Book: Being Becoming

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Richard S. Waguespack, Ph.D., LCSW

Welcome to BEING BECOMING, a unique portal  of articles, education and services surrounding the interdisciplinary study of BEING from a Christian perspective!  Visitors can expect to find themes pertaining to Ontology -- the philosophical study of the nature of being, becoming and existence.   This work covers interior dynamics of individuals - from physiology to spirituality as well as related environments and their systems. 

Our community seeks to identify and examine  variables that promote or detract from spiritual, intellectual, emotional, social, vocational and physical health and well being.  Challenges for corporate success, individual transitions and holistic personal adjustment throughout the lifespan are considered part of this focus.

Join me in preparing a launch of Being Becoming: Integrative Theory -- the first book from the planned Being Becoming Series. Already available from Waguespack Seminars is a closely related online course: Being and Systems: Paradigms For Social Workers and Other Healthcare Professionals.  Finally, online, phone and in person local support from New Life Coaching will soon be available.

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Contact Richard Waguespack richard@beingbecoming.us

Dialog:

On Unbelievably High Opioid Use in the US

Richard S. Waguespack, Ph.D., LCSW

Keith LePage, Ph.D.

More than a third of US adults prescribed opioids in 2015

 

WOW!!!   :   [

Compare to SOMA in Brave New World.  Also see articles and quotes at the end of this blog to verify that in the not too distant past, this guess would have been more or less correct.  Also note that this is a distinctively "American problem".

Richard Waguespack  August 1 at 10:17pm ·

I find this very hard to believe - My guess would be 12-15 percent tops and as low as 6-7 percent. Any insight about the validity of this article?

More than a third of US adults prescribed opioids in 2015
By Andrew M. Seaman Reuters Health - The United States needs to curb excessive opioid prescribing and improve access to pain management techniques, suggests a new government study. "A very large… ca.news.yahoo.com

Keith LePage

Looks like a real journal. http://annals.org/.../prescription-opioid-use-among-u-s...

Prescription Opioid Use Among U.S. Adults: Our Brave New World | Annals of Internal Medicine | American College of Physicians
Acknowledgment: The author thanks Maxim D. Shrayer, PhD, and Robert H. Fletcher, MD, MSc, for reviewing earlier drafts of this manuscript.
annals.org  August 1 at 10:38pm

Richard Waguespack

I guess there are several different definitions of opioids. August 1 at 10:54pm

Reply
Keith LePage

The prototypical opioid is morphine. However, any compound that interacts with one of the opioid receptors, and produces a morphine-like effect is considered an opioid. For example Dextromethorphin, which is contained in many cough syrups, is a dextrorotary opioid. August 1 at 11:06pm

Reply
Keith LePage

Of course the primary target of the Dextrophin, metabolic product of Dextromethorphan is the NMDA receptor and is called a dissociative analgesic. August 1 at 11:12pm

Reply
Richard Waguespack

Richard Waguespack I would say at least 7-8 lobes or more have opiate/opioid receptors and there are probably at least 15 different kinds. Then we have peripheral ones that may not be opiate/opioid per se but are related to analgesic pain relief... this may be the largest category... and some drugs are hybrids or just outside of... x, but connect to y. I would say that the "keys" coming from the agonist/antagonist agents might be flexible in some cases, though the "locks" are staples. It is just like ADD medication. Strattera is not an amphetamine, but it "kinda" acts like one. August 1 at 11:17pm
 
Reply
Richard Waguespack

For several years in private practice in SC I treated a number of patients with dissociative disorders. I thought giving medication of almost any kind blunted the effect of the abreactive therapy and made it take much longer to bring about integrations.  August 1 at 11:21pm

Reply
Richard Waguespack

Why do they refer to dextroamphetamine as a dissociative analgesic? August 1 at 11:25pm

Reply
Keith LePage

There are four classed of opioid receptors;mu, kappa, delta and NOR. A fifth, zeta, was proposed several years ago, but was found to share very little homology with any other OR. There a number of subtypes in each class.  August 2 at 8:27am

Reply
Keith LePage

A dissociative analgesic (Dextroamphetamine, PCP, Ketamine) induces memory loss. This effect is likely due to high density of NMDA receptors (the high affinity binding site for these compounds) found in the hippocampus. Blockade of NMDARs inhibits short-term memory. Dextroamphetamine is an amphetamine and to my knowledge is not considered a dissociative analgesic.  August 2 at 8:35am

