Tag Archives: addiction

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

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

Inconsistent Definitions of Opioid Use Disorder

Agreement between definitions of pharmaceutical opioid use disorders and dependence in people taking opioids for chronic non-cancer pain (POINT): a cohort study – The Lancet Psychiatry – free full-text – Mar 2015

Background

Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used.

I find it outrageous that OUD can be diagnosed on a whim just by using the fitting definition in one of the several classification systems.

The DSM-5 is the worst, thanks to its “spectrum” of Opioid Use Disorder (OUD), which always places us pain patients, with our regularly prescribed opioids, into the low end of this spectrum.  Continue reading