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What Will the Opioid Crisis Look Like in Five Years?

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What Will the Opioid Crisis Look Like in Five Years?

Posted on: November 20th, 2019 by Access Computer No Comments

As an Infectious Disease physician, Dr. Bruce E. Ruben is always learning more about how current issues affect his patients’ healthcare. This article by Jirka Taylor and Peter Reuter originally appeared in the Concord Monitor in New Hampshire last week. Dr. Ruben found this commentary on what the opioid crisis will look like in five years to be a fascinating look at this world-wide problem and thinks his patients should read it too.

Few people had ever heard of fentanyl five years ago. By 2018 this synthetic opioid was implicated in more than 30,000 fatal overdoses in the United States. The next stage of the fast-changing opioid crisis may well depend on how the illegal drug markets morph in the years to come.

In the corners of Europe that have been dealing with fentanyl as long or longer than the United States, each illegal market for opioids took distinct turns. In some, heroin disappeared. In others, opioid nasal sprays arrived. Online sales became the norm. Any of these things could happen here.

What Will the Opioid Crisis Look Like in Five Years?

It’s Estonia where heroin practically disappeared. In the early 2000s, the Taliban’s prohibition on growing poppies in Afghanistan had a ripple effect in Europe constricting the heroin supply. Fentanyl smuggled from or through Russia took its place. Today, tiny Estonia (population about 1.3 million) has the only “mature” fentanyl market in the world.

The replacement of heroin with fentanyl in its drug market was devastating: By 2012, Estonia had one of the highest per capita rates of fatal overdoses in the world. Two other observations, however, offer a bit more reassurance. First, fentanyl does not seem to attract new users: The number of opioid users in Estonia began declining in the 1990s and has continued on that trend. Second, although fentanyl is much cheaper than heroin to produce and ship, drug traffickers do not appear to have lowered street prices, also limiting its spread.

Nearby Latvia underwent a different shift, essentially skipping the fentanyl stage. Stronger variations of the fentanyl molecule, called analogs, started appearing in large quantities around 2014. Until very recently, the most common was carfentanil. One gram of pure carfentanil represents thousands of lethal doses for those without opioid tolerance.

Despite this dangerous potency, Latvian health statistics don’t show a substantial increase in overdose deaths. This suggests that Latvian users and dealers have found comparatively safer ways of consuming synthetic opioids and that overdose death levels don’t inevitably have to skyrocket like they did in Estonia. (Some certainly go unrecorded, but the undercount would have to be enormous for Latvia’s fatal overdose rate to approach Estonia’s.)

Sweden, unlike every other country, developed parallel opioid markets: one for heroin and another for fentanyl analogs. Around 2014, dealers started selling fentanyl analogs online, offering direct-mail delivery. After a period of experimentation, these online dealers settled on an analog nasal spray—a popular alternative for people who preferred not to inject drugs.

Some, though not all, of these facets—the disappearance of heroin, direct online sales, nasal sprays, potent analogs—have begun to pop up in distinct pockets of the United States. None have become widespread in North America yet—but there is no reason why they couldn’t.

Sweden, Latvia and Estonia are, to be sure, much smaller than the United States. But it is useful to think of them as equivalent to a city or small state with a comparatively concentrated supply chain. That also shows us regions just a few hundred miles apart might be affected by fentanyl in completely different ways. The areas of North America that have suffered the most in the opioid crisis—New England, the Midwest, Appalachia, British Columbia—are likely to confront fentanyl in localized ways as well. That will have ramifications for prevention, provision of treatment and other services, and law enforcement efforts.

Despite the variations, there is an overarching commonality to the European cases, too: Once a synthetic opioid like fentanyl becomes dominant, it stays that way. The United States should prepare for fentanyl and other synthetic opioids as a lasting phenomenon, and learning from other countries’ experiences is an important part of that effort.

Jirka Taylor is a policy analyst at the nonpartisan, nonprofit RAND Corporation. Peter Reuter is a professor in the School of Public Policy and Department of Criminology at the University of Maryland. Both are authors of “The Future of Fentanyl and Other Synthetic Opioids.”

