Could Marijuana Replace Opioids As A Painkiller? Experts Are Skeptical

https://www.forbes.com/sites/michelatindera/2017/12/03/could-marijuana-replace-opioids-as-a-painkiller-experts-are-skeptical/#1477810f6209

The heavy marketing and widespread access to opioid pills sparked a national crisis that’s now labeled a “public health emergency” by the U.S. government. Last year, some 60,000 Americans died of drug (including opioid) overdoses—that’s some 12,000 more than traffic-related deaths in the same year. As physicians look for new, less harmful, ways to manage their patients’ pain, could medical marijuana be the answer–or the makings of another public health crisis?  

That question was asked by an audience member at the Forbes Healthcare Summit in New York on Thursday. The idea drew immediate skepticism from Tom Frieden, who headed the Centers for Disease Control and Prevention under President Obama and now heads a non-profit, Resolve to Save Lives.

 “The huge problem with legalization is that in the current legal context of the U.S., if you legalize a product you cannot restrict its market, and what we’re looking at is the prospect of having Big Tobacco paralleled by Big Marijuana actively promoting marijuana use,” Frieden said. “It could be very harmful for some people and some communities. That said, there may be a role for some individuals, and obviously this is a tough issue.”

Wilson Compton, the deputy director at the National Institute on Drug Abuse, said that the National Institutes of Health is trying to support more rigorous research on medical marijuana. He said the studies out there today tend to be small and disparate with the different types of pain conditions that are looked into. “While it looks like there’s a general signal, we don’t know who the marijuana, or the cannabinoids within the plant, might be useful for,” Compton said. “And that’s where I think research needs to move.”

Medical marijuana is now legal in 29 states and the District of Columbia, and as that number continues to grow, more drug companies are looking for ways to use the plant and its potent cannabinoids to relieve pain. Several companies like publicly-traded GW Pharmaceuticals and Cara Therapeutics are developing drugs using these properties but none have been approved by the Food and Drug Administration yet.

But Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University and a critic of opioid overuse, said that at least marijuana would be better than opioids

 “If I had a patient who was suffering from severe intractable pain and had tried everything, I would sooner try marijuana on a patient than heroin,”

Kolodny said. “When you are prescribing opioids, you are essentially giving them heroin.”  

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The Feds Are Sticking It To Chronic Pain Patients

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N.J. opioid prescriptions were among lowest in U.S. before Christie’s tough new law

http://www.nj.com/politics/index.ssf/2017/05/nj_tied_for_the_lowest_rate_of_opioid_prescription.html

TRENTON — New Jersey last year reported one the lowest opioid prescription rates in the nation, even before Gov. Chris Christie signed into law tough new restrictions limiting when doctors may prescribe potentially addictive pain killers, according to a new survey. 

In New Jersey, prescriptions declined from 5.16 million to 4.59 million, a decline of 11 percent, according to a report released by the American Medical Association.

That amounts to 0.5 prescriptions per capita, second-lowest behind California and Hawaii at 0.4 scripts. New Jersey is tied with Alaska, Massachusetts, Minnesota and New York, according to the report released Friday.

In its report, “Physicians’ progress to reverse nation’s opioid epidemic,” the leading lobby for doctors said prescribing rates have declined in all 50 states. During the same period of time, physician use of state prescription drug monitoring programs and the number of physicians undertaking training programs on opioid prescribing, pain management, addiction have spiked dramatically.

Opioids over-prescribed in South, but not much in N.J.

“These are good signs of progress, but to truly reverse the nation’s opioid epidemic, we all have much more work to do,” said Patrice A. Harris, who chairs the AMA’s Board of Trustees. 

Despite its dense population and ample access to physicians, New Jersey has ranked low in opioid prescription rates for some time. In 2012, the U.S. Centers for Disease Control and Prevention found 63 prescriptions were written for every 100 people New Jersey, at the bottom with New York, Minnesota, California and Hawaii in the lowest group.

Alabama and Tennessee were the highest-prescribing states, recording 143 prescriptions per capita, the CDC found in 2012. 

