Maia Szalavitz
Posted December 11, 2008 12:46 PM (EST)
The Huffington Post
Our coverage of the possible nomination of Rep. Jim Ramstad as "drug czar" has kicked up quite a fuss, spurring many comments here and a sign-on letter by addiction professionals that was cited by John Tierney in this week's New York Times. Nearly 300 leaders in the addiction treatment field so far have added their signatures. Now, the Minnesota Independent is reporting that Ramstad's real ambition is to serve as the head of the Substance Abuse and Mental Health Services Administration (SAMHSA).
While that sounds better than having him in charge of drug policy overall as "drug czar," in fact, it is a position in which he could possibly do more damage by replacing evidence-based treatment with ideology "behind the scenes."
Let's look once at his record. With politicians, I find that support for needle exchange tends to be a good proxy for whether you "follow the data" or follow the political winds of ideology. As we know, Ramstad went with ideology -- and even when he had a recent chance to revise his position to allow Washington, DC to use its own money for such programs, he remained firmly stuck in the past and voted to try to block that.
Then, there's methadone and other maintenance treatments. Against the weight of an Institute of Medicine study -- the Institute of Medicine is the agency charged by Congress with resolving medical controversies with data -- he opposed maintenance so much that he didn't want to give insurance parity for coverage.
In other words, while parity would have advanced all other addiction treatments, if his early parity bills had passed, the best-supported treatment for heroin addiction would have become harder to get.
Is someone who opposes what the science says is the best treatment for heroin addiction really someone we want in charge of the agency which is supposed to help disseminate evidence-based care?
And, of course, there's his earmark and other support for Teen Challenge. This is a "treatment provider" which claims that addiction is a sin, not a disease -- and the only help it offers for addicts is conversion to a particular form of Christianity. No medication, no evidence-based therapies, no credentialed counselors -- it doesn't even advise participation in 12-step programs, which is the one treatment modality we know Ramstad favors!
Ramstad sponsored a bill to change the name of the National Institute on Drug Abuse to the National Institute on Diseases of Addiction. As I wrote yesterday, either he really doesn't believe addiction is a disease -- in which case, he's a hypocrite and not someone we want running a treatment agency or he doesn't vet programs that he supports, in which case he's also not a good choice to head an agency that funds various kinds of treatment and initiatives [pdf] for promoting the best care.
The head of SAMSHA should be someone who promotes evidence-based treatment -- not someone who only supports the science when it bolsters his personal beliefs.
[And, so that I don't have to write this piece ever again, Ramstad should not be considered as head of the National Institute on Drug Abuse -- the agency in charge of research on addictions at NIH, no matter what name it turns out to be given -- either!]
Thursday, December 11, 2008
Critics Attack Ramstad as Possible Drug Czar Candidate
Join Together.org
December 10, 2008
Former Rep. Jim Ramstad (R-Minn.) might not even be in the running for the job of Barack Obama's drug czar, but that hasn't stopped critics from saying he would be a poor choice because of his past opposition to needle-exchange programs and medical marijuana.
Ramstad's name has been floated as a possible pick for director of the Office of National Drug Control Policy (ONDCP) in the Obama administration, although some sources say he is more likely to be tapped as head of the Substance Abuse and Mental Health Services Administration (SAMHSA).
Letter-writing campaigns by the Drug Policy Alliance (DPA), a group of addiction-treatment professionals led by the past president of the addictions division at the New York State Psychological Association, and the National Black Police Association (NBPA) urge the president-elect not to make Ramstad the nominal chief of the national war on drugs.
"While we applaud Representative Ramstad for his courageous and steady support for expanding drug treatment access and improving addiction awareness, and honor his own personal and very public triumph over addiction, we have strong reservations about his candidacy for the drug czar position," according to the letter sent to Obama and signed by DPF and NBPA as well as a variety of AIDS prevention groups and others. "In his twenty-eight years in the U.S. House, Representative Ramstad has consistently opposed policies that seek to reduce drug-related harm and create common ground on polarizing issues."
Writing in the Huffington Post, Maia Szalavitz also criticized Ramstad for once earmarking $235,000 for the Minnesota chapter of the controversial Teen Challenge program.
Obama's transition team has not made any public announcements about filling the position of ONDCP director.
December 10, 2008
Former Rep. Jim Ramstad (R-Minn.) might not even be in the running for the job of Barack Obama's drug czar, but that hasn't stopped critics from saying he would be a poor choice because of his past opposition to needle-exchange programs and medical marijuana.
Ramstad's name has been floated as a possible pick for director of the Office of National Drug Control Policy (ONDCP) in the Obama administration, although some sources say he is more likely to be tapped as head of the Substance Abuse and Mental Health Services Administration (SAMHSA).
Letter-writing campaigns by the Drug Policy Alliance (DPA), a group of addiction-treatment professionals led by the past president of the addictions division at the New York State Psychological Association, and the National Black Police Association (NBPA) urge the president-elect not to make Ramstad the nominal chief of the national war on drugs.
"While we applaud Representative Ramstad for his courageous and steady support for expanding drug treatment access and improving addiction awareness, and honor his own personal and very public triumph over addiction, we have strong reservations about his candidacy for the drug czar position," according to the letter sent to Obama and signed by DPF and NBPA as well as a variety of AIDS prevention groups and others. "In his twenty-eight years in the U.S. House, Representative Ramstad has consistently opposed policies that seek to reduce drug-related harm and create common ground on polarizing issues."
Writing in the Huffington Post, Maia Szalavitz also criticized Ramstad for once earmarking $235,000 for the Minnesota chapter of the controversial Teen Challenge program.
Obama's transition team has not made any public announcements about filling the position of ONDCP director.
Monday, December 8, 2008
Drug Czar Controversy - Tierney Lab @ NY Times mentions Andrew Tatarsky's sign-on letter
December 8, 2008, 12:23 pm
By John Tierney
NY Times
Some researchers in substance-abuse treatment and advocates for the medical use of marijuana marijuana are alarmed at reports that Representative Jim Ramstad, a Republican from Minnesota, is a candidate to become the next drug czar — the director of the office of National Drug Control Policy. In a joint letter to President-elect Barack Obama, coordinated by Andrew Tatarsky, the past president of the division of addictions of the New York State Psychological Association, dozens of academics and other professionals in substance-abuse treatment write:
Similar concerns have been raised in another joint letter, coordinated by the Drug Policy Alliance endorsed by more than three dozen other public-health, criminal-justice and drug-treatment organizations. They write to Mr. Obama:
The costs of the war on drugs are summed up by Ethan Nadelmann, the executive director of the Drug Policy Alliance, in a Wall Street Journal op-ed article celebrating the 75th anniversary of the repeal of Prohibition. After noting that that the repeal was popular not just among drinkers but also non-drinkers worried about the rise in organized crime and other consequences of Prohibition, Mr. Nadelmann writes:
The joint letter to Mr. Obama organized by Dr. Tatarsky suggests a different approach: “We need a new bottom line for U.S. drug policy so that treatment is more available and addiction is treated like a health issue, not a criminal issue. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general, not a military general or police officer.”
