Thursday, February 28, 2013

Surviving Over dose.

This is a YouTube video from Recovery Alliance. The amount of over dose in Florida is extremely high and dangerous. With the soon passing of Senate Bill 808 and House of Representative 735

These bills are sponsor by our Sen. Gwen Margolis, the House of Representative sponsors by Mark Pafford. This Naloxone will become part of the syringe exchange program.






Monday, February 25, 2013

What's Wrong With Addiction Treatment in America?

What's Wrong With Addiction Treatment in America?

From Dr. Mark Willenbring MD Substace Matter.

Since Jane Brody quoted me in her column in the New York Times, I've been inundated with calls, emails and other inquiries. Here are some themes, impressions and stories that help illustrate the gaps and barriers to receiving up to date, consumer-friendly, addiction treatment.

1. "He's been through treatment program after treatment program. None of them worked! And we still don't really feel he's had a good evaluation or any continuity of treatment."

This has been a very consistent experience reported by families of someone with an addictive disorder. There is a profound sense of being out there alone, in sharp contrast to having a relative with colon cancer. There is a great sense of fragmentation of care, as well as inconsistent opinions and recommendations. Because "programs" are arbitrarily time-limited, they have no ongoing responsibility of the care of their patients, unlike other medical specialities. How would you like it if your oncologist only saw you for 8 weeks, and then treatment ended? And once "the program" has ended, there is no care, no one to help you manage an out-of-control situation. And it's worse when "the program" is in a distant location. What is learned in an artificial, low-stress environment and now access to alcohol or drugs does not translate well when you get back home. The stacks of bills, the crying baby, the leaking roof, and the liquor store around the corner make it pretty difficult. Addiction is best treated like other disorders, with people living in their own communities, learning how to stay sober there, with everything that's going on.

2. "I (or my loved one) is in (or about to begin) a treatment program for drug X. But they don't seem to have the kind of treatments you talk about. Where can I get that kind of treatment?"

Many people I talk to are trying to figure out what type of treatment or treatment facility is going to be best for their particular problem. And they don't know where to get reliable information. Much of the information, practices and pronouncements are not supported by scientific studies, but that doesn't stop treatment programs from asserting them anyway. So the marketplace is confusing, not unlike walking through a market with each vendor hawking her wares. Testimonials and outrageous claims abound! Literally fantastic outcomes are assured! That's right! Step right up and submit your payment now! You won't be sorry! We promised 100% success if you do exactly as we tell you and you really want to succeed!

(So if you fail...'s your fault. Sorry.)

We need an ethic of professionalism in addiction treatment that at least reduces that type of selling of services. We need to embrace an ethic of adhering to scientific findings, and changing our beliefs when the facts change. We need to foster the humility to care, even though our treatments are only partially effective, and in some cases totally ineffective. We can't abandon our patients because we cannot change the course of their illness. Do you really think they want to die? They don't! But they and we are helpless in the face of their brain dysregulation. As is true with so many human ailments: cancer, heart disease, stroke, diabetes, depression, arthritis, multiple sclerosis. As our understanding of these diseases advances, through scientific research, our tools for preventing and treating them will improve. But it will cost a lot and take a long time. But our only hope is to support it. Research on addictions and their treatment.

Fresh NEWS in Florida SB 808 and HR735

I received the news from the Florida Medical Association:

The Florida Medical Association on the syringe exchange legislation proposed for the 2013 legislation session. The bills are HB 735 by Rep. Mark Pafford and SB 808 by Sen. Gwen Margolis. At this point, session officially begins next Tuesday. The House and Senate bills received their committees of reference last week. Unfortunately, both received 4 committee assignments each which isn’t a great sign but not totally unsuspected either. The main hurdle at this point is getting the bills heard in their first committees of reference.

Email Gwen Margolis
and  Mark Pafford

Thanks them let them know that substance use treatment requires quality assurance like expected of all other medical services.

My response:

I have a grave concern, which I would like to see how it can be incoporated in the bill. That is need for quality assurance. It is unfortunately but substantial number of professionals in social science has been ignoring both ethics and appropriate medical protocol and best practice. Often taking upon them to create policies and practices that is inconsistent with the best interest of their clients or patients, mostly for their own convenience.

As you may know by now, that has been a great concern of late Dave Purchase who just passed away, and numerous professionals associated with the harm reduction practice. We are all very concern to assure scientifically based practices which has been ignored by the Substance Use Disorder treatment community. This professionals seem to think that they do not need to follow the same scientific standards expect of all other medical fields. You might have received from NASEN documents associated with science and best practice. If you do not have them, I can provide them to you as they have given me the courtesy of sending me copies.

As you might know, syringe exchange will only but one service. This could be the opening to health system to a disfranchised population that we have been everything but ignoring, discriminate, stigmatized and even acted with bigotry. I assert that this manner of acting toward these individuals is consistent with racism.  Perhaps this is the reason that we are not making much head way with appropriate treatment of this population.

I am concern for patient’s safety and rights, and to tell you the truth neither the State of Florida Depatment of Children and Family who are suppose to license the facilities nor the treatment  facilities seem to be joyfully oblivious to the needs of this type of patients. Their professional behavior is more consistent with self-preservation and convenience than patient’s needs.

