TIBS Bend – Sept. 2017

Welcome

Marjorie Meret Carmen

Marjorie Meret-Carmen

During the last three years, while planning this medical symposium to address a subject that has been a pharmaceutical conundrum for decades, I have been asked many questions. These two come up most often:

*Why did I decide to create a symposium around something that happened to me almost a decade ago, when a physician handed me a prescription for Ativan to offset insomnia and panic attacks, resulting in benzodiazepine dependence, withdrawal and recovery?

*How will Advocates For Social Reform have a positive impact on how these particular medications, once thought to be minor tranquilizers, are ‘appropriately’ prescribed?

My intention for this Symposium is to issue a call for further scientific research into benzodiazepines and other bio-psychiatric medications. We are not out to ‘bash benzos’, totally aware of their potential positive use in traumatic situations. We do not support efforts to castigate or litigate against the pharmaceutical companies who created benzodiazepines, as many patients have done. However, we do support legislation protecting patients with ‘Advised Consent’ information–as being done in Massachusetts.

The Symposium will delve into the complications that arise when benzos are coupled with other bio-psychiatric drugs. We will hear from people who have gone through the ‘benzo gauntlet’ to achieve recovery, and from those who continue to view their ‘benzos’ as lifesavers.

Special appreciation to our Program Medical Director, Steven Wright, M.D.; Kristi Miller, TIBS Project Manager; The St.Charles Health System/St. Charles, Bend , our co-sponsors, Kimberly Swanson, Ph.D., the Symposium’s St. Charles advisor, and Lisa Dobey of the St. Charles Foundation, for giving a home to The International Benzodiazepine Symposium 2017.

Marjorie Meret-Carmen, M.Ed.


A Note from our Program Medical Director

Dr Steven WrightThe story behind TIBS is the story of millions around the world, who in good faith took advice from those of us prescribing benzodiazepines and have had serious consequences.  They are not rare tragedies, but individuals whose lives have been altered by the very agents that were intended to help.

This symposium is designed to amplify these concerns with the best evidence-based practices in prescribing benzodiazepines.  We will address the following questions in a balanced and substantial manner:

  • Is there a role for benzodiazepine use for anxiety states and insomnia?
    • For short term use?
    • For long term use?
  • What are non-benzodiazepine approaches to anxiety states and insomnia?
    • How do these approaches compare to benzodiazepines in terms of efficacy and adverse effects?
    • What are the best practices for treatment selection?
  • What are the adverse reactions seen with benzodiazepine use?
    • Identified early in the course of therapy?
    • Identified after long-term use?
  • What is the difference between ‘dependence’ and ‘addiction’ when it comes to benzodiazepines?  
  • How are benzodiazepine adverse reactions identified and treated, particularly during benzodiazepine withdrawal and post-withdrawal?

We understand there is a great need for improving prescribing practices for these potent medications, and are grateful to the St. Charles Health System for their commitment to Safe Prescribing Practices.  

Our intention for this symposium is to seed initiatives through clinician and patient education, shared decision-making, evidence-based advocacy, potential regulatory reform, and an advanced research agenda to examine the clinical questions that really matter.  

Steven Wright, MD
 

Background

Benzodiazepines are a class of psychoactive agents which bind to the GABA receptor of the brain, causing the receptor to become more sensitive to activation by naturally occurring gamma-aminobutyric acid (GABA). In the late 1950s Leo Sternbach accidentally discovered chlordiazepoxide (brand name Librium), the first of many of this drug category found to have potential benefit for anxiety, insomnia, muscle spasm, and seizures. Discovered much later, “Z drugs” – named that way because most generic names begin with the letter “Z” – are non-benzodiazepine compounds which also affect the GABA receptor but have a more favorable effect on sleep architecture compared to the benzodiazepines.

These substances have been used over many years, and indeed by 1977 benzodiazepines were the most prescribed class of medications in the world. Even today, however, their apparent benefit for the short term has led to long-term use in large numbers of individuals, a practice that  has been challenged. Benzodiazepine use can result in serious adverse reactions, which have been well described, but are often not taken seriously as evidenced by the lack of knowledge, informed consent, and ability to respond to patient concerns by prescribers. Indeed it has taken a crisis – the prominent role benzodiazepines have had in the opioid overdose epidemic – to redirect our attention to these medications.

