I'm in Phoenix today for Arizona's first Harm Reduction Conference Any Positive Change 2019 at Black Canyon Conference Center in Phoenix.
As I attend harm reduction events I remind those who attend that the people who abuse opioids aren't the only victims of the opioid crisis.
Pain patients are victims too. Patients by the thousands have been forced tapered off medications they've used for many years forcing some to turn to the streets, and others to simply end the pain.
If someone abuses opioids and overdose it's sad. If a pain patient ends their life for lack of pain control, it's a tragedy
Arizona legislators passed the Arizona Opioid Epidemic Act limiting the dose a pain patient can receive, but there is no limit on dose for those who choose to abuse opioids.
Friday, March 29, 2019
Monday, March 25, 2019
Study Finds 90% of Medicare Patients Have Little Risk of Opioid Overdose
Study Finds 90% of
Medicare Patients Have Little Risk of Opioid Overdose
By Pat Anson, PNN
Editor
Current methods used
to identify Medicare patients at high risk of overdosing on prescription opioids
target many people who are not really at high risk, according to a team of
researchers who found that over 90% of patients have little to no risk of
overdosing.
The
computer models developed three risk groups that predict which patients are at
risk of overdosing over a 12 month period.
·
Low
risk patients (67.5%) have 0.006% risk of overdose
Put
another way, out of 100,000 Medicare patients in the low risk group, six would
have an overdose; while there would
be 1,770 overdoses in a high risk group of the same size
Sunday, March 17, 2019
Some Brave Physicians Stand Up for Pain Patients, Some Brave Reporters Tell the Truth About Opioids
Some Brave Reporters are Telling the Truth About Opioids
Some brave reporters like George Knapp an investigative reporter for the Channel-8's I-Team tell the truth about opioids and pain patients in stories like his I-TEAM report on Opioid Addiction Versus Dependency
When the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain came out most of the pain management physicians in my area misunderstood that:
1. they were guidelines and not a rule, regulation, or law.
2. the guidelines were for Primary Care Physicians and NOT pain management.
In Northern Arizona I was unable to find one, not one pain management physician who understood the 2018 Arizona Opioid Epidemic Act
Every so called pain management physician I contacted told me they were limited by the 90 or 120 mg MME limit. Read the law, that's not what the law says...
Is it they can't read and understand the law? Or are they so afraid of the government they're willing to violate their oath to do no harm and let patients suffer and die in pain?
Could you? Could you watch someone suffer in pain if you had the power to lessen their suffering? Could you? If you had the power to allow someone in pain to get up and get out of their house, to do things that improve their quality of life. Could you? Could you just watch them suffer in pain?
The legislature put protections in the 2018 Arizona Opioid Epidemic Act to protect current chronic patients, but physicians simply ignore these protections. Even when I hand them this email from Governor Ducey's Office outlining the protections.
They read the governors email and actually say, "I'm not going to break the law". When I tell them this is the law, they just say "I'm not going to break the law"....
Many of the current problems with pain patients turning to street drugs and overdosing are caused because physicians refused to follow the protections the legislature placed in the Arizona Opioid Epidemic Act to protect current pain patients.
It was well known that forced tapering of current pain patients who had built a tolerance to opioid pain medications over years of use would have no choice but turn to the street if doses were reduced too low.
Some Brave Physicians Stand Up for Pain Patients
Dr Marx is one of a hand full of pain management specialists who understand pain management are standing up for pain patients.
In the I-TEAM story Opioid Addiction Versus Dependency
Dr. Marx says pain patients do develop a dependence on their medication, but they can take it basically forever without harm it allows them to keep their jobs, remain active, have a life. Those who've had their meds cut have suffered terribly, and many have committed suicide. Their need for medication is not addiction
"Dependence is not addiction," Ziegler said. "Withdrawal is not addiction. Addiction is a completely separate matter. As lot of people can be managed well on prescription therapy. For those who can be managed well, why are you trying to change their treatment?"
