Efforts to Combat Prescription Opioid Abuse

Prescription opioid abuse is now epidemic in our country. The statistics regarding addiction and death are staggering.

The rate of death due to overdose of prescription opioids more than quadrupled between 1999 and 2010. This far exceeds the combined death toll from cocaine and heroin overdoses. In 2010 alone, prescription opioids were involved in 16,651 overdose deaths, whereas heroin was implicated in 3036. A full 82% of the deaths due to prescription opioids and 92% of those due to heroin were classified as unintentional.

Rates of emergency department visits and substance abuse treatment admissions related to prescription opioids have also escalated dramatically. In 2007, prescription-opioid abuse cost insurers an estimated $72.5 billion – a substantial increase over previous years. Although these costs are similar to those associated with diseases such as asthma and HIV infection, a dramatically lower amount of health care dollars are spent to treat substance use disorders.

Responding to the prescription pill addiction epidemic, The Department of Health and Human Services (HHS) is implementing a widespread effort to address the key risks involved in prescription drug abuse, particularly opioid-related overdoses and deaths. This focuses on four main objectives: providing prescribers with the knowledge to improve their prescribing decisions and the ability to identify patients’ problems related to opioid abuse, reducing inappropriate access to opioids, increasing access to effective overdose treatment, and providing substance abuse treatment to persons addicted to opioids.

Basically, these objectives could be reduced to two words: knowledge and treatment. Physicians need increased education about opioids and heightened awareness about addiction. Prescriptions are written too flagrantly, far too often and with too little information about the patient’s substance use history. These dangerous and addictive drugs are simply too easy to obtain today.

For those with opioid addiction, we need a greater availability of treatment using evidence based therapies, including medication-assisted therapies (MATs) such as naltrexone and buprenorhine. When prescribed and monitored properly, MATs are safe, cost-effective, reduce risk of overdose and generally help patients recover. Yet, these drugs are underutilized due to barriers such as insurance coverage, too few qualified prescribers and negative attitudes and misunderstandings about medications among treatment professionals, recovering people, and lay people alike. Too many people continue to erroneously believe that MATs replace one addiction with another.

So, we return to the need for increased education. If physicians and the public alike had an improved understanding of substance use disorder, especially in the area of opiate addiction, patients would be helped rather than shamed. In place of lives continuing to be wrecked and lost by this disease (both addicts and their loved ones), we may see scores more added to the ranks of those who are saved, recovered and restored to health.

A Jumbo Mistake

Numbers are the bane of many women. Often, this negativity involves the numbers found on a scale, but also extends to the sizes of clothes. How many girls and women have I seen in treatment who would literally starve themselves to death if only they could be a size 00?

Therefore, I generally applaud attempts by manufacturers to defuse the size issue, but not here.

Recently, a Japanese clothing company (interestingly called FATYO) unveiled a new wardrobe line with not a single number; however, the “new” approach was obviously not designed to promote anyone’s self-esteem. A shopper might ask for a shirt or pair of pants in a “titch, skinny, fat, or jumbo.” I suppose it is possible that whoever was hired for translation purposes may have had it in for the company!

Really…jumbo?

It remains to be seen how well FATYO will fare in the marketplace, but I’m thinking the outcome will be poor in the U.S. It is regrettable that in their noble effort to get away from numbers, this company went the wrong way altogether with their language.

Wouldn’t it be nice if someone came out with a line of clothing — jeans or otherwise — whose sizes were: gorgeous, awesome, beautiful, and extra beautiful? Now that would be a store I would shop at!

An interesting side note to this story is what lawmakers in Japan have implemented regarding size. In 2009, the government set maximum waistline sizes for citizens over 40, they were: 33.5 inches for men and 35.4 inches for women. In order to receive Japanese health coverage, employees must get their waistlines checked annually; if deemed overweight, they are sent to health counseling.

This brings weight stigma to a whole new level. What about the concept of size diversity? What about the concept of health at every size? What about using more accurate markers of health than waist size, such as blood pressure, blood sugar levels, cholesterol levels? All of which are much better predictors of health risk than waist size.  And, what about the relevance of exercise to health?

