Tag Archives: opioids

Opioid analgesic tolerance without hyperalgesia

Analgesic tolerance without demonstrable opioid-induced hyperalgesia: a double-blinded, randomized, placebo-controlled trial of sustained-release m… – PubMed – NCBI – Aug 2012

Although often successful in acute settings, long-term use of opioid pain medications may be accompanied by waning levels of analgesic response not readily attributable to advancing underlying disease, necessitating dose escalation to attain pain relief.

How can a doctor determine whether a patient’s increasing pain is attributable to “advancing underlying disease” or tolerance to opioids?

It’s impossible for anyone except the patient to determine this. Even for myself, it’s difficult to distinguish between increasing pain versus increasing tolerance to the medication.   Continue reading

CDC Rx Opioid Overdose Deaths Are Inaccurately High

CDC Researchers State Overdose Death Rates From Prescription Opioids Are Inaccurately High | Cato @ Liberty – March 22, 2018 – By Jeffrey A. Singer

In an article in the April 2018 issue of the American Journal of Public Health, four researchers at the Centers for Disease Control and Prevention’s Division of Unintentional Injury Prevention report that the CDC’s methods for tracking opioid overdose deaths have over-estimated the number of those deaths due to prescription opioids, as opposed to heroin, illicitly manufactured fentanyl, and other illicit variants of fentanyl.

They called the prescription opioid overdose rate “significantly inflated.”

This extremely significant and pertinent admission didn’t even cause a hiccup in the anti-opioid fervor fueling so much misguided policy.    Continue reading

Depression in chronic pain: opioids responsible?

This article made a big splash arguing that opioids, and not the pain we take them for, cause our depression.

Depression in chronic pain: might opioids be responsible? : PAIN – M.D. Sullivan and D.N. Juurlink – Nov 2018

Of course, the answer is “NO”, but this low-quality study with specious claims of “causal inference” tries to show a causal relationship that cannot be proven.

As usual, they are looking only at opioids with little concern for chronic pain, but if we substitute the words “chronic pain” everywhere they say “opioids” these studies make a lot more sense.   Continue reading

Morphine, Narcolepsy, and EDS

I recently received an email from a reader describing a strange connection she noticed between a sleep disorder and opioids:

I thought you might find this interesting–I most certainly did.

Morphine reversed narcolepsy in mice, and a brain sample from a deceased woman–previously treated for narcolepsy, but who’d taken morphine for a bad back–showed that the morphine had caused her hypocretin (orexin)-managing brain cells grow back to the point where she had complained of even sleeping too much!   Continue reading

Opioid Drugs Work Differently Than Natural Opioids

Opioid Drugs Work Differently Than Natural Opioids – RELIEF: PAIN RESEARCH NEWS, INSIGHTS AND IDEAS – By Kayt Sukel – Sept 2018

Opioid drugs like morphine and fentanyl relieve pain by attaching to and activating opioid receptors, which are proteins on the surface of nerve cells. The body’s own morphine-like chemicals, called endogenous opioids, do the same. As a result, scientists thought opioid drugs and endogenous opioids worked in the same way to ease pain. 

opioid drugs and natural opioids first activate opioid receptors at the cell membrane (which separates the inside of cells from the outside environment), and then in structures within the cell called endosomes.

But only opioid drugs go a step further: they also activate the receptors in the Golgi apparatus, a structure deeper inside the cell.   Continue reading

Fentanyl: Potent and Deadly in Illicit Form

The Fentanyl Story – The Journal of Pain – Dec 2014 – free full-text article

Here’s everything you ever wanted to know about fentanyl, the ultra-strong opioid first synthesized in 1960 for IV medical use.

This article explains the history and the rationale for using this particular opioid medically in transdermal patches (continuous dose) and sublingual wafers (immediately effective).

Unfortunately, even in 2014, it seems the scientific community was unaware that fentanyl was and is being illicitly manufactured for sale on the black market. It is this illicit fentanyl that’s causing so many overdoses due to its extreme potency and poorly controlled careless handling.   Continue reading

Low Risk of Opioid Use Disorder in Primary Care

Low Risk of Producing an Opioid Use Disorder in Primary Care by Prescribing Opioids to Prescreened Patients with Chronic Noncancer Pain | Pain Medicine | Oxford Academic – March 2017

This study shows what pain patients have been saying all along: prescribing opioids for patients with chronic pain very rarely causes problems of drug abuse.

Objective: 

To examine the risk of developing aberrant behaviors that might lead to a substance use disorder (addiction) when prescribing opioids for the relief of chronic noncancer pain in primary care settings.   Continue reading

Tapentadol: for acute and chronic pain

Here are excerpts from 5 PubMed studies on tapentadol (an atypical opioid):

Tapentadol Prolonged Release for Chronic Pain: A Review of Clinical Trials and 5 Years of Routine Clinical Practice Data. – PubMed – NCBI – Pain Pract. June 2017

Tapentadol prolonged release (PR) for the treatment of moderate to severe chronic pain combines 2 modes of action.

These are μ-opioid receptor agonism and noradrenaline reuptake inhibition in a single molecule that allow higher analgesic potency through modulation of different pharmacological targets within the pain-transmitting systems.   Continue reading

Ketamine’s antidepressive effects tied to opioid system in brain

Ketamine’s antidepressive effects tied to opioid system in brain – By Kimber Price – Aug 2018

Scientists at the Stanford University School of Medicine have discovered that ketamine works as an antidepressant at least in part by activating the brain’s opioid system.

The finding overturns previously held beliefs that the drug’s antidepressant effects stemmed solely from its impact on the glutamate system.

These beliefs led to the widespread use of ketamine to treat depression and spurred the development of glutamate-blocking drugs for use as antidepressants.   Continue reading

Efforts to curb opioid Rx may have backfired

Government efforts to curb opioid prescriptions may have backfired – Aug. 24, 2018

In the case of the DEA’s 2014 action to move opioid painkillers [hydrocodone, Vicodin] to a more restricted class, this “may inadvertently motivate surgeons to prescribe greater amounts to ensure adequate pain treatment,” said Dr. Jennifer Waljee, lead author of one of the studies.

Her team believes that once prescription refills became tougher under the new DEA rules, surgeons who worried about a patient’s longer-term pain control simply ordered a larger number of pills so the patient had a “stockpile” of opioids to use at home.  

This seems like a perfectly appropriate medical response to such arbitrary limits.   Continue reading