Author Archives: Benjamin Swasey

Ben is an editor — and occasional blogger — for wbur.org.

The Face Of Opioid Addiction: Vinnie, A ‘Regular’ Guy From Revere

In this 2013 file photo, a recovering heroin addict holds a demonstration dose of the medication Suboxone. (M. Spencer Green/AP)

In this 2013 file photo, a recovering heroin addict holds a demonstration dose of the medication Suboxone. (M. Spencer Green/AP)

By Dr. Annie Brewster
Guest Contributor

Want a glimpse of what opioid addiction really looks like?

Meet Vinnie: a self-described “regular” guy from Revere, Mass., and a recovering drug addict.

Toothless, and 60, Vinnie was prescribed opioids — Oxycodone, Oxycontin, Dilaudid, among others — for a chronic pain condition. Though he says he never intended to abuse these medications, Vinnie became an addict, taking painkillers for 28 years as his doctors kept prescribing higher and higher doses to manage his pain. Listen to his story here:

Vinnie stopped caring about anything except opioids, and finding his next dose of medication.

Vinnie, from Revere, is a recovering drug addict.

Vinnie, from Revere, is a recovering drug addict.

His marriage fell apart. He missed opportunities to spend time with his only daughter as she grew up. He became estranged from friends. He stopped taking care of his body and lost his teeth, gained 100 pounds, and developed diabetes, heart disease and arthritis. He fundamentally lost his will to live and contemplated suicide.

Ultimately, it was a pharmacist who put a stop to Vinnie’s opioid use by refusing to fill his prescription. After his initial panic, this abrupt end to the drugs led Vinnie to connect to a new doctor, an addiction specialist. His new regimen included a slow tapering of the narcotics and the initiation of Suboxone therapy.

The state and nation are in the midst of an escalating opioid crisis — it’s estimated that 100 Americans died each day from opioid overdoses in 2013, and the number of deaths from drug overdoses was three times that of the combined deaths from car accidents and homicides in that same year.

Just this week Massachusetts Gov. Charlie Baker enlisted medical schools to provide more addiction-related training to medical students. Against this backdrop, Vinnie’s story shows the harsh reality of addiction as well as a path to recovery.

How to fix it? It’s clear that a multifaceted approach is needed, as outlined in an extensive report put out by Gov. Baker’s Opioid Working Group in June.

One element, relevant to Vinnie, is consideration of one of several medications available to treat opioid addiction, including methadone, buprenorphine and naltrexone. Currently, these medications are underused, partly because they are controversial. Continue reading

CDC: One-Third Of Children With ADHD Diagnosed With The Disorder Before Age 6

(Vivian Chen/Flickr)

(Vivian Chen/Flickr)

One-third of children diagnosed with ADHD were diagnosed young — before the age of 6 — according to a new national survey from the U.S. Centers for Disease Control and Prevention.

Earlier, the CDC found that based on parental reports, 1 in 10 school-aged children, or 6.4 million kids in the U.S., have received a diagnosis of ADHD, a condition marked by symptoms including difficulty staying focused and paying attention, out of control behavior and over-activity or impulsivity.

The percentage of children diagnosed with ADHD has increased steadily since the late 1990s and jumped 42 percent from 2003-2004 to 2011-2012, the CDC says. Last year, concerns flared when a report found that thousands of toddlers are being medicated for ADHD outside of established pediatric practice guidelines.

In the current analysis, also based on parental reporting, and using data drawn from the 2014 National Survey of the Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder and Tourette Syndrome, the CDC also found:

•The median age at which children with ADHD were first diagnosed with the disorder was 7 years old

•The majority of children (53.1%) were first diagnosed by a primary care physician

•Children diagnosed before age 6 were more likely to have been diagnosed by a psychiatrist

•Children diagnosed at age 6 or older were more likely to have been diagnosed by a psychologist

•Among children diagnosed with ADHD, the initial concern about a child’s behavior was most commonly expressed by a family member (64.7%)

•Someone from school or daycare first expressed concern for about one-third of children later diagnosed with ADHD (30.1%)

•For approximately one out of five children (18.1%), only family members provided information to the child’s doctor during the ADHD assessment

What are we — parents, educators, doctors — to make of all this? In particular, what does it mean that so many very young kids are being diagnosed with an attention disorder? (Has anyone ever encountered a 4- or 5-year-old child who is not hyperactive, impulsive and inattentive??)

