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 ...
by Chad D. Kollas MD, Terri A. Lewis PhD, Beverly Schechtman and Carrie Judy“I'm present. Uh … I do have a conflict. I receive funding to conduct reviews on opioids, and I'll be recusing myself after the um, director's, uh, um, um, uh … update.”- Dr. Roger Chou, Center for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control (NCIPC) Board of Scientific Counselors (BSC) Meeting Friday, July 16, 2021.IntroductionFor those familiar with the controversial relationship between the anti-opioid advocacy group, Physicians for Responsible Opioid Prescribing (PROP, recently...
CONCLUSION: Further research is necessary to examine the possible negative impact of the opioid epidemic on opioid prescribing in hospice and palliative care.PMID:34292770 | DOI:10.12968/ijpn.2021.27.5.255
ConclusionDespite being turned back from an effort to bluntly reduce opioid prescribing by the FDA in 2013 based on a lack of scientific evidence for its position (17,18), PROP has had a disproportionate effect on opioid policy in the Untied States for almost a decade. PROP found a willing federal regulatory partner in the CDC, and while PROP may not have “secretly written” the 2016 CDC Pain Guidelines (75), they certainly enjoyed disproportionate representation on CDC’s review panels and Core Expert Group (23-25) in a process that lacked transparency (22, 23, 26, 27). When the CDC admitted that its Pain ...
Nearly 50% of cancer patients and 75% of those with advanced cancer suffer from disease-related pain.  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 ...
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.
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]
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.
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.
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.
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.
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