DEA Is About to Demonstrate “How Little They Know About What They Imagine They Can Design”
Jeffrey A. SingerLast month the Drug Enforcement Administration, tasked with setting quotas for opioid production in the U.S,announced a proposal to reduce production levels another 10 percent, having already reduced production by 25 percent in 2017 and an additional 20 percent in 2018. This would bring down production levels to 53 percent of 2016 levels. Yesterday the DEA released aproposal to develop “use-specific” quotas. The DEA press release explains this as follows:Today ’s proposal amends the manner in which DEA grants quotas to manufacturers for maintaining inventories…The proposal also introduces several n...
Source: Cato-at-liberty - October 24, 2019 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Synthetic Opioid Crisis Still Growing, Often Among Unwitting Users
Although opioid prescriptions in the U.S. have fallen, opioid overdose deaths remain at historic levels. The continued spread of fentanyl and other illicitly manufactured synthetic opioids suggests the problem could still get worse. (Source: The RAND Blog)
Source: The RAND Blog - October 13, 2019 Category: Health Management Authors: Bryce Pardo; Beau Kilmer Source Type: blogs
More Research Shows It's Not The Prescriptions, It's The Prohibition
Jeffrey A. SingerThe latest issue ofPublic Health Reports (the official journal of the Office of the Surgeon General and U.S. Public Health Service) presents a study by researchers at Boston University and the Massachusetts Department of Public Health which provides further evidence that the narrative driving present opioid overdose policy —that it results primarily from doctors prescribing opioids to patients in pain—is wrong. It results from non-medical drug users accessing drugs in the black market that results from prohibition. In the early part of this century the “drugs of choice” for non-medical users were d...
Source: Cato-at-liberty - October 9, 2019 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
The Rise and Rise of Quantitative Cassandras
By SAURABH JHA, MD
Despite an area under the ROC curve of 1, Cassandra’s
prophesies were never believed. She neither hedged nor relied on retrospective
data – her predictions, such as the Trojan war, were prospectively validated. In
medicine, a new type of Cassandra has emerged –
one who speaks in probabilistic tongue, forked unevenly between the
probability of being right and the possibility of being wrong. One who, by conceding
that she may be categorically wrong, is technically never wrong. We call these
new Minervas “predictions.” The Owl of Minerva flies above its denominator.
Deep learning (DL)...
Source: The Health Care Blog - October 7, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Artificial Intelligence Data Medical Practice Physicians RogueRad @roguerad acute kidney injury AI deep learning machine learning predictions Saurabh Jha Source Type: blogs
Part 2 - We Were Wrong 20 Years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid Doses
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 greatly liberalize...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 3, 2019 Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs
Delivering a New Postal Trade Deal
Simon LesterWe at Cato's trade policy center have criticized the Trump administration's trade policy quite a bit these past couple years, but last October I wrote positively about the administration's attempt to reform an obscure international agency at the margins of trade policy (but kind of central to some actual trading):The administration is concerned about the Universal Postal Union (UPU), a specialized agency of the UN.The UPU was established by the Berne Treaty of 1874 and became a UN agency in 1948. The administration has taken issue with the "terminal dues" rates issued by the UPU, under which, the administr...
Source: Cato-at-liberty - September 26, 2019 Category: American Health Authors: Simon Lester Source Type: blogs
Is the DEA Branching Out Into Regulating Medicine?
Jeffrey A. SingerThe Drug Enforcement Administration, having virtually eliminated the diversion of prescription pain relievers into the underground market for nonmedical users, appears to be setting its sights on regulating the medical management of pain, a mission not suited for law enforcement. Acting under the authority of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act), the DEA announced a proposal to reduce, once again, the national production quotas for fentanyl, morphine, hydromorphone (Dilaudid), oxycodone, and oxymorphone, bringing...
