Cotton Fever by Dr. Jana Burson

I can only copy what is best that I see, and Dr. Jana Burson do not stay behind.

Cotton Fever

Posted October 6, 2013 by janaburson in Cotton fever. Tagged: cotton fever. 2 Comments

An addict still using heroin recently asked me what “cotton fever” was, and how he could tell if he was sick with it.

Cotton fever is caused by bacteria commonly found on cotton plants, initially named Enterobacter agglomerans, later changed to Pantoea agglomerans. Most intravenous drug addicts filter heroin through cotton filters, to remove particles that could clog both their injection needle and their veins. Sometimes fibers of cotton break off from the filter, carrying the bacteria with it. These bacteria in the bloodstream cause fever and chills, but in a healthy person, this usually resolves on its own. It’s rare to see it cause serious infection. However, doctors still recommend addicts with cotton fever seek medical care and receive appropriate antibiotics, due to possible impairment of their immune system brought about by intravenous drug use. (1)

At least one study isolated an endotoxin produced by this Enterobacter bacteria, so it’s possible that the fever is actually caused by this toxin released from the bacteria and not from an actual infection.

Enterobacter species, while found in feces of both animals and humans, are also found in the plant world. Usually, these bacteria aren’t a particularly vicious, which is why they rarely cause sepsis (overwhelming infection) unless the individual has an impaired ability to fight infection. In the 1970’s, some medical products (blood, IV fluids) were found to be infected with this species, and caused significant infections, but this was probably due to a large amount of the bacteria infused into patients.

Cotton filters become more fragile with use, so addicts using new filters probably have a lower risk of cotton fever. After cotton filters are used, they remain moist and can become colonized with all sorts of bacteria, especially if they are kept warm, as happens when they are stored in a pocket, close to the body. These bacteria can cause infection when injected. Cotton filters can transmit hepatitis C and possibly other infections, if they are shared with other drug users. (2)

Filters also retain some of the injected drug, making them of some value in the world of intravenous addicts. It’s considered a gesture of generosity to offer another addict your “cottons” because the addict will get some small amount of the drug. (3)

Even in view of all of the above, it’s still better to use a filter than to use unfiltered heroin. A new cotton cigarette filter has been shown to remove up to 80% of particulates in heroin, and reduces the risk of thrombosis of the vein from particles. Other makeshift filters are made from clothing, cotton balls, and even tissue paper.

Syringe filters are manufactured for medical and laboratory use. They can be designed to filter particles down to 5 micrometers. Besides being more expensive and difficult to obtain, studies show these filters retain more of the drug than other makeshift filters, making them less desirable to some addicts. (2)

Cotton fever itself usually isn’t fatal. The biggest challenge is knowing if the addict has cotton fever or something worse, like sepsis. Sepsis is an infection of the blood stream, and even heart valves can become infected, causing serious and life-threatening problems.

I asked a former IV drug addict about his experience with cotton fever.

Me: What does cotton fever feel like?

Former Addict: You get a fever that kind of feels like withdrawal. You know there’s something bad wrong, and you don’t know what to do about it. I’ve laid on the floor and thought I was going to die. A lot of times people get it when they’re rinsing, and that means they’re coming down anyway. When the dope got short and I was rinsing cottons, that’s when I got it.

Me: How long does it last?

FA: It seems like it lasts a long time, but the intensity is bad maybe an hour or two. You shake, you sweat; it feels just like the flu.

Me: Ever go to the hospital with cotton fever?

FA: No, no! (said emphatically) I was usually wanted by the police. Only time I went to the hospital is with severe trauma.

Me: I don’t understand what you mean by rinsing.

FA: Rinsing’s when you squeeze that last little bit of drug out of the cotton [filter]. You rinse the spoon and cotton with a little water. I would save all my cottons. That was my rathole for when the dope ran out. I would actually load the cottons into the barrel of a syringe then draw water in to the barrel of syringe, then squeeze until they were bone dry. I squirted that on to a spoon, and used a new cotton to draw that into a syringe.

Me: Why do you use cotton filters? Do you use it with every drug you injected?

