Wednesday, August 04, 2010

Smoky Mountain Center LME: Cracks to Fissues & the Case for Synthetic Cannabanoids

(submitted as an Opinion piece to the Smoky Mountain News):

Smoky Mountain Center LME’s Balsam Center : Cracks to Fissures & the Case for Synthetic Cannabanoids

By Marsha V. Hammond, PhD, Licensed Psychologist

The Balsam Center, located on the main highway, between Waynesville and Sylva, has undergone another quiet revolution. With Smoky Mountain Center LME’s now legislatively mandated complete divestment of clinical services, Appalachian Counseling Services, in the area for several years now, has taken over the maintenance and supervision of the psychiatric services which are manned by some fine psychiatric nurse practitioners, psychiatrists, inclusive of the ACT Team, which attends, in home, to people with SPMI, Severe Persistent Mental Illnesses. Several months ago one of the members of the ACT Team killed himself. Was it the stress or his job? People say he was acting normally just prior to this tragic incident.

Another matter has more fundamentally impacted citizens who have received clinical services at The Balsam Center: about six months ago the Clinical Director, a man known to be a likeable psychiatrist, mandated that no more anxiolytics e.g., Klonepin, Ativan, Valium, Xanax or psychostimulants e.g., Adderall, Ritalin, Vivance, would be prescribed. The histories of addictions to Ativan, Valium, and Xanax are well documented. Klonepin, on the other hand, has provided non-addictive relief to patients of mine whom experience depression coupled to anxiety, for instance. I’ve now had to spend my clinical time, first of all finding a psychiatric medication provider, then writing the referral with details of the history of medication issues for the patient; then the patient has to drive 25 miles, if they have transportation, to Asheville or further in order to receive some Klonepin. Klonepin has what is known as a slowly accelerating ‘clean drug profile’, unlike Valium, for instance, which has a ‘double peak’, quite a few hours after its first jolt of addictive relief. Many people take Klonepin to help with sleep; Ambien, another sleep medication, is supposed to only be taken for a short period of time. There is no kick when you take Klonepin. So, why has it been removed from the formulary of The Balsam Center?

Was it the diversion of the medications by poor people, receiving disability checks, and thus access to NC Medicaid’s $3 co-pay, to others who offset their own health difficulties or poverty? Some, to be sure, stock-pile these meds and/ or stand to profit as the middle man as the pills pass from one hand to another, each time with a hike in the price. The problems of diversion are very probably even more true pertaining to narcotics which are not prescribed by psychiatrists but by local physicians (less and less) or pain treatment doctors (some of them) whom give their patients a whopping seven minutes of their time (and if you’re one minute late, you miss your appointment all together; this is not a confabulated story).

A couple of weeks ago, the New York Times documented that the #1 killer in some of these United States is overdoses of prescribed medication. Thus, a more fundamental issue is the impact of Big Pharma on our very living conditions. Are there safer avenues to relief from mental pain which is certainly exacerbated by conditions known well to displaced factory workers (there are many), and their adult spouses, living in their months-behind rented trailers and apartments? Can the Balsam Center reconsider the usefulness of anxiolytics and psychostimulants?

Pandora’s box is full of unexpected surprises, some of them scary jack-in-the-boxes and some associated with matters to perhaps be reconsidered. Moreover, science continues to relentlessly race ahead regardless of our ability to ethically consider matters. Candace Pert is well known for having discovered the opiate receptor over 20 years ago; surprisingly, it is present in your gut. Now, to expand upon that notion of the vast mystery of this human body, and given that some people want to make money and others want relief, the colloquially known ‘head shops’ are selling ‘synthetic marijuana’ which provides considerable relief to people with anxiety coupled to depression (as it often is). Of course, there is a law in the NC State Legislature, knocked down, perhaps temporarily, to cut off this access.

‘Synthetic cannabanoids’ generally are shorter acting than cannabis, the plant, because there are one or two cannabanoid analogues rather than dozens, which are present in the plant cannabis. It cannot be detected with a drug or urine screen because the drugs bind to a different site on the two known cannabinoid receptors, CB1 and CB2, which all humans have. CB1 receptors are on cells present mostly in the Central Nervous System, less so in the Peripheral Nervous System whileas CB2 receptors are present peripherally and in the spleen, which concerns itself with immune system functioning. The first cannabanoid receptor, Anandamide, discovered rather recently, derives its name from the Hindi root word, ‘ananda’ or ‘bliss’ and is commonly associated with the euphoria of ‘being stoned.’ This was followed by the discovery of the 2-AG cannabanoid receptor.

