Quaternary Prevention Subjects in General Medicine
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Depression and Antidepressants in Australia and Beyond - a Critical Public Health Analysis Melissa Raven University of Wollongong
University of Wollongong Research Online University of Wollongong Thesis Collection University of Wollongong Thesis Collections 2012 Depression and antidepressants in Australia and beyond - a critical public health analysis Melissa Raven University of Wollongong Recommended Citation Raven, Melissa, Depression and antidepressants in Australia and beyond - a critical public health analysis, Doctor of Philosophy thesis, Faculty of Arts, University of Wollongong, 2012. http://ro.uow.edu.au/theses/3686 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: [email protected] Depression and antidepressants in Australia and beyond A critical public health analysis A thesis submitted in fulfilment of the requirements for the award of the degree Doctor of Philosophy from UNIVERSITY OF WOLLONGONG by Melissa Raven BA(Hons), MPsych(Clin), MMedSci(ClinEpid) Faculty of Arts 2012 ii Certification I, Melissa Raven, declare that this thesis, submitted in fulfilment of the requirements for the award of Doctor of Philosophy, in the Faculty of Arts, University of Wollongong, is wholly my own work unless otherwise referenced or acknowledged. The document has not been submitted for qualifications at any other academic institution. Melissa Raven 5 July 2012 iii iv Concise table of contents List of acronyms .................................................................................... xiii Abstract .................................................................................................. -
Overdiagnosis and Overtreatment Over Time
University of Massachusetts Medical School eScholarship@UMMS Family Medicine and Community Health Publications and Presentations Family Medicine and Community Health 2015-6 Overdiagnosis and overtreatment over time Stephen A. Martin University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/fmch_articles Part of the Community Health and Preventive Medicine Commons, Diagnosis Commons, Family Medicine Commons, Preventive Medicine Commons, and the Primary Care Commons Repository Citation Martin SA, Podolsky SH, Greene JA. (2015). Overdiagnosis and overtreatment over time. Family Medicine and Community Health Publications and Presentations. https://doi.org/10.1515/dx-2014-0072. Retrieved from https://escholarship.umassmed.edu/fmch_articles/318 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Family Medicine and Community Health Publications and Presentations by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Diagnosis 2015; 2(2): 105–109 Opinion Paper Open Access Stephen A. Martin*, Scott H. Podolsky and Jeremy A. Greene Overdiagnosis and overtreatment over time Abstract: Overdiagnosis and overtreatment are often Introduction thought of as relatively recent phenomena, influenced by a contemporary combination of technology, speciali- In recent years, an increasing number of clinicians, jour- zation, payment models, marketing, and supply-related nalists, health service researchers, and policy-makers demand. Yet a quick glance at the historical record reveals have drawn attention to the problems of overdiagnosis that physicians and medical manufacturers have been and the overtreatment that it so often engenders [1, 2]. -
Opioid Overdose TOOLKIT: Information for Prescribers TABLE of CONTENTS
S A M H S A Opioid Overdose TOOLKIT: Information for Prescribers TABLE OF CONTENTS INFORMATION FOR PRESCRIBERS OPIOID OVERDOSE 3 TREATING OPIOID OVERDOSE 7 LEGAL AND LIABILITY CONSIDERATIONS 9 CLAIMS CODING AND BILLING 9 RESOURCES FOR PRESCRIBERS 9 ACKNOWLEDGMENTS, ETC. 11 n Acknowledgments n Disclaimer n Public Domain Notice n Electronic Access and Copies of Publication n Recommended Citation n Originating Office Also see the other components of this Toolkit: . Facts for Community Members . Five Essential Steps for First Responders . Safety Advice for Patients & Family Members . Recovering from Opioid Overdose: Resources for Overdose Survivors & Family Members INFORMATION FOR PRESCRIBERS pioid overdose is a major public health problem, accounting for TAKE SPECIAL PRECAUTIONS almost 17,000 deaths a year in the United States [1]. Overdose WITH NEW PATIENTS. Many experts Oinvolves both males and females of all ages, ethnicities, and recommend that additional precautions demographic and economic characteristics, and involves both illicit be taken in prescribing for new patients opioids such as heroin and, increasingly, prescription opioid analgesics [5,6]. These might involve the following: such as oxycodone, hydrocodone, fentanyl and methadone [2]. 1. Assessment: In addition to the patient Physicians and other health care providers can make a major history and examination, the physi- contribution toward reducing the toll of opioid overdose through the cian should determine who has been care they take in prescribing opioid analgesics and -
SAMHSA Opioid Overdose Prevention TOOLKIT
