Malibu Beach Recovery Center

Recently Malibu Beach Recovery Center CEO Joan Borsten and I were talking about some dramatic news.

First, last year the American Society of Addiction Medicine (ASAM) introduced a new definition of addiction that “knocks the psychological element off centre stage, redefining addiction as a chronic neurological disorder and an imbalance in the brain’s ‘reward’ circuitry.” (That’s from an editorial in a nutrition and mental health newsletter from the International Schizophrenia Foundation.) Joan applauded ASAM for finally recognizing what scientists like Dr. Kenneth Blum and NIDA chief Dr. Nora Volkow have known for decades -- that addiction is a chronic brain disease. Remember her Dopamine for Dummies article?

Second, SAMHSA (Substance Abuse and Mental Health Administration) has announced a working definition of “recovery,” (from mental disorders and substance abuse disorders). The group worked with people from behavioral health care, among others, to detail the essential, common experiences of those recovering from these conditions. They offer this statement:

“A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

And these components that support a life in recovery:

• Health: Overcoming or managing one's disease(s) as well as living in a physically and emotionally healthy way.
• Home: A stable and safe place to live.
• Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society.
• Community: Relationships and social networks that provide support, friendship, love, and hope.

Here’s what I see: Every field needs a vocabulary people can agree on. It drives the work and indicates what the field is about. It supports the members and the experts, and it’s important.

We are still at the start of this New Year.  I’m thinking of all the people in recovery and wishing them well. I’m thankful for all the recovery centers around the country helping them to improve their life and reach their new potential.

In the last few years, we’ve heard about a huge problem in our country: meth labs, especially in remote areas in places like Missouri. Residents living in poverty with few income possibilities have turned to making meth as a way to make money, with dire consequences for the rest of the population.

Just when I thought the problem may be abating, I see a December USA Today article that the problem is still going strong in Missouri. In fact, it has been for 12 years. I did a web search for “methamphetamine” and I can’t believe how many sites with recipes for making it come up!

Meth has limited medical uses, according to NIDA, the National Institute on Drug Abuse. NIDA’s webpage for the drug  is chock full of information. You can smoke, snort, or inject methamphetamine, or dissolve it in water or alcohol and drink it (although it has a bitter taste), and it produces an intense rush when taken the first three ways I mentioned.

In NIDA’S words:

Long-term methamphetamine abuse has many negative health consequences, including extreme weight loss, severe dental problems (“meth mouth”), anxiety, confusion, insomnia, mood disturbances, and violent behavior. Chronic methamphetamine abusers can also display a number of psychotic features, including paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects crawling under the skin). Transmission of HIV and hepatitis B and C can [also] be consequences of methamphetamine abuse. 

Throughout the nation, almost 7,000 meth labs have been seized to date. (Equipment and dump sites are included in that figure.) Luckily, similar to their actions regarding bath salts, states are stepping in and passing legislation to restrict the sale of cold and allergy medicines containing pseudoephedrine, one of the ingredients of homemade meth. I don’t know about your state, but here in NJ you have to ask for certain cold medications because they’ve been moved to behind the counter.

2011 may well be remembered as the year the nation finally ­­realized that it is not just celebrities who are dying from legally prescribed drugs, but tens of millions of ordinary folk – from children to adults to aging baby boomers, in every city and town.  Many of us already suspected what a recent analysis by the Los Angeles Times confirmed:  drug deaths now outnumber those killed in traffic accidents, and prescription drugs are largely to blame.

Law enforcement has begun to take note:  most daily on the organization’s facebook page, Members of the National Coalition Against Prescription Drug Abuse (“NCPDA”) post news about crack downs on local “pill mills” – doctors who make a living writing prescriptions for anyone who pays.  

Unscrupulous doctors operating out of store fronts, with cash counting machines, or via internet, create just part of the grisly statistics.  National and state legislators now need to regulate the practice of pain management – not just for those who specialize in this new field, but for the doctors who staff the Emergency Rooms and Urgent Cares, and also dentists.  Too many of these medical professionals write prescriptions for narcotics and benzodiazepines without a thought to the long-term consequences, or the history of the patient.

