A way to predict who’ll become a drug addict
http://www.cbsnews.com/news/a-way-to-predict-wholl-become-a-drug-addict/?
Most MEDICAL DIRECTORS – abt 75% – are just GP/FP with a few internists thrown in… In all likelihood, they no longer practice medicine and may have not have practiced much after graduating from school and getting their license. Most are making medical decisions way outside of their skill sets and since their paycheck comes from the insurance company… one would suspect that their opinions are biased toward what would benefit the bottom line of the insurance company. This may be the primary reason that there are so many personal injury lawyers… trying to level the playing field for the injured person against the demands of the insurance company. IMO, this article is basically a bunch of HOGWASH !
Allen, 25, works in a Trenton, New Jersey, auto body shop alongside a middle-aged man who’s straining to lift bumpers and fenders. Allen’s co-worker came back after a hip replacement because he feared that he would be fired. Allen knows this guy will turn to “street meds” to ease his pain.
Dr. Adam Seidner knows the same thing — from his sky-high view as global medical director at Travelers Insurance (TRV). Armed with “big data” on 1.5 million injuries and disabilities, Seidner believes he can predict who’s at risk of becoming an addict — and how best to treat them. That has led Travelers to develop a system to profile not actual painkiller addicts, but potential ones.
If Seidner is right, it could help address a problem that’s now a plague. Some 2 million Americans are hooked on highly potent prescription drugs like fentanyl, while another 500,000 are “in the clutches of heroin.” In recent years, more Americans have died annually from overdoses, 33,000 of them, than from car accidents — a list that includes celebrities such as Prince and Michael Jackson.
Frightening overdose rates fueled by deadly heroin-fentanyl mix
So what’s Seidner’s solution? First, get rid of the addiction fiction claiming that people choose to become junkies. “Perhaps 5 percent of addicts do it for the euphoria,” said Seidner, who spent years detoxing prisoners. “Most take opioids to relieve suffering from chronic pain.”
And that’s scary because it puts an estimated 50 million Americans who suffer from chronic pain in the cross-hairs of potential addiction. They come to doctors’ offices complaining of bad backs, repetitive stress, falls, strains and “soft tissue” injuries.
Ever since the 1980s, about nine times out of 10, doctors have traditionally prescribed the most effective remedy for pain: drugstore opioids. They range from the mild, like codeine, to the strong, such as OxyContin (oxycodone) and Percocet (a combination of acetaminophen and oxycodone).
Although opioids curb the pain, they don’t cure the patient. And they have a will of their own. Within a month, these drugs invade the patient’s mind, which then tells the body to “feel” pain, whether it’s real or not, and thus creates a dependency.
Patients then demand the opioid — in stronger and stronger doses — and if they can’t get it legally or through their medical plan, they may steal prescription pads, use drugs like Imodium that mimic some of opioids’ effects and ultimately move on to street sources, where a $10 bag of heroin is both cheaper and stronger than a $200 prescription.
After years of trying to “just say ‘no’” to an epidemic that kills 46 people a day in the U.S., the medical profession, along with federal and state governments, recognized the danger. “I will not willingly watch another 1,600 of our citizens die,” former presidential candidate and New Jersey Governor Chris Christie told his state legislature this year.
Surgeon general reveals shocking report on substance abuse and addiction
On Jan. 19, the mayor of Everett, Washington, also asked the city council to authorize a lawsuit against Purdue Pharma, the maker of OxyContin, alleging that it knew the painkiller was being diverted to the illicit market and didn’t do enough to stop it.
But stopping the deadly flow of painkillers is a difficult process. As one doctor in Princeton, New Jersey, who asked not to be identified, said: ”What do you do when a patient comes to you in pain?” Physicians still write more than 200 million opioid prescriptions a year.
The latest data from Maryland, Ohio and New England, where the opioid crisis is most intense, shows an increase in fatalities. Drug companies have promoted medications like fentanyl, a synthetic opioid that can be as much as 50 times more potent that heroin.
“It’s like pushing on one side of a balloon,” said Travelers’ Seidner. “It just bulges out the other.”
Travelers has a big dog in this fight. It’s the largest workers’ compensation insurer in a $45 billion business that helps companies manage medical benefits for employees injured on the job. It handles a quarter-million of these claims each year.
“I had no idea that we were addicting people”
The longer an employee stays off the job and runs up medical bills, the more the insurer loses. The average claim now runs $40,000 over three years. But with caps on temporary disability now declared unconstitutional in some states, claims could last for decades.
