In this life, everything should be as simple as it is, but not simpler. That includes this questionnaire study about marijuana as an “exit” drug for substance abuse. This article hit a nerve because there are issues here I have come up against before. And I mean “against.” I don’t mean to say it isn’t “good science;” it is. I’m talking about the emotional resistance to the idea that detoxifying from a medication can be comfortable, painless, and effective. I see this coming like I see the sun rising in the morning, because I have been to this place. A few years ago, I found myself in an informal banquet room across the parking lot from a hotel type establishment in a touristy part of San Diego. There was a woman rep from the drug company, Hythiam. She wasn’t an ex beauty queen like most reps, but a fairly credentialed therapist who actually knew what she was talking about. My husband was there with me; a younger, chubbier, and more naïve me – therefore, less authoritative.
These Hythiem/Prometa folks had a great schedule of IVs that removed physiological cravings for various substances of abuse, including methamphetamine. Basically, they use safe and older type drugs intravenously for a lovely pharmacological intervention. The cravings stop, and the person does not “need” to use the drug. Neither they nor I was stupid and naive enough to think that was all you had to do. Aftercare was important and I was ready to jump in. They recommended vitamins — I recommended lots of vitamins, high dose, and chelated to cross the blood-brain barrier. But these addicted folks needed “prosthetic lives.” When all you can muster goes to satisfying a craving or a need, there are not many hours left in the day for work or relationships. I helped with this, too. Some people had problems, but they were mostly because of the psychosocial void left when they did not go for drugs, and their inability to fill it. I worked my damnedest with these folks; and like the company, was eager to be accepted into the addiction community. There was this reception, and they had invited people from every substance abuse program in town. I was there and ready to go to bat as the only physician who had experience with these folks locally. Two people showed up. One was an older, fatherly type. The other was a young sidekick who was presumably learning from him. This older guy said something that rings in my ears now. “You got to earn your sobriety.” Read more on Time to Stop Judging and Start Healing…
Filed under medicine, News, Substance Abuse by on Jan 4th, 2013. Comment. 
The first time I heard about using empty whipped cream dispensers to get “high” was a long time ago. I was living at my parents’ house after I had finished medical school in France. I had done my thesis as quickly as possible, in the fall. My residency was projected to start July first. I promised my parents I would do what I could to earn my keep. I sold kitchen cabinet fronts over the telephone, got involved in a chorus production of “Pirates of Penzance,” and substitute taught for awhile.
As a substitute teacher in suburban Boston I was taught everything from senior hygiene to 9th grade algebra. A principal saw me teach 9th grade algebra and told me the heck with the credentials — the way I put across factoring quadratics was good enough for him to take me on permanently. I was leading the class in yelling, singing, and dancing “everybody factor.” And they were.
I told him I was going Cincinnati to start a surgical residency. He stared at me in disbelief. I told him I had more important news for him. Read more on Teens and Inhalant Addiction and — K2 Spice?…
Filed under Addictions, Education, Family, News, Substance Abuse by on Aug 30th, 2012. Comment.
Whitney Houston’s death might be “old news” already, but I still think her death may not have been in vain.
Because Whitney was a star, we were treated to hearsay before facts. She drank in the morning, in a public place, and according to some observers may have been behaving a bit strangely.
There is an old screener for alcoholism called the “CAGE” questionnaire. It’s named after the four questions that presumably even a primary care physician — who has little room left in an overtaxed memory — could remember. Read more on Whitney Houston’s Death May Not Have Been in Vain…
Filed under abuse, Addictions, Celebrities, Disease, prescription drugs, Substance Abuse by on Aug 23rd, 2012. Comment.
Hello health care system. This is weird, to put it mildly.
As far as anyone seems to be able to figure out what happened, this 38 year old nurse killed five dialysis patients and “assaulted” five others by putting sodium hypochlorite – bleach — in their dialysis tubing.
She had some problems with domestic violence and public intoxication and such. But according to the relevant statements, that was all resolved before she did this.
Jurors have convicted her of capital murder, but she is not going to get the death penalty. Mostly, this is because she is deemed to be of no further danger if she’s kept out of health care. Her daughter seems to be taking it hard. This is an indication for counseling, but not a change in Mommy’s sentence. Read more on When Nurses Kill…
Filed under medicine, Public Health System, Substance Abuse, Violence by on Jul 25th, 2012. Comment.
“Old Marley was as dead as a doornail.”
