How best to fight the opioid crisis? (2 Viewers)

[eurotrashman]

I’m not sure what this has to do with the rights of people.  They got sued and lost.  The damages just weren’t as high as expected.

When people kill other people and damage lives people go to jail.  When it takes place in a board room, they shake out pennies from their seat cushions and no one goes to jail.  Neat system.

 

[SaintsInDome2006]

The Chinese Connection to the Flood of Mexican Fentanyl

- Turns out the fentanyl market is principally moving through Mexico.

 

[SaintsInDome2006]

The Brazen Way a Chinese Company Pumped Fentanyl Ingredients Into the U.S.

Yuancheng used an army of young, perky salespeople to peddle illegal chemicals to Americans.

 

[Henry Ford]

@The Commish

Update:

My relative had one “bad” (but still virtually pain free - mostly anxiety/mood issues were bad) day.  And didn’t sleep, so her immediate thought was “well, it worked for two days and that’s more than I ever expected.”

She was having headaches and mild anxiety, difficulty sleeping, and stomach cramps and figured maybe it wasn’t going to be a long term solution for things other than pain, but still was glad to be virtually pain free.  So I asked her what kind of other stuff she’d been taking with it.

She hasn’t taken a Norco in three days.  For possibly the first time in over ten years.  She was going through opiate withdrawal and didn’t even realize it. 

So three (and a half now) days in, she hasn’t touched her opiates, which she is prescribed four per day and has been for many, many years, and didn’t even realize it.

Another update. 

She hasn’t taken an opiate in over ten months. 

 

[Terminalxylem]

Perhaps in that study for those specific types of patients. But different conditions would likely show different results. There is no one size fits all answer here, no matter how badly some people want it to be so.

The study is relevant because it is one of the few randomized trials comparing opioid to non-opioid analgesia for non-cancer chronic pain. Although opioids are not first-line therapy for musculoskeletal pain, they are commonly prescribed for this indication - the subjects were inadequately controlled on their non-opioid pain regimen at enrollment. This study supports the general recommendation to avoid using them in this context. I see nothing in the JAMA article suggesting opioids aren’t necessary/helpful for other types of pain, despite the editorial you linked. Is it possible the Pain News Network has its own biases?

 

[Tau837]

The study is relevant because it is one of the few randomized trials comparing opioid to non-opioid analgesia for non-cancer chronic pain. Although opioids are not first-line therapy for musculoskeletal pain, they are commonly prescribed for this indication - the subjects were inadequately controlled on their non-opioid pain regimen at enrollment. This study supports the general recommendation to avoid using them in this context. I see nothing in the JAMA article suggesting opioids aren’t necessary/helpful for other types of pain, despite the editorial you linked. Is it possible the Pain News Network has its own biases?

I'm not sure why you are responding to a post that from March 2018, but I posted a number of links and a good amount of information about that study, not just the Pain News Network link. See this post, for example.

As I posted previously:

• The study addressed a form of chronic pain for which opioids are not routinely used as a first choice therapy. Anti-inflammatory medications have typically been the preferred medical treatment for lower back pain and arthritis, not opioids.
  
• The study employed dose levels at and below the very bottom of the therapeutic range for opioids when they are used. It is not surprising that dosage below the normal lowest levels prescribed would not provide effective pain relief.
  
• The authors failed to acknowledge effects of anti-depressant medications added to the non-opioid side of the trial; such medications are frequently used off-label in pain management, particularly for neuropathic pain.
  
• Dr. Erin Krebs was a primary author of the study. She is well known to have an anti-opioid bias, as described in the PNN article I linked.
  

For those reasons, the study is not particularly meaningful.

Beyond that, it is not just what is in the study, it is how the study was reported. The media reported sensationalistic headlines like “Opioids Don’t Treat Chronic Pain Any Better Than Ibuprofen” (Newsweek), “Opioids Don’t Beat Other Medications for Chronic Pain” (NPR), and “Opioids no better than common painkillers for treating chronic pain, study finds” (Chicago Tribune). All of those headlines and articles were misleading at best, since they all inappropriately generalized the study results to the larger chronic pain population.

 

[The Commish]

Another update. 

She hasn’t taken an opiate in over ten months. 

That is ####### awesome Henry Ford!!! 

Has she seen a significant increase in quality of life, mood etc?

 

[Henry Ford]

That is ####### awesome Henry Ford!!! 

Has she seen a significant increase in quality of life, mood etc?

She certainly hasn’t seen a decrease.  Other medications are being played with because they can be now that she isn’t on the opiates - so some good days and bad. But all of the opiate side effects are gone, which is a huge deal. 

 

[Terminalxylem]

I'm not sure why you are responding to a post that from March 2018, but I posted a number of links and a good amount of information about that study, not just the Pain News Network link. See this post, for example.

As I posted previously:

• The study addressed a form of chronic pain for which opioids are not routinely used as a first choice therapy. Anti-inflammatory medications have typically been the preferred medical treatment for lower back pain and arthritis, not opioids.
  