Speakers

Robert Whitaker, Key Note Speaker

Robert Whitaker is the author of five books, three of which tell of the history of psychiatry. His first, Mad in America: Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill was named by Discover magazine as one of the best science books of 2002. His second on this topic, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, won the Investigative Reporters and Editors book award for best investigative journalism in 2010. His latest, which he co-authored with Lisa Cosgrove, is Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. Prior to writing books, he worked as the science and medical reporter at the Albany Times Union newspaper in New York for a number of years. He is also the publisher of a mental health webzine, madinamerica.com.

Rossman, Martin  MD 

Martin Rossman, MD, is a pioneer in mind-body medicine, founder of The Healing Mind, co-founder of the Academy for Guided Imagery, Clinical Faculty member at the University of California San Francisco Medical School, and an advisory board member of Dr. Andrew Weil’s Integrative Medicine Program. His cutting-edge research in guided imagery has contributed to the current paradigm of holistic health and has influenced the work of many of its prominent leaders. Dr. Rossman has authored numerous books and CDs, including Guided Imagery for Self-Healing and recentlyThe Worry Solution which teaches readers how to capitalize on the powerful mental force behind worry. He is a widely sought-after speaker and has been featured in academic, trade, and popular national media.

http://www.zhibit.org/WallaceMendelson

Mark D. Sullivan, M.D., Ph.D.

Dr. Sullivan received his M.D. and his Ph.D. in Philosophy from Vanderbilt University. He is Professor of Psychiatry and Adjunct Professor of Anesthesiology and Pain Medicine and Adjunct Professor of Bioethics and Humanities at the University of Washington. He has served as attending physician in the UW Center for Pain Relief for over 25 years, where he is Co-Director of Behavioral Health Services. He has published over 250 peer- reviewed articles, many on the interaction of physical health and mental health in patients with chronic illness.

Elaine Walters, MS

Elaine Walters is the founding Executive Director of the Trauma Healing Project, an organization that provides professional and community training and technical assistance, and direct healing support for survivors. Prior to this position she coordinated the Sexual Assault Nurse Examiner Program for the Attorney General’s Sexual Assault Task Force in Oregon. For the last 20 years she has been a consultant, trainer and community organizer working to address and eliminate intimate violence. She has designed and facilitated workshops and trainings on many related topics and has provided direct services and support to youth and adults impacted by violence, abuse and other forms of trauma.

Steve Flowers, MA, LMFT

Steve Flowers has been deeply invested in meditation practice since 1974 and is in private practice specializing in mindfulness-based psychotherapy for the treatment of stress-related conditions. A former professor of psychology with the program for College Education Afloat at Chapman University, Steve is the author of The Mindful Path Through Shyness: how mindfulness and acceptance can free you from shyness, social anxiety and avoidance, and co-authored with Bob Stahl, PhD: Living With Your Heart Wide Open: how mindfulness and compassion can free you from inadequacy, unworthiness and shame.

Steve is certified as an MBSR teacher from the Center for Mindfulness at the University of Massachusetts Medical School where he is also in a supervisor in their MBSR teacher trainer program – Oasis. He is the director of the Mindfulness-Based Stress Reduction program online and at Enloe Medical Center in Chico, California where he has provided these programs for 19 years.  Steve and his teaching partner Dr. Bob Stahl provide 5 – 6 accredited mindfulness-based stress reduction retreats a year for physicians, psychologists, nurses and licensed mental health professionals. You can reach Steve Flowers through his website www.mindfullivingprograms.com.

Michael Miller, MD

Michael M. Miller, MD, DFASAM, DLFAPA, is the medical director of the Herrington Recovery Center at Rogers Memorial Hospital in Oconomowoc, Wisconsin. He is a board-certified general psychiatrist and addiction psychiatrist, and is a Distinguished Life Fellow of the American Psychiatric Association. Dr. Miller has practiced addiction medicine for more than 30 years and is certified in addiction medicine by the American Board of Addiction Medicine ABAM where he is also an at-large director. A Distinguished Fellow of the American Society of Addiction Medicine (ASAM), he has served in ASAM on multiple task forces and executive roles including as past president. He served as Managing Editor for the 2013 edition of The ASAM Criteria and he chaired the Action Group within ASAM that produced the Standards of Care for the Addiction Specialist Physician. Through 2015, he chaired the Steering Committee of ASAM’s Practice Improvement and Performance Measurement Action Group. In addition, he has held a variety of important posts in the Wisconsin Medical Society and the American Medical Society, including being elected to serve on the Council on Science and Public Health of the latter. As full professor at the University of Wisconsin School of Medicine and Public Health, he is a faculty member for the Addiction Psychiatry Fellowship and the Addiction Medicine Fellowship. He also is an assistant clinical professor in the psychiatry and behavioral medicine department at the Medical College of Wisconsin. The recipient of multiple prestigious awards, Dr. Miller is a widely sought after speaker nationally and internationally on topics related to addiction, psychiatry, medical economics / quality / ethics, and public health.

