Norman S Miller

Health Advocates PLLC · Medical Legal

Cannabidiol (CBD) is a substance chemically derived from Cannabis sativa and discussed to be non-psychoactive. According to the FDA, marijuana is classified as a schedule I substance; however, hemp which is defined as extracts from marijuana including cannabinoids containing less than 0.3% tetrahydrocannabinol (THC), is excluded from that controlle...

Marijuana is the most consumed illicit drug in the world, with over 192 million users. Due to the current legalization push of marijuana in the United States, there has been a lack of oversight regarding its public health policies, as marijuana advocates downplay the drug’s negative effects. This paper’s approach is from a public health perspective...

Marijuana is currently a growing risk to the public in the United States. Following expanding public opinion that marijuana provides little risk to health, state and federal legislatures have begun changing laws that will significantly increase accessibility of marijuana. Greater marijuana accessibility, resulting in more use, will lead to increase...

Why are opioid medications prescribed in large quantities and high frequency when there is little or no proven efficacy for their therapeutic value? Why are opioids the most commonly prescribed medication in the United States for the past decades when the adverse consequences continue to grow and mount? Why does the medical profession continue to p...

The following review of literature regarding the pharmacology of marijuana is intended to demonstrate its mental and physical pharmacological effects. "Marijuana" refers specifically to the dried leaves and flowering tops or "herbal cannabis”, the natural form of cannabis as derived from the plant Cannabis sativa. Another term for marijuana is the...

Marijuana addiction often is questioned, debated and dismissed as beneficial, not addicting and without serious adverse effects. However, examining the evidence derived from clinical practice and scientific research as illustrated and validated in the diagnostic criteria in the Diagnostic and Statistical Manual, fifth edition, (DSM-5), marijuana is...

Marijuana is the most commonly used illicit substance in the United States and worldwide. The smoking of marijuana is an increasingly observed phenomenon in the adolescent population and even more common nowadays than cigarette smoking. A special focus should therefore aim to the effects of marijuana in that particular age group. Adolescents are pa...

The medical justification as to the risks and benefits associated with the use of marijuana for medical purposes is not supported by current medical research and state and federal laws in the United States. State endorsed “medical marijuana” currently take the form of a dried plant, cannabis sativa. State laws in favor of legalizing marijuana for m...

This review is based on literature search to determine the risks and benefits of marijuana as a medical agent and the role for marijuana in mainstream medicine. “Marijuana" is the natural form of cannabis derived from the Cannabis sativa plant and refers specifically to the dried leaves and flowering tops or "herbal cannabis”. Other terms for marij...

Marijuana is a substance that has been used for recreational purposes since ancient years and that is currently discussed to have a therapeutic or medical value and to be seen as a Medicine. According to the FDA, marijuana is classified as a Schedule I drug with high risk of addiction and no medical benefit. However, it is legal in several states f...

Why are opioid medications prescribed in large quantities and high frequency when there is little or no proven efficacy for their therapeutic value? Why are opioids the most commonly prescribed medication in the United States when their adverse consequences continue to grow? Why does the medical profession continue to prescribe opioid medications t...

Despite the widespread prescribing of opioid medications for the treatment of chronic pain, there is little or no evidence for its efficacy. In fact, the studies show that long-term prescribing of opioid medications leads to significant morbidity and mortality. The Controlled Substance Laws define prescription opioids as dangerous and addicting med...

The psychiatric symptoms, particularly depression and anxiety, associated with chronic use of opioid medications as a result of overprescribing are common and debilitating. Opioid medications are classified as depressants and induce serious depression and anxiety, particularly with chronic and persistent use. The Diagnostic and Statistical Manual o...

The prevalence of alcohol dependence in cocaine addicts is important to determine for clinical prognosis, treatment, and genetic research. The prevalence of alcohol dependence by cocaine addicts may be a common cause for relapse to cocaine. Cocaine addiction and alcohol dependence may be treated similarly if both diagnoses are present. The rate of...

