Access to Catastrophic Benefits under the SABS: ONtario Personal Injury Law

Working with several injured accident victims who suffer life-altering changes as a result of traumatic events in their lives is both daunting and rewarding.  The injured victim and their families require immediate insurance coverage for a multitude of expenses for medical costs and attendant needs that are not available through the public health care system.

In the context of motor vehicle liability insurance, the Ontario Government has recognized over the years and since 1990 the need for an expense recovery system outside of the traditional tort system so that the injured party does not have to await the outcome of litigation against an at-fault party before getting reimbursed for their expenses.  Since 1990, the Statutory Accident Benefit Schedule (“SABS”) has provided up-front medical, rehabilitation, attendant care, income benefit and other expenses to injured accident victims regardless of fault (i.e. No-Fault Benefits).  Since 1996, the SABS have provided a two-tiered delivery of medical, rehabilitation, attendant care and housekeeping coverage depending on the classification of the injury.

The term “Catastrophic” is defined in the SABS and is used as a division for the most serious and permanently injured to access increased benefits past the fixed periods assigned for the “non-Catastrophic” claimants.

This paper will examine some of the legislative changes that have emerged since the introduction of Catastrophic Impairment in the SABS and the jurisprudence that has resulted from the most contentious clauses of the definition.

1.    Legislative Framework

Sections 2(1.2)(e) through (g) of the current version  of the SABS define “Catastrophic Impairment” as follows:

(1.2)  For the purposes of this Regulation, a catastrophic impairment caused by an accident that occurs after September 30, 2003 is,
(a) paraplegia or quadriplegia;
(b) the amputation or other impairment causing the total and permanent loss of use of both arms or both legs;
(c) the amputation or other impairment causing the total and permanent loss of use of one or both arms and one or both legs;
(d) the total loss of vision in both eyes;
(e) subject to subsection (1.4), brain impairment that, in respect of an accident, results in,
(i)    a score of 9 or less on the Glasgow Coma Scale, as published in Jennett, B. and Teasdale, G., Management of Head Injuries, Contemporary Neurology Series, Volume 20, F.A. Davis Company, Philadelphia, 1981, according to a test administered within a reasonable period of time after the accident by a person trained for that purpose, or
(ii)    a score of 2 (vegetative) or 3 (severe disability) on the Glasgow Outcome Scale, as published in Jennett, B. and Bond, M., Assessment of Outcome After Severe Brain Damage, Lancet i:480, 1975, according to a test administered more than six months after the accident by a person trained for that purpose;
(f)    subject to subsections (1.4), (2.1) and (3), an impairment or combination of impairments that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in 55 per cent or more impairment of the whole person; or
(g) subject to subsections (1.4), (2.1) and (3), an impairment that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in a class 4 impairment (marked impairment) or class 5 impairment (extreme impairment) due to mental or behavioural disorder. O. Reg. 281/03, s. 1 (5).

If an individual meets any of the above criteria they are deemed to have sustained a catastrophic injury.

How does the determination affect the level of benefits?

Under the current version of the SABS, the following coverage is expanded if an individual is “Catastrophic”:

1.    Medical and rehabilitation limits are increased from $100,000 available for 10 years, to a lifetime maximum of $1,000,000;
2.    Attendant care coverage is increased from a maximum of $3,000 per month for two years to $6,000 per month, to a lifetime maximum of $1,000,000;
3.    Housekeeping coverage extends for life; and
4.    Case management services are covered.

Changes under Bill 198

In 2003, the Ontario Government made some changes to the definition of Catastrophic Impairment under Bill 198 that applies to accidents that occur after September 30, 2003.  One of the significant changes can be found in the re-wording of clauses (b) and (c) which included the loss of both arms and both legs, whereas the initial regulations did not include this in the definition.

Another considerable change was made to section 2(2) of the SABS (now 2(2.1) for accidents that occur after September 30, 2003), which focuses on the point in time in which an individual’s injuries can be deemed catastrophic.  The old regulation stated that the insured person’s condition had to have stabilized and was not likely to improve, but the definition is reworded to say that the “insured person’s condition is unlikely to cease to be a catastrophic impairment”.  Moreover, section 2(2) has also been amended to require only two years to have elapsed since the accident as opposed to the three years in the previous version before a catastrophic determination can be made.

2.    Jurisprudence

The severely injured and their families have extensive needs and whether one qualifies for “Catastrophic” under the SABS plays a dramatic role in one’s ability to obtain timely and necessary care.  The likelihood of a severely injured accident victim pursuing maximum recovery to independence will in part depend on the level of services one can obtain.  It is surprising that given what is at stake in obtaining higher level SABS coverage, that there has not been a litany of jurisprudence to interpret widely how the definition should be interpreted.

The definition is clear with respect to interpreting 2(1.1)(a) through (d) as these are objectively determined.  However with respect to 2(1.1)(e) through (g), the assessors must use subjective criteria to make the determination.  This is the area where litigation is most often seen.

