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
A Doctor ’s Painful Struggle With an Opioid-Addicted Patient - Siddhartha Mukherjee - The New York Times
I once found myself entrapped by a patient as much as she felt trapped by me. It was the summer of 2001, and I was running a small internal-medicine clinic, supervised by a preceptor, on the fourth floor of a perpetually chilly Boston building. Most of the work involved routine primary care — the management of diabetes, blood pressure and heart disease. It was soft, gratifying labor; the night before a new patient's visit, I would usually sift through any notes that were sent ahead and jot my remarks in the margins. The patient's name was S., I learned. She had made four visits to the emergency room complaining o...
Source: Psychology of Pain - February 5, 2018 Category: Anesthesiology Source Type: blogs
FDA REMS Blueprint on Opioids Finalized
On January 30, 2018, the United States Food and Drug Administration (FDA) finalized the “Opioid Analgesic REMS Education Blueprint for Health Care Providers Involved in the Treatment and Monitoring of Patients with Pain.” The Blueprint includes educational messages for health care providers involved in the treatment and monitoring of patients with pain. It also includes information on pain management, including the principles of acute and chronic pain management; non-pharmacologic treatments for pain; and pharmacologic treatments for pain (non-opioid analgesic and opioid analgesic). This REMS represents a major ...
Source: Policy and Medicine - February 2, 2018 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff 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
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
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
Founder and Owner of Insys Arrested
Late last week, John N. Kapoor, the founder and majority owner of Insys Therapeutics, Inc., was arrested and charged with leading a conspiracy to profit by using bribes and fraud to cause the illegal distribution of a Fentanyl spray intended for cancer patients experiencing breakthrough pain.
The superseding indictment includes allegations of RICO conspiracy, conspiracy to commit mail and wire fraud, and conspiracy to violate the Anti-Kickback law. It also includes additional allegations against former Insys executives and managers who were initially indicted in December 2016.
The Justice Department claims that Kapoor an...
Source: Policy and Medicine - October 30, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Purdue's Opioid Marketing is Target of a Federal Criminal Probe
As reported by Bloomberg:Federal prosecutors in Connecticut began a criminal investigation into Purdue Pharma Inc. ’s marketing of the controversial opioid painkiller OxyContin.U.S. Attorney Deirdre Daly is gathering documents about Purdue ’s claim that OxyContin provides 12 hours of pain relief. A Los Angeles Times investigation, published last year, found that Purdue ignored evidence showing the drug’s effects failed to last that long in some patients, increasing the risk of withdrawal, abuse and addiction. “Purdue is committed to being part of the solution to our nation’s opioid crisis and has been c...
Source: Pharma Marketing Blog - October 26, 2017 Category: Pharmaceuticals Tags: Opioids Purdue Pharma Source Type: blogs
FDA Takes Important Steps to Stem the Tide of Opioid Misuse and Abuse
By Scott Gottlieb, M.D. America is awash in immediate-release (IR) opioids. About 90 percent of all opioid pain medications prescribed – or 160 million prescriptions a year – are for IR formulations like hydrocodone and acetaminophen or oxycodone and acetaminophen … Continue reading → (Source: FDA Voice)
Source: FDA Voice - September 28, 2017 Category: American Health Source Type: blogs
Too many pain pills after surgery: When good intentions go awry
As a physician with an interest in reducing opioid-related problems, I frequently hear stories from colleagues and friends about their loved ones who either struggle with opioid addiction or have even died from opioid-related overdose. My follow-up question to them is usually: “How did it begin?” Almost every time the answer is the same: the individual experienced acute pain either from a trauma or surgery, was started on opioids by a doctor, and then couldn’t quit.
My son’s baseball coach, who is not in the medical field, described it perfectly. He went in for a minor back surgery and was discharged with 60 tabl...
Source: Harvard Health Blog - September 11, 2017 Category: Consumer Health News Authors: Scott Weiner, MD Tags: Addiction Health Injuries Pain Management Surgery Source Type: blogs
Cutting down on opioids has made life miserable for chronic pain patients - Slate
On July 26, Todd Graham, 56, a well-respected rehabilitation specialist in Mishawaka, Indiana, lost his life. Earlier that day, a woman complaining of chronic pain had come to Graham's office in hope of receiving an opioid such as Percocet, Vicodin, or long-acting OxyContin. He reportedly told her that opioids were not an appropriate first-line treatment for long-term pain —a view now shared by professionals—and she, reportedly, accepted his opinion. Her husband, however, became irate. Later, he tracked down the doctor and shot him twice in the head.This horrific story has been showcased to confirm that physicians ...
Source: Psychology of Pain - August 30, 2017 Category: Anesthesiology Source Type: blogs
Opioid Abuse Up Among Older Adults
Source: U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), news release, July 26, 2017
“While *opioid abuse has fallen among younger Americans, the same cannot be said for older adults, a new government report shows.
Rates of opioid abuse among young adults — aged 18 to 25 — decreased from 11.5 percent in 2002 to 8 percent in 2014. But in adults 50 years and older, opioid abuse doubled, from 1 percent to 2 percent, according to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).”
“These findings highlight the need for prevention programs for all a...
Source: BHIC - July 28, 2017 Category: Databases & Libraries Authors: Michelle Burda Tags: General Opioid Abuse and Addiction Public Health Senior Source Type: blogs
Treating pain after opioid addiction: A personal story
Follow me on Twitter @Peter_Grinspoon
As a primary care physician at Massachusetts General Hospital (MGH), I am profoundly grateful for my 10 years in recovery from opiate addiction. As detailed in my memoir Free Refills, I fell into an all too common trap for physicians, succumbing to stress and ready access to medications, and became utterly and completely addicted to the painkillers Percocet and Vicodin. After an unspeakably stressful visit in my office by the State Police and the DEA, three felony charges, being fingerprinted, two years of probation, 90 days in rehab, and losing my medical license for three years, I fi...
Source: Harvard Health Blog - April 7, 2017 Category: Consumer Health News Authors: Peter Grinspoon, M.D. Tags: Addiction Drugs and Supplements Managing your health care Pain Management Source Type: blogs
If you have low back pain try these steps first
Low back pain, the scourge of mankind: it is the second leading cause of disability here in the United States, and the fourth worldwide. It’s also one of the top five medical problems for which people see doctors. Almost every day that I see patients, I see someone with back pain. It’s one of the top reasons for lost wages due to missed work, as well as for healthcare dollars spent, hence, a very expensive problem.
Looking at two kinds of back pain
Let’s talk about the most common forms of back pain: acute (which lasts less than four weeks) and subacute (which lasts four to 12 weeks). Most of these cases (approximate...
Source: Harvard Health Blog - April 3, 2017 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Back Pain Managing your health care Pain Management Source Type: blogs
How the opioid epidemic became America ’s worst drug crisis ever, in 15 maps and charts - Vox
With all the other news going on, it can be easy to lose track of this fact. But it's true: In 2015, more than 52,000 people died of drug overdoses, nearly two-thirds of which were linked to opioids like Percocet, OxyContin, heroin, and fentanyl. That's more drug overdose deaths than any other period in US history — even more than past heroin epidemics, the crack epidemic, or the recent meth epidemic. And the preliminary data we have from 2016 suggests that the epidemic may have gotten worse since 2015.This situation did not develop overnight, but it has quickly become one of the biggest public health crises faci...
Source: Psychology of Pain - March 30, 2017 Category: Anesthesiology Source Type: blogs