I asked two doctors — a pediatrician and a psychiatrist — for their impressions of the CDC report. Both agreed that we seem to have two problems when it comes to ADHD: over-diagnosing and under-diagnosing. Here, lightly edited, are their responses.

First, the pediatrician:

James M. Perrin, MD, is a professor of pediatrics at Harvard Medical School and associate chair of MassGeneral Hospital for Children. Dr. Perrin is also the immediate past president of the American Academy of Pediatrics and chaired the 1990s committee that wrote the first practice guidelines for ADHD (and he was on the committee for the 2011 revision).

RZ: How difficult is it to diagnose ADHD in children under 6 years old?

JP: In the pediatric community, we have worked over last 15 years to train general pediatricians to make diagnoses of ADHD reliably and follow very clear, specific guidelines on how to do so. In 2011, the AAP revised its practice guidelines for ADHD and included the opportunity to diagnose children ages 4 and 5 years old.

At the same time we recognize it’s very hard to do that well in that age group…because a lot of children are inattentive at 4 — you don’t expect them to work hard and read a Hardy boys book for an hour and half. Five is often impulsive, active, so it’s not unusual to have symptoms that children with ADHD would also have at age 4, 5. So, it’s not easy.

We did say [in the guidelines] pretty clearly that you shouldn’t make the diagnoses without significant impairment of normal behavior. What we mean by that is a child whose symptoms impair her ability to play with other children, or whose behavior is so out of control that it’s dangerous, for instance she runs out in front of cars, or has many accidents, that’s when the symptoms become impairing. Continue reading

Bleeding Disorder? National Expert Discusses Questions Around Cambridge Baby’s Death

Aisling Brady McCarthy

Aisling Brady McCarthy watches as her attorney addresses the court during a status hearing at Middlesex Superior Court in Woburn in May. McCarthy, a nanny from Ireland, was accused of killing a 1-year-old Massachusetts girl in her care two years ago. (Charles Krupa/AP)

Aisling Brady McCarthy is back in her native Ireland now, after murder charges against her were dropped in the death of Rehma Sabir, a Cambridge infant in her care. But while the case is over, the mystery remains: How did Rehma die?

The Middlesex County district attorney’s office says a review of the case raised the question of whether 1-year-old Rehma had an undiagnosed blood disorder that could have caused her brain hemorrhage. A press release from the office cites these details from the medical examiner:

“Review of Rehma’s coagulation and hematology testing, her history of bruising, the NIH guidelines for diagnosis of von Willebrand disease, and literature on the subject suggest to me that Rehma’s low von Willebrand factor could have made her prone to easy bleeding with relatively minor trauma.

“Given these uncertainties, I am no longer convinced that the subdural hemorrhage in this case could only have been caused by abusive/inflicted head trauma, and I can no longer rule the manner of death as a homicide.  I believe that enough evidence has been presented to raise the possibility that the bleeding could have been related to an accidental injury in a child with a bleeding risk or possibly could have even been a result of an undefined natural disease.  As such I am amending the cause and manner of death to reflect this uncertainty.”

So, then, a bleeding disease might have caused a spontaneous hemorrhage? Or the combination of the disease and a minor head injury led to death? And if so, could it be that quite a few of the contested accusations of baby abuse in recent years could be thus explained away?

Dr. Shannon Carpenter (courtesy)

Dr. Shannon Carpenter (courtesy)

I turned to Dr. Shannon Carpenter, a bleeding disorders specialist who has done research and written American Academy of Pediatrics reports on checking children for bleeding disorders when there’s a question of abuse. She’s the chief of hematology at Children’s Mercy Hospital in Kansas City, Missouri, and the director of the Kansas City Regional Hemophilia Center.

