Dr. Reef Karim
Dr. Reef Karim, a physician, psychiatrist and addiction specialist, reveals five things you may not know about drug dependency. Plus, why heroin and prescription drug addictions are so dangerous.

1) People need to recognize that they are consumers and their doctors are their expert advisers. But just like you research a product that you want to buy at the store, you also have to research your physicians and the medications that you are putting in your body. You need to be your own consumer advocate. It's ultimately your job to know what medications you are taking and why. If you have a vulnerability to an addiction, it is your job to tell the doctor this information.

2) Doctors are overprescribing medications. Prescription medications are a good thing and are necessary…but only in limited amounts, unless you have a chronic medical illness. Doctors need to be reminded that certain medications—narcotic analgesics (Vicodin, OxyContin, etc.), stimulants (Adderall, Dexedrine, etc.) and sedative hypnotics (Xanax, Ativan, etc.)—have addictive potential in certain people.

As a medical industry, we need to be regulating medications and only prescribing what is necessary (instead of giving out 120 OxyContins, we should be giving out 15 to 30 and having the patient return). I am a huge fan of initially giving medications but then tapering them down and finding alternative ways to relieve stress, bad mood states, impulsivity, sleep difficulties, etc.
3) We are currently in a prescription pill epidemic. The numbers are higher than ever. Recently, according to Monitoring the Future and National Household Survey, 12th graders are popping prescription pills recreationally more than they are smoking marijuana. Thus, abusing pills has now passed up marijuana as our biggest problem in this demographic. And if people can't get ahold of narcotic pills like OxyContin and Vicodin, they may reach out for heroin if they are trying to avoid withdrawal symptoms.

4) Heroin is an incredibly dangerous drug because it gets past the blood brain barrier so quickly and it has such a short half-life (two to three hours). So it works very quickly, but then you start withdrawals soon. Thus, using heroin is a full-time job. You spend all your time getting the drug, using the drug and then withdrawing…and then trying to get more drugs to avoid the withdrawals. It's a constant cycle, and you don't have time for anything else…like a job or raising kids or doing anything productive.

5) Treatment for opiate dependence. We have all heard of Methadone and in the movies, we've seen the traditional opiate detox portrayals (in a hospital bed shaking and in pain), but many people aren't aware of the medication Suboxone, which was FDA approved in 2002 to 2003 and can be used in an outpatient setting for opiate detoxification or short-term maintenance or long-term maintenance treatment.

As the person addicted to opiates doesn't have to go every morning to a methadone clinic and doesn't have to check into a hospital (unless the detoxification or diagnosis is complicated), this medication has helped to treat many more people and helped to reduce some of the stigma. As such, many opiate-dependent people have kicked the drugs and become functional members of society.
As a reminder, always consult your doctor for medical advice and treatment before starting any program.


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