Dr. Henry Paul, MD

Psychiatrist, Author and Educator

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

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.

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

A VERY SAD STORY

March 17th, 2015

Suicide is every parent’s nightmare. On an ongoing basis, there are pressures in teenager’s lives that we know about, and we don’t know about. It’s never simple. In the case of 13 year-old Cayman Naib who was found near his home with a self-inflicted gunshot wound last week, I am sure there are a lot of questions that friends, teachers, and family are asking themselves.

According to the CNN story, Naib left shortly after receiving an email from the school about overdue homework. Most likely that was not the trigger for his suicide. As an adolescent psychiatrist, I know that these stories are usually far from complete. I believe there might have been signs of pre-suicidality that were missed. A suicide rarely happens out of the blue after an email about homework, although sometimes a suicide does appear to come out of nowhere. More often some social rejection or another stressor is present.

Psychological testing of all students is not practical, but the good education of teachers (see our recent blog) and parents to signs of depression or other mental disorders is best.

I think it needs to be pointed out that suicide does not discriminate. The best defense against these situations is knowledge, and the courage of parents to ask the right questions. Here is a list of warning signs that I posted for parents in an earlier blog.

I want to make it clear that knowing the warning signs of suicide can save lives, but it certainly is no guarantee. Hopefully, families that are faced with the suicide of a loved one can eventually find peace, and they need to know that this is not their fault.

Click here for more on Cayman Naib’s story.

Disclaimer
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.

CHECKLIST FOR PARENTS CONCERNED ABOUT TEEN SUICIDE — WHAT TO DO!

March 29th, 2014

If you suspect that your teen might be depressed or contemplating suicide then you need to act right away. Here is a quick list of things to look for:

Always take seriously any mention or discussion of death, dying, suicide, self destruction or other evidence of morbid thinking that your teenager may manifest
Talk to your teen, listen, don’t lecture, express love and reassurance, and realize that suicidal ideation and depression are usually temporary and treatable states but probably need immediate professional intervention.
If you are worried that your teenager may be contemplating suicide, remove any weapons, pills, or other objects of substances in the house to which he or she may have access to achieving the act.
Get professional help immediately. Remember that depression is almost always indicated in suicidal teenagers and that a combination of “talk therapy” and medication can turn things around.
Get the numbers and/or websites of suicide hotlines both to report any fears or concerns you may have and to learn more about the likelihood of your teen carrying through any suicide attempt if you remain unsure.
Note changes in behavior mentioned previously (including dressing in black) and take them seriously. Engage your teen in conversation about what’s going on with him or her in his or her life and what he or she intends by the changes in dress or behavior you have noticed.
Don’t Judge. Family supportiveness is crucial. The point is always to get your teen to talk, not to lecture or try to persuade him or her out of feelings.
Be especially alert if your family has had a history of suicide or suicide attempts.
Understand that in a minority of cases, if the depression or other underlying reasons for your teen’s suicidal thoughts and/or behavior indicate it, your teen may need hospitalization and a combination of therapy and medication.
The most important thing you can do if you think your child is suicidal is to explore the situation openly. If your child states that he has suicidal ideas or intentions or plans then an immediate mental health evaluation is necessary. Go to the nearest hospital emergency room or mental health crisis unit.

Check my February blogs on Suicide for more information, and certainly feel free to contact me.

Statistics of Suicide
The Warning Signs of Suicide
What to Do If You Feel Your Child Might Be Suicidally Depressed

THERE IS A “SUICIDE EPIDEMIC” – SO WHAT DO PARENTS DO?

March 28th, 2014

Sadly, teen suicide once again takes front and center in the news. Suicide is never more devastating than when a teenager makes the decision to end his or her own life. Last Saturday, New York City School Chancellor Carmen Farina said that ten students in the New York City public school system had taken their own lives in the past seven weeks creating a “suicide epidemic” in our schools.

City Health Department stats are showing a rise in youth suicides, with suicide the third leading cause of death for New Yorkers ages 15 to 24. In 2010, 58 people in that age group took their lives. In 2011, the toll was up to 64, and in 2012,it reached 66.

So how worried do parents have to be that their own teens may make this terrible choice? This is frightening for parents, particularly when you hear the current numbers. Most teens of course never consider suicide, but if you are worried there are things you need to know and signs to watch for.

What you need to know is that there are many theories out there as to why teens commit suicide; focusing on stress and family turmoil; confusion, self-doubt, the impact of recent humiliations; and the effects of alcohol and drugs. Moving, feeling isolated, sexual or physical abuse, and divorce and family break-up have also been implicated as triggers. Family history may also play a role: teens with relatives who have committed suicide may be more likely to consider it themselves.

Perhaps, the most plausible overall reason for teenage suicide is only this: the teenager feels hopeless! This is often a symptom of major depression, as well as feeling caught in inner conflicts and/or environmental constraints or difficulties from which the teenager feels there is no escape. Because the most common psychiatric diagnosis associated with suicide is depression, it is crucial for parents to watch for symptoms that commonly indicate this condition. If your child is suffering from a recent onset of sad mood, irritability, withdrawal, eating or sleeping disorders, seems to have shown a marked decline in school performance, can’t concentrate, is fixating on a particularly painful experience of humiliation, or is afflicted by headaches of gastrointestinal complaints, regard it as an urgent “heads up.”

Often teens who are suicidal give verbal hints about suicide. “I cannot take it anymore” or “you’d be better off without me” are the kinds of warning statements a suicidal teenager often makes – warnings that are too frequently dismissed as evidence of passing adolescent mood swings. Also, talk of the afterlife, joining someone in heaven or dark and morbid interests and preoccupations. Also, dark music, internet searches having to do with death and/or suicide are red flags. Lastly writings or postings online are often warnings. Lastly a quick switch from depression to a good mood possibly associated with having “cleaned house” is a serious development.