Dr. Carpenter was not involved in the Cambridge case, but speaking generally she says that sadly, no, there’s no kinder explanation here: Abusive head trauma — a better term than “shaken baby syndrome” because abuse can involve more than shaking — is far more common than serious bleeding disorders, and even children with severe disorders are extremely unlikely to have fatal brain bleeds. Our conversation, lightly edited:

Dr. Carpenter, what are we to make of the medical examiner’s mention of Von Willebrand disease — a not-very-rare bleeding disorder — and the suggestion that death could have resulted from disease or “an accidental injury in a child with a bleeding risk”?

One thing I would say is, most patients with von Willebrand disease have a mild disorder, mostly manifested by nosebleeds, bruising, and gum bleeding, and do not seem to have an increased risk for intracranial hemorrhage. Research is ongoing in this area and I think there may be more information coming, but from a clinical perspective, when we see patients with the most common types of von Willebrand disease, we do not have a high concern for intracranial hemorrhage in those patients, certainly not spontaneously.

“Unfortunately, child abuse is more common than bleeding disorders.”

– Dr. Shannon Carpenter

The most severe forms of von Willebrand disease occur in about 1 percent of people with von Willebrand disease, probably less than that. And even in the most severe forms, the risk of having a bleed inside of the head is probably less than 2 percent. So it’s a very rare event. This would be an unusual presentation for von Willebrand disease. I don’t know the specifics of this patient’s case, and I don’t know what her actual von Willebrand factor level was, but even if she was low enough to be diagnosed with the most common form of von Willebrand disease, this kind of bleeding would not be typical for that kind of diagnosis.

But, I suppose, possible?

While anything is possible, you have to look at what’s probable and what other patients have experienced. And patients with bleeding disorders are not immune to trauma, whether it’s inflicted or non-inflicted. I would say if a child came to me with type 1 von Willebrand disease, the most common type, the mild form of von Willebrand disease, with a typical toddler head bump that would not otherwise cause someone to seek medical care, I would not worry about intracranial hemorrhage in that patient.

And if a child had a more severe form of von Willebrand disease?

Then I might be concerned.

But if it were a severe form, wouldn’t it have likely shown up by 1 year of age? Continue reading

Baker Enlists Help Of Medical Schools In Fight Against Opioid Addiction Crisis

Gov. Charlie Baker met with the deans of the state’s four medical schools on Wednesday to enlist their help in fighting the opioid addiction crisis here.

Deans from UMass Medical School, Harvard Medical School, Boston University School of Medicine, and Tufts School of Medicine, as well as the leadership of the Massachusetts Medical Society, met with the governor to discuss an effort to better educate medical students in pain management and “safe opioid prescribing methods.”

“The avenue prescription pain pills can provide to addiction and heroin use further stresses the need for advancing safe and responsible prescribing methods in the medical community,” Baker said in a statement.

According to that statement, those at the meeting agreed to work together towards developing best practices, enhancing their school’s curriculum, and identifying opportunities for collaboration across institutions.

Developing better training for doctors was one of several recommendations made by Baker’s opioid working group, which was tasked with figuring out ways to help stem the addiction crisis in the state.

Continue reading

Mass. 2014 Health Care Spending Rises Faster Than State Goal

Massachusetts spent $632 million more on health care last year than it was supposed to, according to a report from the state’s Center for Health Information and Analysis.

The goal, established via a 2012 law, is to keep health care spending in line with the rising costs of other goods and services. Every year the state sets a benchmark. In 2013 — the first year of accountability — Massachusetts stayed well under the cap. But last year, spending shot right past the 3.6 percent target and hit $54 billion, a 4.8 percent increase over the previous year. Continue reading

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What Does Nanny Case Reversal Say About Shaken Baby Syndrome?

