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Tag: chronic pain

  • Can Low-Dose Naltrexone Work For Pain Relief?

    Can Low-Dose Naltrexone Work For Pain Relief?

    Some chronic pain patients say that naltrexone has offered them much-needed relief.

    Naltrexone has changed Lori Pinkley’s life. But unlike most people who have benefited from the drug, she’s not using it to treat alcohol or opioid use disorder. Pinkley uses naltrexone to treat chronic pain. 

    “I can go from having days that I really don’t want to get out of bed because I hurt so bad, to within a half-hour of taking it, I’m up and running, moving around, on the computer, able to do stuff,” Pinkley told NPR. 

    Jumpstarting Endorphins

    Pinkley’s physician, Dr. Andrea Nicol, is a pain specialist at the University of Kansas. She started prescribing naltrexone to Pinkley about a year ago. For people living with substance use disorder, she said, 50 milligrams of naltrexone blocks the brain’s opioid receptors.

    However, Nicol said that in her pain patients, a much lower dose of about 4.5 milligrams helps their malfunctioning nervous systems reset and work optimally, and jumpstart the production of endorphins, which contribute to natural pain relief. 

    “What it’s felt to do is not shut down the system, but restore some balance to the opioid system,” she said. 

    There have not been any wide-scale studies of low-dose naltrexone, which is sold under the brand names Revia and Vivitrol to treat addiction. However, a review recently published in the journal Medical Sciences found that naltrexone has entirely different effects at low doses. 

    Different Dynamics In Low Doses

    “In substantially lower than standard doses, they exert different pharmacodynamics,” the review authors wrote of naltrexone and a related drug, naloxone. This makes them potentially useful in treating pain, and keeping patients off high-dose opioids, said Dr. Bruce Vrooman, the study author. He added that patients on low-dose naltrexone report fewer side effects than patients on opioids. 

    “Those patients may report that this is indeed a game changer. It may truly help them with their activities, help them feel better,” he said. 

    Doctors Are Unaware Of Its Off-Label Use

    However, naltrexone faces barriers to becoming a widely-used pain reliever. First, many doctors don’t know that it can be prescribed for pain relief, or may not be comfortable prescribing it “off label.” In addition, pharmacies don’t sell such small doses, so people using low-dose naltrexone need to use compounding pharmacies, and insurance often won’t cover the medicine. 

    Finally, there is little interest from companies in producing naltrexone products. Since it’s already available as a generic, there’s less profit to be derived from it. 

    “Bringing a new drug to market requires getting FDA approval and that requires doing clinical trials,” said Patricia Danzon, a professor of health care management at the Wharton School at the University of Pennsylvania. “That’s a significant investment, and companies—unsurprisingly—are not willing to do that unless they can get a patent and be the sole supplier of that drug for at least some period of time.”

    View the original article at thefix.com

  • Doctor Calls For Caution In Reducing Opioids

    Doctor Calls For Caution In Reducing Opioids

    For some patients who have been doing well on opioids long-term, it makes sense to “leave well enough alone,” the doctor said. 

    Today, much of the medical community is focused on reducing opioid prescriptions after decades of overprescribing, but one doctor is an outspoken critic of weaning patients who are doing well on long-term or high-dose opioid prescriptions. 

    Dr. Stefan Kertesz, a primary care physician who focuses on addiction medicine and works with the homeless population, told STAT News that he is challenging the idea that even people who are doing well on opioids need to have their medications reduced or replaced. 

    “I think I’m particularly provoked by situations where harm is done in the name of helping,” said Kertesz, who is also a professor at the University of Alabama at Birmingham School of Medicine. “What really gets me is when responsible parties say we will protect you, and then they call upon us to harm people.”

    In particular, Kertesz takes issue with the CDC’s 2016 opioids prescription guidelines. The guidelines were interpreted very strictly, and have led to many pain patients—even those who have not abused their medications—seeing their care regimen change. 

    For some patients who have been doing well on opioids long-term, it makes sense to “leave well enough alone,” Kertesz said. 

    He believes that the general recommendation to be careful when prescribing opioids is sound advice. However, when the recommendations are taken as a mandate, problems can arise, he said in a written response to the guideline. 

    “This is a guideline like no other… its guidance will affect the immediate well-being of millions of Americans with chronic pain,” Kertesz wrote.

    In another written response he said, “Most of us wish to see an evolution toward fewer opioid starts and fewer patients at high doses,” but doctors need to be able to leave some patients on opioids as clinically necessary without feeling like they are putting their careers at risk. 

