Aug 9, 2021, 13:40 by admin admin

This week’s submissions reflect a strong bias to basic science, unapologetically. There are times when the brain is a three-pound grey pudding with obscure eponyms assigned to slightly darker streaks and patches, waiting to lose a contest between its inebriated owner and a delivery van.

Aug 9, 2021, 13:40 by admin admin

This past month a friend died. He did so quietly, drawing no attention to himself, despite having known for a number of years that this was impending; and certainly imminent within the past few months. I only knew of it because of a kind of long-term, episodic, two-student mini-seminar that we held for each other, on the topic of life’s end. The cause of his death was what will likely occur for many of us who are older - although he was not so very far into middle-age himself - if we are not infected by a Chinese chicken, stricken by a smartphone-distracted Mercedes-Benz driver, or overcome by gravity while a passenger in a helicopter. Nor was it from a substance use disorder, with all its attendant risks of infection and trauma. It was a cancer, for which the merits of 21st-century medicine shone, in that his life’s length and quality were clearly improved by treatment

Aug 9, 2021, 13:40 by admin admin

Some days ago, I was witness to an extraordinary event. That’s not quite right; I was an invited participant, in consequence of the way the event was handled. Two friends married, for whom such a marriage would have resulted in imprisonment, or just as likely, the deaths of either or both spouses, just within this past century. Wonderfully choreographed, with many hundreds of family and friends attending from homes thousands of miles afar, the marriage was between two exceptionally caring healthcare professionals who had been imaginatively, patiently planning toward this point for over eight years.

Aug 9, 2021, 13:40 by admin admin

The New York Times (NYT) Science section of 03 January carried this eulogy, by Knvul Sheikh*: “Dr. Heather Ashton, 90, Dies; Helped People Quit Anxiety Drugs” An excerpt from this review of Dr. Ashton’s professional life underscores how it is not merely opioids which have led to our dereliction of better judgment, in the prescribing of addiction-activating drugs: “Heather was a remarkable person,” Nicol Ferrier, an emeritus professor of psychiatry at Newcastle University who worked closely with Dr. Ashton, said in an interview. “She was very upset by this problem of benzodiazepine dependence that was essentially caused by doctors overprescribing the medications, and she took it upon herself to help patients struggling to withdraw from them.”

Aug 9, 2021, 13:40 by admin admin

It is with great pleasure we get to finish off the year with our annual tribute to Bill’s editorials. This is not just some 80’s sit-com ploy to keep our readers’ attention by re-running clips of the most watched episodes- it is a moment to show thanks for all that Bill shares by pouring out his thoughts 51 weeks a year…So let’s take a look back at 2019, make some sense out of it, and get ready for the twenties of the 21st century.

Aug 9, 2021, 13:40 by admin admin

In this holiday season, "gift giving" has become a trope, investing it with a spiritual value that makes the endless and fervent buying-and-giving-and-receiving-and-exchanging seem somehow a little sacred. But that misses the point. The gifts in such seasons are not those by us to spiritual entities, but from them to us. We give thanks to you, the readers for guiding our shared patients to a place of sustained relief.

Aug 9, 2021, 13:40 by admin admin

A December 11 article by Coffin et al. in JAMA Psychiatry suggests efficacy for the use of mirtazapine in management of methamphetamine use disorder, as well as some positive effect upon high-risk sexual behavior. The article particularly stirred up interest among one large group of addiction specialists, stimulating a high baud-rate exchange both pro/con.

Aug 9, 2021, 13:40 by admin admin

High-activity antiretroviral therapy (HAART) first arrived in 1993, comprised of a variety of agents active against human immunodeficiency virus (HIV). These included fusion inhibitors, integrase inhibitors, protease inhibitors, NNRTIs and both nucleoside and nucleotide reverse transcriptase inhibitors.

Aug 9, 2021, 13:40 by admin admin

High-activity antiretroviral therapy (HAART) first arrived in 1993, comprised of a variety of agents active against human immunodeficiency virus (HIV). These included fusion inhibitors, integrase inhibitors, protease inhibitors, NNRTIs and both nucleoside and nucleotide reverse transcriptase inhibitors.

