Posts tagged - Fentanyl

Jails and Prisons Encouraged to Keep Inmates on Pharmaceuticals

Posted on: May 30, 2018, in: , , , ,

Is medication-assisted-treatment a good idea in dealing with opioid addicts in jails and prisons? The use of buprenorphine is said to be more compassionate, because “there’s no need for someone to suffer through withdrawal,” that “inmates can die from dehydration and loss of electrolytes,” and thus substituting buprenorphine for the addict’s usual opioid is the best solution.

April, a former drug abuse and detox worker who does not wish to be named, is blunt in her appraisal: “That’s stupid,” She said. “Alcoholics are more likely to die from withdrawal than opioid addicts. Opioid addicts get diarrhea during withdrawal, so they need water and electrolytes, which can be easily handled by staff. They don’t need pharmacists, trained doctors and buprenorphine, which is just another opioid.”

She said that some addicts go to jail specifically to dry out.

And the articles touting the benefits of medication assisted treatment on inmates are a bit fuzzy regarding outcomes. Will the medication be used to gradually taper off the opioid and then off the buprenorphine, or will the inmate be maintained on the buprenorphine after release, or even for the rest of his or her life?

No Comments

How to Get All Americans on Drugs

Posted on: September 22, 2017, in: , , , , , , , , , , , , , , ,

The problem we psychiatrists and pharmaceutical CEOs face is how to hook more than 323 million people in the United States.  Those 323 million people are living their lives and many don’t realize they should be on drugs. Fortunately, one in six are already taking psychoactive drugs, so the problem might not be so tough after all. That leaves some 270 million more to go. And a year ago, ABC News reported that: 21.5 million people aged 12 and older had a substance use disorder in 2014.

OK, so that leaves about 248 million total that aren’t on regular psychoactive drugs. About 40,000 people died last year of opioid overdoses, so that helps trim the odds, but it’s a slow process, and about 4 million babies were born in the same period, and even though from .06 percent to .34 percent of them were born addicted to opioids, they keep arriving and most are born clean. Luckily, kids – especially boys – don’t like to sit still and thus they drive teachers crazy, so we put at least 10 percent of the teachers on antidepressants and about 11 percent of children aged 4-17 are on ADHD drugs. As they get older, well, you know how teenagers love drugs!

By the time they get to be teenagers, 15 percent have all the indicators of lifetime alcohol abusers, and 16 percent are confirmed drug abusers. But even though drugs are easy for them to access — 81 percent have the opportunity to use illicit substances, unfortunately only about 42.5 percent actually tried them. So we’ve got to do better at getting them to try drugs, and then lace them with opioids or Fentanyl to make those kids permanent users.

Once we’ve got those low-hanging fruit, though, the tough part starts, and we need a plan, as there’s a lot of people still resisting psychoactive drugs and cutting into our profits and our control. Medical offices are doing their part, asking patients if they have pain and prescribing heavy opioids for it. But “the opioid crisis” as the whiners call it, is giving opioids a bad name. Luckily we’ve got “direct to consumer” ads for prescription drugs so that bumped our sales up 30 percent or more, but we’ve got a lot more to do. So the next step is a bit of a detour, but stay with me, it will all make sense in a moment.

The first step is to legalize street drugs, starting with marijuana. About 20 states have legalized it for medical use which is pretty easy to establish for most people. “Ow! My back hurts,” is about all it takes. Eight states have legalized marijuana for recreational use, and there’s not much push-back on it, surprisingly. Luckily, parents and grandparents from the 1960s – who smoked weed with 1-3 percent THC – don’t realize that the THC in these new varieties can be as high as 37 percent. And very bright marijuana dispensaries are putting THC in gummy bears, cookies, candy and berry smoothies, to draw in the younger crowd.

The next step is to legalize heroin, methamphetamine, etc. Now if you don’t think that’s possible, hold on to your hat. Oregon has already decriminalized possession of small amounts,  and a California ballot measure would legalize psychedelic mushrooms, and that’s just the beginning.

So with marijuana legalized, opioids all over the place, the next step is something called “Harm Reduction.” This is where we really scoop up the undrugged. Here’s how it sounds, goes something like this: “The war on drugs is lost, you can’t keep people off drugs, the kids are going to experiment, so we might as well legalize everything, and make it safe to use. Give the kids clean needles, drugs that aren’t laced with other stuff, give them a safe place to use. Kids are going to experiment, so let’s make it safe for them to do so. Keep government out of things we do to our own bodies, follow the libertarian ideal, use drugs if you want. Stuff like meth that makes you crazy, well just be careful, you know.”

