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Archive for February, 2012

Buprenorphine Availability, Diversion, and Misuse: A Summary of the CESAR FAX Series

Monday, February 27th, 2012

U n i v e r s i t y o f M a r y l a n d , C o l l e g e P a r k

From the Center for Substance Abuse Research

Buprenorphine diversion and nonmedical use appear to be increasing.

The number of buprenorphine drug items secured in law enforcement operations and analyzed by state and local forensic laboratories has increased from 21 in 2003 to 8,172 in 2009. Buprenorphine has been smuggled into state prisons, including those in Maine, Massachusetts, New Jersey, New Mexico, Pennsylvania, and Vermont. More than one-half of buprenorphine-related emergency department (ED) visits are for the nonmedical use of the drug. The estimated number of ED visits related to the nonmedical use of buprenorphine has more than tripled, from 4,440 in 2006 to 14,266 in 2009. A recent study found that injecting drug users (IDUs) in Rhode Island were more likely to use diverted buprenorphine/naloxone to self-medicate while non-IDUs were more likely to use the diverted drug to get high. Regardless of whether diverted buprenorphine is being used nonmedically to self-treat opiate addiction or to get high, unmonitored use of diverted buprenorphine places users at serious risk for potential adverse health effects, especially when taken in combination with other opioids or with depressants such as sedatives, tranquilizers, or alcohol.

 

Policy changes that may decrease buprenorphine diversion and misuse

The apparent increase in buprenorphine availability, diversion, and nonmedical use suggest the need for buprenorphine policy changes. First, current testing protocols, including those of medical examiners and drug testing programs, should include routine testing for buprenorphine to estimate the full magnitude of and to monitor buprenorphine diversion and misuse. Second, physician education programs for prescribing buprenorphine, especially strategies to detect and deter diversion and misuse, need to be strengthened. A recent study found that waivered physicians had limited knowledge of buprenorphine pharmacology and legislative issues, suggesting that the mandatory 8-hour training required to obtain a waiver to prescribe buprenorphine may be inadequate. 

 

 

 

 

 

 

 

 

 

CESAR will continue to monitor the diversion and abuse of buprenorphine and report on developments as they arise.

Alcohol problems not uncommon among surgeons: study

Thursday, February 23rd, 2012

 Feb 23 (Reuters) - About 15 percent of surgeons have alcohol abuse or dependency problems, a rate that is somewhat higher than the general population, according to a U.S. study.Researchers, who published their findings in the Archives of Surgery, also said that surgeons who showed signs of alcoholism were 45 percent more likely to admit that they had a major medical error in the past three months.

The team, led by Michael Oreskovich at the University of Washington, sent out a survey to more than 25,000 surgeons, of whom some 7,200 responded.

 

Questions were asked about work, lifestyle and mood, and several were used to screen for alcohol abuse or dependency.

 

Overall, 15 percent of surgeons showed signs of alcohol problems. Other studies have estimated that, among the general population, the rate of alcohol problems is about nine percent.

 

The study did not determine why alcohol problems might be more common among surgeons, whose field is considered particularly demanding, but did show that alcohol problems were linked with the doctors who were reporting depression and burnout as well.

 

“The nature of the beast is that the percent of emergencies, the percent of after hours work, and actual scheduled work itself all require an energy and concentration that is really different than a lot of other specialities,” Oreskovich said.

 

About 14 percent of male surgeons and 25 percent of female surgeons showed signs of alcohol problems, though the study could not explain why women appear to be more at risk.

 

“Observations from previous studies show that the stress of being a surgeon, and balancing professional and personal obligations, is much more prevalent in female than male surgeons,” Oreskovich added.

 

Among the 722 physicians who said they had a major medical error in the past three months, 77 percent of them scored within the range of having alcohol problems.

 

“Surgery is a stressful business. There are people who turn to alcohol to help deal with their stress,” said Edward Livingston, a professor at the University of Texas Southwestern Medical Center, who was not involved in the study.

 

“Does that affect their performance? Who knows?”

 

In an editorial that accompanied the report in the Archives of Surgery, Livingston said the response rate to the survey — 7,200 out of more than 25,000 — was very low.

