Marijuana in Pregnancy (and in general)

Some interesting research has come up recently regarding Marijuana and pregnancy.  Although marijuana (also known as ‘pot’ or ‘weed’) is  considered a ‘soft drug’, as opposed to things like heroin or cocaine, it does have problems of its own. Weight gain, poor memory, and breathing issues are among the main concerns.  There are questions about whether marijuana increases the risk of lung cancer.  There are also problems surrounding the fact that marijuana is illegal.  You go to jail for possession – there has been a recent change to Canadian federal legislation requiring mandatory minimum sentencing for all drug related crimes.

Another problem with marijuana being illegal is that the production is not regulated.  That means that dealers can, and do, put all kinds of drugs into marijuana.  I have even read about formaldehyde being use.  This is a poison.  Unfortunately, it can give a high similar to marijuana, so dealers sometimes put it in if the marijuana is not sufficiently strong for their customers.  I have read about dealers combining marijuana with PCP, among other drugs.  In my practice, I have found that marijuana frequently has traces of cocaine or benzos in it.  This may be intentional lacing from the dealers, but it can also be from cutting the various drugs on the same table, or using the same uncleaned scales for all the drugs they deal.  In any case, a lot of the available marijuana is not clean.

Marijuana has also been shown to cause an increased risk of developing schizophrenia in youth who are predisposed to developing it.  Unfortunately it is hard to find out who is predisposed.  That means that a youth who uses marijuana may develop schizophrenia only if they use it, and not otherwise.  This is quite serious.  It is not reversible.  Also, some research suggests that marijuana use can actually shrink the brain.  It may be important to tell your children this.

Recent research is showing that marijuana has further issues if taken during pregnancy.

“Most additional concerns about THC come from the mental health literature, because of the now well-documented link between THC and psychosis — we do have concerns (by extrapolation of these mental health data) about THC and the fetal brain,” he said.  The study is published in the July 2012 issue of PLoS One.  (Taken from Medscape News, Psychiatry July 30, 2012).

“Regarding [tetrahydrocannabinol (THC), the active ingredient in marijuana], this study provides yet another warning about changing your lifestyle months and months before you try to conceive,” principal investigator Gustaaf A. Dekker, MD, PhD, with the University of Adelaide, in South Australia, told Medscape Medical News.  According to Dr. Dekker, this is the first time THC has been linked to premature birth. (Taken from Medscape News, Psychiatry July 30, 2012).

Of course, all of the concerns that I mentioned above apply to pregnancy as well.  That means formaldehyde or PCP in your marijuana may be getting to your fetus, which can have further effects on your child.

Permanent link to this article: http://www.fedsanchez.com/wordpress/2012/08/24/marijuana-in-pregnancy/

Methadone and Codeine

Over-the-counter (OTC) medications are medications that you can buy from a pharmacist without a prescription. Patients often complain that OTC drugs should not be restricted during the Methadone Maintenance Treatment program because they are available without a prescription. I will discuss the reasons you should not use OTCs drugs that contain Codeine.

Codeine is a common ingredient in OTC drugs. Please check the ingredients on your OTC medication to see if Codeine is, in fact, present. Examples of OTC medications that contain Codeine include Tylenol 1, some cough syrups, Robaxacet, as well as various allergy and cold remedies.

Even a small amount of Codeine can cause your urine drug test to become positive for Morphine. This is because Codeine is metabolized by the liver into Morphine. In fact, Codeine itself has no pain relieving action on the body. This is why people do not inject Codeine. Codeine must be eaten, and then it will pass through the liver, get metabolized into Morphine. Only then can it give it’s pain relieving qualities. So, in the end, if you take even a small amount of Codeine, it looks like you are using Heroin, or other similar opiates, on the urine drug test.

For this reason, it is important that you avoid all Codeine containing products while in treatment.

Pain is a very useful thing. It lets you know that you have caused damage to your body. It is not always to your benefit to remove all, or sometimes even any, of the pain. The pain can help you avoid certain activities that are causing your body harm, and avoid making your condition worse.

