I ’m a doctor. I worry every time I prescribe painkillers to a patient. - Vox
& quot;Please, I need my Oxycodone! & quot; my patient, M, pleaded with me. < br > < br > My eyes met his. I observed every fleeting facial expression, hoping to gauge his intentions. The discussion about whether to continue to prescribe this medication was one I & #39;d had too many times with too many patients over the past few months. < br > < br > & quot;My arthritis is always worst in the winter, & quot; he said, rubbing his lower back. < br > < br > It was a snowy afternoon in clinic, and M and I were in the midst of a debate. Oxycodone is an opioid medication, and, like other painkillers such as Oxycontin, Percocet,...
Source: Psychology of Pain - March 16, 2016 Category: Anesthesiology Source Type: blogs

Who should bear a dying man’s burden?
Sedated by Oxycodone, Ted slept despite the rhythmic ruckus of his breathing machine. He never felt quite rested in the hospital. While awake, his gaze often lingered on a snapshot that captured him in the past: full of laughter and radiant joy with his little granddaughter, Tara. The grandfather in the photo — muscular, mischievous — barely resembled the emaciated elder in the bed who silently mouthed short answers to my questions. Ted had come to the hospital for cancer chemotherapy, but, within a few weeks, he became inseparable from his ventilator. Soon, he began needing dialysis as well. By the time I met ...
Source: Kevin, M.D. - Medical Weblog - March 16, 2016 Category: Journals (General) Authors: Tags: Physician Palliative care Source Type: blogs

Fight The Urge To Criminalize Opioid Addiction Behaviors
Editor’s note: This post is part of a Health Affairs Blog Symposium on Health Law stemming from 4th Annual Health Law Year in P/Review conference hosted by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. Holly Fernandez Lynch wrote an introductory post in January 2016 and you can access a full list of symposium pieces here or by clicking on the “The Health Law Year in P/Review” tag at the bottom of any symposium post. You can also watch the video of the presentation on which this post is based. It’s well known that the U.S. is in the midst of a prescription opi...
Source: Health Affairs Blog - March 9, 2016 Category: Health Management Authors: Rebecca Haffajee Tags: Drugs and Medical Technology Public Health Quality criminal justice drug treatment needle exchange programs Opioid Addiction prescription drug addiction The Health Law Year in P/Review Source Type: blogs

Endo New York Settlement Announcement
New York Attorney General Eric T. Schneiderman announced an agreement with Endo Health Solutions, Inc. and Endo Pharmaceuticals, Inc. (collectively, "Endo"), which make and sell Opana ER, a long-acting opioid. Opana, one of Endo's prescription drugs, was long abused in New York State. In May 2011, for example, after a spike in opioid prescribing and abuse, Nassau County issued a Public Health Alert on the increasing use and abuse of Opana ER, warning both the public and law enforcement of the dangers associated with the prescription drug. In July 2012, USA Today reported that Opana ER was actually the drug of choice for ...
Source: Policy and Medicine - March 9, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Kay’s food addictions . . . gone
Kay shared her Wheat Belly experience over her first 4 weeks: “After over 30 years of battling food addiction and morbid obesity, I had just about given up. You name it, I have tried it, even lap-band surgery which worked temporarily but, of course, did not solve the problem. “Now, for the first time in my life, I am not struggling with food: I am not craving, obsessing, or even really thinking about food. I’ve been doing Wheat Belly about a month and am down about 20 pounds, but the most striking thing is that my desire to eat compulsively is GONE. I am utterly stunned by this. “I can’t beg...
Source: Wheat Belly Blog - February 28, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Success Stories addictions binge eating bulimia exorphins food addictions gluten grains opiates Source Type: blogs

2016 The Year of Pharmacy Enforcement
Conclusion The unfortunate thing is that in all four cases this was preventable.  In the Palisades, Nashville and CVI cases, the proper internal review and the establishment of SOPs, basic training, and monitoring were the need. In the case of MedIV, establishing a Quality Management System and following current Good Manufacturing Practices could have prevented needless tragedy. Over the years, pharmacy compliance programs have been sorely neglected. Pharmacies and pharmacists need to take compliance seriously and take the necessary steps to establish or reinforce their programs -- before the Government com...
Source: Policy and Medicine - February 19, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

What Do We Know About Medical Errors Associated With Electronic Medical Records?
By ROSS KOPPEL Recently, the Journal of Patient Safety published a powerful and important article on the role of EHRs in patient harm, errors and malpractice claims. The article is open access. Electronic Health Record–Related Events in Medical Malpractice Claims by Mark L. Graber, Dana Siegal, Heather Riah, Doug Johnston, and Kathy Kenyon.  

