Attached a letter to the editor sent to the Miami Herald, Sun Sentinel and SunPost in response to their articles about prescription drug abuse.
LETTER
Prescription opioid use and dependence reached a record high threatening the public health of our society.
North America, with 4 percent of the world population consumes more than 50 percent of the world's supply of morphine and narcotic prescription drugs! It is unlikely that Americans suffer from an opioid deficiency syndrome but are using them for any aches or pains for which those drugs are not intended for.
The prescription of those drugs are strictly regulated by the Drug Enforcement Administration (DEA) but they can be easily obtained from unscrupulous black marketeer selling those drugs via the Internet, drug dealers and also from self-declared pain specialists, better described as " drug dealers in white coats", who advertise their services on backpages of local newspapers.
Many doctors who appropriately prescribe pain medications are caught between the regulatory scrutiny of law enforcement agencies, and the demands of their patients for immediate pain relief. Most of us rely on the information supplied by the patient and cannot verify the accuracy of the information. Those doctors are then blamed for an overdose death and as a result are increasingly reluctant to issue pain medications.
Therefore, we need to built in safe guards to protect physicians and patients by creating a state-wide prescription drug database to identify and to curb narcotic prescription drug abuse. Such legislation would save countless lives and protect physicians and patients who legitimately require appropriate pain management modalities. The legislation should also include the narcotic pain medications dispensed in doctors offices. Otherwise, doctor shoppers will use those pill mills in medical practices to feed their addiction.
Bernd Wollschlaeger,MD
President of the Florida Society of Addiction Medicine
16899 NE 15th Avenue
North Miami Beach,L 33162
Phone: 305-940-8717
Thursday, December 27, 2007
Prescription Drug Abuse in the News
Attached another article from a local newspaper regarding the prescription drug abuse.
According to the Florida Department of Law Enforcement I2007 Interim Report Prescription drugs (76%) are found to dominate at lethal levels when compared to illicit drugs (24%). Prescription drugs are also found to be the majority of non-lethal occurrences at 64% in contrast to illicit drugs at 36%. The prescription drugs tracked in this report are: all Benzodiazepines, Carisoprodol/Meprobamate, and all Opioids except Heroin.
As an organization we need to speak up and especially point the finger on those "drug dealers in white coat" aka our fellow colleagues, who run lucrative pill mills that readily supply drugs to anyone who is willing to pay.As long as we hesitate calling them what they are, drug dealers, we will NOT address the problem.
The silence of the medical profession will encourage those " doctors" to continue their business.
Now its time to speak up!
Yours
Bernd
SUNPOST 12/20/07
Prescription for Death
Prescription drugs claim more lives than cocaine and heroin combined
By Angie Hargot
Photo illustration by James Wilkins
Florida corpses are telling a disturbing tale — and they’re using terms like blow, smack or meth less often than harder-to-pronounce, and more deadly, prescription drugs.
Prescription drug use isn’t just increasing in Florida — it’s killing nearly three times more people than cocaine, heroin and methamphetamines combined, in part because of a growing supply of street pharmaceuticals.
In the first six months of this year, cocaine, heroin and methylated amphetamines caused the deaths of 470 people statewide, while the five most commonly prescribed painkillers and tranquilizers caused 1,324 deaths, according to a Florida Department of Law Enforcement report detailing drug use identified by state medical examiners during autopsies.
Cocaine, the state’s deadliest substance, killed 398 people statewide, while heroin killed 38 and methylated amphetamines killed 34, according to the report.
However, during the same time period, methadone, a drug often prescribed to heroin addicts, killed 392 people; benzodiazepines, which include widely prescribed tranquilizers such as Valium and Xanax, 353; oxycodone, commonly sold as OxyContin, 323; hydrocodone, a painkiller often prescribed as Vicodin and Lortab, 134; and morphine, 122.
“We’ve become a medicated society,” said Howard Lerner, clinical director of South Miami Hospital’s substance abuse treatment program. “Ten years ago, we never saw drugs marketed on TV. Now they’re selling them like McDonald’s hamburgers. The availability is a progression of the numbers. Many more people are attracted to it.”
‘Lethal Levels’
Of the 87,500 people who died in Florida between January and June, medical examiners detected drugs in the systems of 3,980 corpses at the time of autopsy — nearly 5 percent more than in the second half of 2006, according to the Dec. 4 report.
Yet prescription drugs, which “dominate at lethal levels when compared to illicit drugs,” accounted for 69 percent of all the drugs found at autopsy — 2 percent more than in the previous six-month period, according to the report.
“In general, there is certainly an increase across the board” in prescription drug use and abuse, Lerner said. “Because of an increase in marketing, there’s a lot more usage. “Younger people are selling them on the streets.”
That doesn’t mean illicit street drugs more commonly associated with overdoses aren’t still killing plenty of Floridians, either directly or indirectly.
Take cocaine, for example. Medical examiners detected various amounts of cocaine in 1,008 corpses statewide, of which it killed 398. Yet, 13 percent of the 610 who died with nonlethal levels of cocaine in their systems were homicide victims.
In Miami-Dade County, the narcotic was found during 84 autopsies and caused 16 deaths.
“The leading causes of death in this country are all drug-related — alcohol, murder …,” said Jay M. Holder, a board-certified addictionologist who runs the Exodus Treatment Center in Miami.
In fact, 57 percent of the 59,000 people arrested by the Miami-Dade County Narcotics Bureau in the last year had records of violent crimes and robberies. Even more had theft and burglary records, said Major Charles Nanney, whose bureau polices everything from marijuana grow houses to a burgeoning MySpace market for MDMA, more commonly known as ecstasy.
“There is a crime-drug nexus,” Nanney said. “The main use is still cocaine and heroin. Twenty-five years ago a kilo of coke was $50,000. Now the price is lower.”
Rx Factor
Still, the growing number of prescription-related deaths has garnered much concern among government and law enforcement officials, as well as substance abuse counselors. The problem, according to Nanney, “comes down to availability.”
There’s no doubt the findings are troubling.
