Download Practice Newsletter 2016 2nd Quarter

Practice News…..
April 2016
Second Quarter
Bickford Health Associates, PC/Ted Herwig MD
714 Main Street Yarmouthport, MA 02675 Telephone (508) 362-1600 Fax (508) 362-5957
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The Patient Portal, are YOU
connected?
And Ted Herwig MD
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Patient Education Focus:
(See: bickfordhealth.com)
Drug Addiction
By Mayo Clinic
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Cris Reid NP
The Opioid Crisis…..the good, the bad and the ugly.
It is difficult to pick up the
local newspaper without
seeing evidence of the toll
the misuse of opioids has
caused in our community.
Governor Baker enacted
new measures in March to
deal with the state’s opioid
epidemic. Opioid
prescriptions are being
scrutinized by the
pharmacy, the state and
insurance companies. How
have we responded to this
epidemic? The good news
is, we have made changes
over the years to be more
judicious in our prescribing
practices. We do have
patients who are in need of
opioids, and they are
prescribed, along with a
contract to sign, random
urine checks and other
measures to keep
everyone as safe as
possible. We meet together
to look for alternative
Drug Addiction is a complex illness…according to the National Institute
on Drug Abuse. Addiction affects multiple brain circuits, including those
involved in reward and motivation, learning and memory and inhibitory
control over behavior. That is why addiction is a brain disease. Some
individuals are more vulnerable than others to becoming addicted,
depending on the interplay between genetic make-up, age of exposure
to drugs and other influences. Nora D. Volkow MD December 2012
The Patient Portal
Kay O’Keeffe NP
If you aren’t familiar with
the patient portal, read on.
It is an online application
that allows you to
communicate and interact
with us via the internet. This
is a service that is available
to patients in the practice
24 hours a day. This
On Call
Susan V Duenas NP
methods for pain
management and dose
reductions. The bad news
is, sometimes prescriptive
narcotics fall in to the
hands of unscrupulous
people. And the really
ugly news is, people die.
We do not want to be part
of the problem, rather, we
want to be part of the
solution to end these
casualties on Cape Cod.
SV Duenas NP
encrypted portal is
integrated with your
electronic health record.
Through this portal, you
have the ability to send a
message, request a
medication refill, or request
an appointment. You may
also view and update
personal information, and
review lab results and other
documents. If you aren’t
“WEB ENABLED,” the first
step is to call or come by
and register for this service
at the front desk. After
signing a consent form, you
will be assigned a User
Name and Password. Once
you log in for the first time,
you will be asked to
change your password. We
hope you join us!
Are you aware that Bickford Health Associates, which includes Jeffrey
Martens MD, Kay O’Keeffe NP, Cris Reid NP and Susan Vecchione
Duenas NP, along with our office suite partner, Ted Herwig MD, have a
rotation call schedule? This means that you can call our main number,
508-362-1600, after hours and get some “expert” advice, when you
need it, day or night.
Prescription drug abuse
By Mayo Clinic Staff
Prescription drug abuse is the use of a prescription medication in a way not intended by the prescribing
doctor. Prescription drug abuse or problematic use includes everything from taking a friend's prescription
painkiller for your backache to snorting or injecting ground-up pills to get high. Drug abuse may become
ongoing and compulsive, despite the negative consequences.
An increasing problem, prescription drug abuse can affect all age groups, but it's more common in young
people. The prescription drugs most often abused include opioid painkillers, sedatives, anti-anxiety
medications and stimulants.
Early identification of prescription drug abuse and early intervention may prevent the problem from turning
into an addiction.
Signs and symptoms of prescription drug abuse depend on the specific drug. Because of their mindaltering properties, the most commonly abused prescription drugs are:

Opioids, such as oxycodone (Oxycontin, Roxicodone) and those containing hydrocodone (Vicodin,
Lortab, Norco), used to treat pain

Anti-anxiety medications and sedatives, such as alprazolam (Xanax) and diazepam (Valium),
and hypnotics, such as zolpidem (Ambien), used to treat anxiety and sleep disorders

Stimulants, such as methylphenidate (Ritalin, Concerta, others), dextroamphetamine and
amphetamine (Adderall XR) and dextroamphetamine (Dexedrine), used to treat attentiondeficit/hyperactivity disorder (ADHD) and certain sleep disorder
Signs and symptoms of prescription drug abuse
Sedatives and anti-anxiety medications
Opioid painkillers
Constipation
Drowsiness
Nausea
Confusion
Feeling high (euphoria)
Unsteady walking
Slowed breathing rate
Slurred speech
Drowsiness
Poor concentration
Confusion
Dizziness
Poor coordination
Problems with memory
Increased pain with higher doses
Slowed breathing
Other signs include:

Stealing, forging or selling prescriptions

Taking higher doses than prescribed

Excessive mood swings or hostility

Increase or decrease in sleep

Poor decision-making

Appearing to be high, unusually energetic or revved up, or sedated

Continually "losing" prescriptions, so more prescriptions must be written

Seeking prescriptions from more than one doctor
When to see a doctor
Talk with your doctor if you think you may have a problem with prescription drug use. You may feel
embarrassed to talk about it — but remember that medical professionals are trained to help you, not
judge you. It's easier to tackle the problem early before it becomes an addiction and leads to moreserious problems.
Teens and adults abuse prescription drugs for many reasons, such as:

To feel good or get high

To relax or relieve tension

To reduce appetite or increase alertness

To experiment with the mental effects of the substance

To maintain an addiction and prevent withdrawal

To be accepted by peers or to be social

To try to improve concentration and academic or work performance
Many people fear that they may become addicted to medications prescribed for medical conditions, such
as painkillers prescribed after surgery. However, people who take potentially addictive drugs as
prescribed don't often abuse them or become addicted.
Risk factors for prescription drug abuse include:

Past or present addictions to other substances, including alcohol and tobacco

Family history of substance abuse problems

Younger age, especially the teens or early 20s

Certain pre-existing psychiatric conditions

Exposure to peer pressure or a social environment where there's drug use

Easier access to prescription drugs, such as having prescription medications in the home medicine
cabinet

Lack of knowledge about prescription drugs and their potential harm
Older adults and prescription drug abuse
Prescription drug abuse in older adults is a growing problem, especially when they combine drugs with
alcohol. Having multiple health problems and taking multiple drugs can put seniors at risk of misusing
drugs or becoming addicted.
Abusing prescription drugs can cause a number of problems. Prescription drugs can be especially
dangerous — and even lead to death — when taken in high doses, when combined with other
prescription drugs or certain over-the-counter medications, or when taken with alcohol or illegal drugs.
Medical consequences
Here are examples of serious consequences of prescription drug abuse:

Opioids can cause low blood pressure, a slowed breathing rate and potential for breathing to stop, or
a coma. Overdose has a significant risk of death.

Sedatives and anti-anxiety medications can cause memory problems, low blood pressure and
slowed breathing. Overdose can cause coma or death. Abruptly stopping the medication may cause
withdrawal symptoms that can include nervous system hyperactivity and seizures.

Stimulants can cause dangerously high body temperature, heart problems, high blood pressure,
seizures or tremors, hallucinations, aggressiveness, and paranoia.
Physical dependence and addiction
Because commonly abused prescription drugs activate the brain's reward center, it's possible to develop
physical dependence and addiction.

Physical dependence. Physical dependence (also called tolerance) is the body's response to longterm use. People who are physically dependent on a drug may need higher doses to get the same
effects and may experience withdrawal symptoms when cutting back or abruptly stopping the drug.
Physical dependence may also become evident if a drug the body becomes adjusted to over time,
even without dosage change, is stopped abruptly.

Addiction. People who are addicted to a drug can have physical dependence, but they also
compulsively seek a drug and continue to use it even when that drug makes their lives worse.
Other consequences
Other potential consequences include:

Engaging in risky behaviors because of poor judgment

Using illegal drugs

Being involved in crime

Motor vehicle accidents

Decreased academic or work performance

Troubled relationships
Your primary care doctor may be able to help you overcome a prescription drug abuse problem.
However, if you have an addiction, your doctor may refer you to an addiction specialist or to a facility that
specializes in helping people withdraw from drugs.
What you can do
To prepare for your appointment, make a list of:

All the medications you're taking, including over-the-counter drugs, herbs and supplements, as
well as the dose and frequency

Any symptoms you're experiencing

Key personal information, including any major stresses or recent life changes

Questions to ask your doctor
Questions to ask your doctor may include:

What are my treatment options?

How long does it take for treatment to work?

Should I see a specialist?

How can we manage my other health conditions during treatment?

Do you have any brochures or other printed material I can have? What websites do you recommend?
What to expect from your doctor
Your doctor may ask these questions:

What prescription medications do you take? How much and how often do you take them?

How long have you had this problem?

What, if anything, prompted it?

How severe are your symptoms?

Do you have a past history of drug abuse or addiction?

Do you use recreational drugs? Do you smoke?