Last year, the CDC set guidelines for prescribers which state a seven-day supply is typically all that is required. In February in a show of determination to combat an epidemic of overdoses, Gov. Chris Christie and the Legislature adopted a law setting a five-day initial prescription that a doctor could increase after four days if pain has not subsided.

The Medical Society of New Jersey, the state affiliate for the American Medical Association, opposed the bill and predicted  cautious doctors would be reluctant to recommend opioids when they are necessary. 

Mishael Azam, chief operating officer for the Medical Society, said that prediction has come true, based on conversations with its members.

“Since the CDC guidelines were released and (S3) was signed, patients feel like criminals for needing pain medication,” Azam said.

“Patients who need medication for mobility or daily quality of life are losing access because physicians are being blamed for opioid addiction, thus reducing even legitimate prescribing,” Azam said. “Physicians are in fact learning and changing behavior, doing their best to balance the goals of treating patients and reducing addiction.”

Christie has made reducing the addiction and overdose rate of heroin and prescription drugs the centerpiece of his final year in office.

Backed by CDC studies and statistics that have shown a corresponding rise in the number of opioid prescriptions and fatal overdoses, Christie has taken aim at prescribing practices in the state and expanded the requirements that pharmacists update and doctors consult the statewide prescription monitoring database.

The law says doctors treating patients for acute pain must limit the length of the initial prescription to no more than five days. The law allows physicians to add another five days to the prescription after the fourth day if the pain has not subsided.

The measure would not apply to hospice or cancer patients or people in long-term care facilities, according to the bill. Nor would it apply to patients who are being treated for chronic pain.

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Meth-related overdose deaths hit record number in WV

https://www.wvgazettemail.com/news/health/meth-related-overdose-deaths-hit-record-number-in-wv/article_67cb7c01-fba3-5dbc-80c8-f9913e07dfde.html

Overdose deaths related to methamphetamine in West Virginia have increased by 500 percent in just four years, according to new data released by the state Health Statistics Center.

A record-number 129 people have died from meth-related overdoses this year — and that number is expected to increase significantly as the state catches up on counting fatal overdoses.

About half of the meth overdoses involve fentanyl, a powerful synthetic opioid that remains the leading cause of drug overdoses in West Virginia. Addicts are using meth laced with fentanyl, sometimes unknowingly, said Chad Napier, prevention officer with the Appalachian High Intensity Drug Trafficking Area.

“A lot of these people don’t know what they’re getting,” Napier said. “We’re seeing the meth cut with fentanyl, so that’s increasing the meth [overdose] numbers, I believe.”

Kanawha and Cabell counties have been hardest hit by meth-related overdoses. Thirty Kanawha residents have died from meth overdoses this year, 28 in Cabell. Raleigh and Wood counties had the next-highest number of fatal meth-related overdoses with eight each.

Statewide, meth-related overdose deaths have increased each of the past four years — from 21 in 2014, 49 in 2015, 107 in 2016 and 129 deaths so far this year.

Police agencies are seizing an increasing amount of crystal meth made in Mexico by drug cartels and distributed in Appalachia through Atlanta; Columbus, Ohio; and Detroit, Napier said.

Several years ago, meth dealers and users across the state were making the drug in small, clandestine “shake-and-bake” labs, but the number of those labs has declined significantly as crystal meth from Mexico has become the preferred choice among users.

Dr. Rahul Gupta, state health commissioner, said drug users also are mixing meth and heroin. The Mexican-made meth inundated the southwestern United States before spreading east.

“We’re seeing a lot more meth, and it’s a different kind of meth than we were seeing five or six years ago,” Gupta said. “There’s a push from the cartels to get these drugs out there.”

Doctors sometimes prescribe methamphetamine, sold under the Desoxyn brand, to treat people with attention-deficit disorder. But the state Board of Pharmacy has found no meth-related overdoses linked to prescription methamphetamine.

“The stats reflect illicit meth,” said Mike Goff, an administrator at the pharmacy board. “[Overdoses caused by] street drugs are all up.”

For instance, there’s been a resurgence of cocaine abuse in the region, Napier said, along with a corresponding increase in cocaine-related overdose deaths.

In West Virginia, cocaine deaths jumped from 57 in 2014 to 157 in 2016, and 126 cocaine-related fatal overdoses have been reported this year with many more to be counted. Cabell County leads the state with 31 cocaine-related overdose deaths this year.

