Speed-like stimulants prescribed for adult ADHD part of ‘psychiatric fad’

http://news.nationalpost.com/health/speed-like-stimulants-prescribed-for-adult-adhd-part-of-psychiatric-fad-risk-being-used-for-mental-edge

In an article published this month in the Canadian Journal of Psychiatry, McGill University psychiatrist Dr. Joel Paris says the diagnostic criteria for adult ADHD are so broad they could easily describe anyone who has trouble focusing…

ADHD, Paris said, is a neurodevelopmental disorder rooted in childhood. According to the official diagnostic criteria, an adult can’t have ADHD if he or she did not have it as a child.

“I do a lot of consultations for family doctors, a couple of hundred a year,” he said. “And some patients are coming in having received this diagnosis and stimulants without sufficient data to support it.

“They complain of various things — I can’t focus or I can’t multi-task, I can’t get things done, I’m disorganized,” he said. But they have no history of ever having been in trouble at school, or being sent to the principal’s office or pulled out of class.

“Once you’re on stimulants, and you feel they help you a little bit you may just take them for the rest of your life,” Paris said. High doses of stimulants can cause high blood pressure and arrhythmias, or erratic heart beat in people with underlying structural changes in their heart. Health Canada recently strengthened warnings that an array of ADHD drugs can increase the risk of suicidal thoughts.

Stimulants can also make mental disorders worse. “You don’t want to take speed — and this is essentially speed — if you’re schizophrenic or have bipolar disorder, anxiety disorder, sleep problems or a whole host of other psychiatric conditions,” said Dr. Allen Frances, a professor emeritus at Duke University who chaired the task force that produced the fourth version of the DSM, the Diagnostic and Statistical Manual of Mental Disorders used the world over to diagnose mental illness.

“Pharma has already created a wild and dangerous epidemic of prescription narcotics,” Frances said. “Next on its agenda is pushing the sale of prescription speed.”

“If we want to allow people to take speed for performance enhancement, or make it legal for recreational purposes, there should be a discussion of that,” said Frances, author of Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma and the Medicalization of Ordinary Life.” …

Under comments:

stmccrea • 9 days ago
Possibly the most important statement in this article may be missed in all the emotional and controversial rhetoric in the article and the comments. Namely: these drugs can be very destructive to people who have other psychiatric issues, such as psychotic symptoms, high anxiety, severe depression and/or manic behavior. As a person who works with foster kids, I have seen many examples of anxious kids (often with PTSD symptoms) given stimulants who then become manic or aggressive and are then diagnosed with “bipolar disorder” and put on antipsychotic drugs that they don’t need and that have extremely serious side effects. I have seen adults get into this pattern as well when unknowingly treated by unethical or incompetent psychiatrists who are unable or unwilling to distinguish between a side effect and a client’s actual symptoms. Fortunately, adults are much more able to inform themselves of these risks than are the children I work with.

If adults find stimulants helpful in their lives, I see no reason why they should not be able to obtain them. But I do think informed consent is extremely important, both for the reasons I stated above, and because when they are misused (as they frequently are, especially by college students, apparently), stimulants can be extremely addictive.

—- Steve

mukwah • 10 days ago
I used to love ritalin.

(2014) Reasons for opioid use among patients

http://www.ncbi.nlm.nih.gov/pubmed/24814051

Abstract: The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in the Prescription Opioid Addiction Treatment Study, a randomized controlled trial of treatment for prescription opioid dependence. Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reason for use; avoiding withdrawal was rated as the most important reason for current use in both groups. Participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. Results highlight the importance of physical pain as a reason for opioid use among patients with chronic pain.