Clause (e)(i):  Determination by Glasgow Coma Scale “GCS”

Under this clause of the definition an individual may be deemed under the SABS to have met the “Catastrophic Definition” if they have received a score of nine (9) or less on the GCS, according to a “test administered within a reasonable period of time after the accident and that the test is performed by a person trained for that purpose”.

The GCS measures brain impairment by evaluating the best response of an individual in three areas, being eye response, verbal response and motor response.  A rating is then given on a scale in each category as to whether there was no response to a full response.  This test is useful in determining the level of brain functioning that a person has at a given time.  Whether or not the individual has ultimately sustained a serious or permanent brain injury is not determined by the GCS alone and it does not play a role under subsection (e)(i).  Therefore, although the GCS score could indicate future brain impairment it may very well be that a person who has early low GCS scales will not be permanently impaired and can be perfectly independent.

This definition of Catastrophic Impairment is highly contentious as the GCS can be unreliable, particularly under the following conditions:

1.    Influence of alcohol or narcotics on the GCS score;
2.    Ability to speak English;
3.    Emergency Intubation;
4.    Pre-existing Disability (such as hearing impairment);
5.    Facial injury; and
6.    Other medical factors (such as diabetic, administration of drugs during treatment).

The timing of the reading is also important as set out in the SABS.  The SABS indicate the reading must be “administered within a reasonable period of time after the accident” to be valid.  Some injuries may result in a transient loss of consciousness for a matter of minutes after an accident followed by a full recovery.  Other injuries may provide for a high GCS reading followed by a gradual deterioration which later is determined to reflect a severe brain injury.

In a 2000 private arbitration decision, Unifund v. Fletcher , Arbitrator Robinson concluded that the claimant did not suffer a catastrophic impairment thereby overturning the decision of the assessors who previously found the claimant to be catastrophic.  In Fletcher, GCS scores of 6, 8 and 9 were taken within the first half hour of the accident.  However, the GCS score never fell below 9 after the first half hour following the accident.  The assessors relied only on the first GCS scores of 6 and 8 taken just minutes earlier than the above-9 GCS scores, and the Arbitrator concluded that this approach was incorrect.

Another decision on the issue of GCS is the Financial Services Commission of Ontario (“FSCO”) case of Young v. Liberty Mutua1 .  In this case, Arbitrator Allen was required to review an assessment by a Designated Assessment Centre which determined that the claimant was not catastrophically impaired.  The claimant’s GCS scores were below 9 in the initial 28 minutes of care post-accident before the claimant was intubated.  Arbitrator Allen held that there is no set time for what exactly constitutes a reasonable period of time but that it “must be determined in the context of the particular circumstances of each case”.

Additionally, in the Young case it was noted that the intubation did not occur until well after the initial GCS scores were taken and that the time prior to intubation was a reasonable period of time to make a determination of catastrophic impairment based on the recorded GCS scores.  The arbitrator’s decision in Young was upheld on judicial review .

In Holland v. Pilot , Keenan, J. delivered a judgment in the Superior Court on similar issues involving a 15-year-old pedestrian struck by a motor vehicle.  In this case the plaintiff had ingested both alcohol and marijuana and the main point of contention was whether or not the drugs and alcohol in the plaintiff’s system could have had an adverse affect on the GCS scores therefore rendering them invalid.

While the parties’ experts differed on the influence of drugs and alcohol on the GCS reading, Keenan, J. found in favour of the insured and in doing so he demonstrated a reluctance to deviate from the legislative intent and to rely upon the GCS scores.  He ultimately made the finding that the injured individual met the catastrophic impairment requirement.

In Tournay v. Dominion , the only issue in dispute was whether or not a GCS score recorded on an intubated patient was, in law, a “valid” GCS score.  In this case, during the four hours of her post-accident treatment where GCS scores were conducted, there were a number of GCS scores of less than 9 during both the times she was intubated and while she was not.  There was evidence presented that Ms. Tournay’s daughter recalled that she attempted to wake her mother up “by grabbing her arm and shaking her for approximately 10 minutes”.  Since she did not respond to her attempts, Ms. Tournay’s daughter feared that she had died.  

Arbitrator Kominar heard arguments from the insurer that GCS scores while intubated were valid for medical purposes; they were not valid under the SABS.  Arbitrator Kominar did not believe that the GCS scores should be interpreted differently under the SABS and noted “If the scores, as recorded, were perfectly valid for medical purposes, then they are perfectly valid for purposes of the Schedule”.  As a result, Ms. Tournay was deemed to be catastrophically impaired.

Similarly, in the case of Michalski (Litigation Guardian of) v. Wawanesa Mutual Insurance Co. , FSCO Arbitrator Alves noted that the insured person’s GCS scores as recorded by the paramedics and later by the hospital as 3 and 9 respectively.  She ruled that there is a presumption for treating the injured claimant as catastrophic unless there are arguments about whether the test was administered within a reasonable time or by qualified personnel.  A special award was also ruled as against Wawanesa for their failure to recognize the seriousness of the injuries almost two years after the accident.