Source: Cato-at-liberty - September 23, 2019 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Tackle Fentanyl like a Poisoning Outbreak, Not a Drug Epidemic
America ' s fentanyl problem is far deadlier than past crises with other illegal drugs. New ideas, be they public policies, technologies or law enforcement strategies, are desperately needed. Continuing to treat fentanyl just like previous drug epidemics will likely be insufficient and may condemn thousands more to early deaths. (Source: The RAND Blog)
Source: The RAND Blog - September 2, 2019 Category: Health Management Authors: Bryce Pardo; Jonathan P. Caulkins; Beau Kilmer Source Type: blogs
NJ Appellate Court Overturns Suspension of Aid-in-Dying Law
This morning, a New Jersey appellate court overturned a superior court’s temporary restraining order that had suspended the state’s new medical aid-in-dying law.
The court’s ruling stated: “Having reviewed the record against the applicable law, we conclude the court abused its discretion in awarding preliminary injunctive relief...Accordingly, we dissolve the restraints issued pursuant to the August 14, 2019 order.”
The appellate court ruling reinstated the law, which originally took effect on Aug. 1. Now, terminally ill state residents will be able to use it to peacefully end their suff...
Source: blog.bioethics.net - August 27, 2019 Category: Medical Ethics Authors: Thaddeus Mason Pope, JD, PhD Tags: Health Care syndicated Source Type: blogs
Shaking Down Drug Makers Won't Stop IV Drug Users
On August 26 Oklahoma State Judge Thad Balkman ruled that Johnson& Johnson must pay $572 million to the state of Oklahoma for contributing to the local opioid addiction crisis. Johnson& Johnson sold two opioids: a fentanyl skin patch with the brand name Duragesic, and Nucynta,a synthetic opioid similar to tramadol but stronger.Nucynta is not as addictive as most other synthetic and semi-synthetic opioids and has been shown to have low levels of abuse in post-marketing studies. Fentanyl skin patches are very difficult and inconvenient to convert for non-medical use. The Drug Enforcement Administration claims th...
Source: Cato-at-liberty - August 27, 2019 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
It's Not The Number of Pills--It's The Number of Deaths That Matter
A letter to the editor in the August 14 New England Journal of Medicine by researchers at the University of Michigan proudly reported on the results of their effort, called the Michigan Surgical Quality Collaborative (MSQC), to reduce the volume of opioids prescribed for postoperative pain. The Collaborative developed a set of guidelines for its participating prescribers.As a result, they found that from January 2017 through May 2018, the mean number of pills prescribed for postoperative pain decreased from 26 (+/-2) pills pre-guideline to 18 (+/ – 3) pills post-guideline. Patient pill consumption also decreased from ...
Source: Cato-at-liberty - August 16, 2019 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Senator Portman Presumes To Know How Many Days Of Pain Relief All 328 Million Americans Need
With clear evidence that restricting the number of prescriptions increased the death rate by driving non-medical users to heroin and fentanyl, the last thing one wants to hear about is a politician planning to double down on this deadly policy by calling for further prescription limits for patients in pain.Yet Senator Robert Portman (R-OH) is proposing legislation that would impose a national 3-day limit on opioid prescriptions following surgeries. He will be kind enough to allow exceptions for people dealing with cancer, chronic pain, and “other serious matters”—whatever that means.Government data show there i...
Source: Cato-at-liberty - July 26, 2019 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Washington Post Revelation of Pain Pill Distribution Only Helps to Fuel the False Narrative
The Washington Post recently received access to a database maintained by the Drug Enforcement Administration that tracks the manufacture and distribution of every prescription opioid in the country. It reported that 76 billion pills were distributed throughout the US between 2006 and 2012, with higher volumes shipped to the areas that were most hard hit with opioid-related overdose deaths. This is being offered as proof that the overprescribing of prescription opioids caused the overdose crisis. But this flies in the face of other powerful evidence. Research reported in the Journal of Pain Research last February t...
Source: Cato-at-liberty - July 18, 2019 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
