Zohydro – New Drug Causes Concern

“It will kill people as soon as it’s released.” This statement was made last fall by Dr. Andrew Kolodny, president of the advocacy group Physicians for Responsible Opioid Prescribing. It appeared in a letter to the Food and Drug Administration written by a coalition of more than 40 health care, consumer and addiction treatment groups. The topic: the FDA’s controversial decision to approve Zohydro, a new hydrocodone-based drug. Like heroin, this drug is opiate-based; it is five times more potent than Vicodin and Loritab.  The potential for abuse and addiction is astronomical.
Currently, 120 million opioid prescriptions are filled each year. They are by far the most commonly abused prescription medications in the U.S.
The truth is, we are right in the middle of a prescription drug use disorder epidemic; deaths from overdose have quadrupled since 1999. And yet, despite efforts by the medical community to revoke approval, this drug became available to consumers in March of this year.
Why place yet another drug that carries enormous abuse potential on the market? Supporters indicate that physicians need more tools in their toolboxes to treat the most extreme cases of pain such as post-surgical back pain, extreme trauma or cancer. Those standing in opposition claim that it is all about the bottom line and the millions of dollars that such a drug will bring to pharmaceutical companies.
As far as I am concerned, the last thing we need is another potent prescription pain medication with such highly addictive properties –especially in today’s clinical environment in which prescriptions are regularly written by woefully under-educated and under-trained physicians. These are not “bad” doctors who intend harm; they are simply people who do not have the training or accountability to identify addiction risk, or even active addiction.
Of course, patients with little to no addiction risk can probably use this drug safely. But even someone with a relatively low risk of substance use disorder is a strong candidate for addiction, abuse, and very possibly, death, given the properties of this medication.

Up Close and Personal with Suicide

The CDC reported that 38,000 people died in the U.S. by suicide. It now surpasses motor vehicle accidents as a cause of death and is listed as 10th most common cause of all deaths in our country. It probably ranks 1st for the most stigmatized and least talked about form of death in our country.

As a psychiatrist, many of my patients struggle with suicidal thoughts, sometimes as part of major depression, PTSD, bipolar disorder, addiction, eating disorders or personality disorders. In my own recovery from an eating disorder, substance abuse and trauma, it is a mind state that I am familiar with.

But, I’ve never known it quite as intimately as I have since being informed of my nephew’s death by suicide in January of this year.

To experience the pain first hand that rips through a family after suicide was altogether a different experience than helping people professionally with suicidal thoughts, suicide attempts or loss of a loved one after suicide.

I was on vacation with my new family in Mexico, returning from an activity-packed, day-long trip to an adventure park. We returned to our hotel well after the sun went down. I reflexively checked my cell phone upon getting back to our room, expecting nothing more than maybe a few emails. To my surprise and then panic, there were missed calls from my mother, sister, brother and a few ominous texts. “Call me as soon as you can. Something bad has happened.”

I felt it in my body and knew it my heart it was something serious. Stepping outside to the balcony, I tried my sister. Voicemail. Then my mother. I could tell she had been crying. “Are you sitting down?” she asked. “

Yes,” I said, even though I wasn’t.

“Are you really sitting down?”

“Yes, I’m sitting.” I was annoyed that she knows me well enough to know I was not seated. Impatiently, and riddled with anxiety, I sat.

“Tommy killed himself.”

Floodgates opened. Pain, sadness, hurt, anger, guilt, shock, confusion — all at once. I asked for details. She shared what she knew.

I’m an addiction psychiatrist, CEO and Medical Director of a large residential treatment center for women with suicidal thoughts and addiction. With my nephew, drugs were involved. He was sick, in pain (but not obviously so), and clearly alone. He was adamantly against any attempts to intervene on his decided way of life and his life philosophy, part of which included the use of what he considered life-enhancing drugs—namely marijuana, ecstasy, and LSD. He was a talented dancer and street performer — into the rave scene in Chicago. And like so many in that world, he embraced drugs as a meaningful and important part of life. Not the so-called “hard” drugs like crack or heroin, but all the drugs people in that scene say should be legal because…”they’re not addictive, it enhances my life, opens me up, blah blah blah.”

I wonder if he ever considered that these drugs might play a role in making him think his time had come at the age of 32, and it was the plan of the universe for him to take his own life on the 2nd day of 2014.

I saw his life, which included early developmental trauma. In my experience as a psychiatrist, unhealed early life trauma is integrally linked to suicide attempts, suicidal thoughts, mood disorders and addictive disorders.

Like so many who have experienced suicide in their family, I have been plagued by the usual questions: How could this happen in my own family? How could I have prevented it? What could I have done differently? Although the questions are seemingly unavoidable, at the end of the day, they lead nowhere. So now I focus on how fortunate I am for all the love and support I have in my life, especially the support I received from my therapist, family, and hundreds of people in the 12 step recovery community who not only kept me alive, but taught me (teach me!) how to thrive. Every single day of my life in recovery I am blessed with the brave women at Timberline Knolls, who have the courage to ask for help and give me the gift of bearing witness to their miraculous journeys.