FA: I used cotton to strain any dirt that may be in the product, that might get up in the syringe. I didn’t want no dirt. Didn’t have to be cotton. [If you don’t use a filter, you] shoot a bunch of trash up in yourself, and get trash fever.

I used an itty bitty cotton. Some people would use a quarter of cigarette butt. That was wasteful to me. It got too saturated, could hold too much residue, or dope.

I didn’t have to use cotton with quarter gram morphine or Dilaudid. Not enough trash to stop it up. If there’s trash in the syringe, I used a cotton.

Thankfully, this person has been in recovery from addiction for more than fourteen years.

Recovery is the best way to avoid cotton fever. You never have to go through that again.

1. Rollinton, F; Feeney, C; Chirurgi, V; Enterobacter agglomerans-Associated Cotton Fever, Annals of Internal Medicine 1993; 153(20): 2381-2382.
2. Pates, R; McBride, A; Arnold, K; Injecting Illicit Drugs, (Oxford, UK, Blackwell Publishing, 2005) pp. 41-43.
3. Bourgois, Phillippe; Schonberg, Jeff; Righteous Dopefiend,(Berkeley, California, University of California Press, 2009) pp8-9, 83-84.

34 YEARS the Feds. say nothing less than measurable proof of therapeutic success would be acceptable

From "Coping with Psychiatric and Psychological Testimony", by Dr. David Faust,  and Jay Ziskin

If this was quoted in 1979 to psychologist in the monthly magazine the monitor.  Why are all
the Federal Agencies continue to promote pseudoscientifically procedures?  Patients have the
right to know, and we should cause a big fuzz and write to the directors and chiefs of this
federal agencies.  Perhaps I will make a list of emails for you all to write to them.


This Evidence Based treatment have fallen in deaf ears. In fact the first record I find is
in the Chief of what is not SAMHSA back in the 1970, for those who are interested I find the
reference..... In fact I just found it. it was a Dr. Gerald Klerman, in 1979 wrote to the American
Psychiatric Association in APA's magazine The Monitor November 1979 page 9. quoted as
saying that nothing less than measurable proof of therapeutic success would be acceptable
to the government. "One can not demonstrate the efficacy of therapy in terms of the
"INTENTION OF ITS PROPONENT... never can a therapy can be consider routine and
acceptable on the basis of testimony of authorities... it goes on.

Here is the whole article. If you want a copy of the actual "The APA Monitor this article came out in November 1979 I will be glad to do so. Please email me at worsetreatmentihad@gmail.com

Klerman Challenges Professions To Prove Therapy Works
Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) chief Gerald Klerman, addressing the annual meeting of the American Psychological Association in September, called on the mental health professions to take on the task of psychotherapy evaluation, noting that the promise of national health insurance and the consumer movement have led to a climate which demands more than custom as justification for reimbursement. Elaborating on an earlier speech in which he underscored the need,, to circumscribe legitimate mental health activity, Klerman told APA that nothing less-.than measurable proof of therapeutic success would be acceptable given the federal government's sizable and expanding role as a third-party payer. "We can attack the problem of defining boundaries in part by returning to the practical problem that many therapeutic methods are well intended; but poorly established in terms of safety, efficacy and economy. One cannot demonstrate the efficacy of a therapy in terms of the intentions of its proponents." "Neither can a therapy be considered routine and acceptable on the basis of the testimony of authorities--that is/ because outstanding •members of the profession are of the opinion that it is useful, safe and effective. I believe that only evidence as to outcomes will suffice in the rigorous climate of consumerism and health insuranc~ coverage."
Klerman pointed to the recently established National Center for Health Care Technology as a sign of the times. The center is currently evaluating 40 treatment methods for efficacy, including aversive drug treat- ment of alcoholism. "I view this as a possible prototype," Klerman said--"a 'shadow of the future.' Next year, evaluation of the efficacy of group treatment of family distress might be requested. Or of chlorpromazine for treatment of schizophrenia. Or Librium for sleep and anxiety." "The establishment of this center within a short time of the formation of the Health Care Financing Administration to tighten the federal reimbursement purse strings, in my view, makes it especially noteworthy," Klerman added. "As the federal third-party payer, HCFA dispenses dollars in the 'megabillion' range. It thus inevitably sets a tone which other reimbursers may follow." The public no longer accepts credentialing and licensure as sufficient guarantees of effective and safe service, Klerman said. "The new consumerism demands •a  new 10ok at these protections. It demands not just good training, but good services. It demands an evaluation not just of the state of the artist, but the state of the art .... If we don't respond, i~ will be brought upon us." W.H.