The most recent Court interpretation on the GCS is the decision of Liu v. 1226071 .  In this case the plaintiff had GCS scores of less than 9 in less than 40 minutes of time, before they rose to 12 and 14 in the 40 and 42 minutes following the accident, respectively.  Wright, J. determined that less than 40 minutes was a reasonable amount of time, however, he felt that the DAC Assessment finding the plaintiff Catastrophically Impaired was in error.  Wright J. felt that since 2003 Mr. Liu (four years after his accident) was able to manage his property, care for himself in terms of nutrition, healthcare, shelter, clothing and hygiene, was capable of making complex decisions and traveled to China twice making his own arrangements, did not suggest to him that he was a Catastrophically Impaired person.  The jury award of $865,000 for future care costs.  Wright J. ordered that since the plaintiff was not “Catastrophic” the future care was not payable.  The case was decided under Bill 59 (accidents from November 1, 1996 until September 30 2003).  Under Bill 59 an individual had to be “Catastrophically Impaired” in order to be able to claim medical expenses.

Jurisprudence shows a trend that a GCS score of 9 or less will continue to favour the designation of catastrophic impairment.  With the exception of Liu and Unifund, insurers have had little success challenging the validity of GCS scores.

Clause (f):  55% or more Whole Body Impairment
Clause (g):  Class 4 or 5 Impairment due to Mental or Behavioural Disorder
Can Clauses (f) and (g) be combined?

The first case to thoroughly examine the definition of clauses (f) and (g) was Desbiens v. Mordini  in 2004.  In this case Speigal, J. was asked to interpret 2(1.1)(f) of the SABS.   Desbiens was the first trial decision in which a plaintiff was found to be Catastrophically Impaired on the basis of one of the definitions of Catastrophic Impairment outlined in the applicable statutes and regulations.  Prior to his accident, Mr. Desbiens was a paraplegic as a result of falling off a roof while in the course of his employment.  Despite his paraplegia, Mr. Desbiens claimed that he was quite independent as he still had the ability to move around in his manual wheelchair and drive his altered vehicle.  He was also able to take care of himself with little assistance.  In fact, very few accommodations were required to his home to facilitate his independence in that regard.

After the motor vehicle accident, Mr. Desbiens claimed to have lost the independence he once had as the new injuries he sustained did not permit him to perform some of the essential tasks he was once able to perform on his own.

The decision states that the AMA Guides clearly anticipate that a given physician’s judgment and discretion will play a role in the assessment of the impairment.  Spiegel J. opined that the AMA Guides should not be applied without consideration of the particular reality of the individual being assessed.

One debate in the Desbiens decision revolved around the fact that based on his physical impairments resulting from the accident, Mr. Desbiens did not meet the requirements of clause (f), 55% WPI.  However, the most contentious part of the Desbiens decision is Spiegel J.’s analysis concerning the combination of physical and psychological impairments to arrive at the 55% WPI.  Essentially, it was argued by plaintiff’s counsel that Mr. Desbiens’ physical and psychological impairments could be combined under clause (f) to determine whether he had a WPI rating that was greater than 55%.

It was Mr. Desbiens’ position that the definition of impairment in the regulations included both psychological and physical impairments and that since clause (f) referred to a combination of impairments and not a combination of just ‘physical’ impairments, both physical and psychological impairments ought to be included in evaluating WPI.

The conclusion of Spiegel J. was that clause (f) was intended to be a ‘catch-all’ provision for the benefit of those who are in the greatest need of health care.  Spiegel J. concluded there was nothing in the legislation to indicate that physical and psychological impairments could not be added.  As he saw it, clause (f) used the wording ‘any’ combination of impairments.  While the definition in clause (g) did not include classes 1-3 psychological impairments, Spiegel J. found that there was nothing to prohibit those mild to moderate classes of psychological impairments from being considered in clause (f) for the purposes of the calculation of 55% WPI rating.  Spiegel J. believed that if the drafters had intended to exclude psychological impairments from clause (f), it could have easily specified that only physical impairments be included.

Desbiens has been followed in subsequent decisions and continues to be the leading Court decision on the issue of calculating WPI.

Another case to consider this issue was McMichael and Belair Insurance .  In McMichael, Arbitrator Muir was faced with the issue of whether or not the claimant had suffered a Catastrophic Impairment pursuant to clauses (f) and (g) of section 2(1) of the SABS. Arbitrator Muir first analyzed the application of clause (g), impairment due to mental and behavioural disorders.  He considered the impact of Desbiens and noted that Desbiens had established that “class 4” impairment in any one of the four areas of functioning was sufficient to establish Catastrophic Impairment.  He concluded McMichael had sustained “class 4” impairment and was therefore Catastrophically Impaired under clause (g).

Arbitrator Muir also considered whether McMichael met the catastrophic definition in clause (f), being whether he had a WPI of 55% or more.  On the basis of his physical impairments alone, Arbitrator Muir found that the claimant did not meet the 55% WPI threshold, but he then considered the issue of combining both physical and psychological impairments to reach the 55% WPI rating as set out in Desbiens.

