https://www.peoplespharmacy.com/2018/04/02/how-does-temperature-affect-mail-order-medicines/

Prescription drugs have become pricey. That’s why insurance companies may try to save money by encouraging patients to buy mail order medicines. Are there problems with this practice?

Many insurance companies love mail order pharmacies. That’s because they can often save money by having patients get their medicines from large services rather than local pharmacies. Pharmacy benefit managers (PBMs) are the middlemen between drug companies, pharmacies and payers. Many large PBMs own or control mail order pharmacies. If patients don’t get their medicines through this channel, they may have to pay more for their prescriptions. Are there any concerns about mail order medicines that have been ignored by PBMs, the FDA and insurance companies? Check these liv pure reviews.

A retired professor of molecular biology performed an experiment that would suggest the answer is yes.

Mail Order Medicines and the Postal Service:

Q. I read your column concerning pharmaceutical drugs left in a cold mailbox in winter. A few years ago, I measured summer temperatures in our mailbox with an accurate electronic thermometer. Read more about Adderall otc.

I was concerned that my drugs might be damaged with the very high temperatures here in Tempe, AZ. The mail is delivered in the afternoon when the sun hits the mailbox.

I am attaching an Excel file of what I found. The temperature of the mailbox was significantly higher than the air temperature. The average daily mailbox temperature between August and October was 121 F. Clearly those high temperatures would be expected to have some effect on many drugs.

Since doing that project, I stopped having my drugs sent by mail and now use an in-store pharmacy. Neither the drug companies nor the FDA seemed to provide helpful information when I asked them about this problem.

Do High Temperatures Affect Mail Order Medicines?

A. Your spreadsheet is fascinating. On some days, the temperature in your mailbox reached 130 to 140 F. That is way outside the acceptable storage range, even for a short period of time.

Guidelines for medications generally call for storage at room temperature (68 to 77 F). During shipping, temporary fluctuations are allowed between 59 and 86 F. Even on the coolest days of your two-month project, your mailbox hit at least 95 F.

How Heat Might Impact Mail Order Medicines:

Some medications could deteriorate rapidly under high heat or extreme cold. Drugs for asthma, diabetes, thyroid and anxiety could be especially vulnerable.

Researchers in the division of Pulmonary and Critical Care Medicine at the Cart T. Hayden VA Medical Center in Phoenix, Arizona performed an interesting experiment (Chest, Dec. 2005). They had heard that the asthma drug formoterol (Foradil) was “aggregating in mailboxes in the summer in Arizona.”

These investigators exposed capsules of formoterol to temperatures between 104 and 158 F for three hours and at 158 F for 15 to 180 minutes. The results were worrisome.

They concluded:

“These data demonstrate that the exposure of formoterol to heat decreases drug delivery and that caution should be used when mailing, transporting or storing formoterol.

“The use of mail-order pharmacies appears to be increasing both in the private sector as well as in the Veterans Healthcare Administration. It is usually assumed that the conditions of mail shipment approximate room temperature and humidity. However, it seems likely that shipped medications might be subjected to extremes in temperature such as those during the time spent in a mailbox prior to patient pick up. In addition, medications already in the patient’s possession might be subjected to environmental extremes such as being left in an automobile for an extended time on a hot day.

“The present study demonstrates that heating formoterol to temperatures that might be encountered during an Arizona summer lowers powder delivery. Combined with the reports from patients who received deformed formoterol capsules in mailboxes during summer months, it seems likely that temperature led to the decrease in powder delivery.”

What Should You Do About Mail Order Medicines?

Arizona gets especially hot during the summer. But you do not have to live in Phoenix or Tempe to be exposed to high temperatures. When medicines sit in a hot car or a mail box for hours, they will almost assuredly be exposed to temperatures outside the mandated shipping range (59 to 86 F). And in the winter they could easily be exposed to freezing temperatures.

Mail order pharmacies and the FDA need to address this weakness in our drug delivery system. Medications that are exposed to severe temperature fluctuations may not perform as anticipated. They may also deteriorate more rapidly.

