Prescription drug abuse and the physician gatekeeper

Opioid painkillers such as Vicodin (hydrocodone) and OxyContin (oxycodone) are crucial medical tools that are addictive and widely abused. Tranquilizers and sleeping pills of the benzodiazepine class, e.g., Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam), are safe and effective in limited, short-term use, but are often taken too freely, leading to drug tolerance and withdrawal […]


A patient I see for psychotherapy, without medications except for an occasional lorazepam (tranquilizer of the benzodiazepine class), told me his prior psychiatrist declared him grossly undermedicated in one of their early sessions, and had quickly prescribed two or three daily drugs for depression and anxiety. He shared this story with a smile, as we’ve […]

Polypharmacy — Sloppy thinking in psychiatry 2

My second post in this series on sloppy thinking in psychiatry is devoted to polypharmacy, the medical term for prescribing multiple medications at once, especially for the same problem. Polypharmacy is at best a risk thoughtfully taken because nothing simpler and safer will do. At worst it’s a dangerous error, exposing patients to unnecessary hazards […]

Diagnostic alphabet soup

Earlier this year a reader asked me:

“I would be very interested to hear your thoughts on patients becoming too focused on diagnoses. […] While I was in an RTC as a teenager, and recently in the hospital as an adult, I have found that people almost treat their diagnoses as a competition. I was […]

Politics, religion, and ADHD meds

Cross-posted from Technorati with permission.

At a dinner meeting a couple of weeks ago I met two psychiatrists who work at Kaiser Permanente, the large HMO system that boasts a 24% health insurance market share in California. (This has nothing to do with my story really. I just think it’s amazing that a quarter of […]

My post on Technorati, the popular blog portal, recently invited bloggers to contribute to their newly revamped site. I signed up and submitted an article there, on ADHD medication. I’m happy to say it appeared on their site this morning, as the leading post in their “lifestyle” section. (I’m sure it will rotate out of the leading position […]