Prescribers, Rethink Those Opioid Scripts

Dr. Debra Houry of the CDC presents at NIH.
Dr. Debra Houry of the CDC presents at NIH.

A dad clutches his daughter’s senior photo. She’ll never make it to graduation. After suffering a sports-related injury, the teen was prescribed an opioid for pain relief. She became addicted and joined a growing U.S. epidemic: People who died from an overdose of prescription opioids.

Images of grief-stricken families haunt Dr. Debra Houry, director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. A practicing emergency room doctor for more than 15 years, she gave a lecture, “America’s Opioid Overdose Epidemic: What We Know and How Health Practitioners Can Help,” at NIDCR Clinical Research Grand Rounds recently.

“For me, the opioid epidemic has been personal,” Houry explained. “I still see my patients’ faces and remember their stories. I’ve seen [the epidemic] evolve over the past 15 years. I’ve seen patients come in with really intractable pain—you want to take care of their pain. I’ve seen patients struggling with addiction and I’ve helped them navigate the system. I’ve also seen patients after they’ve overdosed and I’ve reversed them with naloxone. I’ve also not been successful at times and had to tell family members they’ve lost a loved one.”

Read more
Stimulating the Brain from Without: Therapy and Science

NIMH’s Dr. MatthewRudorfer
NIMH’s Dr. Matthew Rudorfer

Renowned television host Dick Cavett once had this to say about electronic convulsive therapy (ECT), which he underwent for depression: “In my case, ECT was miraculous. It was like a magic wand.”

It is shock therapy’s stubborn efficacy that has kept it alive, despite the alarming image it typically conjures.

The procedure began in Rome in 1938, when Drs. Ugo Cerletti and Lucio Bini induced seizures in patients by shocking them with electricity. Two years later, at an American Psychiatric Association meeting in Cincinnati, shock therapy made its U.S. debut, said NIMH’s Dr. Matthew Rudorfer. He was one of two speakers from that institute who walked a Lipsett Amphitheater Grands Rounds audience through the history and future prospects of “non-invasive neuromodulation” on Mar. 15.

Over the years, ECT has come in and out of fashion, said Rudorfer, who came to NIH in 1985 and has been involved in protocols employing ECT in Clinical Center patients with depression, and more recently has worked with NIMH grantees around the country seeking to optimize the intervention. True, in its early days, shock therapy fractured bones and broke teeth, but it has also offered relief in the most intractable cases of depression. Its adherents, including Kitty Dukakis, wife of former presidential hopeful Michael Dukakis, swear by its efficacy. The ECT of the moment is kinder and gentler than its brutal predecessor.

Read more