Tag Archives: United States

Suicide and Drug Addiction

October 10, 2014

Suicide Rate in Drug Addiction and How to Naturally Prevent

Drug addiction has been known for its destructive effects on the addicts. Most of the side effects are known by many especially depression and other withdrawal symptoms that an addict faces whenever he tries to stop using the drugs. However there is also another serious problem that has now been linked to drug and substance addiction- suicide. Suicide among drug addicts has become a serious problem that have to be curbed as many addicts are finding it the easiest way to end their suffering and depression as they struggle to set themselves free from addiction. Most of the people who commit suicide do it under the influence drugs. The use of opiates like oxycodone and heroin are leading cause of suicides.

Cocaine Use Increased Odd of Suicide Attempt 

Suicide Student Overwhelmed Asking For Helphas been a problem that the society has been fighting with. It has very many causes, however as revealed by a study that was led by Richard Ries MD of Harborview Medical Center University of Washington Seattle, Wa, the major cause of suicide attempts are the use of drugs and substance. This study reveals that of all the major causes of suicide attempts, cocaine use leads by increasing suicide attempts 62 times more likely. This is followed by major depression which increases the odd of suicide attempts 41 times more likely. Alcohol use follows by increasing odd of suicide attempts 8 times more likely. This supports the notion that drug and substance addiction increases chances of a person committing suicide.

In this same study it was found that among other factors divorce and separation increased odd of suicide attempts 11 times more likely. A person may argue that now that divorce and separation also increases the likelihood of a person committing suicide then there is no way to link drug addiction to increased suicide cases. However if deviate from your view you will realize that drug and substance addiction has a bigger role in even divorce and separation. Most of the cases where married parties have to separate or divorce are often linked to drug abuse. A person gets drunk and becomes abusive needless to mention he may not be able to stand with his responsibilities causing the family to break. Socially, the use of drugs and getting addicted to them will even determine the people you relate with and what jobs you will even do. So drug and substance addiction will affect a marriage in many and may be the driving factor that leads to separation linked to increased suicide cases.

However it not reasonable to ignore other factors that may lead to divorce and separation such as infidelity, having abusive partners (some people get abusive even without using drugs), financial problems and other mere misunderstandings. In these cases it calls for counseling in order to rectify the problems before it results in divorce. As it turns saving a divorce may count in reducing the rate of suicide. Marriage counselors may help in restoring peace in a marriage.

What Predicts Suicide Attempts in Alcoholics?

Teen alcohol addiction (drunk teens with vodka bottle)Several studies have linked drug use to increase in suicide attempts. The addicts need to be helped through various ways to help them stay away from suicide thoughts. The doctors have found various ways through which they can predict whether a person addicted to alcohol may attempt suicide or not. These insights may help the doctors to find ways to counsel the addicts to be free from suicide thoughts. One of these pointers is the family history of attempted suicides. When a person has a family member who had committed suicide they are said to develop suicide thoughts. When these suicide thoughts become dominant in their minds they begin to view it as the best solution to end their addiction problems. By studying their family suicide attempt history they can be helped to adopt better ways of solving problems. Another pointer is adverse childhood experience. There are childhood experiences that keep haunting an individual. These thoughts may even be the cause why a person becomes alcoholic. Experiences such as rape, neglect or sodomy may leave a person feeling unworthy and such attitude may cause suicide. The doctors may find ways of helping such an addict to avoid suicide.

Today, suicide has become a major catastrophe. In America alone it is reported that suicide is among top 3 or 4 causes of death in the US from teens to 50. To reduce this rate, there are a lot that needs to be done. Fortunately several studies have shown the major causes of suicide and so an action plan can be developed to minimize the causes of suicidal deaths in both teens and adults not only in America but also in other continents.

Suicide Screen, Assessment Risk and Referral

Suicide is one of the major causes of deaths in teens. For this reasons there is need to screen the alcoholics and even teens for suicide risks. Unfortunately screening for suicide risks has not been utilized in the past majorly because many institutions lack these mental health resources. Risk assessment will be done after the screening to show probability of suicidal death occurring and after this probability is known then various measures can be taken to help the person before he becomes a victim of suicide. In most institutions there may not be abled professionals to handle a subject given the suicide risk factor may be high. In this case referrals become necessary where the person may be taken to more equipped centers with abled professionals who can help prevent such deaths.