    Kertesz encouraged the CDC to clarify that the guidelines were recommendations only, not policy proclamations. 

    “It is imperative that healthcare professionals and administrators realize that the Guideline does not endorse mandated involuntary dose reduction or discontinuation,” he wrote in one letter that he co-authored. “Patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use.”

    Now, Kertesz is hoping to secure funding to study suicides caused by reduction in pain medications. 

    “You have three things that are potentially simultaneously associated with harm: Pain itself. Opioid dependence, the dependence itself. And the event, however we wish to interpret it clinically—as resurgent pain or untreated opioid dependence—in patients who are having opioids taken away,” he explained. 

    Despite his dedication to speaking out against uniform opioid reductions, Kertesz sometimes still feels nervous about standing against the mainstream medical community.  

    “Every single bit of it involves ambivalence and driving myself crazy,” he said. “Like, am I making a mistake? Am I going to blow up my career?”

    View the original article at thefix.com

  • Woman Testifies About Chronic Pain, Opioids From Cot

    Woman Testifies About Chronic Pain, Opioids From Cot

    “We must invest in the discovery of new, effective, and safer options for people living with pain,” Cindy Steinberg said in prepared remarks.

    It’s heartbreaking to see the faces of the opioid epidemic—young lives cut short by drug overdoses. Yet, this week another tragic but often overlooked face of the epidemic was on display when a woman testified before Congress from a cot, detailing her life with chronic pain. 

    Cindy Steinberg, national director of policy and advocacy for U.S. Pain Foundation spoke before the Senate Committee on Health, Education, Labor and Pensions during a hearing entitled “Managing Pain During the Opioid Crisis.”

    Steinberg’s chronic pain began 18 years ago when filing cabinets and cubical walls fell on her at work. Today, she isn’t able to sit or stand for long periods without experiencing muscle spasms and pain.

    She told the committee that her life is like “being a prisoner in your own body and being tortured,” according to the National Pain Report. 

    Steinberg argued that substance abuse and access to pain management medications for those who need them are two entirely separate issues. She said that rising overdoses has highlighted an existing problem, “underscor[ing] our failure to provide adequate, safe, accessible treatment options for pain relief.”

    “We can and must restore balance to opioid prescribing,” Steinberg said. 

    According to NBC News, Steinberg said in her prepared remarks, “In the near term, we can and must restore balance to opioid prescribing with depoliticized, rational and cleareyed recognition of the risks and benefits of these medications. In the long term, we must invest in the discovery of new, effective, and safer options for people living with pain.”

    Others who advocate for pain patients, including Richard “Red” Lawhern, director of research for the Alliance for the Treatment of Intractable Pain, were happy to see Steinberg’s story in the spotlight.

    “Steinberg directly challenged the lack of resident expertise on pain management at CDC, suggesting that Congress direct the much better equipped NIH to rewrite the guidelines based on recommendations of the HHS (Department of Health & Human Services) Task Force. This is a recommendation I support,” Lawhern said. 

    Committee Chair Senator Lamar Alexander of Tennessee seemed to empathize with Steinberg’s concerns, saying the “massive effort in reducing the supply of opioids has had the unintended consequence of hurting people who need them.”

    This week, research emerged showing that current changes in access to prescription opioids are unlikely to reduce the number of opioid overdoses. The research shows that projected annual opioid overdose deaths will reach 82,000 by 2025. 

    View the original article at thefix.com

  • Alcohol, Inflammation, and Chronic Illness: My Story

    Alcohol, Inflammation, and Chronic Illness: My Story

    For my particular condition as well as other inflammatory chronic illnesses, alcohol can actually mess up your gut flora, which is where many diseases originate.

    During graduate school—about seven years ago now—I was partying wildly. I was part of a theatrical show, which had me out late very often. Drinking was a sort of currency; it’s how we bonded, how we synced our feelings, how we operated. Alcohol was almost always used as a way to create our art; we believed the night was magical only if filled with wine and sparkling cava and fancy martinis. And I don’t blame us. We were young and energetic and in love with our lives.

    But as someone with both serious education debt and a full-time job, it was hard to balance my copious drinking. Real life—the daytimes—were sober and slow, and my evenings were wild and loud and, yes, usually drunk. Too many mornings were impossible. Too many days I’d show up late. Too many conversations half-remembered, blurry, embarrassing.

