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

Narcan or Narcan’t?
​Part 2 in a Four-part Series​A 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

The Other Opioid Epidemic
By HANS DUVEFELT, MD “I made myself a hypodermic injection of a triple dose of morphia and sank down on the couch in my consulting-room….I told her I was all right, all I wanted was twenty-four hours’ sleep, she was not to disturb me unless the house was on fire.” – Axel Munthe, MD, The Story of San Michele (1929) When people in this country mention the opioid epidemic, most of the time it is in the context of addiction with its ensuing criminality and social deprivation, and the focus is on opioids’ medical complications like withdrawal, overdose and death. But that is only one of the opioid epidemics we have...
Source: The Health Care Blog - January 2, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

The Political Economy of Fentanyl
By KAREN SIBERT, MD Just say No to Fentanyl. No, I’m not talking about putting fentanyl into my own veins — a remarkably bad idea. I’m questioning the habitual, reflex use of fentanyl, a synthetic opioid, in clinical anesthesiology practice. I’ve been teaching clinical anesthesiology, supervising residents and medical students, in the operating rooms of academic hospitals for the past 18 years. Anesthesiology residents often ask if I “like” fentanyl, wanting to know if we’ll plan to use it in an upcoming case. My response always is, “I don’t have emotional relationships with drugs. They are tools in our ...
Source: The Health Care Blog - January 2, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized 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

TBTAM ’s Top Ten Podcasts of 2017
You know you’re a radio junkie when you find yourself scribbling not just prescriptions, but lists of podcasts for your patients to listen to on their long plane flights or drives to Flordia or wherever else they are heading for the winter months. I figured if I wrote them all down, I could save myself the scribbling and just share a link to the list. And so here, in no particular order, are the podcasts I found myself recommending over and over again this past year. S-Town Part mystery, part bizarre tale, part crazy sad but also totally wonderful and addicting. I fell in love with this guy John B McLemore, quirks ...
Source: The Blog That Ate Manhattan - December 12, 2017 Category: Primary Care Authors: Margaret Polaneczky, MD Tags: Just for Fun best podcasts top ten Source Type: blogs

Her Chronic Pain Was a Medical Mystery. Was It an Unexplained Condition? - The Daily Beast
Leslie Levine's searing pains started the day after Thanksgiving in 2006. They began in her toes, which turned strangely dark. Then the agony crept upward."It felt like my legs were being dipped in boiling oil 24/7," she said.The emergency room and a series of doctors could do little but scratch their heads and offer her painkillers."I was living on oxycodone and very grateful for it," Levine said, then Harvard University's chief patent attorney. But it wasn't enough."By January, I was on disability, because I was in such pain and could hardly walk."Her internet search for answers ...
Source: Psychology of Pain - December 7, 2017 Category: Anesthesiology Source Type: blogs

Ingestible Biosensor for Tracking Opioid Use Following Acute Injury
This study provides important pilot data regarding the utility of the digital pill as an investigational tool for direct assessment of opioid ingestion and patient self-administration behavior.  In the future, the digital oxycodone pill could be used by physicians to monitor and identify escalating opioid use, and intervene in cases of suspected tolerance or addiction development. Flashback: Electronic Pills Powered by Gastric Acid to Guarantee Compliance: Interview with etectRx President & CEO Harry Travis… Study in journal Anesthesia and Analgesia: Oxycodone Ingestion Patterns in Acute Fracture Pain With Dig...
Source: Medgadget - November 28, 2017 Category: Medical Devices Authors: Iris Kulbatski Tags: Anesthesiology Medicine Pain Management Public Health Source Type: blogs

LITFL Review 308
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 308th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week This week’s ERCast chats with Ashley Liebig about 3 things we can do to improve our overall...
Source: Life in the Fast Lane - November 19, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V 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

Digital Health Supports The Fight Against Opioids
The widespread U.S. opioid & overdose crisis is an ever-increasing tragic concern for everyone: writhing victims, family members being fain to see their relatives suffer or die, doctors prescribing opioid pain-killers what they thought before as safe, and regulators imposed to handle a tough situation. Addiction. It’s painful to even read about the skyrocketing numbers of people suffering, thus we decided to map how digital health could help tackle the opioid crisis. Why is it so difficult to deal with the opioid crisis? Once you become addicted, it sticks with you for a long time, if not for life, just as a chronic...
Source: The Medical Futurist - November 14, 2017 Category: Information Technology Authors: nora Tags: Bioethics Mobile Health Virtual Reality in Medicine AI artificial intelligence data data analytics drugs future gc3 Innovation opioid opioid crisis pharma technology wearables Source Type: blogs

Drugstore pain pills as effective as opioids in ER patients - AP
Emergency rooms are where many patients are first introduced to powerful opioid painkillers, but what if doctors offered over-the-counter pills instead? A new study tested that approach on patients with broken bones and sprains and found pain relievers sold as Tylenol and Motrin worked as well as opioids at reducing severe pain.The results challenge common ER practice for treating short-term, severe pain and could prompt changes that would help prevent new patients from becoming addicted.The study has limitations: It only looked at short-term pain relief in the emergency room and researchers didn't evaluate how patient...
Source: Psychology of Pain - November 7, 2017 Category: Anesthesiology 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