Dr. Henry Paul, MD

Psychiatrist, Author and Educator

STOP THE DELAY! RELEASE NEW PAINKILLER PRESCRIPTION GUIDELINES

January 1st, 2016

“In 2013, health care providers wrote 207 million prescriptions for opioid painkillers, almost quadruple the number written in 1999.” Senator Joe Manchin, Beckley (WV)Register-Herald

Yesterday in my blog I talked about the need for the Affordable Care Act, also known as Obamacare, to include medication-assisted drugs to help those in treatment for opioid addiction. There is a movement afoot to make this happen, and I support it. Today, I want to talk about the letter that Senator Joe Manchin (D-WV) sent this month to HHS Secretary Sylvia Burwell urging her to support the release of the CDC’s guidelines for prescribing opioids.

According to Manchin, this report has been delayed due to pressure from outside groups and objections from the Food and Drug Administration (FDA). Manchin told the Beckley (WV) Register-Herald, “At a recent meeting, the FDA’s Director of the Division of Anesthesia, Analgesia and Addiction Products, Sharon Hertz, was one of the strongest voices against the guidelines,” Manchin wrote, adding, “While the President of the United States, the Department of Health and Human Services, and every other agency of the federal government has been actively working to save lives and stop this epidemic, the FDA is working against these efforts and further endangering the public.”

Opioids are prescribed for pain management, but they are dangerous. Opioid addiction is a medical condition characterized by the overuse and abuse of opioids (i.e. morphine, heroin, codeine, oxycodone, hydrocodone, etc.). When abused, all of these classes of drugs directly or indirectly cause a pleasurable increase of dopamine in the brain’s reward pathway. Addiction happens when a person seeks to experience repeatedly that rewarding or “high” feeling.

The over-prescribing of opioids is the main problem. Many of these drugs are given for longer than 30 days – the time it takes to become addicted. Also, these drugs are often prescribed to teenagers recovering from sports injuries. Painkillers are the beginning of the addiction that leads to heroin. Why? Because heroin is cheaper. According to the CDC, in 2013, 207 million prescriptions were written for prescription opioid pain medications. Those are a lot of prescriptions. With the misleading information presented early on to doctors, there has been a lot of confusion and second-guessing about the use of these drugs and the potential risks.

I join Senator Manchin in urging Burwell “to stand behind the CDC in pushing for the strongest possible set of recommendations to help end prescription opioid abuse and overdose deaths.” It’s true that the horse is already out of the gate and that the epidemic is in full swing, but we can turn this around, and we have to start somewhere. These new guidelines regulating opioid prescribing, along with the medication-assisted drugs are good first steps.

LINKS
The Neurobiology of Opioid Dependence: Implications for Treatment
DrugFacts: Prescription and Over-the-Counter Medications
Manchin decries delay of CDC guidelines for prescribing opioids
The Monster of Accidental Opioid Addiction

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.

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

AUTISM SPECTRUM DISORDER NUMBERS RISING

November 23rd, 2015

Exactly one year ago I did a blog on this topic. At that time, I agreed with Amy Daniels, the assistant director for public health research at Autism Speaks, a New York City-based advocacy group, when she said in a CBS News interview that a significant part of the increase in autism has resulted from changes in diagnosis and reporting and not due to an actual increase in frequency of the disorder.

Daniels was speaking about results of a Danish study that last year attributed the rise in cases of children diagnosed with autism to the redefinition of what autism is and how it is reported. I agreed then, and I agree now that the “big jump” in the numbers of children diagnosed is due to more inclusive diagnostic criteria, and that leads to an increase in numbers.

Now, again a year later, we have a new study from the CDC that is reporting a “big jump in the number of children with autism.” The CDC’s National Center for Health Statistics is reporting that about one in 45 children between the ages of 3 and 17 have autism. The previous report by the CDC was one in 68 children. The CDC’s reasoning for the significant increase in numbers is due to the way they presented the questions in the National Survey of Children’s Health. The surveys from 2011 to 2013 reported that 1.25% of children had some level of autism. In 2014, the number jumped to 2.24% – a significant increase. The reason for the increase? The CDC is attributing it to survey techniques and how the questions were worded to parents.

