Category Archives: Medication

Medication And Addiction

Drug treatment providers in California and elsewhere have relied for decades on abstinence and therapy to treat addicts. In recent years, they’ve turned to medication.

Faced with a worsening opiate epidemic and rising numbers of overdose deaths, policymakers are ramping up medication-assisted treatment.

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President Barack Obama at the end of April 2016 said he’d allocate more money for states to expand access to the medications. He also proposed that physicians be able to prescribe one of the most effective anti-addiction drugs, buprenorphine, to more patients.

California already plans to expand access to medications as it launches an overhaul of the state’s substance abuse treatment system for low-income residents. The state recently embarked on a five-year demonstration project on the premise that addiction is a chronic disease and should be treated as such.

While medication is not for everyone, it can be critical for some people with severe addiction, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services. The medications, she said, “have been proven as the gold standard for really helping people recover.”

The best-known medication, methadone, blocks the effect of certain drugs and lessens withdrawal symptoms. It is highly regulated and can only be prescribed by clinics that have government approval. Buprenorphine, which can be prescribed in doctors’ offices, produces mild opioid effects while also easing withdrawal symptoms. Another medication available by prescription, naltrexone, blocks the effect of opioids.

The medications are available across the country but must be prescribed by physicians with special training. There are only about 30,000 authorized doctors nationwide, and they can only prescribe to a limited number of patients.

Obama’s proposal would allow qualified doctors to prescribe buprenorphine to 200 patients, up from 100.

That could make a big difference in California, Perez said. The state is also trying to better link treatment centers with trained prescribing doctors so that physicians can consult with one another on treatment options for their patients. “Not all physicians, even in the substance use field, have that clinical knowledge,” she said.

The use of medication in treatment conflicts with the 12-step and Narcotics Anonymous philosophy of addiction recovery, which is based on abstinence, experts said. For many, experts said, simple abstinence doesn’t work.

“You would hope that just by talking to somebody, they could get rid of their problem with drugs,” said James Sorensen, a University of California, San Francisco professor and interim director of the substance abuse and addiction medicine program at Zuckerberg San Francisco General Hospital. “The reality is, that is simply not efficient, so we look for other tools.”

Medication is one of the most successful, evidence-based treatments available, and more access should have a big impact on those with substance abuse disorders, said John Connolly, deputy director for substance abuse prevention and control for the Los Angeles County Department of Public Health. But, he cautioned medication should be used alongside more traditional treatment methods.

“The medication has tremendous effect, but it is most impactful when it is prescribed with the necessary counseling and social supports,” he said.

Stephen Kaplan, director of behavioral health and recovery services for San Mateo County, said the county has increased its use of medication. About two years ago, the county began a pilot project to prescribe naltrexone to people with severe alcoholism who hadn’t been successful in traditional treatment.

The medication reduced people’s cravings and drinking, Kaplan said. The county recently began expanding the project to include people with opiate addictions.

Kaplan said he respects providers who believe that replacing one drug with another is not true recovery. But from a policy standpoint, Kaplan said, the medications are effective and should be more integrated into overall recovery for people with substance abuse disorders.

“We need to make available to them every possible option,” he said.

Perez of the state Department of Health Care Services said she believes that Obama’s focus on the opiate epidemic — and his recognition that it is a disease and not a moral failing — helps reduce the stigma.

“That makes a huge difference in folks coming forward and looking for treatment,” she said

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Ten Myths About Psychotropic Drugs

Dr. Peter Gotzsche has created a controversy and sparked criticism over what he sees as a damaging over-prescription of drugs by psychiatrists.

Gotzsche recently compiled a list of ten common myths held not only by the general public, but also trained psychiatrists concerning the safety of psychotropic drugs, and the rationale for their use.1pillst

As an internist, Gotzsche remarked that since he was outside of the political orthodoxy of the world of psychiatric medicine, he was free to express what he believed to be the sentiments of many psychiatrists who must remain quiet in their objections for fear of hurting their careers.

1.  Mental diseases are caused by a chemical imbalance in the brain

“We have no idea about which interplay of psychosocial conditions, biochemical processes, receptors and neural pathways that lead to mental disorders and the theories that patients with depression lack serotonin and that patients with schizophrenia have too much dopamine have long been refuted.”

2.  It’s easy to go off antidepressants any time you want to

Here, Gotzsche points to drug trails involving agoraphobics and people suffering from panic disorder, whom were not depressed.  Fifty percent of the patients found it difficult to come off antidepressants even though they were gradually reducing their doses.  It could not be that the patients saw their depression returning, as they were not depressed to begin with.

3.  Psychotropic drugs are to mental illness as insulin is to diabetes

“When you give insulin to a patient with diabetes, you give something the patient lacks, namely insulin. Since we’ve never been able to demonstrate that a patient with a mental disorder lacks something that people who are not sick don’t lack, it is wrong to use this analogy.”

4.  Psychotropic drugs reduce the number of chronically ill patients

“In 1987, just before the newer antidepressants (SSRIs or happy pills) came on the market, very few children in the United States were mentally disabled. Twenty years later it was over 500,000, which represents a 35-fold increase. The number of disabled mentally ill has exploded in all Western countries.”

5.  SSRIs don’t cause suicide in children and adolescents

“The companies and the psychiatrists have consistently blamed the disease when patients commit suicide. It is true that depression increases the risk of suicide, but happy pills increase it even more, at least up to about age 40, according to a meta-analysis of 100,000 patients in randomized trials performed by the US Food and Drug Administration.”

6.  SSRIs don’t have side effects

“Patients care less about the consequences of their actions, lose empathy towards others, and can become very aggressive. In school shootings in the United States and elsewhere a striking number of people have been on antidepressants.”

7.  SSRIs are not addictive

“The worst argument I have heard about the pills not causing dependency is that patients do not require higher doses. Shall we then also believe that cigarettes are not addictive? The vast majority of smokers consume the same number of cigarettes for years.”

8.  The prevalence in depression has increased a lot in recent history

Gotzsche points out that this is difficult if not impossible to determine, as the criteria for being diagnosed as clinically depressed has been drastically lowered over the last 50 years.

9.  The main problem is not overtreatment, but undertreatment

“In a 2007 survey, 51% of the 108 psychiatrists said that they used too much medicine and only 4 % said they used too little. In 2001-2003, 20% of the US population aged 18-54 years received treatment for emotional problems.”

10.  Antipsychotics prevent brain damage

“Some professors say that schizophrenia causes brain damage and that it is therefore important to use antipsychotics. However, antipsychotics lead to shrinkage of the brain, and this effect is directly related to the dose and duration of the treatment.”

Read the rest of the article here:http://www.designntrend.com/articles/10379/20140123/danish-doctor-offers-ten-myths-psychotropic-drugs.htm