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More Evidence That Opioid Policymakers Keep Aiming at the Wrong Target
Jeffrey A. SingerA new study released earlier this year adds more evidence to the mountains of evidence that policymakers trying to solve the overdose crisis have been aiming at the wrong target.Researchers from the Dartmouth University School of Medicine recently published in theAnnals of Surgery the results of a  prospective clinical trial of 221 opioid naïve surgical patients prescribed opioids at discharge and followed for one year after surgery. Eighty‐​eight percent of the patients had cancer‐​related operations. Their surgeons prescribed opioids for pain control when they discharged them home from the hosp...
Source: Cato-at-liberty - May 30, 2023 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs

Undisclosed Conflicts of Interest by Physicians Creating the CDC Opioid Prescribing Guidelines: Bad Faith or Incompetence?
We described above how changes in opioid policy aimed at reducing Washington State’s Medicaid and Workers Compensation costs contributed to an increase in methadone deaths between 2003 and late 2014 (23-25). Focusing on similar cost reductions, the Centers for Medicar e and Medicaid Services (CMS) proposed rules for 2019 including several directives intended to reduce " Opioid Overutilization, ” including adoption of the “90 morphine milligram equivalent (MME) threshold cited by the 2016 CDC Opioid Guideline (147, 148). Simply put, reduced prescribing reduces costs for prescribed medications.Chou received research fu...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 12, 2022 Category: Palliative Care Tags: health policy judy kollas opioids research schechtman Source Type: blogs

A man in his 60s with chest pain. Cardiologist refuses to take to the lab. Obvious STEMI, even with criteria. Yet final diagnosis " NSTEMI " . This happens far too often.
Submitted by Anonymous MD, edits by MeyersA man in his 60s with past medical history of multiple sclerosis and hypertension was brought in by EMS from home for chest pain thatstarted acutely just prior to arrival. He rated the pain at 9/10, describes as pressure, radiates towards the left arm with associated shortness of breath, diaphoresis and had one episode of emesis. He did not have a prior history of CAD or other cardiac disease. His pain improved to 6/10 after EMS gave him 3 sprays of sublingual nitroglycerin and 324 mg of aspirin. Prehospital ECGs:What do you think?Both ECGs are diagnostic of acute LAD OMI...
Source: Dr. Smith's ECG Blog - April 15, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

Opioid Equianalgesic Tables are Broken
by Drew Rosielle (@drosielle)I am proposing we do away with equianalgesic table (EAT) as a tool to inform clinical decisions about opioid rotations/conversions. Fundamentally, EATs create too many problems, and there are simpler and safer ways to teach clinicians how to convert between different opioids.Part 1: New Data Can ' t Fix the EATA couple HPM fellows every year ask me which table do I prefer to use —the old EAT or the new one? By the old one, they refer to the table most of us used or were at least deeply familiar with for the last 10-20 years. By the new one, they mean the one created by Dr. Mary Lynn McPherson...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 21, 2022 Category: Palliative Care Tags: opioid pain rosielle Source Type: blogs

PROP s Disproportionate Influence on U.S. Opioid Policy: The Harms of Intended Consequences
ConclusionDespite being turned back from an effort to bluntly reduce opioid prescribing by the FDA in 2013 based on a lack of scientific evidence for its position (17,18), PROP has had a disproportionate effect on opioid policy in the Untied States for almost a decade. PROP found a willing federal regulatory partner in the CDC, and while PROP may not have secretly written the 2016 CDC Pain Guidelines (75), they certainly enjoyed disproportionate representation on CDCs review panels and Core Expert Group (23-25) in a process that lacked transparency (22, 23, 26, 27). When the CDC admitted that its Pain Guideline had been...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 3, 2021 Category: Palliative Care Tags: CDC health policy kollas opioids pain prop Source Type: blogs

PROP ’s Disproportionate Influence on U.S. Opioid Policy: The Harms of Intended Consequences
ConclusionDespite being turned back from an effort to bluntly reduce opioid prescribing by the FDA in 2013 based on a lack of scientific evidence for its position (17,18), PROP has had a disproportionate effect on opioid policy in the Untied States for almost a decade. PROP found a willing federal regulatory partner in the CDC, and while PROP may not have “secretly written” the 2016 CDC Pain Guidelines (75), they certainly enjoyed disproportionate representation on CDC’s review panels and Core Expert Group (23-25) in a process that lacked transparency (22, 23, 26, 27). When the CDC admitted that its Pain Guideline ha...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 3, 2021 Category: Palliative Care Tags: CDC health policy kollas opioids pain prop Source Type: blogs

Wait, Other People Don ’ t Think about Suicide?
The most startling thing I’ve heard in my life is that not everyone thinks about suicide every day. Or now and then. Or even once in a long while. Can that be? I heard this from a co-worker a while ago. We were collaborating on a dreary project, and I joked about it being the kind of work that makes you want to kill yourself and what a relief that would be. “I know, right?” I expected her to say. Instead, she chuckled uncomfortably, then asked if I really thought that way. When I said yes, she was taken aback and a little disbelieving. “You never have?” I asked. “Of course not!” I was taken aback. And a littl...
Source: World of Psychology - April 28, 2020 Category: Psychiatry & Psychology Authors: Rich Pliskin Tags: Personal Suicide Depression Suicidal Thoughts Source Type: blogs

White collar crime
John Kapoor, CEO of Insys Therapeutics, was sentenced yesterday to 5 1/2 years in prison. That ' s a pretty stiff sentence, right?Well let ' s see now. What did he do exactly?His company sold fentanyl under the brand name Subsys. As you probably know, fentanyl is an extremely powerful synthetic opioid that is responsible for a high percentage of the overdose deaths in the current epidemic of opioid addiction. As a prescription drug, it was approved by the FDA only for so-called breakthrough pain in cancer patients. But Insys literally bribed doctors to prescribe it inappropriately, resulting in8,000 known deathsand countle...
Source: Stayin' Alive - January 24, 2020 Category: American Health Source Type: blogs

