Posts

November 27, 2014

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12:36 AM | Buprenorphine Diversion: Beyond a Superficial Understanding
First Posted 11/19/2013 In ‘Addiction Treatment with a Dark Side’, Deborah Sontag of the New York Times shared her observations of the clinical use of buprenorphine for treating opioid dependence, warts and all.  Readers of the Talk Zone know my bias—that buprenorphine/Suboxone is one of the only effective treatments for opioid dependence, and many patients […]

November 26, 2014

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4:06 PM | Treatment Resistance in Eating Disorders
Clinicians treating patients with eating disorders find the challenge great with many treatment-resistant cases.To some extent, this is true of any clinical disorder. Outpatient treatment rolls and inpatient samples are over-represented by those failing to respond to initial interventions.A medical example is helpful here. Endocrinologists specializing in diabetes see more complicated cases where glucose control is difficult and diabetic complications are common.Diabetics with easy glucose […]
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12:40 AM | Killing the Suboxone Gift Horse with Naltrexone
First Posted 11/14/2013 I received an email update today with important news from the world of psychiatry and addiction.  The email highlighted a study from the October issue of Jama Psychiatry, entitled ‘A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers’.  The study compared relapse rates in opioid addicts who were tapered […]

November 24, 2014

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7:12 PM | 5 Sneaky Signs of Depression You May Be Overlooking
Things have changed a lot in the past 30 years when it comes to our ideas about depression. In the 1980s and even the 1990s, people often still saw it as a moral weakness, a sign of being “crazy,” or as something to be dismissed completely. Today most people not only know someone who has […]
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6:47 PM | We Are Capable Of Far More Than The Limitations Most People Accept
Do you have bipolar disorder or know somebody who does? What would change if you could learn how to turn depression and mania on and off whenever you wanted to? The entire way we look at bipolar disorder would change in profound ways. Some of them are beyond most people’s imagination, but a simple illustration […]
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6:15 PM | Pregnant Taking Suboxone: Should Social Services be Involved?
First Posted 11/4/2013 I recently saw a new patient who described treating her own opioid dependence with diverted Suboxone.  She sheepishly described reading everything she could find about buprenorphine and meticulously using half of her friend’s medication to avoid other opioids, without fail, for four years. She would likely be treating herself now, if she […]
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11:45 AM | How to Deal with Invasive Thoughts
I’m no stranger to nasty thoughts. I recognize when they’re present so innately that it’s safe to say it almost hurts. In my almost nine years of living with schizophrenia I’ve had to battle my fair share of these thoughts and I’ve gotten so good at it that I can almost see them coming from […]
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11:30 AM | Cracked Science Video 4: Irreproducible
We often hear the science corrects itself in the long run, but how efficient is this mechanism? Jonathan Jarry reports that reproducibility in the scientific literature is not always a given. (Des sous-titres en français seront bientôt disponibles!) Just so you are not too demoralized, the landscape may be changing: http://www.nature.com/news/journals-u… http://www.nature.com/news/metascienc… Continue reading →

November 21, 2014

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3:00 AM | DA Asks ‘Why Still On Suboxone?’
First Posted 10/13/2013 A person in my practice was stable on Suboxone/buprenorphine for several years, until he developed a painful injury.   During the time the injury was treated, the person experienced significant pain.  I worked with his surgeon to provide adequate pain relief, which for patients on buprenorphine or Suboxone  consists of a high dose […]
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1:45 AM | Suboxone Detox is a Sucker’s Bet
First Posted 10/6/2013 I attended the US Psychiatric and Mental Health Congress meeting last week and actually attended the meetings (the event was held in Las Vegas), but I was disappointed by the absence of lectures about addiction.  There are other mental health groups geared more toward addiction, but one would think that psychiatry would maintain […]

November 19, 2014

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12:41 AM | Suboxone Not on the Affordable Care Act FAQ
First Posted 9/15/2013 I’ve written the first two parts of a three-part column about unintended consequences.  Part one described why discounts demanded from insurers for front-line services (e.g. office visits) create challenges for independent primary care practices that don’t have other sources of revenue, particularly revenue from procedures.  Part two explained why physicians employed by […]