Belair raised the argument that in Desbiens the Court had expert opinion evidence before it to comment on the translation of qualitative psychological impairment ratings into a WPI rating which was not the case in McMichael.  Arbitrator Muir rejected Belair’s argument and found that the plaintiff did not need an expert’s evidence to determine whether or not it was appropriate to add psychological and physical impairments.  He determined that this was a question involving the interpretation of the SABS.  Arbitrator Muir agreed with the claimant that the SABS required the addition of all impairments to arrive at the appropriate WPI and adopted the Desbiens analysis.  However, he did conclude that there would be some risk of double counting if the claimant’s psychological and physical impairments were added in this case and he therefore did not continue to assign a percentage to the psychological impairments.  While the facts giving rise to the circumstances in Desbiens and McMichael are very different, Arbitrator Muir appeared to have followed the reasoning in Desbiens.

The appeal of McMichael  was heard by Director’s Delegate Makepeace on the issue of the method of assessing Catastrophic Impairment under the SABS and Arbitrator Muir’s decision was ultimately upheld on appeal.  Director’s Delegate Makepeace adopted the statements in Desbiens that the AMA Guides are to be given a “fair, large and liberal” interpretation.  Director’s Delegate noted that ‘impairment’ is defined very broadly under the SABS thereby ensuring that the most seriously impaired claimants may qualify for enhanced benefits, whatever the nature of their impairments.  According to Director’s Delegate Makepeace, the drafters of the legislation created alternative ways of satisfying the Catastrophic Impairment definition to avoid under-inclusiveness and ensure that impairments of equal seriousness are treated equally under the SABS.  The appeal, however, did not consider the issue of combining physical and psychological impairments to arrive at a WPI rating.

In G. v. Pilot Insurance Co  the issue was whether the claimant had sustained a Catastrophic Impairment as per clauses (f) and (g) of the definition in the SABS.  Arbitrator Blackman adopted and followed the reasoning in Desbiens.  The Arbitrator noted that there are arguments to be made that psychological impairments should not be included in a WPI rating but then he rejected each one, stating that clauses (f) and (g) are separated by the word “or” which means that the clauses were meant to be mutually exclusive.  However, Arbitrator Blackman found that this was not the intent of the drafters of the legislation because this would mean that clauses (a) to (g) were mutually exclusive.

The second argument he rejected was the idea that a percentage could not be assigned to psychological impairments.  According to Arbitrator Blackman, he was in agreement with the decisions in McMichael and Desbiens that despite the practical difficulties, all impairments however caused must be included in the WPI.  Arbitrator Blackman stated that an insured person should not be penalized just because medical science lacks an objective means of rating psychological impairments via percentages.

Arbitrator Blackman also noted that the Guides deliberately did not use percentages to estimate mental impairment because of their subjective nature, the dilemma being that clause (f) requires a percentage analysis.  Arbitrator Blackman stated that the SABS provide that if an impairment, or by implication an impairment rating, is not provided, one must then look to a listed impairment most analogous to the impairment sustained.

As in Desbiens, Arbitrator Blackman notes that the 4th edition of the AMA Guides refer to the 2nd edition which provides ranges of percentages that can be applied to the classes of psychological impairments.  He not only assigned percentages to the claimant’s psychological impairments and added them to his physical impairments as in Desbiens, but also added a number of physical impairment ratings that had not been included in the CAT DAC in order to find that the claimant did meet the 55% WPI threshold set out in clause (f) of the Catastrophic Impairment definition.  Director’s Delegate Makepeace on appeal  confirmed the decision.

In P. (B.) v. Primmum  the applicant was involved in a motorcycle accident.  The damage to his right leg was so severe, that his leg was not salvageable and the amputation of his right leg from the knee down was required.  At issue in this case was whether the claimant was Catastrophically Impaired under clause (f) as a result of the amputation of his right leg.  

One of the experts in this case relied on his own interpretation of Desbiens and stressed that the AMA Guides are not a complete guide and that an assessor should exercise clinical judgment to adjust a score upwards.  He found that the claimant met the 55% threshold with an upwards final adjustment.  Additionally, it was argued that discretion lies with the decision maker to make a finding of Catastrophic Impairment in cases where the cost of future treatment exceeded the non-catastrophic limits.  In this case, the cost for future prosthesis and care were well beyond the non-catastrophic limits.  In his reasons, Arbitrator Blackman rejected this approach to the determination of Catastrophic Impairment and stated that:

“I am not persuaded by the … argument that I have discretion to make a finding of catastrophic impairment where the cost of future treatment exceeds the non-catastrophic limits under the Schedule.  That in my view, simply defeats the intent of the legislation that a requisite designation of impairment, in addition to reasonable and necessary need, determines entitlement at a certain monetary level.”

Fundamentally, Arbitrator Blackman did not agree with the opinion of Dr. Ameis that a final adjustment is warranted when examining the wording of the legislation and the AMA Guides.

Ultimately, Arbitrator Blackman followed Desbiens and his own judgment in G. v. Pilot and considered the various experts reports and based on a review of them and the AMA Guides, he attributed various WPI designations to both physical and psychological impairments which exceeded the 55% WPI threshold, therefore determining that the claimant was Catastrophically Impaired.

