Dialog: On Unbelievably High Opioid Use in the US

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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A Reality Check On Commercial Medicine

BEING BECOMING A Reality Check On Commercial Medicine Richard Waguespack, Ph.D., LCSW Gullibility to the claims of medicine especially when attached to commercial interests has been a mainstay of most US consumers for decades.  Perhaps the best place to begin addressing this major cavity is to make it easier for younger people to witness the

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Dialog: On Unbelievably High Opioid Use in the US

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

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Whose Changing The Meaning?

  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

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BEING BECOMING CRITIQUE OF DEEPAK CHOPRA’S SO CALLED 17 PRINCIPLES Image already added         After finishing a talk at a recent neurosciences conference in Columbus Ohio (April 29, 2017), Deepak Chopra appeared in a webcast entitled Does the soul have independent existence?  Understand these 17 principles and know the answer for yourself. This man evidently wants

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Whose Changing The Meaning?

Book: Being Becoming

cropped-art1-e1493619159292.jpg
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.

In Whose Changing the Meaning?, Dana Pope explains in striking clarity the importance of integrity in language and its relationship to what is at stake in western civilization.  While meanings do expand and multiply over time through normal transitions, today our language is undergoing revision by many whose primary purpose is not to communicate honestly, but to spin and manipulate!  

The contemporary focus on external change, constructing language and platforms to accomplish self serving or ignoble agendas, often handicaps internal growth,  trust, and the capacity for quality bonding with others.  We must be more aware that entire industries are organized and led by extremely intelligent 'masters of manipulation' willing to teach their craft to others.

Today, we can find numerous sites and platforms such as Changing Minds governed by an ethos of changing others.  "Welcome to ChangingMinds.org, the largest site in the world on all aspects of how we change what others think, believe, feel and do."  Assuming that the potential for some good may be present in these objectives, it never-the-less signals a dire need to be wary and to question the ends and means of major catalysts and calls to action.  Dana has consequently written a book to address the issues of language manipulation by unscrupulous actors in virtually all walks of life. 

Put simply, Dana is motivated to expose what has happened to our language and communication -- and continues unabated at an alarming rate.  Believing that our most basic moral compass and capacity to communicate authentically requires thoughtful re-calibration, she cites Webster to underscore the virtue of prudence as necessary to avoid further abuse and erosion.  Noah Webster (1758-1843) was profoundly in tune with the ethos of the founders of our country.  “Webster states that prudence is, “more in foreseeing and avoiding evil than in devising and executing that which is good”  (Chapter 8).

From a linguistic or epistemological perspective Dana tends to be a strict foundationalist.  From the onset of the book, she hold firmly to this construct, often taking absolute positions about preserving early frames of meaning, often with the assumption that such pristine references often contained a higher level of implicit morality.  While there may be limitations in application, there is no question that reference to such a paradigm is very needed for reform in education and so many other venues that extend from it - and more critically -- back into it.

The book routinely points out trends of thought and behavior narrating the perilous times we live in --- where the self serving habitually orchestrate public communication containing all manner of malfeasance with the “sheeple” just going along with it.  To perk our powers of observation and defense, Dana cites Nathaniel Hawthorne to call our attention to the power of  “Words – so innocent and powerless as they are, as standing in a dictionary, how potent for good and evil they become in the hands of one who knows how to combine them”  (Chapter 4).

While reading this book it is virtually impossible to escape from the poignant realization for which there is abundant evidence.  Our basic foundations for adequate and holistic communication, and indeed our basic freedoms are often imperceptibly threatened by the questionable wordsmiths (advertisers and promoters) who so often serve the corrupt objectives of public, nonprofit and private sectors without batting an eye.  

From corporations wanting to foist harmful products to government agencies and officials seeking to illegitimately (unlawfully) empower themselves at the expense of the people, we find actors and objectives that are not at all in keeping with sacred principles regarding the dignity of the human person, the best interest of humanity and its inalienable rights.  Dana is acutely aware that the favorite targets of most nefarious  target freedom to live out Christian teachings protected by God, our Constitution, Bill of Rights and related Documents.  The remaining list of works with the potential to truly enhance and benefit our culture is very extensive -- and also subject to considerable risk of suppression, misrepresentation and misalignment.

