Opiates delay stomach emptying and slow down the normal activity of the small intestine and colon. Narcotic bowel syndrome (NBS) is a subset of opioid bowel dysfunction that is characterized by chronic or frequently recurring abdominal pain that worsens with continued or escalating dosages of opiates. This syndrome is under recognized and may be becoming more prevalent. This may be due in the United States to increases in using opiates for chronic painful disorders and addiction. NBS can occur in patients who receive high dosages of opiates by physicians unaware of the hyperalgesic effects of chronic opiates. Hyperalgesia is a condition where chronic use of opiates cause pain.

It has long been recognized that opiates affect gastrointestinal activity. These effects, known as opioid bowel (or gastrointestinal) dysfunction are manifest as constipation, nausea, bloating, ileus and sometimes pain. When pain is the predominant symptom, the condition has been termed narcotic bowel syndrome (NBS). NBS is characterized by the progressive and somewhat paradoxical increase in abdominal pain despite continued or escalating dosages of opiates prescribed in an effort to relieve the pain. This entity was first reported two decades ago in the United States. Many of these patients are experiencing the NBS and benefit from opiate detoxification. We consider this to be a rapidly emerging health problem that requires attention.

The syndrome is characterized by chronic or intermittent colicky abdominal pain that worsens when the opiate effect wears down. While narcotics/opiates may seem helpful at first, over time the pain-free periods become shorter, leading to increasing opiate doses. Ultimately, increasing dosages enhance the adverse effects on pain sensation and delayed motility, thereby initiating the development of NBS.

Although pain is the dominant feature, nausea, bloating, vomiting, abdominal distension and constipation are common. Eating can aggravate the symptoms, so when the condition lasts for weeks, mild weight loss may occur due to anorexia or a willful restriction of eating out of fear of aggravating the pain. The symptoms may correlate with delayed gastric emptying.

A common and misleading consequence of NBS is that abdominal X-rays may show signs suggestive of a partial intestinal obstruction, which in fact is due to an adynamic ileus or pseudo-obstruction. There may also be large amounts of fecal retention seen. Laboratory tests including blood count, amylase, lipase, liver chemistry and urine analyses are usually normal.

The key to the diagnosis of NBS is the recognition that chronic or escalating doses of opiates lead to continued or worsening symptoms rather than benefit. However since the symptoms are nonspecific and many clinicians are unaware that narcotic medications can actually sensitize patients to the experience of pain. Thus, continued treatment with opiates lead to a vicious cycle of pain, use of more opiates and continued or worsening pain.

NBS remains under-recognized symptoms due to lack of knowledge about the long-term effects of opiates as causes of visceral pain and GI disturbances, and difficulties in clinically distinguishing abdominal pain that results from, rather than is benefited by opiates.

One of the subjects that I have taught for over twenty-five years is psychopharmacology. It might be helpful to challenge one of the great myths about mental disorders, namely that they are caused by chemical imbalances. This myth is founded on some of the tricks that are pulled in so-called scientific research in psychology and psychiatry. First, there is a large volume of research claiming to discover all kinds of chemical imbalances in a wide variety of psychiatric disorders. The manipulation of research has become one of the most powerful and most unethical marketing tools ever devised. Not one study can be replicated at the testing labs of hospitals or by laboratories involved in clinical patient care. All that one needs to do is ask his or her doctor to order a blood or urine test to confirm any psychiatric disorder, and the response will be, “I’m sorry, but no such test exists.” Replication is a basic step for all sciences.

The second manipulation is a bit trickier to follow. An unethical researcher, earning grant money from the pharmaceutical companies, injects test subjects with a radioactive sample of a nervous system hormone, such as dopamine, serotonin, nor-epinephrine, and so on, and then trace, using either CT scans, MRIs, or PET scans, exactly to what parts of the brain the chemicals go. They can even trace the hormones to microscopic receptor sites on the ends on neurons. They then repeat the injection process with a radioactive sample of one of the drugs that supposedly correct chemical imbalances, such as antidepressants that elevate serotonin, or amphetamines that effect serotonin and dopamine, and so on and so forth. By golly the drugs go to the same exact parts of the brain and receptor sites as the hormones. Conclusion, the drugs are correcting chemical imbalances!

Not so fast. The part they do not tell the public, and even professional psychiatrists, psychologists, and practicing physicians, is that we can precisely measure hormone levels in all people, and diagnosis does not matter. We can measure the metabolites in the blood, which are the residue left after the hormones are metabolized i.e. used by the nerve and body cells. This tells us the precise amount of hormones carried in anyone’s body. When that is done, as it has by numerous honest researchers, we discover that the amount of hormones are exactly the same for anyone with a diagnosis, such as depression, attention deficit disorders (ADD/ADHD), bipolar, and schizophrenia, as with anyone diagnosed as perfectly normal.