3.    Conclusion: Will the Cat stay in the Hat?

The “Catastrophic” definition has been in use for over 10 years and has only received a few minor changes by the legislature.  It is predicted that the areas that have been litigated that were highlighted in this paper are likely to face reform in the near future.

Currently, the Ontario Government is undertaking a five-year review on Auto Insurance.  Submissions from various stakeholders can be viewed on their website address:  http://www.fsco.gov.on.ca/english/insurance/auto/5yr-review/default.asp .  

The Insurance Bureau of Canada (“IBC”) has published their submissions which indicate that they have a working group of scientists who have collaborated to review the current evidence used to classify brain injury.  It seems clear that the IBC has targeted the elimination of Clause (e) as it relates to the use of the GCS scale score of 9 for entitlement.  By excluding the GCS score from the “Catastrophic Definition” the government will need to find a substitute measure in its place.  Alternative measures that have been considered reveal evaluations of post traumatic amnesia coupled with a lower score such as 5 or less on the GCS will be required to meet the proposed new definition.  Such strict and subjective measurements are certain to increase litigation costs and raise the uncertainty for entitlement for a much needed group of accident victims.  It is likely that the number of brain-injured accident victims who qualify for Catastrophic Injury under the SABS will drop significantly if such reform is allowed.  

While legislative changes to the Catastrophic Definition are likely in the next few years, the issue of interpretation will remain clouded requiring ongoing litigation.  Jurisprudence to date has favoured a trend of fairness allowing mostly the injured accident victim to succeed.   Insurers have argued to the government that the Courts have broadened the definition which has increased costs to insurers.   These comments do not reflect the reality of the benefit approval process embedded in the SABS.  Ultimately, if an injured accident victim requires medical or attendant care services; the individual is required to submit treatment plans and requests for reimbursement that are subject to the SABS requirement of approval and medical requirement.  The insurers routinely deny various treatment and attendant care request for Catastrophic and Non-Catastrophic claimants alike and thus the designation of Catastrophic does not designate the entitlement without satisfying the needs based test.  Benefits are only paid if they are deemed to be “reasonable and necessary”.  Thus, insurers are misguided by demanding tighter legislation to allow fewer claimants to be declared Catastrophic.

Auto Insurance under the SABS continues to be the subject of reform as we enter the 5th such reform since 1990.  Despite the insurance industry and government trying to strike a balance for a profitable industry and fair reparation system, it is clear that the most seriously injured accident victims needs should be fully indemnified without compromise. For more information visit http://www.gluckstein.com

Any person who wants to quit his smoking habit should definitely make use of either herbal smoke or legal buds. This will help any person who is addicted to smoking to get over his habit in a slow, easy and gradual manner. Legal buds and herbal smoke are two of the most well-known methods which are being used by people all over the world today in order to quit smoking.

The herbs which are present in these methods have been mainly responsible in helping these people in giving up this addictive habit. Many people stand testimony to the fact that the use of herbs is very useful during the process of de-addiction. They make it much easier for the person to go through the withdrawal symptoms which they are likely to experience during this span of time. Many different kinds of herbs as well as herbal products are available which can help a person to completely overcome this smoking habit.

In order to make the process of quitting smoking a lot easier, it is equally important that the right kind of herbal mixture which can be used for this purpose should be procured. Many countries like the United States of America has provided a legal sanction for the usage of herbs and herbal smoke for people who would like to give up their smoking habit.

Many different herbal combinations and herbal smoke combinations are available in the market for people who would like to give up their addictions. But none of these herbal smoke combinations or legal buds contains even a small amount of nicotine. The absence of this harmful substance known as nicotine is one of the main reasons as to why many people want to make use of them in order to give up their smoking habit. This will also regulate the amount of nicotine which makes it entry into the body. This will also reduce the amount of dependency which they have on tobacco and this will also make it a lot easier for them to deal with all the withdrawal symptoms which they are likely to go through during the process of giving up smoking.

People have been making use of legal buds as well as herbal smoke for almost half a century in order to quit smoking. But they should also select the right flavor as well as the right combination which will suit their individual purpose. It should be suitable to their taste buds. Without this, the process of quitting smoking can prove to be difficult for the person. Since nicotine and tobacco cannot be found in any of these legal buds or herbal smoke products, people can be rest assured that they are not causing any kind of harm to their health by making use of these products. www.bigheadshop.com is one website which deals in many different kinds of legal buds, herbal smoke, marijuana alternatives and many other different kinds of smoking accessories. The products which are being sold by them have proven to be extremely effective while people try to quit smoking and the quality of these products cannot be matched easily.

Smokers seeking to give up a smoking habit have several options to choose from today. There is a surfeit of new stop smoking medication hitting the smoking cessation shelves with each passing day. The spurt of introduction of these therapies is at an alarming rate, and it could certainly confound a smoker who wants to select the best method for him- or herself. However, a careful knowledge of the different methods and their pros and cons can help to make a decision about the best method.

