Substance Abuse

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97 million Americans with chronic pain and I got a 57 year old screamer in a wheelchair. Back pain, leg pain, pain in places she was not sure of. No, psychiatrists are not supposed to give out morphine.  Yes, I know I have a prescription pad.  But I keep it close to my heart, locked in my file cabinet, or in my purse, because I actually enjoy practicing medicine and do not enjoy the vision of my license certificate on wings on its way out the window. Even if I could have done it fearlessly, I would not have increased her pain medicine.  The more you give, the more they hurt, the more they need.  This is written in a lot of places but you only have to look at the patients who have been created into addicts, and there are plenty of them.

Alternative recommended approach nobody will listen to: A Bryn Mawr college student, apparently not loaded down with clinical cynicism or even clinical experience, came up with this one.

The way it is said is brilliant.  We all act as if we had a pool of attention, and the more of it we place on something that is not pain, the less pain we feel. Experiments cited go from virtual reality to guided imagery to music. Read more on Down With Pain…

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I thought this person should be fired from the county clinic, but most counties don’t let me do that sort of thing.  The state of California has a nice service, where I ask to see who else is prescribing this person the same abusable drugs that I am.  I try to work with people who abuse drugs, I really do.  In one sense, it is the purest of pharmacologies, in that things I usually think are parts of a physician-patient encounter, like conversation and logic, play little or no role. House said that patients lie.  House is a Vicodin (opiate) addict.  Some of my more intelligent substance abusers are House fans. The same way that “Cops” was the most watched TV show in prison, when I was a jailhouse doc.

This person, was getting weaned off amphetamines.  After a lot of  years, I am not very sure I believe in ADHD, or “Attention deficit disorder.”  We all have problems of differential maturity.  These are just people who learn to concentrate later.  They may have other skills like class clowning that are way ahead.  My book learning was ahead of my social skills for a lot of my life. Besides, most anybody brightens up when you give them amphetamines.  Not that the effect lasts very long, mind you.  Even kids who take Ritalin in a quest to do better on the Scholastic Aptitude Test seem to revert pretty quickly to their previous state of dullness. Read more on Getting Amphetamines In Other Places…

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She was 29 years old and so obese that she had to walk through the door to my office sideways.  She had put on most of the weight, she said, after she had
been date-raped.

She did not remember much about what happened.  She knew the guy who had been with her, and avoided him as best she could, although she still had thoughts of him, that intruded into either her nighttime dreams or her daytime thoughts.  And she had the characteristic “hyper-arousal.”  I have learned, the hard way, never to think of slamming the door or clapping my hands to test this one.  I only did that once or twice and always regretted it.  I just asked her if a sudden noise made her jump in the air, ever, and she nodded.  “How did you know?”  she asked. Read more on Roofies, Ruffies, or Mexican Valium: It Doesn’t Say “I Love You.”…

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He looked more like the romantic hero from the era of Lord Byron than a psychiatric patient – he wore his hair longer than today’s style and he obviously pumped iron.  Indeed, I found out that working out was an important part of his life.

He was 28, and he had just been released from a two day stay at hospital and his medication was standard fare — Zoloft (sertraline) antidepressant.

I had no clue why he had to be seen by me on an emergency basis. It turned out he had been admitted to the hospital because he was uncomfortable about his roommate’s anger.  He had been concerned he might get “attacked.” I had no way of telling whether the roommate had an actual history of this sort of behavior or if this was delusional.  But the roommate was not the patient before me. “Just give me klonopin,” Lord Byron said. “Everybody else does.” Read more on Fixing The Problem Is Much Better Than Taking Addictive Drugs…

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My husband and I were staying in one of these extended-stay hotels in a medium-large California town while I spent a few weeks getting the local clinic straightened out.

A large group had pretty much taken over the hotel for a wedding ceremony in the garden on Saturday.  So Friday and Saturday nights there were some pretty wild looking revelers whom my dear husband had to dodge on the way to the ice machine.

A group on the second balcony; another one by the pool — laughing loudly, behaving erratically. Every age group represented, but it seemed they were all getting along together happily. Read more on The Wild Wedding Weekend…

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He was 50 and he told me right up front, “I need more of the medications the other doctors give me.  You can just renew them for me; that is why I am here.”