Some patients say that “the pain was so bad, regular Tylenol and Advil did not help. I had to take a T3!” My feeling is that if the pain is strong enough that you feel the need to take something stronger than regular Tylenol or Advil, then you really need a firm diagnosis, and medical supervision, from a medical professional. In this kind of situation, you should visit the emergency department, Walk-in Clinic, or your physician. Any opiate medication that you take will simply mask the pain, causing delayed diagnosis and appropriate treatment.

For example, you may have back pain from working. If you take Codeine, the pain will be reduced, and this will allow you to work more. The problem is that the source of the pain has not been treated. So, continuing to do what caused the pain in the first place will make the pain, and damage that the pain indicates, worse. The result will likely be more pain. In general, it is important to avoid using Codeine unless advised by a doctor.

Tylenol 1, 2, or 3, contain small amounts of Codeine. If your Methadone dose is any higher than a minimal dose, then the Codeine in these formulations are likely not giving you much pain relief at all. They are probably only making your urine drug test show up positive for Morphine. The pain control you are experiencing is more than likely due to the acetaminophen, or regular Tylenol, that is in the formulation. Try using Tylenol regular, or extra strength, and see if that alone will help your pain as much as the Tylenol with Codeine. Please be advised that Tylenol does have side effects and complications of its own. These are mostly related to the liver. Please check with your doctor to make sure it is safe for you to take Tylenol.

Another choice would be to use Advil, or other anti-inflammatories. The benefit of these anti-inflammatories is that they will decrease the swelling and inflammation that is causing the pain. In many cases, the anti-inflammatory will leave you with a little bit of pain. This residual pain is useful to let you know what you shouldn’t to be doing. Basically, if it hurts, don’t do it. Please check with your doctor before using these, as there are some conditions that make using over-the-counter anti-inflammatories dangerous. These conditions include ulcers, hiatal hernias, or other conditions that are sensitive to anti-inflammatories.

If you are using eight or more Advil or Tylenols per day, then you should see a medical professional. Both of these medications have side effects, so prolonged regular use can result in damage to your body. Sometimes this damage can be permanent and potentially life-threatening.

Permanent link to this article: http://www.fedsanchez.com/wordpress/2012/07/28/pain-control-without-opiates/

Opiates and Constipation

A common side effect of methadone, as well as other opiates, is constipation. People generally do not like to discuss this, but they really should. Constipation can result in abdominal pain. This can worsen the discomfort that you may go through during withdrawals, adding to the misery of addiction.

There are many causes of constipation. Check with your doctor before treating it yourself. Like everything else, your should have a firm diagnosis before treating any condition. You don’t want to delay a diagnosis of something serious. Also, you don’t want to treat it with something that could possibly make your condition worse. The treatment can sometimes cause complications for other medical problems you may have. Be safe, and check with your doctor before starting any treatment.

The good news is that it can usually be treated very easily. In most cases, the constipation caused by methadone does not require any medication at all. Simply adding a lot of fiber and water to your diet can get rid of the problem.

Fiber works because it is not absorbed by your gut (intestines). The fiber stays there. It absorbs water from the rest of your body while sitting in your gut, as long as you have extra water in your body to spare. The only way you can have extra water is if you drink enough water. For most people, you would need to drink 2 liters of water a day. Ask your doctor about how much water you would need.

Please note that coffee and alcohol do not count as water. Both of these actually caused you to urinate out more water than you consume in that drink. Consider them to be negative water. This is a common mistake. If you only drink coffee for fluids, then you are not really taking much in at all.

The best source of fiber is fibrous vegetables and fruits. Generally, if it gets caught in your teeth, then it is probably fiber, except for things like meat. Most fiber in fruits comes from the skin. That is why bananas do not actually have much fiber. We don’t generally eat the peel.

If you don’t want to eat more, or can’t afford to buy more, vegetables and fruits, then a great source of fiber is All Bran cereal. By ‘All Bran’ I mean the cereal that actually says All Bran, not Bran Flakes, etc. All Bran cereal is basically 100% bran fiber. Other cereals tend to have significantly less. Check the nutritional information on the side of the box and compare the amount of fibre to your current cereal and you will see that there’s a huge difference. You do not need to change cereals. You can just add All Bran to your current cereal.