Has anyone in your family had a history of drug abuse or addiction?
Doctors generally base a diagnosis of prescription drug abuse on medical history and answers to other
questions. In some cases, certain signs and symptoms also provide clues.
Blood or urine tests can detect many types of drugs. These tests can also help track the progress of a
person who's getting treatment.
Treatment options for prescription drug abuse vary, depending on the type of drug used and your needs.
But counseling, or sometimes psychotherapy, is typically a key part of treatment. Treatment may also
require withdrawal (detoxification), addiction medication and recovery support.
Counseling
A licensed alcohol and drug counselor or other addiction specialist can provide individual, group or family
counseling. This can help you:

Determine what factors may have led to the prescription drug abuse, such as an underlying mental
health problem or relationship problems

Learn the skills needed to resist cravings, avoid abuse of drugs and help prevent recurrence of
prescription drug problems

Learn strategies for developing positive relationships

Identify ways to become involved in healthy activities that aren't related to drugs

Learn the steps to take if a relapse happens
Withdrawal
Depending on the prescription drug and usage, detoxification may be needed as part of treatment.
Withdrawal can be dangerous and should be done under a doctor's care.

Opioid withdrawal. Opioid tapering involves gradually decreasing the dose of medication until it's no
longer used. Other medications — such as clonidine (Catapres), a drug mainly used for high blood
pressure — can be used to help manage opioid withdrawal symptoms during this process.
Buprenorphine, buprenorphine with naloxone (Suboxone) or methadone may be used by doctors
under specific, legally regulated and monitored conditions to ease symptoms of withdrawal from
opioid painkillers. Vivitrol, a version of the drug naltrexone, given by injection once a month by a
health care provider may help people stay off opioids early in their recovery.

Withdrawal from sedatives or anti-anxiety medications. If you've used prescription sedatives or
anti-anxiety drugs for a long time, it may take weeks to slowly taper off them. Because of withdrawal
symptoms, it can take that long for your body to adjust to low doses of the medication and then get
used to taking none at all. You may need other types of medication to stabilize your mood, manage
the final phases of tapering or help with anxiety, and you'll need to work closely with your doctor.

Stimulant withdrawal. There are no approved drugs used for treating stimulant withdrawal.
Treatment typically focuses on tapering off the medication and relieving withdrawal symptoms —
such as sleep, appetite and mood disturbances.
Overcoming prescription drug abuse can be challenging and stressful, often requiring the support of
family, friends or organizations. Here's where to look for help:

Trusted family members or friends

Your doctor, who may be able to recommend resources

Self-help groups, such as a 12-step program

Your church or faith group

School counselor or nurse

Support groups, either in person or from a trustworthy website

Your employee assistance program, which may offer counseling services for substance abuse
problems
You may be embarrassed to ask for help or afraid that your family members will be angry or judgmental.
You may worry that your friends will distance themselves from you. But in the long run, the people who
truly care about you will respect your honesty and your decision to ask for help.
Helping a loved one
It can be difficult to approach your loved one about prescription drug abuse. Denial and anger are
common reactions, and you may be concerned about creating conflict or damaging your relationship with
that person.
Be understanding and patient. Let the person know that you care about his or her well-being. Encourage
your loved one to be honest about drug use and to accept help if needed. A person is more likely to
respond to feedback from someone he or she trusts. If the problem continues, further intervention may be
necessary.
Intervention
It's challenging to help a loved one struggling with drug problems or other destructive behavior. People
who struggle with addictive behaviors are often in denial or unwilling to seek treatment. And they may not
recognize the negative effects their behavior has on themselves and others. An intervention can motivate
someone to seek help for addictive behaviors.
An intervention is a carefully planned process involving family and friends and others who care about a
person struggling with addiction. Consulting an intervention professional (interventionist), an addiction
specialist, psychologist or mental health counselor can help you organize an effective intervention.
This is an opportunity to confront the person about the consequences of addiction and ask him or her to
accept treatment. Think of an intervention as giving your loved one a clear opportunity to make changes
before things get really bad.
Prescription drug abuse may occur in people who need painkillers, sedatives or stimulants to treat a
medical condition. If you're taking a commonly abused drug, here are ways to decrease your risk:

Make sure you're getting the right medication. Make sure your doctor clearly understands your
condition and the signs and symptoms. Tell your doctor about all your prescriptions, as well as overthe-counter medications, herbs and supplements, and alcohol and drug use. Ask your doctor whether
there's an alternative medication with ingredients that have less potential for addiction.

Check in with your doctor. Talk with your doctor on a regular basis to make sure that the
medication you're taking is working and you're taking the right dose.