• The study employed dose levels at and below the very bottom of the therapeutic range for opioids when they are used. It is not surprising that dosage below the normal lowest levels prescribed would not provide effective pain relief.
  
• The authors failed to acknowledge effects of anti-depressant medications added to the non-opioid side of the trial; such medications are frequently used off-label in pain management, particularly for neuropathic pain.
  
• Dr. Erin Krebs was a primary author of the study. She is well known to have an anti-opioid bias, as described in the PNN article I linked.
  

For those reasons, the study is not particularly meaningful.

Beyond that, it is not just what is in the study, it is how the study was reported. The media reported sensationalistic headlines like “Opioids Don’t Treat Chronic Pain Any Better Than Ibuprofen” (Newsweek), “Opioids Don’t Beat Other Medications for Chronic Pain” (NPR), and “Opioids no better than common painkillers for treating chronic pain, study finds” (Chicago Tribune). All of those headlines and articles were misleading at best, since they all inappropriately generalized the study results to the larger chronic pain population.

Sorry, I haven’t read every thread before I joined the forum; I just saw your post. To restate:

1. The study participants had uncontrolled chronic musculoskeletal pain at enrollment. This is a common clinical occurrence where ramping up to opioids is considered, not using them as first line therapy.  Despite being discouraged, low back are osteoarthritic pain are among the most common reasons for opioid prescription.

2. While opioids dosing was on the low end initially, it isn’t out of line with that used when transitioning from NSAIDs or other non-opioids. Moreover, the doses were escalated up to 100 ME/day - I know you’re familiar with much higher MEs, but that’s a pretty hefty dose for the typical patient who’s initiating opioids. They probably avoided some abuse of the drugs by prescribing conservatively.

3. The antidepressants were added precisely for their role in managing pain, which is explicit in the study design. The whole point was comparing opioid to non-opioid modalities. In real life multiple approaches would be employed (likely opioids would be added to a regimen containing NSAIDs, Tylenol, neuropathic and possibly topical pain meds), but it makes sense to keep opioids separate in the experimental context to minimize confounders.

4. I don’t know anything about the first author. But even if she has an “anti-opioid bias”, I can interpret the study design and findings, and it seems reasonable, albeit small.

5. The media’s reporting of the findings (including the Pain News Network) is irrelevant to the study results. I prefer to look at actual data over sensationalized headlines, and suggest you do the same.

The study reminds me of others comparing surgical versus non-surgical management of various joint problems. More often than not, conservative measures do just as well as aggressive ones over the long term. But that doesn’t stop orthopedists from operating, just as the pain specialists in the blogs you link won’t stop prescribing. While many of those prescriptions are appropriate, we still have a long way to go to eliminate unnecessary opioid use. Chronic musculoskeletal pain is at the top of the list where evidence based guidance is sorely lacking, so I appreciate the JAMA study’s attempt.

 

[Sinn Fein]

Turns out Karl Marx was wrong - Oxycontin is the opioid of the masses.

 

[Mystery Achiever]

National Take Back day this Saturday.
https://takebackday.dea.gov/

 

[Tau837]

Excellent and informative articles:

• HOW CDC DUPED THE NATION — PART I, How CDC Duped the Nation With Artificially Inflated Data
  
• HOW CDC DUPED THE NATION — PART II, How CDC Duped the Nation by Exploiting Known System Failures
  
• HOW CDC DUPED THE NATION — PART III, How CDC Duped the Nation Using Distorted Conceptions
  
• Unscientific Guidelines Are Being Peddled As ‘Evidence-Based’ Medicine
  
• Policies Fail on Small Scale, Yet Forced Nationally
  
• The Recommendations that Shaped a National Crisis
  

From that last article:

It appears federal agencies have not only been ignoring important stakeholders’ dissent to these low evidence, unscientific interventions, but they also continue to barrel forward with their strategy in partnership with many others no matter the cost; even if the cost is American lives...

Thousands (at least) have died due to these policies and the lack of evidence they’re based on. Millions more have been left to suffer pointlessly. All due to how this crisis has been framed using taxpayer dollars to dupe the American people into believing that we need to spend billions on interventions that have shown no return on investment for the American people...

Please do not wait until armed DEA agents are banging down your door for a pill count after a surgery, injury, or illness to demand that the appropriate stakeholders are immediately included in the developmental process of health policy, that those with conflicts of interest are excluded, and to demand an emergency review of the Drug Enforcement Agency’s conduct by Congress as well as neutral third party watchdog groups.

The process is happening now, sick and injured Americans don’t have time to wait and each of you could be adversely affected by this in the very near future. Don’t wait until you’re lying helplessly in an emergency room before you realize your doctors’ hands are tied.

 

[msommer]

Didn't Jared fix this already?

 

[Tau837]

AMA: ‘CDC Guideline Has Harmed Many Patients’

About time.