 

“If you have a low response rate, you don’t know if it represents the universe of people you’re trying to study,” he told Reuters Health.

 

Oreskovich said it’s possible that the percent of surgeons with alcoholism is underestimated in this study because the people who were less likely to respond might have shame and fear associated with their alcohol abuse and dependence that they don’t want to report on the survey.

 

Studies of physicians who go into rehabilitation show very low relapse rates back into substance abuse, he added. SOURCE: bit.ly/z31Rs7 (Reporting from New York by Kerry Grens at Reuters Health; editing by Elaine Lies and Bob Tourtellotte)

Special Investigation: Why ARE so many doctors addicted to drink or drugs?

Thursday, February 23rd, 2012

Disturbing new research reveals that one in six doctors has been hooked on alcohol or drugs. How has this happened - and what are the implications?

The patients were waiting dutifully. But their young female doctor seemed reluctant to attend to their ailments at morning surgery. As the minutes ticked by, her door remained firmly shut.

The reason for her absence soon became apparent. When staff finally went to investigate, Emily Heinzman was found slumped unconscious over her desk at Oulton Medical Centre, near Leeds. The room reeked of alcohol; the dishevelled doctor was snoring loudly and oblivious to the world.

Man drinking

Surveys of hospital trusts also found that a third of male junior doctors and almost one in five of their female peers have used cannabis, ecstasy, cocaine and other hallucinogenic drugs

Clearly, Heinzman had not been taking her medicine properly. For this bright, intelligent 31-year-old usually tried to ensure she wouldn’t suffer any ill-effects from the previous night’s drinking - by taking a cocktail of drugs.

Using all the pharmaceutical skills she had learned during an expensive university education, Heinzman would mix herself ‘magic elixirs’ to deal with the raging headaches and trembling hands that always followed when she had too much to drink - an occurrence which, as the years went by, had become a nightly event.

At her upmarket docklands apartment in Leeds, she kept thousands of tablets in dozens of bottles. There was codeine, temazepam, diazepam and co-codamol - all highly addictive substances that are often used as a temporary treatment for drug addicts.

In truth, the only really surprising thing about this sordid tale of abuse is how commonplace it has become in the medical profession

And there was another problem: the drugs had been stolen. Heinzman had obtained them by writing fake prescriptions for non-existent patients.

Although she claimed she drank and took drugs to ease the pain of a break-up, Heinzman also liked getting high - and she was in the perfect position to exploit a never- ending supply of pharmaceuticals.

But prescription drugs weren’t her only addictions. She was also a heavy cocaine user. And she was handing out stolen drugs to her friends and holding late-night parties at her flat in Leeds,where drink and narcotics flowed.

Indeed, when the law finally caught up with her, cocaine - along with countless other substances - was found to be coursing through her veins.

Finally arrested and brought to court last year, it transpired that she’d been living this secret lifestyle for several years, treating patients at the same time as she was bingeing on drugs and alcohol.

Heinzman was given an eight-month jail term - suspended for 18 months - and ordered to carry out 100 hours’ Community Service after she admitted 16 charges of fraud relating to her fake prescriptions. Not surprisingly, she also feared losing her job.

But this month, three years after her drug-taking spiralled out of control, Heinzman was cleared to resume her medical career after serving a 12-month suspension imposed by the General Medical Council hearing into her potentially life-threatening behaviour.

Ambulance

While medical staff are dealing with the growing carnage caused by drunks in chaotic Accident and Emergency wards, these same professionals are themselves increasingly intoxicated

Before she was cleared to return to work - on condition she remained ‘clean’ - Peter Atherton, a lawyer for the General Medical Council, outlined the full scale of her abuse of the system, revealing that she had used a number of cunning schemes to ensure her supply of drugs.

‘She used many different names, and multiple addresses for the same patient,’ he said. ‘Prescriptions have been presented in many different large pharmacies, where staff were less likely to remember her. The efforts and preparation appear to have been a way of covering her tracks.’

Dr Emily Heinzman

Emily Heinzman had obtained drugs by writing fake prescriptions for non-existent patients

But, in truth, the only really surprising thing about this sordid tale of abuse is how commonplace it has become in the medical profession.

