry for the military — there just aren’t many options out there to effectively treat chronic pain.  It’s obvious the VA is struggling to treat not only recent veterans, but those from all of our past wars too.  And with the war against opioids and other drugs commonly used to treat pain, there are even less options for the VA.  Although I have to say that VA doctors appear to have nothing to fear from the DEA.

I think it’s just plain cruel to withhold medical cannabis from our veterans, many of whom can’t afford it even when they live in a legal state.  It’s cruel and shameful, as are most aspects of the drug war.

This documentary about the VA’s crisis hotline is among Sunday’s Oscar nominees

A two-year VA study released in 2010 found that the rate of veteran suicides increased by about 20 percent compared to 2007 estimates. More than two-thirds of the individuals who killed themselves were 50 or older, suggesting the increase was not driven by former troops returning from the wars in Iraq and Afghanistan.

However, the VA last year reported an uptick in suicides among young veterans, and a Pentagon report in January showed that suicides by active military personnel have stood at record levels for five consecutive years, including more than 280 last year…

The VA crisis line (800-273-8255) is a toll-free, confidential resource. It’s responders are trained to deal with issues ranging from anxiety and depression to chronic pain and homelessness.

The call center has answered more than 1.1 million calls since it opened in 2007, according to a VA fact sheet. The crisis line has included online-chats since 2009 and texting since 2011.

Dramatic Increase in Assisted Suicides in Switzerland

According to Exit, the most common reasons for wanting to die were terminal cancer, age-related diseases and chronic pain disorders…  Two thirds of those the organisation assists suffer from terminal illnesses, Sutter says, while a third suffer from incurable illnesses or are in chronic pain.

Investigation: Army substance-abuse program in disarray

The Army’s transfer of substance-abuse outpatient treatment from medical to non-medical leadership in 2010 has led to substandard care, the mass exodus of veteran personnel and the hiring of unqualified clinic directors and counselors, according to senior Army clinical staff members and records obtained by USA TODAY…

One tragic result: the Army estimates that since 2010, about 90 soldiers committed suicide within three months of receiving substance-abuse treatment. At least 31 suicides followed sub-standard care, according to tabulations by the clinical staff, although they did not specifically link the deaths to poor treatment.

In a 2012 case, Army managers hired an unlicensed counselor at Fort Sill in Oklahoma over the objections of senior clinical personnel. The counselor began seeing patients and gave a “good” rating to a soldier who hanged himself two hours later, according to an internal Army report provided to USA TODAY…

An Institute of Medicine panel of scientific experts on substance abuse warned in a 2012 report that the military faces a public health crisis in drug and alcohol abuse. Members of the panel, part of the National Academy of Sciences, said they were surprised by documents supplied by USA TODAY showing that treatment efforts have gotten worse…

Parliamentary questions (2/4/2015)

Subject: Chronic pain and access to treatment

Chronic pain affects 20% of the European population, but remains poorly managed and undertreated. As well as affecting employment and the profitability of companies, pain, in its chronic form, may provoke varying degrees of disability and may cause anxiety and depression, including a heightened risk of suicide. Chronic pain sufferers in Europe are denied many recognised patient rights, including access to treatment, information and new technologies.

In 2011 the World Health Organisation (WHO) issued Policy Guidelines for Controlled Substances, which state that opioid analgesics are considered to be essential medicines and are indispensable for the treatment of moderate to severe pain. However, not all the Member States have policies that ensure access to this kind of treatment. The WHO guidelines provide advice on policies and legislation with regard to the availability, accessibility, affordability and supervision of controlled medicines.

1. Is the Commission aware of these data and of the WHO guidelines?

2. What measures is the Commission taking to ensure that the WHO guidelines are applied at national level?

3. Would the Commission consider facilitating the sharing of policy-related best practices between Member States with a view to preventing inequality of access to pain treatment in Europe?

Brought to you by SAMHSA

3/3/2015, Managing Chronic Pain & Medication Misuse

After being arrested for forging a prescription, he spent nine years “doctor shopping” for pills, losing jobs, and suffering overdoses and suicide attempts. After nine years, he made it through rehab and he has been sober since 2007…  Mr. Loffert’s trajectory is a common one.

Common?  Really?  Maybe for those who suffer from addiction, but not for chronic pain patients.

According to SAMHSA’s Treatment Improvement Protocol (TIP) 54, “Managing Chronic Pain in Adults with or in Recovery from Substance Use Disorders,” almost one third of chronic pain patients may have substance use disorders…

May have?  Let’s see, that’s 30% of about 45 million (to 100 million) people who suffer from chronic pain in this country.  That’s 13.5 million people.  Wow, SAMHSA, way to earn your budget.

Dangerous interactions can also occur with medications used to treat mental illnesses such as depression, which is common among pain patients.

Depression is common?  No, it’s sadness that’s common among pain patients, not depression. And when you add sadness to constant pain, anxiety, and stress, you might just be diagnosed with Major Depressive Disorder — especially if your pain is under-treated.

Non-opioid pain treatments or other services, such as physical therapy or acupuncture, are better options for those who may need ongoing treatment for pain, particularly since there is little evidence for effectiveness of opioids in the long-term treatment of chronic pain…

There is “little evidence” because the research hasn’t been done, not because opioids are ineffective for long-term treatment.  And tell me, SAMHSA, where is the evidence that expensive physical therapy or acupuncture are effective long-term treatments for chronic pain?  Because if there’s evidence, maybe then insurance companies would cover those treatments.

…continue to offer waiver training for physicians interested in providing office-based treatment of opioid use disorders with buprenorphine under the Drug Addiction Treatment Act of 2000.

So, what is the difference in the abuse rates between bupe and other opioids?  It seems like bupe is abused in about the same percentage of patients as hydrocodone and other opioids, but since the government is heavily invested in bupe, SAMHSA gets to advocate for one drug over another.

Click to access TIP54.pdf

A Treatment Improvement Protocol

Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders

Current Opioid Misuse Measure (Page 58)

How often have you been in an argument?

How often have you gotten angry with people?

Symptoms and signs of opioid withdrawal are as follows. (Page 61)

Symptoms include:
• Abdominal cramps, nausea, vomiting, diarrhea
• Bone and muscle pain
• Anxiety
• Insomnia
• Increased pain sensitivity in the original painful site

Gee, I could suffer from all those symptoms just from being in constant pain, without taking any drugs at all.  Watch out, if you have a stressful job and food poisoning or the flu, you could be assessed as a drug addict.

To SAMHSA, every chronic pain patient either has, or will develop, a drug addiction.  Of course, chronic pain patients are like a whole new toy for SAMHSA — how many other patient groups can they claim suffer from addiction?  I wonder how many people who work at SAMHSA suffer from addiction themselves?  Maybe they’re all graduates of an AA program.

Because SAMHSA is an agency centered around drug abuse and addiction, I guess they have a rather narrow focus on drug issues.  After all, SAMHSA is a big part of the drug war.  They’ve been around so long, yet our drug abuse problems keep escalating… it appears they’re not very good at their job.  Why would anyone listen to them?

Janis Joplin

“The official cause of death was an overdose of heroin, possibly compounded by alcohol. Cooke believes that Joplin had accidentally been given heroin that was much more potent than normal, as several of her dealer’s other customers also overdosed that week…”

“Janis was like an angel who came and paved a road white chicks hadn’t walked before.”  Etta James