Please note that this article was written in 1979, that is over 34 years ago, and clinician continue to do their own thing and call it treatment.

Advice to Mental Health Clinicians (take it will you. Your patients lives depends on them

Advice for Mental Health Clinicians

Mark Willenbring, MD at Substance Matters: Science and Addiction - 2 weeks ago

A clinician recently sent me this email: *Dr. Willenbring,* * * *I read an article in the New York Times from early this year discussing Effective Addiction Treatment that in part highlighted your comments and Alltyr's mission to be a 21st century model for addictions treatment.* * * *As a therapist in an outpatient practice not specializing in addictions treatment--but who nevertheless encounters co-morbidity with substance abuse on a pretty regular basis--it can be confusing to know how to approach the psychosocial aspects of treatment. I believe in a multimodal approach for chron... more »

I also suggest that people read Drs. Scott O. Lilienfeld (Editor), William T. O'Donohue (Editor) book

"GREAT IDEAS of Clinical Science: 17 Principles that Every Mental Health Professional Should Understand"

This two guys and others have been trying (I think some times in vain  but they are making some headway, to me just do not seem to be fast enough) to convince clinicians to become scientist first and then practitioners. Suggest you follow them and if you get existed start reading the references study in the back of the books.

I got mind use and very good condition from ABebooks  http://www.abebooks.com/ (I don't get a toaster for announcing them, I do not care where you get the books  from)

Another one read by Scott is 

Brainwashed: The Seductive Appeal of Mindless Neuroscience [Hardcover]

 

too much rubbish being written about Neuroscience and this book ought to help you to be more critical about what is being said by Professionals who are extrapolating way beyond the data available.  I don't always agree with what they have to say but scoot specially is Definitely a clear thinker.

Your feedback and Statements are always. Welcome.

My statistics on this blog, shows that there is a fairly high rate of visits to this site. Since I opened it a years or so ago. I has had over 1,500 visits or so a year.  My stats do not state whether your are visiting by mistakes, or you are actually reading the articles. But I would surely welcome what
you have to say. Whether you agree with me or not. I try not to take my "believes" very seriously
although I take it with commitment to the improvement of.

I am in the process of reading a book that has been confirming quite a  bit of what I think about
our current Rehabilitation of Substance Use Treatment.  The book is "Inside Rehab.: The Surprising Truth About Addiction Treatment-and How to Get Help That Works" by Anne Flesher not written by
a professional but by an investigative reporter.  She is quite nice about some of the error that these
rehabilitation facilities are doing. I would be a lot more confrontative given the fact of the devastation that they can cause in patients lives. Too frequently some (not all of these) facilities make rules, regulations, and policies that are based for the facilities conveniences not for the best interest of the patients.  And they can do quite a bit of damage in individuals if they have not done it in large groups of people

So do me a favor, and react to some of these articles that I place in this blog. AS YOU MAY NOTE, not of all of the articles are written by me. I give credit and they are written by other sources.

How to switch from methadone to buprenorphine from Jonaburson's blog

How to Switch from Methadone to Buprenorphine (Suboxone)

janaburson at Janaburson's Blog - 4 days ago

I’ve helped about thirty or forty people switch from methadone to buprenorphine. Some were patients at my office, where I do office-based treatment with buprenorphine (formerly known as Suboxone or Subutex), and some have been patients at one of the two opioid treatment programs where I work. Most of the time, the transition goes smoothly; […]

Methadone Dosing: Use the Evidence

From: Janaburson's Blog


While Methadone and other medical replacement therapy has been badmouth by most if not
all member of organization like X Anonymous.  Methadone and Bupernorphine, for opiates
as well as Naltrexone for Alcoholics.
http://www.dpt.samhsa.gov/pdf/NTXWPFinalPDF.pdf
  Scientific evidence discoveries have shown that medication replacement therapy are substantially more effective (and safer) than Alcoholic Anonymous or Narcotics Anonymous. The animosity by members of these organizations is reprehensible given that they do not have any evidence except their own bias and poorly conceived opinions.