“We have seen an increase in prescription drug deaths in recent years,” FDLE spokesperson Kristin Perelluha said.
Although heroin, which killed 84 percent of the 45 people with the drug in their systems, topped the list of the state’s most lethal drugs — those that caused death in more than 50 percent of people in which it was found — methadone, oxycodone and fentanyl followed closely behind.
Methadone, which is often prescribed to treat the pain associated with heroin withdrawal, caused the deaths of 354 more people than heroin statewide. It killed 392 — nearly 74 percent — of the 533 people in whom the substance was found. Methadone was found in eight Miami-Dade decedents, of which it killed three.
The report also noted a 5 percent increase in the use of benzodiazepines, the most widely prescribed and detected prescription drug. Benzodiazepines killed 353 — 30 percent — of the 1,167 people in whom it was found, including 260 from alprazolam alone, which is often sold under the trade names Xanax and Niravam.
“What we’re seeing is the same individuals with cocaine and heroin addiction, now also with a whole litany of prescription drugs,” Holder said, adding that time-released medications are particularly dangerous when mixed with alcohol. “OxyContin is very powerful. An addict will chew that, and it’s 100 percent absorbed immediately, bypassing the time-release.”
Use of oxycodone, the painkiller often marketed under the brand name OxyContin, increased 9 percent from last year, killing 323 — about 57 percent — of the 568 people in whom the substance was found, including six of nine in Miami-Dade. The pills sell for $20 to $30 each on the street, said Nanney, who, in his 20 years of service, has arrested several doctors for selling OxyContin prescriptions.
“There has been a crackdown on oxycodone and OxyContin,” Lerner said, adding that prescriptions often fall into the hands of some abusers who go “doctor shopping,” frequenting different doctors and getting prescriptions for pain medications from each of them. That tactic can also lead to overdoses even for those prescribed the medication for genuine ailments. Taking them with alcohol can cause respiratory failure, for example.
The street pharmaceutical market also carries a unique problem: dosing. “It’s not logical,” Nanney said. “Someone might know ‘I can take this much cocaine,’ for example, but the same size pill could be 20 mg or 40 mg. It’s easy to overdose.”
Hydrocodone, a painkiller prescribed under the brand names Vicodin and Lortab, caused the deaths of 134 users statewide, though it was found in 380 bodies. It killed one of two deceased Miami-Dade users.
Morphine, another painkiller, killed 122, or nearly half of the 280 deceased users statewide, and half of the 10 users in Miami-Dade.
Fentanyl, a pain reliever sold under the name Actiq, which is 80 times more potent than morphine and often administered via a mouth swab or lollipop to facilitate speed of absorption, killed more than half of the 103 people who had it in their systems.
Many hospitals have recently pushed to better control the prescription of opiates, Lerner said, the use of which continues to increase. Medical examiners detected a 27 percent increase in one opiate-based painkiller, hydromorphone, which is two to eight times stronger than morphine and marketed under the trade name Dilaudid.
Some of these drugs, Lerner said, are sold by unethical doctors who “open clinics to distribute meds to anyone who has the money to pay for them.”
Both Holder and Lerner, who mostly counsel patients for cocaine and alcohol problems, said that they also see patients with addictions who are taking prescription drugs according to their doctor’s instructions, who prescribed them without asking enough questions about the indicators of a possible addiction.
Behind the Eight Ball
Still, Florida is one of few states that does not track prescriptions. So far, 35 states have passed legislation to create prescription monitoring systems, with at least 24 of them already in use. The Florida Legislature has routinely rejected similar efforts for the last six years, citing privacy issues.
However, some state lawmakers now want to implement a pilot program that would create a $1.6 million computerized monitoring system to track painkiller prescriptions in Broward County. The proposed system, which would be funded with private money and federal grants, would keep patient medication records that could be accessed by doctors, pharmacists, patients, law-enforcement agencies and the Agency for Health Care Administration.
“If you open the New Times and look at the local ads, a significant percentage are pain management clinics that even specifically say ‘OxyContin’ in their ads,” Holder said. “Basically they are saying, ‘Come get your prescription.’ What’s killing people may not be the drugs, but the doctors that give patients the drugs.”
Comments? E-mail angie@miamisunpost.com.
According to the Florida Department of Law Enforcement I2007 Interim Report Prescription drugs (76%) are found to dominate at lethal levels when compared to illicit drugs (24%). Prescription drugs are also found to be the majority of non-lethal occurrences at 64% in contrast to illicit drugs at 36%. The prescription drugs tracked in this report are: all Benzodiazepines, Carisoprodol/Meprobamate, and all Opioids except Heroin.
As an organization we need to speak up and especially point the finger on those "drug dealers in white coat" aka our fellow colleagues, who run lucrative pill mills that readily supply drugs to anyone who is willing to pay.As long as we hesitate calling them what they are, drug dealers, we will NOT address the problem.
The silence of the medical profession will encourage those " doctors" to continue their business.
Now its time to speak up!
Yours
Bernd
SUNPOST 12/20/07
Prescription for Death
Prescription drugs claim more lives than cocaine and heroin combined
By Angie Hargot
Photo illustration by James Wilkins
Florida corpses are telling a disturbing tale — and they’re using terms like blow, smack or meth less often than harder-to-pronounce, and more deadly, prescription drugs.
Prescription drug use isn’t just increasing in Florida — it’s killing nearly three times more people than cocaine, heroin and methamphetamines combined, in part because of a growing supply of street pharmaceuticals.
In the first six months of this year, cocaine, heroin and methylated amphetamines caused the deaths of 470 people statewide, while the five most commonly prescribed painkillers and tranquilizers caused 1,324 deaths, according to a Florida Department of Law Enforcement report detailing drug use identified by state medical examiners during autopsies.
Cocaine, the state’s deadliest substance, killed 398 people statewide, while heroin killed 38 and methylated amphetamines killed 34, according to the report.
