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Pills

24

Jul 16

July 24, 2016

New Suboxone Limits for Physicians

By Andrew Rountree

Recently, the U.S. Department of Health and Human Services decided to increase the number of patients that physicians can treat with Suboxone. Beginning around 2002, physicians who went to a training program have been allowed to prescribe Suboxone for up to one hundred patients. This has become an important treatment option for opiate-dependent patients and has undoubtedly led to many patients stabilizing their lives and committing to long-term recovery.

When determining rules for Suboxone treatment, the government intentionally chose a design that was different from methadone programs. Methadone was approved as a treatment for opiate addiction around 1970. Because it is an addictive and abused drug, it could only be given out in licensed clinics. Restrictive regulations were put in place, including required daily attendance at the clinic, and supervised consumption of medications. In some ways, the regulations contributed to the problem. It is difficult for patients on methadone to travel or hold a job, and they are regularly exposed to other actively using drug addicts. In order to avoid the same consequences, rules for Suboxone were designed to allow a physician in private practice to prescribe Suboxone type products for up to one month or longer. There were, however, no requirements for counseling, drug testing, or any other case management services.

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28

Jun 16

June 28, 2016

Medication-Assisted Treatment – MAT

By Andrew Rountree

Recently, the New York Times ran an article proposing that most opiate addicts should receive Medication Assisted Treatment (MAT). I couldn’t agree with them more.

Success rates for patients with opiate addiction who are not treated with any form of MAT are horrible. An important study I have quoted for many years made this abundantly clear. The study was out of Seattle. It followed 124 patients who went into a hospital to start their recovery from opiate addiction. About 26% were not even able to complete the detoxification. The others were all offered good treatment options – 28 day inpatient rehab, outpatient counseling, recovery residences, etc. After 3 months, there were only 4 successful patients. This equates to a success rate of only 3%. And, all of these patients were motivated. They went into a hospital to get clean. But, there is something about opiate addiction that makes relapse so much more likely than other addictions. Hence, the need for MAT.

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disease

26

May 16

May 26, 2016

Online Porn May Damage Teenage Brains

By Andrew Rountree

The internet is a marvelous thing. It can bring us information at lightning speed and help us learn things, get places, and entertain ourselves. Some of us older folks can remember life before the internet, but it is hard for anyone to imagine life now without the internet. But new inventions can have unintended consequences.

There have always been some people who enjoy sexual arousal and new inventions have often been used to feed that appetite. Soon after photographs were invented, some enterprising fellows began to make pornographic pictures. When moving pictures were invented around 1900, it was not long after that there were pornographic movies being made and watched. And, so it is with the internet. From the earliest days of the world-wide web enterprising people started to make money by providing pornography online.

There has been, and always will be, a ready market for pornography – it excites the Dopamine part of our brain that is biologically wired for sex and survival. We are born with a natural strong desire for sex, and anything that excites that part of our brain has a strong influence on us. Did you ever notice that beer and car TV commercials almost always involve seductively clad women? Online pornography has taken this to a new level. The numbers are staggering. In the US alone, there are over 100 million visitors to adult sites every month. It has been calculated, just in 2015, there were more hours spent on one particular pornography website than the number of hours that Homo Sapiens have been in existence!

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11

Apr 16

April 11, 2016

Expecting Miracles

By Andrew Rountree

I’m not saying that miracles can’t and don’t happen anytime and anywhere, but seeing miracles is a daily occurrence in my job.

For instance…this week James* came in to get his second naltrexone implant. April did the implant, but she grabbed me on his way out and said, “I knew you’d want to say hello to James.”

Now I’m getting older and a lot of times it takes me a minute to remember who I’m looking at. That’s what was going on as I looked at this handsome, smiling young man in front of me. He grinned kind of sheepishly and said, “ Sorry I gave you guys such a hard time during my detox.”

And then I remembered. James was terrified of the Accelerated Opiate Detox process. He had heard some horror stories about the ultra rapid detox done under anesthesia, but even more than that, he was terrified to give up his dope. It had become a very reliable friend to him. He had a three-week old son at home, and he knew he wanted to be the kind of dad this little one deserved. So he took a deep breath and went through with it.

Checking on him the first couple weeks after he was done, James was struggling with anxiety and sleeping issues. We encouraged him, gave him some tips, urged him to continue with the therapist we’d helped him find and assured him what he was feeling was normal.

And now, here he was, two months later. The 145 pound, 6 foot, acne-ridden guy that was with us in January was transformed. James has put on 15 pounds. His skin is clear, his smile is huge. He proudly flashed us a picture of his son.

That’s a miracle.

Look for another miracle story in the next couple days.

Joan R. Shepherd, FNP

*I don’t use anyone’s real name, and I change details that might identify a patient.

FENTANYL

28

Mar 16

March 28, 2016

The New Fentanyl Epidemic

By Andrew Rountree

Just when you thought the heroin epidemic was bad enough, now we are seeing a new and even worse epidemic – Fentanyl. We started to hear about Fentanyl since it has been a contributing factor in many recent overdose deaths.

In its prescription form, Fentanyl is known as Actiq, Duragesic, and Sublimaze. Street names for the drug include Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, as well as Tango and Cash.

Over the last year or two, there have been many clusters of fatal overdoses in communities all over America – often 10 or more people dying in one community in one weekend. And the cause has been found that people who were buying heroin on the street was mixed with Fentanyl.

Fentanyl is a synthetic opiate, just like Percocet, oxycodone, heroin and all of the others – except it is even more powerful, and even more deadly. Fentanyl is 50 times more powerful than heroin. It acts quickly and it seems to shut off the breathing control centers in the brain even more than other opiates. Fentanyl has been used with medical patients for over 30 years. It is very fast acting, and very powerful, so it is used routinely in anesthesia to put patients to sleep. It does its job of putting someone into a complete coma very efficiently, but if the patient is not intubated and on a breathing machine, it stops them from breathing and the patient dies very quickly.

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