Certainly life within the Church and its mission are threatened by misapplications of language.  While I cannot agree with Dana's interpretation of Martin Luther's interaction with the Church and the essential variables that pertain, she has many other sections with really helpful insights pertaining to Scripture, relativism in the Church, and more foundational definitions of critical words such as “hate” and “meek” that we do well to examine.

Dana submits early on in Chapter 2:

"Of all the words in the dictionary, Webster was known to have only coined one. The word was demoralize, meaning, “to corrupt or undermine the moral of; to destroy or lessen the effect of moral principles; to render corrupt in morals.” Noah used the word in the context of the demoralization of the language. Even at that time, the language was changing as far as the meaning of words. Webster questioned that if there was not a standard of reference, how will students be able to study America’s history and literature. This was an important focal point for Noah. So sure of himself, on June 4, 1800 Webster placed an ad in a Connecticut newspaper stating he was going to create a Dictionary of the American Language. People spoke out against this ."

By the end of book Dana suggests a new agenda.  Having routinely demonstrated a penchant for analyzing historical changes or compounding meaning of various pivotal words in our language, she ends the book with a section: “New Words Needed”.   The outgrowth of strict foundationalism in a developing society is constructionism.   Rather than load up multiple meanings in one word, let's created a new word for every meaning.  While such a black and white approach may have drawbacks, it is something to weigh in many situations where epistemology is unduly compromised.  There is more to it than can be explained in the book review.

If nothing else, Dana has established herself as a premier contemporary foundationalist, a virtually unrivaled textbook example.   Such a frame may warrant critical notice of philosophers and certain textbook writers in various fields.  The typical reader will not walk away without noticing limitations  but few readers can work through this publication without learning many new things and thinking through some very critical and pivotal issues in education, linguistics, epistemology, public and private life and commerce.

In the end its about communicating within constructs that both motivate and are wide enough and perhaps even fuzzy enough for multiple interpretations... and hence we must accept that the tools of language are much more about intent than their construction per se.  Still, there is something about a good construction that tends to move individuals, groups and societies in the wrong direction.  Of course the opposite is also demonstrably true.

The bottom line is more publications, scripts and  public communicators need to be held to account. If we regularly allow those with questionable or nefarious agendas to abuse the system we won't trust enough to have optimal communications.  Functional teams in business and education will appreciate reminders and reorientation towards foundational structures as well as opportunities to serve as reputable constructionists... in this way the best of the old and new meet and shake hands and the imposing imposters are set at bay... how about those apples for a new day?

A good read for the educator, business leader, social thinker and more!  [Updated 8.3.17]

Pope, Dana Lynn (2017-05-05). Who's Changing the Meaning? Dana Lynn Pope, LLC. Kindle Edition.

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Dana creates business systems for start-up businesses and large companies in need of a turn around.  This is accomplished by working with organizations on their distribution process, financial planning, trend analysis, inventory flow, along with management and employee building, to improve gross margin. She attributes network marketing as providing the knowledge needed for success.

Dana lives in the Dallas-Fort Worth Metro area.   See LinkedIn Profile

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A Reality Check On Commercial Medicine

BEING BECOMING A Reality Check On Commercial Medicine Richard Waguespack, Ph.D., LCSW Gullibility to the claims of medicine especially when attached to commercial interests has been a mainstay of most US consumers for decades.  Perhaps the best place to begin addressing this major cavity is to make it easier for younger people to witness the

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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

Read More »

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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

Read More »

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Richard Waguespack’s Reaction To Dr. Leon Eisenburg’s Deathbed Reflections on ADD / ADHD

Commentary on suppressed Eisenburg "Deathbed Reflections" on ADD/ADHD" and closely related Kagan Interview on ATTENTION DEFICIT DISORDERS

By Richard Waguespack, Ph.D., LCSW

Very recently a very informative and responsible article on Dr. Eisenburg, a man accepted by some as the 'Father of ADHD' was published by realfarmacy.com and yet was removed even before I finished this commentary.  It read "The Man Credited with “Discovering” ADHD Makes a Startling Deathbed Confession “ADHD is a prime example of a fictitious disease.”  realfarmacy.com|By The Farmacy. 

The only trace I could find of the Eisenburg piece was a commentary from Snopes that ranked this smothered article as "mostly true" and then went on to ratify the content.  I suppose such an outcome works better than a 404 error page. Perhaps the piece raised too many uncomfortable questions for psychiatrists, pharmacists and others to address in public forums and regular practice or the authors did not think it good for business.