However, during the same time period, methadone, a drug often prescribed to heroin addicts, killed 392 people; benzodiazepines, which include widely prescribed tranquilizers such as Valium and Xanax, 353; oxycodone, commonly sold as OxyContin, 323; hydrocodone, a painkiller often prescribed as Vicodin and Lortab, 134; and morphine, 122.
“We’ve become a medicated society,” said Howard Lerner, clinical director of South Miami Hospital’s substance abuse treatment program. “Ten years ago, we never saw drugs marketed on TV. Now they’re selling them like McDonald’s hamburgers. The availability is a progression of the numbers. Many more people are attracted to it.”
‘Lethal Levels’
Of the 87,500 people who died in Florida between January and June, medical examiners detected drugs in the systems of 3,980 corpses at the time of autopsy — nearly 5 percent more than in the second half of 2006, according to the Dec. 4 report.
Yet prescription drugs, which “dominate at lethal levels when compared to illicit drugs,” accounted for 69 percent of all the drugs found at autopsy — 2 percent more than in the previous six-month period, according to the report.
“In general, there is certainly an increase across the board” in prescription drug use and abuse, Lerner said. “Because of an increase in marketing, there’s a lot more usage. “Younger people are selling them on the streets.”
That doesn’t mean illicit street drugs more commonly associated with overdoses aren’t still killing plenty of Floridians, either directly or indirectly.
Take cocaine, for example. Medical examiners detected various amounts of cocaine in 1,008 corpses statewide, of which it killed 398. Yet, 13 percent of the 610 who died with nonlethal levels of cocaine in their systems were homicide victims.
In Miami-Dade County, the narcotic was found during 84 autopsies and caused 16 deaths.
“The leading causes of death in this country are all drug-related — alcohol, murder …,” said Jay M. Holder, a board-certified addictionologist who runs the Exodus Treatment Center in Miami.
In fact, 57 percent of the 59,000 people arrested by the Miami-Dade County Narcotics Bureau in the last year had records of violent crimes and robberies. Even more had theft and burglary records, said Major Charles Nanney, whose bureau polices everything from marijuana grow houses to a burgeoning MySpace market for MDMA, more commonly known as ecstasy.
“There is a crime-drug nexus,” Nanney said. “The main use is still cocaine and heroin. Twenty-five years ago a kilo of coke was $50,000. Now the price is lower.”
Rx Factor
Still, the growing number of prescription-related deaths has garnered much concern among government and law enforcement officials, as well as substance abuse counselors. The problem, according to Nanney, “comes down to availability.”
There’s no doubt the findings are troubling.
“We have seen an increase in prescription drug deaths in recent years,” FDLE spokesperson Kristin Perelluha said.
Although heroin, which killed 84 percent of the 45 people with the drug in their systems, topped the list of the state’s most lethal drugs — those that caused death in more than 50 percent of people in which it was found — methadone, oxycodone and fentanyl followed closely behind.
Methadone, which is often prescribed to treat the pain associated with heroin withdrawal, caused the deaths of 354 more people than heroin statewide. It killed 392 — nearly 74 percent — of the 533 people in whom the substance was found. Methadone was found in eight Miami-Dade decedents, of which it killed three.
The report also noted a 5 percent increase in the use of benzodiazepines, the most widely prescribed and detected prescription drug. Benzodiazepines killed 353 — 30 percent — of the 1,167 people in whom it was found, including 260 from alprazolam alone, which is often sold under the trade names Xanax and Niravam.
“What we’re seeing is the same individuals with cocaine and heroin addiction, now also with a whole litany of prescription drugs,” Holder said, adding that time-released medications are particularly dangerous when mixed with alcohol. “OxyContin is very powerful. An addict will chew that, and it’s 100 percent absorbed immediately, bypassing the time-release.”
Use of oxycodone, the painkiller often marketed under the brand name OxyContin, increased 9 percent from last year, killing 323 — about 57 percent — of the 568 people in whom the substance was found, including six of nine in Miami-Dade. The pills sell for $20 to $30 each on the street, said Nanney, who, in his 20 years of service, has arrested several doctors for selling OxyContin prescriptions.
“There has been a crackdown on oxycodone and OxyContin,” Lerner said, adding that prescriptions often fall into the hands of some abusers who go “doctor shopping,” frequenting different doctors and getting prescriptions for pain medications from each of them. That tactic can also lead to overdoses even for those prescribed the medication for genuine ailments. Taking them with alcohol can cause respiratory failure, for example.
The street pharmaceutical market also carries a unique problem: dosing. “It’s not logical,” Nanney said. “Someone might know ‘I can take this much cocaine,’ for example, but the same size pill could be 20 mg or 40 mg. It’s easy to overdose.”
Hydrocodone, a painkiller prescribed under the brand names Vicodin and Lortab, caused the deaths of 134 users statewide, though it was found in 380 bodies. It killed one of two deceased Miami-Dade users.
Morphine, another painkiller, killed 122, or nearly half of the 280 deceased users statewide, and half of the 10 users in Miami-Dade.
Fentanyl, a pain reliever sold under the name Actiq, which is 80 times more potent than morphine and often administered via a mouth swab or lollipop to facilitate speed of absorption, killed more than half of the 103 people who had it in their systems.
Many hospitals have recently pushed to better control the prescription of opiates, Lerner said, the use of which continues to increase. Medical examiners detected a 27 percent increase in one opiate-based painkiller, hydromorphone, which is two to eight times stronger than morphine and marketed under the trade name Dilaudid.
Some of these drugs, Lerner said, are sold by unethical doctors who “open clinics to distribute meds to anyone who has the money to pay for them.”
Both Holder and Lerner, who mostly counsel patients for cocaine and alcohol problems, said that they also see patients with addictions who are taking prescription drugs according to their doctor’s instructions, who prescribed them without asking enough questions about the indicators of a possible addiction.
Behind the Eight Ball
Still, Florida is one of few states that does not track prescriptions. So far, 35 states have passed legislation to create prescription monitoring systems, with at least 24 of them already in use. The Florida Legislature has routinely rejected similar efforts for the last six years, citing privacy issues.