Dr. Walter Hofman: Coroner addresses local heroin deaths

http://www.timesherald.com/opinion/20150713/dr-walter-hofman-coroner-addresses-local-heroin-deaths

Montgomery County, with almost 800,000 inhabitants, is the 3rd largest population in the Commonwealth of Pennsylvania. In 2014, the deaths of 161 citizens were reported by the Montgomery County Coroner due to overdoses of prescription and /or non-prescription drugs. The manner of death was predominantly accidental but some were suicidal…

These drugs are all too easy to obtain. In almost 100 percent of the cases, patients go to multiple doctors for the same ailment, receive a number of prescriptions for the same drug, and fill them all at one neighborhood pharmacy…

In 100 percent of cases, are these patients paying cash?  Because paying cash for multiple doctors and prescriptions for the same drug is very expensive.  And insurance doesn’t cover the same service multiple times in the same day or month.

Who are these patients who can afford such costs? Are they drug dealers from the street or from Wall Street?  Are they pain patients hoarding medications out of fear? Are patients taking these large amounts by themselves and not selling any?

It may come as a surprise to many, but the majority of the overdose cases we examine are not facilitated by shady transactions with a drug dealer in a dark alley, but filled by prescription at local pharmacies.

A legal drug dealer, out in the open, in public, filling prescriptions for legal drugs.  Why is one transaction shady and the other isn’t?  They’re selling the same products. But one dealer paid the government for a license and is selling government-approved drugs, while the street dealer doesn’t have the money or connections to do the same. Plus, the street dealer’s customers — unlike the pharmacy’s — usually don’t have insurance.

Even though more people now have insurance, there are still millions who don’t have any. And even with insurance, there will still be plenty of patients who can’t afford to regularly see a doctor. The cost of seeing a doctor is added to the cost of every prescription, which is one of the reasons it’s cheaper to buy drugs on the street.

Fentanyl is a drug 10-20 times stronger than heroin and is most often prescribed for pain. When scraping the fentanyl patches or crushing lozenges, and then mixing with heroin, an even more dangerous situation occurs…  Other opioid analgesics that are being used with heroin are hydromorphone, levophanol, meperidine, methadone, morphine, oxycodone and oxymorphone…

Finally, it has been stated that “some people who use large amounts of drugs often and long enough become addicted.” Not always true. Using a drug for a short time is adequate to become “hooked,” and sometimes only requires one use…

Dr. Walter Hofman is a board-certified Forensic Pathologist and cororner of Montgomery County

Sometimes only requires one use…  “Sometimes” is pretty vague, but I’d say the more accurate description is that addiction rarely happens with a single use of a drug.

http://ireta.org/2015/05/26/updates-on-a-prescription-drug-monitoring-program-in-pennsylvania/

On October 27, 2014, Pennsylvania passed a law that will modernize our prescription drug monitoring program and undoubtedly save lives. However, implementation will be even more complex than the lengthy legislative process we’ve already seen. We’ll continue to share information about our PDMP as the program gets off the ground. Look for further blog posts about the role of prescription monitoring as part of a public health effort to reduce overdose, address risky substance use and addiction, and most importantly, to improve the quality of care that all patients receive.

Kolodny gets air time at the Financial Times

This guy is really boring.  He says the same stuff over and over again — it’s like he’s stuck on one channel.  But what makes this particular video interesting is how much blame is being shoveled on doctors, including doctors who don’t use the PDMPs.  Time to shame doctors into distrusting their patients and viewing each and every one as a potential drug addict…

http://video.ft.com/4385493799001/The-rise-of-opioid-addiction-in-the-US/Companies

How risky is it to take aspirin?

Do they sell aspirin in the underground market? No, because it’s legal, regulated, and there aren’t any restrictions to access. There are also no sin taxes on aspirin, which helps make it cheap. But how safe is aspirin (or any NSAID)?

http://www.reuters.com/article/2007/05/09/us-risks-idUSN0737156120070509

For 50-year-old men, taking a full-sized, 325 mg aspirin every day to prevent heart disease and stroke carries a risk of 10.4 deaths per 100,000 men per year over and above their overall death risk.

Using Vioxx for arthritis pain carried a risk of 76 deaths per 100,000 people per year. Merck and Co withdrew Vioxx in September 2004 after it was shown to double the risk of heart attack and stroke.