According to shocking new figures, up to one in six doctors will have been addicted to drink or drugs - or both - at some stage in their medical career, raising the horrifying prospect that these highly-paid carers may have your life in their trembling hands.

And that’s not all. Surveys of hospital trusts also found that a third of male junior doctors and almost one in five of their female peers have used cannabis, ecstasy, cocaine and other hallucinogenic drugs.

‘The problems will become more acute in future, as drug and alcohol dependency is becoming more common in the population as a whole,’ say the authors of Invisible Patients, a government-funded study into the scale of the crisis.

‘It may be easy to spot a health professional who is obviously under the influence of drugs or alcohol, but persistent and long-term substance misuse can be harder to pick up and the consequences for quality and safety of care harder to predict.

‘Working while under the influence of drugs or alcohol increases the chances that healthcare workers will make mistakes and communicate poorly with colleagues and patients,’ say the authors, revealing that more than 15,000 British doctors suffer from drink and drug addictions.

In other words, while medical staff are dealing with the growing carnage caused by drunks in chaotic Accident and Emergency wards, these same professionals are themselves increasingly intoxicated.

That was certainly the case for Dr Michael Wilks, a general practitioner who was downing a bottle of whisky a day between examining patients.

‘I was in a bit of a mess after several years of denial about the scale of the problem,’ he told me. ‘I thought I could handle it because I was a doctor. I don’t think I was a good doctor, but I don’t think I was a dangerous doctor.

‘Doctors are taught to be decisive and they are treated with respect,. So to ask for help, you have to climb down off your pedestal and admit you have a problem’

‘I was certainly deeply unhappy. I finally realised I couldn’t go on drinking, but I also knew that I couldn’t stop. I approached a patient I’d helped with an alcohol problem 15 years earlier and asked him for help. He told me what he’d done to get sober and for the first time in my life I listened.’

Now sober for 20 years and deputy chairman of the Sick Doctors Trust, a charity established to help medics addicted to booze and drugs, Dr Wilks says the medical profession is in deep denial about the scale of its alcohol problem.

‘Doctors are taught to be decisive and they are treated with respect,’ he says. ‘So to ask for help, you have to climb down off your pedestal and admit you have a problem. Doctors don’t want to reach out for that help - because they don’t understand that a real alcoholic cannot help themselves.’

Such is the stigma among alcoholic doctors that few are willing to be named. But many interviewed by the Mail, on conditions of anonymity, revealed harrowing details of how their drink-sodden lives as medical students did not stop when they became full-time professional medics.

Incredibly, doctors told me how they hook themselves up to saline drips before going to bed to combat the effects of alcohol, and how they and their friends self-prescribe drugs to ease their symptoms. One even said his recollections of carrying out medical procedures after drinking were ‘vague’.

The most striking example of this growing scourge emerged last year when it was revealed that one doctor drank three bottles of vodka a day, and was often so drunk on duty that he didn’t know his own name, let alone how to carry out correct medical procedures.

Some professionals in the medical industry cope with stress by finding solace at the bottom of a glass

Some professionals in the medical industry cope with stress by finding solace at the bottom of a glass

Dr Ramasankerpersad Jairam, who worked at Coventry’s Walsgrave Hospital, left his hospital accommodation in such a squalid state that the bedding and curtains had to be burned and the carpets steam cleaned.

For more than a year, other staff covered up his drink problem, with hospital security helping him to bed most nights. He was even seen propped up against a hospital wall, clearly drunk.

Concerned colleagues took a blood sample from Dr Jairam when he fell unconscious. Fearing he may die of acute alcohol poisoning, it transpired he was almost five times over the drink- drive limit when dealing with patients.

Disturbingly, however, a General Medical Council disciplinary inquiry heard from fellow medical specialists that there was no evidence that his drinking had caused ‘any direct harm’ to patients.

There are no country-wide rules preventing doctors from drinking. Nor is there a policy of random blood tests for drink and drugs

In fact, as well as the obvious risk posed to patients, this superior attitude to drink and drug abuse is also killing doctors. Studies have shown they are three times more likely to die as a result of alcoholrelated cirrhosis of the liver.

But many are in denial, believing the normal rules don’t apply to them. Indeed, surveys have shown that even school pupils know more about safe drinking levels than medical students.

