Category Archives: Opioid Debate

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.

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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

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

Risk of Opioid Medication Discontinuation

Opioid medication discontinuation and risk of adverse opioid-related health care events. – PubMed 2019 Aug

Between 2012 and 2017, the United States dramatically reduced opioid prescribing rates.

While this may be appropriate given the opioid epidemic, there has been little research to guide the clinical practice of discontinuing patients from opioid medications and opioid death rates have continued to increase.

These forced tapers have been a horrible experiment on thousands of people, enacted without any knowledge of what the outcome might be.   Continue reading

Outcomes After Opioid Tapers: Time to Start Counting

Outcomes After Opioid Dose Reductions and Stoppage: It’s Time to Start Counting – Stefan G. Kertesz, MD, MSc – Aug 2019

As clinicians reconsidered the value of a muchoversold drug class [opioids], the institutions that govern, regulate, pay, and police health care pushed for reductions. 

The unanswered question[s] would be

  • how such reductions would be carried out,
  • who might measure the outcomes, and
  • whether those outcomes included benefits, harms, or both.

And into that chasm of deliberate blindness are falling the suicides of pain patients who cannot live with their pain untreated.
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Misconceptions About Opioid Use Disorders

Prevalent Misconceptions About Opioid Use Disorders in the United States Produce Failed Policy and Public Health Responses | Clinical Infectious Diseases | Oxford AcademicAugust 2019 – free full-text

The current opioid crisis in the United States has emerged from higher demand for and prescribing of opioids as chronic pain medication, leading to massive diversion into illicit markets.

This massive diversion is how so many millions of pills ended up on the streets, not from individuals stealing a handful of pills from grandma’s medicine cabinet.

This is an aspect of the “opioid crisis” that seems deliberately ignored. I suspect it’s because supposedly “legitimate” opioid dealers have been able to deflect investigations of their opioid supply chain dealings by pointing to the drama of “innocent kids” overdosing on prescription opioids (not prescribed to them).  Continue reading

Clinical Drug Diversion Costly

Clinical Drug Diversion Costly to Health Care Organizations – Clinical Pain Advisor – Mar 2019

U.S. health care organizations lost nearly $454 million due to clinical drug diversion in 2018, according to the 2019 Drug Diversion Digest, released by Protenus Inc.

This article is written from the viewpoint of “Practice Management”, which nowadays isn’t about “practicing medicine” but about how to make money from it. These folks measure opioids by money gained/lost.

THE DEA always brags about how many pills/doses of opioids they confiscate in their raids, but here opioids aren’t counted by the pill of the MME, but by the mighty dollar.  Continue reading

Mortality After Discontinuation of Opioid Therapy for Pain

Mortality After Discontinuation of Primary Care-Based Chronic Opioid Therapy for Pain: a Retrospective Cohort Study. – PubMed – NCBI – J Gen Intern Med. – Aug 2019

BACKGROUND:

Despite known risks of using chronic opioid therapy (COT) for pain, the risks of discontinuation of COT are largely uncharacterized.

These “risks of discontinuation of COT” are not “largely uncharacterized” but rather completely unstudied.

Pain patients being tapered are being used as guinea pigs because those who are restricting opioids have no idea what the results might be.  Continue reading

Patients left in anguish by doctors ‘terrified’ of addiction

Pain patients left in anguish by doctors ‘terrified’ of opioid addiction, despite CDC change – Ken Alltucker and Jayne O’Donnell, USA TODAY – June 2019

I’m encouraged to see this article in such a mainstream publication where it will be seen by more than just patients and their doctors.

The Centers for Disease Control and Prevention issued guidelines in 2016 to cut back prescriptions after years of liberal opioid dispensing contributed to addiction and overdose deaths. 

Those guidelines influenced more than doctors: State regulators, health insurers and even disability administrators have cited the federal guidelines to justify policies that limit pain pill prescriptions.  Continue reading