Opioid addiction is an epidemic. Let ’s treat it like one.

If we want to talk about the opioid epidemic as an actual epidemic, let’s use the same terms we use for communicable disease: agent, vector/environment, host. Virulence. Transmission. Immunity. The media has done a great job of providing descriptive statistics of the epidemic. And recent oversight, both legislative and advisory, have attempted to focus on altering vector (prescriber) behavior in the wake of apparent failed attempts to reduce agent virulence. What seems to be lacking in the overall discussion though, in my opinion, is a focus on the host. That is where eradication of epidemics has generally been more successful. What is unique about modern chronic disease epidemics, contrasted to classic infectious disease epidemics, is the unique behavioral vulnerability of the host. People have no problem adopting mosquito nets, fleeing plague-infested quarters of the city or submitting to vaccination. And yet, they flock to Krispy Kreme, tobacco and opioids despite the knowledge that these agents can destroy them. We are drawn like moths to a flame to that which we know to be harmful to us  —  if we deem short-term benefit to outweigh the long-term cost. (“Delay discounting,” as Marc Lewis calls it. Check out his wonderful little book, The Biology of Desire.) Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Pain Management Primary Care Source Type: blogs

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DiscussionThe social construction of the opioid epidemic polarizes individuals as good or bad with little attention paid to underlying institutional interests both in the creation of the problem or in the solutions that are proposed. We show that as concerns about harms from opioids become more pronounced, the narrative shifts to home in on illicit street-use with a corresponding uptake of stigmatizing references to “addicts”. Concurrently, most references to the pharmaceutical industry disappear from view. This framing of the problem defines the kinds of solutions that then seem natural. For example, increased...
Source: Social Science and Medicine - Category: Psychiatry & Psychology Source Type: research
CONCLUSIONS: Chronic pain serves as an important factor in the persistence of drug use in more than one-third of PWID in this sample. The high prevalence of chronic pain with drug use for pain suggests that proper pain management is likely to be an essential component of preventing or regressing injection drug use in PWID, with data needed on effective interventions for this population. PMID: 31704433 [PubMed - as supplied by publisher]
Source: Addictive Behaviors - Category: Addiction Authors: Tags: Addict Behav Source Type: research
Abstract The opioid epidemic is a significant public health concern linked to chronic pain. Despite efforts to change opioid prescribing practices for chronic pain, opioid-involved overdoses remain at an all-time high. Research focused on identifying individual difference factors for problematic opioid misuse in the context of chronic pain have identified certain psychological variables that may confer heightened risk for opioid-related problems. Anxiety sensitivity, or fear of anxiety-related physical sensations, has been linked to opioid-related problems among adults with chronic pain. Yet, it is possible that t...
Source: Addictive Behaviors - Category: Addiction Authors: Tags: Addict Behav Source Type: research
AbstractPurpose of ReviewThe purpose of this review is to examine the impact of the opioid epidemic in adolescents and young adults and recent findings regarding the treatment of opioid use disorder (OUD) in pediatric medical settings.Recent FindingsExisting guidelines for the treatment of chronic pain in adults are not intended to be applied to adolescents, who arguably may need different interventions that balance the need to mitigate the long-term impact of chronic pain with the need to limit opioid misuse. Screening, brief intervention, and referral to treatment is an important upstream strategy to prevent opioid misus...
Source: Current Addiction Reports - Category: Addiction Source Type: research
Publication date: Available online 12 September 2019Source: EXPLOREAuthor(s): Arya. Nielsen, L.Susan. WielandAbstractCochrane is an international non-profit organization established in 1993 to produce and disseminate high quality and unbiased systematic reviews of evidence on health care interventions. At the forefront of systematic review methodology, Cochrane is generally accepted to be among the most carefully prepared and rigorous sources of systematic review evidence. There are numerous Cochrane reviews on nonpharmacologic interventions for pain and multiple Cochrane reviews evaluating acupuncture therapy in pain cond...
Source: EXPLORE: The Journal of Science and Healing - Category: Complementary Medicine Source Type: research
Depending on what you read, kratom is a dangerous, addictive drug with no medical utility and severe side effects, including overdose and death, or it is an accessible pathway out of undertreated chronic pain and opiate withdrawal. How can the US Drug Enforcement Agency (DEA), medical professionals, and millions of regular kratom users have such divergent views of the same plant? What is kratom? Kratom (Mitragyna speciosa) is a tropical tree from the coffee family native to Southeast Asia, with properties that range from stimulant-like, energizing and uplifting, to opiate-like, causing drowsiness and euphoria. Kratom has d...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Addiction Pain Management Vitamins and supplements Source Type: blogs
CONCLUSIONS: A high level of willingness to wear an overdose detection device was observed in this setting and a range of factors associated with overdose were positively associated with willingness. Since some factors, such as homelessness may be a barrier, further research is needed to investigate explanations for unwillingness and to evaluate real world acceptability of a wearable overdose detection devices as this technology becomes available. PMID: 31269963 [PubMed - in process]
Source: Addiction Science and Clinical Practice - Category: Addiction Authors: Tags: Addict Sci Clin Pract Source Type: research
Conclusions: These findings highlight a vulnerable population of polysubstance users with chronic pain, and indicates the need for more comprehensive assessment and treatment of chronic pain.
Source: Journal of Addiction Medicine - Category: Addiction Tags: Original Research Source Type: research
By CLAIRE GALOFARO Associated Press The World Health Organization notified U.S. lawmakers last Wednesday that it will discontinue two publications on prescribing opioid painkillers in response to allegations that the pharmaceutical industry influenced the reports. The pledge to remove the guidelines comes a month after U.S. Reps. Katherine Clark and Hal Rogers accused the WHO of being influenced by Purdue Pharma, the American manufacturer of the potent painkiller OxyContin. The lawmakers' report claimed the guidelines, crafted in part by organizations with financial ties to the company, downplay the risk of opioids despite...
Source: JEMS: Journal of Emergency Medical Services News - Category: Emergency Medicine Authors: Tags: News Patient Care AP News Tag Source Type: news
CONCLUSION: The epidemic of opioid misuse has shown that there is a lack of fundamental knowledge about the characteristics and management of chronic pain, that conflicts of interest and validity of models must be more intensively considered in the context of drug development and that novel analgesics with less addictive potential are urgently needed. Currently, the most promising perspectives appear to be augmenting endogenous opioid actions and the selective activation of peripheral opioid receptors. PMID: 31222410 [PubMed - as supplied by publisher]
Source: Schmerz - Category: Anesthesiology Authors: Tags: Schmerz Source Type: research
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