Author: Shernide Delva
These are just a few of the incentives doctors have received from prescription opioid companies. Did these goodies get you your last opioid prescription?
Could incentives be responsible for our current opioid epidemic?
That’s exactly what researchers set out to understand.
A recent report confirmed what many have suspected: doctors are receiving incentives from major opioid makers. In fact, one out of every 12 U.S doctors gets money, lunch or something else of value from companies that make opioid drugs, the study concluded.
Furthermore, companies are spending more time and effort marketing opioids to doctors than they are other less addictive painkillers. These finding will help understand why doctors have played such a major role in the opioid addiction crisis.
“A large proportion of physicians received payments — one in 12 physicians overall,” said Dr. Scott Hadland of the Boston Medical Center. “Tens of millions of dollars were transferred for marketing purposes for opioids.”
Dr. Hadland and colleagues went through databases from the Centers for Medicare and Medicaid Services, the federal government office that oversees public health insurance.
The 2010 Affordable Care Act includes the Physicians Payments Sunshine Act. This act required medical product makers to report any offerings or goodies made to doctors or to teaching hospitals. However, incentives are often disguised as something else.
“In some cases, they are money provided directly to physicians — for example, the speaking fees, the consultant fees and the honoraria. In other cases it is reimbursement for things like travel,” Hadland said.
On average, doctors get a single “payment,” usually a mean worth of $15 about once a year. Still, there are a select few doctors that are reaping the most benefits.
“The top 1 percent of physicians (681 of them) received 82.5 percent of total payments in dollars,” the team wrote in their report, published in the American Journal of Public Health.
These incentives could influence doctors to prescribe opioids to their patients:
“One of the main drivers of the epidemic has been the vast overprescribing of prescription pain medications,” the study notes.
Between 2013 and 2015, the team found 375,266 payments totaling 26 million distributed to more than 68,000 doctors.
While larger fees mostly accounted for speaker fees, more leisurely incentives like food and drink accounted for 94 percent of the payments.
“I do think the practice is exceedingly common. Increasingly, medical schools are restricting the ability of pharma companies to come to speak to medical students and even faculty,” Hadland said.
With all this said, do small incentives really make a difference? After all, can a doctor really be bought for the price of a boxed lunch?
The research indicates that, yes, these little goodies do influence prescribing. Last year, a study revealed that physicians who accepted even one meal by a drug company were more likely to prescribe a name-brand drug to patients later.
This is not the first time investigations were conducted on possible incentives. After earlier controversies and studies, the Pharmaceutical Research and Manufacturers of America issued a voluntary code of conduct to curb the once widespread practice of handing out free mugs, prescription pads, and other swag covered in drug brand names.
Some cities and states especially hit by the opioid abuse epidemic have even sued drug makers saying their practices have helped fuel the problem. The CDC states doctors have contributed to the addiction crisis by prescribing opioids to too many patients. These prescriptions are often prescribed at high doses for too long which only increases the vulnerability to addiction.
The result is deadly.
There were more than 30,000 fatalities in the United States in 2015, the federal government said.
“I think that first and foremost we have known that one of the main drivers of the epidemic has been the vast overprescribing of prescription pain medications,” said Michael Botticelli, former director of the White House Office of National Drug Control Policy, and now executive director of the Grayken Center for Addiction Medicine at the Boston Medical Center.
According to Botticelli, the answer is independent education, free of the need to promote a specific product.
“At the federal and state level (we may need to) move toward mandatory prescriber education to counteract industry’s influence over prescribing behavior,” he said. “Clearly, guidelines are not enough.”
For a long time, prescribing opioids was one of the first responses to pain management. Now other alternatives are being promoted such as pain management devices and holistic alternatives.
Botticelli agrees that while pain is a major problem, the answer is not more opioids.
“Yes, we want to make sure people’s pain is appropriately treated, but we know that longer and higher doses have significantly added to the addiction problem that we have in the United States,” he continued.
What are your thoughts? Did you know about these incentives? More studies are coming out revealing the back story to what led to the prescription opioid epidemic.
Opioid addiction has become a public health crisis. Now, more than ever is the time to seek treatment. Recovery is possible. You do not have to feel out of control. There is a solution. If you are struggling with substance abuse, call now. Do not wait.