 

 

 

Reflections on NEDAW 2014

“I Had No Idea” was the theme of this year’s National Eating Disorders Awareness Week. We had a whole program of events on campus in honor of the week and all of the brave women suffering from, recovering from, and thriving beyond their eating disorders, as well as those who love and support them.

The theme this year got me thinking about all the things I had no idea about earlier in my life.

I had no idea …

  • how seriously ill I was before finding help that worked.
  • I was anorexic; the bulimia was much easier to recognize.
  • I was also an alcoholic.
  • how much I starved myself of support and help.
  • how much help I needed, and deserved.
  • I was a trauma survivor and a child of an alcoholic.
  • I also had depression.
  • there was a way out, since I was fairly convinced I would die of my eating disorder.
  • that treatment and 12 step support could work for me, too.
  • how to do it.
  • how to ask for help, or that I really needed it for that matter!
  • I was a good person with gifts to share.
  • how beautiful life is, how much a part of it I am, and how wonderfully gracious God is!
  • that I would become Lily’s mom aka “sunshine in a dog.”
  • I would be recovered for 13 years and counting.
  • I would marry the love of my life, I would be blessed with a family and close friends.
  • I would become medical director and CEO of the best treatment center on the planet and would be blessed daily with our amazing patients and staff.

For all of you in recovery, I hope your life is rife with incredible “I had no ideas,” that fill you with joy and gratitude every single day. Additionally, if you know a woman who is struggling with an eating disorder, or any type of addiction,   please encourage her to seek help. Because here is the truth: everyone has an abundant life just waiting to happen; but until a woman strives for, and achieves recovery, she will continue to have NO idea how extraordinary, wonderful, and rewarding life can be.

2014 Sochi Olympics — A Personal Highlight

Growing up, my family life was wrought with negative experiences common to many other children of alcoholics. Despite the difficult times and life traumas, I have very fond memories of watching the Olympics as a family. I’m grateful to have carried that tradition to my current family, as an adult woman in recovery.

One of my favorite moments of this year’s Sochi Olympics was at the very beginning of the games. I sat with my husband and step kids watching the opening night for the figure skating competition. A young, rather emaciated female skater whisked and twirled about the ice with grace. Out of nowhere, my 12-year-old step son piped up and asked, “Daddy, are these girls slutty?” I was immediately grateful to be alive, well and present to experience this gift in my life.

My husband redirected our son for using the word “slutty” and started to explain the need for minimalism in skate uniforms. I intervened. It was a wonderful and legitimate question. I could certainly appreciate why he might associate scantily clad and highly made-up girls with “sluttiness.” I explained to him that the girl probably wasn’t slutty in any regard, but ice dancer’s outfits more often than not are “slutty” looking. I also pointed out that although the male ice dancers wear tight fitting uniforms, they don’t show anywhere near the amount of skin that the women do.

He naturally and curiously asked why. Being who I am, I took it a few steps further and discussed the connection between objectification, sexualization and eating disorders—all highly prevalent in elite female figure skaters. The sexualization of young women is ever increasing for those in the spotlight, and those who watch the spotlight—at a high cost to their well being. If we looked at Katarina Witt, both her body (athletic and strong) and her outfits, they were much less anorexic and sexualized than what we see on the ice dancers today.

Sadly, this phenomenon is pervasive in women’s sports…take a look at what has happened in women’s tennis.

Before

After

The Diseased Brain, Choice and Addiction

The death of Phillip Seymour Hoffman shocked the entire country. So sad and so incredibly senseless – it was a genuine tragedy. But, possibly even more tragic is that his death is not all that unique. Every single year thousands of people in the U.S. die from a drug overdose. Unlike Phillip Seymour Hoffman, the majority of people who die from addiction are not celebrities. They are everyday people, men and women, boys and girls who share a disease – one that they simply cannot overcome on their own.

And yet, the world at large continues to beg the questions: Why? Why didn’t he know better? Didn’t she realize if she did this long enough, it would kill her?

It’s time to stop asking these questions and start understanding what happens to the brain when a person is addicted. In a nutshell, the brain’s ability to function correctly is altered. The alterations happen in a few important places. One is in the brain’s reward center, which gets very active when the person’s drug of choice is ingested. This activity is associated with the release of dopamine in the reward area, which produces a feeling of wellbeing, euphoria, and decreased negative emotions.

Another change takes place in the prefrontal cortex, the part of the brain responsible for self-control, decision making and exercising judgment. When the reward center goes crazy after a person uses a drug he or she is addicted to, the prefrontal cortex essentially goes off line, and the individual is unable to use this area of the brain to make good long-term decisions. Brain imaging studies from drug-addicted individuals show actual physical changes and decreased activity in the prefrontal areas.

