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Trending Now: Prescription Addiction

pill-manIs the medical profession finally catching on? I recently saw signs of hope.

In the February 22/29th edition of Jama (*1), the editors described a report issued by the CDC in a splendidly titled tome, Morbidity and Mortality Weekly Report.

Throughout the dryly presented data were intertwined subtle sirens of alarm: The rate of unintentional drug overdose deaths in the United States has risen over 600% in the years between 1997 and 2007.

We are not talking about heroin or methamphetamine or crack. We’re talking about prescribed analgesics. Prescribed. According to the CDC, “drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg. of morphine per person in 1997 and approximately 700 mg. per person in 2007,” a dose high enough for everyone in this country to take a standard 5 mg dose every 4 hours for 3 weeks.(*2)

The report continues its assessment and finally makes this stunning observation: “Prescription drug abuse is the fastest growing drug problem in the United States…and has been driven by a class of prescription drugs called opioid analgesics.”

It goes on: “For every unintentional overdose death…nine persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence and 461 report non-medical uses of opioid analgesics.”

Why? How could this be? Are these drugs being stolen? Manufactured by thugs in a trailer in the desert? Sold by wayward pharmacists? Smuggled from Canada? Hardly that dramatic. In fact, we are being addicted by the people we trust the most: “In an attempt to treat patient pain better, practitioners have greatly increased their rate of opioid prescribing over the past decade.”

Did someone say there was a war on drugs?

Allow me to share a more personal and human rendition of these statistics. One was a patient (name and details changed) whose situation was far too common, and one was a personal experience I had after a back injury.

The patient came to me with minor anxieties and some depression in large part due to unresolved grief. She was in her mid-thirties, a nurse, without major medical complications. Almost all her complaints centered on her fear of abandonment in relationships. Early on in treatment, she slipped at work (trying to move a large man from bed to a wheel chair) and injured her shoulder. After MRI’s and doctor visits that lasted months, they finally determined that she had some injured tendons. They put her on Vicodin. They refused her any other form of treatment.

That was 15 years ago. Needless to say her doses increased dramatically over the years as did her anxiety, her depression, and finally she was able to witness the abandonment she so feared. Her marriage fell apart. She was so addicted to the Vicodin that the withdrawal was more frightening than the dissolution of her family.

I have seen this scenario in different forms at least a hundred times. I have made phone calls begging physicians to please reconsider their choice of medication and allow for other medical solutions: acupuncture, physical therapy, massage, homeopathy, mindfulness meditation, hypnosis. With the exception of a few truly open-minded practitioners, the answer was a uniform “no.”

Why would anyone object to an alternative treatment if it brought relief at lower cost and without the risk of addiction and all the associated medical risks?

I found this out for myself personally not more than a few years ago. I fell (hard) and twisted my back. When it happened, I was more embarrassed than in pain and told myself (and everyone else watching), “Oh, I’ll be fine. It’s fine.” Within the time it took for my adrenal glands to stop pumping, the pain became intolerable. I could not walk. My husband took me to urgent care and they told me it was a muscle sprain because there was nothing on the x-ray. They urged me (I mean this literally) to take pain killers.

I said, “No, thank you.”

The doctor on staff looked at me cross-eyed and said, “What do you mean, ‘no, thank you?’”

I said, “I mean no. I don’t want them. How about some aspirin or ibuprofen or something like that?”

He reluctantly gave in and wrote the prescription but not without saying, “You’re going to be sorry.”

The pain was not going away as quickly as I’d hoped but I had seen what opioid analgesics could do and was determined to do whatever I had to do to avoid it. After putting up a fight with the insurance company that lasted two months, I finally went for an MRI where they found the bulging disc that was impinging on my sciatic nerve.

I found a physical therapist who was a hands-on genius and she relieved the pain with a combination of deep tissue massage and abdominal strengthening. We also used guided meditation. She used to tell me to “imagine the butter melting” as she focused on releasing the Iliopsoas, particularly Psoas Major which is the muscle that connects the hip to the spine. It was miraculous and immediate joy.

It was getting better. I was still in pain and not as limber as I used to be, but it was moving in a good direction. And I was willing to work hard to get better. That is, until the insurance company insisted on a new doctor. He looked over my chart and said, “You’re going to need Vicodin.”

