Deeming Regulations have been released!!!!

[stols001]

Robino, dependence is actually worse than addiction, in the DSM. The list of symptoms is the same in both cases, and doctors (and hopefully the patients involved) go through those questions. I believe that if you have some symptoms, you are considered addicted, and if you have more sx, you get the "dependence" as by then many addicts are doing compulsive drug seeking behaviors and stuff that indicate a more severe addiction issue.

I've always used it that way, as I was trained to, however researchers working on DSM V point out this is a grave mistake as you can be dependent on something benign, like an anti-depressant, be physically dependent on it as it may cause sx of withdrawal when you stop taking it, merely as your brain has adjusted. They are looking to separate these two terms completely, where dependence is classified by maybe needing medications, that one must take, and will have discontinuation syndrome afterward, whereas addiction will now only mean the "bad" drugs, including nicotine (it's in the DSM, as is coffee).

I think it's right to go that route, however, as we do need a way from distinguishing these two types of events which usually progress very differently. Most people taking an anti-depressant don't crave more, don't commit criminal acts, but are dependent on their medication to function well. I don't think addiction needs to be a pejorative word, just a descriptive one, and it could easily be used with levels "Addiction to tobacco, Level 4" might be my designation for example.... That sort of thing. I do think it would clear up any confusions.

But also...Let's remember that gayness used to be a diagnosable offense, and transgender is still in there, mainly to allow psychologist to bill persons wishing to transition fully to their different gender, got to find a way to bill! I guess what I'm saying it may have some epidemiology to it, but it's hardly based on hard science though they are doing their best to keep up, it's still.... a billing matrix basically, though it can help a clinician try to figure out where to *start* with a patient, that's about it.

Anna

Anna

 

[1/2 fast]

I have Medicare with a supplemental, and my records just show that I'm a former smoker, no mention of continued nicotine use in any way. My PCP is just thrilled that I quit smoking.

Exactly the same for me. On of the few (very few) benefits of getting older. Was paying an extra thirty or forty insurance dollars a month foe "nicotine use" before I retired under the promise/threats of testing which never actually happened.

 

[Eskie]

Robino, dependence is actually worse than addiction, in the DSM. The list of symptoms is the same in both cases, and doctors (and hopefully the patients involved) go through those questions. I believe that if you have some symptoms, you are considered addicted, and if you have more sx, you get the "dependence" as by then many addicts are doing compulsive drug seeking behaviors and stuff that indicate a more severe addiction issue.

I've always used it that way, as I was trained to, however researchers working on DSM V point out this is a grave mistake as you can be dependent on something benign, like an anti-depressant, be physically dependent on it as it may cause sx of withdrawal when you stop taking it, merely as your brain has adjusted. They are looking to separate these two terms completely, where dependence is classified by maybe needing medications, that one must take, and will have discontinuation syndrome afterward, whereas addiction will now only mean the "bad" drugs, including nicotine (it's in the DSM, as is coffee).

I think it's right to go that route, however, as we do need a way from distinguishing these two types of events which usually progress very differently. Most people taking an anti-depressant don't crave more, don't commit criminal acts, but are dependent on their medication to function well. I don't think addiction needs to be a pejorative word, just a descriptive one, and it could easily be used with levels "Addiction to Tobacco, Level 4" might be my designation for example.... That sort of thing. I do think it would clear up any confusions.

But also...Let's remember that gayness used to be a diagnosable offense, and transgender is still in there, mainly to allow psychologist to bill persons wishing to transition fully to their different gender, got to find a way to bill! I guess what I'm saying it may have some epidemiology to it, but it's hardly based on hard science though they are doing their best to keep up, it's still.... a billing matrix basically, though it can help a clinician try to figure out where to *start* with a patient, that's about it.

Anna

Anna

Actually, the new DSM V labels it as tobacco use disorder (change tobacco for whatever other stuff you want). The level of "use disorder", mild, moderate, and severe are based on how many of say 8-11 criteria and behaviors are associated with the substance. So 2 or 3 is mild, 4 to 6 moderate, etc. No more use of dependence, addiction, or abuse.