Earlier this year we interviewed Dr. Marc Mandel, MD, a Beverly Hills doctor who often serves as a medical expert in Workers' Comp cases involving pain.  Most often the doctors whose treatment he reviews are anesthesiologists. To become pain management specialists they study the pain management curriculum – there is no residency program -- and pass a board test which certifies them in the sub specialty.  

Treatment of pain, says Dr. Mandel, is often related to blocking different nerves, something anesthesiologists are quite adept at doing. 

Dr. Mandel goes on to say:  “The classical textbook on pain management was authored by Doctor Aronoff.  In the introductory chapter of the classic book, he states, 'too many visits to this office may be deleterious to your health'.  And what Doctor Aronoff was stating is that the goal of pain management is to help the patients cope with their pain.  It’s not to simply ply them with medications.  Because if you have an addictive personality, and probably 15 to 20 percent of us do, you’re gonna get hooked on the medications.  And consequently, you’re gonna need ever increasing amounts of drugs to allay the symptoms of pain.

“Now if someone has terminal cancer, I think it’s important to give them medications to make their life as comfortable as possible since the end is near.  But if you’re dealing with a young, adult otherwise healthy person, I think it’s not the best practice to ply them with an enormous number of addicting narcotics.”

Just last week a client, we will call her Lynda, had a very impacted wisdom tooth which needed to be pulled while she was still in treatment. Lynda was born addicted to cocaine. She has battled most of her young life with substance abuse, specifically opiates.  The dentist was told not to use narcotics and he did not, but a subsequent infection sent her to another dentist.  His staff was warned that Lynda was in early recovery when the appointment was made, and the counselor who accompanied her wrote a note to the dentist.  Nonetheless, he handed her a prescription for percoset, a Schedule II (controlled) narcotic whose main active ingredients include oxycodone -- basically synthetic morphine and highly addictive.   As an addict, Lynda was really tempted -- after all it was a dentist who wrote the prescription.  It took virtually the whole clinical team to talk her down.   Next morning I called the dentist, more to enlighten him then to complain.  I said that a Class II narcotic could “awake the sleeping dragon” in any addict and cause a relapse.  My comments were met with pure attitude.

A week before that Lynda’s roommate Anais managed a trip to the Emergency Room for “excruciating” back pain.   A chiropractor confirmed that years of living on the street had taken its toll and that now, off pain-numbing opiates, Anais was finally feeling the consequences.   He also said she could manage the pain with over the counter ibuprofen.  The paramedics told the ER staff Anais wa a patient at an alcohol and drug treatment center.  The counselor accompanying her told the doctor she was in early recovery.   Yet when Anais shooed the counselor out of the room, the ER doctor gave her a shot of morphine. 

Krissie Bergo, who we wrote about last June, came to us through Workers' Comp.  She spent 73 days at Malibu Beach Recovery Center and then 6  weeks at Oceanside Transitional Living.  It cost her insurance more than $100,000 to get her off $50,000/month of toxic opiates and benzodiazepines, all prescribed by a single Workers' Comp pain management doctor.  Incredibly the next Workers' Comp doctor she was assigned ordered her back on hydrocodone, another addictive Schedule II (controlled) narcotic.  She knew enough about addiction to refuse.  Then she went to the dentist and though she told him she was in recovery, he used a benzodiazepine to numb her gums.  I believe it was inadvertent, but warned that Krissie was an addict,  he need to be more vigilant.  She spiraled out of control and had to check back in to MBRC to avoid relapse.

Any addict looking for a quick fix, or a prescription on which to relapse, has to go no further than our local Urgent care.  The doctor told me he would rather give the patient demanding narcotics what he/she wants and out the front door than risk a bad internet write-up.  

ER doctors who want to do the right thing may be putting their jobs at risk said Douglas, a former drug and alcohol counselor who called in to the September 27, 2011 broadcast of “Talk of the Nation.” Douglas told Neil Conan, host of the award-winning  PBS news show, that two of his current clients are emergency room physicians,  He said doing the right thing is hard when you are graded on performance, which includes patient feedback.

