mortiz095

Here's my response to a column by Maia Szalavitz on the recent recommendation by an FDA panel to change hydrocodone (Vicodin, Norco and others) from Schedule III (where prescriptions can be phoned or faxed in) to Schedule II (where prescriptions have to be printed.) You can access her column here . I think the idea is to reduce the number of opioid pain medications circulating in the community. Opioids are now the most prescribed medications in the US. Between 1998 and 2008 the number of prescriptions for hydrocodone (the opioid in Vicodin, Norco and others) increased 53%, from about 80 million to 120 million, whereas the increase in other opioids was 20-34%. Hydrocodone accounts for more emergency department visits than any other opioid as well. As someone who treats chronic pain as well as addiction, I don't like the restrictions on schedule II drugs, and I worry about undertreatment of chronic pain. But deaths from overdosing on opioid painkillers has more than tripled sinc...

Epidemiology of pain among outpatients in methadone maintenance treatment programs Lara Dhingra, Carmen Masson, David C. Perlman, Randy M. Seewald, Judith Katz, Courtney McKnight, Peter Homel, Emily Wald, Ashly E. Jordan, Christopher Young, and Russell K. Portenoy Drug and Alcohol Dependence, 2013-02-01, Volume 128, Issue 1-2, Pages 161-165 Copyright © 2012 Elsevier Ireland LtdAbstract Background This analysis explored the prevalence and correlates of pain in patients enrolled in methadone maintenance treatment (MMT). Methods Patients in two MMT programs starting a hepatitis care coordination randomized controlled trial completed the Brief Pain Inventory Short-Form and other questionnaires. Associations between clinically significant pain (average daily pain ≥ 5 or mean pain interference ≥ 5 during the past week) and sociodemographic data, medical status, depressive symptoms, and health-related quality of life, and current substance use were evaluated in multivariate analyses. Results ...

Hot off the presses (or screen), a new review by the European ADHD Guidelines Group found that non-medication treatments for ADHD are not supported by current evidence. Here's the abstract from The American Journal of Psychiatry . Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments Edmund J.S. Sonuga-Barke, Ph.D., Daniel Brandeis, Ph.D., Samuele Cortese, M.D., Ph.D., et al. European ADHD Guidelines Group Objective: Nonpharmacological treatments are available for attention deficit hyperactivity disorder (ADHD), although their efficacy remains uncertain. The authors undertook meta-analyses of the efficacy of dietary (restricted elimination diets, artificial food color exclusions, and free fatty acid supplementation) and psychological (cognitive training, neurofeedback, and behavioral interventions) ADHD treatments. Method: Using a common systematic search and a rigorous coding and data ...

Yesterday, I posted about the changes in diagnosis of substance use disorders (SUDs) in DSM5 by addressing a key point about whether addiction is a disease, and what that actually means. This is second post that derives from a conversation that Maia Szalavitz and I have been having on this topic. You can read her post on this topic here. 2. What about DSM5 and the changes from DMS4? This is mostly a technical question relating to cut points. How many substance-related symptoms or criteria does one have to have before calling it a disease, meaning a focus of treatment interventions? As it turns out, there is no clear cut-point. Essentially, the more symptoms one has, the more likely they are to be associated with distress and dysfunction. Earlier in the course of the disorder (and most cases don't progress beyond mild to moderate disorder), most symptoms are "internal" meaning that the individual struggles with control of ingestion, especially once ingestion starts. (Goin...

I recently had a (friendly) exchange with Maia Szalavitz on the changes to the diagnosis of substance use disorders in DSM5. She and I disagree as to what is likely to happen, and whether DSM5 is a step forward or backward, although we agree on the eventual goal of reducing stigma and making treatment more accessible in more places and with more choice concerning the type and format of treatment offered.  Here are some of my thoughts about the changes in diagnosis in DSM5. This is Part 1 from an email reply to Maia.  1. First, is addiction a disease? Well, of course it is. it's hereditary, has a predictable onset, course, complications and characteristics. It causes people great harm and even death. It is a disorder of brain regulation of ingestive behavior, similar to eating disorders. Two ideas can make this assertion seem less clear.  The first is that disordered behavior is caused by something other than a disordered brain. Western analytical philosophy and religions ...

In this week's Morbidity and Mortality Weekly Report (MMWR) the CDC reported that childhood obesity among 3-4 year old children in Los Angeles County and New York City has leveled off and even declined a bit. The children studied were receiving public assistance nutritional services under the Women, Infants' and Childrens' (WIC) programs in the two most populous counties in the US. Both jurisdictions undertook programs to educated mothers about proper nutrition and exercise, although New York started earlier. The results are encouraging.           Prevalence of obesity among 3-4 year-olds in LA County and New York City Ethnicity and obesity Childhood obesity varies by ethnicity. See the charts below., Hispanicstended to have more obesity compared to Blacks, Whites, and Asians. Why this is true is unclear but it is a national trend. Overall, these are encouraging results, suggesting that our increased awareness of diet and obesity, and subse...

SAMHSA recently issued a report about addiction program treatment admissions where the primary problem was a combined dependence on benzodiazepine anti-anxiety and opioid pain medications. There has been a marked increase in such admissions, in the face of overall decrease admissions for other psychoactive substances (see chart below.) Number of admissions for combined benzodiazepine and opioid dependence: What is interesting is that the prevalence (the proportion of people in the country with a disorder) of each has not risen since 2002. Here is the annual prevalence of opioid and other illicit drug dependence or abuse according to NSDUH data. As you can see, dependence upon prescription opioids has remained stable between 2002 and 2011. What has changed is the number of people presenting for treatment, and deaths due to prescription opioids, both of which have risen dramatically in recent years. It is very likely that the increase in people seeking treatment is a result of the inc...

In a surprising new study, David Fiellin and his colleagues at Yale found that adding cognitive behavior therapy (CBT) to buprenorphine plus medical management along did not change outcomes. That's right, folks, nothing. This adds to the growing evidence that the primary reason people get better with Suboxone (buprenorphine is the primary ingredient) is the drug not the counseling. In another recent study, Roger Weiss and colleagues with the NIDA Clinical Trials Network found that the intensity of counseling made no difference in outcomes. Of course, they also found that after 11 weeks of Suboxone maintenance, when subjects were tapered off, the relapse rate within 8 weeks was more than 90%. Here's a graph showing the final comparative outcomes. Note that in the first 12 week, pharmacotherapy management along (PM) actually had better  outcomes, although not significantly so. This will be hard to hear for many who are deeply committed to and believe passionately that it's th...