Drugs and substance abuse contribute greatly to suicidal deaths and that is why here at AWAREmed we approach addiction integratively so that we not only deal with withdrawal symptoms but also assess other risk factors. Dr. Dalal Akoury (MD) has helped many addicts to retrace their steps and overcome addiction. You can call on her for more help.

Suicide Rate in Drug Addiction and How to Naturally Prevent

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Types of Opioids and Their Uses

October 4, 2014

Type of Opioids, Their Uses and Side Effects

172468400_80_80Opioids are drugs that many people cannot do without. They are essential in hospitals as they are the most effective drugs that can be used to aid the pain patients. Diseases such as cancer are synonymous to pain and in some situations going through the treatments will be very painful and therefore there is need for a drug that will work in different ways to curb the pain that may be disabling to the patient. Chronic pain in itself presents a torture to the patient and without pain relievers, such pain may cripple a patient. The opioids are not news to many years; people know them some as dangerous drugs that should never have been created in the first place. While to many they has become very valuable essentials that they cannot survive without- the pain patients (and even addicts). However, people are not always informed about the given types of opioids.  The opioids are mostly classified according to their source. There are opioids that are naturally extracted from the poppy plant and used without designing or any other further processing. These will fall under natural opioids.  Opioids may be extracted from the poppy plant but then is further processed. This group is referred to use semi-synthetic opioids while there are some that are some opioids that are processed in the labs. The opioids falling in this group are known as synthetic opioids.

The naturally sourced opioids

The natural opioids are those that are naturally available from the poppy plant. After extraction they are not further processed in a manner that will deplete their contents. Some of these natural opioids are used as pain relievers in hospitals.

Here are examples of the opioids;

Morphine

Morphine is naturally extracted from poppy plant. It is the most dominant opiate in the poppy plant. It was the first active ingredient that was extracted from the poppy plant. Apart from morphine there are also other alkanoids of different types that are found in the opium. The major source of morphine is a chemical extraction from opium.

Despite its use in hospitals for pain relief in patients with intense pain, morphine has a high potential of addiction, tolerance and psychological dependence which develops very rapidly. However psychological dependence takes a little bit longer to develop and may take several months. With morphine, tolerance to respiratory depression and euphoria develops more rapidly than tolerance to analgesia.

Thebaine

Thebaine is naturally available in small quantities in opium. It is also known as Paramorphine. It is white, crystalline, slightly water-soluble and poisonous alkaloid.  The Thebaine-Constituent of Raw-Opium is normally between 0.2% and 1.5%. However higher amounts have been reported. It is not used for therapeutic or recreational purposes, but is converted industrially into a variety of compounds such as oxycodone, oxymorphone, nalbuphine, naloxone, naltrexone, buprenorphine and etorphine.

In the past thabaine was believed to have no properties that were like those of morphine. However there are many studies that have found that thebaine has a considerable potential for dependence both psychological and physical when used in large doses for a long period of time.

Codeine

Naturally extracted from the poppy plant, codeine is used in hospitals as a narcotic pain-reliever and cough suppressant. It functions similar to morphine and hydrocodone. Moreover, when taken a small amount of codeine is converted to morphine in the body. However the mechanism of action of codeine is not known but just like morphine, codeine binds to opioid receptors in the brain. These receptors are important for transmitting the sensation of pain throughout the body and brain. Codeine increases tolerance to pain, decreasing discomfort, but the pain still is apparent to the patient. Despite its ability to suppress coughs and enable pain tolerance, it has the following side effects, noisy breathing, sighing, slow breathing with long pauses between breaths, drowsiness and blue colored lips.

Semi-synthetic opioids

This is a group of drugs that are naturally extracted from the poppy plant but are further processed before they are used. An example is heroine.

Heroine

Comes from the opium poppy but is further processed. When pure it is a white powder that has a bad taste. Some heroin is dark brown, and black tar heroin is either sticky or hard and looks like roofing tar. It has pain relieving properties. Unlike most pain relieving narcotics that are accepted in most states when prescribed by doctors, heroin is illegal in most countries basically because it is highly addictive and has quite grave side effects. Some of the withdrawal symptoms include; sleeplessness, bad chills and sweats, muscle pain, stomach cramps, nausea, vomiting, and diarrhea.

