Category Archives: Health care

Opioid Analgesics for Chronic Pain

By Mary Lou Bossio, NP

Chronic pain can be one of the more challenging conditions to manage, especially when it has been refractory to multiple modalities. An appreciation of chronic pain and its prevalence, along with thorough understanding of provider responsibilities, patient rights and the appropriateness of opioid analgesics for this population, are needed. Such knowledge provides a foundation for evaluating chronic pain and developing an individualized management plan. When opioids are used, prepare for both expected and unexpected results.

Chronic pain is pain without apparent biologic value that has persisted beyond the time in which normal healing should have occurred, usually 3 months.1 In 2004, chronic pain was internationally recognized as a major health care problem and a disease in its own right.2 Today, countless medical experts and health agencies contend that chronic pain should be treated with the same priority as the disease that caused it.3

History of Standards

The creation and endorsement of formal guidelines for the use of opioid analgesics in chronic pain management is relatively new. The American Pain Society (APS) and the American Academy of Pain Medicine (AAPM) issued a statement in 1996 to define when and how opioids should be prescribed for patients with chronic pain.4

Despite this formal position, pain continued to be undertreated due to fears of legal and criminal liability for prescribing controlled substances.5,6 This prompted the development and 1998 adoption of the Model Guidelines for the Use of Controlled Substances by the Federation of State Medical Boards of the United States.7 This document, which became policy in 2004, defines when opioids are appropriate for acute and chronic pain and details patient monitoring to deter drug diversion.8,9

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has issued standards on pain assessment and management. The standards, which took effect in 2001, state that all patients have the right to appropriate assessment and management of pain; that all patients should be assessed for pain and receive individualized care; that response to treatment should be monitored; and that treatment plans should be modified when necessary.10

Although the JCAHO standards provided a formal framework for pain management, they did not stipulate how appropriate management would be achieved, and a number of guidelines were subsequently issued.9-12The prevalence of guidelines and JCAHO standards today means that failing to prescribe appropriate medications constitutes undertreatment of pain and a departure from acceptable standards of practice.8

Opioid Need

An analysis of international s
tudies shows that 1 in 5 adults and 1 in 3 older adults experience moderate to severe pain lasting more than 3 to 6 months.1,13 A study of more than 3,500 primary care patients in the United Kingdom found that about half reported pain lasting more than 3 months.
14

And an international study that included the United States revealed that about 20% of more than 5,000 primary care patients experienced pain for more than 6 months.15 Put in everyday terms, as little as 1 in 10 and as many as 1 in 2 patients who present to a health care provider may have chronic pain.

Trends in Prescribing

Arthritis and other musculoskeletal disorders are the most frequently mentioned chronic health conditions significant enough to result in activity limitations among U.S. adults ages 18 to 64.16

An analysis of office visits and opioids prescribed for patients with musculoskeletal disorders in 1980 and 2000 revealed that office visits did not increase for these conditions. This analysis, which was based on data from the National Ambulatory Medical Care survey, also revealed that prescriptions for opioid analgesics for chronic pain doubled (8% to 16%), and the use of stronger opioid analgesics quadrupled (2% to 9%).17

The increase in opioid analgesic prescriptions is a sign that progress has been made in pain management.18-21 However, this trend has not allayed concerns that increased use of opioids would lead to more opioid abuse and addiction. As a result, studies were conducted to identify any abuse of opioid analgesics.

Continue reading Opioid Analgesics for Chronic Pain

Pain-Topics.org News/Research UPDATES: Pain Management Fails Due to Rx-Drug Abuse Fears

In reality, this is a tragedy that has plagued or country since Nixon’s ‘Reign of terror’; i.e. his two-term presidency… the same which caused the continued death toll in Laos, Cambodia and Vietnam. The terrorism at home was to become an international war, destroying the innermost soul of our police, military and our families in the inner-city, to the suburbs.  The war on drugs became a war on the poor later under Regan/Bush with CRACK.

