Tag Archives: opioids

New CVS Opioid Policy: Rx Limits & Nonmedical Switching

New CVS Opioid Policy Raises Concerns Over Prescription Limits, Nonmedical Switching – Sept 2017 – Donald M. Pizzi

CVS Caremark’s announcement that it is adopting an “enhanced opioid utilization management policy” in early 2018 (see Public-Health Experts Are Skeptical of the CDC’s New Anti-Opioid Campaign) has some in the pain community concerned that the pharmacy chain is dictating medical [care] to and potentially taking important medication options away from those who need them.

Chief among its features is a seven-day limit on the opioid medications it dispenses “for certain acute prescriptions for patients who are new to therapy.”

Remember, this 7-day limit is only for *new* prescriptions and does not apply to long-term prescriptions for chronic pain.   Continue reading

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Prescribed Opioids After Surgery Often go Unused

Study: Many Patients Don’t Use Prescribed Opioids After Surgery – Pain Medicine News – Oct 2017

A new study found that over two-thirds of patients did not use opioids prescribed to them postoperatively.

If opioids were as addictive as advertised, we wouldn’t be seeing opioids unused. The fact that patients may take only a few of their prescribed opioids contradicts the assertions that merely a taste of opioids causes almost everyone to become addicted.

How does the anti-opioid leader of PROP, Kolodny, explain that?  Continue reading

Underlying Factors in Drug Overdose Deaths

Underlying Factors in Drug Overdose Deaths | Substance Use and Addictive Disorders | JAMA | The JAMA Network – October 11, 2017
JAMA Viewpoint:  Deborah Dowell, MD, MPH; Rita K. Noonan, PhD; Debra Houry, MD, MPH

This is the “viewpoint” of the very influential Dr. Houry,  the Director of the National Center for Injury Prevention and Control (NCIPC) at CDC, who has been instrumental in restricting prescription opioids.

Since 2010, overdose deaths involving predominantly illicit opioids (heroin, synthetic nonmethadone opioids, or both) have increased by more than 200% (Figure).

Continue reading

Increased use of heroin as an initiating opioid of abuse

Increased use of heroin as an initiating opioid of abuse. – PubMed – NCBI – Addict Behav. 2017 Nov;

Note to CDC: data now clearly show that prescribed opioids are *not* the initiating drugs for addiction and fatal overdoses, so stop harassing pain patients!

Given the relatively recent growth in access to heroin and a more permissive atmosphere surrounding its use, we hypothesized that an increasing number of persons with limited experience and tolerance to opioids would experiment with heroin as their first opioid rather than more common prescription opioid analgesics. 

Spoiler alert: their hypothesis was proven true. Continue reading

Optimal Opioid Prescribing Based on Type of Surgery

Seeking an Optimal Opioid Prescribing Pattern Based on Type of Surgery – October 2, 2017

Guidelines for prescribing opioid pain medication with regard to acute pain recommend the lowest dose possible for the shortest duration needed to relieve pain, but specific guidelines for outpatient pain relief following surgery are still lacking.

Now, an analysis of more than 200,000 patients who had one of eight common surgical procedures may offer more clear guidance for this much needed pain management population. The study was published in JAMA Surgery.  

“Optimal” prescription lengths varied widely, according to senior study author Louis L. Nguyen, MD, MBA, MPH, associate professor of surgery at Harvard Medical School and a vascular surgeon at Brigham & Women’s Hospital in Boston.   Continue reading

NIH: 5% Addicted when Opioids used for Pain

Opioids and Chronic Pain | NIH MedlinePlus the Magazine – Spring 2011

Here is the US Government’s take on opioids as of 2011, where they mention that only about 5% of people who take opioids pain relievers develop an addiction.

Opioids are commonly prescribed because they are effective in relieving many types of pain. These medications are classified as narcotics and can be dangerous when abused.

When used properly, opioids such as morphine have long been known to help the severe pain that follows surgery and to alleviate the suffering of people with advanced cancer.  

The anti-opioid agitators are not concerned about “alleviating suffering”, even though that is the goal of every therapeutic encounter. Instead, they propose we all learn to live with our permanently painful conditions which, coincidentally, they don’t seem to have. Continue reading

PROPer Nanny | Dr. Jeffrey Fudin

PROPer Nanny | Dr. Jeffrey Fudin – September 22, 2017

Dr. Fudin has written another clever piece about the absurdities of the lengths the anti-opioid lobby (PROP) is willing to go in their search for targets: the latest is their proposal that all “high-dose” opioids be banned.

They want to force us to take multiple lower-dose pills instead of one high-dose pill… in the name of reducing the skyrocketing numbers of overdoses from illicit injected opioids.

This is literally crazy: completely illogical, sustained only by mental fantasies.  Continue reading

Opioids in chronic pain: 17 Case Reports

Opioids in chronic pain: 17 Case ReportsOpioids in chronic noncancer pain: More faces from the crowd – Pain Res Manag – Jul-Aug 2012 – C Peter N Watson, MD FRCPC – Free full-text article PMC3411376

The present article contains 17 case reports of 11 CNCP conditions (followed to 2011) selected to illustrate specific issues from a survey of 84 patients with intractable CNCP treated with opioids and followed every three months for a median of 11 years.

  1. Most patients in the total sample reported 50% or greater relief and a moderate improvement in disability.
  2. Problematic use, tolerance and serious adverse effects, including constipation, were not major issues

Continue reading

A Plea for Proper Opioid Tapering

Editor’s Memo: A Plea for Proper Opioid Tapering – Practical Pain Management – Dr. Forest Tenant – Editor’s Memo July/August 2017

It wasn’t long after the opioid guidelines from the Centers for Disease Control and Prevention (CDC)1 were released in 2016 that I began to hear rumors about pain patients being cut off from opioids and then committing suicide.

I initially didn’t take these reports seriously, since the

CDC guidelines neither placed a ceiling on opioid dosages
nor required that patients be “cut off” of opioids 

But as I noted in a previous Editor’s Memo: a survey of 1,978 chronic pain patients found that  Continue reading

Less than 5% Risk of Opioid Use Disorder in Patients

Low Risk of Producing an Opioid Use Disorder in Primary Care by Prescribing Opioids to Prescreened Patients with Chronic Noncancer Pain. – PubMed – NCBI –  2017 Mar

Here’s the main finding of this study:

Less than 5% of our study population
revealed any evidence of substance use disorder.

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