However, some state lawmakers now want to implement a pilot program that would create a $1.6 million computerized monitoring system to track painkiller prescriptions in Broward County. The proposed system, which would be funded with private money and federal grants, would keep patient medication records that could be accessed by doctors, pharmacists, patients, law-enforcement agencies and the Agency for Health Care Administration.
“If you open the New Times and look at the local ads, a significant percentage are pain management clinics that even specifically say ‘OxyContin’ in their ads,” Holder said. “Basically they are saying, ‘Come get your prescription.’ What’s killing people may not be the drugs, but the doctors that give patients the drugs.”
Comments? E-mail angie@miamisunpost.com.
Sunday, November 4, 2007
Pain and Addiction in the news
Dear Friends and Colleagues:
Attached you find an e-mail from Dr. Andrea Trescot and a link to a congressional hearing "NASPER: Why Has the National All Schedules Prescription Electronic Reporting Act Not Been Implemented?"
I am very proud of Dr. Trescots accomplishments and was honored working with her on the FMA Pain Journal http://www.fmaonline.org/education/PainJournal2006.pdf project which was forwarded to the committee members.
We all need to work together to stop the epidemic of pain medication abuse. Why do US citizens who comprise 4% of the world population consume >90% of the worlds Hydrocodone supply!!!!!
Now is time to act to take measures to stop the rampant abuse of pain medications without jeopardizing the access to medications of those in need.
FSAM will participate in an outreach program to educate physicians from other specialty societies about this issue.
We need to work together and make change happen.
Yours
Bernd
===========================================================================
> My testimony before the House Committee on Energy and Commerce can be found at http://energycommerce.house.gov/cmte_mtgs/110-oi-hrg.102407.NASPER.shtml.
> The full download is about an hour and a half; my testimony starts about 1:20. After my 5 minute statement, you will hear the questions by Rep Whitfield, who holds the journal up for the cameras. A copy of the journal may be going to the White House.
Attached you find an e-mail from Dr. Andrea Trescot and a link to a congressional hearing "NASPER: Why Has the National All Schedules Prescription Electronic Reporting Act Not Been Implemented?"
I am very proud of Dr. Trescots accomplishments and was honored working with her on the FMA Pain Journal http://www.fmaonline.org/education/PainJournal2006.pdf project which was forwarded to the committee members.
We all need to work together to stop the epidemic of pain medication abuse. Why do US citizens who comprise 4% of the world population consume >90% of the worlds Hydrocodone supply!!!!!
Now is time to act to take measures to stop the rampant abuse of pain medications without jeopardizing the access to medications of those in need.
FSAM will participate in an outreach program to educate physicians from other specialty societies about this issue.
We need to work together and make change happen.
Yours
Bernd
===========================================================================
> My testimony before the House Committee on Energy and Commerce can be found at http://energycommerce.house.gov/cmte_mtgs/110-oi-hrg.102407.NASPER.shtml.
> The full download is about an hour and a half; my testimony starts about 1:20. After my 5 minute statement, you will hear the questions by Rep Whitfield, who holds the journal up for the cameras. A copy of the journal may be going to the White House.
Monday, October 29, 2007
FSAM: Where Are We Today?
Dear Friends and Colleagues:
I just returned from an ASAM Chapter Council meeting (10/27-10/28/07) in Washington and want to share some of my observations and thoughts with you.
Almost thirty representatives from eleven state, two regional chapters and one international chapter were present for the two-day meeting.
With 136 chapter members Florida has met its 2007 recruitment goal - more can be achieved - and now ranks No.3 after California and New York.
Among others we discussed:
1) MAKING OF OUR MEDICAL SPECIALTY: hopefully, most of you know that ASAM has founded the American Board of Addiction Medicine (ABAM) and has created the 14-member Medical Specialty Action Group, yours truly included, to select specialty directors to serve on the new board. This is a tedious and long process but we anticipate that within 3-15(?) years we will have established the specialty of addiction medicine. We heard a detailed report by Kevin Kunz regarding the progress made and please contact me for further details.
2) PARITY ISSUES: Ken Roy provided us with a superb overview of the status of two bills in the House (HR 1424) and Senate (S 558) and he outlined the pros and cons of both versions. At this point in time ASAM is pleased that both chambers of congress deal with the issues of Mental Health and Addiction Treatment parity. ASAM prefers and supports the House version and is concerned about the many flaws contained in the Senate version. If those bills pass both chambers of congress they will be discussed in the conference committee to find a compromise version. We will keep you posted about the progress made.
3) ADOPT A RESIDENCY: Norm Wetterau presented a program that intends to improve the education in primary care regarding addiction medicine related issues by adopting a residency program to precept student, train faculty and to help make changes in the residency that would improve treatment of addictive diseases. Some of you may already pursue similar activities and I suggest that we all pool our experience and resources to improve the outcome of our efforts.
4) CAPITOL CAMPAIGN: develop a program that will raise funds to support ABAM, Parity efforts, he work of the chapters council and other projects. We also heard a presentation from a consultant group in Washington how to obtain federal funds to finance and support projects on state and national level. I will forward more detailed information and a project proposal, which we should submit for funding through federal earmarks. Project examples could include substance abuse counseling at schools, specific substance abuse counseling and treatment programs etc.
I also want to remind you that I persistently pursue the realization of the following goals set by my person at the beginning of my presidency:
1.Reorganize FSAM as a full-service membership organization promoting the interest of healthcare professionals involved in addiction care, research and treatment.
STATUS: Formation of a membership committee (pending) and development of a recruitment and retention program. VOLUNTEERS WANTED!!
2.Promote excellence of care in addiction medicine through education and training of physicians and other allied healthcare professionals.
STATUS: We develop and prepare an enhanced and improved annual meeting.
3.Achieve cooperative relationships with other medical specialties to foster the integration of screening and intervention modalities in patient care.
STATUS: All THREE FSAM resolution submitted at the FMA Annual meeting (Parity included) passed including SBI efforts to be supported by the FMA.
4.Create a FSAM Political Action Committee (PAC), educate political decision makers about the importance of sustainable funding mechanism for community based addiction treatment modalities and advocate for the promotion of addiction care and research in primary care.
