Dear Friends and Colleagues:
Attached you find an article from the Sunday edition of the Miami Herald regarding the issue of impaired healthcare professionals.
Despite the apparent criticism of an opaque system that appears (for the public at least) to protect impaired practitioners Dr.Pomm points out the obvious success rate of the monitoring system.
I think that we need to proactively monitor our own profession and report those who truly need assistance and support.
We should not leave it up to the public or the lawyers to judge us but be proactive in the pursuit of protecting our patients and our profession.
I am looking forward to your comments.
Yours
Bernd
==============================================================================
Posted on Sun, Mar. 16, 2008
Healthcare practitioners with drug problems hidden by the system
BY JOHN DORSCHNER AND PATRICK DANNER
In August 2006, the former wife of a Broward psychologist sent a letter to state authorities saying she had visited his home 'and saw cocaine paraphernalia, an empty bottle of Oxycontin and a small Ziploc bag . . . with `whitish-beigy' colored small rocks,'' according to a court document.
That event started an investigation and later a lawsuit against ''John Doe, Ph.D.'' The psychologist's name has not been revealed. The Department of Health won't say if he's still practicing. ''Everything about this case is confidential,'' says spokeswoman Eulinda Jackson.
The case is another example of how far state regulators will go to protect healthcare professionals.
''Doctors like to protect other doctors,'' says Sidney M. Wolfe, a physician with the Washington-based Public Citizen consumer group which has published a series of studies on how lax regulatory groups are in disciplining healthcare professionals.
In the case of the unknown psychologist confidentiality is key in order to get professionals to seek help, says Raymond Pomm, head of the group that handles the impaired physicians' program. ``If we don't protect them, they won't come knocking on the door.''
But court records reveal John Doe, Ph.D. refused to participate. Pomm's program, Professional Resource Network, asked him to respond to his ex-wife's allegations. He didn't. In October 2006, PRN sent him a certified letter. He didn't respond. Over the next year, PRN kept repeating the request.
Finally, in November, the Department of Health sued ''John Doe Ph.D'' in Broward Circuit Court to compel him to submit to a mental and physical test. Wherever his real name appeared in court documents, it was blacked out. The psychologist has yet to respond.
''It's always been troubling to me that the profession protects itself to the detriment of the public,'' says Ervin Gonzalez, a Coral Gables lawyer who has represented patients in malpractice lawsuits. ``The profession closes in and has star chamber-type proceedings that no one knows about or hears about. I think it should be in the sunshine. I think it should be transparent.''
Gonzalez says doctors generally are allowed to continue to practice while the Department of Health brings such actions. That due process is a fundamental right, but ''after there is a probable cause finding and evidence of a legitimate risk to the public, then I think the public should know,'' he says.
That means making the physician's name public at that point so patients can decide for themselves. ''It's a matter of great public importance, I believe,'' Gonzalez says.
According to the state's Medical Quality Assurance Division, 127 complaints were received in fiscal 2007 concerning Florida's 3,571 licensed psychologists. In 12 cases, investigators found there was probable cause that state rules had been violated. Final outcome: No licenses revoked, one suspended and 11 psychologists were fined.
State officials have asked that the John Doe Ph.D. file be sealed completely, but the judge has yet to make a decision and a hearing last month was postponed. The state statute governing such cases requires that the psychologist's name be kept confidential in court documents and proceedings be closed to the public. But nothing in the statute says that the entire file must be sealed.
The attorney for the Health Department in the case, Cynthia L. Jakeman, did not respond to a request for comment.
Pomm says PRN has a ''very strict'' program of testing and compliance, and the doctors are highly motivated because they don't want to lose their licenses. He says 87.2 percent of medical doctors and osteopathic physicians successfully complete the program and never relapse -- a far better success rate than most rehab programs.
''We see 9.3 percent relapse one time, 1.7 percent relapse two times only and 1.8 percent three times or more. These are very good rates,'' says Pomm.
However, ''before July 1, 2005, there was a loophole,'' in which practitioners who had successfully completed the program and were thought to have relapsed could not be forced to take a urine test. ''We fixed that with legislation,'' says Pomm. Under the present PRN program, if a practitioner misses a urine test or a group counseling session, ``we basically pull them out of practice.''
In the case of John Doe Ph.D., court filings hint at multiple problems. One document indicates he successfully completed a PRN program in January 2006. In a filing in a custody battle for his children, he said he had been ''clean'' of ''hard-core'' drugs from August 2000 to April 2006, ``when he began taking a prescription of oxycodone for chronic neck, back and right knee pain.''
On Aug. 5, 2006, he said he was in an opiate detox program. Less than three weeks later, his ex-wife notified PRN of seeing drug paraphernalia in his home.
When the Health Department sued John Doe Ph.D., it stated ''probable cause existed to believe that respondent was unable to practice psychology with reasonable skill and safety,'' which appears to indicate that the department was asking the psychology board to suspend his license. However, in the minutes of that board's regular meetings, available on the Internet, there is no indication of any Broward psychologist being suspended for drug allegations.
Arthur Levin of the Center for Medical Consumers in New York says ''it's just crazy'' for regulators to protect the identity of a healthcare practitioner who refuses to cooperate. Levin appreciates the need for confidentiality. ``I live with somebody who is in recovery. But it's a little different in the case of a professional.''
Some believe impairment problems are not as critical with a psychologist as they would be with, say, a heart surgeon, but Michael Herkov, a clinical psychologist and a professor at the University of North Florida, says psychology also involves life-and-death decisions.
''Psychologists don't just listen,'' says Herkov. ``Bartenders listen. Psychologists are involved in the diagnosis and treatment of mental disorders. . . . More people die each year from suicide than do from homicide. Decisions have to be made. Do you have to be hospitalized immediately? . . . These are situations with serious consequences.''
Court records show it's unusual for the Department of Health to sue a John Doe to demand the taking of mental and physical exams. There are only four such cases in Miami-Dade and Broward counties over the past five years. The other two cases in Broward involve John Doe, MD and Jane Doe, LPN (licensed practical nurse).
