501 (c) (3) Non-Profit Corporation
(A Subsidiary of Medical Assisted Treatment )

Mourn not the dead that in the cool earth lies but rather mourn the apathetic, throng the coward and the meek who see the world's greatest anquish and its wrong and dare not to speak. -Ralph Chaplin


 Buprenorphine is a partial opioid agonist. It can cause a diminished response to opioid pain medications.

This patient is taking a combination drug of buprenorphine, a partial opiate agonist, and naloxone, an opioid antagonist (naloxone is only clinically active when abused parenterally). Patients taking buprenorphine may have a diminished response to opiate medications (including those for the management of cough or pain). 

Opiate-containing preparations should be avoided when non-opiate therapy is available as an alternative.
In an emergency situation requiring pain relief in patients taking buprenorphine, a suggested plan of management is regional anesthesia, conscious sedation with a benzodiazepine, use of non-opioid analgesics or general anesthesia.

 In a situation requiring opiate analgesia, the dose of opiate required maybe greater than usual. A rapidly acting opiate analgesic, which minimizes the duration of respiratory depression, should be used. The dose of opioid medication should be titrated against the patient's analgesic and physiological response, with close monitoring by trained staff.

Overdose with buprenorphine alone is uncommon
. In a situation that a patient taking buprenorphine has overdosed and is unconscious, the primary management should be the re-establishment of adequate ventilation with mechanical assistance of respiration, if required.

 Overdose in combination with other Central Nervous System Depressants should be considered because of the increased potential for life-threatening events. Naloxone may not be effective in reversing any respiratory depression produced by buprenorphine. High doses of naloxone hydrochloride, 10-35 mg/70 kg, may be of limited value in the management of buprenorphine overdose. Doxapram (a respiratory stimulant) has also been used.

Spears Slapped With Hit-and-Run Charge 

Britney Spears will be tested for drugs and alcohol twice weekly after a judge finds there is "habitual, frequent and continuous use of controlled substances and alcohol" by the pop singer.

LOS ANGELES (Sept. 22) - Britney Spears legal woes mounted Friday as prosecutors charged her with misdemeanor counts of hit and run and driving without a valid license after she allegedly smashed her car into another in a parking lot in August. If convicted, the singer could face up to six months in jail and a $1,000 fine for each count, said Nick Velasquez, spokesman for the city attorney's office.

Messages left with Spears' attorneys were not immediately returned.

The accident occurred August 6, Velasquez said.

Spears, 25, was filmed by paparazzi that day steering her car into another vehicle as she tried to turn into a spot in a Studio City parking lot. After assessing the damage to her own car only, she was shown on paparazzi video walking away.

Three days after the accident, the owner of the other vehicle, Kim Robard-Rifkin, filed a police report, and investigators later determined that Spears does not have a license, officials said.

Robard-Rifkin, a 59-year-old registered nurse, learned it was Spears who had hit her car through a video posted on the celebrity Web site

She said she was "sort of amused and sort of shocked" when she learned Spears was the source of the damage, adding that she had expected to hear from the star's camp.

"I simply want my car fixed, the same as I would fix somebody's car if I had done that," Robard-Rifkin told the site in August.

Spears was scheduled to be arraigned October 10, but she is not required to appear.

The case comes days after a court commissioner ordered her to undergo random drug and alcohol testing twice a week in her child custody dispute with ex-husband Kevin Federline. She must also meet eight hours a week with a parenting coach, who will observe and report back to the court about her parenting skills.

Her management firm also recently dropped her, and her performance at this year's MTV Video Music Awards was widely panned. Spears' new album is set for release November 13.

Copyright 2007 The Associated Press. The information contained in the AP news report may not be published, broadcast, rewritten or otherwise distributed without the prior written authority of The Associated Press. All active hyperlinks have been inserted by AOL.
2007-09-21 19:47:41

Prior written permission obtained from Associated Press.  

The Los- Angeles Superior Court orders both Spears and ex-husband Kevin Federline to refrain from substance usage around their two young children, but only Spears is ordered to submit to drug testing.

It does not care if you are rich or poor, famous or unknown, a man or woman, or even a child.  If science-based treatment principles are followed, addiction treatment can work, and people can reclaim their lives."

Celebrity Recovery Misadventures Hurt Treatment's Images

In and out of rehabilitation and all over the tabloids, celebrity addicts like Lindsey Lohan, Britney Spears and Nicole Ritchie are damaging the image of "Addiction Treatment Programs," some observers say.

Reuters reported that incidents like Lohan being arrested for drunk driving after leaving a recovery program with an alcohol-monitoring bracelet, or Spears twice spending less than a day in treatment programs before being admitted for the third time, make "a mockery out of rehabiltation programs" said Harris Stratyner of the Caron Foundation.

"In some ways it is starting to make rehabilitation programs look like a joke and that is sad because hundreds of thousands of people a year are saved," he said.