If your teen has attempted suicide before, you need to be particularly alert: seek professional help right away.

I will follow-up with a blog tomorrow that deals with “What to Do.” Check out my February blogs on Suicide, too. Certainly, if you have any questions, please email me.

Statistics of Suicide
The Warning Signs of Suicide
What to Do If You Feel Your Child Might Be Suicidally Depressed

CBS Local Report: NYC Public Schools Have Seen 10 Student Suicides In 7 Weeks
New York Post 10 NYC schoolchildren have committed suicide in 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.

WHAT TO DO IF YOU FEEL YOUR CHILD MIGHT BE SUICIDALLY DEPRESSED

February 18th, 2014

The most important thing you can do if you think your child is suicidal is to explore the situation openly. If your child states that he has suicidal ideas or intentions or plans then an immediate mental health evaluation is necessary.

Unfortunately, things are not always that clear, so first ask yourself is my child or teenager depressed? If after a week or two, a sad mood does not budge or gets worse and signs of depression are present, be concerned. Talk to your child openly about how he or she is feeling. Include direct questions about suicide. Many parents mistakenly feel that by asking about suicide they will put it in a child’s mind. This does not happen. It is important to know what your child is thinking and direct questioning is the best way to find out. You can ask directly about suicidal ideas, rehearsals, preparations, and the like. This can also be done by asking something like: Sometimes when we feel like this, thoughts of dying or wanting to take your own life can pop up. Has that ever happened to you? Further probing can include other questions like:

Do you think about death?
Do you feel like you want to disappear?
Do you feel hopeless?
Do you think about the afterlife?

It is also essential that you look for possible signs of preparation: a note or other writing, a weapon, or hoarded medication. Increased drug use is also a high risk sign

If, after open, kind, and compassionate questioning of your sad child, without lecturing or criticizing, you see no progress in the depression, and have little or no handle on understanding the situation, and see any signs of possible suicidal intent, then a mental health assessment is needed. No time should be wasted in getting professional attention.

THE WARNING SIGNS OF SUICIDE

February 13th, 2014

Potentially suicidal young people frequently show warning signs. What follows is a list of some of the thoughts, feelings, and actions that could indicate that a young person is contemplating suicide. They range from internal, unexpressed thoughts, like wanting to die, to overt actions, like writing a note or collecting drugs or weapons.

Thoughts of death
Wanting to die
Prior suicide attempts/gestures
Feeling that the world would be better off if they were dead
Feeling useless and hopeless
Giving verbal hints about not being able to take it anymore
Writing about death
Getting absorbed in music, video sites, or activities stressing death or suicide
Talking of the afterlife
Dressing in black
Becoming absorbed in morbid subjects
Having an inappropriate burst of enthusiasm or cheerfulness after being depressed (this sometimes indicates that a person has decided to commit suicide)
Cleaning house and putting his/her things in order
Writing a suicide note
Buying books or researching modes of suicide
Idealizing celebrities who have committed suicide or died in other ways
Engaging in drunken driving
Accumulating weapons

If you see any of these signs you should be immediately concerned and contact a medical health professional right away. In my next blog I will discuss having an open conversation with your sad/depressed child if you suspect that he or she might be contemplating suicide, but is not showing any clear signs like those listed above.

THE STATISTICS OF SUICIDE

February 11th, 2014

Of course, suicide is always a worry when there is talk about depression. While suicide is quite uncommon for younger children, we do see an increase starting at about nine years old. By 13 to 14 years old, the rate of suicide increases and becomes the third highest cause of death for 10 to 24 year-olds. The rate of suicide under ten years old is about .8/100,000 children, it doubles in the 10 to 14 year old group but then increases to about 8/100,000 by 15 to 19 years old. Suicide attempts are often reported as accidents and are not reflected in the statistics — like the depressed teenager who crashes the car into a tree. About two thousand suicides in youngsters occur in the United States each year. There are about one hundred thousand world-wide. While depression is the main risk factor associated with youth suicide, other conditions also raise the risk:

· Behavior disorders

· Physical/sexual abuser

· Severe anxiety

· Eating disorders

· Suicide in the family

· Substance abuse

· Being bullied

· Family disruption

There are many triggers for suicide including being rejected socially or in a love relationship, school failure or expulsion, being caught by the police doing an antisocial act, feeling humiliated, being intoxicated, and experiencing family stress. Hopelessness, often found in depressed youngsters, is one of the most indicative signs of a possible suicide attempt.

So where do antidepressants fit into adolescent/teen suicide? After some preliminary studies had come out from the FDA in 2003 and 2005 saying that there was an increased risk in suicidal thoughts in children, adolescents and young adults, parents became scared to have their child on any of these medications. There was, and still is, a lot of information on the Internet to dissuade parents from using antidepressants, so I understand the fear.

Here’s how I see it. When the studies came out, many psychiatrists, me included, spoke out nationally emphasizing that if, in fact, this was a risk, it was so rare that most of us had never seen it and that proper monitoring by the prescribing physician would, in all probability, be enough to ward off any tragedy. Despite this, the new prescribing of antidepressants dropped markedly. Tragically the suicide rate increased in teenagers. No scientific correlation was made, but it seems that this was related to less use of the antidepressants which could have treated the depression and prevented the suicide.

The reality is that, if prescribed correctly under the guidance of an experienced psychiatrist, I do not think there is an increased risk of suicide. Further studies about particular drugs with proper control groups will clarify this. What I recommend is that parents do not withhold antidepressants on what we know so far, but parents should be cautious and make sure that their child is being monitored for every possible side effect.