FEELING NO PAIN, USING COCAINE

We don't talk much about cocaine anymore. The emphasis these days is on opiates and prescription drug abuse. Yet just as many Americans use cocaine as they do heroin. The difference is that cocaine is 'marginally socially acceptable' in many wealthier circles. For that reason, discussion about it does not peak interest. Cocaine was more or less 'normalized' by high-level executives and celebrities. It is available at parties and bars and folks don't see it as an addictive substance. Even detoxes do not accept clients who only abuse cocaine. The problem however, is cocaine causes serious damage to the brain. Using it with alcohol, even socially, can produce cocaethylene which can be fatal. Smoking cocaine in crack form, causes Dopamine flooding and a slower re-uptake. That means that it is all but impossible to stop smoking until the crack runs out. It goes to the reward center of the brain and produces such a pleasurable effect that people do not want to stop smoking. So the question becomes, why do people smoke cocaine or snort it if it is damaging? Are they addicted? There is no one answer to these questions. People use illicit drugs for many reasons. But they are not addicted to the substance cocaine. They are addicted to the feeling they get when they use this substance. It takes them out of the everyday world that surrounds them and puts them in a different emotional state where no one can demand from them. They do not have to live up to anyone else's expectations. But, damage from cocaine abuse clearly outweighs the good feeling that users get when they are high. It is a negative tool to avoid reality and responsibility. In between use, folks become irritable and anxious. And combined with other drugs it can be fatal. Although not a gateway drug, rarely do we meet clients who only use cocaine. Patients come to us when their life is out of control. When the cocaine/crack use has financially devastated them. And when they have alienated their family and friends in favor of their on-going affair with the drug. Cocaine abuse is a serious problem in America. We should not turn our heads and ignore it when family members use the drug. We should encourage them to get help before they lose everything that is important to them.

NURSE, HEAL THYSELF FIRST

In the past seven years I have treated dozens of nurses. Some have come to us for alcohol dependence. But the majority have been Opioid Dependent. That's correct. These professionals that we depend upon to hold our hands and minister to us when we are sick, are often very ill themselves.

They begin by taking Percocets for stress, then a little Oxycontin for back pain and many of them progress to Dilaudid to get through their shift. The sad part of this behavior is that they more often than not, they take medicine from their places of work - hospitals, nursing homes and even hospice. Some even substitute placebos for the actually pain medications, leaving their patients in distress.

Although this is the minority of people in the nursing profession, it still begs the question, WHY? Is the job too stressful? Do we not provide enough down time for our most valuable caregivers? Are there folks in the profession with no regard for a work ethic and who leave their co-workers to run back to back shifts because they feel like calling in sick? Do some people enter the profession with a predisposition towards drug addiction?

I do not have the answer. What I do know is that this is becoming a problem that we need to address. I also think that support for recovery is a better idea than punishment. We need nurses. They deserve our help, if not for humanitarian reasons, than at the very least because it is good Karma.

CHILDREN DRINKING AT HOME

This morning's special news segment addressed the question about whether or not parents should introduce alcohol in the home, so that children will understand how to drink when they reach majority age. The issue with the question posed, is that there is an assumption made, that parents themselves understand how to drink reasonably.

The problem is that children and teens are not physically capable of handling alcohol. Developmentally, they need pure foods such as fruits, nuts and vegetables, grass-fed beef and poultry, for brain growth. They do not need alcohol at a time when the brain is learning and expanding its knowledge base.

They also do not need to emulate the drinking behaviors of adults around them. Especially when most do not understand that a woman should drink a maximum of 3-4 (one ounce) drinks in an evening at most, and a man about 5 ounces. A standard size glass of wine in America is over the three ounces to begin with. And watching parents who come home and have a beer to relax each night sends a negative message that alcohol is an acceptable tool to use to unwind.

Whether the drinking age is 21 or 18, teaching people how to drink is a great idea. Waiting until the brain and body can handle alcohol is an even better idea!

MARIJUANA PARENTING

Today, I attended a conference that focused on the damage drugs and alcohol can do to the adolescent brain. Most people in the audience were not worried about the effects of marijuana; they were focused on alcohol and 'hard' drugs. In fact, some even defended the position the MA DCF has taken - that removal of children for parental abuse of marijuana is not going to happen.