Rather than just bury my own commentary in exasperation amidst the suspicious withdrawal, I reinforce the points made herein with reference to another very similar interview of Harvard psychiatrist Dr. Jerome Kagan by Speigel online in August 2012, "Speigel Interview with Jerome Kagan 'What About Tutoring Instead of Pills?'" Here is He refers to ADD as an "invention" that encouraged “fuzzy diagnostic practices” and the over-prescription of drugs such as Ritalin for behavioral problems in children.

Though sometimes helpful, Amphetamines can also cause much harm, especially with long term use. The reality is until fairly recently, Americans have largely been denied optimal management of ADD/ADHD because of the inflexibility built into the allopathic orientation of many MDs serving this industry.  One of the most troublesome practices in ADD/ADHD treatment was to insist that patients take amphetamines on a definitive regular schedule without teaching them to read signs of adrenal stress, exhaustion and burnout, making careful adjustments along the way.  Though this protocol  has fortunately waned in recent years, there remains a residual crater of profound blindness, in part caused by a greedy pharmaceutical industry and researchers with overly simplistic self serving models, at times contributing to other mental disorders and even non psychiatric physical problems in vulnerable young patients.

After several decades of very slowly recognized evidence pointing to the negatives associated with 'standard' inflexible standard treatment regimes of ADD/ADHD and the rising status of Osteopathic and Naturopathic  physicians, we are learning in retrospect how much better life would have been for millions had their insights and methods had more influence and been incorporated into standard models of practice much earlier.

Think about this question.  Had the holistic physicians dominated the treatment of ADD/ADHD in the early years, what might of been different?  I think we would see less mental illness and dual diagnosis.

For starters, we can assume that if the pedagogy of such practitioners had been in vogue in the early days, the approach would have likely been to treat the problem with as many holistic alternatives as possible and in some cases cautiously move a low dose amphetamine into the equation.  In many other cases alternative treatments may have been decided upon.  Clearly, somewhat fewer people would have been issued amphetamines, but more pointedly, the prescription strengths would have been less and given with much more flexible instructions supporting multiple supplements and more.  They would have recognized that while almost all antidepressants should be given on a regular schedule, amphetamines were not of the same nature and required a completely different approach. 

Those who really understand their neurology and physiology REALIZE intuitively, You don't push these on an inflexible schedule - but what is the value of "intuition" to a typical allopathic physician - especially in the "old days" where few had the nerve to publicly question prevailing paradigms and approaches?  "Evidently", not enough!!!

In the alternative schema, Holistic treatments would have much more quickly emerged.  The first line of treatment would have BEGUN with holistic, flexible and adaptive approaches to include supplements and lifestyle changes along with  more moderate use of amphetamines and the routine inclusion of  a variety of positive catalysts and buffers such as Vitamin B's and fish oil (just to start a long list which might include agents like magnesium, lecithin, zinc and many others).  Who knows what new and better holistic interventions may have been developed had the pedagogical space for ADD/ADHD been dominated by other schools of thought.

It is not so much a question that these ADD/ADHD diagnosis' and in many cases drug treatments have some validity, it is the sufferer's have been to some extent abused, deprived of good  guidance and multifaceted treatment.  ADD and ADHD are real conditions. Categorizing them as mental disorders per se is a complicated matter and something they have been pretty careless about framing and establishing.  On the other hand, we have 'traditional' physicians like Hallowell and Ratey who themselves suffered from ADD / ADHD and were way ahead of the curve in advising many people within the ADD spectrum on how cope and adjust to in order to live out more optimal lives. 

Contemporary neuroimaging is fairly clear in detecting the existence of 'cognitive deficit disorders' ranging from ADD to Asperger's to Autism... these categories  define what is diverting from "normal function" in a continuum of degree and severity.  Again, we have come to a point in time where it is now reasonable to claim that ADD and ADHD can be detected in neuroimaging with a significant degree of diagnostic objectivity and certainty.

Eisenburg may have had noble motives for identifying the top end of these syndromes and yet it seems at the end of his life, doubts about the merits of his observations and analysis emerged because of the large numbers whose conditions could be construed as ADD/ADHD and because of so much grey running into normal was also a factor.  He never-the-less addressed a distinct set of variables of a somewhat distinct portion of the population adroitly - with diagnostic criteria.   Unlike the nature of almost any other medical condition, there are some, but not a lot of ADD / ADHD individuals who will end up being more successful than most of their peers and contemporaries. This confounds the category of prognosis and opens it up very wide.