November 17, 2014

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2:10 AM | Chipping Suboxone
First Published 8/31/2013 One reply to my last post said I go ‘on and on’ about things that could be said with fewer words.  I asked the person to send me his/her version, and I hope he does—not to prove anything, but because I appreciate the chance to learn.  He wrote that his problem is […]

November 15, 2014

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7:45 PM | Overcoming 3 Common Obstacles in Therapy
If you’re new to therapy, you may not know what to expect. To help you make the most of the process, we asked seasoned clinical psychologist Ryan Howes, Ph.D, to share the three biggest obstacles in therapy along with how to overcome each one. 1. Shame Howes believes shame is the most debilitating obstacle to […]

November 13, 2014

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12:37 AM | Suboxone Abuse Pt I
First Posted 8/11/2013 We’ve all read articles about the epidemic of opioid dependence during the past ten years.  We’ve heard the concern over pain medications being overly-prescribed by some physicians.  Some of us older docs even remember the claims, by the Joint Commission on Hospital Accreditation and other medical watchdogs, that physicians were undertreating pain and […]

November 12, 2014

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4:58 AM | The Ibogaine Cure
First Posted 7/28/2013 Ibogaine, a drug long-rumored to treat opioid withdrawal, has become a hot topic for those taking buprenorphine.  Ibogaine is a complex molecule that comes from a group of plants that are known, in West Central Africa, as Iboga.  In native African culture the drug is used to induce psychedelic states that are part […]

November 11, 2014

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4:55 PM | Recovering from an Eating Disorder in a Society that Loves Fat Shaming (and Dieting)
Is ED recovery easier when your body is “normative or stereotypically desirable”? The anon asking the question implied that recovery could be more difficult because “an obese person … will never stop hearing hearing extremely triggering stuff about their body type.” Anon asked, “Have there been any studies on this?” Andrea tackled this question in her last post (it might be helpful to read it first if you […]

Berner, L.A., Shaw, J.A., Witt, A.A. & Lowe, M.R. (2013). The relation of weight suppression and body mass index to symptomatology and treatment response in anorexia nervosa., Journal of Abnormal Psychology, 122 (3) 694-708. PMID: http://www.ncbi.nlm.nih.gov/pubmed/24016010

Bulik, C.M., Marcus, M.D., Zerwas, S., Levine, M.D. & La Via, M. (2012). The changing "weightscape" of bulimia nervosa., The American Journal of Psychiatry, 169 (10) 1031-6. PMID: http://www.ncbi.nlm.nih.gov/pubmed/23032383

Lebow, J., Sim, L.A. & Kransdorf, L.N. (2014). Prevalence of a History of Overweight and Obesity in Adolescents With Restrictive Eating Disorders., The Journal of Adolescent Health, PMID: http://www.ncbi.nlm.nih.gov/pubmed/25049202

McKisack, C. & Waller, G. (1997). Factors influencing the of group psychotherapy for bulimia nervosa., The International Journal of Eating Disorders, 22 (1) 1-13. PMID: http://www.ncbi.nlm.nih.gov/pubmed/9140730

Sim, L., Lebow, J. & Billings, M. (2013). Eating Disorders in Adolescents With a History of Obesity, PEDIATRICS, 132 (4) DOI: 10.1542/peds.2012-3940

Wildes, J.E. & Marcus, M.D. (2012). Weight suppression as a predictor of weight gain and response to intensive behavioral treatment in patients with anorexia nervosa., Behaviour Research and Therapy, 50 (4) 266-74. PMID: http://www.ncbi.nlm.nih.gov/pubmed/22398152

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November 08, 2014

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2:49 PM | Treating Opioid Dependence Harder in Young People
Originally Posted 5/11/2013 The forces of nature appear intent on reversing mankind’s progress toward better health.   An example is the ever-increasing resistance of bacteria to antibiotics.  A timeline of the existence of humans and bacteria shows that bacteria have been around for a very long time— much longer than mammals, and much, much longer than humans.  In fact by the […]
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1:35 AM | Comedy Quiz Show on Pseudoscience in Montreal
If you like this blog and would like to see me host a comedy quiz show on pseudoscience, come to Pub St-Paul on Sunday, November 16 at 5PM for a fun evening of comedy, reason, and alcohol! Andrew Cody, from Within Reason, will be a panelist and will be joined by Montreal-based stand-up comedians Darren Henwood, … Continue reading →