WATCH: Opioid Crisis - Reporter George Knapp's complete interview with Dr. Stephen Ziegler
Some brave reporters like George Knapp an investigative reporter for the Channel-8's I-Team tell the truth about opioids and pain patients in stories like his I-TEAM report on Opioid Addiction Versus Dependency
When the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain came out most of the pain management physicians in my area misunderstood that:
1. they were guidelines and not a rule, regulation, or law.
2. the guidelines were for Primary Care Physicians and NOT pain management.
In Northern Arizona I was unable to find one, not one pain management physician who understood the 2018 Arizona Opioid Epidemic Act
Every so called pain management physician I contacted told me they were limited by the 90 or 120 mg MME limit. Read the law, that's not what the law says...
Is it they can't read and understand the law? Or are they so afraid of the government they're willing to violate their oath to do no harm and let patients suffer and die in pain?
Could you? Could you watch someone suffer in pain if you had the power to lessen their suffering? Could you? If you had the power to allow someone in pain to get up and get out of their house, to do things that improve their quality of life. Could you? Could you just watch them suffer in pain?
The legislature put protections in the 2018 Arizona Opioid Epidemic Act to protect current chronic patients, but physicians simply ignore these protections. Even when I hand them this email from Governor Ducey's Office outlining the protections.
They read the governors email and actually say, "I'm not going to break the law". When I tell them this is the law, they just say "I'm not going to break the law"....
Many of the current problems with pain patients turning to street drugs and overdosing are caused because physicians refused to follow the protections the legislature placed in the Arizona Opioid Epidemic Act to protect current pain patients.
It was well known that forced tapering of current pain patients who had built a tolerance to opioid pain medications over years of use would have no choice but turn to the street if doses were reduced too low.
Some Brave Physicians Stand Up for Pain Patients
Dr Marx is one of a hand full of pain management specialists who understand pain management are standing up for pain patients.
In the I-TEAM story Opioid Addiction Versus Dependency
Dr. Marx says pain patients do develop a dependence on their medication, but they can take it basically forever without harm it allows them to keep their jobs, remain active, have a life. Those who've had their meds cut have suffered terribly, and many have committed suicide. Their need for medication is not addiction
"Dependence is not addiction," Ziegler said. "Withdrawal is not addiction. Addiction is a completely separate matter. As lot of people can be managed well on prescription therapy. For those who can be managed well, why are you trying to change their treatment?"
WATCH: Opioid Crisis - Reporter George Knapp's complete interview with Dr. Stephen Ziegler
Sunday, March 10, 2019
People Selling Illegal Opioids Get a Warning Letter from FDA - DEA Raids Physician for Prescribing Them?
FDA News Release FDA takes action against 53 websites marketing unapproved opioids as part of a comprehensive effort to target illegal online sales.
"The U.S. Food and Drug Administration today (June 5th 2018) announced that it has warned nine online networks, operating a total of 53 websites, that they must stop illegally marketing potentially dangerous, unapproved and misbranded versions of opioid medications, including tramadol and oxycodone".
"Companies who fail to correct the violations, as outlined in the warning letters, may be subject to enforcement action, including product seizure or injunction".
In the article Dr Tennant say's
"The U.S. Food and Drug Administration today (June 5th 2018) announced that it has warned nine online networks, operating a total of 53 websites, that they must stop illegally marketing potentially dangerous, unapproved and misbranded versions of opioid medications, including tramadol and oxycodone".
"Companies who fail to correct the violations, as outlined in the warning letters, may be subject to enforcement action, including product seizure or injunction".
Opioid Epidemic? Where's DEA?
These guys are selling illegal opioid medications, including tramadol and oxycodone and they get "warning letters".
Why isn't DEA kicking down their doors? They "may be subject to enforcement action", and what enforcement "product seizure or injunction".
People selling oxycodone get a warning letter from the FDA while DEA agents with automatic weapons raid 77 year old Dr Forest Tennant's office and home.
Patients need to read about Dr Forest Tennant. He's one of the nations leading pain specialists who has done a lot of research into pain management. Dr Tennant had his home and office raided by DEA recently. LINK DEA Raids Dr Tennant
In the article Dr Tennant say's
“They’re not just going after me, they’re going after patients," “I think the country better understand what they’re doing here. They’re saying that regulations don’t count, standards don’t count, and they’ll decide who can get drugs and how much.
