Mark S. Kosins, M.D.
Mark S. Kosins, M.D.
Biography
Deborah J. Beaver, MS, LMFT
Deborah J. Beaver, MS, LMFT
Biography
Cindy Dupuie, MS
Cindy Dupuie, MS
Biography
Michael Roham, PA
Michael Roham, PA
Biography
Welcome Address Driving Directions General Practice Info Office Hours Insurances Accepted Hospital Affiliation
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Welcome

 

 
Top Psychologist in San Clemente
Mark Kosins M.D. And Associates is ranked as a top Psychiatrist in San Clemente Ca
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Mark Kosins, M.D. and Associates has been recognized as
one of the top San Clemente Psychiatry practices.
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By Dr Kosins for my patients:
WE NOW HAVE A MOBILE SITE.  
TYPE IN MARKKOSINSMD.COM
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Mark Kosins MD & Michael Roham PA
302 N. El Camino Real #112
San Clemente, CA 92672
949 489 9898   Markkosins@aol.com
Board Certified Psychiatrist
Professor of Psychiatry and Family Medicine
Western University of Health Sciences
F
We hope you know that we try to make your interaction with us a special experience. We are very committed to providing you with a kind and polite and respectful environment. When you engage our office on the phone with Ingrin  or Susan, we hope it is a helpful and pleasant experience. We hope that when you
come through the door you find a quiet, pleasant, and a safe environment. 
We are committed to seeing one person at a time, and we hope that you find the time spent with us demonstrates a sense of caring, is educational, and is compassionate. Any of you who know me know that I have tried to continually challenge
myself with new areas of knowledge dedicated to TO further complete myself as a physician. 
 Dr Kosins, Michael Roham PAC,  Ingrin Curry and Susan Villlasenor


 

News for Healthier Living

Many With Opioid Addiction Don't Get Meds That Can Help

WEDNESDAY, March 20, 2019 (HealthDay News) -- Most people struggling with opioid addiction lack access to FDA-approved medications that can head off withdrawal symptoms and quell their cravings, a new report finds.

Methadone, buprenorphine and extended-release naltrexone all help opioid addicts by targeting the same brain receptors triggered by narcotics, and they have been proven effective and lifesaving, the report says.

More than 2 million people in the United States are thought to have opioid use disorder (OUD), and 47,000 died from an opioid overdose in 2017.

Studies have shown that opioid users are up to 50 percent less likely to die when they're receiving long-term methadone or buprenorphine treatment, according to the report.

Unfortunately, most opioid users in the United States don't receive any treatment at all, and only a fraction of those in treatment have been prescribed any of these medications, the researchers said.

The report, from the National Academies of Sciences, Engineering, and Medicine, argues for removing barriers that have made these medications inaccessible to many.

For example, methadone can only be administered through specialty opioid treatment programs, even though evidence shows it's just as effective when handed out by a family doctor.

Buprenorphine can be prescribed by doctors, but only if they've had specialized training and received a waiver from the Drug Enforcement Administration, the report noted. Fewer than 3 percent of health care providers have bothered to jump through those hoops, and those who have face regulations limiting the number of patients they can treat with buprenorphine.

Additionally, most residential treatment centers don't offer any of the medications, and if they do, they rarely offer all three.

"The factors impeding full use of FDA-approved medications to treat OUD must be addressed, including stigma surrounding both addiction and the medications used to treat it, as well as counterproductive ideologies that consider addiction simply a failure of will or a moral weakness, as opposed to understanding that opioid use disorder is a chronic disease of the brain that requires medical treatment," said Alan Leshner.

Leshner is retired chief executive officer of the American Association for the Advancement of Science and head of the committee that conducted the study.

Only 6 percent of treatment facilities offered all three medications in 2016, Leshner said, while only 5 percent of those addicted to opioids received medication for their addiction.

"The regulations that currently exist restrict access to methadone and buprenorphine in ways that our committee believes are far too prohibitive, and that accounts for the fact that too many people who might provide these medications don't," Leshner said.

