EXPERT
Dr. C. Lord, MD
Addiction Medicine Specialist | Addiction Medicine
Dr. Clifton Lord (Fred) is Medical Director of Connecticut Valley Recovery Services in Windsor VT and the Acadia Health Comprehensive Treatment Center/ Opioid Treatment Program in West Lebanon, NH, providing evaluation and treatment of substance use and related disorders including FDA approved medications for opioid use and alcohol use disorder. CVAR also provides treatment for Hepatitis C, individual and group counseling and case management.
A 1978 graduate of the University of Vermont (now Larner) College of Medicine, he trained in General Surgery at Bridgeport Hospital (Yale University Affiliated Surgery Program), Orthopedic Surgery at the Brown University Combined Orthopedic Residency program (Rhode Island Hospital and Providence RI Veteran Affairs Medical Center) where he was a Haffenreffer Fellow in Surgical Sciences, and Orthopedic Oncology at the Massachusetts General Hospital in Boston. After a 15-year career, he retired from active surgery and, after a brief hiatus in administration, completed the Addiction Medicine Fellowship at the University of Florida. He returned to Windsor in 2007 and established CT Valley Recovery Services, the precursor to the present practice.
Dr. Lord has been principal investigator and network/project director for several Agency for Healthcare Research and Quality (AHRQ) and Healthcare and Rural Services Administration (HRSA) grants dealing with health information technology and network development in rural healthcare settings. He was the project director for a HRSA Rural Opioid Response (RCORP) grant (20GA1RH39550), to improve prevention and treatment of opioid use disorder in Windsor County, VT from 2020 to 2023. He serves as a preceptor for Addiction Psychiatry Fellows at the Geisel School of Medicine, where he is Clinical Assistant Professor of Psychiatry. He is also a preceptor and Adjunct Faculty for the Master of Physician Assistant Studies program at Franklin Pierce University.
Dr. Lord is a member and Fellow of the American Society of Addiction Medicine and a member of the American College of Academic Addiction Medicine. He is currently President of the Northern New England Society of Addiction Medicine
A 1978 graduate of the University of Vermont (now Larner) College of Medicine, he trained in General Surgery at Bridgeport Hospital (Yale University Affiliated Surgery Program), Orthopedic Surgery at the Brown University Combined Orthopedic Residency program (Rhode Island Hospital and Providence RI Veteran Affairs Medical Center) where he was a Haffenreffer Fellow in Surgical Sciences, and Orthopedic Oncology at the Massachusetts General Hospital in Boston. After a 15-year career, he retired from active surgery and, after a brief hiatus in administration, completed the Addiction Medicine Fellowship at the University of Florida. He returned to Windsor in 2007 and established CT Valley Recovery Services, the precursor to the present practice.
Dr. Lord has been principal investigator and network/project director for several Agency for Healthcare Research and Quality (AHRQ) and Healthcare and Rural Services Administration (HRSA) grants dealing with health information technology and network development in rural healthcare settings. He was the project director for a HRSA Rural Opioid Response (RCORP) grant (20GA1RH39550), to improve prevention and treatment of opioid use disorder in Windsor County, VT from 2020 to 2023. He serves as a preceptor for Addiction Psychiatry Fellows at the Geisel School of Medicine, where he is Clinical Assistant Professor of Psychiatry. He is also a preceptor and Adjunct Faculty for the Master of Physician Assistant Studies program at Franklin Pierce University.
Dr. Lord is a member and Fellow of the American Society of Addiction Medicine and a member of the American College of Academic Addiction Medicine. He is currently President of the Northern New England Society of Addiction Medicine
46 years
Experience
Dr. Clifton F. Lord, MD
- Windsor, VT
- University of Vermont College of Medicine
- Accepting new patients
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Cocaine and perindopril
cocaine is a chronotropic- affecting heart rate- and ionotropic- increasing strengh of contraction- drug for the heart muscle. It also constricts blood vessels- that's why ENT READ MORE
cocaine is a chronotropic- affecting heart rate- and ionotropic- increasing strengh of contraction- drug for the heart muscle.
It also constricts blood vessels- that's why ENT surgeons use it for topical anesthesia, because it decreases bleeding.
Faster heart rate +increased strength of contraction against increased resistenc (constricted blood vessels) equals elevated blood pressure. So, by using cocaine, your blood pressure med probably doesn't work and you're setting yourself up for stroke, heart attack, kidney failure, etc. \
It also constricts blood vessels- that's why ENT surgeons use it for topical anesthesia, because it decreases bleeding.
Faster heart rate +increased strength of contraction against increased resistenc (constricted blood vessels) equals elevated blood pressure. So, by using cocaine, your blood pressure med probably doesn't work and you're setting yourself up for stroke, heart attack, kidney failure, etc. \
Drug abuse
very rapid and very significant rise in blood pressure, into stroke territory.
Transitioning from fentanyl to methadone to Suboxone
Methadone is much safer than fentanyl and there is no issue at all with making that change. Frankly, I would not recommend initiating buprenorphine at this time. The risk of READ MORE
Methadone is much safer than fentanyl and there is no issue at all with making that change.
