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Prescription Drug Abuse and Policy Changes

July 19, 2010 by Editor

As prescription drug abuse is on the rise, the Washington State Department of Health reports that overdoses have replaced car crashes as the leading cause of injury-related deaths. From 2003 to 2008, the rate of prescription overdoses and hospitalizations rose 90 percent.

The most prevalent drug overdose and death culprits appear to be Vicodin, Oxycontin and Methadone, all opiods. The overuse of Vicodin can lead to increased tolerance and addiction. One risk of Vicodin addiction includes liver toxicity, which increases for users without a tolerance to the drug. Oxycontin users may suffer from respiratory depression or arrest, skeletal-muscle flaccidity, blood-pressure and heart-rate reduction, coma and death.

As for Methadone, the FDA has issued a public health advisory warning that deaths and life-threatening side effects have been reported for both new users and those that switched to Methadone after being treated for pain with other strong narcotic pain relievers. The drug can cause slow or shallow breathing and change in heartbeat that may not be felt by the patient.

The trend of drug use has evolved since popular use of certain drugs each era – from LSD in the 1960s, heroin in the 1970s, crack cocaine in the 1980s, crystal meth in the 1990s to the current prescription drug abuse.

This year’s latest drug control strategy emphasizes anti-drug programs and encourages health care providers to screen for drug problems before addiction sets in, marking a change in policy. The policy requires early detection of patient drug use and database tracking of physicians that overprescribe addictive painkillers.

Policy reform also allocates drug control budget funds to a 13 percent increase in spending on drug prevention programs. A 3.7 percent increase in addiction treatment was also approved for the budget.

The aim for policy reforms includes goals to reduce the rate of youth drug use and drug-induced deaths by 15 percent, and drug use among young adults by 10 percent. The administration also hopes to reduce the number of chronic drug users by 15 percent.

Narcotic Bowel Syndrome

May 6, 2010 by Editor

Chronic use of opiate drugs can cause a syndrome of chronic abdominal pain, vomiting, weight loss, and features of intestinal pseudo-obstruction associated with prolonged use or abuse of opiate drugs. Symptoms resolved rapidly in all patients when narcotic/opiate administration was stopped. The narcotic bowel syndrome is a clinically important and frequently unrecognized cause of chronic abdominal pain.

Opiates delay stomach emptying and slow down the normal activity of the small intestine and colon. Narcotic bowel syndrome (NBS) is a subset of opioid bowel dysfunction that is characterized by chronic or frequently recurring abdominal pain that worsens with continued or escalating dosages of opiates. This syndrome is under recognized and may be becoming more prevalent. This may be due in the United States to increases in using opiates for chronic painful disorders and addiction. NBS can occur in patients who receive high dosages of opiates by physicians unaware of the hyperalgesic effects of chronic opiates. Hyperalgesia is a condition where chronic use of opiates cause pain.

It has long been recognized that opiates affect gastrointestinal activity. These effects, known as opioid bowel (or gastrointestinal) dysfunction are manifest as constipation, nausea, bloating, ileus and sometimes pain. When pain is the predominant symptom, the condition has been termed narcotic bowel syndrome (NBS). NBS is characterized by the progressive and somewhat paradoxical increase in abdominal pain despite continued or escalating dosages of opiates prescribed in an effort to relieve the pain. This entity was first reported two decades ago in the United States. Many of these patients are experiencing the NBS and benefit from opiate detoxification. We consider this to be a rapidly emerging health problem that requires attention.

The syndrome is characterized by chronic or intermittent colicky abdominal pain that worsens when the opiate effect wears down. While narcotics/opiates may seem helpful at first, over time the pain-free periods become shorter, leading to increasing opiate doses. Ultimately, increasing dosages enhance the adverse effects on pain sensation and delayed motility, thereby initiating the development of NBS.

Although pain is the dominant feature, nausea, bloating, vomiting, abdominal distension and constipation are common. Eating can aggravate the symptoms, so when the condition lasts for weeks, mild weight loss may occur due to anorexia or a willful restriction of eating out of fear of aggravating the pain. The symptoms may correlate with delayed gastric emptying.

A common and misleading consequence of NBS is that abdominal X-rays may show signs suggestive of a partial intestinal obstruction, which in fact is due to an adynamic ileus or pseudo-obstruction. There may also be large amounts of fecal retention seen. Laboratory tests including blood count, amylase, lipase, liver chemistry and urine analyses are usually normal.

The key to the diagnosis of NBS is the recognition that chronic or escalating doses of opiates lead to continued or worsening symptoms rather than benefit. However since the symptoms are nonspecific and many clinicians are unaware that narcotic medications can actually sensitize patients to the experience of pain. Thus, continued treatment with opiates lead to a vicious cycle of pain, use of more opiates and continued or worsening pain.