    And then my chronic illness kicked in. The official diagnosis was about a year ago, although I had been experiencing symptoms for years before that—and alcohol only ever made them worse, I’ve now realized.

    Living with a Chronic Disease

    I have ankylosing spondylitis (AS). It’s an inflammatory and degenerative spinal disease that causes immobility, disfigurement, and issues with my joints, eyes, stomach, and heart. Inflammation is the name of the game with this condition: my immune system attacks itself, leading to painful inflammation that, if left untreated, could prevent me from walking and moving in the future.

    Before my diagnosis, “wellness” wasn’t even in my vocabulary. I didn’t sleep enough, I didn’t take care of my mental health, I didn’t stretch or work out often, I didn’t put clean foods into my body. And I certainly didn’t look at alcohol as a problem.

    Around the time I hit my late 20s, I stopped wanting to be so wild, so I cut back on the partying and the drinking. I suffered from all sorts of AS-related symptoms—horrific pain, joint immobility, digestive issues, constant eye inflammation—which forced me into periods of rest. I realized that a life without all that alcohol was a better life. Not only was I sleeping more often, but my pain management was easier. I was able to quiet my mind, go inward, and find and develop tools to soothe myself. Life was better when I wasn’t filling my calendar with endless parties that were all centered around the idea of getting wasted.

    I don’t regret my younger days and I don’t judge people who drink. I still adore a few glasses of wine here and there, but I have learned that alcohol is something that doesn’t necessarily contribute to a person’s wellness.

    For me, and for many other people dealing with chronic illness, inflammation is our enemy and we must be proactive in preventing it. If alcohol plays a role in inflammatory processes, we need to know about it so we can make informed decisions about our health.

    What Is Inflammation?

    Inflammation is the body’s response to harmful toxins or infections. Acute inflammation is good. It protects you when you’ve got a cut by sending white blood cell soldiers to the area. Chronic inflammation is very bad. It creates a state of constant internal fighting.

    According to the Canadian Institute of Health, “Despite its crucial role in protecting the body, inflammation can also be inappropriate and ‘misplaced’ leading to a wide range of chronic conditions such as rheumatoid arthritis, inflammatory bowel disease, asthma, and multiple sclerosis. Inflammation also plays an important role in the most common causes of death worldwide, including atherosclerotic cardiovascular disease, cancer, and chronic obstructive lung disease. Taken together, it is clear that inflammation contributes broadly to chronic illnesses.”

    Alcohol and Inflammation

    According to the World Journal of Gastroenterology, chronic usage of alcohol can lead to systemic inflammation.

    But what about less-than-chronic use of alcohol? According to Vincent M. Pedre, M.D. at mind body green, “Large amounts of alcohol can create intestinal inflammation through multiple pathways.” For my particular condition as well as other inflammatory chronic illnesses, alcohol can actually mess up your gut flora, which is where many diseases originate.

    When I got serious about taking care of my body, I spent a lot of time learning about the potential factors that could make me worse. I didn’t want to give up on all pleasures in life, and I’m not practicing complete abstinence, but I have cut drastically back on alcohol. If I didn’t, my pain levels would be through the roof.

    Learning to Take Care of Myself

    Part of growing up and taking accountability has been making this one particular change. I now say no to “another glass of wine” more often than I say yes. I now have to decline nights out because my health is a priority. And I now try to create experiences that don’t center on alcohol. I won’t lie and say it’s easy—because it’s not. Our society loves alcohol and most social and work functions utilize alcohol as a lubricant and a sort of badge of bonding. But knowing what’s at risk is more important than ordering that fancy martini.

    As a child of two people who suffered through addiction, I am aware of my own potential downfall when it comes to addictive behaviors. I try to be both cognizant and accountable when it comes to caring for my future health, and my body today.

    Living with a chronic illness means constantly managing your output, your pain, your relationships, your doctor appointments (or lack of healthcare). Adding dangerous variables that could erase all that effort just isn’t worth it to me anymore.

    Some people, especially those who live with chronic pain, use alcohol to self-medicate and manage their pain. We desperately need more advocacy and resources around this issue. According to Andrew Haig, MD, “Alcohol use must be understood in individuals with chronic pain, both because of the drug interactions induced by alcohol and because of the independent effect alcoholism has on disability and suffering.”

    It’s not an easy road. I’m a writer who lives in New York City—a city known for its nightlife. Drinking is part of the culture here. And I can be fairly introverted. These are all things that drinking is rumored to help with: alcohol makes you more creative, more outgoing, more fun. Right?