“The finding that taking Vioxx for a year is much more risky than a year of car travel, swimming or being a firefighter suggests that greater scrutiny of drug risks may be warranted,” the researchers wrote.

Using Tysabri, known generically as natalizumab, to treat multiple sclerosis raises the death rate by 65 per 100,000 people a year…

https://www.propublica.org/article/tylenol-mcneil-fda-behind-the-numbers

Data compiled by the U.S. Food and Drug Administration has linked as many as 980 deaths in a year to drugs containing acetaminophen. In addition, FDA reports of death associated with acetaminophen have been increasing faster than those for aspirin, ibuprofen and many other common over-the-counter pain medicines.

Data obtained from the U.S. Centers for Disease Control and Prevention show that more than 300 people die annually as a result of acetaminophen poisoning.

Beginning in 2006, according to the CDC, the number of people who died after accidentally taking too much acetaminophen surpassed the number who died from intentionally overdosing to commit suicide…

Why the large differences? Because each organization’s data has strengths and weaknesses.

The FDA relies primarily on individual case reports, called FDA Adverse Event Reports, submitted by drug makers, consumers and doctors. Drug makers must submit information about any cases they learn about involving side effects linked to their drugs, while reports by consumers and healthcare workers are voluntary. The reports often lack key information. By some estimates, the FDA system captures from 1 percent to 10 percent of adverse events involving drugs.

Most important, the reports do not demonstrate a causal connection between a person’s death and a particular drug, just an association. This is a crucial issue for acetaminophen, because that drug is often combined with other drugs into one medication. For example, the prescription painkiller Vicodin combines acetaminophen with the powerful opioid painkiller hydrocodone. If a person dies after taking Vicodin, the FDA report does not say whether it was caused by hydrocodone or acetaminophen, or even some other drug. So the FDA data only allows one to say a drug is linked to or associated with the death…

But the quality of the reports depends upon the judgments of the local officials who review medical files, conduct autopsies and ultimately fill out death certificates…

After examining the data sets and checking the numbers with the CDC and AAPCC, ProPublica has generally relied upon the CDC figures as a primary source of information. We judged that the death certificate information, while imperfect, represented the most rigorous collection of data. (And yes, we are aware of the series we did pointing out the flaws of death investigations in America.)…

All we can say is that only a tiny fraction of people who take acetaminophen appear to suffer injuries or fatalities as a result. Adding up the highest estimates of injuries and deaths linked to acetaminophen would result in a total of a little over 110,000 incidents annually. About 27 billion doses were sold in 2009, the most recent year for which figures are publicly available. If all the pills were consumed, that would mean about one injury for every quarter million doses. In actuality, that almost certainly lowballs the rate of injuries, but by how much, nobody knows.

http://www.ncbi.nlm.nih.gov/pubmed/9715832

(1998) Recent considerations in nonsteroidal anti-inflammatory drug gastropathy.

Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated…

Analysis of these data indicates that: (1) osteoarthritis (OA) and rheumatoid arthritis (RA) patients are 2.5-5.5 times more likely than the general population to be hospitalized for NSAID-related GI events; (2) the absolute risk for serious NSAID-related GI toxicity remains constant and the cumulative risk increases over time; (3) there are no reliable warning signals- >80% of patients with serious GI complications had no prior GI symptoms; (4) independent risk factors for serious GI events were age, prednisone use, NSAID dose, disability level, and previous NSAID-induced GI symptoms; and (5) antacids and H2 antagonists do not prevent NSAID-induced gastric ulcers, and high-risk NSAID users who take gastro-protective drugs are more likely to have serious GI complications than patients not taking such medications. Currently, limiting NSAID use is the only way to decrease the risk of NSAID-related GI events…

Thinking of you, Amelia and Hardy Leighton

http://www.rcinet.ca/en/2015/07/30/couple-dies-opioid-drug-use-increasing/

Photo caption:  North Vancouver couple Amelia and Hardy Leighton were found dead after inhaling a street drug laced with fentanyl.