Fast-Forward to today: M.D.’s  and patients are the newest target of the ‘New Prohibition’.  Doctors are afraid of the “Drug Enforcement Agency” which has become a paramilitary organization fighting against the rights of you and I. They are correct in harboring fears, medical offices must close due to dispensing lifesaving medical treatment to sick people.  All in the name of ‘public safety’ and jaded “morality”.

Opium based treatment options are systematically being eliminated. The Sumerians, Egyptians and the West have safely used opium and newer ‘opiates’ to kill pain and extend the quality of millions of people with minimal division and almost zero risk, but are now “the newest devil” in this costly and dangerous war.

This war has no end; unless saner, cooler heads end what was started almost forty years ago. Shouldn’t we trust our doctors, Government, and Police to have our collective safety – not our systematic demise in mind? Free doctors from this insanity… until this slight is overturned, we cannot truly be free.

Pain-Topics.org News/Research UPDATES: Pain Management Fails Due to Rx-Drug Abuse Fears

Mainstream picks up on poppy legitimization scheme

Back in February I posted about a viable alternative to eradication in the Afghan opium war — embracing the opium poppy as a legitimate resource. Parisian security and policy think-tank Senlis Council issued a report on this issue last month that strongly supports this position.

Well, it looks like the idea is finally gaining a bit of momentum in the mainstream press, with articles and commentary appearing in the Toronto Star and on the AFP Wire.

What is most fascinating about this plan is not only the benefits for Afghanistan’s impoverished farmers, but also the ability to fill the 550  (metric) tonne shortfall worldwide in the demand for legitimate opiate-based pain medication. Poppies are already grown in places like Australia, India and Turkey for legitimate uses, and the market is both well-regulated and profitable for the regions involved.

This clearly has a valid impact on security and stability in the region too, as pointed out by U of T professor Benedikt Fischer, who did research for Senlis and is quoted in the Star story:

"Instead of believing in the crazy idea of us being able to eradicate it, why not use the resource for legitimate and worthwhile purposes"

The eradication policy assumes farmers will switch to other crops. But no alternatives pay enough, so it turns them against the struggling government of Afghan President Hamid Karzai and Canadian and other foreign troops trying to eliminate Taliban insurgents.

Sounds good to me.

Mainstream picks up on poppy legitimization scheme — Poppies.org

The Truth about The American Drug War

 The War on Drugs

June 14, 2010

Since 1970, $33 billion has been spent marketing drug prevention campaigns to school kids. However, from 1970, the decrease in drug use among high school students is still 0%. In reality, the increase in Americans who will try drugs this year compared to 1970 is 10 million. Someone is arrested for violating the drug law every 17 seconds, and 37 million people have been arrested in the US for drug crimes. The total amount spent on those arrests comes to $121 billion. As the numbers of drug users increases, the numbers of visits to the doctor will correlate, especially in the near future. Medical billing and coding specialists are needed by all doctors, which means that this is a profession that will not become obsolete, but rather the demand for it is perpetually growing. Furthermore, medical billing and coding specialists are needed to aid millions of Americans involved with drugs.

The War on Drugs
Truth About The War on Drugs

Via: Medical Coding Certification

Can a Pill Make You Smarter?

Can a Pill Make You Smarter?

Can a Pill Make You Smarter?

A series of new drugs promises to increase our productivity and focus.

By Joanne Chen

A series of new drugs promises to increase our productivity and focus.

I would have made the perfect poster child for the “Just Say No” campaign. Black coffee — lots of it — is my only vice. I militantly oppose tobacco, sleeping pills, and excessive alcohol. I assert a defiant Non! to marijuana, cocaine, and steroids (not that anyone has ever offered me any). Somehow, I made it through prep school and college among the most prudish of friends. To me, anyone who engaged in chemical enhancements was a slacker or a cheater, and most certainly someone I didn’t know.

