Dr. Henry Paul, MD

Psychiatrist, Author and Educator

TREATING OPIOD ADDICTION UNDER OBAMACARE

December 31st, 2015

There has been a movement afoot by physicians, social workers, and consumer advocacy groups to require all healthcare plans on the federal exchange to cover medications that are used to treat people addicted to painkillers.

The federal government has declared opioid addiction a “public health crisis,” and the Centers for Disease Control and Prevention (CDC) reported that more than 28,600 people died in 2014 due to overdoses from prescription painkillers, other opioids, and heroin. From Congress right down to local government officials everyone is trying to find solutions to handle the growing opioid and heroin epidemic. To turn this around is going to take a lot of education, compassion and better treatment options for those addicted, and support and guidance for those family members, friends, and loved ones who are trying to help.

It certainly would be a wise choice to cover the cost of the medication-assisted treatment. For so many addicts relapse is more common than you’d think. To begin with, it is hard to get into a treatment program due to the lack of inpatient and outpatient treatment programs, and if you do get into a program, once you’re through the cost of staying drug-free can become a burden too.

Drug addiction treatment has been shown to reduce associated health and social costs by far more than the cost of the treatment itself. According to Drugabuse.gov, the average cost for one full year of methadone maintenance treatment is approximate $4,700 per patient (2012 statistic). That is a lot less than incarcerating someone at a cost of nearly $24000 a year. And let’s face it, many of those addicted to painkillers are never going to get the necessary treatment in prison to deal with their addiction and turn their lives around. Jails are not, and never will be, appropriate treatment centers for addicts. I don’t believe that prison is an alternative to a drug treatment program. We need more treatment centers, more programs and more money to fight this epidemic. Call your elected officials and let them know that you want medication-assisted drugs covered under the healthcare bill.

LINKS
Opioid addiction treatment argued as ‘essential’ insurance benefit
Is drug addiction treatment worth its cost?
Drug Overdose Deaths by State, US 2013 and 2014

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

20,000 GUN SUICIDES EVERY YEAR

December 24th, 2015

In a letter posted on the Brady Center & Campaign to Prevent Gun Violence, President Dan Gross said, “There are 20,000 gun suicides in the United States every year, more than 50 every single day. That’s more than half of all suicides and two-thirds of all gun deaths. These tragedies rarely make the news, or prompt action from our lawmakers, but they add up to a national tragedy of staggering proportions.”

The Brady Center released a study in September 2015 that examined the danger of having a gun in the home and its strong link to suicide. The study found that the impulsivity of many suicide attempts, and the fact that, even more than depression or substance abuse, the strongest predictor of how likely a person is to die from suicide is a gun in the home. According to the study, a gun in the home makes a suicide three times more likely.

I have written some blogs on gun violence mostly related to mass shootings. But, with all the debate that the mass shootings sparked, sadly the discussion never included guns and their role in suicide. I applaud the Brady Center for raising awareness about this important issue. Sadly, so many parents, spouses and others who choose to have a gun in their home do not realize how tragically that decision can impact their lives until it is too late.
Here are some key facts from the study:

The firearm suicide rate has increased more than 13 percent between 2007 and 2013
Suicide is the second leading cause of death among adolescents and young adults aged 10 to 24 years
85 to 91 percent of firearm suicide attempts are fatal, while drug overdose, is only fatal 2 percent of the time. This is a startling fact since the study points out that 92 percent of those who fail in a suicide attempt choose to embrace life and generally do not die by suicide.

The New York Times ran an editorial in September when the study was released. I liked what they said, “The suicide problem is enormously complicated without irresponsible access to guns. At a minimum, people who own guns should be required to keep them firmly under lock for the safety of society, let alone their own families.”

I agree that much more discussion and awareness needs to happen around the link between guns and suicide. The Brady Center is pushing for that happen. So check out the study, share the link and help the discussion to grow!

LINKS
The Truth About Suicide & Guns
Cayman’s Story
Full Report “The Truth About Suicide & Guns
The New York Times “The Quieter Gun Death”

CHEERLEADING: FEWER INJURIES BUT MORE SEVERE

December 17th, 2015

Interesting study out last week that says that cheerleading is a less dangerous sport for teens. The report does note that even though there are fewer accidents those that do happen tend to be more severe and more likely to result in concussions.

According to Reuters, “On average, cheerleading typically has less than one injury for every 1,000 minutes of participation time, meaning there’s no more than one accident every 17 hours, the study found.”

According to the report the only sports that are safer are track and field and swimming. The injury rates are obviously much higher for football and surprisingly high for girls’ soccer.