November 07, 2014

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9:32 PM | Who Pays For Health Care? (Hint: We ALL Do)
First Published 4/20/2013 I realize that practice patterns differ between practices, even those treating the same condition (opioid dependence) with the same medication (buprenorphine).  Differing patient characteristics result in different regional standards of care, for example.  And some areas have access to services (e.g. group treatments or laboratory testing) that may not be as available […]
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4:50 PM | Eating Disorders: Weekend Reading Links
I am focusing on recent research in eating disorders this month on Brain Posts.Here are some of the research abstracts I will be reviewing for upcoming posts.Clicking on the title will take you to the PubMed abstract and also to a link for the free full-text manuscript.Higher parental education as a risk factor for eating disordersThis study of the Swedish population examined the effect education and social class on risk for eating disorders. Individuals diagnosed with an eating disorder were […]

November 06, 2014

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2:31 AM | A Letter from Drug Court
I recently received a note from an area drug court, asking for help tapering one of my patients off buprenorphine. The patient came to me 4 years ago after being treated for a congenital pain condition.  He had been treated with 150 mg of methadone per day, becoming dependent on the medication after taking it […]

November 05, 2014

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12:17 AM | Should Addiction Treatment Include ‘Shame’?
Originally Posted 3/23/2013 I generally write positive articles about the use of buprenorphine for treating opioid dependence, and my articles have been reflective of my attitude toward the medication. The field of psychiatry encompasses more conditions than it does effective treatments for those conditions, and my initial experiences treating people with buprenorphine were strikingly positive. […]

November 04, 2014

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4:30 PM | Reasons Why Your Teen Is Drinking
Reasons Why Your Teen Is Drinking [Article via Psychology Today. Click above for full post] Alcohol and substance use is widespread among adolescents with recent figures finding that 71% of students have tried alcohol and 54% have reported being drunk... Read More ›

November 03, 2014

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8:24 PM | An Interview with the ATTC
For those who missed it, I recently provided some opinions about buprenorphine treatment for The Bridge, a journal produced by the Addiction Technology Transfer Center Network.  The discussion was published in The Bridge Volume 4, Issue 3, and is copied below. Question 1. The introduction to buprenorphine treatment in the U.S. has occurred through a […]

November 02, 2014

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2:30 AM | Suboxone as Problem, Suboxone as Solution
Originally Posted 3/14/2013 A local District Attorney wrote to me last week to express his concern about the increased diversion of buprenorphine.  I often sense an undercurrent of tension when I cross paths with attorneys, aware of the different attitudes that we hold that arise from our different roles in society. The DA wrote about the […]

October 31, 2014

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9:51 PM | Boo!
Happy Halloween everyone! Tonight, all over the world, ghoulish graveyards, macabre monsters and spooky skeletons are going to scare all children and adults alike, sending them screaming and running down the road. All but SM. SM was the name given to a woman who was studied by scientists, in 2010, when they discovered that she […]
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3:45 PM | How Mindful Analogies Can Help Kids in Therapy
School-aged children (6 to 11 years) often wonder why they are sitting in your office for therapy. Many thoughts and emotions are associated with coming to a mental health provider’s office, including curiosity, anxiety and even fear. In order to help kids deal with whatever may be bringing them to therapy, it’s important that they […]

October 30, 2014

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10:31 PM | Suboxone Makes Me Fat and Boring and Stupid
Originally posted 3/6/2013 A late post tonight, since my new exercise program has pushed my blogging back by an hour or so each night.  My suspicions about exercise were correct, by the way; it is much easier to suggest exercise to other people than it is to actually exercise.  I’ve been at it since the […]

October 29, 2014

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4:43 PM | Peer-Directed Education For Bipolar Disorder The Focus Of A New Tufts University Study
The Mood Disorders Program at Tufts University Medical Center has just completed a pilot study of the Bipolar IN Order peer-directed online education program. They found it to be “the first psychosocial intervention that has improved awareness of mood symptoms (insight) in bipolar illness… If confirmed, these data would indicate that this peer-based psycho-educational intervention […]
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