As if getting clean wasn’t tough enough already, recovery patients in Utah will soon not be allowed to smoke cigarettes in rehab. The state’s Recovery Plus initiative will require all substance abuse and mental health treatment facilities that receive public funding to be tobacco-free by next March. Some centers, like adult detoxification center Volunteers of America (VOA), have implemented the ban ahead of schedule, and they are finding a significant number of clients are having a more difficult time completing the program. "The cigarette thing almost made me walk out," says Dusti Benavidez, a patient at VOA. “I understand we have to climb a mountain to get clean. Can we climb one mountain at a time?" Patients who smoke prior to admittance are provided with nicotine replacement therapy and education. Even still, the impact of the ban will be felt by a significant amount of people; about 66% of those in substance abuse programs are smokers, according to Utah Division of Substance Abuse and Mental Health. Many clients have already left the detox prematurely, and therefore not receiving assessments for admission to treatment programs, according to VOA residential service director Andrew Johnston. “We’re waiting to see if our numbers rebound to previous levels,” he says. If the number of clients continues to drop, the center may ask the state to waive the ban.
Despite the struggle, research shows that kicking the habit during detox may be worth it, as people who give up smoking during treatment have a 25% better chance of long-term abstinence from alcohol and drugs. Treatment providers are especially eager to promote health and wellness in the state, as Utah clients with mental illness and/or substance abuse issues tend to have a life span that’s 29 years shorter than the general population. “We have a responsibility to view ourselves as health care providers," says Rick Hendy, program administrator of adult mental health for the state Division of Substance Abuse and Mental Health. Utah clinics are not the only place to enforce smoking bans; a Texas rehab center voluntarily kicked out tobacco just a few months ago, and New York and New Jersey have made all rehab facilities entirely smoke-free.
With the rate of Rx overdose deaths quadrupling in the last decade, the US federal government is mobilizing its best line of defense against a rising surge of painkiller abuse. Today, House lawmakers will introduce legislation that would require most pain drugs to adopt safeguards to deter abuse, such as making the pills more difficult to crush or inject. Rep. Bill Keating, lead sponsor of the bipartisan bill, says Congress considers painkiller abuse to be a "major public health epidemic," and any products that fail to meet these new safety features would be removed from the FDA’s list of approved generic drugs.
While Keating says the bill has "broad support" in the House, there are some concerns that it could do more harm than good. "The proposed legislation would be detrimental to patients and could potentially remove FDA-approved safe and effective generic medicines from those who rely on them," says Ralph G. Neas, president of the Generic Pharmaceutical Association, an industry trade group. "Addressing prescription-drug abuse is of utmost importance to the generic pharmaceutical industry. Policy makers should let the medical evidence guide actions in addressing this critical issue." Recently, only a few drug brands have made tamper-resistant formulations, with mixed results; when OxyContin became harder to crush, its sales dropped in many locations, which seemed to suggest that the safeguards were working. However, many OxyContin users simply switched to crushable Opana or even heroin. Whatever happens, the abuse-deterrent formulations are generally priced the same, and there is no difference in medication quality, so patients taking the drugs as prescribed should notice no real difference if the drug companies do adopt these safeguards.
Q: As an alcoholic, could you have avoided using in the first place if you had known better? Or is it something you had to go through in order to get better?
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The authorities who are investigating the death of Sage Stallone found numerous large empty prescription bottles and bags of white powder while searching his room. Although the baggies would suggest drug use, authorities believe a more "likely scenario" is that the son of Sylvester Stallone was dealing mass quantities of hydrocodone and not using at the time. They dubiously cite his weight—he stood at 5'7" and weighed 188 pounds on the day of his death—as the main reason for believing Sage wasn't an addict. One law enforcement source says, "He was pudgy, and drug addicts are almost always rail thin." Although authorities didn't find any hydrocodone in his house, they did find 60 empty prescription bottles that had held a minimum of 500 pills each. They believe that Sage could have been in possession of up to 30,000 tablets at one point that were likely shipped from another country. And while they're confident that the bags of white powder found in the room will test positive as ground-up hydrocodone, they are not making any claims about the bag's contents until the tests are done. Sylvester met with famed private investigator Scott Ross yesterday, who will be doing his own investigation into the death of Sly's son.