Most in this special category would have had the benefit of understanding their conditions in early childhood and learned to successfully master helpful adaptions with an eye to fully utilize available support and education. Predictably some of the education will be both very informative as well as aspirational -- more fully including perspectives on how these 'disorders' may be gifts and how great people in history evidenced similar struggles  and prevailed with a lifetime of impressive achievements!  

Such thinking has not played well with the epistemology of medicine.  After all, medical notions such as "prognosis" are meant to predict the success of treatment within more manageable and reliable constructs.

Being ADD/ADHD is a little like being an alcoholic because the suffer is urged to accept his or her condition and overcompensate by mastering study techniques, eat the right things, take the right supplements, get out of denial and learn how to relate better to others and anticipate dealing with struggles ahead equipped with the best social support and medicine has to offer.  In addition, "the others" in patient's life might be candidates who are informed about the condition and learn ways to be supportive.  To their credit, some ADD snuffer's have successfully capitalized on this caring culture, receiving compassionate assistance from schools, workplaces, summer camps and Church communities.  The have "found" themselves and often a large measure of success, albeit somewhat fragile.

So, here we go, achieving at the top end of the treated ADHD spectrum is arguably better than reaching a "social normal" and yet the top end sometimes, demands" medical attention and related support to get there.  This is a similar to the host of concerns invoked by nootropics in general.   Such issues are augmented because ADD / ADHD people at times demand special accommodations in school and yet when they enter the workplace may seem more presumptuous and less manageable than peers who were more disciplined, better students with more socially acceptable outlook and personality.  Conversely, a portion of ADD people may also be a bit more "noticed" and demanding as they blossom into highly creative, intuitive and inspirational roles. 

Eisenburg arrived in the world under a given set of conditions.  He chose to embrace medicine as a career.  He, like the vast majority of his peers may have been in partial  denial about the  the magnitude of predatory and unethical practices rolled out by Big Pharma - which almost surely had a significant influence on his medical practice.  His remarks dismissing ADD as factitious seem to translate into a sentiment that he would like to destroy the entire paradigm and its contingencies and start over.  

Those who produce texts in the history of medicine and other related scholars would do well to probe the depths of such notions - including the possibility of questionable agendas, not on the surface that indicate the desire to frame interventions with new underlying of  'preferred scripts' and socially acceptable developmental paradigms for such individuals.   Clearly most people believe in self direction for patients, but fewer evidence the magnanimity to create societies that make is possible for such people to succeed on a high level  

Until recently, America's record for a high quality supportive culture for people with disabilities, even subtle ones has been one of the best the modern world has known. We are still doing pretty well but seem to be slipping in education generally and our workplace is very complex.  It is a tremendous undertaking to attempt to draw those with 'minor handicaps' to a high level of functioning when our current norm is at such a low level. 

The "evidence" is not so much that Eisenburg's diagnosis of or at least perception of  ADD / ADHD was 'incorrect', but his evidently flawed capacity to diagnose, discern and "rule on" the nefarious nature of Big Pharma's agendas and their plans to orchestrate them through such leaders as Eisenburg.

For the sake of a less disputable and reliable history of medicine for posterity, I would like to know a fuller account of Eisenburg's day to day orientation  --  where he and other practitioners he knew decided that pressing for rather exacting regimes for amphetamines was not working so well and especially over the long run quite possibly doing damage.  Maybe now in the wake of Eisenburg, others with similar life experience will step up to the plate with more more transparency and accuracy.

Who is going to do justice to the American public as well as the future of medicine.? Tell the truth without too much white wash - PLEASE!

Transitioning to the arena of education served Eisenburg and others very well.  It is utterly obvious that schools have had trouble managing many kids diagnosed with attention deficit disorders, AND they almost always behaved better on medication.  The issue is in earlier times, such problems existed, but was somehow managed by individuals overcompensating without medication.  There problems were much more under the radar. 

Discipline is about controlling impulses and not causing trouble even if you feel somewhat "out of it".  For those who believe in a modicum of free will, encouraging self discipline and offering proper guidance can go much further than drugs to accommodate those suffering from attention deficit distractibility and impulse control issues. However, most today would argue that the use of drugs to increase performance of the ADD/ADHD population is essential.  Integrating these perspectives for a proper balance seems essential if we are to advance our educational systems to a higher, more competitive level.