That’s where Travelers’ addict-prediction model comes in, because the first step is to identify a potential addict. To do that, Seidner has assembled “statisticians and brainiacs” to predict which injuries will turn into chronic pain cases and push the patient down the “slippery slope” to opioid dependency.
Travelers developed a program called Early Severity Predictor, which looks at four areas:
- Pharmaceutical frequency. What drugs are the patients using and how much. Are they also popping pills on the side?
- Co-morbidity. Are they suffering from other conditions, like diabetes or osteoporosis? Do they smoke?
- Muscular health. Are they in good condition?
- Mental health. Are they angry with their employers? Do they fear going back to work and facing the same injury?
Other factors the model considers are sex, socioeconomic status, education and the nature of the injury: shoulder, knee or slipped disk.
A typical person with a chronic injury who might become dependent could be a middle-aged white male factory worker with a bad back.
Identifying the potential addict is only part of the problem. Getting rid of the chronic pain and the potential addiction is the other.
Once such a patient is identified, Travelers can begin to harness resources. It starts by talking to the patient’s doctor. In many states, doctors are under no obligation to talk to the insurer, but nearly seven in 10 will. This is probably because the insurer covers treatments like physical therapy, sports medicine, stimulation devices, yoga, stretching and psychology.
Drug addict-turned-millionaire’s inspiring life story
“We embrace all modalities, but we don’t do traditional psychoanalysis,” said Seidner. “Instead, we use therapy that will change behavior.”
Seidner and his team have analyzed 20,000 cases of opioid addiction since 2015, identified 9,000 at-risk patients and worked with 2,500 of them. Since then, about 1,400 no longer demonstrate any significant use of opioids, and medical expenses have fallen by 50 percent.
Much of that reduction has come from reduced use of opioids, which used to constitute 50 percent of all the prescription drugs that workers comp paid for, according to Travelers Vice President Rich Ives. Now it’s only 23 percent.
Vice President Loretta Worters of the Insurance Information Institute, which represents the industry, concurred that “Travelers Early Severity Predictor is certainly helping.”
Let’s be clear. Travelers will only help the companies that pay its premiums and the people employed by those companies. But its strategy, including how to predict drug addiction, provides a roadmap for governments, doctors or anyone with a chronic injury who wants to escape the curse of opioid dependency.
In some instances, it’s as easy as looking in a mirror. If you’re taking drugs for a bad back, consider stretching. If you hate your job, try to find another one before you’re reinjured. If you’re depressed, seek help.
Opioids will only make things worse. And when you take an opioid of any kind, the addiction clock is ticking. If taken longer than a month, you may already be addicted and not even know it.
Finally, when you see a doctor for pain, ask whether another treatment beside opioids might work — before he or she pulls out the prescription pad.
“Probably 80 percent of the time it’s a bad idea to prescribe opioids,” Seidner said. “We need to address the pain, but how we do it is the important thing.”
Filed under: General Problems
So an algorithm invented with corporate financially vested interest will further impose itself in between a patient and their provider?! What a sick world we live in. I’m 35, live in the worst imaginable pain and after 23 years was cut off of my medication due to license suspension of my pain physician. I cannot live like this I’m beyond fed up. How our government and our doctors think it’s okay to be this inhumahe is beyond me. I only hope society wakes up to this madness so suffering of others will be prevented.
I just got done fighting with United Health to get my Botox approved for my muscle spasms that my neurologist and I believe are the main trigger for my constant migraines. They said they wont pay for it for spams (the its FDA approved) unless I have some type of deformity…Like I look like Frankenstein’s buddy Igor I suppose. Chronic Migraine for me is all they will cover it for. So my neurologist had to manuver my diagnosis codes around to get it covered. By the way I did get my shot, but I had been miserable since a mid Nov accident where my car hit a guardrail and was totaled, I had a side to side whiplash and concussion when the drivers side took the brunt of the hit when the car flipped around. Airbags did NOT go off front or sides and the ambulance and ER they took me to totally ignored me on my neck and upper shoulder pain…no C-spine protections, MRI, Xrays, nothing. My local docs were pissed. My husband was mad because he used to be an EMT and was a manager for a Big Ten football team, so he knows concussion protocols. Anyhow when I got my Botox, the right side of my neck and shoulder were still having spasms from the accident and lack of initial treatment from the ER. So I got shots on both sides. I am feeling better. I just hope I can keep this dose lasting the 3 months til my next round. The accident apparently knocked out my other prior Botox treatment. Yeah I fired off a complaint to the ER and ambulance service..still waiting to hear back….probably never. The strongest thing I’m lucky to get now is Tramadol and Robaxin. Makes it tough to work a 12hr agency day standing most of the day because my back still bothers me. NSAIDs no longer because my kidneys plummet to stage 3 kidney disease, so I’m in a Catch 22…I’m not an addict, take my meds as ordered and only when I cant stand it anymore…or is that their new definition too??? They’re starting to get limiting on my Norcos for my chronic kidney stones too. I should be glowing with all the xrays and CT scans
I just get a brain freeze on some of the issues these people try to put down the pain community’s throat. A way to detect who will be a addict. Such Garbage they talk. Do they think we are stupid we’ll hummm
We are really making all this complicated . Why.