There is a third part to the perpetuation of scam information. We are told that when a drug alleviates certain psychiatric conditions, such as depression and anxiety, that the drug is therefore correcting obvious chemical imbalances. However, this type of logic is not permitted in true science. This is called “allopathic logic”, which is a no no.

A quick analogy will help clear this up. If one drinks alcohol, then one experiences a relief from anxiety. Alcohol is a drug, a sedative. Can we say that alcohol clears up chemical imbalances that cause anxiety? If that were so then the entire human race is running around with chemical imbalances. The same is true for any drug used for any purpose, such as antidepressants for depression, tranquilizers for anxiety, mood stabilizer drugs for bipolar disorder, and even antipsychotic drugs for schizophrenia. This type of logic is not permitted within proper scientific circles. Sadly, proper scientific circles are evaporating within psychiatry and psychology. Those who are ethical researchers make no such claims.

Dr. David B. Stein is Professor of Psychology and Criminal Justice at Virginia State University. He is a best-selling author, and his books include: Ritalin is Not the Answer: A Drug-free, Practical Program for Children Diagnosed with ADD or ADHD; The Ritalin is Not the Answer Action Guide: An Interactive Companion to the best-selling Drug-Free ADD/ADHD Parenting Program; Unraveling the ADD/ADHD Fiasco: A Guide for Successful Parenting; and Controlling the Difficult Adolescent: The REST Program (Real Economy Program for Teens).

TALLAHASSEE – Florida will join 38 other states that have created prescription drug monitoring systems under a bill quietly signed into law today by Gov. Charlie Crist. But it will likely be months before the drug database becomes a reality: First the Department of Health must seek private and federal grants to pay the millions of dollars needed to design and create the tracking system, which some critics contend won’t go far enough to battle the growing problem of prescription drug fraud in Florida.

South Florida has become a haven for so-called pill mills where people from across the country have been able to get prescription painkillers such as Oxycodone. The increased scrutiny over Florida’s reputation persuaded lawmakers to create a tracking system, more than seven years after former Gov. Jeb Bush first called for its creation. “It has become an epidemic,” said state Sen. Mike Fasano, R-New Port Richey, one of the main sponsors of the drug monitoring bill. “This all must end. This has to be stopped. Florida can no longer be looked at as the pill mill state of the nation.” National drug czar R. Gil Kerlikowske in May even cited the legislation, saying he hoped it would be enacted because prescription drug fraud was an “acute problem” in Florida.

The new law requires that Florida track prescriptions of controlled substances designated as Schedule II, III and IV drugs, which includes drugs such as codeine, methadone, amphetamines, anabolic steroids and Ketamine. The legislation pushed by Fasano was backed by a large swath of lawmakers from both parties, but not everyone embraced the bill. A group of top House Republicans – including House Majority Leader Adam Hasner, Rep. Ellyn Bogdanoff, Rep. David Rivera and incoming House Speaker Dean Cannon – wrote a letter to Crist urging that he veto the bill.

Those Republicans, echoing past criticisms, said they were concerned that sensitive information would wind up in the hands of criminals and terrorists. They cited an incident in Virginia in which hackers reportedly broke into a database in that state. Fasano brushed aside those criticisms, pointing out that the state is enacting public records exemptions for the database. He also noted that insurance companies and pharmacists already track what drugs patients are receiving.

But Rep. Carl Domino, R-Jupiter, contends the bill may do little to prevent drug abuse because the new law gives physicians, health care providers and pharmacists up to 15 days to report that certain drugs were dispensed to a patient. “I think there are ways to reduce drug deaths,” said Domino, who sponsored a rival drug monitoring bill that went nowhere during this spring’s session. “This bill doesn’t stop it any way that I can see. … No one can point to me how it will stop a kid getting a prescription down the street 10 minutes later.” House sponsor Rep. Marcelo Llorente, R-Miami, said the 15-day deadline was placed into law to give flexibility to health care providers. He said many providers will be able to provide the information on a much quicker basis.

“I adamantly believe this bill will save thousands of lives on annual basis,” Llorente said. But first state officials have to create the database. And before that happens, the state will set up a task force to oversee the creation of the tracking system and create an organization to accept grants to help pay for the system.

Most opiate users never nap and during the night they do not experience good REM sleep. This may be another factor contributing to the sadness and depression that opiate dependent people experience.

