How Opioids And Heroin Affect The Brain

www.drphil.com/videos/how-opioids-and-heroin-affect-the-brain/

It is estimated that 2 million Americans 12 or older are addicted to prescription pain relievers. According to the CDC, deaths from prescription pain killers have more than quadrupled since 1999, with 91 Americans dying every day from an opioid overdose.

“People sometimes think that an addiction is psychological. But we’re not talking about a psychological addiction here. We’re talking about an addiction that affects a number of structures [in the brain],” Dr. Phil says.

He is joined by Dr. Charles Sophy, who is board certified in adult, child and adolescent psychiatry, and family practice, and is the medical director for DCFS in Los Angeles, to explain how using opioids and heroin affect the brain.

“Any drug that you’re putting in your body is changing the chemistry of your brain, which will affect parts of your brain,” Dr. Sophy says. “Frontal lobe is the part that does executive functioning, judgment, insight, impulse control.”

 Dr. Phil adds that opioids and heroin change the efficiency with which a person performs cognitive functions, and affect the cerebellum which involves coordination. “Once these brain structures are changed, they’re recoded,” he says.

Dr. Sophy concurs. “They don’t go back to the way they ever were,” he says.

In the video above, the doctors explain to Carrie, a guest who admits that she is addicted to Oxycodone and has abused heroin in the past, what other areas are affected by this drug use. And, two other doctors weigh in with the correct way to take opioids to prevent getting addicted.

It would appear that Dr. Phil is once again confusing ADDICTION and PHYSICAL DEPENDENCY… but it sounds to me like he has also explained how UNTREATED ACUTE PAIN… can “reprogram the brain” and becomes CHRONIC PAIN and Dr Sophy agrees with him ?

Scope of practice of a GP/FP

A couple of days ago I posted this blog 

#Walgreens: pharmacist told me he can no longer fill it (opiate) because I do not have cancer

“Hello Steve do you know who I contact to complain about filling my prescription? For the last 2 years I have been filling my prescription at Walgreens and the pharmacist told me he can no longer fill it because I do not have cancer. I am 60 yrs old have had 2 back operations my prescription is oxycodone 30 mg two times a day it’s crazy what he told me. Thanks”

On comment by a person whose ID’d  suggested that they have a PharmD degree … got me thinking… of the “excuses” Pharmacists are using to support their “medical decisions”

“Wow. As a pharmacist, I can assure you there is A LOT MORE to that story. It’s far more likely that the MD who wrote the RX is under DEA investigation or the MD is practicing outside of the scope of his/her practice (family practice MD who’s trying to function as a pain specialist, etc). And you are correct – there’s nothing you can do to force the Pharmacist to fill a script. Just the same way that a MD cannot be forced to write you a prescription, a pharmacist cannot be forced (or coerced) into filling a script.”

‘the MD who wrote the RX is under DEA investigationlast thing that I knew about our legal system is that any us citizen is “innocent until proven guilty” I know one physician that has been “under investigation” for abt FOUR YEARS… this physician still has a license in good standing and still has a DEA license in good standing.  But this physician to is having trouble with some local pharmacists refusing to fill the controls this prescriber writes… to the best of my knowledge .. these same pharmacists do not have a problem with filling this prescriber’s prescriptions that are written for NON-CONTROLLED medications.

“MD is practicing outside of the scope of his/her practice (family practice MD who’s trying to function as a pain specialist, etc)….

I wonder if these same Pharmacist challenge a GP/FP’s prescribing within their scope of practice for treating any pt with any number of health issues where there is a specialist that deals with a specific disease state… some particular examples.

If a pt is diagnosed with diabetes, should the pt then be referred out to a endocrinologist ?

If a pt is diagnosed with asthma or emphysema should be referred to a Pulmonologist ?