SAMHSA Opioid Overdose Prevention TOOLKIT Opioid Use Disorder Facts Five Essential Steps for First Responders Information for Prescribers Safety Advice for Patients & Family Members Recovering From Opioid Overdose TABLE OF CONTENTS SAMHSA Opioid Overdose Prevention Toolkit Opioid Use Disorder Facts.................................................................................................................. 1 Scope of the Problem....................................................................................................................... 1 Strategies to Prevent Overdose Deaths.......................................................................................... 2 Resources for Communities............................................................................................................. 4 Five Essential Steps for First Responders ........................................................................................ 5 Step 1: Evaluate for Signs of Opioid Overdose ................................................................................ 5 Step 2: Call 911 for Help .................................................................................................................. 5 Step 3: Administer Naloxone ............................................................................................................ 6 Step 4: Support the Person’s Breathing ........................................................................................... 7 Step 5: Monitor the Person’s Response .......................................................................................... -
BOOKTIVISM: the Power of Words
BOOKTIVISM: The Power of Words Book•ti•vi•sm(noun). 1. The mobilization of groups of concerned citizens produced by reading books offering powerful analyses of social or political issues. 2. A call to action based on the sharing of knowledge through books. 3. Books + activism = “booktivism.” 4. A term first used at the SellingSickness, 2013: People Before Profits conference in Washington, DC, see www.sellingsickness.com. Read. Discuss. Be thoughtful. Be committed. Here are some more suggestions to get you started: 1) Set up a reading group on disease-mongering among interested friends and colleagues. If you do The books included in BOOKTIVISM celebrate recent contributions to the broad topic of disease- not already have a group of interested readers, post a notice in your workplace, library, community mongering, especially as they examine the growing prevalence and consequences of overtreatment, center, apartment building, etc. Once you have a group, decide where to meet. Book clubs can overscreening, overmarketing, and overdiagnosis (see Lynn Payer’s 1992 classic, Disease-Mongers: How meet anywhere – at homes, in dorms, in pubs, in coffeehouses, at libraries, even online! Decide on Doctors, Drug Companies, and Insurers Are Making You Feel Sick, for an introduction to timing and format. Will you meet monthly/bimonthly? You’ll need time to prepare for the sessions, disease-mongering). but not so much time that you lose touch. Circulate the reading guide. It is usually best if one person leads each discussion, to have some questions at the ready and get things rolling. Although the challenge to disease-mongering is not unprecedented (the women’s health movement of the 1970s was another key historical moment), these books represent an impressive groundswell OR, maybe you’d like to of amazing, powerful, brilliant, and often deeply unsettling investigations by physicians, health scientists, 2) Set up a lecture/discussion group. -
Greenshield.Ca MORE HEALTH CARE DOESN’T NECESSARILY MEAN BETTER HEALTH …But It Can Mean More Harm
AUGUST/SEPTEMBER 2019 Don’t miss episode 19 of our podcast as we discuss better approaches to health care with Dr. Danielle Martin, family physician, author, chief medical executive at Women’s College Hospital, and YouTube star. CLICK HERE TO LISTEN WHAT’S INSIDE MORE HEALTH CARE DOESN’T NECESSARILY MEAN BETTER HEALTH Page 2 WHAT’S UP... Drug pricing in the news Message of health care survey: evolve with the times Page 12 greenshield.ca MORE HEALTH CARE DOESN’T NECESSARILY MEAN BETTER HEALTH …But it can mean more harm Turns out that 60 really is the new 40—and even 80 is the new 60—as people worldwide are living longer. In fact, we can expect to live more than twice as long as our ancestors.1 So why then, if we are healthier and more active than ever, are more people becoming patients? It’s because health care is no longer considered just for the sick, it has expanded into also focusing on the well. At first blush, this may sound like a good thing; it may sound like prevention. But if your plan members are healthy—in that they don’t have health problems that need solving— health services may actually create problems. Problems like overdiagnosis and in turn, overtreatment—including all the anxiety, energy, time commitment, potential costs, and even physical harm that can come along with it. The controversy surrounding the medicalization of healthy people raises awareness of the difference between what is truly prevention versus what is just early diagnosis that may—or may not—be a good thing. -
Chapter 2 Medication- Assisted Treatment