Once these changes occur in the brain of an addicted person, their ability to exert free will is limited. This is one of the physical aspects of the disease that a person with addiction is powerless over. Thankfully, there are other powerful parts to us as human beings than the brain alone. The most important when it comes to recovering from addiction is the spirit. You can’t use a broken brain to heal a broken brain. Although people with substance use disorders can’t change the way their brains respond to drugs or alcohol, they do have choice in one area: how much help are they willing to get to understand what needs to happen and what they need to do on a daily basis to stay in remission.

The power of 12 step support groups and good addiction professionals are key because they act as an external prefrontal decision making support for people whose brains need time to heal. The frontal lobes will heal over time, but the reward center changes are more permanent.

This distinction is critical to understand. A doctor who prescribes to a heroin addict, albeit one who has been sober for 20 years, needs to understand the risks and necessary precautions that must be put in place for that person to safely use the medication. A doctor who does not do this is negligent. And a person with addiction, despite many years of sobriety, needs to understand this as well. We all benefit from an extra set or two of high functioning prefrontal cortices looking over our decisions.
The first time a person takes drugs, a choice is involved; those who develop addictions usually could never imagine where that first choice would eventually lead them. Once addiction takes hold, choice is limited—not to whether or not to continue using, or whether or not to relapse, but limited to how much help and for how long that person is willing to be connected to this help. Until this truth is understood, friends, families, doctors, and the media will keep asking the same question – “Why?” Followed by the same remark – “tragic.”

The Ultimate Loser

Social media sites have been pressed into overdrive this week by reaction to the season finale of “The Biggest Loser.” This is because a 24-year old woman, Rachel Frederickson, was declared the proud winner of the show by losing a record-breaking percentage of her total body weight.

Speaking of proud – we cannot even begin to imagine how profoundly proud the shameless producers of this show must be with this dangerous result. Indeed, what a coup. In a matter of mere months, they managed to successfully move this young woman out of one disordered-eating illness and well into another. Yesterday: compulsive overeating. Today: anorexia nervosa. No doubt about it: Rachel’s show-winning BMI falls within the diagnostic parameters for anorexia.

I wonder if Rachel or her loved ones have any idea that she went from one eating disorder that offers its own unique medical, emotional and physical risks to another that boasts the highest mortality rate of ALL psychiatric disorders. That’s right — people die from anorexia more than any other mental disease.

Not only did this contestant lose a shocking amount of weight, but she did it in a fast and unsustainable way. Of course, what they don’t tell viewers, since it just might damage ratings, is that this weight was lost in a way that put this woman at risk of cardiac compromise, liver inflammation, dehydration and other medical consequences.

Imagine the millions of vulnerable, unsuspecting viewers that actually bought into the notion that this weight loss was positive and healthy. After all, this is a show that cares deeply about the contestants and wants only for them to achieve health, fitness and wellness – isn’t that right?

Like so many of the other “lucky” winners that came before her, Rachel will likely be back up to, or exceed, her original weight within a year from now–that is, if she doesn’t die from complications of restrictive eating and over-exercise.

We hope the money she won for abusing herself will not be spent frivolously. It may prove invaluable in the future when her emotional well-being and physical body are so devastated by an eating disorder that she needs to seek professional treatment (with eating disorder specialists) simply to regain her health.

Addiction…A Choice?

Addiction to drugs or alcohol is a medical illness, a disease of the brain. And yet, there are those who continue to insist that substance addiction is a choice.

Several weeks ago, Matthew Perry, who portrayed Chandler Bing on the highly successful Friends sitcom, traveled to the UK to lend assistance to a new drug program involving the courts. While there, he appeared on a television show alongside journalist and anti-drug campaigner Peter Hitchens. A heated debate ensued.

Regarding his own addiction, Perry said, “I’m a drug addict and if I have a drink I can’t stop… if I think about alcohol, I cannot stop.”

Hitchens responded: “People have problems with drugs and drink. People like taking them and don’t want to stop. It doesn’t mean they have a disease.”

“Don’t want to stop?” How about the truth: so many addicts desperately want to never use again, but they can’t stop. Why? Because they are addicted, physiologically as well as psychologically.

Saying that a person addicted to drugs can “just stop” is like telling a diabetic they can simply toss out that insulin and be fine. That person will not be fine – that person will die.

Addicts don’t have a choice about whether or not they have an addiction, their choice is not in whether or not they have the disease but in whether or not they are willing to get the help they need on a daily basis to recover.

From the Eyes of Babes…A Fresh Perspective

I had the opportunity to bring my step-kids with me to work on Dec. 26th. They spent the day watching movies, playing games and such on their I-things in my office. They got to hear the 2 code greens called over the intercom on Willow that day, and have now identified Willow as the problem lodge. Occasionally after work they will ask me how Willow is doing.