The article is remarkable for several reasons: Considerably over 80% of the reported errors involve horrific patient harm: many deaths, strokes, missed and significantly delayed cancer diagnoses, massive hemorrhage, 10-fold overdoses, ignored or lost critical lab results, ...
Source: The Health Care Blog - January 11, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

LITFL R&R – Best of 2015
This article is one more piece of the mounting evidence demonstrating a clear call to change what is the usual care in many  institutions in the U.S. Stop the madness! Chest pain is tough — it’s the second most ED common chief complaint, and it scares the heck out of us and our patients – partially because missed MI is one one of the top causes of litigation. But we also see a ton of resources spent on a terribly low yield from chest pain workups. This new study in JAMA-IM including Mike Weinstock (of Bounceback fame), Scott Weingart and David Newman looked at the bad outcomes of patients with normal ECG...
Source: Life in the Fast Lane - January 9, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Trauma critical care examination research and reviews Source Type: blogs

Kentucky Attorney General Settles Two Cases Against Life Science Companies
Kentucky Attorney General Jack Conway has settled a lawsuit with Purdue Pharma, the manufacturer of OxyContin, for $24 million. AG Conway also settled a suit with Johnson & Johnson over their drug Risperdal for $15.5 million. Neither company admits to any wrongdoing in the settlements. AG Conway stated that, "[t]hese companies engaged in reckless behavior that put our citizens at risk. Both companies knowingly and aggressively marketed drugs they knew to be harmful in order to drive profits. I am pleased we were able to recover damages for the Commonwealth and recover funds to help expand addiction treatment in Kentu...
Source: Policy and Medicine - January 8, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Opioid Drugs for Mental Anguish: Basic Research and Clinical Trials
The prescription opioid crisis of overdosing and overprescribing has reached epic proportions, according to the North American media. Just last week, we learned that 91% of patients who survive opioid overdose are prescribed more opioids! The CDC calls it an epidemic, and notes there's been “a 200% increase in the rate of overdose deaths involving opioid pain relievers and heroin.” A recent paper in the Annual Review of Public Health labels it a “public health crisis” and proposes “interventions to address the epidemic of opioid addiction” (Kolodny et al., 2015).In the midst of this public and professional outc...
Source: The Neurocritic - January 7, 2016 Category: Neuroscience Authors: The Neurocritic Source Type: blogs

Stealth Public Relations and Health Advocacy, Special Pleadings and the Opposition to Guidelines Discouraging Overuse of Narcotics
As I have written before as a physician who saw too many dire results of intravenous drug abuse, I was amazed how narcotics were pushed as the treatment of choice for chronic pain in the 1990s, with the result that the US was once again engulfed in an epidemic of narcotic abuse and its effects.  In mid-December, 2015, as reported in the Washington Post,The nation continues to suffer through a widespread epidemic to prescription opioids and their illegal cousin, heroin. The CDC estimated that 20 percent of patients who complain about acute or chronic pain that is not from cancer are prescribed opioids. Health-care prov...
Source: Health Care Renewal - January 4, 2016 Category: Health Management Tags: CDC Cephalon conflicts of interest deception Endo Health Solutions Johnson and Johnson narcotics public relations Purdue Pharma stealth health policy advocacy Source Type: blogs

Off-label Marketing is "Dead," Diversion Cases on the Rise
"Off-label marketing is dead so-to-speak. There's been a death knell of that."  That news was delivered by Charlene Fullmer, Deputy Director of the Department of Justice's Affirmative Civil Enforcement ("ACE") unit in Philadelphia at the Pharmaceutical Compliance Congress and Best Practices Forum. Fullmer was joined by colleagues Kristen Williams and Jeff Steger for the AUSA panel, an annual event at the Compliance Congress that offers insight into what's coming across the desks of top attorneys at the DOJ.  As Fullmer explained it, the DOJ continues to prosecute pharmaceutical companies for off-label ...
Source: Policy and Medicine - November 5, 2015 Category: American Health Authors: Policy and Medicine Writing Staff Source Type: blogs

Research & Reviews in the Fastlane 106
This study investigated the use of apneic oxygenation in the ICU. The researchers found no difference in the lowest O2 sat. However, it’s unclear if this study is applicable to the ED setting and it likely does not reflect our standard management (33% had BPAP during apnea, 40% had BVM during apnea). For now, collective anecdotes of efficacy reign while we await research in the ED setting. The authors conclusion is that apneic oxygenation does not appear to increase lowest arterial oxygen saturation during endotracheal intubation of critically ill patients compared to usual care. Although this is the first randomized...
Source: Life in the Fast Lane - October 28, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Clinical Research ECG Education Emergency Medicine Intensive Care Pediatrics Public Health R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs

How Many More Annas Must Die?
It’s been over a year since my older sister Anna died, so I choke up less readily while speaking about it.  The raw anger is less, but the frustration of losing someone to a preventable medical mistake will always remain with me.   Anna was five years older than me, my only sister, and the one I often turned to for advice. We were close despite living 600+ miles apart.  She was smart and insightful; she was at ease in most social situations. I, on the other hand, was the nerdy kid sister who loved science, who became a physician in my early 40’s. In 2012, Anna’s world turned upside down when she was diagnosed wit...
Source: Disruptive Women in Health Care - September 29, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Advocacy Policy Publc Health Quality Source Type: blogs

California Steps Up To Respond To The Opioid Addiction Epidemic
Saturday, September 26, 2015, marks the tenth annual National Prescription Drug Take-Back Day, led by the US Drug Enforcement Administration and participating local law enforcement organizations across the country. While prescription medications play an important role in the health of millions of Americans, this event recognizes that unused drugs pose a health risk to people who take them without a prescription and pose an environmental risk when they are disposed of improperly. This Saturday, Americans are urged to bring unwanted medications to a free and anonymous collection site in their community. Efforts like Take-Bac...
Source: Health Affairs Blog - September 24, 2015 Category: Health Management Authors: Kelly Pfeifer Tags: Drugs and Medical Technology GrantWatch Health Professionals Hospitals Public Health California California HealthCare Foundation Health Philanthropy Opioid Addiction Substance Use Prevention Source Type: blogs