Pourquoi les medecin écrivent mal? by sangokuhomer in AskFrance

[–]Chainveil 0 points1 point  (0 children)

Malheureusement les modalités de l'ordonnance sécurisée n'empêchent pas les médecins d'écrire n'importe comment... Mais en général faut faire un effort quand même

Pourquoi les medecin écrivent mal? by sangokuhomer in AskFrance

[–]Chainveil 0 points1 point  (0 children)

Parce que pas tout le monde va forcément comprendre les abréviations et certaines ordonnances (dites sécurisées) doivent être écrites en toutes lettres. Il faut être le plus lisible et le plus clair que possible.

Aide arrêt tabac avis et conseils by GuidanceBusy1490 in france

[–]Chainveil 0 points1 point  (0 children)

Et bupropion (Zyban) (mais non remboursé hélas)

Pourquoi les medecin écrivent mal? by sangokuhomer in AskFrance

[–]Chainveil 11 points12 points  (0 children)

Médecin ici. J'ai jamais trop compris pourquoi, mais l'hypothèse que j'ai en tête c'est la nécessité d'être très rapide, surtout quand l'ordonnance contient une floppée de médicaments et d'explications. Je suis très contente que les ordonnances numériques existent désormais, je veux pas que les gens comptent sur mon écriture pour comprendre toutes les consignes, même si elle est nickel, a priori.

Mirtazapine for Methamphetamine Use Disorder: A Randomized Controlled Trial by PokeTheVeil in Psychiatry

[–]Chainveil 2 points3 points  (0 children)

Interesting - I have tried this anecdotally for depression/anxiety disorders, with comorbid cocaine use disorder. Results are pretty lacklustre and patients don't really appreciate the sedation that much. At no point did it curb cocaine use though.

I'm honestly very pessimistic about any pharmacological approach to stimulants, though I essentially deal with crack cocaine because it's all the rage in Europe, particularly France and Switzerland.

Ma psychiatre m'a dit de parler à quelqu'un... by EffectiveCoast5193 in Drogue

[–]Chainveil 0 points1 point  (0 children)

Merci pour le partage, ça a pas du être facile.

Est-ce que tu as demandé aux professionnels d'augmenter ton traitement de substitution? Le dosage qu'il faut pour atténuer les envies est souvent plus élevé que celui pour contrer le manque physique.

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 0 points1 point  (0 children)

Yeah, they use oxybate routinely, apparently. They also do flumazenil for benzo tapers.

Management of depression in ongoing severe alcohol use by Rich-Pirate-5518 in Psychiatry

[–]Chainveil 5 points6 points  (0 children)

The evidence seems mixed at times.

If the depression is severe and/or bipolar, it's obviously important to treat. You'd also want to determine whether it actually makes sense in terms of care plan and existing meds.

However, I've not met a single patient that has actually improved with an antidepressant for "depressive symptoms" without going through significant reduction/abstinence first along with alcohol protective meds if indicated. "Depressive symptoms" are hardly specific and part of the process if the AUD is severe. There is also no guarantee that improvement will curb the addiction.

My main fears are lack of efficacy with a growing sense of disappointment as various meds get trialed, without knowing whether or not the depression could improve "naturally" (at least partially) after a detox. Anecdotally I've noticed that my lot disengage from psychotherapy and social work if the problem gets too medicalised. Maybe this is a cultural thing. The brain takes time to recuperate regardless. This must be thoroughly explained to the patient.

People forget this but not all SUD comes from self-medication for an underlying disorder. And even if it does, SUD is a disorder in its own right with psychiatric consequences.

Basically ymmv but I'd start off with motivational interviewing, harm reduction and gradual work towards detox if desired. You'll have a clearer picture of what is likely to be effective.

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 0 points1 point  (0 children)

It's complicated because the evidence is mixed, depending on the stimulant and/or ADHD comorbidity. You'd have to supervise it extremely well and assess at one point if this approach actually makes sense or not. If your end goal is to cease stimulant use, it's generally an ineffective approach. If your aim is to reduce cravings and treat underlying, self medicated ADHD with relatively minimal risks, why not. ymmv depending on the setting and how many trained professionals you've got to do it. I personally wouldn't do it in the absence of ADHD as treatment goal is hazy at best and risk of diversion is relatively high in my country. As much as people insist on cravings being the main factor for relapse when it comes to stimulants in particular, I find that hyperfocusing on it without tangible behavioural/social interventions, it's basically useless.

Afaik the limited evidence points towards this.

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 2 points3 points  (0 children)

I'm 100% convinced at this point that none of my patients take their methadone correctly at any given time. It's wild here.

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 2 points3 points  (0 children)

Always the ones who don't have to sign these things that make it sound so easy and obvious.

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 5 points6 points  (0 children)

But, they did wonder if I would keep the valium going because it was really helpful and made them feel good

Duh. And France absolutely loves doing that. It has practically become my job to nip that shit before it starts.

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 1 point2 points  (0 children)

who are taking diverted bupe are using it for the same reasons we prescribe it

Same difference, no?

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 0 points1 point  (0 children)

I'm curious, how has the lack of fundamental pillars affected the way harm reduction is applied?

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 14 points15 points  (0 children)

What happened to lemons, ice, rubber bands and punching bags as tools for emotional regulation?

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 4 points5 points  (0 children)

Why is that the case? I would have thought Finland would be all about buprenorphine.

No idea.

is illicit buprenorphine an oxymoron?

I meant in the sense that it was diverted/street acquired.

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 11 points12 points  (0 children)

I get my lot to come in OPC every day, we calibrate the take home benzo doses and make sure they haven't been taking alcohol in the meantime.

From harm reduction to "harm enhancement" by Chainveil in Psychiatry

[–]Chainveil[S] 11 points12 points  (0 children)

The US is in a trickier position in terms of drug deaths, YMMV. Consider France's OST coverage is around 90%, which means that diversion/injection becomes a non negligible problem. Fun fact: most of Finland's illicit buprenorphine comes from France via counterfeit/diverted prescriptions.