Dealers also are lacing cocaine with fentanyl, Napier said, though he didn’t know the percentage of cocaine-related deaths that also involved fentanyl.

Not long ago, it was uncommon for meth addicts to abuse opioids or for heroin or pain-pill addicts to use meth. That’s changed during the past two years.

“They’re mixing stimulants with depressants,” Napier said.

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CVS looks to expand health clinics with Aetna deal

http://www.theledger.com/news/20171201/cvs-looks-to-expand-health-clinics-with-aetna-deal

NEW YORK — CVS Health Corp is planning to significantly expand health services at its retail pharmacies if it completes a more than $66 billion deal for insurer Aetna Inc , a move that could save more than $1 billion annually, people familiar with the matter said.

A key rationale is to use many of the U.S. pharmacy chain’s 9,700 brick-and-mortar outlets to improve access to preventative care and cut back on some emergency room visits for Aetna’s roughly 23 million members with medical coverage, these people said.

The full benefits of the strategy will take several years to realize, requiring billions of dollars in investment to increase the number of CVS clinics and provide the staff and equipment for a wider variety of treatments, the people said.

Those funds would be diverted from planned investments in CVS retail facilities, and not amount to additional expenses, they said.

Deal talks between the companies are still underway, and an agreement could be announced as early as Sunday or Monday, sources familiar with the matter told Reuters. It is also possible that a deal is delayed or does not materialize, they said.

Health insurers have redoubled their efforts to cut costs in a time of steep prescription drug price rises and requirements to care for even the sickest patients under the Affordable Care Act.

Aetna last year tried to buy rival Humana Inc to gain more leverage over costs, but that transaction, as well as a proposed merger between Anthem Inc and Cigna Corp , was shot down by antitrust regulators.

Many insurers have already been encouraging patients to use urgent care centers, which can provide some of the same services as emergency rooms for as little as a tenth of the cost, said Laurel Stoimenoff, chief executive of the Urgent Care Association of America.

Minuteclinics

The industry has grown to about 8,000 urgent care centers nationwide, as more hospitals, insurers and private operators open such walk-in facilities, Stoimenoff said, with 400 to 500 centers added each year. They may be staffed by doctors and provide relatively advanced care including X-rays.

 CVS operates more than 1,000 MinuteClinics, which offer more basic services ranging from flu shots to physicals and are mainly staffed by nurse practitioners.

Combined with Aetna, the company would be able to seamlessly access medical records, offer certain preventive services to covered members for free and make drugs promptly available in adjacent CVS pharmacies, said Dan Mendelson, president of consultancy Avalere Health.

The in-store clinics could provide immunizations, check if a patient needs antibiotics, help manage chronic illnesses like diabetes or even administer medications by infusion, but are unlikely to offer acute treatment of serious injuries, healthcare experts said.

“It would probably be unsettling to people coming in to buy socks to have someone with a bleeding head come in for stitches,” said Greg Burke of the United Hospital Fund, a non-profit focused on improving healthcare in New York.

Expanding the clinics could eventually save the combined company more than $1 billion annually by substituting low-cost treatments in CVS stores for more expensive hospital visits, two people familiar with the matter said. The combined net income of Aetna and CVS is forecast to be about $9.25 billion in 2017, according to Thomson Reuters data.

Aetna competitor UnitedHealth Group Inc operates 230 MedExpress urgent care centers in 17 states in one of its fastest-growing divisions, with nearly 20 percent compounded revenue growth per year.

For CVS, which has seen non-pharmacy sales decline at its stores, the clinics could have the added benefit of bringing in new customers and providing alternatives for less productive retail space.

“It’s a tough retail environment. I think they’re going to devote less space to it and more to different healthcare services and clinics,” said Jeff Jonas, a portfolio manager at Gabelli Funds which owns shares in Aetna and CVS.

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How opioids started killing Americans at the corner pharmacy

http://www.sentinelsource.com/how-opioids-started-killing-americans-at-the-corner-pharmacy/article_4e393039-7b4d-5de4-b435-4c09930101dd.html

It’s been conventional wisdom for some time now that America’s opioid epidemic began at the pharmacy. Now there are numbers to put any doubt to rest.