Synthetic opioids

These are opioids that are made in laboratories. They include;

Methadone

Methadone is used as a pain reliever and as part of drug addiction detoxification and maintenance programs and is only available from certified pharmacies. This drug helps reduce the severity of withdrawal symptoms that are suffered by heroin addicts when they stop using heroin. Some of its side effects include; rapid heart rhythm, severe dizziness and chest pain among others.

Oxycodone

This is an FDA approved drug for use in pain relief as well as suppressing coughs. This drug is a strong pain reliever and works better for both opioidsmoderate and severe pain. It increases tolerance to pain hence eliminating discomfort. It also causes sedation. May cause very severe side effects when mixed with alcohol. Cases of death have been reported.

Fentanyl

Fentanyl is an opioid medication that is used for anesthesia to help prevent pain after surgery or any other medical procedure that may result in moderate or severe pain. It is injected in the muscle or in the vain through IV. It is mostly used before surgery. Side effects include severe dizziness, drowsiness and impaired reactions.

Finally, you need more information to stay away from dependence on alcohol and drugs as these have crippled societies and that is why here at AWAREmed we are dedicated to finding the best solutions to addiction and dependence on substances. Dr. Dalal Akoury (MD) is always in the mood of helping any patient to be addiction free. Do not hesitate to call on her for help in managing any sort of chronic pain or any type of addiction as well as other diseases.

Type of Opioids, Their Uses and Side Effects 

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Pain Addiction Continuum

October 2, 2014

Pain Addiction Continuum and How To Deal With It

Pain AddictionPain management is an important part of treatment especially in situations where the patient is to go through intense like during chemotherapy for cancer patients or after going through surgery.  Nobody will like to have intense pain maim him for even the least amount of time. People like to be happy and avoid anything that may bring them pain. However in some instances there has to be pain for a much serious health problem to be solved. To manage pain certain drugs are used that helps you to endure the pain, unfortunately most of these are addictive and so as you are using them to manage pain you are at risk of addiction. Opiates are the mostly used drugs in pain management and they work well in ensuring that your pain is moderated if not done away with completely. However effective they are these drugs are very rewarding and before you know it the body may be adapted to these drugs so much that you will feel like you need to take them every time and increase the dosage over a time. Due to their rewarding nature they can be easily abused and a treatment that once began on the right foot may end up being another nightmare in a person’s life hence there is need for actions to be taken to help patients not to be addicted to this pain drugs.

Now back to the point pain and addiction may occur as a continuum or just two different entities. Here we see how pain addiction continuum occurs and how to deal with it. When the drugs are given for pain management you will be using them for just that for quite a time without feeling the intense craving for them. But as time goes by and you are still using them you will begin to have craving for these drugs not only to use them within the specified dosage but you may begging to desire mega doses which is now addiction so pain addiction continuum is rather the changes that takes place in your body demanding for more of the drug and hence dependence on these drugs. The use of opiates in pain management may work well for some people while for others it may not and their treatment may work better if they stopped using the opiates therefore it is important to work with experts in this field who will know when to use and when to stop using these opiates to avoid the dangers of addiction that may come with them. This means that the treatment must have a clear exit strategy from the opiates to help the patient overcome the cravings for more of the pain drugs.

Pain management demands that the doctor must be able to assess the patient well that is before issuing a prescription and during the course of treatment. The doctor should improve patient care by bio psychosocial model assessment of   the patient’s past and even present aberrant if any of such exist. All this will help the doctor decide on how best to prescribe the drugs in dosages that will reduce risks to addiction. Today the doctors are aware that pain management drugs poise a great threat to addiction in patients unlike in the past when it was thought that if a patient did not have a history of drug abuse disorder. The risk  of getting addicted to the opiates used in pain management is higher and this fallacy and past belief that it had low chances of inducing addiction in patients with no history of substance use disorder has never served this industry. It is quite fortunate that avenues are now opening as the doctors are slowly waking up to the reality of pain addiction continuum and proper exit strategies are being developed to help the cancer patients to evade addiction. The addiction that arises from use of opiates in pain management may be caused by many factors but the biggest culprit is poor management of chronic pain.