CALL NOW 1-800-951-6135
Author: Shernide Delva
Overconfidence in Recovery:
Confidence is supposed to be an excellent quality. We are always told to believe in ourselves in every endeavor we pursue. Whether it is a sport or a school exam, having confidence is touted as the key to success. However, when it comes to addiction recovery, can too much confidence actually become harmful?
Overconfidence Can Lead to Relapse:
The reality is too much confidence is not great in recovery. While it is great to have confidence in your program, it is important to stay humble. The emotions that arise from overconfidence can block underlying issues. Having an overconfident mindset can hinder your recovery process. It is important to make recovery a priority regardless of how much time you have.
Why Overconfidence Encourages Relapse:
- Distorted Self-Image: A major part of recovery is staying humble. Overconfidence makes someone believe that they are not as bad as newcomers. They may start to feel they no longer need their program and start to ponder if they are an addict at all. Overconfidence encourages the belief that it is not a huge deal to have a drink or use casually, which is far from true for an addict.
- Irrational Thoughts: Overconfidence can lead an addict to believe they deserve certain rewards in conjunction to their success. They might feel they are worthy of a celebration. They quickly convince themselves that one drink is not going to hurt them because they are now “in control” of their addiction. This is risky behavior and can lead someone down a slippery slope.
- Complacent Behavior: This is when an addict starts to believe that their addiction is not nearly as bad as they once thought. They start believing that they can now live normally due to the length of time they have been sober. They think they are cured so they slowly stop going to meetings and stop thinking of themselves as an addict. This leads to new addiction or a relapse.
Signs of Overconfidence Include:
- Rejecting suggestions from others
- Seeking immediate results
- Belief in having all the answers
- Always seeing your situation as unique from everyone else
- Feeling that you deserve preferential treatment
- Feeling “healed” or “in control”
- Always wanting to lead instead of listening
It is crucial to understand that addiction will not simply disappear. Regardless of how long you have been sober, addiction can always creep up again. Addiction is not a curable disease; it is a manageable disease that does not have room for overconfidence.
How We Become Too Confident:
Overconfidence may be a trait acquired in recovery, or it can be a trait a person struggled with before sobriety. In fact, most addicts battle overconfidence their entire life. For example, those times you tried to use and thought no one would notice.
Sadly, this behavior can persist after recovery even after hitting rock bottom. Even those with no history of overconfidence can start to become overzealous in their recovery program. They start to believe that they are above the rest of their friends and family because of the work they have done in their recovery.
Consequences of Overconfidence:
When you act too confident, you hurt yourself and others. You hurt others who are still learning to trust the person you have become. You hurt yourself because overconfidence increases the vulnerability to a relapse. It is important to remember that recovery is something that takes effort every single day. Regardless of how much time you have, stay humble in your program. It is better to be safe than sorry.
Remember to support others struggling, and stay focused on your recovery. Overconfidence is not a quality anyone should strive for. Instead, focus on staying sober every single day. If you are struggling to stay sober, or are currently having issues with substance abuse. Please reach out. We want to help you get back on track.
CALL NOW 1-800-951-6135
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Author: Shernide Delva
The opioid epidemic continues to worsen year after year. In 2015, painkillers and heroin killed more than 33,000 people, according to the CDC. About half of those overdoses involved prescription pain medication.
New policies and laws introduced in recent years aim to prevent the number of opioid prescriptions distributed. However, these stricter policies come riddled with negative consequences. For example, chronic pain sufferers are finding it more and more difficult to manage their pain with opioids now that some of these laws have been implemented.
An article in The Tennessean references a woman named Bridget Rewick. Rewick has experienced pain for all of her adult life. At 56 years old, she is on disability. She does not work and worries about the strain on her body from being out. Pain swells through her body causing her to need a cane to walk.
She has avascular necrosis, which means her bone tissues are dying faster than her body can repair it. Rewick uses opioid painkillers to manage her pain. However, these days, when she goes to the pharmacist, she says she gets looks. She admits she feels judged by the increasingly conscious medical community.
“I am almost afraid to go to the doctor sometimes to say I have pain,” Rewick says. “Because I don’t want be seen as a pill seeker.”
Unfortunately for Rewick, she has more than judgment to worry about. The recent federal crackdowns on drug abuse have resulted in stricter guidelines on the use of opioids to address chronic pain.
Opioid Limits State by State
In Tennessee, there is now a limit set by the Department of Health on how many daily doses of opioids doctors may prescribe. New guidelines spell out protocols for giving drugs to women of child-bearing age and establish certification requirements for pain medicine specialist.
