Category Archives: Opioid Debate

Patients Vulnerable to Limits on Opioid Rx

Limits on Opioid Prescribing Leave Patients With Chronic Pain Vulnerable – from Jama – Rita Rubin, MAApril 29, 2019

Thomas Kline, MD, PhD, refers to 22 of his patients as “pain refugees.”

Stable for years taking opioid therapy for chronic pain, these patients sought out Kline—well-known for his advocacy on their behalf on Twitter and elsewhere—because their physicians had abruptly cut their dose or refused to refill a prescription.

They had appealed to multiple physicians for treatment with no success before contacting him, said Kline. Continue reading

The Many (Surprising) Health Benefits of Meth

The Many (Surprising) Health Benefits of Methhttps://psmag.com – by Troy Farah – May 2019

Before fentanyl was the demon drug du jour, meth was seen as the worst, most destructive, most evil chemical you could find on the streets.

we’re constantly warned never to try meth—”not even once,” goes the refrain—or it will instantly cause addiction and ruin your life.

Here’s a secret: Meth is an incredible medicine. Some preliminary research suggests that meth can be neuroprotective against stroke and traumatic brain injury, even stimulating the growth of brain cells.

Stimulant-related deaths are indeed on the rise in North America—in some regions, meth is even more prevalent than heroin

Other Americans are prescribed actual, pure meth by their doctors.

It happens less frequently these days, but in ADHD, obesity, or narcolepsy cases where nothing else has worked, a drug called Desoxyn (methamphetamine hydrochloride) can sometimes help. It can even be prescribed to children as young as seven.

Meth didn’t make a “comeback”; it never left.

It can’t return with a “vengeance” and it can’t be “evil” because we’re talking about a chemical compound here. It has no personality, no feelings, no intentions.

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Thus it does a disservice to science and to medicine, as well as to the people who use these drugs responsibly, to treat a molecule with dualistic properties purely as a poison.

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‘It’s Just a Stimulant, Like Any Other Stimulant’

For Jordan*, the meth he’s prescribed works better against his ADHD with fewer side effects than the Adderall he’d been on for 20 years.

Jordan, a middle-aged man from North Carolina who works in clinical research, now switches every three months between Adderall and Desoxyn to prevent building a tolerance to either stimulant.

Jordan says. “I’ve been on the medications for years, but I can take Adderall or methamphetamine and take a nap afterwards. I don’t have any noticeable side effects.”

So can I! I have ADHD and am prescribed a relatively low dose of Adderall. I’ve noticed that I can take a full dose and it seems to make me less frazzled, to the point that I also can fall asleep with it in my system.

Jordan also doesn’t feel “high” from the doses he takes—approximately 10 to 15 milligrams of meth per day.

When I read articles and books by people who have grappled with an addiction to methamphetamine, I’ve always heard about the euphoria and the ability to stay up for days, be super productive and energized.

Not so for me.

I suppose mine is a “paradoxical reaction” (like I have to antihistamines), where it feels like it’s slowing my brain to a speed I can actually follow instead of zipping all over crazily (like a BB in a boxcar).

Part of the reason Jordan asked to try Desoxyn in the first place was to see if he’d develop any of the “stereotypical meth addict problems,” as he puts it. He hasn’t.

For Joan*, a 66-year-old grandmother living off the grid in northern Georgia, Desoxyn makes her feel normal. “Not high, not hyped up, just normal,” she tells me.

But Desoxyn has not only helped her socialize, manage bills, and finish her master’s degree in social work; it’s also helped with Joan’s depression and self-esteem.

“The only downside is the cost,” she says. “It’s one of the oldest drugs on the market, but even generic, it is outrageously expensive.”

How Meth Can Treat Brain Injury—and Much More

Street doses of meth can be extremely damaging to your health. The purity of such drugs is often unknown, and repeated, high doses of meth have been proven to be neurotoxic.

But in low, pharmaceutical-grade doses, meth may actually repair and protect the brain in certain circumstances.