More than half of all people who succumbed to an overdose between 2001 to 2007 were chronic pain sufferers who filled an opioid prescription and sometimes even saw a doctor in the month before they died. Only 4 percent were ever diagnosed as having an abuse problem, said Mark Olfson, one of five researchers who conducted a massive study of the crisis and its causes for Columbia University Medical Center.

The findings of the new study, published Tuesday in the American Journal of Psychiatry, split the epidemic into two groups: those who were diagnosed with chronic pain and those who weren’t. In the year before they died, about two-thirds of those studied were diagnosed with chronic pain and prescribed an opioid. (Many would also get a prescription for anti-anxiety drugs called benzodiazepines, which can make for a deadly combination.) The other third among those who died had no diagnosed chronic pain but became addicted to opioids in another way.

“Those are different populations,” Olfson said in a telephone interview. “Understanding those things puts us in a better position to combat the epidemic.”

According to the National Institute on Drug Abuse, more than 33,000 Americans died from opioid overdoses in 2015. Most of those deaths were linked to prescription pain pills, though the use of heroin was already growing rapidly, accounting for almost 13,000 fatalities that year. The scourge has continued to inundate America’s health care infrastructure. An analysis published this week by OM1 Inc., a company that uses artificial intelligence to improve health outcomes,

found that in the second quarter of 2017, one out of every six emergency room visits in the U.S. was opioid-related.

And while opioid prescriptions have become harder to come by, the drugs are still too easy to obtain, U.S. health officials have said. The amount of opioid painkillers prescribed in the U.S. peaked in 2010 and declined each year through 2015, according to the Centers for Disease Control. Nevertheless, the drugs are prescribed about three times as much as they were in 1999, the CDC said in July.

Olfson said he hoped the study would alert lawmakers and health care providers to those at highest risk, as well as the dangers of prescribing opioids and benzodiazepines simultaneously.

Each piece of data, he said, helps give people a sense of the “crisis we’re in the midst of.”

“found that in the second quarter of 2017, one out of every six emergency room visits in the U.S. was opioid-related”

The article was about OPIATE OD’s… ED visits that could include “opiate related”.. would be someone in pain- or addicted – seeking a prescriptions for a opiate...

10 Most Common Reasons for an ER Visit

Most of the TOP TEN REASONS for a person to go to an emergency room is for direct/indirect issues that would involved PAIN..

The “crisis” that we are in.. seems to be more build out of FABRICATED DATA !… it is more like a “magic act” than reality..

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Boston Doctor Criticizes New Opioid Awareness Campaign

www.boston.cbslocal.com/2017/11/30/boston-doctor-criticizes-new-opioid-awareness-campaign/

A new public awareness campaign on trains and buses statewide is the latest effort to prevent the opioid crisis.

It’s called “Resist The Risk” and it in features powerful images like a baby in the hospital with the words “the first weeks of my life were spent in detox.”

“The point of these images was to grab people’s attention to get them thinking about this,” said Acting US Attorney William Weinreb.

“Resist The Risk” opioid awareness ad (WBZ-TV)

The US Attorney District of Massachusetts and DEA New England Field Division are sponsoring the campaign, which kicked off this week. It includes four different ads that will be on MBTA buses along with Red and Orange line trains.

The campaign is already drawing criticism from a local doctor.

“Showing a consequence that’s scary that might happen to somebody years down the line is not effective for youth,” said Boston Medical Center Doctor Richard Saitz.

Boston Medical Center addiction specialist Dr. Richard Saitz says the ads may be counterproductive and drive addicts away from treatment.

“Resist The Risk” opioid awareness ad (WBZ-TV)

“If they could simply stop drug use and resist the risk they would. They can’t, they need help to do so, they need treatment,” said Dr. Saitz.

Acting US Attorney William Weinreb is defending the program saying the ads are geared toward informing young people about the dangers of opioids.

“Our message is directed at a different population, people who are not already addicted, but people who are thinking about using pain pills recreationally,” said Weinreb.

The Acting US Attorney admits the ads are stirring up controversy, but points out it’s getting the conversation going on the topic.