It is a very difficult decision that parents have to make when deciding whether or not to let their child participate in sports, particularly ones that are deemed dangerous. On one hand, children need to get exercise and it is good character building for young people to participate in team sports. On the other hand, when faced with the news about concussions and death it is not surprising that parents are fearful for their children’s safety when playing a sport like football. Look, even if you’re not a football fan, you can’t turn on the television without hearing something about the ongoing controversy over concussions and football.

The debate has been raging in this country for years now about the lack of exercise and the growing waistline of our young Americans. So how do parents decide where to draw the line? I think that you have to take into account that so many sports, like track and field, baseball, swimming and cheerleading are important because they get kids active, they build self-esteem and they teach comradery and teamwork.

I recommend that if parents have concerns that they discuss them with their pediatrician, the school and their children. Here are some alternatives to team sports that I recommend to help keep your child active.

Sports that are off the playing field such as skiing, swimming, Tae Kwon do, running, kick-boxing, resistance/weight training, etc. are very good for exercising. These days with extreme sports kids are finding where they “fit in” so take an interest in what they’re interested in and encourage them to pursue it.
Encourage exercise at the local gym. Suggest that they go with their friends. Encourage them to embrace exercise as a lifestyle change that they will have for a lifetime.
Outdoor sports such as kayaking, bike riding and hiking are also good alternatives. They can also be done in groups to encourage comradery.

Please send me your thoughts on exercise.

LINKS
Cheerleading Among the Safest Sports
Sitting Around Isn’t Good for Anyone’s Health

PSYCHIATRIC DRUGS FOR BABIES – REALLY?

December 14th, 2015

Is it possible that psychiatric medications tested on adults and meant to treat adult psychiatric disorders are now being used to treat psychiatric disorders in children younger than two years old? So it seems according to The New York Times story last week. “Still in a Crib, Yet Being Given Antipsychotics” by Alan Schwarz.

According to the NYT story, “Cases like that of Andrew Rios, in which children age 2 or younger are prescribed psychiatric medications to address alarmingly violent or withdrawn behavior, are rising rapidly, data shows. Many doctors worry that these drugs, designed for adults and only warily accepted for certain school-age youngsters, are being used to treat children still in cribs despite no published research into their effectiveness and potential health risks for children so young.”

Using drugs “off-label” for treating all kinds of conditions from cancer to ADHD has become so common that almost every drug at some point is prescribed off-label. Off-label means the medication is being used in a manner not specified in the FDA’s approved packaging label or insert. Off-label prescribing isn’t necessarily bad. It can be beneficial.

In child and adolescent psychiatry, the majority of the drug prescribing is done off-label. Few medications are approved for young people, but making these valuable medications unavailable because drug companies have not tested them for all conditions and populations would cause a lot of prolonged suffering and even deaths. This is the case for hundreds of drugs, not just psychotropic medications. Studies have been coming out showing the helpfulness of psychotropic medication in young people, and hopefully, science and research will continue to catch up with clinical reality.

One problem with children under two receiving these medications is that one cannot get the feedback that you get treating older children and adults. Babies have very limited language skills and cannot participate in guiding treatment decisions. Additionally, the effects of these medications on the development of the young body of a baby are not known, and I think it is rational to worry about the high possible vulnerability of infant tissues.

As much as I believe in using drugs off-label I believe that babies should not be given psychotropic medication. Further tests are needed, and behavioral modifications should be tried first.

LINKS
Still in a Crib, Yet Being Given Antipsychotics

THE FINAL SHOT – MENTAL ILLNESS

December 11th, 2015

A USA TODAY story out yesterday said, “At a time of heightened concern over police shootings, a new report estimates that people with mental illness are 16 times more likely than others to be killed by police.”

Why is this? The problem is a lack of treatment for those with mental illness, and I also think a lack of training of law enforcement to recognize it. Mental illness is still something that carries a stigma. People, in general, don’t want to talk about it. For years now, the main thing driving the conversation about mental health has been the mass shootings. People are arguing that mental illness is the reason behind the mass shootings.

Now, a new study out from the Virginia-based Treatment Advocacy Center is saying that about one-in-four fatal police encounters involve someone with mental illness. This study is moving beyond saying that not just those who decide to shoot others in a mass shooting have some mental illness, but that many victims of shooting by law enforcement may also have mental health issues that made them do something illegal that got them killed.

I agree, and this is why we need more dialogue and more solutions on how to help those with mental illness. There are over 8 million people in the United States who have a mental disorder that can alter their thinking and perception of the world around them. From paranoid syndromes to fear, loneliness and anger there are plenty of emotions, disturbances of judgement and other issues that are associated with mental illness that can cause a person to act out or sometimes simply not understand laws or social constructs. And, the disorders themselves ranging from bipolar disorder to schizophrenia to various personality and substance abuse disorders that increase vulnerability often go undiagnosed. For many, even if they are diagnosed, some just stop taking their medications and other forms of treatment.

