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In mad scramble to deal with opioid crisis, many mistakes are being made

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* AP

Dr. Mary Meengs remembers the days, a couple of decades ago, when pharmaceutical salespeople would drop into her family practice in Chicago, eager to catch a moment between patients so they could pitch her a new drug.

Now living in Humboldt County, Calif., Meengs is taking a page from the pharmaceutical industry’s playbook with an opposite goal in mind: to reduce the use of prescription painkillers.

Meengs, medical director at the Humboldt Independent Practice Association, is one of 10 California doctors and pharmacists funded by Obama-era federal grants to persuade medical colleagues in Northern California to help curb opioid addiction by altering their prescribing habits.

* But is the pendulum starting to swing too far the other way? The I-Team looks at new restrictions on opioid prescriptions

Jenni Grover, an ambassador for the U.S. Pain Foundation and a chronic pain advocate, said the stories of desperation she hears are heartbreaking. She said patients tell her they’re being treated as if they are criminal drug addicts, and doctors are abandoning them because of new regulations and possible scrutiny by the medical community and federal regulators. […]

State and federal leaders, as well as medical practitioners and other providers, are using multiple strategies to address the opioid crisis; curtailing the opioid supply is one of them. Drug abuse experts say between 2001 and 2011 there was a huge increase in prescriptions for drugs such as morphine, codeine and hydrocodone. They say these pills flowed too freely to the wrong kind of patient, causing unnecessary and deadly addictions and helping fuel the drug epidemic. […]

New analysis from the National Conference of State Legislatures shows 24 state governments taking action.

Most of the legislation limits first-time prescriptions to seven days. Some states are also setting dosage limits. As of right now, Illinois has no mandated restrictions.

The president of the Illinois State Medical Society said the group will continue to lobby against regulation.

But, Dr. Kern Singh, a spinal surgeon with Midwest Orthopaedics at Rush University Medical Center, said the reality is it’s very difficult to get insurance coverage for the non-narcotic, safer alternative treatments because they are so expensive.

Working with other pain specialists at Rush, he said they have created an effective approach to surgical pain that uses fewer opioids, but is frustrated because most insurance companies refuse to cover the safer, more expensive medication.

* The addiction problem is all too real

Last year, according to the New York Times, more Americans died of drug overdoses than were killed in the entire Vietnam War.

* From a press release

While the nation’s opioid epidemic has been portrayed primarily as an issue for white suburbanites, African Americans in Chicago and other cities in the Midwest are also significantly affected by opioid use but receive little attention, according to a new report by the Chicago Urban League’s Research and Policy Center.

The report, titled “Whitewashed: The African American Opioid Crisis,” notes that the African American death rate from opioid overdose in 2015 was higher than the general population in five states, including four in the Midwest: Illinois, Minnesota, Missouri, and Wisconsin. The African American death rate from opioid overdose was also higher in West Virginia and Washington, D.C.

In Chicago in 2016, the African American death rate involving fentanyl, heroin and other opioids was 56% higher than the white death rate (39.3% vs 25.1%). While Black people make up approximately 32% of the city’s population, they accounted for nearly half (48.5%) of all opioid deaths. Death rates were highest in Black communities on the South and West sides, with Austin suffering the highest death rate of all community areas.

The report also highlights that African Americans are disproportionately arrested for drugs, at nearly three times the rate of whites, while approaches to the opioid epidemic have focused more on treatment. […]

* With so many people addicted in this country, rehab scams are everywhere

(T)he $35 billion rehab industry is increasingly being exploited by individuals who are taking advantage of those who need help the most. (For an excellent glimpse into these issues, the 2015 documentary The Business of Recovery lays out a chilling case for a broken, ailing, desperately in-need-of-its-own-rehab rehab system.)

* However, there is an alternative for at least some of that pain treatment

Illinois’ medical community has been somewhat reluctant to publicly embrace medical marijuana in the two years since the state’s first dispensaries opened.

But some physicians say the matter has taken on added urgency as the nation sinks deeper into an opioid crisis involving both prescription drugs, and heroin and its synthetic analogs. The U.S. Centers for Disease Control and Prevention reports there are 40 prescription opioid deaths a day, Illinois health officials have warned it’s the most dangerous public health issue facing the state and President Donald Trump has declared opioid addiction a public health emergency. […]

Though Bush-Joseph speaks for himself — not for Rush University Medical Center where he is a professor, and not for the Chicago White Sox or Bulls, with whom he has worked — his word as a leading arthroscopic surgeon carries some weight. After severe injury or surgery, he concedes patients typically need opioids like Percocet and Vicodin for a month or two. But after that, he believes patients should have potential access to marijuana as another longer-term alternative. […]

The doctors support a new bill before the Illinois General Assembly that would expand the state medical marijuana program to allow cannabis to be used by any patient who qualifies for use of opioids. Such a change could vastly expand the program, which now has only about 27,000 participants. Currently there are about 40 specific conditions, including cancer and AIDS, that qualify sufferers to apply to use medical marijuana.

If passed into law, the new bill would allow those who qualify to receive a one-year marijuana card, without the fingerprinting and criminal background check now required. Approval would be expedited to 14 days, rather than the two to three months it can now take.