Poorly managed chronic pain

Now that we have learnt that there is risk of addition from the use of pain management drugs like the opiates it is better to exercise better management of chronic pain. Today chronic pain is one of the nightmares that many people are fighting every day. These people can use anything given to them to kill that pain without thinking twice and this shows how vulnerable they are. It therefore calls for professionalism in dealing with these people and doctors must find better ways to manage chronic pain in a way that reduces their risk to addiction.

In the past pain had been poorly manage owing to such beliefs that I have discussed above. Patients were put on opiate drugs to kill pain without assessing them and this often led to serious health problems since every patient is unique owing to the fact that they have different history relating to the substance use disorder. There is also need to explore other ways of pain management methods as opposed to singly using the opiates in pain management. Some of the natural pain management methods that work better are discussed here.

Proliferative therapies for pain (Natural)

Prolozone™ Therapy– Dr. Frank Shallenberger pioneered this type of proliferative therapy, Prolozone therapy uses ozone, a naturally occurring form of oxygen with powerful regenerative capacity owing to its extra oxygen atom. It works by increasing oxygen circulation and delivery into the damaged areas. This helps in strengthening ligaments and tendons as well as in rebuilding cartilage in the treated joint.

Prolotherapy– this therapy was pioneered by Former U.S. Surgeon General Dr. C. Everett Koop who had used it successfully to treat his chronic back pain. It is the oldest and most widely used form of proliferative therapy that has been used since the 1930’s.it involves injecting a natural substance such as dextrose to purposefully provoke mild localized inflammation. This increases the blood supply and flow of nutrients to the area, and the body responds by regenerating the damaged structures.

Pain addictionPlatelet Rich Plasma Injection (PRP) Therapy -involves the use of the body’s own platelets for treatment of pain. It involves drawing a small amount of blood that is centrifuged to separate out the plasma this creates blood that is concentrated in platelets. The high concentration of platelets in the plasma is rich in bioactive proteins and growth factors that can accelerate tissue repair and regeneration. Today this therapy is become more popular with athletes.

Here at AWAREmed we are dedicated to finding the best solutions to chronic illnesses and that is why Dr.Dalal Akoury (MD) is always in the forefront advocating for integrative medicine since it is only through integrative medicine that a person can be healed wholly. Do not hesitate to call on her for help in managing any sort of chronic pain as well as other diseases.

Pain Addiction Continuum and How To Deal With It

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Buprenorphine and opioids

October 2, 2014

Buprenorphine as Opioid Receptor Antagonist

buprenorphineBuprenorphine is a semi-synthetic opioid derived from thebaine. It is a pain killer and has gained a great deal of notoriety for its ability to interrupt severe opiate addiction, including heroin and methadone addictions. It got approved in 2002 by the FDA for use as an opiate addiction treatment. Dependence on pain drugs is common but very dangerous and that is why buprenorphine is of importance in fighting opioid independence.

Today, buprenorphine is being used in office based treatment of opioid dependent patients. Buprenorphine is a partial mu-opioid receptor agonist. Several clinical studies indicate buprenorphine is effective in managing opioid addiction and dependence. In all of the clinical tests Buprenorphine was found to be more effective than placebo for managing opioid addiction. However, it may not be superior to methadone incase high doses are needed. It is comparable to lower doses of methadone, however. When using buprenorphine, there are critical phases that must be followed. These phases include; include induction, stabilization, and maintenance. Experts advise that Buprenorphine therapy should be initiated at the onset of withdrawal symptoms and adjusted to address withdrawal symptoms and cravings. Advantages of buprenorphine include low abuse potential and high availability for office use. Disadvantages include high cost and possible lack of effectiveness in patients who require high methadone doses. Most family physicians are required to complete eight hours of training before they can prescribe buprenorphine for opioid addiction. Let’s get all the detailed facts here.