What do you think of Mr. Ramstad as drug czar? Do you have any other nominees for the job? Or other advice for Mr. Obama on drug policy?
By John Tierney
NY Times
Some researchers in substance-abuse treatment and advocates for the medical use of marijuana marijuana are alarmed at reports that Representative Jim Ramstad, a Republican from Minnesota, is a candidate to become the next drug czar — the director of the office of National Drug Control Policy. In a joint letter to President-elect Barack Obama, coordinated by Andrew Tatarsky, the past president of the division of addictions of the New York State Psychological Association, dozens of academics and other professionals in substance-abuse treatment write:
This country needs a drug czar who supports evidence-based policies and one
who will make decisions based on science, not politics or ideology. We strongly
believe that Congressman Ramstad is not that person.
Rep. Ramstad voted in 1998 in favor of making permanent the federal funding
ban on syringe exchange. In 2000, he voted to prohibit the District of Columbia
from spending its own locally-raised funds on syringe exchange programs, and in
2007, he voted against lifting the same DC ban, despite decades of research
showing that syringe exchange programs reduce the spread of HIV/AIDS, save
lives, save money, and do not increase drug use. Representative Ramstad has also
consistently opposed congressional efforts to stop the arrest of patients with
HIV/AIDS, cancer, and other illnesses who use medical marijuana to ease their
pain and suffering in states where it is legal.
Similar concerns have been raised in another joint letter, coordinated by the Drug Policy Alliance endorsed by more than three dozen other public-health, criminal-justice and drug-treatment organizations. They write to Mr. Obama:
You showed strong leadership on the campaign trail by pledging to lift the federal funding ban on syringe exchange programs, end the excessive federal law enforcement raids aimed at medical marijuana patients, and eliminate the crack/powder cocaine sentencing disparity. . . We urge you to nominate for drug czar someone with a public health background, who is committed to reducing the spread of HIV/AIDS, hepatitis C and other infectious diseases, open to systematic drug policy reform, and able to show strong leadership on the issues you believe in.
The costs of the war on drugs are summed up by Ethan Nadelmann, the executive director of the Drug Policy Alliance, in a Wall Street Journal op-ed article celebrating the 75th anniversary of the repeal of Prohibition. After noting that that the repeal was popular not just among drinkers but also non-drinkers worried about the rise in organized crime and other consequences of Prohibition, Mr. Nadelmann writes:
They saw what most Americans still fail to see today: That a failed drug prohibition can cause greater harm than the drug it was intended to banish.
Consider the consequences of drug prohibition today: 500,000 people incarcerated in U.S. prisons and jails for nonviolent drug-law violations; 1.8 million drug arrests last year; tens of billions of taxpayer dollars expended annually to fund a drug war that 76% of Americans say has failed; millions now marked for life as former drug felons; many thousands dying each year from drug overdoses that have more to do with prohibitionist policies than the drugs themselves, and tens of thousands more needlessly infected with AIDS and Hepatitis C because those same policies undermine and block responsible public-health policies.
And look abroad. At Afghanistan, where a third or more of the national economy is both beneficiary and victim of the failed global drug prohibition regime. At Mexico, which makes Chicago under Al Capone look like a day in the park. And elsewhere in Latin America, where prohibition-related crime, violence and corruption undermine civil authority and public safety, and mindless drug eradication campaigns wreak environmental havoc.
The joint letter to Mr. Obama organized by Dr. Tatarsky suggests a different approach: “We need a new bottom line for U.S. drug policy so that treatment is more available and addiction is treated like a health issue, not a criminal issue. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general, not a military general or police officer.”
What do you think of Mr. Ramstad as drug czar? Do you have any other nominees for the job? Or other advice for Mr. Obama on drug policy?
Saturday, December 6, 2008
Letter to President Elect Obama Regarding the Selection of our Next Drug Czar…From Substance Use and Mental Health Treatment Professionals
Click here to sign-on to the letter at Andrew Tatarsky's website.
Dear President-Elect Obama,
As substance-use and mental-health professionals treating patients with substance use disorders, we are concerned about reports that President-elect Obama is considering Congressman James Ramstad as our next “Drug Czar,” or director of the Office of National Drug Control Policy. This country needs a Drug Czar who supports evidence-based policies and one who will make decisions based on science, not politics or ideology. We strongly believe that Congressman Ramstad is not that person.
While we applaud Representative Ramstad for his courageous and steady support for expanding drug treatment access and improving addiction awareness, and honor his own personal and very public triumph over addiction, we have strong reservations about his candidacy for the Drug Czar position. In his twenty-eight years in the U.S. House, Rep. Ramstad has consistently opposed policies that seek to reduce drug-related harm and create common ground on polarizing issues.
Rep. Ramstad voted in 1998 in favor of making permanent the federal funding ban on syringe exchange. In 2000, he voted to prohibit the District of Columbia from spending its own locally-raised funds on syringe exchange programs, and in 2007, he voted against lifting the same DC ban, despite decades of research showing that syringe exchange programs reduce the spread of HIV/AIDS, save lives, save money, and do not increase drug use. Rep. Ramstad has also consistently opposed congressional efforts to stop the arrest of patients with HIV/AIDS, cancer, and other illnesses who use medical marijuana to ease their pain and suffering in states where it is legal.
Unlike you and Vice-President-Elect Biden, Rep. Ramstad has also failed to cosponsor any legislation eliminating the sentencing disparity between crack cocaine and powder cocaine, despite the fact that there were three different crack/powder reform bills in the 110th Congress. A number of recent studies have found that long prison sentences are one factor driving disproportionate rates of HIV/AIDS infections in communities of color. A primary task of the next Drug Czar should be to deal with this and other issues related to over-incarceration.
We need someone committed to reducing the harms associated with both drugs and punitive drug laws. Someone who supports:
1. Treatment interventions across the spectrum of readiness to change such as: Recovery Readiness, Motivational Interviewing, and other interventions which do not require abstinence for active substance users just beginning to work on their substance use; substitution treatments like methadone and buprenorphine (the most proven effective treatments for opiate-dependent patients); and abstinence-focused in- and out-patient treatments for those working toward abstinence and recovery.
2. Integrated treatment for patients with co-occuring psychiatric, medical, and lifestyle disorders – a group that makes up the majority of patients with serious substance use disorders.
3. Syringe exchange programs to halt the spread of HIV/AIDS and hepatitis C,. This is an intervention that has been proven to dramatically reduce the transmission of infectious disease and reduce drug use in the injecting population without increasing drug use.
We need a new bottom line for U.S. drug policy so that treatment is more available and addiction is treated like a health issue, not a criminal issue. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general not a military general or police officer.