This was first discovered in 2008, when researchers at Queen’s Medical Center Neuroscience Institute in Honolulu, Hawaii, unexpectedly found that patients who tested positive for methamphetamine were significantly less likely to die from the injuries.

To learn more, in 2011, a different team from the University of Montana applied meth to slices of rat brain that had been damaged to resemble the brains of stroke victims

  • At low doses, the meth gave better behavioral outcomes and even reduced brain-cell death.
  • At high doses, the meth made outcomes worse.

Because meth stimulates the flow of important neurotransmitters

  • dopamine,
  • serotonin, and
  • norepinephrine

—the Montana researchers theorized that methamphetamine may provide neuroprotection through multiple pathways.

To test the proposition, Poulsen and colleagues gave TBI to rats. The rats given meth performed better at a task called the Morris water maze,

But the team also found that low doses of meth were protecting immature neurons, while also promoting the birth of new brain cells that are important for learning and memory. The same was also true for rats that were given meth, but not injured.

a wide variety of stimulant therapies for TBI is being explored, with positive results. These include trials with

  • modafinil, a narcolepsy drug;
  • amantadine, a Parkinson’s drug; and
  • dextroamphetamine, one of the components of Adderall.

Methylphenidate, also known as Ritalin, seems to be the stimulant most popular in these trials. For example, in 2004, researchers at Drucker Brain Injury Center at MossRehab Hospital in Pennsylvania gave methylphenidate, better known as Ritalin, to 34 patients with moderate to severe TBI. They reported significant improvements in information processing and attention.

Twelve years later, in Gothenburg, Sweden, another 30 patients suffering from prolonged fatigue following TBI were given methylphenidate and observed for six months. They also showed improved cognitive function and reduced fatigue.

But the reason meth isn’t studied more rigorously—for TBI, for Alzheimer’s and Parkinson’s, for stroke—could also come down to money. Methamphetamine is off-patent, meaning there may be less financial incentive for pharmaceutical companies to explore the drug’s potential uses.

While Methamphetamine may not be widely recognized as medicine, it clearly has potential to heal as well as harm.

Recognizing the duality of meth is arguably all the more essential in the face of a rising stimulant overdose crisis.

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“Stigma regarding any substance use or substance use disorder is counterproductive,” says Dan Ciccarone, professor of family medicine at the University of California–San Francisco

“Everything will kill you, if you take enough of it,”

Yes, this is even true of water: Hyponatremia

Poulsen says. “Some things don’t require a lot to do that. Meth is one of those things. But just like any drug, the difference between a poison and a cure is the dose.

Opioid Treatment Programs to Provide Suicide Care

Opioid Treatment Programs Gear Up to Provide Suicide Careby Christine Vestal– Apr 2019

It’s long been suspected that the nation’s unprecedented drug overdose epidemic and sharply rising suicide rates are linked.

Now health researchers are finding concrete evidence that the two preventable causes of death — which are among the top 10 in the United States — are intrinsically related:

  • People with an opioid addiction are at much higher risk for suicide than the rest of the population; and
  • opioid use was a contributing factor in more than 40% of all suicide and overdose deaths in 2017, according to data from the U.S. Centers for Disease Control and Prevention. [Note: this identifies opioids only as *contributing* to overdose deaths]    Continue reading

Is the DEA Overreaching Its Authority?

Is the Drug Enforcement Administration (DEA) Overreaching Its Authority? – 4th May, 2019 – By Lynn Webster, M.D. – (This article, in a slightly edited form, first appeared on Pain News Network on May 5, 2019.)

Why Is the DOJ Conducting Criminal Investigations?

This is an excellent question because:

Medical practice is regulated by the states,
not the federal government.

The U.S. Department of Justice (DOJ) does not have the authority to determine which health care activities constitute a “legitimate medical purpose under Federal Drug Enforcement Administration (DEA) regulations.   Continue reading

Opioid Overreaction

Opioid OverreactionNYTimes.com – By David Leonhardt –  Mar 2019

I’m encouraged to see this very reasonable article in the New York Times, which has previously published some anti-opioid pieces of questionable accuracy. 