Tennessee is not the only state seeing these types of policies. Across the country, new legislatures limit the amount of opioids and range of opioids that can be prescribed. Therefore, chronic pain patients are finding it increasingly difficult to manage their pain, without having to overcome assumptions and red tape.
In fact, some doctors have opted to stop prescribing opioids completely.
This leaves those with legitimate chronic pain with fewer places to turn to. While most chronic pain patients agree that it is absolutely necessary to tackle opioid addiction issues, they still believe there are legitimate pain sufferers who struggle to find relief.
“This epidemic has destroyed people’s lives, and I think the motivation (to regulate) is appropriate,” Rewick says. “But they don’t understand the ramifications of how pain affects people every day. … I am not expecting to be completely without pain, but I have the right to have quality of life.”
In the United States, at least 100 million adults suffer from common chronic pain conditions. Chronic pain is defined as pain lasting longer than 90 days. Chronic pain can range from disease to injury. Sometimes the cause of chronic pain is unknown.
Sadly, chronic pain reduces quality of life and productivity. It disturbs sleep and can lead to anxiety and depression. Chronic pain is the leading cause of long-term disability.
Building Relationships and Trust
Furthermore, it is difficult for doctors to know if a patient is authentic. No one can look a patient and know for sure if their claim of pain is insecure.
Dr. John Guenst, an internal medicine doctor with Saint Thomas Medical Group, sees chronic pain patients all the time. He believes the relationship is the most important factor.
“You have to listen to their story; you have to examine them, you have to start from scratch without your bias and turn over every stone that is reasonable,” he said. “You are giving patients the benefit of the doubt.”
Guenst said his opioid prescription rate “is very low compared to my peers, but I am not afraid to use them.”
Clinics Say No to Opioid Prescriptions?
Still, some medical professionals have decided not to prescribe all-together. Last year, Tennova, one of the largest health systems in Tennessee, decided to no longer prescribe long-term opioid pain medications to patients at two pain management clinics.
This was a response to recent CDC guidelines. Although the guidelines set by the CDC are voluntary, many doctors around the country are adopting them and are weaning patients off opioids or choosing not to prescribe them at all.
These sudden changes come with good intentions; however, it remains a tricky manner. Untreated chronic pain is connected to depression, mental illness, financial problems, and even further substance abuse.
What is the solution to this? Time will tell. However, it is clear this is a serious problem with an even more complicated solution. If you are currently struggling with substance abuse, please call now. We want to help.
CALL NOW 1-800-951-6135
Author: Shernide Delva
The controversy surrounding the Megyn Kelly Sunday Night show continues. The first investigation piece on drug addiction focused on issues plaguing the South Florida recovery community.
Now, Megyn Kelly returns to cover addiction treatment, and this time her show is highlighting another polarizing subject: harm reduction programs. On Sunday night, Megyn Kelly’s shows featured The Sinclair Method. The Sinclair Method is a harm reduction treatment program that allows patients who struggle with alcohol use disorder to continue drinking.
The segment introduces viewers to Marisa, a 25-year-old binge drinker. The crew follows Marisa around for day one of her introduction to The Sinclair Method.
First Marisa sees a doctor, who gives her a prescription. Shortly after taking the prescription, she has a drink. According to Marisa, her intense cravings to binge disappears.
“I feel like I could have another drink or not have another drink and be totally fine,” she tells the camera.
The apparent miracle pill is naltrexone, a commonly used opioid antagonist typically used to treat heroin addiction. However, under The Sinclair Method, the drug is used to treat alcoholism.
“The drug blocks pleasure receptors in the brain―a buzzkill,” Melvin explains in a voiceover. “And when combined with psychotherapy sessions, the theory goes, eventually the cravings go away.”
Essentially, the idea behind the program is patients take naltrexone before drinking and over time, the desire to excessively drink diminishes. For Marisa, the unorthodox treatment seems to have worked. Only three months after starting the treatment, she told NBC she had lost her drive to drink.
Still, this approach is far from traditional. The 12-step model of addiction promotes abstinence only treatment. The show highlighted an interview with Hazelden Betty Ford’s executive director, Chris Yadron.
“The 12 steps are crucial because it’s a spiritual program of recovery,” he told Melvin.
Dr. Mark Willenbring who once ran the NIH’s alcohol recovery research defended The Sinclair Method, added that 12-step approaches do not rely on modern science.
