Hepatic mortality, confidentiality in addiction health records, early discharges from treatment, epidemiologic correlations, cannabis contaminant, doctors with addictions, cocaine testimonial

by | Addiction

https://www.asam.org/resources/publications/asam-weekly/asam-weekly-editorial-comment

Bill Haning MD

  • The British Medical Journal article on increased alcoholic hepatic mortality reads well against a JAMA article drawn from 70 years of Australian statistics (below), citing the correlation between alcohol/tobacco consumption and declining cancer deaths.  The teasers raised by the former article are of course what factors would contribute to increased consumption of alcohol, or to increased toxicity of the alcohol being consumed.
  • A discussion of proposed Title 42 US Code changes reflects the need for balance between privacy and effective communications in providing addiction treatment.  At the same time, the prevailing climate of commercial and even governmental intrusion into privacy is likely to make the Congressional discussion adversarial.
  • A review of early discharges from treatment is itself another discussion of balance. There is a theory that intervention during a crisis, such as an emergency room visit (e.g., SBIRT), provides a powerful impetus towards effective treatment; but it is countered by concern that too premature or forceful a referral may lead to early discharge against medical advice.
  • Brodifacoum, a vitamin K antagonist, has been identified as the contaminant responsible for hemorrhage in users of synthetic cannabinoids. The next question to be answered is, how did it get there? One mundane hypothesis is that it may have been used to control pests in the production of the plant material generally used as a vehicle for synthetic cannabinoids; or even in cannabis agriculture  subsequently augmented with synthetic agents. User blogs have cited the poisonings as another argument for legalized, regulated cannabis production.
  • A long-standing tenet of substance use disorders as they affect our colleagues has been that doctors develop addiction at the same rate as the general population; but they differ from the general population in their choice of substances.
  • A celebrity’s discussion of her cocaine use and recovery is cogent in light of the increasing attention being paid to sources of burnout among physicians.

This week, International Doctors in Alcoholics Anonymous (IDAA, https://www.idaa.org/ ) – which happily includes the spectrum of healthcare providers and  their families, and the full range of substances and processes of addiction – meets in Reno, Nevada. It’s not too late to go; as we are accustomed to hearing from recovering patients and friends, you are only ever truly late for your first meeting.

Comment;

So many areas of interest!

Dr. Raymond Oenbrink
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