You can also cook with All Bran.

The Institute of Medicine recommends that males aged 19-50 should eat 38 grams of fiber per day. Females aged 19-50 should have 25 g per day. Men over 50 should have 30 g per day, whereas women above 50 should have 21 g per day.

Another great source of fiber is Metamucil. This is probably the most expensive way to get fiber. There are many other formulations. Check the nutritional information on the product you are considering. Also consider the other things that are in the product. If you are unsure, check with your doctor before using it.

Fibre may cause problems for you if you have certain medical issues. Check with your doctor before changing your diet too much.

So, basically you need two things to get rid of your constipation. Fiber and water. If you honestly tried both of these at the same time, and still have constipation, then mention this to your doctor. There may be another cause of the constipation other than just using opiates.

Permanent link to this article: http://www.fedsanchez.com/wordpress/2012/07/13/opiates-and-constipation/

Peer Support Groups – NA CA AA

Peer support groups are meetings where people who share common problems can discuss their experiences and get support from each other. These groups include Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, and Alanon (a group for families of alcoholics).

Many people do not want to go to these meetings for various reasons. “I don’t have such a bad problem.” “I don’t have the time.” “There are no meetings in my area.” “I work all day.”

These are examples of reasons why people don’t want to go to one of these meetings. I’d like to share some reasons why you may want to go to one or more of these meetings.

None of these meetings are regulated. That means there is no central authority which tells these groups the way they should act. For this reason, one group may be inappropriate for your needs, while another down the road may be simply fantastic. Each individual meeting is shaped by the people who attend. One group may be full of homeless people who are using hard drugs every day. Another group may be full of professionals. What I’m trying to say is that if you attend a group, and you don’t like it, don’t give up. You should move on to the next meeting, in a different location or at a different time. Eventually you will find a group that fits your needs and personality.

Once you find a group you like, then you will discover the benefits of attending. The group will allow you to unload many, if not all, of the feelings you have towards your situation. It is hard to describe the release you can feel with sharing some deeply private emotions about things that have happened to you or that you have done.

You will also hear stories that other people will tell. This can help you feel that you are not alone in your struggle. It can help you develop a sense of community, and feel that you have some supports to back you up in times of trouble.

At one point, you may decide to get a sponsor. This person is generally somebody who has been clean and sober for a certain amount of time. That person has likely been through many of the things that you could be going through right now. This can result in a very deep friendship, and personal understanding between the two of you. More importantly, this person can be a support to you during times when you are feeling like using. Sometimes a simple text, email, or phone call to or from somebody who cares about you is enough to keep you from using.  Your family can help, but a sponsor can help much more.  You should try to use as many resources as you can to help you through your troubled times.

There are many other supports and counseling that are available. Please talk to your doctor about these.

These peer support groups are easy to find on the Internet. For your convenience, I have included several links below. As you can see, in the Mississauga and West Toronto area there are many meetings at many different times during the week. I’m sure that you can find one that fits your location and schedule.

 

In Toronto: 1.888.696.8956   mail@torontoana.org

Narcotics Anonymous Meetings in GTA (Greater Toronto Area):   http://www.torontona.org/calendar/category/meetings/

Cocaine Anonymous Meetings in GTA:   www.ca-on.org/meetings.html

Alcoholics Anonymous Meetings in GTA: https://aatoronto.org/v3/index.php/a-a-events

Alanonal-anon.alateen.on.ca/

Permanent link to this article: http://www.fedsanchez.com/wordpress/2012/07/06/peer-support-groups-na-ca-aa/

Free Dental Clinics

Many people complain of problems with their teeth while in the methadone program. There are many rumors that claim that methadone ‘rots your teeth’. However, it is more likely related to the fact that Methadone causes dry mouth and sugar cravings. Put these two items together, and many people end up sipping on pop or other sugary drinks throughout the day. This sipping on sugary drinks, as well as not brushing your teeth, will result in dental problems. One alternative would be to sip on water, rather than sugary beverages, for your dry mouth. It is also very important for you to brush your teeth at least twice a day, especially after meals.

