Recovery Michigan

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Breaking the Silence Against Domestic Violence

Post-Traumatic Stress Disorder (PTSD) is a serious condition that most people associate with soldiers on the battlefield and war veterans. This is particularly true in my hometown of San Diego, which has the nation’s largest population of military personnel and nearly 25,000 veterans receiving care for PTSD (from 2010-2016). However, few people are aware that PTSD is prevalent among victims of domestic violence. In fact, a study found that up to 88 percent of women living in domestic violence shelters have PTSD. Often, the trauma is as severe as military combat.

My name is Dovie Yoana King, and I am a survivor of domestic violence living with PTSD. I am also a victim’s rights pro bono attorney, single mother and local elected official. As we approach PTSD Awareness Month in June, I hope to get an early start in giving voice to other survivors of domestic violence who live with the invisible scars caused by this silent epidemic.

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Disabled people represent one of the largest, yet most underrepresented marginalized groups. Around 10% of the world’s population, or 650 million people, live with a disability.

Many disabled people continue to fight for equal rights and access to vital medications, despite facing barriers like immense physical pain, very limited energy, constant illness, and other obstacles. However, the disabled community struggles to be seen and heard due to accessibility issues that persist in many activist and political spaces.

Because many abled people have so little experience with real disabled people, sometimes abled people misunderstand their needs and the core issues they face. This can result in abled people unintentionally perpetuating misunderstandings and misinformation when they attempt to advocate for the disabled community.

People with disabilities experience a whole side of the War on Drugs that abled people do not see, and that information is crucially important to crafting good drug policies.

This issue of The SSDP Mosaic will introduce you to the issues disabled people face in activist spaces and discuss some of the ways in which the War on Drugs deeply impacts disabled people’s day-to-day lives.

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One morning I went out for pancakes and ended up sharing a booth wall with an energetic gentleman and his family. While waiting for my food to arrive, I couldn’t help but listen in on his table. He had lots of opinions and was telling stories when one of his family members asked: “So, what happened at work?”

The conversation died. After a full minute, he finally responded. “Jerry, threw me under the bus with the whole PTSD thing.”

Silence.

“He really messed up the car I was working on and I was getting so pissed, and he was all up in my face saying, ‘What, are you going to have an episode?!’ Sure, I know I get heated and it’s hard to control that, but I he didn’t have to throw it in my face like that.”

A younger man at the table put his hand on his shoulder “you know that guy’s a jerk, don’t let him get to you.”

“I know. It’s just not fair, because I know they took his side,” was the last thing I heard on the matter.

The truth about Post Traumatic Stress Disorder (PTSD) is that anyone can experience it. Even the United States Department of Veteran Affairs has chosen to simply post the definition directly from the DSM-V without any sort of asterisk or simplification for those not serving in the military. No one is shielded and even indirect trauma (such as simply hearing about a loved one being hurt) can cause its onset.

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For Thomas P. Yacoe, the word is “terrifying.”

Leah Hemberry describes it as “constant fear.”

For Michael Tausig Jr., the terror is “beyond description.”

All three are patients struggling with chronic pain, but what they are describing is not physical agony but a war inside the medical community that is threatening their access to painkillers — and, by extension, their work, their relationships, and their sanity.

Two years after the United States saw a record 27,000 deaths involving prescription opioid medications and heroin, doctors and regulators are sharply restricting access to drugs like Oxycontin and Vicodin. But as the pendulum swings in the other direction, many patients who genuinely need drugs to manage their pain say they are being left behind.

Doctors can’t agree on how to help them.

“There’s a civil war in the pain community,” said Dr. Daniel B. Carr, president of the American Academy of Pain Medicine. “One group believes the primary goal of pain treatment is curtailing opioid prescribing. The other group looks at the disability, the human suffering, the expense of chronic pain.”

Pain specialists say there is little civil about this war.

“There’s almost a McCarthyism on this, that’s silencing so many people who are simply scared,” said Dr. Sean Mackey, who oversees Stanford University’s pain management program.

“The thing is, we all want black and white. We don’t do well with nuance. And this is an incredibly nuanced issue.”