One of the biggest changes for all substances, including tobacco, is including craving in establishing the extent of the disorder. It wasn't used as a criteria for tobacco or other substances in earlier DSM versions.

 

[stols001]

No, it was not. Thanks for the update Eskie, it sounds like it's a reasonable change. We're still transitioning and I thought I was all excited to read my copy.... Then the fire happened. I should catch up, but I like that wording, and the qualifiers. Seems quite sensible to me, most of what is in DSM-V that I have read, I'm pretty okay with.

Anna

 

[beckdg]

VA and Medicaid can't keep hold of my mother's records that she personally produced in duplicate up to 5 times in certain cases.

It's almost a weekly conversation at this point.

I wouldn't assume they KNOW anything.

Guns don't kill people, virgins do! -Jim Jeffries

 

[beckdg]

Gottlieb and Zeller were nervous. This was no routine announcement. The big news is not about ecigs, it's about going after the $1 trillion a year tobacco business. America has only a small percentage of the world's smokers but we can show leadership. This qualifies. Taking the nic out of cigarettes might work if there is a good alternative. We all agree that ecigs are a good alternative. I won't be without my stockpile but I'm hopeful.

Consider we know that nic is far from the end all of the addiction.

I'd say it's posturing for appeasement instead of addressing the actual problem.

Guns don't kill people, virgins do! -Jim Jeffries

 

[leftyandsparky]

VA and Medicaid can't keep hold of my mother's records that she personally produced in duplicate up to 5 times in certain cases.

It's almost a weekly conversation at this point.

I wouldn't assume they KNOW anything.

Guns don't kill people, virgins do! -Jim Jeffries

My dad had to sign a document about his pain meds stating that he would not see another dr for pain and if he got a prescription from another dr for pain meds he would loss his VA benefits.

 

[beckdg]

Consider we know that nic is far from the end all of the addiction.

I'd say it's posturing for appeasement instead of addressing the actual problem.

Guns don't kill people, virgins do! -Jim Jeffries

Also allows for the continued vilification of nicotine products leaving way to justify any control over vaping in the near future.

Guns don't kill people, virgins do! -Jim Jeffries

 

[DC2]

VA and Medicaid can't keep hold of my mother's records that she personally produced in duplicate up to 5 times in certain cases.

My father's doctors still ask me every visit what medications he is taking.
I don't know where to start with how wrong that is.

 

[beckdg]

My dad had to sign a document about his pain meds stating that he would not see another dr for pain and if he got a prescription from another dr for pain meds he would loss his VA benefits.

Seems standard practice.

Though if another practice is treating another condition, there's ways around that.

You just have to cross reference, inform both parties completely and be willing to constantly exchange documents for them.

Basically just get further into the process than any sane person wants.

On top of Medicaid and the VA, my mother's also dealing through workman comp and a lawsuit.

Being a retired career RN who's diligent with records and following up, she's well prepared and knows her rights and limits.

Though still a bit crazy/obsessive.

Guns don't kill people, virgins do! -Jim Jeffries

 

[leftyandsparky]

Seems standard practice.

Though if another practice is treating another condition, there's ways around that.

You just have to cross reference, inform both parties completely and be willing to constantly exchange documents for them.

Basically just get further into the process than any sane person wants.

On top of Medicaid and the VA, my mother's also dealing through workman comp and a lawsuit.

Being a retired career RN who's diligent with records and following up, she's well prepared and knows her rights and limits.

Though still a bit crazy/obsessive.

Guns don't kill people, virgins do! -Jim Jeffries

I didn't know that was being practiced until he got hurt at work and had to go to the workmans comp dr. I know the VA always ask for info they should of already had. Maybe new leadership will change things for the better. I know when I was there for the past 3 mo I would step out to vape and a lot of older veterans were really interested in my device for stop smoking. Maybe all this new FDA stuff will encourage dr to tell patients.

 

[sofarsogood]

Consider we know that nic is far from the end all of the addiction.

My personal experience was, the day I started vaping my daily cigs went from 25 to 5 a day and stayed there with no effort. It was amazing. My perception was those last 5 cigarettes were to get some chemicals that aren't nicotine. As soon as I was certain I'd never stop vaping going to zero cigs was not so tough.