In this July 30, 2015 photo, Aisling Brady McCarthy leaves court proceedings at Middlesex Superior Court in Woburn. Middlesex DA Marian Ryan announced Monday that the murder charge against the Irish nanny had been dropped. (Keith Bedford/The Boston Globe via AP)

In this July 30, 2015 photo, Aisling Brady McCarthy leaves court proceedings at Middlesex Superior Court in Woburn. Middlesex District Attorney Marian Ryan announced Monday that the murder charge against the Irish nanny had been dropped. (Keith Bedford/The Boston Globe/Pool)

You read about the striking reversal in the latest Boston nanny case and you wonder: How does this happen? How could a medical examiner first say a baby died of “complications from blunt force head injuries” and then, two years after the baby’s Irish nanny is accused of murder, decide that the cause of death is “undetermined”?

The medical examiner’s report has not been publicly released, but the Middlesex district attorney’s press release does cite a major review process that included “expert witness reports from the defense and prosecution, additional transcripts of police interviews, transcripts of grand jury testimony, additional medical records, DCF reports, and additional laboratory testing.”

On Radio Boston today, co-host Anthony Brooks spoke with Dr. Robert Sege, a member of the American Academy of Pediatrics’ committee on child abuse and neglect, and vice president at Health Resources in Action, a public health policy organization. Here’s an excerpt of that conversation, lightly edited:

Anthony Brooks: This is the second time in a year that the Massachusetts medical examiner has reversed its finding in a baby’s death, and we’ve been reading that in the United States, 16 convictions have been overturned since 2001, including three last year. So does this raise questions about the diagnosis of shaken baby syndrome? What are your thoughts on that?

Dr. Robert Sege: To me, it doesn’t raise the question at all. If you think about it, there are people who are falsely accused of murder, robberies, all kinds of things and the justice system is not perfect. So in a situation where we have hundreds and perhaps a thousand infants a year who experience shaken baby syndrome, the fact that 16 convictions over a multi-year period were overturned lets me know that the justice system worked, and that people get a fair shot at getting their story told…

I’m very happy that we live in a country with a judicial system that looks at things skeptically and tries to make sure that justice is done. It doesn’t change anything about whether or not shaken baby syndrome or abusive head trauma exists. Sadly, it does.

I want to read you one quote from Gregory Davis, the chief medical examiner in Birmingham, Alabama, and board chair of the National Association of Medical Examiners. He told the Washington Post:

“You can’t necessarily prove [shaken baby syndrome] one way or another … Neither side can point to compelling evidence and say, ‘We’re right and the other side is wrong.’ So instead, it goes to trial.”

Do you disagree with that?

I actually do, and I think part of the issue is that many cases of abusive head trauma never make it to trial, sometimes because the police and the prosecutors can’t figure out who the perpetrator was, but often — and I’ve certainly seen this — because someone confesses. It’s a very sad situation, but frequently a person just reaches the end of their rope. They’re frustrated, the infant won’t shut up, they don’t mean to cause harm or death but they just can’t stand it anymore. Continue reading

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Why You Should Get Plenty Of Sleep Tonight: Avoid That Cold

Lack of sleep can lead to bad outcomes, from crankiness to extreme mental distress.

Now researchers report an association between insufficient sleep and getting sick. Specifically, they conclude that shorter sleep duration was associated with increased susceptibility to the common cold. Adults who slept fewer than 5 hours or between 5 and 6 hours were at greater risk of developing a cold compared to those sleeping more than 7 hours per night, according to the study, published in the journal Sleep.

(Seniju/Flickr)

(Seniju/Flickr)

The authors conclude:

Given that infectious illness (i.e., influenza and pneumonia) remains one of the top 10 leading causes of death in the United States, the current data suggest that a greater focus on sleep duration, as well as sleep health more broadly, is indicated.

NPR reports further on the study:

Aric Prather, a psychologist at the University of California, San Francisco, who studies how our behaviors can influence our health…wanted to document the extent to which a good night’s sleep is protective. So, he and a group of colleagues recruited 164 healthy men and women — their average age was 30 years old — to take part in a study. Using sleep diaries and a device similar to a Fitbit, the researchers assessed each participant’s sleep for a week.