While relapse is common in addiction recovery, celebrities often seem to operate by their own rules during their spotlighted struggles with alcohol and other drugs, seemingly coming and going from treatment as they please.

"I would hope that people understand addiction is a very serious illness and that the perception in the public mind doesn't become that this is all a joke," said Jon Morgenstern of The National Center on Addiction and Substance Abuse at Columbia University.

 "In the last thirty years, because high-profile people have sought treatment, it's become more socially acceptable that people do have alcohol and drug problems and need to get help. So I hope that tide is not turning against us.

Reference:  Reuters         Published: 25 July 2007

Editor's Note:

They all had everything going for them in their lives but still they needed  to  self-medicate themselves.  I  believe  they have received "Preferential Treatment," but I am not sure it have served them for the best. Sooner or later they will hit another car and possibly take another's life and /or leave them mangles for life. Whose fault will it be then?  It will noy entirely be theirs but the ones giving them the "Preferential Treatment." It is our Judges that should serve the time for their actions because they failed all these girls. What do you think?

 They must assume  responsibility for their actions. They have a chronic, recurring disease. They should not be locked up simply because they have substance-abuse disorders . I believe if they hurt another person and/or caused damage to another's property, then certainly they must be required to accept responsiblility for their actions.  

Do I believe having them serve time will deter then from using?  No, absolutely not!  Has it deterred the use of drugs? No! There is a well -founded science-base for understanding addiction as a chronic, recurring disease, characterized by compulsive drug seeking and use.

An abundance of of research has consistently shown that chronic drug use affects the brain in fundamental ways often remaining long after the drug use behavior has stopped. 

From this knowledge, we are now able to accept that for some addicted persons, medications are critical to treat drug-induced brain deficits in order to help sustain a symptoms-free lifestyle.


Why do people relapse?  

The answer is that even though they have been abstinent, the neurobiologic changes inflicted on their brains by long term addiction have not been returned to normal, and they are therefore, still vulnerable to certain stimuli, called "triggers." Examples of triggers include, exposure to the substance or paraphernalia of their addiction, i.e. just seeing a heroin spoon or something that resembles it? Another is returning to a place associated with their addiction.  Another common trigger is association with persons with whom the addiction took place. Any of these or other associations can cause strong craving for the drug and severly test the person's resolve to remain abstinent.

One of the most common triggers for relapse is stress. It might be caused by financial problems, marital troubles, the threat of incarceration, difficulties with an employer, or any of the "slings and arrows of outrageous fortune" to which we are all subject. And there is, as almost always, an underlying neurobiologic reason for it; it involves endorphins.

In addition to their vital roles in the experiences of pain and pleasure, there is an additional function that endorphins play. They help us withstand stress. When confronted with danger, we have to quickly decide between "fight or flight." A complex array of chemical changes prepares us for both. The adrenal glands provide both adrenaline and adrenal steroids, to produce the "amped up" effect. To provide a balance, endorphins are released to prevent loss of control. In other words, endorphins act as "mood stabilizers". Once again, an example of exquisite balance.

The problem for those addicted to opiates is that their endorphin systems have been disabled by their addiction. Consider this analogy.

To protect a large building from fire, a system is designed to release fire retardant from sprinklers in response to an increase in temperature. An external force, say sunspots, causes the temperature to rise to unprecedented levels, releasing a huge flood of retardant, which causes a lot of damage.

When the force is spent and the clean-up is finished, the decision is made to decrease the sensitivity of the sensors. The force continues intermittently to cause the release of retardant, and the sensitivity of the sensors continues to be decreased. Finally a point is reached where, when a real fire occurs, the sensors and the system are no longer able to respond, and outside sources of the retardant must be purchased and employed. 

As a part of the neuroadaptation to the constant injection of large doses of opiates, the brain renders the opiate receptors less responsive to the continuing external heat of heroin doses, making them insensitive to the relatively small amounts of endorphins released by the brain. The addicted brain realizes the imbalance and the lack of response and interprets this as a deficiency of opiates which causes craving. So unless and until the endorphin-receptor system has been completely rehabilitated by prolonged abstinence, the system won't be effective in producing the proper response in a time of stress. The constant heat of addiction has damaged the system, which is the protection against the onset of stress.

So how long does it take to rehabilitate the endorphin system, and how can we tell when it is fully recovered ?

The answer to both questions is that we just don't know. It is important to keep in mind that because methadone is continuing to interact with the opiate receptors throughout treatment, the endorphin system cannot be rehabilitated while on therapeutic doses of methadone. In order to discontinue methadone treatment, the patient must have the methadone dose slowly decreased so that the brain can recalibrate to each new level. If the taper were to proceed too swiftly, the patient will begin to have withdrawal symptoms. Each patient is different, and the pace must be adjusted to the individual's tolerance.

Written:  Deborah Shrira         Published: 22 September 2007