Reply
Richard Waguespack

Thanks. Anything affecting memory, especially long term memory would present major obstacles for therapy focused on dissociative disorders. Yet, I bet there are physicians prescribing such medication to people with dissociative disorders because they did not even recognize them or believe in them or care... they treat symptoms in a superficial way... it may be getting better these days with more education.  August 2 at 11:54am

Reply
Keith LePage

Unfortunately, the inappropriate use pharmaceutics in the treatment of dissociative disorders is still widespread.  Amphetamines are often viewed as "genius" drugs that enhance learning and memory. While there is evidence that such drugs enhance learning, the therapeutic window is narrow and the abuse potential is high. August 2 at 12:09pm

Reply
Richard Waguespack

Morphine is considered an opiate, right?... close to the original chemical formula of secretion from opiate bulbs. August 1 at 11:27pm

Reply
Keith LePage

Yes. Morphine is considered the prototypical opioid. Morphine was originally thought to be a good tool to combat opium addition. Heroin was once thought to be the cure for morphine addiction. Methadone is....... Well you get the idea. Substituting one opioid derivative another addictive opioid has not been a particularly successful strategy. August 2 at 12:09pm

Reply
Richard Waguespack

The way I see it, Methadone is true synthetic and Morphine is an opiate... right... (?) the "prototypical" is the chemical structure model for synthetics to fit into...  August 2 at 12:32pm

Reply
Richard Waguespack

Thanks.

Reply
Keith LePage

There are many synthetic opioids such Hydromorphine, Demerol, Fentanyl, Diluadid etc. They nomenclature is based on the structure from which they have been derived from. August 2 at 12:34pm

Reply
Keith LePage

I spend a good bit of time evaluating novel synthetic opioids. The goal was to develop compounds with less likely to cause dependence while maintaining the analgesic benefits.  August 2 at 12:37pm

Reply
Richard Waguespack

Better to be on Methadone (or other more advanced synthetics as you mention), even though it may hurt a bit because addicts do very bad things when their supply runs out.  Methadone has little high and creates some basis of stability. I think detox centers need to find ways of moving people off methadone with higher success rates with little recidivism... but since it depends on willpower and character in short supply with most addicts, we have a problem, a human rather than a chemical problem, primarily - there must be a law of diminishing return in improving synthetics. You should mean "synthetic opiates"...right??... I think this definition offers a more contained representation --- these days opioid is too broad with more license to move away from the original prototype as you say... a 'synthetic of a synthetic'? If we have synthetic opioids then we are really in trouble because maybe even Tylenol would fit the category, right...? I am exaggerating for the sake of discussion...do you agree with my take here?  August 2 at 12:48pm

Reply
Keith LePage

Acetaminophen may act on TPRV1 and endogenous cannabanoid pathways. I am unaware of any activity at any of the opioid receptors. The date is incomplete. Actually, I believe most of today's abuse is tied to synthetics such as Oxycontin, Dilaudid, Fentanyl and so on. Just fyi, most pharmacologists steer clear of the word "addiction". Dependence is a more accurate term when discussing biological activity.  Addiction is more of a psychological state that my very well include dependence on some drug.
August 2 at 12:49pm

Reply
Richard Waguespack

It would be better to have conversations like this on beingbecoming.us or waguespack-seminars.org Wish I had thought of that.  August 2 at 12:50pm (Edited August 13 at 10:07am)

Reply
Keith LePage

Feel free to copy to your page.  August 2 at 12:50pm

Reply
Richard Waguespack

I might edit a little and put in a blog and put your picture on the bottom with a description and then invite others from around the world to comment. I will put a google translator on the page.  August 2 at 12:52pm

Reply ·
Keith LePage

Sounds good. Pays to keep the old noggin in action.  August 2 at 12:53pm

Reply
Keith LePage

Do you own a copy of Goodman and Gilman? August 2 at 12:54pm

Reply
Richard Waguespack

No question... use or lose.... please comment on the conceptual issue I brought up... August 2 at 12:54pm  (Edited August 13 at 10:13am)

Reply
Richard Waguespack

I have Psychopharmacology: Straight Talk on Mental Health Medications by Joe Wegmann, RPh, LCSW. He is a pharmacist and clinical social worker like me. How good are Goodman and Gilman in balancing and supplementing and withholding medication interventions in reference to the other treatments available? August 2 at 12:59pm

Reply
Richard Waguespack

Like psychotherapy.  A medical malpractice attorney I know should take note... the new normal for physicians it to refer for such treatments and recognize the limitations of what they may be attempting. August 2 at 1:00pm