But then I discovered Smart Drugs. Crack for nerds.
Continue reading Can a Pill Make You Smarter?

I.O.U.S.A. – One Nation. Under Debt. In Stress.

1:21:29 – 7 months ago

Wake up, America! We’re on the brink of a financial meltdown. I.O.U.S.A. boldly examines the rapidly growing national debt and its consequences for the United States and its citizens. Burdened with an ever-expanding government and military, increased international competition, overextended entitlement programs, and debts to foreign countries that are becoming impossible to honor, America must mend its spendthrift ways or face an economic disaster of epic proportions.

Watch the video below – – – – – >

Continue reading I.O.U.S.A. – One Nation. Under Debt. In Stress.

Wired Science News for Your Neurons

Brain-Enhancing Drugs: Legalize ‘Em, Scientists Say

By Brandon Keim December 10, 2008 | 1:09 pm |
Categories:
MedicineRitalin
If drugs can safely give your brain a boost, why not take them? And if you don’t want to, why stop others?

In an era when attention-disorder drugs are regularly — and illegally — being used for off-label purposes by people seeking a better grade or year-end job review, these are timely ethical questions.

The latest answer comes from Nature, where seven prominent ethicists and neuroscientists recently published a paper entitled, “Towards a responsible use of cognitive-enhancing drugs by the healthy.”

In short: Legalize ‘em. Continue reading Wired Science News for Your Neurons

FDA Panel Urges Ban on Vicodin, Percocet

“Also recommends dosing limits for OTC painkillers that contain acetaminophen, like Tylenol or Excedrin, because of link to liver damage.”

“TUESDAY, June 30 (HealthDay News) — The popular prescription painkillers Vicodin and Percocet, which combine acetaminophen with an opiate narcotic, should be banned, and the maximum dose of over-the-counter painkillers with acetaminophen, like Tylenol or Excedrin, should be lowered, a U.S. Food and Drug Administration advisory panel urged Tuesday.

The panel’s recommendations followed the release of an FDA report last month that found severe liver damage, and even death, can result from a lack of consumer awareness that acetaminophen — which is easier on the stomach than such painkillers as aspirin and ibuprofen — can cause such injury.

The dangers from use or abuse of Vicodin and Percocet may be even more concerning, one key panelist said.

"It seems to me that problems with opiate combinations are clearly more prevalent," Dr. Lewis S. Nelson, chairman of the FDA’s Drug Safety and Risk Management Advisory Committee, said during a Tuesday press conference held after the two-day meeting.

Explaining the panel’s 20-17 vote to ban prescription acetaminophen/opiate drugs, Nelson said, "There are many deaths that relate to problems with prescription opiate combination acetaminophen products, whereas the number of deaths clearly related to the over-the-counter products are much more limited."

But the FDA advisers also took aim at over-the-counter (OTC) acetaminophen products. The agency’s report found that many people may consume more than the recommended dose of these pain relievers in the mistaken belief that taking more will prove more effective against pain without posing health risks. Consumers may also not know that acetaminophen is present in many over-the-counter products, including remedies for colds, headaches and fevers, making it possible to exceed the recommended acetaminophen dose, the report said.

Based on that, the FDA advisory panel voted 21-16 to lower the maximum daily dose of nonprescription acetaminophen, which is currently 4 grams — equal to eight pills of a drug such as Extra Strength Tylenol. The panel was not asked to recommend another maximum daily dose.

The panel also voted 24-13 to limit the maximum single dose of acetaminophen to 650 milligrams. The current single dose of Extra Strength Tylenol, for instance, is 1,000 milligrams.

The panel also voted 26-11 to make the 1,000-milligram dose of acetaminophen available only by prescription.

The advisers voted against other safety restrictions for other over-the-counter drugs such as NyQuil or Theraflu, which contain acetaminophen and other ingredients that treat cough and runny nose. Patients often mix the cold medications with pure acetaminophen drugs, like Tylenol, leaving them vulnerable to dangerously high levels of acetaminophen.