The People’s Pharmacy Solution:

We think that there is an answer to the dilemma that patients are faced with when they receive mail order medicines. There are affordable temperature and humidity sensors that can be placed in every prescription (and vitamin) package. These disposable monitors will reveal if the contents of the package have been exposed to temperatures outside the limits for that medication (or dietary supplement).

We think mail order pharmacies and PBMs have an obligation to their clients to verify that drugs are kept within the guidelines during shipping. If they cannot demonstrate that successfully they should either send another package or refund the patient’s money and allow people to purchase their medication in a pharmacy at no additional cost.

What do you think?

Share your own experience with mail order medicines in the comment section below.

Federal law requires the Manufacturer, Wholesaler and Pharmacy to store medication within a specific range – normally 59-86 F –  Once a pharmacy hands off the medication to a shipper (USPS, FEDX, UPS) they don’t have any legal requirement to maintain those storage temp and unless the pharmacy has packaged the medication is some sort of shipping container to maintain the specific temperature, the shipper is none the wiser and will handle the package as they do any other package.

While use of mail order pharmacy may seem convenient,  the pt’s medication and in turn their health may being put at risk.  Many mail order pharmacies give financial incentive to use them…

As long as the pts know the potential risk for using mail order… it is their choice … some may have to use mail order for personal financial reasons.

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https://www.washingtonpost.com/news/wonk/wp/2017/03/29/since-2007-the-dea-has-taken-3-2-billion-in-cash-from-people-not-charged-with-a-crime

The Drug Enforcement Administration takes billions of dollars in cash from people who are never charged with criminal activity, according to a report issued today by the Justice Department’s Inspector General.

Since 2007, the report found, the DEA has seized more than $4 billion in cash from people suspected of involvement with the drug trade. But 81 percent of those seizures, totaling $3.2 billion, were conducted administratively, meaning no civil or criminal charges were brought against the owners of the cash and no judicial review of the seizures ever occurred.

That total does not include the dollar value of other seized assets, like cars, homes, electronics and clothing.

These seizures are all legal under the controversial practice of civil asset forfeiture, which allows authorities to take cash, contraband and property from people suspected of crime. But the practice does not require authorities to obtain a criminal conviction, and it allows departments to keep seized cash and property for themselves unless individuals successfully challenge the forfeiture in court. Critics across the political spectrum say this creates a perverse profit motive, incentivizing police to seize goods not for the purpose of fighting crime, but for padding department budgets.

Law enforcement groups say the practice is a valuable tool for fighting criminal organizations, allowing them to seize drug profits and other ill-gotten goods. But the Inspector General’s report “raises serious concerns that maybe real purpose here is not to fight crime, but to seize and forfeit property,” said Darpana Sheth, senior attorney of the Institute for Justice, a civil liberties law form that has fought for forfeiture reform.

The Inspector General found that the Department of Justice “does not collect or evaluate the data necessary to know whether its seizures and forfeitures are effective, or the extent to which seizures present potential risks to civil liberties.”

In the absence of this information, the report examined 100 DEA cash seizures that occurred “without a court-issued warrant and without the presence of narcotics, the latter of which would provide strong evidence of related criminal behavior.”

Fewer than half of those seizures were related to a new or ongoing criminal investigation, or led to an arrest or prosecution, the Inspector General found.

“When seizure and administrative forfeitures do not ultimately advance an investigation or prosecution,” the report concludes, “law enforcement creates the appearance, and risks the reality, that it is more interested in seizing and forfeiting cash than advancing an investigation or prosecution.”

The scope of asset forfeiture is staggering. Since 2007 the Department of Justice’s Asset Forfeiture Fund, which collects proceeds from seized cash and other property, has ballooned to $28 billion. In 2014 alone authorities seized $5 billion in cash and property from people — greater than the value of all documented losses to burglary that year.

In most of the seizures examined by the Inspector General, DEA officers initiated encounters with people based on whether they met certain criteria, like “traveling to or from a known source city for drug trafficking, purchasing a ticket within 24 hours of travel, purchasing a ticket for a long flight with an immediate return, purchasing a one-way ticket, and traveling without checked luggage.”