Yes, the drugs help, but if we are depending on drugs as the primary variable to control behavior problems at the starting gate, we will probably keep handing out higher MGs in greater volume in the near future.  At the root, we as a society and as families and individuals are dealing with basic pastoral and philosophical issues!  Let's not let the school district consultants minimize these variables - they should be up for discussion and part of the counseling process!

Many in the medical community have made 'functional and often self serving assumptions' about best practices, human nature, the value of human life in the context of spiritual growth and freedom as well as physician's perceived  "need" to comply with the ethos of unreasonable health care organizations in league with Big Pharma.  For the most part they have not pushed back so much.  However, hopefully there is change on the horizon.  We can no longer afford to sweep so many issues under the rug and claim we are adequately communicating.  We are not.  We may know the answers, but we are terribly short on public testimonials and earnest disclosures in the interest of the common good from those who have moved on from the status quo.

Perhaps Eisenburg would have preferred ADD/ADHD be described as "minor' abnormalities that in times prior have generally been thought of as personality traits or minor handicaps, but not mental disorders.  There is wisdom in such an orientation but it does not play well with No Child Left Behind Laws, Big Pharma and other industries that benefit from platforms that serve their best interest.  Perhaps if another brand of medicine had dominated treatment in the earlier stages of recognizing these 'syndromes' within an more holistic integrative medicine venue, the magnitude of problems would have been less.  In the final analysis we want a culture that cares and we also want all individuals to assume as much responsibility as they can.

Eisenburg' is quoted in this article:

Let’s go back 50 years. We have a 7-year-old child who is bored in school and disrupts classes. Back then, he was called lazy. Today, he is said to suffer from ADHD (Attention Deficit Hyperactivity Disorder). . . . Every child who’s not doing well in school is sent to see a pediatrician, and the pediatrician says: “It’s ADHD; here’s Ritalin.” In fact, 90 percent of these 5.4 million kids don’t have an abnormal dopamine metabolism. The problem is, if a drug is available to doctors, they’ll make the corresponding diagnosis.).

While agreeing with Eisenburg's sentiments about the problems with contemporary medical practice and ADD treatment,  it does seem he feels compelled to frame his position within a set of variables that comply with a mechanistic and very misleading paradigm.  Herein lies a very major misgiving that has risen to the surface in my mind -- and stayed there.  A person suffering from ADD/ADHD  may have a basically "intact dopamine metabolism" (in relation to existing brain and nervous system) but still have minor brain damage or congenital defects in the distribution of neurons or certain kinds of glial cells (the hallmark of many ADD cases) which requires overcompensation AND regulation, NOT normalization by the 'intact dopaminergic' system that medication ramps to a much fuller throttle. 

Brain and related nervous system physiology will probably produce normal or near normal levels of dopamine for the ADD/ADHD suffers, but the neurotransmitters are serving defective or abnormal "hardware".  In order to sustain optimal learning and development in ADD / ADHD, allopathic physicians have gotten into the habit of pushing the dopmergenic system to be more productive -- YET, not to overproduce in order to compensate for inadequate levels of dopamine.  They simply want to 'ramp up' the functioning of the brain and nervous system and entire physiology to a more optimal level - for a limited amount of time. 

The big error of many allopathic orientations is to function with an ethos that does not demand they be much better equipped to define and address complexities in a way where the consumers (patient and family) know what the benefits, risks and drawbacks are and be given some ideas of various thresholds of homeostasis waxing and waning over a long period of time that they need to consider.   Discussions about a wide range of alternative and multifaceted treatment and ongoing complementary / integrative supplements that may allow for lower dosing of amphetamines is absolutely essential.  In this way the patient and family can plan better, making much better choices at almost every interval.

The challenge at hand is similar to a long distance runner asking a doctor for a cortisol shot in order to compete in the next big event.  Sure, this major anti-inflammatory agent is going to remove pain and its symptoms but not the source of the pain. A day or two after the event when the endorphins and related agents recede, a much greater pain from an injury re-injured and made worse will likely result.  Maybe the doctor should have engaged in a holistic discussion with the patient even if he made less money AND also referred the patient and loved ones to a counselor with knowledge about the condition and proven ability to help.