STATUS: PENDING. VOLUNTEERS NEEDED. We have developed a close working relationship with a legislator (Florida House Representative Ed Homan) who has introduced a Metal Health Parity bill in the House. We not only need to support him verbally but also FINANCIALLY!!!
5.Establish a planning committee to design a strategic plan outlining the vision of our organization for a statewide drug control and treatment program.
STATUS; PENDING. IDEAS? VOLUNTEERS?
PLEASE CONTACT ME VIA E-MAIL info@miamihealth.com or PHONE (305)940-8717 FOR MORE INFORMATION, YOUR QUESTIONS OR SUGGESTIONS.
YOURS
Bernd
I just returned from an ASAM Chapter Council meeting (10/27-10/28/07) in Washington and want to share some of my observations and thoughts with you.
Almost thirty representatives from eleven state, two regional chapters and one international chapter were present for the two-day meeting.
With 136 chapter members Florida has met its 2007 recruitment goal - more can be achieved - and now ranks No.3 after California and New York.
Among others we discussed:
1) MAKING OF OUR MEDICAL SPECIALTY: hopefully, most of you know that ASAM has founded the American Board of Addiction Medicine (ABAM) and has created the 14-member Medical Specialty Action Group, yours truly included, to select specialty directors to serve on the new board. This is a tedious and long process but we anticipate that within 3-15(?) years we will have established the specialty of addiction medicine. We heard a detailed report by Kevin Kunz regarding the progress made and please contact me for further details.
2) PARITY ISSUES: Ken Roy provided us with a superb overview of the status of two bills in the House (HR 1424) and Senate (S 558) and he outlined the pros and cons of both versions. At this point in time ASAM is pleased that both chambers of congress deal with the issues of Mental Health and Addiction Treatment parity. ASAM prefers and supports the House version and is concerned about the many flaws contained in the Senate version. If those bills pass both chambers of congress they will be discussed in the conference committee to find a compromise version. We will keep you posted about the progress made.
3) ADOPT A RESIDENCY: Norm Wetterau presented a program that intends to improve the education in primary care regarding addiction medicine related issues by adopting a residency program to precept student, train faculty and to help make changes in the residency that would improve treatment of addictive diseases. Some of you may already pursue similar activities and I suggest that we all pool our experience and resources to improve the outcome of our efforts.
4) CAPITOL CAMPAIGN: develop a program that will raise funds to support ABAM, Parity efforts, he work of the chapters council and other projects. We also heard a presentation from a consultant group in Washington how to obtain federal funds to finance and support projects on state and national level. I will forward more detailed information and a project proposal, which we should submit for funding through federal earmarks. Project examples could include substance abuse counseling at schools, specific substance abuse counseling and treatment programs etc.
I also want to remind you that I persistently pursue the realization of the following goals set by my person at the beginning of my presidency:
1.Reorganize FSAM as a full-service membership organization promoting the interest of healthcare professionals involved in addiction care, research and treatment.
STATUS: Formation of a membership committee (pending) and development of a recruitment and retention program. VOLUNTEERS WANTED!!
2.Promote excellence of care in addiction medicine through education and training of physicians and other allied healthcare professionals.
STATUS: We develop and prepare an enhanced and improved annual meeting.
3.Achieve cooperative relationships with other medical specialties to foster the integration of screening and intervention modalities in patient care.
STATUS: All THREE FSAM resolution submitted at the FMA Annual meeting (Parity included) passed including SBI efforts to be supported by the FMA.
4.Create a FSAM Political Action Committee (PAC), educate political decision makers about the importance of sustainable funding mechanism for community based addiction treatment modalities and advocate for the promotion of addiction care and research in primary care.
STATUS: PENDING. VOLUNTEERS NEEDED. We have developed a close working relationship with a legislator (Florida House Representative Ed Homan) who has introduced a Metal Health Parity bill in the House. We not only need to support him verbally but also FINANCIALLY!!!
5.Establish a planning committee to design a strategic plan outlining the vision of our organization for a statewide drug control and treatment program.
STATUS; PENDING. IDEAS? VOLUNTEERS?
PLEASE CONTACT ME VIA E-MAIL info@miamihealth.com or PHONE (305)940-8717 FOR MORE INFORMATION, YOUR QUESTIONS OR SUGGESTIONS.
YOURS
Bernd
Wednesday, October 10, 2007
JOURNAL CLUB
Dear Friends and Colleagues:
Attached a very interesting article regarding the promising results of a study using Topiramate for the treatment of alcohol dependence. For more information see http://jama.ama-assn.org/cgi/content/full/298/14/1641.
The authors conclude that:
"Our finding in this study that topiramate is a safe and consistently efficacious medication for treating alcohol dependence is scientifically and clinically important. Alcoholism ranks third and fifth on the US and global burdens of disease, respectively. Discovering pharmacological agents such as topiramate that improve drinking outcomes can make a major contribution to global health. Because topiramate pharmacotherapy can be paired with a brief intervention deliverable by nonspecialist health practitioners, a next step would be to examine its efficacy in community practice settings."
Looking forward to your comments.
Yours
Bernd
============================================================================
Topiramate for Treating Alcohol Dependence
A Randomized Controlled Trial
Bankole A. Johnson, DSc, MD, PhD; Norman Rosenthal, MD; Julie A. Capece, BA; Frank Wiegand, MD; Lian Mao, PhD; Karen Beyers, MS; Amy McKay, PharmD; Nassima Ait-Daoud, MD; Raymond F. Anton, MD; Domenic A. Ciraulo, MD; Henry R. Kranzler, MD; Karl Mann, MD; Stephanie S. O’Malley, PhD; Robert M. Swift, MD, PhD; for the Topiramate for Alcoholism Advisory Board and the Topiramate for Alcoholism Study Group
JAMA. 2007;298:1641-1651.