We need a Drug Czar who welcomes and encourages new ideas and research. We need a Drug Czar who is committed to reducing the number of nonviolent offenders behind bars. Our country's next Drug Czar should be fully committed to major sentencing reform. There should also be greater emphasis on educating our judges, prosecutors, and parole and probation officers to the complexities of substance use disorders and the process of change and recovery. When patients in treatment for substance use disorders "slip" it is more the norm than not; as an expected part of the process of change, it should not lead to automatic termination of treatment and incarceration. These decisions need to be made in conjunction with the clinical staff working with these patients who have the expertise to make them.
We need a Drug Czar who understands there are many roads to recovery and recovery can take different paths. We strongly believe that our views are in the best interests of individuals struggling with substance use disorders and all Americans and will be considered in your choice of the next Drug Czar.
Thank you.
Sincerely,
Andrew Tatarsky, PhD
Founding Executive Board Member and Past President, Division on Addictions, New York State Psychological Association
Click to view signatures already on the letter
Thursday, December 4, 2008
APSAD Annual Scientific Conference 2008 - Australasian Professional Society on Alcohol and other Drugs.
November 23 - 26, 2008 Part I (Sunday 23 Nov).
This year's APSAD conference was a fine affair. I must have been to 15 or more of these in most State capitals, Cairns and Canberra. I missed last year’s Fest in Auckland but those who attended said it was excellent. Like national leaders’ meetings with their funny hats, shirts and coats, each APSAD conference is characterised by its own conference attaché bag. This natural-inspired over-the-shoulder model was one of the few I could imagine using in the future.
The venue was splendid, Darling Harbour being just an 8 minutes (downhill) walk from Town Hall station which made me into a commuter again. With medical practice responsibilities I was a part-time conference goer.=C 2 Thus these notes are incomplete and (as usual) opinionated.
The Sunday afternoon pre-conference session had been booked by the only drug company with a major stake in our field. Reckitt-Benckiser is manufacturer of buprenorphine which is the only registered alternative to methadone, the latter being a generic drug with small bread-and-butter profit lines in comparison. The sponsors began with the topics of pharmaceutical abuse and innovations in addiction management, then ending with two presentations on the potential cardiac complications of methadone before a panel discussion to which I had been invited (and generously funded).
Adrian Dunlop spoke eloquently about the past, present and future of addiction treatments.
Dr Eric Strain covered some historical details of non-medical use of pharmaceuticals in the US, giving some results on prevalence and consequences from household surveys over 25 years. Apparently most users obtained their supplies from one doctor; many from friends or relatives with less only ~1% or less from the internet. Australian figures may be quite different as people are entitled to attend more than one doctor on Medicare. Another speaker quipped that if Australia had a Bill of Rights, it would include being able to attend “as many doctors as you like”. Dr Strain touched on the gap between occasional use and dependent use, something some of us may still forget because of the selected referrals we receive. The other major differences between American street heroin users and those abusing pain killers is that the latter are more likely to be employed, white race and non-injectors. Dr Strain was too modest to mention his own research on buprenorphine abuse and perhaps too polite to mention the reported non-medical use of buprenorphine, including a naloxone combination product which became the drug of choice (mostly injected) by more than half those presenting for treatment in Wellington, New Zealand (see Robinson 1993).
Dr Nick Lintzeris gave some pointers about pharmaceutical abuse in Australia. His talk ending with a plea to put methadone treatment, including side effects, into context both globally, as well as for individual patients. In his rather frequent exposure during the conference, he reminded us that there are much more relevant issues for opioid therapy as patients get older such as testosterone levels, calcium leaching, osteoporosis, dental, viral and bowel problems.
Jason White detailed the rather sparse literature on cardiac complications in methadone recipients. He seemed persuaded that the connection between methadone and torsade is significant and that methadone treatment could be restricted or further regulated as a result. As a demonstration of patients on ‘normal’ methadone treatment coming to torsade, he cited Pearson and Woosley’s report of 59 FDA notifications from 1969 to 2002. While not fully documented, from the limited data 12 could have been on ‘standard’ MMT, 8 of whom were over 40 years of age. This leaves just 4 reported ‘standard’ MMT cases in the USA over a 33 year period in the age group we normally start on MMT. Justo’s more recent literature review found only 6 of 40 cases reported could have been on ‘standard’ MMT cases without other triggering factors (85% had one or more of these known causes of QT prolongation aside from high methadone doses).
0A
QT prolongation on the cardiograph has long been know to occur in about a quarter of methadone patients yet its only serious consequence, ‘torsade de pointes’ tachycardia, hardly ever seems to occur in young patients (<40>40 years of age, electrolyte disturbance,20etc.
As our patient population on maintenance treatment gets older so we must be more vigilant about this and other eventualities. As with other related medical issues, close attention should be paid to cardiac status. This may include an ECG in those taking over 150mg, those prescribed other ‘at risk’ medications or those with HIV or personal/family history of unexplained syncope or fainting.
At this session I was delighted to finally learn the origin of the term ‘ether-a-go-go’ which is from the rhythmic dancing induced in the legs of doomed drosophila drones (flies) under the influence of ether in genetic experiments on channel blockers.
We were then shown a 15 minute video ‘interview’ with Colorado cardiologist Dr Mori Krantz detailing blow by blow the now supposedly conclusive case for methadone’s guilt beyond reasonable doubt in causing fatal arrhythmias. The final proof of any medical argument, we are told, involves randomisation of subjects and so the RCT by Wedam is proffered. This trial, a secondary analysis of ECG tracings obtained incidentally in a 1990s RCT, showed very high rates of QT prolongation in the first 4 months of MMT but no cases of torsade. On e of the panellists said to me privately that this appears to be rather persuasive of the safety of methadone rather than the opposite.
As above, hardly anyone has ever seen a case except in patients who are already stressed and in highly complex medical circumstances. I note that since his classic description of 17 non-fatal cases in 2002 (8 were pain management cases), Krantz has only reported two other individual cases of torsade, one of which was due to cocaine.
In the video, we are told that because one cannot diagnose an electrical disturbance after death, coroners are unable to detect whether the death was due to cardiac arrhythmia or respiratory depression from the drug. In fact many cases are very clear at autopsy as having the classic findings of post mortem sub-acute lung changes and high blood levels as to leave little doubt abou t the cause of death. So while Krantz’s proposition may be true for a certain minority, with a 20% mortality, there ought to be 4 times as many (80%) torsade survivors. Yet few if any of these ever seem to get to an emergency room (or ambulance) and have their potentially fatal problem diagnosed with a simple cardiograph tracing. Such reports are exceedingly scarce or non-existent. I called one of Australia’s busiest casualty departments to be told that their long-time medical director had never seen a case of methadone associated torsade. He also pointed out that for the past several years, modern cardiograph machines have given an automated print-out of QTc, making this information much more available that previously. This just might be the single most important cause of the ‘epidemic’ of electrical changes in the absence of actual symptomatic disease.
