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.

Aug 9, 2021, 13:40 by admin admin

Our medical school introduced 77 new students this week, culminating in a White Coat Ceremony. This may not be fully familiar to readers, but it’s nothing more than a robing-ceremony. Students are provided and cloaked with a short clinical coat, given a stethoscope and a book of Oslerian aphorisms, and congratulated on making it through the gauntlet. All this takes place before their parents, friends, sometimes spouses or intended spouses, possibly some bank loan officers, and not uncommonly the mentors who induced them to stay the course. It concludes in the assembly reciting the Oath of Hippocrates, mindful of the fact that they are not doctors, yet; but that the tenets of the Oath still apply as students.

Aug 9, 2021, 13:40 by admin admin

My editorial this week was superseded over the course of the weekend. It became clear that consultation was needed, and in a profession that is founded on the consultative process, that is no light matter. So I put it to bed. Therapeutic coma, if you will. That left me with a brain full of dendritic tangles, from which I despaired of summoning any inspiration; and this caused me to pick up a book. I have an original copy of Benjamin Rush’s “Medical Inquiries and Observations upon the Diseases of the Mind,” published in 1812. To read it is to wonder at times if Dr. Rush was not being facetious in addressing certain topics.

Aug 9, 2021, 13:40 by admin admin

Please look to the last link and edit, a question of crime vs. misconduct in the California penal system. The issue tried relates to possession of cannabis in a controlled or special setting. In this instance, the inmates who were originally convicted may be seen as having committed a type of status offense, similar to when a minor consumes alcohol or violates curfew. This judgment must have been exasperating to both sides of the aisle, prosecution and defense, and entertaining to the gallery.

Aug 9, 2021, 13:40 by admin admin

A link to a BuzzFeed piece on addiction memes is included below, in which the work of Timothy Kavanagh is reviewed by journalist Derek Garner. The memes do not require editorial interpretation by me, but because of the potentially inflammatory nature of the material, it seemed wisest for me to take advantage of this editorial spot occurring at the top of the Weekly’s front page.

Aug 9, 2021, 13:40 by admin admin

Apart from the discussion of the Pennsylvania Society of Addiction Medicine's efforts to improve access to buprenorphine, legislatively, the topics this week focus on the needs of women, the newborn, and adolescents.

Aug 9, 2021, 13:40 by admin admin

The claim associated with the linked article in Journal of Neuroinflammation warrants special attention this week. A novel opioid under investigation is described as being less subject to specific adverse properties associated with morphine, notably aggravation of acute pain over the long term and initiation of a chronic nociceptive state. The principle underlying this transition to chronicity is postulated as inflammatory, a contention that has been increasingly supported.

Aug 9, 2021, 13:40 by admin admin

In last week’s ASAM Weekly (04 June 2019), Dr. Raymond Anton and co-authors replied to a guest editorial by Dr. Stuart Gitlow, in reference to a Clinical Psychiatry News 21 February report from the December 2018 meeting of the American Academy of Addiction Psychiatry (AAAP). As is customary in an exchange of letters, Dr. Gitlow’s response is provided below, in conclusion:

Aug 9, 2021, 13:40 by admin admin

(Dr. Stuart Gitlow’s guest editorial, titled “End-point in AUD Treatment” and posted 26 February 2019, followed comments reported from Dr. Raymond Anton and colleagues in the December 2018 AAAP meeting, in Clinical Psychiatry News dated 21 February.) Response to Dr. Gitlow regarding use of the WHO risk drinking reduction to guide medication-based treatments. In a recent guest editorial, Dr. Stuart Gitlow expresses some concerns about a proposed new AUD clinical trial efficacy outcome measure based upon reductions in World Health Organization (WHO) risk drinking levels. The editorial suggests more broadly that “reductions in alcohol use” are not an adequate measure of recovery from AUD, as they may reflect only a reduction in symptoms (that is alcohol related pathology).

Aug 9, 2021, 13:40 by admin admin

For the years that I have been with the Weekly, I have been grateful to the ASAM staff leadership for observing Memorial Day. It is one day that I’ve always taken more seriously than those associated explicitly with other historical events. Mention of it here has particular significance, given the long association of alcohol use with military service.

Aug 9, 2021, 13:40 by admin admin

Even for this periodical, the variety of topics included today is unusual. The We Rise project in the Los Angeles, alcohol use in pregnancy, the impact of psychostimulants on opioid use and mortality rates, alcoholism and emotional responsiveness, major national policy initiatives, and the adverse effects of early discontinuation of opioids in those on long-term management are among these. A week seldom goes by without this periodical including a piece that reflects the concerns of physicians about governmental restrictions placed on either opioid analgesia or pharmacologic management of opioid addiction; so noting that frequency leads to the following overview.

Aug 9, 2021, 13:40 by admin admin

Sessi Kuwabara Blanchard, in last week’s issue of Filter, an online journal emphasizing public policy in the realm of drug use and addiction, describes Congressional initiatives relating to buprenorphine prescribing limits. Before opening the link, please know that while Filter has several intelligently written and apparently well-researched articles displayed, it is of uncertain provenance: no editorial or financial support information, no editorial objectives, no history.

Aug 9, 2021, 13:40 by admin admin

All around us during this last month of spring are the phenomena of emergence: graduations, convocations, celebrations. Students complete some phase of their education and are reminded by high-minded pedants that they are just about to enter another phase of it.

Aug 9, 2021, 13:40 by admin admin

Decades ago, as an older resident in a second career, I met with a 17-year-old Chinese-Hawaiian-Filipino male in the emergency room of a large acute-care hospital. He will be “Kyle”. He was agitated and acknowledged intense anxiety. The basis for his evaluation was his inability to communicate coherently, plus his acknowledgment that he was experiencing auditory hallucinations.