CHAPTER 2 MEDICATION- ASSISTED TREATMENT Authors: Stephenson, D. (2.1 Methadone) Ling, W.; Shoptaw, S.; Torrington, M. (2.2 Buprenorphine) Saxon, A. (2.3 Naltrexone) 2.1 METHADONE 2.1.1. Introduction to Methadone hours in most patients. Methadone undergoes extensive Treatment first-pass metabolism in the liver. It binds to albumin and other proteins in the lung, kidney, liver and spleen. Tissue stores in these areas build up over time, and there is a Clarification of terms gradual equilibration between tissue stores and methadone in circulation. This buildup of tissue levels produces daily increases in the medication’s impact on the patient until California and Federal Regulations regarding methadone steady state is reached, which takes about 5 days. use the term Opioid Addiction to refer to the condition that is listed in the DSM-5 as Opioid Use Disorder (OUD). Methadone’s unique pharmacologic properties make it highly effective for management of OUD. The slow onset of action Methadone: description, Properties & means that there is no rush after ingestion. The long half-life means that craving diminishes and symptoms of withdrawal Black Box Warning do not emerge between doses, ending the cycling between being sick, intoxicated and normal and decreasing craving. Methadone is a synthetic opioid that can be taken orally and acts as a full agonist at the mu receptor. It is available However, the long half-life also means that any given dose in liquid or tablet form. In California, OTPs are required to of methadone will produce a higher blood level each day use the liquid formulation. -
Alcohol Withdrawal Management Protocols for OASAS 820 Program A
Alcohol Withdrawal Management Protocols for OASAS 820 Program A In order to be eligible for alcohol withdrawal management at OASAS 820 treatment programs, the patient should either be having mild-to-moderate withdrawal (reflected by a CIWA-Ar of at least between 8 and 10) or be expected to have significant withdrawal based upon past medical history, amount and duration of alcohol use, and/or signs of withdrawal beginning while intoxicated/with a detectable blood alcohol content. In addition, the patient should not have acute medical or psychiatric problems that would make care within an OASAS 820 treatment program inadvisable due to safety concerns. As evidence clearly supports the use of benzodiazepines for the treatment of alcohol withdrawal – and chlordiazepoxide appears superior to other benzodiazepines due to its longer half-life and self-tapering effect – this is the preferred drug for alcohol withdrawal management. However, if the patient has a history of liver cirrhosis or is over the age of 60, one may consider the use of lorazepam as it is mostly metabolized via Phase 2 conjugation as opposed to Phase 1 oxidation and may be a safer choice in specific situations. The choice of alcohol withdrawal management protocols is a complex one, governed by the premise that the goal is to perform the safest and most comfortable withdrawal management possible. Both undermedication and overmedication are problematic. If a patient is undermedicated, particularly for alcohol withdrawal, one risks the possibility that the patient may progress to severe withdrawal and delirium tremens (which carries a mortality rate of about 5%). On the other hand, overmedication can lead to over-sedation, which can result in dangerous behavior as well as falls and other traumatic injuries. -
TIP 63: Medications for Opioid Use Disorder
Medications for Opioid Use Disorder For Healthcare and Addiction Professionals, Policymakers, Patients, and Families TREATMENT IMPROVEMENT PROTOCOL TIP 63 Please share your thoughts about this publication by completing a brief online survey at: https://www.surveymonkey.com/r/KAPPFS The survey takes about 7 minutes to complete and is anonymous. Your feedback will help SAMHSA develop future products. TIP 63 MEDICATIONS FOR OPIOID USE DISORDER Treatment Improvement Protocol 63 For Healthcare and Addiction Professionals, Policymakers, Patients, and Families This TIP reviews three Food and Drug Administration-approved medications for opioid use disorder treatment—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support people in recovery. TIP Navigation Executive Summary For healthcare and addiction professionals, policymakers, patients, and families Part 1: Introduction to Medications for Opioid Use Disorder Treatment For healthcare and addiction professionals, policymakers, patients, and families Part 2: Addressing Opioid Use Disorder in General Medical Settings For healthcare professionals Part 3: Pharmacotherapy for Opioid Use Disorder For healthcare professionals Part 4: Partnering Addiction Treatment Counselors With Clients and Healthcare Professionals For healthcare and addiction professionals Part 5: Resources Related to Medications for Opioid Use Disorder For healthcare and addiction professionals, policymakers, patients, and families TIP 63 MEDICATIONS FOR OPIOID USE DISORDER Contents EXECUTIVE -
Psychiatric Medications in Children ‐ 101