Then the scientists sprayed a live common cold virus into each person’s nose.

“We infected them with the cold virus,” Prather says, then quarantined everybody and watched to see who got sick…

“What we found was that individuals who were sleeping the least were substantially more likely to develop a cold,” Prather says. Continue reading

Study: Marijuana More A Habit For College Students Than Cigarettes

The study's lead investigator says the findings suggest that teenagers and young adults have absorbed public health warnings about the dangers of cigarettes but increasingly regard marijuana as benign or carrying few risks. (Jeff Chiu/AP, File)

The study’s lead investigator says the findings suggest that teenagers and young adults have absorbed public health warnings about the dangers of cigarettes but increasingly regard marijuana as benign or carrying few risks. (Jeff Chiu/AP, File)

More U.S. college students are making a habit of using marijuana, which has supplanted cigarettes as the smoke-able substance of choice among undergraduates who light up regularly, a study released Tuesday found.

Just under 6 percent of the full-time students surveyed by University of Michigan researchers for the annual “Monitoring the Future” study reported using pot either every day or at least 20 times in the previous 30 days.

By contrast, 5 percent of respondents identified themselves as heavy cigarette smokers, a steep decline from the 19 percent who said they smoked daily in 1999.

The findings suggest that teenagers and young adults have absorbed public health warnings about the dangers of cigarettes but increasingly regard marijuana as benign or carrying few risks, lead investigator Lloyd Johnston said.

Continue reading

Caregiver Nation: Snapshot Of 43 Million Americans Who Give Unpaid Care

(a4gpa/Flickr)

(a4gpa/Flickr)

By Marina Renton
CommonHealth intern

A high-stress job that requires a full-time commitment for no pay.

What kind of work fits that description? The answer should resonate with more than 43 million Americans: unpaid family caregiving.

As the population ages and more people need care, the ratio of available family caregivers to care recipients is declining, and efforts to support family caregivers are beginning to make headway in the political sphere.

Among those who need that support most: “higher-hour” caregivers, who spend more than 21 hours a week on caregiving, according to “Caregiving in the U.S. 2015,” a report released this summer by the National Alliance for Caregiving and the AARP Public Policy Institute.

Ask Massachusetts resident Diane Gwynne, 56. After her mother’s sudden death this past December, Gwynne found herself trying to balance her career and household responsibilities with caring for her 92-year-old father, who has dementia.

“I was so overwhelmed,” Gwynne said of when she first started caring for her father. “It was so sudden. I didn’t even know where to turn.”

Last year, Gwynne’s mother had an intuition that the Christmas of 2014 would be the family’s last. Gwynne’s mother was in her 80s and her father was seven years older, in his 90s. Both were feeling the effects of age.

“My mother said, ‘I want to put all the decorations up, because I think this is going to be our last year all together,’ ” Gwynne recalls. Her mother, it turned out, was unknowingly predicting her own death: She passed away just before the New Year.

Suddenly, her bereaved children found themselves managing the estate, taking their father to medical appointments, and making arrangements for his day-to-day care.

Caregivers By The Numbers

Caregiving in the U.S. 2015,” a report that comes out every few years and aims to profile the nation’s family caregivers, looks at the demographics of family caregivers, along with the emotional, physical and financial challenges they face.

Based on the results of online interviews with 1,248 adult caregivers who provide care to adults, the report offers a quantitative snapshot of the country’s caregivers. Among its findings:

• Approximately 43.5 million adults in the country have provided some form of unpaid care to an adult or child with special needs in the past year.

• About 39.8 million Americans have cared for an adult (over 18 years old), and 34.2 million an adult over 50, in the past year. In other words, about 18 percent of U.S. adults have shouldered some unpaid caregiving responsibilities in the past year.

• The average caregiver is a 49-year-old woman caring for a relative. (Eighty-five percent of caregivers look after a relative, 49 percent a parent or in-law.)

