Heroin Use On The Rise

Attached a link to an interesting article titled "As pill mills fade away, heroin fills the void" highlighting the emerging trend of heroin use among former Oxycontin abusers. I have noticed a similar uptick of heroin use among my patients seeking outpatient treatment. This is especially worrisome because heroin is cheaper and more potent than ever and it now spreads across all demographic and ethnic boundaries. We need to respond to this trend by developing and aggressive public education campaign about the dangers of heroin, introduction of needle exchange programs and promotion of outpatient treatment programs. Yours Bernd

The Gun Lobby Target Doctors

The gun lobby paranoia seems to have infected all branches of our government, but even I am surprised how far politicians are willing to go to please their NRA sponsors. In today's Miami Herald an article titled " Medical liability bill gets snagged by gun concerns" highlights such an example. According to the article a Senate priority bill to limit the liability of Florida doctors ran into trouble in the House on Monday when opponents suggested that it could be used by insurance companies who represent the doctors to create a private registry of gun owners. The bill, HB 827, would deal with what are known as “ex parte communications” in malpractice cases and would allow lawyers for doctors hit with a malpractice claim to interview any other doctor about a patient’s health record in private. Rep. James Grant, R-Tampa, believes that the provision could open the door to lawyers asking doctors about the gun-toting habits of their patients and, over time, use that information to build a database of gun owners who could be charged higher insurance rates. Grant filed an amendment to the bill Monday that would prohibit doctors from revealing any information about a patient’s gun ownership, as well as any history of child abuse, sexual abuse, substance abuse, mental health and reproductive history unless the patient’s lawyer is present. Just to make sure that we understand this mind-boggling political acrobatic: Rep Grant BELIEVES that insurance companies will mine these records to essentially eliminate potential risky clients, especially gun owners, who then would be charged higher insurance rates. Therefore, according to his amendment, doctors would be prohibited from collecting and revealing such information, unless the patient's lawyer is present. Sounds reasonable? Well, probably in the mind of those who believe that the government is trying to disarm Americans by buying ammunition in large amounts, or those who believe in black helicopters following their every move etc. What is more troubling that those "freedom fighters" are willing to gag doctors and force them to sanitize their medical records in order to please their NRA masters. Why do we vote for these NRA stooges? What happened to our individual freedom from interference in our lives and professions? Its time to expose these so-called politicians as willing executioners of the NRA. Yours Bernd

Needle Exchange Program

Attached a link to an interesting article published in today's Miami Herald titled "Needle exchange bill inching forward in the Florida Legislature" highlighting HB Bill 735 calling for a a five-year pilot program in Miami-Dade County to legalize syringe and needle exchange programs. Such exchanges operate in at least 35 states, but remain illegal in Florida. A similar bill in the Senate, sponsored by Miami Democratic Sen. Gwen Margolis, has stalled.The bill is based on research conducted by University of Miami students. The bill calls for the exchange program to provide free, clean and unused needles and hypodermic syringes in exchange for used needles and syringes as a way to curb the transmission of diseases among injection drug users, as well as to protect emergency workers and members of the public who might inadvertently come into contact with contaminated injection supplies. Participants would also receive educational materials, HIV counseling and testing and referrals to drug treatment. The program would operate for five years and be funded through grants and donations. I fully support needle exchange programs and the efforts to push this bill through the Florida legislature. The legislation is also being supported by the Florida Osteopathic Medical Association, the Florida Nurse Practitioner Network and the Florida Academy of Family Physicians. I am confident that FSAM will join the efforts, too. I look forward to your comments and responses. Yours Bernd

Stimulant Abuse: The New Prescription Drug Abuse Epidemic

Attached you find a link to an important article published in today's New York Times titled "A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise" highlighting the staggering increase in ADHD diagnosis and related stimulant prescription use. Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention. The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 53 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis. About one in 10 high-school boys currently takes A.D.H.D. medication, the data showed. Sales of stimulants to treat A.D.H.D. have more than doubled to $9 billion in 2012 from $4 billion in 2007, according to the health care information company IMS Health.Even more teenagers are likely to be prescribed medication in the near future because the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis and treatment. The question remains: are millions of children receiving medication merely to calm behavior or to do better in school? We also should be aware that those medications are often NOT taken as prescribed, shared with or sold to classmates, contributing to diversion long tolerated in college settings and also gaining traction in high-achieving high schools. The C.D.C. director, Dr. Thomas R. Frieden, likened the rising rates of stimulant prescriptions among children to the overuse of pain medications and antibiotics in adults.“We need to ensure balance,” Dr. Frieden said. “The right medications for A.D.H.D., given to the right people, can make a huge difference. Unfortunately, misuse appears to be growing at an alarming rate.” “There’s no way that one in five high-school boys has A.D.H.D.,” said James Swanson, a professor of psychiatry at Florida International University and one of the primary A.D.H.D. researchers in the last 20 years. “If we start treating children who do not have the disorder with stimulants, a certain percentage are going to have problems that are predictable — some of them are going to end up with abuse and dependence. And with all those pills around, how much of that actually goes to friends? Some studies have said it’s about 30 percent.” As physcians we should stop giving in to parents and patients pressures to prescribe these stimulants indiscriminately. We must refocus our efforts on proper and evidence based ADHD diagnosis, demand special training of stimulant prescribers and tracking of stimulant prescriptions. Otherwise, we will force the federal government to step in with tighter regulations.

