Dr. Henry Paul, MD

Psychiatrist, Author and Educator

ALARMING JUMP IN SUICIDE RATES

April 26th, 2016

I was surprised by the latest CDC report out this week that showed suicide rates in the United States were at their highest level in three decades. The report released on Friday said that suicides have increased in the US to a rate of 13 per 100,000 people, the highest since 1986. The increase is particularly pronounced among middle-age white people who now account for a third of all US suicides.

According to the CDC study, more than 14,000 middle-aged white people killed themselves in 2014, and the overall suicide rate rose by 24% from 1999 to 2014. Among white men ages 45 to 64, the rate increased 43% and increased 63% for women in the same age-range. The study did not venture to say what the causes might be for the increase, but I think we can surmise that mental health, substance abuse and difficult economic times have contributed.

The study also showed a jump in the suicides amongst girls between the ages of 10 to 14. From 1999 to 2015 the number tripled from 50 to 150. This number is still very low but the fact that it tripled is a concern.

The study did show a decline for two groups; black men and seniors over age 75.

Robert D Putnam, a professor of public policy at Harvard, told the New York Times, “This is part of the larger emerging pattern of evidence of the links between poverty, hopelessness and health.”

The New York Times also reported that since they ran their story last week, they had gotten an overwhelming response. If you need to speak with someone for yourself or a friend or loved one you can call:

National Suicide Prevention Hotline: No matter what problems you are dealing with they want to help you find a reason to keep living. By calling 1-800-273-TALK (8255) you’ll be connected to a skilled, trained counselor at a crisis center in your area, anytime 24/7. This is a confidential, free call.

Crisis Text Line: They serve anyone, in any type of crisis, providing access to free, 24/7 support and information via the medium people already use and trust: text. According to their website this is how it works:

Text 741-741 from anywhere in the USA, anytime, about any type of crisis.
A live, trained Crisis Counselor receives the text and responds quickly.
The volunteer Crisis Counselor will help you move from a hot moment to a cool moment
As always, if this is an emergency and someone is in crisis you should call 911.

LINKS
U.S. Suicide Rate Jumps to 30 Year High NY Times, April 2016
Crisistextline.org
National Suicide Prevention Hotline
Suicide is a Growing Epidemic in America Dr. Henry Paul Blog, November 2015

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.

WHY SHOULD I CARE ABOUT A DRUG ADDICT?

April 15th, 2016

Addiction is similar to other diseases, such as heart disease. Both disrupt the normal, healthy functioning of the underlying organ, have serious harmful consequences, are preventable, treatable, and if left untreated, can last a lifetime. Source: From the laboratories of Drs. N. Volkow and H. Schelbert.

Last week I posted a blog about Narcan™ (naloxone), an opiate antidote that saves lives! It was brought to my attention this week that a local community coalition spreading the word about opiate and heroin addiction was offering a free Narcan training, and I was surprised by some of the online conversation about it.

Some of the comments were about “letting the addicts die” because they (the addict) had made a choice to use drugs. Others were debating whether-or-not addiction is a disease. What these comments tell me is that there is a lot of confusion out there amongst adults about opiate addiction (including heroin, which is an opiate). So, I thought I would dry to address some of the confusion here.

First, drug addiction is a disease that develops over time as a result of the initially voluntary behavior of using drugs. While the full causes are not known drug addiction does take on a life of its own. Addiction ends up affecting a host of functions of a person’s body and mind.

In June of 2015, TIME magazine had a cover story, “Why America Can’t Kick Its Painkiller Problem.” The story makes the case that these addictions no longer start in the dark alleys with drug dealers, but rather start in doctors’ offices with everyday people seeking relief for their pain. These painkillers, known as opioids, are used to treat everything from migraine headaches to back pain, to sports injuries, to severe pelvic pain to chronic Lyme disease.

Here’s a little excerpt from the article that gives a pretty clear picture. “The longer patients stay on the drugs, which are chemically related to heroin and trigger a similar biological response, including euphoria, the higher the chances users will become addicted. When doctors, regulators and law-enforcement officials try to curb access, addicted patients buy the pills on the black market, where they are plentiful. And when those supplies run short, people who would never have dreamed of shooting up, like suburban moms and middle-class professionals, seek respite from the pain of withdrawal with the more potent method of dissolving and injecting the pills’ contents, or going straight to heroin.” (Massimo Calabresi, TIME)

This opiate epidemic is leading elected officials and the medical community to a point where we have to rethink pain management in this country. Law enforcement is on the treatment side. Yes, believe-it-or-not getting arrested leads to the beginning of treatment for many. What we need to do, and what was evident to me by reading some of the comments online, is that we have to put much more effort into awareness and prevention.