International Symbol for No ExcusesThat’s probably the second most common thing a patient says to me.  The most common is, “Why didn’t my other doctors tell me that?” No, I don’t just renew prescriptions, I explained to him.  I told him that I need to get to know my patients, so that I can make sure that I give them the correct medications.

“I don’t want you to do that,” he said to me.  “All the other doctors just give me renewals.” I told him I didn’t much care, that was not how I worked, and if he wanted renewals he would have to tell me how he was doing. Read more on Self-Medicating On Pot And Booze As A Life Plan…

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Tinkerbell has come a long way from the light reflected with a mirror in the original J.M. Barrie play of Peter Pan, back in 1904 — l argely through being part of the Disney stable of ideals for young girls. I remember, even though I have always been a lover of personal expression through the visual arts, being asked, as early as the second or third grade, to draw a princess. 

Huh?  Read more on Paris Hilton, Tinkerbell and Girl Bratz as a Role Model…

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I guess the death of Anna Nicole Smith has become old news.  All I found in the daily newspaper was a short item saying that the trial was going on in Los Angeles.

After more than one internet search, the only mention I found of what is going on online is this one, in what seems to be a Seattle tabloid.

I strongly suspect that this is a road that has been travelled more than I know.  After all, I am not exactly a celebrity watcher. Nevertheless, from what we already know about folks like Michael Jackson, and from what Dr. Nathalie Maullin seems to have said under oath, I think we have a pretty good idea of what it is like to be a drug-seeking celebrity.

First, I think it worth noting that Dr. Maullin was on staff at Cedars-Sinai at the time. Now putting aside the PR of the latter (it is allegedly the best in L.A.; they have ads and some top notch publicity firm–) Cedars Sinai is a hospital.  I can testify that to be on staff at any clinic or hospital, they do a background check. Read more on Anna Nicole’s Doctors Couldn’t Have Made Worse Decisions If They Tried…

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I have a fable that is obviously too late for Aesop’s collection of same.  It is unlikely to make its way into any later anthology. I might as well tell you about a tiny town whose sole virtue that it was on an interstate road that took a lot of people from various parts of California into Las Vegas, that famous refuge for people who are too sober and trying to get rid of excess money, sometimes while getting either married or divorced. Actually Littletown (we will call it that to avoid embarrassment to all two or three law abiding citizens). Had just one more virtue. Their county hired me as a consultant.  I did last in that job for a while, even though it covered three different small clinics, each of which needed me just a day or two a week. Since every morning when I woke up, I had to have my husband remind me not only what day of the week it was, but what city and clinic I was supposed to be at. The clinic buildings looked different from one another on the outside, a fact which didn’t help me very much because I ended up working on the inside and usually ate lunch at my desk. The patients in all three clinics were different from those that I had seen prior to that time in my career, for I had not done more than sporadic work with addicts, and there were a fair amount of people on crystal meth.  I practiced “from the book” and did the best I could (I always do) and helped some people somewhat, to get treatment and put their lives together.  But it was in Littletown, where the stores on Main Street were empty and the only local culture was the yogurt shelf at the (chain) supermarket, that I really learned about crystal meth for the first time. Read more on Once Upon A Time There Was An Explosion…

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It has been over ten years since my husband and I visited this often-quiet community in Nevada.  Gambling, resorts, a legal whorehouse not far out of town, pawn shops, bars; standard Nevada. Only the faintest echoes of the silver boom, people grasping for the romance, the all-night party feeling.  We are not big gamblers, but we did some shows, and the party feeling was good for a weekend.

That was ten years ago.  Now, there are a bunch of people looking for free beer, not caring about its quality.  People talking about getting “wasted” and nobody, but nobody, talking about having “fun” doing it. There is a pall over the gambling halls.  People are counting their pennies on 99cent specials.  There are certainly no echoes whatsoever of the silver boom, and no evidence of romance, and only two or three people sitting in a room full of slot machines.

Some of what I do is very analytical.  I actually figure out how many mg. of medication or supplement someone needs as a function of their weight.  I think of the chemical reactions in their body that are either not working at all, or are working overtime. Some of what I do–sometimes I am surprised to know just how much and how effective it is–is feeling; is intuitive.  Whether we are where the rich people go or where the poor people go, I feel fear.  I am sure that this fear comes from feeling that the economy is “bad.” Read more on Don’t Get Wasted — Get Busy!…

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