This is a problem for doctors - but it also has profound implications for patients. One doctor, who asked to remain anonymous, revealed that he drank himself senseless at least four nights a week - with what he called ‘definite health implications’ for himself and his patients when he was on duty.

Describing the medical profession as ‘hypocritical’ in its attitudes to alcohol, the doctor added: ‘This dependence on alcohol for social interaction and relaxation should be worrying to all medical students and perhaps we should strive to live by example.’

Yet, astonishingly, there are no country-wide rules preventing doctors from drinking. Nor is there a policy of random blood tests for drink and drugs - something that many other professions, including bus and train drivers, must submit to.

Indeed, there are huge disparities between the policies of individual NHS trusts - some doctors are even allowed to drink while on call.

Yet some doctors insist the scale of the problem is exaggerated.

Prizzi Zarsadias, a trainee doctor and editor of the British Medical Journal’s magazine for students, said: ‘I’ve heard of people using saline drips to rehydrate themselves while they sleep off the drink - but as far as I’m concerned, it’s an urban myth.’

She also dismissed suggestions that, as doctors, she and her colleagues believe they are impervious to the problems faced by ‘ordinary’ people.

‘It’s got nothing to do with feeling superior,’ she said. ‘My view is that it’s down to the long hours that doctors have to put in - the sheer volume of work. They just use their free time to the max.

‘The types of people who become doctors are often extrovert and when they celebrate, they really go for it. We know what’s on the line if we fail - there’ s a lot of stress and that makes certain people drink more as a release.’

Yet many older doctors scoff at the ’stress’ argument, pointing out that doctors’ hours have never been shorter and the rewards greater.

But as alcohol claims 40,000 lives a year in the UK, doctors are falling prey to Britain’s binge- drinking culture.

But with so many doctors drinking themselves silly, while being charged with advising others against alcohol abuse, it seems that in alcohol-soaked Britain, it’s now very much a case of the blind leading the blind.

Written by Andrew Malone

Read more: http://www.dailymail.co.uk/news/article-1277955/Special-Investigation-Why-ARE-doctors-addicted-drink-drugs.html#ixzz1nEtqemSD

Others should follow Ontario’s OxyContin lead, experts say

Tuesday, February 21st, 2012

The Canadian Press

Posted: Feb 20, 2012 7:08 AM ET

Last Updated: Feb 20, 2012 12:30 PM ET

Ontario intends to remove OxyContin from its list of funded drugs.
Ontario intends to remove OxyContin from its list of funded drugs. (iStock)

Addiction experts are applauding Ontario’s new restrictions on OxyContin and the drug replacing it, but say the country needs a national strategy to tackle widespread abuse of prescription painkillers.

The province’s decision to remove OxyContin and its successor from the list of drugs it routinely funds is a “very positive thing overall,” said Dr. Irfan Dhalla of Toronto’s St. Michael’s Hospital.

His research found the addition of long-acting oxycodone — the form contained in OxyContin — to Ontario’s drug plan in 2000 coincided with a spike in opioid-related deaths.

Imposing tighter controls on prescriptions “is not going to solve the problem by itself, but it’s a major step forward,” he said.

The maker of OxyContin will stop manufacturing the drug in Canada at the end of the month and replace it with a new formulation called OxyNeo.

Ontario health officials said Friday the new drug will be funded through the province’s Exceptional Access Program, meaning prescriptions will fall under stricter regulations.

As other provinces weigh whether to include OxyNeo in their formulary, experts such as Dhalla are urging Ottawa to take the lead in combating what has become a national health crisis.

Benedikt Fischer, director of the Centre for Applied Research in Addictions and Mental Health at Simon Fraser University, said “concerted measures” could help prevent smuggling of the drug across provincial borders.

“Let’s say in Manitoba or in Quebec, the restrictions aren’t there, there’s a much higher supply and there’s a great black market demand in Ontario, it’s quite possible the stuff will come in from the neighbouring provinces,” he said.

“It’s one reason why approaches to those kinds of measures in Canada should really be harmonized across the board,” he said.

Manitoba and British Columbia are among a handful of provinces that have yet to decide whether to fund OxyNeo once OxyContin is discontinued.