In Miami-Dade, the lone such case involves a Jane Doe, RN (registered nurse). There is no indication of what the case was about or how it was resolved.
When a consumer hears rumors about a practitioner and drug use, such allegations are virtually impossible to check out.
Some months ago, a person called a Miami Herald reporter and named a Miami-Dade cosmetic surgeon who continued to practice while having drug problems. The caller gave detailed information, such as saying the surgeon relapsed six times in rehab programs.
On the Department of Health website, the surgeon is indicated as having a ''clear/active license.'' No disciplinary actions are listed.
When a reporter asked Pomm about the surgeon, he said he couldn't say anything about specific doctors.
Monday, March 17, 2008
Saturday, February 23, 2008
JOURNAL CLUB: Cocaine Abuse - A Case report
Attached a case report published in the current edition of CONSULTANT http://www.consultantlive.com/print.jhtml;jsessionid=ZCJKOW4131PZGQSNDLPSKHSCJUNN2JVN?articleID=206503919&url_prefix=
Looking forward to your comments.
Yours
Bernd
Renal Infarction: An Unusual Complication of Cocaine Abuse
By ASIM ABBASI, MD, ANDY ARWARI, MD, ALI ALIZADEHSOVARI, MD, and SAMER NUHAILY, MD,
February 01, 2008 URL: http://www.consultantlive.com/showArticle.jhtml?articleId=206503919
A 63-year-old African American man presented with severe epigastric pain of 1 day's duration. The pain was sharp and continuous and radiated toward the left flank. There were no aggravating or relieving factors or previous similar episodes. The patient denied fever, chills, urgency, frequent or painful urination, and gross hematuria. Earlier that day, he had taken an antacid for presumed gastritis and had a bout of emesis. The patient had a history of cocaine abuse and admitted that he had smoked one fourth of a bag of cocaine the day before presentation.
Blood pressure was 159/93 mm Hg; heart rate, 73 beats per minute; temperature, 36.9°C (98.4°F); respiration rate, 18 breaths per minute; and oxygen saturation, 98% on room air. The chest was clear. Cardiac findings were within normal limits. The abdomen was scaphoid, without scars, rashes, or lesions. There was severe epigastric tenderness and tenderness to percussion of left costovertebral angle, without guarding, spasm, or rebound; no masses or abnormal pulsations were noted. Genitourinary and rectal findings were normal; stool was guaiac-negative. Other physical findings were noncontributory.
The differential diagnosis included renal colic, pyelonephritis, acute gastritis, mesenteric ischemia, and renal infarction. Intravenous hydration with normal saline was started, pending the results of further investigations.
The white blood cell count was 17,300/µL, with 77.2% neutrophils; the hemoglobin level was 13.6 g/dL. Hematocrit was 40.2%; platelet count, 266,000/µL; blood urea nitrogen, 7 mg/dL; serum creatinine, 1.0 mg/dL; total protein, 6.1 g/dL; and serum albumin, 3.0 g/dL. Total bilirubin was 1.1 mg/dL; aspartate aminotransferase, 63 U/L; alanine aminotransferase, 41 U/L; alkaline phosphatase, 51 U/L; serum sodium, 135 mEq/L; potassium, 3.5 mEq/L; chloride, 104 mEq/L; carbon dioxide, 36.2 mEq/L; and lactate dehydrogenase, 341 U/L. A urinalysis showed trace proteinuria, 1 to 3 red blood cells per high-power field, and no white blood cells or casts. Urine toxicology confirmed the presence of cocaine.
CT scans of the abdomen showed acute infarcts in the medial upper pole and lateral lower pole of the left kidney (Figure). There was no vascular disease in the abdominal aorta, celiac artery, or superior mesenteric arteries. No definite plaque lesions were seen in the right or left renal arteries.
Duplex ultrasonography showed normal blood flow in both renal arteries. Blood and urine cultures were negative. Screening for hypercoagulability (factor V Leiden, prothrombin gene, protein C, protein S, antithrombin III, antiphospholipid antibody, and homocysteine); collagen disease (rheumatoid factor and antinuclear antibody); and lipid disorders was negative for thromboembolic phenomena. A transesophageal echocardiogram showed no evidence of an intracardiac thrombus or valvular vegetations.
Cocaine-induced renal infarction was diagnosed by exclusion. The patient was given supportive therapy for 3 days and was discharged. His renal function was observed during the hospitalization, and renal failure did not occur. His serum creatinine level at the time of discharge was 1.1 mg/dL.
RENAL COMPLICATIONS OF COCAINE ABUSE
Cocaine abuse has reached epidemic proportions in United States.1 Cocaine use has deleterious effects on multiple organ systems. Common toxic effects on the vascular system include myocardial ischemia, mesenteric ischemia, and cerebrovascular accidents. Myocardial ischemia and cerebrovascular accidents are the most common causes of hospitalizations related to cocaine abuse. The annual cost of cocaine-related hospitalizations has exceeded $80 million.2
Renal injury. Renal complications of cocaine abuse are relatively rare. The pathophysiology of renal injury involves changes in renal hemodynamics, glomerular matrix synthesis, degradation, oxidative stress, and induction of renal atherogenesis. These changes may lead to both acute and chronic renal injury. There are several case reports of acute tubular necrosis caused by rhabdomyolysis after cocaine abuse.3 Acute renal failure with accelerated hypertension or malignant hypertension can be precipitated by cocaine use.4
Other renal complications include acid-base and electrolyte imbalance (with both acidemia and alkalemia), increased incidence of urinary tract infection in cocaine-exposed infants, and increased risk of chronic renal failure in patients with hypertension—especially in African Americans.
Renal infarction. Spontaneous renal infarction secondary to cocaine abuse is rare. Patients usually pre- sent with persistent flank or abdominal pain with or without fever, nausea, and vomiting. Of the reported cases of cocaine-induced renal infarction, most involved the right kidney. The predilection for the right kidney may be related to increased resis- tance to blood flow in the right renal artery, compared with the left renal artery, because of its longer course.5
Pathophysiology. The precise mechanism of cocaine-induced renal infarction is unclear. Platelet aggregation and endothelial and vasospastic injury secondary to thromboxane synthesis are possible causes.6 Renal biopsy findings may include arterial and venous thrombosis as well as obliterative arteriopathy. However, our observation in this case and a review of the literature suggest that renal infarction can occur without thrombosis in patients with a history of cocaine abuse.