Pergolizzi, Joseph  MD

Joe Pergolizzi, MD, is an internationally recognized expert in perioperative and pain medicine whose innovative clinical practice offers personalized, highly compassionate medical care. He specializes in clinical research, consulting with major research institutions and drug developers worldwide, which has resulted in many important natural and synthetic products with improved efficacy and safety for patients. Dr. Pergolizzi has held various positions at prestigious academic medical institutions, collaborates with the Food and Drug Administration’s Safe Use Initiative, and has authored over 200 peer reviewed articles, abstracts, platform presentations, and book chapters in his areas of interest and expertise.

Twohig, Michael  PhD

Michel Twohig, PhD, is a licensed psychologist in the state of Utah and a Professor of Psychology at Utah State University. He received his B.A. and M.S. from the University of Wisconsin-Milwaukee, his Ph.D. from the University of Nevada, Reno, and completed his clinical internship at the University of British Columbia Hospital. He is past-President of the Association of Contextual Behavioral Science, the organization most associated with Acceptance and Commitment Therapy (ACT). His research primarily focuses on the use of ACT across a variety of clinical presentations. He has published over 100 scholarly works including two books: An ACT-Enhanced Behavior Therapy approach to the Treatment of Trichotillomania (with Woods) and ACT Verbatim for Depression and Anxiety (with Hayes). His research has been funded through multiple sources including the National Institute of Mental Health.

Raffa, Robert  PhD

Robert Raffa, PhD, has a professional career devoted to the pharmacologic understanding of the balance between the therapeutic utility and abuse potential of drugs – and how this can be applied rationally and responsibly. With master’s degrees in both Biomedical Engineering and Toxicology and a doctorate in Pharmacology, he has had pivotal roles in drug development and is co-holder of nine patents on analgesic agents. He has been the recipient of more than $3 million in research funding – including from the National Institutes of Health – to investigate drug action and drug misuse. He has authored over 300 papers in refereed journals and is co-author or co-editor of several books and the Journal of Clinical Pharmacy and Therapeutics. Recently retired as Professor Emeritus after 20 years as tenured faculty at Temple University School of Pharmacy, Dr. Raffa continues to publish and speak worldwide.

Mendelson, Wallace  MD

Wallace Mendelson, MD, is a retired professor of psychiatry and clinical pharmacology at the University of Chicago. He has been the director of the sleep laboratory at the National Institute of Mental Health Intramural Program, the Sleep Disorder Center at the Cleveland Clinic, and the Sleep Research Laboratory at the University of Chicago. He has won awards including the award for excellence in sleep and psychiatry from the National Sleep Foundation, and the William C. Dement academic achievement award by the American Sleep Disorders Association. He has written numerous scientific papers and authored or co-authored four books.  His newest book, ‘The Science of Sleep’ from the University of Chicago Press, is being released in September 2017.

http://www.zhibit.org/WallaceMendelson

Anna Lembke, MD

Dr. Lembke received her undergraduate degree in Humanities from Yale University and her medical degree from Stanford University School of Medicine. She completed a residency in Psychiatry, and a fellowship in mood disorders, both at Stanford, and is currently Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She has published over 50 peer-reviewed articles, chapters, and commentaries, and is author of the book: Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Johns Hopkins University Press, November 2016).

Emerson, Cheryl  MS, NCC, LPC

Cheryl Emerson is a Licensed Professional Counselor (LPC) in private practice in Bend, Oregon. She specializes in trauma care and offers counseling services to adults, adolescents, couples, and families presenting with a wide variety of concerns. She holds a Masters in Counseling, is an Adjunct Instructor in the Masters in Counseling program at Oregon State University-Cascades, and is a certified trainer in Question-Persuade-Refer (QPR). Ms. Emerson is particularly focused on suicide prevention, intervention, and postvention. She receives regular requests to speak, consult and is a Master Trainer in Applied Suicide Intervention Skills Training (ASIST), the most widely used suicide intervention training worldwide.

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