    In the end, the answer doesn’t matter, because today I choose my body. I choose my future. I choose to stay balanced and mindful. And when I do, my body responds in kind.

    View the original article at thefix.com

  • New Non-Opioid Treatment For Back Pain Heads To Clinical Trials

    New Non-Opioid Treatment For Back Pain Heads To Clinical Trials

    Researchers hope the non-opioid treatment for back pain will be approved by the FDA so that it will be eligible for coverage by Medicaid and Medicare.

    Researchers at West Virginia University (WVU) are taking part in a clinical trial for a non-opioid, non-steroid treatment of a common form of back pain that is usually treated with opioid painkillers.

    The Rockefeller Neuroscience Institute is the first site to enroll a patient in a randomized trial, currently in its third phase, that uses a micropellet injection of clonidine—a treatment for blood pressure and pain—to alleviate pain caused by sciatica. The participation of WVU is part of what the university described as its ongoing commitment to fight opioid addiction in a state that had the highest rate of opioid-related overdose deaths in the nation.

    The Institute reported on November 15 that it had successfully injected the clonidine micropellet, which is approximately half the size of a grain of rice, into a patient’s lower back. The micropellet dissolves in the body and is expected to provide relief from acute pain caused by sciatica, a common form of back pain that radiates from the sciatic nerve down the lower back through the hips, buttocks and down each leg.

    As the West Virginia Gazette noted, 60% of sciatica patients—which include some five million U.S. residents—are treated with opioid medication.

    “We hope that the patients that have sciatica will have very good and prolonged pain relief from this formulation of this medicine,” said Dr. Richard Vaglienti, principal investigator for WVU’s site of the study and director of the Center for Integrative Pain Management. “This is a medicine we’ve used for many years for pain in anesthesiology, and now it’s been formulated into these pellets that we’re injecting into the patients’ epidural space in hopes of finding a better treatment than what we have now.”

    Currently, one patient from WVU has been enrolled, though others have signed up and are ready for treatment. The study itself will enroll 200 patients nationwide; if effective, the study authors hope to have it approved by the Food and Drug Administration (FDA) so that it will be eligible for coverage by Medicaid and Medicare.

    Making the drug available to all Americans, and especially those in West Virginia, is key to WVU’s participation in the study.

    “Sadly, West Virginia, in 2017, had the highest drug overdose mortality in the nation, followed by Ohio,” said Dr. Ali Rezai, executive chair of the Rockefeller Neuroscience Institute, and scientific adviser to Sollis Therapeutics, which developed the clonidine micropellet.

    “It’s important that we also explore solutions to deal with the opioid crisis, and in this case, be the first in the country to use this technology so we can stop opioid addiction at its roots.”

    View the original article at thefix.com

  • The Other Side of the Opioid Epidemic: Chronic Pain Patients

    The Other Side of the Opioid Epidemic: Chronic Pain Patients

    “It is borderline genocide,” said DeLuca, 37. “You are allowing [chronic pain patients] to go home and essentially suffer until they kill themselves.”

    Last year, Lauren DeLuca went to the emergency room in the middle of the night, violently ill and in pain with a pancreatic attack. Despite the fact that she was passing out and vomiting profusely, DeLuca said that she received little help.

    “I was essentially turned away,” she told The Fix. “Everywhere [I went] I was being accused of lying, accused of making it up.”

    Over the next three weeks, DeLuca lost 20 pounds, unable to eat because of her pain and vomiting. Doctors, she said, were too paralyzed by the fear of overprescribing powerful opioid pain relievers to help her. Eventually, DeLuca’s arteries and organs were permanently damaged by her inability to eat, halting her plans to start a family, and leaving her with lifelong health issues. Even after all that, she had issues accessing the opioid pain relief that would make her life bearable.

    “I’m a continuous level 10 pain. If you don’t medicate me, I’m screaming,” she said.

    Frustrated and desperate, DeLuca founded the Chronic Illness Advocacy and Awareness Group, first as a Facebook community and later as an advocacy organization that aims to help chronic pain patients who feel that new opioid regulations put their lives at stake.

    “It is borderline genocide,” said DeLuca, 37, who lives in Massachusetts. “You are allowing them to go home and essentially suffer until they kill themselves.”