Laboratory studies. Leukocytosis, hematuria, and elevated levels of lactate dehydrogenase are common but nonspecific findings in patients with renal infarction. These findings can also be seen in patients who have renal venous thrombosis, papillary necrosis, and nephrolithiasis.
Diagnosis. A CT scan of the abdomen is both sensitive and specific for the diagnosis of renal infarction. With the use of intravenous contrast, renal arteries can also be evaluated for plaques or clots. Sagittal reconstruction through the abdominal aorta can adequately demonstrate findings in the aorta, celiac trunk, and superior mesenteric arteries. Coronal reconstruction of the renal arteries is usually best.
The possibility of infarction secondary to an embolic phenomenon should be ruled out with hypercoagulability studies and transesophageal echocardiography.
Treatment and outcome. There is no consensus on the treatment of renal infarction. For this patient, supportive therapy was started early on admission. Because his renal function did not decline, no further treatment was warranted. He was referred to social services for treatment of cocaine abuse but was lost to follow-up.
KEY POINTS FOR YOUR PRACTICE
Consider renal infarction in a patient with a history of cocaine abuse who presents with acute abdominal or flank pain.
A CT scan of the abdomen is both sensitive and specific for the diagnosis of renal infarction.
Further evaluation with transesophageal echocardiography and laboratory studies for thromboembolic phenomena is indicated to rule out embolic infarction.
Looking forward to your comments.
Yours
Bernd
Renal Infarction: An Unusual Complication of Cocaine Abuse
By ASIM ABBASI, MD, ANDY ARWARI, MD, ALI ALIZADEHSOVARI, MD, and SAMER NUHAILY, MD,
February 01, 2008 URL: http://www.consultantlive.com/showArticle.jhtml?articleId=206503919
A 63-year-old African American man presented with severe epigastric pain of 1 day's duration. The pain was sharp and continuous and radiated toward the left flank. There were no aggravating or relieving factors or previous similar episodes. The patient denied fever, chills, urgency, frequent or painful urination, and gross hematuria. Earlier that day, he had taken an antacid for presumed gastritis and had a bout of emesis. The patient had a history of cocaine abuse and admitted that he had smoked one fourth of a bag of cocaine the day before presentation.
Blood pressure was 159/93 mm Hg; heart rate, 73 beats per minute; temperature, 36.9°C (98.4°F); respiration rate, 18 breaths per minute; and oxygen saturation, 98% on room air. The chest was clear. Cardiac findings were within normal limits. The abdomen was scaphoid, without scars, rashes, or lesions. There was severe epigastric tenderness and tenderness to percussion of left costovertebral angle, without guarding, spasm, or rebound; no masses or abnormal pulsations were noted. Genitourinary and rectal findings were normal; stool was guaiac-negative. Other physical findings were noncontributory.
The differential diagnosis included renal colic, pyelonephritis, acute gastritis, mesenteric ischemia, and renal infarction. Intravenous hydration with normal saline was started, pending the results of further investigations.
The white blood cell count was 17,300/µL, with 77.2% neutrophils; the hemoglobin level was 13.6 g/dL. Hematocrit was 40.2%; platelet count, 266,000/µL; blood urea nitrogen, 7 mg/dL; serum creatinine, 1.0 mg/dL; total protein, 6.1 g/dL; and serum albumin, 3.0 g/dL. Total bilirubin was 1.1 mg/dL; aspartate aminotransferase, 63 U/L; alanine aminotransferase, 41 U/L; alkaline phosphatase, 51 U/L; serum sodium, 135 mEq/L; potassium, 3.5 mEq/L; chloride, 104 mEq/L; carbon dioxide, 36.2 mEq/L; and lactate dehydrogenase, 341 U/L. A urinalysis showed trace proteinuria, 1 to 3 red blood cells per high-power field, and no white blood cells or casts. Urine toxicology confirmed the presence of cocaine.
CT scans of the abdomen showed acute infarcts in the medial upper pole and lateral lower pole of the left kidney (Figure). There was no vascular disease in the abdominal aorta, celiac artery, or superior mesenteric arteries. No definite plaque lesions were seen in the right or left renal arteries.
Duplex ultrasonography showed normal blood flow in both renal arteries. Blood and urine cultures were negative. Screening for hypercoagulability (factor V Leiden, prothrombin gene, protein C, protein S, antithrombin III, antiphospholipid antibody, and homocysteine); collagen disease (rheumatoid factor and antinuclear antibody); and lipid disorders was negative for thromboembolic phenomena. A transesophageal echocardiogram showed no evidence of an intracardiac thrombus or valvular vegetations.
Cocaine-induced renal infarction was diagnosed by exclusion. The patient was given supportive therapy for 3 days and was discharged. His renal function was observed during the hospitalization, and renal failure did not occur. His serum creatinine level at the time of discharge was 1.1 mg/dL.
RENAL COMPLICATIONS OF COCAINE ABUSE
Cocaine abuse has reached epidemic proportions in United States.1 Cocaine use has deleterious effects on multiple organ systems. Common toxic effects on the vascular system include myocardial ischemia, mesenteric ischemia, and cerebrovascular accidents. Myocardial ischemia and cerebrovascular accidents are the most common causes of hospitalizations related to cocaine abuse. The annual cost of cocaine-related hospitalizations has exceeded $80 million.2
Renal injury. Renal complications of cocaine abuse are relatively rare. The pathophysiology of renal injury involves changes in renal hemodynamics, glomerular matrix synthesis, degradation, oxidative stress, and induction of renal atherogenesis. These changes may lead to both acute and chronic renal injury. There are several case reports of acute tubular necrosis caused by rhabdomyolysis after cocaine abuse.3 Acute renal failure with accelerated hypertension or malignant hypertension can be precipitated by cocaine use.4
Other renal complications include acid-base and electrolyte imbalance (with both acidemia and alkalemia), increased incidence of urinary tract infection in cocaine-exposed infants, and increased risk of chronic renal failure in patients with hypertension—especially in African Americans.