So what’s the answer? Well, I think that Mayor de Blasio and #ThriveNYC is a start. I believe that having a dialogue and trying to develop programs that can help those suffering from mental illness is a good place to start. Look, people with mental illness are no more violent than others. A better understanding by all will help many to seek and get the help they need. America has to embrace this conversation before change can ever really take hold.

Join me on Facebook and let’s have a conversation about this. Ideas and change come from collaborative thinking and open discussion.

LINKS
“I Called the Police for Help, Not to Kill My Son”
Groups call on Congress to reform mental health system

CHILD ABUSE, STRESS AND THE HOLIDAYS!

December 8th, 2015

The holidays for many are a joyous time of year. They are also a very stressful time. The increased stress put on families this time of year often leads to more cases of child abuse or neglect. Sad but true!

Statistics shows that the holidays are often the busiest time of year for agencies working with children and families dealing with abuse and neglect. The stress of dealing with holiday travel, planning, relationships, expenses and the likes leaves parents feeling angry and short on patience, and that can lead to abuse. The economic and personal stresses that can wear on a family over the course of a year are increased by the extra demands that the holidays place on their time, money and energy. Additionally, the increase in alcohol consumption during the holidays can lead to parents losing their tempers.

What makes this whole situation worse is the unrealistic expectations that both children and parents place on the “perfect” holiday. Having to chase down that one gift the kids just have to have is exhausting! So here are some things that families can do to minimize the risk of abuse.

Have a budget for the holidays. Nothing creates more stress than over-spending.
Sit down with you children and discuss the plans for the holidays and temper expectations on gifts and time. A big cause of holiday stress is having too much to do in a short period. Create a schedule so that everyone knows what to expect and can plan accordingly. Teens especially should be involved in the scheduling as they will want to include opportunities to spend time with their friends over the holiday break.
Having kids home from school when you have to work is stressful. Work out a plan sooner rather than later to make sure that kids are covered. Spouses maybe can split coverage so not as to miss too much time at work.
Limit your travel during this time. The holidays are a busy time to travel in general. If you have to travel leave enough time to get to your destination and expect delays. Go into your trip with a heavy dose of patience because you’re going to need it.
Take some time and get out for a walk or a drive. It is amazing what a little fresh air and sunlight can do.
Watch what you eat and drink. It’s easy with all the pies, goodies and alcohol to over-do-it during the holidays.
Stick to your daily routine. If that means exercising in the morning – then do it. If it means eating a healthy diet – stick to it.
Reach out to a support group either online or locally. It helps to talk with others.
Make sure to get sleep. Your body needs a good night’s sleep.

THRIVENYC EXPECTED TO TRANSFORM A CITY

December 3rd, 2015

New York City Mayor Bill de Blasio has announced new mental health initiatives for New York City. On November 25, the Mayor and his wife, First Lady Chirlane McCray, appeared on NPR’s Morning Edition to discuss ThriveNYC and how they hope it will transform their city.

De Blasio told host Linda Wertheimer, “We have a fundamental health problem in our city, in our nation, in New York City, as one-in-five New Yorkers are affected by some form of mental illness. And this requires a very comprehensive response, and it begins with making sure people can get access to mental health services.”

An $850 million program, ThriveNYC aims to hire 400 mental health clinicians for high-need communities and provide mental health training to a quarter-million New Yorkers.

The initiative will launch with mental health screenings for postpartum depression. “Despite the great benefit it provides, screening for postpartum depression has not been part of a woman’s routine care,” said McCray in an interview with the Huffington Post last week.

According to the Mayor’s office, the city’s Health and Hospitals, which runs 11 hospitals and Maimonides Medical Center — which together handle a quarter of the city’s births — have pledged to make the depression checks universal for pregnant women and new mothers within two years. It is estimated that one in ten new mothers, meaning 12,000 to 15,000 cases a year in the city, suffers from some sort of post-partum depression. The city’s eventual goal is universal screening.

Homelessness is a big part of this program. “The key is to make sure that people who are suffering – people who have a mental illness – don’t go on the street to begin with – that they are treated.” McCray told Wertheimer.

This is a step in the right direction for New York. I’m sure there will be details to work out as the initiatives unfolds but you have to start somewhere. I think that Mayor de Blasio and his wife are making a great start. Let’s support them.

Get a full copy of the ThriveNYC report (PDF). Understanding New York City’s Mental Health Challenge here. For more details on the initiative visit https://thrivenyc.cityofnewyork.us/.

LINKS

Huffington Post The Important Thing Hospitals Have Pledged To Do For New Moms

NPR NYC Mayor Unveils Ambitious Plan To Combat Mental Health Illnesses