Saturday, February 4, 2017

Monthly Vivitrol treatment helps fight heroin addiction

My office offers this highly effective treatment and accepts Anthem, Optum and Anthem insurances without extra costs. Call us today at 310-829-4640.

Sean Lyman has a standing appointment at his doctor's office every 28 days. Like clockwork, the recovering heroin addict is injected with an emerging treatment drug that he says has turned his life around.
"The shot is just... I don't know how to describe it, besides it's a miracle," Lyman told CBS News.
The 25-year-old Vermont resident has battled addiction for years; he was hooked on prescription painkillers before he moved on to the more powerful and cheaper alternative, heroin. Lyman says he's been in and out of jail and more than half a dozen rehab programs that haven't worked.


Now Lyman is among a small, but growing number of opioid addicts embracing Vivitrol. The monthly injection is the first treatment that's kept him clean.
Doctors and the drug maker, Alkermes, recommend users go through detox first. Then, the injection stops cravings and blocks the body's opioid receptors, so even if users try to get high they don't feel it. Vivitrol is not addictive like other treatments can be, including suboxone and methadone, and there's no black market for it. Lyman said not long after he began the injections, he put it to the test.
"I actually tried... to get high because I was having a hard time and the shot stopped it." Lyman said. "At the time, I was very angry that I didn't get high. But the next day, I was so thankful. I can't even describe it. And I haven't even thought about sticking a needle in my arm since then."

Sean Lyman.

Lyman lives in White River Junction, Vermont. Since he started his Vivitrol injections 15 months ago, he says six of his friends have died from overdoses. Like much of the country, Vermont is in the grips of a drug crisis that prompted Gov. Peter Shumlin to devote his entire 2014 State of the State address to the heroin epidemic. The number of people treated for heroin abuse there has quadrupled over the past decade. Shumlin has been candid and outspoken about the problem and is leading the call for new solutions. He believes Vivitrol may be one of them.
"The first thing we're doing is approving it in all of our treatment centers. And we've been building out treatment centers like mad in Vermont. So then we also want to try it in our prisons because that's frankly a good place to do it," Shumlin said.
The state is rolling out a pilot program this month where recovering addicts coming out of the Marble Valley Correctional Center in Rutland will be offered the shot. If successful, state leaders plan to expand it to all of the state's seven prisons, which could help as many as 350 inmates.
"Let's start providing treatment and medicines that can actually get people back to productive lives," Shumlin said in an interview.
The pilot program is funded as part of a three-year, $3 million grant from the U.S Department of Health and Human Services/Abuse & Mental Health Services Administration. Outside of the program, the shot can cost more than $1,000 a month, but many insurance companies and Medicaid cover it.
Vivitrol was first approved to treat alcohol dependence in 2006. Since the FDA approved the injection for opioid dependence in 2010, Alkermes says there are now around 100 programs using it in 30 states. Since its approval, sales have jumped from more than $18 million in 2009 to more than $106 million in the first three quarters of 2015 . While the company said programs in Michigan, Missouri, Maryland, New York, Massachusetts, and Ohio were some of the earliest adopters, it believes Vermont is the only state that has approved it for use statewide.
"It is gratifying to see use of VIVITROL increasing across the country. It has taken time - VIVITROL is a new approach to treating opioid addiction and it requires new behaviors by physicians, counselors, nurses and other elements of the treatment system," Alkermes CEO Richard Pops said in a statement. "In many ways, the expansion of these programs has been somewhat organic, meaning that the success of one program in a particular county may spur another county to develop their own."
Lyman says he will keep taking Vivitrol until he is comfortable enough to stop. But for the first time in years he says he's happy. He now has a full-time job and he and his girlfriend have a baby daughter. He says she is a constant reminder of why he's fighting to stay clean.
"Knowing I can live a life sober, and not have to depend on that. I can't stop smiling thinking about it. It's just crazy."

Saturday, April 30, 2016

There is a fine line between tolerance and death

This really breaks my heart. I feel like I grew up under his Purple glory. Prince's death was probably an accidental overdose.

With these drugs, the difference between tolerance and death is a fine line. Rebound pain is a symptom I see frequently with opiate use. When the levels of the opiate drops in the blood, the dependent brain senses the drop and creates symptoms to get what it thinks it needs. These symptoms are "flu like" with increasing pain. The brain creates and escalates pain to get more drug. Rebound pain is a common cause of accidental overdose.

The treatment is to detox off opiate meds to extinguish the rebound effect and treat the underlying cause of pain--here possibly minimally invasive hip surgery. Also motivational psychotherapy to minimize tolerance in the future, is tremendously helpful.

Sunday, July 26, 2015

Adderall Cheaters

Everyday in my practice I see patients who want these drugs. They usually don't have ADHD and present very normally on mental status examinations. Using these drugs for performance enhancement is unethical. I treat disease. I have seen patients get angry and leave bad reviews because I refuse to give out these controlled substance prescriptions. They always refuse the non-stimulant medications for ADHD and insist on getting their Adderall.

Guess what, I insist on not colluding with these patients and their manipulations.

I find the PDMP website helpful in recognizing prescription drug misuse and check these files on all patients.

Monday, June 15, 2015

MIND your Health

This summer MIND your health. Besides exercising and eating right, think about how your brain is doing. 

Are you sleeping 8 hours most nights? 
Are you restless and feel nervous all the time? 
When was the last time you really enjoyed anything? 
Are you bored? 
Do you feel stuck? 
How is your energy, motivation and concentration? 
Are you irritable and moody all the time? 
Do you smoke marijuana or tobacco to relax? 

These are all signs of mental illnesses that could shorten your life.

Sunday, June 14, 2015

The Good, Bad and Ugly

When I see patients, I begin by using a biopsychosocial model.This kind of orientation allows me to organize treatment plans that are comprehensive and keeps the big picture in mind. It also prevents me from missing the details that are important to your healthcare.

The Good is in reference to biology. Is your health good? Is there a medical condition or history that is relevant now? Is there a drug use issue that is impacting you? Are there side effects from medications you use for other medical illnesses? Are you healthy without other undiagnosed illnesses causing problems? Are you nutritionally sound? Are there polypharmacy issues where drug interactions are causing changes in your mental status? Is there a history of mental disorders that could be genetically relevant? These are just some of the questions that I consider.

The Bad usually refers to the bad coping skills that are abnormal psychological processes involved in mental diseases. All people have experienced distress at sometime during their childhood. Most of us got through these trying times with successful resolution of  these conflicts. Some of the solutions we learned in response to conflict in the past, may not be sufficient now. In fact not only are they inadequate, they can be harmful. Understanding insufficient or harmful coping skills and learning better coping skills not only feels better but prevents future mental disease escalation and relapse. In fact, learning better coping skills can be curative.

The Ugly is usually the devastating social consequences of mental diseases in our lives. I typically see patients divorce, lose jobs, lose everything important in their lives. The ugly is usually the worse part of the diseases I treat. Families destroyed, individuals desolate. We are a social species, our survival individually and as a group depends on our social viability. A healthy person is socially engaged, fulfilled and happy.

As I continue with my postings, I will show how I use the good, bad and ugly (biopsychosocial approach) in the specific disorders that I treat.