Frankly, I would not recommend initiating buprenorphine at this time. The risk of precipitating withdrawl while you are pregnant is very high and risks miscarriage or premature labor, depending on how far along you are.
You really should be stable on the methadone before you consider switching and at that, I would recommend waiting until after delivery to do so.
Frankly, I would not recommend initiating buprenorphine at this time. The risk of precipitating withdrawl while you are pregnant is very high and risks miscarriage or premature labor, depending on how far along you are.
You really should be stable on the methadone before you consider switching and at that, I would recommend waiting until after delivery to do so.
Clonidine for withdrawal?
First- understand that, since I do not know your wife and have no established medical relationship with her, nothing i say can be taken as medical advice and I will not give any. That READ MORE
First- understand that, since I do not know your wife and have no established medical relationship with her, nothing i say can be taken as medical advice and I will not give any.
That said, in general terms, 0.1 mg of clonidine twice a day is on the low end for opioid withdrawal. He may have prescribed that for fear of causing a severe drop in blood pressure when she stands up. Again, not knowing the circumstances, I can't say for sure. If you can't reach him, best bet is to take her to the ER- there are other meds that are helpful with opioid withdrawal and she can be evaluated for that.\
Good luck.
That said, in general terms, 0.1 mg of clonidine twice a day is on the low end for opioid withdrawal. He may have prescribed that for fear of causing a severe drop in blood pressure when she stands up. Again, not knowing the circumstances, I can't say for sure. If you can't reach him, best bet is to take her to the ER- there are other meds that are helpful with opioid withdrawal and she can be evaluated for that.\
Good luck.
Hydrocodone withdrawal?
Opioid withdrawal (I assume that's the issue since he's been on these meds for 15 years and is now without) is a potentially dangerous thing in older people, especially with coronary READ MORE
Opioid withdrawal (I assume that's the issue since he's been on these meds for 15 years and is now without) is a potentially dangerous thing in older people, especially with coronary artery disease.
Many emergency departments now have programs where they will evaluate a patient for opioid withdrawal and if appropriate start medication with a referral to a provider who can provide ongoing treatment. It sounds like he is physically dependent, no necessarily "addicted", but that needs to be looked into.
Good luck
Many emergency departments now have programs where they will evaluate a patient for opioid withdrawal and if appropriate start medication with a referral to a provider who can provide ongoing treatment. It sounds like he is physically dependent, no necessarily "addicted", but that needs to be looked into.
Good luck
Can cannabis addiction be fixed?
No, but it can be treated and put into remission. Good for you for recognizing that marijauna is addictive. There are no evidence based medication treatments but there are psychosocial READ MORE
No, but it can be treated and put into remission. Good for you for recognizing that marijauna is addictive. There are no evidence based medication treatments but there are psychosocial treatment modalities that can help. Best to call your local community mental health organization and ask about substance use counseling. Good luck.
I took 10 mg of klonopin yesterday... I wasn't trying to hurt myself. My concern now is withdrawal?
Not after one dose.
Dependency to opiate vs addiction
This raises an all too common point. There are 11 criteria, according to the DSM V, for an opioid use disorder. You can "Google" thern. You will note that 2 of them are "tolerance"- READ MORE
This raises an all too common point. There are 11 criteria, according to the DSM V, for an opioid use disorder. You can "Google" thern. You will note that 2 of them are "tolerance"- less effect from the same dose or needing a higher dose for the same effect- and "withdrawal"- developing symtoms like nausea, diarhea, sweating, tremor etc.. If someone is taking opioids chronically for a definite diagnosis for which opioids are a legitimate treatment, those two criteria are not considered in evaluating a patient for OUD. So if you look the criteria up, discard these two and do not answer "yes" to at least three of the other 9 criteria, then you are DEPENDENT, not ADDICTED. Your drug counselor brother ought to know this. So I can only surmise that he either doesn't know what he's talking about (which leads to the question 'how good a drug counselor is he?") or there is an ulterior motive here which your parent's estate could certainly qualify for.
Here's a few other questions- have you been steadily increasing your dose, and it seems it's never enough? Do you run out early? Are you calling your provider frequently for early refills and making excuses like, "I lost my prescription", "it was stolen", "I accidently washed it in the laundry", "I knocked over the bottle and the pills went down the sink"....If the answer is "no" then you can't even be accused of abusing your medicine (with a straight face, anyway.....)
I would recommend that you find a REAL drug counselor with the initials LADC after the name (Licensed Alcohol and Drug Counselor), or an Physician certified by the American Board of Addiction Medicine or the American Board of Preventive Medicine- Addiction and make an appt for an evaluation.. You can find the latter on the American Society of Addiction Medicine's website (www.ASAM.org) under the tab "find a doctor" put in your state or zip code and you will get a list of patients within your area. If they agree with my remote assessment, that will bolster your case if you have to sue your brother.