    Good Intentions, Dangerous Consequences

    The negative effects of opioids are widely known. Overzealous and irresponsible prescribing practices, sometimes by doctors receiving kick-backs from drug companies, are blamed for causing the opioid epidemic that has claimed more than 70,000 American lives last year alone. In an effort to reduce the number of people dying from drug overdoses, policymakers have targeted prescription opioids, issuing guidelines for prescribers and in some cases, regulating the number of pills and the dosage that can be issued to patients.

    As a result, the total number of opioid prescriptions issued in America peaked in 2012 and has fallen steadily since. While policymakers praise this as a win in the fight against opioids, chronic pain patients and some medical professionals argue that the regulations have placed a burden on people who need opioids to function.

    “The restrictive prescribing laws are misguided and have unintended consequences,” said Lynn R. Webster, MD, a vice president of scientific affairs for PRA Health Sciences, past president of the American Academy of Pain Medicine and the author of The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.

    It’s true, Webster said, that opioids were being over-prescribed, particularly for acute (short-term) pain. Limits on prescriptions for acute pain make sense for most patients (although not all, he said), but doctors are also being pressured through laws, recommendations, and insurance policies to taper chronic pain patients off opioid regimens that have been working for them for years.

    “This is despite being compliant and not showing any signs of drug-related problems,” Webster said.

    In 2016, the Centers for Disease Control and Prevention issued guidelines urging prescribers to “carefully justify a decision” to put a patient on a dose of opioids higher than 90 milligrams per day. While the CDC said it consulted experts, pain advocates say that this is a relatively arbitrary number that is devastating for patients like Krista Battrick of Washington state.

    Battrick, 50, suffers from chronic nerve pain caused by complications from a dental implant. She has been on opioids for 16 years and was able to use them to keep her pain at about a 1 on scale of 10. However, following the CDC recommendations, her doctor informed her he would no longer be prescribing opioids. Battrick struggled to find a new pain doctor who would take her given her high dosage. After three months, she finally found a new doctor, but he insisted on tapering her opioid dose so quickly that she experienced withdrawal symptoms.

    “I am now in pain every single day,” she said, explaining that her new normal is pain at about a 4 or 5, with breakthrough pain that occasionally keeps her confined to bed. “I am angry because I feel like the decision to make these ‘guidelines’ were made by people who have never experienced chronic pain and have never talked to anyone who has experienced chronic pain.”

    Battrick isn’t the only one who is upset. Richard Lawhern, co-founder of the Alliance for the Treatment of Intractable Pain, became involved in the chronic pain community when he started caring for his wife, who has chronic facial pain. He says that backroom deals and biased anti-opioid reviews made between governing bodies, especially the CDC, led to what he calls a “draconian reduction” in the number of opioids being prescribed. In part because of what he calls “these distortions,” Lawhern has filed a formal complaint with the the Office of Inspector General (OIG) for the United States Department of Health and Human Services (HHS), accusing the CDC of fraud in forming and issuing the 2016 opioid prescription guidelines.

    The Root of The Issue

    Pain patient advocates say that these policies stem from a fundamental misunderstanding about prescription opioids and opioid overdose deaths. They argue that the rate of opioid prescriptions being written was never causally tied to the rate of opioid-related drug overdoses. But despite the lack of research, Lawhern said that the medical community — and then policymakers — began to treat this premise as fact.

    “That point of view was never based on fact or data,” he said. “Yet it was accepted at face value by people in the medical profession who felt it to be intuitively right.”

    The data, he said, show no cause and effect relationship between opioid overdose deaths and overprescribing, but the CDC has turned a blind eye.

    “When you plot the rate of opioid prescribing against the rate of overdose deaths from all causes, what you get is a shotgun pattern with no trend lines,” Lawhern said. “There is no cause and effect relationship there, but the CDC has actively resisted doing the analysis and validating that reality.”

    Webster agrees. “The media and policymakers clearly don’t understand that the drug problem is not from prescription opioids,” he said, pointing out that while prescription rates have dropped dramatically, overdose rates are at an all-time high.

    “It is naive to think that limiting access to prescription opioids will stop abusers from abusing,” he said. “They will just go to the street, where the more dangerous drugs exist, to get what they want.”

    As chronic pain patients have more trouble accessing the medications that let them live their lives, DeLuca sees more lashing out at addiction patients, blaming the behaviors of “some junkies” for affecting their ability to get pain relief. DeLuca said that she tries to stay out of the blame game.

    “We shouldn’t be demonizing substance abuse either. They are human beings suffering as well, and they need treatment,” DeLuca said. “But everyone in the pain community feels we have been betrayed: that policymakers feel that people with substance abuse disorders deserve a life and we pain patients don’t.”

