The Opiate and Heroin Epidemic in America (4 Viewers)

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Time theft: the unseen harm of abusive oversight

The Chilling Effect: How Fear Drives Doctors Away from Pain Patients

 

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From Former Secretary of Veterans Affairs Calls for ‘Opioid-Free VA’:

His opening line gets straight to the point he’s trying to make: “There is a time for everything. Now is the time for the Department of Veterans Affairs to go opioid-free.”

His column is promoting a dangerous message, and I fear that Shulkin’s credentials will lead people to take his stance seriously. It’s especially abhorrent because veterans are more likely to have chronic pain and have suicide rates twice as high as civilians, often due to poorly treated pain.

I suspect that if Shulkin ever needed opioids for his own pain, he would not hesitate to take them. His is the type of column that is only written about other people’s pain – and other people’s pain is always easy to endure.

I hope that his proposal is ignored and ridiculed as the nonsense it is. But after witnessing opiophobia for the last decade, I worry that the opposite will happen, and that policymakers will take Shulkin’s ideas seriously.

 

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Opioid prescribing guidelines ignore metabolism

Metabolism of opioids into metabolites that can cross the blood-brain barrier is mediated by CYP-450 series enzymes in the human liver. Because of natural genetic polymorphism between individuals, (1) some people are “poor” metabolizers, (2) some are “average” metabolizers, and (3) some are “hyper” metabolizers.

An estimated 20-30 percent of pain patients fall into category 1 or category 3 above. To provide adequate pain control, poor opioid metabolizers may need many times the opioid dose levels recommended by FDA for average metabolizers. The same is also true for “hyper” metabolizers.