Re: Enlightenment or Crisis of Conscience

[Guest guest]

yes, your Rx's are being diverted to "off label use"

even "normal kids" raid the medicine chest at their friends homes these days.

Most patients should be advised to have a "meds safe" if they receive any narcotics.

re: this patient

I have patients with much the same profile.

It seems to me this is typical for a teen bipolar; age of onset 13 yrs

they seem to tolerate, even "thrive:" on doses of drugs that would put you or i into a coma.

the narcotics calm and center them.

yes, suboxone makes them high and its hard for them to get off.

and their "brain is on fire" (quoting a CME lecture) so they use massive quantities of mild tranquillizers

I have found i cannot get them off the other drugs until they take a mood stabilizer eg: lithium

cut him off and he will get the drugs elsewhere.

Kathy, you are not alone.

dennis galvon

Enlightenment or Crisis of Conscience

This week I had a talk with a 17 year old patient of mine because his mother brought him in for depression. He tells me he has been depressed since he was 13 or so (8th grade). The only time he remembers being happy is when he is on drugs. He has been smoking pot and drinking which his parents now know. But he is taking Percocet and smoking pot before school every morning. He abuses Suboxone and Subitrex often. He says he is taking a lot of Benadryl and OTC sleeping aid because he can’t sleep and his thoughts are racing. He has tried pretty much everything I know of.

So I battle with what I can tell his Mom. He has thought of suicide but doesn’t actually want to do it because of his dog. He is very close to his brother but they can only talk when stoned and he can’t tell him about the other drugs. The brother tried suicide a few years ago and was using drugs. Diagnosed bipolar and my patient doesn’t want to upset his brother as he had a problem with suboxone (On an aside, how are suboxone and subitrex drugs of abuse? I thought they were opiate blockers but my patient assures me you get high).

He says he is taking enough Benadryl every night to kill him (my word). I have seen people who take 20 Benadryl and they don’t wake up for 2 days. He gets up at 6 AM and goes to school so I can’t believe his quantities. He isn’t actively suicidal but could accidentally kill himself He did agree to treatment. He did go to his mom for help. I made him promise no more than 2 Benadryl at night until he gets into treatment. But I am very afraid for him. I can’t betray his trust unless he is going to kill himself or others. So it’s a fine line.

But what hit me an hour or two later is that he could be taking drugs I have prescribed for someone else. Most of what he takes are prescription meds. This is hardly new, I know that. You here on the news that kids are abusing prescription drugs but they say it’s from their parents medicine cabinets. It’s not. How do we, as doctors that are morally and socially responsible keep this stuff out of our kids mouths. Can we? Why do our patients sell them? I just suddenly got the guilty feeling that I am dealing the drugs to the kid; it’s me. I know it’s not, not directly. But do I know that all of my patients take their own meds? (I am not a prescriber of Suboxone or Subitrex). To what lengths must I go to reassure myself that my patients aren’t lying to me and do need their pain meds or Klonopin or whatever?

Do you all think about this too? That night, I felt like I had been smacked in the face and it’s been on my mind ever since.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

CyberDefender has scanned this email for potential threats.Version 2.0 / Build 4.03.29.01Get free PC security at http://www.cyberdefender.com

[Guest guest]

yes, your Rx's are being diverted to "off label use"

even "normal kids" raid the medicine chest at their friends homes these days.

Most patients should be advised to have a "meds safe" if they receive any narcotics.

re: this patient

I have patients with much the same profile.

It seems to me this is typical for a teen bipolar; age of onset 13 yrs

they seem to tolerate, even "thrive:" on doses of drugs that would put you or i into a coma.

the narcotics calm and center them.

yes, suboxone makes them high and its hard for them to get off.

and their "brain is on fire" (quoting a CME lecture) so they use massive quantities of mild tranquillizers

I have found i cannot get them off the other drugs until they take a mood stabilizer eg: lithium

cut him off and he will get the drugs elsewhere.

Kathy, you are not alone.

dennis galvon

Enlightenment or Crisis of Conscience

This week I had a talk with a 17 year old patient of mine because his mother brought him in for depression. He tells me he has been depressed since he was 13 or so (8th grade). The only time he remembers being happy is when he is on drugs. He has been smoking pot and drinking which his parents now know. But he is taking Percocet and smoking pot before school every morning. He abuses Suboxone and Subitrex often. He says he is taking a lot of Benadryl and OTC sleeping aid because he can’t sleep and his thoughts are racing. He has tried pretty much everything I know of.

So I battle with what I can tell his Mom. He has thought of suicide but doesn’t actually want to do it because of his dog. He is very close to his brother but they can only talk when stoned and he can’t tell him about the other drugs. The brother tried suicide a few years ago and was using drugs. Diagnosed bipolar and my patient doesn’t want to upset his brother as he had a problem with suboxone (On an aside, how are suboxone and subitrex drugs of abuse? I thought they were opiate blockers but my patient assures me you get high).

He says he is taking enough Benadryl every night to kill him (my word). I have seen people who take 20 Benadryl and they don’t wake up for 2 days. He gets up at 6 AM and goes to school so I can’t believe his quantities. He isn’t actively suicidal but could accidentally kill himself He did agree to treatment. He did go to his mom for help. I made him promise no more than 2 Benadryl at night until he gets into treatment. But I am very afraid for him. I can’t betray his trust unless he is going to kill himself or others. So it’s a fine line.