In my practice, I have seen that a lot of people use opiates such as Tylenol 1, 2, or 3, Percocet, or even Dilaudid and stronger narcotics for dental pain. Some even rub crushed OxyContin or Cocaine into the painful tooth to help control pain.

Although you may not get high from this practice, and feel that this is not truly ‘drug use’, it is hard to separate the results of the urine drug screen from problematic drug use. For this reason, any non-prescribed use of cocaine or narcotics must be considered potentially problematic drug use in the methadone clinic setting. For this and other reasons, carries will be removed if you use cocaine on the teeth in this way.

There are a lot of alternatives for tooth pain control. You could use over-the-counter painkillers, such as Advil or Tylenol. Please check with your physician before doing so, because these can have side effects which can seriously affect your stomach, liver, or other organs. You should make sure you can take them safely before you do so.

Please note that although 222 and Tylenol 1 are considered over-the-counter drugs, they do contain codeine, and should not be used for your pain control.

Another way to deal with your tooth pain is dental wax. This wax can be bought from a pharmacy. Please ask your physician, or pharmacist, about whether it is appropriate to use this in your specific case.

Of course, the best way to deal with tooth pain is to see the dentist. Many people feel that these dental services are not available to them as they do not have insurance or money. However, there are a number of free dental clinics available in the Toronto area.

There is information available at www.toronto.ca/health/professionals/dental_services/index.htm

Where are these free dental clinics in Toronto or the GTA? They can be found at www.toronto.ca/health/dental/locations.htm

I hope this helps. And remember, prevention is the best cure. Brush your teeth at least twice a day, and avoid sugar drinks.

Permanent link to this article: http://www.fedsanchez.com/wordpress/2012/06/22/free-dental-clinics/

Trillium Drug Plan

If you are having difficulty in paying for your medication, including methadone or suboxone, you should l think about taking advantage of the Ontario Government’s Trillium Drug Plan. I called to ask about details (1.866.856.6799), and found out that the plan itself does not cost anything, but the deductible is 4% of your household income. That means that if you don’t use it, it doesn’t cost anything, but if you do use it, you have to pay for your own medication until the amount of the deductible is reached.

So, let’s say you earn $20,000 a year. 4% of that is $800. Methadone costs $6-8 per day. Let’s say your pharmacy charges you $6 per day. That is $2190 per year ($6 times 365 days/year). So, you pay the first $800, and Trillium pays the rest ($1390). Now, if you get other medications, such as antibiotics, then Trillium would cover the cost of that entirely, since you already paid the $800 deductible.

If you earn more money, then you pay a higher deductible. If you make more than $54,750 per year, the your deductible would be $2190. So, you would be paying for all you methadone yourself. But you would still be covered for any medication above and beyond that.

They told me that no one is refused. Also, if you do not use your plan for a period of 18 months, the plan is cancelled. You would then have to reapply.

They also told me that if you are a senior, you can apply for copayment costs. I am not sure about the details of that, so ask them.

In order to apply, you need one of the following:

1) Your prior year’s tax assessment showing you income; OR

2) An accountant statement stating your prior year’s income; OR

3) Employee statement showing your prior year’s income; OR

4) A signed statement by yourself stating you did not work the prior year. This last option will take longer to process, but it should be accepted.

If you are interested in finding out more information, call them at 1.866.856.6799, 1.800.575.5386, or visit their website at http://benefitsontario.com/ontario-trillium-drug-program/

Permanent link to this article: http://www.fedsanchez.com/wordpress/2012/06/14/trillium-drug-plan/

Bath Salts

With the recent reporting of an act of cannibalism in Miami, awareness of bath salts has increased dramatically. I have done some investigation to find out what these so-called Bath Salts really are.