Further on in the presentation Krantz states the obvious it’s not to say that there is an epidemic of cardiac events in America”. Yet elsewhere he has written that large number of patients are at risk of developing torsade. Fanoe’s Copenhagen syncope study was put up as a written question in the video ‘interview’ (there was no interviewer as such) but Krantz failed to comment on it for some reason. Fanoe showed that out of 800 cases (with no torsade reported) that high rates of syncope (over 20% in most dose groups) in methadone patients was at least in part substantially explained by cardiac conduction problems such as torsade. This is hard to understand for a complication known to occur in less than 1% of patients). Krantz then alluded to Chugh’s Portland study suggesting that it lent support to his torsade theory, yet like so many of the other quoted references, this is another report which does not document any torsade cases. Perhaps I belabour the point. Where are all the bodies in this serial killing, Miss Marple?
[more about lives saved in another conference posting shortly]
Comments by Andrew Byrne ..
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dr Andrew Byrne MB BS (Syd) FAChAM (RACP)
Dependency Medicine,
75 Redfern Street, Redfern,
New South Wales, 2016, Australia
Email - ajbyrne@ozemail.com.au
Tel (61 - 2) 9319 5524 Fax 9318 0631
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Surgery web page: http://www.redfernclinic.com/#news
References:
Robinson GM, Dukes PD, Robinson BJ, Cooke RR, Mahoney GN. The misuse of buprenorphine and a buprenorphine-naloxone combination in Wellington, New Zealand. Drug Alcohol Dependence 1993 33;1:81-6
Strain EC, Stoller K, Walsh SL, Bigelow GE. Effects of buprenorphine versus buprenorphine/naloxone tablets in non-dependent opioid abusers. Psychopharmacology (Berl) 2000 Mar;148(4):374-83
Justo D. Methadone-Induced Long QT Syndrome vs Methadone-Induced Torsades de Pointes. Arch Intern Med 2006 166:2288
Wedam EF, Bigelow GE, Johnson RE, Nuzzo PA, Haigney MCP. QT-Interval Effects of Methadone, Levomethadyl, and Buprenorphine in a Randomized Trial. Arch Intern Med 2007 167;22:2469-2473
Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, D. Robertson AD, Mehler PS. Torsade de Pointes Associated with Very-High-Dose Methadone. Ann Intern Med. 2002 137:501-504
Krantz MJ, Rowan SB, Mehler PS. Cocaine-related torsade de pointes in a methadone maintenance patient. J Addict Dis. 2005;24(1):53-60
Krantz MJ, Garcia JA, Mehler PS. Effects of buprenorphine on cardiac repolarization in a patient with methadone-related torsade de pointes. Pharmacotherapy 2005 25:611-614
Fanoe S, Hvidt C, Ege P, Jensen GB. Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen. Heart 2007;93;1051-1055
Chugh SS, Socoteanu C, Reinier K, Waltz J, Jui J, Gunson K. A Community-Based Evaluation of Sudden Death Associated with Therapeutic Levels of Methadone. American Journal of Medicine 2008 121: 66-71
This year's APSAD conference was a fine affair. I must have been to 15 or more of these in most State capitals, Cairns and Canberra. I missed last year’s Fest in Auckland but those who attended said it was excellent. Like national leaders’ meetings with their funny hats, shirts and coats, each APSAD conference is characterised by its own conference attaché bag. This natural-inspired over-the-shoulder model was one of the few I could imagine using in the future.
The venue was splendid, Darling Harbour being just an 8 minutes (downhill) walk from Town Hall station which made me into a commuter again. With medical practice responsibilities I was a part-time conference goer.=C 2 Thus these notes are incomplete and (as usual) opinionated.
The Sunday afternoon pre-conference session had been booked by the only drug company with a major stake in our field. Reckitt-Benckiser is manufacturer of buprenorphine which is the only registered alternative to methadone, the latter being a generic drug with small bread-and-butter profit lines in comparison. The sponsors began with the topics of pharmaceutical abuse and innovations in addiction management, then ending with two presentations on the potential cardiac complications of methadone before a panel discussion to which I had been invited (and generously funded).
Adrian Dunlop spoke eloquently about the past, present and future of addiction treatments.
Dr Eric Strain covered some historical details of non-medical use of pharmaceuticals in the US, giving some results on prevalence and consequences from household surveys over 25 years. Apparently most users obtained their supplies from one doctor; many from friends or relatives with less only ~1% or less from the internet. Australian figures may be quite different as people are entitled to attend more than one doctor on Medicare. Another speaker quipped that if Australia had a Bill of Rights, it would include being able to attend “as many doctors as you like”. Dr Strain touched on the gap between occasional use and dependent use, something some of us may still forget because of the selected referrals we receive. The other major differences between American street heroin users and those abusing pain killers is that the latter are more likely to be employed, white race and non-injectors. Dr Strain was too modest to mention his own research on buprenorphine abuse and perhaps too polite to mention the reported non-medical use of buprenorphine, including a naloxone combination product which became the drug of choice (mostly injected) by more than half those presenting for treatment in Wellington, New Zealand (see Robinson 1993).
Dr Nick Lintzeris gave some pointers about pharmaceutical abuse in Australia. His talk ending with a plea to put methadone treatment, including side effects, into context both globally, as well as for individual patients. In his rather frequent exposure during the conference, he reminded us that there are much more relevant issues for opioid therapy as patients get older such as testosterone levels, calcium leaching, osteoporosis, dental, viral and bowel problems.
Jason White detailed the rather sparse literature on cardiac complications in methadone recipients. He seemed persuaded that the connection between methadone and torsade is significant and that methadone treatment could be restricted or further regulated as a result. As a demonstration of patients on ‘normal’ methadone treatment coming to torsade, he cited Pearson and Woosley’s report of 59 FDA notifications from 1969 to 2002. While not fully documented, from the limited data 12 could have been on ‘standard’ MMT, 8 of whom were over 40 years of age. This leaves just 4 reported ‘standard’ MMT cases in the USA over a 33 year period in the age group we normally start on MMT. Justo’s more recent literature review found only 6 of 40 cases reported could have been on ‘standard’ MMT cases without other triggering factors (85% had one or more of these known causes of QT prolongation aside from high methadone doses).
0A
QT prolongation on the cardiograph has long been know to occur in about a quarter of methadone patients yet its only serious consequence, ‘torsade de pointes’ tachycardia, hardly ever seems to occur in young patients (<40>40 years of age, electrolyte disturbance,20etc.
As our patient population on maintenance treatment gets older so we must be more vigilant about this and other eventualities. As with other related medical issues, close attention should be paid to cardiac status. This may include an ECG in those taking over 150mg, those prescribed other ‘at risk’ medications or those with HIV or personal/family history of unexplained syncope or fainting.
At this session I was delighted to finally learn the origin of the term ‘ether-a-go-go’ which is from the rhythmic dancing induced in the legs of doomed drosophila drones (flies) under the influence of ether in genetic experiments on channel blockers.
We were then shown a 15 minute video ‘interview’ with Colorado cardiologist Dr Mori Krantz detailing blow by blow the now supposedly conclusive case for methadone’s guilt beyond reasonable doubt in causing fatal arrhythmias. The final proof of any medical argument, we are told, involves randomisation of subjects and so the RCT by Wedam is proffered. This trial, a secondary analysis of ECG tracings obtained incidentally in a 1990s RCT, showed very high rates of QT prolongation in the first 4 months of MMT but no cases of torsade. On e of the panellists said to me privately that this appears to be rather persuasive of the safety of methadone rather than the opposite.