jmo,,excellent point,,people do not look at your aspect,,of ”proper” testing ,,or the limitation of certain test methods or machines,,,Ditto same thing is happening to me,,rite now,,,All I needed/wanted was at first for the surgeon to go back in,,w/ a camera again to look around to see if all this ,”badly beaten up,” organs he saw during surgery had healed at all,,No,,,then I said ok,,lets just go for a mri of my thoracic,,to make sure another tumor was not in the subarachnoid space,,and a repeat echo of the pancreas,,NO!!!!!!!!!!!Instead,,,I had to go thru,,a endoscope,,,,a ct w/contrast,which i am severely allergic to,,thus prednisone was given,,which really defeated it purpose as prednisone reduces swelling in internal organs,very well,,and benadryl,,,Thus this ct,,most likely will show no swollen organs,,I KNOW ct’s never showed my spinal cord tumors in the past,,never,,,,as a mri was done 24 hours after a ct,,huge tumor found in the thoracic,,20 years but the ct,completely missed it.,,Soo I knoe ct’s DO NOT SHOW ALL TUMORS,, SOO,, this ct is a complete WASTE OF MONEY,,but that contrast AFTER the preprednisone wore off,,swelled up my inner’s soo bad,,I didn’t go potty for 36 hours,and my belly is soo swollen it hurts worse then normal,,and my kidneys are killen me rite now,soo wth,,, ,I did get my repeat echo,,,,,but if it shows the duct/pancreas swollen again,,r they going to blame that contrast,,????I know echo’s never showed any calcification,,,but when the surgeon went in w/a camera,for surgery,both my organs had calcification,,and that gallbladder ,,”was a gravel pit,.”’ when thee echo only showed a ,”few,” stones../Sooo my point being,,these tests NEVER EVER show everthing,,and I am willing to bet ,,MISS A LOT,,BUT THAT IS NEVER ADMITTED TO OR MENTIONED by these insurers,,,or some Doc’s either,,,,,it’s like they want to get that ,’normal,” on your record soo they can go onto the next,,,,jmo,,maryw
Ok, here’s my problem with Travelers and the other Workman’s Comp insurers. I’m a victim of their cost saving practices. I’m not an addict but I do use low dose opiates and have for the last 6 years without increase. As a matter of fact I personally lowered my dosage over the years from 80mg a day hydrocodone to 40mg per day. I am also a smoker with diabetes and my work related injuries were to my back and neck. I did not fear going back to work after my 1st injury and I still went back after my 4th injury. My injuries range from you first back injury in 1990 to my last injury in 2010. Over that 20 year period I may have or at the most had taken 20 or 30 viciden 5-500 pills and I didn’t start taking opioid medications regularly until December 2012.
Now, I am a victim of workman’s comp because the insurance companies were too cheap to allow proper diagnostic testing such as MRI and CT scans to determine the actual extent of the damage to the soft tissue in my spine. Even when I fractured my back from an 18 foot fall, flat on my back on a dumpster, I was only given x-rays and treated for the fractures. I was young and stubborn so there was no way I was going to let this stop me so 3 months later I was back to work.
My next injury happened in 1998 when my reflex action to catch a falling 400 lb I-beam from landing on my foot. I caught it but severely strained my back and possibly tore tissue but because I was denied an MRI, no body knows.
Between 2002 and 2010 I experienced 2 bad slip on ice and fall injuries and again X-ray and no MRI. Physical therapy to bandaid my injuries until I could not longer claim my current conditions on these injuries so my continued medical bills they are not responsible for. Every one of my work related injuries were either because of faulty safty equipment or unsafe work conditions.