If you're doing research on pain management look at Dr Tennant's
Pain Management Articles
If you're doing research on pain management look at Dr Tennant's
Pain Management Articles
The Law Enforcement Action Partnership
The Law Enforcement Action Partnership
The Law Enforcement Action Partnership’s mission is to unite and mobilize the voice of law enforcement in support of drug policy and criminal justice reforms that will make communities safer by focusing law enforcement resources on the greatest threats to public safety, promoting alternatives to arrest and incarceration, addressing the root causes of crime, and working toward healing police-community relations.
Saturday, March 9, 2019
Good News: Opioid Prescribing Fell. The Bad? Pain Patients Suffer, Doctors Say.
Doctors and insurers are using federal guidelines as cover to turn away patients, experts tell the C.D.C. and Congress.
Friday, March 8, 2019
Tuesday, March 5, 2019
Truth Or DARE a collection of data counter to the war on drugs narrative
A new page telling the truth about the opioid epidemic and our nations war on drugs everyone needs to read..
Truth Or DARE
a collection of data counter to the war on drugs narrative
Truth Or DARE
a collection of data counter to the war on drugs narrative
Saturday, March 2, 2019
A Little Prediction of Next Drug Epidemic..... Cocaine
In 2017 the Washington Post ran an article "American cocaine use is way up. Colombia’s coca boom might be why" LINK to Article
I also recently read some of the governments crop reports that coca in recent years have been going up dramatically.
Mexican drug cartels are always years ahead of DEA on production and marketing. After all they are marketing experts making enough money to control most of the Mexican Government.
Mark my words the next big drug "epidemic" is coming and it going to be Cocaine and it's going to be big......
I also recently read some of the governments crop reports that coca in recent years have been going up dramatically.
Mexican drug cartels are always years ahead of DEA on production and marketing. After all they are marketing experts making enough money to control most of the Mexican Government.
Mark my words the next big drug "epidemic" is coming and it going to be Cocaine and it's going to be big......
Friday, March 1, 2019
Were You Given Toradol in the Emergency Department Rather than Opioids and Have a BAD Reaction?
Toradol in Place of Opioid Pain Medications isn't a good idea. While
at the KRMC ER several months ago I overhead several patients who came to the ER for some type of pain being given Toradol
rather than an opioid pain medication.
I
know how dangerous Toradol is. I was given Toradol back in the 90’s when like
today doctors would give you anything rather than an opioid pain medication.
Two days later my stomach was really messed up, I was throwing up blood and ended
up back in the ER with IV’s to stop the bleeding.
If you know someone who was given Toradol rather than pain medications and had a serious side effect like ulcers, gastrointestinal bleeding or perforation of the stomach or intestines.
PLEASE FILE A COMPLAINT with Arizona Medical Board
Both
Toradol and Morphine have Black Box Warnings
Black Box Warning
A
black box warning is the strictest warning put in the labeling of prescription
drugs or drug products by the Food and Drug Administration (FDA) when there is
reasonable evidence of an association of a serious hazard with the drug. Having
the black box around the warning means that an adverse reaction to the drug may
lead to death or serious injury
Black Box Warning Toradol.
Appropriate Use
for short term (up to 5
days in adults) tx of moderately severe acute pain requiring opioid-level
analgesia and only as continuation of parenteral tx, if necessary; total
combined duration should not exceed 5 days; not indicated for minor or chronic
pain; oral tx not indicated in peds; max recommended total daily dose 40 mg PO
and 120 mg IV/IM; doses above label recommendations incr. serious adverse event
risk w/o improved efficacy
GI Risk
incr. serious GI adverse
event risk, incl. bleeding, ulcer, and stomach or intestine perforation, which
can be fatal; may occur at any time during use and w/o warning sx; elderly pts
at greater risk for serious GI events; contraindicated in active PUD, recent GI
bleeding or perforation, and PUD or GI bleeding hx
Cardiovascular Risk
NSAIDs incr. risk of
serious and potentially fatal cardiovascular thrombotic events, incl. MI, and
stroke; risk may occur early in tx and may incr. w/ duration of use;
contraindicated for CABG peri-operative pain
Renal Risk
contraindicated if adv.