Some of the encounters were based on tips from confidential sources working in the travel industry, a number of whom have received large sums of money in exchange for their cooperation. In one case, officers targeted an individual for questioning on a tip from a travel industry informant that the individual had paid for a plane ticket with a pre-paid debit card and cash.

Most individuals who have cash or property seized by law enforcement do not dispute the seizure. There’s no right to an attorney in forfeiture proceedings, meaning defendants must foot the bill for a lawyer themselves. In many cases, forfeiture amounts are so small that they’re not worth fighting in court.

Forfeiture cases are also legally complex and difficult for individuals to win. Forfeiture cases are brought against the property, rather than the individual, leading to Kafkaesque case titles like United States v. $8,850 in U.S. Currency and  United States of America v. One Men’s Rolex Pearl Master Watch.

While criminal proceedings assume the defendant’s innocence, forfeiture proceedings start from the presumption of guilt. That means that individuals who fight forfeiture must prove their innocence in court.

For these reasons, many defendants don’t bother disputing forfeitures. The Inspector General’s report, however, finds that those who do often get at least a portion of their cash returned. Only one-fifth of people who had their cash seized by the DEA disputed the seizures in court. But among those who contested the seizure, nearly 40 percent ended up getting all or some of their cash returned, suggesting that the DEA’s forfeiture net ensnares many individuals not involved in wrongdoing.

In a written response to the Inspector General, the Department of Justice said it had “significant concerns” with the report, noting that global criminal enterprises launder trillions of dollars annually and calling asset forfeiture “a critical tool to fight the current heroin and opioid epidemic that is raging in the United States.”

It also took issue with the Inspector General’s analysis of the 100 DEA cash seizures it examined, saying more of them were connected with criminal activity than the report suggested.

The Inspector General stood by the report and dismissed the Department’s concerns as “assumptions and speculation.” The Drug Enforcement Administration did not respond to a request for comment.

“Nobody in America should lose their property without being convicted of a crime,” said the Institute for Justice’s Sheth. “If our goal is to curb crime, we should simply abolish civil forfeiture” and only forfeit property after a criminal conviction is obtained, she added.

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www.painnewsnetwork.org/stories/2018/3/22/opioid-painkillers-top-selling-drug-in-10-states

If you live in Oklahoma, the drug you’re most likely to be prescribed is the opioid painkiller Vicodin — or some other combination of hydrocodone and acetaminophen.

In Texas, the #1 drug is Synthroid (levothyroxine) – which is used to treat thyroid deficiencies.

In California, its Lipitor (atorvastatin) – a statin used to treat high cholesterol.

And Tennessee has the unique distinction of being the only state in the country where the addiction treatment drug Suboxone (buprenorphine/naloxone) is the most prescribed drug.

These findings are part of an interesting study by GoodRx, an online discount drug company, on prescribing trends in all 50 states. GoodRx looked at pharmacy and insurance data from around the country – not just its own customers — from March 2017 to February 2018.

It then developed a map to show how prescription trends can vary by region and by state.

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Opioid overdoses spike 30 percent, hospitals report

https://www.cbsnews.com/news/opioid-overdoses-increase-across-us/

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Using Marijuana 2 Times a Month Cost This Doctor His License

https://www.doximity.com/doc_news/v2/entries/11612578

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www.chronicdiseasecoalition.com/news-three-states-harmful-health-insurance-practices-making-headlines/

Patients, advocates and elected officials often use the media to promote legislation and bring awareness to chronic disease. During the month of March, we read articles, letters to the editor and op-eds that addressed how to protect patients’ rights. We’ve outlined three of our favorites below:

1. For years, epilepsy patient Erin Guard could not find a treatment that controlled her seizures without experiencing intense side effects, including dizziness and slurred speech. Finally, when Guard was a teenager, her doctors found a substitute that helped prevent seizures without the dangerous side effects. Four months after her doctors prescribed the effective treatment, however, her insurance notified her and said she would have to go back to her original medication or pay out of pocket for the new medication, regardless of whether she could afford it.