The report's committee included Walter Ginter, a person with opioid use disorder who now serves as project director for the Medication-Assisted Recovery Support (MARS) network in New York City.

"I first entered medication-based treatment in 1977," Ginter said. "It's hard for me to envision a way in which I would still be alive if not for medication."

Ginter agreed that regulations need to be revamped to better help addicts.

"The burden of regulatory compliance directly affects patients greatly," Ginter said. "When I ask patients leaving medication-based treatment if they would stay if they could get their methadone from an office-based provider, as I do, they always say yes."

The report highlights four barriers that prevent effective medication-based addiction treatment:

  • Misunderstanding and stigma about the nature of drug addiction and the medications used to treat it.
  • Inadequate education and training of professionals who most often deal with opioid addicts, including treatment providers, police and corrections staff.
  • Regulations restricting methadone and buprenorphine prescription that are not supported by the evidence or applied to medications used to treat other types of brain disorders.
  • A fragmented system of care for people with opioid use disorder, including insurance coverage for their treatment.

Lindsey Vuolo is director of health law and policy for the Center on Addiction in New York City. "This report underscores one of the greatest tragedies of the opioid epidemic. We have effective treatments but most people with opioid addiction don't receive them, significantly increasing their risk for death," she said.

"With 130 Americans dying every day from an opioid overdose, we'd expect more to be done to address the barriers identified in this report, and implement solutions to expand access to treatment," Vuolo continued. "Stigma -- against addiction and its treatment -- prevents the type of response we'd see for any other disease."

Use of these medications should be extended to many other health care settings, including pharmacies, mobile units, community health centers and hospital emergency departments, the report argues.

The medications also should be used more often in jails and prisons, the report suggests. Even though more and more people who are addicted to opioids are being incarcerated, OUD meds are often withheld from prisoners or provided only on a limited basis for medically supervised withdrawal.

As a result, few people in prison or under supervision of drug courts are prescribed these medications. The lucky few who do receive medication are not connected with care upon their release, leaving them on their own to deal with their addiction.

According to Leshner, "Curbing the epidemic will require an 'all hands on deck' strategy across every sector -- health care, criminal justice, people with OUD and their family members, and beyond -- in order to make meaningful progress in resolving this crisis."

More information

The American Psychiatric Association has more on opioid use disorder.

 

 

 




 

News for Healthier Living

Giving OD Antidote to Those Using Powerful Painkillers Might Save Lives

MONDAY, June 27, 2016 (HealthDay News) -- In the wake of the musician Prince's death from a painkiller overdose, a new study suggests some opioid-related deaths could be prevented by routinely prescribing an antidote for certain patients who take the medications.

Researchers found that those who received prescriptions for the antidote naloxone (Evzio) were less likely to return for emergency care related to their painkiller use.

"The study should encourage primary-care providers to prescribe naloxone to their patients on chronic opioid therapy," said Dr. Alexander Walley. He's an addiction specialist and assistant professor of medicine at Boston University School of Medicine. He was not involved in the study.

According to a federal report released earlier this month, an estimated 2 million people in the United States were addicted to prescription opioid painkillers like OxyContin and Vicodin in 2012-2013. Misuse of the drugs has skyrocketed over the past decade, the U.S. study found, and local officials are seeing high numbers of overdose deaths.

The new study examined the use of naloxone, a drug that's used to reverse the effects of opioid painkillers.

Study author Dr. Phillip Coffin, director of Substance Use Research with the San Francisco Department of Public Health, said, "Since the mid-1990s, programs have been dispensing naloxone directly to people who use [illegal] drugs, as they are the most likely people to be present when an overdose occurs." These programs have had a "remarkable" impact on overdose death rates and are cost-effective, he added.

In the new study, researchers tracked what happened after 38 percent of nearly 2,000 opioid painkiller patients at San Francisco clinics received prescriptions for naloxone. All of the patients took the opioid for chronic pain, such as pain related to cancer, Coffin said.

