Medication-assisted treatment (MAT) is the use of medications in combination with counseling and behavioral therapies, which is effective in the treatment of opioid use disorders (OUD) and can help some people to sustain recovery.
More must be done to facilitate treatment options and the development of therapies to address OUD as a chronic disease with long-lasting effects. This means helping more people secure MAT, which requires us to break the stigma often associated with some of the medications used to treat OUD. It also requires us to find new and more effective ways to advance the use of medical therapy for the treatment of OUD.
There are three drugs approved by the FDA for the treatment of opioid dependence: buprenorphine, methadone, and naltrexone. All three of these treatments have been demonstrated to be safe and effective in combination with counseling and psychosocial support. Everyone who seeks treatment for an OUD should be offered access to all three options as this allows providers to work with patients to select the treatment best suited to an individual’s needs. Due to the chronic nature of OUD, the need for continuing MAT should be re‐evaluated periodically. There is no maximum recommended duration of maintenance treatment, and for some patients, treatment may continue indefinitely.
Bunavail (buprenorphine and naloxone) buccal film
Cassipa (buprenorphine and naloxone) sublingual film
Probuphine (buprenorphine) implant for subdermal administration
Sublocade (buprenorphine extended‐release) injection for subcutaneous use
Suboxone (buprenorphine and naloxone) sublingual film for sublingual or buccal use, or sublingual tablet.
Subutex (buprenorphine) sublingual tablet
Zubsolv (buprenorphine and naloxone) sublingual tablets
Dolophine (methadone hydrochloride) tablets
Methadose (methadone hydrochloride) oral concentrate
Vivitrol (naltrexone for extended-release injectable suspension) intramuscular
So much of our world is drug oriented. We understand overall, that without drugs, even chemicals, our world would be full of disease, food sources would be lessened, and conveniences would be limited. As this thesis is written, the touch is embracing plastic keys, rubberized mouse pads, vinyl coated wiring – my elbows pushing steadily on laminate. The rubber tips of my work tools include rubber ear tips on my stethoscope, rubberized tubing to the metal plated bell to listen to patients’ hearts with a plastic cover shield to clean off.
So what is the deal with the lead in the toys? The recent recall included over 405,000 lead contaminate toys from the Chinese manufacturers. Some of the toys recalled were “Duck Family,” Robot 2000, Big Red Wagons, Winnie-the-Pooh spinning products.
To my knowledge, no child has been severely poisoned with these toys, nor injured in a poisoning sense with these lead toys. The greatest majority of lead cases these days are from old paints…pre-1976…when lead was taken out of the USA marketplace of paints. So old paint chips that children eat or ate, especially in older home and apartment buildings renovations, was and are the source. But the biggest reduction in lead overall in the USA was the reduction of lead in gasoline. This essentially stopped the big problem. More discussion of lead poisoning was when under Clinton’s administration, the lead limits were reduced to an absolute low level despite little or no data to support the new change. But even with this new limit in children, few ever have had disease.
Nicotine in itself is a drug, a chemical that has been used obviously in smoking addiction, but in itself is not a bad thing. It has been used in industry in a variety of compounds. Nicotine, however, is the buzz in smoking. Just good old craziness allowed the U.S. to create multi-millionaire attorneys fighting for “our rights” and for those who “didn’t know” cigarettes were bad, yet the USA funds tobacco, the tribes sell tobaccos at reduced prices to entice smoking, and the CDC funds research to explore “the nicotine drug cure,” and it is all still legal. At a recent American Heart Association meeting, research on the new nicotine vaccine has made some promising head roads. One year and five shots later, the vaccine doubled the number of “stopped” addicted smokers from about 6% to 15% over the year. The problem still exists that less than 10%, some say lower, smokers of cigarettes ever stop that consistently try to stop. How many smokers? About 46-50 million in the U.S. and about half of them will try to stop sometime. The vaccine is a potentially great drug to help. The nicotine blocker med which castMD has written on before still helps to, but so far is not necessarily more effective than the patch or the gum. Stopping smoking takes good old will power.