So here’s our opportunity. Drugs are going to hook millions of people. Couple shots of meth and bang! We have a psycho who needs lifelong maintenance care. Kids on opioids just trippin’ away, everybody smoking powerful weed. We’re already discovering – surprise surprise – that marijuana use causes psychosis, which should bring in lots of visits to psychiatry, during which they can prescribe “Medication Assisted Treatment” or MAT. So what you do with MAT is switch the user from an opioid or meth or weed to methadone, buprenorphine or naltrexone. Those are legal drugs that we manufacture, and with the Affordable Care Act’s parity between physical and mental health, it’s all paid for by the taxpayers. And by the way, methadone is super addictive as well, and the psychiatrists have deemed drug dependence an illness that is lifelong,  so we have a lifetime income for every customer we treat.

But now comes the beautiful part. Our pharmaceutical companies can now produce ecstasy, heroin, oxycontin, methamphetamine, codeine, all that lovely stuff. We’re all rigged up to produce billions of pills, and make trillions of dollars, and we are all legal, so people trust our products. Then we drop the prices to squeeze out all the other competitors, then we own the drug business, and almost all of those 323 million people are our customers, paying us trillions of dollars.

But wait, there’s more! With all those overdoses, we also have a drug for that! Evzio, for example, will save those dying of overdoses, and costs $4,500/dose. With everyone on opioids, every first responder, cop, teacher, parent, doctor, nurse, bartender, drill sargeant, minister is going to need one! Bonanza!

Right now, in 2017, BigPharma — I think we’re justified in calling ourselves that, don’t you? — BigPharma is making more than $1 trillion a year in revenue on drugs, with a 21 percent profit margin, and some 7,000 new drugs in development. Oh sure, we have our detractors, the Scientologists, drug abuse organizations, parents, law enforcement, but we alone practically support the media networks with direct to consumer drug ads, we support state and local governments with taxes on drug sales, and in a few years we will run this country. We’ve been spreading lies about Scientology since 1950, but more needs to be done.

Pablo Escobar controlled the government of Colombia with cocaine drug money, but he’s small potatoes compared to what we will do to Planet Earth! Viva Farmaceutico! Viva Psiquiatria! Viva Mucho Dinero!

No Comments

Colonoscopy: What’s Wrong With Versed?

Posted on: March 19, 2016, in: , , , , , ,

For me, Versed crossed the line. Colonoscopy is a kind of plumbing inspection with perhaps some minor repairs along the way. But blanking out memory is not plumbing or repair, it is messing with the patient’s mental faculties. I’m old enough that a drug to induce amnesia is about the last thing I’d want.

I recently had my first colonoscopy. I don’t usually write about personal stuff, but my wife died of colon cancer a year ago and I’ve become an advocate of colonoscopy simply because if she’d had one a few years earlier, she might still be with us.

A colonoscopy is pretty basic. The process starts with a consultation or a presentation about colonoscopy, how it works and what to expect. You fast for a day before the procedure, and take a laxative that cleans out the intestines. You may have to stop taking certain medications and there are other cautions you will receive from your doctor.

Polyp

A colon polyp which is removed during a colonoscopy.

During the procedure, the doctor inflates your intestines with air and runs a camera inside to look for abnormal growths such as polyps. Anything suspicious, is burned off or biopsied to see if it is dangerous. A few hours later you go home, eat a meal and get on with things. I had a $250 copay but if it is done as preventive care, many insurance companies require no copay.

In my consultation I discovered that I would receive three drugs during the procedure: Fentanyl, Versed and Propofol.

I’d heard of Propofol before, as Michael Jackson used this drug to sleep and an overdose might be what killed him.

Fentanyl, according to the National Institute on Drug Abuse is: “a powerful synthetic opiate analgesic similar to but more potent than morphine. It is typically used to treat patients with severe pain, or to manage pain after surgery.” So that was a bit alarming. So far two heavy drugs for what was promoted as a minor outpatient procedure.

And finally, Versed, which – according to the materials my doctor gave me – blocks unpleasant memories and produces a type of amnesia.

I can understand painkillers if the procedure is going to be painful. Nobody wants to undergo surgery or dental work without anesthesia. But for me, Versed crossed the line. Colonoscopy is a kind of plumbing inspection with perhaps some minor repairs along the way. But blanking out memory is not plumbing or repair, it is messing with the patient’s mental faculties. I’m old enough that a drug to induce amnesia is about the last thing I’d want.

So there was no way in hell was I going to allow Versed, and I made sure the doctor, nurse and anesthesiologist knew that and would not administer it. They were quite amenable to what I asked.

I do remember parts of the procedure and do remember some cramp-type pains. The doctor cut off four polyps, but the pains were tolerable.

So as a result of my experience I would suggest: Get screened, especially if you are older than 50. The American Cancer Society  has an information page on various options. And when you talk to your doctor, make sure to discuss what will be done and what drugs will be used. Don’t put it off, as stage IV colon cancer can kill you. But get educated, ask questions and weigh your options.

1 Comment