Aug 9, 2021, 13:40 by admin admin

Inserted here is a link to a RAND Corporation offering, a free downloadable text of 295 pages… It is provocatively entitled, “The Future of Fentanyl and Other Synthetic Opioids.” It is the closest I will have to a Thanksgiving gift for you.

Aug 9, 2021, 13:40 by admin admin

Although September is Recovery Month, among those in recovery that part of the calendar most venerated and most feared is this interval of November-January. For here coincide holidays and inaugurations, periods of revelry and of reverie, rehabilitation and regrets. While the season is a less official celebration of recovery, it is certainly more visceral. Continuing the past two weeks’ characterizations of addiction and recovery, it is right to give examples of both those with and without the disease, “Donna” and Ahmed, who serve those with it.

Aug 9, 2021, 13:40 by admin admin

Methamphetamine: The USA Today piece below (“Cheap and powerful ‘meth 2.0’…”) seeks to build a case for response to an ostensibly new addiction threat, from methamphetamine (MA). It is not clear that the author demonstrates a difference between the MA in circulation three decades ago and that currently available; or between the effects then and now.

Aug 9, 2021, 13:40 by admin admin

In 2003, I found myself back in uniform at the beginning of another war. Part of that time was spent in Manama, the capital of Bahrain, in comparatively safe, even comfortable circumstances. It was, moreover, a sufficiently urban setting that some peculiarly Western institutions found homes there. There were two meetings of Alcoholics Anonymous weekly, both bracketing the weekend with its holy days, one hosted by a hospital, the other by a church not so distant from the hospital.

Aug 9, 2021, 13:40 by admin admin

Role models and accomplishments in recovery have provided guidance to those who were ambivalent, assurances to those who were desperate, and a validation of shared human experience to those who felt alone, since the beginning of Alcoholics Anonymous (AA). In fact, this is not unique to AA; the Temperance Movement and its predecessors relied heavily on personal testimonials to achieve authenticity, or at least the appearance of authenticity. Reasoning from the abstract may be satisfying for a teacher but is seldom of much use to the pupil; even less so when the pupil is cognitively impaired. To reason more from example or even by analogy requires real skill from the teacher. It is translation at its best. Translation is, after all, movement of the un-comprehended into the realm of understanding.

Aug 9, 2021, 13:40 by admin admin

As noted, the interval 21-27 October is National Addiction Treatment Week. Initiated by the American Society of Addiction Medicine in 2017, its aim is to annually rekindle a conversation regarding the origins, characterization, diagnosis, and treatment of addiction disorders (http://treataddictionsavelives.org/about/ ). The style of such an event is familiar to us all: the effort to bring about a national understanding of an epidemic illness and its human devastation was most recently memorably evident in the AIDS epidemic.

Aug 9, 2021, 13:40 by admin admin

In the April 2019 issue of National Geographic magazine on cities (https://www.nationalgeographic.com/magazine/2019/04/ ), the segment on Singapore asks the important question of social control versus autonomy: what are we willing to give up for security? I submit this just as an analogy in considering the measures for treating addiction.

Aug 9, 2021, 13:40 by admin admin

Readership attention is invited to the opioid use disorder education requirement proposal (The Journal of Law, Medicine & Ethics), below. The follow-up question is whether such a proposal is sufficiently broad.

Aug 9, 2021, 13:40 by admin admin

In psychiatric residency training, there is an admonition that every supervisor makes to the trainee, at some point: listen for what isn’t being said. There are various interpretations of this – one is simply, “Look for what history you have omitted.” Another, less obvious translation is to listen for what has been either concealed or repressed.

Aug 9, 2021, 13:40 by admin admin

This about a graceful but unwanted departure. This past week, Penny Mills, Executive Vice President and Chief Executive Officer of the American Society of Addiction Medicine, announced her wish to retire in June of 2020. She will conclude her 10th year with us having done all that we could want and more, more even that we had wit to ask. With characteristic professional commitment, she has provided us fully 9 months in which she will aid in the selection of a successor.

Aug 9, 2021, 13:40 by admin admin

In context with the lead article, The Future of Fentanyl and Other Synthetic Opioids (RAND), consider examining a text edited by David F. Musto, One Hundred Years of Heroin (Auburn House 2002). Cited in several national conference presentations in the past year, it is a compilation of 14 articles dovetailed to form a coherent history of the archetypal opioid of misuse.