Undoing the harm: Tapering down from high-dose opioids

For many years, health care providers like me were told that we were undertreating pain and that pain was a vital sign that needed to be measured. Concurrently, we were reassured that opioids were a safe and effective way to treat pain, with very little potential for development of abuse. As a result, opioid prescriptions in the United States skyrocketed. A common way to compare opioids is to calculate their strength relative to morphine, called morphine milligram equivalents, or MMEs. In 1992, our country dispensed 25 billion MMEs of prescription opioids; by 2011, that number had reached 242 billion. Meanwhile, opioid-related deaths and treatment admissions increased in parallel. Over the past several years, we have come to recognize that high doses of opioids for patients with chronic, non-cancer pain can be extremely dangerous. Furthermore, there is increasing evidence that long-term opioid therapy is not very efficacious. Multiple studies culminated in the Centers for Disease Control and Prevention (CDC)’s 2016 Guideline for Prescribing Opioids for Chronic Pain, which states that providers “should avoid increasing dosage to 90 MME or more per day or carefully justify a decision to titrate dosage to 90 MME or more per day.” As a point of reference, a commonly prescribed opioid is oxycodone, the medicine in the brand name Percocet. A 5-mg dose of oxycodone equals 7.5 MMEs, so you would reach the 90 MME threshold by taking 12 or more of these pills per day....
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Addiction Pain Management Risks and Prevention Source Type: blogs

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ConclusionsPamidronate is a safe and efficient method of CRMO therapy, particularly in cases refractory to NSAIDs treatment. Treatment with pamidronate provides both symptomatic relief as well as normalisation of bone morphology.
Source: Joint Bone Spine - Category: Orthopaedics Source Type: research
Publication date: Available online 16 June 2019Source: Joint Bone SpineAuthor(s): Pierre Letellier, Florian Bailly, Marina Assadourian, Antoine Potel, Violaine Foltz, Sophia Ascione, Laetitia Morardet, Myrianne Le Ralle, Bruno Fautrel, Arnaud Dupeyron, Nada Ibrahim-Nasser, Isabelle Griffoul-Espitalier, Bernard Duplan, Johann Beaudreuil, Laure Gossec
Source: Joint Bone Spine - Category: Orthopaedics Source Type: research
Pfizer has agreed to buy Array Biopharma in a $10.64 billion cash deal.
Source: PharmaManufacturing.com - Category: Pharmaceuticals Source Type: news
With all the news media accounts and reports from governmental health organizations about the opioid epidemic, including the 70,237 drug overdose deaths in 2017, a newly emerging threat is gaining attention: use and misuse of benzodiazepines, opioid drugs and Z-drugs. Specifically, combining these three drugs can create a deadly combination that snuffs out lives. Benzodiazepine Overdose Deaths on the Rise Benzodiazepines, a class of sedative narcotic drugs including Xanax and Valium used to treat anxiety, insomnia and other disorders and classified as Schedule IV under the Controlled Substances Act by the Drug Enforcement ...
Source: Psych Central - Category: Psychiatry Authors: Tags: Addictions Substance Abuse Suicide Source Type: news
The crushing toll of the opioid crisis is daily news, including stories about ways to “fix” it. A wide array of initiatives has been brought forward in an attempt to curb this epidemic and the damage it causes. Prescription monitoring programs (PMPs) are one of them. The goal of PMPs is a good one — to identify patients who are being prescribed multiple medications by multiple clinicians. It is a means to introduce some stewardship for preventing overuse and misuse of prescription drugs. How prescription monitoring programs work Prescription monitoring programs are state-based electronic databases that pr...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Addiction Drugs and Supplements Health Source Type: blogs
Conclusion Clinicians should be aware of state laws regarding consent for alcohol and substance use treatment for minors. While family participation is the ideal strategy for treatment, minors can invoke the right of confidentiality to bar clinicians from sharing information regarding substance use with their families. Clinicians should obtain appropriate consent for communications and maintain confidentiality when possible, but above all ensure the safety of the adolescent while providing optimal care. Advice from peers, hospital ethical committees, and/or attorneys is recommended in these situations. Acknowledgment The a...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Child Adol Mental Disorders Commentary Current Issue Ethics in Psychiatry Substance Use Disorders adolescents confidentiality diversion opioids safety Source Type: research
This past week, Governor John Kasich of Ohio issued an executive order limiting the amount of opioids doctors and dentists can prescribe to no more than a 7 day supply. Failure to comply could result in disciplinary action, including loss of license. Exceptions exist only for patients with cancer or those enrolled in hospice programs. For all the rest, it represents a hard full stop. No longer will the chronic pain sufferer, the woman status post lumbar back fusion x 3, be able to get a prescription for a month's supply of oxycodone with 3 refills.On the surface this appears to be a reasonable initiativ...
Source: Buckeye Surgeon - Category: Surgery Authors: Source Type: blogs
By KAREN SIBERT, MD A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling to see it become the cause of rising numbers of deaths from overdose.  Fentanyl is a potent medication, useful in the operating room to cover the intense but short-...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Fetanyl Source Type: blogs
By KAREN SIBERT, MD A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling to see it become the cause of rising numbers of deaths from overdose.  Fentanyl is a potent medication, useful in the operating room to cover the intense but short-...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Fetanyl Source Type: blogs
"If you do not change direction, you may end up where you are heading." -- Lao Tzu Over the last few weeks, the CDC, the U.S. Department of Health and Human Services (HHS), and the president of the United States have all separately hit the emergency button over the subject of chronic pain treatment and opioid pain killers. Concerns over the rising tide of pain killer addiction, accidental overdose deaths, and a carryover effect causing a steep rise in heroin use have made this a "code blue" emergency for Washington. President Obama has made it clear that addressing the opioid epidemic is now an administ...
Source: Healthy Living - The Huffington Post - Category: Consumer Health News Source Type: news
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