NBS remains under-recognized symptoms due to lack of knowledge about the long-term effects of opiates as causes of visceral pain and GI disturbances, and difficulties in clinically distinguishing abdominal pain that results from, rather than is benefited by opiates.

Acupuncture Provides Long-Term Relief of Low Back Pain

April 5, 2010 by Editor

Approximately 70% of our patients are addicted to opiates for pain management and the majority are on opiates due to back pain. Back pain is one of the most common reasons people see a pain management doctor and start on opiate drugs. Up to 80% of the world’s population will suffer from back pain at some point in their lives, with the lower back as the most common location of pain.

Although most episodes of low back pain last less than two weeks, research has shown that recurrence rates for low back pain can reach as high as 50% in the first few months following an initial episode or injury.

While it is difficult to resolve lower back pain, the use of acupuncture has increased dramatically in the past few decades. Placebo-controlled studies have validated it as a reliable method of pain relief. The results of a recent study published in the Clinical Journal of Pain provide further proof that acupuncture is a safe and effective procedure for low-back pain, and that it can maintain positive outcomes for periods of six months or longer. Seeking acupuncture therapy may be an answer to relieving pain without the use of opiates that can have many negative side-effects and cause addiction.

Bipolar Disorder Overdiagnosed?

April 2, 2010 by Editor

Study Shows Many People Who Are Told They Have the Disorder Don’t Meet Standard Criteria

By Charlene Laino
WebMD Health News
Reviewed by Louise Chang, MD

Many people who have been told by their doctors that they have bipolar disorder don’t really have it.

So say researchers who used a standardized, comprehensive, psychiatric diagnostic interview to evaluate 700 adult psychiatric outpatients.

About 20% had previously been diagnosed with bipolar disorder. But only 13% met the criteria, says Mark Zimmerman, MD, associate professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University in Providence and practicing psychiatrist at Rhode Island Hospital in Providence.

“In about half of patients previously diagnosed with bipolar disorder, we couldn’t confirm the diagnosis,” he tells WebMD.

There are real dangers to overdiagnosis, chief among them unnecessary exposure to mood stabilizers and all their powerful side effects, Zimmerman says. There’s also the stigmatization of having a serious, possibly lifelong mental illness.

The study is being published online by the Journal of Clinical Psychiatry and presented at the annual meeting of the American Psychiatric Association.

Why Is Bipolar Disorder Overdiagnosed?

Bipolar disorder used to be called manic depression because it is characterized by bouts of depression and bouts of mania. Patients experience dramatic mood swings between euphoria and severe depression; they may have hallucinations or delusions.

Patients with anxiety, agitation, irritability, and restlessness that does not persist are sometimes misdiagnosed with bipolar disorder, Zimmerman says.

“These could be symptoms of bipolar disorder. But they really have to be accompanied by other criteria, such as hyperactivity, feeling energetic despite just a few hours of sleep, or inflated self-esteem,” he says.

Ironically, one reason the disorder is being overdiagnosed is “because so much has been written about it being under-recognized,” Zimmerman says.

“It’s difficult to go to a lecture on bipolar disorder that doesn’t begin with, ‘Make sure you don’t miss…,'” he says. “So clinicians are loathe to miss it.”

The increased availability of medications for the treatment of bipolar disorder may also play a role in overdiagnosis, Zimmerman says. “Physicians have a tendency to diagnose something that they feel they are comfortable treating,” he says.

So what should you do if you think you’ve been misdiagnosed with bipolar disorder?

“If you’re at all uncertain about the diagnosis, speak to your doctor and make sure you understand why you’ve been given that diagnosis. If you remain unconvinced, get a second opinion,” Zimmerman says.

A Note from Rapid Drug Detox

According to several researchers, marketing tactics by the drug industry are contributing to a huge overdiagnosis of bipolar disorder. Studies have shown evidence that fewer than half of patients who were given a diagnosis of the disorder actually had it, as reported in the Journal of Clinical Psychiatry. Their finding contradicts previous claims that the illness was underdiagnosed. Results from this study suggest that bipolar disorder is being overdiagnosed, and, given the serious side effects that the treatments can cause, patients need to be aware of this.

11 Drug-Free Tips for Living with Chronic Pain

March 22, 2010 by Editor

1. Try deep breathing or meditation techniques to relieve pain without drugs.

Meditation and deep breathing allows the body to relax without the aid of opiates, easing pain and tension that tighten muscles.

Try these soothing repetition steps to help you relax:

Find a quiet spot and comfortable body position
Imagine a spot just below your navel
Breathe into that spot, fill your abdomen with air
Let air fill you from the abdomen up, then let it out, like deflating a balloon.
Ignore any disruptive or negative thoughts
Repeat a relaxing word or phrase (a mantra)

2. Reduce negative emotions and stress in your life.

Learn to take control of stress – depression, stress, anxiety and anger can all increase your body’s susceptibility to chronic pain.

