The Agony of Withdrawal
Part 3 in a Four-Part SeriesA 26-year-old man presented with fatigue. He complained of body aches, diarrhea, and nausea. His history was significant for chronic back pain, for which he had been prescribed oxycodone that he has taken daily for three years. He reported that he had stopped taking it two days before his visit.He denied other medication or drug use. He was alert but restless and diaphoretic. His ECG showed sinus tachycardia. His labs included a WBC of 12, Hgb of 12, glucose of 89 mg/dL, creatinine of 1.0 mg/dL, sodium of 140 mEq/L, potassium of 3.8 mEq/L, and CK of 140 U/L. He was experiencing opioid with...
Source: The Tox Cave - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Ideology vs. Science
Joshua Sharfstein in JAMA discusses the opioid abuse epidemic and what to do about it. This is an opinion piece that doesn ' t have references, but I can assure you that he is right on the facts. People with opioid addiction seldom succeed in maintaining long term recovery without what we call Medication Assisted Treatment. That means either methadone or buprenorphine, both of which are themselves opioids. As Sharfstein tell us, " Many still believe that those who take methadone or buprenorphine are ' trading one addiction for another, ' ' in bondage, ' or ' taking a cop-out. ' " People who are using these medications may ...
Source: Stayin' Alive - February 14, 2018 Category: American Health Source Type: blogs
Involuntary treatment for substance use disorder: A misguided response to the opioid crisis
Recently, Massachusetts Governor Charlie Baker introduced “An Act Relative to Combatting Addiction, Accessing Treatment, Reducing Prescriptions, and Enhancing Prevention” (CARE Act) as part of a larger legislative package to tackle the state’s opioid crisis. The proposal would expand on the state’s existing involuntary commitment law, building on an already deeply-troubled system. Baker’s proposal is part of a misguided national trend to use involuntary commitment or other coercive treatment mechanisms to address the country’s opioid crisis.
The CARE Act and involuntary hold
Right now, Section 35 of Massachuset...
Source: Harvard Health Blog - January 24, 2018 Category: Consumer Health News Authors: Leo Beletsky, JD, MPH Tags: Addiction Health Source Type: blogs
Stop Calling it an Opioid Crisis--It's a Heroin and Fentanyl Crisis
The National Center for Health Statisticsreported last month that a record 63,600 deaths occurred in 2016 due to overdoses. Diggingdeeper into that number shows over 20,000 of those deaths were due to the powerful drug fentanyl, more than 15,000 were caused by heroin, and roughly 14,500 were caused by prescription opioids, although it has been known for years that, inmost cases of prescription opioid deaths, the victims hadmultiple other potentiating drugs onboard. The rest of the deaths were due to methamphetamines, cocaine, benzodiazepines, and methadone.Drugs Involved in U.S. Overdose Deaths* - Among the more than 64,00...
Source: Cato-at-liberty - January 8, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Comparing medications to treat opioid use disorder
This study was widely covered in the press, and many of the sound bites and headlines reporting the two treatments to be equally effective were a bit misleading.
The advantages and disadvantages of buprenorphine (Suboxone, Subutex, Zubsolv, Probuphine, Sublocade)
Buprenorphine is a partial opioid agonist medication. This medication activates the same receptors in the brain as any opioid, but only partly. Because its effects are long-lasting, it can be taken once a day to relieve cravings, prevent withdrawal, and restore normal functioning in someone with opioid use disorder. Because it is a partial agonist, it has a ceilin...
Source: Harvard Health Blog - January 3, 2018 Category: Consumer Health News Authors: Sarah Wakeman, MD, FASAM, Medical Director, Massachusetts General Hospital Substance Use Disorder Initiative Tags: Addiction Health Source Type: blogs
Narcan or Narcan’t?
Part 2 in a Four-part SeriesA 57-year-old man presented with acute onset altered mental status. His family said he had been behaving normally. Prior to dinner, however, he became difficult to arouse, and was speaking gibberish. He was somnolent but arousable to physical stimuli on arrival in the ED.He answered questions inappropriately and would then go back to sleep. His past medical history was consistent with hypertension, hypercholesterolemia, and spinal fusion a month ago. His medications included lisinopril, atorvastatin, and hydrocodone. His vital signs were a blood pressure of 110/65 mm Hg, heart rate of 90 b...
Source: The Tox Cave - January 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Are family physicians the best weapon against opioid crisis?
As the national opioid crisis takes center stage, I want to make a case for the authority of the family physician in managing and treating this problem.