ABSTRACT
Context Hypothetically, topiramate can improve drinking outcomes among alcohol-dependent individuals by reducing alcohol's reinforcing effects through facilitation of -aminobutyric acid function and inhibition of glutaminergic pathways in the corticomesolimbic system.
Objective To determine if topiramate is a safe and efficacious treatment for alcohol dependence.
Design, Setting, and Participants Double-blind, randomized, placebo-controlled, 14-week trial of 371 men and women aged 18 to 65 years diagnosed with alcohol dependence, conducted between January 27, 2004, and August 4, 2006, at 17 US sites.
Interventions Up to 300 mg/d of topiramate (n = 183) or placebo (n = 188), along with a weekly compliance enhancement intervention.
Main Outcome Measures Primary efficacy variable was self-reported percentage of heavy drinking days. Secondary outcomes included other self-reported drinking measures (percentage of days abstinent and drinks per drinking day) along with the laboratory measure of alcohol consumption (plasma -glutamyltransferase).
Results Treating all dropouts as relapse to baseline, topiramate was more efficacious than placebo at reducing the percentage of heavy drinking days from baseline to week 14 (mean difference, 8.44%; 95% confidence interval, 3.07%-13.80%; P = .002). Prespecified mixed-model analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days (mean difference, 16.19%; 95% confidence interval, 10.79%-21.60%; P < .001) and all other drinking outcomes (P < .001 for all comparisons). Adverse events that were more common with topiramate vs placebo, respectively, included paresthesia (50.8% vs 10.6%), taste perversion (23.0% vs 4.8%), anorexia (19.7% vs 6.9%), and difficulty with concentration (14.8% vs 3.2%).
Conclusion Topiramate is a promising treatment for alcohol dependence.
Attached a very interesting article regarding the promising results of a study using Topiramate for the treatment of alcohol dependence. For more information see http://jama.ama-assn.org/cgi/content/full/298/14/1641.
The authors conclude that:
"Our finding in this study that topiramate is a safe and consistently efficacious medication for treating alcohol dependence is scientifically and clinically important. Alcoholism ranks third and fifth on the US and global burdens of disease, respectively. Discovering pharmacological agents such as topiramate that improve drinking outcomes can make a major contribution to global health. Because topiramate pharmacotherapy can be paired with a brief intervention deliverable by nonspecialist health practitioners, a next step would be to examine its efficacy in community practice settings."
Looking forward to your comments.
Yours
Bernd
============================================================================
Topiramate for Treating Alcohol Dependence
A Randomized Controlled Trial
Bankole A. Johnson, DSc, MD, PhD; Norman Rosenthal, MD; Julie A. Capece, BA; Frank Wiegand, MD; Lian Mao, PhD; Karen Beyers, MS; Amy McKay, PharmD; Nassima Ait-Daoud, MD; Raymond F. Anton, MD; Domenic A. Ciraulo, MD; Henry R. Kranzler, MD; Karl Mann, MD; Stephanie S. O’Malley, PhD; Robert M. Swift, MD, PhD; for the Topiramate for Alcoholism Advisory Board and the Topiramate for Alcoholism Study Group
JAMA. 2007;298:1641-1651.
ABSTRACT
Context Hypothetically, topiramate can improve drinking outcomes among alcohol-dependent individuals by reducing alcohol's reinforcing effects through facilitation of -aminobutyric acid function and inhibition of glutaminergic pathways in the corticomesolimbic system.
Objective To determine if topiramate is a safe and efficacious treatment for alcohol dependence.
Design, Setting, and Participants Double-blind, randomized, placebo-controlled, 14-week trial of 371 men and women aged 18 to 65 years diagnosed with alcohol dependence, conducted between January 27, 2004, and August 4, 2006, at 17 US sites.
Interventions Up to 300 mg/d of topiramate (n = 183) or placebo (n = 188), along with a weekly compliance enhancement intervention.
Main Outcome Measures Primary efficacy variable was self-reported percentage of heavy drinking days. Secondary outcomes included other self-reported drinking measures (percentage of days abstinent and drinks per drinking day) along with the laboratory measure of alcohol consumption (plasma -glutamyltransferase).
Results Treating all dropouts as relapse to baseline, topiramate was more efficacious than placebo at reducing the percentage of heavy drinking days from baseline to week 14 (mean difference, 8.44%; 95% confidence interval, 3.07%-13.80%; P = .002). Prespecified mixed-model analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days (mean difference, 16.19%; 95% confidence interval, 10.79%-21.60%; P < .001) and all other drinking outcomes (P < .001 for all comparisons). Adverse events that were more common with topiramate vs placebo, respectively, included paresthesia (50.8% vs 10.6%), taste perversion (23.0% vs 4.8%), anorexia (19.7% vs 6.9%), and difficulty with concentration (14.8% vs 3.2%).
Conclusion Topiramate is a promising treatment for alcohol dependence.
Wednesday, September 26, 2007
Membership Issues
Dear Friends and Colleagues:
I have participated in todays ASAM Membership Committee conference call.
Membership recruitment and retention is essential for the viability of our organization and we need to extend every effort to speak to those doctors who have yet to renew their dues.
I will therefore assist John to identify those members to be called ASAP to renew their membership.
I also consider it as a priority to form a membership committee to develop a membership recruitment and retention plan.
It is of interest to note that residents (physicians in postgraduate training programs) only comprise 5% of the total ASAM membership.
We need to attract those physicians early in their career and convey to them the message that addiction medicine may be a career choice in the future.
With the formation of ABAM (American Board of Addiction Medicine) and the subsequent creation of addiction medicine fellowships I see a unique opportunity to attract those physicians towards our profession.
All of these issues should be dealt with by an active and strong membership committee co-chaired by the Chapter President.
What are your thoughts regarding this issue?
Yours
Bernd
I have participated in todays ASAM Membership Committee conference call.
Membership recruitment and retention is essential for the viability of our organization and we need to extend every effort to speak to those doctors who have yet to renew their dues.
I will therefore assist John to identify those members to be called ASAP to renew their membership.
I also consider it as a priority to form a membership committee to develop a membership recruitment and retention plan.