But what hit me an hour or two later is that he could be taking drugs I have prescribed for someone else. Most of what he takes are prescription meds. This is hardly new, I know that. You here on the news that kids are abusing prescription drugs but they say it’s from their parents medicine cabinets. It’s not. How do we, as doctors that are morally and socially responsible keep this stuff out of our kids mouths. Can we? Why do our patients sell them? I just suddenly got the guilty feeling that I am dealing the drugs to the kid; it’s me. I know it’s not, not directly. But do I know that all of my patients take their own meds? (I am not a prescriber of Suboxone or Subitrex). To what lengths must I go to reassure myself that my patients aren’t lying to me and do need their pain meds or Klonopin or whatever?

Do you all think about this too? That night, I felt like I had been smacked in the face and it’s been on my mind ever since.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

CyberDefender has scanned this email for potential threats.Version 2.0 / Build 4.03.29.01Get free PC security at http://www.cyberdefender.com

[Guest guest]

Do you offer him a Rehab program for treatment?-- lia Leite- MDPalm Beach Hello Health

[Guest guest]

Yes, I referred him to two centers that deal with the dual

diagnosis of the adolescent. He is not willing to admit he has a drug

problem, he is “self-medicating”. He is admitting to the

depression. Baby steps. I don’t want to lose him. Get

him into therapy and then we can deal with the ginormity of his problems.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of lia

Leite-

Sent: Saturday, January 08, 2011 10:19 AM

To:

Subject: Re: Enlightenment or Crisis of

Conscience

Do you offer him a Rehab program for treatment?

--

lia Leite- MD

Palm Beach Hello Health

CyberDefender has scanned this email for potential threats.

Version 2.0 / Build 4.03.29.01

Get free PC security at http://www.cyberdefender.com

[Guest guest]

 Good job Saradarian  agree to  not   lose him./build trust.Did I ever tell you I was the doc on the Augusta Maine Mental Health Institute   adolescent unit for a year.oyFocus on the two things   that are predictors of  success in at least the general adolescent population-

does he have goals? 

Any goal-

Keeps you going

 Is there any adult in his life that he trustsAnyone?Do you have psych  available  to phone consult with, to help you? DId you contract with him for safety?   I read your post too fast.

 and then think about what  neurological remodelling is going on i n the  NORMAL teenager's brain(unless " normal  teenager " is an oxymoron)Good job 

--      MD          ph    fax impcenter.org

[Guest guest]

I gather you are doing as well as anyone can with this interesting pt... I know what I'm thinking but what is your differential Dx or final and what are you treating him with? I was a pretty messed up kid and I knew a bunch more too growing up in Da Bronx... Absolutely keep his faith as well as you can without putting him at increased risk... Paramount at this point in the game for sure... Best of luck and keep us in the loop....

To: Practice Management Issues Cc: Sent: Sat, January 8, 2011 9:42:27 AMSubject: Enlightenment or Crisis of Conscience

This week I had a talk with a 17 year old patient of mine because his mother brought him in for depression. He tells me he has been depressed since he was 13 or so (8th grade). The only time he remembers being happy is when he is on drugs. He has been smoking pot and drinking which his parents now know. But he is taking Percocet and smoking pot before school every morning. He abuses Suboxone and Subitrex often. He says he is taking a lot of Benadryl and OTC sleeping aid because he can’t sleep and his thoughts are racing. He has tried pretty much everything I know of.

So I battle with what I can tell his Mom. He has thought of suicide but doesn’t actually want to do it because of his dog. He is very close to his brother but they can only talk when stoned and he can’t tell him about the other drugs. The brother tried suicide a few years ago and was using drugs. Diagnosed bipolar and my patient doesn’t want to upset his brother as he had a problem with suboxone (On an aside, how are suboxone and subitrex drugs of abuse? I thought they were opiate blockers but my patient assures me you get high).

He says he is taking enough Benadryl every night to kill him (my word). I have seen people who take 20 Benadryl and they don’t wake up for 2 days. He gets up at 6 AM and goes to school so I can’t believe his quantities. He isn’t actively suicidal but could accidentally kill himself He did agree to treatment. He did go to his mom for help. I made him promise no more than 2 Benadryl at night until he gets into treatment. But I am very afraid for him. I can’t betray his trust unless he is going to kill himself or others. So it’s a fine line.

But what hit me an hour or two later is that he could be taking drugs I have prescribed for someone else. Most of what he takes are prescription meds. This is hardly new, I know that. You here on the news that kids are abusing prescription drugs but they say it’s from their parents medicine cabinets. It’s not. How do we, as doctors that are morally and socially responsible keep this stuff out of our kids mouths. Can we? Why do our patients sell them? I just suddenly got the guilty feeling that I am dealing the drugs to the kid; it’s me. I know it’s not, not directly. But do I know that all of my patients take their own meds? (I am not a prescriber of Suboxone or Subitrex). To what lengths must I go to reassure myself that my patients aren’t lying to me and do need their pain meds or Klonopin or whatever?

Do you all think about this too? That night, I felt like I had been smacked in the face and it’s been on my mind ever since.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

CyberDefender has scanned this email for potential threats.Version 2.0 / Build 4.03.29.01Get free PC security at http://www.cyberdefender.com