In a report filed on the NBC News (11/13, Fox) website Benjamin Zablotsky, an epidemiologist at the National Center for Health Statistics who helped lead the study said, “One in 45 is what we think is the most accurate parental report of autism to date. I think within this report we found that the way that we ask the parents about autism spectrum disorder can have an impact on the way the parents respond to the question.” Thus, the children have not changed just how we make a diagnosis. This, of course, begs the questions about over diagnosis by over inclusion.

What other research is showing is that autism is simply being recognized and diagnosed more often and that children who were classified with something broad like pervasive developmental disorder are being reclassified to the more specific autism.

Regardless of where we stand on the academics of this debate if you suspect that your child has an autism spectrum disorder (ASD), you should schedule your child to see a child psychiatrist for proper diagnosis. If your child has an ASD, there are medications for some of the behavioral issues and alternative therapies that can help as well.

With an ASD diagnosis, parents will also have to reach out to the school district to have the proper classifications and education plan implemented. In some cases, depending on the severity of the diagnosis, a child may have to attend a specialized program/school outside of the public school system. The school, along with a child’s pediatrician and psychiatrist will be instrumental in designing and implementing the proper program.

On my blog, “I think my child might be on the spectrum” you will find more information on the ASD and the symptoms to look for.

LINKS:
Dr. Henry Paul — Autism – What is really behind the rising numbers?
AP — Latest US estimate suggests 1 in 45 children have autism
USA Today — Study Finds more than 2% of children have autism
Los Angeles Times — 1 in 45: New autism statistic suggests children with condition may have been undercounted

DISCLAIMER
The 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.

EXCESSIVE TEXTING IS A REAL PROBLEM WITH TEENS

November 4th, 2015

Ask any parent who is raising teens today what it’s like to try to speak to your kids when they have a cell phone. At the dinner table, in the car, watching a movie, shopping, at work or just walking – their heads are down and their fingers are tapping away. Teens today are always on their phones. Try being around a teen who misplaces their phone and chaos breaks out until it’s found. Cell phones today are almost as important to teens as food (and some teens might even say their phone is more important)!

With this type of cell phone obsession, how are parents ever supposed to trust their teens not to text and drive? No matter how much parents talk to their teens about the dangers of texting behind the wheel, the temptation is still too great. Excessive texting is rampant and no doubt here to stay.

According to the CDC, each day in the United States, more than nine people are killed, and more than 1,153 people are injured in crashes that are reported to involve a distracted driver.

A distracted driver is a person who takes their eyes off the road, hands off the steering wheel or mind off of driving. Activities that cause distractions include using a cell phone, texting, eating, using in-vehicle navigation systems, and using audio devices.

The National Highway Transportation and Safety Administration (NHTSA) ran a campaign in October that emphasized the five most dangerous and deadly behaviors for teen drivers. One of those five was using a cell phone or texting while driving.

The NHTSA says on their website that “texting or dialing while driving is more than just risky – it’s deadly. In 2013, among drivers 15 to 19 years old involved in fatal crashes, 11 percent were reported as distracted at the time of the crash. This age group has the highest percentage of drivers distracted by phone use.”

Parents are facing an uphill battle trying to convince their teen of the dangers of texting and driving. Online Schools reported in 2012 that 52% of young-adult drivers said it was easy to text and drive while 34% of teens said they have texted while behind the wheel.

I would be remiss to say that teens are the only ones partaking in this risky behavior of texting and driving. Parents are doing it too! It’s a classic case of do as I say, not as I do. When it comes to highway safety, the parent is the role model. Unfortunately, from the studies that I’ve read most teens believe that adults, including their parents, are texting and driving. So if parents want to have an impact on their teens safety behind the wheel – parents must first practice what they preach. That’s always the best place to start!

Links:
‘5 to Drive’ campaign
Driving While Intexticated
Teen drivers are texting, just like their parents Washington Post, 2012