Good luck
CFL, FASAM
Here's a few other questions- have you been steadily increasing your dose, and it seems it's never enough? Do you run out early? Are you calling your provider frequently for early refills and making excuses like, "I lost my prescription", "it was stolen", "I accidently washed it in the laundry", "I knocked over the bottle and the pills went down the sink"....If the answer is "no" then you can't even be accused of abusing your medicine (with a straight face, anyway.....)
I would recommend that you find a REAL drug counselor with the initials LADC after the name (Licensed Alcohol and Drug Counselor), or an Physician certified by the American Board of Addiction Medicine or the American Board of Preventive Medicine- Addiction and make an appt for an evaluation.. You can find the latter on the American Society of Addiction Medicine's website (www.ASAM.org) under the tab "find a doctor" put in your state or zip code and you will get a list of patients within your area. If they agree with my remote assessment, that will bolster your case if you have to sue your brother.
Good luck
CFL, FASAM
Can medications give you a false positive on a drug test?
There are a couple of issues- First and most important, is that your goddaughter's parole officer is playing a PO's favorite game of "GOTCHA!" We use urine drug tests for treatment- READ MORE
There are a couple of issues-
First and most important, is that your goddaughter's parole officer is playing a PO's favorite game of "GOTCHA!" We use urine drug tests for treatment- if there's a positive, let's talk about it and figure out what's going on, not "how can I nail you now?"
He is undoubtedly using what is called a point of care test, which is probably a cup, or a dip stick, that uses a process called immunoassay. This uses paper impregnated with antibodies to various drugs that react with a specific drug to show a Line on the strip. These have a high incidence of false positives and i NEVER make a decision based on a POC test alone. Before any action is taken the specimen should be sent to the lab for confirmation where they use a test system that identifies the specific molecule. False positives are very rare. We use a slightly more accurate immunoassay system in our office, and we still very frequently see positives for fentanyl that come back negative on confirmation.
Finally, yes, trazodone can cause a false positive test for fentanyl on immunoassay so the specimen should be sent out for confirmation. Sertaline (Zoloft) can also cause a false positive for benzodiazepines (Xanax).
Your goddaughter's attorney should vigorously challenge the PO's finding.
Congratulations to your granddaughter for doing the hard work of recovery. Stay strong. \
CFL
First and most important, is that your goddaughter's parole officer is playing a PO's favorite game of "GOTCHA!" We use urine drug tests for treatment- if there's a positive, let's talk about it and figure out what's going on, not "how can I nail you now?"
He is undoubtedly using what is called a point of care test, which is probably a cup, or a dip stick, that uses a process called immunoassay. This uses paper impregnated with antibodies to various drugs that react with a specific drug to show a Line on the strip. These have a high incidence of false positives and i NEVER make a decision based on a POC test alone. Before any action is taken the specimen should be sent to the lab for confirmation where they use a test system that identifies the specific molecule. False positives are very rare. We use a slightly more accurate immunoassay system in our office, and we still very frequently see positives for fentanyl that come back negative on confirmation.
Finally, yes, trazodone can cause a false positive test for fentanyl on immunoassay so the specimen should be sent out for confirmation. Sertaline (Zoloft) can also cause a false positive for benzodiazepines (Xanax).
Your goddaughter's attorney should vigorously challenge the PO's finding.
Congratulations to your granddaughter for doing the hard work of recovery. Stay strong. \
CFL
Can drug addiction be fixed without medications?
First- one does not "fix" an addiction- addiction is a chronic relapsing brain disease, chronic just like hypertension and diabetes. They are treated, and controlled or go into READ MORE
First- one does not "fix" an addiction- addiction is a chronic relapsing brain disease, chronic just like hypertension and diabetes. They are treated, and controlled or go into remission- not cured.
Opioid and alcohol use are the conditions that have medications approved by the FDA for treatment. In times past, treatment of these conditions were largely psychosocial- 12 step models, various modes of psychotherapy, other peer supports like SMART or Rational Recovery, religous groups. All of these have some effectiveness for some people- I achieved recovery without medications, for example. However, the vast majority do not. Medication treatment has become a mainstay of treatment although fewer than 20 percent of people who meet criteria for alcohol use disorger and 20-25% of opioid use disorder receive medication. A recent study from Yale University offered evidence that treatment of opioid use disorder without medication is worse than no treatment at all.
Keep an open mind- if someone recommends medication, seriously consider it.
Opioid and alcohol use are the conditions that have medications approved by the FDA for treatment. In times past, treatment of these conditions were largely psychosocial- 12 step models, various modes of psychotherapy, other peer supports like SMART or Rational Recovery, religous groups. All of these have some effectiveness for some people- I achieved recovery without medications, for example. However, the vast majority do not. Medication treatment has become a mainstay of treatment although fewer than 20 percent of people who meet criteria for alcohol use disorger and 20-25% of opioid use disorder receive medication. A recent study from Yale University offered evidence that treatment of opioid use disorder without medication is worse than no treatment at all.
Keep an open mind- if someone recommends medication, seriously consider it.