And then there is the date-rape drugged toys. Most of this happened if not all was with the “Aqua Dots” toys. It seems that one of the chemicals in the surrounding coating changes or gets metabolized in the body when eaten. This is an extremely unique and interesting mass-market finding. It is really quite amazing that it was found. The GHB that was found is extremely difficult to measure generally. Many times in the ER, labs can not find it. It is metabolized quickly. Some of the previous day’s internet drug providers (illicit) sold chemicals that would convert to GHB. Some of these chemicals are still passed around and used at “rave parties” and other parties. GHB is a dangerous drug. It is illicit. It can kill you or make you unable to defend, protect, or interact. Thusly, called the date-rate drug. However, it was a prescription drug known as Rohypnol that was one of the original date rape drugs. It is also now illegal in the U.S., but probably can be found in the international markets illegally…not sure of legally however. Always open your own beverage and never leave one sitting around…especially in the club scene.
Did Bonds do it or not? Will the “asterisked” marked Hall of Fame baseball be delegated a fraud by another drug story? Not just another drug related story in recent and past news. Maybe all steroids should just be allowed in all athletics. Tell the athletes the risk, the wrestlers, the baseball players, and the Olympians. All these steroid abuse stories have hit the news just in the past months.
But the problem with that is…this story…
Doping in sports is a problem. But would you give or have someone else give your daughter or son steroids for performance enhancement? Watching little league and junior to senior sports makes me wonder. How far would a parent or caregiver go?
From the 1976 Olympians of East German come the latest stories of abuse, which is being called in a new documentary “The Great Olympic Drug Scandal: Revealed.” The sports “theme plan” developed relied on anabolic steroids. That year, 40 gold medals were placed over East Germany’s team members with a heavy emphasis on women’s swimming events winning all the golds in nearly all the events. Children were given oral tablets and injections, even on the day of competition in the Olympics, untraceable at that time. Coaches were rewarded by success, despite the unethical mark. Some athletes recruited prior to teenage were started on performance enhancement drugs. Doctors were required to sign confidentiality agreements despite the unethical mark.
Some of the athletes had sexual identity and self-worth problems while growing up. Many had obvious gynecological irregularities. In later life, sexual identity was explored and some even had sex changes. But many have been left out of the story lines…How has their lives been altered? How many have died unknown, changed forever by the decay of human value, gross ethical breaches of doctors, and limitless greed of self-flagellating coaches.
Systematic. Documented in abusive performance. Involuntary. Organized to destroy human life. Sidelined by death. Welcome to professional sports and Olympian sports.
Welcome to Beijing anyone?
Welcome to the Drugs’ Hall of Shame! It is NOT about performance…
Workplace drug tests recently have shown a decrease in cocaine positives during the first half of 2007. The positive tests for cocaine dropped 16% as the overall rate was 0.58 percent. This rate is the lowest since tracking the information back in 1997 by one lab. The lowest rate of decline was in the Midwest while the highest rate of decline was in the New England areas. The total tests counted for this tracking included about four and one-half million urine drug tests, which all included testing for cocaine and other drugs of abuse. Some believe the shortage of cocaine and higher costs are driving the decline, while European cocaine abuse is becoming increasingly popular, adding to world-wide demand. As a Medical Review Officer for Work-Place Drug Testing, cocaine remains popular.
In another report on drugs of abuse, marijuana recently was highlighted. It is apparent that reefing the great weed is about 5 times more harmful than one cigarette. The apparent problem is a greater intensity of airway obstruction. This effect may be caused by an increased “holding” of the smoke which is a longer time of interaction with the lung tissue. Another concept is that the smoke is literally hotter, creating a deeper thermal injury to the lung tissue itself. Interestingly, when compared to regular smokers, the marijuana smokers had less emphysema changes.
DAWN, or the Drug Abuse Warning Network, continues to focus on hydrocodone. This narcotic goes with the brand names of Norco, Lortab, Vicodin – but is generic in many prescriptions. Sales of hydrocodone and oxycodone have dramatically increased over the past years. The Pharma industry spends over 3 times as much on advertising as it did a decade ago.
www.castMD.com has written on this plague and the advertising push to addiction by the Pharma industry in past postings.
Despite the pressure to put these dangerous and addictive drugs on a higher schedule of restriction of prescribing, Schedule II, the FDA and DEA has been lobbied heavily to not do so.
With all the Pharma advertising, a push toward better pain management, and the abuse of narcotics, hydrocodone based drugs and combo drugs ranked number 2 in 2006 just behind the cholesterol lowering brand name, Lipitor. From 2001 to 2006, hydrocodone prescriptions rose by 2/3rds.