The idea was that these patients would have the antidote on hand if they overdosed. The "rescue kits" require a witness to respond and administer the drug to the person who overdoses, said Walley.

"Naloxone blocks the effects of opioids and will cause a person who is overdosing to be able to breathe again and wake up," he explained. "It has no effect on people who are not using opioids and therefore is very safe."

The researchers found that those who received naloxone prescriptions had 47 percent fewer opioid-related emergency room visits per month over the following six months, and 63 percent fewer over a year, compared to opioid patients who didn't receive naloxone.

However, only about 12 percent of all patients went to the emergency room for opioid-related issues during the study period. Overall, the findings suggested that naloxone prescriptions for 30 patients would translate to one averted ER visit, Coffin said.

In a related study, Coffin said, researchers found that the antidote saved 5 percent of a randomly selected group of patients.

As for cost, Coffin said insurance companies generally paid for the antidote medication without a struggle. The retail price for the drug is about $15 to $30 per dose, he said.

But shouldn't these patients not be taking opioids at all if they're at risk for overdose?

Some patients require opioid treatment for their pain despite the risk of overdose, Coffin explained, and some are at risk of an overdose because there's such "a narrow window" between taking enough and taking too much.

Walley praised the study and said he doesn't see any downsides to offering the overdose antidote.

"Friends and family of people at risk for overdose should also be included in efforts to implement overdose prevention education and naloxone rescue kits," Walley said. And emergency training in first aid and CPR should include education in how to use the rescue kits, he said.

Coffin said it's especially important for certain painkiller patients to have the antidote on hand.

"The [U.S.] Centers for Disease Control and Prevention now recommends offering naloxone to patients on long-term opioid therapy who are taking more than 50 morphine-equivalent milligrams daily, who have a history of overdose or substance-use disorder, or who are also taking medications such as benzodiazepines [a class of tranquilizers]," he said.

Coffin urges steps beyond those recommendations: "Even for patients who are unlikely to overdose, it may be important to have naloxone in the house in case of accidental exposures or unintentional diversion of medications," he said.

The study appears in the Aug. 16 issue of Annals of Internal Medicine

More information

For more about opioid addiction, try the U.S. National Institute on Drug Abuse.


NOW FOR SOME NEW INFORMATION

I believe that it is a good idea to have this on hand    
depressioncenter.org/toolkit 
please type it in your browser and see all the great 
    We do not provide refills on evenings, weekends, holidays or Friday since we are not in the office.If you need a refill for any scheduled medication such as stimulant, benzodiazepine, sleeping medication, sedative, muscle relaxer or pain medication, we only do that with an appointment. We always try to make sure you have enough medications till the next visit.  Please do not ask for any refill without giving us at least 3 days notice.  The rules for prescribing have changed and we have to have a way to all deal with this.

If you need a refill, go to an emergency room or take the prescription we gave you or your bottle that has refills to your pharmacy.

 
Make an Online Appointment Doctor Scheduling Software
by Appointment-Plus

Mark Kosins, M.DTrained at University California Irvine-Graduated 1975-board certified-caring-willing to go the extra step to help you. He works closely with Michael Roham PA to provide comprehensive and quality care.

302 N. El Camino Real #112
San Clemente, CA 92672
 949 489-9898 
 
markkosinsmd.com

To reach the office via e-mail, please click the Contact Us form on this website.  Thank you.


He specializes in innovative diagnosis and treatment planning for the full spectrum of emotional and psychiatric problems including DEPRESSION, ANXIETY  & PANIC DISORDERS, OCD, ADHD/ADD, BI POLAR, SUBSTANCE ABUSE  DISORDERS, EATING DISORDERS, FIBROMYALGIA AND PAIN SYNDROMES .

He can provide both psychotherapy and medication management, or can work with your therapist/ practitioner.
  He works closely with Michael Roham PA.