What we call substance abuse residential "treatment" today is only so by long term declaration, and is not supported by quantitative empirical research. As far as I Know it is neither effective and I suspect (without any data) that it causes relapse and possibly other bad habit. I like to avoid stating patients safety and syringe exchange program by people who have political and funding sources but not the require appropriate medical skills to provide quality assurance work. Unfortunately, having an education and a license is not guaranteeing it.

I also have copies of a draft of a bill that is being worked in North Carolina. As far as I can tell me and
have been the only two underground clean syringe programs in South Florida and doing our best at providing safe syringe and information.

I will look for the bills and see what suggestion or respond further.

Friday, February 22, 2013

In Memoriam: Dave Purchase, Needle Exchange Pioneer

From Stop

Needle exchange pioneer Dave Purchase died last month in Tacoma, Washington, where he had long resided and where he began handing out sterile syringes to prevent the spread of AIDS among intravenous drug users back in the summer of 1998. Purchase died on January 21 of complications from pneumonia. He was 73.
Dave Purchase
Purchase is widely cited as having started the first needle exchange in the country, although that is difficult to verify.

While the most dominant treatment use in the United States is a violation of the 1st Amendment of

the constitution as 7 court cases concluded that the 12 Steps of Narcotics Anonymous is substantially religious. Fact is that there is no scientific support for the 12 Step programs that are so forcefully pushed on patients with an extremely low rate of "recovery".

Comparably, syringe exchange program makes a point of evidence based on science, and Dave Purchase have created protocols and best practice documentation to run these programs. Unfortunately some of this Syringe Exchange programs are not all together scientifically base and make their policies and regulations and treatment protocols basically on capriccios speculations. Harm Reduction have put their nose to the grind where science is concern. They will make mistakes, but will take correction when needed. That is one of the signs of good science, another is bending themselves backwards proving themselves wrong.

'Good Samaritan' Laws Could Help Overdose Victims—If Only People Knew They Existed

'Good Samaritan' Laws Could Help Overdose Victims—If Only People Knew They Existed

I Have yet to see one newspaper or a Television or radio station mentioning this new law where they exist. People are being informed by word of mouth and people are still hessitent. We really need to get the media on the ball to save some lives.

In New York and other states, drug users are supposed to be granted immunity when they call 911 to save their friends' lives. But the police and the public have yet to get the message.

Number of Deadly Drug Overdoses Rises for 11th Year

This article comes from Joint Together a web based newletter.
The number of deadly drug overdoses in the United States increased for the 11th consecutive year, according to new government data. More than 22,000 people died of overdoses involving

Sunday, February 10, 2013

Treatment for Opiate Dependent individuals

You can get a copy of this TIP43 by calling 1-877-726-4727

The State Methadone Treatment Guidelines

Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs

Treatment Improvement Protocol (TIP) Series, No. 43

Center for Substance Abuse Treatment.
Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005.
Report No.: (SMA) 05-4048

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Order print copy from SAMHSA

This TIP, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, incorporates the many changes in medication-assisted treatment for opioid addiction (MAT) that have occurred over the most active decade of change since the inception of this treatment modality approximately 40 years ago. The TIP describes the nature and dimensions of opioid use disorders and their treatment in the United States, including basic principles of MAT and historical and regulatory developments. It presents consensus panel recommendations and evidence-based best practices for treatment of opioid addiction in opioid treatment programs (OTPs). It also examines related medical, psychiatric, sociological, and substance use disorders and their treatment as part of a comprehensive maintenance treatment program. The TIP includes a discussion of the ethical considerations that arise in most OTPs, and it provides a useful summary of areas for emphasis in successfully administering MAT in OTPs.

Friday, February 1, 2013

Emergency Room because of Buprenorphine

This article comes from an email I received from

I have not yet, evaluated this article using my critical thinking skills I learned by reading Critical Thinking About Research: Psychology and Related Professions, written by Dr. Julian Meltzoff  I highly recommended to advocates, patients and professionals who wants to improve their skills as consumers of research documents in psychology and related professions (i.e. social worker, counseling, psychiatric nurse, etc). 
This is not a book on research design or high level statistics. I consider it a book of concepts 
and ways of evaluating scientific documents.  I am alarmed by the little number of professionals that actually understand Evidence Based Treatment (which really means Scientific Researched modalities for validity and reliability.  Clinicians in mental health know next to nothing about science.  They sound like they do by throuhing around some statistics and using buzzwords and impressive language. But in close examination, I have come to realized they are actually in full of rubbish (to put it mildly).  Another book that open my eyes on this Evidence Based Treatment movement, which I see may clinicians holding it or taking it as if it was another fad. Which is actually how they now practice. Clinicians are currently practicing by fads and agreement not by evidence. The other book is "Whores of the Courts: Fraud of Psychiatric Testimony and the Rape of American Justice by Dr. Margaret A. Hagen. both books are not fad, but the a growing number of scientifically based well researched, cited and documented record of the practice of a health system going nuts. Ignoring not only the science they claim to practice but the critical Code of Ethics necessary for the welfare of their patients.
Clinicians are actually joyfully oblivious to the harm they are producing to substance use and mental health patients. Unfortunately it is not an exception, but a rule, the conditions are prevalent not only a few examples.

Please help me think about this article, and make some comments on what you read.

Emergency departments reported a significant rise in the number of visits related to the opioid addiction medication buprenorphine between 2005 and 2010, according to a new government report.