Renal infarction. Spontaneous renal infarction secondary to cocaine abuse is rare. Patients usually pre- sent with persistent flank or abdominal pain with or without fever, nausea, and vomiting. Of the reported cases of cocaine-induced renal infarction, most involved the right kidney. The predilection for the right kidney may be related to increased resis- tance to blood flow in the right renal artery, compared with the left renal artery, because of its longer course.5
Pathophysiology. The precise mechanism of cocaine-induced renal infarction is unclear. Platelet aggregation and endothelial and vasospastic injury secondary to thromboxane synthesis are possible causes.6 Renal biopsy findings may include arterial and venous thrombosis as well as obliterative arteriopathy. However, our observation in this case and a review of the literature suggest that renal infarction can occur without thrombosis in patients with a history of cocaine abuse.
Laboratory studies. Leukocytosis, hematuria, and elevated levels of lactate dehydrogenase are common but nonspecific findings in patients with renal infarction. These findings can also be seen in patients who have renal venous thrombosis, papillary necrosis, and nephrolithiasis.
Diagnosis. A CT scan of the abdomen is both sensitive and specific for the diagnosis of renal infarction. With the use of intravenous contrast, renal arteries can also be evaluated for plaques or clots. Sagittal reconstruction through the abdominal aorta can adequately demonstrate findings in the aorta, celiac trunk, and superior mesenteric arteries. Coronal reconstruction of the renal arteries is usually best.
The possibility of infarction secondary to an embolic phenomenon should be ruled out with hypercoagulability studies and transesophageal echocardiography.
Treatment and outcome. There is no consensus on the treatment of renal infarction. For this patient, supportive therapy was started early on admission. Because his renal function did not decline, no further treatment was warranted. He was referred to social services for treatment of cocaine abuse but was lost to follow-up.
KEY POINTS FOR YOUR PRACTICE
Consider renal infarction in a patient with a history of cocaine abuse who presents with acute abdominal or flank pain.
A CT scan of the abdomen is both sensitive and specific for the diagnosis of renal infarction.
Further evaluation with transesophageal echocardiography and laboratory studies for thromboembolic phenomena is indicated to rule out embolic infarction.
Sunday, February 10, 2008
Journal Club
Dear Friends and Colleagues;
Attached a series of articles published in Family Medicine Journals and Magazines regarding substance Abuse and Dependence:
1) Baclofen Cuts Alcohol Use in Cirrhosis Patients
2) Warning Reissued for Fentanyl Deaths, Side Effects
3) FDA Warns About Methadone-Related Deaths, Serious Events
4) Research Sought on Physicians' Addiction Recovery
I look forward to your comments.
Bernd
====================================================================================
Family Practice News
Volume 38, Issue 2, Page 23 (15 January 2008)
Baclofen Cuts Alcohol Use in Cirrhosis Patients
JOHN R. BELL (Associate Editor)
Alcohol-dependent persons with cirrhosis of the liver who were treated with baclofen, a ?-aminobutyric acid-B receptor agonist, were more than six times as likely to cease their alcohol use as were patients who took a placebo, according to a study.
The trial is the first “in which effectiveness and safety of an anticraving drug has been investigated in individuals with advanced liver disease,” wrote Dr. Giovanni Addolorato of the Catholic University of Rome, and colleagues. They reported results for 84 alcohol-dependent patients with a diagnosis of cirrhosis who were randomly assigned in equal number to a 12-week regimen of either baclofen or placebo.
The baclofen dosage was 5 mg three times daily for the first 3 days and 10 mg three times daily thereafter. Mean patient age was 49 years in both groups. Patients were seen weekly for the first month, then every 2 weeks until the end of the study (Lancet 2007;370:1915-22).
At 12 weeks, 30 (71%) of the 42 patients in the baclofen group were abstinent from alcohol, compared with 12 (29%) of the 42 patients in the placebo group (odds ratio 6.3).
In addition, those given baclofen showed improvements in measures of liver function, including ALT, bilirubin, international normalized ratio, ?-glutamyltransferase, and albumin. The drug was also associated with a greater number of nondrinking days than was placebo (63 days vs. 31 days), as well as a lower rate of relapse to heavy drinking at 60 days (19% vs. 45%).
Treatment with baclofen also reduced alcohol cravings, as measured with the obsessive-compulsive drinking scale.
Baclofen was not associated with any hepatotoxicity. There were no incidents of encephalopathy or hyperammonemia and no serious events leading to discontinuation of the drug. Tolerability was reported as fair, with headache, tiredness, vertigo, and sleepiness reported in small numbers of patients in both groups.
These results “suggest that baclofen, because of its anticraving action and safety, could have an important role for treatment of alcohol-dependent patients with advanced liver disease,” the researchers wrote. They cautioned that further studies are needed to establish optimal treatment duration and longer-term tolerance.
In a commentary accompanying the report, Dr. James C. Garbutt of the University of North Carolina at Chapel Hill, and Barbara Flannery, Ph.D., of RTI International, Baltimore, called the findings “surprisingly robust” and of potentially great clinical importance, given the routine exclusion of alcoholic patients with cirrhosis from trials of anticraving drugs because of the concern about hepatotoxicity (Lancet 2007;370:1884-5).
They also noted that the higher dropout rate in the placebo group (31%) versus the baclofen group (14%) is of interest, because it may have skewed the results in favor of baclofen, given that these were assumed to be because of relapse, and thus affected the primary end point.
The study authors declared no financial conflict of interest. The study was supported by the Italian Ministry for University, Scientific, and Technological Research, and by the European Research Advisory Board.
====================================================================================
Family Practice News
Volume 38, Issue 2, Page 23 (15 January 2008)
Warning Reissued for Fentanyl Deaths, Side Effects
Recent reports of death and life-threatening side effects associated with the fentanyl patch prompted the Food and Drug Administration to once again issue a warning about improper prescribing and use of the transdermal administration.
The last warning came in 2005 after similar reports.