Hydrocodone is the number one drug in its category to arrive at the Emergency Department. It is also the number one drug of its category reported to the National Forensic Lab Info System.
www.castMD.com says, “Ban hydrocodone or elevate the Schedule.” It is a considerable concern of abuse in junior high kids, high school kids, and patients.” Should it be banned?
Diarrhea is certainly a “not so talked about” medical condition. But today, at least one kind of diarrhea is becoming quite a medical problem. It is the Clostridium Difficile colitis (colon infection and inflammation).
Physicians, nurses, clinics and hospitals as well as Public Health agencies are seeing a rise in the incidence of this C. Difficile associated diarrhea. This change in the demographics of this disease is toward a younger and healthier group of patients, and not the classic patients.
The typical patients for this “C. Diff.” diarrhea have been the elderly, those with recent antibiotic usage, and those on certain higher risk medications such as clindamycin, cephalosporins, and quinolones. Recent hospitalization and the use of gastric acid blockers, now advertised daily on television and print media are also higher risk factors.
The use of gastric acid blockers has been studied and continues to be. This arena of high use of these acid pH changing medicines in the gut may be contributing to the growth of the C. Diff. more quickly in the gut, than without the acid blocker.
The toxin in itself from the bacteria, can cause worsening symptoms such as toxic mega colon, severe sepsis, perforation of the gut, a need for colectomy (removal of the colon), and even death.
The diarrhea is many times unrelenting. It continues to be watery, sometimes mucous-like, and eventually bloody. But many patients wait to see if the diarrhea will clear. Dehydration and weight loss can be associated with such diarrhea also.
There are both blood tests for the disease and stool tests specific to the disease.
If you are on antibiotics, and develop diarrhea over 24 hours you must call your health care provider or doctor. The best treatment is to stop the antibiotic immediately with your doctor’s order if possible.
Many times two different OTHER antibiotics are used to treat the C. Diff. infection of the colon. One antibiotic for the C. Diff. is only about 80% effective now, while the backup drug is only about 90% effective. But now, resistance is starting to mount to these treatments, leaving patients in severe distress with life-threatening diarrhea and infection.
New studies are being done now using probiotics. Specifically Sacharomyces boulardii and other lactobacilli have been studied. Many are recommending the use of probiotics with the initiation of antibiotics and other antimicrobials.
There are many reasons patients get diarrhea. But you can eliminate some high risk yourself. So, do not use antibiotics without a reason. Do not borrow or loan antibiotics. Always talk with your doctor if you develop diarrhea while on antibiotics. When in doubt, call.
CastMD says, “You do NOT want to develop this toxic type of diarrhea.”
DRUGS IN WORKPLACE – ARE YOU TRYING TO SKIRT THE ISSUE?
A month or so ago the Feds released their workplace data regarding use of drugs while on duty in various jobs and employments. These are the newest data compared to previous studies in mid-nineties.
Industries that continue to have high rates of on the job drug use and use of drugs are those industries in general that continue to have high job turnover rates.
Illicit drug usage among the 18-64 year olds working full-time was the highest in food service and accommodation industry, construction work, entertainment and arts, information services, and management support companies.
The highest rate was 16.9 percent of the food and accommodation employees used illicit drugs in the last month, in the survey.
Construction workers and miners had the highest heavy use alcohol rates at 17.8 percent. Even CEO’s rate was at 8 percent for heavy alcohol usage.
Marijuana continues to lead the pack on illicit drug use for these surveys.
Over 12 percent of the illicit drug users had three or more employers in the past year! Current drug users had twice the rate of missing one or more days in the last month.
Increased rates of illicit drug use were seen in men and lesser paid jobs.
About half of the full-time workers report that their company does pre-placement drug testing. Protective services had the highest rate (76%) of this type of testing, while legal occupations had the lowest (14%) reported in the study.
Only one-third of the workers reported random drug testing policies by their employers.
ONLY one-third of the workers reported they would be less likely to work for companies with random testing programs in place.
An Idaho case in Boise is coming down the legal pipeline. This case is significant as the plaintiff is support by the Center of Individual Rights group.
According to my understanding these are the general issues.
The baby was presented to the ER for evaluation and treatment. The baby was ill. The baby was five-weeks old. The mother consented to evaluation on this sick infant. The mother agreed to labs and iv fluids.