So, in 2012 after suffering for years and only taking ibuprofen for my pain I started dropping things. I would just be walking along carrying something and my hands would open up and drop it. Next my legs would just give out so I finally got an MRI. The very first question out of my doctors mouth was, ” How the HELL are you still working everyday?” Then he sent me to a neurologist to have needles stuck into me and electronic current to test my nerves. That’s when opiates, injections and all other forms of step theropies started being prescribed to me because the ibuprofen no longer cut it.
In April of 2013 I had the first of 8 surgical procedures and was prescribed 2 Norco 10-325 every 6 hours and I continued that dosage until July of 2014 when I started bringing that dose down to 1 pill every 6 hours. 6 months after my final surgery I attempted to return to work, I lasted 2 and a half weeks and could no longer work. I was worse after all the medical procedures which by the way we’re supposed to rid me of opiates but instead made them a part of my everyday life.
So, medical professionals attempting to tell me that my dependency is the beginning of addiction just PISS’S ME OFF. Here’s the kicker. If I would have refused the surgeries and just been able to treat my pain with low dose opioids, today I would still be working and collecting a pretty good living instead of fighting for my earned and paid in to SSDI. Also, if properly preformed diagnostic tests would have been done at the time of my injuries, I truly believe that my treatments would have more effective because they would have known about all the other damage.
Amen Dr.Cheek&Blargh,,,,jmo,,that point,,that ,”drugs don’t cause addiction and its not addiction that keeps u taking MEDICINES,,IT THE PHYSICAL PAIN FROM A MEDICAL CONDITION!!!dahh,,,,,boy u can really tell the arrogance +ignorance of this ,”articles,”,,propaganda ..its sooo obvious,,,they are not CPP,, or doctors who treat CPP,,,,mary
That was a weird way of describing dependency. It’s not from the drugs telling the body to feel pain. Dependency happens because opioid moleules link to mu receptors and suppress the release of noradrenaline. When NA is suppressed you get drowsiness, slowed respiration, etc. With repeated exposure to the opiate the body adjusts and the neurons that produce NA the neurons increase their production of NA. As a result of all this, roughly normal amounts of NA are produced because the opioid is in your system and there you have dependency. If you stop the opioids you have withdrawal because excessive amounts of NA are produced which causes the withdrawal symptoms. Addiction is when this is linked to pleasure and it involves a lot more stuff than this.
That article was intentionally inflammatory. They try to make people think that in a month you will be addicted to a medication that immediately makes your pain worse and the medication does nothing to help make the pain better. They don’t even mention that the fentanyl that is being abused is the illicet stuff from China. This is such a poorly written article.
I forgot to put the link in for the webinar above. It is https://join.me/sevenpillars. The DVD is available at http://www.sevenpillarstotalhealth.com
WRONG! WRONG! WRONG!! This is just more of the standard propaganda that drugs cause addiction. There is no solution here because:
1. Pain continues after an injury because conventional medicine doesn’t address the cause. And using NSAIDS (first line treatment) actually prevents healing, creating a chronic condition. It’s not addiction that keeps the person on the meds, it’s the continued pain.
2. Drugs don’t cause addiction. But I DO know the cause. I have a DVD explaining it, and I do a monthly webinar the first week of every month. The next webinar is Wed, Feb 1 at 12:00 PM EST. Please come and learn the REAL cause of drug abuse.
Dang it,,why can’t i comment on that site???Another verbal criminal type thingy??Anywho,,my pain management,again cost 250 bucks,,,for almost 15 years,,,Then Dr.Government budd’d in,,and now,,,its over 80,000,,with all this testing,,,but w/just pain management its 10,000 a year,,,They have MADE it expensive w/all their inept rules,guidelines etc,,,,Every so-called piece of data on addiction is a lie,,plain and simple,,,,They are not calling diabetics ,”addicts,” to insulin are they??It is a ,”2000-2017 witch hunt,,,,,,and us cpp’s,our doc’s,,our pharmacist,,,are thee so-called ,”witches of Salem,,,maryw
There are numerous falsities in the statements of people interviewed for this article. High on that list is the notion that a worker with lower back pain from a job related injury is at the highest risk for drug addiction. That’s just plain nonsense. As health journalist Maia Szlavavitz writes in Scientific American, the highest risk of drug addiction occurs in adolescents and in the unemployed.
CBS News: you LIE!