Try these drug-free stress-reducing and relaxing techniques:

Listen to soothing, calming music
Mental imagery relaxation is a form of mental escape (imagine a calm beach or quiet place)
Progressive muscle relaxation – alternately tensing and then relaxing muscles can relieve stress

3. Rely on natural endorphins from exercise, not drugs, to boost pain relief.

Exercise strengthens muscles, helps prevent injury & further pain, and releases natural endorphins to help improve your mood while blocking pain signals without the help of drugs. Additionally, by keeping your weight down, you can reduce heart disease risk and control blood sugar levels, important if you have diabetes.

4. Reduce drinking, which increases sleep problems.

Pain can make sleep difficult and drinking can increase sleep problems – drinking less or none can help you with getting enough rest each night.

5. Join a support group for those living in chronic pain without drugs.

Sometimes you need to ask for help – it’s a sign of strength, not weakness. When you’re surrounded by people living with chronic pain, you feel less alone and you can benefit from their wisdom in coping with pain. Or, consider meeting with a mental health professional. Counseling can help you develop a healthier attitude by learning how to cope and avoid negative thoughts that increase pain.

6. Don’t smoke.

Smoking can increase painful circulation problems and your risk of heart disease and cancer.

7. Document your pain level every day.

Try documenting a journal of your daily “pain score.” At the end of each day, rank your pain level on a 1 to 10 pain scale, and document your activities that day. Bring this book with you to every doctor visit, and try reviewing it yourself to see what you can change about your daily habits to decrease your pain score.

8. Learn biofeedback to decrease pain severity naturally without drugs.

Here’s how it works: You wear sensors that let you “hear” or “see” certain bodily functions like pulse, digestion, body temperature, and muscle tension. The squiggly lines and/or beeps on the attached monitors reflect what’s going on inside your body. Then you learn to control those squiggles and beeps. After a few sessions, your mind has trained your biological system to learn the skills.

9. Get a massage to relieve chronic pain.

Massage can help reduce stress and relieve all types of chronic pain and tension, including back and neck pain.

10. Eat a healthy diet.

A well-balanced diet reduces heart disease risk, keep weight under control and improve blood sugar levels.

Try these foods for a low-fat & sodium diet:

Fresh fruits and vegetables
Cooked dried beans and peas
Whole-grain breads and cereals
Low-fat cheese, milk and yogurt
Lean meats

11. Distract yourself from pain to enjoy life more – don’t rely on drugs.

Focusing on pain can worsen it. Instead, find something you love to do – a sport or hobby that keeps you busy and thinking about things besides your pain. You can always take control of your own life, even if you can’t prevent pain altogether.

Psychiatric Disorders

March 22, 2010 by Editor

The psychiatric and pharmaceutical industry compare psychiatric disorders such as Bi-Polar Disorder, Depression, Attention Deficit Disorder (ADD/ADHD), Post-Traumatic Stress Disorder, etc. to medical conditions such as cancer, diabetes and heart disease. However, no scientific tests can verify the medical existence of psychiatric disorders.

The psychiatric industry claims that there are certain medical conditions that exist without verifiable tests, therefore there does not exist one for mental illnesses. While there may exist rare medical conditions without verifiable medical tests, there are no psychiatric disorders that can be verified medically as a physical abnormality or disease.

Often brain scans used to prove schizophrenia or depression have not been conducted on people not taking antipsychotic drugs. Such scans have been documented to cause brain atrophy, or shrinkage. Other brain scans have compared brains of smaller children to show smaller brains in comparison to larger and older children. The scans were used to claim that children with ADHD have smaller brains. However, none have been conclusively proven to verify mental disorders as abnormalities of the brain.

This is not to say that people don’t get depressed, troubled, or even sometimes act psychotic. For example, can soldiers returning from war experience extreme and often debilitating stress? Yes, but it is less likely to be a medical condition of the brain. Can mothers become distraught after a joyous occasion such as the birth of a child? Yes, but again, it is unlikely to be a brain abnormality or mental disease. It may not be the best decision to prescribe these people certain drugs documented by international regulatory agencies to cause mania, psychosis, worsening depression, heart attack, stroke and sudden death. Additionally, new or nursing mothers may risk birth defects or damage to infants from prescription drugs.

Any drug taken influences behavior or mood, whether it be cocaine, marijuana or heroin. This does not mean someone who acts or feels differently on cocaine does so because they had a cocaine imbalance, with which the cocaine then corrected. It means that drugs change moods, emotions and behavior. But while the illicit use of drugs is universally frowned upon, psychiatric drugs are conversely viewed as “good” drugs, despite the fact many are more addictive than cocaine or heroin. Drug addiction leads to the greater issues of drug abuse and withdrawal.

The larger problem is that the biological drug model prevents governments from allocating funding to actual medical solutions to people experiencing difficulty. There are also viable, non-harmful medical treatments that do not receive government funding because the psychiatric/pharmaceutical industry spends much of its budget on advertising and lobbying efforts.

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