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Archive for September, 2012

This opinion article Valium and the New Normal by Robin Marantz Henig is must reading for all college health professionals and therapists to stimulate discussion among us about what we have done in the past in our prescribing habits and what we continue to do.

We need to be serious in our self-examination of how we respond therapeutically to our student-patients’ challenges and anxieties.   If  “normal” is a prescription-medicated state for over 25% of our patient population (far higher if considering the number on daily synthetic hormones), in addition to those who self-medicate regularly with recreational substances, what are we actually accomplishing in helping prepare students for their lives outside the ivory tower?  That all solutions are found in a bottle of one sort or another?

The sought-for “normal,” in otherwise healthy individuals, has become a quest to quash unpleasant feelings and emotions.  Is that really what we want to accomplish with our patients? Or should we be helping them learn (after all, they are in college to learn) the art of resiliency and coping?

As a wise relative would say to me when I felt I couldn’t handle yet another stress while I was in school:  “this too shall pass.”

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This article summary is worth sharing with college health providers and staff, as well as students.

Hookah smoking has been shown to actually be more hazardous than cigarette smoking, something most students are unaware of.

Hookah Smoking Increasingly Common

 

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The U.S. Preventive Services Task Force have a draft recommendation for primary care providers to screen and do brief counseling regarding binge drinking and risky alcohol use for adults age 18 and over.  This is encouraging to those of us in college health who have been using brief screening and motivational interviewing to identify and support reducing risky drinking in our student populations.

The USPSTF is soliciting public comment on the recommendation.

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This opinion article brings up some important points relevant to how we might approach treatment of college students’ sleep issues–

Rethinking Sleep–New York Times 9/23/12

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Autumnal Beginning

“That old September feeling, left over from school days, of summer passing… obligations gathering, books and football in the air … Another fall, another turned page: there was something of jubilee in that annual autumnal beginning, as if last year’s mistakes had been wiped clean by summer.”
~Wallace Stegner in Angle of Repose
 

How is it the same day can be wistful and yet jubilant?  More than New Year’s Day, the beginning of autumn represents so many turned over “leafs”.  We are literally reminded of this whenever we look at the trees and how their leaves are turning and letting go, making joy as they make way, the slate wiped clean and ready to be scribbled on once again.

Tomorrow the school where I’ve worked for nearly a quarter century welcomes back 15,000 students to its halls and classrooms.  We at the Student Health Center see or are contacted by 2% of those students every day about their health concerns and symptoms.  I am struck anew every autumn when each adult comes to the university with that clean slate, hoping to start fresh, leaving behind what has not worked well for them in the past.  These are patients who are open to change because they are dedicating themselves to self-transformation through knowledge and discipline.

It is a true privilege, as a college health doc, to participate in our students’ transition to become autonomous critical thinkers who strive to better the world as compassionate global citizens.  Their rich colors deepen once they let go to fly wherever the wind may take them.

We who remain rooted in place celebrate each new beginning, knowing we nurture the coming transformation.

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This is an excellent summary for why our advice and opinions need to be more accessible to our college student-patients online, as that is where they are looking first:

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Persistent Cannabis users show neuropsychological decline from childhood to midlife  

This recent study published in the Proceedings of the National Academy of Sciences warrants attention among college health providers who are seeing nearly a third of their student-patients using cannabis in various forms within the previous thirty days, primarily for recreational purposes, but increasingly as legal treatment for medical diagnoses.

if you believe the extremely vocal marijuana proponents, cannabis can treat almost any condition under the sun, and in a number of states now is being prescribed and encouraged for everything from anxiety to insomnia to sinusitis to asthma to arthritis to headaches to premenstrual syndrome.  If you are simply alive, there is a good chance you have at least one symptom that warrants a medical marijuana card. It is a fine example of not-so-modern snake oil, as it has been around for thousands of years, except now we have multiple state legislative bodies putting their stamp of approval on it.  I’m concerned our nation’s overwhelming drug abuse statistics will not decline with the legalization of the possession of small amounts of marijuana for medicinal purposes,  in addition to open marketing, sale and distribution.  We are simply bringing the dealers and pushers out of the shadows–not a bad thing if we can all agree that a staggering percentage of the population, including our brain-development-vulnerable adolescents, suffer symptoms deemed worthy of being medicated with a mood altering substance well known to cause dependency, not to mention a host of psychiatric problems including new onset panic disorder, dissociative symptoms and psychosis in vulnerable individuals.

Patients who have antipathy for the pharmaceutical industry or for government agencies responsible for studies of drug safety and effectiveness seem to lose their skepticism when confronting the for-profit motivation of marijuana growers, brokers and storefront sellers.  These patients prefer to trust a physician/chiropractor/naturopath sitting in a temporary booth at a Hemp Fest willing to pocket $150 cash for a ten minute assessment of symptoms in exchange for a signature on a medical marijuana card. Many choose not to be followed by responsible health care providers who might actually take a thorough history, do a complete examination and lab tests including drugs of abuse testing, possibly order confirmatory imaging studies, and might actually recommend treatment that is proven in multiple controlled studies to be effective.

In my university health center clinic I’ve been asked by several otherwise healthy teenage college students if I would prescribe medical marijuana for their stress-related headaches.  These young people have friends who have gotten their medical marijuana card elsewhere so they can “smoke whenever they need to” without fear of being found in possession by law enforcement.  They want the “get out of jail free” card, or better yet, “never get arrested to begin with” card.  They have symptoms, as all of us do, but none of these are patients with chronic disease found unresponsive to other treatment.   These are patients who have never had more than a cursory headache evaluation, never had a trial of non-pharmaceutical modalities like relaxation techniques or massage, or prophylaxis with non-addictive medication.  Yet they are willing to sign on to a substance that has, at best, a shadowy origin with no quality standards in production, distribution or dosing, is traditionally and most expediently used only by inhaling smoke or vapor, and has well-studied adverse effects on short and long term memory, focus and reaction time.   All this defies logic, especially in a college student who needs every neuron at the ready to absorb, retain and process complex information, something marijuana has proven ability to impair.  I’m perplexed at how easily these leaves of grass are given a pass by young and old, rich and poor, professional and blue collar, liberal and conservative.

Certainly marijuana is the “least” of the problem recreational drugs, not as physically devastating nor by itself  responsible for overdose fatalities like alcohol, benzodiazepines, cocaine, methamphetamines, or opiates, but it still has the potential to ruin lives.   In its twenty first century ultra high concentrated version,  far more powerful than the weed of the sixties and seventies, it renders people so much less alive and engaged with the world.   They are anesthetized to all the opportunities and challenges of life.  You can see it in their eyes and hear it in their voices.  In a young person who uses regularly, which a significant percentage choose to do in their fervent belief in its touted “safety”, it can mean more than temporary anesthesia to the unpleasantness of every day hassles.  They never really experience life in its full emotional range from joy to sadness, learning the sensitivity of becoming vulnerable, the lessons of experiencing discomfort and coping, and the healing balm of a resilient spirit.  Instead, it is all about avoidance, emotional anesthesia and getting high.

Benumbed, blunted, and stunted.  Surely yet another indication for the prescription of medical marijuana.

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