A coroner has confirmed that a couple in the province of British Columbia died July 20th after ingesting toxic levels of fentanyl, a synthetic opioid painkiller 50 to 100 times more powerful than morphine. This comes at a time when researchers have found recreational drug users are switching to alternative opioids after the much-abused prescription drug, oxycodone was changed to make it more difficult to tamper with.

The drug’s manufacturer changed the formulation of the drug in 2010 to one that could not be crushed for snorting or injecting. Shortly afterwards, the province of Ontario began to monitor doctors’ prescription patterns for narcotics.

That and media reports about the abuse of oxycodone and overdose deaths prompted Ontario doctors to reduce the prescriptions they wrote for the drug, according to the study. But there were substantive increases in the prescription of other strong opioids like fentanyl and hydromorphone.

So while the deaths due to oxycodone dropped 30 per cent by the end of 2013, fatal overdoses from all opioids jumped 24 per cent between 2010 and 2013. While Ontario reports the highest opioid abuse, it would be reasonable to suspect the trend was similar in other provinces like British Columbia.

Officials across Canada continue to struggle to try to find ways to stem the illegal and sometimes fatal use of prescription opioids.

Hardy and Amelia Leighton were in their 30s when they were found dead in their suburban home, leaving their two-year-old son an orphan.

The reason drugs wind up in the underground market is because of restrictions placed upon them in the legal market.  If the Leightons had been able to buy their drug of choice at Walgreens, like any adult can buy a bottle of aspirin, they would still be alive.

(Photo taken 6/10/2015.)

CVS Minute Clinic

http://www.forbes.com/sites/neilversel/2014/07/21/cvs-minute-clinic-experience-is-efficient-and-effective-but-ehr-interoperability-isnt/

Back in February, major pharmacy chains including Walgreen Co., CVS Caremark, Rite Aid, Kroger and Safeway all announced via the White House website — an official channel if there ever was one — that they were endorsing the Blue Button initiative. Blue Button, a protocol developed at the Department of Veterans Affairs and now open to the general public, is an easy, one-click way for people to download health records from provider portals for personal reference or sharing with other providers. The idea is to support consumer access to their own records and promote health information exchange…

http://www.huffingtonpost.com/2015/01/12/retail-clinics_n_6445506.html

Why We’re Picking Walmart And CVS Over Doctors’ Offices

CVS Health’s MinuteClinic, the market leader with close to 1,000 locations in 31 states and the District of Columbia, had more than 18 million patient visits in 2013, up from 5 million just two years prior, according to the company. It plans to have 1,500 clinics by 2017…

Locations like these offer basic check-ups plus vaccinations and treatment for minor ailments, and their medical professionals can write prescriptions. Unlike the pharmacy and grocery chains, Walmart is positioning itself as a true primary care provider, while both Walmart and Walgreens tout their services for patients with chronic diseases. Walmart sets a flat price of $40 per visit (or $4 for company employees), while CVS Health and Walgreens charge less than $100 for most treatments. Lab work, drugs, vaccines and other things carry additional fees…

Retail clinics also typically offer a less-comprehensive set of services than urgent-care centers, and don’t have as much high-tech equipment…

My guess is that they don’t prescribe opioids either.

The Doctor Is Back In

https://painkills2.wordpress.com/2015/07/31/the-doctor-is-in/

Dear Dr. P:  The icing was fantastic. Can’t thank you enough for the link. Unfortunately, it only worked once. Then I just got fat. Now I’m suffering from too much anxiety and depression, too. What should I do?  Sammy with the Jersey City Blues

Dear Sammy:

I’m sorry to hear that icing treatment only worked for you that one time. Many other readers swear by it and use icing on a daily basis.  I’ve even read reports of icing being used as an aphrodisiac and to treat cancer. For some, it can be a miracle drug. However, icing is not for everyone, and Dr P has plenty of options left in his bag o’ treatments.