The Anti-Aging Myth

Attached a link to an interesting article published in today's Miami Herald highlighting the proliferation of so-called anti-aging clinics in South Florida whose unscrupulous operators are peddling steroids and growth hormones. I also recommend reading the excellent commentary by Fred Grimm. I hope that my fellow colleagues will join me in the effort to curtail the (ab)use of steroids and growth hormone products which can have serious and detrimental health effects. We should point out those so-called "doctors" who are profiting from promoting the use of steroids for muscle-building and human growth hormone (hGH). We should make it clear to those "doctors" that federal law prohibits the use of such substances except for rare circumstances such as growth retardation. Instead, those "doctors" are promoting the use of human growth hormone therapy to treat patients suffering from low energy, increased fat or a slowing sex drive. Now is time to act and to speak up. Yours Bernd

Gun Safety

Attached a link to an article titled " The Pediatricians vs. the NRA" published on slate.com. We need to continue pushing for the implementation of common-sense gun safety measures and doctors play an important role to communicate this issue with their patients. Yours Bernd VISIT MY NEW WEB SITE AT www.bwollschlaeger.com

Guns,NRA and the Affordable Care Act

The tragedy of the horrific shooting in Newtown Connecticut gradually faded from the daily news. Sadly, this shooting will be followed by another one and we will continue to seek answers to why it happened and what we could have done to prevent another massacre. In my opinion we have to recognize that the National Rifle Association (NRA) tentacles of influence have penetrated all aspects of our lives. An article published in the Washington Post highlighted that the National Rifle Association successfully lobbied for the national health care law signed by President Obama in 2010 to include provisions restricting the ability of doctors and health plans to collect patient information about gun ownership.The language, pushed by the National Rifle Association in the final weeks of the 2010 debate over health care was discovered only in recent weeks by some lawmakers and medical groups and is drawing fierce criticism. The provision says that “wellness and prevention” portions of the health-care law “may not require the disclosure or collection of any information” relating to the “presence or storage of a lawfully possessed firearm or ammunition in the residence or on the property.” Further, the measure says the law cannot be used to “maintain records of individual ownership or possession of a firearm or ammunition.” It adds that the price of health coverage may not be affected by the ownership, possession or use of guns. The deal to add gun language to the health-care bill was struck so quietly that several top officials in the Obama administration and in Congress had no idea the passages had been added until approached by The Washington Post last week. Its important to understand that this questionable legislative compromise erected an almost insurmountable barrier to the type of research required to address gun safety and gun control issues vital for addressing the issues involved in the post-Newtown policy debate. Again, the NRA has skillfully implemented a gag rule into the health care law preventing physicians to contribute to the data collection of ANY gun related issue. As parents, responsible citizens and physicians we need to continue and intensify our struggle against the metastasizing influence of the NRA in our government and lives. Yours Bernd ADDENDUM: Attached the original wording contained in Sec. 1001\2717 PHSA t: PROTECTION OF SECOND AMENDMENT GUN RIGHTS.- "(1) WELLNESS AND PREVENTION PROGRAMS.-A wellness and health promotion activity implemented under subsection (a)(l)(D) may not require the disclosure or collection of any information relating to- "(A) the presence or storage of a lawfully-possessed firearm or ammunition in the residence or on the property of an individual; or "(B) the lawful use, possession, or storage of a firearm or ammunition by an individual. "(2) LIMITATION ON DATA COLLECTION.-None of the authorities provided to the Secretary under the Patient Protection and Affordable Care Act or an amendment made by that Act shall be construed to authorize or may be used for the collection of any information relating to- "(A) the lawful ownership or possession of a firearm or ammunition; "(B) the lawful use of a firearm or ammunition; or "(C) the lawful storage of a firearm or ammunition. "(3) LIMITATION ON DATABASES OR DATA BANKS.-None of the authorities provided to the Secretary under the Patient Protection and Affordable Care Act or an amendment made by that Act shall be construed to authorize or may be used to maintain records of individual ownership or possession of a firearm or ammunition. "(4) LIMITATION ON DETERMINATION OF PREMIUM RATES OR ELIGIBILITY FOR HEALTH INSURANCE.-A premium rate may not be increased, health insurance coverage may not be denied, and a discount, rebate, or reward offered for participation in a wellness program may not be reduced or withheld under any health benefit plan issued pursuant to or in accordance with the Patient Protection and Affordable Care Act or an amendment made by that Act on the basis of, or on reliance upon- "(A) the lawful ownership or possession of a firearm or ammunition; or "(B) the lawful use or storage of a firearm or ammunition. '(5) LIMITATION ON DATA COLLECTION REQUIREMENTS FOR INDIVIDUALs.-No individual shall he required to disclose any information under any data collection activity authorized under the Patient Protection and Affordable Care Act or an amendment made by that Act relating to- "(A) the lawful ownership or possession of a firearm or ammunition; or "(B) the lawful use, possession, or storage of a firearm or ammunition.