This list can go on and on ad nauseam

Some years ago I got a call from a Dentist who specialized in treating TMZ, myofascial trigger point pain and the like, he was also an associate professor at a large west coast dental school, but his prescriptions for non-controlled medications for the appropriate treatment of the disease issues that he was treating was being challenged by some local pharmacist for him prescribing “outside his scope of practice”… when in reality these Pharmacists only saw the initials behind his name indicating that he had a DENTAL DEGREE and JUMPED TO THE CONCLUSION… based on that slim amount of information that he was “outside his scope of practice”

And I agree with this poster that THERE IS A LOT MORE TO THIS STORY…  if what this pt said in the email to me is true.. that the pt had filled the same prescription at the same Walgreens for TWO YEARS from the same doctor… and this Pharmacist ignored this fact that what he was dealing with was a opiate dependent pt…  The dose was within the CDC’s guidelines as upper limit of MME’s  Pharmacists will require pts to wait until there is only 2 to 0 days of medication left from the previous prescription… so this pt being denied his routine opiate (Oxycodone) prescription could end up in a full blown COLD TURKEY WITHDRAWAL within a few hours not to mention UNTREATED ELEVATED CHRONIC PAIN.

All healthcare professionals have a “scope of practice” … who is in charge of making sure that Pharmacists do not exceed their scope of practice?

 

 

When Cops Play Doctor: How the drug war punishes pain patients

The steady stream of celebrity stories about prescription drug abuse makes Americans keenly aware of the dangers of overdosing on medications like OxyContin and Vicodin. And from President Obama’s Drug Czar to California Attorney General Jerry Brown, politicians are calling for greater power to monitor doctor-patient relationships in order to fight the “epidemic” of prescription drug overdosing. But maybe the real epidemic is underdosing. Countless Americans suffer with severe chronic pain because doctors are afraid to treat them properly. Michael Jackson’s death unleashed a flurry of media stories about all aspects of the pop star’s life, including his alleged prescription drug abuse. On the same day countless millions watched Jackson’s star-studded memorial service, reason.tv interviewed another musician. Seán Clarke-Redmond, a man who enjoyed an active live before the neurodegenerative disease ALS, often referred to as Lou Gerig’s disease, rendered him nearly immobile—he can no longer even play the piano. The disease also left him in almost constant pain. Redmond is prescribed some medication, but not nearly enough to keep his pain under control. Dr. Frank Fisher says Redmond’s case is an appallingly common one. “Chronic pain in America is an enormously under treated disease,” says Fisher, a Harvard-trained physician. “It’s a public health disaster.” Pain specialists like Fisher and patients’ groups like the Pain Relief Network battle law enforcement officials who are forever on the lookout for “pill mills” and patients who misuse pain medicine. Fisher notes that the same medications so often associated with celebrity addiction are the same medications that combat pain most effectively. Fisher has treated his patients with high doses of opioids-that is, until a swat team raided his clinic and threw him behind bars. “They were trying to give me 256 years to life,” says Fisher who argues that fear of prosecution often prevents doctors from treating chronic pain patients effectively. What allows doctors’ medical decisions to be overruled by police? “What we’re dealing with is a mass insanity,” says Fisher. “We call it the war on drugs.” “When Cops Play Doctor” is written and produced by Ted Balaker and hosted by Nick Gillespie. Director of Photography is Alex Manning, Associate Producers are Hawk Jensen and Paul Detrick.

Medications & Malpractice: Holding doctors accountable can prove difficult for patients, families

https://www.heraldandnews.com/news/medications-malpractice-holding-doctors-accountable-can-prove-difficult-for-patients/article_4b4841af-552f-56c7-8c26-b74431036aa4.html

John Lester memorialLori Lester never dreamed that her husband of 15 years — and someone she had known for 40 — would take his own life.

“He was a very happy man, everyone said that about him,” the Klamath Falls realtor told the Herald and News this past week. “If you were down, he would lift you up, no matter how bad a day he had. He was always upbeat.”

Yet, at age 59, John Lester shot himself in their ranch-style home off Old Midland Road on Jan. 8, 2014.

 

John’s close friend, Bub Haigh, and Lori had made plans the night before to take John to Bend to seek medical attention. On the morning of the 8th, Haigh was en route and Lori was rushing out of the house to feed the horses so she could travel with Bub and John to Bend.