Nuance does not matter to people like Tausig, 43, who has been unable to work or socialize since 2008, when the last of his five spinal reconstruction surgeries left him in constant pain.

He last got a taste of life without opioids a few years ago, when his pharmacy’s corporate parent imposed opioid-distribution limits, forcing him to find a new one.

“Those three days were among the worst of my life,” he said. “I wandered the house at night, legs shaking like a whirling mass of putty, sleepless and without respite from the pain.”

Now, with regulators and health industry leaders continuing to bear down on opioids, and the arrival of a new president whose statements indicate that he might further restrict opioid distribution, Tausig’s worries have deepened.

“It’s put the fear of God in me.”

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A new study led by UC San Francisco scientists shows that brain cells, or neurons, react differently to opioid substances created inside the body – the endorphins responsible for the “natural high” that can be produced by exercise, for example – than they do to morphine and heroin, or to purely synthetic opioid drugs, such as fentanyl. The researchers say their findings may help explain why the use of synthetic opioids can lead to addiction.

Since both synthetic opioids and the natural, “endogenous” opioids produced in the brain bind to and activate opioid receptors on the surface of nerve cells, scientists have long assumed that both types of molecules target the same cellular systems. But the new research reveals that these molecules also activate opioid receptors inside cells, and that the locations of these activated intracellular receptors differ between natural and synthetic opioids.

In the new study, published in the May 10 issue of Neuron, the researchers report that this difference could help explain why the effects of synthetic opioid drugs are more rewarding than those produced by endogenous opioids.

“There has been no evidence so far that opioid drugs do anything other than what natural opioids do, so it’s been hard to reconcile the experiences that drug users describe – that opioid drugs are more intensely pleasurable than any naturally rewarding experience that they’ve ever had,” said Mark von Zastrow, MD, PhD, a professor of psychiatry at UCSF and senior author on the new paper. “The possibility that these opioid drugs cause effects that natural opioids cannot is very intriguing because it seems to parallel this extremely rewarding effect that users describe.

At some point, you have to struggle with the symptoms, not just try to avoid them.....

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From war to child abuse. From mass shootings to car crashes. From domestic violence to sex slavery. These are just some examples of the countless traumatic experiences that can cause a person to develop PTSD (Post-Traumatic Stress Disorder).

It’s a complex and compounding disorder that manifests different for everyone.

As someone who has battled PTSD for more than a decade, I have firsthand experience with the common and quite risky “fight-or-flight” response and subsequent adrenaline rush that accompany this severe disorder.

I know better than most how difficult it can be to tackle, manage, and control the symptoms, daily, weekly, yearly.

Knowledge and understanding of the disorder can give any person who suffers from it the capacity to overcome the symptoms, regardless of severity. Absolutely anyone.

To accomplish this, the PTSD sufferer needs a custom-tailored plan of action, a good support system, and a lot of tenacity. You need to find out what works for you.

If you are sick and tired of enduring the frequent unwelcome thoughts, the extreme sense of fear, the flashbacks, and hyperarousal for many years — like me — you will want to move forward in life.

When you find yourself at a point where you no longer want to live in fear or have daily fight-or-flight responses, then it is time to attempt to deal with your PTSD.

This is the regulatory framework for SUD services confidentiality....

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On Tuesday, the House Energy and Commerce Health Subcommittee convened a hearing on 42 CFR Part 2 – regulations pertaining to the disclosure and sharing of a patient’s substance use treatment records. The bill in question, the Overdose Prevention and Patient Safety Act (H.R. 3545) intends to amend federal regulation related to substance use health records, aligning it with the Health Information Portability and Accountability Act or HIPAA, the law that governs privacy standards for other health care records. The Subcommittee is expected to vote on this legislation in the near future.

H.R. 3545 would allow for the sharing of patient information for the explicit purposes of treatment, payment or other health care operations like case management and care coordination. The law includes a long and detailed list of restrictions on when and where patient information could be used in civil and criminal proceedings, making clear that these records are prohibited from being used as evidence or a basis to press charges in criminal cases against patients.

Rep. Earl Blumenauer (D-OR), who co-authored the legislation with Rep. Markwayne Mullin (R-OK), said, “Simply put, an antiquated law prevents lifesaving medical care for patients in recovery for substance use disorders.”

