The Agony of Withdrawal
Part 3 in a Four-Part SeriesA 26-year-old man presented with fatigue. He complained of body aches, diarrhea, and nausea. His history was significant for chronic back pain, for which he had been prescribed oxycodone that he has taken daily for three years. He reported that he had stopped taking it two days before his visit.He denied other medication or drug use. He was alert but restless and diaphoretic. His ECG showed sinus tachycardia. His labs included a WBC of 12, Hgb of 12, glucose of 89 mg/dL, creatinine of 1.0 mg/dL, sodium of 140 mEq/L, potassium of 3.8 mEq/L, and CK of 140 U/L. He was experiencing opioid with...
Source: The Tox Cave - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Psychology Around the Net: February 17, 2018
Hello, Psych Central readers.
For this week’s Psychology Around the Net, we’re diving into vibes and what causes us to feel them, how we can use our emotions to cause positive environmental change, ways to help children better understand and practice mindfulness, and more.
I’ve chosen to not address the school shooting at Marjory Stoneman Douglas High School in Parkland, Florida in this week’s Psychology Around the Net, as many of our Psych Central writers have already and are continuing to do so. I encourage you to browse our latest blog posts for our team’s insights.
How Real Are Vibes: Th...
Source: World of Psychology - February 17, 2018 Category: Psychiatry & Psychology Authors: Alicia Sparks Tags: Addiction Children and Teens Depression Disorders Green and Environment Mindfulness Psychology Around the Net Recovery Research Substance Abuse Technology Buprenorphine Environmental Threats language Obsessive Behavior selfie Source Type: blogs
What ’s our goal with opioid treatment?
When I started treating opioid dependence, I began with high expectations. I was frustrated with what had become a mindless, ineffectual exercise in providing medication for chronic pain. I saw too many patients “circling the drain” on opioids. Most admitted they still had chronic pain despite their high consumption of opioids. Many patients needed their medication just to feel normal and avoid withdrawal. Others wished they could stop taking opioids but were unable to tolerate severe cravings in addition to withdrawal. Getting off opioids seemed impossible. Instead of being part of the solution, I felt like I was part...
Source: Kevin, M.D. - Medical Weblog - February 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/layne-kamalu" rel="tag" > Layne Kamalu, MD < /a > Tags: Physician Pain Management Primary Care Source Type: blogs
The ghost in the basement
Follow me on Twitter @BillEduTheater
We are fortunate to have a country home in the Catskills where we can escape city life. An eight-year-old neighbor often crosses our meadow or bikes over to stop by for a visit. While I’d like to think I’m the featured attraction, his visits are not just to see me; of much greater interest is our basement with its shelves of toys and games. Particularly appealing to this lad is the sports equipment: hockey sticks, goalie pads, a goal to shoot on, baseball mitts, a batting helmet, a catcher’s mask, soccer balls, and more. Name the sport and it is most likely we have equipment for i...
Source: Harvard Health Blog - January 12, 2018 Category: Consumer Health News Authors: Bill Williams Tags: Addiction Health Source Type: blogs
Stop Calling it an Opioid Crisis--It's a Heroin and Fentanyl Crisis
The National Center for Health Statisticsreported last month that a record 63,600 deaths occurred in 2016 due to overdoses. Diggingdeeper into that number shows over 20,000 of those deaths were due to the powerful drug fentanyl, more than 15,000 were caused by heroin, and roughly 14,500 were caused by prescription opioids, although it has been known for years that, inmost cases of prescription opioid deaths, the victims hadmultiple other potentiating drugs onboard. The rest of the deaths were due to methamphetamines, cocaine, benzodiazepines, and methadone.Drugs Involved in U.S. Overdose Deaths* - Among the more than 64,00...
Source: Cato-at-liberty - January 8, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Comparing medications to treat opioid use disorder
This study was widely covered in the press, and many of the sound bites and headlines reporting the two treatments to be equally effective were a bit misleading.
The advantages and disadvantages of buprenorphine (Suboxone, Subutex, Zubsolv, Probuphine, Sublocade)
Buprenorphine is a partial opioid agonist medication. This medication activates the same receptors in the brain as any opioid, but only partly. Because its effects are long-lasting, it can be taken once a day to relieve cravings, prevent withdrawal, and restore normal functioning in someone with opioid use disorder. Because it is a partial agonist, it has a ceilin...
Source: Harvard Health Blog - January 3, 2018 Category: Consumer Health News Authors: Sarah Wakeman, MD, FASAM, Medical Director, Massachusetts General Hospital Substance Use Disorder Initiative Tags: Addiction Health Source Type: blogs
Narcan or Narcan’t?
Part 2 in a Four-part SeriesA 57-year-old man presented with acute onset altered mental status. His family said he had been behaving normally. Prior to dinner, however, he became difficult to arouse, and was speaking gibberish. He was somnolent but arousable to physical stimuli on arrival in the ED.He answered questions inappropriately and would then go back to sleep. His past medical history was consistent with hypertension, hypercholesterolemia, and spinal fusion a month ago. His medications included lisinopril, atorvastatin, and hydrocodone. His vital signs were a blood pressure of 110/65 mm Hg, heart rate of 90 b...
Source: The Tox Cave - January 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Are family physicians the best weapon against opioid crisis?
