We Need to Do Better

Last week New Hampshire lost two young university women to suspected Ecstasy or MDMA overdoses.  We offer our deepest sympathies to the families and friends of these women.  Such tragedies highlight the problems we face of drug use and addiction in New Hampshire and serve as a call to action to do all we can to prevent the physical and emotional harm that result from substance use and abuse.

Be Mindful of Habits

We are what we repeatedly do. Excellence, then, is not an act, but a habit.   - Aristotle 

What Can You Buy for $40 Billion a Year

It isn't news that we are in a budget crisis or that our leaders in Washington are looking at ways to reduce spending, but how they are planning to do this is worthy of our attention.  AMNews reported last week that President Obama's 2014 budget blueprint aims to cut $400 billion from healthcare over the next 10 years.  AMNews link: Click here

Addressing the State's Mental Health Crisis.

The state budget cuts over the past two years have impacted the health of our patients and the public health infrastructure in many ways, but perhaps the most damaging cuts have fallen on those with mental illness.  In 2009, the legislature's budget resulted in the closure of 60 beds at New Hampshire Hospital (NHH) the state’s inpatient psychiatric care hospital.  The community mental health safety net took a significant hit as well.  While this made the budget look better on the surface, the problems associated with mental illness did not disappear and neither did their costs.  

Yesterday we received good news from the state. Health and Human Services Commissioner, Nick Toumpas, announced short term and long term plans to address the state's mental health crisis.  

Ace of Spades

This past Sunday, as our nation readied itself to partake in the annual Super Bowl ritual of food, spirits, commercials and, of course, football, a man lay dead in his apartment across the river from MetLife Stadium. Too many chicken wings, Bud Lights and blue-green Skittles? Not at all. This man died from a presumed heroin overdose, possibly from a batch of heroin laced with fentanyl, which has caused numerous deaths in the past few months.  See the CBS News report here.

What's in a zip code?

As there are many more states and providers across the country focusing on the epidemic of opioid abuse and addiction concerns, there can be some utility in recognizing patterns that exist within your own zip code. “Each community chooses its opioid.  Within a 60-mile radius of where I have worked, patients have told me that ‘only idiots’ abuse any opioid other than ‘fill in the blank.’  Heroin, oxycodone, meperidine, hydromorphone, fentanyl, dextromethorphan- they all have been abused, but usually only one is abused in any given community. This is primarily due to control of the drug scene by one gang or another.  If opioids do have to be prescribed, limit dosing to three to four days maximum because follow-up for persistent pain is essential.”  ACEP Now, Feb 2015, Vol.34, Number 2, p.

A Worthwhile Trip to D.C.

Last week I had the pleasure of joining Scott Colby, the NHMS Executive Vice President and Dr. Gary Woods, the NHMS Delegate to the AMA, for the annual AMA National Advocacy Conference and Lobby Day in Washington, DC.  Each year the AMA sponsors this conference to update us on current national policy issues and to provide us an opportunity to meet with our congressional delegation to discuss those issues.  We learned about: the challenges of paying for Graduate Medical Education and workforce adequacy; proposals coming out of the CMS Innovations Center; and that everyone wants to fix the SGR but no one believes a permanent fix is possible... for now.  The conference was informational and prepared us to meet with our delegation.

When Traumatic Events Unfold...

“When I was a boy and I would see scary things in the news, my mother would say to me, "Look for the helpers. You will always find people who are helping.” Fred Rogers  Since the tragic events of Monday's bombing at the Boston Marathon there has been a tremendous outpouring of emotions and I was particularly moved by the above quote that is making the rounds on Facebook and twitter.  Perhaps this resonated with me because I grew up watching Mr.

A Painful and Protected Disease Kept Isolated From the Cure



Anytime there is a really sick child or adolescent, regardless of whether or not you are specialty trained in pediatrics, there is a visceral pain and wanting to immediately remedy the condition.  For many of those faced with such circumstances, there is rarely an opportunity to completely eradicate the underlying disease or offending circumstances.  We look to bring more eyes and minds together to stop the disease process, to reduce the suffering and to help the patient, their parents and caregivers. Often entire communities come together to raise support for a child or a family dealing with cancer.  Dozens or more people put their personal needs aside and focus intently on those of a family hoping to stop the cancer that is ravaging their child’s physicality, devouring their emotional existence and impacting their lives forever.   This occurs despite a complete lack of knowledge about the disease.

Where there's smoke...

Smoking is on the minds of our legislators. Both tobacco and marijuana have been the subjects of spirited discussion and hearings the past few weeks and NHMS has been present bringing the voice of science, reason, and our patients. In regards to tobacco, NHMS has prepared a policy analysis (see report) that looks at the impact of a tobacco tax increase, taking into consideration the following:

• Smoking costs an average of $2,784 in direct medical expenses per smoker per year;
• Tobacco price increases of 10% consistently yield a 4% decrease in adult smoking and a 7% decrease in youth smoking;
• People of low socio-economic status have much higher smoking rates and poorer health outcomes; and
• The smoking rate among Medicaid beneficiaries is 57% compared to the overall NH of 19%.

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