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Archives for December, 2011

Addiction

The Debate Continues

I've described the ongoing debate over use of opioids for chronic pain, and shared information about a group of physicians who are attempting to reduce the damage caused by careless over-prescribing.  Their attempts have created some backlash, as described here.

Feel free to comment in response -- here or there, or both! Pills photo available from...
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General

More of a Painful Topic

Thank you for your comments about my post about treating chronic pain with opioids.  I was in the middle of adding a response to one of the comments this morning, when I decided to elevate my response to a post of its own. Starting a new post might, I hope, keep the discussion going… and besides, I was struggling to find a stopping point!

Here are highlights from the...
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Addiction

Relapse in an Era of Buprenorphine

A recent experience with a patient helped me realize the dramatic difference in the treatment of opioid dependence, in an era of buprenorphine.

I randomly drug-test for a wide range of substances.  I don’t test because of a lack of trust for patients;  I test because before the era of buprenorphine, insight—a more fundamental character trait than honesty-- would rapidly change after relapse.  Almost immediately after the onset of an opioid high,...
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Addiction

More About Inappropriate Opioid Prescribing

I have asked for permission to repost an article from the web site of CBC Radio, and I'm waiting for their answer.  In the meantime, I'll provide a link to the article, along with a teaser.  The article also refers to a podcast of a Town Hall event featuring Dr. Andrea Furlan, a pain specialist from Toronto, Christine Bois from the Centre for Addiction and Mental Health (Canada), and Detective...
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Psychology

The Value of Psychiatry(?)

As a solo-practice psychiatrist, I am more connected to the cost/value equation of my services than the typical system-employed physician.  I’ve also written in prior posts about my concerns with modern psychiatry.  I have worked in a variety of settings over the course of my career, and I realize that coming to an understanding of something as complicated as another person’s subjective life experience is a very difficult endeavor.

At the very...
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