While Politicians Cut Opioid Prescriptions, Fentanyl —With Help From the “Dark Web” and the USPS— Becomes the Number One Killer
A May 22 story in Bloomberg News describes with painstaking detail the underground pipeline through which the powerful synthetic opioid fentanyl floods the US market. According to the Drug Enforcement Administration, while the Mexican cartel plays a role by using its well-established heroin and methamphetamine d istribution networks, most of the fentanyl comes in to the US from China. The raw materials to make the synthetic opioids are cheap and they can be manufactured rather quickly in small laboratories. The laboratories are constantly creating new variations so as to skirt restrictions the Chinese government places...
Source: Cato-at-liberty - May 23, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
New Research Reinforces Earlier Studies Suggesting PDMPs Are Adding to Opioid Overdose Rate
A study published last year by researchers at the University of Pennsylvania and Pennsylvania State University found that state Prescription Drug Monitoring Programs (PDMPs), a popular method used to drive down the opioid prescription rate, do not drive down opioid overdose death rates, but might have the unintended consequence of adding to them, by driving users to the underground market where dangerous drugs like fentanyl and heroin await them. Another study last October by a Purdue University researcher found that while PDMPs drove down the prescription rate of oxycodone, they significantly drove up the rate of her...
Source: Cato-at-liberty - May 9, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Why physicians should respect the pain patients report
We’re all human beings, but we’re not all alike.
Each person experiences pain differently, from an emotional perspective as well as a physical one, and responds to pain differently. That means that physicians like myself need to evaluate patients on an individual basis and find the best way to treat their pain.
Today, however, doctors are under pressure to limit costs and prescribe treatments based on standardized guidelines. A major gap looms between the patient’s experience of pain, and the limited “one size fits all” treatment that doctors may offer.
Concerns about the opioid epidemic make the problem worse....
Source: Kevin, M.D. - Medical Weblog - May 3, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/karen-s-sibert" rel="tag" > Karen S. Sibert, MD < /a > Tags: Physician Hospital-Based Medicine Pain Management Primary Care Source Type: blogs
Primary care physicians are on the front line of the opioid epidemic. Help them.
When it comes to the opioid epidemic, physicians are some of the best drug dealers around with almost unrestricted access to the purest substances. As the opioid epidemic spirals out of control, physicians continue to be able to provide their patients with a variety of options, including oxycodone, morphine and fentanyl. Many people would be surprised to know that physicians don’t need any additional training to prescribe opiates to their patients especially considering that 40 percent of opioid deaths last year involved a prescription medication. But paradoxically, if physicians want to treat opioid addiction, they are ...
Source: Kevin, M.D. - Medical Weblog - May 1, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/arjun-gokhale-and-john-huston" rel="tag" > Arjun Gokhale, MD and John Huston, MD < /a > Tags: Conditions Pain Management Primary Care Source Type: blogs
New York Times Succumbs to The False Narrative Driving Opioid Policy-and Deaths
In an April 21 editorial, the New York Times succumbs to the false narrative reverberating in the media echo chamber that blames the opioid overdose crisis on doctors overprescribing opioids to their patients in pain. Even worse, the Times perpetuates a significant component of that narrative: the myth that such overprescribing can essentially be traced to nothing more than a single letter to the editor by researchers at Boston University in the New England Journal of Medicine in 1980 touting the low addictive potential of opioids when prescribed in the medical setting. In fact, numerous studies before and after that...
Source: Cato-at-liberty - April 24, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
OPDP Sends First Untitled Letter of 2018
Here we are…barely finished with the first quarter of 2018, and the United States Food and Drug Administration (FDA) Office of Prescription Drug Promotion (OPDP) has finally issued its first untitled letter of the year. The letter, sent to Collegium Pharmaceutical, dealt with an exhibit promoting the company’s opioid drug Xtampza ER (oxycodone).
The exhibit in question was Collegium’s exhibit booth at the American Society of Health-System Pharmacists’ summer 2017 meeting. The exhibit promoted Xtampza ER, which is an opioid approved for managing "pain severe enough to require daily, around-the-clock, long-term opio...
Source: Policy and Medicine - April 13, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
New Study from American Action Forum Adds to the Argument Against Present Supply-Side Opioid Policy
On April 11 the Washington Post cited a new study from the American Action Forum that reinforces arguments I have made here and here, that despite a dramatic reduction in the opioid prescription rate —a 41 percent reduction in high-dose opioid prescriptions since prescriptions peaked in 2010—the overdose rate continues to climb, as nonmedical users have simply migrated to more dangerous substitutes like fentanyl and heroin while the supply of diverted prescription opioids suitable for abuse continues to come down.I have a minor quibble with the study ’s finding that “the annual growth rate of prescription o...