Remember Julie Andrews in the Sound of Music? She sang of another treatment in the song, “My Favorite Things.”  Part of it goes like this:

When the dog bites,
when the bee stings
when I’m feeling sad,
I simply remember my favorite things
and then I don’t feel so bad

Now, I want you to sing this song at least once a day.  Think of bee stings as anxiety and dog bites as fear or anger.  And I also want you to practice thinking of your favorite things.  Make a list, if you want. If you feel creative, you can write your own lyrics to the song. Or make it into a rap song. There are no rules for this treatment.

I suppose you should give up on the icing therapy, but you might try celery with ranch dressing. You know, when you’re feeling anxious or sad. But it needs to be homemade or the treatment won’t work.

Good luck, Dude with the Blues.

Warning: Dr. P is not a real doctor. But following in the famous footsteps of Dr. House on TV, Dr. P plays a doctor on the internet.

Alcohol for chronic pain?

http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/52846?xid=nl_mpt_DHE_2015-07-31&eun=g875301d0r

Patients with chronic widespread pain (CWP) who consume moderate amounts of alcohol have lower levels of disability, according to a large new population-based study from the United Kingdom…

A smaller U.S. study previously showed that in patients with fibromyalgia, moderate alcohol consumption was associated with reduced symptom severity and increased quality of life. However, the current study also linked alcohol consumption with the likelihood of reporting CWP. The new study was published in Arthritis Care & Research…

Authors of the previous study discussed possible mechanisms linking alcohol consumption with reduced disability. One is that ethanol enhances GABA release in the brain…

Well, this is great news.  Alcohol is a fairly cheap drug.  I should learn how to like the taste of alcohol — think pina colada.

I wonder, though, what is the risk of abuse and addiction with alcohol?  The risk of toxic levels of ethanol, overdose, and death? The risk of suicide? Brittle bone disease and Alzheimer’s? How many of these patients drank too much and then got behind the wheel of a car? Were involved with domestic violence?

How many of these pain patients also suffered from depression and, by drinking alcohol, increased their depressive symptoms?  How many suffered from new symptoms of depression? How many patients mixed prescription drugs with alcohol?

Doctors advocating for alcohol to treat chronic pain?  Okay, now I’ve seen it all.  There’s no doubt that alcohol is used for self-medication, especially by poor people, but usually they aren’t just suffering from chronic pain.  Many times, alcohol use comes with some type of mental illness, like addiction or anxiety, whether it’s mild or severe. Is alcohol the best treatment for anxiety?  Maybe it’s better than Xanax?

I’m not against the use of alcohol, or any drug that helps treat a medical condition.  But patients should be informed of all their choices, and the risks that come with each.  Why would a pain patient choose a drink over Vicodin or bud?  Lack of access and cost, but also, people’s brains are wired differently.  Some people are sensitive or allergic to opioids, just like alcohol.

I really wish I could treat my pain with alcohol.  It would make things a lot easier.  But I don’t think Medicare or Social Security would be okay with me using alcohol to treat chronic pain, even if I wanted to.

In the old days, lots of people used alcohol to treat pain.  Then, new drugs were developed, synthesized, and created by Big Pharma, and they didn’t come with the stigma of alcohol. But which products are better to treat pain?  We’d have to break that question down into the best drugs to treat the different kinds of pain, and whether the drugs would be used over a short or long period of time.  Which drugs cause the least short- and long-term damage?

If you break your foot and use a drink or two to dull the pain instead of taking a Vicodin, I don’t see anything wrong with that.  If you eat a pot brownie to do the same, there’s nothing wrong with that either.  Some people will pop a couple of aspirin for a broken bone and that will work just fine.  Some people will be able to sleep through the worst of the pain episodes.  (Lucky folks.)