 

The Mayo Clinic on the Effects of Hyperbaric Oxygen Treatment

Posted on: November 6th, 2019 by Access Computer No Comments

Overview

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. Hyperbaric oxygen therapy is a well-established treatment for decompression sickness, a hazard of scuba diving. Other conditions treated with hyperbaric oxygen therapy include serious infections, bubbles of air in your blood vessels, and wounds that won’t heal as a result of diabetes or radiation injury.

hyperbaric-oxygen-therapy-chamber-west bloomfield-michigan

In a hyperbaric oxygen therapy chamber, the air pressure is increased to three times higher than normal air pressure. Under these conditions, your lungs can gather more oxygen than would be possible breathing pure oxygen at normal air pressure.

Your blood carries this oxygen throughout your body. This helps fight bacteria and stimulate the release of substances called growth factors and stem cells, which promote healing.

Why it’s done

Your body’s tissues need an adequate supply of oxygen to function. When tissue is injured, it requires even more oxygen to survive. Hyperbaric oxygen therapy increases the amount of oxygen your blood can carry. An increase in blood oxygen temporarily restores normal levels of blood gases and tissue function to promote healing and fight infection.

Hyperbaric oxygen therapy is used to treat several medical conditions. And medical institutions use it in different ways. Your doctor may suggest hyperbaric oxygen therapy if you have one of the following conditions:

  • Anemia, severe
  • Brain abscess
  • Bubbles of air in your blood vessels (arterial gas embolism)
  • Burn
  • Decompression sickness
  • Carbon monoxide poisoning
  • Crushing injury
  • Deafness, sudden
  • Gangrene
  • Infection of skin or bone that causes tissue death
  • Nonhealing wounds, such as a diabetic foot ulcer
  • Radiation injury
  • Skin graft or skin flap at risk of tissue death
  • Vision loss, sudden and painless

The evidence is insufficient to support claims that hyperbaric oxygen therapy can effectively treat the following conditions:

  • AIDS/HIV
  • Allergies
  • Alzheimer’s disease
  • Arthritis
  • Asthma
  • Autism
  • Bell’s palsy
  • Brain injury
  • Cancer
  • Cerebral palsy
  • Chronic fatigue syndrome
  • Cirrhosis
  • Depression
  • Fibromyalgia
  • Gastrointestinal ulcers
  • Heart disease
  • Heatstroke
  • Hepatitis
  • Migraine
  • Multiple sclerosis
  • Parkinson’s disease
  • Spinal cord injury
  • Sports injury
  • Stroke

Risks

Hyperbaric oxygen therapy is generally a safe procedure. Complications are rare. But this treatment does carry some risk.

Potential risks include:

  • Temporary nearsightedness (myopia) caused by temporary eye lens changes
  • Middle ear injuries, including leaking fluid and eardrum rupture, due to increased air pressure
  • Lung collapse caused by air pressure changes (barotrauma)
  • Seizures as a result of too much oxygen (oxygen toxicity) in your central nervous system
  • In certain circumstances, fire — due to the oxygen-rich environment of the treatment chamber

How you prepare

Pure oxygen can cause fire if a spark or flame ignites a source of fuel. Because of this, you can’t take items such as lighters or battery-powered devices into the hyperbaric oxygen therapy chamber. In addition, to limit sources of excess fuel, you may need to remove hair and skincare products that are petroleum-based and potentially a fire hazard. Ask a member of your health care team for specific instructions before your first hyperbaric oxygen therapy session.

What you can expect

During hyperbaric oxygen therapy

Hyperbaric oxygen therapy typically is performed as an outpatient procedure and doesn’t require hospitalization. If you’re already hospitalized and require hyperbaric oxygen therapy, you’ll remain in the hospital for therapy. Or you’ll be transported to a hyperbaric oxygen facility that’s separate from the hospital.

Depending on the type of medical institution you go to and the reason for treatment, you may receive hyperbaric oxygen therapy in one of two settings:

  • A unit designed for 1 person. In an individual (monoplace) unit, you lie down on a table that slides into a clear plastic tube.
  • A room designed to accommodate several people. In a multiperson hyperbaric oxygen room — which usually looks like a large hospital room — you may sit or lie down. You may receive oxygen through a mask over your face or a lightweight, clear hood placed over your head.

