Opiate addiction and prescription drug abuse: a pragmatic approach.

During this second decade of the 21st century, the United States is

in the midst of a major public health problem. At near epidemic

proportions, the abuse of prescription drugs and especially opiates

significantly contributes to escalating care costs, increasing patient

hospitalizations, and growing numbers of untimely deaths.

Although tobacco, alcohol, and marijuana traditionally have

represented the drugs of choice for adolescents, recreational use of

pharmaceuticals has the potential to become as prevalent. This is due to

prescription medications' relative low cost, ready availability,

and accepted medical usage. In addition, the problem is exasperated by a

small percentage of unscrupulous providers who for financial gain play a

major role in this epidemic.

Some may question the usage of the term epidemic; however,

statistics bear the appropriateness of this appellation. Approximately

14% of American adults are estimated to be using pain medications for

nonmedical purposes, and the recreational usage of opioids has steadily

risen during the past decade. From 2002 to 2006, the percentage of young

adults aged 18 to 25 abusing prescription opioids increased from 4.1% to

4.6%. These figures suggest that approximately 1.5 million young adults

are regularly abusing these medications.

Additionally, opioid-related emergency room visits increased 126%

from 2004 to 2008. Treatment admissions for non-heroin opioid abuse and

dependence are also on the rise. From 1996 to 2006, the numbers of these

treatments nearly quadrupled nationally from 16,605 to 74,750. In West

Virginia, this trend especially has been severe. During the same

ten-year period, non-heroin opioid treatments soared in the Mountain

State from two treatments per every 100 thousand to 78 in every 100

thousand. Currently, West Virginia has the third highest non-heroin

opioid treatment rate in the nation.

While we believe that the majority of physicians are treating

patient pain appropriately, a number indiscriminately prescribe opiates.

This is done without a proper treatment plan of when and how to use the

medications, without assessing the illness for the need of such

medications, and a lack of use of standardized pain assessment

instruments. Some physicians routinely neglect alternatives to narcotics

for treatment such as psychosocial and behavioral Opioid Treatment techniques as well as

non-addictive adjunctive medicines to reduce dependencies on opioids.

The result has created a culture of iatrogenic drug addiction, and the

offending providers are ascribed as being "legalized drug

pushers." It is our intention to propose pragmatic changes to

physician practices to address this ever growing problem.

Pain Management: Prescription of narcotics for non-cancer pain

should be a treatment that is time-limited and of a last resort. It

should only be used when non-narcotic and psychosocial interventions

have failed. Even when legitimately used, the prescriptions should

include a dosage, quantity, and treatment duration that is adequate to

treat the pain. Monitoring the usage of these medications reduces the

risk of patient abuse and dependence, and it decreases the likelihood of

diversion through the drug's sale or theft. Since diverted

prescription pain medications are the leading source of opioid access

for adolescents, the importance of limiting quantities of prescribed

narcotics cannot be overstated.

Opioid Treatment Dependence: Although methadone and

leva-acetylmethadol (LAAM) have been used as agonist replacement

treatments for opioid dependence, the Substance Abuse and Mental Health

Services Administration are now recommending buprenorphine (Subutex[R])

and Suboxone[R], a combination of buprenorphine and naloxone, as

office-based treatment alternatives for opioid addictions. Physicians

can be licensed to prescribe buprenorphine with minimal training and are

only required to be able to refer patients for adjunctive psychosocial

treatments. Unfortunately, buprenorphine has developed a street value.

The duration of treatment dosage of Suboxone[R] has been debated, but

the medication has been successful in the treatment of opioid addicts.

We believe, however, that unless these medications are properly

controlled, they will meet the same fate and notoriety of methadone.

Motivation: Another factor that plays an important role in the

prognosis and treatment of drug addiction is motivation. Detoxification is not a cure. When utilized without adequate support measures and

proper follow-up, detoxification has proven to be ineffective. While

continually problematic, assessing an individual's motivation is

subjective. Although psychological tools exist, consequences or losses

associated with drug use and abuse is a more accurate predictor Methadone Drug of a

patient's motivation. These consequences may include being

ostracized socially and religiously and may be indicated by the losses

of income, jobs, professional licensures, and intimate relationships. As

society becomes more tolerant to these issues, drug addiction and abuse

becomes more pronounced. Often the patient's family and friends

ignore or enable the addiction.