* Related…

* ‘It never really leaves you.’ Opioids haunt users’ recovery: It’s hard to say whether businessman Kyle Graves hit rock bottom when he shot himself in the ankle so emergency room doctors would feed his opioid habit or when he broke into a safe to steal his father’s cancer pain medicine. For straight-talking ex-trucker Jeff McCoy, it was when he grabbed a gun and threatened to blow his brains out if his mother didn’t hand over his fentanyl patches.

* Opioid addiction treatments face off in US trial: Both drugs had high relapse rates and there were overdoses, including fatal ones, in the experiment in 570 adults. The study , published Tuesday in the journal Lancet, is the first to compare the two drugs in the United States, where an opioid addiction epidemic has doctors and policymakers deeply divided over treatment strategies.

posted by Rich Miller
Monday, Nov 20, 17 @ 11:55 am

Comments

  1. https://www.scientificamerican.com/article/people-are-dying-because-of-ignorance-not-because-of-opioids/

    Comment by Anonymous Monday, Nov 20, 17 @ 12:09 pm

  2. From the Nov. 8 New York Times:

    A combination of Tylenol and Advil worked just as well as opioids for relief of pain in the emergency room, a randomized trial has found.

    Researchers studied 416 men and women who arrived in the E.R. with moderate to severe pain in their arms or legs from sprains, strains, fractures or other injuries. They randomly assigned them to an oral dose of acetaminophen (Tylenol) with either ibuprofen (Advil) or the opioids oxycodone, hydrocodone or codeine. Two hours later, they questioned them using an 11-point pain scale.

    The average score was 8.7 before taking medicine. That score decreased 4.3 points with ibuprofen and Tylenol, 4.4 with oxycodone and Tylenol, 3.5 with hydrocodone and Tylenol, and 3.9 with codeine and Tylenol. In other words, there was no significant difference, either statistically or clinically, among any of the four regimens. The study is in JAMA.

    The lead author, Dr. Andrew K. Chang, a professor of emergency medicine at Albany Medical College, said that while any single patient might find opioids more effective, on average, even for the severe pain of fractures, non-opioids worked just as well.

    Comment by Moe Berg Monday, Nov 20, 17 @ 12:23 pm

  3. treat it like class x pot, background check, and only one dispensary, serial numbers on pills

    Comment by Rabid Monday, Nov 20, 17 @ 1:17 pm

  4. I don’t have a digital sub, but the WSJ had a good article on how we can combat the opioid problem by studying marijuana with a gateway to legalization. There’s a bill in the Senate, sponsored by Orrin Hatch of all people, to fund these studies.

    https://www.wsj.com/articles/can-marijuana-alleviate-the-opioid-crisis-1511104543

    Comment by ChrisB Monday, Nov 20, 17 @ 1:56 pm

  5. There needs to be a middle ground. Some of the steps taken right now are reactionary. This must have been what it was like when marijuana was put on the dangerous drug list.
    I am not denying the opioid issue, but there are individuals who have a valid need and who take the proper dosages. Also there are those with a variety of stomach issues. Those folks can not take , NSAIDs (Advil, Alleve, etc) due to resultant stomach bleeding.
    The people abusing opioids need to be stopped, but punishing those folks with a valid prescription for therapeutic doses of opioids is wrong.

    Comment by illinoised Monday, Nov 20, 17 @ 1:57 pm

  6. I just spent the long weekend with a person who suffers from severe and literally unstoppable black pain. Sleep is near impossible and the smallest physical movements necessary for daily life are excruciating. She and her doctor are supremely conscious of the problem of prescription pain medications for chronic conditions and she is an unusually controlled, strong willed woman who is able to ration her taking of the pills. But she is also empathetic and highly aware that many people who suffer like that simply cannot resist taking more and more drugs in hopes of even the slightest periods of relief. Observing her struggles and talking with her about this was eye-opening to say the least.

    Comment by Responsa Monday, Nov 20, 17 @ 3:51 pm

  7. Thanks for posting this, Rich. I worry about people who need these things to function losing their access. I was on serious opioids for about 6 years before they finally figured out I needed a hip replacement. Not good, but better than laying on the couch all day crying. At least I could work. Addiction is always the case with these things, but abuse is not.

    Comment by bad hip Monday, Nov 20, 17 @ 4:24 pm

  8. The Purdue Pharma types who created this new “market” for their brand of heroin should be sharing a cell with El Chapo.

    Comment by wordslinger Monday, Nov 20, 17 @ 5:17 pm

  9. Totally agree, word. Probably some prescribers and druggists should be de-licensed as well. All those Oxys didn’t get from the factory to the patient by themselves.

    I could be convinced otherwise, but I’m not ready to hop on board with the idea that we can substitute med-mar for opioids for every condition with no discretion.

    Comment by Arthur Andersen Monday, Nov 20, 17 @ 6:11 pm

  10. Just had knee replacement surgery. Could not have made it without hydrocodone. Two months later I had weaned myself off altogether. Taking opioids is not an instant path to addiction.

    Comment by Chicago Barb Monday, Nov 20, 17 @ 8:20 pm

  11. a junkie doesn’t need a background check like the citizenry does for a class x drug

    Comment by Rabid Tuesday, Nov 21, 17 @ 5:58 am

  12. I agree that there needs to be a middle ground, but how about letting the physicians make the medical decisions (with their patients) and let the politicians stick to politics. Never a great option when legislators decide to practice medicine. That said, might be worth looking at who can actually write a prescription for narcotics, and do they really need that authority?

    Comment by Keepin' Track Tuesday, Nov 21, 17 @ 9:07 am

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