For the last 6 months I’ve been working on a book directed toward the army of Masters level behavioral health clinicians who will be trained to work in primary care. As part of the Affordable Care Act, the federal government has made a commitment to integrate behavioral health with physical medicine. In line with learning as much as I can, I’ve been attending every symposium and workshop. In May, I attended a workshop sponsored by SAMSHA on using technology to enhance clinical care.
Understandably, the workshop presenters were proud of their web sites informing consumers of available treatments. Unfortunately, the available treatments for depression were mostly drugs. This did not surprise me. What did surprise me was the newly developed website on options for those who are addicted to opiates. The SAMSHA website was a better drug advertisement for buprenorphine, methadone, and naloxone than even the pharmaceutical companies could have developed. Under the guise of consumer choice, SAMSHA is encouraging substitute opiate receptor stimulating drugs (buprenorphine and methadone) as a first option. They think people should be given this option, even before they try sobriety.
As everyone knows, the rates of opiate addiction are sky high. As acknowledged by a May 2014 New England Journal of Medicine article written by Tom Frieden, Director of the CDC, and Nora Volkow, head of the NIDA, (along with several others) most current opiate addiction is attributable to physician-induced drug dependence. When the cost of oxycontin becomes excessive, people switch to street heroin. The NEJ article extoled the virtues of the “evidence-based” switch to methadone or burprenorphine as a form of recovery.
I should clarify my objections to the federal government’s promotion of opiate receptor stimulating drugs. I’m pretty much of a civil libertarian on the issue of drugs. Prior to the first federal law against opiates (the Harrison Act of 1914), opiates were not much of a problem in this country. The Harrison Act was passed in order to ingratiate the United States to China, where opiates were a problem. I agree with Michele Alexander’s viewpoint as expressed in “The New Jim Crow”: American drug laws have been an excuse to imprison African American men and rob them of their civil liberties. I’m against laws making drugs illegal, but I am not for the federal government becoming the drug pusher.
If the federal government decides that opiate addiction is ok, as they seem to have conceded, shouldn’t the question be “what is the cheapest and the safest opiate?” In Europe, heroin is an option right along with buprenorphine and methadone. All of the opiate receptor stimulating drugs can induce lethal overdoses. As drugs go, other than OD potential, opiate agonist drugs are relatively benign (provided one does not use a dirty needle). However, methadone is arguably worse than heroin. Methadone is associated with cardiac arrhythmias and need for a pacemaker. Heroin does not induce this problem. The withdrawal from methadone is more severe and protracted than from heroin. As noted before, heroin is cheaper, which ought to be a consideration for Medicare and Medicaid. So why not just legalize heroin and call it recovery?
Physicians have saddled America with addiction to antidepressants, antipsychotics, and benzodiazpines. It seems to me that the “back-door” legalization of opiates under the guise of “treatment” ought to at least be debated out in the open.
By the way, if anyone is willing to share a short description of his/her withdrawal from an antidepressant or antipsychotic to be printed in my book, please e-mail me at [email protected]. Thanks.
Very well put. I take the issue even further. The chemical included in Ritalin is like cocaine. Adderall is amphetamine. If you take these without so called “medical supervision” you can be jailed. However our tax dollars not only promote their usage but they subsidize that hundreds of thousands, maybe millions, are put on them through medicaid.
On the issue of drugs I am also civil libertarian but with a caveat. I defend the free circulation of drugs but that also businesses and governments be free to discriminate against those who use them. Freedom of people to get high but also freedom of people NOT to associate with those who get high. Then, hopefully, everybody is happy with the consequences of their own choices.
One of the most pernicious effects of psychiatry is that it gives people excuses for their misbehavior. That needs to be addressed as well.
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There was an awesome episode on South Park on that:
http://en.wikipedia.org/wiki/Bloody_Mary_%28South_Park%29
Btw, I really don’t understand the idea of substituting one addictive and potentially harmful substance with another. This is what all these “methadones” and other drugs basically do. They hook you up on a legal drug called medicine instead of legal drug called alcohol/nicotine or illegal drug. The difference is in legal classification not in science.
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I pretty much agree. I think however, each drug should be considered on its own merits before deciding whether businesses can discriminate. About 20 years ago, the New York Transit Authority fired an African American train operator who was a methadone maintenance patient. The case was argued as a class action basis. Since the majority of heroin addicts in New York were African American it was argued that discriminating against methadone patients was racial discrimination. I think they lost the case, but Enoch Gordis, who had Nora Volkow’s job, wrote an impassioned editorial about discriminating against those with the disease of addiction. If taken in low dose, opiates are not performance impairing-as far as I know.