I've been telling smoker friends at work about the likely nic reduction for cigs to judge their reaction. Their heads go down for a moment. When their eyes come back into view I think I see a tiny hint of anxiety but more quiet support. When I was smoking I used to wish I'd go out one day and there was no place to buy cigarettes any more. Don't be surprised if most smokers quietly support this.

 

[beckdg]

My father's doctors still ask me every visit what medications he is taking.
I don't know where to start with how wrong that is.

Between fraudulent claims for narcotics (especially the elderly who might need to sell them for supplemental income), forgetfulness and the likelihood of a team of doctors prescribing possibly dangerous combos, sadly that becomes more and more necessary as life goes on.

You'd think they'd keep better records and communication, but it's better to ask to mitigate any slip ups or omissions.

Might save his life one day.

A PITA, yes.

But a minor one considering what's at stake.

Guns don't kill people, virgins do! -Jim Jeffries

 

[beckdg]

I didn't know that was being practiced until he got hurt at work and had to go to the workmans comp dr. I know the VA always ask for info they should of already had. Maybe new leadership will change things for the better. I know when I was there for the past 3 mo I would step out to vape and a lot of older veterans were really interested in my device for stop smoking. Maybe all this new FDA stuff will encourage dr to tell patients.

VA has a longstanding record of not keeping track. It's an internal issue. Seems they have higher priorities.

I see a lot of older truckers with simple setups.

Many fail though it seems, sadly.

Guns don't kill people, virgins do! -Jim Jeffries

 

[oplholik]

My pharmacy has records of all my prescriptions, I'm sure they all do, don't they? It supposedly red flags any dangerous combinations of drugs, or dangerous dosages that may be prescribed. The pharmacist has caught a couple for me that were in error.

 

[stols001]

Well, yes, they are supposed to do that. Either I've never had a medication error, (this wouldn't shock me I am .... about my scripts and read them before leaving... I'm not taking a med I haven't researched first, either. That said, I find Walmart to actually be the best (Costco too) for keeping my info on file and "counseling" me. LOL, I usually try to find a question the pharmacist can't answer. Like, I was on fluconase, which is an inhaled steroid for allergies, and it said right on the box, "Consult your pharmacist if you begin taking oral steroids." So I did, accompanied by the box.
"Um, this thing here says I should inform you if I start taking regular steroids. What should I do?"
"I have no idea."
"Wait, what? It says right HERE to consult you."
"Well, it should probably be fine....."
"Deep sigh.... followed by returning home and looking it up myself."

That was CVS though. I used them for years as they were convenient to my location, but it got to be a bit much after a while.

Also, not all pharmacies are linked, even between chains, so you might pick up one med somewhere, and the pharmacy will log it, but not combine it, if you know what I mean.

I Do Not rely on pharmacists for my med questions generally. Unless they are hospital pharmacists, who are usually Utterly Awesome In All Ways....

Anna

Anna

 

[beckdg]

My pharmacy has records of all my prescriptions, I'm sure they all do, don't they? It supposedly red flags any dangerous combinations of drugs, or dangerous dosages that may be prescribed. The pharmacist has caught a couple for me that were in error.

They have great systems these days.

But they're not foolproof.

Humans are still the final measure.

Guns don't kill people, virgins do! -Jim Jeffries

 

[DC2]

You'd think they'd keep better records and communication, but it's better to ask to mitigate any slip ups or omissions.

Good point.

 

[mikepetro]

They are already on us about flavors, gee, I wonder if this will piss the Feds off. A little discretion within the industry might go a long way.......

 

[coldgin96]

They are already on us about flavors, gee, I wonder if this will piss the Feds off. A little discretion within the industry might go a long way.......


View attachment 676081

Let me just say, I agree with you. I believe in total freedom whereas I should be able to swing my arm wherever and whenever I want to but that privilege ends where my neighbor's nose begins. Unfortunately, that's not the world we live in and we have to put up with some, "give and take." For the sake of being able to vape open systems and flavors legally, I'm willing to put up with some discretion towards the, "children," however misguided it may be.