Tag Archives: addiction

More Reasons For Opioid Policy to Shift

Data From Germany Provide More Reasons For Policy to Shift From Prescription Pills to Harm Reduction – Cato.org – By Jeffrey A. SingerAug 2019

In February of this year, I co-authored a paper in the Journal of Pain Research explaining why there is no correlation between the amount of opioids prescribed and the incidence of non-medical use or prescription pain-reliever use disorder.

See my post on this paper: Non-medical opioid users were not pain patients

Now researchers in Germany have provided more evidence to pour cold water on the idea of any relationship between the volume of opioid prescribing and the incidence of opioid use disorder.   Continue reading

Addiction Is Not Dependence

Addiction Is Not Dependencepracticalpainmanagement.com – Aug 2019

In this editorial, Jennifer P. Schneider, MD, PhD, digs into a common—and frustrating—misunderstanding in pain medicine terminology.

FDA approved the buprenorphine implant, branded as Probuphine, in 2016 “for the maintenance treatment of opioid dependence.”

  • Was it approved for the treatment of what we now call Opioid Use Disorder (OUD)?
  • Or was the intent to approve it for physical dependence, a condition found in most opioid-treated chronic pain patients as well as opioid addicts?

It is not clear from the language.   Continue reading

DSM-5 Criteria for Opioid Use Disorder

DSM-5 Criteria for Diagnosis of Opioid Use Disorder– from American Psychiatric Association

These are the latest diagnostic criteria for what used to be called addiction. They make it seem like everyone on opioid therapy for chronic pain has “opioid use disorder” (OUD).

The writers of this new version of the manual thought the term “addiction” would be stigmatizing, so they created this new disorder as a continuum of “dependence”, further erasing the line between “use of opioids” and “addiction to opioids”.

It makes me think they themselves can’t see the difference that’s so obvious to us. Or perhaps they relied on addiction specialists, most of whom see any use of opioids beyond 90 days as an “opioid use disorder”.   Continue reading

Real Overdose Data from NIDA

Here is a whole page of some excellent charts from the National Institute of Drug Abuse (NIDA). – July 2019

NIDA has the most accurate, up to date, and pertinent information, since it’s the federal agency whose mission it is to deal with drug abuse, not the CDC or FDA.

Below is the chart showing that it’s illicit Fentanyl that’s increasingly involved. Note that in the numbers for prescriptions, the opioids are almost always not prescribed to the person overdosing.

Overdoses Increasing – With or Without Opioids

Nonopioid Overdose Death Rates Rose Almost As Fast As Those Involving Opioids, 1999-2016 – July 2019

A very recent PubMed study counting all the non-opioid overdose deaths shows the “crisis” is about overdoses from all kinds of illicit drugs, not only opioids (heroin, fentanyl) and certainly not from prescribed medication.

The number of Americans dying from drug overdoses has risen rapidly, but the contribution of nonopioid drugs to this growth is not well understood. Using vital statistics data from the universe of deaths among US residents in the period 1999-2016, I calculated levels of and increases in overall nonopioid fatal overdose rates and those for subgroups stratified by manner of death, sex, race/ethnicity, and age.

From 1999 to 2016 the number of nonopioid drug deaths rose 274 percent, and deaths per 100,000 population rose by 223 percent. Over the same period, opioid-involved fatality counts and rates grew by 371 percent and 307 percent, respectively.

Fatal overdose rates involving stimulants increased more than tenfold, with slower growth but higher rates for deaths involving sedatives and cocaine.

The current state of opioid prescribing

Addiction Medicine and Relapse Prevention – Practical Pain Management by Jennifer Schneider, MD, PhD
The current state of opioid prescribing, addiction, and response in the United States – undated but most likely 2019 

The State of Opioid Affairs

One of the most commonly discussed public health issues in the US today is the opioid overdose deaths crisis and how to solve it.

The “usual suspects” are clinicians who prescribe opioids, and the most commonly proposed solution is to decrease the number of opioid prescriptions.   Continue reading

Scapegoating opioid makers lets true offender get away

Scapegoating opioid makers lets true offender get away – UPI – by Dr. Jeffrey A. Singer – Apr 2019

This article contains a slew of opioid addiction facts and numbers, clearly showing that opioid prescriptions for pain are *not* the problem.

Like the tobacco companies in the 1990s, it is understandable to focus indignation at companies, driven by the profit motive, that purvey products that can cause harm and even death. It is reasonable to question and criticize their marketing ethics and aggressiveness.

But at the end of the day, extracting a pound of flesh from the Sacklers won’t stop the overdose rate from climbing.   Continue reading

Opioid Addiction AND Pain Treatment

One of us was a pain patient saved by opioids, the other was addicted to them. We both deserve a solutionLos Angeles Times – By Ryan Hampton and Kate M. Nicholson – Apr 2019

This is an excellent article in a popular mainstream publication written by two people on the opposite ends of the “opioid crisis”. They point out that a common solution is needed, not one at the expense of the other, as has been done in the past.

Opioids have figured prominently in both our lives.

  • For Kate, they were a lifeline after a surgical mishap left her unable to sit, stand or walk for more than a decade.
  • For Ryan, they were a gateway to a dark decade of heroin addiction.

many Americans believe that we have over-treated pain at the expense of those who became addicted to prescription opioids.   Continue reading

Drugs Are Hurting More People Than Ever

Why Drugs Are Hurting More People Than Ever – And What to Do About ItDan Bier  -March 18, 2019

America’s drug overdose problem is severe, persistent, and still deteriorating.

For years, states and the federal government have taken drastic action to curb drug deaths, from restricting painkiller prescriptions, to cracking down on drug cartels, to cutting the overall production of legal opioids.

But the problem is only getting worse.   Continue reading

Dolphins Use Toxic Pufferfish to Get High

Dolphins Seem to Use Toxic Pufferfish to Get High | Smart News | Smithsonian – Dec 2013

Just for fun:

Humans aren’t the only creatures that suffer from substance abuse problems.

  • Horses eat hallucinogenic weeds,
  • elephants get drunk on overripe fruit and
  • big horn sheep love narcotic lichen.

Monkeys’ attraction to sugar-rich and ethanol-containing fruit, in fact, may explain our own attraction to alcohol, some researchers think.   Continue reading