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.

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: