Tag Archives: opioids

It’s a (illicit) Fentanyl Crisis, Stupid!

It’s a Fentanyl Crisis, Stupid! – Kaatje Gotcha Crippled Comedy – Medium – by Kaatje Gotcha | Crippled Comedy – Dec 2018

This excellent article from an author crippled by spinal pain tells the story of the current “pain crisis”.

She explains how the CDC guidelines were written in secrecy with input mainly from anti-opioid activists and how these guidelines have had horrible effects on pain care in this country. She backs up her statements with numerous current references, as everyone should (and the anti-opioid zealots never do).

In 2012, life was great: I proudly wore a white coat with a stethoscope around my neck and finally felt useful to humanity. 

Because the author was/is a medical professional, she knows what she’s talking about. Continue reading

Almost All Overdose Deaths Involve Multiple Drugs

Almost All Overdose Deaths Involve Multiple Drugs, Federal Report Shows  – By Erin Schumaker – Dec 12, 2018

A new report analyzing the drugs involved in fatal overdoses once again emphasized fentanyl’s role in the United States’ opioid crisis and highlighted a point frequently made by public health experts:

Most people who fatally overdose
have more than one drug in their system.

In 2016, about 70 percent of fatal overdoses involving fentanyl or heroin involved another drug as well, and roughly 74 percent of fatal overdoses involving cocaine also involved one or more other drugs.   Continue reading

Correcting FDA Questions about Drug-Seeking

Evaluation of US Food and Drug Administration-recommended abuse-potential questions in chronic pain patients without history of recreational opioid use: results and plan for research – free full-text /PMC6301309/ – Dec 2018

Background

Existing patient-reported outcome (PRO) assessments that measure the human abuse potential for opioid analgesics have been tested exclusively in experienced recreational opioid users, as required by US Food and Drug Administration (FDA) guidance.

Methods

The goals of the current studies were to modify items from FDA-recommended abuse potential PRO assessments to specify the analgesic benefits versus the euphoric effects of opioids and to ascertain the clarity, understandability, appropriateness, and validity of the modified questions.  Continue reading

Pain Deniers Endangering Lives

Pain Deniers – from “Pulse Voices”  where both those providing and receiving healthcare write about their experiences.

The stabbing pain in my abdomen jolted me awake at 3 a.m.

Four broken bones, giving birth to two babies, gallstones – all minor aches compared to this. At the hospital they found no reason for my pain. The blood tests were normal. I had no fever. They sent me home.

It went away, and then it happened again two days later.   Continue reading

Review of HHS Report on Pain Mgmt Best Practices

This major report is long and detailed, so I covered most of it in three long posts:

  1. HHS Report on Pain Mgmt Best Practices – part 1
  2. HHS Report on Pain Mgmt Best Practices – part 2
  3. HHS Report on Pain Mgmt Best Practices – part 3

 

If you’re interested in a particular section of the report, below is the full article outline with links to each section:   Continue reading

Opioids Effective for Peripheral and Neuropathic Pain

Oral opioid therapy for chronic peripheral and central neuropathic pain. – PubMed – NCBI – Pain Clinical Research Center, Department of Neurology, University of California, San Francisco, School of Medicine, San Francisco, USA – free full-text in N Engl J Med. – Mar 2003

This careful and rigorous study from 15 years ago showed clearly that an opioid, at least levorphanol, can be very effective for “central sensitization” types of pain.

I suspect the current doubts about opioid effectiveness for neuropathic pain are because they are afraid to use strong enough opioids in sufficient doses, because this article shows levorphanol IS effective.

Background:

Although opioids are commonly used to treat chronic neuropathic pain, there are limited data to guide their use. Few controlled trials have been performed, and many types of neuropathic pain remain unstudied.  Continue reading

Impact of opioid dose reduction

[Full text] Impact of opioid dose reduction on individuals with chronic pain: results of an online survey | JPR – by Twillman RK, Hemmenway N, Passik SD, Thompson CA, Shrum M, DeGeorge MK – Nov 2018

Background: In 2016, the Centers for Disease Control and Prevention (CDC) released a guideline on opioid prescribing for primary care physicians. Patients with chronic pain receiving long-term opioid therapy were surveyed to assess the incidence and impact of opioid dose reduction following this guideline’s promulgation.

Methods:

Members of an advocacy organization for people with chronic pain were invited to participate in a 16-item, anonymous, online survey conducted in September/October 2017.  Continue reading

Measurement of Chronic Pain and Opioid Use Evaluation

Measurement of Chronic Pain and Opioid Use Evaluation in Community-Based Persons with Serious Illnesses | Journal of Palliative Medicine – by Kathleen Puntillo, and Ramana K. Naidu – Mar 2018

I had high hopes for this paper after reading the abstract and finding this conclusion, which feels so spot-on:

Conclusions:

Accountability for high quality care for community-dwelling patients requires selection of metrics that will capture the

  • burden of chronic pain and
  • beneficial use or misuse of opioids.

Continue reading

Opioid Withdrawal Not Deadly? Wrong

Opioid Withdrawal Not Deadly? Wrong | Medpage Today – by Jeffrey E. Keller, MD Nov 2018

I’ve seen enough patients withdrawing from opioids [in a jail medical practice] that I think I am reasonably knowledgeable on the topic. Because of this, I was quite surprised when I ran across this sentence in a recent edition of The Medical LetterOpioid withdrawal is not life-threatening.”

The problem is that although this sentence seems quite self-assured, it is flat out wrong. In fact, it is not just wrong; it is also dangerous.

People do die from opioid withdrawal. I know of several such cases from my work with jails.   Continue reading

Opioids ARE effective versus placebo in chronic pain

Efficacy of opioids versus placebo in chronic pain: a systematic review and meta-analysis of enriched enrollment randomized withdrawal trials – Meske DS, Lawal OD, Elder H, Langberg V, Paillard F, Katz N – 19 December 2017

This is a study from almost a year ago that gives evidence that opioids ARE effective for our chronic pain. PROP manipulates the evidence to make it seem like opioids don’t work for us.

Introduction: To evaluate opioids’ efficacy in chronic non-cancer pain, we performed a meta-analysis of published clinical trials for μ-opioid receptor agonists performed for US Food and Drug Administration approval.

Methods: MEDLINE and Cochrane trial register were searched for enriched enrollment randomized withdrawal studies (before June 2016).   Continue reading