Guard, who lives in Illinois, became the latest victim of non-medical switching, an increasingly common – and dangerous – insurance practice that occurs when a provider switches a patient’s prescribed treatment for reasons other than health and safety. The Illinois Legislature is currently considering House Bill 4146, which would prevent insurance providers from changing drug coverage during the middle of a plan year if it had previously approved the treatment. The bill has been assigned to the House Insurance: Health & Life Committee.

To read about Guard’s story, click here: http://www.chicagotribune.com/business/ct-biz-illinois-nonmedical-switching-bill-0315-story.html

2. Fred Jorgenson, president of the Academy of Medicine of Cleveland & Northern Ohio, recently published an article on Cleveland.com raising awareness about two step therapy bills that are currently in the Ohio General Assembly, Senate Bill 56 and House Bill 72. In his letter to the editor, he explains that step therapy can have dangerous health consequences to patients who suffer from chronic illness. Step therapy, otherwise known as fail first, is another harmful insurance practice that happens when an insurance provider believes a cheaper, riskier drug is a better than a doctor-prescribed treatment. Providers will only cover the original treatment if a patient first fails the cheaper medication.

Dr. Jorgenson said, “For a person with epilepsy, it could mean having a seizure. For someone with inflammatory bowel disease, it could mean serious flare ups that can sideline a person for days. For someone with cancer, it could mean that their disease progresses.”

He called for the Ohio General Assembly to act on behalf of patients and pass the two bills that would reform step therapy requirements.

To read Dr. Jorgenson’s letter the editor, click here: http://www.cleveland.com/letters/index.ssf/2018/03/ohio_lawmakers_can_reform_step.htm

3. Finally, two state representatives in Maine, Bob Foley and Health Sanborn, authored an op-ed published in the Maine Press Herald bringing attention to non-medical switching, a problem many Mainers with chronic health conditions face. While insurance companies attempt to justify non-medical switching by saying it keeps medical costs down, Foley and Sanborn cite a recent analysis from the Institute for Patient Access disproving that theory. (And, in fact, this study found that step therapy may actually lead to an increase in costs due to nondrug expenses.)

The two representatives have introduced a bill in the Maine Legislature, Legislative Document 696, that would address this issue and stop insurers from denying patients access to their prescribed treatment.

Read Representatives Foley and Sanborn’s op-ed here: https://www.centralmaine.com/2018/03/09/from-the-state-house-doctors-not-insurers-should-prescribe-mainers-medications-and-treatment/?rel=related

The Chronic Disease Coalition supports legislation on the state and federal level that puts patients over insurance profits.

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www.painnewsnetwork.org/stories/2018/3/29/cdc-blames-fentanyl-for-spike-in-overdose-deaths

March 29, 2018

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https://www.healthline.com/health/leading-causes-of-death#1

For more than a decade, heart disease and cancer have claimed the first and second spots respectively as the leading causes of deaths in America. Together, the two causes are responsible for 46 percent of deaths in the United States. Combined with the third most common cause of death, chronic lower respiratory diseases, the three diseases account for half of all deaths in the United States.

For more than 30 years, the U.S. Centers for Disease Control and Prevention (CDC) has been collecting and examining causes of death. This information helps researchers and doctors understand if they need to address growing epidemics in healthcare. The numbers also help them understand how preventative measures may help people live longer and healthier lives.

The top 12 causes of death in the United States account for more than 75 percent of all deaths. Learn about each of the main causes and what can be done to prevent them.

1. Heart disease

Number of deaths per year: 633,842

Percent of total deaths: 24.1 percent

More common among:

• men
• people who smoke
• people who are overweight or obese
• people with a family history of heart disease or heart attack
• people over age 55

What causes heart disease?

Heart disease is a term used to describe a range of conditions that affect your heart and blood vessels. These conditions include:

• heart arrhythmias (irregular heartbeats)
• coronary artery disease (blocked arteries)
• heart defects

Tips for prevention

Many cases of heart disease can be prevented through lifestyle changes. These changes include:

• quitting smoking
• eating a healthier diet
• exercising at least 30 minutes a day, five days a week
• maintaining a healthy weight

2. Cancer

Number of deaths per year: 595,930

Percent of total deaths: 22.7 percent

More common among: Each type of cancer has a specific set of risk factors, but several risk factors are common among multiple types. These risk factors include:

• people of a certain age
• people who use tobacco and alcohol
• people exposed to radiation and sunlight
• people with chronic inflammation
• people who are obese
• people with a family history of the disease

What causes cancer?