SKYPE visits now available when appropriate. My Skype name is mskosins.

Our approach is to combine conventional and (when appropriate and requested) alternative-holistic medicine using the most suitable method that will work best for you. Often this can reduce the need for high doses of medication. The bottom line is to do what will help you feel well with minimal or no side effects.

•   The patient gets a one-hour Psychiatric evaluation and often a nutritional evaluation as appropriate. The nutritional evaluation is generally done at a separate appointment.

CALL NOW FOR AN APPOINTMENT or second opinion AND STOP THE CYCLE OF EMOTIONAL PAIN.

IT’S NATURAL TO HAVE PROBLEMS, BUT DON’T WAIT TILL YOUR LIFE COMES APART. Dr Kosins has been treating patients ranging in age from 4 to 84 in Orange County for more than 20 years. Let him help you work toward a better life NOW. 

Send an e mail. call and ask a question, (markkosins@aol.com) check me out further  ( or go to  www.southorangecountypsychiatrist.com  or markkosinsmd.com)

.
See our nutritional health store at      www.markkosinsmd.meta-ehealth.com

Our approach is to combine conventional and alternative medicine using the modality that will work best for you. If you prefer only medications we can do that as well.  When appropriate, we use supplements to augment or replace the need for high doses of medication. At the same time, we will combine medications and or supplements based upon your symptoms and what you are comfortable with. We do not believe that you must comply with my plan for care. Instead, our approach is to partner with you regarding a plan of action that makes sense to you. We specialize in a wide variety of behavioral, learning and emotional problems for children, teenagers and adults with and without ADD/AHD. We also treat anxiety, depression, and bipolar disorder.

I have a reputation for evaluating and treating difficult diagnoses and chemical imbalances that may cause underachievement, school failure, depression, obsessive-compulsive disorders, bi-polar disorders, panic and anxiety, aggressiveness, and brain toxicity from drugs and/or alcohol abuse.

I work with a number of professionals on staff and in the community. These  professionals evaluate and treat a variety of  disorders, each specializing in specific areas of mental health ranging from stress, anxiety and depression to child, adolescent, family and geriatric therapy. This diverse expertise enables us to provide a broad range of quality mental health and other services to our community.

There are inexpensive genetic tests we can do to help determine which medicines will work best for you.

Address
Mark Kosins, M.D. and Associates
302 N. El Camino Real
Suite 112

San Clemente, CA 92672
Phone: (949) 489-9898

Fax: (949) 489-2569

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Driving Directions

 

From the North:


 Get off at Palizada and go Right. Take Palizada two lights to El Camino Real and go Left on El Camino Real. My office is on the right two blocks down. 302 N. El Camino real  #112 San Clemente CA 92672.

Park in front or turn right on Miramir and park underneath.

 From the South:

Take 5 freeway north. Get of at Presidio and go left to El Camino Real. Turn right on El Camino Real and go about 1/2 mile (two blocks past Del Mar) and we are on the left.

We are in the big white Spanish building. Street Level. In Front.  #112.

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General Practice Info

We are currently welcoming new patients. 

Check out Mark Kosins MD on YouTube! And thanks for listening

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What ARE SPECT SCANSWhat I want to know about a scan. (Requires Microsoft Word to view.)
Office Hours

Our office hours are Monday through Thursday from 8:30 AM to 5:30 PM. Other times may be arranged by appointment.

No prescription refills are provided without a face to face visit. AHHD medications are the exception. We will give you enough meds till your next visit and refills. If you need a refill take your bottle or the prescription we gave you at your last visit to your pharmacy.Generally we must see you every three months at a minimum. 

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Insurances Accepted
At this time, Dr. Kosins is not affiliated with any insurance plans.  We can provide you with a "Superbill" at the end of your visit that you can submit to your insurance  for reimbursement, however, the amount that is reimbursed is entirely up to the discretion of your insurance company.

 

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Hospital Affiliation
Saddelback Memorial Hospital - Laguna HIlls

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