 

“After I fed the horses, we were just about to leave when I found him in the bedroom,” she said.

Up until Christmas 2013, everything seemed to be going in the right direction for the Lester family. They were finally getting clear of debt incurred while operating long-haul trucks and a gravel-hauling business, Lester’s Dump Trucks. Lori, now 59, had purchased a Klamath Falls real estate business (Apodaca-Pierce and Associates) and the family was busy planning outings for the coming year.

“He told me that 2014 was going to be more for me [her year],” Lori said. “We had finally made it over the hump, we owned our equipment outright. John was planning on remodeling our home that year, which had been built in the 1950s. He had bought new appliances and had worked on replacing the countertops. He was just so upbeat.”

Anxiety attacks

It was about five years ago that the anxiety surfaced.

John had been taking medications for “travel anxiety” that could be traced to an incident early in his career.

“He was unloading a truck in Bakersfield, Calif., when the engine in the back of the truck exploded. He received serious burns on his arms, back and face and was hospitalized for three months,” Lori said.

“At one point we were going to Bend to see the children when he said we needed to turn around. I had never seen him like that. We had to head home. It was tough to plan a trip anywhere. That’s when we sought medical attention,” she said.

By the end of December 2013, however, John Lester was on a downward spiral. For five years, 2009-2013, he received insomnia and anti-anxiety prescriptions from a Klamath Falls clinic.

In December of 2013, doctors at the clinic cut off his prescriptions, warning they were highly addictive.

 

John ran out of his prescriptions for sleep and anxiety just before Christmas. He returned to the clinic with worsening symptoms, more than once, asking for refills for the medications he had been given since 2009.

“He was so surprised they had cut him off, rather than lowering the dosage or finding something else he could use. I didn’t know what to do. He wouldn’t let me call 911 to get him help.”

It was four years ago Monday.

The clinic where he was refused more medications was Basin Immediate Care, owned by TLP Inc. and operated by physicians Thomas Koch, Laura Moore, Kathie Lang and J. Eric Brunswick. They were the subject of a medical malpractice lawsuit brought by Lori Lester in October 2015.

In March 2016, the case was dismissed from trial with “no awards to either party,” the court order obtained by the H&N read. However, H&N would later learn the case went to confidential negotiations for settlement instead of trial. (For details of the suit, see the sidebar online).

The clinic’s doctors were contacted through their office manager to comment on this story, but they declined. The physicians and Lori Lester cannot talk about the settlement as they are all bound by a non-disclosure agreement.

“I would not wish this on anyone. I came home to a dark house every day after John was gone, there wasn’t even a noise.” Lori reminisced, “We had made plans for the rest of our lives.”

 

Do Patients Pay Less for Cheap Care? Why the CVS/Aetna Deal Matters

https://www.doximity.com/doc_news/v2/entries/10680265

On a recent trip to urgent care for my child, I began to more clearly see how the changes in medicine are affecting our patients and who is benefiting from the bottom line of what is occurring in the US healthcare system.

A minor injury to my 2-year-old son had me waiting patiently to be seen at a local urgent care center. Eventually, a nurse practitioner evaluated, correctly diagnosed, and successfully treated my son. (I make it a habit not to treat my own children, as I feel it more appropriate to be “mom” instead of “Dr. Jones” to my children in these types of situations). I appreciate nurse practitioners and feel they provide a great service and are filling in gaps in areas of need, especially in this time of physician shortage.

My concern arose as I considered how this medical care visit was truly playing out financially. I paid a copay with my insurance; no big deal; it was $30. My insurance would be covering the majority of the visit. However, ultimately the company running the urgent care facility would be charging the same rate to my insurance and same copay to me for my son’s care regardless of whether I saw a physician or a nurse practitioner. I went as far as calling a billing specialist in membership services at my insurance company to ask if this was the case. She confirmed that there is indeed not a separate charge for urgent care visits depending on the level of provider seen.

