Attached a letter to the editor sent to the Miami Herald, Sun Sentinel and SunPost in response to their articles about prescription drug abuse.
LETTER
Prescription opioid use and dependence reached a record high threatening the public health of our society.
North America, with 4 percent of the world population consumes more than 50 percent of the world's supply of morphine and narcotic prescription drugs! It is unlikely that Americans suffer from an opioid deficiency syndrome but are using them for any aches or pains for which those drugs are not intended for.
The prescription of those drugs are strictly regulated by the Drug Enforcement Administration (DEA) but they can be easily obtained from unscrupulous black marketeer selling those drugs via the Internet, drug dealers and also from self-declared pain specialists, better described as " drug dealers in white coats", who advertise their services on backpages of local newspapers.
Many doctors who appropriately prescribe pain medications are caught between the regulatory scrutiny of law enforcement agencies, and the demands of their patients for immediate pain relief. Most of us rely on the information supplied by the patient and cannot verify the accuracy of the information. Those doctors are then blamed for an overdose death and as a result are increasingly reluctant to issue pain medications.
Therefore, we need to built in safe guards to protect physicians and patients by creating a state-wide prescription drug database to identify and to curb narcotic prescription drug abuse. Such legislation would save countless lives and protect physicians and patients who legitimately require appropriate pain management modalities. The legislation should also include the narcotic pain medications dispensed in doctors offices. Otherwise, doctor shoppers will use those pill mills in medical practices to feed their addiction.
Bernd Wollschlaeger,MD
President of the Florida Society of Addiction Medicine
16899 NE 15th Avenue
North Miami Beach,L 33162
Phone: 305-940-8717
Thursday, December 27, 2007
Prescription Drug Abuse in the News
Attached another article from a local newspaper regarding the prescription drug abuse.
According to the Florida Department of Law Enforcement I2007 Interim Report Prescription drugs (76%) are found to dominate at lethal levels when compared to illicit drugs (24%). Prescription drugs are also found to be the majority of non-lethal occurrences at 64% in contrast to illicit drugs at 36%. The prescription drugs tracked in this report are: all Benzodiazepines, Carisoprodol/Meprobamate, and all Opioids except Heroin.
As an organization we need to speak up and especially point the finger on those "drug dealers in white coat" aka our fellow colleagues, who run lucrative pill mills that readily supply drugs to anyone who is willing to pay.As long as we hesitate calling them what they are, drug dealers, we will NOT address the problem.
The silence of the medical profession will encourage those " doctors" to continue their business.
Now its time to speak up!
Yours
Bernd
SUNPOST 12/20/07
Prescription for Death
Prescription drugs claim more lives than cocaine and heroin combined
By Angie Hargot
Photo illustration by James Wilkins
Florida corpses are telling a disturbing tale — and they’re using terms like blow, smack or meth less often than harder-to-pronounce, and more deadly, prescription drugs.
Prescription drug use isn’t just increasing in Florida — it’s killing nearly three times more people than cocaine, heroin and methamphetamines combined, in part because of a growing supply of street pharmaceuticals.
In the first six months of this year, cocaine, heroin and methylated amphetamines caused the deaths of 470 people statewide, while the five most commonly prescribed painkillers and tranquilizers caused 1,324 deaths, according to a Florida Department of Law Enforcement report detailing drug use identified by state medical examiners during autopsies.
Cocaine, the state’s deadliest substance, killed 398 people statewide, while heroin killed 38 and methylated amphetamines killed 34, according to the report.
However, during the same time period, methadone, a drug often prescribed to heroin addicts, killed 392 people; benzodiazepines, which include widely prescribed tranquilizers such as Valium and Xanax, 353; oxycodone, commonly sold as OxyContin, 323; hydrocodone, a painkiller often prescribed as Vicodin and Lortab, 134; and morphine, 122.
“We’ve become a medicated society,” said Howard Lerner, clinical director of South Miami Hospital’s substance abuse treatment program. “Ten years ago, we never saw drugs marketed on TV. Now they’re selling them like McDonald’s hamburgers. The availability is a progression of the numbers. Many more people are attracted to it.”
‘Lethal Levels’
Of the 87,500 people who died in Florida between January and June, medical examiners detected drugs in the systems of 3,980 corpses at the time of autopsy — nearly 5 percent more than in the second half of 2006, according to the Dec. 4 report.
Yet prescription drugs, which “dominate at lethal levels when compared to illicit drugs,” accounted for 69 percent of all the drugs found at autopsy — 2 percent more than in the previous six-month period, according to the report.
“In general, there is certainly an increase across the board” in prescription drug use and abuse, Lerner said. “Because of an increase in marketing, there’s a lot more usage. “Younger people are selling them on the streets.”
That doesn’t mean illicit street drugs more commonly associated with overdoses aren’t still killing plenty of Floridians, either directly or indirectly.
Take cocaine, for example. Medical examiners detected various amounts of cocaine in 1,008 corpses statewide, of which it killed 398. Yet, 13 percent of the 610 who died with nonlethal levels of cocaine in their systems were homicide victims.
In Miami-Dade County, the narcotic was found during 84 autopsies and caused 16 deaths.
“The leading causes of death in this country are all drug-related — alcohol, murder …,” said Jay M. Holder, a board-certified addictionologist who runs the Exodus Treatment Center in Miami.
In fact, 57 percent of the 59,000 people arrested by the Miami-Dade County Narcotics Bureau in the last year had records of violent crimes and robberies. Even more had theft and burglary records, said Major Charles Nanney, whose bureau polices everything from marijuana grow houses to a burgeoning MySpace market for MDMA, more commonly known as ecstasy.
“There is a crime-drug nexus,” Nanney said. “The main use is still cocaine and heroin. Twenty-five years ago a kilo of coke was $50,000. Now the price is lower.”
Rx Factor
Still, the growing number of prescription-related deaths has garnered much concern among government and law enforcement officials, as well as substance abuse counselors. The problem, according to Nanney, “comes down to availability.”
There’s no doubt the findings are troubling.
“We have seen an increase in prescription drug deaths in recent years,” FDLE spokesperson Kristin Perelluha said.
Although heroin, which killed 84 percent of the 45 people with the drug in their systems, topped the list of the state’s most lethal drugs — those that caused death in more than 50 percent of people in which it was found — methadone, oxycodone and fentanyl followed closely behind.
Methadone, which is often prescribed to treat the pain associated with heroin withdrawal, caused the deaths of 354 more people than heroin statewide. It killed 392 — nearly 74 percent — of the 533 people in whom the substance was found. Methadone was found in eight Miami-Dade decedents, of which it killed three.
The report also noted a 5 percent increase in the use of benzodiazepines, the most widely prescribed and detected prescription drug. Benzodiazepines killed 353 — 30 percent — of the 1,167 people in whom it was found, including 260 from alprazolam alone, which is often sold under the trade names Xanax and Niravam.
“What we’re seeing is the same individuals with cocaine and heroin addiction, now also with a whole litany of prescription drugs,” Holder said, adding that time-released medications are particularly dangerous when mixed with alcohol. “OxyContin is very powerful. An addict will chew that, and it’s 100 percent absorbed immediately, bypassing the time-release.”
Use of oxycodone, the painkiller often marketed under the brand name OxyContin, increased 9 percent from last year, killing 323 — about 57 percent — of the 568 people in whom the substance was found, including six of nine in Miami-Dade. The pills sell for $20 to $30 each on the street, said Nanney, who, in his 20 years of service, has arrested several doctors for selling OxyContin prescriptions.
“There has been a crackdown on oxycodone and OxyContin,” Lerner said, adding that prescriptions often fall into the hands of some abusers who go “doctor shopping,” frequenting different doctors and getting prescriptions for pain medications from each of them. That tactic can also lead to overdoses even for those prescribed the medication for genuine ailments. Taking them with alcohol can cause respiratory failure, for example.
The street pharmaceutical market also carries a unique problem: dosing. “It’s not logical,” Nanney said. “Someone might know ‘I can take this much cocaine,’ for example, but the same size pill could be 20 mg or 40 mg. It’s easy to overdose.”
Hydrocodone, a painkiller prescribed under the brand names Vicodin and Lortab, caused the deaths of 134 users statewide, though it was found in 380 bodies. It killed one of two deceased Miami-Dade users.
Morphine, another painkiller, killed 122, or nearly half of the 280 deceased users statewide, and half of the 10 users in Miami-Dade.
Fentanyl, a pain reliever sold under the name Actiq, which is 80 times more potent than morphine and often administered via a mouth swab or lollipop to facilitate speed of absorption, killed more than half of the 103 people who had it in their systems.
Many hospitals have recently pushed to better control the prescription of opiates, Lerner said, the use of which continues to increase. Medical examiners detected a 27 percent increase in one opiate-based painkiller, hydromorphone, which is two to eight times stronger than morphine and marketed under the trade name Dilaudid.
Some of these drugs, Lerner said, are sold by unethical doctors who “open clinics to distribute meds to anyone who has the money to pay for them.”
Both Holder and Lerner, who mostly counsel patients for cocaine and alcohol problems, said that they also see patients with addictions who are taking prescription drugs according to their doctor’s instructions, who prescribed them without asking enough questions about the indicators of a possible addiction.
Behind the Eight Ball
Still, Florida is one of few states that does not track prescriptions. So far, 35 states have passed legislation to create prescription monitoring systems, with at least 24 of them already in use. The Florida Legislature has routinely rejected similar efforts for the last six years, citing privacy issues.
However, some state lawmakers now want to implement a pilot program that would create a $1.6 million computerized monitoring system to track painkiller prescriptions in Broward County. The proposed system, which would be funded with private money and federal grants, would keep patient medication records that could be accessed by doctors, pharmacists, patients, law-enforcement agencies and the Agency for Health Care Administration.
“If you open the New Times and look at the local ads, a significant percentage are pain management clinics that even specifically say ‘OxyContin’ in their ads,” Holder said. “Basically they are saying, ‘Come get your prescription.’ What’s killing people may not be the drugs, but the doctors that give patients the drugs.”
Comments? E-mail angie@miamisunpost.com.
According to the Florida Department of Law Enforcement I2007 Interim Report Prescription drugs (76%) are found to dominate at lethal levels when compared to illicit drugs (24%). Prescription drugs are also found to be the majority of non-lethal occurrences at 64% in contrast to illicit drugs at 36%. The prescription drugs tracked in this report are: all Benzodiazepines, Carisoprodol/Meprobamate, and all Opioids except Heroin.
As an organization we need to speak up and especially point the finger on those "drug dealers in white coat" aka our fellow colleagues, who run lucrative pill mills that readily supply drugs to anyone who is willing to pay.As long as we hesitate calling them what they are, drug dealers, we will NOT address the problem.
The silence of the medical profession will encourage those " doctors" to continue their business.
Now its time to speak up!
Yours
Bernd
SUNPOST 12/20/07
Prescription for Death
Prescription drugs claim more lives than cocaine and heroin combined
By Angie Hargot
Photo illustration by James Wilkins
Florida corpses are telling a disturbing tale — and they’re using terms like blow, smack or meth less often than harder-to-pronounce, and more deadly, prescription drugs.
Prescription drug use isn’t just increasing in Florida — it’s killing nearly three times more people than cocaine, heroin and methamphetamines combined, in part because of a growing supply of street pharmaceuticals.
In the first six months of this year, cocaine, heroin and methylated amphetamines caused the deaths of 470 people statewide, while the five most commonly prescribed painkillers and tranquilizers caused 1,324 deaths, according to a Florida Department of Law Enforcement report detailing drug use identified by state medical examiners during autopsies.
Cocaine, the state’s deadliest substance, killed 398 people statewide, while heroin killed 38 and methylated amphetamines killed 34, according to the report.
However, during the same time period, methadone, a drug often prescribed to heroin addicts, killed 392 people; benzodiazepines, which include widely prescribed tranquilizers such as Valium and Xanax, 353; oxycodone, commonly sold as OxyContin, 323; hydrocodone, a painkiller often prescribed as Vicodin and Lortab, 134; and morphine, 122.
“We’ve become a medicated society,” said Howard Lerner, clinical director of South Miami Hospital’s substance abuse treatment program. “Ten years ago, we never saw drugs marketed on TV. Now they’re selling them like McDonald’s hamburgers. The availability is a progression of the numbers. Many more people are attracted to it.”
‘Lethal Levels’
Of the 87,500 people who died in Florida between January and June, medical examiners detected drugs in the systems of 3,980 corpses at the time of autopsy — nearly 5 percent more than in the second half of 2006, according to the Dec. 4 report.
Yet prescription drugs, which “dominate at lethal levels when compared to illicit drugs,” accounted for 69 percent of all the drugs found at autopsy — 2 percent more than in the previous six-month period, according to the report.
“In general, there is certainly an increase across the board” in prescription drug use and abuse, Lerner said. “Because of an increase in marketing, there’s a lot more usage. “Younger people are selling them on the streets.”
That doesn’t mean illicit street drugs more commonly associated with overdoses aren’t still killing plenty of Floridians, either directly or indirectly.
Take cocaine, for example. Medical examiners detected various amounts of cocaine in 1,008 corpses statewide, of which it killed 398. Yet, 13 percent of the 610 who died with nonlethal levels of cocaine in their systems were homicide victims.
In Miami-Dade County, the narcotic was found during 84 autopsies and caused 16 deaths.
“The leading causes of death in this country are all drug-related — alcohol, murder …,” said Jay M. Holder, a board-certified addictionologist who runs the Exodus Treatment Center in Miami.
In fact, 57 percent of the 59,000 people arrested by the Miami-Dade County Narcotics Bureau in the last year had records of violent crimes and robberies. Even more had theft and burglary records, said Major Charles Nanney, whose bureau polices everything from marijuana grow houses to a burgeoning MySpace market for MDMA, more commonly known as ecstasy.
“There is a crime-drug nexus,” Nanney said. “The main use is still cocaine and heroin. Twenty-five years ago a kilo of coke was $50,000. Now the price is lower.”
Rx Factor
Still, the growing number of prescription-related deaths has garnered much concern among government and law enforcement officials, as well as substance abuse counselors. The problem, according to Nanney, “comes down to availability.”
There’s no doubt the findings are troubling.
“We have seen an increase in prescription drug deaths in recent years,” FDLE spokesperson Kristin Perelluha said.
Although heroin, which killed 84 percent of the 45 people with the drug in their systems, topped the list of the state’s most lethal drugs — those that caused death in more than 50 percent of people in which it was found — methadone, oxycodone and fentanyl followed closely behind.
Methadone, which is often prescribed to treat the pain associated with heroin withdrawal, caused the deaths of 354 more people than heroin statewide. It killed 392 — nearly 74 percent — of the 533 people in whom the substance was found. Methadone was found in eight Miami-Dade decedents, of which it killed three.
The report also noted a 5 percent increase in the use of benzodiazepines, the most widely prescribed and detected prescription drug. Benzodiazepines killed 353 — 30 percent — of the 1,167 people in whom it was found, including 260 from alprazolam alone, which is often sold under the trade names Xanax and Niravam.
“What we’re seeing is the same individuals with cocaine and heroin addiction, now also with a whole litany of prescription drugs,” Holder said, adding that time-released medications are particularly dangerous when mixed with alcohol. “OxyContin is very powerful. An addict will chew that, and it’s 100 percent absorbed immediately, bypassing the time-release.”
Use of oxycodone, the painkiller often marketed under the brand name OxyContin, increased 9 percent from last year, killing 323 — about 57 percent — of the 568 people in whom the substance was found, including six of nine in Miami-Dade. The pills sell for $20 to $30 each on the street, said Nanney, who, in his 20 years of service, has arrested several doctors for selling OxyContin prescriptions.
“There has been a crackdown on oxycodone and OxyContin,” Lerner said, adding that prescriptions often fall into the hands of some abusers who go “doctor shopping,” frequenting different doctors and getting prescriptions for pain medications from each of them. That tactic can also lead to overdoses even for those prescribed the medication for genuine ailments. Taking them with alcohol can cause respiratory failure, for example.
The street pharmaceutical market also carries a unique problem: dosing. “It’s not logical,” Nanney said. “Someone might know ‘I can take this much cocaine,’ for example, but the same size pill could be 20 mg or 40 mg. It’s easy to overdose.”