Seizing the Opportunity in America ’ s Opioid Crisis
“Perhaps everything that is terrible is, in the deepest sense, something that wants our love.” – Rilke The overdose epidemic in the U.S. has been called “the greatest public health crisis of our time.” It’s also our greatest opportunity. The opioid crisis is an identity crisis: it’s a challenge to how we see ourselves. Do we truly believe that we are all in this together? One answer leads us deeper into despair. The other, into a hopeful future. It’s been said that “doing more things faster is no substitute for doing the right things.” What are the “right things,” the measures that can r...
Source: World of Psychology - November 30, 2019 Category: Psychiatry & Psychology Authors: Psych Central Guest Author Tags: Addiction Publishers The Fix opioid crisis Source Type: blogs

What Are Opioid Overdose Signs?
On average, 130 Americans die from an opioid overdose every day. The Centers for Disease Control and Prevention (CDC) considers opioid overdose an epidemic in the United States, estimating it responsible for nearly 68 percent of 70,000 drug-related deaths in 2017. Understanding the effects of opioids can prevent opioid overdose, and knowing the opioid overdose signs can save lives. What Are Opioids? Opioids are a class of drugs naturally found in the opium poppy plant. Opioid drugs reduce pain by binding to opioid receptors in your brain, spinal cord and other areas of the body, creating morphine-like effects. The CDC ide...
Source: Cliffside Malibu - November 21, 2019 Category: Addiction Authors: Jaclyn Uloth Tags: Addiction Heroin Painkiller Substance Abuse drug overdose opiate opiate abuse opiate addiction opiates opioid opioids Source Type: blogs

Part 2 - We Were Wrong 20 Years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid Doses
by Drew Rosielle (@drosielle)This is the second in a series of several posts about many aspects of my current thinking about opioids.The first post is here:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Over-prescribing fueled the current drug overdose epidemic, and many of us who thought we were stamping out needless suffering contributed to the epidemic.A lot of what I read and believed about opioids early on in my career was wrong.I ’m old enough to remember those heady days in which there was a pretty large and ‘successful’ movement in American medicine to greatly liberalize...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 3, 2019 Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs

Senator Portman Presumes To Know How Many Days Of Pain Relief All 328 Million Americans Need
With  clear evidence that restricting the number of prescriptions increased the death rate by driving non-medical users to heroin and fentanyl, the last thing one wants to hear about is a politician planning to double down on this deadly policy by calling for further prescription limits for patients in pain.Yet Senator Robert Portman (R-OH) is  proposing legislation that would impose a national 3-day limit on opioid prescriptions following surgeries. He will be kind enough to allow exceptions for people dealing with cancer, chronic pain, and “other serious matters”—whatever that means.Government data show there i...
Source: Cato-at-liberty - July 26, 2019 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs

Fentanyl, How Bad Is It?
How Bad Is Fentanyl? Fentanyl is an extremely dangerous synthetic opioid. Unlike some other opioids that occur naturally, it is man-made for the purpose of helping aid people suffering from extreme pain. It can be administered for recovery after surgery, during cancer treatments or for recovery after a painful injury. The Drug Enforcement Administration (DEA) classifies fentanyl as a Schedule II controlled substance. This means that it is legal for medical use, however, it has an extremely high potential for abuse and addiction. Understanding Fentanyl Significantly stronger than morphine or oxycodone, Fentanyl can be fatal...
Source: Cliffside Malibu - April 2, 2019 Category: Addiction Authors: Jaclyn Uloth Tags: Addiction Addiction to Pharmaceuticals Drug Rehab Information Drug Treatment Heroin Painkiller Substance Abuse Synthetic fentanyl prescription drug abuse prescription drug addiction prescription drug detox prescription drug use p Source Type: blogs

The Fentanyl Crisis and What You Need to Know
What is Fentanyl? According to the National Institute on Drug Abuse, Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine, but is 50 to 100 times more potent. It is a schedule II prescription drug, and it is typically used to treat patients with severe pain, for side effects surrounding aggressive cancer treatments or to manage pain after major surgery. It can be administered as an injection, a transdermal patch or as a lozenge. Under the medical supervision of a professional, there is little risk for addiction. However, that is not to be overlooked, as any exposure to Fentanyl at all will run the ...
Source: Cliffside Malibu - January 3, 2019 Category: Addiction Authors: Jaclyn Uloth Tags: Addiction Addiction Recovery Addiction to Pharmaceuticals Detox Resources for Alcohol and Drugs/Opiates Drug Rehab Information Drug Treatment Heroin Medical Substance Abuse Synthetic drug abuse drug abuse epidemic fentanyl opioid Source Type: blogs

Johnson and Johnson ' s Latest Ethical Misadventures: Settled Kickback Allegations, Reportedly Concealed Knowledge of Adverse Effects of a " Sacred Cow " Product
Giant pharmaceutical/ biotechnology/ device company Johnson& Johnson has its famous" credo " which starts withWe believe our first responsibility is to the doctors, nurses and patients, to mothers and fathers and all others who use our products and services.  In meeting their needs everything we do must be of high quality..Nonetheless, the company has a long history of ethical misadventures (lookhere, and see appendix below).  Now late in 2018,  we note two more Johnson& Johnson misadventures. In chronological order,$360 Million Settlement of Allegations of Kickbacks to Medicare/ Medicaid Patients to...
Source: Health Care Renewal - December 15, 2018 Category: Health Management Tags: adulterated drugs adverse effects deception impunity Johnson and Johnson kickbacks legal settlements Source Type: blogs