The COVID-19 pandemic has devastated America’s health, taking more than 500 thousand American lives, upending the economy, and perpetuating racial
The U.S. …
The pandemic’s epidemic: opioid use disorder and subpar suboxone access
“I am [sharing] my story as I would like to raise awareness about the dangers of benzodiazepines and advocate for stronger warning labels.”
I paused to wipe away tears before typing the final words of Bobbi’s report into the FDA’s MedWatch online reporting system. Bobbi, a physician assistant, was forced into medical detox by her state medical board after suffering adverse effects from prescription clonazepam. Six years …
The updated benzodiazepine boxed warning: What you need to know
In the waning days of the Trump administration, a surprising announcement came down from the Department of Health and Human Services (HHS) that the barrier required to write buprenorphine prescriptions for opioid use disorder would be lifted via reform of the so-called “X-waiver.”
The X-waiver is a rare regulation in American medicine that requires an 8-hour training and documented DEA permission before a medical doctor can prescribe Suboxone to …
The confusing policy surrounding the buprenorphine X-waiver
Like many scary health scenarios where patients seek some modicum of influence, the COVID-19 pandemic has led to patient demand for “immune-boosting” dietary supplements. Toilet paper wasn’t the only essential item being limited by stores; bottles of zinc and vitamin C flew off the shelves as consumers stocked up. The role of vitamin D in COVID-19 has been conflated and deflated depending on …
6 unconscious biases against vitamins and supplements
It was September 11, 2001. My dad had cheated on my mom again, the building that I worked in at that time had received an anonymous tip that we were a potential target for the terrorist attacks, and my mom, who needed a reprieve from my dad’s crap, was vacationing in Florida and was worried for me and my well-being. Plus, my dad was threatening to kill himself, and I …
An excerpt from Medical Marijuana: A Clinical Handbook.
Imagine two patients sitting in the waiting area of a clinic. The first is a man in his sunset years who has recently begun treatment for stage 2 lung cancer. His treatment involves the use of chemotherapy, which has …
Clearing the misinformation surrounding medical cannabis
President Trump recently signed two executive orders directly related to prescription drug prices in the U.S.
One order would allow the “reimportation” of prescription drugs from Canada. This longstanding idea would allow U.S. pharmacies and drug wholesalers the ability to pay generally much lower prices for their prescription drugs by getting them from Canadian suppliers who benefit from government management of the system. Many consumers have been buying direct from Canadian …
Why is the government so scared of directly negotiating drug prices?
Sometimes, old ideas and time-tested treatments remain the best. Newer doesn’t always mean better. Except in the case of one of our oldest antihistamines, tried-and-true Benadryl. It is time for that old drug to be retired, sent off to pasture, and never used again. Goodbye, Benadryl. Fare thee well, adieu, and don’t let the door hit you on the way out.
Benadryl (diphenhydramine) was introduced in 1946. The top single that …
Goodbye, Benadryl: It is time for you to retire
“Boxed warnings” or “black boxes” are the strictest FDA label warnings. They appear on cigarettes, fluoroquinolones (for tendon rupture), Lamictal (for SJS and TEN), Accutane (birth defects), and other products with well-known risks.
The industry obviously dislikes black boxes since they reduce sales (though their lobbyists charge the boxes “confuse” and “unnecessarily alarm” patients).
So it was no surprise that when the Read more…
Black boxes: health warning or profit warning?
In the wake of the opioid epidemic, benzodiazepines have been called “our other prescription drug problem” and “the next U.S. drug crisis.” Prescriptions are on the rise, with over 30 million Americans reporting benzodiazepine use in the previous year. This is alarming, as benzodiazepines are implicated in at least 30% …
Stop cutting patients off their prescribed benzodiazepines
Before direct-to-consumer ads, physicians tried to reassure patients they were probably fine. Today, drug ads and online symptom checkers do just the opposite. The most insidious are “unbranded” ads that scare people about a disease without mentioning the drug they are trying to sell. Notable unbranded disease campaigns sell the obscure exocrine pancreatic insufficiency, shift work sleep disorder, and non-24-hour, sleep-wake disorder. Unbranded advertising is designed to appear like a …
Drugmakers discover tardive dyskinesia. And they profit in it.
As an academic psychiatrist who treats people with anxiety and trauma, I often hear questions about a specific class of medications called benzodiazepines. I also often receive referrals for patients who are on these medications and reluctant to discontinue them.
There has been increasing attention into long-term risks of benzodiazepines, including potential for addiction, overdose, and cognitive impairment. The overdose death rate among patients receiving …
Why your doctor may be concerned about prescribing benzodiazepines
Along with a steeper financial burden and an increasingly competitive academic environment, this year’s incoming freshman university class will likely be confronted with the pressure to take a little pill that some popular culture references say will make you “awesome at everything.” Or they may eschew the temptation and rely on the standard practice of study, sleep, repeat.
Welcome to #GenerationAdderall, the …
Don’t use stimulants to cram for exams. It ruins sleep and doesn’t help test scores.
In previous posts, we have reviewed the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as the off-label prescribing of gabapentinoids, for treating anxiety disorders. Anxiety is such a ubiquitous problem that it is not surprising that many other compounds have been used off-label as well. In this posting, we will review some of the common ones: propranolol, mirtazapine, and quetiapine. …
Second-tier, off-label treatments for anxiety
Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15.
She has had countless disappointing visits with doctors. Some said they couldn’t help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome.
Pinkley has taken opioids a few times after surgeries, but they never helped her underlying pain, she said.
“I hate …
Using low-dose naltrexone to treat pain
Americans have always loved their medicines and sought them out actively to cure whatever ailed them. Their interest ranged all the way from “staying well” to “feeling better.” Productivity in this hard-charging, pull yourself up by the bootstraps society required activity, and it’s hard to be active when you’re sick.
In the 18th-century in Germany, England, France, and Switzerland, men practicing pharmacy saw their retail operations as the …
How we got from 18th-century tinctures to the opioid crisis
Medical treatment has knocked down tumors in 6-year-old Easton Daniels’ brain, but the drug used also wiped out his immune system.
To bolster his immune function and help keep him healthy, he has visited a hospital for intravenous infusions of immune globulin about every month for the past year and a half.
But in early July, his family was stunned by a letter from Cincinnati Children’s Hospital: “All of Easton’s appointments canceled …
An expensive treatment may be a victim of its own widening use
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Marijuana is made from the dried flowers of the cannabis plant. Made of more than 500 chemicals, including over 100 compounds called cannabinoids, the primary active compounds in the plant are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC acts on specific brain cell receptors that …
Does marijuana really relieve pain? Here’s what anesthesiologists say.
One question I get asked a lot lately is this: “Is it OK for me to use CBD oil?”
First of all, CBD oil and associated preparations are types of alternative medications, medicines that might not be mainstream or readily prescribed by doctors, but are nevertheless used by many people on their own. Alcohol and marijuana are two substances that are often used as “medicines” by those that think they function …
Considering CBD oil? This psychiatrist suggests these questions to ask first.
An excerpt from Understanding Medicines for Anxiety.
In addition to medicines with FDA indications for anxiety, such as benzodiazepines and some antidepressants, a number of drugs are frequently prescribed off-label. Among these are gabapentin and the related compound pregabalin, collectively known as gabapentinoids. Their popularity is remarkable: gabapentin has been …
Off-label use of gabapentin and pregabalin for anxiety
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