Nicotine dependence is currently recognized as a psychiatric disorder. Although the prevalence of nicotine dependence nas waned in recent years, it remains a significant source of morbidity and mortality and is growing among young people. It is well documented that nicotine is an agent of addiction via the inhalation route. Tolerance and dependence...

This study examined temporal patterns of service utilization, disability benefits, and substance use. Specifically, it investigated whether the first day of the first week of each month (when disability payments are disbursed) was associated with increased emergency room (ER) use and more frequent cocaine use among psychiatric patients. All 1993 ps...

The public and managed care organizations are increasingly looking to physicians for leadership and advocacy for patients who have drug and alcohol addictions. Despite the presence and effects of alcohol related disorders, medical schools and residency programs fail to teach such disorders to their students competently. Alcohol and drug dependence...

To even the playing field, a stigmatized class of alcoholics and drug addicts might band together for collective strength to claim damages from fraudulent and negligent practices by producers of addicting alcohol and other drugs. Over the last decade, class action suits grew increasingly successful in obtaining large settlements for individuals who...

Addictions and the law are interwoven in court cases, legislative actions, constitutional law, and administrative policy. This chapter focuses on the treatment of alcohol and drug addiction infused crime by the law in the United States. In general, the law views alcohol and drug addiction as an illness in an individual who bears responsibility for...

The protocols for controlling drugs and estimates of United States medical requirements for scheduling drugs arose from the Controlled Substance Act (CSA). The responsibility for controlling and scheduling drugs and other substances is jointly shared by the Drug Enforcement Agency (DEA) expressed through the United States attorney general, and the...

This chapter focuses on the role of expert witness in civil and criminal testimony. An expert witness is a witness who, by the virtue of skill, education, experience, or training, is held to have knowledge in a particular subject above that of the average layperson. Expert testimony and evidence have become a critical component of many civil and cr...

OverviewClinical PrevalenceClinical DiagnosisClinical ComorbidityTreatment of Medical Disorders Associated with Alcohol and Drug use and AddictionWhy Physicians are Unprepared to Treat Drug-and Alcohol-Related DisordersSummaryReferences

Extent of Dependence on Opiate MedicationsSigns and Symptoms of Dependence on Opiate MedicationsPsychological Consequences (Chemically Induced)Occupational Difficulties as a Result of AddictionBiological Mechanisms Underlying Addiction and DependencePhysiological Responses to IntoxicationTolerance and DependenceIncreased Sensitivity to Chronic Admi...

Our study showed that the perception of pain lessens with detoxification from chronic prescription opiate medications. Thus, removal of opiates resulted in less pain, and chronic administration of opiates actually increased pain perceptions. The underlying pathophysiology of increased pain sensitivity from chronic administration is not well underst...

Controlled substances can be used for legitimate medical purposes to relieve pain and suffering, and allow management of medical and surgical conditions, whether acute or chronic in duration. However, because these are attractive, addicting drugs, diversion from sources such as physicians and pharmacists can lead to serious health problems. Of impo...

The purpose of this work is to document whether prescription opioid medications used for pain enhanced or worsened pain syndromes from medical conditions in patients who received a diagnosis of prescription opioid dependence as determined by a diagnosis by Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria. Further, whether det...

p>The 2003 National Survey on Drug Abuse and Health (NSDUH) demonstrated that 2.6 million people in the United States misused pain relievers, including hydrocodone and oxycodone. The misuse of prescription medicines affects a broad range of users, particularly older adults, adolescents, and women. There has been a sharp increase in new users of pre...

p>Physicians are in a unique position to assess and treat people who seek evaluation and treatment for medically related health problems associated with drug and alcohol use and addiction. Well-known medical complications result from drug disorders, including addiction to opiates. Addictions are too numerous to cite but prominently include widespre...

In conclusion, complex medical and psychiatric comorbidity is com-mon in individuals with substance use disorders. It is important to assess comorbidity because of the implications for prevention and treatment. Studies of the neurobiology of substance use and psychiatric disorders are accumulating rapidly and informing treatment development. Inform...