In the US, we don’t discriminate against people taking meds for epilepsy–which are impairing. Although I don’t know, whether persons with epilepsy can fly for Delta. In terms of confusion on how to regard drugs, a prof from the Philosophy of Neuroscience department at Georgia State gave a symposium advocating that people in high performance jobs (pilots, surgeons, etc.) should be required to take performance enhancing stimulants.
It’s going to take a long time to sort it out. In the meantime, I’m sure we’ll have even more chemical interventions to debate.
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“It strikes me the “back-door” legalization of opioids under the guise of “treatment” ought at least be debated out in the open.” I totally agree. What is going on in this country?
It strikes me “the government” and / or doctors are basically just turning the mainstream medical community into street drug pushers (actually worse, since they’re forcing, defrauding, and coercing patients to take drugs chemically identical to street drugs, while misinforming patients as to what the drugs actually are, and how addictive they are).
How embarrassing to confess, I used to believe doctors were ethical and respectable. But I was not raised to believe people who deal street drugs are ethical or respectable, even if they rename the street drugs and the dealers have “alphabet soup” after their name.
And, truly, of what benefit are doctors, if the patients can not trust them to offer safe, non-addictive, and effective treatments, and have to research the adverse drug effects themselves because the doctors are being misinformed as to the ADRs and withdrawal effects of their drugs? It strikes me mainstream medicine is becoming corrupted to the point they will, in time at least, lose all credibility.
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I do not think doctors go into medicine to bad things. They just get misinforI don’t think doctors start out wanting to do bad things. They get misinformed by teachers who are often the highly paid (by the pharmaceutical houses) key opinion leaders. I’m delighted that at Pharmed Out at Georgetown Medical School, the med students are protesting. Check it out, their web site is good.
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Jill–Be that as it may about these many hearts of gold, plenty of American students go into the helping profession looking hunrgily at the enticements of authority over those who come under their supervision hoping for unbiased help, and unable to get it. The ability to push people around with your medical credentials is certainly built into the roll out to attract new blood.
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travailler-vous
And it ain’t just psychiatrists that go into medicine to be able to push people around. There are a lot of “doctors” in the other specialties that do a lot of pushing people around too. I had a GP call me noncompliant in the first five minutes of my first visit with him, simply because I stated that I was not going to take a staten, which he was heavily pushing in my direction. He is no longer my GP. One visit with him was more than enough for me. Any doctor that takes care of me better get ready to collaborate with me rather then commanding me as to what I’ll do.
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That is true. The paternalistic attitude in doctors has been a plague in medicine since at least XIXth century with a detriment to the patients. Even now, there are many cases like that outside psychiatry, especially in gynecology, which is targeting another historically disenfranchised group – women. There is a case for it going now in Poland, where there are doctors who refuse not only to perform legal abortions (which are legal only in case of rape or incest, severe congenital illness of a fetus or danger to the health and life of a mother) but even to send women for prenatal examinations because “they may want to have an abortion if the baby is sick”. There were cases of a woman being forced to give birth to a baby without brain and with severely malformed skull and right now some people want a raped 11 year old to carry a baby to term. I’m not even mentioning countless other examples of not prescribing contraception to avoid women fucking around (because that’s what we do when no paternal figure is there to guard our chastity) or traumatising women during labour.
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The is a loophole in our mental healto act here in Australia. When you are referred for an examination by a psychiatrist you lose you right to liberty, but not your right to consent. A limbo if yout like.
When i was on referral the nurse wanted me to take medication that caused me stomach problems many years before. I refused and was assertive about it.
I was surrounded by 12 people who(whosecurity guards and nurses) and a doctor held up a large needle saying “I’m the boss around here”. Fearing that if i did not take the oral medication i would be restrained and injected with an unknown substance i took the tablets.
This is what’s called consent in our hospitals.
I wondered how it would be viewed if i had 12 bikers surround my unwilling date and produce a knife to gain consent to sexual relations would be viewed by these people.
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Well, but that’s exactly you’re lack of insight – you see: when the doctors and nurses do it is a good therapeutic thing and any resistance on you side is a clear sign of mental illness with violent tendencies. You’re just delusional to compare good doctors and nurses who are clearly well-meaning and are helping you to criminals.
It’s catch 22 – you can’t reason with that system.