LINKS
Drugs, Brains, and Behavior: The Science of Addiction – this booklet explains scientific information about addiction that is easily understandable. Here is a link to a PDF you can download.

Why America Can’t Kick Its Painkiller Problem – You do need a TIME subscription to read this article.

How Science Has Revolutionized the Understanding of Drug Addiction

Easy to Read Drug Facts from the NIDA

WHY SHOULD I GET NARCAN™ TRAINING?

April 4th, 2016

Narcan™ (naloxone) is an opiate antidote that saves lives! And, you should know how to use it because someday someone in your family just may need it.
Overdoses from painkillers and heroin, both opioids, are alarmingly on the rise in the United States. Opioids include heroin and prescription pain pills like morphine, codeine, oxycodone, methadone and Vicodin. When a person is overdosing on an opioid, breathing can slow down or stop, and it can be very hard to wake them from this state.

Who is at risk for overdose? Your grandmother who just had a knee replacement, your aunt who is dealing with chronic back pain, your teenage son or daughter who first takes painkillers while recovering from a sports injury. The list can go on and on. Sadly, painkillers are prescribed at alarming rates, and long-term use leads to addiction. These painkillers are often the gateway drug for heroin.

On Tuesday, President Obama announced a series of initiatives aimed at curbing America’s opioid addiction epidemic. The steps he outlined would make it easier to obtain medication-based treatment, expand Medicaid coverage and increase the availability of a drug that saves people from overdoses.

Narcan is a drug that can save people from overdosing. It can be delivered in the nostrils with the use of a mucosal atomization device (MAD) or intramuscularly with a syringe. Narcan is a non-patient specific prescription that is distributed through an authorized agency, such as a local health department, and given to individuals who have been trained in opioid overdose recognition and response consistent with that agencies registration with their state.

What does Narcan do? Simply, Narcan knocks the opioids out of the opiate receptors in the brain. Tom Ferraro, professor of biomedical sciences at Cooper Medical School of Rowan University in Camden, N.J. told Newsworks in an online article published in 2014 that it essentially “blocks the ability of opioids to do what they do at the molecular level.”
Ferrero went on in the article to explain, “The proteins in your brain have special receptors that, when unlocked, release certain biochemical reactions. Think of opioids, like heroin, as being special keys, says Ferraro. When they get in your brain, they seek out those receptors, ‘latch on’ and unlock the lock. When the drug opens and closes that lock repeatedly, it ‘triggers a cascade of biochemistry inside that particular cell.’” He says, “this is the basic mechanism of being high. The heroin repeatedly unlocks the lock, releasing euphoria, pain relief and addiction from that cell.”

Narcan, on the other hand, cannot be used to get a person high, and if given to an individual who has not taken opioids, it will not have any effect on them. For more information on Narcan visit FDA.gov

LINKS
Obama Pushes For More Treatment for Opioid Addiction
CVS to Sell Heroin OD Reversal Drug Narcan in More Pharmacies
The overdose ‘antidote’: how Narcan works

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.

BLACK BOX WARNING ON PAINKILLERS

March 25th, 2016

“They’re the most powerful painkillers ever invented, and their creating the worst addiction crisis America has ever seen.” TIME Magazine Cover June 2015

The US Food and Drug Administration this week announced that painkillers, such as OxyContin and Fentanyl, will now have to carry a “black box” warning stating the dangers of abuse, addiction, overdose and death.

It is called a black box warning because that is how it appears – in a black box. According to the FDA website, “it appears on a prescription drug’s label and is designed to call attention to serious or life-threatening risks.”

The FDA hopes that this warning will help to slow a growing epidemic in this country of opioid addiction that is leading to heroin addiction, overdose and death. In 2015, TIME magazine reported in their cover story that “9.4 million Americans take opioids for long-term pain and 2.1 million are estimated by the NIH (National Institutes of Health) to be hooked.”

The article went on to say that the crisis is a “tragic combination of good intentions, criminal deception and feckless oversight to turn America’s desire to relieve its pain into such widespread suffering.”