Recommended Treatment Guidelines: While general guidelines for drug

abuse treatment should be observed, we recommend the following:

a. Restricting the patient to use one pharmacy of his or her choice

throughout the treatment.

b. Requiring the patient to attend regular Narcotics Anonymous,

Alcoholic Anonymous, or other treatment support group meetings. The

patient should attend at least three sessions per week during the first

three to four months of treatment. These meetings can be gradually

lessened after this time period.

c. Obligating the patient to pay co-payments in advance. Third

parties can assist by keeping co-pays as low as possible ($10 to $20 per

session). In addition, we recommended requiring Medicaid patients to pay

a nominal fee of $5 to $10 to demonstrate responsibility towards the

treatment process. If patients fail to attend designated treatment

and/or counseling sessions, prescriptions should be withheld until such

time as the patient returns to compliance.

d. Reporting excessive charges by physicians and counselors to the

appropriate state agencies.

e. Using standardized tests, such as pain assessment tools, as

absolutely necessary. Documenting the use of adjunctive treatment

modalities remains important.

f. Administering a goal-directed therapy with gradual tapering of

medication as the patient progresses through treatment.

g. Constructing a patient agreement that includes random pill

counts and monitored drug screening that is strictly adhered to by the

physician or therapist.

h. Monitoring and documenting the patient's weaning process of

the medication. This is especially critical when dosages have been

increased or have been at a high level for long periods.

i. Requiring physicians to complete periodic training and

continuing education when dispensing narcotics on a long-term basis.

Licensure renewal may be tied to the successful completion of this


j. Collaborating between physicians and addiction specialists is


k. Limiting the Suboxone[R] treatment, in most cases, to not exceed

16 mg per day.

l. Documenting objective factors in detoxification including blood

pressure, pulse, respiration, diarrhea, rhinorrhea, and lacrimation.

These should be combined with subjective symptoms to individualized


While the above mentioned treatment recommendations represent a

practical approach employed by physicians, these are only part of the

equation. We believe that these steps alone are insufficient and

additional action at the public policy level is needed. These include

the following:

First, the DEA's regulations for Schedule II drugs with a high

likelihood for abuse need to be seriously evaluated. Such drug

dispensing should be restricted and time-limited. Medicaid in West

Virginia presently limits this to one month's duration. In

addition, triple prescription copies are warranted. One copy would be

kept on file with the prescribing physician, one with the dispensing

pharmacist, and one submitted to the Drug Enforcement Agency in order to

review and verify that the drugs are being dispensed properly.

Second, the Board of Medicine should conduct periodic audits of

patients' charts and other physician records for compliance with

good clinical practice guidelines. This is especially critical in regard

to cases where physicians are prescribing large numbers of narcotics.

Third, an increased level of public education regarding opiates and

their inherent dangers needs to be promoted via the media at the

national and local levels. Patients must Can Methadone be educated on the proper

disposal of leftover portions of opioid prescriptions. This will

contribute to a decrease in the number of diverted pain medications sold

on the street.

Fourth, there should be greater enforcement of providers accepting

private or government insurance (Medicaid and Medicare). Physicians

engaged in abusive charges in exchange for prescribing narcotics need to

be reported to the Board of Medicine. Conversely, patients guilty of

doctor or pharmacy shopping should be investigated by the proper

authorities and the appropriate charges be filed against the patient.

Finally, controlled prospective studies need to be conducted to

determine treatment effectiveness of Suboxone[R] across multiple social

and economic domains. Post treatment follow up needs to be conducted by

interviews and random drug testing for an additional year. Success would

be determined upon the patient's ability to resume, maintain, and

fulfill social and personal role obligations. Results would be

triangulated through the comparison with other studies.

While prescription drug abuse exists in epidemic proportions, it

has the potential to spiral out of control to conditions not yet seen in

modern society. The implementation of more stringent guidelines and

broad-reaching educational programs are imperative to stop this

continually developing trend.

by Khalid M. Hasan, MD and Omar K. Hasan, MD


The Spice Drug: A Dangerous New Drug

There's a drug popular with teens in the U.S. that many parents may never have heard of, but worst of all - it is legal. This drug, called "Spice" or "K2" is said to give the user a marijuana-like high. Sold in shops and online as incense, it is being smoked as a legal alternative to marijuana. But this drug appears to have far more dangerous side-effects and without the necessary regulation, consumers have no idea what they're really getting.

Spice originally appeared on the scene in the late 1990s, but didn't really become popular until 2008. As the drug gained popularity in Europe, scientists began conducting research into the composition of this drug and any potential effects on the body. As a result of these investigations, many countries subsequently banned Spice including Germany, France, Chile, Poland, Russia, South Korea, Sweden, Switzerland, Austria, and the U.K. The United States currently has no such ban on the drug, likely due to the fact that it has only recently become popular in the U.S.

German researchers were able to determine that Spice contained a variety of synthetic cannabinoids, which are chemical compounds devised to produce marijuana-like effects. There was a high quantity of other synthetic chemicals found as well, indicating that a user really has no way of knowing what they are being exposed to. Worse yet, Spice appears to have many negative side effects that marijuana does not such as anxiety attacks, hallucinations, nausea, and a chemical dependency. Three teenagers in Roswell, GA were recently hospitalized after using Spice. One teen had a severe reaction to the drug, resulting in swelling of the brain.

