Science and Psychology
Physicians realize limits of their substance abuse and mental health patients.
Clearly, there needs to be standards that require all Primary Care Centers and Hospitals to have a staff psychologist available:  See-

Date: 1/29/2013 10:30 AM
Media Contact: SAMHSA Press Office
Telephone: 240-276-2130

Sharp rise in buprenorphine-related emergency department visits from 2005 to 2010

Visits involving non-medical use of buprenorphine also increase

Hospital emergency department visits linked to buprenorphine, a medication to treat opioid addiction, increased substantially – from 3,161 visits in 2005 to 30,135 visits in 2010 with 52 percent (15, 778) in 2010 involving non-medical use – according to a new report by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Of the buprenorphine-related, non-medical use related visits in 2010, 41 percent involved just the use of buprenorphine. The remaining 59 percent of these non-medical visits involved the use of other substances such as pharmaceuticals including benzodiazepine (27 percent), narcotic pain relievers (12 percent), and illicit drugs like marijuana (11 percent), heroin (9 percent) and cocaine (8 percent). In 2010, most buprenorphone-related emergency department visits for non-medical use involved males (66 percent). Patients aged 26 to 34 years old represented the largest proportion of visits for non-medical use of the medication.

Buprenophine was approved as a treatment for opioid addiction in 2002 and is usually prescribed to patients by certified physicians, mostly in office-based treatment settings. Since its introduction the use and availability of the partial opioid medication has significantly increased. In 2005 5,656 certified physicians were prescribing buprenorphine to 100,000 patients. By 2010, 18,582 certified physicians were prescribing the medication to more than 800,000 patients

Although its overdose risk and abuse potential is thought to be lower than other treatments for opioid addiction such as methadone, buprenorphine, like any prescription medication, may cause serious harmful health consequences. This is particularly true when the drug is taken improperly or for non-medical uses. In 2010, there were 2.3 million emergency department visits related to the misuse of all drugs.

Federal, state, and other entities have taken steps to reduce the risk of buprenorphine diversion and abuse. For example, FDA has required a Risk Evaluation and Mitigation Strategy for certain buprenorphine products that will include physician education and medication guides. SAMHSA announced recently that the agency will monitor for buprenorphine abuse and diversion, and provide resources for physician education. The Federation of State Medical Boards is updating its guidelines for buprenorphine use in Office Based Treatment settings.

The report, entitled, Emergency Department Visits Buprenorphine is based on findings from the 2005 to 2011 Drug Abuse Warning Network (DAWN) reports. DAWN is a public health surveillance system that monitors drug-related morbidity and mortality through reports from a network of hospital across the nation. The complete survey findings are available on the SAMHSA web site at:

For more information about SAMHSA visit:

Mediator:  Slimming Drug a Killer
 Mediator, a drug licensed for use by diabetics that became widely prescribed in France …  Mediator, a drug licensed for use by diabetics that became widely prescribed in France as a slimming aid, “probably” caused at least 1,300 deaths before it was withdrawn, a study published on Thursday said.  Mahmoud Zureik of the National Institute of Health and Medical Research (Inserm), who co-led the probe, told AFP that around 3,100 people had required hospitalisation during the 33 years during which the drug was sold.
However, these figures could well be an “underestimate,” he said.  The study, appearing in the specialised journal Pharmacoepidemiology & Drug Safety, finetunes an estimate by Zureik in 2010 that the death toll from the scandal was between 1,000 and 2,000.
Mediator, known by its lab name as benfluorex, was initially licensed to reduce levels of fatty proteins called lipids, with the claim that it
helped diabetics control their level of blood sugar. But it also suppressed appetite, which meant it gained a secondary official use to help obese diabetics lose weight. In fact, it was widely sold on prescription for non-diabetics wanting to slim.
In 2009, Mediator was pulled from the European market amid evidence that it damaged heart valves and caused pulmonary hypertension.
Its French manufacturer, Servier, is being probed on suspicion of dishonest practices and deception.
The new study is an extrapolation based on figures for deaths from faulty heart valves, although not from hypertension, among major users of the drug.  The main data comes from France’s national health insurance system, which said that 303,000 patients used Mediator in 2006.
According to Mediator, 145 million packets of Mediator were sold on the French market before the drug was pulled.
The Mediator case came to light after a scandal involving a similar type of anti-obesity drug, fenfluramine, in the late 1990s.
 Cognitive behaviour therapy and exercise both good for chronic widespread pain

Arch Intern Med 2011, doi:10.1001/archinternmed.2011.555 [PubMed® abstract]

Cognitive behaviour therapy, exercise, or both together worked significantly better than treatment as usual for adults with unexplained widespread pain (fibromyalgia) in a recent trial from the UK. When asked to gauge how much they had improved after six months of treatment, 30% (26/87) of those treated with cognitive therapy, 35% (32/92) of those given an exercise regimen, and 37% (35/94) of those treated with both reported feeling much better or very much better than they had at the start of the trial. Just 8% (7/88) of controls reported the same magnitude of improvement; the other 92% reported minimal improvement or worse.