Here’s what the FDA told CNN about how this warning will work. “When a patient gets his or her prescription filled, the bottle should have a notification indicating there is a black-box warning for the drug. The consumer would need to go to the manufacturer’s website for details. In addition, pharmacists are encouraged to provide patients with a medication guide — consumer-friendly language explaining the risks of the drug. Under this new effort from the FDA, all instant-release drugs will need to have such a guide. It is up to the pharmacist to dispense this information, something the FDA encourages.”

The FDA ruling is a long-overdue step toward fighting America’s drug epidemic. I’m not sure it is realistic to assume that consumers will go to the manufacturers website for details, but I do think that pharmacists taking the time to go over the risks of painkillers will help. I have to agree with Senator Markey in what he told CNN, “It’s too little, too late.” We have a long way to go to turn this epidemic around and educating the public and doctors is key.

LINKS
Time Magazine Releases Cover Story on Pain Killers
Physicians for Responsible Opioid Prescribing
FDA now requires ‘black box’ warning on painkillers

YOU WANT TO BULLY ME?

March 18th, 2016

Bullying is a topic that I have talked about frequently in my blog and with patients and educators. Sadly, bullying is much worse for children today. Why? Because social media created cyberbullying making it easy for bullies to taunt, tease and threaten their victims around-the-clock.

I recently came across a story online at Choices magazine by a young woman who was bullied and decided to fight back. The article tells the story of Nicole, who had hundreds of friends and never thought she’d ever be the target of bullying. Until one day she was accused of doing something that angered many in her class, and so she was now being trashed on Facebook, tormented by a barrage of nasty, hurtful texts and on the verge of falling apart. Until one day she decided to fight back. Choices chronicles her story in “The Girl Who Got Even: A True Cyberbullying Story.”

Nicole’s mom became concerned about the bullying and did some research and found Shawn Edgington, one of America’s leading experts on cyberbullying prevention. Edgington had been speaking at schools and had come to the realization that teens would respond better if he had a young person they could relate to, so he asked Nicole if she would tell her story. She told Choices, “She jumped at the opportunity. For her, there was no better way to get even with her tormenters than by telling the world what she had endured and what she had learned.”

With Nicole as his campaign spokesperson, Edgington formed the Great American NO BULL Challenge. Their website says their mission is to provide a global social media platform to promote youth leadership, cyber citizenship, and social change through peer-to-peer engagement and action. NO BULL is powered by the voices of youth (ages 13-23) through short video documentaries, PSAs, and Vines that they write and produce.

Nicole told Choices that working with Edgington on his campaign has been healing for her. She even said that one of the students who tormented her reached out to apologize for believing in the false accusations and partaking in the bullying.

It was great that Nicole confided in her mother and that her mother was proactive in helping her daughter. Parents need to educate themselves about bullying. There are effective intervention programs across the country that parents should get involved with in their children’s schools. Schools should be encouraged to create and enforce anti-bullying policies and to have class discussions about bullies.

I have counseled plenty of children over the years who have been the victims of childhood bullying. Bullying comes in many forms, but intimidation, teasing and the threat of violence are often involved. The sooner a child begins to deal with their bullying the better the outcome. For Nicole, she not only beat back the bullies she found that she “felt relief” and that her world seemed “in balance” again.

LINKS

The Girl Who Got Even: A True Cyberbullying Story – Choices
Shawn Edgington – Cyberbully Prevention Expert
Great American NO BULL Challenge
What to Do If You Think Your Child is Being Bullied – Dr. Henry Paul Blog

YES, IT CAN HAPPEN IN YOUR FAMILY!

March 9th, 2016

The hardest part about the heroin epidemic in this country is getting those who think “not in my family” to understand that it happens to ANY family. It happens to high school and college athletes – the “good kids” — and it occurs in higher numbers in our adult population over age 50. Why? Because painkillers are prescribed to injured athletes and adults with injuries and chronic pain, and painkillers are a gateway drug to heroin.

Let’s focus today on adolescent athletes and how an injury can lead to addiction. A 2013 study published in the American Journal of Public Health found that young athletes are 50 percent more likely to abuse painkillers. Just yesterday CBS News ran a story about college high school wrestler Robert King who was prescribed the painkiller Percocet for his broken foot and who just a few years later found himself addicted to heroin.

According to CBS, “King’s story is not an uncommon one. As the heroin epidemic continues to rage throughout the country, high school athletes are falling victim to addiction in alarming numbers.”