I said, “No.”

Once again, that same look: “What do you mean, ‘no?’”

I said, “I don’t want dope. The massage and exercise works. Why can’t we continue that and forget the drugs?”

“Because you’re at maximum improvement. You can get the drugs but not the therapy.”

It was my turn to look at him cross-eyed and I said, much to the amusement of the nurse in the room with us,
“Are you crazy? Who are you working for?”

“According to the insurance company, this is medical standard now.”

I wanted to ask him when the insurance companies and bureaucrats became the arbiters of medical ethics and practice. It became clear to me that because of the structure of medical care today, people who would have otherwise had options and been good doctors, were being led in another direction, a new “standard” set by insurance companies and pharmaceutical interests.

Instead, I just said, “What about your oath?”

“I’m sorry.”

I looked at him and said, “Yes, you are,” and that was that. I walked out. No therapy and no Vicodin. And I had to pay for my own massages and take responsibility for my own recovery. And perhaps this is simultaneously the crux of the problem <em>and </em>the solution. Taking charge of my own healing instead of laying it on the doctor’s shoulders and demanding an immediate pain solution was not easy. In fact, it is an ongoing decision because I still have days with spine-shivering pain. But it has been infinitely better than what I’ve seen with my patients, people who had been struggling with aches and pains or broken hearts turned into addicts with broken homes, empty pockets, and symptoms so wildly erratic they were sometimes mistakenly diagnosed as bipolar instead of addicted. So rather than getting them off the opioids, they were given ever-increasing doses of medication that eventually made reaching–or treating–them impossible.

So, this war on drugs we’re waging? Maybe we should start in the doctor’s office. And it seems to be up to us in more ways than one. I don’t see the pharmaceutical companies leading the battle. Do you?

*1.    CDC Grand Rounds: Prescription Drug Overdoses–a U.S. Epidemic, MMWR, 2012;61:10-13, cited in The Journal of the American Medical Association, February 22/29/20120, Vol. 307, No. 8, page 774
*2.     Ibid.

A Personal Case for Homeopathy Part II

00_homeopathy_splashAfter the debate with my last articles on this topic, I find I couldn’t agree with the critics more. Homeopathy is strange and sounds magical. When I try to explain it to people — despite years of study and personal/professional experience — I wind up sounding like my worst woo-woo nightmare, stumbling over words like “energy,” “resonance” and “organism.”

As I stumble, my husband patiently awaits my sound byte, still anxiously hoping I can give him a way to explain what I do to save him from sounding just as ridiculous.

As he is a musician, I put it to him this way: “Think of it as you do of music… notes and chords… entire arrangements of single notes (or combinations thereof) and the spaces between them.”

He looked at me, single eyebrow raised. I had crossed over onto his turf. I’d better know what I’m talking about.

“In homeopathy, you can think of both the human being (or any living creature for that matter) and the remedy as pieces of music. A person comes in for treatment and the disease or pathology is presenting as a song, out of tune with the rest of the person when in a healthy state. We look for a remedy that most closely matches the totality of that pathology’s song. When we give it to the patient, the remedy cancels the disease. A song for a song. Like cures like.”

Eyebrow is lowered. I am momentarily reprieved. “Is it phase cancellation?”

“I’m not sure because it’s not an opposing frequency, it’s a similar one. But maybe the amplitudes are opposing.”

Eyebrow is raised. I realize that I’m back to where I started.

Perhaps an easier way to see it is with this metaphor:

See yourself as a being of a million small crystals, each one with a frequency. When you become ill, some of those crystals change frequency and begin to vibrate or sing out of tune. When we choose a remedy, we choose it to best match those crystals that have fallen out of tune. When delivered, it shatters those sick crystals, leaving only the healthy ones behind.

Admittedly, it is a metaphor, and as such, still leaves a great deal unexplained. I can understand the frustration of allopaths and critics with the obvious absence of hard, linear facts that are repeatable regardless of the person or place. Compared to current pharmaceutical philosophy, making scientific “sense” of homeopathy is like trying to play ordinary billiards in a quantum pool hall.

