Opioid Rx Limits Will Not Prevent Addiction

Will Strict Limits on Opioid Prescription Duration Prevent Addiction? Advocating for Evidence-Based Policymaking – Mallika L. Mundkur , MD, MPH, Adam J. Gordon , MD, MPH & Stefan G. Kertesz , MD, MSc – June 20, 2017

In 2016, the Centers for Disease Control and Prevention (CDC) issued the first national guideline in the United States regarding opioid prescribing for pain.

The guideline included the recommendation that patients treated for acute pain should receive opioids for no longer than 7 days, prompting at least five states to implement laws requiring prescribers not to exceed this threshold when providing initial opioid supplies.

The rapid conversion of this guideline into policy appears to reflect an underlying assumption that limiting initial opioid supplies will reduce opioid consumption, and thus addiction.   Continue reading

Shorter Courses of Antibiotics May Be Better

Shorter Courses of Antibiotics May Sometimes Be Better in the Long Run –  Nicole Leimbach – Nov 2016

For many years, prescribers have instructed patients to finish their entire course of antibiotics even after they start feeling better.

However, recent study results have shown that longer durations of antibiotics are not always beneficial.

The question many patients and prescribers are starting to ask is whether or not shorter courses are superior.   Continue reading

Most Genes Matter for Most Traits

What If (Almost) Every Gene Affects (Almost) Everything? – The Atlantic – June 2017 – by ED YONG

If you told a modern geneticist that a complex trait—whether a physical characteristic like height or weight, or the risk of a disease like cancer or schizophrenia—was the work of just 15 genes, they’d probably laugh.

It’s now thought that such traits are the work of thousands of genetic variants, working in concert.

The vast majority of them have only tiny effects, but together, they can dramatically shape our bodies and our health. They’re weak individually, but powerful en masse.  Continue reading

Beneficial Effects of Low-Dose Radiation

Evidence That Lifelong Low Dose Rates of Ionizing Radiation Increase Lifespan in Long- and Short-Lived Dogs – PMC5347275 – Feb 2017

After the 1956 radiation scare to stop weapons testing, studies focused on cancer induction by low-level radiation.

Since longevity is a measure of health impact, this analysis reexamined data to compare the effect of dose rate on the lifespans of short-lived (5% and 10% mortality) dogs and on the lifespans of dogs at 50% mortality. The data came from 2 large-scale studies. One exposed 10 groups to different γ dose rates; the other exposed 8 groups to different lung burdens of plutonium

Reexamination indicated that normalized lifespans increased more for short-lived dogs than for average dogs, when radiation was moderately above background.  Continue reading

“Bad Energy” is Core Problem in Fibromyalgia and CFS

Study Suggests “Bad Energy” is Core Problem in Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS) – Health Rising – by Cort Johnson | May 31, 2017

Lactate has become a big deal in both chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM).  A by-product of anaerobic energy metabolism, lactate ordinarily gets pumped out of our cells in large amounts during exertion.

The lactate findings suggest that the energy needs of ME/CFS/FM patients are largely being addressed by glycolysis or anaerobic energy production.

Anaerobic energy production plays an important role in energy production, but when aerobic energy production is not available and it becomes the major source of energy it produces metabolites that produce the burning muscles, fatigue and other symptoms we associate with over-exercise.  Continue reading

Surrogate end points in clinical research: Hazardous

Surrogate end points in clinical research: hazardous to your health. – PubMed – NCBI – Obstet Gynecol. 2005 May

Surrogate end points in clinical research pose real danger.

A surrogate end point is an outcome measure, commonly a laboratory test, that substitutes for a clinical event of true importance.

Resistance to activated protein C, for example, has been used as a surrogate for venous thrombosis in women using oral contraceptives.

Other examples of inappropriate surrogate end points in contraception include the  Continue reading

Better State Guidelines for Use of Opioid Analgesics

Guidelines for the Chronic Use of Opioid Analgesics from State Medical Boards Opioid Guidelines As Adopted April 2017_FINAL.pdf

Adopted as policy by the Federation of State Medical Boards April 2017

INTRODUCTION

In April 2015, the Federation of State Medical Boards (FSMB) Chair, J. Daniel Gifford, MD, FACP, appointed the Workgroup on FSMB’s Model Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain to review the current science for treating chronic pain with opioid analgesics and to revise the Model Policy as appropriate.

In updating its existing policy, the FSMB sought input from a diverse group of medical and policy stakeholders that ranged from experts in pain medicine and addiction to government officials and other thought leaders. 

This what the CDC should have done as well, but did not.  Continue reading

Response to FDA’s Request to Pull Opana Off Market

AIPM’s Response to FDA’s Request to Pull Opana ER Off Market – Academy of Integrative Pain Management Blog

On Thursday, June 8, the U.S. Food and Drug Administration “requested that Endo Pharmaceuticals remove its opioid pain medication, reformulated Opana ER (oxymorphone hydrochloride), from the market,” the FDA said in a statement.

Apparently Opana ER, an extended release form of the opioid drug oxymorphone, was being crushed up and injected by people seeking to abuse it.

“After careful consideration, the agency is seeking removal based on its concern that the benefits of the drug may no longer outweigh its risks. This is the first time the agency has taken steps to remove a currently marketed opioid pain medication from sale due to the public health consequences of abuse.”   Continue reading

CRISPR gene editing can cause unintended mutations

CRISPR gene editing can cause hundreds of unintended mutations | EurekAlert! Science News – May 29, 2017

This is an example of how new drugs developed with the latest new technologies can lead to dangerous unintended side-effects that only become apparent later after many subjects have been “treated”.

When a new technology, like CRISPR gene editing, is used we cannot use past experience to assume anything and cannot predict results precisely because we’re doing something categorically different from before.

As CRISPR-Cas9 starts to move into clinical trials, a new study published in Nature Methods has found that the gene-editing technology can introduce hundreds of unintended mutations into the genome Continue reading

THC Potentiates Analgesic Effects of Opioids

Persistent Potentiation of the Analgesic Effects of Opioids by Delta-9Tetrahydrocannabinol (THC) in Nonhuman Primates – Apr 2017

Improving the analgesic effectiveness of opioids while also reducing the adverse effects is a major goal of pain research.

One approach to this problem has been to combine drugs such as cannabinoids with opioids to determine if this might reduce the dose of opioid required to produce analgesia.

In this experiment, male nonhuman primates (rhesus macaques) were administered a range of doses of THC in combination with cumulative doses of heroin to determine if the combinations produced greater analgesia than that observed with heroin alone.

Briefly, the animals were secured in standard primate ch  airs, tails were shaved, and dipped in a mixed order in three different water temperatures (40 °, 50 °, and 55 °C) until the animal rapidly withdrew his tail, or 20 seconds elapsed. Continue reading