The warning applies to the name brand Duragesic patch (manufactured by Johnson & Johnson) as well as other, generic versions of the patch, and to all dosages, Dr. Robert Rappaport said during a teleconference with reporters.
This particular warning does not, however, apply to other fentanyl formulations.
A warning about the buccal formulation of fentanyl was issued in September 2007. Fentanyl was approved in 1990 for opioid-tolerant patients who had chronic, moderate to severe pain.
The patch is given most commonly to patients who have cancer.
“The fentanyl patches are to be prescribed only for patients who are already tolerant of opioid drug products,” according to Dr. Rappaport.
“Unfortunately, what we are still seeing is that, in some cases, prescribers are giving these patches to patients who are not opioid tolerant, [either] for treatment post surgery, for mild pain, even for a headache. And in those patients this can cause serious and life-threatening respiratory depression.”
Signs of fentanyl overdose include trouble breathing or slow or shallow breathing, slow heartbeat, severe sleepiness, cold or clammy skin, trouble walking or talking, or feeling faint, dizzy, or confused, according to the agency.
Dr. Rappaport, who is the FDA's director of the division of anesthesia, analgesia, and rheumatology products, also emphasized the importance of patient education.
“The prescribers must inform and educate their patients about how to use these products and the dangers of using them in certain ways.
“For instance, [the patches] cannot be used in a setting where they would be exposed to heat, such as in a hot tub, [with] a heating pad, or a heated water bed,” he emphsized, because the high temperatures may increase the amount of fentanyl that reaches the blood stream.
For a full guide to the proper handling, disposal, and replacement of the patches, see www.fda.gov/cder/drug/infopage/fentanyl/fentanyl_apply.pdf.
“We are working with the … manufacturers to continue to add more warnings and cautions on the label and more instructions on the proper use of these products. And we're adding a medication guide that patients will receive with their product at the pharmacy as well,” said Dr. Rappaport.
Although the Food and Drug Administration has said that it did not have available the exact numbers of serious adverse events that have been reported since the last warning, Dr. Rappaport confirmed that at least one event had occurred when a physician prescribed the patch for headache relief, “and it's likely to be a considerably higher number than that.”
In July 2005, the agency issued a similar warning that the patch should be used only in strict accordance with the directions on the product label and in the package insert.
Dr. Rappaport defended the usefulness of the patch in opioid-resistant patients who suffer from chronic pain. However, although these products “fill an important need, improper use and misuse can be life-threatening,” he added.
Health care professionals who encounter any adverse or serious events associated with fentanyl are urged to contact the MedWatch program atwww.fda.gov/medwatch/report/hcp.htmor by telephone at 800-FDA-1088.
=====================================================================================
Family Practice News
Volume 36, Issue 24, Page 5 (15 December 2006)
FDA Warns About Methadone-Related Deaths, Serious Events
Reports of deaths, cardiac arrhythmias, respiratory depression, and other serious adverse events in people treated with methadone for pain prompted the Food and Drug Administration to issue a public health advisory and revise its prescribing information for methadone hydrochloride.
The advisory, which appeared Nov. 27 on the FDA's Web site, states that deaths and life-threatening side effects have been reported in patients just starting treatment with methadone and in those who have switched from other narcotic analgesics to methadone.
“These adverse events are the possible result of unintentional methadone overdoses, drug interactions, and methadone's cardiac toxicities (QT prolongation and Torsades de Pointes),” according to the information for health care professionals also posted on the site. The FDA emphasizes that physicians who prescribe methadone should be familiar with the drug's toxicities and distinctive pharmacologic properties, and that patients on methadone should be closely monitored, particularly when treatment is started and when the dose is adjusted.
The FDA has not changed any requirements governing methadone administration or dosage, according to officials who participated in a teleconference about the advisory. The new label represents the first revision in decades, however, and contains detailed prescribing information not previously available. For example, an expanded section on drug-drug interactions includes drugs that did not exist when physicians started prescribing methadone for pain control in the 1940s. The revision also contains a new table on converting oral morphine to oral methadone for chronic administration.
Conversion tables for other opioids and time frames for methadone rotation are not provided—primarily because these are difficult issues. “Where we did not see consensus in the literature we remained silent,” said Dr. Celia Jaffe Winchell, a team leader for addiction-treatment drugs in the FDA's Center for Drug Evaluation and Research.
Although methadone-related deaths have been on the rise for some years, Dr. Winchell said the FDA decided to act now because recent reports of adverse events and deaths “suggest a lack of information about methadone on the part of prescribers and patients may have played a role.”
These recent reports followed growing use of methadone for chronic pain, according to Dr. Winchell. Starting in the 1970s, methadone prescribing had been largely confined to tightly regulated addiction treatment programs. Over the last decade, calls for better treatment of chronic pain led to resurgence of analgesic use with a wide spectrum of practitioners, not just pain and addiction specialists, starting to prescribe methadone.
“One of the things we are trying to achieve with this series of patient and physician alerts is to educate people about just how complicated the use of methadone can be,” said Dr. Robert Rappaport, director of the FDA's Division of Anesthesia, Analgesia, and Rheumatology Products.
The FDA cannot stop methadone prescribing by physicians who are not pain specialists, Dr. Rappaport said. And even if it could, there are not enough pain specialists to meet the need. Therefore, the agency is seeking to increase knowledge about special properties of methadone that can put patients at risk.
“What we are trying to do is to get the word out to everybody,” Dr. Rappaport said.
Methadone's analgesic effects last for 4–8 hours, but its elimination half-life is 8–59 hours. Because of that, methadone's peak respiratory depressant effects “typically occur later and persist longer than its peak analgesic effects,” according to the FDA.
The agency recommends that physicians evaluate drugs that will be administered with methadone for potential interactions, that the risks of methadone should be carefully weighed against its potential benefits—and that the 40-mg dispersible methadone tablets should not be prescribed for pain, since this formulation is approved only for detoxification and maintenance treatment of narcotic addiction.
Because cross-tolerance between methadone and other opioids is incomplete, switching patients from other opioids to methadone is complex, so patients with a tolerance for other opioids can experience a methadone overdose.
