Dr. Henry Paul, MD

Psychiatrist, Author and Educator

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.

33645761_sSome 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

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 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.

20160404_142120Who 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.

WAITING FOR REHAB TO TAKE YOU

September 16th, 2015

“Wait time is among the most commonly cited barriers to access among individuals seeking entry to substance abuse treatment, yet relatively little is known about what contributes to it.” The American Journal of Drug and Alcohol Abuse

So what do you do if you are put on a waiting list to get into rehab?  Worse yet, what do you do if you are a parent waiting to get your child into rehab?  Waiting to get into drug rehab is a very stressful situation for the addict as well as their family and friends.  The shortage of beds is due to the growing opiate and heroin epidemic.

Just this week, NBC News reported some startling numbers on the wait list for federally-funded rehab.  States like Massachusetts, Florida and Ohio have waits that span from weeks to months.  In Maine, according to the NBC report the wait is as long as 18 months.   More startling is that our prisons are becoming detox facilities.  Most certainly you will detox in prison, but there is no support system in there for helping you find the tools to stay clean and put your life back together when you get out.

The shortage of rehab beds and the growing opiate and heroin epidemic have created a crisis in this country.  One that will have to be seriously addressed by the medical community, as well as our elected officials.  In the meantime, until a solution arises, I support referring patients who can’t get into rehab to a lower level of care such as an outpatient drug program.  Outpatient rehab is a temporary solution but right now next to getting into a rehab it’s the only real option for many addicts.

Look, it certainly isn’t the ideal solution, but it does offer the professional oversight and the support that is needed to help an addict start recovery.  These outpatient programs now allow for drugs like Subutex and Suboxone to be dispensed.  Before these two drugs were added to the outpatient treatment programs drugs like methadone could only be dispensed in specialized addiction treatment centers where you were admitted.

The FDA website confirms that “there are not enough addiction treatment centers to help all patients seeking treatment. Subutex and Suboxone are the first narcotic drugs available under the Drug Abuse Treatment Act (DATA) of 2000 for the treatment of opiate dependence that can be prescribed in a doctor’s office. This change will provide more patients the opportunity to access treatment.”

Subutex and Suboxone help with opiate addiction because they both contain the active ingredient, buprenorphine hydrochloride, which works to reduce the symptoms of opiate dependence.

The American Journal of Drug and Alcohol Abuse did a 2012 study that said that nationwide, only 11 per cent of substance abusers get help from treatment centers.  According to the study the primary reason that number is so low is because the wait time is too long.

The NBC story references another study that says “Even when people sign up for wait lists, they will only tolerate one month on average. 40 per cent of people on a wait list will drop off in two weeks, according to a 2008 study.” Click here for the full NBC Story “As Heroin Epidemic Grows, So Does Rehab Wait” by Charlie Giles, September 6, 2015.

If you have questions about rehab placement in the New York area please email me at drpaul@henrypaulmd.com.

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.

SIGNS YOUR TEEN IS TAKING CLUB DRUGS

June 12th, 2015

23564752_sThere are a lot of club drugs being used on the Rave dance scene. As a parent it is important to know what a Rave is (click here for more on that) and what drugs are available at Raves and the dangers of them. Rave clubs seem to be attracting adolescents and young adults in their mid-to-late 20’s to a place where there is plenty of dangerous substances and drugs. For a list of those drugs you can click here. Read on for the signs that your teenager may have taken club drugs and what you should do.

Signs that your teenager or loved one is using club drugs include:

  • Severe memory problems
  • Pronounced lack of coordination
  • Confusion
  • Depression
  • Chills and sweating
  • Slurred speech
  • Dizziness
  • Nausea
  • Bizarre speech or behavior
  • Fainting

What to do:

  • Most important is to let your teen know that you are informed about these drugs and let them know what the dangers are in detail.
  • Make sure you have a way to contact your teen when they go to a club, party or rave. Call them at regular intervals and set a curfew. Know where your child is going and with whom.
  • If your teen returns and appears to be under the influence of any drug, don’t scold but instead monitor the symptoms closely and if the symptoms appear to be severe seek medical help.
  • If drug use continues seek therapeutic and/or drug counseling. These drugs can be addictive.

Here is a link to the National Institute on Drug Abuse. There are also drug and substance abuse coalitions in many communities throughout the United States. Here are a couple that I found informative:

© Power To The Parent
Metropolitan Drug Commission

POPULAR RAVE DRUGS

June 10th, 2015

What substances are being used on the Rave dance scene? Rave clubs that seem to be attracting adolescents and young adults in their mid-to-late 20’s are known to be connected to a variety of substances and drugs. Here is a list of some of the most accessible and dangerous drugs often available at a rave.