Follow directions carefully. Use your medication the way it was prescribed. Don't stop or change
the dose of a drug on your own if it doesn't seem to be working without talking to your doctor. For
example, if you're taking a pain medication that isn't adequately controlling your pain, don't take more.

Know what your medication does. Ask your doctor or pharmacist about the effects of your
medication, so you know what to expect. Also check if other drugs, over-the-counter products or
alcohol should be avoided when taking this medication.

Never use another person's prescription. Everyone is different. Even if you have a similar medical
condition, it may not be the right medication or dose for you.

Don't order prescriptions online unless they're from a trustworthy pharmacy. Some websites
sell counterfeit prescription and nonprescription drugs that could be dangerous.
Preventing prescription drug abuse in teens
Young people are at especially high risk of prescription drug abuse. Follow these steps to help prevent
your teen from abusing prescription medications.

Discuss the dangers. Emphasize to your teen that just because drugs are prescribed by a doctor
doesn't make them safe — especially if they were prescribed to someone else or if your child is
already taking other prescription medications.

Set rules. Let your teen know that it's not OK to share medications with others — or to take drugs
prescribed for others. Emphasize the importance of taking the prescribed dose and talking with the
doctor before making changes.

Discuss the dangers of alcohol use. Using alcohol with medications can increase the risk of
accidental overdose.

Keep your prescription drugs safe. Keep track of quantities and keep them in a locked medicine
cabinet.

Make sure your child isn't ordering drugs online. Some websites sell counterfeit and dangerous
drugs that may not require a prescription.

Properly dispose of medications. Don't leave unused or expired drugs around. Check the label or
patient information guide for disposal instructions, or ask your pharmacist for advice on disposal.
References
1.
DrugFacts: Prescription and over-the-counter medications. National Institute on Drug Abuse.
http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications. Accessed Aug. 11, 2015.
2.
Prescription drugs. National Council on Alcoholism and Drug Dependence Inc. https://ncadd.org/learn-about-drugs/prescriptiondrugs. Accessed Aug. 11, 2015.
3.
Prescription drug abuse. National Institute on Drug Abuse. http://www.drugabuse.gov/publications/research-reports/prescriptiondrugs/director. Accessed Aug. 11, 2015.
4.
Becker W, et al. Prescription drug misuse: Epidemiology, prevention, identification, and management.
http://www.uptodate.com/home. Accessed Aug. 11, 2015.
5.
Commonly abused drugs charts. National Institute on Drug Abuse. http://www.drugabuse.gov/drugs-abuse/commonly-abuseddrugs-charts-0. Accessed Aug. 11, 2015.
6.
Intervention — Tips and guidelines. National Council on Alcoholism and Drug Dependence Inc. http://ncadd.org/index.php/forfriends-and-family/intervention. Accessed Aug. 11, 2015.
7.
Specific populations and prescription drug misuse and abuse. Substance Abuse and Mental Health Services Administration.
http://www.samhsa.gov/prescription-drug-misuse-abuse/specific-populations. Accessed Aug. 11, 2015.
8.
How to dispose of unused medicines. U.S. Food and Drug Administration.
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm. Accessed Aug. 11, 2015.
9.
Fact sheet: A response to the epidemic of prescription drug abuse. Office of National Drug Control Policy.
https://www.whitehouse.gov/ondcp/prescription-drug-abuse. Accessed Aug. 11, 2015.
10. Drug facts: Prescription drugs. NIDA for Teens. http://teens.drugabuse.gov/drug-facts/prescription-drugs. Accessed Aug. 11,
2015.
11. What to do if you have a problem with drugs: For teens and young adults. National Institute on Drug Abuse.
http://www.drugabuse.gov/related-topics/treatment/what-to-do-if-you-have-problem-drugs-teens-young-adults. Accessed Aug. 20,
2015.
12. Selected prescription drugs with potential for abuse. National Council on Alcoholism and Drug Dependence Inc.
https://ncadd.org/learn-about-drugs/prescription-drugs. Accessed Aug. 11, 2015.
13. Felicilda-Reynaldo RFD. Recognizing signs of prescription drug abuse and addiction, Part 1. Nursing Pharmacology.
2014;23:391.
14. Rohren CH (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 24, 2015.
15. Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 26, 2015.
16. Vivitrol (prescribing information). Waltham, Mass.: Alkermes Inc.; 2013.
www.accessdata.fda.gov/drugsatfda_docs/label/2013/021897s020s023lbl.pdf. Accessed Aug. 25, 2015.
17. Sept. 19, 2015
Original article: http://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/basics/symptoms/con-20032471
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