They were also perceptive enough to notice an ambulance coming to one of the lodges. “Kimber, why is there an ambulance here?”

“Well, someone needs to go to the hospital.”

“Why are you so calm about it?”

“Well, it happens every now and again.”

“For what?”

“Various things, medical problems, to stay safe, etc.”

“Oh. Ok.”

Later, one of my patients who was leaving that day from our PHP stopped by my office to say goodbye, and she introduced herself to them. Both they and she enjoyed that very much.

As we drove off campus later in the afternoon, they noticed two PHP residents smoking outside of the sober living condos and waving goodbye to us—one of whom was the woman leaving that day.

My step son asked with shock, “Kimber, why are they leaving if they are still smoking? Don’t they need to stay until they get better???”

It made me take a step back and consider what we get used to.

Recovery is a process, and many people let go of the things that are killing them in the order of most actively/quickly killing to least.

Can you imagine if nicotine addiction was covered under medical necessity guidelines? If people were treated until they were that well in a controlled setting?

I hope someday the women we treat see themselves and what they are willing to put up with in the way of self destruction like my step-kids do.

I hope that for all of us.

Gratitude

Making a daily gratitude list was a critical part of my early recovery. I finally found a sponsor who had what I wanted. Before I was actually ready to work with a sponsor, I spent about a year “working” with people who did not have what I wanted, and with whom I did not really connect. It was what I did to prove to everyone that 12 step programs had no value. Of course, I had never worked the steps. Deep down inside, I knew I was different, and therefore, it wasn’t going to work for me!

The person I asked to sponsor me when I was actually ready to commit to the steps was someone I had known since the very first meeting I ever went to. She had a nice house, a husband she loved deeply and meaningful work. I was attracted to her spirit. She was full of joy, compassion and understanding—none of which I believed I deserved. I was shocked when she said yes after I asked her to sponsor me.
The first assignment she gave me was to write down three things I was grateful for every day. Then she dropped the bomb and suggested that I call her on a daily basis. That was a bit much, but I did it anyway. She would share her gratitude list for the day with me, and I would do the same. Calling her every day was easier when I knew there would be a structure to it. There was nothing worse for me back then than calling a complete stranger and stumbling through an awkward, uncomfortable conversation. Actually, my disease was worse for me at that time, but it didn’t always seem that way when I faced the prospect of taking a new action…especially one that involved other human beings.

There were days that I found it hard to see three things to be grateful for, but making a conscious effort to look for those things changed me, my view of the world, my view of my life and God’s presence in my recovery. There were several days when I saw no progress, and felt abandoned and alone, but that gratitude list helped me see the many ways God was actually in my life in the present.

And now many years later, I can come up with about three things per minute that I am grateful for, such as the many messages of gratitude I receive from the women whose lives have been transformed through the journey they started at TK. Women who were once devastated by depression, eating disorders, addictions, and trauma, who are living full and abundant lives in recovery. Real deal.

Gratitude

Making a daily gratitude list was a critical part of my early recovery. I finally found a sponsor who had what I wanted. Before I was actually ready to work with a sponsor, I spent about a year “working” with people who did not have what I wanted, and with whom I did not really connect. It was what I did to prove to everyone that 12 step programs had no value. Of course, I had never worked the steps. Deep down inside, I knew I was different, and therefore, it wasn’t going to work for me!

The person I asked to sponsor me when I was actually ready to commit to the steps was someone I had known since the very first meeting I ever went to. She had a nice house, a husband she loved deeply and meaningful work. I was attracted to her spirit. She was full of joy, compassion and understanding—none of which I believed I deserved. I was shocked when she said yes after I asked her to sponsor me.

The first assignment she gave me was to write down three things I was grateful for every day. Then she dropped the bomb and suggested that I call her on a daily basis. That was a bit much, but I did it anyway. She would share her gratitude list for the day with me, and I would do the same. Calling her every day was easier when I knew there would be a structure to it. There was nothing worse for me back then than calling a complete stranger and stumbling through an awkward, uncomfortable conversation. Actually, my disease was worse for me at that time, but it didn’t always seem that way when I faced the prospect of taking a new action…especially one that involved other human beings.

There were days that I found it hard to see three things to be grateful for, but making a conscious effort to look for those things changed me, my view of the world, my view of my life and God’s presence in my recovery. There were several days when I saw no progress, and felt abandoned and alone, but that gratitude list helped me see the many ways God was actually in my life in the present.

And now many years later, I can come up with about three things per minute that I am grateful for, such as the many messages of gratitude I receive from the women whose lives have been transformed through the journey they started at TK. Women who were once devastated by depression, eating disorders, addictions, and trauma, who are living full and abundant lives in recovery. Real deal.