    The Spiral of Restricting Pain Relief

    Many pain patients now feel that they need to prove that they are worthy of pain medication, that they’re not making up symptoms to score a high.

    Dina Stander, 56, is a lucky pain patient in that she has found a primary care doctor who helps her navigate her hereditary spine and joint condition and the pain it brings. Even still, she recently received push-back from the doctor when she asked for a refill on pain medication that she keeps on hand for emergencies.

    “I had to remind him that I do not usually ask for pain meds. The last time was two years ago. …I do not abuse pain meds,” said Stander, who lives in Massachusetts. “Only then did his eyebrow settle; he remembered I am not a risk to his paperwork status with the DEA I guess.”

    This skepticism is part of the reason that Stander doesn’t use opioids for day-to-day management of her condition.

    “What used to be a simple request is now an interrogation,” she said. “If I was to go back on an opioid pain regimen, I would have to pee in a cup every month and contend with the stares and stigma from desk staff when I went to pick up scrips, or suspicion and scrutiny at the pharmacy.”

    Pain patients get judged in part because of a widespread misconception that they could get relief from alternative treatments rather than opioids, if only they’d try.

    “If you’re on a long-term opioid plan, the alternatives have been tried and failed,” DeLuca said.

    Although policymakers and members of the public wouldn’t assume they have the knowledge to dictate how medical professionals treat other illnesses, they have no problem doing so when it comes to chronic pain.

    “Chronic pain is a serious disease and, for many, it can be as malignant as cancer. But it is treated as if were a trivial problem, largely fabricated, so people can get drugs,” Webster said. “There appears to be little compassion for people in pain.”

    In the most severe cases, access to opioids for pain relief can be a matter of life and death. DeLuca said that just this week she has had three chronic pain patients message her on Facebook expressing suicidal ideation. Nearly every source interviewed for this story emphasized the risk of suicide for pain patients who lose access to opioids.

    “Some people who will not be able to find pain relief due to the new policies will just give up, and unfortunately, some will commit suicide,” Webster said. “This is not hyperbole.”

    Meeting in the Middle

    Just as addiction and recovery communities feel overwhelmed trying to solve the overdose crisis, pain patients can be jaded about whether their need will be heard and responded to by the medical community, especially in an environment where prescription limits get widespread praise.

    However, DeLuca says there are practical actions that could make a difference. The CDC says that its guidelines that recommend limiting dosage at 90 milligrams are “not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.” However, palliative care — ongoing care for life-limiting illnesses — is defined differently in each state. DeLuca and her advocacy group would like to see the United States adopt the World Health Organization’s definition of palliative care, and use that to identify patients who should be exceptions to the restrictive guidelines.

    Webster says that policymakers need to remember that restricting opioid prescriptions — particularly for the sickest patients — is not the solution to the opioid epidemic.

    “The country has a drug crisis, not just an opioid crisis,” he said. “Most of the harm from opioids are from the opioids being smuggled into the country from China and Mexico, but nearly all the government’s interventions are based on limiting access to pain medication for people in pain. This is terribly misguided. It doesn’t address the major drug problem. What policymakers have failed to recognize is that there are unintended consequences when the most hurting amongst us cannot find relief. This is the bigger tragedy.”

    View the original article at thefix.com

  • "Dilbert" Creator Addresses Son’s Apparent Fentanyl Overdose

    "Dilbert" Creator Addresses Son’s Apparent Fentanyl Overdose

    “If you don’t have any personal experience with opioid addiction, it doesn’t look like anything else you’ve ever seen,” Adams said.

    Cartoonist Scott Adams is grieving the loss of his stepson, who died of an apparent fentanyl overdose last weekend. On a live video stream Monday, Adams described the moment he found out about 18-year-old Justin’s death and the path that led his son to his demise.

    “Yesterday I got a call… from my ex-wife who told me that my stepson, the little boy that I raised from the age of two, was dead,” said Adams, better known as the creator of the Dilbert comic strip.

    “He died last night… in his bed from what appears to be a fentanyl overdose. I got to watch my dead, blue, bloated son taken out on a stretcher in front of his mother and biological father.”

    Justin had a fentanyl patch on his arm, Adams said. “Fentanyl probably killed my son yesterday.”

    Justin had struggled with his drug use for years. “We weren’t surprised, because he’d had a long battle with addiction since he was 14,” said Adams.

    A traumatic injury as a young man had changed him completely. “He had a very bad head injury when he was 14 from a bicycle accident. His behavior changed after the accident,” said Adams. “He sort of lost his ability to make good decisions… He lost his impulse control, he lost his fear.”

    His family couldn’t help him, Adams said, especially because was never ready to seek help. “He never wanted to get better. From the time he started doing drugs, he wanted to do more drugs and that’s all he wanted.”

    Adams described what it’s like to see a loved one lost in addiction. “If you don’t have any personal experience with opioid addiction, it doesn’t look like anything else you’ve ever seen,” he said in the emotional live stream. “It turns people into walking zombies who quite clearly are not in their own mind and are not in control of their actions.”

    Fentanyl is a pharmaceutical painkiller said to be 50-100 times stronger than morphine. Because of its high potency and the growing demand for opioids, an illicit market for fentanyl has emerged. It is said to have fueled the rise in opioid-related deaths over the years.

    In 2016, the Centers for Disease Control and Prevention (CDC) recorded 63,632 drug overdose deaths in the U.S.—42,249 of them involved prescription and illicit opioids, including fentanyl.

    Adams, who’s made a name for himself as a conservative pundit of some sort, goes on to “call for [the] execution” of the people who according to the U.S. government are to blame for the fentanyl crisis—Chinese suppliers.

    Adams stoically explains that executing “Chinese executives” of companies who produce and distribute illicit fentanyl “would be a great step.”

    View the original article at thefix.com

  • Pain Patients Rally To Have Voices Heard

    Pain Patients Rally To Have Voices Heard

    “The real message is that people in chronic pain are not drug abusers. Illicit drug use is the enemy,” said one rally participant. 

    People suffering from chronic pain gathered earlier this week in New Hampshire, hoping to share their frustrations about prescription opioid restrictions in one of the states hardest hit by the opioid epidemic. 

    “The pendulum has swung so far that now, people who have legitimate, documented, disease and illness and pain are now having their medications limited,” Bill Murphy, who helped organize the rally, told WMUR.

    Similar Don’t Punish Pain rallies were held in about 80 locations around the country. Participants say that they need pain medications—including opioids—to manage their chronic conditions. They say that long-term use of opioids can vastly improve the lives of people suffering from chronic pain, but that opioid painkillers have become misunderstood and stigmatized because of widespread misuse. 

    “Chronic pain patients are being denied their medications due to a false narrative that the drug epidemic is caused by prescription pain pills,” Kim Patty, who helped organize a rally in Springfield, Missouri, told the Springfield News-Leader. “The drug epidemic is being caused by heroin and synthetic fentanyl.”

    Participants in New Hampshire said this message gets lost. “It’s important for pain patients to have respect,” said Edie Allyn-Paige, who lives with chronic pain. “You know, every day, I have to choose whether or not to get out of bed.” 

    Bobbi Blades has had chronic pain for 30 years caused by a bone that presses on a nerve. She said that without opioids she wouldn’t have been able to complete rehabilitation, which helped her regain the ability to walk. “The real message is that people in chronic pain are not drug abusers,” she said. “Illicit drug use is the enemy.”

    Murphy said that unlike many people who abuse opioids, responsible users take low doses and are functional at home and at work. Despite that, many people have had their doctors cut back on their pain medications under pressure to reduce prescribing. “Because of that low-dose regimen, (people) are still working, raising families, and their doctors are feeling pressured to reduce that pain medication,” he said.

    Cheryl Ostrander, who rallied in Springfield, said she has used painkillers to help her cope with breast cancer, knee replacements, spinal fusions and fibromyalgia.

    “I am struggling really hard just to stay here,” Ostrander said. “I am in pain just like every day of my life. I’m a mess, but I don’t deserve to be treated like a criminal to get my pain medication.”

    View the original article at thefix.com

  • Marijuana's Pain-Relieving Properties To Be Studied By UCLA Researchers

    Marijuana's Pain-Relieving Properties To Be Studied By UCLA Researchers

    “The public consumption of cannabis has already far outpaced our scientific understanding. We really desperately need to catch up.”

    Thirty states and Washington D.C. have medical marijuana programs, but there has been little scientific research into the pain relieving properties of pot.

    Now, however, researchers at the University of California Los Angeles are trying to change that, by conducting research into marijuana as a pain reliever. 