Hydrocodone, a painkiller prescribed under the brand names Vicodin and Lortab, caused the deaths of 134 users statewide, though it was found in 380 bodies. It killed one of two deceased Miami-Dade users.
Morphine, another painkiller, killed 122, or nearly half of the 280 deceased users statewide, and half of the 10 users in Miami-Dade.
Fentanyl, a pain reliever sold under the name Actiq, which is 80 times more potent than morphine and often administered via a mouth swab or lollipop to facilitate speed of absorption, killed more than half of the 103 people who had it in their systems.
Many hospitals have recently pushed to better control the prescription of opiates, Lerner said, the use of which continues to increase. Medical examiners detected a 27 percent increase in one opiate-based painkiller, hydromorphone, which is two to eight times stronger than morphine and marketed under the trade name Dilaudid.
Some of these drugs, Lerner said, are sold by unethical doctors who “open clinics to distribute meds to anyone who has the money to pay for them.”
Both Holder and Lerner, who mostly counsel patients for cocaine and alcohol problems, said that they also see patients with addictions who are taking prescription drugs according to their doctor’s instructions, who prescribed them without asking enough questions about the indicators of a possible addiction.
Behind the Eight Ball
Still, Florida is one of few states that does not track prescriptions. So far, 35 states have passed legislation to create prescription monitoring systems, with at least 24 of them already in use. The Florida Legislature has routinely rejected similar efforts for the last six years, citing privacy issues.
However, some state lawmakers now want to implement a pilot program that would create a $1.6 million computerized monitoring system to track painkiller prescriptions in Broward County. The proposed system, which would be funded with private money and federal grants, would keep patient medication records that could be accessed by doctors, pharmacists, patients, law-enforcement agencies and the Agency for Health Care Administration.
“If you open the New Times and look at the local ads, a significant percentage are pain management clinics that even specifically say ‘OxyContin’ in their ads,” Holder said. “Basically they are saying, ‘Come get your prescription.’ What’s killing people may not be the drugs, but the doctors that give patients the drugs.”
Comments? E-mail angie@miamisunpost.com.
Sunday, November 4, 2007
Pain and Addiction in the news
Dear Friends and Colleagues:
Attached you find an e-mail from Dr. Andrea Trescot and a link to a congressional hearing "NASPER: Why Has the National All Schedules Prescription Electronic Reporting Act Not Been Implemented?"
I am very proud of Dr. Trescots accomplishments and was honored working with her on the FMA Pain Journal http://www.fmaonline.org/education/PainJournal2006.pdf project which was forwarded to the committee members.
We all need to work together to stop the epidemic of pain medication abuse. Why do US citizens who comprise 4% of the world population consume >90% of the worlds Hydrocodone supply!!!!!
Now is time to act to take measures to stop the rampant abuse of pain medications without jeopardizing the access to medications of those in need.
FSAM will participate in an outreach program to educate physicians from other specialty societies about this issue.
We need to work together and make change happen.
Yours
Bernd
===========================================================================
> My testimony before the House Committee on Energy and Commerce can be found at http://energycommerce.house.gov/cmte_mtgs/110-oi-hrg.102407.NASPER.shtml.
> The full download is about an hour and a half; my testimony starts about 1:20. After my 5 minute statement, you will hear the questions by Rep Whitfield, who holds the journal up for the cameras. A copy of the journal may be going to the White House.
Attached you find an e-mail from Dr. Andrea Trescot and a link to a congressional hearing "NASPER: Why Has the National All Schedules Prescription Electronic Reporting Act Not Been Implemented?"
I am very proud of Dr. Trescots accomplishments and was honored working with her on the FMA Pain Journal http://www.fmaonline.org/education/PainJournal2006.pdf project which was forwarded to the committee members.
We all need to work together to stop the epidemic of pain medication abuse. Why do US citizens who comprise 4% of the world population consume >90% of the worlds Hydrocodone supply!!!!!
Now is time to act to take measures to stop the rampant abuse of pain medications without jeopardizing the access to medications of those in need.
FSAM will participate in an outreach program to educate physicians from other specialty societies about this issue.
We need to work together and make change happen.
Yours
Bernd
===========================================================================
> My testimony before the House Committee on Energy and Commerce can be found at http://energycommerce.house.gov/cmte_mtgs/110-oi-hrg.102407.NASPER.shtml.
> The full download is about an hour and a half; my testimony starts about 1:20. After my 5 minute statement, you will hear the questions by Rep Whitfield, who holds the journal up for the cameras. A copy of the journal may be going to the White House.
Monday, October 29, 2007
FSAM: Where Are We Today?
Dear Friends and Colleagues:
I just returned from an ASAM Chapter Council meeting (10/27-10/28/07) in Washington and want to share some of my observations and thoughts with you.
Almost thirty representatives from eleven state, two regional chapters and one international chapter were present for the two-day meeting.
With 136 chapter members Florida has met its 2007 recruitment goal - more can be achieved - and now ranks No.3 after California and New York.
Among others we discussed:
1) MAKING OF OUR MEDICAL SPECIALTY: hopefully, most of you know that ASAM has founded the American Board of Addiction Medicine (ABAM) and has created the 14-member Medical Specialty Action Group, yours truly included, to select specialty directors to serve on the new board. This is a tedious and long process but we anticipate that within 3-15(?) years we will have established the specialty of addiction medicine. We heard a detailed report by Kevin Kunz regarding the progress made and please contact me for further details.
2) PARITY ISSUES: Ken Roy provided us with a superb overview of the status of two bills in the House (HR 1424) and Senate (S 558) and he outlined the pros and cons of both versions. At this point in time ASAM is pleased that both chambers of congress deal with the issues of Mental Health and Addiction Treatment parity. ASAM prefers and supports the House version and is concerned about the many flaws contained in the Senate version. If those bills pass both chambers of congress they will be discussed in the conference committee to find a compromise version. We will keep you posted about the progress made.
3) ADOPT A RESIDENCY: Norm Wetterau presented a program that intends to improve the education in primary care regarding addiction medicine related issues by adopting a residency program to precept student, train faculty and to help make changes in the residency that would improve treatment of addictive diseases. Some of you may already pursue similar activities and I suggest that we all pool our experience and resources to improve the outcome of our efforts.
4) CAPITOL CAMPAIGN: develop a program that will raise funds to support ABAM, Parity efforts, he work of the chapters council and other projects. We also heard a presentation from a consultant group in Washington how to obtain federal funds to finance and support projects on state and national level. I will forward more detailed information and a project proposal, which we should submit for funding through federal earmarks. Project examples could include substance abuse counseling at schools, specific substance abuse counseling and treatment programs etc.
I also want to remind you that I persistently pursue the realization of the following goals set by my person at the beginning of my presidency:
1.Reorganize FSAM as a full-service membership organization promoting the interest of healthcare professionals involved in addiction care, research and treatment.
STATUS: Formation of a membership committee (pending) and development of a recruitment and retention program. VOLUNTEERS WANTED!!
2.Promote excellence of care in addiction medicine through education and training of physicians and other allied healthcare professionals.
STATUS: We develop and prepare an enhanced and improved annual meeting.
3.Achieve cooperative relationships with other medical specialties to foster the integration of screening and intervention modalities in patient care.
STATUS: All THREE FSAM resolution submitted at the FMA Annual meeting (Parity included) passed including SBI efforts to be supported by the FMA.
4.Create a FSAM Political Action Committee (PAC), educate political decision makers about the importance of sustainable funding mechanism for community based addiction treatment modalities and advocate for the promotion of addiction care and research in primary care.
STATUS: PENDING. VOLUNTEERS NEEDED. We have developed a close working relationship with a legislator (Florida House Representative Ed Homan) who has introduced a Metal Health Parity bill in the House. We not only need to support him verbally but also FINANCIALLY!!!
5.Establish a planning committee to design a strategic plan outlining the vision of our organization for a statewide drug control and treatment program.
STATUS; PENDING. IDEAS? VOLUNTEERS?
PLEASE CONTACT ME VIA E-MAIL info@miamihealth.com or PHONE (305)940-8717 FOR MORE INFORMATION, YOUR QUESTIONS OR SUGGESTIONS.
YOURS
Bernd
I just returned from an ASAM Chapter Council meeting (10/27-10/28/07) in Washington and want to share some of my observations and thoughts with you.
Almost thirty representatives from eleven state, two regional chapters and one international chapter were present for the two-day meeting.
With 136 chapter members Florida has met its 2007 recruitment goal - more can be achieved - and now ranks No.3 after California and New York.
Among others we discussed:
1) MAKING OF OUR MEDICAL SPECIALTY: hopefully, most of you know that ASAM has founded the American Board of Addiction Medicine (ABAM) and has created the 14-member Medical Specialty Action Group, yours truly included, to select specialty directors to serve on the new board. This is a tedious and long process but we anticipate that within 3-15(?) years we will have established the specialty of addiction medicine. We heard a detailed report by Kevin Kunz regarding the progress made and please contact me for further details.
2) PARITY ISSUES: Ken Roy provided us with a superb overview of the status of two bills in the House (HR 1424) and Senate (S 558) and he outlined the pros and cons of both versions. At this point in time ASAM is pleased that both chambers of congress deal with the issues of Mental Health and Addiction Treatment parity. ASAM prefers and supports the House version and is concerned about the many flaws contained in the Senate version. If those bills pass both chambers of congress they will be discussed in the conference committee to find a compromise version. We will keep you posted about the progress made.
3) ADOPT A RESIDENCY: Norm Wetterau presented a program that intends to improve the education in primary care regarding addiction medicine related issues by adopting a residency program to precept student, train faculty and to help make changes in the residency that would improve treatment of addictive diseases. Some of you may already pursue similar activities and I suggest that we all pool our experience and resources to improve the outcome of our efforts.
4) CAPITOL CAMPAIGN: develop a program that will raise funds to support ABAM, Parity efforts, he work of the chapters council and other projects. We also heard a presentation from a consultant group in Washington how to obtain federal funds to finance and support projects on state and national level. I will forward more detailed information and a project proposal, which we should submit for funding through federal earmarks. Project examples could include substance abuse counseling at schools, specific substance abuse counseling and treatment programs etc.
I also want to remind you that I persistently pursue the realization of the following goals set by my person at the beginning of my presidency:
1.Reorganize FSAM as a full-service membership organization promoting the interest of healthcare professionals involved in addiction care, research and treatment.
STATUS: Formation of a membership committee (pending) and development of a recruitment and retention program. VOLUNTEERS WANTED!!
2.Promote excellence of care in addiction medicine through education and training of physicians and other allied healthcare professionals.
STATUS: We develop and prepare an enhanced and improved annual meeting.
3.Achieve cooperative relationships with other medical specialties to foster the integration of screening and intervention modalities in patient care.
STATUS: All THREE FSAM resolution submitted at the FMA Annual meeting (Parity included) passed including SBI efforts to be supported by the FMA.
4.Create a FSAM Political Action Committee (PAC), educate political decision makers about the importance of sustainable funding mechanism for community based addiction treatment modalities and advocate for the promotion of addiction care and research in primary care.
STATUS: PENDING. VOLUNTEERS NEEDED. We have developed a close working relationship with a legislator (Florida House Representative Ed Homan) who has introduced a Metal Health Parity bill in the House. We not only need to support him verbally but also FINANCIALLY!!!
5.Establish a planning committee to design a strategic plan outlining the vision of our organization for a statewide drug control and treatment program.
STATUS; PENDING. IDEAS? VOLUNTEERS?
PLEASE CONTACT ME VIA E-MAIL info@miamihealth.com or PHONE (305)940-8717 FOR MORE INFORMATION, YOUR QUESTIONS OR SUGGESTIONS.
YOURS
Bernd
Wednesday, October 10, 2007
JOURNAL CLUB
Dear Friends and Colleagues:
Attached a very interesting article regarding the promising results of a study using Topiramate for the treatment of alcohol dependence. For more information see http://jama.ama-assn.org/cgi/content/full/298/14/1641.
The authors conclude that:
"Our finding in this study that topiramate is a safe and consistently efficacious medication for treating alcohol dependence is scientifically and clinically important. Alcoholism ranks third and fifth on the US and global burdens of disease, respectively. Discovering pharmacological agents such as topiramate that improve drinking outcomes can make a major contribution to global health. Because topiramate pharmacotherapy can be paired with a brief intervention deliverable by nonspecialist health practitioners, a next step would be to examine its efficacy in community practice settings."
Looking forward to your comments.
Yours
Bernd
============================================================================
Topiramate for Treating Alcohol Dependence
A Randomized Controlled Trial
Bankole A. Johnson, DSc, MD, PhD; Norman Rosenthal, MD; Julie A. Capece, BA; Frank Wiegand, MD; Lian Mao, PhD; Karen Beyers, MS; Amy McKay, PharmD; Nassima Ait-Daoud, MD; Raymond F. Anton, MD; Domenic A. Ciraulo, MD; Henry R. Kranzler, MD; Karl Mann, MD; Stephanie S. O’Malley, PhD; Robert M. Swift, MD, PhD; for the Topiramate for Alcoholism Advisory Board and the Topiramate for Alcoholism Study Group
JAMA. 2007;298:1641-1651.
ABSTRACT
Context Hypothetically, topiramate can improve drinking outcomes among alcohol-dependent individuals by reducing alcohol's reinforcing effects through facilitation of -aminobutyric acid function and inhibition of glutaminergic pathways in the corticomesolimbic system.
Objective To determine if topiramate is a safe and efficacious treatment for alcohol dependence.
Design, Setting, and Participants Double-blind, randomized, placebo-controlled, 14-week trial of 371 men and women aged 18 to 65 years diagnosed with alcohol dependence, conducted between January 27, 2004, and August 4, 2006, at 17 US sites.
Interventions Up to 300 mg/d of topiramate (n = 183) or placebo (n = 188), along with a weekly compliance enhancement intervention.
Main Outcome Measures Primary efficacy variable was self-reported percentage of heavy drinking days. Secondary outcomes included other self-reported drinking measures (percentage of days abstinent and drinks per drinking day) along with the laboratory measure of alcohol consumption (plasma -glutamyltransferase).
Results Treating all dropouts as relapse to baseline, topiramate was more efficacious than placebo at reducing the percentage of heavy drinking days from baseline to week 14 (mean difference, 8.44%; 95% confidence interval, 3.07%-13.80%; P = .002). Prespecified mixed-model analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days (mean difference, 16.19%; 95% confidence interval, 10.79%-21.60%; P < .001) and all other drinking outcomes (P < .001 for all comparisons). Adverse events that were more common with topiramate vs placebo, respectively, included paresthesia (50.8% vs 10.6%), taste perversion (23.0% vs 4.8%), anorexia (19.7% vs 6.9%), and difficulty with concentration (14.8% vs 3.2%).
Conclusion Topiramate is a promising treatment for alcohol dependence.
Attached a very interesting article regarding the promising results of a study using Topiramate for the treatment of alcohol dependence. For more information see http://jama.ama-assn.org/cgi/content/full/298/14/1641.
The authors conclude that:
"Our finding in this study that topiramate is a safe and consistently efficacious medication for treating alcohol dependence is scientifically and clinically important. Alcoholism ranks third and fifth on the US and global burdens of disease, respectively. Discovering pharmacological agents such as topiramate that improve drinking outcomes can make a major contribution to global health. Because topiramate pharmacotherapy can be paired with a brief intervention deliverable by nonspecialist health practitioners, a next step would be to examine its efficacy in community practice settings."
Looking forward to your comments.
Yours
Bernd
============================================================================
Topiramate for Treating Alcohol Dependence
A Randomized Controlled Trial
Bankole A. Johnson, DSc, MD, PhD; Norman Rosenthal, MD; Julie A. Capece, BA; Frank Wiegand, MD; Lian Mao, PhD; Karen Beyers, MS; Amy McKay, PharmD; Nassima Ait-Daoud, MD; Raymond F. Anton, MD; Domenic A. Ciraulo, MD; Henry R. Kranzler, MD; Karl Mann, MD; Stephanie S. O’Malley, PhD; Robert M. Swift, MD, PhD; for the Topiramate for Alcoholism Advisory Board and the Topiramate for Alcoholism Study Group
JAMA. 2007;298:1641-1651.