Cognitive therapy was delivered by telephone, eight times over six months. Exercise sessions were delivered once a month by a trained instructor, who recommended at least two visits to the gym each week coupled with brisk walking between visits. Both treatments had a limited impact on a large number of secondary outcomes including quality of life, and cost effectiveness analyses were equally hard to interpret. Even so, a linked editorial is confident that cognitive therapy and exercise look like good options for the large numbers of primary care patients currently taking opioid drugs for chronic widespread pain or fibromyalgia (doi:10.1001/archinternmed.2011.547). Both treatments are less risky than drugs and encourage patients to take control of their own illness. Around a fifth of all primary care visits in the US currently end in a prescription for opioid pain killers, says the editorial.


Cite this as: BMJ 2011;343:d7335



See lovely Science Web site at:







Alcohol and Drugs:

Alcohol and drug abuse are devastating American society, are a major source of healthcare costs, loss of industrial and workforce productivity, move countless families from the middle class into poverty, is over crowding jails, and makes up a large portion of emergency room and nursing home visits and placements.  Societies are being attacked by criminals, cartels, and manufacturers of drugs and alcohol and social structure is being undermined.  Large numbers of ill people (the addicted) have their illness ignored and untreated and go to waiting lists, jails without proper staffing and treatment for their illness, and are mislabeled “career criminals” instead of crime complicated addict lifestyles as a component of a serious illness.  Below are basic learning materials to begin your process of understanding addiction in the brain, patient, family, and society:






A Very Extensive Benzodiazepine Review For Advanced Professionals:

Some Valuable Information about Anxiety Disorders:

Below is a film that has some valuable pathophysiology and pharmacokenetics related to anxiety and its control.  This film has the typical Medical Model mistakes and faulty conceptualization.  First, that medications such as anxyolitics and antidepressants “control most of the symptoms of an anxiety or depressive disorder”.  In fact, these classes of medications actually work with less than half of the people they are given to, and they only control a few of the many symptoms of these diseases and no medication has ever been found to rise to the level of cure or even stand alone treatment for a depressive or anxiety disorder (see:   Clearly, psychotherapies that effectively treat the entire syndromes of the anxiety disorders and depressive disorders are available and scientifically proven effective.  Any real treatment plan for these diseases should include them, and should view medication approaches as short-term and palliative or minority symptom “control” techniques rather than a “treatment, or treatment plan”.  Clearly, anxiety and depression in their normal state are helpful emotions and cues that are needed by the higher cortical centers for decision making and valuing of expereince and needs.  Our goal is to train our brain, or learn to interpret and appropriately apply these signals/affects without alcohol or drugs or maladaptive acting out these feelings.  We simply can’t be healthy by subscribing to a path of chemically controling these emotions and pretending that that is improving our self-management or achieving health.  Medications are helpful, but not a solution, and those who pretend they are are short-sighted, lack expertise and training, or are inappropriately enamered with their chemistry set.  Enjoy the film:

Differentiating medical from psychological disorders: How do medically and nonmedically trained clinicians compare?

Abstract 1991-24344-001  Publication Date  Accepted: Nov 5, 1990  Revised: Nov 2, 1990 First Submitted: Feb 26, 1990

Existing research has demonstrated that many medical disorders manifest with behavioral symptomology. A relatively conservative estimate of so-called “medical masquerades” is around 10%. This study compared 3 types of health care clinicians, 30 in each group, (psychiatrists, nonpsychiatric physicians, and nonmedically trained mental health psychotherapists) with regard to their accuracy in diagnosing 3 types of clinical vignettes (psychiatric, somatoform, and medical masquerades). There were few differences in the accuracy of diagnosis of the clinical vignettes as judged by the 3 groups of professionals. Thenonmedically trained mental health psychotherapists were as accurate in judging the vignettes as were the 2 medically trained groups. The results do not support the contention that in the diagnosis of these disorders nomedically trained psychotherapists are less accurate than those medically trained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Overview of Behavioral Health’s Future Configuration

For more information go to the Academy of Medical Psychology web site and click on Health Reform Guidelines (