    “We’re not trying to do pro-cannabis research or anti-cannabis research,” Dr. Jeffrey Chen, director of the UCLA Cannabis Research Initiative told NBC News. “We’re just trying to do good science.”

    The initiative’s first goal will be to conduct a high-quality clinical research trial into pain relief. It will look at which types of cannabis products provide the most pain relief and whether cannabis may be able to replace opioid pain relievers for some patients.

    Edythe London, a professor of psychiatry and pharmacology at the UCLA school of medicine, designed the study to test different combinations of THC, the principal psychoactive component of marijuana, and cannabidiol, an anti-inflammatory component that does not give a high. She wants to measure which “produces the most good,” she said, in terms of reducing pain and opioid use.

    Studies have shown that states with medical marijuana programs have fewer opioid overdose deaths. However, there haven’t been studies that show whether pain patients are switching from opioids to medical marijuana, or studies to see how effective medical marijuana is at treating pain in individuals.

    Because of this, the proposed UCLA study is “much-needed research,” according to Yuyan Shi, a health policy analyst at the University of California, San Diego, who studies the health consequences of marijuana and opioid use. 

    The study still needs to be approved by the Food and Drug Administration and the Drug Enforcement Administration, and more funding is needed.

    However, Chen said that more organizations and individuals are realizing the importance of studying cannabis. Because of this, the research already has funds from the Semel Institute for Neuroscience and Human Behavior at UCLA, federal and state sources, and private donors, he said. 

    “The public consumption of cannabis has already far outpaced our scientific understanding,” Chen said. “We really desperately need to catch up.”

    Chen hopes that the pain relief study will just be the first step for the research initiative. 

    “While our priority is to study the therapeutic potential and health risks of cannabis on the body, brain, and mind, our mission is the interdisciplinary study of the wide-ranging health, legal, economic, and social impacts of cannabis,” he wrote in a message on the organization’s website. 

    View the original article at thefix.com

  • Could A Scientific Study Have Slowed The Opioid Crisis?

    Could A Scientific Study Have Slowed The Opioid Crisis?

    Researchers suggest that a recent pragmatic trial could have played a key role in curbing the crisis. 

    While opioids are effective for acute pain relief, the widespread addiction and dependence that have swept up the country have showed that the powerful pills have unintended consequences, even as studies suggest that opioids are less effective for long-term pain than over-the-counter options. 

    Most medications are approved after undergoing a randomized controlled trial, but a different type of scientific study could have showed the real-world problems with using opioids for chronic pain relief, according to Aaron E. Carroll, a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist.

    “These different kinds of studies actually exist. They are called pragmatic trials, and a recent one might have helped serve as a brake as the opioid epidemic accelerated,” Carroll writes in an essay for The New York Times. 

    Whereas randomized controlled studies evaluate whether a drug is effective in ideal circumstances, pragmatic studies measure a drug’s effectiveness in the real world. 

    “A pragmatic trial seeks to determine if, and how, an intervention might work in practice, where decisions are more complicated than in a strictly controlled clinical trial,” Carroll writes. 

    A randomized controlled study of opioids, for example, would compare whether people taking opioids get more pain relief than those taking a placebo. This is challenging, however, because people who are being treated for pain are desperate for relief, and often change treatments hoping to find one that will work. 

    “Under these conditions, it’s hard to get patients to participate, and the same with doctors,” Carroll writes. 

    The Strategies for Prescribing Analgesics Comparative Effectiveness study took a more pragmatic approach to analyzing the effectiveness of pain relief medications, comparing opioids to non-opioid treatment.

    Whether a patient was receiving opioid or non-opioid treatment there were options to progress to stronger pain relief options, which helped people stick with the study long-term, rather than dropping out to try other pain relief. Doctors could also change doses and medications within the same class, tailoring treatment to the individual patients. 

    “That’s how actual care occurs,” Carroll writes. “This way, you can measure how treating someone with opioids might compare with treating someone without opioids for a sustained period.”

    The study eventually showed that adverse symptoms were lower for patients treated without opioids, and those patients were also less likely to become dependent. 

    Although studies like this are important, Carroll writes that they’re unlikely to become mainstream because of their intricacies and expense. 

    “Although drug companies are willing and ready to pay for randomized controlled trials to prove efficacy, it’s not clear who is going to finance studies like these,” Carroll writes. “They use lots of different drugs—which is what happens in the real world—and no company wants to foot the bill for other companies’ products to be evaluated. Certainly no opioid-related companies would want to pay for this trial.”

    View the original article at thefix.com