http://janaburson.wordpress.com/2013/07/07/methadone-dosing-use-the-evidence/

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Methadone Dosing: Use the Evidence

Posted July 7, 2013 by janaburson in Evidence-based Treatments, Methadone dosing. Tagged: methadone dosing. 7 Comments

methadone

The most successful opioid treatment programs and the most successful patients in those programs use evidence-based dosing of methadone. Many studies over the last 40 years show patients do better on adequate doses of methadone. They have better outcomes when they’re on enough methadone to block physical withdrawal signs and symptoms than when they’re on insufficient doses.
In the past, methadone clinics often had dose caps. Some clinics told their patients they didn’t need any more than 60 or 70mg of methadone per day. But over the last 40 years, we have multiple studies showing poorer outcomes at clinics with these low dose caps, as opposed to individualized dose determination. Numerous studies show higher drop-out rates in patients on doses less than 60mg, as well as more illicit opioid use and higher rates of HIV infection, as compared to patients on 100mg or more. For most patients, the blocking effect is seen in the neighborhood of 80 to 120mg of methadone per day. (In Tennessee, there are still dose caps. In that state, doctors have to get approval from a non-physician at the state’s Department of Mental Health to take a patient’s dose above 120mg.)
Patients vary widely the way they metabolize methadone. A patient with slow methadone metabolism may do best on 30mg of methadone per day, and a fast metabolize may need much more than 120mg per day. This rate of methadone metabolism is probably determined by our genetics. When patients ask me how much methadone they should be taking, my answer is, “Enough.” I’m not advocating taking doses higher than they need to be, but if the patient looks like they’re in withdrawal, and they feel like they’re in withdrawal, it’s best to take the dose up. We want to use the lowest effective dose.
There are still misguided opioid treatment programs that try to keep methadone doses low. Sometimes clinic staff can send shaming verbal or nonverbal messages, and imply patients who ask for an increase in their dose are somehow trying to get one over on the clinic. Staff shouldn’t shame patients who ask for a dose increase; staff should defer decisions about methadone dosing to their medical personnel.
Sometimes patients don’t want to increase their dose of methadone because they have mixed feelings about their treatment. If they feel guilty about being in a methadone program, they may want to keep their dose low. Sometimes family members, with the best of intentions, will demand the patient stay on a low dose, not understanding that their loved one is less likely to do well on an inadequate dose.
Frequently I see patients who are feeling bad, not sleeping, and achy all over in the mornings, and dosing at 40mg. I ask them if we can increase their dose, and they say something like, “No, I promised myself I wouldn’t go higher than 40mg.” Too often, patients don’t increase their dose for fear that coming off methadone will be harder to do at higher doses. This may be partly true. It may not be harder to come off of, but it take longer to taper off a higher dose. But the patient won’t do as well while they’re in treatment, so what’s the point?
Some patients prefer low doses because they want to have just enough methadone per day to keep them out of terrible opioid withdrawal, but not so much to block the euphoria they get from using an illicit opioid later in the day.
I tell patients that methadone is a little like chemotherapy. For chemo to work, you have to take a big enough dose to do the job. It’s the same way with methadone. It’s not a perfect analogy but patients get what I’m saying.
Let’s turn to the other side of dosing. I’ve seen some clinics with many patients on what I would consider very high methadone dosing. It’s hard to criticize, because I do think there are some patients who need doses higher than 250mg, particularly if they’re on certain medications, or are pregnant. But that’s rare, and at some clinics, many patients seem to be on these big doses. Since these patients have their dose increased slowly, they build a tolerance to the methadone, so such patients aren’t sedated. There’s no long-term damage to the body with very high dose methadone, but higher doses can cause some problems.
It may be hard for a patient on a very high dose to transfer to another clinic. Some methadone clinic medical directors are hesitant to accept a patient in transfer if they’re on 200-plus milligrams of methadone, unless there’s evidence that this dose is required. For example, I was looking over the records of a patient on 290mg, in preparation for transfer. This man was on no other medications and otherwise healthy. When I saw the peak and trough data, I was puzzled, because they were both high, and this was done at 200mg of methadone. So why was the patient taken to 290 milligrams? I know peak and trough levels aren’t the only factor to be considered when determining the right methadone dose, but there was scant information about why the doctor decided to raise the dose, or even if the patient had even seen the doctor recently. I wasn’t particularly concerned the patient would be sedated, because the dose had been raised slowly, over months. But I was concerned that the patient was on more methadone than he needed, especially since many of the patients at this clinic were on doses of more than 200mg per day.
Some studies have shown higher doses of methadone affect the way electrical impulses are transmitted through the heart. In some studies, higher methadone doses are more likely to produce prolongation of the QT interval than lower doses. (2) This QT prolongation does put patients at risk for a potentially fatal heart rhythm problem. The medical literature at present suggests that periodic EKG screening of patients on doses above 100mg is probably a good idea, but there’s still disagreement on this issue.
There is another factor to be considered. This may offend some readers, but we need to acknowledge the nature of addiction. It’s a disease who tells its sufferers, “More is better!” I think it’s important to acknowledge this point, and discuss it openly, but not in a shaming way. This psychological part of addiction doesn’t always go away within the first few weeks.
My approach to a patient on a relatively high dose, who desires an increase in methadone, is to meet with the patient, preferable prior to dosing. Sometimes I like to meet the patient two hours post-dose if I’m worried about sedation. I ask about withdrawal symptoms and check for pupil size and reaction, and other signs. I check the last drug screen. If the patient doesn’t describe withdrawal symptoms, and I don’t see objective signs of withdrawal, I’ll ask the patient how they expect to feel on an ideal dose of methadone, and if it’s possible their addiction is driving the desire to increase. I’m surprised that most patients aren’t offended, but welcome the opportunity to talk openly. Some patients say they honestly can’t tell if they are in withdrawal, or if their addiction tells them they are in withdrawal. My job is to help decide which it is.
Some patients feel “high” for the first few days after a dose increase, but tolerance builds quickly to this feeling. Some patients mistakenly believe they should always get that high after dosing. If the addiction is driving the patient’s way of thinking, the dose may never be “enough.” When I explain this to patients, most understand.
1. http://international.drugabuse.gov/sites/default/files/pdf/methadoneresearchwebguide.pdf
2. Krantz, Lewkowlez, Hays, et.al., “Torsade de Pointes Associated with Very-High Dose Methadone, Annals of Internal Medicine, Sept. 17, 2002, Vol 137(6) pp 501-505.

