Let’s Not Keep Meds From Chronic Pain Patients Because Dr. Nick Keeps Killing Celebrities.

Via wikimedia.

Opinion by Terry Gotham

This article goes out directly to the party people & Burners who think they can party like rockstar gods. While the measure of any varsity party person is the ability to handle multiple types of substances concurrently, that game has become intensely more dangerous in the last 5 years. In case you missed it, the coroner’s reports on Tom Petty & Dolores O’Riordan’s deaths came back. The lead singer of The Cranberries & one of the most distinctive voices of a generation is suspected of killing herself via fentanyl poisoning. And Tom Petty’s toxicology is so startling, I’ll just quote TMZ  (yes, it’s been corroborated elsewhere put the pitchforks down) directly:

Tom’s autopsy report shows the singer was on several pain meds, including Fentanyl patches, oxycodone (Oxycontin), temazepam (Restoril), alprazolam (Xanax), citalopram (Celexa), acetyl fentanyl and despropionyl fentanyl. The reason doctors prescribed the meds was because of a number of medical problems, including emphysema, knee problems and a fractured hip.
~Tom Petty Died From Massive Accidental Drug OD. TMZ.com 1.19.18

In the immortal words of Alex Shulgin, that is a “heroic” cocktail. For all my psychonauts and chem nerds out there, Kevin Shanks has an exceptional review of the chemicals here. For people out there that might not be too familiar with pharmacology, I’d like to explain why this combination of drugs is terrifying and a perfect example of the crisis currently afflicting all 50 states. While many have seen that pile of substances and flagged it as an “opiate overdose,” in a lot of toxicology reports, autopsies revealing multiple drugs are categorized in similarly incorrect ways. Some counties would flag it as a synthetic opiate overdose, while others only bucket many different types of opiates under the umbrella term “drug overdose.” Still others might even classify it as a benzo or Xanax overdose. While New York City differentiates between fentanyl and heroin in its reporting, this is not the norm. And that is a huge problem. Especially now that it’s easier than ever to be on half a dozen different drugs.

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10 Questions With Terry Gotham: Brad Burge (MAPS)

(When meeting Brad Burge several years ago, I was immediately struck by his masterful ability to communicate to all comers at an academic conference we were speaking at. He connected immediately, and never lost the purpose, message, or empathy that we all strive to have when speaking to people we care about, even when addressing someone he’d never met before. He’s become one of MAPS’ most effective ambassadors, overseeing a period of rapid visibility expansion, to the point where MDMA & PTSD is coming up at the watercooler and at the holiday dinner table. I wanted an update on the MDMA/PTSD clinical trial after my previous article on it, so I was overjoyed when he obliged! Enjoy the chat, and feel free to refer to it while talking about MDMA & PTSD with your family over the holidays!)

Photo courtesy of MAPS.

Interview by Terry Gotham

1. Even with the recent Breakthrough Therapy designation, how do you keep going in the Age of Trump?
We have been able to make a lot of progress since the election, including getting the FDA’s stamp of approval for Phase 3 trials and the Breakthrough Therapy Designation, which came in August. Trump has taken a fairly hands-off policy when it has come to the FDA so far and has given every indication that his administration supports facilitating accelerated development of pharmaceuticals and new medical treatments. Plus, and more importantly, we see psychedelic science and psychedelic therapy research as bipartisan issues, since they are not about being countercultural or revolutionary or being oppositional in the traditional sense, but rather about being careful scientists and treating serious mental health conditions. Of course we think that this research has tremendous transformational value, and that the approval of MDMA-assisted psychotherapy for PTSD is likely to change how our culture understands and treats mental illness, but we are working with the system to make those changes happen, not outside it. We have had equally positive media reports, for example, from The New York Times and Scientific American as from Fox News and Breitbart.

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Ketamine & Mental Health: What We Know Already

A very good friend sent me a landmark study surrounding Ketamine a little while ago.  In drug research, big effects and powerful findings are usually accompanied by tiny sample sizes and weird statistics magic to rig the findings. So when I read the meta-analysis and systematic review published in The American Journal of Psychiatry, I was heartened. This is serious science and serious stats, with 167 patients evaluated across multiple studies. Also, the reporting scales (MADRS, HAM-D, QIDS-SR & the BDI) are well understood, robust and respected in the field. All of this adds up to this results abstract being very, VERY important:

Ketamine rapidly (within 1 day) reduced suicidal ideation significantly on both the clinician-administered and self-report outcome measures. Effect sizes were moderate to large (Cohen’s d=0.48–0.85) at all time points after dosing. A sensitivity analysis demonstrated that compared with control treatments, ketamine had significant benefits on the individual suicide items of the MADRS, the HAM-D, and the QIDS-SR but not the BDI. Ketamine’s effect on suicidal ideation remained significant after adjusting for concurrent changes in severity of depressive symptoms.
~The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review & Individual Participant Data Meta-Analysis (Wilkinson et al)

That’s a dense couple of sentences, so let me explain why it’s so earth shattering. Suicidal thoughts, (known as suicidal ideation in clinical psychology) and depressed feelings are very difficult to get rid of, especially for depressed people. Treatment-resistant depression is a term associated with someone who has attempted multiple types of treatment for their Axis I disorder, but it hasn’t gotten better. After trying multiple types of interventions with no success, people slide quickly into hopelessness and thoughts of self harm. Up until now, depression treatments like SSRI drugs and Cognitive Behavioral therapy take time to work, sometimes more than a month. If you’re not in a good place right now, these things can’t help you. Ketamine infusions help immediately, and the change is apparent both to the patient and to the interviewing physician afterwards. This bit is huge, as most drug research relies heavily on self-report, which leads to bias and distorted findings. But, people are already talking to the press swearing by it, and it’s getting quite a lot of press, so here’s what they’re talking about.

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