I am a family physician and have been treating patients with opioid dependence and addiction for 12 years. These patients comprise about half of my practice. The other half is representative of a typical primary care practice. I have patients who have been treated at methadone clinics, dedicated buprenorphine clinics and pain clinics. My patients have participated in hospital-based detox programs as well as outpatient and inpatient rehabilitation programs. Most of my patie...
Source: Kevin, M.D. - Medical Weblog - December 31, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/layne-kamalu" rel="tag" > Layne Kamalu, MD < /a > Tags: Physician Pain Management Primary Care Source Type: blogs
Preventing overdose deaths is not one-size-fits-all
By now, we all know that the number of opioid-related deaths in the United States has reached epidemic proportions. Despite the Centers for Disease Control and Prevention declaring an epidemic in 2011, the death rate has continued to increase every year, with more than 30,000 deaths per year now attributed to opioids. Graphs from the CDC show the geographic distribution of the epidemic and demonstrate that nearly the entire United States is involved. This tragic death toll has culminated in many local, state, and federal government initiatives to fix the problem, including President Trump’s recent declaration that the op...
Source: Harvard Health Blog - December 22, 2017 Category: Consumer Health News Authors: Scott Weiner, MD Tags: Addiction Behavioral Health Source Type: blogs
PhRMA Releases New Policy Proposals
On December 11, 2017, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued statements of support for several policy proposals focused on resolving the opioid crisis. The proposals included: limits on prescribing, a ban on prescribing of Schedule II opioids in an office setting, ongoing prescriber training, and expanded access to addiction treatment options.
Along with the policy proposals came an announcement that PhRMA and the Addiction Policy Forum have entered into a multi-year, multi-million dollar initiative to combat the opioid crisis and implement the Forum's plan to help solve the opioid crisis....
Source: Policy and Medicine - December 21, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
If we are serious about addressing the opioid epidemic, this is what we should do
Multiple state leaders, including Maryland Gov. Larry Hogan, and even President Trump have declared states of emergency in response to the opioid epidemic. Policymakers claim to be battling this public health crisis on all fronts, but one arena continues to be conspicuously ignored: our prisons and jails.
Roughly half of all incarcerated individuals suffer from addiction. And in the two weeks following their release, former prisoners are 129 times more likely to die from overdose than members of the general population.
This is despite the fact that we have robust evidence showing that we can decrease the incidence of relap...
Source: Kevin, M.D. - Medical Weblog - December 1, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/justin-berk" rel="tag" > Justin Berk, MPH, MBA < /a > Tags: Physician Emergency Medicine Primary Care Public Health & Policy Source Type: blogs
Looking under the hood: How brain science informs addiction treatment
As a neuroscientist I have been trained to think in a certain way, almost like a car mechanic, who “looks under the hood” at the brains of laboratory rats exposed to drugs. If we can figure out exactly which genes, proteins, brain regions, and neural connections go awry in substance use disorders (SUDs), we can fix those “broken” parts in the brain and design better long-term approaches to addiction treatment. While there is great promise in this approach, it’s not so easy to get under the hood of people who desperately need help with a SUD. It’s very different from working with lab rats. And it can take a long...
Source: Harvard Health Blog - November 15, 2017 Category: Consumer Health News Authors: Elena H. Chartoff, PhD Tags: Addiction Behavioral Health Brain and cognitive health substance use disorders (SUDs) Source Type: blogs
The Modern-Day Plague
Part 1 in a Four-part SeriesA 32-year-old man was taken to the ED by EMS after being found unresponsive in a subway station. His pupils were pinpoint, and he was breathing at fourth breaths per minute. He had a blood pressure of 94/63 mm Hg, pulse oximetry of 91% on room air, and a heart rate of 51 beats per minute. He was given 2 mg of intranasal Narcan by EMS and became more responsive, breathing at 14 breaths per minute with a blood pressure of 125/82 mm Hg, heart rate of 74 bpm, and 98% on room air. He admitted in the ED to using three bags of heroin.The opioid epidemic is a national public health crisis in the U...
Source: The Tox Cave - November 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Hospice: Another sad sector of the opioid crisis
Help yourself?
A person addicted to drugs might do anything to get their hands on the next dose. Whether that means ‘borrowing’ painkillers from a relative who had their wisdom teeth extracted, breaking into cars to grab small bills and coins, or stealing their mother’s jewelry –all things I’ve seen myself– there are no real limits. So I was saddened but not surprised to read Dying At Home In An Opioid Crisis: Hospices Grapple With Stolen Meds, which highlights the trouble dying patients face in keeping hold of their painkillers.
The Kaiser Health News examples are only anecdotal, but th...
Source: Health Business Blog - August 30, 2017 Category: Health Management Authors: dewe67 Tags: Culture Patients Pharma Source Type: blogs
