Could breastfeeding kill a newborn? That is the question a California district attorney will ask a jury at the trial of a breastfeeding mother. Most women do not intend to harm their children but substance abuse and addiction comes with a heavy price. Such was the case of Maggie Jean Wortman, who has been charged with second degree murder after medical tests revealed that her newborn son died from methamphetamine intoxication obtained through her breast milk. Wortman’s 19-month-old daughter also tested positive for methamphetamine and was placed in protective custody. How could this happen?
The transfer of drugs from the mother’s blood to human milk depends on the chemical composition of the drug. Antibiotics such as penicillin will remain in the mother’s blood for long periods of time whereas certain types of blood pressure and heart medications will remain in the milk. During the first three days after birth, higher concentrations of medicine remain in breast milk. Wortman’s attorney is attempting to argue that methamphetamine in breast milk could not kill a baby but here’s why he’s wrong: Read more »
Prescription opiates rose to one-third of all treatment admissions in 2009, from 8% in 1999, reflecting the rising trends in prescription opiate abuse. There were nearly 2 million substance abuse treatment admissions in 2009 among people ages 12 and older were reported to the Treatment Episode Data Set, a reporting system involving treatment facilities from across the country.
Five substance groups accounted for 96% of admissions: alcohol (42%), opiates (21%), marijuana (18%), cocaine (9%), and methamphetamine/amphetamines (6%), reported the Substance Abuse and Mental Health Services Administration. The data came from 49 states and Puerto Rico. Georgia and the District of Columbia did not report admissions for 2009. One person can be reported as multiple admissions in a year. Read more »
Doctors today are wary about treating chronic pain. One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, “fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 … [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008.”
Requiring chronic pain patients to sign pain contracts is a way to mitigate this risk. But how does that affect the doctor-patient relationship?
Indeed, a contract is an adversarial tool. Essentially, it states that a patient must comply with a strict set of rules in order to receive medications, including where and how often they obtain controlled substances, and may involve random drug testing. Break the contract and the patient is often fired from the practice. Read more »
*This blog post was originally published at KevinMD.com*
I’ve discovered over the years that I really like economics. I never took an econ class in my entire life, since I was pretty focused on the life sciences, but I’ve picked up a fair amount informally over the years. Fortunately I have a strong background in statistics and math, and I’ve done a lot of reading on economics. I wouldn’t say that I have any special level of understanding or credibility on the topic. Perhaps it should be noted that my wife took away the checkbook for good reason. But I enjoy it as a topic, as something to read about and a powerful tool for understanding how the world works.
One consequence of being an ER doc is that you are pretty close to “the street,” and I don’t mean Wall Street. I mean the folks living and scrounging on the streets. As a matter of functioning in the job, you learn the street jargon, you learn what drugs people are using and why, and what the effects of those drugs look like.
The other day I saw a middle-aged guy brought in for acting really weird. Though everything in his social history argued against it, he just looked like he was on meth. I checked a tox, and sure enough, it came back positive. He strenuously denied any drugs, but eventually gave in and admitted the meth use.
I remember in residency walking through downtown Baltimore with a fellow resident and our spouses, and we amazed them by serially identifying the likely drug of choice of the various street people we passed, based on casual observation of their behavior. It’s just what we do. Baltimore was a heroin town. Read more »
*This blog post was originally published at Movin' Meat*
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