The FDA also recommends that health care professionals who prescribe methadone carefully read and follow the prescribing information for Dolophine, the marketed methadone product, which was revised and approved on Nov. 17. Methadone is approved for moderate to severe pain that is not responsive to nonnarcotic analgesics, as well as for detoxification and maintenance treatment of opioid addiction.
The public health advisory on methadone, new prescribing information, and information for patients and physicians can be found atwww.fda.gov/cder/drug/infopage/methadone/default.htm. Serious adverse events associated with methadone can be reported to the FDA's MedWatch program atwww.fda.gov/medwatch/report.htm, by fax at 800-FDA-0178, or by calling 800-FDA-1088.
Senior Writer Elizabeth Mechcatie contributed to this report.
=====================================================================================
Family Practice News
Volume 38, Issue 1, Page 47 (1 January 2008)
Research Sought on Physicians' Addiction Recovery
CORONADO, CALIF. — Of 104 physicians in New York state who were admitted to substance abuse treatment programs between 2003 and 2004 and were monitored for a mean of 41 months by the state's Committee for Physicians' Health, only 9 (9%) were discharged because of noncompliance with program expectations.
That might spell success at first glance, but at the annual meeting of the American Academy of Addiction Psychiatry, Dr. Marc Galanter emphasized the need for more research to optimize treatment outcomes for physicians in recovery.
“There are still a number of issues to be considered,” said Dr. Galanter, professor of psychiatry and director of the division of alcoholism and drug abuse in the department of psychiatry at New York University, New York. “One is the need for prospective study—following the treatment contemporaneously—which we have yet to see,” he said. “Another is to better understand the role of medication.
Buprenorphine inevitably will be used more widely; however, the question of whether physicians should be allowed to practice while taking opioid maintenance therapy is likely to become a political issue at the state level. Dr. Galanter advised that a more active role for cognitive-behavioral therapy “be studied because this is a modality that is currently regarded as essential to effective treatment.”
Dr. Galanter based his remarks on results from a study he led that sought to provide an independent evaluation of the oversight and rehabilitation of 104 substance-abusing physicians who had completed their monitoring period by the New York State Committee for Physicians' Health (CPH). About 30% of physicians who enroll in the CPH program receive at least 28 days of inpatient treatment. Components of ambulatory management include workplace monitoring, 12-step program attendance, and random urine toxicologies.
The researchers, who were not affiliated with CPH, selected the 104 records at random (Am. J. Addict. 2007;16:117–23). The mean age of the study participants was 42 years, most (96) were male, about half (51) were married, and 66 were employed as physicians at the time of admission.
More than half (59) had a history of substance abuse treatment, and 38 had attended 12-step meetings before program admission. In addition, 33 were in psychotherapy of some sort prior to admission, and 27 were taking psychiatric medications, primarily antidepressants.
“This underlines the importance of psychiatric input and oversight in these programs,” said Dr. Galanter, who is also the editor of the journal Substance Abuse.
The most common primary substance of abuse was alcohol (38), followed by prescription opiates (35). The top five medical specialties represented were anesthesia (22 physicians), internal medicine (11), family medicine (10), obstetrics and gynecology (9), and pediatrics (8).
On average, the overall period of treatment and monitoring was 41 months, and 30 participants required inpatient hospitalization at study entry.
Fifteen physicians did not want to attend 12-step meetings but were pressed by counselors to do so. Of those, nine later went. “The outcome of those pressed to go was not significantly different from that of the other patients,” he said. “So apparently the coercive nature of the treatment in that regard was not compromising to the outcome.”
Of the 104 patients, 38 relapsed as confirmed by urine toxicology or by confirmation from an informed source. Even under good circumstances, some relapse is inevitable before the patient is stabilized, Dr. Galanter said.
“The pressure of the needs of public health that they experience puts them in a difficult position,” Dr. Galanter said. “My impression is that it's remarkable how effective they are in balancing the physician needs against the demands of the general public.”
Predictors of relapse included past use of cocaine, unemployment at the time of program admission, a greater mean number of urines tested, and a longer length of program involvement.
Nine patients were discharged for noncompliance with program expectations. “They essentially lost the option of practicing medicine,” he said. “Relatively speaking, this gives you an idea of a very good outcome, considering that full compliance is essential to success in this program.”
Attached a series of articles published in Family Medicine Journals and Magazines regarding substance Abuse and Dependence:
1) Baclofen Cuts Alcohol Use in Cirrhosis Patients
2) Warning Reissued for Fentanyl Deaths, Side Effects
3) FDA Warns About Methadone-Related Deaths, Serious Events
4) Research Sought on Physicians' Addiction Recovery
I look forward to your comments.
Bernd
====================================================================================
Family Practice News
Volume 38, Issue 2, Page 23 (15 January 2008)
Baclofen Cuts Alcohol Use in Cirrhosis Patients
JOHN R. BELL (Associate Editor)
Alcohol-dependent persons with cirrhosis of the liver who were treated with baclofen, a ?-aminobutyric acid-B receptor agonist, were more than six times as likely to cease their alcohol use as were patients who took a placebo, according to a study.
The trial is the first “in which effectiveness and safety of an anticraving drug has been investigated in individuals with advanced liver disease,” wrote Dr. Giovanni Addolorato of the Catholic University of Rome, and colleagues. They reported results for 84 alcohol-dependent patients with a diagnosis of cirrhosis who were randomly assigned in equal number to a 12-week regimen of either baclofen or placebo.
The baclofen dosage was 5 mg three times daily for the first 3 days and 10 mg three times daily thereafter. Mean patient age was 49 years in both groups. Patients were seen weekly for the first month, then every 2 weeks until the end of the study (Lancet 2007;370:1915-22).
At 12 weeks, 30 (71%) of the 42 patients in the baclofen group were abstinent from alcohol, compared with 12 (29%) of the 42 patients in the placebo group (odds ratio 6.3).
In addition, those given baclofen showed improvements in measures of liver function, including ALT, bilirubin, international normalized ratio, ?-glutamyltransferase, and albumin. The drug was also associated with a greater number of nondrinking days than was placebo (63 days vs. 31 days), as well as a lower rate of relapse to heavy drinking at 60 days (19% vs. 45%).