Cancer is the result of rapid and uncontrolled cell growth in your body. A normal cell multiplies and divides in a controlled manner. Sometimes, those instructions become scrambled. When this happens, the cells begin to divide at an uncontrolled rate. This can develop into cancer.

Tips for prevention

There’s no clear way to avoid cancer. But certain behaviors have been linked to increased cancer risk, like smoking, so avoiding those may help you cut your risk. Good changes to your behaviors include:

• maintaining a healthy weight, eating a balanced diet, and exercising regularly
• quitting smoking, and drinking in moderation
• avoiding direct exposure to the sun or ultraviolet tanning lights
• having regular cancer screenings, including skin checks, mammograms, prostate exams, and more

3. Chronic lower respiratory diseases

Number of deaths per year: 155,041

Percent of total deaths: 5.9 percent

More common among:

• women
• people over age 65
• people with a history of smoking or exposure to second-hand smoke
• people with a history of asthma
• individuals in lower-income households

What causes respiratory diseases?

This group of diseases includes:

• chronic obstructive pulmonary disease
• emphysema
• asthma
• pulmonary hypertension

Each of these conditions or diseases prevents your lungs from working properly. They can also cause scarring and damage to the lung’s tissues.

Tips for prevention

Tobacco use and second-hand smoke exposure are the primary factors in the development of these diseases. Quit smoking, and limit your exposure to other people’s smoke to reduce your risk. See what readers had to say when asked for real and practical tips to help you quit smoking.

4. Accidents (unintentional injuries)

Number of deaths per year: 146,571

Percent of total deaths: 5.6 percent

More common among:

• men
• people age 1 to 44
• people with risky jobs

What causes accidents?

Accidents lead to more than 28 million emergency room visits each year. The three leading causes of accident-related death are:

• unintentional falls
• motor vehicle traffic deaths
• unintentional poisoning deaths

Tips for prevention

Unintentional injuries may be the result of carelessness or a lack of careful action. Be aware of your surroundings, and take all proper precautions to prevent accidents or injuries.

If you hurt yourself, seek emergency medical treatment to prevent serious complications.

5. Stroke

Number of deaths per year: 140,323

Percent of total deaths: 5.3 percent

More common among:

• men
• women on birth control
• people with diabetes
• people with high blood pressure
• people with heart disease
• people who smoke

What causes a stroke?

A stroke occurs when the blood flow to your brain is cut off. Without oxygen-rich blood flowing to your brain, your brain cells begin to die in a matter of minutes.

The blood flow can be stopped because of a blocked artery or bleeding in the brain. This bleeding may be from an aneurysm or a broken blood vessel.

Tips for prevention

Many of the same lifestyle changes that can reduce your risk for heart disease can also reduce your risk for stroke. These changes include:

• exercising more, eating better, and maintaining a healthy weight
• controlling your blood pressure
• stopping smoking, and drinking only in moderation
• managing your blood sugar level and diabetes
• treating any underlying heart defects or diseases

6. Alzheimer’s disease

Number of deaths per year: 110,561

Percent of total deaths: 3.9 percent

More common among:

• women
• people over age 65 — the risk for Alzheimer’s doubles every five years after age 65, according to the National Institute on Aging
• people with a family history of the disease

What causes Alzheimer’s disease?

The cause of Alzheimer’s disease is unclear, but researchers and doctors believe a combination of a person’s genes, lifestyle, and environment, impacts the brain over time. Some of these changes occur years, even decades, before the first symptoms appear.