Prince Edward Island and New Brunswick have chosen not to pay for the new drug, which is formulated to make abuse more difficult.

Unlike OxyContin the tablet is hard to crush and when added to liquid it forms a thick gel that stops oxycodone from being extracted for injection.

But that won’t help those who have developed addictions to the drug in pill form, Fischer said. “They can still simply swallow it,” he said.

It’s also possible addicts will turn to other painkillers or illicit drugs once OxyContin is off the market, he said.

“One thing that’s for sure is that those people who have dependence will not suddenly be cured of their dependence because of OxyContin disappearing,” he said.

“Those people who have dependence or are inclined to abuse will continue to do so, they will just have to adapt to the situation.”

From The Secret Daily Teachings

Monday, February 6th, 2012

Today, be grateful. Be grateful for your favorite music, for movies that make you feel good, for your phone that connects you with people, for your computer, and for the electricity that lights up your life. Be grateful for air travel that flies you everywhere. Be grateful for the roads and traffic lights that keep the traffic in order. Be grateful to those who built our bridges. Be grateful for your pet, for your child, for your loved ones, for your eyes that enable you to read this. Be grateful for your imagination. Be grateful that you can think. Be grateful that you can speak. Be grateful that you can laugh and smile. Be grateful that you can breathe. Be grateful that you are alive! Be grateful that you are You!

Be grateful that there are two words that can change your life.

Thank you! Thank you! Thank you!
May the joy be with you,

Rhonda Byrne

Practical tips to inspire you to invite compassion into your day-to-day living.

Wednesday, February 1st, 2012

Can you see yourself caring for others in a sincere, meaningful way? It’s not impossible or just for people with sensitive hearts.

You can be kinder, more relatable and helpful to anyone who comes along your path. Inspired by the book by Karen Armstrong, Twelve Steps to a Compassionate Life, here are six practical tips to inspire you to invite compassion into your day-to-day living.

Be kind to yourself
“You yourself, as much as anybody in the universe, deserve your love and affection.” The Buddha

A compassionate life radiates from the inside out, so the only way to truly show love to others is to first start with yourself. Stop being your worst critic and turn into your greatest cheerleader. Be patient with yourself instead of rushing to assume the worst of your abilities. Resolve to speak only good things about you instead of putting yourself down. The compassion you feel inwardly will overflow to everyone in your life.

Be a giver
One way to be more compassionate is to give. You can give money to your house of worship or to charity. You can also donate clothes to organizations that help the homeless. However, your offerings don’t have to be to a stranger. Look for opportunities to give amongst your friends and family. Perhaps your cousin has fallen on tough times or a friend just lost a spouse. You can be an angel for someone in need who’s close to home.

Find a cause
Many people don’t have a cause — an issue or a plight about which they feel strongly. Causes give life fire. Want to know what your cause is? Ask yourself this question: what upsets you most when you watch your local news? Where do you see injustice that really riles you up? What makes you want to stick up for the underdog? These are clues that will lead you to organizations that you can join and support.

Forgive both big and small offenses
To lead with compassion means to extend mercy to others. That can be difficult when you feel like you’ve been wronged. Whether it’s a major crime against you or something as small as the rudeness of a stranger, you can learn to be a forgiving person. Forgiveness shows love to people in your life whether you feel like they deserve it or not. It frees the offending person, but it also releases you from the burden of carrying resentment.

Take care of something or someone
Be an active participant in the care and nurturing of another living thing. It doesn’t matter if it’s a child, a spouse, a pet or a plant. When someone else’s ability for growth and maturity is dependent on you, it calls for something special to rise up inside of you. It expands your heart and builds up your capacity for kindness.

Expand your worldview
Having compassion comes from a place of empathy, which is the ability to feel someone else’s feelings. That can be difficult when most of us exist in our own tiny universe. So you have to push yourself beyond the knowledge and influence your own family and social circles. Read biographies about people you have nothing in common with. Watch documentaries made by and for ethnicities , genders and religions other than your own. You can go beyond tolerance to understanding when you make an effort to see life through someone else’s eyes.

Jennifer E. Jones is the Inspiration Editor at BeliefNet.

 

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