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Its bizarre that the new Act will include an “unreasonable refusal” clause to cover this loophole. In other words if you say no, this is an unreasonable refusal.
Given that all it takes here to be referred for an examination by a psychiatrist is a finger point, and the community nurse will make up grounds to refer to avoid liability, you can now be medicated for the illness that they fabricate.
Essentially the people who have a history of getting it wrong, are now going to be given further powers to abuse people. It will be disastrous, but will make their jobs easy.
On both occasions which i have been referred i have been examined and released by a psychiatrist because i didn’t have a mental illness. The incompetents who referred in the first place now get to drug me for the illness that they imagined i had?
I don’t know if this makes sense but it is just ludicrous to give unqualified people the power to do this.
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Stephen–I’m glad you entered this observation again–at least I know someone brings this up in other threads. My own situation has revolved around the problem more of how psychiatrization effects other physician attitudes, for instance skeptical that you are in pain or prohibitionistic if you ask about something to relax your spasmic muscle.
After writing this note about the obvious connection between the problem of controlling behaviors in “hospitals” (types of jails, really) I went back to this article by Joanna Moncrieff that works on aspects of the general problem as connected with diagnosis. I am sure you have probably read it, but it’s a keeper–
http://www.psychiatry.freeuk.com/Jodiagnosis.pdf
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“integrate behavioral health with physical medicine”
There is a place for it and this place is: training the health professionals in trauma prevention and recognition. Every practicing doctor in any area of medicine should learn about how medical procedures can be traumatising for a patient, how to minimise the trauma and how the trauma can occur not due to the procedure itself but from the kind of treatment patients receive from the stuff (my friend who’s a psychologist can certify on how an arrogant doctor can traumatise a woman during otherwise normal, uncomplicated labour). They should be taught that good doctor-patient relationship is key to proper diagnosis and treatment and that patient is doctor’s partner and not a pupil who has to be schooled or penalised for misbehaviour. And that some patients come in with existing traumas which should never be disregarded but the doctor’s behaviour and therapy plan should be modified accordingly (say in gynecological procedures on a rape victim).
But of course that’s not what it’s about. It’s about selling pills :/.
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Hi Jill,
I saw a very good documentary recently called “the house I live in”. It covered the issue of illegal drugs and racial discrimination very well, from the Chinese and opium, through to what appears now to be a war on the poor with meth amphetamine.
I guess with the levels of corruption that I see in government these days, it’s hardly surprising that they want to convert doctors into an army of drug pushers. I can’t help but wonder if honesty and integrity will ever become fashionable.
Kind regards
Boans
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Jill–It’s another charming remark of Szasz’s that I’ve found all too true time an time again. Nowehere will you find such continual displays of repressive discourtesy as in groups of psychiatrists attending to their involutary patients, even in office visits. It is ridiculous, and Szasz said it flat out: Psychiatrists like to push people around.
Additionally, good intentions get nothing done by themselves. Intending to help someone can also easily go wrong, as the proverbial story of the kind-hearted neighbor who causes your spinal cord to rupture in abruptly helping you to your feet after you’ve been hit by a car and your back got broken. Intending to listen, intending to find things out, and intedning to re-think the labels hardly happens at all in these locked units staffed with fine caregivers all who started out to “help”. They help the non-patients almost exclusively.
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Jill, Also, regarding the previous post where the comments showed how folks reacted to some fervent declaration about how to “get off of it” and “move on” if you something really hit you hard, I found this … (very handy)…
http://www.psychologytoday.com/blog/feeling-relating-existing/201110/trauma-and-the-hourglass-time
I’ve heard lots of non-professionals say “let it go” whether or not that was appropriate, and
I think my or someone’s label or simply their Otherness was the excuse, and that for themselves they gave whatever time they so desired to a setback, a worry, or a pain.
I can’t see that even for much of anything that affects you, or that would if you considered its significance, that you should square up with it by forgetting it, if that could actually count as squaring up with it. Obviously, there can be a better time than the existing moment rather often, for going into anything you care or wonder about or need to do in reaction. Likewise, as you will recall from Berne, you can find people stuck in roles in psychological games, such as “I don’t know–yes, but” But I do not believe that Berne looked to ordering the person in denial or doubt or confusion to “get serious and get over it”.
Good luck with your program.
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Sorry, Jill, I’m sure that you see that the game that Berne described which the general scenario you were bringing up last time resembled was “Why don’t you? Yes, but–”
My attention was off to the detail, there.
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