The FDA is not obligated to follow the recommendations of its advisory panels, but it typically does so.

Dr. Sandra L. Kweder, deputy director of the FDA’s Office of New Drugs at the Center for Drug Evaluation and Research, gave a strong hint of what the agency might do with the advisory panel’s recommendations.

"I think the top recommendation of this committee was that the agency needs to do something to address and decrease the usual dose of acetaminophen, both for over-the-counter products and also prescription combination products," Kweder said during the press conference.

She added, "There was a clear message that there is a high likelihood of overdose from prescription narcotic/acetaminophen combination products. If we don’t eliminate these combination products, we should certainly at least lower the usual acetaminophen dose patients receive in those prescription combination products."

At the very least the agency should require new warning labels on these prescription combinations that alert patients to the potential of liver damage if they take too much acetaminophen, she said.

Speaking for the OTC drug industry, Lynda A. Suydam, of the Consumer Healthcare Products Association (CHPA), said her group was "pleased the committee did not recommend eliminating these important nonprescription products."

However, in a statement, she added that CHPA was "disappointed in [the panel’s] divided vote to lower the maximum daily dose and the single dose of 1000 mg acetaminophen. There was a notable lack of data referenced by the committee to support these recommendations and overwhelmingly strong data affirming the efficacy and safety of acetaminophen in its current dosage forms."

Another expert took a different view. Dr. John H. Klippel, chief executive officer of the Arthritis Foundation, said Tuesday’s votes were very important to "people with arthritis because acetaminophen is a very commonly used medication to control pain."

"Lowering the maximum dose, providing that kind of guidance to patients, if it increases safety, would be something the arthritis community would support," he said. "Every person who takes this drug sees it as valuable, but they want clear guidance so they won’t be harmed by the drug."

Dr. Lewis W. Teperman, director of transplant surgery and vice chairman of surgery at New York University School of Medicine, said he also supported the panel’s decision to recommend lowering doses of acetaminophen.

"It’s not that the doses can get you in trouble, but the very young and the very old can get into trouble easily," he said. Also if you are sick, there is the danger of taking cold remedies that contain acetaminophen plus taking pure acetaminophen drugs as well, he noted.

But Klippel added that the vote to make the 1,000-milligram dose of acetaminophen available by prescription only would overburden the health-care system. "Given the massive number of people who rely on this drug for pain control, making the maximum dose requiring a prescription, I think, is going to place undo burden on the health-care system," he said.

Teperman disagreed.

"The 1,000 milligram pill should never be at the patient’s discretion. It should only be prescribed by a physician," Teperman said. "If you took an entire bottle of Tylenol Extra Strength, three days later you would be in a coma and needing a liver transplant."

For more on acetaminophen, visit the U.S. National Library of Medicine.

SOURCES: June 30, 2009, press conference with Sandra L. Kweder, M.D., deputy director, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, and Lewis S. Nelson, M.D., chairman, FDA Drug Safety and Risk Management Advisory Committee, and associate professor, department of emergency medicine, NYU Langone Medical Center; John H. Klippel, M.D., CEO, Arthritis Foundation; Lewis W. Teperman, M.D., director of transplant surgery, vice chairman of surgery, New York University School of Medicine, New York City; June 30, 2009, news release, Consumer Healthcare Products Association; May 28, 2009, news release, U.S. Food and Drug Administration”

 

I wonder what this will do to the millions of people who are in pain consistently.  Conversely what about those in acute pain? The extremely numerous Rx’s written daily for hydrocodone/APAP will not be available… then maybe they should be put over the counter.  Civilized people should be treated as though they have a brain and not looked at in a biblical or moral controlled light which hurts so many due to the prohibition and lack of health care providing adequate pain relief.  I will try and stay on this story… interesting.