A full-scale campaign is under way to change the public perception of drug addiction, from a moral failing to a brain disease. Last spring, HBO aired an ambitious series that touted addiction as a “chronic and relapsing brain disease.” In early July, a Time magazine cover story suggested that addiction is the doing of the neurotransmitter dopamine, which courses through the brain’s reward circuits. And now Congress is weighing in.

A new bill sponsored by Sen. Joe Biden, D-Del., would change the name of the National Institute on Drug Abuse to the National Institute on Diseases of Addiction and change the name of the National Institute on Alcohol Abuse and Alcoholism to the National Institute on Alcohol Disorders and Health. Called the Recognizing Addiction As a Disease Act of 2007, it explains, “The pejorative term ‘abuse’ used in connection with diseases of addiction has the adverse effect of increasing social! stigma and personal shame, both of which are so often barriers to an individual’s decision to seek treatment.” Addiction should be known as a brain disease, the bill proclaims, “because drugs change the brain’s structure and manner in which it functions. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.”

As a psychiatrist who treats heroin addicts and a psychologist long interested in the philosophical meaning of disease, we have chafed at the “brain disease” rhetoric since it was first promulgated by NIDA in 1995. Granted, the rationale behind it is well-intentioned. Nevertheless, we believe that the brain disease concept is bad for the public’s mental health literacy.
Characterizing addiction as a brain disease misappropriates language more properly used to describe conditions such as multiple sclerosis or schizophrenia—afflictions that are neither brought on by sufferers themselves nor modifiable by their desire to be well. Also, the brain disease rhetoric is fatalistic, implying that users can never fully free themselves of their drug or alcohol problems. Finally, and most important, it threatens to obscure the vast role personal agency plays in perpetuating the cycle of use and relapse to drugs and alcohol.

It is true that a cocaine addict in the throes of a days-long binge or a junkie doubled over in misery from withdrawal can’t reasonably be expected to get up and walk away. Yet addicts rarely spend all of their time in the throes of an intense neurochemical siege. In the days between binges, cocaine addicts make many decisions that have nothing to do with drug-seeking. Should they try to find a different job? Kick that freeloading cousin off their couch for good? Register for food stamps? Most of the patients one of us treats hold jobs while pursuing their heroin habits.

In other words, there is room for other choices. These addicts could go to a Narcotics Anonymous meeting, enter treatment i! f they have private insurance, or register at a public clinic if they don’t. Self-governance, in fact, is key to the most promising treatments for addiction. For example, relapse prevention therapy helps patients identify cues—often people, places, and things—that reliably trigger a burst of desire to use. Patients rehearse strategies for avoiding the cues if they possibly can and managing the craving when they cannot. In drug courts (a jail-diversion treatment program for nonviolent drug offenders), offenders are sanctioned for continued drug use (perhaps a night or two in jail) and rewarded for cooperation with the program. The judge holds the person, not his brain, accountable for setbacks and progress.

The brave new world of brain scanning figures prominently in the new disease rhetoric. During imaging experiments in which an addict is shown drug paraphernalia, the reward centers in his brain light up like a Christmas tree. It’s easy to be misled into believing that these colorful images prove that the addict is helpless to change his behavior. In a powerful experiment, Deena Weisberg, a doctoral candidate at Yale University, and her colleagues presented non-experts with flawed explanations for psychological phenomena. They were adept at spotting the errors—until, that is, these explanations were accompanied by “Brain scans indicate … ” With those three words, Weisberg’s participants suddenly found the flawed explanations compelling. Yet in truth, at least at this stage of the technology, we rarely learn as much by visualizing addicts’ brains than by asking them what they are experiencing and what they desire.

Telling the public that addiction is a “chronic and relapsing brain disease” suggests that an addict’s disembodied brain holds the secrets to understanding and helping him. It implies that medication is necessary and that interventions must be applied directly at the level of the brain. But that’s not how people recover. For actress Jamie Lee Curtis, for example, quitting painkillers was a spiritual matter. When she appeared on Larry King Live recently, the guest host asked her, “What made you get clean?” She responded, “Well, you know what, that turning point was a—was really a moment between me and God. I never went to treatment. I walked into the door of a 12-step program and I have not walked out since.”

Finally, dare we ask: Why is stigma bad? It is surely unfortunate if it keeps people from getting help (although we believe the real issue is not embarrassment but fear of a breach of confidentiality). The push to destigmatize overlooks the healthy role that shame can play, by motivating many otherwise reluctant people to seek treatment in the first place and jolting others into quitting before they spiral down too far.

You would think Congress has better things to do than legislate name changes. And in the long run, the well-meaning effort to overmedicalize addiction could have baleful consequences. Addiction is not as hopeless or uncontrollable as the brain disease metaphor suggests. Yes, like other bad habits, it is in our brains—but like other bad habits, it can be broken.