I have written blogs about painkiller and heroin addiction for the past year and the need in this country for more awareness, and I applaud families who are opening up about their loved one’s addiction. Now, even in obituaries families are candidly disclosing the cause of death as a drug addiction. Families are not trying to scare anyone. On the contrary, they are helping to promote awareness that just may save a life.

In the CBS story, Jack Riley, Deputy Administrator of the Drug Enforcement Administration (DEA), emphasized that addiction cuts across every demographic group. He told CBS, “Heroin never discriminates, and athletes are no different. This dangerous drug has become a powerful weapon of mass destruction for drug addicts, some of whom are athletes who first became addicted to painkillers while rehabilitating from sports injury.”

So what should parents do? Most important is to educate yourself about the growing painkiller and heroin epidemic. If your school or community is offering drug awareness education forums — go! Encourage your friends to go with you too. Learn about Narcan™ (naloxone) an opiate antidote. Opioids include heroin and prescription pain pills like morphine, codeine, oxycodone, methadone and Vicodin. Many local communities are training first responders and school staff in the use of Narcan.

Trust your instincts. If you think something is off with your teen, you’re probably right. Ask questions and get answers. If you have a child on pain medication, ask the doctor about it. In the end, remember this is an epidemic in this country so do what you can do to prevent it from spreading to your family. Knowledge is power – always a good place to start!

LINKS

The surprising path from student athlete to heroin addict CBS

You can make a difference in the growing heroin epidemic. Blog by Dr. Henry Paul

He died of a Heroin overdose! Blog by Dr. Henry Paul

LET ‘EM SLEEP

March 9th, 2016

The debate rages on about whether-or-not schools are starting too early in the morning for teenagers. Currently, in the U.S. more than 4 in 5 middle and high schools start classes at or before 8:30 am.

TIME magazine recently ran a story “Why schools are struggling to let students sleep in.” In the article California school assistant superintendent, Jody McClay remembers first hearing complaints several years ago from parents and students who said that school was starting too early. She said it puzzled her at first and that she thought at the time the simple solution was just for kids to go to bed earlier. Then she learned about sleep phase delay. This disorder is a medical term for how puberty affects bedtime. The hormone changes cause a shift in the circadian rhythms that makes it difficult, if not impossible, for some teens to go to bed before 11 pm and wake up before 8 am. This lead McClay to ask the question; should school start later?

In 2014, the American Academy of Pediatrics made a formal recommendation to delay school start times. Studies have shown that students who do get more sleep, preferably nine hours, perform overall better in school, particularly on tests.

It seems like starting school an hour later shouldn’t be such a big deal, but it is. It’s also costly. The snags many districts face in starting school later include costly changes in busing, complications for athletic programs that most likely will see students leaving early for games, a need to adjust the starting time in primary schools to accommodate busing schedules, and a later start time for students who want to work after school.

For parents starting school later makes it more difficult. Starting school an hour later can create a host of problems for parents trying to get to work on time.
Some schools are making the change and have done so with precision, patience, compromise and lots of trial and error and studying what works and what doesn’t. Karen Garza, the superintendent of Fairfax County Public Schools in Virginia, said that her school has made the change and that, for the most part, it’s been a success. Garza thinks that other schools will take the plunge – they have to. I agree.

LINKS

Why Schools Are Struggling to Let Students Sleep In TIME (available to subscribers online)

Why More Schools Are Letting Their Students Sleep In Huffington Post

New Study Says Let Them Sleep In Dr. Paul Blog

“SAD” MAY BE HEREDITARY

February 26th, 2016

It probably seems odd that I’m writing about seasonal depression when spring
is right around the corner. But in October, I did a blog about Seasonal Affective Disorder (SAD). The symptoms mimic those of depression, and the disorder is believed to be triggered by changes in daylight, making it more prevalent in the late fall heading into the winter months when the days get shorter. Well, now it seems there might be a gene that predisposes a person to SAD. The details were published today in the in the Proceedings of the National Academy of Sciences.

Because SAD almost always occurs during the winter months, researchers have believed the condition was triggered by light or rather the lack of light. It is believed that the changes in sunlight affect the circadian rhythms of people with SAD messing up their biological clocks. It is also believed that the increase in the production of melatonin, which is produced at higher levels in the dark could also be a cause.

The researchers in this new study analyzed a group of patients with SAD and also with another sleep disorder called Familial Advance Sleep-Phase syndrome. They identified a mutation in a gene called PER3 suggesting that this gene might both affect sleep and mood.