The problem is that homeopathy is aimed at treating the individual with a single remedy, chosen specifically for him or her. It is not for treating masses of people with the same pill. Twenty people could have the “same” flu, but each one would need a different remedy (not necessarily Oscillococcinum) and be rightly cured because each one would manifest illness in a way that is utterly unique to him-/herself. We always treat the person, not the disease. As such it is exceedingly difficult, if not impossible to replicate homeopathic treatment the way pharmaceutical companies try to do in drug trials.

A Simple Case in Point

My dog, who is not generally considered a good candidate for placebo, was sitting in on a session with a young patient I had been seeing for quite a while. While he was curled up on the couch next to her, he looked up at my patient and she frowned, “God, what’s wrong with him?!”

Without warning his eye had started bulging out of its socket. I was taken aback and instantly concerned. I begged her indulgence and called my homeopathic vet, who is located about two hours from us. He told me to take him for an emergency physical exam at a local hospital.

I asked for an emergency reschedule (she was in no danger and there was no threat to the therapeutic relationship) and rushed him over. After the exam, the local vet ruled out the more terrifying possibilities (rupture, tumor etc…) and pronounced it an inflammation, probably due to a scratch, spider bite or bee sting. She prescribed a bucket full of different pills and ointments.

More at ease now that there was no crisis and my panic had passed, I thanked her and left with just one of the ointments in case I didn’t find the right remedy immediately.

When I got back, I went to the repertory (in a computer, unlike my first homeopathic physician) and made a scrupulous list of his visible symptoms. Obviously I could only surmise how he felt, so I didn’t even try. These were the rubrics I chose for him:

1. Eye, inflammation

2. Eye, inflammation, acute

3. Generals, aggravated on the right side

4. Generals, sudden onset

5. Eye, lachrymation

6. Eye, protrusion with red discoloration.

The remedy was Apis Mellifica, potentized bee venom. This is a particularly straightforward example of how like (when it is potentized, meaning highly diluted to the smallest possible dose) cures like: Venom cancels out venom. Within minutes of giving the dog a few pellets, the inflammation was gone. And it never came back. No other treatment was necessary.

Is it always so straightforward? Hardly. I wish it were. It is especially more complicated when people come in with years and years of emotional suffering, chronic illness, and lists of medications sometimes two pages long. I had one patient on 27 medications because she had been diagnosed depressed. Was she feeling any better? Not in the slightest. It was a long haul to wellness for her with the incredible help of a thorough and patient physician.

Taking someone’s case in this situation takes a great deal more time, sensitivity and patience than a simple inflammation. But the essential idea, the bedrock of the interview is the same: Find the remedy that matches the totality of symptoms, which means understanding precisely what it is in her life, in her experience, in her soul that has led to and expresses the essence of the state she is in. It is not enough to say someone is depressed. The word “depressed” doesn’t really mean anything. To say, on the other hand, as one patient did, that she felt forsaken, was chronically sad because she felt all alone in the world yet she was averse to company — that begins to narrow it down a bit. When she added that she had no will power, yet felt better from a good debate, a challenging puzzle, or a lively conversation (mental exertion ameliorates), we begin to see how “depression” expressed itself uniquely in her. The remedy that patient needed (based on those and other symptoms) was Natrum Silicatum.

Now, just because you’re sad doesn’t mean you should go buy Natrum Silicatum. That is the mistake a lot of people and even poorly trained homeopaths make. It is unlikely that you will receive the benefit she did because her state (remember those crystals) was a Natrum Silicatum state. When it was given, what was unhealthy shattered and left behind only what was vital and strong.

I do not blame the debunkers. Homeopathy is very hard to repeat experimentally precisely because of the way it works: Individually. And so much of its success is in the hands of the homeopath whose task it is to see the patient clearly for who he or she is, to see that particular light, to hear that singular song. This is a hard pill to swallow until you’ve seen it work. But when you have seen it — it’s the easiest one of all.

Leading With Love and Verbal First Aid for Children

I wrote this article a while back, but the time has come to share what I’ve learned from my dogs and how it applies to Verbal First Aid with children. Yes, in so many ways, they have been my greatest teachers: presence, consistency, and the demands made on me have been challenges that have changed my life and my practice.

In memory of Angie and Ty. We love you still. Every day.

http://www.huffingtonpost.com/judith-acosta-lisw-cht/leading-with-love-kid-whi_b_677393.html