As above, hardly anyone has ever seen a case except in patients who are already stressed and in highly complex medical circumstances. I note that since his classic description of 17 non-fatal cases in 2002 (8 were pain management cases), Krantz has only reported two other individual cases of torsade, one of which was due to cocaine.
In the video, we are told that because one cannot diagnose an electrical disturbance after death, coroners are unable to detect whether the death was due to cardiac arrhythmia or respiratory depression from the drug. In fact many cases are very clear at autopsy as having the classic findings of post mortem sub-acute lung changes and high blood levels as to leave little doubt abou t the cause of death. So while Krantz’s proposition may be true for a certain minority, with a 20% mortality, there ought to be 4 times as many (80%) torsade survivors. Yet few if any of these ever seem to get to an emergency room (or ambulance) and have their potentially fatal problem diagnosed with a simple cardiograph tracing. Such reports are exceedingly scarce or non-existent. I called one of Australia’s busiest casualty departments to be told that their long-time medical director had never seen a case of methadone associated torsade. He also pointed out that for the past several years, modern cardiograph machines have given an automated print-out of QTc, making this information much more available that previously. This just might be the single most important cause of the ‘epidemic’ of electrical changes in the absence of actual symptomatic disease.
Further on in the presentation Krantz states the obvious it’s not to say that there is an epidemic of cardiac events in America”. Yet elsewhere he has written that large number of patients are at risk of developing torsade. Fanoe’s Copenhagen syncope study was put up as a written question in the video ‘interview’ (there was no interviewer as such) but Krantz failed to comment on it for some reason. Fanoe showed that out of 800 cases (with no torsade reported) that high rates of syncope (over 20% in most dose groups) in methadone patients was at least in part substantially explained by cardiac conduction problems such as torsade. This is hard to understand for a complication known to occur in less than 1% of patients). Krantz then alluded to Chugh’s Portland study suggesting that it lent support to his torsade theory, yet like so many of the other quoted references, this is another report which does not document any torsade cases. Perhaps I belabour the point. Where are all the bodies in this serial killing, Miss Marple?
[more about lives saved in another conference posting shortly]
Comments by Andrew Byrne ..
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dr Andrew Byrne MB BS (Syd) FAChAM (RACP)
Dependency Medicine,
75 Redfern Street, Redfern,
New South Wales, 2016, Australia
Email - ajbyrne@ozemail.com.au
Tel (61 - 2) 9319 5524 Fax 9318 0631
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Surgery web page: http://www.redfernclinic.com/#news
References:
Robinson GM, Dukes PD, Robinson BJ, Cooke RR, Mahoney GN. The misuse of buprenorphine and a buprenorphine-naloxone combination in Wellington, New Zealand. Drug Alcohol Dependence 1993 33;1:81-6
Strain EC, Stoller K, Walsh SL, Bigelow GE. Effects of buprenorphine versus buprenorphine/naloxone tablets in non-dependent opioid abusers. Psychopharmacology (Berl) 2000 Mar;148(4):374-83
Justo D. Methadone-Induced Long QT Syndrome vs Methadone-Induced Torsades de Pointes. Arch Intern Med 2006 166:2288
Wedam EF, Bigelow GE, Johnson RE, Nuzzo PA, Haigney MCP. QT-Interval Effects of Methadone, Levomethadyl, and Buprenorphine in a Randomized Trial. Arch Intern Med 2007 167;22:2469-2473
Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, D. Robertson AD, Mehler PS. Torsade de Pointes Associated with Very-High-Dose Methadone. Ann Intern Med. 2002 137:501-504
Krantz MJ, Rowan SB, Mehler PS. Cocaine-related torsade de pointes in a methadone maintenance patient. J Addict Dis. 2005;24(1):53-60
Krantz MJ, Garcia JA, Mehler PS. Effects of buprenorphine on cardiac repolarization in a patient with methadone-related torsade de pointes. Pharmacotherapy 2005 25:611-614
Fanoe S, Hvidt C, Ege P, Jensen GB. Syncope and QT prolongation among patients treated with methadone for heroin dependence in the city of Copenhagen. Heart 2007;93;1051-1055
Chugh SS, Socoteanu C, Reinier K, Waltz J, Jui J, Gunson K. A Community-Based Evaluation of Sudden Death Associated with Therapeutic Levels of Methadone. American Journal of Medicine 2008 121: 66-71
Thursday, October 30, 2008
Can Sips at Home Prevent Binges?
By ERIC ASIMOV
Published: March 26, 2008
New York Times
PARENTS always want to share their passions with their children. Whether you’re a fan of baseball or the blues, sailing or tinkering with old cars, few things are as rewarding as seeing a spark of receptivity in the eyes of the next generation.
It usually doesn’t take. Most of the time kids — teenagers, anyway — would as soon snicker at their old man’s obsessions as indulge him. Even so, I can’t help hoping that my sons might share my taste in music and food, books and movies, ball teams and politics. Why should wine be any different?
It’s the alcohol, of course, which makes wine not just tricky but potentially hazardous. Nonetheless, I would like to teach my sons — 16 and 17 — that wine is a wonderful part of a meal. I want to teach them to enjoy it while also drumming it into them that when abused, wine, like any other alcoholic beverage, can be a grave danger.
As they were growing up I occasionally gave them tastes from my glass — an unusual wine, perhaps, or a taste of Champagne on New Year’s Eve. They’ve had sips at Seders and they see wine nightly at our dinner table. With both boys now in high school, I thought it was time to offer them the option of small tastes at dinner.
In European wine regions, a new parent might dip a finger in the local pride and wipe it lovingly across an infant’s lips — “just to give the taste.” A child at the family table might have a spoonful of wine added to the water, because it says, “You are one of us.” A teenager might have a small glass of wine, introducing an adult pleasure in a safe and supervised manner. This is how I imagined it in my house.
But about a year ago, my wife attended a gathering on the Upper East Side sponsored by several high schools addressing the topic of teenagers and alcohol.
The highly charged discussion centered on the real dangers of binge drinking and peer pressure, of brain damage and parental over-permissiveness, and of the law.
One authority disparaged the European model, saying that teenage drinking in Europe —never mind which part — is much worse than it is in the United States. The underlying message was that nothing good comes from mixing alcohol and teenagers.
My wife was shaken. We agreed to hold off on the tasting plan. But I decided to try to get some answers myself.
Click here to continue reading article at New York Times
Published: March 26, 2008
New York Times
PARENTS always want to share their passions with their children. Whether you’re a fan of baseball or the blues, sailing or tinkering with old cars, few things are as rewarding as seeing a spark of receptivity in the eyes of the next generation.
It usually doesn’t take. Most of the time kids — teenagers, anyway — would as soon snicker at their old man’s obsessions as indulge him. Even so, I can’t help hoping that my sons might share my taste in music and food, books and movies, ball teams and politics. Why should wine be any different?