My question to anyone who has seen a nurse practitioner or other qualified individual is, “Is your co-pay lower for the service? Do you receive a discount for not seeing the higher paid/more trained physician?” In my situation, there was no reduction of copay. So, if they are collecting the same amount for the service provided despite a disparity in income level of the provider, who benefits from this profit?

The company running the urgent care center reaps all of the benefits of employing a healthcare provider with a lower salary than that of a physician. Their smaller salary likely means more profit for the company.

Again, I am in no way against using mid-level providers, nurse practitioners, midwives, etc. They are here to stay and play an important role in healthcare moving forward. However, my argument is that if a company is benefiting financially from hiring “cheaper” people to provide care to their patients, they should at least be passing the savings on to the patients who are receiving the care. Often, these companies are looking for the financial bottom line and what they can get away with to reap the most profit. It is a primary responsibility of top administrators to make money for the company, and we can hardly blame them for successfully completing the role they were hired to fulfill.

Transparency is required in these situations. The patient must know they are not seeing a physician — when they could be — for the same cost to themselves and their insurance company. They should have the ability to demand physician care if desired.

A prime example how this business scenario is becoming the future of medicine can be seen in the recent proposed merger of CVS and Aetna. The companies involved are in a massive media campaign to make patients think this is to their benefit. Please remember, these are businesses at the end of the day, and their ultimate goal is to increase financial return to investors. The basic facts are still at play: a drug store is buying an insurance company.

On Wall Street, the widely held belief behind this merger is that by teaming up, CVS and Aetna can have a fighting chance against the behemoth that is “Amazon”, as this online giant attempts to get into prescription drug sales.

Often, the patient is the one to suffer in situations such as this merger, as they will actually pay more and receive less choice. It’s a monopoly, and if your insurance is owned by a drug store company, guess which prescription you will likely receive? The one on formulary at CVS of course! So, if the prescription chosen to treat your condition is on formulary at CVS, there most certainly is less overall cost in the healthcare transaction. So, does the patient pay less since their prescription costs less or a lower copay for seeing a mid-level provider in a “clinic” in CVS stores?

You guessed it, the company will profit each time a prescription is written for a drug under their formulary instead of one that isn’t. The company will also profit each time a mid-level provider sees a patient instead of a physician. Again, is this in the best interest of the patient?

One last piece of information to consider, the Aetna CEO will walk away with $500 million in cash and stock if this deal goes through. This executive, who is not a physician, has much to gain from this merger. I don’t begrudge anyone good fortune, but I also don’t believe the media should portray that the patients are the primary ones to benefit in a deal such as this.

Patients and physicians are no longer accepting the status quo and what everyone outside of healthcare is telling us is “in our best interest”. We see and understand what is going on. We are speaking up and demanding better.

Dr. Valerie A. Jones is a board certified OB/GYN and ACOG Fellow. She is currently a Doximity Fellow and physician/patient advocate. She can be reached on her website: ObDoctorMom.com.

careful who you are friendly with

#Walgreens: pharmacist told me he can no longer fill it (opiate) because I do not have cancer

Hello Steve do you know who I contact to complain about filling my prescription? For the last 2 years I have been filling my prescription at Walgreens and the pharmacist told me he can no longer fill it because I do not have cancer. I am 60 yrs old have had 2 back operations my prescription is oxycodone 30 mg two times a day it’s crazy what he told me. Thanks

 

I can tell you who to complain to …but… NO ONE CARES… and WILL NOT DO A THING…

Let’s start with Walgreen’s corporate… their Rx sales are up 7%+ and they just picked up 2000 former Rite Aid stores.. they are good for the next year or two with the stock market looking for them to increase sales/profits…  We have a serious – and growing – pharmacist surplus… and if they were unhappy about their pharmacists running customers off – especially those having controlled Rxs filled – they would replace those pharmacists… but.. they are not… you  can call them and they will tell you that they can’t force a pharmacist to fill a prescription – and they are right… but don’t have to keep those who do employed…

 