ABSTRACT
Context Hypothetically, topiramate can improve drinking outcomes among alcohol-dependent individuals by reducing alcohol's reinforcing effects through facilitation of -aminobutyric acid function and inhibition of glutaminergic pathways in the corticomesolimbic system.
Objective To determine if topiramate is a safe and efficacious treatment for alcohol dependence.
Design, Setting, and Participants Double-blind, randomized, placebo-controlled, 14-week trial of 371 men and women aged 18 to 65 years diagnosed with alcohol dependence, conducted between January 27, 2004, and August 4, 2006, at 17 US sites.
Interventions Up to 300 mg/d of topiramate (n = 183) or placebo (n = 188), along with a weekly compliance enhancement intervention.
Main Outcome Measures Primary efficacy variable was self-reported percentage of heavy drinking days. Secondary outcomes included other self-reported drinking measures (percentage of days abstinent and drinks per drinking day) along with the laboratory measure of alcohol consumption (plasma -glutamyltransferase).
Results Treating all dropouts as relapse to baseline, topiramate was more efficacious than placebo at reducing the percentage of heavy drinking days from baseline to week 14 (mean difference, 8.44%; 95% confidence interval, 3.07%-13.80%; P = .002). Prespecified mixed-model analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days (mean difference, 16.19%; 95% confidence interval, 10.79%-21.60%; P < .001) and all other drinking outcomes (P < .001 for all comparisons). Adverse events that were more common with topiramate vs placebo, respectively, included paresthesia (50.8% vs 10.6%), taste perversion (23.0% vs 4.8%), anorexia (19.7% vs 6.9%), and difficulty with concentration (14.8% vs 3.2%).
Conclusion Topiramate is a promising treatment for alcohol dependence.
Wednesday, September 26, 2007
Membership Issues
Dear Friends and Colleagues:
I have participated in todays ASAM Membership Committee conference call.
Membership recruitment and retention is essential for the viability of our organization and we need to extend every effort to speak to those doctors who have yet to renew their dues.
I will therefore assist John to identify those members to be called ASAP to renew their membership.
I also consider it as a priority to form a membership committee to develop a membership recruitment and retention plan.
It is of interest to note that residents (physicians in postgraduate training programs) only comprise 5% of the total ASAM membership.
We need to attract those physicians early in their career and convey to them the message that addiction medicine may be a career choice in the future.
With the formation of ABAM (American Board of Addiction Medicine) and the subsequent creation of addiction medicine fellowships I see a unique opportunity to attract those physicians towards our profession.
All of these issues should be dealt with by an active and strong membership committee co-chaired by the Chapter President.
What are your thoughts regarding this issue?
Yours
Bernd
I have participated in todays ASAM Membership Committee conference call.
Membership recruitment and retention is essential for the viability of our organization and we need to extend every effort to speak to those doctors who have yet to renew their dues.
I will therefore assist John to identify those members to be called ASAP to renew their membership.
I also consider it as a priority to form a membership committee to develop a membership recruitment and retention plan.
It is of interest to note that residents (physicians in postgraduate training programs) only comprise 5% of the total ASAM membership.
We need to attract those physicians early in their career and convey to them the message that addiction medicine may be a career choice in the future.
With the formation of ABAM (American Board of Addiction Medicine) and the subsequent creation of addiction medicine fellowships I see a unique opportunity to attract those physicians towards our profession.
All of these issues should be dealt with by an active and strong membership committee co-chaired by the Chapter President.
What are your thoughts regarding this issue?
Yours
Bernd
Tuesday, August 14, 2007
Science Of Addiction: A JAMA Book Review
The Science of Addiction: From Neurobiology to Treatment
By Carlton K. Erickson, 288 pp, $32.
New York, NY, WW Norton Professional Books, 2007.
ISBN-13 978-0-3937-0463-1.
JAMA. 2007;298:809-810.
The term "addiction" commonly triggers stereotypic misperceptions about the compulsive, out-of-control use of illicit drugs resulting from a perceived amendable behavioral flaw. In 1988, the United States Supreme Court in a disputed decision declared alcoholism to be "willful misconduct." However, several decades of comprehensive genetic and neurobiological research have provided indisputable evidence that addiction is brain disease resulting from mesolimbic brain dysregulation that, if diagnosed in a timely fashion, can be properly treated. Addiction meets all characteristics of the disease concept, ie, (1) a clear biological basis; (2) unique, identifiable signs and symptoms; (3) a predictable course and outcome; and (4) the inability to control the cause of the disease.
In this context, Erickson's book provides a compelling overview of the "science of addiction" and superbly summarizes the state of the art of addiction medicine. In 10 easy-to-read chapters, the author guides the reader through basic neuroanatomy, neurobiology, and neurochemistry; the pharmacology of different drugs of abuse, including alcohol, depressants, and stimulants; current treatment algorithms; the strategies of addiction research; and the future outlook of the evidence-based research principles.
The text begins with a challenge of the terminology and characterization of "addiction," calling it unscientific, broad, too vague, and stigmatized. According to the author, the term provokes "pejorative misperceptions," and he uses the term "chemical dependence" instead to properly identify the impaired control over the drug use, the defining hallmark of this brain disease. He also suggests separating the colloquial term "addiction" from the scientific terminology of "chemical dependence," thereby not precluding its use but understanding its limitation. Erickson emphasizes that "the reluctance to define addiction as a disease stems partly from a desire to hold drug users accountable for their actions," and that "any approach that tries to understand addiction from a purist or unitary view misses other key components." Chemical dependence is a "compulsive, pathological, impaired control over drug use, leading to an inability to stop using drugs in spite of adverse consequences."
Drugs with a dependence liability not only produce a positive mood but trigger the mesolimbic dopamine system, resulting in an activation of the so-called "reward pathway." Neuroscientists believe that in some individuals the function of these neurotransmitter systems is disrupted due to genetic "miswiring," long-term exposure to a drug, or—more likely—a combination of genetic heritability, drug exposure, and environmental influences. This may explain why any drugs of abuse can induce dependence in susceptible individuals but not for every person who may use them occasionally or who has abused them during their lifetime.
The detailed review of the basic science of chemical dependence provides ample evidence that the dysregulation in the mesolimbic dopamine system constitutes the disease, just as poor dopamine function in the basal ganglia is the etiologic cause of Parkinson disease. Therefore, drug-seeking and drug-taking are only the symptoms of the disease, just as muscle rigidity and tremors are only the symptoms of Parkinson disease.
The author also provides a brief but comprehensive overview of the genetics of chemical dependence. Family, twin, and adoption studies demonstrate that genetic factors contribute to the risk of alcoholism. Scientists have identified some possible causative genes and certain risk genes which, in susceptible individuals exposed to drugs of abuse, may activate a cascade of neurochemical events leading to chemical dependence. The argument that chemical dependence is a brain disease, comparable to other brain diseases, begs the question about similar treatment approaches.
Erickson correctly emphasizes that any treatment approach cannot rely on pharmacological solutions alone. The treatment must be individualized and should take so-called harm reduction strategies, also known as harm minimization, into consideration. Such an approach includes methadone maintenance and needle-exchange programs that often ruffle the feathers of the proponents of abstinence-based programs.
In the last few years, new pharmacological treatments have broadened the opportunities for the outpatient management of patients with chemical dependencies. For example, anticraving, antirelapse, and abstinence-enhancing medications are now part of the treatment armamentarium for alcohol dependence and include naltrexone, acamprosate, and topiramate. The US Food and Drug Administration approval of buprenorphine for the treatment of opioid dependence extends the treatment outreach from federally approved methadone clinics to almost all physicians who have completed an 8-hour certification course.
In the remainder of the book, Erickson reviews the scientific methodology of addiction research and the exciting results of brain imaging studies in chemical dependence. These include positron emission tomography, functional magnetic resonance imaging, and single-photon emission computerized tomography. The imaging modalities illustrate that drug treatment as well as the anticipation of the active drug itself can trigger neurochemical changes and are valuable tools for studying the effectiveness and compatibility of interactional behavioral interventions and pharmacotherapy.
Unfortunately, the author has missed the opportunity to discuss the screening and brief intervention methods that can be incorporated into the clinical practice identifying patients at risk for chemical dependence. For example, the National Institute on Alcohol Abuse and Alcoholism has published valuable screening and brief intervention tools on its Web site1 that can assist health care professionals in risk stratification strategies for patients with chemical dependence. However, the book provides the knowledge that chemical dependence is a brain disease, and an understanding of this disease concept of addiction ensures that millions of individuals with chemical dependence can now receive appropriate and suitable treatments.
In summary, I recommend this excellent book as a "must-read" for any medical student, physician, or other allied health professional dedicated to the care of their patients with the treatable disease of addiction.
Financial Disclosures: None reported.
Bernd Wollschlaeger, MD, Reviewer
University of Miami
Miami, Florida
info@miamihealth.com
REFERENCES
1. National Institute on Alcohol Abuse and Alcoholism. A Pocket Guide for Alcohol Screening and Brief Intervention. http://pubs.niaaa.nih.gov/publications/Practitioner/PocketGuide/pocket_guide.htm. Accessibility verified July 18, 2007.
Book and Media Reviews Section Editor: John L. Zeller, MD, PhD, Contributing Editor.
By Carlton K. Erickson, 288 pp, $32.
New York, NY, WW Norton Professional Books, 2007.
ISBN-13 978-0-3937-0463-1.
JAMA. 2007;298:809-810.
The term "addiction" commonly triggers stereotypic misperceptions about the compulsive, out-of-control use of illicit drugs resulting from a perceived amendable behavioral flaw. In 1988, the United States Supreme Court in a disputed decision declared alcoholism to be "willful misconduct." However, several decades of comprehensive genetic and neurobiological research have provided indisputable evidence that addiction is brain disease resulting from mesolimbic brain dysregulation that, if diagnosed in a timely fashion, can be properly treated. Addiction meets all characteristics of the disease concept, ie, (1) a clear biological basis; (2) unique, identifiable signs and symptoms; (3) a predictable course and outcome; and (4) the inability to control the cause of the disease.
In this context, Erickson's book provides a compelling overview of the "science of addiction" and superbly summarizes the state of the art of addiction medicine. In 10 easy-to-read chapters, the author guides the reader through basic neuroanatomy, neurobiology, and neurochemistry; the pharmacology of different drugs of abuse, including alcohol, depressants, and stimulants; current treatment algorithms; the strategies of addiction research; and the future outlook of the evidence-based research principles.
The text begins with a challenge of the terminology and characterization of "addiction," calling it unscientific, broad, too vague, and stigmatized. According to the author, the term provokes "pejorative misperceptions," and he uses the term "chemical dependence" instead to properly identify the impaired control over the drug use, the defining hallmark of this brain disease. He also suggests separating the colloquial term "addiction" from the scientific terminology of "chemical dependence," thereby not precluding its use but understanding its limitation. Erickson emphasizes that "the reluctance to define addiction as a disease stems partly from a desire to hold drug users accountable for their actions," and that "any approach that tries to understand addiction from a purist or unitary view misses other key components." Chemical dependence is a "compulsive, pathological, impaired control over drug use, leading to an inability to stop using drugs in spite of adverse consequences."
Drugs with a dependence liability not only produce a positive mood but trigger the mesolimbic dopamine system, resulting in an activation of the so-called "reward pathway." Neuroscientists believe that in some individuals the function of these neurotransmitter systems is disrupted due to genetic "miswiring," long-term exposure to a drug, or—more likely—a combination of genetic heritability, drug exposure, and environmental influences. This may explain why any drugs of abuse can induce dependence in susceptible individuals but not for every person who may use them occasionally or who has abused them during their lifetime.
The detailed review of the basic science of chemical dependence provides ample evidence that the dysregulation in the mesolimbic dopamine system constitutes the disease, just as poor dopamine function in the basal ganglia is the etiologic cause of Parkinson disease. Therefore, drug-seeking and drug-taking are only the symptoms of the disease, just as muscle rigidity and tremors are only the symptoms of Parkinson disease.
The author also provides a brief but comprehensive overview of the genetics of chemical dependence. Family, twin, and adoption studies demonstrate that genetic factors contribute to the risk of alcoholism. Scientists have identified some possible causative genes and certain risk genes which, in susceptible individuals exposed to drugs of abuse, may activate a cascade of neurochemical events leading to chemical dependence. The argument that chemical dependence is a brain disease, comparable to other brain diseases, begs the question about similar treatment approaches.
Erickson correctly emphasizes that any treatment approach cannot rely on pharmacological solutions alone. The treatment must be individualized and should take so-called harm reduction strategies, also known as harm minimization, into consideration. Such an approach includes methadone maintenance and needle-exchange programs that often ruffle the feathers of the proponents of abstinence-based programs.
In the last few years, new pharmacological treatments have broadened the opportunities for the outpatient management of patients with chemical dependencies. For example, anticraving, antirelapse, and abstinence-enhancing medications are now part of the treatment armamentarium for alcohol dependence and include naltrexone, acamprosate, and topiramate. The US Food and Drug Administration approval of buprenorphine for the treatment of opioid dependence extends the treatment outreach from federally approved methadone clinics to almost all physicians who have completed an 8-hour certification course.
In the remainder of the book, Erickson reviews the scientific methodology of addiction research and the exciting results of brain imaging studies in chemical dependence. These include positron emission tomography, functional magnetic resonance imaging, and single-photon emission computerized tomography. The imaging modalities illustrate that drug treatment as well as the anticipation of the active drug itself can trigger neurochemical changes and are valuable tools for studying the effectiveness and compatibility of interactional behavioral interventions and pharmacotherapy.
Unfortunately, the author has missed the opportunity to discuss the screening and brief intervention methods that can be incorporated into the clinical practice identifying patients at risk for chemical dependence. For example, the National Institute on Alcohol Abuse and Alcoholism has published valuable screening and brief intervention tools on its Web site1 that can assist health care professionals in risk stratification strategies for patients with chemical dependence. However, the book provides the knowledge that chemical dependence is a brain disease, and an understanding of this disease concept of addiction ensures that millions of individuals with chemical dependence can now receive appropriate and suitable treatments.
In summary, I recommend this excellent book as a "must-read" for any medical student, physician, or other allied health professional dedicated to the care of their patients with the treatable disease of addiction.
Financial Disclosures: None reported.
Bernd Wollschlaeger, MD, Reviewer
University of Miami
Miami, Florida
info@miamihealth.com
REFERENCES
1. National Institute on Alcohol Abuse and Alcoholism. A Pocket Guide for Alcohol Screening and Brief Intervention. http://pubs.niaaa.nih.gov/publications/Practitioner/PocketGuide/pocket_guide.htm. Accessibility verified July 18, 2007.
Book and Media Reviews Section Editor: John L. Zeller, MD, PhD, Contributing Editor.
Thursday, August 9, 2007
Upcoming Events
Dear Friends and Colleagues;
I want to inform you about two upcoming events:
1. August 22-24th, 2007, Florida Alcohol And Drug Abuse Association, Orlando Florida
* Stacy Seikel, August 22nd,6:30PM - 10:00 PM Presentation about
"Prometa, A Treatment Program for Methamphetamine,Cocaine and Alcohol
Addiction"
1. August 24th-27th, 2007, FMA Annual Meeting, Hollywood, Florida
* Reference Committees will discuss three FSAM resolutions
Please call me for any questions or further information.
Yours
Bernd
I want to inform you about two upcoming events:
1. August 22-24th, 2007, Florida Alcohol And Drug Abuse Association, Orlando Florida
* Stacy Seikel, August 22nd,6:30PM - 10:00 PM Presentation about
"Prometa, A Treatment Program for Methamphetamine,Cocaine and Alcohol
Addiction"
1. August 24th-27th, 2007, FMA Annual Meeting, Hollywood, Florida
* Reference Committees will discuss three FSAM resolutions
Please call me for any questions or further information.
Yours
Bernd
Tuesday, August 7, 2007
California To end Physicians Monitoring Program
Dear Friends and Colleagues:
Attached some info regarding a very troublesome development in California.
Yours truly,
Bernd
============================================================================
Calif. To End Program for Addicted Doctors
August 7, 2007
News Summary
The Medical Board of California has decided to end its diversion program for doctors who are grappling with addiction problems, the San Diego Union-Tribune reported Aug. 5.
The decision came in the wake of a report that concluded that the 27-year-old diversion program didn't do enough for addicted doctors and failed to protect patients. The program is scheduled to end next June unless the board decides to somehow overhaul it.