Douglas (caller):  “So they'll get clients, patients coming in who are drug-addicted, on Oxycontin, other drugs like you've mentioned, and will press for the drugs...If they spend the time discouraging that patient, it ends up scoring negatively against them.”

In the United Kingdom doctors are being sued for creating prescription drug addicts amid claims they have failed to follow safety guidelines published more than 20 years ago.

Are frustrated Americans going to "occupy" the lobby of the AMA this year?  Stay tuned.

You often hear that addiction  is an equal opportunity disease and truth be told, people from all walks of life end up in prison because of drugs, whether due to possession, dealing, or committing crimes to be able to buy them.

Here’s one statistic regarding the extent of the problem: A writer in the August issue of Perspectives, A Journal on Addiction Research and Public Policy (the journal's website is http://www.ncaddnj.org), said “there are more than two million jail and prison inmates, “and “about 15% have histories of heroin dependence.”

But inmates with a history of crimes not related to drugs have substance abuse problems, too. So it’s not surprising so many of those incarcerated try to have drugs smuggled in to them. What is surprising is the current drug of choice is Suboxone, a legal, synthetic opiate used to efficiently detox addicts off other opiiates such as heroin and oxycodone, also used for pain management.   Addicts who can afford the high cost sometimes use suboxone or subutex -- both medically known as buprenorphone -- instead of methadone to prevent opiate usage.

According to a New York Times article, friends and families of inmates (I assume that’s who the smugglers are) crush Suboxone pills into a paste and spread it on children’s artwork, spread it under stamps on inmates’ mail for them to lick, or tuck it behind envelope seams. Smugglers have even included it under pictures in kids’ coloring books.  The New York Times article further reports that suboxone has become a coveted contraband because it can provide a sense of euphoria.

The Cumberland County jail has a new rule that every piece of mail must come in a white envelope -- so officials can detect the orange tint of the suboxone strips when they hold the envelope up to the light.  At the Maine Correctional Center officials remove all mail from envelopes before delivering it to thwart suboxone smugging.  Any mail containing crayon scribblings, stickers, or glitter glue are not delivered.  In Massachusetts, suboxone makes up 12 percent of all contraband discovered in state prisons.

The Perspectives journal article writer noted that few inmates receive drug abuse treatment while incarcerated and are at high risk for relapse once they leave. (The New York Times cited a 2009 study in which only seven state prison systems were found to offer inmates Suboxone, and criticized the way it was done.) Some people would say well, at least there are seven. But this is yet another area where we as a nation need to improve.

Joan Borsten contributed to this article.

In an earlier post I wrote about alcohol abuse in England and what the English government is doing to try and combat it.  England seems truly concerned about its problem.  Another country --Vietnam -- made the news in September, in an article about how that country handles substance abuse. Vietnam’s approach can only be classified as horrifying. 

This country’s program, as the government describes it, doesn’t sound horrific on the surface. Addicts are given “labor therapy” in which they learn skills -- basket weaving, processing cashew nuts, and sewing, for example. But it’s actually forced labor. 

The Human Rights Watch organization said that the substance abusers are paid little or nothing, beaten, given electric shocks, and sent to solitary confinement. And sadly, some of the items they make are exported to the U.S. Some jacket liners actually went to Columbia Sportswear, through one of its subcontractors. Columbia fired the company on learning this, and gave the pieces to charity. Bravo, Columbia.

In Vietnam, alcohol treatment is “re-education”, which oppressive and repressive regimes are famous for. One former detainee said that the only rehabilitation he and others got was being made to march and chant “Try your best to quit drugs!” The relapse rate is 89%. You wonder how any of these substance abusers recover.

These “addiction centers” are given tax-exempt status, but they’re actually profit centers that operate under a “special administrative system.” The astounding facts just go on and on. 

How can people have so little regard for human life? We’re not perfect in this country; it’s not as if Americans don’t commit abuses. Whereever they occur, it’s just not right. And we may have more progress to make when it comes to legislation, funding for addiction treatment and changing attitudes toward addiction, but …. that article was hard to swallow.