It is estimated that 898,000 adults in the United States are opioid dependent. Treating opioid dependence as a chronic disorder improves outcomes and opioid maintenance is the most effective way to decrease illicit use in patients who are addicted to opioids. Without opioid maintenance, it will be easy for any user of opiates for pain to be an addict of the same therefore various strategies must be put in place to exercise opioid maintenance for the safety of the patients. Over the past years Methadone has been the treatment of choice in the United States; however, methadone maintenance programs typically have stringent entrance criteria, long waiting lists, and primarily are located in urban areas. It has been verified that only 14 percent of patients who are addicted to opioids are treated in traditional methadone clinics. Research from the 1970s demonstrated that the analgesic buprenorphine (Subutex), a partial mu-opioid receptor agonist, may effectively treat patients with heroin addiction.

In the Drug Addiction Treatment Act of 2000 physicians are authorized to provide office-based treatment for opioid addiction. Through this act physicians are allowed to prescribe Schedule III, IV, or V “narcotic” medications that are approved by the U.S. Food and Drug Administration (FDA) for patients with narcotic-use disorders. In 2002, buprenorphine and combination buprenorphine/naloxone (Suboxone) was approved by the FDA to manage opioid dependence .It is therefore a legally usable drug that is available in health centers and clinics.

How to use

As stated earlier the Management of opioid addiction with buprenorphine can be divided into three phases: induction, stabilization, and maintenance. The induction phase includes the initial transition from illicit opioid use to buprenorphine and typically lasts three to seven days. Patient education is important during this phase and should emphasize the risk of precipitating withdrawal if buprenorphine is initiated too soon after opioid use. Generally, buprenorphine should be initiated 12 to 24 hours after short-acting opioid use and 24 to 48 hours after long-acting opioid use. It is preferable for most patients to use combination of buprenorphine/naloxone tablets.  It is however advised that pregnant women who are to use buprenorphine and some patients using long-acting opioids such as methadone should use the buprenorphine-only formulation. For those who are on long- acting opioid use, the methadone dose should be less than 30 mg and the patient should switch to the combination tablet after several days.

When the patient has shown opioid withdrawal symptoms, the initial doses should be administered under physician observation (4/1 mg buprenorphine/naloxone or 2 mg buprenorphine if the patient is dependent on a long-acting opioid). It is important for the physician to monitor the patient for precipitated withdrawal and excessive side effects like sedation). If the patient continues to exhibit signs of opioid withdrawal after two hours, another 4/1 mg dose of buprenorphine/naloxone should be administered. Patients who are dependent on long-acting opioids should receive 2 mg buprenorphine every one to two hours. The maximum recommended first-day dosage of buprenorphine is 8 to 12 mg. If the patient continues to show signs of withdrawal, the physician may administer adjunctive nonopioid and symptomatic treatments to help the situation.

Difference between methadone and morphine

There are some differences between methadone and morphine. Some of the differences lie in their costs and uses. Here are some of the differences.

Methadone is much cheaper as compared to morphine. For this reason many physicians favor methadone. Methadone also lasts longer than morphine- it lasts ten times longer than morphine. Methadone also lasts longer than morphine in the body. It takes 24 hours while morphine takes only 2-3 hours only in the body. However methadone should not be used for slight pain despite its availability and cheaper cost.

Another difference is that methadone is excreted through urine while morphine is excreted through the liver and bile ducts before its exit in the urine.

 

BuprenorphineThese drugs are also used in different situations. Methadone is mostly used after unsuccessful use of morphine or when the patient has a history of drug abuse. If tis patient is morphine it may lead to relapse hence methadone is considered safer than morphine. Morphine is addictive while methadone is not addictive.

Here at AWAREmed we are dedicated to finding the best solutions to chronic illnesses and that is why Dr. Dalal Akoury (MD) is always in the forefront advocating for integrative medicine since it is only through integrative medicine that a person can be healed wholly. Do not hesitate to call on her for help in managing any sort of chronic pain as well as other diseases.