Tips for prevention

While you can’t control your age or genetics, which are two of the most common risk factors for this disease, you can control certain lifestyle factors that may increase your risk for it by:

• exercising and remaining physically active throughout your life
• eating a diet filled with fruits, vegetables, healthy fats, and reduced sugar
• treating and monitoring any other chronic diseases you have
• keeping your brain active with stimulating tasks like conversation, puzzles, and reading

7. Diabetes

Number of deaths per year: 79,535

Percent of total deaths: 3.0 percent

More common among:

Type 1 diabetes is more commonly diagnosed in:

• people with a family history of the disease, or a specific gene that increases the risk
• children between the age of 4 and 7
• people living in climates further away from the equator

Type 2 diabetes is more common among:

• people who are overweight or obese
• adults over age 45
• people who have a family history of diabetes

What causes diabetes?

Type 1 diabetes occurs when your pancreas cannot produce enough insulin. Type 2 diabetes occurs when your body becomes resistant to insulin or doesn’t make enough of it to control your blood sugar levels.

Tips for prevention

You cannot prevent type 1 diabetes. However, type 2 diabetes may be prevented with several lifestyle changes. These changes include:

• reaching and maintaining a healthy weight
• exercising for at least 30 minutes, five days a week
• eating a healthy diet with plenty of fruits, vegetables, whole grains, and lean proteins
• having regular blood sugar checks if you have a family history of the disease

8. Influenza and pneumonia

Number of deaths per year: 57,062

Percent of total deaths: 2.2 percent

More common among:

• children
• the elderly
• people with chronic health conditions
• pregnant women

What causes influenza and pneumonia?

Influenza (the flu) is a highly contagious viral infection. It’s very common during winter months. Pneumonia is an infection or inflammation of the lungs. The flu is one of the leading causes of pneumonia. Find out how to determine if you have the flu or a cold.

Tips for prevention

Before flu season, people in the high-risk category can and should get a flu vaccine. Anyone else concerned about the virus should get one, too. To prevent the spread of the flu, be sure to wash your hands well and avoid people who are sick.

Likewise, a pneumonia vaccine is available for people with a high risk of developing the infection.

9. Kidney disease

Number of deaths per year: 49,959

Percent of total deaths: 1.9 percent

More common among:

• people with other chronic conditions, including diabetes, high blood pressure, and recurrent kidney infections
• people who smoke
• people who are overweight or obese
• people with a family history of kidney disease

What causes kidney diseases?

The term kidney disease refers to three main conditions:

• nephritis
• nephrotic syndrome
• nephrosis

Each of these conditions is the result of unique conditions or diseases.

Nephritis, or kidney inflammation, can be caused by an infection, a medication you’re taking, or an autoimmune disorder.

Nephrotic syndrome is a condition that causes your kidneys to produce high levels of protein in your urine. It’s often the result of kidney damage.

Nephrosis is a type of kidney disease that ultimately can lead to kidney failure. It’s also often the result of damage to the kidney from either physical or chemical changes.

Tips for prevention

Like with many of the other leading causes of death, taking better care of your health can help you prevent kidney disease. Lifestyle changes that can reduce your risk include:

• eating a lower-sodium diet
• stopping smoking and drinking
• losing weight if you’re overweight or obese, and maintaining it
• exercising for 30 minutes, five days a week
• having regular blood and urine tests if you have a family history of the disease

10. Suicide

Number of deaths per year: 44,193

Percent of total deaths: 1.7 percent

More common among:

• men
• people with brain injuries
• people who have attempted suicide in the past
• people with a history of depression and other mental health illnesses
• people who abuse alcohol or drugs

What causes suicide?

Suicide, or intentional self-harm, is death caused by a person’s own actions. People who die by suicide direct harm at themselves and die due to that harm. Almost 500,000 people are treated in emergency rooms each year for self-inflected injuries.

Tips for prevention

Suicide prevention aims to help individuals find treatment that encourages them to end suicidal thoughts and start finding healthier ways to cope. For many people, suicide prevention includes finding a support system of friends, family, and other people who’ve contemplated suicide. In some cases, medication and in-hospital treatment may be necessary.

If you’re thinking about harming yourself, consider contacting a suicide prevention hotline. You can call the National Suicide Prevention Lifeline at 800-273-8255. It offers 24/7 support. You can also review our mental health resources list for more information about ways to find help.