4692114_sEcstasy is the most popular and well-known club drug. It is also referred to as “Molly”, E, X, “Adam” and “clarity”. It is a synthetic drug similar to amphetamines and mescaline (a hallucinogen). It both stimulates and causes psychedelic or hallucinogenic effects. It is most popular in a tablet or capsule form, and its effects typically last for three to six hours. It increases heart rate and blood pressure, and because it enables its user to dance all night, it often causes dehydration. Ecstasy can lead to heart and kidney disease, brain damage, and in rare cases can cause a marked muscle breakdown, high body temperature, heart attacks, strokes and seizures.

GHB (gamma hydroxybutyrate) is also known as “G”, liquid ecstasy, and “Georgia Homeboy”. It is a very common drug at Raves that is often made with mail-order ingredients. It is ingested as a liquid, powder, tablet or capsule. GHB is both a sedative and a euphoriant. This is a drug that effects the central nervous system causing its user to feel relaxed and sedated. At high levels, it can slow breathing and heart rate to dangerously low levels. Overdose with this drug can occur quickly and be fatal. GHB is often used with alcohol, and this can be a deadly combination.

Rohypnol, in the same family as Valium and Xanax, is known as the “forget me pill”.  It is usually taken orally and is easily slipped into drinks. Rohypnol is a popular date rape drug because it causes memory loss from the moment it is taken. It lowers blood pressure, causes dizziness and confusion, as well as urine retention.

Methamphetamine is known as speed, meth crystal, glass, “Tina” and “Chalk”. It is very common at Rave parties. It acts as a stimulant and causes memory loss, uncontrollable aggression and violence, psychosis and nerve damage. It is an extremely disinhibiting drug and its users frequently engage in unsafe sex that often exposes them to sexually transmitted diseases, such as HIV and Hepatitis C.

Ketamine, also known as “special k”, “vitamin K” and “new ecstasy” is also known as angel dust. It is similar to the dangerous drug PCP. It is sometimes snorted or smoked with marijuana or cigarettes. Some people inject it, too. It causes serious neurological, blood pressure and breathing problems.

LSD, familiar for decades, is also known as acid. It wreaks havoc with your perceptions, thoughts, and feelings. It is taken as a pill, liquid or on a saturated blotted paper. LSD can cause severe psychotic reactions that can last long afterwards.

I’ll discuss what to do if you suspect that your child is taking these drugs in my next blog.

My Teen Wants to Go to a Rave.  What’s a Rave?

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.

MY TEEN WANTS TO GO TO A RAVE! WHAT IS A RAVE?

June 5th, 2015

If you’ve got a teenager in the house than you need to know about “raves.” A rave party is typically an all-night, ear-splitting underground party that features electronic music. Ever heard of Daft Punk? Now Grammy Award winners, they got their start as a “rave” band.

23354899_sThese raves are held in places like warehouses, rental halls, barns, and open-air spaces where kids go crazy and, almost always, find drugs in abundance. The drugs available at raves may not be familiar to you, but they ought to be. Their effects are alarming and potentially life threatening.

The rave party phenomenon has been around for more than 20 years. It started in the UK and quickly spread to the US; particularly to the West Coast. It didn’t take long for it to spread across the country. The drugs offered at the raves primarily keep kids (yes, they are marketing to kids) energetic and dancing all night. Club drugs, as they are known, are dangerous, and parents need to know what they are and what the signs are that their kids may be taking them.

Most of the club drugs are made illegally, come from unknown sources, and are made with various mixes of unknown chemicals. On their own or mixed with alcohol and other drugs, they can be catastrophically toxic and sometimes fatal. Adding to their danger is that little is known about their toxicity making it difficult to treat overdoses.

Many of these drugs are colorless, odorless and tasteless posing a serious threat for young unsuspecting teens. Since some of these drugs cause amnesia, date rape and unrecalled sexual assault is one frequent outcome. Teens who take these drugs may often engage in risky sex that they don’t remember, and that exposes them to contracting sexually transmitted diseases including HIV and Hepatitis C.

Research has shown that club drugs have long-lasting effects on muscle tissue and the brain, especially memory functions. Combined with alcohol, as they often are at rave parties, their effects become potentially fatal. In 2013, there were four deaths linked to the club drug Molly. These deaths opened a nationwide dialogue about the use of illegal stimulants at concerts, raves and electronic dance music shows. It also shed some light on the music venues and the difficulties encountered by organizers to keep those substances out.

Last year, I wrote about the club drug Molly and its dangers. I will highlight some of the other drugs (cocaine, meth, LSD, etc.) that are popular with teens in my next blog. I’ll also discuss what to do if you suspect that your child is taking these drugs.

Learn more about Molly: 

Molly: Why the Club Drug is so Dangerous
Club Drug ‘Molly’ Eyed in Four Deaths
There’s Something about Molly

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.