Currently there is no way to test for the use of Spice, as it is not a regulated drug. Theoretically, children under the age of 18 cannot buy the drug, as Methadone Side head shops and online stores are not Heroin Methadone supposed to sell to minors. As this drug is still legal in the U.S., many people may be led to believe that it is a safe alternative to marijuana. This could not be further from the truth. Parents, teachers, and lawmakers need to be made aware that this drug is out there and that it has the potential to harm the lives of our children.


Deutsche Welle: Germany Bans Cannabis-Like Drug

Times Online: 'Spice' Ban As Tests Show Legal Drug As Potent As Cannabis

Wikipedia Entry for "Spice"

Mind Hacks - Spice Flow: The New Pharmacology

My Fox Atlanta: Roswell Police Warn of Synthetic Pot

Creative Loafing: Spice Is A Helluva Drug

Pfizer blocks use of drugs for lethal injections

Pharmaceutical company Pfizer said Friday it was blocking use of its drugs in lethal injections, which means all federally-approved drugmakers whose medications could be used for executions have now put them off limits.

"Pfizer makes its products to enhance and save the lives of the patients we serve. Consistent with these values, Pfizer strongly objects to the use of its products as lethal injections for capital punishment," the company said in the statement made public on its website Friday.

The company's announcement has limited immediate impact. Its action is an enhancement of a previous policy that follows Pfizer's $15.23 billion purchase of Lake Forest, Illinois-based Hospira Inc. last year. Hospira had previously prohibited the use of its drugs in capital punishment, as have several other drugmakers.

Pfizer shares closed even Friday at $33.19.

The development means the approximately 25 FDA-approved companies worldwide able to manufacture drugs used in executions have now blocked the use of the Addiction Programs drugs, according to Treat Opiate Reprieve, a New York-based human rights organization opposed to the death penalty.

"Pfizer's actions cement the pharmaceutical industry's opposition to the misuse of medicines," Maya Foia, Reprieve director, said in a statement.

Pfizer's announcement Heroin Methadone was unlikely to have much effect on executions, which have slowed in recent years as drugmakers' prohibition on the drugs took effect.

However, as recently as last year, records showed that labels of Arkansas execution drugs appeared to indicate that the state's potassium chloride, which stops the heart, was made by Hospira. Pfizer spokeswoman Rachel Hooper said the company couldn't speculate on the impact of Addiction Programs its decision.

Ohio, which last executed an inmate in January 2014, has repeatedly pushed back executions while it looks for drugs. It now has more than two dozen inmates with firm execution dates, but no drugs to put prisoners to death with.

Some remaining death penalty states have been using compounded versions of drugs that fall outside of FDA approval.

Texas, with the country's busiest death chamber, obtains its pentobarbital for lethal injections from a supplier the state identifies only as a licensed compounding pharmacy. A law that took effect last year keeps the identity of the drug provider confidential. The state has carried out six executions so far in 2016. At least eight are scheduled for the coming months, including two in June.

Texas is fighting a lawsuit trying to force it to identify drugmakers from April 2014, when attorneys unsuccessfully filed appeals to stop two executions by seeking the identity of the drug providers, and September 2015, when the state's secrecy law took effect.

Similar lawsuits about whether states must identify their providers have been argued in states including Georgia, Arkansas and Missouri.

There have been 14 executions in the U.S. so far in 2016 in five states: six in Texas, five in Georgia and one each in Alabama, Florida and Missouri. Last year, there were 28 in six states.

Some states have passed laws allowing older methods of execution if needed. Last year, Utah approved the use of firing squads for executions if drugs aren't available, while Oklahoma became the first state to approve nitrogen gas for executions if lethal injection drugs become unavailable or are deemed unconstitutional.

In 2014, Tennessee passed a law allowing the use of the electric chair if lethal drugs can't be found. Virginia is debating a similar bill.

The seven drugs affected by Pfizer's policy: pancuronium bromide, potassium chloride, propofol, midazolam, hydromorphone, rocuronium bromide and vecuronium bromide.


How ToGet Bigger Breasts Naturally Without Surgery – Easy Tips

Every girl would want to know the secrets on how to get bigger breasts naturally without surgery. The good news is that you are about to find out few of them. Getting bigger breasts is almost every girl's dream because it makes them look and feel desirable and it also makes them look more flattering in certain stylish clothes.

As everyone knows, naturally big breasts are kindly bestowed upon girls through their genes. So girls with a more generous bosom should thank their lucky stars. For those who have smaller breasts and would like to have bigger ones, there is still a chance to get them without having to go under the knife. Although small breasts is not a bad thing (many famous Hollywood actresses have small breasts but still have great appeal, such as Keira Knightley), many women want it very much because it will make them feel more confident and attractive.