If the program ends, California would be the only state in the U.S. without a diversion mechanism for addicted doctors.
Under the program rules, doctors who confidentially sought help with addiction problems could keep their licenses if they attended treatment and self-help groups, and submitted urine tests. The Medical Board appoints a monitor to keep track of their progress, but the report said oversight was lacking.
Research showed that about 18 percent of doctors who entered the program completed treatment, far short of the 90 percent completion rate in North Carolina, for example.
Jeoffry Gordon, a past president of the Medical Board, said the state should offer some type of treatment to doctors. Others suggested that physicians be barred from practicing for six months while they get treatment.
============================================================================
Attached some info regarding a very troublesome development in California.
Yours truly,
Bernd
============================================================================
Calif. To End Program for Addicted Doctors
August 7, 2007
News Summary
The Medical Board of California has decided to end its diversion program for doctors who are grappling with addiction problems, the San Diego Union-Tribune reported Aug. 5.
The decision came in the wake of a report that concluded that the 27-year-old diversion program didn't do enough for addicted doctors and failed to protect patients. The program is scheduled to end next June unless the board decides to somehow overhaul it.
If the program ends, California would be the only state in the U.S. without a diversion mechanism for addicted doctors.
Under the program rules, doctors who confidentially sought help with addiction problems could keep their licenses if they attended treatment and self-help groups, and submitted urine tests. The Medical Board appoints a monitor to keep track of their progress, but the report said oversight was lacking.
Research showed that about 18 percent of doctors who entered the program completed treatment, far short of the 90 percent completion rate in North Carolina, for example.
Jeoffry Gordon, a past president of the Medical Board, said the state should offer some type of treatment to doctors. Others suggested that physicians be barred from practicing for six months while they get treatment.
============================================================================
Tuesday, July 10, 2007
Chantix For The Treatment Of Alcohol Addiction?
Anti-smoking drug Chantix works for alcohol too
Medical Studies/Trials
Published: Tuesday, 10-Jul-2007
According to researchers a popular anti-smoking pill may also curb the urge to drink alcohol.
The drug varenicline is already on the market under the brand name Chantix to help smokers kick the habit but new preliminary research now suggests it could also be useful in helping heavy drinkers quit.
The research which was carried out on rats provided the rodents with intermittent access to 40 proof alcohol for four months and by varying the access to the liquor supply the rats were made to crave it.
The researchers say every time the rodents had access to booze, they upped their intake and drank all day and withdrawing the alcohol made them want to drink even more.
After months of this behaviour and a total of 37 binge-drinking sessions, all the rats cut their drinking in half when given varenicline.
When taken off the drug, the rats did not immediately imbibe more, a rebound effect that has affected other treatments.
Varenicline has been available as a smoking cessation aid for nearly a year in the U.S. and the European Union, and as well as being safe it does not suppress the appetite and is not metabolized in the liver.
Bartlett says this is a major plus because long term drinkers often have liver damage.
According to the researchers the drug targets a pleasure center in the brain and has the potential to be considered as a treatment for addictions such as gambling and painkillers.
Varenicline works by latching onto the same receptors in the brain that nicotine binds to when inhaled in cigarette smoke, an action that leads to the release of dopamine in the brain's pleasure centers; the drug blocks any inhaled nicotine from reinforcing that effect.
The new study suggests alcohol also acts on the same locations in the brain and varenicline, might be equally as effective for curbing drinking.
Selena Bartlett, a University of California neuroscientist who led the study says the drug has already proven itself safe for people trying to stop smoking and is now a potential drug to fight alcohol dependence.
Experts say smoking and drinking often go together and a single drug able to tackle both addictions is not surprising.
The researchers at the University of California along with the National Institute on Alcohol Abuse and Alcoholism, plan to conduct clinical trials in humans of the drug's effectiveness in curbing alcohol cravings and dependence.
The drug is already approved by Food and Drug Administration and this should speed the process up.
But skeptics warn that varenicline does not work for all smokers and it's highly unlikely it will work for all drinkers and some experts insist there is a common biological basis for addictions to both alcohol and tobacco.
Although drug company Pfizer provided the drug for the study it was not involved in the research and is apparently undecided whether to seek broader FDA approval for the drug.
The study is published in the journal Proceedings of the National Academy of Sciences.
Medical Studies/Trials
Published: Tuesday, 10-Jul-2007
According to researchers a popular anti-smoking pill may also curb the urge to drink alcohol.
The drug varenicline is already on the market under the brand name Chantix to help smokers kick the habit but new preliminary research now suggests it could also be useful in helping heavy drinkers quit.
The research which was carried out on rats provided the rodents with intermittent access to 40 proof alcohol for four months and by varying the access to the liquor supply the rats were made to crave it.
The researchers say every time the rodents had access to booze, they upped their intake and drank all day and withdrawing the alcohol made them want to drink even more.
After months of this behaviour and a total of 37 binge-drinking sessions, all the rats cut their drinking in half when given varenicline.
When taken off the drug, the rats did not immediately imbibe more, a rebound effect that has affected other treatments.
Varenicline has been available as a smoking cessation aid for nearly a year in the U.S. and the European Union, and as well as being safe it does not suppress the appetite and is not metabolized in the liver.
Bartlett says this is a major plus because long term drinkers often have liver damage.
According to the researchers the drug targets a pleasure center in the brain and has the potential to be considered as a treatment for addictions such as gambling and painkillers.
Varenicline works by latching onto the same receptors in the brain that nicotine binds to when inhaled in cigarette smoke, an action that leads to the release of dopamine in the brain's pleasure centers; the drug blocks any inhaled nicotine from reinforcing that effect.
The new study suggests alcohol also acts on the same locations in the brain and varenicline, might be equally as effective for curbing drinking.
Selena Bartlett, a University of California neuroscientist who led the study says the drug has already proven itself safe for people trying to stop smoking and is now a potential drug to fight alcohol dependence.
Experts say smoking and drinking often go together and a single drug able to tackle both addictions is not surprising.
The researchers at the University of California along with the National Institute on Alcohol Abuse and Alcoholism, plan to conduct clinical trials in humans of the drug's effectiveness in curbing alcohol cravings and dependence.
The drug is already approved by Food and Drug Administration and this should speed the process up.
But skeptics warn that varenicline does not work for all smokers and it's highly unlikely it will work for all drinkers and some experts insist there is a common biological basis for addictions to both alcohol and tobacco.
Although drug company Pfizer provided the drug for the study it was not involved in the research and is apparently undecided whether to seek broader FDA approval for the drug.
The study is published in the journal Proceedings of the National Academy of Sciences.
Addiction Research In The News
I hope you didn't miss todays (07/10/07) great interview with Dr. Volkow on NPR (Fresh Air) entitled "No,really, this is your brain on drugs."
Nora Volkow, director of the National Institute on Drug Abuse, ranks as one of the U.S.'s leading addiction researchers. She's helped demonstrate that addiction is in fact a disease — a disease of the brain — and that all addictions, whether it's to drugs, alcohol, tobacco, sex, gambling or even food, are more alike than was previously thought.Volkow, who's the great-granddaughter of Russian revolutionary Leon Trotsky, grew up in Mexico City — in the house where her famous ancestor was assassinated.
Very informative and fascinating.
A MUST for anybody who is interested in addiction and want to draw others towards other profession.
LINK: http://www.npr.org/templates/story/story.php?storyId=11847222
Yours
Bernd
Nora Volkow, director of the National Institute on Drug Abuse, ranks as one of the U.S.'s leading addiction researchers. She's helped demonstrate that addiction is in fact a disease — a disease of the brain — and that all addictions, whether it's to drugs, alcohol, tobacco, sex, gambling or even food, are more alike than was previously thought.Volkow, who's the great-granddaughter of Russian revolutionary Leon Trotsky, grew up in Mexico City — in the house where her famous ancestor was assassinated.
Very informative and fascinating.
A MUST for anybody who is interested in addiction and want to draw others towards other profession.
LINK: http://www.npr.org/templates/story/story.php?storyId=11847222
Yours
Bernd
Monday, June 25, 2007
Buprenorphine Use In the US
The First Three Years of Buprenorphine in the United States: Experience to Date and Future Directions.
Review Article, Journal of Addiction Medicine. 1(2):62-67, June 2007. Fiellin, David A. MD
Abstract: Buprenorphine, primarily as the buprenorphine/naloxone combination, has been available in the United States for office and specialty treatment program-based care since 2003. The existing evidence, collected primarily from federal sources, indicates that access to this type of treatment has expanded, that more than 50% of the 12,000 physicians able to provide this care are not addiction specialists, that buprenorphine diversion is low, that physician scrutiny by federal agents is infrequent, and among those receiving treatment patient acceptance is high. Implementation has been slowed because of physician training and support needs, reimbursement, and limits on the number of patients each physician can treat. As a result there are geographic variations in access and unmet treatment needs. The United States Congress has moved twice to loosen numerical limitations, now allowing each physician to treat up to 100 patients. Future research and evaluation are needed to ensure that opioid-dependent patients receive optimal care with buprenorphine.
(C) 2007 American Society of Addiction Medicine
Buprenorphine: The Basic Pharmacology Revisited.
Invited Review
Journal of Addiction Medicine. 1(2):68-72, June 2007.
Cowan, Alan PhD
Abstract:
The historical background leading to the current use of buprenorphine as an analgesic and its role in the management of opioid dependence is summarized. The popular description of buprenorphine as a "partial agonist" is discussed in relation to efficacy in animal models of antinociception and clinical analgesia. The latest information on the respiratory depressant effects of buprenorphine and its N-dealkylated metabolite (norbuprenorphine) is presented. New data on the buprenorphine withdrawal syndrome in rats are described.
(C) 2007 American Society of Addiction Medicine
Review Article, Journal of Addiction Medicine. 1(2):62-67, June 2007. Fiellin, David A. MD
Abstract: Buprenorphine, primarily as the buprenorphine/naloxone combination, has been available in the United States for office and specialty treatment program-based care since 2003. The existing evidence, collected primarily from federal sources, indicates that access to this type of treatment has expanded, that more than 50% of the 12,000 physicians able to provide this care are not addiction specialists, that buprenorphine diversion is low, that physician scrutiny by federal agents is infrequent, and among those receiving treatment patient acceptance is high. Implementation has been slowed because of physician training and support needs, reimbursement, and limits on the number of patients each physician can treat. As a result there are geographic variations in access and unmet treatment needs. The United States Congress has moved twice to loosen numerical limitations, now allowing each physician to treat up to 100 patients. Future research and evaluation are needed to ensure that opioid-dependent patients receive optimal care with buprenorphine.
(C) 2007 American Society of Addiction Medicine
Buprenorphine: The Basic Pharmacology Revisited.
Invited Review
Journal of Addiction Medicine. 1(2):68-72, June 2007.
Cowan, Alan PhD
Abstract:
The historical background leading to the current use of buprenorphine as an analgesic and its role in the management of opioid dependence is summarized. The popular description of buprenorphine as a "partial agonist" is discussed in relation to efficacy in animal models of antinociception and clinical analgesia. The latest information on the respiratory depressant effects of buprenorphine and its N-dealkylated metabolite (norbuprenorphine) is presented. New data on the buprenorphine withdrawal syndrome in rats are described.
(C) 2007 American Society of Addiction Medicine
Is Compulsive Gambling an Addiction?
AMA Won't Call Compulsive Gaming 'Addictive'
June 25, 2007
There's not enough evidence to suggest that compulsive video-game playing rises to the level of addiction as with alcohol or other drugs, according to the American Medical Association (AMA).
Reuters reported June 24 that an AMA panel dropped a proposal to include video game addiction in the American Diagnostic and Statistical Manual of Mental Disorders (DSM).
"There is nothing here to suggest that this is a complex physiological disease state akin to alcoholism or other substance abuse disorders, and it doesn't get to have the word addiction attached to it," said Stuart Gitlow of the American Society of Addiction Medicine and Mt. Sinai School of Medicine in New York.
The proposal was debated at the recent AMA annual meeting in Chicago. The study panel recommended that the issue of video-game addiction be revisited when the next revision of the DSM is due, in five years.
Some doctors argued strongly for inclusion of video-game addiction. "Working with this problem is no different than working with alcoholic patients. The same denial, the same rationalization, the same inability to give it up," said Thomas Allen of the Osler Medical Center in Towson, Md.
June 25, 2007
There's not enough evidence to suggest that compulsive video-game playing rises to the level of addiction as with alcohol or other drugs, according to the American Medical Association (AMA).
Reuters reported June 24 that an AMA panel dropped a proposal to include video game addiction in the American Diagnostic and Statistical Manual of Mental Disorders (DSM).
"There is nothing here to suggest that this is a complex physiological disease state akin to alcoholism or other substance abuse disorders, and it doesn't get to have the word addiction attached to it," said Stuart Gitlow of the American Society of Addiction Medicine and Mt. Sinai School of Medicine in New York.
The proposal was debated at the recent AMA annual meeting in Chicago. The study panel recommended that the issue of video-game addiction be revisited when the next revision of the DSM is due, in five years.
Some doctors argued strongly for inclusion of video-game addiction. "Working with this problem is no different than working with alcoholic patients. The same denial, the same rationalization, the same inability to give it up," said Thomas Allen of the Osler Medical Center in Towson, Md.
Tuesday, June 19, 2007
FSAM Resolutions Gain Support
Dear Friends and Colleagues:
GOOD NEWS!!!!!
I presented the FSAM to the South Florida Caucus, representing an influential and sizeable voting block of ~50 delegates .
All resolution were adopted and will be supported by the three largest county medical societies in Florida (Dade, Broward, Palm Beach).
Now we have to continue the political battle at the state medical society meeting in Miami in August.
I will attend the AMA Annual meeting in Chicago this weekend and (among many other issues) will lobby support for the ABAM (American Board of Addiction Medicine) .
As of tomorrow our resolutions will be part of the FMA Delegates handbook and listed as sponsored by FSAM, Dade, Broward and Palm Beach Medical Societies. Stacy is trying to gain the support of the Orange County Medical Society.
Yours
Bernd
PS: Attached you find some more information about my book, which was featured today on the frontpage of the Miami Herald http://www.miamiherald.com/460/story/144059.html .
Web Site: www.agermanlife.com
GOOD NEWS!!!!!
I presented the FSAM to the South Florida Caucus, representing an influential and sizeable voting block of ~50 delegates .
All resolution were adopted and will be supported by the three largest county medical societies in Florida (Dade, Broward, Palm Beach).
Now we have to continue the political battle at the state medical society meeting in Miami in August.
I will attend the AMA Annual meeting in Chicago this weekend and (among many other issues) will lobby support for the ABAM (American Board of Addiction Medicine) .
As of tomorrow our resolutions will be part of the FMA Delegates handbook and listed as sponsored by FSAM, Dade, Broward and Palm Beach Medical Societies. Stacy is trying to gain the support of the Orange County Medical Society.
Yours
Bernd
PS: Attached you find some more information about my book, which was featured today on the frontpage of the Miami Herald http://www.miamiherald.com/460/story/144059.html .
Web Site: www.agermanlife.com
Monday, June 18, 2007
UDDL Repeal In Florida
Dear Friends and Colleagues;
Attached some background info regarding the UDDL status in Florida:
======================================================================================
Section 627.629,Florida Statutes (2000), permits an insurance company to include the following exclusion in a health insurance contract "Intoxicants and Narcotics: The insurer will not be liable for any loss resulting from the insured being drunk or under the influence of any narcotic unless taken on the advice of a physician."A person is "drunk" when operating a motor vehicle if he or she has a blood alcohol level of .08 gram per alcohol per 100 milliliters of blood. See § 316.193, Fla. Stat. (2000). Even though driving under the influence is a crime in Florida, there currently is no statutory authorization for an alcohol exclusion in a Florida No-fault Automobile Insurance PIP policy. See § 627.736(2), Fla. Stat. (2000). When the no-fault laws were first enacted, the legislature did permit an alcohol exclusion in a PIP policy if the circumstances involved a conviction for DUI. See ch. 71-252, § 7, Laws of Fla. See also Travelers Indem. Co. of Am. v. McInroy, 342 So. 2d 842 (Fla. 1st DCA 1977). Experience with that exclusion caused the legislature to withdraw its authorization in 1982. See ch. 82-243, § 554, Laws of Fla. Unfortunately, a Florida Supreme Court decision from 2001 is blocking the UDDL repeal:
"CONCLUSION: Ms. Steck had a blood alcohol level more than three times the legal limit for driving while intoxicated when she walked into Dale Mabry Highway, a major Tampa thoroughfare, and was struck by a car. Any reasonable, disinterested third party would agree that her injuries suffered in the accident resulted from her drunkenness.