 

To Med or Not to Med…That is the Question

According to the World Health Organization, depression is on the rise and is expected to be one of the biggest health problems we face by the year 2020. Millions of people take antidepressants every day; a significant number of them are women. We know that depression is far more common in women than in men and that the highest prevalence occurs during child bearing ages (mid-twenties to mid-forties). And, depression doesn’t disappear when a woman becomes pregnant. It is estimated that between 10% and 25% of pregnant women suffer with major depression.

So, while many commonly used antidepressants have been shown to be safe during pregnancy, countless numbers of women are plagued by the decision of whether to continue to take medication during their pregnancy, or stop. Nearly every woman is committed to do everything in her power to nurture and protect the baby growing in her womb. Frequently, those women who don’t or can’t have a serious mental illness, physical illness or addiction that interferes with their ability to care for themselves.

Far too often, women with depression or anxiety decide to discontinue their medications during pregnancy, and they base this decision on myth, fear, stigma and shame rather than scientific evidence of the actual risks and benefits of being on antidepressants during pregnancy.

It is important to remember that most women take these medications for a reason, often because depression has profoundly and quite negatively impacted their lives. Many women and healthcare practitioners fail to take into account the risks for a woman and her baby when stopping her antidepressant. Most healthcare providers are quick to relay the risks of staying on antidepressants, the biggest of which substantiated by the scientific literature, is neonatal withdrawal syndrome, which lasts two to three days after birth and is characterized by irritability and poor feeding. The scientific literature is largely mixed about other hazards of being on antidepressants while pregnant, but the largest study in 2013 showed no increased risk of malformations, miscarriage, stillbirth or pulmonary hypertension in the newborn.

What people spend far less time thinking about and talking about are the risks of untreated depression during pregnancy. Discontinuing antidepressants can have harmful consequences to the mother and her baby, which include:

  • increased use of cigarettes, alcohol or other substances
  • deteriorating social function, emotional withdrawal, worry related to pregnancy and excessive concern about their future ability to parent
  • impaired ability to attend regular obstetric visits and comply with prenatal advice;
  • malnutrition which can lead to low birth weight
  • increase in risky behavior and impaired capacity to avoid dangerous behavior
  • heightened risk of self-injurious, psychotic, impulsive, and harmful behaviors
  • increased risk of postpartum depression or PPD
  • difficulty carrying out maternal duties and bonding with their children

Whether to continue taking any medication during pregnancy comes down to individual choice. But, far better it be an informed, evidence-based decision, than one based on societal pressure, shame or fear. The risks and benefits will depend on the person, her history of depression, severity of depression, length of time on and response to antidepressants, and whether or not non-pharmacologic therapies have been effective in treating her depression. Whatever you decide, it is important to remain connected to people who can help you, support you and recognize signs of depression interfering with your abundant life.

 

Recovery Nugget

Last week, I shared about my experience at the university eating disorders awareness walk. I left all of you with a little cliff hanger. A few have emailed or texted me asking me to spill the beans – to which I responded, “You will just have to wait for next week’s blog!”

So here it is. The best thing I shared about my experience, strength and hope in recovery at that walk, probably the coolest thing that has ever happened to me, and something I was pretty sure would never, ever happen in my life, has been added to the long list of abundant gifts from God in recovery.

About three months ago, after a very short time of trying, I found out that my husband and I are with child!

There are many reasons why I told myself that would/could never happen to me. These reasons, all products of “disease thinking,” included: I was sick for too long and messed up my body; I pissed away my 20s; I’m somehow subhuman and don’t have the same rights and privileges as all parents my age in the world; I’m too old; I can’t possibly deserve this gift … and life is already too good, way better than I ever imagined possible.

Here is an absolute truth about disease thinking: it only produces lies.

I have always been in awe of the power of our bodies to heal themselves. And now, I’m especially in awe of the power of my body to support, nurture and nourish a growing baby boy.

I have heard his heart beat on several occasions…from within my body…just wild! I have seen ultrasound pictures, both of which brought tears of real joy to my eyes, with my husband, David, by my side, holding my hand, tearing up as well.