It is of interest to note that residents (physicians in postgraduate training programs) only comprise 5% of the total ASAM membership.
We need to attract those physicians early in their career and convey to them the message that addiction medicine may be a career choice in the future.
With the formation of ABAM (American Board of Addiction Medicine) and the subsequent creation of addiction medicine fellowships I see a unique opportunity to attract those physicians towards our profession.
All of these issues should be dealt with by an active and strong membership committee co-chaired by the Chapter President.
What are your thoughts regarding this issue?
Yours
Bernd
Tuesday, August 14, 2007
Science Of Addiction: A JAMA Book Review
The Science of Addiction: From Neurobiology to Treatment
By Carlton K. Erickson, 288 pp, $32.
New York, NY, WW Norton Professional Books, 2007.
ISBN-13 978-0-3937-0463-1.
JAMA. 2007;298:809-810.
The term "addiction" commonly triggers stereotypic misperceptions about the compulsive, out-of-control use of illicit drugs resulting from a perceived amendable behavioral flaw. In 1988, the United States Supreme Court in a disputed decision declared alcoholism to be "willful misconduct." However, several decades of comprehensive genetic and neurobiological research have provided indisputable evidence that addiction is brain disease resulting from mesolimbic brain dysregulation that, if diagnosed in a timely fashion, can be properly treated. Addiction meets all characteristics of the disease concept, ie, (1) a clear biological basis; (2) unique, identifiable signs and symptoms; (3) a predictable course and outcome; and (4) the inability to control the cause of the disease.
In this context, Erickson's book provides a compelling overview of the "science of addiction" and superbly summarizes the state of the art of addiction medicine. In 10 easy-to-read chapters, the author guides the reader through basic neuroanatomy, neurobiology, and neurochemistry; the pharmacology of different drugs of abuse, including alcohol, depressants, and stimulants; current treatment algorithms; the strategies of addiction research; and the future outlook of the evidence-based research principles.
The text begins with a challenge of the terminology and characterization of "addiction," calling it unscientific, broad, too vague, and stigmatized. According to the author, the term provokes "pejorative misperceptions," and he uses the term "chemical dependence" instead to properly identify the impaired control over the drug use, the defining hallmark of this brain disease. He also suggests separating the colloquial term "addiction" from the scientific terminology of "chemical dependence," thereby not precluding its use but understanding its limitation. Erickson emphasizes that "the reluctance to define addiction as a disease stems partly from a desire to hold drug users accountable for their actions," and that "any approach that tries to understand addiction from a purist or unitary view misses other key components." Chemical dependence is a "compulsive, pathological, impaired control over drug use, leading to an inability to stop using drugs in spite of adverse consequences."
Drugs with a dependence liability not only produce a positive mood but trigger the mesolimbic dopamine system, resulting in an activation of the so-called "reward pathway." Neuroscientists believe that in some individuals the function of these neurotransmitter systems is disrupted due to genetic "miswiring," long-term exposure to a drug, or—more likely—a combination of genetic heritability, drug exposure, and environmental influences. This may explain why any drugs of abuse can induce dependence in susceptible individuals but not for every person who may use them occasionally or who has abused them during their lifetime.
The detailed review of the basic science of chemical dependence provides ample evidence that the dysregulation in the mesolimbic dopamine system constitutes the disease, just as poor dopamine function in the basal ganglia is the etiologic cause of Parkinson disease. Therefore, drug-seeking and drug-taking are only the symptoms of the disease, just as muscle rigidity and tremors are only the symptoms of Parkinson disease.
The author also provides a brief but comprehensive overview of the genetics of chemical dependence. Family, twin, and adoption studies demonstrate that genetic factors contribute to the risk of alcoholism. Scientists have identified some possible causative genes and certain risk genes which, in susceptible individuals exposed to drugs of abuse, may activate a cascade of neurochemical events leading to chemical dependence. The argument that chemical dependence is a brain disease, comparable to other brain diseases, begs the question about similar treatment approaches.
Erickson correctly emphasizes that any treatment approach cannot rely on pharmacological solutions alone. The treatment must be individualized and should take so-called harm reduction strategies, also known as harm minimization, into consideration. Such an approach includes methadone maintenance and needle-exchange programs that often ruffle the feathers of the proponents of abstinence-based programs.
In the last few years, new pharmacological treatments have broadened the opportunities for the outpatient management of patients with chemical dependencies. For example, anticraving, antirelapse, and abstinence-enhancing medications are now part of the treatment armamentarium for alcohol dependence and include naltrexone, acamprosate, and topiramate. The US Food and Drug Administration approval of buprenorphine for the treatment of opioid dependence extends the treatment outreach from federally approved methadone clinics to almost all physicians who have completed an 8-hour certification course.
In the remainder of the book, Erickson reviews the scientific methodology of addiction research and the exciting results of brain imaging studies in chemical dependence. These include positron emission tomography, functional magnetic resonance imaging, and single-photon emission computerized tomography. The imaging modalities illustrate that drug treatment as well as the anticipation of the active drug itself can trigger neurochemical changes and are valuable tools for studying the effectiveness and compatibility of interactional behavioral interventions and pharmacotherapy.
Unfortunately, the author has missed the opportunity to discuss the screening and brief intervention methods that can be incorporated into the clinical practice identifying patients at risk for chemical dependence. For example, the National Institute on Alcohol Abuse and Alcoholism has published valuable screening and brief intervention tools on its Web site1 that can assist health care professionals in risk stratification strategies for patients with chemical dependence. However, the book provides the knowledge that chemical dependence is a brain disease, and an understanding of this disease concept of addiction ensures that millions of individuals with chemical dependence can now receive appropriate and suitable treatments.
In summary, I recommend this excellent book as a "must-read" for any medical student, physician, or other allied health professional dedicated to the care of their patients with the treatable disease of addiction.
Financial Disclosures: None reported.