Treatment with baclofen also reduced alcohol cravings, as measured with the obsessive-compulsive drinking scale.
Baclofen was not associated with any hepatotoxicity. There were no incidents of encephalopathy or hyperammonemia and no serious events leading to discontinuation of the drug. Tolerability was reported as fair, with headache, tiredness, vertigo, and sleepiness reported in small numbers of patients in both groups.
These results “suggest that baclofen, because of its anticraving action and safety, could have an important role for treatment of alcohol-dependent patients with advanced liver disease,” the researchers wrote. They cautioned that further studies are needed to establish optimal treatment duration and longer-term tolerance.
In a commentary accompanying the report, Dr. James C. Garbutt of the University of North Carolina at Chapel Hill, and Barbara Flannery, Ph.D., of RTI International, Baltimore, called the findings “surprisingly robust” and of potentially great clinical importance, given the routine exclusion of alcoholic patients with cirrhosis from trials of anticraving drugs because of the concern about hepatotoxicity (Lancet 2007;370:1884-5).
They also noted that the higher dropout rate in the placebo group (31%) versus the baclofen group (14%) is of interest, because it may have skewed the results in favor of baclofen, given that these were assumed to be because of relapse, and thus affected the primary end point.
The study authors declared no financial conflict of interest. The study was supported by the Italian Ministry for University, Scientific, and Technological Research, and by the European Research Advisory Board.
====================================================================================
Family Practice News
Volume 38, Issue 2, Page 23 (15 January 2008)
Warning Reissued for Fentanyl Deaths, Side Effects
Recent reports of death and life-threatening side effects associated with the fentanyl patch prompted the Food and Drug Administration to once again issue a warning about improper prescribing and use of the transdermal administration.
The last warning came in 2005 after similar reports.
The warning applies to the name brand Duragesic patch (manufactured by Johnson & Johnson) as well as other, generic versions of the patch, and to all dosages, Dr. Robert Rappaport said during a teleconference with reporters.
This particular warning does not, however, apply to other fentanyl formulations.
A warning about the buccal formulation of fentanyl was issued in September 2007. Fentanyl was approved in 1990 for opioid-tolerant patients who had chronic, moderate to severe pain.
The patch is given most commonly to patients who have cancer.
“The fentanyl patches are to be prescribed only for patients who are already tolerant of opioid drug products,” according to Dr. Rappaport.
“Unfortunately, what we are still seeing is that, in some cases, prescribers are giving these patches to patients who are not opioid tolerant, [either] for treatment post surgery, for mild pain, even for a headache. And in those patients this can cause serious and life-threatening respiratory depression.”
Signs of fentanyl overdose include trouble breathing or slow or shallow breathing, slow heartbeat, severe sleepiness, cold or clammy skin, trouble walking or talking, or feeling faint, dizzy, or confused, according to the agency.
Dr. Rappaport, who is the FDA's director of the division of anesthesia, analgesia, and rheumatology products, also emphasized the importance of patient education.
“The prescribers must inform and educate their patients about how to use these products and the dangers of using them in certain ways.
“For instance, [the patches] cannot be used in a setting where they would be exposed to heat, such as in a hot tub, [with] a heating pad, or a heated water bed,” he emphsized, because the high temperatures may increase the amount of fentanyl that reaches the blood stream.
For a full guide to the proper handling, disposal, and replacement of the patches, see www.fda.gov/cder/drug/infopage/fentanyl/fentanyl_apply.pdf.
“We are working with the … manufacturers to continue to add more warnings and cautions on the label and more instructions on the proper use of these products. And we're adding a medication guide that patients will receive with their product at the pharmacy as well,” said Dr. Rappaport.
Although the Food and Drug Administration has said that it did not have available the exact numbers of serious adverse events that have been reported since the last warning, Dr. Rappaport confirmed that at least one event had occurred when a physician prescribed the patch for headache relief, “and it's likely to be a considerably higher number than that.”
In July 2005, the agency issued a similar warning that the patch should be used only in strict accordance with the directions on the product label and in the package insert.
Dr. Rappaport defended the usefulness of the patch in opioid-resistant patients who suffer from chronic pain. However, although these products “fill an important need, improper use and misuse can be life-threatening,” he added.
Health care professionals who encounter any adverse or serious events associated with fentanyl are urged to contact the MedWatch program atwww.fda.gov/medwatch/report/hcp.htmor by telephone at 800-FDA-1088.
=====================================================================================
Family Practice News
Volume 36, Issue 24, Page 5 (15 December 2006)
FDA Warns About Methadone-Related Deaths, Serious Events
Reports of deaths, cardiac arrhythmias, respiratory depression, and other serious adverse events in people treated with methadone for pain prompted the Food and Drug Administration to issue a public health advisory and revise its prescribing information for methadone hydrochloride.
The advisory, which appeared Nov. 27 on the FDA's Web site, states that deaths and life-threatening side effects have been reported in patients just starting treatment with methadone and in those who have switched from other narcotic analgesics to methadone.
“These adverse events are the possible result of unintentional methadone overdoses, drug interactions, and methadone's cardiac toxicities (QT prolongation and Torsades de Pointes),” according to the information for health care professionals also posted on the site. The FDA emphasizes that physicians who prescribe methadone should be familiar with the drug's toxicities and distinctive pharmacologic properties, and that patients on methadone should be closely monitored, particularly when treatment is started and when the dose is adjusted.
The FDA has not changed any requirements governing methadone administration or dosage, according to officials who participated in a teleconference about the advisory. The new label represents the first revision in decades, however, and contains detailed prescribing information not previously available. For example, an expanded section on drug-drug interactions includes drugs that did not exist when physicians started prescribing methadone for pain control in the 1940s. The revision also contains a new table on converting oral morphine to oral methadone for chronic administration.
Conversion tables for other opioids and time frames for methadone rotation are not provided—primarily because these are difficult issues. “Where we did not see consensus in the literature we remained silent,” said Dr. Celia Jaffe Winchell, a team leader for addiction-treatment drugs in the FDA's Center for Drug Evaluation and Research.
