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.

Aug 9, 2021, 13:40 by admin admin

Two of the articles discussed relate directly to the US incarcerated population. This invites commentary on how we may best serve them. Citizens and former citizens in our prisons exceed 2.3 million in 2019, with 11 million spending some time in jails over the year. Of these, a reliable estimate of those with substance use disorders still wants determining but certainly exceeds 50%.

Aug 9, 2021, 13:40 by admin admin

The creative intelligence is ethically neutral. It can confer therapeutic benefit or lethality with equal facility. The moral compass of its owner determines the direction of its effect: in its most mundane form we encounter it during our brighter patients’ justifications for drug or alcohol use.

Aug 9, 2021, 13:40 by admin admin

When we began the present format for the ASAM Weekly, it was to improve access to recently-arriving news in the addiction medicine field. Judging by the subscription rate and similar factors (e.g., click-rate, email comments), we have enjoyed some success. But there are obstacles to assigning the correct treatment to the illness that become apparent in publications advancing either pharmacotherapies or nonpharmacologic therapies. One of these is in the area of trustworthiness.

Aug 9, 2021, 13:40 by admin admin

In the interval since last week's editorial, I received a number of suggested community recovery options. I'm a little cautious about opening this up to a listing or inventory of all programs, community and otherwise. But whether such an inventory belongs in the pages of ASAM Weekly is less relevant than whether there should be such an inventory, somewhere. ASAM makes no endorsement, direct or inferred, of any of the programs, and particularly not of those that have some commercial underpinnings (with reference to the Therapeutic Communities examples provided last week; which, just as TCs generally, may have no-cost or externally-supported components).

Aug 9, 2021, 13:40 by admin admin

In the interval since last week's editorial, I received a number of suggested community recovery options. I'm a little cautious about opening this up to a listing or inventory of all programs, community and otherwise. But whether such an inventory belongs in the pages of ASAM Weekly is less relevant than whether there should be such an inventory, somewhere. ASAM makes no endorsement, direct or inferred, of any of the programs, and particularly not of those that have some commercial underpinnings (with reference to the Therapeutic Communities examples provided last week; which, just as TCs generally, may have no-cost or externally-supported components).

Aug 9, 2021, 13:40 by admin admin

I discussed the various cultures of both addiction and recovery from addiction this past week, at the International Doctors in Alcoholics Anonymous (IDAA) conference in Knoxville, Tennessee. Most of the topic was dedicated to the conceptual utility of a cultural model in providing effective interventions and structured treatment for addictions. But it also offered an opportunity to look briefly at what else is available, in addition to twelve-step programs, as community mutual assistance organizations. Such knowledge is an ethical and professional imperative.

Aug 9, 2021, 13:40 by admin admin

This week’s emphases are dominantly on social interventions: season as an indicator for prevention, the parenting role and punishment, telemedicine (2 times), care for the caregiver (resident duty hours caps). In the article below addressing seasonal onset of drug misuse (Palamar J. et al.), the authors conclude that possibly more effort should be put into prevention methods prior to the onset of summer. This may be so, although it begs the question of whether publicity-centered interventions have value, seasonal or otherwise. From the sidelines, having heard very many AA & NA testimonials regarding the onset of drug or alcohol use, the most frequently-named culprits have been boredom, drug availability, and peer induction.