We choose to detox our patients in a private, clean and relaxed environment at our JCAHO facility. We do not feel an anesthesia detox is safer if performed in an intensive care unit. In fact, we feel strongly the opposite. The following story tells the truth about the problems with hospitals and especially ICU’s. The ever increasing resistant bacterias found in the intensive care units of hospitals nationwide is something all patients should be concerned about. A person should not be exposed to this type of environment unless they are truly in critical or grave condition and this type of monitoring is necessary to risk the devastating health problems that could occur.

A well known Boston based surgeon recently examined the perils of managing the intensive care of hospitalized patients. He found that complications can arise in every area of an ICU. One of the most alarming among them is the risk of infection – either delivered by an IV line or from pneumonia. Hospital MRSA infection rates, among them, remain a problem and can be very serious if not deadly.

Also, during the 4 months of monitoring, 554 patient errors were detected. Of those errors, 147 of them had the potential to cause significant damage to the patient. More than any other preventable complication that caused concern for the ICU patient is the IV line infections.

On average, 4% of those lines become infected within 10 days. That contributes to 200,000 serious infections nationwide. Survival rates are as low as 72%. That means 50,000 patients or more are dying every year from infections acquired from an ICU admission.

We are the only anesthesia detox center that does not require our patients to be exposed to this type of environment. We do not accept patients that would have a medical need to be detoxed in an intensive care unit. We feel if a patient’s medical condition warrants admittance to an intensive care unit, they are not a good candidate and should not have the detox procedure.

The investigators determined that these biased trials may result in misinformation which could lead to unwanted side effects, and unnecessary use of certain drugs, etc. They looked at 164 drug trials conducted over a 2 year period that were published in medical journals, as well as some not published yet, and found many discrepancies that tended to lead to more favorable presentations. The conclusions were that the scientific information that professionals rely upon is incomplete and potentially biased. The results of this study were published in the current issue of PLoS Medicine, an online medical journal.

The medical record is also the primary source for much of the health care information sought by parties outside the direct health care delivery relationship. These data are important because health care information can influence decisions about an individual’s access to credit, admission to educational institutions, and his or her ability to secure employment and obtain insurance. Inaccuracies in the information, or its improper disclosure, can deny an individual access to these basic necessities of life, and can threaten an individual’s personal and financial well- being.

Privacy

A major concern is adequate confidentiality of the individual records being managed electronically. According to the LA Times, roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient’s records during a hospitalization, and 600,000 payers, providers and other entities that handle providers’ billing data have some access. Multiple access points over an open network like the Internet increases possible patient data interception. In the United States, this class of information is referred to as Protected Health Information (PHI) and its management is addressed under the Health Insurance Portability and Accountability Act (HIPAA) as well as many local laws. The organizations and individuals charged with the management of this information are required to ensure adequate protection is provided and that access to the information is only by authorized parties. The growth of EHR (electronic health records), creates new issues, since electronic data may be physically much more difficult to secure, as lapses in data security are increasingly being reported. Information security practices have been established for computer networks, but technologies like wireless computer networks offer new challenges as well.

A related concern is the potential privacy risk posed by interoperability. One of the most vocal critics of EMRs (electronic medical records), New York University Professor Jacob M. Appel, has claimed that the number of people who will need to have access to such a truly interoperable national system, which he estimates to be 12 million, will inevitable lead to breaches of privacy on a massive scale. Appel has written that while “hospitals keep careful tabs on who accesses the charts of VIP patients,” they are powerless to act against “a meddlesome pharmacist in Alaska” who “looks up the urine toxicology on his daughter’s fiance in Florida, to check if the fellow has a cocaine habit.”

Pharma Parties: A Definition

There’s no doubt that teenagers are easily influenced, but new indications are pointing to a disturbing trend in which teens steal prescription drugs from their parents’ medicine cabinets and create “prescription cocktails” that can be shared with friends at parties. Prescription medications such as Xanax®, OxyContin®, and Ambien® are some of the popular name brand pills that teenagers look for when raiding their household medicine cabinets.

Pharma Parties: Is Your Teen Participating?

Since prescription medications can be prescribed for a number of reasons and aren’t always taken on a regular basis, it can be easy for a teenager to take one or two pills from each medicine bottle without anyone noticing. If a household has sleeping prescriptions and cough medicines that are only used every few months, it’s simple to not notice that extra pills have gone missing. Mixing prescriptions together can lead to drug abuse and addiction, though, so it’s important to keep track of all of the medicines located within your home.

On top of looking out for any unusual behaviors, parents should also keep prescription medicines in an attended area where quantities can be monitored. If you aren’t using a certain prescription anymore, dispose of it immediately.