Mexico ’s poor have little luck obtaining opioids intended for palliative care

If you ’re poor and terminally ill in southern Mexico, there’s far less chance you’ll get the painkillers you need for palliative care than your cousins in more prosperous regions, particularly those pharmacy-rich areas along Mexico–U.S. border, say UCLA researchers and colleagues who studied opioi d dispensing levels across the country.What ’s more, the researchers’ paper in the journalThe Lancet Public Health suggests it ’s likely that some of the opioids intended for Mexican citizens are ending up in American pockets.Despite a Mexican government initiative launched in 2015 to improve access to prescription opioids among palliative care patients, the country has seen only a marginal increase in dispensing levels, and inequities in dispensing have left many of the nation ’s poorest residents without comfort in their final days, said lead author Dr. David Goodman-Meza, an assistant professor of medicine in the infectious diseases division at theDavid Geffen School of Medicine at UCLA.“People in the poorest areas of Mexico are dying in pain,” Goodman-Meza said. “A lot of work needs to be done to increase access to opioids for those who have a medical need for them in Mexico.”The researchers analyzed data on prescription drug dispensing from August 2015 to October 2019 for all 32 Mexican states and six large metropolitan areas. They compared opioid prescribing levels against the expected need for the drugs ...
Source: UCLA Newsroom: Health Sciences - Category: Universities & Medical Training Source Type: news

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Nearly 50% of cancer patients and 75% of those with advanced cancer suffer from disease-related pain. [1] In light of the opioid epidemic and high rates of prescription opioid misuse in the United States, there is an emphasis to prescribe responsibly, which includes using non-opioid modalities, careful screening and monitoring for opioid misuse. [2-4] It is recommended to treat mild to moderate cancer pain first with non-opioid analgesics (such as NSAIDS or acetaminophen), adjuvant analgesics (such as antidepressants, anticonvulsants, topical agents or corticosteroids) psychosocial support, physical therapy, education and ...
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
This study aimed to synthesise evidence for the role and response of palliative care and hospice teams to viral epi/pandemics, to inform the COVID-19 pandemic response. We conducted a rapid systematic review according to PRISMA guidelines in five databases. Of 3094 papers identified, ten were included in this narrative synthesis. Included studies were from West Africa, Taiwan, Hong Kong, Singapore, the United States and Italy.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Tags: COVID-19 for Fast Track Publication Source Type: research
CONCLUSION: The absence of opioid stewardship and prospectively screening ORAEs represents a gap in current practice at surveyed hospitals. Hospitals have an opportunity to implement and refine best practices such as access to pain management specialists, use of formulary restrictions, and retrospective and prospective monitoring of adverse events to improve opioid use. PMID: 32236455 [PubMed - in process]
Source: American Journal of Health-System Pharmacy : AJHP - Category: Drugs & Pharmacology Authors: Tags: Am J Health Syst Pharm Source Type: research
COVID-19 is anticipated to spread widely in the United States by the end of 2020.(1) Widespread transmission of COVID-19 in the United States could translate into large numbers of people needing medical care at the same time. This will push many health systems to the point of rationing limited resources such as ICU beds and life sustaining machinery, as has occurred in Italy.(2) Patients and their families at the peak of the pandemic will face symptoms, emotional distress, and decision-making in the face of uncertainty and limited options.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Tags: Letter Source Type: research
The United States continues to face a public heatlh crisis of epic proportion, with over 500,000 deaths from opioid overdoses since 2000. Medications for opioid use disorder, like buprenorphine, offer patients an effective approach to cessation. Unfortunately many barriers to use of medications for opioid use disorder exist, including insufficient number of programs offering medications for opioid use disorder, inadequate number of addiction specialists to provide these medications, and stigma surrouding patients with opioid use disorders and the medications used to treat them.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
Guidelines for safe opioid prescribing practices have largely excluded palliative care populations and there is a general lack of evidence for appropriate risk mitigation measures in this population. In lieu of such guidelines many have recommended using a “universal precautions” approach using tools from the chronic pain arena.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
It is well known that loneliness is a significant risk factor for premature mortality and is comparable with the effects of smoking. However, little attention has been paid to the terrible impact of loneliness and social isolation experienced by seriously ill patients. On the provider side, palliative clinicians often feel profoundly isolated from the traditional curative medical culture exclusively focused on diseases. Being alone and loneliness are different but related. Social isolation is the objective physical separation from other people while loneliness is the subjective distress feeling of being alone or separated.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
This study evaluated the utility of ketamine and/or lidocaine in decreasing opioid consumption during acute pain episodes in adolescents with sickle cell disease. There has been an increased effort to promote opioid-sparing pain relieving methods given the ongoing opioid epidemic. Recent findings There have been six studies published over the past decade that highlight the ability of ketamine to reduce opioid consumption in the management of sickle cell disease-related pain, primarily in adult patients. There has been one study (2015) that demonstrated a similar benefit with lidocaine, however this was also in adult pat...
Source: Current Opinion in Supportive and Palliative Care - Category: Palliative Care Tags: BLOOD, BONE MARROW AND LYMPHATICS: Edited by Christopher Dalley Source Type: research
Authors: Kalangara J, Potru S, Kuruvilla M Abstract While opioids represent one of the most common medication allergy labels, these labels are often unsubstantiated in clinical practice. The removal of erroneous opioid allergy labels has a unique importance in the population with acute or chronic pain. The current approach to patients with pseudo-allergy to opioids is switching to an alternative opioid with less histamine release. Thus, allergy labels to relatively lower potency opioids such as codeine may be feasibly result in the prescription of stronger medications like fentanyl that would otherwise not be indic...
Source: Journal of Pain and Palliative Care Pharmacotherapy - Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research
by Drew Rosielle (@drosielle)This is the second in a series of several posts about many aspects of my current thinking about opioids.The first post is here:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Over-prescribing fueled the current drug overdose epidemic, and many of us who thought we were stamping out needless suffering contributed to the epidemic.A lot of what I read and believed about opioids early on in my career was wrong.I ’m old enough to remember those heady days in which there was a pretty large and ‘successful’ movement in American medicine to gr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs
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