Psychiatric Medications in Children ‐ 101 Cindy Ellis, M.D. Developmental/Behavioral Pediatrics June 26, 2015 OBJECTIVES • Discuss general principles regarding use of psychotropic medications • Review how medications work in the body and considerations for use in children • Overview of specific medications and indications for use in the pediatric population Treatments for Emotional and Behavioral Problems Educational • Information Behavioral • Address functions • External modifications Biomedical • Target underlying neurological functioning Biomedical Treatments Focus on the potential links between: Symptoms of the disorder (expressed in behavior) and Neurobiologic systems involved in the etiology and pathogenesis of the symptoms (e.g., specific neurotransmitter systems) Pharmacological or medication treatments Most widely used biomedical treatment for behavioral and emotional problems in children Biomedical Treatment: Medication Typically considered when problem or symptoms of the disorder: – Significantly interfere with an individual’s functioning – Have not responded or shown suboptimal response to appropriate behavioral interventions, or – Pose an acute safety risk How Medications Work in the Body • Most drugs alter central nervous system function by acting at the level of the individual nerve cell • The human brain contains approximately 20 billion neurons • Groups of neurons in the brain have specific functions • some are involved with thinking, learning, and memory • some are responsible for receiving sensory information. • some communicate with muscles, stimulating them into action How Medications Work in the Body Each neuron has a cell body, an axon, and many dendrites • The cell body controls all of the cell's activities • The axon extends out from the cell body and transmits messages to other neurons • Dendrites also branch out from the cell body. -
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[T]His Advertising Promotes Only the Most Expensive
presents "[T]his advertising promotes only the most expensive products, it drives prescription costs up and also encourages the 'medicalization' of American life — the sense that pills are needed for most everyday problems that people notice, and many that they don’t." — Jerry Avorn, New York Times Convincing people they are sick and need a drug is a multi-billion dollar industry. In 2015, Big Pharma dropped a record- breaking $5.4 billion on direct-to-consumer (DTC) ads, according to Kantar Media. And it paid off for Big Pharma. The same year, Americans spent a record $457 billion on prescription drugs. The U.S. and New Zealand are the only countries where DTC is legal. Americans also pay more for drugs and devices than any other country. The bulk of these ads appear on TV at a rate of 80 ads per hour of programming, according to Nielsen. Behind the drug and device ads saturating TV, radio and digital media are hidden costs and devastating side effects that companies don't advertise, and critics say the ads drive up drug prices and erode the patient-doctor relationship. With the price of drugs skyrocketing, politicians and health-care providers question Pharma's DTC spending, which exceeds money spent on research and development. Even presidential hopeful Hillary Clinton called for an end to tax breaks for drug ads and for tougher regulations. But the money spent on DTC is just one small cog in Big Pharma's well-oiled marketing machine. Companies spend billions more on getting doctors to write prescriptions for their expensive brand-name drugs or devices for uses not approved by the Food and Drug Administration — a controversial practice called off-label marketing. -
Medications Used in the Management of Substance Use Disorders
MEDICATIONS USED IN THE MANAGEMENT OF SUBSTANCE USE DISORDERS Opioid Agonist Therapy (OAT) for Opioid Dependence GENERIC ADULT STARTING DOSE PREGNANCY SAFETY MARGIN EFFICACY ADVANTAGES DISADVANTAGES (BRAND NAME) (MAX PER DAY) CATEGORY FOR OAT FOR OAT Methadone • Specialty consultation advised. • Give orally in a single • Contraindications include • Serious overdose • First-line (Dolophine, Methadose) • Titrate carefully, consider daily dose. any situation where Opioids and death treatment methadone’s delayed • FDA approved for are contraindicated, such may occur if option for cumulative effects. detoxification treatment as patients with respiratory benzodiazepines, chronic Opioid • Individualize dosing regimens and maintenance treatment depression (in the absence of sedatives, dependence (AVOID same fixed dose for of Opioid dependence in resuscitative equipment or in tranquilizers, that meets all patients). conjunction with appropriate unmonitored situations) and antidepressants, DSM-IV-TR social and medical services. patients with acute bronchial alcohol or other criteria. asthma or hypercarbia, known CNS depressants or suspected paralytic ileus. are taken in • May prolong QTc intervals addition. on ECG; risk of cardiac • Methadone arrhythmias. contraindicated • Discontinue or taper the with selegiline. methadone dose and consider C/D • Avoid concurrent an alternative therapy if the use of methadone QTc > 500ms. with nilotinib, • Plasma half-life may be longer tetrabenazine, than the analgesic duration. ziprasidone, • Delayed analgesia or alcohol, st. johns toxicity may occur because wort, valerian, kava of drug accumulation after kava, and repeated doses, e.g., on days grapefruit juice. two to five; if patient has • Avoid excessive sedation during concurrent use of this timeframe, consider buprenorphine temporarily holding dose(s), with alcohol, st. lowering the dose, and/or johns wort, valerian slowing the titration rate.