 

Buprenorphine as Opioid Receptor Antagonist

 

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Proper use Opioids to Curb Addiction and Dependence

October 1, 2014

 

Better Use of Opioids to Curb Addiction and Dependence

opioidsThe opioid drugs have brought relief to many people that were suffering severe pain enough to even disable them. The use of these drugs however should be done with extreme caution as this is like a double aged knife. We talk of collateral damage here with this I mean that these drugs should be used in a manner that they are safe enough not to cause myriad problem such as addiction and dependence on these records.  Today there are millions of Americans who depend on these opioid drugs to overcome what might otherwise be agonizing, crippling pain. However, each year, the numbers of people who have become addicted to these drugs rise. The very same drugs that help them to overcome the pain are poising a great danger in their lives needless to mention the use of these drugs has led to death of many Americans. The main cause of these deaths is overdose. Prescription opioid overdoses caused more than 16,000 deaths in the United States in the year 2010 alone. This is for times the number of deaths that were recorded in 1999 to have been caused by prescription opioid overdose. In the past it was not  easy for both private and public health facilities to act on these unpleasant statistics but slowly they seem to lay strategies to curb the use of these opioid drugs and so far these strategies have shown positive results as very many lives have been saved not only in America but also in other continents.

The Centers for Disease Control and Prevention has cited Florida as one of the cities where the deaths have dropped owing to these strategies that have been employed by the health sector. The deaths dropped from 3201 as was in 2010 to 2666 in 2012. The report clarifies that most of these deaths were reduced due to reduction in prescription of these drugs to pain patients. There were fewer prescriptions to these opioid drugs as a result of in the policy that regulated the flow of these drugs. These policy changes led to a close of 250 of the state’s pill mills that were considered high volume pain medication dispensaries.

The United States remains far and away the world’s largest user of prescription opioids, with 259 million prescriptions written in 2012, according to the CDC — twice as many, per capita, as the next-largest consumer, Canada. A separate CDC report issued the same day as the Florida update showed that prescription rates vary widely among states. Now, when we take America out of the picture and we begin to find reasons why there are problems with the opioid medications we learn that one of the causes of these problems is;

Irresponsible prescription

Every patient entrusts his with the doctor, however in some situations this dependence may be abused either intentionally or unintentionally. Some doctors are opiophobiac and hence reluctant to give right doses to the patients while in some scenarios a patient may be handled by a doctor who is not experienced in pain treatment hence may either overdose or under dose the patient. Cases of overdose are a major cause of deaths from use of these pain drugs.

Another source of complication is, the patient may be afraid of these drugs as they are often portrayed negatively by the media. The fear of addiction and dependence may make a patient not to use the drugs as prescribed.

Due to the problems that were faced by both doctors and patients in dealing with the opioid medications, the universal precautions were developed to offer a structured rational approach to pain patients and serve “as a guide to start a discussion within the pain management and addictions communities. They are not promoted as complete precautionary measures but as a guide to opioid medications.

The difference between physical dependence, addiction and PSEUDO-ADDICTION

These three have different meanings. However they have always been confused causing fear among patients using these drugs. Physical dependence is the case that arises when a person has been using these drugs for some time. The body physically becomes dependent on these drugs so much that when you stop using them you will show signs of withdrawal. This is normal and happens with other medications not only with opiates.

Addiction on the other hand is a case when a person losses control of the drugs. He no longer can maintain the doses as prescribed but begins to take much more than the prescribed doses. In most cases those addicted to a drug will not accept that they are but will go through all hustles to satisfy their craving for the drug.

 What is pseudo-addiction?

opioidsWhen a pain patient on opioids begins behaving in a manner that most addicts do but in real sense he is not addicted, this is called pseudo-addiction. The patient will demand for more drugs because the doses he got have not settled the pain. They will even use more than the prescribed doses in a bid to cool the pain and are often early to request for more drugs since they overused the ones they were given to cool the pain . The difference between pseudo-addiction and addiction is the reason behind the need for more drugs; an addict needs more drugs to satisfy his craving while in pseudo-addiction a patient needs more drugs because of the pain.

You need more information to stay away from dependence on alcohol and drugs as these have crippled societies and that is why here at AWAREmed we are dedicated to finding the best solutions to addiction and dependence on substances. Dr. Dalal Akoury (MD) is always in the mood of helping any patient to be addiction free. Do not hesitate to call on her for help in managing any sort of chronic pain or any type of addiction as well as other diseases.

Better Use of Opioids to Curb Addiction and Dependence

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