The polestar for interpreting statutes is legislative intent. Statev. Webb,398 So.2d 820, 824 (Fla. 1981). The Legislature permits health insurers to exclude losses,which result from the commission of felonies or engaging in an illegal occupation. Can anyone reasonably believe that when Section 627.629 was enacted to permit exclusions“for any loss resulting from the insured being drunk,” the Legislature intended for this
exclusion to be limited only to biological effects upon the body from the use of intoxicants?
This Court should follow Harris, should specifically reverse Mason II, and should hold that the drunkenness exclusion authorized by Section 627.629, Florida Statutes and included in Ms. Steck’s policy excludes coverage for all expenses caused, either directly or indirectly, by her walking into the path of oncoming traffic while drunk. The summary judgment on liability in favor of Ms. Steck should be reversed, and this case should be remanded with directions that summary judgment be entered in favor of BCBSF in regard to all expenses incurred to treat injuries sustained
in the June 29, 1997 accident.
=====================================================================================
Looking forward to your comments.
Bernd
Attached some background info regarding the UDDL status in Florida:
======================================================================================
Section 627.629,Florida Statutes (2000), permits an insurance company to include the following exclusion in a health insurance contract "Intoxicants and Narcotics: The insurer will not be liable for any loss resulting from the insured being drunk or under the influence of any narcotic unless taken on the advice of a physician."A person is "drunk" when operating a motor vehicle if he or she has a blood alcohol level of .08 gram per alcohol per 100 milliliters of blood. See § 316.193, Fla. Stat. (2000). Even though driving under the influence is a crime in Florida, there currently is no statutory authorization for an alcohol exclusion in a Florida No-fault Automobile Insurance PIP policy. See § 627.736(2), Fla. Stat. (2000). When the no-fault laws were first enacted, the legislature did permit an alcohol exclusion in a PIP policy if the circumstances involved a conviction for DUI. See ch. 71-252, § 7, Laws of Fla. See also Travelers Indem. Co. of Am. v. McInroy, 342 So. 2d 842 (Fla. 1st DCA 1977). Experience with that exclusion caused the legislature to withdraw its authorization in 1982. See ch. 82-243, § 554, Laws of Fla. Unfortunately, a Florida Supreme Court decision from 2001 is blocking the UDDL repeal:
"CONCLUSION: Ms. Steck had a blood alcohol level more than three times the legal limit for driving while intoxicated when she walked into Dale Mabry Highway, a major Tampa thoroughfare, and was struck by a car. Any reasonable, disinterested third party would agree that her injuries suffered in the accident resulted from her drunkenness.
The polestar for interpreting statutes is legislative intent. Statev. Webb,398 So.2d 820, 824 (Fla. 1981). The Legislature permits health insurers to exclude losses,which result from the commission of felonies or engaging in an illegal occupation. Can anyone reasonably believe that when Section 627.629 was enacted to permit exclusions“for any loss resulting from the insured being drunk,” the Legislature intended for this
exclusion to be limited only to biological effects upon the body from the use of intoxicants?
This Court should follow Harris, should specifically reverse Mason II, and should hold that the drunkenness exclusion authorized by Section 627.629, Florida Statutes and included in Ms. Steck’s policy excludes coverage for all expenses caused, either directly or indirectly, by her walking into the path of oncoming traffic while drunk. The summary judgment on liability in favor of Ms. Steck should be reversed, and this case should be remanded with directions that summary judgment be entered in favor of BCBSF in regard to all expenses incurred to treat injuries sustained
in the June 29, 1997 accident.
=====================================================================================
Looking forward to your comments.
Bernd
Is Alcohol Cardioprotective?
Drink to your health - is alcohol really cardioprotective?
In the April 2007 edition of the New Zealand Family Physician is a clinical review Drink to your health is alcohol really cardioprotective? by Graham Gulbransen and Ross McCormick which begins: A convenient and widely held belief is that a few drinks are good for the heart. This view is based largely on epidemiological studies similar to those that mistakenly showed that menopausal hormone replacement therapy (HRT) was cardioprotective. Because of confounding and misclassification, non-randomised uncontrolled studies can never confirm such beliefs. This article reviews the medical literature on alcohol and coronary heart disease (CHD), looking at evidence for and against cardioprotection.
The review starts with an introduction:
"In 1926 Raymond Pearl first described the J-shaped alcohol-mortality curve: moderately alcoholised fowls had the lowest mortality, followed by those not exposed, with heavily alcoholised fowls having the highest mortality!
"In the past 30 years more than 100 epidemiological studies have suggested that moderate alcohol consumption (in humans!) is cardioprotective. In New Zealand we follow the Alcohol Advisory Council of New Zealand guidelines that define safer or moderate drinking as up to 20 grams of alcohol daily for women and 30 grams for men. However, a 1987 Lancet editorial, Dying for a Drink urged caution, The higher mortality among abstainers has not been fully explained but may well be a spurious finding in a group of men who may be at higher risk for other reasons The U [J] shaped curve has been interpreted uncritically The message we should be delivering unequivocally is that alcohol is bad for health."
NZFP Volume 34 Number 2, April 2007 122-126. 2007 The Royal New Zealand College of General Practitioners
Drink to your health is alcohol really cardioprotective? Graham Gulbransen and Ross McCormick. Correspondence to Graham Gulbransen gg@woosh.co.nz
In the April 2007 edition of the New Zealand Family Physician is a clinical review Drink to your health is alcohol really cardioprotective? by Graham Gulbransen and Ross McCormick which begins: A convenient and widely held belief is that a few drinks are good for the heart. This view is based largely on epidemiological studies similar to those that mistakenly showed that menopausal hormone replacement therapy (HRT) was cardioprotective. Because of confounding and misclassification, non-randomised uncontrolled studies can never confirm such beliefs. This article reviews the medical literature on alcohol and coronary heart disease (CHD), looking at evidence for and against cardioprotection.
The review starts with an introduction:
"In 1926 Raymond Pearl first described the J-shaped alcohol-mortality curve: moderately alcoholised fowls had the lowest mortality, followed by those not exposed, with heavily alcoholised fowls having the highest mortality!
"In the past 30 years more than 100 epidemiological studies have suggested that moderate alcohol consumption (in humans!) is cardioprotective. In New Zealand we follow the Alcohol Advisory Council of New Zealand guidelines that define safer or moderate drinking as up to 20 grams of alcohol daily for women and 30 grams for men. However, a 1987 Lancet editorial, Dying for a Drink urged caution, The higher mortality among abstainers has not been fully explained but may well be a spurious finding in a group of men who may be at higher risk for other reasons The U [J] shaped curve has been interpreted uncritically The message we should be delivering unequivocally is that alcohol is bad for health."
NZFP Volume 34 Number 2, April 2007 122-126. 2007 The Royal New Zealand College of General Practitioners
Drink to your health is alcohol really cardioprotective? Graham Gulbransen and Ross McCormick. Correspondence to Graham Gulbransen gg@woosh.co.nz
Wednesday, June 13, 2007
FSAM RESOLUTIONS FOR FMA MEETING
Dear Friends and Colleagues:
I seek your comments, critique and suggestions regarding both resolutions:
FLORIDA MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution:
Introduced by: Florida Society of Addiction Medicine
Subject: Repeal of Certain Provisions of the Uniform Individual Accident and
Sickness Policy Provision Law (UPPL)
Referred to:
Whereas, in 1947, the National Association of Insurance commissioners (NAIC) adopted the UPPL (Uniform Accident and Sickness Policy Provision) as a model law. The law states that health insurers would not have to reimburse patients for costs incurred when an accident is a result of "the insured's being intoxicated or under the influence of any narcotic” unless administered on the “ advice of a physician,” thus allowing insurers to deny payment for treatment of alcohol-related injuries; and
Whereas, forty to fifty percent of injured patients treated in ERs are under the influence of alcohol or other intoxicant; and
Whereas, data from the Centers for Disease Control and Prevention indicate that emergency room physicians are significantly less likely to screen injured patients for an alcohol problem in UPPL states due to reluctance to potentially burden patients, even those drinking in a legal manner, with large medical bills caused by denial of coverage under UPPL; and
Whereas, there are over 40 studies evaluating the use of brief alcohol interventions in health care settings, including ERs and trauma centers, that document effectiveness in reducing subsequent alcohol intake, DUI's, alcohol-related traffic infractions, alcohol-related arrests, and injury-related hospital readmission;and
Whereas, denial of coverage under UPPL also has a potentially large financial impact on emergency rooms; and
Whereas, our American Medical Association support state and specialty medical societies and the public heath associations in their efforts to secure repeal of laws and state insurance codes which allow for the denial of insurance payments for the treatment of injuries sustained as a consequence of the insured person being intoxicated due to alcohol or under the influence of narcotics; therefore be it
RESOLVED, that our Florida Medical Association supports and endorses legislation intended to repeal the Uniform Individual Accident and Sickness Policy Provision Law, thereby allowing for insurance payments for the treatment of injuries sustained when the insured person is intoxicated or under the influence of narcotics.
============================================================================
FLORIDA MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution:
Introduced by: Florida Society of Addiction Medicine
Subject: Parity for Mental Health and/or Substance Use Disorders
Referred to:
Whereas, substance abuse and/or dependence , also commonly referred to as “addictions,” are components of a “brain disease,” not unlike any other brain disease such as Parkinson Disease or Depression; and
Whereas, such a brain disease can be successfully treated involving pharmacological, behavioral and psychosocial approaches; and
Whereas, most health plans do not provide equal access and coverage for mental health and addiction treatment modalities compared to other medical and surgical benefits; and
Whereas, the Florida legislature has not enacted comprehensive parity legislation which eliminates discriminatory co-payments, deductibles, and annual and lifetime caps; and
Whereas, the Florida legislature has not enacted comprehensive parity legislation that include coverage for substance use and addictive disorders; and
Whereas, our AMA reaffirmed its support for parity in treatment coverage for mental illness and substance use disorders at the 2006 Interim meeting of the AMA House of Delegates in Las Vegas; therefore be it
RESOLVED, that our Florida Medical Association supports and endorses legislation mandating that a health plan provide both equal treatment limits and financial requirements for all conditions listed in the DSM-IV, as compared to medical and surgical benefits under that plan; and be it further
RESOLVED, that any such legislation require any health plan to provide the same level of out-of-network coverage for mental health and addiction treatment as for out-of-network benefits for medical and surgical treatment.
===========================================================================
FLORIDA MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution:
Introduced by: Florida Society of Addiction Medicine
Subject: Support of Screening and Brief Intervention Measures
Referred to:
Whereas, today there are over 20 million Americans who meet the medical definition of abuse or addiction to drugs and alcohol and over 94% of those Americans are unaware that they need help and have not sought treatment or intervention from health care professionals; and
Whereas, by encouraging health care professionals to identify at-risk populations and by early intervention programs, we can significantly reduce the abuse of alcohol and addiction to drugs among Americans; and
Whereas, substance abuse screening and intervention (SBI) programs are cost-effective and successful strategies in regard to reducing substance abuse and other health problems associated with drug use; and
Whereas, The Federal Government has established in seventeen states (including Florida) a demonstration program entitled “ Screening, Brief Intervention, Referral and Treatment”(SBIRT); and
Whereas, As of January 2007,more than 460,000 patients have been screened as part of the SBIRT demonstration program and a six month follow-up review of patients showed significant declines in substance abuse after the brief interventions; and
Whereas, since January 2007 doctors can bill Medicaid for drug and alcohol abuse screening using "CMS codes” approved by the Centers for Medicare and Medicaid Services; therefore be it
RESOLVED, that our Florida Medical Association supports the development and promotion of CME programs instructing physicians on how to conduct screening and brief intervention modalities ; and be it further
RESOLVED, that our Florida Medical Association supports any legislative efforts to mandate health plans to reimburse doctors for screening and brief intervention modalities.
I seek your comments, critique and suggestions regarding both resolutions:
FLORIDA MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution:
Introduced by: Florida Society of Addiction Medicine
Subject: Repeal of Certain Provisions of the Uniform Individual Accident and
Sickness Policy Provision Law (UPPL)
Referred to:
Whereas, in 1947, the National Association of Insurance commissioners (NAIC) adopted the UPPL (Uniform Accident and Sickness Policy Provision) as a model law. The law states that health insurers would not have to reimburse patients for costs incurred when an accident is a result of "the insured's being intoxicated or under the influence of any narcotic” unless administered on the “ advice of a physician,” thus allowing insurers to deny payment for treatment of alcohol-related injuries; and
Whereas, forty to fifty percent of injured patients treated in ERs are under the influence of alcohol or other intoxicant; and
Whereas, data from the Centers for Disease Control and Prevention indicate that emergency room physicians are significantly less likely to screen injured patients for an alcohol problem in UPPL states due to reluctance to potentially burden patients, even those drinking in a legal manner, with large medical bills caused by denial of coverage under UPPL; and
Whereas, there are over 40 studies evaluating the use of brief alcohol interventions in health care settings, including ERs and trauma centers, that document effectiveness in reducing subsequent alcohol intake, DUI's, alcohol-related traffic infractions, alcohol-related arrests, and injury-related hospital readmission;and
Whereas, denial of coverage under UPPL also has a potentially large financial impact on emergency rooms; and
Whereas, our American Medical Association support state and specialty medical societies and the public heath associations in their efforts to secure repeal of laws and state insurance codes which allow for the denial of insurance payments for the treatment of injuries sustained as a consequence of the insured person being intoxicated due to alcohol or under the influence of narcotics; therefore be it
RESOLVED, that our Florida Medical Association supports and endorses legislation intended to repeal the Uniform Individual Accident and Sickness Policy Provision Law, thereby allowing for insurance payments for the treatment of injuries sustained when the insured person is intoxicated or under the influence of narcotics.
============================================================================
FLORIDA MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution:
Introduced by: Florida Society of Addiction Medicine
Subject: Parity for Mental Health and/or Substance Use Disorders
Referred to:
Whereas, substance abuse and/or dependence , also commonly referred to as “addictions,” are components of a “brain disease,” not unlike any other brain disease such as Parkinson Disease or Depression; and
Whereas, such a brain disease can be successfully treated involving pharmacological, behavioral and psychosocial approaches; and
Whereas, most health plans do not provide equal access and coverage for mental health and addiction treatment modalities compared to other medical and surgical benefits; and
Whereas, the Florida legislature has not enacted comprehensive parity legislation which eliminates discriminatory co-payments, deductibles, and annual and lifetime caps; and
Whereas, the Florida legislature has not enacted comprehensive parity legislation that include coverage for substance use and addictive disorders; and
Whereas, our AMA reaffirmed its support for parity in treatment coverage for mental illness and substance use disorders at the 2006 Interim meeting of the AMA House of Delegates in Las Vegas; therefore be it
RESOLVED, that our Florida Medical Association supports and endorses legislation mandating that a health plan provide both equal treatment limits and financial requirements for all conditions listed in the DSM-IV, as compared to medical and surgical benefits under that plan; and be it further
RESOLVED, that any such legislation require any health plan to provide the same level of out-of-network coverage for mental health and addiction treatment as for out-of-network benefits for medical and surgical treatment.