Although methadone-related deaths have been on the rise for some years, Dr. Winchell said the FDA decided to act now because recent reports of adverse events and deaths “suggest a lack of information about methadone on the part of prescribers and patients may have played a role.”
These recent reports followed growing use of methadone for chronic pain, according to Dr. Winchell. Starting in the 1970s, methadone prescribing had been largely confined to tightly regulated addiction treatment programs. Over the last decade, calls for better treatment of chronic pain led to resurgence of analgesic use with a wide spectrum of practitioners, not just pain and addiction specialists, starting to prescribe methadone.
“One of the things we are trying to achieve with this series of patient and physician alerts is to educate people about just how complicated the use of methadone can be,” said Dr. Robert Rappaport, director of the FDA's Division of Anesthesia, Analgesia, and Rheumatology Products.
The FDA cannot stop methadone prescribing by physicians who are not pain specialists, Dr. Rappaport said. And even if it could, there are not enough pain specialists to meet the need. Therefore, the agency is seeking to increase knowledge about special properties of methadone that can put patients at risk.
“What we are trying to do is to get the word out to everybody,” Dr. Rappaport said.
Methadone's analgesic effects last for 4–8 hours, but its elimination half-life is 8–59 hours. Because of that, methadone's peak respiratory depressant effects “typically occur later and persist longer than its peak analgesic effects,” according to the FDA.
The agency recommends that physicians evaluate drugs that will be administered with methadone for potential interactions, that the risks of methadone should be carefully weighed against its potential benefits—and that the 40-mg dispersible methadone tablets should not be prescribed for pain, since this formulation is approved only for detoxification and maintenance treatment of narcotic addiction.
Because cross-tolerance between methadone and other opioids is incomplete, switching patients from other opioids to methadone is complex, so patients with a tolerance for other opioids can experience a methadone overdose.
The FDA also recommends that health care professionals who prescribe methadone carefully read and follow the prescribing information for Dolophine, the marketed methadone product, which was revised and approved on Nov. 17. Methadone is approved for moderate to severe pain that is not responsive to nonnarcotic analgesics, as well as for detoxification and maintenance treatment of opioid addiction.
The public health advisory on methadone, new prescribing information, and information for patients and physicians can be found atwww.fda.gov/cder/drug/infopage/methadone/default.htm. Serious adverse events associated with methadone can be reported to the FDA's MedWatch program atwww.fda.gov/medwatch/report.htm, by fax at 800-FDA-0178, or by calling 800-FDA-1088.
Senior Writer Elizabeth Mechcatie contributed to this report.
=====================================================================================
Family Practice News
Volume 38, Issue 1, Page 47 (1 January 2008)
Research Sought on Physicians' Addiction Recovery
CORONADO, CALIF. — Of 104 physicians in New York state who were admitted to substance abuse treatment programs between 2003 and 2004 and were monitored for a mean of 41 months by the state's Committee for Physicians' Health, only 9 (9%) were discharged because of noncompliance with program expectations.
That might spell success at first glance, but at the annual meeting of the American Academy of Addiction Psychiatry, Dr. Marc Galanter emphasized the need for more research to optimize treatment outcomes for physicians in recovery.
“There are still a number of issues to be considered,” said Dr. Galanter, professor of psychiatry and director of the division of alcoholism and drug abuse in the department of psychiatry at New York University, New York. “One is the need for prospective study—following the treatment contemporaneously—which we have yet to see,” he said. “Another is to better understand the role of medication.
Buprenorphine inevitably will be used more widely; however, the question of whether physicians should be allowed to practice while taking opioid maintenance therapy is likely to become a political issue at the state level. Dr. Galanter advised that a more active role for cognitive-behavioral therapy “be studied because this is a modality that is currently regarded as essential to effective treatment.”
Dr. Galanter based his remarks on results from a study he led that sought to provide an independent evaluation of the oversight and rehabilitation of 104 substance-abusing physicians who had completed their monitoring period by the New York State Committee for Physicians' Health (CPH). About 30% of physicians who enroll in the CPH program receive at least 28 days of inpatient treatment. Components of ambulatory management include workplace monitoring, 12-step program attendance, and random urine toxicologies.
The researchers, who were not affiliated with CPH, selected the 104 records at random (Am. J. Addict. 2007;16:117–23). The mean age of the study participants was 42 years, most (96) were male, about half (51) were married, and 66 were employed as physicians at the time of admission.
More than half (59) had a history of substance abuse treatment, and 38 had attended 12-step meetings before program admission. In addition, 33 were in psychotherapy of some sort prior to admission, and 27 were taking psychiatric medications, primarily antidepressants.
“This underlines the importance of psychiatric input and oversight in these programs,” said Dr. Galanter, who is also the editor of the journal Substance Abuse.
The most common primary substance of abuse was alcohol (38), followed by prescription opiates (35). The top five medical specialties represented were anesthesia (22 physicians), internal medicine (11), family medicine (10), obstetrics and gynecology (9), and pediatrics (8).
On average, the overall period of treatment and monitoring was 41 months, and 30 participants required inpatient hospitalization at study entry.
Fifteen physicians did not want to attend 12-step meetings but were pressed by counselors to do so. Of those, nine later went. “The outcome of those pressed to go was not significantly different from that of the other patients,” he said. “So apparently the coercive nature of the treatment in that regard was not compromising to the outcome.”
Of the 104 patients, 38 relapsed as confirmed by urine toxicology or by confirmation from an informed source. Even under good circumstances, some relapse is inevitable before the patient is stabilized, Dr. Galanter said.
“The pressure of the needs of public health that they experience puts them in a difficult position,” Dr. Galanter said. “My impression is that it's remarkable how effective they are in balancing the physician needs against the demands of the general public.”
Predictors of relapse included past use of cocaine, unemployment at the time of program admission, a greater mean number of urines tested, and a longer length of program involvement.
Nine patients were discharged for noncompliance with program expectations. “They essentially lost the option of practicing medicine,” he said. “Relatively speaking, this gives you an idea of a very good outcome, considering that full compliance is essential to success in this program.”
Thursday, December 27, 2007
Letter To The Editor
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
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
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
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