During hyperbaric oxygen therapy, the air pressure in the room is about two to three times normal air pressure. The increased air pressure will create a temporary feeling of fullness in your ears — similar to what you might feel in an airplane or at a high elevation. You can relieve that feeling by yawning or swallowing.

For most conditions, therapy lasts approximately two hours. Members of your health care team will monitor you and the therapy unit throughout your treatment.

After hyperbaric oxygen therapy

You may feel somewhat tired or hungry following your treatment. This doesn’t limit normal activities.

Results

To benefit from hyperbaric oxygen therapy, you’ll likely need more than one session. The number of sessions depends on your medical condition. Some conditions, such as carbon monoxide poisoning, might be treated in three visits. Others, such as nonhealing wounds, may require 20 to 40 treatments.

Hyperbaric oxygen therapy alone can often effectively treat decompression sickness, arterial gas embolism and severe carbon monoxide poisoning.

To effectively treat other conditions, hyperbaric oxygen therapy is used as part of a comprehensive treatment plan and administered with other therapies and drugs that fit your individual needs.

 

Contact Encompass Healthcare today to schedule a consultation with Dr. Bruce Ruben

Why Self-Care is So Important

Posted on: May 22nd, 2018 by Access Computer No Comments
At Encompass HealthCare and Wound Medicine, we know how important both self-care and the role of caretaker is to our patients. On a daily basis, we salute those men and women who take care of our patients by driving them to doctor’s visits at Encompass, ensuring they are eating properly, doling out their medication and advocating for them. Whether the caregiver is a hired professional, a family member or a friend, we recognize the sacrifice these individuals are making on behalf of another soul.

What Defines Self-Care?

This month, however, we want to focus our blog post on another issue that is of utmost concern for our patients at Encompass. The role of self-care in your daily health regimen. After all, no one cares about you more than yourself. You might rely on a caregiver for some daily functions and tasks, but there are many ways that you can provide self-care management to ensure a healthy lifestyle for yourself that is free from disease, infections and wounds.
Some tips for self-care include living a healthy life by trying to only eat healthy foods, get enough sleep, exercise regularly and take only the doctor’s prescribed doses of your medicines. Regardless of your age, it’s important to manage stress and go for regular medical check-ups.
Additionally, one of the most important aspects of self-care that Dr. Bruce Ruben at Encompass HealthCare encourages is to practice good hygiene. Good hygiene is important for social, medical, and psychological reasons in that it not only reduces the risk of illness, but it also improves the way others view you and how you view yourself. Dealing with infectious disease, Dr. Ruben cannot stress enough the importance of good hygiene on a regular basis as a key principle in self-care for his patients.

Social Interaction is Self-Care

Believe it or not, another aspect of self-care is social interaction. Studies have shown that individuals who live sociable lives live longer. See friends and family members to build your sense of belonging. You can also join a variety of different support groups to make new friends. Encompass HealthCare can recommend some local support groups and social clubs to help keep you active and involved.Self-care is important value at Encompass HealthCare & Wound Medicine, West Bloomfield, Michigan
Finally, hobbies are an integral part of healthy self-care. Try to do something you enjoy every day, whether it be exercising, dancing, going to a movie, taking a walk, watching a favorite TV show, working in the garden, painting or reading. You should also find ways to relax, like meditation, yoga, getting a massage, taking a bath or walking on a local path.
It is our strong desire at Encompass HealthCare and Wound Medicine that our patients live long and healthy lives. We know you can’t do that on your own. It takes a village of caretakers, support team and physicians. However, self-care management is also a very critical component of your healthy life.

“Mom, There’s Nothing To Eat!”

Posted on: August 1st, 2016 by Mindy Ruben No Comments

“Mom, There’s Nothing To Eat In The House!”

How many times have we heard our kids say this? Still huffing and puffing from carrying in 8 or 9 plastic bags full of groceries, some of which have magically transformed into tourniquets around the ends of my fingers, I look at my kids incredulously: “Nothing in the house to eat?”

Sound familiar? Encompass HealthCare & Wound Medicine, West Bloomfield, Michigan.

“The fridge is so full, I can barely fit in anything else and the pantry is chock full of your favorites…what do you mean ‘there is nothing to eat?!'”

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