• Less than a third of unpaid caregivers retain some kind of paid help.

While she had helped out both her parents in recent years, it wasn’t until her mother’s death that Gwynne and her sister became the primary caregivers for their father.

Continue reading

I Never Expected To Love My Kids’ Sex Ed Course, But I Do

Oh boy... (Romana Klee/Flickr)

Oh boy… (Romana Klee/Flickr)

Truth is, I dreaded my children’s sexual education.

I’d read that parents can be a powerful force for smarts about sex, so I’d tried to script imaginary heart-to-hearts. But in my head, they all sounded like this: “Please don’t do these incredibly stupid things that I did when I was young.”

So I procrastinated, abetted by the younger generation’s point-blank refusal to let me even broach this most awkward of topics. Then, last year, word came home that middle-school health class would use a curriculum called “Get Real” that involved extensive family homework activities.

“Now I’m in for it,” I thought.

But in fact, I was in for a shockingly pleasant surprise — one that more and more parents may experience in the coming years if Get Real’s popularity continues to grow. As of this year, it has been adopted by 200 schools in seven states — 175 of them in Massachusetts. That’s up from 132 schools in 2012.

And in recent months, Get Real has scored two victories: An analysis by the Wellesley Centers for Women reported that students who go through Get Real do become likelier to delay sex, and the federal government put it on a list of “evidence-based” sex-ed programs.

No way is Get Real, which was created by the Planned Parenthood League of Massachusetts, for everybody. It strongly promotes abstinence as the healthiest choice for young people, but it’s not the sort of “abstinence-only” program that many parents and schools seek; it also includes teachings on birth control and preventing infection.

But perhaps more than any other curriculum out there, it pulls parents into the sex-ed endeavor, and here’s my pleasant surprise: It wasn’t awkward.

The Get Real homework prompted conversations about friendships, about feelings, about life lessons. I got to reminisce about my first crush, and talk about how important I think it is to stand up for yourself with a boyfriend or girlfriend. I even got to vent about how perniciously relationships are portrayed in that detestable high-school-girl series, “Pretty Little Liars.”

Sure, the course teaches intimate anatomy and the changes of puberty, but the body part it seemed to focus on most was the heart. It was teaching — well, love. Or rather, the skills that can make love better. Healthier. Skills like self-awareness and communication — useful in their own right, and also in service of sex-ed goals like preventing pregnancy and infections.

“We believe that if young people are able to develop healthy relationships in all aspects of their lives, they’re going to be that much better able to negotiate healthy sexual relationships,” says Jen Slonaker, vice president of education and training at the Planned Parenthood League of Massachusetts.

“The sad truth is that by the time young people get to college, it may be too late.”

– Nicole Cushman,
of sex-education organization Answer, on rape prevention

At this national moment of rising discussion about campus rape — from “Missoula” to this week’s New Hampshire prep school trial — the need for such skills has never seemed more urgent. And they take time to develop, says Nicole Cushman, executive director of Answer, a national sex-education organization based at Rutgers University.

“When people talk about sexual assault and rape prevention on college campuses,” she says, “the sad truth is that by the time young people get to college, it may be too late, because we haven’t really laid the groundwork by teaching them these basic concepts about communication and relationships from a younger age. So I really believe that comprehensive sex education is sexual assault prevention.”

‘Red Flags’

Ashley, a Boston high school senior who is on the Get Real Teen Council, went through the curriculum beginning in middle school but says she really started seeing its effects when she got to high school.

“I know that what I learned in Get Real classes made me see certain red flags in my friends’ relationships and my own relationships, and helped me solve what I need to do in order to get away from the red flags,” she says.

One friend who took the class with her drew on it to resist sexual pressure, Ashley says: “She didn’t know if she was ready to have sex, and she touched upon the consent part — she was like, ‘I don’t have to do this, necessarily. It’s like — consent. It’s not fair. I don’t have to engage.’ ” Continue reading

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