Source: Cato-at-liberty - April 12, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Celebrities get shingles, too
Follow me on Twitter @RobShmerling
Perhaps you heard the news recently that Lin-Manuel Miranda has shingles. Headlines announced this in a variety of ways:
Hamilton creator Lin-Manuel Miranda is suffering from shingles (NY DailyNews)
Lin-Manuel Miranda has shingles; must be quarantined from his baby (today.com)
Lin-Manuel Miranda has shingles, regrets joke about blurred vision (CBS News).
Without more information, these headlines might leave you wondering: is this a serious condition? Is it dangerous for children? Can it lead to blindness?
What is shingles?
The term “shingles” refers to a painful rash caused by infec...
Source: Harvard Health Blog - April 11, 2018 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Health Infectious diseases Skin and Hair Care Vaccines Source Type: blogs
America's War on Pain Pills Is Killing Addicts and Leaving Patients in Agony - Reason.com
Craig, a middle-aged banking consultant who was on his school ' s lacrosse team in college and played professionally for half a dozen years after graduating, began developing back problems in his early 30s. " Degenerative disc disease runs in my family, and the constant pounding on AstroTurf probably did not help, " he says. One day, he recalls, " I was lifting a railroad tie out of the ground with a pick ax, straddled it, and felt the pop. That was my first herniation. "After struggling with herniated discs and neuropathy, Craig consulted with " about 10 different surgeons " and decided to have his bottom three vertebrae ...
Source: Psychology of Pain - March 23, 2018 Category: Anesthesiology Source Type: blogs
Hospitalized Patients Are Civilian Casualties in the Government's War on Opioids
A recentstory by Pauline Bartolone in the Los Angeles Times draws attention to some under-reported civilian casualties in the government ’s war on opioids: hospitalized patients in severe pain, in need of painkillers. Hospitals across the country are facing shortages of injectable morphine, fentanyl, and Dilaudid (hydromorphone). As a result, trauma patients, post-surgical patients, and hospitalized cancer patients frequently go un dertreated for excruciating pain.Hospitals, including the ones in which I practice general surgery, are working hard to ameliorate the situation by asking medical staff to use prescription opi...
Source: Cato-at-liberty - March 18, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
The War on Opioids Has Become a War on Patients
As Anne Fuqua recentlypointed out in the Washington Post, non-medical drug users accessing heroin and fentanyl in the underground drug market are not the only victims in the opioid crisis. Many patients whose only relief from a life sentence of torturing pain are also victims. That is because policymakers continue to base their strategies on the misguided and simplistic notion that the opioid overdose crisis impacting the US,Canada, andEurope, is tied to doctors prescribing opioids to their patients in pain.Unfortunately, political leaders and the media operate in an echo chamber, reinforcing the notion that cutting back o...
Source: Cato-at-liberty - March 12, 2018 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
How Corporate Health Care Leaders Maintain Their Impunity: The Case of Purdue Pharma's Funding of the Washington Legal Foundation to Attempt to Weaken the Responsible Corporate Officer Doctrine
The ongoing epidemic ofnarcotic (opioid) abuse, and the resulting rise in the deaths due to overdoses, has focused attention on pharmaceutical companies ' aggressive promotion of these drugs which minimized their substantial risk.A recent article in the Intercept showed how the leadership of one such company tried to insulate itself from responsibility for such actions even while such promotions were continuing.Background: Impunity of Top Leaders of Big Health Care OrganizationsFor years, we have railed against theimpunity of top leaders of health care organizations. We have noted that despite numerous legal settleme...
Source: Health Care Renewal - March 6, 2018 Category: Health Management Tags: impunity legal settlements narcotics Purdue Pharma responsible corporate officer doctrine tobacco Source Type: blogs
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
There ’s no easy way out of the opioid epidemic
Across the United States at least forty people die each day from overdosing on opioids like Vicodin, codeine, heroin, and oxycontin. Seven percent of drivers who died in car crashes last year were found to have prescription opioids in their systems — seven times more than in 1995.
Considering these alarming rates of overdosing and DUIs, this is serious business. Authorities view it in their traditional way: the problem is drugs. Thus doctors should curtail prescribing, and patients should clean up and go through rehab.
But the situation’s less about drugs than, frankly, rampant suicide. These drugs’ risks...
Source: Kevin, M.D. - Medical Weblog - February 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jeff-kane" rel="tag" > Jeff Kane, MD < /a > Tags: Physician Pain Management Psychiatry Source Type: blogs
Welcome to the DOG Patch: first in a series?
Lately my dander is up so often and so copiously, over what ' s happening in health care and the world at large, I ' m exhausted. Covered with nasty dander. Cowering under the sheets. Others seem to share this dysphoria. But I found if not a cure, at least a palliative. There ' s so much dander I can scrape it off with a great big shovel and toss as much as I can your way. Here ' s my first DanderOmnium Gatherum, or DOG, from the Cetona DOG Patch. Remember, these stories are all DOGs.Litmus Test for New HHS Secretary. The new sheriff at Health& Human Services, Alex Azar, has barely had a chance to wipe his feet in...
Source: Health Care Renewal - February 15, 2018 Category: Health Management Source Type: blogs