Some Americans suffering from chronic pain have recently lost access to medicines that helped them live normal lives.

Other patients have had to turn to invasive and dangerous treatments, like spinal injections. Continue reading

Health Officials Reach Out To Pain Patients

Amid Opioid Prescriber Crackdown, Health Officials Reach Out To Pain Patients – Apr 2019

A pharmacist in Celina, Tenn., was one of 60 people indicted on charges of opioid-related crimes last week, in a multistate sting. John Polston was charged with 21 counts of filling medically unnecessary narcotic prescriptions.

Here’s the first hint that this article is only about people with addiction, while people with pain are forgotten: the article uses the word “narcotics” to describe our prescribed medicines, instead of “pain medication”, “opioids”, or even the all-encompassing “drugs”, which is the term favored by the CDC when counting overdoses.

I’m sure they are well aware that most people will assume they’re referring to opioids, and even more precisely (wrong), “prescription opioids”.

With so many more accurate and representative words to choose from, using the word “narcotics” here was clearly an intentional reference to opioid addiction and a deliberate slap in the face of pain patients who have to take these medications to achieve some quality of life

Continue reading

Rx Drug Monitoring Programs: Helpful or Harmful?

How Helpful—Or Harmful—Are Prescription Drug Monitoring Programs? – FilterMag.org – by Jackie Rocheleau April 9, 2019

Before admitting new patients to his practice, Dr. Miguel Diaz checks their prescription history. Diaz, a family medicine physician with Community Care Physicians, PC in Clifton Park, New York, logs onto the state’s prescription drug monitoring program, or PDMP.

There, he sees everything the patient has been prescribed during the past year and who prescribed it.

PDMPs are now being used for all “scheduled” medications, not just opioids, and are made available for perusal by law enforcement and their minions.  Continue reading

Escalating Opioid Doses in Chronic Pain

Escalating Opioid Doses in Chronic Pain – by Judy George, Senior Staff Writer, MedPage Today – Apr 2019

This study, like 99% of the research being done, assumes opioid doses are completely independent of pain levels, making it utter nonsense to anyone who understands pain.

Increases in prescription opioid doses were unrelated to most clinical outcomes among chronic pain patients, according to a 2-year prospective cohort study.

Moreover, patients who had been prescribed a stable dose of long-term opioid therapy demonstrated few clinically significant changes in pain-related outcomes over time.    Continue reading

Health officials warn against rapid opioid tapers

Health officials warn against rapidly tapering down opioids for pain patients: ‘It’s a game-changer’ – By Elizabeth Llorente | Fox News

Ms. Llorente has proven to be a powerful ally. She’s written several articles for the ultimate mainstream media, Fox News, that protest the treatment of chronic pain patients.

Now that both the CDC and FDA have warned against forced tapers, there’s hope that the ignorant belief that all pain patient are just addicts who shouldn’t be taking opioids will be exposed for the lie it is.

Federal agencies behind efforts to address the nation’s harrowing opioid epidemic took major steps this week to address a brewing public health crisis involving pain patients who have been wrongly cut off or abruptly tapered down from their prescription painkillers.   Continue reading

CDC Joins FDA in Decrying ‘Mandated Dose Reduction’

Seeking to Clarify Its Opioid Prescribing Guidelines, CDC Joins FDA in Decrying ‘Mandated or Abrupt Dose Reduction’– by Jacob Sullum – Apr 2019

Acknowledging the suffering caused by “misinterpretation” of the opioid prescribing guidelines it published in 2016, the U.S. Centers for Disease Control and Prevention (CDC) yesterday sought to clarify that it never recommended imposing involuntary dose reductions on chronic pain patients.

In a letter to physicians who had objected to that widespread practice, CDC Director Robert Redfield emphasized that his agency “does not endorse mandated or abrupt dose reduction or discontinuation, as these actions can result in patient harm.”

The CDC may not “endorse” them, but they deliberately looked the other way for 3 years while this was happening.  Continue reading