One of the most common ways on how to have bigger breasts naturally is to go to the gynecologist and inquire about female contraceptives. These contraceptives contain female hormones that will also increase the breast size. Many women have started with contraceptives and experienced the effect of having bigger breasts.

Many girls swear that massaging one's breasts frequently will also enable them to grow a little bit bigger. Younger girls who do this while the breasts are still in the stage of development are said to more likely see better results. On a side note, studies have shown that massaging one's breasts frequently will make it less likely for a person to develop breast cancer.

Gaining some weight will also increase your breast size naturally without surgery. Some girls are naturally very thin which often leads them to not have well-developed breasts. Eating a proper diet with foods that are rich in protein can increase your chances of getting bigger breasts. Also, avoiding caffeine is a must if you want to have bigger breasts, especially when you are taking supplements to help increase their size.

Also, sometimes the right type of bra will do just the trick. Bra inserts are a great way to enhance your cup size and make certain clothes look more flattering on you. Try on some silicone bra inserts at your local lingerie store, and see if that works for you. Push up bras and padded bras are every girl's immediate wish come true for naturally "big" breasts.

Aside from push up bras and bra inserts, you can also choose certain types of clothes to make fashion give you the illusion of a more generous chest. Try on some V-neck shirts that are hugging your body, as well as wrap around blouses. A blouse with a voluminous amount of frill on the chest area can also boost the appearance of having bigger breasts.

Big breasts are usually seen as beautiful. However, the most important is that you should learn to love whatever breast size you may have. Learn from beautiful supermodels and actresses such as Kate Moss and Mila Jovovich, who have rocked the world of superstars sans big breasts.


extra large implants pictures


The Best Recommendation Accessible For Personal Finances

Obtaining your personal finances in check is essential to long term success. This involves incorporating effective budgeting strategies in your lifestyle. So, why does living within a strict budget feel as if this sort of stress on your lifestyle? It does not have to feel in this way. Living with limited funds, while still living well, can be done. On this page, we shall talk about some practical advice.

If you are planning a significant trip, consider opening a new bank card to finance it which offers rewards. Many travel cards are even affiliated with a hotel chain or airline, meaning that you get extra bonuses for utilizing those companies. The rewards you rack up can cover a hotel stay as well as a complete domestic flight.

You need to keep their life organized and also this includes personal finances. Having all account information as well as password information as well as other sensitive,important, and also other useful paperwork in the secure location may help one greatly. It will not only be safe but it will likely be very easy to access when you need it to get a personal finance related matter.

When you are saving to have an emergency fund, aim for around 3 to 6 months amount of cost of living. This is not a large amount, thinking about the difficulty in finding employment should you ever lose your task. Actually, the larger the emergency fund, the greater position you would be directly into ride out any unforeseen financial catastrophes.

You're one of many if you make an error or two together with your personal finances. Should this be your first time to bounce a check, your bank may waive the fee. This is possible when you have a good banking record.

Make your home's appraisal in mind as soon as your first property tax bill is released. Consider it closely. If your tax bill is assessing your house being significantly more then what your own home appraised for, you should certainly appeal your bill. This could save you a substantial amount of money.

When writing checks or making use of your debit card, always take note of your purchase with your check ledger. You don't need to do your subtracting on the moment you are making the investment, but make note from it. Calculate your expenses at least once every day. In this way, you should never be overdrawn.

Applying for money for college and scholarships will help those attending school to obtain a little extra money that may cushion their own personal finances. There are various scholarships an individual can attempt to be eligible for a as well as these scholarships will give you varying returns. The important thing to obtaining extra money for school is always to simply try.

A great way to reduce costs, with gas being as expensive since it is, is to cut down on the driving. If you have several errands to work, try to do them altogether in a single trip. Connect all of the places you have to head to into a reliable path to save mileage, as well as in effect, save on gas.

Try paying for your meal and also other daily purchases on credit cards. Then, at the end of the month, be worthwhile that charge card completely. This demonstrates that you're capable of being responsible when borrowing money which you'll pay it back. This can be a nice, good way to improve your credit score.

Use cash for purchases. Eliminate credit cards and atm cards and employ cash for purchases. Make use of the envelope system to allocate a budget for monthly expenses. Use a separate envelope for every different form of expense, and put a certain volume of cash in every one. By doing this, you won't over-spend on any monthly expenses. A good idea would be to have another envelope marked 'emergency', containing cash that could basically be used if really necessary. Seal this envelope, as this makes you less tempted to 'borrow' from it.

While we have realized, money is not easy to maintain in grasp. It seems like when we have money, we do not possess it long. However, together with the aforementioned worthwhile tips on this page, your hard earned dollars will not escape your money unnoticed. Personal finance is a subject of ease when you apply these guidelines for your budget!



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