The proposed analysis and evaluation of the data elements in the OPP and other similar regulatory programs will support the following potential impact on the patients and physicians in Michigan and other states: Reduced rates of addictive use of prescriptions of Schedule II medications. Reduced rates of addictive patterns of prescribing of Schedule...

The purpose of the study was to document the substantial increase in problematic use of hydrocodone and oxycodone in an addiction treatment population. Our study consisted of a retrospective review of medical records from all patients admitted and discharged in 2000 from Sparrow/St. Lawrence Addiction Detoxification Unit (N = 534). A literature rev...

Smoking cessation treatment providers need to consider many factors for each individual patient, including familiarity with available medications, efficacy, specific population characteristics, patient preference, prior patient experience with treatments (both negative and positive), cost, ease of use, adverse effects, and even managed care restric...

This article has reviewed some of the neurobiological aspects of cocaine, alcohol, and heroin dependence, and how they affect the determination of treatment options. These agents have similar actions on reward circuitry, and each increases DA and β-endorphin levels in the NAc. Chronic exposure to cocaine, alcohol, and heroin is associated with simi...

A previous history of alcohol or drug abuse puts patients at higher risk for opiate dependence. Article includes methods for managing opiate withdrawal.

Most primary care physicians do not feel competent to treat alcohol- and drug-related disorders. Physicians generally do not like to work with patients with these disorders and do not find treating them rewarding. Despite large numbers of such patients, the diagnosis and treatment of alcohol- and drug-related disorders are generally considered peri...

Research studies indicate that sites and pathways for appetitive drive states, that are located in the limbic system, appear to be responsible for normal and pathological craving for alcohol and other addicting drugs. Pathological craving for alcohol and drugs in humans has been substantiated by animal studies, which have identified neurosubstrates...

Of central importance is that our clinical experience and treatment outcome studies to date strongly suggest that coercion is fundamental to addiction treatment and favorable outcomes from therapeutic interventions. Often the alcoholic/drug abuser must be given an opportunity to feel, face, or experience the "consequences" of their alcohol and drug...

Intoxication with alcohol results in depressed global glucose metabolism that continues into the stages of withdrawal and abstinence. The decrease in metabolism, however, is not equal across the brain, with certain regions more affected than others. Such a pattern of disturbance suggests that the effect of alcohol on the brain cannot simply be a no...

The mortality rate from alcoholism and related comorbidities is high. Studies show multiple causes of premature death from alcoholism. Several studies showed that abstinence had a positive effective on the overall survival of alcoholics. Alcoholics who abstained from alcohol, particularly continuously, showed reduced mortality rates and increased y...

Due to political and economic forces, the physician will increasingly play a pivotal role in securing adequate prevention and treatment for alcohol and drug problems. Thus far, the large body of knowledge and skill for prevention and treatment of addictive disorders has been underutilized by the physician in clinical practice and patient care. Rece...

We sought to determine the impact of a lifetime diagnosis of major depression on addiction treatment outcome. Structured interviews were conducted upon admission, and consecutive structured interviews were conducted prospectively for treatment outcome at 6 and 12 month follow-up periods. A multisite evaluation study of patients undergoing addiction...

The primary care physician is in a good position to diagnose, manage and intervene with patients who are undergoing the process of treatment and recovery from alcohol and drug disorders. Medications such as benzodiazepines are effective in the treatment of withdrawal syndromes, and naltrexone and disulfiram can be used to augment relapse prevention...

The close association of nicotine addiction and alcoholism is well established. As many as 80% of alcoholics smoke, and 30% of smokers are alcoholics. The mortality from cigarette smoking and alcoholism individually is very high, as an estimated 400,000 deaths from tobacco and 100,000 deaths from alcoholism are reported annually. Cigarettes and alc...

Most medications with major potential for abuse and addiction belong to the sedative-hypnotic class. This encompasses benzodiazepines, barbiturates, and the opiates (including natural and synthetic derivations of opium) (Jaffe, 1990; Jaffe & Martin, 1990; Rall, 1990). This chapter is devoted to the sedative-hypnotic class, featuring benzodiazepines...