Bernd Wollschlaeger, MD, Reviewer
University of Miami
Miami, Florida
info@miamihealth.com
REFERENCES
1. National Institute on Alcohol Abuse and Alcoholism. A Pocket Guide for Alcohol Screening and Brief Intervention. http://pubs.niaaa.nih.gov/publications/Practitioner/PocketGuide/pocket_guide.htm. Accessibility verified July 18, 2007.
Book and Media Reviews Section Editor: John L. Zeller, MD, PhD, Contributing Editor.
By Carlton K. Erickson, 288 pp, $32.
New York, NY, WW Norton Professional Books, 2007.
ISBN-13 978-0-3937-0463-1.
JAMA. 2007;298:809-810.
The term "addiction" commonly triggers stereotypic misperceptions about the compulsive, out-of-control use of illicit drugs resulting from a perceived amendable behavioral flaw. In 1988, the United States Supreme Court in a disputed decision declared alcoholism to be "willful misconduct." However, several decades of comprehensive genetic and neurobiological research have provided indisputable evidence that addiction is brain disease resulting from mesolimbic brain dysregulation that, if diagnosed in a timely fashion, can be properly treated. Addiction meets all characteristics of the disease concept, ie, (1) a clear biological basis; (2) unique, identifiable signs and symptoms; (3) a predictable course and outcome; and (4) the inability to control the cause of the disease.
In this context, Erickson's book provides a compelling overview of the "science of addiction" and superbly summarizes the state of the art of addiction medicine. In 10 easy-to-read chapters, the author guides the reader through basic neuroanatomy, neurobiology, and neurochemistry; the pharmacology of different drugs of abuse, including alcohol, depressants, and stimulants; current treatment algorithms; the strategies of addiction research; and the future outlook of the evidence-based research principles.
The text begins with a challenge of the terminology and characterization of "addiction," calling it unscientific, broad, too vague, and stigmatized. According to the author, the term provokes "pejorative misperceptions," and he uses the term "chemical dependence" instead to properly identify the impaired control over the drug use, the defining hallmark of this brain disease. He also suggests separating the colloquial term "addiction" from the scientific terminology of "chemical dependence," thereby not precluding its use but understanding its limitation. Erickson emphasizes that "the reluctance to define addiction as a disease stems partly from a desire to hold drug users accountable for their actions," and that "any approach that tries to understand addiction from a purist or unitary view misses other key components." Chemical dependence is a "compulsive, pathological, impaired control over drug use, leading to an inability to stop using drugs in spite of adverse consequences."
Drugs with a dependence liability not only produce a positive mood but trigger the mesolimbic dopamine system, resulting in an activation of the so-called "reward pathway." Neuroscientists believe that in some individuals the function of these neurotransmitter systems is disrupted due to genetic "miswiring," long-term exposure to a drug, or—more likely—a combination of genetic heritability, drug exposure, and environmental influences. This may explain why any drugs of abuse can induce dependence in susceptible individuals but not for every person who may use them occasionally or who has abused them during their lifetime.
The detailed review of the basic science of chemical dependence provides ample evidence that the dysregulation in the mesolimbic dopamine system constitutes the disease, just as poor dopamine function in the basal ganglia is the etiologic cause of Parkinson disease. Therefore, drug-seeking and drug-taking are only the symptoms of the disease, just as muscle rigidity and tremors are only the symptoms of Parkinson disease.
The author also provides a brief but comprehensive overview of the genetics of chemical dependence. Family, twin, and adoption studies demonstrate that genetic factors contribute to the risk of alcoholism. Scientists have identified some possible causative genes and certain risk genes which, in susceptible individuals exposed to drugs of abuse, may activate a cascade of neurochemical events leading to chemical dependence. The argument that chemical dependence is a brain disease, comparable to other brain diseases, begs the question about similar treatment approaches.
Erickson correctly emphasizes that any treatment approach cannot rely on pharmacological solutions alone. The treatment must be individualized and should take so-called harm reduction strategies, also known as harm minimization, into consideration. Such an approach includes methadone maintenance and needle-exchange programs that often ruffle the feathers of the proponents of abstinence-based programs.
In the last few years, new pharmacological treatments have broadened the opportunities for the outpatient management of patients with chemical dependencies. For example, anticraving, antirelapse, and abstinence-enhancing medications are now part of the treatment armamentarium for alcohol dependence and include naltrexone, acamprosate, and topiramate. The US Food and Drug Administration approval of buprenorphine for the treatment of opioid dependence extends the treatment outreach from federally approved methadone clinics to almost all physicians who have completed an 8-hour certification course.
In the remainder of the book, Erickson reviews the scientific methodology of addiction research and the exciting results of brain imaging studies in chemical dependence. These include positron emission tomography, functional magnetic resonance imaging, and single-photon emission computerized tomography. The imaging modalities illustrate that drug treatment as well as the anticipation of the active drug itself can trigger neurochemical changes and are valuable tools for studying the effectiveness and compatibility of interactional behavioral interventions and pharmacotherapy.
Unfortunately, the author has missed the opportunity to discuss the screening and brief intervention methods that can be incorporated into the clinical practice identifying patients at risk for chemical dependence. For example, the National Institute on Alcohol Abuse and Alcoholism has published valuable screening and brief intervention tools on its Web site1 that can assist health care professionals in risk stratification strategies for patients with chemical dependence. However, the book provides the knowledge that chemical dependence is a brain disease, and an understanding of this disease concept of addiction ensures that millions of individuals with chemical dependence can now receive appropriate and suitable treatments.
In summary, I recommend this excellent book as a "must-read" for any medical student, physician, or other allied health professional dedicated to the care of their patients with the treatable disease of addiction.
Financial Disclosures: None reported.
Bernd Wollschlaeger, MD, Reviewer
University of Miami
Miami, Florida
info@miamihealth.com
REFERENCES
1. National Institute on Alcohol Abuse and Alcoholism. A Pocket Guide for Alcohol Screening and Brief Intervention. http://pubs.niaaa.nih.gov/publications/Practitioner/PocketGuide/pocket_guide.htm. Accessibility verified July 18, 2007.
Book and Media Reviews Section Editor: John L. Zeller, MD, PhD, Contributing Editor.
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