Meds

Redefining medical caution: How recent studies challenge benzodiazepine prescription norms

Meds
January 22, 2024

I want to draw your attention to two fairly recent studies. One of these is the BIND study. I love it when studies use easy-to-remember acronyms because it really helps to keep them straight. The BIND study found that “Many prolonged symptoms subsequent to benzodiazepine use and discontinuation … have been shown in a large survey of benzodiazepine users. Benzodiazepine-induced neurological dysfunction (BIND) has been proposed as a term …

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Why new cancer treatments cannot save us

Meds
January 16, 2024

In 2020, the ICPerMed (International Consortium for Personalized Medicine) published a ten-year vision for how personalized medicine, a new form of medicine, has the potential to rebuild an equitable and accessible health care system by 2030.

Precision or personalized medicines are drugs developed with genomic sequencing technologies, targeting the critical genes in specific types of cancer or genetic diseases. Thus, PMs are highly effective in treating their …

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What the DEA does not understand or does not care about medication cessation decisions

Meds
January 13, 2024

Reports sent back to Washington during the Vietnam War made it clear to everyone. The U.S. was winning. There could be no debate or doubt. It was right there in the numbers. When searching for a metric to measure “success,” U.S. politicians and the military had come to rely on body count comparisons. Defining “winning” as having a higher body count. And by that measure, the U.S. was indeed winning. …

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AI enforcement in health care: Unpacking the DEA’s approach to the opioid epidemic

Meds
January 2, 2024

In 2017, Attorney General Jeff Sessions became convinced that the opioid crisis was not the fault of cartels smuggling fentanyl across porous American checkpoints. And it wasn’t due to pharmaceutical companies corrupting drug approval officials and DEA administrators by hiring them as consultants after making decisions in the company’s favor. No. The opioid crisis was caused by American physicians coddling pain patients and addicts.

But reviewing all the actions of tens …

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Ben Franklin’s timeless wisdom: a key to solving America’s opioid crisis

Meds
January 2, 2024

In 1736, Ben Franklin famously advised Philadelphians that preventing fires is better than fighting them. Mr. Franklin’s advice is just as applicable today in addressing America’s opioid crisis. Billions of opioid settlement dollars are being distributed to every state, and a portion of those funds should be allocated to preventing opioid addictions, not just buying fire extinguishers (Narcan) and fighting fires (medication-assisted therapy or substance use disorder treatment). Preventing opioid …

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What the media gets wrong when reporting on “overprescribing”

Meds
December 24, 2023

A recent article in the Macomb Daily reported that a “Shelby Township doctor was convicted last Thursday of all counts for conspiring to distribute more than 300,000 opioid prescription pills valued at over $6 million, following a trial in U.S. District Court in Ann Arbor, according to federal authorities.”

This sounds very serious on its face. But without context, the public, and even we, have no idea what this means. …

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The DEA’s war on addiction doctors

Meds
December 19, 2023

Tennessee Dr. Ralph Thomas Reach is a vastly experienced addiction medicine physician. Continued application of his knowledge and pioneering experience could improve the opioid drug overdose death rate in his state. Unfortunately, the state government revoked his medical license, and Dr. Reach will soon begin serving six months in federal prison, followed by 18 months under house arrest.

After obtaining approval from the Drug Enforcement Administration, Dr. Reach had been treating …

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How gene editing and immunotherapy are changing lives

Meds
December 14, 2023

When I started medical school thirty years ago, and learned about the discovery of streptomycin, I wondered what it must have been like for the doctors who first used it to cure the “white death.” How satisfying it must have been to tell a previously hopeless patient, “We can cure you.”

What brought this to mind was my rotation at an old part of the hospital where I was training. I …

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Narcan: Widening access to overcome opioid overdoses

Meds
December 2, 2023

I often recommend books or podcasts for you when they address timely topics in mental health. The May 4, 2023, episode of The Daily podcast was one such episode that I think you should listen to. On that episode, Jan Hoffman, a health law and affairs reporter for The New York Times, was interviewed about Narcan, its history, current and future use, and how we might all take advantage of …

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Are clinicians complicit in the Fentanyl epidemic?

Meds
November 19, 2023

I have a friend. He is non-medical, just a person who knows a lot of people. He grew up on the rough side of town.

He has lost five friends or relatives this past year, he tells me. All to Fentanyl overdoses.

Most were young, in their twenties or thirties. Two were friends of his son, who is in his early thirties.

Most had been on prescribed opioids for a confirmed back injury—a …

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Will GLP-1s allow our society to eschew its responsibility to create a healthy environment?

Meds
November 17, 2023

Since Ozempic entered the cultural zeitgeist, I have been overwhelmed with requests from my patients – both those who meet criteria to start the medication and those who do not – for this new class of “miracle” drug. While it does work like a miracle for some, there are also those for whom the promise rings hollow – those who are unable to tolerate the medications due to side effects, …

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Can ketamine and SSRIs offer a complete depression treatment?

Meds
November 3, 2023

We have a problem with current recommendations for depression treatment. Thirty-five percent of patients will not go into remission or get any relief at all from SSRIs and SNRIs. And even when it does work, it takes about six weeks to start having an effect.

The prevailing theory was that serotonin, abbreviated 5-HT, was the “satisfaction” neurotransmitter. Just as dopamine has been considered the pleasure neurotransmitter. Using selective serotonin reuptake inhibitors …

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Cannabis compounds in fracture pain relief and healing

Meds
October 31, 2023

In a recent study published in the Journal of Bone and Mineral Research, it was found that two compounds found in cannabis, cannabidiol, and cannabigerol, may not just ease the pain of fractures but also speed up fracture healing. The study, titled “Cannabidiol (CBD) and Cannabigerol (CBG), Nonpsychotropic Cannabinoids, as Analgesics that Effectively Manage Bone Fracture Pain and Promote Healing in Mice,” is …

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Codeine cough syrup: a controversial classification

Meds
October 13, 2023

Did you know that promethazine with codeine cough syrup had a high risk of diversion and high risk of addiction? I didn’t.

From my experience, this is the only effective prescription cough medicine available. Sure, you can prescribe what is essentially over-the-counter dextromethorphan. But be ready when the patient throws a fit because that’s what they’ve been using for the last several days or weeks, and it wasn’t effective. Tessalon Perles …

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Levamisole is good for your dog, but bad for your cocaine

Meds
September 25, 2023

In recent years, public attention has been focused on the presence of Fentanyl-laced cocaine. It has overshadowed another new threat just as heinous yet relatively unknown – that of levamisole. Since the turn of the century, the use of levamisole has grown as a “filler” to cut or increase the amount of cocaine sold. Other than for veterinary use, this compound has been largely abandoned by human medicine due to …

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13.1 million missing Americans since 1980. Where’s the outrage?

Meds
September 20, 2023

Americans die younger than people living in other wealthy nations. A lot younger. That’s been the case since the early 1980s, and it’s getting worse. A lot worse. Since 1980, 13.1 million American lives have been lost relative to other wealthy nations.

Did we even see this in the news? The entire population of the Los Angeles metropolitan statistical area lost in a little over 40 years. Over 2 million were …

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Ketamine for mental health conditions: What every primary care physician needs to know

Meds
September 18, 2023

Wait times to find high-quality mental health support continue to be an issue, lagging from weeks to months in, leading to primary care physicians (PCPs) assuming a large role in addressing the pressing shortage of mental health services. Acting as the point of entry into the mental health care system, PCPs are encountering patients with complex mental health challenges who are often unable to secure appointments with specialists for …

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