This means that there must be a reason why the receptors are present in humans and as good a theory as I have heard was recently posited by a physician colleague of mine: the cannabanoid receptor system is activated with stress and injury or as he calls it, ‘the lost battle’ scenario: you’ve lost the fight with the saber-tooth tiger or the bear drug your kill off into the woods, leaving you to run up into the tree and nurse your injuries and catch your breath. Internally, your body is ramping up the cannabanoid receptor system, pumping up your immune system, tamponading the bleeding, and relieving your pain.

Big Phama, on the other hand, willing to make money, and a lot of it, finds medications, such as Klonepin, which provide specific relief for specific symptoms. And it’s problematic due to diversion? Pick your poison and to my mind, the further we get away from assisting Big Pharma in accumulating massive profits, the closer we get to well-deserved research on the endocannabanoid system present in every one reading this opinion piece.


".....Nationwide, fatalities from prescription drug overdoses are the second-leading cause of accidental death behind car accidents and, in some states, are the leading cause, according to the Centers for Disease Control and Prevention. ..."

Monday, August 02, 2010

NC Family Care Homes Report 4 Killings : Come IN Department of Health Service Regulation (under NC DHHS)

I contacted NC Disability Rights about a year ago about the conditions in these homes. I have clients who live there.
Study: Four killings reported in rest homes
by Michael Biesecker

"....The state estimates that about a quarter of all patients in the 627 adult care homes across North Carolina have a primary diagnosis of mental illness.....

Lanier Cansler, the state's secretary for Health and Human Services, said Tuesday that if mentally ill patients weren't housed in rest homes, many would be on the street.....

The explosion of mental patients in rest homes is an unintended result of a 1999 U.S. Supreme Court ruling that mandated that people be cared for in their home communities whenever possible, rather than being institutionalized in big state hospitals. As part of a 2001 effort aimed at complying with the ruling, North Carolina downsized its state-run psychiatric hospitals and disbanded county-run mental health agencies in favor of a plan to treat patients through a network of private, for-profit companies....."


See these other Defarge notes on the family care homes:


Wednesday, May 13, 2009

NC Family Care Homes: mental health issues go unaddressed & providers are banned from premises: defacto mini-prisons


Monday, March 16, 2009

NC Depart.of Hlth Service Regulations & what they have to say about my complaints on a Family Care Home:nothing useful to those w/ mental health problems

Sunday, August 01, 2010

MHA-NC, since 1939 NOW to Close It's Doors:NC DHHS Waltzing Matilda While Looking Out The Window

Man, what is it going to take to wake up the state call their attention to the strain on the Medicaid, in particular, system (state run)?

This is the oldest MH provider in NC, operating since 1939.

Everytime the NC State Legislature vis a vis NC DHHS has jerked the choke collar of the providers.....saying they would do this and then that...and then pulling the rug out from under the providers...its been like a family that keeps trying to pay its mortgage when the jobs keep being pulled out from underneath the family providers.

Sorry, I don't think it was because Mr. Tote and some executives were making what moderately paid executives usually make. You can't run a company when the funds ebb and flow just like you can't run a house-hold when you keep getting downsized.

This is a VERY big deal.


"Sunday, August 1, 2010

Oldest mental health advocacy group in NC to close due to financial problems

From The News & Observer:
RALEIGH, N.C. -- The financially troubled Mental Health Association of North Carolina is shutting down.A brief statement released July 30 by the organization’s interim executive director, Christie Foppiano, confirmed that MHA is insolvent and shutting its doors.“In the days ahead, MHA will be working to wind up its affairs and close,” the statement said. “MHA-NC is disappointed that it is unable to meet its financial commitments and continue to carry out its mission to promote mental health awareness, prevent mental illness and eliminate discrimination against people with mental illness.”

Incorporated in 1939, MHA is the oldest advocacy group for people with mental illness in the state and once one of North Carolina’s largest providers of housing and treatment for the population it served.The true depth of the group’s financial problems in recent years, hidden from most of its employees and even its board members, came to light in May when MHA’s longtime executive director, John Tote, was appointed to head the state’s mental health system.

Tote was forced to withdraw from the high-profile appointment less than a week later, after news reports that MHA faced more than $1.5 million in IRS liens related to years of unpaid payroll taxes.On July 26, MHA lost its accreditation, cutting off the group's access to federal Medicaid reimbursements. Without the ability to bill Medicaid, the organizations fate was sealed.The operation of MHA's remaining group homes and treatment programs across the state will be assumed by Easter Seals UCP of North Carolina."