===========================================================================
FLORIDA MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution:
Introduced by: Florida Society of Addiction Medicine
Subject: Support of Screening and Brief Intervention Measures
Referred to:
Whereas, today there are over 20 million Americans who meet the medical definition of abuse or addiction to drugs and alcohol and over 94% of those Americans are unaware that they need help and have not sought treatment or intervention from health care professionals; and
Whereas, by encouraging health care professionals to identify at-risk populations and by early intervention programs, we can significantly reduce the abuse of alcohol and addiction to drugs among Americans; and
Whereas, substance abuse screening and intervention (SBI) programs are cost-effective and successful strategies in regard to reducing substance abuse and other health problems associated with drug use; and
Whereas, The Federal Government has established in seventeen states (including Florida) a demonstration program entitled “ Screening, Brief Intervention, Referral and Treatment”(SBIRT); and
Whereas, As of January 2007,more than 460,000 patients have been screened as part of the SBIRT demonstration program and a six month follow-up review of patients showed significant declines in substance abuse after the brief interventions; and
Whereas, since January 2007 doctors can bill Medicaid for drug and alcohol abuse screening using "CMS codes” approved by the Centers for Medicare and Medicaid Services; therefore be it
RESOLVED, that our Florida Medical Association supports the development and promotion of CME programs instructing physicians on how to conduct screening and brief intervention modalities ; and be it further
RESOLVED, that our Florida Medical Association supports any legislative efforts to mandate health plans to reimburse doctors for screening and brief intervention modalities.
Monday, June 4, 2007
Marijuana in the News
Monday, June 4, 2007
Letter To The Editor
RE: Double standards persists on marijuana 06/04/07
The article “Double standards persists on marijuana” reveals the widespread use of marijuana and suggest that this drug is less dangerous even harmless compared to other “real” drugs. This is an urban myth far from the truth! Cannabinoids, the active ingredients in Marijuana, trigger the pleasure and reward system in the brain, resulting in the repetitive use of the drug to avoid withdrawal symptoms that include irritability, anger and depressed mood. Chronic use of marijuana can lead to anxiety and panic disorder, worsened short-term memory, reduced sex drive and deceased motivation.
In animal studies chronic exposure to marijuana changed the structure and function of parts of the brain (hippocampus) in ways similar to the effects of the aging process. College students who use marijuana report significantly higher rates of motor vehicle crashes, smoking, use of alcohol and tranquilizers, use of sex as a coping mechanism, violent dreams, sleeplessness and psychiatric problems than do nonusers. Furthermore, marijuana smoke does have a significantly higher tar content than cigarettes, contains many carcinogens and, unlike most cigarettes, is smoked unfiltered. This can cause chronic lung disease, including chronic bronchitis, and lung cancer.
We should not debate marijuana’s safety anymore. Decades of research have provided overwhelming evidence to the contrary. We should ask ourselves instead, why the United States, with only 4 percent of the world's population, consumes two-thirds of the world's illegal drugs? Can we only manage our reality with an unhealthy dose of mood-altering substances? If true, how can we change that?
Bernd Wollschlaeger,MD,FAAFP, President, Florida Society of Addiction Medicine
Phone: (305) 940-8717, E-mail: info@miamihealth.com
Posted on Mon, Jun. 04, 2007
Double standard persists on marijuana
BY LYDIA MARTIN AND FRED TASKER
At a recent backyard barbecue in Miami's Upper Eastside, a group of middle-age, middle-class folks tamely sipped berry cocktails and beers. Among them: a couple of lawyers, a couple of city administrators and an arts administrator. Somewhere between the skirt steak and the apple pie, somebody lit a joint and passed it around.
Nobody blinked. Even in mainstream, white-collar settings, smoking marijuana can be commonplace and unremarkable, like having a little wine with dinner.
Once a stamp of the arty, the marginal and the counterculture, today marijuana's popularity cuts across social boundaries. Yet several high-profile marijuana arrests have recently made headlines, highlighting the hazy double standard that exists around an illegal, potentially harmful drug that continues to encroach into the mainstream:
• In March, Lawrence Korda, 59, a Broward Circuit Court judge, was charged with openly smoking marijuana in a park in Hollywood. Korda completed a drug and alcohol program to erase the misdemeanor charge, and must take monthly random drug tests for six months and perform 25 hours of community service.
• Last month, Utpal Dighe, 31, a prosecutor in the Miami-Dade state attorney's office, was fired after police charged him with buying marijuana from a street dealer in Coconut Grove.
• Also last month, Ricky Williams, 30, erstwhile superstar running back for the Dolphins, probably ended his Miami career by testing positive for marijuana for the fifth time.
For good or ill, people from all walks smoke weed. In fact, 40.1 percent of all Americans 12 years old and up admit having tried marijuana at least once -- and 6 percent acknowledge having used it in the past month, federal drug surveys show. The FBI says 786,500 people were arrested for it in 2005, the latest figures available.
One group at least modestly turning away from marijuana is middle- and high-schoolers, ages 12 to 17. The percentage who have used pot at least once dropped from more than 20 percent in 2000 to about 17 percent in 2005, federal researchers say.
''I don't know if more people are smoking or more people are admitting it,'' said Betsy Wise, a Miami stand-up comic. Wise recently started to freelance for a New York ad agency. She confided in a co-worker that a friend was delivering pot brownies to the office -- and told him to help himself.
''When I got to the agency, all but a few of the brownies were gone,'' Wise said. ``Pretty much everyone partook, right in the office. They all greeted me with smiles. I thought that was remarkable. I would have expected maybe one or two people would have been simpatico.''
More and more, weed is cropping up in the popular culture. It isn't just the domain of hip-hop records with parental-guidance labels. On cable-TV shows like Six Feet Under,The Sopranos,Entourage and The L Word, characters have sparked up casually, the way they might sip merlot, without their marijuana use being part of any plot development or morality tale.
And it isn't just cable. On ABC's Brothers & Sisters, Sally Field's character gets high. The kids on That '70s Show often emerged from clouds of funny smoke.
GOING UPSCALE
''I think there is more of a laissez-faire attitude these days about smoking pot,'' said Jenji Kohan, creator of Showtime's Weeds, about a mother who sells marijuana to make ends meet after her husband dies unexpectedly. 'One of the things that I find interesting is that there are boutique farms that are really into their strains. It reminds me of when wine started to become really popular and people started talking about this vine and that grape. Marijuana has become more upscale. In L.A., dealers have full menus of `unique teas.' ''
Not that marijuana use is a function of wealth.
For $20 on the street, a buyer can score one-eighth ounce of low-grade marijuana from Mexico, Belize or Jamaica -- enough for four or five cigarettes. For $800, the connoisseur can acquire an ounce of exotic, extra-potent marijuana grown from modern hybrids in hydroponic labs or special soil indoors in ''grow-houses'' from Pompano Beach to Coral Gables, said James Hall, director of the Center for the Study and Prevention of Substance Abuse at Nova Southeastern University.
''It's like wine; you can buy an expensive one or you can buy the jug stuff,'' Hall said.
The truth is, for all of the marijuana possession arrests, police often look the other way, or let smokers go with friendly warnings.
At a Snoop Dogg concert at a Fort Lauderdale club a while back, a uniformed officer stood by unflinchingly as Snoop, and dozens in the audience, sent up telltale clouds.
''It's selective enforcement,'' said Miami musician Todd Thompson, who doesn't have a problem admitting that he gets high. ``At Langerado [a Broward outdoor music festival], there was smoking going on everywhere. I wouldn't do it in front of a cop, just in case. But cops don't always do something about a little marijuana smoke.''
Marijuana laws are a mishmash among the 50 states. It isn't entirely legal anywhere, but 12 states have at least partly decriminalized it, to the point that in Alaska there is no penalty for possessing an ounce or less at home.
In Florida, possession of 20 grams or less -- 28 grams would be an ounce -- is a misdemeanor punishable by a year in jail and/or a $1,000 fine; having more than 20 grams is a felony worth five years and/or a $5,000 fine.
Over the decades, debate about whether marijuana should be legalized has remained lively.
Said Howard Finkelstein, Broward County public defender and legal guru of the ''Help Me Howard'' segment on WSVN-Fox 7: 'We're making war on our own people. We take good fathers and lawyers and doctors and wives and make them outlaws. We're playing a stupid and harmful game of `gotcha.' ''
Some support for legalization comes from the belief that it's not dangerous to health, says Dr. J. Bryan Page, professor of anthropology and psychiatry and an expert on substance abuse in the University of Miami Department of Psychiatry.
''A student I knew claimed to be part of a group who all had grade-point averages over 3.6 who were very regular users,'' he said. 'She wanted me to study them to counter all the `Just say no' stuff.''
White House drug czar John Walters, not surprisingly, sees it differently. In April, his office released an analysis from the University of Mississippi's Potency Monitoring Project that said the level of THC -- the psychoactive ingredient in marijuana -- has more than doubled since 1983, from 4 percent to 8.5 percent.
`WAKE-UP CALL'
''This new report serves as a wake-up call for parents who may still hold outdated notions about the harms of marijuana,'' his announcement said.
The increased potency is from the exotic new hybrids and sophisticated indoor growing techniques, says Nova Southeastern's Hall.
Marijuana-related emergency-room visits increased from 45,000 in 1995 to 119,000 in 2002, the most recent comparison available, federal drug officials say.
Added Dr. Nora Volkow, director of the National Institute on Drug Abuse: ``Science has shown that marijuana can produce adverse physical, mental, emotional and behavioral changes, and -- contrary to popular belief -- it can be addictive.''
Norman Kent, a Fort Lauderdale lawyer and board member of NORML, the National Organization for the Reform of Marijuana Laws, scoffed: ``More people died last year from eating spinach than smoking pot.''
Letter To The Editor
RE: Double standards persists on marijuana 06/04/07
The article “Double standards persists on marijuana” reveals the widespread use of marijuana and suggest that this drug is less dangerous even harmless compared to other “real” drugs. This is an urban myth far from the truth! Cannabinoids, the active ingredients in Marijuana, trigger the pleasure and reward system in the brain, resulting in the repetitive use of the drug to avoid withdrawal symptoms that include irritability, anger and depressed mood. Chronic use of marijuana can lead to anxiety and panic disorder, worsened short-term memory, reduced sex drive and deceased motivation.
In animal studies chronic exposure to marijuana changed the structure and function of parts of the brain (hippocampus) in ways similar to the effects of the aging process. College students who use marijuana report significantly higher rates of motor vehicle crashes, smoking, use of alcohol and tranquilizers, use of sex as a coping mechanism, violent dreams, sleeplessness and psychiatric problems than do nonusers. Furthermore, marijuana smoke does have a significantly higher tar content than cigarettes, contains many carcinogens and, unlike most cigarettes, is smoked unfiltered. This can cause chronic lung disease, including chronic bronchitis, and lung cancer.
We should not debate marijuana’s safety anymore. Decades of research have provided overwhelming evidence to the contrary. We should ask ourselves instead, why the United States, with only 4 percent of the world's population, consumes two-thirds of the world's illegal drugs? Can we only manage our reality with an unhealthy dose of mood-altering substances? If true, how can we change that?
Bernd Wollschlaeger,MD,FAAFP, President, Florida Society of Addiction Medicine
Phone: (305) 940-8717, E-mail: info@miamihealth.com
Posted on Mon, Jun. 04, 2007
Double standard persists on marijuana
BY LYDIA MARTIN AND FRED TASKER
At a recent backyard barbecue in Miami's Upper Eastside, a group of middle-age, middle-class folks tamely sipped berry cocktails and beers. Among them: a couple of lawyers, a couple of city administrators and an arts administrator. Somewhere between the skirt steak and the apple pie, somebody lit a joint and passed it around.
Nobody blinked. Even in mainstream, white-collar settings, smoking marijuana can be commonplace and unremarkable, like having a little wine with dinner.
Once a stamp of the arty, the marginal and the counterculture, today marijuana's popularity cuts across social boundaries. Yet several high-profile marijuana arrests have recently made headlines, highlighting the hazy double standard that exists around an illegal, potentially harmful drug that continues to encroach into the mainstream:
• In March, Lawrence Korda, 59, a Broward Circuit Court judge, was charged with openly smoking marijuana in a park in Hollywood. Korda completed a drug and alcohol program to erase the misdemeanor charge, and must take monthly random drug tests for six months and perform 25 hours of community service.
• Last month, Utpal Dighe, 31, a prosecutor in the Miami-Dade state attorney's office, was fired after police charged him with buying marijuana from a street dealer in Coconut Grove.
• Also last month, Ricky Williams, 30, erstwhile superstar running back for the Dolphins, probably ended his Miami career by testing positive for marijuana for the fifth time.
For good or ill, people from all walks smoke weed. In fact, 40.1 percent of all Americans 12 years old and up admit having tried marijuana at least once -- and 6 percent acknowledge having used it in the past month, federal drug surveys show. The FBI says 786,500 people were arrested for it in 2005, the latest figures available.
One group at least modestly turning away from marijuana is middle- and high-schoolers, ages 12 to 17. The percentage who have used pot at least once dropped from more than 20 percent in 2000 to about 17 percent in 2005, federal researchers say.
''I don't know if more people are smoking or more people are admitting it,'' said Betsy Wise, a Miami stand-up comic. Wise recently started to freelance for a New York ad agency. She confided in a co-worker that a friend was delivering pot brownies to the office -- and told him to help himself.
''When I got to the agency, all but a few of the brownies were gone,'' Wise said. ``Pretty much everyone partook, right in the office. They all greeted me with smiles. I thought that was remarkable. I would have expected maybe one or two people would have been simpatico.''
More and more, weed is cropping up in the popular culture. It isn't just the domain of hip-hop records with parental-guidance labels. On cable-TV shows like Six Feet Under,The Sopranos,Entourage and The L Word, characters have sparked up casually, the way they might sip merlot, without their marijuana use being part of any plot development or morality tale.
And it isn't just cable. On ABC's Brothers & Sisters, Sally Field's character gets high. The kids on That '70s Show often emerged from clouds of funny smoke.
GOING UPSCALE
''I think there is more of a laissez-faire attitude these days about smoking pot,'' said Jenji Kohan, creator of Showtime's Weeds, about a mother who sells marijuana to make ends meet after her husband dies unexpectedly. 'One of the things that I find interesting is that there are boutique farms that are really into their strains. It reminds me of when wine started to become really popular and people started talking about this vine and that grape. Marijuana has become more upscale. In L.A., dealers have full menus of `unique teas.' ''
Not that marijuana use is a function of wealth.
For $20 on the street, a buyer can score one-eighth ounce of low-grade marijuana from Mexico, Belize or Jamaica -- enough for four or five cigarettes. For $800, the connoisseur can acquire an ounce of exotic, extra-potent marijuana grown from modern hybrids in hydroponic labs or special soil indoors in ''grow-houses'' from Pompano Beach to Coral Gables, said James Hall, director of the Center for the Study and Prevention of Substance Abuse at Nova Southeastern University.
''It's like wine; you can buy an expensive one or you can buy the jug stuff,'' Hall said.
The truth is, for all of the marijuana possession arrests, police often look the other way, or let smokers go with friendly warnings.
At a Snoop Dogg concert at a Fort Lauderdale club a while back, a uniformed officer stood by unflinchingly as Snoop, and dozens in the audience, sent up telltale clouds.
''It's selective enforcement,'' said Miami musician Todd Thompson, who doesn't have a problem admitting that he gets high. ``At Langerado [a Broward outdoor music festival], there was smoking going on everywhere. I wouldn't do it in front of a cop, just in case. But cops don't always do something about a little marijuana smoke.''
Marijuana laws are a mishmash among the 50 states. It isn't entirely legal anywhere, but 12 states have at least partly decriminalized it, to the point that in Alaska there is no penalty for possessing an ounce or less at home.
In Florida, possession of 20 grams or less -- 28 grams would be an ounce -- is a misdemeanor punishable by a year in jail and/or a $1,000 fine; having more than 20 grams is a felony worth five years and/or a $5,000 fine.
Over the decades, debate about whether marijuana should be legalized has remained lively.
Said Howard Finkelstein, Broward County public defender and legal guru of the ''Help Me Howard'' segment on WSVN-Fox 7: 'We're making war on our own people. We take good fathers and lawyers and doctors and wives and make them outlaws. We're playing a stupid and harmful game of `gotcha.' ''
Some support for legalization comes from the belief that it's not dangerous to health, says Dr. J. Bryan Page, professor of anthropology and psychiatry and an expert on substance abuse in the University of Miami Department of Psychiatry.
''A student I knew claimed to be part of a group who all had grade-point averages over 3.6 who were very regular users,'' he said. 'She wanted me to study them to counter all the `Just say no' stuff.''
White House drug czar John Walters, not surprisingly, sees it differently. In April, his office released an analysis from the University of Mississippi's Potency Monitoring Project that said the level of THC -- the psychoactive ingredient in marijuana -- has more than doubled since 1983, from 4 percent to 8.5 percent.