“We don’t send someone with diabetes to a spa for a month, teach them diet and exercise and then say, ‘Go to support groups, but don’t take insulin.’ I mean, that’s the absurdity of what we’re doing now,” he said. “We’re still providing the same pseudo treatment that we provided in 1950. And 85% of rehabs in the country are 12-step rehabs. People don’t have any choice.”
The tension between abstinence-based and harm-reduction approaches to treatment has created a long-standing controversy in the recovery community. Throughout the segment, tweets were displayed from people who were for and against harm reduction strategies.
“This is very troublesome to see that some doctors are giving people with a thinking disease a “magic” pill,” tweeted one user.
Others felt the treatment option provides another solution than the standard abstinence-only approach. We’ve seen harm reduction programs like Moderation Management receive massive criticism, specifically after the founder, Audrey Kishline, killed a 12-year old girl and her father while driving in an alcoholic blackout.
Overall, programs like these remain controversial and risky. It is best to get treatment to address the underlying issues behind your addiction. If you are struggling with mental illness or addiction, please call now.
CALL NOW 1-800-951-6135
Author: Shernide Delva
Each year, more than 300 million people are affected by depression. Depression is a debilitating illness that is difficult to treat.
What if there was one gene that played a key role in depression? Furthermore, what if that gene could be identified and even manipulated to actually treat depression?
Shockingly, this could all be a possibility. Researchers have discovered a gene that may play a central role in depression. This gene either protects us from stress or triggers a downward spiral depending on its level of activity.
The study was conducted by researchers at the University of Maryland School of Medicine (UM SOM). It was the first to pinpoint in detail how one particular gene, known as Slc6a15, is a key role in depression. The study found the same link in both animals and humans.
“This study really shines a light on how levels of this gene in these neurons affects mood,” said the senior author of the study, Mary Kay Lobo, an assistant professor in the Department of Anatomy and Neurobiology.
“It suggests that people with altered levels of this gene in certain brain regions may have a much higher risk for depression and other emotional disorders related to stress.”
Potential Treatment Solution?
A study like this could help with treating depression in the future, and that help is desperately needed.
Nearly 800,000 people die annually from suicide. It is the second leading cause of death among people between the ages of 15 to 29. Beyond that, depression destroys the quality of life for tens of millions of patients, and their families suffer too. Although environmental factors play a significant role in many cases of depression, genetics are equally as important.
This is not the first time this gene was studied. Back in 2006, Dr. Lobo and her colleagues found that the Slc6a15 gene was common in specific neurons in the brain. They recently demonstrated that these neurons were important in depression.
Connection to Anhedonia
Her lab decided to investigate the specific role these neurons have in depression. In the latest study, she and her team focused on a particular area of the brain called the nucleus accumbens. This region is crucial in the brain’s “reward circuit.”
When you eat a delicious meal or participate in any kind of enjoyable experience, neurons in the nucleus accumbens are activated letting you know the experience is enjoyable. When a person is depressed, it ‘s hard to experience any kind of enjoyment, a condition known as anhedonia.
Researchers discovered subset neurons in the nucleus accumbens called D2 neurons. These neurons respond to the neurotransmitter dopamine, which plays a central role in the reward circuit.
Mainly, these subset neurons responded to feel good chemicals like dopamine which is lacking in those with depression. Next, they studied mice susceptible to depression. These mice tended to withdraw from activities and exhibit behavior indicating depression such as social withdrawal and lack of interest in the food they would normally enjoy.
Dr. Lobo found that when the mice were subject to social stress, the levels of the Slc6a15 gene in the D2 neurons of the nucleus accumbens was noticeably reduced. The researchers also studied mice in which the gene had been reduced in D2 neurons. When those mice were subjected to stress, they also exhibited signs of depression. Furthermore, when researchers increased the levels of Slc6a15 levels in D2 neurons, the mice showed a resilient response to stress.
So what does this mean?
Next, Dr. Lobo looked at brains of humans who had a history of major depression and who had committed suicide. In the same region of the brain as the mice, the gene Slc6a15 was reduced. This indicates that the link between gene and behavior is found in both humans and mice.
In the future, manipulating these genes could help improve depression. While it is still unclear how Slc6a15 operates in the brain, Dr. Lobo states it may work by altering neurotransmitter levels in the brain.
This research could lead to therapies that focus specifically on this particular gene to treat depression. If you are struggling with substance abuse or mental illness, call now. Do not wait.
CALL NOW 1-800-951-6135