As the national opioid crisis takes center stage, I want to make a case for the authority of the family physician in managing and treating this problem.
I am a family physician and have been treating patients with opioid dependence and addiction for 12 years. These patients comprise about half of my practice. The other half is representative of a typical primary care practice. I have patients who have been treated at methadone clinics, dedicated buprenorphine clinics and pain clinics. My patients have participated in hospital-based detox programs as well as outpatient and inpatient rehabilitation programs. Most of my patie...
Source: Kevin, M.D. - Medical Weblog - December 31, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/layne-kamalu" rel="tag" > Layne Kamalu, MD < /a > Tags: Physician Pain Management Primary Care Source Type: blogs
If we are serious about addressing the opioid epidemic, this is what we should do
Multiple state leaders, including Maryland Gov. Larry Hogan, and even President Trump have declared states of emergency in response to the opioid epidemic. Policymakers claim to be battling this public health crisis on all fronts, but one arena continues to be conspicuously ignored: our prisons and jails.
Roughly half of all incarcerated individuals suffer from addiction. And in the two weeks following their release, former prisoners are 129 times more likely to die from overdose than members of the general population.
This is despite the fact that we have robust evidence showing that we can decrease the incidence of relap...
Source: Kevin, M.D. - Medical Weblog - December 1, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/justin-berk" rel="tag" > Justin Berk, MPH, MBA < /a > Tags: Physician Emergency Medicine Primary Care Public Health & Policy Source Type: blogs
Naloxone: An important tool, but not the solution to the opioid crisis
In this study, we aimed to define how many patients who were treated with naloxone by an ambulance crew and initially survived were still alive after one year. Even though these patients are typically just observed in the ED hallway, allowed to sober while the ED staff is busy taking care of other patients with life-threatening emergencies like heart attacks, trauma, and strokes, our team hypothesized that the individual sobering in the hallway bed has perhaps one of the highest one-year mortality rates of anyone seen in the department.
Here’s how the study worked — and what we found
To perform the study, we took advan...
Source: Harvard Health Blog - November 30, 2017 Category: Consumer Health News Authors: Scott Weiner, MD Tags: Addiction Health naloxone Source Type: blogs
The Opioid Commission: Ringing The Right Alarm To Respond To The Overdose Epidemic
The 20-year opioid overdose epidemic confronting our nation has continued unabated largely because of an uncoordinated response that has over emphasized supply-side interventions (i.e. prescriber guidelines, Prescription Drug Monitoring Programs, law enforcement) rather than dramatically increasing access to evidence-based treatment as occurred in other Western nations with great success. The White House’s Opioid Commission (chaired by Governor Chris Christie, R-NJ) in declaring a national emergency and breaking with this failed tradition offers much hope for stemming the overdose death rate.
The Opioid Commission’s in...
Source: Health Affairs Blog - August 21, 2017 Category: Health Management Authors: Arthur Robin Williams and Adam Bisaga Tags: Featured Public Health Quality Opioid Addiction opioid epidemic Source Type: blogs
Missing the Point of Buprenorphine Treatment
A forum reader wrote about concerns over a partner on buprenorphine. Her concerns pointed out a common misperception about the goals of treatment of opioid use disorder using buprenorphine, or using methadone for that matter.
Her question, amended for privacy:
I married the love of my life. He is still he love of my life but has been an addict for 15 of them. Our children have been greatly affected by his addiction. He made promise after promise that he was clean, and I dove back in with complete faith time after time only to get burned.
His addiction started with recreational pills increasing over time, but now he i...
Source: Suboxone Talk Zone - June 17, 2017 Category: Addiction Authors: admin Tags: Addiction Buprenorphine Suboxone treatment buprenorphine treatment opioid taper rapid detox Suboxone taper Source Type: blogs
Missing the Point of Buprenorphine Treatment
A forum reader wrote about concerns over a partner on buprenorphine. Her concerns pointed out a common misperception about the goals of treatment of opioid use disorder using buprenorphine, or using methadone for that matter.
Her question, amended for privacy:
I married the love of my life. He is still he love of my life but has been an addict for 15 of them. Our children have been greatly affected by his addiction. He made promise after promise that he was clean, and I dove back in with complete faith time after time only to get burned.
His addiction started with recreational pills increasing over time, but now he i...
Source: Suboxone Talk Zone - June 17, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine Suboxone treatment buprenorphine treatment opioid taper rapid detox Suboxone taper Source Type: blogs
Missing the Point of Buprenorphine Treatment
A forum reader wrote about concerns over a partner on buprenorphine. Her concerns pointed out a common misperception about the goals of treatment of opioid use disorder using buprenorphine, or using methadone for that matter.
Her question, amended for privacy:
I married the love of my life. He is still he love of my life but has been an addict for 15 of them. Our children have been greatly affected by his addiction. He made promise after promise that he was clean, and I dove back in with complete faith time after time only to get burned.
His addiction started with recreational pills increasing over time, but now he i...
Source: Suboxone Talk Zone - June 17, 2017 Category: Addiction Authors: admin Tags: Addiction Buprenorphine Suboxone treatment buprenorphine treatment opioid taper rapid detox Suboxone taper Source Type: blogs