You can file a complaint with the pharmacy board… but most of those boards are stacked with non-practicing corporate pharmacists and they are not about to do anything against those who sign their paycheck.. and they will also tell you that they can’t make a pharmacist to fill a prescription.. although they could investigate a pharmacist for denial of care for failing to fill a legit/on time/medically necessary Rx and fine, suspend and/or charge them with unprofessional conduct … but… they won’t

 

You can file a complaint with your insurance company because Walgreen is listed as one of their preferred pharmacies network… and they will tell you that they can’t make a pharmacist fill a Rx… and they could threaten to toss Walgreens out of their network … but… they won’t… because they continue to get monthly premiums to provide you with necessary medical services and if they don’t have to pay for your Oxy… they end up making more money… and after all … they are a FOR PROFIT business …

 

Walgreens is discriminating against someone who is disabled and it is a civil right violation under the Americans with Disability Act and you can file a complaint at the federal level but it is under the Dept of Justice … just like the DEA… so hell will probably freeze over before one federal agency takes on another federal agency violating laws… especially since they are under the same Cabinet position.

 

IMO.. your only option is to find a independent pharmacy where you will be dealing with the Pharmacist owner and unlike the Walgreen’s – or any other chain pharmacist – doesn’t get paid by running customer off…

Here is a website to help you find one by zipcode   http://www.ncpanet.org/home/find-your-local-pharmacy

Transfer all your prescription to one.. .Walgreens doesn’t deserve your patronage and you should not have to beg someone to let you give them your money.

Torture American Style ?

If this had been a video of one of the terrorist in GITMO – who has tried to kill us… this would be all over the national news… but… since it is being done “quietly” in a hospital…  normally few would be aware of it…

Is AMY a “prisoner” of the war on drugs ?

Isn’t prisoners of war entitled to certain rights ?

#OurPain: The other side of opioids

http://www.lasvegasnow.com/news/ourpain-the-other-side-of-opioids/852432872

LAS VEGAS – Millions of Americans who rely on opioid medications for pain relief are in anguish because of government pressure to reduce prescriptions across the board.

Doctors, pharmacists, and other providers have already made drastic cuts in the amount of pain medicine they dispense, with more cuts on the way. The actions are being taken in response to media reports about an opioid epidemic.

I-Team reporter George Knapp begins a week-long investigative project examining “The other side of opioids.” 

Imagine diabetics being told they can no longer be prescribed insulin? Or cancer patients being told that chemotherapy is no longer an option? We Americans like to say we don’t want anything coming between a doctor and a patient. But for tens of millions of chronic pain patients, there’s an entire gaggle of middlemen who decide whether a patient gets medicine that a doctor has prescribed.

When Las Vegas mental health counselor Chad Broderick shot up a pain clinic before taking his own life in June, some media reports explained it as the actions of a drug addict. Those who knew Broderick say it wasn’t addiction that drove him over the edge, it was pain.

An estimated 100 million Americans — one in three — have experienced chronic pain, that is, pain lasting longer than three months. Of those, as many as 30 million are now considered to be collateral damage because of the war against opioids.

“I’ve been through it all,” said Barby Ingle, pain patient advocate. “Over treatment, under treatment, mistreatment, no treatment.”

Barby Ingle was a cheerleading coach at a major university, ran her own business, was happily married. Pain took it all away.

“Every single aspect of your life. Physically, emotionally, spiritually, financially, it wiped me out.”

Serious injuries put her in a wheelchair for seven years, which caused other painful diseases, including something called RSD.

“It feels like someone put lighter fluid on me, caught me on fire, and it’s real difficult to put out,” Ingle said.

Forty-three doctors later, she was treated with a powerful painkiller and got her life back. She now advocates for other pain patients who have, in effect, become opioid refugees.

“There is 100 million Americans and here in Nevada, approximately 980,000 chronic pain patients that need help. Opiates should not be taken off the table because there is media hype and hysteria,” she said.