Bath Salts are not Epsom salts, or other such true bath salts (harmless bath additives) that people use in order to treat various conditions while taking a bath.

The drug Bath Salts that I am talking about here is also known as Ivory Wave, Purple Wave, Vanilla Sky, and Bliss. It is made from three synthetic stimulants that are currently available legally in Canada. There has been a ban in the United States since October 2011. The Canadian government is rapidly trying to ban these products, due to the realization that the risk to public safety is quite immense.

I believe that the reason why they are called Bath Salts is because once they are produced, they look like real bath salts. This has allowed them to fly under the radar in many places.

Although the Bath Salts are made from currently legal stimulants, they are very powerful. Addiction to them seem to be very strong, and overdose is dangerously easy. Overdose can result in severe paranoia, agitation, chest pain, hallucination and suicidal ideation. Here is a video of somebody who used to be addicted to bath salts, who talks about his experiences with it. It is quite shocking, so please view it with caution.

UPDATE – the video has been removed from YouTube.

Permanent link to this article: http://www.fedsanchez.com/wordpress/2012/06/07/bath-salts/

Mental health check up

Check-up from the Neck Up.

Have you ever wondered about whether you have depression, anxiety, or other mood issues? This website, brought to you by the Mood Disorders Association of Ontario, presents a questionnaire which can help you come to your own conclusions. This is not a substitute for professional help, but it can help you figure out what direction to take.

There are many features of this website which are very informative. You can find many fact sheets about various important topics. For example, there is a fact sheet on ‘Early Psychosis and Young People.’ It explains what psychosis is, including what symptoms to watch out for. It talks about risk factors, and what you need to tell your doctor should you decide to go seek help. It also talks about certain treatment options and things that you need to do in order to get better.

Other topics include anxiety and mood disorders, bipolar disorder (manic-depression), depression, postpartum depression, menopause, seasonal spectrum disorder, suicide, and teen depression.

There are some guides available, which can help you with various things such as ‘Helping Someone with a Mood Disorder,’ or ‘Guide to Finding a Therapist.’

The links section includes many other websites that may interest you.

There is also an ‘In Crisis’ section, which lists a couple of phone numbers and websites that you can access if you are having an active crisis.

I hope you find this site useful and informative, either for yourself or someone you love.

Give it a try.

Permanent link to this article: http://www.fedsanchez.com/wordpress/2012/06/03/mental-health-check-up/

Health Supplement Evidence

Snake Oil – Scientific evidence for popular health supplements.

I found this website that uses Flash. I’m not a big fan of Flash media, but this one is worth a look.

They have included many health supplement claims, and evaluated the scientific evidence for using or not using them. I found some of the claims to be quite surprising. Unfortunately, some of the claims are not so good.

It is important to note that some of the claims appear in several places. That’s because the supplement may be good for one thing but not so good for another. For example Fish oil, or omega-3 fatty acids, appears seven times. It seem to be good for heart disease and certain cancers, but not so great for depression, Alzheimer’s, Crohn’s disease, or diabetes. I guess some of these products claim to be wonder drugs. But that shouldn’t detract from the fact that they may be good for some things. They just aren’t good for everything.

Click here to enjoy it..

Permanent link to this article: http://www.fedsanchez.com/wordpress/2012/06/02/health-supplement-evidence/

Welcome

Welcome to my blog. I am a Methadone Physician working in Etobicoke, West Toronto, Ontario, Canada. This is where you can find some useful information about addictions and drugs in general. I will be adding posts frequently, so check back.

Please feel free to leave some comments. You can do that at the bottom of almost all the pages or posts.

If you leave comments that are not appropriate, they will be removed.

You do not need to leave your name or email. In fact, I encourage you NOT to leave your name or email, and leave your comments Anonymous. If you leave your name, real or fake, please be advised that there is no confidentiality here. Anybody on the Internet, and so the world, can read the name that you leave here.

Let me know if you would like to see something posted here. Any feedback is appreciated.

Again, be nice.

Permanent link to this article: http://www.fedsanchez.com/wordpress/2012/06/01/welcome/