Fentanyl: Separating Fact from Fiction

Fentanyl: Separating Fact from FictionPractical Pain ManagementLast updated on: April 12, 2019

The US Centers for Disease Control and Prevention continue to report increasing opioid-related deaths despite declining rates of opioid prescribing.

Dramatically on the rise is the role of illicit synthetic fentanyl derivatives. These potent Schedule I drugs have dwarfed deaths from prescription-opioid overdose deaths, even among those that possess prescription opioids from a nonmedical source

Part of the discrepancy is that overdose deaths are frequently reported through ICD-10 codes, based on the International Statistical Classification of Diseases and Related Health Problems, which do not allow for delineation of overdoses by

  • a legitimately prescribed opioid versus
  • an illicit opioid, versus
  • a combination of these and/or other non-opioid sedative hypnotics.

Continue reading

Obscure advisory committees on U.S. drug pricing

The obscure advisory committees at the heart of the U.S. drug pricing debate – Reuters – by Caroline Humer – April 2019

Expectations were high last year for three new migraine drugs hitting the market from Amgen Inc, Eli Lilly and Co and Teva Pharmaceutical Industries.

Priced around $7,000 each, the drugmakers called them “breakthrough” treatments designed to prevent migraines when taken year-round, and estimated that millions of patients could benefit

But a small group of external medical experts who quietly advise U.S. health insurers on new drugs was not impressed, according to a private meeting held at UnitedHealth Group’s OptumRx offices in Chicago that was attended by Reuters.   Continue reading

Opioids allocated based on business decision

‘Business decision’: Former DEA official works for opioid lawyers but set standards for how many pills were madeBy John O’Brien | Sep 3, 2019

The DEA knew more about what quantities of opioids went where than anyone else, so I’m baffled why they didn’t stop the excessive orders that everyone is complaining about now.

Asked what would’ve happened if a pharmaceutical distributor wanted advice on whether a large order of opioids was suspicious, the man in charge of federal regulation of those pills for 10 years said he wouldn’t have helped.

Instead, Joe Rannazzisi, who set always-increasing opioid quotas for theindustry while he headed a Drug Enforcement Agency department from 2005-15, said the company would be left on its own to figure it out.    Continue reading

Opinion | Fear, Loathing and Fentanyl Exposure

Opinion | Fear, Loathing and Fentanyl Exposure – https://www.nytimes.com/ By The Editorial BoardApril 4, 2019

The New York Times has published many articles about the “opioid crisis” that follow the usual unchecked assumptions around opioids, so I’m glad this opinion piece by the “top guns” of the Times finally explains the problems posed by fentanyl: it’s super potent, but not by accidental skin exposure or “breathing fumes”.

As baseless public health scares go, the one about police officers and nurses purportedly overdosing from passive fentanyl exposure should have been easy to dispel.

Emergency workers across the country have reported dozens of such incidents in recent years, but their symptoms are often inconsistent with opioid poisoning.    Continue reading

Women More Adept Than Men At Discerning Pain

Women May Be More Adept Than Men At Discerning Pain : Shots – Health News : NPR – August 26, 2019 – Patti Neighmond  – Twitter

I like this article because it has links to reputable sources, like PubMed abstracts from the NIH. Unfortunately, it starts out with the usual trope:

The pathway to opioid abuse for women often starts with a prescription from the doctor’s office. [wrong, wrong, wrong…]

This is an outdated and completely incorrect myth of anti-opioid propaganda. The CDC data clearly shows that pain patients taking prescribed (for them) opioids account for only a minuscule number of the opioid overdoses, as I have posted previously:  Continue reading

Different Pain, Different Neural Circuits

Responses to External Threats and Sustained Pain Travel Via Different Neural Circuits – Practical Pain Management – By Kerri Wachter with Qiufu Ma, PhD – Jan 2019

New study outcomes in mice suggest that common pain measurement tools may be inadequate.

Different neural pathways appear to underlie

  • reflexive responses to external threats and
  • coping responses to sustained pain

I’m surprised this hasn’t been obvious to researchers because it’s certainly clear to pain patients. The experience of acute pain, like stubbing your toe, is wildly different than that of long-term pain, like failed back surgery, so it seems obvious to me that different aspects of our nervous system are involved.  Continue reading

Blunting pain’s emotional component

Blunting pain’s emotional component | Newswise: News for Journalists – Mar 2019

Chronic pain involves more than just hurting. People suffering from pain often experience sadness, depression, and lethargy.

These days, I’m almost surprised they’re not claiming that people are causing their own pain when they experience “sadness, depression, and lethargy”.

That’s one reason opioids can be so addictive — they not only dampen the pain but also make people feel euphoric. [not!]

Wrong. Those of us using opioids for serious pain do not experience this euphoria; see Opioids + Pain != Euphoria for an explanation why this doesn’t happen.    Continue reading

Neurosteroids: Endogenous Role in Human Brian

Neurosteroids: Endogenous Role in the Human Brian and Therapeutic Potentials – free full-text /PMC3139029/ – July 2011

This chapter provides an overview of neurosteroids, especially their impact on the brain, sex differences and therapeutic potentials.

Neurosteroids are synthesized within the brain and rapidly modulate neuronal excitability. Neurosteroids such as allopregnanolone are positive allosteric modulators of GABA-A receptors with powerful antiseizure activity in diverse animal models.

Neurosteroids increase both synaptic and tonic inhibition. They are endogenous regulators of seizure susceptibility, anxiety and stress.

This is exactly the kind of information I was looking for: a potential new treatment for the anxiety that has tormented me for decades.  Continue reading

The Pre-Modern Approach to Pain Treatment

The March Toward a Pre-Modern Approach to the Treatment of Pain Continues, Undeterred by Science By Jeffrey A. SingerAug 2019

It seems that no amount of data-driven information can get policymakers to reconsider the hysteria-driven pain prescription policies they continue to put in place.

For all human beings, data is far less stimulating than hysteria. That’s why movements, like the anti-opioid zealotry, use scare tactics to motivate and mobilize the populace.

I can understand lay politicians and members of the press misconstruing addiction and dependency, but there is no excuse when doctors make that error.

I used to believe that doctors knew far more about my body and its functions than I did, but what I’ve seen during this “opioid” crisis has disabused me of that quaint notion.  Continue reading

Effect of chronic opioid therapy on pain and survival

UMN researchers study effect of chronic opioid therapy on pain and survival in sickle cell disease | EurekAlert! Science News Apr 2019

Though this article is specifically about Sickle Cell Disease, it can be applied to many other kinds of chronic pain.

New UMN research recently published Blood Advances, Kalpna Gupta, PhD, Professor of Medicine, University of Minnesota Medical School, demonstrates the impact of opioids on the survival of humanized mouse models with sickle cell disease, compared to normal mice.

Sickle Cell Disease (SCD) affects millions of people throughout the world. The genetic disease worsens over time and can cause lifelong pain.

Given the often severe nature of the pain associated with SCD opioid use is a rule not an exception for treatment.    Continue reading