Opioid drugs are commonly used for the relief of pain. The standard medications for severe pain are the derivatives of the opium poppy (opiates) and synthetic drugs that activate the same receptors (opioids). In addition to alleviating perception of pain, however, many opioids also produce a state of well-being or euphoria through central nervous s...

MDMA, known as "ecstasy," a designer drug, is becoming popular with American adolescents at dance halls known as "raves" and on college campuses. It seems logical that easy availability, affordability, the perception of safety, and peer acceptance and encouragement to initiate use will lead to increased misuse of MDMA. MDMA has been implicated in a...

A multisite, longitudinal study of patients undergoing inpatient alcohol and drug dependence treatment was conducted in private inpatient facilities, consisting of 4339 subjects from 38 independent programs enrolled in a national addiction treatment outcomes registry. Structured interviews were conducted upon admission, including documentation of c...

A multi-site, longitudinal study of patients undergoing outpatient alcohol and drug dependence treatment was conducted in private outpatient facilities, consisting of 2,029 subjects from 33 independent programs enrolled in a national addiction treatment outcomes registry. Pretreatment demographic and substance variables, treatment utilization varia...

The integration of pharmacological therapies for comorbid disorders requires an acceptance of independence and interactions of respective addictive and psychiatric disorders. At the same time, alcohol and other drugs induce psychiatric states that are indistinguishable from psychiatric disorders. On the other hand, while psychiatric disorders do no...

Over the past decade, radical changes have occurred in the availability and funding of treatment services for individuals with addictive disorders. Traditional inpatient and residential treatments have been replaced by outpatient settings. "Standard" addiction treatments, such as 28-day inpatient hospitalizations, are largely a thing of the past. T...

Addiction to alcohol and other drugs is a serious public health problem that is one of the most common disorders seen in medical practice. Although it is an extremely common disorder, it is poorly diagnosed and treated by physicians. In order to begin to develop an integrated approach to education and addiction, one must define the many roles of th...

The outcome of severe mental illness is greatly diminished when persons also abuse alcohol and other drugs. This paper debunks any notion that substance abuse is acquired, rather portraying drug use and abuse to be an addiction and disease. The author then summarizes relevant factors related to diagnosing this disease including the need for a perio...

It is estimated that 30–40% of patients presenting to primary care physicians will have a primary or secondary mental illness. Despite the large number of patients being seen, primary care physicians underdiagnose and undertreat those with identifiable psychiatric disorders. In order to meet the needs of future primary care practitioners, there mus...

The vulnerability to develop addiction to alcohol has been well established in familial and genetic studies. Similar familial and genetic studies have supported a vulnerability to drug addiction. The co-occurrence of alcohol and drug addiction in the same individuals is highly prevalent in clinical populations. Common putative neurochemical mechani...

Proper diagnosis of comorbid disorders is crucial in treatment planning for the dually diagnosed. Since psychoactive substance use can obfuscate the diagnosis, special care must be taken to exclude organically based syndromes. Adequate periods of abstinence should first be achieved and subsequently the patient re-examined for residual symptoms comp...

Designed to meet the diverse needs of family and primary care physicians, psychiatrists and mental health professionals, and medical students and residents, this text offers step-by-step recommendations on the selection and application of both pharmacological and psychosocial therapies. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The diagnosis of depression has been viewed as an important factor in the treatment response for those who have alcohol and other drug dependence. The objective of the study was to examine the prevalence of a lifetime history of major depression in inpatients with a substance use disorder in addictions treatment. An evaluation study of 6,355 patien...

Treatment for persons with severe mental illness who also abuse alcohol and other drugs is fundamentally abstinence based. The impact of abstinence-based therapies is affected by the person's ability to abstain, level of social supports, associated medical and psychiatric comorbidities, and commitment to recovery. Indications of inpatient and outpa...