Let us tackle these new stop smoking medication methods one by one. The first on the list would certainly be nicotine replacement. Though it has been in use since the seventies, nicotine replacement can be termed as new, because it is regularly undergoing modification, and also the medical fraternity prescribes this method in favor of any other. The principle of this method is to keep smokers on a dose of nicotine, so that they do not feel the craving for the actual cigarette.

Now, how does that help? For that we must accept the fact that nicotine has no other harmful effects on the human body except keeping the addiction alive. Tar in the cigarettes is infinitely more hazardous to health. Keeping up on nicotine will see to it that the amount of tar entering the body is reduced. Nicotine replacement methods are available in several forms, such as gums, lozenges and patches, out of which the patches are the most popular.

Depression is a very commonly occurring condition of nicotine replacement methods. In fact, sometimes the depression can be so aggravated that the smokers could revert to active smoking. Hence, most doctors would couple nicotine replacement with a steady dose of antidepressants. Commonly prescriped antidepressants today are Chantix and Wellbutrin, and new stop smoking medication is constantly being developed in the form of antidepressants. Using antidepressants, the nervous system becomes stronger, and determination for quitting becomes easier.

One of the most worrisome factors in giving up smoking is coping up with the withdrawal symptoms that might occur. New stop smoking medication does take great care of that, since withdrawal problems can take a person back to smoking. Also, the importance of diet and lifestyle is emphasized.

At the same time, it is also true that antidepressants have contraindications. A large number of diseases can be aggravated by using antidepressants, and some of the leading ones here are all ailments of the liver and kidney, and chronic conditions like diabetes mellitus. There are side effects of using them too, such as the development of suicidal tendencies in people using them. Hence, not all new stop smoking medication is good for everyone.

Among all the different new stop smoking medication available today, the herbal remedies are by far the safest. Since they contain no hazardous chemicals at all, they can be used by people of all constitutions. St. John’s Wort is a popular herb used today, which helps people face the depression in a better way. Also, lobelia, a very ancient herb creates a strong dislike for the taste of tobacco in the smoker. Several herbs are mixed together in the right proportions nowadays and made into formulations, which are best for quitting the habit.

A huge benefit of these herbal remedies is that they will not only keep the person away from the addiction, but they will also clear out the toxins that have built in his or her body over years of smoking. Thus, by using this new stop smoking medication, there is a very great chance that the body of the person will return back to its original healthy state, as it was before the smoking habit took over.

A very effective formulation that makes this happen is SmokeRX, which – like all other herbal methods available today – is a carefully prepared blend of the right herbs in the right proportions. Working quite fast, the formulation sees to it that people do not get the craving for cigarettes ever again in their lives.

Finally, it must be remarked that herbal methods are not actually new stop smoking medication, though they seem new. The fact is that individual herbs have been in use for centuries, though their formulations have been prepared only recently with the several research facilities available. This has made the world become aware of these remedies in a very significant manner.

More Copaxone questions please visit : DrugsFreeFAQ.com

Assistance beside the MS drug Tysabri?
My sister was diagnosed with multiple sclerosis on her 22end birthday, she has tried copaxone, rebif, novantrone-(chemo), and plasmapheresis all to no nouns. she is now on tysabri and has had two infusions and she is worried that it is not working. my examine is how long before she sees any improvements “>

For society next to multiple sclerosis, i be on avonex for almost 18 months, worst 18 months of my energy…?
side effects included flu like symptoms, horrible nightmares and skin rashes to name a few. my neurologist wants me to start using “capaxone”, what are your personal experiences next to side effects of “capaxone? I use copaxone ,been taking for 6 years now,works exceptionally…

Is here any research into multiple post injection reaction when one treated next to copaxone for MS?
I have relapsing remitting MS and are experiancing multiple injection reactions while on Copaxone, eg. increased heart rate, hot flushes, dizziness, vomitting, shortness of breath straight after having my injection. This has happen approx 6 times in 2 months. Any ideas would be appreciated. http://en.wikipedia.org/wiki/Glatiramer_?…

Where can i catch an auto injector to administer copaxone for ms treatment?
– Your prescribing MD will have to write a script for you for the autoinjector. You can also call the pharmacy or the Teva Marion support hotline for further instructions specific to your situation You can call Shared Solutions at 1-8OO-887-8100 and ask them to call your doctor for…

Copaxone shot injection sites really acting up?
have been on copaxone for MS for 2 weeks now. my injection site’s have become totally very swollen and very very itchy and very tight also very hot! even the ones i have done almost a week ago. any help as to what might be going on would be great thanks! – ring your doctor and/or…

Copaxone Side Effect?
i started copaxone on last friday and on sunday my eyes started to feel sore, dry, sensitive to light and a little out of focus. im not sure if its the copaxone or something else… have anyone who has taken copaxone had side effects like this? – The following side effects on the eyes have be reported for…

Help injecting copaxone..?
ok so this is supposed to be day 2 with the copaxone but i cant bring myself to push the button to give myself the shot…im not afraid of needles or shots when a nurse gives it to me but for some common sense i have major anxiety giving it to myself..i wouldnt even let my husband or mom do it.what do…

Copaxone- if you can’t afford it will the U.S. policy cover it for you.?
My cousin has MS and cannot afford her copaxone. She will do without when she has to due to lack of funds. She lives surrounded by Nevada. – State Medicaid should help.

