Gregory B. Collins

Synthetic legal intoxicating drugs: the emerging 'incense' and 'bath salt' phenomenon

Synthetic legal intoxicating drugs (SLIDs), such as those commonly contained in products sold over the counter as “bath salts” and “incense,” have risen tremendously in popularity in the past few years. These drugs can have powerful adverse effects, including acute psychosis with delusions, hallucinations, and potentially dangerous, bizarre behavior. These products are gaining in popularity among drug abusers, because they are cheap and produce a powerful high. They may not be detectable on standard urine drug screening.

Chemical Dependency Treatment Outcomes of Residents in Anesthesiology: Results of a Survey

Substance abuse is a potentially lethal occupational hazard confronting anesthesiology residents. We present the results of a survey sent to all United States anesthesiology training programs regarding experience with and outcomes of chemically dependent residents from 1991 to 2001. The response rate was 66%. Eighty percent reported experience with impaired residents and 19% reported at least one pretreatment fatality. Despite this familiarity, few programs required pre-employment drug testing or used substance abuse screening tools during interviews. The majority of impaired residents attempted reentry into anesthesiology after treatment. Only 46% of these were successful in completion of anesthesiology residency. Eventually, 40% of residents who underwent treatment and returned to medical training entered another specialty. The mortality rate for the remaining anesthesiology residents was 9%. Long-term outcome was reported for 93% of all treated residents. Of these, 56% were successful in some specialty of medicine at the end of the survey period. We hypothesize that specialty change afforded substantial improvement in the overall success rate and avoided significant mortality. Redirection of rehabilitated residents into lower-risk specialties may allow a larger number to achieve successful medical careers.

Chloroquine psychosis masquerading as PCP: a case report.

Abstract Chloroquine and its derivatives have been drugs of choice in the prophylaxis and treatment of malaria for over 50 years. These drugs are also frequently used in the treatment of various rheumatologic disorders. Because many Americans now travel abroad and may require chloroquine prophylaxis, as well as the fact that such medications are readily available through Internet-based supply houses, clinicians should be aware of the potential toxicity associated with the use of these agents. We present the case of an adolescent female who presented with acute, chloroquine-induced toxic psychosis resembling that induced by phencyclidine (PCP) in clinical presentation and laboratory findings. In the acute setting, the differentiation between chloroquine toxic psychosis and PCP psychosis may be difficult. Therefore, the syndrome of chloroquine-induced psychosis is reviewed and its differentiation from PCP psychosis highlighted as it relates to important aspects of this case.

Medication-assisted treatment of opiate dependence is gaining favor

People addicted to opiates are more likely to avoid returning to these drugs if they participate in a program that includes taking maintenance doses of methadone or buprenorphine than with an abstinence program. Although medical opinion has long been divided on the issue of abstinence vs medication-assisted treatment, the latter seems to be gaining respect as an evidence-based approach. Recovering addicts are more likely to avoid returning to the use of opiates if they participate in a program that includes taking maintenance doses of methadone or buprenorphine.

Anabolic-Androgenic Steroid Abuse by Physicians

Abstract Physicians are not immune to the rising popularity of anabolic-androgenic steroid (AAS) abuse. We present three cases of physician-patients who recently required inpatient substance abuse treatment stemming from the abuse of AAS or related compounds. These individuals shared a number of clinical and psychological features that led to or resulted from their abuse of ergogenic substances. Each incurred severe professional, legal, domestic and/or health consequences as a result of their abuse. The common features identified in these patients suggest the presence of an overriding “risk behavior syndrome” that may predispose susceptible individuals to AAS abuse. The reinforcing properties of AAS and the potential for dependence remains an active area of research. Effective treatment of these individuals requires recognition of the causative factors as well as the high likelihood of other substance abuse that must also be addressed. With proper support and monitoring, these individuals can resume productive professional careers.

Patient-provider e-mail communication as an adjunctive tool in addiction medicine.

Abstract Frequent electronic mail communication between patients and their addiction specialist can be utilized as an adjunct in the treatment of alcohol or substance dependency. Selected patients benefit from mandatory daily electronic mail communications with their provider through enhanced accountability, frequent self-assessment, deterrents to isolation, and a sense of continuous access to care. Participants have found the experience easy and enjoyable and all have maintained continuous sobriety. We present our experience using this modality as a series of illustrative case reports and a discussion of the implications of using electronic mail with patients in addiction medicine

E-cigarettes: Safe to recommend to patients?

Electronic cigarettes (e-cigarettes)—devices that generate a nicotine vapor that can be inhaled by the user in a fashion that mimics the experience of smoking—are increasing in popularity, and many people seem to view them as reasonable alternatives to nicotine replacement therapy to help them refrain from smoking. Physicians should not encourage such a view. E-cigarettes are unregulated nicotine delivery systems that have never been subjected to any kind of testing of safety or of efficacy as nicotine replacement therapy. Moreover, for young people who have never smoked, these devices could potentially serve as a gateway drug. E-cigarettes have never been subjected to testing of safety or efficacy as nicotine replacement therapy.

Reentry of anesthesiology residents after treatment of chemical dependency—is it rational?

Although chemical dependency has been widely acknowledged as the most significant occupational safety issue for anesthesiology, it is neither new nor is it restricted to physicians or the United States. Early work with cocaine by William Halsted to produce topical and conduction anesthesia also resulted in his addiction to cocaine. Almost as soon as anesthesiology began to be recognized as a unique medical specialty, physician anesthesiologists were known to have a high incidence of addiction and suicide [1]. This elevated risk has not changed significantly for the past three decades [2,3], and although first reported in US physicians giving anesthesia, it is reported with the same alarming incidence in the United Kingdom [4] and among nurse anesthetists [5]. Although addiction carries substantial risk to health wherever it occurs, addiction to anesthesia drugs has great lethality. Suicide is highly associated with chemical dependency on anesthesia drugs [6], and unfortunately, death is often the first sign of this form of addiction [7,8]. Despite increasingly widespread recognition of the seriousness of this problem, improved methods to prevent diversion of controlled substances, and education about the risks, the incidence of addiction has not changed [9], nor has the morbidity [10]. There is clearly an association between risk of addiction and the handling of anesthesia drugs [11]. Several reasons for this association have been proposed in the anesthesiology literature. Some of the causes are thought to be early drug experimentation, prior addictive tendency [10], and other high-risk behavior [12]. An interest in pharmacology undoubtedly is a factor that draws physicians to anesthesiology. In the course of learning to give anesthesia (and beyond), the realities of stress, production pressure, low self-esteem, and working alone undoubtedly contribute to self-medication and chemical dependency. Growing experience with administering anesthesia drugs creates the fallacy of control, which makes the transition from self-medication to chemical

Drug Abuse and Addiction

People from all walks of life can experience problems with their drug use, regardless of age, race, background, or the reason they started using drugs in the first place. Some people experiment with recreational drugs out of curiosity, to have a good time, because friends are doing it, or to ease problems such as stress, anxiety, or depression. However, it’s not just illegal drugs, such as cocaine or heroin, that can lead to abuse and addiction. Prescription medications such as painkillers, sleeping pills, and tranquilizers can cause similar problems. In fact, next to marijuana, prescription painkillers are the most abused drugs in the U.S. and more people die from overdosing powerful opioid painkillers each day than from traffic accidents and gun deaths combined. And addiction to opioid painkillers can be so powerful it has become the major risk factor for heroin abuse.