It’s the alcohol, of course, which makes wine not just tricky but potentially hazardous. Nonetheless, I would like to teach my sons — 16 and 17 — that wine is a wonderful part of a meal. I want to teach them to enjoy it while also drumming it into them that when abused, wine, like any other alcoholic beverage, can be a grave danger.
As they were growing up I occasionally gave them tastes from my glass — an unusual wine, perhaps, or a taste of Champagne on New Year’s Eve. They’ve had sips at Seders and they see wine nightly at our dinner table. With both boys now in high school, I thought it was time to offer them the option of small tastes at dinner.
In European wine regions, a new parent might dip a finger in the local pride and wipe it lovingly across an infant’s lips — “just to give the taste.” A child at the family table might have a spoonful of wine added to the water, because it says, “You are one of us.” A teenager might have a small glass of wine, introducing an adult pleasure in a safe and supervised manner. This is how I imagined it in my house.
But about a year ago, my wife attended a gathering on the Upper East Side sponsored by several high schools addressing the topic of teenagers and alcohol.
The highly charged discussion centered on the real dangers of binge drinking and peer pressure, of brain damage and parental over-permissiveness, and of the law.
One authority disparaged the European model, saying that teenage drinking in Europe —never mind which part — is much worse than it is in the United States. The underlying message was that nothing good comes from mixing alcohol and teenagers.
My wife was shaken. We agreed to hold off on the tasting plan. But I decided to try to get some answers myself.
Click here to continue reading article at New York Times
Tuesday, October 21, 2008
Drug Offers Effective Alternative Treatment for Heroin Addicts
October 20, 2008
Research Summary
The latest research from the North American Opiate Medication Initiative (NAOMI) suggests that hydromorphone -- an opiate found in prescription cough medicines like Dilaudid -- is more effective than methadone in reducing rates of illicit drug use and improving abstinence retention rates among opiate addicts, the National Post reported Oct. 18.
NAOMI researchers prescribed medical-grade heroin, methadone and hydromorphone to individuals addicted to heroin. After three years, the study found that those both the heroin-maintenance and hydromorphone group had better outcomes than the methadone group. Hydromorphone was so effective that almost all the participants in the group believed they were being given heroin.
"To be perfectly frank, there is a stigma attached to heroin. That would make [hydromorphone] particularly attractive in places where the concept of using heroin would be untenable as a public policy," said Martin Schechter, lead investigator of the project and director of the University of British Columbia School of Population and Public Health.
Schechter said that while there would be challenges to using hydromorphone to treat addiction, the hurdles would be small compared to getting prescription heroin approved. The researchers are already in negotiations with the Vancouver Coastal Health Authority about making the NAOMI research center into a permanent drug-treatment clinic that would offer methadone and hydromorphone maintenance.
From Join Together.org - Research News
Research Summary
The latest research from the North American Opiate Medication Initiative (NAOMI) suggests that hydromorphone -- an opiate found in prescription cough medicines like Dilaudid -- is more effective than methadone in reducing rates of illicit drug use and improving abstinence retention rates among opiate addicts, the National Post reported Oct. 18.
NAOMI researchers prescribed medical-grade heroin, methadone and hydromorphone to individuals addicted to heroin. After three years, the study found that those both the heroin-maintenance and hydromorphone group had better outcomes than the methadone group. Hydromorphone was so effective that almost all the participants in the group believed they were being given heroin.
"To be perfectly frank, there is a stigma attached to heroin. That would make [hydromorphone] particularly attractive in places where the concept of using heroin would be untenable as a public policy," said Martin Schechter, lead investigator of the project and director of the University of British Columbia School of Population and Public Health.
Schechter said that while there would be challenges to using hydromorphone to treat addiction, the hurdles would be small compared to getting prescription heroin approved. The researchers are already in negotiations with the Vancouver Coastal Health Authority about making the NAOMI research center into a permanent drug-treatment clinic that would offer methadone and hydromorphone maintenance.
From Join Together.org - Research News
Wednesday, October 15, 2008
Drinking Alcohol Associated With Smaller Brain Volume
ScienceDaily (Oct. 14, 2008)
The more alcohol an individual drinks, the smaller his or her total brain volume, according to a new report.
Brain volume decreases with age at an estimated rate of 1.9 percent per decade, accompanied by an increase in white matter lesions, according to background information in the article. Lower brain volumes and larger white matter lesions also occur with the progression of dementia and problems with thinking, learning and memory. Moderate alcohol consumption has been associated with a lower risk of cardiovascular disease; because the brain receives blood from this system, researchers have hypothesized that small amounts of alcohol may also attenuate age-related declines in brain volume.
Carol Ann Paul, M.S., of Wellesley College, Mass., and colleagues studied 1,839 adults (average age 60) who were part of the Framingham Offspring Study, which began in 1971 and includes children of the original Framingham Heart Study participants and their spouses. Between 1999 and 2001, participants underwent magnetic resonance imaging (MRI) and a health examination. They reported the number of alcoholic drinks they consumed per week, along with their age, sex, education, height, body mass index and Framingham Stroke Risk Profile (which calculates stroke risk based on age, sex, blood pressure and other factors).
"Most participants reported low alcohol consumption, and men were more likely than women to be moderate or heavy drinkers," the authors write. "There was a significant negative linear relationship between alcohol consumption and total cerebral brain volume."
Although men were more likely to drink alcohol, the association between drinking and brain volume was stronger in women, they note. This could be due to biological factors, including women's smaller size and greater susceptibility to alcohol's effects.
"The public health effect of this study gives a clear message about the possible dangers of drinking alcohol," the authors write. "Prospective longitudinal studies are needed to confirm these results as well as to determine whether there are any functional consequences associated with increasing alcohol consumption. This study suggests that, unlike the associations with cardiovascular disease, alcohol consumption does not have any protective effect on brain volume."
This study was supported by a contract from the National Heart, Lung, and Blood Institute's Framingham Heart Study, National Institutes of Health; grants from the National Institute on Aging; and a grant from the National Institute of Neurological Disorders and Stroke.
The more alcohol an individual drinks, the smaller his or her total brain volume, according to a new report.
Brain volume decreases with age at an estimated rate of 1.9 percent per decade, accompanied by an increase in white matter lesions, according to background information in the article. Lower brain volumes and larger white matter lesions also occur with the progression of dementia and problems with thinking, learning and memory. Moderate alcohol consumption has been associated with a lower risk of cardiovascular disease; because the brain receives blood from this system, researchers have hypothesized that small amounts of alcohol may also attenuate age-related declines in brain volume.
Carol Ann Paul, M.S., of Wellesley College, Mass., and colleagues studied 1,839 adults (average age 60) who were part of the Framingham Offspring Study, which began in 1971 and includes children of the original Framingham Heart Study participants and their spouses. Between 1999 and 2001, participants underwent magnetic resonance imaging (MRI) and a health examination. They reported the number of alcoholic drinks they consumed per week, along with their age, sex, education, height, body mass index and Framingham Stroke Risk Profile (which calculates stroke risk based on age, sex, blood pressure and other factors).