Copaxone, what are adjectives the uses of?
I have taken this since 1995. Just searching for updated material. – It appears to be mainly used within treatment of MS Source(s): http://www.copaxone.com/

What are the potential affects of the medication copaxone injection?
an injection given for multiple sclerosis – Hi Sharyn, I have been taking it for about 5 years and have have no side effects, except for the occasional site reactions. You could check the package insert for all the details. I didn’t do well on the Interferons at adjectives. I…

Where is the best place to inject copaxone?
My personal preference is the stomach for an injection of this type. my mom rotates them around her body. so like, one day her thigh/hip one day her upper arm. i think it help avoid repeating irritation from the shot? try calling your doctor tomorrow and asking their best suggestion, that would be best. …

Copaxone and Marijuana usage?
I suffer from Multiple Sclerosis and take the medicine Copaxone. I was wondering since I smoke marijuana and use copaxone will any harm be done (besides the unmistakable from weed)? – Sadly, no one is going to be able to tell you what the drug interactions could be between Copaxone (which I take also) and marijuana (don’t entail it…

Any info of someone using Copaxone and Lipitor for MS?
– No personal experience here and I don’t think it’s been tried in humans yet but here are a couple of links/information. Good Luck. A Statin Improves Performance of Multiple Sclerosis Drug By Ed Edelson HealthDay Reporter THURSDAY, March 16 (HealthDay News) — The same researchers who showed that…

Does the tenderness from taking Copaxone ever be in motion away?
This is my third time on the drug. Always after a few weeks on it I start experiencing weakness. This is the type of weakness where I’m bone tired, but can’t sleep. Any treatments for this? I can take concerta when I want, but choose not to because it cause so much afterward anxiety.

My daughter have lost her chore and we will not be capable of afford her subsequent shipment of Copaxone, what do we do?
She is 27, her job has been “eliminated” basically because she get hurt on the job. Has had to have reconstructed hip surgery and she in a minute has no insurance. She has remained in remission with the Copaxone and…

Rebif, Copaxone or Avonex for MS – pluses and minuses?
I have a friend who was diagnosed today with MS. Fortunately, it was caught rash. She’s trying to decide between Avonex, Copaxone and Rebif. Does anyone have any recommendations, pluses or minuses? Side effects you’ve felt for any of them? – I picked Avonex. Advantages: – once weekly…

Is here any research into multiple post injection reaction when using Copaxone to treat MS?
I have relapsing remitting MS and are experiancing multiple injection reactions while on Copaxone, eg. increased heart rate, hot flushes, dizziness, vomitting, shortness of breath straight after having my injection. This has happen approx 6 times in 2 months. Any ideas would be appreciated. – Vaccinations are bad…

People next to MS taking Copaxone injections?
I have been taking my shots for a month now. I can not take them contained by my legs, they hurt so bad. Every other place they map out is ok. The nurse told me to turn the autoinjector to 4 but even then, it hurts and has a different reaction than the rest of…

There is an increasing trend for anxiety sufferers to choose herbs for anxiety treatment. Although herbs are obviously not strong enough for those whose conditions are more severe, they are still preferred by many as a milder and safer substitution for traditional medications. Amongst all the alternative ways for panic treatment, herbal medicines are quickly gaining popularity.

Herbs used in anxiety treatment are those which contain anti-anxiety properties. Some of the more well-known ones include:

1. Kava Kava

This plant comes from the Kava crops in the western pacific and is effective in delivering tranquillity. Although Kava Kava is not addictive, some researchers believe that it may cause violent allergic reactions in a very small number of patients.

2. Valerian Root

This herbal supplement is extracted from the Valerian flower plant. It is also as a powerful tranquillizer, and is commonly used to reduce symptoms involving insomnia and epilepsy. Valerian extract works rapidly, often in less than an hour, but it is also known to be mildly addictive.

3. St. John’s Wort

St. John’s Wort is also known as Klamath weed or Goat weed. It is used for in anxiety treatment because it contains properties that are capable of combating depression. In some countries, St. John’s Wort is even more often prescribed than traditional medication in treating mild depression.

4. Others

There are more names to be covered, including passion flower, lemon balms, hops, chamomile, magnesium, B-complex, etc.

Herbs have been a hot topic in recent years. If you do some search on the net, you can find heaps of claimed herbal applications for almost all kinds of medical conditions. Some even claim that herbs are magic heals for cancer and AIDS.