Reviews current definitions of relapse, abstinence, and multiple drug addictions and the forms of treatment available for reducing relapse and enhancing abstinence from drug and alcohol addictions. Behavioral studies have focused on controlled drinking and relapse prevention, while broad-spectrum approaches cover social skills training, stress mana...

The prevalence of alcohol and drug disorders is greater than 50% of all patients experiencing traumatic brain injury. The diagnosis of addictive disorders often goes unmade in this patients despite having sustained traumatic brain injury under the influence of alcohol/drugs. The treatment of addictive disorders is not yet integrated in the overall...

Reviews various pharmacological treatments of major comorbid psychiatric disorders in drug and alcohol addictions. Topics addressed include psychotropics for addictive drug and alcohol disorders as well as for comorbid psychiatric disorders (e.g., anxiety, depression, bipolar and psychotic disorders). Potencies and side effect profiles of various a...

Positive patient characteristics have been assumed important in determining treatment outcome for the abstinence-based method of addiction treatment. Thus far, controlled and uncontrolled studies of the abstinence-based method have examined predominantly employed, White, and married populations of alcoholics. We present a treatment outcome study of...

Presents an overview of studies of long-term benzodiazepine (BZ) use, and discusses the confusion between pharmacological dependence (PD) and addictive use of BZs. Illustrations are provided by 3 case histories. Results of controlled studies of abrupt discontinuation, tapered reduction, short-term and long-term outcomes after taper, and comparison...

Differentiates benzodiazepine (BZ) addiction behavior from physiological dependence. Tolerance and dependence are normal adaptations to the continued use of BZs, while addiction is characterized by preoccupation with acquiring drugs, compulsive use, and use despite adverse consequences. The action of BZs in the brain and BZ withdrawal symptoms are...

Discusses patterns of use and abuse of benzodiazepines (BZs), the most widely used of anxiolytic and sedative medications. The 9 BZs recommended for the treatment of anxiety are listed together with the pharmacokinetics of the different medications. BZs with rapid onset are associated with rapid dependence and addictive use. The difficulty of analy...

This review categorizes five main uses of pharmacologic agents in the treatment of alcoholism: reversing the active pharmacologic effects of alcohol; controlling withdrawal symptoms; blocking the desire for alcohol use; treating psychiatric symptoms induced by alcohol and other drugs; and treating independent, but concurrent, psychopathologic condi...

Adolescent alcohol and drug use are associated with many negative consequences. Understanding factors in initiation and patterns of use could aid in treatment and prevention. Sixty-four adolescents calling a cocaine hotline received structured telephone interviews. Mean age was 16.7 years. Two-thirds of the adolescents were young men. Sixty-six per...

Treating withdrawal and post-abstinence craving have had mixed success in eliminating drug use, improving outcomes and reducing relapse. To assess the role of craving and withdrawal in continued drug use we analyzed data at 6 and 12 month follow-up contacts from 1,626 patients voluntarily admitted to a primary rehabilitation center. 42% were diagno...

The history of the dominant form of clinical addictions treatment, namely, the abstinence-based method has not been well recorded in the literature. While experimental forms of addictions treatment have been documented in the studies, their clinical applications have been limited.

The abstinence-based method of addictions treatment is the dominant form of clinical treatment for alcohol and drug addictions. Controlled and large scale evaluation studies have shown the abstinence-based methods to be effective in promoting abstinence, improved psychosocial and medical status.

We have had dichotomous systems for the treatment of addictive and psychiatric disorders. While there has been some movement on each side, the progress toward combined treatment for addictive and psychiatric disorders has been slow. As a result, the treatment for the chronic mentally ill remains limited.

Significant error remains in how to diagnose psychiatric disorders in the presence of addictive disorders. Central to the confusion is the persistent belief that addicts self-medicate an underlying psychiatric disorder. Clarity is possible of both the psychiatric and addictive disorders are allowed independent status and an understanding of the int...

This is a reply to the Wade article. It argues that addiction is an independent illness and that specific treatments for this condition exist.