"Most participants reported low alcohol consumption, and men were more likely than women to be moderate or heavy drinkers," the authors write. "There was a significant negative linear relationship between alcohol consumption and total cerebral brain volume."
Although men were more likely to drink alcohol, the association between drinking and brain volume was stronger in women, they note. This could be due to biological factors, including women's smaller size and greater susceptibility to alcohol's effects.
"The public health effect of this study gives a clear message about the possible dangers of drinking alcohol," the authors write. "Prospective longitudinal studies are needed to confirm these results as well as to determine whether there are any functional consequences associated with increasing alcohol consumption. This study suggests that, unlike the associations with cardiovascular disease, alcohol consumption does not have any protective effect on brain volume."
This study was supported by a contract from the National Heart, Lung, and Blood Institute's Framingham Heart Study, National Institutes of Health; grants from the National Institute on Aging; and a grant from the National Institute of Neurological Disorders and Stroke.
Monday, October 13, 2008
Thinner Cortex In Cocaine Addicts May Reflect Drug Use And A Pre-existing Disposition To Drug Abuse
ScienceDaily (Oct. 13, 2008)
New research findings suggest that structural abnormalities in the brains of cocaine addicts are related in part to drug use and in part to a predisposition toward addiction. The research, published by Cell Press in the October 9th issue of the journal Neuron, maps the topography of the addicted brain and provides new insight into the effect of cocaine on neural systems mediating cognition and motivation.
"Human studies have shown differences in how addicts make judgments and decisions, but it is not well understood how these differences relate to alterations in the structure of the brains of addicts. Claims have been made that cocaine, potentially in connection with alcohol or other drugs, may be toxic to brain cells. We sought evidence supporting a hypothesis that brain thickness is reduced in some brain regions in addicts, is related to altered decision-making and cognition, and might to some limited degree, be connected to their exposure to cocaine," explains senior study author Dr. Hans Breiter from Massachusetts General Hospital.
Dr. Breiter and colleagues found that brain regions involved with regulation of attention and reward, specifically the dorsolateral prefrontal cortex (DLPFC) and insular cortices, were significantly thinner in cocaine addicts when compared with matched controls. Behavioral tests revealed that the thinner cortex was associated with restrictions in preference-based judgment and decision-making, and with less accurate effortful attention. A general reduction in the level of preference and in the range of decisions reflecting these preferences can be considered an example of a fundamental feature of addiction—the loss of interest in many things outside of drug use.
Some cortical thickness differences were associated with years of drug use, but the researchers also observed differences in the symmetry of DLPFC thickness between control subjects and cocaine addicts that suggested predisposition to drug abuse. "In human and animal studies, differences in the structure of the right and left sides of the brain are important for many behaviors, and when these normal differences in brain structure are altered, there may be a genetic basis for the change. We found an altered right/left relationship in a part of the frontal cortex that was also associated with altered judgment and decision-making in addicts. We further found that the overall brain thickness in the cocaine addicts was more uniform across the brain, which is quite different from what is observed in non-drug users. These differences did not correlate with any drug use measure. Together, this set of findings point to predisposing factors being a potential contributing factor to the addiction," explains Dr. Breiter.
In total, these observations provide evidence that cortical thickness abnormalities associated with cocaine addiction may be a reflection of both drug use and a preexisting inclination to drug abuse. "A fundamental component of addiction may involve adaptations and/or developmental predispositions involving brain regions necessary for judgment and decision-making regarding complex rewards and attention towards goal-objects. Addiction thus may represent a complex phenotype with multiple effects necessary for compulsive drug use, and the resulting restriction in the range of behaviors they show," concludes Dr. Breiter.
New research findings suggest that structural abnormalities in the brains of cocaine addicts are related in part to drug use and in part to a predisposition toward addiction. The research, published by Cell Press in the October 9th issue of the journal Neuron, maps the topography of the addicted brain and provides new insight into the effect of cocaine on neural systems mediating cognition and motivation.
"Human studies have shown differences in how addicts make judgments and decisions, but it is not well understood how these differences relate to alterations in the structure of the brains of addicts. Claims have been made that cocaine, potentially in connection with alcohol or other drugs, may be toxic to brain cells. We sought evidence supporting a hypothesis that brain thickness is reduced in some brain regions in addicts, is related to altered decision-making and cognition, and might to some limited degree, be connected to their exposure to cocaine," explains senior study author Dr. Hans Breiter from Massachusetts General Hospital.
Dr. Breiter and colleagues found that brain regions involved with regulation of attention and reward, specifically the dorsolateral prefrontal cortex (DLPFC) and insular cortices, were significantly thinner in cocaine addicts when compared with matched controls. Behavioral tests revealed that the thinner cortex was associated with restrictions in preference-based judgment and decision-making, and with less accurate effortful attention. A general reduction in the level of preference and in the range of decisions reflecting these preferences can be considered an example of a fundamental feature of addiction—the loss of interest in many things outside of drug use.
Some cortical thickness differences were associated with years of drug use, but the researchers also observed differences in the symmetry of DLPFC thickness between control subjects and cocaine addicts that suggested predisposition to drug abuse. "In human and animal studies, differences in the structure of the right and left sides of the brain are important for many behaviors, and when these normal differences in brain structure are altered, there may be a genetic basis for the change. We found an altered right/left relationship in a part of the frontal cortex that was also associated with altered judgment and decision-making in addicts. We further found that the overall brain thickness in the cocaine addicts was more uniform across the brain, which is quite different from what is observed in non-drug users. These differences did not correlate with any drug use measure. Together, this set of findings point to predisposing factors being a potential contributing factor to the addiction," explains Dr. Breiter.
In total, these observations provide evidence that cortical thickness abnormalities associated with cocaine addiction may be a reflection of both drug use and a preexisting inclination to drug abuse. "A fundamental component of addiction may involve adaptations and/or developmental predispositions involving brain regions necessary for judgment and decision-making regarding complex rewards and attention towards goal-objects. Addiction thus may represent a complex phenotype with multiple effects necessary for compulsive drug use, and the resulting restriction in the range of behaviors they show," concludes Dr. Breiter.
Saturday, October 11, 2008
Sacred Intentions - Inside The Johns Hopkins Psilocybin Studies
"And I felt like I was being whisked...whoa, boy...and then I went to all these other places." [Sandy Lundahl (left)]; "We have to move beyond the concept of getting high and seek to become more mature human beings. " [Bill Richards]
By Michael M. Hughes
Sandy Lundahl lies on a couch, her eyes covered with a dark cloth mask. She's listening to classical music through enormous headphones: Brahms' Symphony No. 2, the "Kyrie" from Bach's Mass in B Minor, Barber's Adagio for Strings. An hour earlier, she had swallowed two blue capsules containing close to 30 milligrams of psilocybin, the primary active chemical in Psilocybe cubensis and other "magic" mushrooms, and she's already well on her way on a trip into the hidden spaces of her psyche.