Dr. James J. Scheiner, now 76, was an orthopedic surgeon for over 30 years. He spent many of them abusing the narcotics that were so readily available to him—and harming his patients in the process. He says that he looks back on his story as "a ruined life," even though he managed to get clean after being sent to prison back in the '80s. Now he's written a memoir about his two-faced existence—The Janus Doctor: A Nightmare of Drugs and Deceit—with a mission to expose just how many of the people entrusted with our health are jeopardizing it through their addictions.
Speaking with The Fix from his Maryland home, Scheiner recalls how, struggling against anti-Semitism and academic difficulties to get into medical school in the 1950s, he first took drugs to enhance his performance. While cleaning out the rat colony in the zoology building at the University of Cincinnati, he shared his troubles with a sympathetic retired professor—who introduced him to amphetamines. "To me, it was a wonder drug," Scheiner says. "Suddenly I was able to study for hours." But starting from his residency in Texas, and continuing long into his career as an orthopedic surgeon in Virginia, it was mainly opiate painkillers—above all, Demerol—that gripped him. He would inject himself three or four times a day. "You get this feeling of euphoria, as if you are omnipotent," he says. "Which most doctors have anyway... It's an occupational hazard; you feel as if you're a demigod!"
Having patients' lives in his hands didn't stop him. "I'd feel very alert for a while after I took it, maybe one hour," he tells us. "But then I'd have to leave the room mid-operation to go and inject myself again." Many times, he harmed his patients by causing infections: "When you use these drugs you start perspiring, and during surgery my perspiration would drip into the wound."
Some of Scheiner's colleagues knew, he believes, but he never got busted, thanks to a "vow of silence" in the medical profession. Instead, his practice dwindled as he botched procedures and paperwork, so he seized a lucrative opportunity to conduct clinical trials for a drug company. He was finally caught forging results and inventing patients to feed his habit, and sent to a federal prison for fraud. "I probably could have avoided prison if I'd hired a top-notch lawyer," he says. "But I wanted to go. I could see the damage I was causing and I wanted to go cold turkey." Despite the odds, he succeeded, getting clean in prison without any treatment or support group—apart from the unlikely combined influence of a "wise rabbi" and a "notorious Black Panther member." Scheiner thinks the medical profession's omertà extends to the medical boards: after his release, he was permitted to keep his license, and promptly appointed as head of orthopedics at a VA hospital.
Scheiner stayed drug-free for the rest of his medical career, which included posts in the Middle East and Africa. (Although the drugs he was prescribed after a painful gall bladder operation five years ago led to a year-long relapse.) He says he wrote his book because "I still feel very guilty over what I did, betraying a sacred trust like that, and I want to mitigate the hurt I caused." He believes that people need to be more aware of the risk that their own physicians are abusing drugs; his research in recent years suggests to him that around 15% of doctors do so—"and that's not including recreational use, the ones that go and get drunk, and are on call." He pauses when asked what it was like to be a "Janus" doctor, deceiving everyone around him. "Horrible," he says. "Just horrible."
If you're getting up there in years, you may want to adhere to a daily two-drink maximum, or risk losing some marbles. Older adults who drink heavily may be at a higher risk for cognitive declines that could lead to dementia, according to new research. A study recently presented at the Alzheimer’s Association International Conference in Vancouver followed 5,075 U.S. adults (ages 65 and older) for eight years, tracking their memory and cognitive function via telephone survey. Results showed that the participants who were binge drinking (consuming four or more drinks on one occasion) at least twice a month, were two and a half times more likely to experience memory loss and cognitive decline. "It's not just how much you drink but the pattern of your drinking," says lead study author Dr. Ian Lang. "Older people need to be aware, if they do binge-drink, of the risks and they should change their behaviors." An earlier report conducted by the Centers for Disease Control and Prevention in January found that one in six adults in the US are binge drinkers, and surprisingly, adults aged 65-and-over were the most likely group to binge drink. "Policymakers and public health specialists should know that binge drinking is not just a problem among adolescents and younger adults; we have to start thinking about older people when we are planning interventions to reduce binge drinking," says Lang. However, alcohol in smaller quantities may not be so bad—previous studies have shown that drinking moderate amounts (up to two drinks for men, and one for women) may actually reduce the risk of dementia.