You can click below to read more of the details of the study. This team of researchers actively believes that there is a gene connection. Dr. Louis Ptáček, also a professor of neurology at the UCSF School of Medicine, said to MNT, “This is the first human mutation directly linked to seasonal affective disorder, and the first clear sign of a mechanism that could link sleep to mood disorders.”
This is an exciting time in research because the more we understand what causes these disorders, the better treatment options we can offer to patients.

LINKS
Seasonal affective disorder: first human gene mutation discovered
Don’t Be Sad
Does seasonal affective disorder actually exist?

FIGHTING THE STIGMA OF MENTAL HEALTH

February 19th, 2016

There is a stigma surrounding mental health issues, not just here in the United States, but around the world. There always has been! Today the Huffington Post began their “Young Minds Matter” campaign to raise awareness about mental health in children, and the Dutchess of Cambridge is leading the charge. The former Kate Middleton said in the Huffington Post Wednesday that “she and Prince William wouldn’t hesitate to seek help if they thought their children, George and Charlotte, needed it.”

As a guest editor for the Huffington Post, the Dutchess of Cambridge said in her first blog post for the new series “Young Minds Matter” that she wants to “celebrate the amazing work being done to improve and understand the mental health of young children”. She discussed her charity work and how it led her to realize that unresolved issues in childhood were leading to addiction and mental health problems for many adults. She writes, “What I did not expect was to see that time and time again, the issues that led people to addiction and destructive decision making seemed to almost always stem from unresolved childhood challenges. It became clear to me that many children – even those younger than five – have to deal with complex problems without the emotional resilience, language or confidence to ask for help. And it was also clear that with mental health problems still being such a taboo, many adults are often too afraid to ask for help for the children in their care.”

The new series will explore the issues and work on the mental health of the young child.

I applaud the Huffington Post and the Dutchess of Cambridge for starting this dialogue, and I encourage you to follow and join the discussion. The mental health crisis in the UK mirrors the American crisis, and there is a lot to learn from this ongoing dialogue.

LINKS
Let’s Make a Real Difference for an Entire Generation of Young Children
Duchess of Cambridge raises mental health issues in HuffPost

DABBING – WHY PARENTS NEED TO WORRY!

February 8th, 2016

I came across this article yesterday on dabbing. I hadn’t heard of it before, so I was curious. Dabbing is a new method of smoking pot that gets you the quickest, long-lasting high with just one inhale. That’s right – one drag from a pipe or vaping pen can give the effect of smoking many joints.

On the website, Parents Opposed to Pot (POPPOT), they say that “Dabbing is to marijuana as crack is to cocaine.” They go on to say that the addiction from dabbing can be immediate, and once you do it “is nearly impossible to get unhooked.”

So how are “Dabs” made? According to the POPPOT website, “Dabbers take a tiny bit of butane hash oil, BHO – hardened or buttery, and quickly light it up in a small compartment.” The site explains how the THC is extracted from the plant using butane gas and some type of glass tube. THC is what causes a high. By extracting the THC into an oil (hash oil is known for giving a quick and lasting high) or buttery wax that hardens, you can then break it into tiny pieces that give a high that will last all day.

In states like Colorado where pot is legal, parents are fearful that legalization of the drug is why it is now showing up in middle school. We don’t have studies to confirm this, but I think the parents are right to assume this.

NJ.com reported in an article in September 2015, “According to a 2014 study by the National Institute on Drug Abuse, cigarette smoking by teens is down, but marijuana use has held its own and nearly 45% of the over 41,000 teens polled for the study reported that they’d smoked pot by the time they reached 12th grade, with an alarming number beginning as early as eighth grade.”

Angelo Valente, Executive Director of the Millburn-based Partnership for a Drug-Free New Jersey told NJ.com, “Kids are starting with pot younger and younger and middle school is a pivotal age for experimentation with pot, alcohol, and tobacco, especially when middle and high schools are located on the same campus.”

What I can say to parents is to know what dabbing is, know the signs and symptoms of drug use to watch for with your kids, and seek advice from a professional when you have concerns. Why should parents worry? Dabbing is new, it’s dangerous, it’s highly addictive, and it can result in injury and death.

LINKS
Kids exposed to marijuana at a younger age, experts say — NJ.com
What is “Dabbing” and Why Parents Need to Worry