Lundahl, a 55-year-old self-described skeptic and health educator from Bowie, is looking for God.
Two experienced guides are with her in the room, monitoring her: Mary Cosimano, a clinical social worker, and William "Bill" Richards, a white-haired, 68-year-old psychiatrist and scholar of comparative religion. He's sitting cross-legged on the carpet in front of the couch, ready to help Lundahl--to talk her out of any negative trips, to help her remain focused on the scenes unfolding behind the mask, to offer a drink or some fruit or escort her to the bathroom. The space resembles a clean, warm, but decidedly offbeat living room. The lighting is spare and soft, emanating from two lamps. A bookshelf holds a variety of picture books and well-known spiritual and psychological classics like Freud's The Interpretation of Dreams and The Varieties of Religious Experience by William James. Above the books sits a wooden sculpture of Psilocybe mushrooms. Behind the couch are a Mesoamerican mushroom stone replica and a statue of a serene, seated Buddha. An eye-popping abstract expressionist painting hangs on the wall, an explosion of color and intersecting lines.
This isn't a metaphysical retreat center in San Francisco, or the Manhattan office of a New Age therapist-cum-shaman. Lundahl's first psychedelic experience is taking place in the heart of the Behavioral Biology Research Center building at the Johns Hopkins Bayview campus in Southeast Baltimore, in a room affectionately referred to by both the scientists and the volunteers as the "psilocybin room." She's taking part in the first study of its kind since the early '70s--a rigorous, scientific attempt to determine if drugs like psilocybin and LSD, demonized and driven underground for more than three decades, can facilitate life-changing, transformative mystical experiences.
The study, which took place from 2001 to 2005, and was published in 2006 in the journal Psychopharmacology with a follow-up in 2008 in the Journal of Psychopharmacology, made news around the globe and was greeted by nearly unanimous praise by both the scientific community and the mainstream press. Flying in the face of both government policy and conventional wisdom, its conclusion--that psychedelic drugs offer the potential for profound, transformative, and long-lasting positive changes in properly prepared individuals--may herald a revival in the study of altered states of consciousness.
Nonetheless, Lundahl, for one, wasn't initially impressed by the vibrant imagery behind her closed eyelids.
Click here to continue reading article and see more images at the Baltimore City Paper
Friday, October 10, 2008
Law Equalizes Coverage For Mental, Physical Care
'Milestone' Measure Could Expand Treatment Services
By Chris L. Jenkins
Washington Post Staff Writer
Friday, October 10, 2008; Page B01
An estimated 113 million Americans, including hundreds of thousands in the Washington region, will receive better insurance coverage for their mental health and substance abuse problems because of landmark legislation that for the first time requires mental and physical illnesses to be treated equally.
The law is a culmination of a decade of lobbying and negotiating among advocates for the mentally ill, the insurance industry, the business community -- including the U.S. Chamber of Commerce -- and doctors' groups. The change, which was included in the economic rescue package signed by President Bush last week, will take effect Jan. 1, 2010, for most plans. Businesses with 50 or fewer employees would be exempt.
For decades, insurance companies could offer less coverage for the treatment of depression, anxiety and bipolar disorder than of such diseases as cancer and diabetes -- so people with mental illness or substance abuse problems often had to pay for expensive treatment and medication out-of-pocket.
The new law bars companies from setting higher co-pays or deductibles for mental health and substance abuse treatment. Plans also will be prohibited from lowering benefit levels or restricting the number of outpatient therapy sessions or hospital treatment days. And if a health plan allows out-of-network visits for the treatment of physical illnesses, it will also have to offer identical out-of-network coverage for mental health care.
Advocates and experts said the change represents a fundamental shift in how the mentally ill are treated and could bring medical parity to tens of millions of people.
"This is absolutely milestone legislation for those people who have mental health and substance abuse problems," said Doug Walter, counsel for legislative and regulatory affairs at the American Psychological Association. "It ends the discrimination against people who have long needed the help."
Click here to continue reading article at The Washington Post
By Chris L. Jenkins
Washington Post Staff Writer
Friday, October 10, 2008; Page B01
An estimated 113 million Americans, including hundreds of thousands in the Washington region, will receive better insurance coverage for their mental health and substance abuse problems because of landmark legislation that for the first time requires mental and physical illnesses to be treated equally.
The law is a culmination of a decade of lobbying and negotiating among advocates for the mentally ill, the insurance industry, the business community -- including the U.S. Chamber of Commerce -- and doctors' groups. The change, which was included in the economic rescue package signed by President Bush last week, will take effect Jan. 1, 2010, for most plans. Businesses with 50 or fewer employees would be exempt.
For decades, insurance companies could offer less coverage for the treatment of depression, anxiety and bipolar disorder than of such diseases as cancer and diabetes -- so people with mental illness or substance abuse problems often had to pay for expensive treatment and medication out-of-pocket.
The new law bars companies from setting higher co-pays or deductibles for mental health and substance abuse treatment. Plans also will be prohibited from lowering benefit levels or restricting the number of outpatient therapy sessions or hospital treatment days. And if a health plan allows out-of-network visits for the treatment of physical illnesses, it will also have to offer identical out-of-network coverage for mental health care.
Advocates and experts said the change represents a fundamental shift in how the mentally ill are treated and could bring medical parity to tens of millions of people.
"This is absolutely milestone legislation for those people who have mental health and substance abuse problems," said Doug Walter, counsel for legislative and regulatory affairs at the American Psychological Association. "It ends the discrimination against people who have long needed the help."
Click here to continue reading article at The Washington Post
Monday, October 6, 2008
Psychoanalytic Therapy Wins Backing
By BENEDICT CAREYPublished: September 30, 2008
Intensive psychoanalytic therapy, the “talking cure” rooted in the ideas of Freud, has all but disappeared in the age of drug treatments and managed care.
But now researchers are reporting that the therapy can be effective against some chronic mental problems, including anxiety and borderline personality disorder.
In a review of 23 studies of such treatment involving 1,053 patients, the researchers concluded that the therapy, given as often as three times a week, in many cases for more than a year, relieved symptoms of those problems significantly more than did some shorter-term therapies.
The authors, writing in Wednesday’s issue of The Journal of the American Medical Association, strongly urged scientists to undertake more testing of psychodynamic therapy, as it is known, before it is lost altogether as a historical curiosity.
The review is the first such evaluation of psychoanalysis to appear in a major medical journal, and the studies on which the new paper was based are not widely known among doctors.
The field has resisted scientific scrutiny for years, arguing that the process of treatment is highly individualized and so does not easily lend itself to such study. It is based on Freud’s idea that symptoms are rooted in underlying, often longstanding psychological conflicts that can be discovered in part through close examination of the patient-therapist relationship.
Experts cautioned that the evidence cited in the new research was still too meager to claim clear superiority for psychoanalytic therapy over different treatments, like cognitive behavior therapy, a shorter-term approach. The studies that the authors reviewed are simply not strong enough, these experts said.
Click here to continue reading article at the New York Times
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