11. Septicemia

Number of deaths per year: 40,685

Percent of total deaths: 1.5 percent

More common among:

• adults over age 75
• young children
• people with a chronic illness
• people with an impaired immune system

What causes septicemia?

Septicemia, sometimes called blood poisoning, is caused by a bacterial infection in the bloodstream. Most cases of septicemia develop after an infection somewhere else in the body becomes severe.

Tips for prevention

The best way to prevent septicemia is to have any bacterial infections treated quickly and thoroughly. If you think you may have an infection, make an appointment with your doctor. Complete the full treatment regimen prescribed by your doctor.

Early and thorough treatment can help prevent the spread of any bacterial infection to the blood.

12. Chronic liver disease and cirrhosis

Number of deaths per year: 40,265

Percent of total deaths: 1.5 percent

More common among:

• people with a history of alcohol use and abuse
• a viral hepatitis infection
• an accumulation of fat in the liver (fatty liver disease)

What causes liver disease?

Both liver disease and cirrhosis are the result of liver damage.

Tips for prevention

If you have a problem with alcohol consumption, seek therapeutic or rehab treatment. The longer and more you drink, the greater your risk for developing liver disease or cirrhosis.

Likewise, if you’re diagnosed with hepatitis, be sure to properly treat the condition to prevent unnecessary liver damage.

Death rates that have decreased

Though it’s the most common cause, heart disease deaths have been falling over the last 50 years. However, in 2011, the number of deaths from heart disease began to slowly rise. Between 2011 and 2014, heart disease deaths rose three percent.

Deaths from influenza and pneumonia are likewise falling. According to the American Lung Association, deaths from the two diseases dropped an average of 3.8 percent per year since 1999.

Between 2010 and 2014, deaths from stroke dropped 11 percent.

This falling number of preventable deaths suggests that health awareness campaigns are hopefully increasing awareness of preventative measures people can take to live a longer, healthier life.

Rising death rates

The gap between heart disease and cancer was once much wider. Heart disease’s hold on the number one spot was wide and demanding.

Then, American health experts and doctors began encouraging Americans to curb smoking, and they started treating heart disease. Because of these efforts, the number of heart disease-related deaths has been falling over the last five decades. Meanwhile, the number of cancer-related deaths has been rising.

Just over 22,000 deaths separate the two causes today. Many researchers suspect cancer may over take heart disease as the leading cause of death in coming years.

Accidental deaths are also on the rise. From 2010 to 2014, the number of accident-related deaths increased by 23 percent. This number is fueled largely by substance overdose deaths.

Leading causes of death worldwide

The list of leading causes of death worldwide shares many of the same causes with the U.S. list. These causes of death include:

• heart disease
• stroke
• lower respiratory infections
• chronic obstructive pulmonary disease
• lung cancer
• diabetes
• Alzheimer’s disease and dementia
• diarrhea
• tuberculosis
• road injury

 

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www.khn.org/news/difficult-to-gauge-rate-of-suicide-among-deaths-from-opioid-overdoses/

Mady Ohlman was 22 on the evening some years ago when she stood in a friend’s bathroom looking down at the sink.

“I had set up a bunch of needles filled with heroin because I wanted to just do them back-to-back-to-back,” Ohlman recalled. She doesn’t remember how many she injected before collapsing, or how long she lay drugged-out on the floor.

“But I remember being pissed because I could still get up, you know?”

She wanted to be dead, she said, glancing down, a wisp of straight brown hair slipping from behind an ear across her thin face.

At that point, said Ohlman, she’d been addicted to opioids — controlled by the drugs — for more than three years.

“And doing all these things you don’t want to do that are horrible — you know, selling my body, stealing from my mom, sleeping in my car,” Ohlman said. “How could I not be suicidal?”

For this young woman, whose weight had dropped to about 90 pounds, who was shooting heroin just to avoid feeling violently ill, suicide seemed a painless way out.

“You realize getting clean would be a lot of work,” Ohlman said, her voice rising. “And you realize dying would be a lot less painful. You also feel like you’ll be doing everyone else a favor if you die.”