Yet, these attendees learned today that marijuana may not be a 'gateway' in the traditional sense, but it is harmful nevertheless. It takes approximately 18-24 months for a person to stop depending upon marijuana after discontinuing abuse through harm reduction. And in fact, withdrawal really happens; including mood swings, depression and irritability during protracted withdrawal.

The adolescent brain is not fully formed and smoking marijuana at a young age impedes the user's ability to hold memories and interpret cognitions properly. Smoking causes cognitive distortions.

Developmentally , using drugs and alcohol does not allow the user to progress from adolescence to adulthood emotionally. They get stuck - something we refer to as arrested development.

Most young people begin smoking cannabis around 11 or 12 years old. Research demonstrates that if a 'father figure' is smoking in the home when a child is 6 years old, the child will most likely grow up smoking marijuana as well within 5 or 6years. That makes me wonder whose idea it was at DCF to decide not to consider marijuana as a serious issue.

Smoking marijuana is a serious issue. It is not the cannabis of the 1960's; but cannabis that is ten times stronger. It is not a joke, or a casual source of entertainment. It is a substitute for skills we have not taught our young people. Skills that will help them manage their lives in a more balanced way.

IS MARIJUANA A GATEWAY DRUG?

The question on most folk's minds about addiction is what is wrong with smoking marijuana. It is natural. There is no data on overdose by smoking. And most smokers agree that it is not addictive. While these things may be true, the real question is why do people continue to smoke cannabis on a daily basis. And why is there so much negative press?

The answer is that smoking marijuana changes the way we feel. It numbs us, it clouds our depression, it shifts our focus from everyday stresses to an ethereal experience which takes us out of ourselves. Is the substance itself addictive? NO. Is cannabis a gateway drug leading to more intense addiction and highly volatile drug behaviors? No. So what is the problem?

The problem is that we become attached, dependent and/or addicted to the feeling. To the escape and the method of detachment. Using this method on a daily basis keeps us from doing other things. It does not allow us to develop other coping mechanisms which we need to manage our lives. It prevents us from becoming involved in family and friendships. The loss that we experience is a loss of time. Something we cannot recover.

Marijuana may not be a gateway to other drug use. But it definitely is an obstacle to living life to the fullest.

ADDICTION ELITISM

An elegant looking, well-dressed woman in a designer suit and handbag that cost more than most people's weekly salary, came to see me the other day. She wanted to 'interview' me to see if the treatment my staff and I could provide for her young daughter was up to speed. Her husband had already called and asked about our credentials, years of experience and schools. So this was the in-person visit.

Her daughter was not present. She was at home where she stayed while in the midst of a Percocet-heroin run. Her mother proceeded to tell me that the 17-year old was not like those 'other people' who came to us for treatment. She was not 'that kind of person'; she was from a 'good' home. And could we treat the daughter at home so that she did not have to come in contact with any of the types the mother had seen in our waiting room.

It takes a lot of restraint not to say what is close to the tip of my tongue when folks take such an elitist stance about addiction and treatment. It is an equal opportunity disorder. Addiction knows nothing about socio-economics, or skin color or age. Treatment is not dependent upon the price of a designer bag or the education level of the parents. It is a condition. It can happen to anyone. It is treatable.

As for the therapy most of us in this profession provide, it is not dependent upon the patient's income. It is dependent upon the patient's needs. We work hard regardless of who the patient is or where they come from in an effort to promote wellness - it's that simple.

OVERDOSE PREVENTION

Of course we all know that the best way to prevent drug overdose is not to take any illicit drugs or medications that do not belong to us. Yet each day young people die needlessly by taking large quantities of Opioids such as Percocet, Vicoden, and Heroin. Their friends see that the overdose results in respiratory distress and they become frightened. They either leave the struggling friend or they dump them outside an emergency room door.

But time is crucial when it comes to saving someone who has taken too many drugs or has abused someone's prescription medication. When the respiratory system is depressed by too many opioids the person gasps for air. It does not take too long for death to come.

But there is a substance - Naloxone(Narcan) that average people can be trained to administer that will save lives. Naloxone reverses respiratory failure in seconds. In a study in California where a survey of 48 communities who are trained to use NALOXONE responded, there were 10,171 persons saved with NALOXONE.

Rather than opposing methods of harm reduction in favor of strict abstinence, I encourage communities to seek out hospitals and clinics who are willing to train and give access to Naloxone in an effort to reduce deaths by opioid overdose.