Are herbs really effective? In treating anxiety, will herbal drugs eventually take place of prescribed drugs? At this point of time, the anwser is probably NO. The fact is that there is no strong evidence yet to prove that herbs are effective in treating anxiety or, better yet, anxiety order, on its own. Although you may have come cross the claims by manufacturers of herbal products or testimonies from patients that they have been helped by St John’s Wort or Velerian Root, traditional medications and behavioral therapies are still the best combination in battling anxiety and other mental conditions. The role by herbal medicines is only supplementary to the main two, at the very best. Having said that, herbs still carry their obvious advantage over the more powerful drugs for being less addictive and less harmful.

If your anxiety problem is only minor, your doctor may recommend herbal supplements prior to stronger medications. If you are, just like many others, purchasing herbs for anxiety treatment on your own, you really need to be cautious with your selection. As with every single industry, some manufacturers are more reliable than the others, and you should do yourself a favor to check them out. You can always consult your doctor for a good recommendation if you would like to skip your homework.

Wade Agnew probably knows as much about heroin and the law as anyone. He used it for three decades, was a successful heroin trafficker for ten years, and has studied the legal status of heroin continually since first discovering the drug at University in the late 1960’s.

“My affair with heroin has been an on-going one. I fell in love with it the first time I tried it; as a medicine for what ailed me, it was second to none.”

The author of the recently released autobiography “Cheating the Hangman: True Confessions of a Heroin Trafficker” Wade is calling for the immediate legalization of heroin. Heroin trafficking gives you a very unique perspective on its status in society. The ongoing campaign of denigration is orchestrated, widespread and unrelenting. As Goebels said, if you repeat a lie often enough, eventually people WILL believe it. Wade writes in his book;

“With heroin systematically demonized since the 20’s, it wasn’t surprising most thought it evil incarnate, an extremely dangerous drug, and a force against all the good in society. But in truth it wasn’t toxic for the body, the brain was where the action occurred, and it was some smooth operator. They weren’t monsters, just in exile from a society they refused to recognize.

The orthodoxy fused notions of anarchy, violence and Bolshevism, into a hyper-negative highball, now impossible to unhitch the harness. That willful ignorance was a source of frustration and anger. It imprinted on their self image, colouring their interaction with the world. Why were drunks amusing, junkies sinister? They were thought a harbinger of a heinous moral meltdown, a role they took on with relish.”

Originally set up by a Christian fundamentalist as a vehicle for his moral humbuggery, the “International Narcotics Control Board” is now entrenched as an instrument of US foreign policy and control, and with the organization in its pocket, the United States of America uses it as a propaganda tool; dictating to the world drug policy that serves their agenda and their interests. And make no mistake, it’s a powerful tool.

This evangelizing does enormous harm to individuals around the globe, as well as promoting an illegal trade that fosters and entrenches organized crime, in the same way that prohibition directly fueled the Mafia in 1920’s America; “ignorance on an industrial scale”. Making heroin illegal robs the medical community of the number one pain killer on the planet, and criminalizes those who choose to use it. This is something that the author knows from personal experience, as a successful drug trafficker in the 1970’s and 80’s.

When the Australian Capital Territory Government tried to set up a heroin trial in Canberra; the national capital, to save lives and administer pharmaceutical heroin to selected long term addicts in a safe and supervised environment, the Narcotics Control Board intervened. The extreme variation in the strength of street heroin is a real problem, and the cause of many overdoses, as is the lack of medical supervision and intervention when needed. The Board controls the issuing of licenses allowing countries to grow legal opium for the pharmaceutical industry. They told the Federal Government in no uncertain terms that it risked the Tasmanian opium poppy crop if they allowed this to happen. A compliant and conservative Federal administration caved in to this blackmail. This unaccountable organization wields enormous power. Holland has regularly experienced its pressure to repudiate their liberal drug laws, but stands firm in the face of on-going attacks. Read more about the legal status of heroin at;

http://www.cheatingthehangman.com.au/connections.html

Also read this sample chapter from the author’s book;

THE GRASS IS GREENER:

The Australian heroin market in the 1970’s got a huge leg-up from the Royal Commissions into drugs. State police added the booster rockets. All the national attention was now focused on marijuana ignoring the growing heroin culture, a lens sharpened by the murder of a crusading politician in Griffith, the cannabis capital of the country. People wondered why so few were being arrested, and nothing confiscated. Were cops benefiting from the grass trade? Suddenly the heat was on, questions were being asked. Why were crops being discovered only after the intense press coverage? The speculation continued apace.

This was all music to the ears of the budding heroin importer. With eyes now on the marijuana trade it went underground, leaving markets open for a drug capable of soothing the nerves of jaded hippies, popular, and instantly more effective than years of studying at The Happiness Institute. My mission was delivering forbidden fruit from foreign shores with forensic efficiency, right to your front door. While the new medicine was timely, some burning money would get their fingers singed.

Millions of dollars worth of smoke was seized, while heroin still reached arms unhindered. My business had quadrupled in six months, so I was well aware it was cannibalizing the drug trade. Foisted on cannabis smokers, the drought entrenched a corrupt system with an avalanche of white-powder cash.

But the grass was always greener….

For the details of “Cheating the Hangman: True Confessions of a Heroin Trafficker” go to;

http://www.cheatingthehangman.com.au