The rub came when the baby required a spinal tap and iv antibiotics for evaluation and treatment, immediate or early, to limit the diagnostic possibilities and to provide early treatment for a potential devastating and possible deadly meningitis.
The mother evidently refused.
The Emergency Physician evidently requested protective custody for this infant to proceed. The hospital, the police, the courts agreed with the Emergency Physician and allowed the doctor to proceed.
Now about 5 years later, an entire community to protect this baby is being sued, as the baby and the mother’s rights were violated.
The defense of the doctor, hospital, and police state that the temporary custody allowed the proper diagnosis and treatment of this infant. Infants are tough diagnositc dilemmas naturally.
Courts have upheld even traditional medicine over holistic and alternative methods in cases of seriously or potentially seriously ill or injured children. Of course, that is with needed medical support clinically.
This case will be watched closely by all Emergency Physicians, Emergency Rooms, Law Enforcement Officers, and Courts. If plaintiffs win this case, a significant shockwave will start a sunami of “hands-off” litigation and will create a mountain of defensive medicine procedures, especially in documentation of refusal of treatment and the risks involved.
Who has the right to refuse treatment of an infant and who has the right to treat that infant? Should the law allow medical morbidity and mortality even in the face of “lay person” judgement?
(castMD commentary with EM News review contribution)
According to D.A.W.N. which stands for Drug Abuse Warning Network the top ten Emergency Department visits were surprising. Although this list is published openly, it does run about 1-2 years behind.
ECSTASY (mdma)……………..ALMOST 11,000
This data is from a reporting system in the United States. Many times, GHB for instance, is gone from detection upon arrival to an Emergency Room. Many inhalants cause death, therefore do not show up in the Emergency Room, but rather the Coroner’s venue. Many times the data is also regionally directed, for instance, in high methamphetamine areas, illicit use might be seen higher in the corresponding Emergency Departments.
To round out this medical commentary today, the United States still has these top ten killers.
This data is from the 2004 National Center for Health Statistics, the latest full database. Prevention is the key in almost all of these killers. With the severe childhood obesity concern in the United States, these data may get thrown in the air, with new issues on top. For instance, diabetes and asthma may replace the first and second positions due to the issues of childhood health management in general.
CHRONIC LOWER RESPIRATORY DISEASES…………5.1%
INFLUENZA AND PNEUMONIA……2.5%
As part of my background in pharmacy, emergency medicine, and toxicology, my eye is geared toward new illicit “marketing styles.” One of the latest, yet as usual, older than you think, is “cheese” heroin. This “starter pack” of heroin is REALLY heroin…the DEADLY kind of heroin…the good old toxic illicit heroin.
The difference is in the making of it. The manufacturers of the illicit drug geared for the teens is the mixture of heroin and Tylenol PM©. This multi-drug cocktail of acetaminophen, diphenhydramine (better know as brand name benadryl © and other companies brands) and of course heroin creates a deadly risk. Each item in this mix can be deadly.
As the famed Paracelsus, an earlier father of poisoning stated, “It is not the agent, but rather the dose of the agent. And everything therefore is a poison.”
Acetaminophen remains one of the most toxic poisons if taken in overdose and is the lead cause of death for many years in Europe, while diphenhydramine is again a unique poison in overdose. The anticholinergic side-effects of the drug in overdose creates elevated deathly temperature rise, hallucinations, cardiac instability, agitation, and even death. Heroin for years now continues to plague not only the U.S., but nations around the world. It has enormous addictive potential and leads to severe toxicity, criminality, and occasional deaths on the streets.
Say “Cheese” is a deadly form of a multi-drug extravaganza geared to entice, to addict, and to control your kids. Already in the last 1-2 years, especially in the Texas market, over 20 deaths have occurred. The product appears like Parmesan cheese in structure, yet kills with a vengeance.
Say “Cheese” is usually snorted. Why do drug abusers snort? It is because the absorption rate is good. But I have seen those individuals with chronic cocaine abuse, literally rot the nasal septum out…”look Mom, no septum!”
Post-mortem toxicology tests will reveal the deadly three drugs in this mixture…heroin, diphenhydramine, and acetaminophen.
“Cheese” is not a starter-kit for drug use. “Cheese” is a start-kit for deadly teenager activity.
SAY “CHEESE” MAY BE THE LAST PICTURE TAKEN……..
HUG YOUR KIDS TODAY!