– A Christmas Carol (1843)
Thank you, Charles Dickens, for creating such a wonderful, enduring story, and such an apt simile. If you hadn’t heard it before, that’s probably because it is usually omitted from the children’s versions of the oft-told (and filmed and broadcast) tale. With everyone from Michael Caine to (my favorite) Mr. Magoo starring as the wickedest man who ever snorted “Bah Humbug!” and was converted to the most ardent celebrant of Christmas by the end of the story.
A wonderful, happy story — and it deserves to live forever. But death is not terribly suitable material with which to start a children’s story.
Young women (and men) — some no older than children and many who could be termed “recent children” — were ardent fans of singer Amy Winehouse — who is now “dead as a doornail.” Read more on Amy Winehouse Proved Drugs Aren’t Glamorous…
Filed under abuse, Addictions, End Of Life, Substance Abuse by on Aug 18th, 2011. Comment.
A Minneapolis nurse was accused of stealing pain medicine from a patient. She had a fentanyl habit to feed, and didn’t seem to mind that it left her patient in substantial pain. Unfortunately for her, the patient was a Dakota County Sheriff’s Deputy.
Some women just make bad choices.
The reason I bring this up is not to wonder about if this woman is guilty or not. I can tell you that I share one opinion with the judge — that people who ask for a lot of continuances may be getting everyone angry. Read more on Addiction And Nurses…
Filed under Addictions, News, prescription drugs, Substance Abuse by on May 10th, 2011. Comment.
It took me a while at first to realize that everyplace I saw a green cross, it was going to be a medical marijuana facility. After all, the green cross is some kind of an international symbol for a “druggist,” for someone who sells prescription drugs (primarily) as prescribed. In France, as well as in Canada, I remember following such signs to get a prescription filled.
This one substance, this marijuana, is unique in a couple of ways. First, it is the only prescription drug that has never been required to be tested for safety or efficacy. Second – there is no government oversight as to quality or purity.
Marijuana seems to be something that people want first, then figure out a reason for later. The results are not exactly what I consider beneficial. Read more on Medical Marijuana Can Become Big Business…
Filed under Substance Abuse by on Apr 4th, 2011. Comment.
Here are some phrases that you might not expect to hear sweet, friendly Dr. G use very often:
“No, there is no way in hell I am going to renew that prescription as written.”
“Read my lips. No more oxycodone. We gotta get you into a rehab, sweetie.”
“Sure, you can see another doctor. I don’t know how long it will take to get an appointment. If I am your doctor, you go on a tapering schedule. Today.”
“If I did what you want, I could kiss my license goodbye. I am not prescribing outside my specialty and certainly not this crap. Yes it is crap. I am sorry you don’t like how I talk, but it is crap. I can start getting you off it.”
These are all things I have actually said. Usually loud, yelling over the patient. Read more on Pill Mills Are Death Traps — Marginally Legal…
Filed under Addictions, prescription drugs by on Mar 28th, 2011. Comment.
Recent research by the Centers for Disease Control and Prevention’s National Center for Health Statistics has confirmed a longstanding trend — namely that whites live longer than blacks pretty much consistently, and have for a long time. People have attributed this to the increased difficulty of containing blood pressure in black people — probably a genetic difficulty– which leads to increased rates of both stroke and of heart disease. Both have long been established as being deadly. Plenty of well meaning people have at least tried to deal with this. One of the well-meaning people is me. Many times I have seen people of color for other reasons, checked their blood pressure, been concerned, and referred them to appropriate blood pressure followup by general medical personnel. Of course, I have no way of knowing how many (if any) went where I told them, but I tried.
I mean, I would tell them, “If there is something extra that can be done to make sure you are around for a few more years, to see the grandchildren grow a bit or whatever is precious, then it should be done.” I usually have no problem getting the person to agree, at least in my presence. Menthol cigarettes are a different kind of issue, and therefore a little tougher to be unequivocal about. Read more on Ban Menthols? Our Government To The Rescue!…
Filed under Addictions, Diagnosis, Disease, Government by on Mar 21st, 2011. Comment.
Ahh – 19 years old! It is a magical age. At least it has been my experience in public mental health clinics.
You see, almost without exception any male of 19 years who appears in my office – is a really messed up and sometimes just, plain rotten fellow.
I don’t know what it is about 19.
One of the typical cases – though legally an adult — was functionally a kid, living with his parents and acting out the same kind of adolescent rebellion that most go through at 14 or 15 and out-grow by 17.
Oh, he had it all — One of those cylinders in his earlobe, spreading a hole from a small piercing to the size of a basketball. He told me it was “tribal.” He was a music major at a local, broken down branch of the state college. He wanted to be a performance artist.
Read more on Yes, Virginia — Coffee Can Cause Illness…
Filed under Substance Abuse by on Mar 7th, 2011. Comment.