FREEEEEEE Suboxone Treatment in South Florida

If you live in South Florida or can get there for the number of times that are required by the researchers. There is a Suboxone Treatment starting now in June 2013. You receive the treatment by participating in the studies (and you get paid $500 instead of you paying for the treatment).The study is sponsor by a different pharmaceutical company, not Reckitt Benckiser Pharmaceuticals.

The researcher Segal Institute conduct approximately 300 multi-centered, so there maybe one research center near you that maybe doing the study. The pharmaceutical sponsor for this study is using a different variation of the initial formula. This formula ought to make the Buprenorphine Naloxone more effective and to last longer in the nervous system. To make an appointment in South Florida please call Segal Institute at 1 877 734 2588. When they answer the telephone and you tell them that you want to participate in the new Buprenorphine study, please also tell them that Franco referred you to the study and provided with this initial information. At the end of the number of weeks the studies, (I believe it is 40 but I will double check this number) having participated in the study will approve you for a longer participation. I believe that the sponsor is willing to provide participants with one year of Buprenorphine treatment.

Soon they are also preparing to do a study on medications for cocaine dependence. Perhaps this is the first medication for this ailment.

There are a number of other paid studies now available most of them in Mental Health and Substance Use treatment. When the list becomes available, the list will be made available here. And always tell the researcher that Franco referred you to the study. Let Franco know that you contacted the Segal Institute for Medical Trials. http://www.segaltrials.com there are also studies for Bipolar Disorder; Constipations due to use of Opiate Medication (such as methadone); If you are accepted into one of their studies, I will give you a tip if you informed them of my referring you to them. Please email contact Franco so that arrangements can be made. Franco33139ca@hotmail.com


(to be continuo)