Opiates have been used by humans to control pain for thousands of years. Synthetic versions, opioids, are not appropriate for all pain patients but are a godsend for millions. That word, opioid, is now a staple of nightly newscasts, and the reports typically show pictures of prescription bottles and pain pills, implying that prescription drugs are responsible for an ever-changing number of deaths, 16,000 per year, 30,000, 100,000, the parameters and definitions have proven very flexible.

“I did a 24-hour study using Google News in May of last year, using one word — opioid. I got 75 stories. Every story had some combination of epidemic, abuse, death,” said Dr. Michael Schatman.

He is an internationally known pain expert who has spent much of his life getting patients off of opioids. He says the numbers used to generate anti-opioid hysteria are both exaggerated and distorted. In a paper he co-authored, he writes that the generally accepted base number, 16,000 opioid deaths per year, is largely the result of illicit street drugs, not prescriptions.

“I got some recent data from New Hampshire, that showed over a period of time, 80 percent of the opioid deaths was due to synthetic, non-pharmaceutical Fentanyl, China white, which is mixed with heroin. Because it is an analog of Fentanyl which is a prescription drug, it goes down as a prescription opioid death,” Dr. Schatman said.

The states often cited as the deadliest for opioid OD’s have seen huge increases in illicit Fentanyl. Nationally, Fentanyl deaths jumped 540 percent in a 3-year period. In western states, the illicit opiate of choice is still heroin, which is cheap, plentiful and far more powerful than in years past.

“Illicit Fentanyl and heroin are the drivers of overdose today. Those are illicit opioids,” said Dr. Stephen Ziegler, Indiana University, Purdue University.

He is a social scientist, not a medical doctor. Ziegler has no dog in the opioid fight but bemoans what he calls patient abandonment, that is legitimate pain patients who are cut off from treatment because of deaths from street drugs.

“We’re focusing on prescribers for problem that is significantly being driven by an illegal market,” he said. “It’s almost like we’re arresting the wrong person, and when you do that, it’s means the real suspects are still out there on the loose.”

In Nevada, an opioid task force was created in response to numbers showing Nevada the top five for opioid prescriptions per capita. But Nevada isn’t close to the top five for opioid deaths. In fact, opioid overdoses in Nevada have declined every year since 2011.

The only category with an increase is deaths from heroin. A closer look at the list of opioid deaths as reported by the county coroner show that nearly all of the deaths involve multiple substances including heroin, methadone, methamphetamine, cocaine and alcohol and many of the dead had serious underlying medical conditions. If there is any trace of an opioid in their systems, they are counted as opioid OD’s.

“The study came out just this year, looking at the toxicology of people who died of supposed prescription opioid deaths. The average number of substances found in the system, including alcohol, amphetamines, cocaine, tranquilizers, was six. We’re not talking about 16,000 opioid deaths. We’re talking more like 1,600,” Schatman said.

Millions of legitimate pain patients are now living in fear and anguish because they know that even if their doctors think medication will help them, the simply aren’t going to get it.

Many have lost hope, and like Chad Broderick, have taken their own lives.

#OurPain additional resources where you can learn more about opioids.

 

As seen on the web…. PAIN SPECIALIST … afraid of his/her own shadow

No automatic alt text available.

Suggest that you read this http://nationalpainreport.com/when-equal-isnt-really-equal-8833382.html

Those opiate conversion tables are FUZZY MATH at best.. There is no real way to determine the toxic level on pts with opiates… this 50 MME MAY BE a toxic level on SOME OPIATE NAIVE PT…but there is no reliable way to determine the toxic level on a pt that has been taking opiates for months/years…. but it is CERTAIN that their toxic level will be MULTIPLE TIMES that of a opiate naive pt.

In this particular situation/pt… it is appear that he/she has been on more than 50 MME for some time.. and it WAS NOT TOXIC for this pt… but this SPECIALIST… apparently doesn’t have the self-confidence to rely on his/her own clinical experience in his/her pts taking opiates SAFELY..

I wonder if this “pain specialist” has any problem in giving pts Epidural Spinal Injections (ESI) using Methyprednisolone and other substances which the FDA and the manufacturer DISCOURAGES the use in ESI as being UNSAFE ?