Reply
Keith LePage

G&G is the "gold standard" for describing the physiological actions of therapeutics.  August 2 at 12:59pm

Reply ·
Richard Waguespack

: ] In what phenomenological background? Meds and organicity only? August 2 at 1:00pm

Reply
Richard Waguespack

Of course, this term "organicity" as I mention in first chapter of my forthcoming book Being Becoming: Integrative Theory has undergone many changes... and in terms of interventions may require a much broader synthesis... August 2 at 1:02pm

Reply
Richard Waguespack

I hope you will see fit to endorse... August 2 at 1:02pm

Reply
Keith LePage

It is a reference material that describes the pharmacology of a therapeutic (site of action, pharmacokinetics, structure etc). I would think it would be a valuable resource to anyone seeking to describe medicinal interventions. August 2 at 1:04pm

Reply
Richard Waguespack

I can send you a fairly advanced draft for your comments, especially on first chapter "Re-Framed Physiology".  August 2 at 1:05pm

Reply
Keith LePage

I would be happy to review portions in which I have some expertise. Remember that I am not a clinician.  August 2 at 1:06pm

Reply
Richard Waguespack okay... thanks...August 2 at 1:07pm

Reply
Keith LePage

Have to run. Good talk, Richard.  August 2 at 1:07pm

Reply
Janice Cooper Beard

I can believe this. I had two surgeries in the last year and both times the doctor insisted I leave with a script for one, even with my stating I did not want or need one. when I was being discharged a few weeks ago, the NP asked what level my pain was, I told her zero. She said I had to have a pain script to leave the hospital. My discharge papers said my pain was a level 3! I guess that was to justify pain script...August 2 at 11:08pm

Reply
Richard Waguespack

I find it a good practice to fill the prescription and keep it in the medicine cabinet for those really bad days when an aspirin or Tylenol or Motrin just does not do enough... They should be the furthest thing from one/s mind +/- 340 days out of the year... Maybe our supreme academic pharmacist Keith will have a comment.   🙂 August 2 at 11:13pm

Reply
Janice Cooper Beard (Retired Math Teacher, Meridian MS Public Schools)

Richard Waguespack scripts are still on my desk.....I just don't take them. If I am in enough pain, I will give myself a toradol injection. August 3 at 12:14am

Reply
Keith LePage Pharmacologist.

Richard Waguespack  I agree with you, Richard. The prudent use of pain meds is fine. If pain continues to require the use of pain medication for more than 5 - 7 days one should contact one's physician. The potential for abuse, and subsequent dependence, associated with pain medication is great and trained supervision of their use is critical. I would also caution people to keep such drugs in a private and secure location. Particularly if other people have access to your medicine cabinet.  August 3 at 8:59am

Conclusion of FB Dialog which ends here.  HOWEVER IT MAY CONTINUE ON THIS SITE!!!        :   ]

See Postscripts Below for future discussions.  August 13 10:29am

 According to Here are 10 opiate addiction statistics in the making

"Between the years 1999 and 2010, sales for prescription painkillers to hospitals, doctors and pharmacies increased fourfold. By 2010, the number of pain medications prescribed was enough to keep every single American medicated for one month’s time."

"Since 1999, the number of overdose deaths from pain medications has increased by 300 percent. In 2008, opiate addiction statistics deaths resulting from prescription pain meds totaled 14,800. This number amounts to over and above the combined total for heroin and cocaine-related deaths."

Supplemental Note:  According to CDC Centers for Disease Control and Prevention, The amount of opioids prescribed per person was three times higher in 2015 than in 1999.  [180 MME to 640 MME].  Further, "a dose of 50 MME or more per day, doubles the risk of opioid overdose death, compared to 20 MME or less per day.  At 90 MME or more, the risk increases 10 times.

Final Note: One must wonder if other drugs such as Benzodiazepines are included or excluded from these statistics.  What is the difference between pain and antianxiety medications in the minds of statisticians.  What are some statistical blind spots that may mask our country's drug crisis?  What can we do about such issues?

This commentary is not to be construed as individual medical advise.  Please consult with your own personal physician(s) or other authorized health professional(s).

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Keith LePage, Ph.D.

Keith LePage, Ph.D.

--Worked at Tulane University School of Medicine 
--Worked at University of Georgia
--Studied Genetics at University of New Hampshire
--Studied Microbiology at LSU
--Went to Mandeville High School
--Lives in New Orleans, Louisiana
--From Mandeville, Louisiana

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