David thinks our baby is the luckiest creature in the whole world, having the time of his life. “He gets to spend his days with you, he gets to eat well, meditate with you, go to recovery meetings and learn the value of living a spiritual life. He gets to go to work with you and help women save their lives, drive with you as you go from full-time doctor at TK to amazing wife and mom at home. He gets to eat yummy late-night snacks, and on top of it all, he gets to do his own form of fitness every day, all day (he was quite active last time in the ultrasound!). He gets to have you as his home right now and his mom for the rest of his life.”

Does it get any better, more abundant than this? This I would not want to miss out on. This would not be possible in a life of drinking, restricting, bingeing and purging.

 

 

 

Reflections on College

BUWALKphoto

This past weekend I was blessed with the opportunity to represent TK at the first New England University Eating Disorders Awareness walk at Boston University. And to boot, I had the gift of bringing my step son along. Some of you have seen him with me at the Chicago NEDA walks…never too early to get them involved in the cause!

The Boston event was profound for a number of reasons. The three other speakers were inspiring and wonderful company to be among. Doris Meltzer and her husband spoke about their daughter who died of bulimia at the age of 19. Their message is always heartfelt and an incredibly powerful reminder that eating disorders kill — and that the need for expert care, and adequate amounts of care, are critical, both for sufferers and their families.

College is a time that most people associate with freedom, independence, socializing, “partying” and maybe even a little bit of learning. I had such aspirations when I set off to attend the University of Chicago.

But my bulimia started my freshman year in college, and sadly, my whole college experience was affected by this terrible illness. I maintained all A’s, competed as a college athlete on the softball and basketball teams, and even  got accepted into one of eight  spots in medical school offered each year through the early acceptance program.

My bulimia was a deep, dark, terrible secret. The few attempts I made at student counseling to get help for it were futile. “It’s not that bad, yet.” Or, “We can’t really help you with that, since you get six visits and that’s all.”

Not until my third year of medical school did I finally find a treatment team who knew how to help me (not only with my anorexia and bulimia, but the alcoholism, trauma, depression and anxiety that went along with it). By the time I found this help, I had resigned myself to dying of my bulimia, fairly certain that I was a lost cause and beyond help.

Now fast forward 14 years into the future. I’m standing on a stage at BU, first and foremost as a woman recovered from her eating disorder, speaking to college students, advocates and professionals about hope and recovery. Also, I am standing up there as a wife, married to the love of my life, step-mom (or step-monster as my kids like to joke), daughter, sister, friend, doctor, and CEO/Medical Director of the best residential treatment center in the world for women.

If someone would have told me 14 years ago that this day would happen, I would have tried to have them committed!

Unbelievable grace and abundant gifts have come my way in recovery.

Next week, I will blog about the biggest one yet!

 

 

Celebrate International No Diet Day May 6, 2014

International No Diet Day is celebrated each year by those who recognize the absurdity, futility and dangers of diets.

At Timberline Knolls, we applaud those who created this day. Diets exist for one reason and one reason only: to make money. This is a multi-billion dollar industry. Although diets are supposedly equal opportunity in nature, they are definitely targeted toward women and designed to capitalize on female insecurities linked with the culturally held delusion that thin is beautiful, powerful, loveable and ideal.

Diets hurt women because they discover that they can’t starve themselves consistently; they take that to mean that they are lazy, stupid, fat or just plain bad people. Those who diet and actually lose weight may initially feel good, in control, even beautiful. This is a temporary state (real beauty is an INSIDE job!). When they inevitably fall off the wagon and possibly gain more weight from the point that they started, they feel terrible, depressed, and even suicidal.

Diets are usually rife with strict rules, rigid do’s and don’ts, restrictive amounts and types of foods; they are often short lived, and frequently associated with rebound bingeing, weight gain and the development of eating disorders. Conversely, mindful eating teaches people to experience a wide variety of food choices, flexibility in amount and types of food, pleasure in the process of eating, attention to body hunger/satiety cues, freedom from the good/bad food dichotomy, and an absence of morality in attitudes towards eating.

Unfortunately, our culture continues to buy into the false belief that thinness translates into power, beauty and success. What’s more, the body type most women strive to emulate is far from their natural, beautiful, God-given body type.

International No Diet Day is a good start. Let’s work toward a time that we collectively celebrate No Diet Year, hopefully followed in quick succession by No Diets Forever! This “new normal” must be sprinkled with a healthy serving of weight diversity, intuitive eating, and health at every size!

 

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