renal impairment or if renal failure risk due to volume depletion
Bleeding Risk
contraindicated if
suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis,
incomplete hemostasis, or high bleeding risk because inhibits platelet fxn;
contraindicated as prophylactic analgesic before major surgery
Labor/Delivery Risk
contraindicated in
labor/delivery because may adversely affect fetal circulation and inhibit
uterine contractions
Concomitant NSAID Use
contraindicated in combo
w/ ASA or NSAIDs due to cumulative risk of serious NSAID-related side effects
Intrathecal/Epidural Use
contraindicated due to
alcohol content
Hypersensitivity Rxn
hypersensitivity rxns
range from bronchospasmqq to anaphylactic shock, have appropriate tx available;
contraindicated if previous ketorolac, ASA, or other NSAID hypersensitivity rxn
Special Populations
max total daily dose 60
mg IV/IM in pts 65 yo and older, if wt <50 kg, or moderately elevated Cr;
max single dose 30 mg IM and 15 mg IV in peds pts
Black
Box Warning Morphine.
Appropriate
Use
ER form should only be prescribed by healthcare professionals
knowledgeable in use of potent opioids for chronic pain management; reserve extended-release
and long-acting formulations for pts w/o tx alternatives; ER form not indicated
for prn analgesic use; proper dosing and titration essential to decr. resp.
depression risk
Medication
Error Risk
ensure accuracy when prescribing, dispensing, and administering
morphine oral solution; dosing errors due to confusion between mg and mL or
different concentrations can result in accidental overdose and death; morphine
concentrated oral solution (100 mg per 5 mL) indicated only in opioid-tolerant
pts
Addiction,
Abuse, and Misuse
opioid agonist Schedule II controlled substance w/ risk of
addiction, abuse, and misuse, which can lead to overdose and death; reserve
opioid analgesics for pts w/ inadequate tx alternatives; assess opioid abuse or
addiction risk prior to prescribing; regularly monitor all pts for misuse,
abuse, and addiction
Opioid
Analgesic REMS
FDA required risk evaluation and mitigation strategy (REMS)
program to ensure benefits outweigh risks; REMS-compliant education program
must be avail to healthcare providers; providers are strongly encouraged to
complete REMS-compliant program, counsel pts and/or caregivers w/ each Rx on
safe use, serious risks, storage, and disposal, emphasize importance of reading
med guide, and consider other tools to improve pt, household, and community
safety
Respiratory
Depression
serious, life-threatening, or fatal cases may occur even w/
recommended use; monitor for resp. depression esp. during tx start or after
dose incr; instruct pts to swallow ER tabs whole; crushing, dissolving, or
chewing ER tabs can cause rapid release and absorption of potentially fatal
morphine dose; instruct pts to swallow ER caps whole or sprinkle contents on
applesauce and swallow immed. w/o chewing; crushing, dissolving, or chewing pellets
w/in ER cap can cause rapid release and absorption of potentially fatal
morphine dose
Accidental
Ingestion
accidental ingestion of even one dose, esp. by children, can
result in fatal morphine overdose
Neonatal
Opioid Withdrawal Syndrome
prolonged maternal use of opioid tx during pregnancy can lead to
potentially life-threatening neonatal opioid withdrawal syndrome; infants may
require tx according to neonatology protocols; advise pregnant pts of risks and
ensure appropriate tx avail. if prolonged opioid use required
Avoid
Alcohol
instruct pts using ER caps not to consume alcoholic beverages or
use alcohol-containing prescription or non-prescription medications; alcohol
consumption during tx may result in incr. plasma levels and potentially fatal
morphine overdose
Risks
from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS
depressants, incl. alcohol, may result in profound sedation, resp. depression,
coma, and death; reserve concomitant use for pts w/ inadequate alternative tx
options; limit to minimum required dosage and duration; monitor pts for s/sx of
resp. depression and sedation