The panel of witnesses in addition to Congressman Blumenauer included, Dr. H. Westley Clark, Dean’s Executive Professor, Public Health Program, Santa Clara University; Mr. Gerald DeLoss, Officer, Greensfelder, Hemker, and Gale, P.C.; Mr. Jeremiah Gardner, Manager, Public Affairs and Advocacy, Hazelden Betty Ford Foundation; Mr. Dustin McKee; Director of Policy, National Alliance on Mental Illness of Ohio; Ms. Patty McCarthy Metcalf, Executive Director, Faces and Voices of Recovery.

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Find, share, and connect on the world's largest sober community. 

Sober Grid puts a free peer support network right in your pocket to aid you in your recovery.

"Sober Grid is just like Facebook, but better. The content on the news feed is so helpful for us in the recovery process. It will give you inspiration and motivation to stay sober. Staff is caring, and so are users, you'll make new great sober friends who'll support you every step of the way. Simply amazing!" - Ailette R.

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An investigational two-drug tablet for sublingual administration called ALKS 5461 was effective as adjunctive, long-term treatment for major depressive disorder, researchers reported here.

The open-label phase III trial found 52.5% of patients achieved remission of major depression within 12 months of treatment, with a median time to remission of 59 days, in patients with inadequate response to conventional antidepressants, according to Michael Edward Thase, MD, of the University of Pennsylvania Perelman School of Medicine, and colleagues.

"Antidepressant medications are taken for months or even years, not weeks, so it's important that longer term observational studies be done for every new medication being evaluated as a potential treatment for depression," Thase told MedPage Today. "This is particularly true for ALKS 5461 because this medication works through the opiate pathway, and other medications that work through this pathway are associated with development of tolerance of effects or dependence/withdrawal symptoms when stopping."

Overall, 49% of participants completed the study, with 11% discontinuing due to an adverse event. The most common adverse events reported were headache, nausea, constipation, dizziness, and somnolence. There weren't, however, any reports of weight changes nor changes in metabolic profile. Additionally, there was no evidence of withdrawal after treatment discontinuation.

"The findings are not surprising," said Thase. "We didn't think the drug would be associated with tolerance of therapeutic effects or signs of dependence -- because of the effects of samidorphan -- but it is important to answer these questions with data, not conjecture."

http://bit.ly/2rxRkWn

Treatment benefit clear in less than 3 days, lasts at least a month.

The group with moderate PPD (study 202C) included 104 women. HAM-D total score from baseline of 14.2 points at 60 hours in the brexanolone 90 mg/kg/hour group compared with a 12.0-point reduction in the group who received the placebo (P=0.0160).

Statistical significance was first observed at hour 48 and sustained through day 7, and the mean reduction from baseline in HAM-D score seen at hour 60 in the brexanolone group was maintained at day 30. Clinical Global Impression-Improvement (CGI-I) scales also improved in brexanolone patients (P=0.0005 versus placebo).

The severe PPD group (study 202B) included 122 patients. At hour 60, the 90-μg/kg/hour group showed a mean reduction in HAM-D total score of 17.7 points from baseline compared with 14.0 points with placebo (P=0.0252). Treatment with 60 μg/kg/hour brexanolone produced a significant mean reduction in HAM-D total score of 19.9 points versus placebo (P=0.0013). In the brexanolone groups, reductions in HAM-D total score were first observed at 48 hours, and the effect at 60 hours was maintained at the 30-day follow-up. Additionally, there were significant improvements in the CGI-I at hour 60 at both doses relative to placebo.

Study authors offered no explanation for the numerically greater response with the lower brexanolone dose. Although HAM-D reductions with the higher dose were significantly greater than with placebo at the 60-hour and 30-day points, it showed no advantage at any other evaluation. The lower dose, on the other hand, was consistently superior to placebo. The high dose also did not produce greater rates of HAM-D remission (score of 7 or less) versus placebo, whereas the 60-μg/kg/hour dose did.

Brexanolone was well-tolerated, with common adverse events including headache, dizziness, and somnolence. One patient in each group had a serious adverse event. Neither required hospitalization.