Ohlman, who has now been sober for more than four years, said many drug users hit the same point, when the disease and the pursuit of illegal drugs crushes their will to live. Ohlman is among at least 40 percent of active drug users who wrestle with depression, anxiety or another mental health issue that increases the risk of suicide.

Measuring Suicide Among Patients Addicted To Opioids

Massachusetts, where Ohlman lives, began formally recognizing in May 2017 that some opioid overdose deaths are suicides. The state confirmed only about 2 percent of all overdose deaths as suicides, but Dr. Monica Bharel, head of the Massachusetts Department of Public Health, said it’s difficult to determine a person’s true intent.

“For one thing, medical examiners use different criteria for whether suicide was involved or not,” Bharel said, and the “tremendous amount of stigma surrounding both overdose deaths and suicide sometimes makes it extremely challenging to piece everything together and figure out unintentional and intentional.”

Research on drug addiction and suicide suggests much higher numbers.

“[Based on the literature that’s available], it looks like it’s anywhere between 25 and 45 percent of deaths by overdose that may be actual suicides,” said Dr. Maria Oquendo, immediate past president of the American Psychiatric Association.

Oquendo pointed to one study of overdoses from prescription opioids that found nearly 54 percent were unintentional. The rest were either suicide attempts or undetermined.

Several large studies show an increased risk of suicide among drug users addicted to opioids, especially women. In a study of about 5 million veterans, women were eight times as likely as others to be at risk for suicide, while men faced a twofold risk.

The opioid epidemic is occurring at the same time suicides have hit a 30-year high, but Oquendo said few doctors look for a connection.

“They are not monitoring it,” said Oquendo, who chairs the department of psychiatry at the University of Pennsylvania. “They are probably not assessing it in the kinds of depths they would need to prevent some of the deaths.”

That’s starting to change. A few hospitals in Boston, for example, aim to ask every patient admitted about substance use, as well as about whether they’ve considered hurting themselves.

“No one has answered the chicken and egg [problem],” said Dr. Kiame Mahaniah, a family physician who runs the Lynn Community Health Center in Lynn, Mass. Is it that patients “have mental health issues that lead to addiction, or did a life of addiction then trigger mental health problems?”

With so little data to go on, “it’s so important to provide treatment that covers all those bases,” Mahaniah said.

‘Deaths Of Despair’

When doctors do look deeper into the reasons patients addicted to opioids become suicidal, some economists predict they’ll find deep reservoirs of depression and pain.

In a seminal paper published in 2015, Princeton economists Angus Deaton and Anne Case tracked falling marriage rates, the loss of stable middle-class jobs and rising rates of self-reported pain. The authors say opioid overdoses, suicides and diseases related to alcoholism are all often “deaths of despair.”

“We think of opioids as something that’s thrown petrol on the flames and made things infinitely worse,” Deaton said, “but the underlying deep malaise would be there even without the opioids.”

Many economists agree on remedies for that deep malaise. Harvard economics professor David Cutler said solutions include a good education, a steady job that pays a decent wage, secure housing, food and health care.

“And also thinking about a sense of purpose in life,” Cutler said. “That is, even if one is doing well financially, is there a sense that one is contributing in a meaningful way?”

Tackling Despair In The Addiction Community

“I know firsthand the sense of hopelessness that people can feel in the throes of addiction,” said Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center; he is in recovery for an addiction to alcohol.

Botticelli said recovery programs must help patients come out of isolation and create or recreate bonds with family and friends.

“The vast majority of people I know who are in recovery often talk about this profound sense of re-establishing — and sometimes establishing for the first time — a connection to a much larger community,” Botticelli said.

Ohlman said she isn’t sure why her attempted suicide, with multiple injections of heroin, didn’t work.

“I just got really lucky,” Ohlman said. “I don’t know how.”

A big part of her recovery strategy involves building a supportive community, she said.

“Meetings; 12-step; sponsorship and networking; being involved with people doing what I’m doing,” said Ohlman, ticking through a list of her priorities.

There’s a fatal overdose at least once a week within her Cape Cod community, she said. Some are accidental, others not. Ohlman said she’s convinced that telling her story, of losing and then finding hope, will help bring those numbers down.

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