`WAKE-UP CALL'
''This new report serves as a wake-up call for parents who may still hold outdated notions about the harms of marijuana,'' his announcement said.
The increased potency is from the exotic new hybrids and sophisticated indoor growing techniques, says Nova Southeastern's Hall.
Marijuana-related emergency-room visits increased from 45,000 in 1995 to 119,000 in 2002, the most recent comparison available, federal drug officials say.
Added Dr. Nora Volkow, director of the National Institute on Drug Abuse: ``Science has shown that marijuana can produce adverse physical, mental, emotional and behavioral changes, and -- contrary to popular belief -- it can be addictive.''
Norman Kent, a Fort Lauderdale lawyer and board member of NORML, the National Organization for the Reform of Marijuana Laws, scoffed: ``More people died last year from eating spinach than smoking pot.''
Monday, May 28, 2007
Just A Parents Thought
Dear Friends and Colleagues:
Well, my son made it! He was accepted to attend the University of Central Florida (UCF) and I just returned from the two day long orientation session.
During eight hours each day we were bombarded with a myriad of information, which also included a 10-minute introduction into “Alcohol and other Drug Prevention Programming.”
The program was designed to “ hear about services the counseling center offers to enhance your students success.”
Well, they forgot to mention that the session should have been designed to educate parents how to keep their kids alive once they move onto a college campus.
According to the College Drinking Task Force report to NIH's National Institute on Alcohol Abuse and Alcoholism (NIAAA) http://newsinhealth.nih.gov/2006/September/docs/01features_01.htm , drinking by 18- to 24-year old college students contributes to an estimated 1,700 student deaths, 599,000 injuries and 97,000 cases of sexual assault or date rape each year!
These numbers are indeed sobering and should raise awareness and concerns among parents.
At the same time we were handed a free college orientation newspaper called “Central Florida Future” containing many ads by different sponsors.
One of the ads caught my eye and probably the eye of many college freshmen: “Every Wednesday Night. The Big Show. SOBER TO WASTED IN 3.9 SECONDS. FREE DRINKS FROM 8 TO 11.”
Guess, freedom of speech is more important than the right to live.
Thousands of college students have indeed blasted of to nowhere.
Are we that callous or stupid?
What do you think?
Yours truly,
Bernd
Proud Father of a UCF Freshmen
Well, my son made it! He was accepted to attend the University of Central Florida (UCF) and I just returned from the two day long orientation session.
During eight hours each day we were bombarded with a myriad of information, which also included a 10-minute introduction into “Alcohol and other Drug Prevention Programming.”
The program was designed to “ hear about services the counseling center offers to enhance your students success.”
Well, they forgot to mention that the session should have been designed to educate parents how to keep their kids alive once they move onto a college campus.
According to the College Drinking Task Force report to NIH's National Institute on Alcohol Abuse and Alcoholism (NIAAA) http://newsinhealth.nih.gov/2006/September/docs/01features_01.htm , drinking by 18- to 24-year old college students contributes to an estimated 1,700 student deaths, 599,000 injuries and 97,000 cases of sexual assault or date rape each year!
These numbers are indeed sobering and should raise awareness and concerns among parents.
At the same time we were handed a free college orientation newspaper called “Central Florida Future” containing many ads by different sponsors.
One of the ads caught my eye and probably the eye of many college freshmen: “Every Wednesday Night. The Big Show. SOBER TO WASTED IN 3.9 SECONDS. FREE DRINKS FROM 8 TO 11.”
Guess, freedom of speech is more important than the right to live.
Thousands of college students have indeed blasted of to nowhere.
Are we that callous or stupid?
What do you think?
Yours truly,
Bernd
Proud Father of a UCF Freshmen
Wednesday, May 9, 2007
Journal Club: Article Alert 05/09/07
Stroke in young adults who abuse amphetamines or cocaine
This study by US investigators was conducted to test the hypothesis that young adults who abuse stimulant drugs including amphetamines and cocaine are at a higher risk of stroke. They analyzed the Texas state database of hospital discharge information that occurred during the years 2000 - 2003 for the age range of 18 - 44 years. They identified discharges with a primary diagnosis of stroke and a secondary diagnosis of drug abuse where the drug was specified. Data analysis included logistic regression modeling.
Rates of drug abuse among discharge diagnoses increased most markedly over the years of the study for amphetamines. Increases were also noted for cocaine, cannabis, and opioids. There were not increases in rates for alcohol or hallucinogens. Amphetamine abuse was strongly associated with hemorrhagic stroke, but not ischemic stroke. The strength of this association was more than twice as strong as that of cocaine or alcohol abuse. Cocaine was associated with both hemorrhagic and ischemic stroke.
The authors concluded: “Increases in stimulant drug abuse may increase the rate of hospital admissions for strokes and stroke-related mortality.”
Stimulant abuse is associated with stroke in young adults, especially true for amphetamines.
Arch Gen Psychiatry. 2007;64:495-502. April 2007. © 2007 American Heart Association, Inc.
Stroke in Young Adults Who Abuse Amphetamines or Cocaine A Population-Based Study of Hospitalized Patients, Arthur N. Westover, MD; Susan McBride, RN, PhD; Robert W. Haley, MD
This study by US investigators was conducted to test the hypothesis that young adults who abuse stimulant drugs including amphetamines and cocaine are at a higher risk of stroke. They analyzed the Texas state database of hospital discharge information that occurred during the years 2000 - 2003 for the age range of 18 - 44 years. They identified discharges with a primary diagnosis of stroke and a secondary diagnosis of drug abuse where the drug was specified. Data analysis included logistic regression modeling.
Rates of drug abuse among discharge diagnoses increased most markedly over the years of the study for amphetamines. Increases were also noted for cocaine, cannabis, and opioids. There were not increases in rates for alcohol or hallucinogens. Amphetamine abuse was strongly associated with hemorrhagic stroke, but not ischemic stroke. The strength of this association was more than twice as strong as that of cocaine or alcohol abuse. Cocaine was associated with both hemorrhagic and ischemic stroke.
The authors concluded: “Increases in stimulant drug abuse may increase the rate of hospital admissions for strokes and stroke-related mortality.”
Stimulant abuse is associated with stroke in young adults, especially true for amphetamines.
Arch Gen Psychiatry. 2007;64:495-502. April 2007. © 2007 American Heart Association, Inc.
Stroke in Young Adults Who Abuse Amphetamines or Cocaine A Population-Based Study of Hospitalized Patients, Arthur N. Westover, MD; Susan McBride, RN, PhD; Robert W. Haley, MD
Tuesday, May 1, 2007
ASAM Conference in Miami Was A Smashing Success
News And Updates: The ASAM 38th Annual Scientific Conference Took Place In Miami
The ASAM Scientific Conference took place in Miami from Wednesday, April 26th to Sunday April 29th offering a variety excellent and very informative lectures, symposiums and workshops.
For more information about how to order audio CD’s,CD ROMs, and MP3 Audio files of the excellent scientific program please log on to https://www.dcporder.com/asam .
The conference was preceded by the ASAM Board meeting whose members voted to allocate significant resources from the Ruth Fox Memorial Endowment Fund to support ASAM’s two highest Strategic Priorities: the recognition of Addiction Medicine as a physician specialty by the American Board of Medical Specialties (ABMS) , and the adoption of federal parity legislation by the US congress.
Recognition of Addiction Medicine by the ABMS will assure patients suffering from the disease of addiction that there is a physician fully trained and BOARD CERTIFIED to meet their needs, and will make it easier for them to identify such physicians in their community.
Furthermore, parity will establish a level playing field for patients suffering from the disease of addiction to have their healthcare services for the treatment of their disease of addiction paid by their private health insurance on par with how their health insurance pays for all other medical care.
Parity and ABMS recognized certification will improve access to care, availability and quality of care thereby fulfilling ASAM’s mission.
OUR PATIENTS AND THEIR FAMILIES WILL BE THE BENEFACTORS!
On Sunday morning the ASAM leadership offered a two-hour program to presents the goals and perspectives of the newly formed ASAM’s Medical Specialty Action Group and outline the making of a medical specialty.
The FSAM Board also had the opportunity to meet with several FSAM members present and we discussed how to accomplish the FSAM goals:
1.Reorganize FSAM as a full-service membership organization promoting the interest of healthcare professionals involved in addiction care, research and treatment.
2.Promote excellence of care in addiction medicine through education and training of physicians and other allied healthcare professionals.
3.Achieve cooperative relationships with other medical specialties to foster the integration of screening and intervention modalities in patient care.
4.Create a FSAM Political Action Committee (PAC), educate political decision makers about the importance of sustainable funding mechanism for community based addiction treatment modalities and advocate for the promotion of addiction care and research in primary care.
5.Establish a planning committee to design a strategic plan outlining the vision of our organization for a statewide drug control and treatment program.
I also provided an overview of the Chapter activities that took place in the last two months:
Chapter Activities Update:
1. COMMUNICATION: Creation of a new blog http://fsamnews.blogspot.com/ We encourage you to respond to the posted news item, post your comment and opinions and participate in a continuous dialogue regarding our shared goals and interests
2. EDUCATION: After the successful completion of our last scientific meeting we are planning our 2008 Scientific Conference, which will take place FEBRUARY 28 - MARCH 2, 2008 at the MCKNIGHT BRAIN INSTITUTE UNIVERSITY OF FLORIDA Gainesville,FL. We need volunteers to organize and plan this conference!
3. ADOPT A RESIDENCY PROGRAM: Two residency programs in South Florida expressed their interest in an addiction medicine curriculum. We will support those efforts and Dr. Wollschlaeger will personally be involved in those activities. We are looking forward to your participation and support. For more information contact Dr. Wollschlaeger at info@miamihealth.com
4. POLITICAL ACTION: We will collaborate with the Florida Medical Association and the Florida Academy of Family Physicians in the pursuit of joint policy issues. We need your support to launch the FSAM Political Action Committee (FSAM-PAC).
5. FSAM COMMITTEES: We are looking for interested supporters and volunteers for the following suggested FSAM committees (Membership Development, Education and Research, Legislation) .
I
The ASAM Scientific Conference took place in Miami from Wednesday, April 26th to Sunday April 29th offering a variety excellent and very informative lectures, symposiums and workshops.
For more information about how to order audio CD’s,CD ROMs, and MP3 Audio files of the excellent scientific program please log on to https://www.dcporder.com/asam .
The conference was preceded by the ASAM Board meeting whose members voted to allocate significant resources from the Ruth Fox Memorial Endowment Fund to support ASAM’s two highest Strategic Priorities: the recognition of Addiction Medicine as a physician specialty by the American Board of Medical Specialties (ABMS) , and the adoption of federal parity legislation by the US congress.
Recognition of Addiction Medicine by the ABMS will assure patients suffering from the disease of addiction that there is a physician fully trained and BOARD CERTIFIED to meet their needs, and will make it easier for them to identify such physicians in their community.
Furthermore, parity will establish a level playing field for patients suffering from the disease of addiction to have their healthcare services for the treatment of their disease of addiction paid by their private health insurance on par with how their health insurance pays for all other medical care.
Parity and ABMS recognized certification will improve access to care, availability and quality of care thereby fulfilling ASAM’s mission.
OUR PATIENTS AND THEIR FAMILIES WILL BE THE BENEFACTORS!
On Sunday morning the ASAM leadership offered a two-hour program to presents the goals and perspectives of the newly formed ASAM’s Medical Specialty Action Group and outline the making of a medical specialty.
The FSAM Board also had the opportunity to meet with several FSAM members present and we discussed how to accomplish the FSAM goals:
1.Reorganize FSAM as a full-service membership organization promoting the interest of healthcare professionals involved in addiction care, research and treatment.
2.Promote excellence of care in addiction medicine through education and training of physicians and other allied healthcare professionals.
3.Achieve cooperative relationships with other medical specialties to foster the integration of screening and intervention modalities in patient care.
4.Create a FSAM Political Action Committee (PAC), educate political decision makers about the importance of sustainable funding mechanism for community based addiction treatment modalities and advocate for the promotion of addiction care and research in primary care.
5.Establish a planning committee to design a strategic plan outlining the vision of our organization for a statewide drug control and treatment program.
I also provided an overview of the Chapter activities that took place in the last two months:
Chapter Activities Update:
1. COMMUNICATION: Creation of a new blog http://fsamnews.blogspot.com/ We encourage you to respond to the posted news item, post your comment and opinions and participate in a continuous dialogue regarding our shared goals and interests
2. EDUCATION: After the successful completion of our last scientific meeting we are planning our 2008 Scientific Conference, which will take place FEBRUARY 28 - MARCH 2, 2008 at the MCKNIGHT BRAIN INSTITUTE UNIVERSITY OF FLORIDA Gainesville,FL. We need volunteers to organize and plan this conference!
3. ADOPT A RESIDENCY PROGRAM: Two residency programs in South Florida expressed their interest in an addiction medicine curriculum. We will support those efforts and Dr. Wollschlaeger will personally be involved in those activities. We are looking forward to your participation and support. For more information contact Dr. Wollschlaeger at info@miamihealth.com
4. POLITICAL ACTION: We will collaborate with the Florida Medical Association and the Florida Academy of Family Physicians in the pursuit of joint policy issues. We need your support to launch the FSAM Political Action Committee (FSAM-PAC).
5. FSAM COMMITTEES: We are looking for interested supporters and volunteers for the following suggested FSAM committees (Membership Development, Education and Research, Legislation) .
I
Sunday, April 15, 2007
Drug Court in the News
Dear Friends and Colleagues:
Attached an interesting article from Sundays Miami Herald (04/15/07) emphasizing the critical shortage of judges at Miami Dades Drug Court forcing it to stop the acceptance of new cases due to the high case load.
All of us know that the success rate of people who graduate from the drug court program in terms of recidivism is remarkable.
Substance abuse and dependence is a brain disease and need to be treated medically. Nonviolent crime related to substance abuse and/or dependence should be addressed via legal and medical means and locking those nonviolent offender s up will not resolve their problems.
We all should write our local legislators to increase funding for drug courts and FSAM will play a leading role in this efforts.
Yours
Bernd
Posted on Sun, Apr. 15, 2007
Drug Court puts new cases on hold
BY LISA ARTHUR
Miami-Dade's heralded Drug Court has closed its doors to new defendants until August to give its overwhelmed judge time to whittle down his load of 2,000 cases.
The moratorium went into effect April 9, said Judge Stanford Blake, administrative judge for the criminal division.
''It's purely a numbers game,'' he said. ``There is a point in time when a case load gets too big for one person to handle and we don't have funds for another judge.''
The moratorium is a troubling development for what has been a judicial model for at least 1,400 other drug courts in 47 states and several countries.
The Drug Court, started in 1989 as the first court of its kind in the United States, has allowed thousands of defendants to go through treatment and rehabilitation programs instead of being sent to prison.
''This moratorium is very sad,'' said Judge Jeffrey Rosinek, who runs Drug Court. ``The program really works and this means that for the next four months, hundreds of men and women who could work to change their lives won't be able to take advantage of it. They'll go to court, cop a plea and be right back on the street.''
Rosinek's caseload is about three times the size of a typical circuit judge. Though he doesn't have to take time out to preside over trials, Drug Court defendants are constantly monitored and most take 18 to 24 months to complete the year-long program because of relapses.
Defendants who qualify for Drug Court have been charged with felony drug possession or purchase. Once enrolled in Drug Court, defendants go into treatment programs and have to pass regular drug screening tests. They also receive counseling, job training and other support services. Violent offenders aren't allowed into the program.
The temporary moratorium, which was first reported last week by the Daily Business Review, won't apply to pregnant women, homeless people and juveniles who are charged as adults, said Blake. Judges also will have the option of postponing until August the cases of defendants who would qualify for Drug Court so they could take advantage of the program.
The long-term solution, said Rosinek and Blake, is more resources so that the county can open a second Drug Court. In addition to a judge, the state would have to earmark money for prosecutors, public defenders and court clerks.
''It's one of those problems where you throw a pebble in a lake and watch the ripples,'' Blake said. ``It's a systemwide problem, not just a judge shortage problem.''
Other solutions might include coming up with a streamlined program that ``can give meaningful but shorter treatment and identifying if there are people who have been in the program longer than they need to be.''
Without a permanent solution, Rosinek said, the county could soon find itself back in a crisis.