In the case of ADD / ADHD the damage caused by overuse of amphetamines may not show up for years.  When it does, such etiology may very well be 'overlooked' for obvious reasons - thus the "evidence" for damage is often  cumulative, not obvious for a LONG TIME.  Parkinson's is but one example.  How about depression from a distressed and burned out adrenal system combined with social and economic problems due to decreased levels of functioning?

If the public had relied primarily on Osteopathic and Naturopathic practitioners to help manage  ADD / ADHD from the time it became standardized as a disorder (see a fairly modern description as provided in the DSM II in 1980), Americans suffering from or supporting someone with this condition would surely be in a different boat than the current state of affairs.   But even here, since the allopathic mindset reigned supreme, there were built in disincentives for physicians to look very deeply or to frame in ways which did not empower the medical community and keep patients guessing and off balance - and dependent.

The deep questions and decision making on a philosophical / moral / spiritual level still remain somewhat obscured as a result.  As pointed out in this article, even the public neurological explanations, apologies and caveats from top minds are filled with distortions because they have been cultivated for a very long time with faulty, industry serving models and a gross lack of attention to a host of variables that matter a lot.

The elephant in the room is twofold -- and paradoxical.  On one hand there are technically extra demands on neurochemistry to get from point A to B in ADD treatment.  Confusingly, on the other, there is abundant evidence that when those who really need amphetamines take them, wear and tear on the nervous system and physiology as a whole is considerably less than it would be for someone who really does not meet the criteria for ADD/ADHD but still wants to have the medicine in order to perform better.  I think many would agree with the informal, practice wisdom difficult to prove experimentally that homeostatic adjustments though compounded for anyone who takes amphetamines are not the same for everyone and favor those who clearly have organic deficits to overcome.

We must also consider the generally beneficial complexity of having extra ingredients such as omega3 fatty acids in modern holistic treatment of ADD.  To understand all the variables surrounding the neurology surrounding ADD, not just a reductionistic and often false representation of "dopamine deficinecy" is critical.  What is the function of Choline, acetylchoine, Epinephrine, Norepinephrine, GABA, Glutamate etc.?   According to a fairly comprehensive encyclopedia article Amphetamine (retrieved 5.10.17),

The full profile of amphetamine's short-term drug effects in humans is mostly derived through increased cellular communication or neurotransmission of dopamine,[37] serotonin,[37] norepinephrine,[37] epinephrine,[153] histamine,[153] CART peptides,[166][167] endogenous opioids,[174][175][176] adrenocorticotropic hormone,[177][178] corticosteroids,[177][178] and glutamate,[158][162] which it effects through interactions with CART, 5-HT1A, EAAT3, TAAR1, VMAT1, VMAT2, and possibly other biological targets.[sources 14]

In sum, Amphetamines 'hit' the dopamine receptors, as agonists, but there is a broader cascade going on, both in terms of scope of functions and types of neurotransmitters involved. Put bluntly, frank discussions about the dangers of long term use of amphetamines, including over-taxing  adrenals and to pressuring various  neurons to burn out and not adequately produce, re-uptake and refurbish.

People make the decision to ramp up the dopamine metabolism (better put - amphetamine metabolism) as well as adjacent physiology believing it to be the lesser of two evils.  Taking amphetamines in not inherently good though it may help a person function at his or her best IF NOT ABUSED or depended on too much.  This assumes a person has a strong feel for dangerous thresholds and has a reasonably good handle on life management.  It presumes that treating physicians are able to advise on encourage a holistic treatment regimes.

See Also: Addicted To Adderall (Video - Dr. Oz and Guests)

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Notice:  I am a clinical social worker with an academic Ph.D. in Cultural Clinical Psychology and High School teaching credentials / teaching experience in science, health science technology and other areas.  College teaching experience has been limited to social work, psychology and sociology.  Most of my practice in recent years has been in geriatrics though I am open to limited work with other populations (i.e. Coaching).  I do a lot of independent research in order to develop interdisciplinary systems related to medicine but this is a broader, generalist orientation that to some degree extends beyond medicine per se. 

This article is for informational purposes only and should NOT be construed as medical advice.  Please seek personal medical guidance from a fully credentialed Physician, Pharmacist or Independent nurse practitioner about your individual medical needs.   AGAIN, please consult with such sources before making any medical decisions.

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