The reality is that people use multiple drugs, both legal and illegal, to dull their pain — because many times, one drug is just not strong enough.  It’s always a battle between the level of pain and the strength of treatments (and resulting side effects).  When the pain increases, will one more drink help?  One more pill, one more hit?

How do you effectively treat pain that is constant?  If you can figure that out, you’ll be rich. 🙂

Would People be Less Sweet on Sugar if it Were Taxed?

http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/52834?xid=nl_mpt_DHE_2015-07-30&eun=g875301d0r

On the heels of the British Medical Association (BMA) calling for a sugar tax on beverages, two physicians have engaged in a point-counterpoint on the idea…

A 10% soda tax in Mexico that began in January 2014 appears to be reducing consumption, even though many experts suspected the tax wasn’t large enough to matter. Also last year, the city of Berkeley in California became the first to tax soda, at a penny an ounce, along with sweet tea, sugary juices, and energy drinks…

But the role of sugar in obesity is less clear and associative, making the title of the BMJ debate — “Could a sugar tax help combat obesity?” — misleading, Lustig pointed out…

Sugar has been subsidized in the U.S. for many generations. Criticism of the subsidy has grown in recent years, but if it isn’t rolled back, it would make little sense to tax what we are subsidizing, said Lustig…

“Taxes on unpopular products are not all that difficult to pass, especially when the revenues are targeted to social purposes people want to see.” She added that Berkeley is using its revenues, which at more than $100,000 during the first month of the tax are substantial for the relatively small city, for kids’ health programs…

If the sin taxes we paid really went to causes like kids’ health programs (as cigarette taxes are supposed to), maybe a sugar tax would be easy to pass. But I’ve seen the government move money around like it wasn’t earmarked for anything, so you can’t sell me on this fake deal again

“Maybe such a tax will force hard-working American families to better utilize their limited monies, so that, for example, if they are forced to make a choice, they will chose milk for their children over sugar-sweetened cola,” she wrote…

I suppose milk is better than soda.  Of course, too much milk is also fattening. And some people are allergic to milk, or just plain don’t like it.  I guess there’s always Kool-Aid.

Let’s look at our experiment in sin taxes for cigarettes.  Yes, the high taxes have decreased sales and use.  But I think it was the shaming of users, along with bans on public use, that really had an effect on the number of smokers.

You want to shame fat people?  Shame diabetics?  Push people into the closet when they want to have a soda?  Ban public use of soda?  As if soda was the only product on the grocery store shelf that contains a lot of sugar or is bad for you.  Is ice cream next?  Or are ice cream products okay because they contain a little milk?

Part of the answer is to create better access to fresh fruit and vegetables.  And that means there should be a fruit or vegetable stand wherever there is a fast-food joint.  Wherever they sell soda, they should also have to sell fresh fruit.  It may take some time, but people will start making better choices without being forced or taxed into it.  Using force always means there will be those who rebel.

Facebook posts CAN be used to prosecute benefit cheats in New York test case

http://www.dailymail.co.uk/sciencetech/article-3173222/Facebook-posts-used-prosecute-benefit-cheats-New-York-test-case-Ruling-forces-social-network-comply-warrants-angering-privacy-campaigners.html

Facebook has been told it must comply with almost 400 search warrants seeking users’ postings as part of a fraud investigation, a New York appeals court said on Tuesday. The 381 warrants helped build a massive disabilities benefits fraud case against police and fire department retirees. So far 108 people have pleaded guilty. Some defendants disclosed on Facebook that they flew helicopters, traveled overseas, did martial arts and led active, full lives…

‘Our holding today does not mean that we do not appreciate Facebook’s concerns about the scope of the bulk warrants issued here or about the district attorney’s alleged right to indefinitely retain the seized accounts of the uncharged Facebook users,’ the five-judge panel wrote…

A Manhattan judge sanctioned the warrants in July 2013, saying law enforcement has authority to search massive amounts of material to seek evidence…

Failure just means there’s another way

Photos from 2/24/2015.