''There's nothing out there that is going to stop the caseload from climbing -- it will skyrocket again,'' said Rosinek. ``The long-term solution is bringing a judge on board and adding another drug court with all the staff it needs.''
Attached an interesting article from Sundays Miami Herald (04/15/07) emphasizing the critical shortage of judges at Miami Dades Drug Court forcing it to stop the acceptance of new cases due to the high case load.
All of us know that the success rate of people who graduate from the drug court program in terms of recidivism is remarkable.
Substance abuse and dependence is a brain disease and need to be treated medically. Nonviolent crime related to substance abuse and/or dependence should be addressed via legal and medical means and locking those nonviolent offender s up will not resolve their problems.
We all should write our local legislators to increase funding for drug courts and FSAM will play a leading role in this efforts.
Yours
Bernd
Posted on Sun, Apr. 15, 2007
Drug Court puts new cases on hold
BY LISA ARTHUR
Miami-Dade's heralded Drug Court has closed its doors to new defendants until August to give its overwhelmed judge time to whittle down his load of 2,000 cases.
The moratorium went into effect April 9, said Judge Stanford Blake, administrative judge for the criminal division.
''It's purely a numbers game,'' he said. ``There is a point in time when a case load gets too big for one person to handle and we don't have funds for another judge.''
The moratorium is a troubling development for what has been a judicial model for at least 1,400 other drug courts in 47 states and several countries.
The Drug Court, started in 1989 as the first court of its kind in the United States, has allowed thousands of defendants to go through treatment and rehabilitation programs instead of being sent to prison.
''This moratorium is very sad,'' said Judge Jeffrey Rosinek, who runs Drug Court. ``The program really works and this means that for the next four months, hundreds of men and women who could work to change their lives won't be able to take advantage of it. They'll go to court, cop a plea and be right back on the street.''
Rosinek's caseload is about three times the size of a typical circuit judge. Though he doesn't have to take time out to preside over trials, Drug Court defendants are constantly monitored and most take 18 to 24 months to complete the year-long program because of relapses.
Defendants who qualify for Drug Court have been charged with felony drug possession or purchase. Once enrolled in Drug Court, defendants go into treatment programs and have to pass regular drug screening tests. They also receive counseling, job training and other support services. Violent offenders aren't allowed into the program.
The temporary moratorium, which was first reported last week by the Daily Business Review, won't apply to pregnant women, homeless people and juveniles who are charged as adults, said Blake. Judges also will have the option of postponing until August the cases of defendants who would qualify for Drug Court so they could take advantage of the program.
The long-term solution, said Rosinek and Blake, is more resources so that the county can open a second Drug Court. In addition to a judge, the state would have to earmark money for prosecutors, public defenders and court clerks.
''It's one of those problems where you throw a pebble in a lake and watch the ripples,'' Blake said. ``It's a systemwide problem, not just a judge shortage problem.''
Other solutions might include coming up with a streamlined program that ``can give meaningful but shorter treatment and identifying if there are people who have been in the program longer than they need to be.''
Without a permanent solution, Rosinek said, the county could soon find itself back in a crisis.
''There's nothing out there that is going to stop the caseload from climbing -- it will skyrocket again,'' said Rosinek. ``The long-term solution is bringing a judge on board and adding another drug court with all the staff it needs.''
Sunday, April 8, 2007
Call for Parity
An editorial published in a recent edition of the AMA News calls for mental health parity. This issue is a crucial component in our struggle for recognition of substance abuse and dependence as a disease that requires equal attention in treatment as any other diseases (Diabetes, Heart Disease) do. Unfortunately, the proponents of mental health parity often forget that substance abuse and dependence is part of mental health care. We need to remind them and lobby for our interests and those of our patients.
Yours truly,
Bernd
OPINION
Time to pass mental health parity
The AMA is part of a coalition that supports new Senate legislation to close some gaps in the law requiring equal insurance coverage for mental illness.
Editorial. March 12, 2007.
Cancer. High blood pressure. Depression. Heart disease. All are serious medical conditions that affect millions of Americans. All are treatable. So shouldn't they all be covered equally by health plans?
The sad fact is that insurers have long singled out one of those diseases -- depression -- for lesser coverage. Benefits for mental illness in general often come up short in comparison with those for physical conditions.
Even with passage of the 1996 mental health parity act, barring different dollar limits on annual and life-time benefits, discrimination remained. Higher patient cost-sharing, limits on the number of days in the hospital, and caps on the number of outpatient mental health visits are still common.
That double standard would end if new mental health parity legislation introduced in the Senate passes Congress and is signed into law.
The bipartisan bill is the culmination of more than a year of negotiations between lawmakers, mental health organizations and the traditional foes of such measures: insurers and the business industry.
It has the strong support of the Coalition for Fairness in Mental Illness Coverage, which includes the American Medical Association, the American Psychiatric Assn. and several other health care and patient advocacy groups.
Under this legislation, group health plans no longer would be able to charge higher deductibles, co-payments or other out-of-pocket costs for mental health care. Patients no longer would face tighter restrictions on the number of days in the hospital or outpatient visits. Substance abuse is included in its protections.
Compromises were involved. The measure acknowledges the concerns of insurers and the business community. These groups have long argued that mandating equal benefits for mental illness would make health insurance prohibitively expensive.
The legislation includes one-year exemptions for health plans that experience an increase in actual total plan costs of more than 2% in the first plan year after the measure's implementation or 1% in years thereafter. It also exempts employers with fewer than 50 workers. The legislation would override state laws that differ from it on financial and treatment requirements, physician reimbursement, management of benefits, in- and out-of-network coverage, and cost exemptions.
An estimated 26% of Americans 18 and older -- about one in four adults -- have a diagnosable mental disorder in any given year, according to the National Institute of Mental Health. When applied to Census Bureau figures, that translates into 57.7 million adults.
The stigma historically associated with mental illness and exacerbated by insurance coverage policies has prevented many people from seeking help. This carries a huge economic toll. The combined indirect and related costs of mental illness, including lost productivity, lost earnings due to illness and social costs, are estimated to total at least $113 billion annually, says Mental Health America, an advocacy group.
By putting mental health benefits more on par with medical and surgical coverage, the Senate bill could help end the stigma and would encourage people to get medical care.
Mental illness is very treatable. Between 70% and 90% of people with serious mental illnesses have a significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatment, according to the National Alliance on Mental Illness.
More than a decade has passed since the first mental health parity law was adopted. The Senate consensus legislation, sponsored by Sens. Edward Kennedy (D, Mass.), Pete Domenici (R, N.M.) and Mike Enzi (R, Wyo.), finally could fill many loopholes left by that measure.
There is action on the House side as well. Reps. Patrick Kennedy (D, R.I.) and Jim Ramstad (R, Minn.) are crafting a bill they plan to introduce this spring. President Bush has voiced support for mental health parity in the past.
All this bodes well for success this year. It is time for Congress to finish the job.
Yours truly,
Bernd
OPINION
Time to pass mental health parity
The AMA is part of a coalition that supports new Senate legislation to close some gaps in the law requiring equal insurance coverage for mental illness.
Editorial. March 12, 2007.
Cancer. High blood pressure. Depression. Heart disease. All are serious medical conditions that affect millions of Americans. All are treatable. So shouldn't they all be covered equally by health plans?
The sad fact is that insurers have long singled out one of those diseases -- depression -- for lesser coverage. Benefits for mental illness in general often come up short in comparison with those for physical conditions.
Even with passage of the 1996 mental health parity act, barring different dollar limits on annual and life-time benefits, discrimination remained. Higher patient cost-sharing, limits on the number of days in the hospital, and caps on the number of outpatient mental health visits are still common.
That double standard would end if new mental health parity legislation introduced in the Senate passes Congress and is signed into law.
The bipartisan bill is the culmination of more than a year of negotiations between lawmakers, mental health organizations and the traditional foes of such measures: insurers and the business industry.
It has the strong support of the Coalition for Fairness in Mental Illness Coverage, which includes the American Medical Association, the American Psychiatric Assn. and several other health care and patient advocacy groups.
Under this legislation, group health plans no longer would be able to charge higher deductibles, co-payments or other out-of-pocket costs for mental health care. Patients no longer would face tighter restrictions on the number of days in the hospital or outpatient visits. Substance abuse is included in its protections.
Compromises were involved. The measure acknowledges the concerns of insurers and the business community. These groups have long argued that mandating equal benefits for mental illness would make health insurance prohibitively expensive.
The legislation includes one-year exemptions for health plans that experience an increase in actual total plan costs of more than 2% in the first plan year after the measure's implementation or 1% in years thereafter. It also exempts employers with fewer than 50 workers. The legislation would override state laws that differ from it on financial and treatment requirements, physician reimbursement, management of benefits, in- and out-of-network coverage, and cost exemptions.
An estimated 26% of Americans 18 and older -- about one in four adults -- have a diagnosable mental disorder in any given year, according to the National Institute of Mental Health. When applied to Census Bureau figures, that translates into 57.7 million adults.
The stigma historically associated with mental illness and exacerbated by insurance coverage policies has prevented many people from seeking help. This carries a huge economic toll. The combined indirect and related costs of mental illness, including lost productivity, lost earnings due to illness and social costs, are estimated to total at least $113 billion annually, says Mental Health America, an advocacy group.
By putting mental health benefits more on par with medical and surgical coverage, the Senate bill could help end the stigma and would encourage people to get medical care.
Mental illness is very treatable. Between 70% and 90% of people with serious mental illnesses have a significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatment, according to the National Alliance on Mental Illness.
More than a decade has passed since the first mental health parity law was adopted. The Senate consensus legislation, sponsored by Sens. Edward Kennedy (D, Mass.), Pete Domenici (R, N.M.) and Mike Enzi (R, Wyo.), finally could fill many loopholes left by that measure.
There is action on the House side as well. Reps. Patrick Kennedy (D, R.I.) and Jim Ramstad (R, Minn.) are crafting a bill they plan to introduce this spring. President Bush has voiced support for mental health parity in the past.
All this bodes well for success this year. It is time for Congress to finish the job.
Alcohol Treatment Guide
NIAAA has released an updated guide, “Helping Patients Who Drink Too Much: A Clinicians Guide, for physicians treating patients with alcohol problems.”
For the first time, the publication includes instructions for primary care physicians and nurses who wish to provide medication-based therapy to patients with alcohol dependence.
Other new features include a handout that describes strategies to help patients reduce their drinking or to quit, a web page with resources for physicians and patients, and information about the recently approved monthly injectable version of naltrexone.
The guide is available at http://www.niaaa.nih.gov/guide
For the first time, the publication includes instructions for primary care physicians and nurses who wish to provide medication-based therapy to patients with alcohol dependence.
Other new features include a handout that describes strategies to help patients reduce their drinking or to quit, a web page with resources for physicians and patients, and information about the recently approved monthly injectable version of naltrexone.
The guide is available at http://www.niaaa.nih.gov/guide
NIH Addiction Fellowship
OPEN POSITION: NIH funded fellowship at the SUNY at Buffalo, Departmen of Family Medicine. Slot is vailbale July 1st, 2007
DESCRIPTION: NIH(NRSA) Fellowship "Addiction Research in Medical Settings"; 2-3 year NIH funded research fellowship, > $110,000 ($45K NRSA stipend + $30K clinical work supplement+$35K NIH Loan Repayment ); family health coverage, travel allowance.
REQUIREMENTS: US Citizen, graduate from acredited residency program, evidence of potential for publication, committed to a NIH -funded addiction clinical research career in academic primary care or psychiatry.
CONTACT: e-mail CV & Career Statement to Laurene TumielB_erhalter,PhD at tumiel@buffalo.edu
DESCRIPTION: NIH(NRSA) Fellowship "Addiction Research in Medical Settings"; 2-3 year NIH funded research fellowship, > $110,000 ($45K NRSA stipend + $30K clinical work supplement+$35K NIH Loan Repayment ); family health coverage, travel allowance.
REQUIREMENTS: US Citizen, graduate from acredited residency program, evidence of potential for publication, committed to a NIH -funded addiction clinical research career in academic primary care or psychiatry.
CONTACT: e-mail CV & Career Statement to Laurene TumielB_erhalter,PhD at tumiel@buffalo.edu
Message From Your FSAM President
OPEN LETTER FROM YOUR NEW FSAM PRESIDENT:
Dear Friends and Colleagues:
During its scheduled meeting on March 2nd, 2007 the Executive Board of the Florida Society of Addiction Medicine accepted the resignation of President-Elect Joe Molea,MD and voted unanimously my person as your new President for the term 2007-2009.
I am a board-certified family physician practicing in North Miami Beach, certified in Addiction Medicine (ASAM) and am a certified MRO. I have served on the FSAM Board as the Chairman of Scientific Planning Committee and Information Technology Committee, am an AMA Delegate for the Florida Medical Association (FMA), Co-Chair of the FMA Accreditation and CME Committee, Immediate Past Chair of the AMA International Medical Graduates Section, Board Member of the Florida Academy of Family Physicians, Vice-President of the Dade County Medical Association, and the President of the North Dade County Rotary Club.
As your new President I seek your support to work towards the achievement of the following goals:
1.Reorganize FSAM as a full-service membership organization promoting the interest of healthcare professionals involved in addiction care, research and treatment.
2.Promote excellence of care in addiction medicine through education and training of physicians and other allied healthcare professionals.
3.Achieve cooperative relationships with other medical specialties to foster the integration of screening and intervention modalities in patient care.
4.Create a FSAM Political Action Committee (PAC), educate political decision makers about the importance of sustainable funding mechanism for community based addiction treatment modalities and advocate for the promotion of addiction care and research in primary care.
5.Establish a planning committee to design a strategic plan outlining the vision of our organization for a state-wide drug control and treatment program.
We need your support to realize the above mentioned goals. For that purpose we will utilize a List server, online newsletters and surveys to facilitate your input and will redesign our web site.
Furthermore, I want to solicit your input by forming several committees dealing with education, research, membership development, public relation and legislative issues.Please e-mail us and indicate your interest to participate in those committees.
Our new FSAM Executive Board is comprised of a team of dedicated and experienced fellow colleagues and we are all looking forward to your critique and input.
Yours truly,
Bernd Wollschlaeger,MD,FAAFP
E-mail: info@miamihealth.com
Phone: (305) 940-8717
Dear Friends and Colleagues:
During its scheduled meeting on March 2nd, 2007 the Executive Board of the Florida Society of Addiction Medicine accepted the resignation of President-Elect Joe Molea,MD and voted unanimously my person as your new President for the term 2007-2009.
I am a board-certified family physician practicing in North Miami Beach, certified in Addiction Medicine (ASAM) and am a certified MRO. I have served on the FSAM Board as the Chairman of Scientific Planning Committee and Information Technology Committee, am an AMA Delegate for the Florida Medical Association (FMA), Co-Chair of the FMA Accreditation and CME Committee, Immediate Past Chair of the AMA International Medical Graduates Section, Board Member of the Florida Academy of Family Physicians, Vice-President of the Dade County Medical Association, and the President of the North Dade County Rotary Club.
As your new President I seek your support to work towards the achievement of the following goals:
1.Reorganize FSAM as a full-service membership organization promoting the interest of healthcare professionals involved in addiction care, research and treatment.
2.Promote excellence of care in addiction medicine through education and training of physicians and other allied healthcare professionals.
3.Achieve cooperative relationships with other medical specialties to foster the integration of screening and intervention modalities in patient care.
4.Create a FSAM Political Action Committee (PAC), educate political decision makers about the importance of sustainable funding mechanism for community based addiction treatment modalities and advocate for the promotion of addiction care and research in primary care.
5.Establish a planning committee to design a strategic plan outlining the vision of our organization for a state-wide drug control and treatment program.
We need your support to realize the above mentioned goals. For that purpose we will utilize a List server, online newsletters and surveys to facilitate your input and will redesign our web site.
Furthermore, I want to solicit your input by forming several committees dealing with education, research, membership development, public relation and legislative issues.Please e-mail us and indicate your interest to participate in those committees.
Our new FSAM Executive Board is comprised of a team of dedicated and experienced fellow colleagues and we are all looking forward to your critique and input.
Yours truly,
Bernd Wollschlaeger,MD,FAAFP
E-mail: info@miamihealth.com
Phone: (305) 940-8717
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