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Three days ago I had an appointment with my pain doctor. He prescribed me hydrocodone. He has periodically prescribed this when my pain levels have increased. Normally I take tramadol but sometimes it requires a stronger hydrocodone. The last time I had been prescribed one was eight weeks earlier.  I’ve never had a problem with him prescribing both. I have been advised by both the doctor and my previous pharmacist to never take the two together which I am well aware . normally I take the tramadol but if my pain levels increase I switch and I take the hydrocodone in place of the tramadol until I feel like I can go back to the tramadol . I do this deliberately because I do not want to stay on hydrocodone every day but I need something so I prefer the lesser. 

So I go to the doctor and things have changed and he needs to now do a facet Rhizotomy of my L5 right side due the spinal stenosis. He prescribed me some hydrocodone and my appointment is December 19 . I take it to the Walgreens pharmacy where I always gone and a new pharmacist says that she doesn’t feel comfortable filling it.

First she said that about the mix of the two and I told her I have been advised by the previous pharmacist as well as my doctor never to take together… then she stated that she felt because I had tram on hand that I should just take that and not the hydrocodone and I told her I have a need for the hydrocodone and then she just flat out said she wasn’t comfortable with it.

I am not Dr shopping, I am not pharmacy shopping. I deliberately make sure my pain doctor fills both prescriptions and I go to the same pharmacy and I have been for a year and a half for both prescription . I do not fill these regularly ,sometimes I have anywhere from 7 to 12 weeks in between prescriptions. And I don’t want to try to go to a different pharmacy because I don’t want to be accused of pharmacy shopping.

I’ve had four surgeries in the last three years and I do have chronic pain however sometimes I don’t need hydrocodone. But when I do need it I don’t understand why her personal feelings have a right to tell me I can’t when my physician feels that it’s necessary.

I also am on permanent disability as a result of my condition.

I see that I can file a complaint but I don’t know whether what she did falls under the category. I know that she can refuse for specific reasons but she did say verbatim “I just don’t feel comfortable with it” she said this at least three times.

This morning I’m going in again which will be my fourth morning in a row and I’m sure she’s going to refuse it again. And I’m just wondering what I can tell her in response regarding the Legality of the of this refusal.

One of the recommendation for pts is to always use the SAME PHARMACY… many pts believe that if they go to the same “physical pharmacy” each month that they are going to the SAME PHARMACY..

However, especially in chain stores… one or more of the pharmacists that are in charge of the Rx dept may have changed in the interim month…  and along with that change can come a new pharmacist with a change in experience level, opinions, biases, phobias.. basically “there is a new sheriff in town”

But there are some 22,000 independent pharmacies out there.. where you will be dealing with the Pharmacist/owner… and generally they don’t change “sheriffs” randomly… and unlike their chain counterparts.. they only get paid when they fill legit/on time/medically necessary prescriptions…  and tend to not “play games” with the pt’s necessary medications.

Here is a link that can help anyone find a independent pharmacy by zip code.

http://www.ncpanet.org/home/find-your-local-pharmacy 

More and more pts are discovering that trying to “buck the system” typically does not get them very far. We have a serious – and growing – pharmacist SURPLUS.. and if the chain pharmacies were not happy with their pharmacists turning down controlled prescriptions and denying care to pt with legit/on time/medically necessary prescriptions… they would BE REPLACING THEM… since they are not … it would appear that they could care less about those pts that are thrown into cold turkey withdrawal or denied timely access to their medically necessary medication.

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The real history of the DEA and opioids

https://www.washingtonpost.com/opinions/the-real-history-of-the-dea-and-opioids/2017/12/01/6ab9d194-d5f7-11e7-9ad9-ca0619edfa05_story.html

The Nov. 29 news article “Ex-DEA officials want anti-opioid tool restored” continued the false narrative that a law passed by Congress and signed by President Barack Obama hinders the Drug Enforcement Administration’s efforts to combat the opioid epidemic.

As a former associate chief counsel for the DEA, I was responsible for supervising all administrative litigation and enforcement actions against DEA registrants. During my tenure, my team initiated a record number of enforcement actions, including immediate suspension orders. After my departure, the volume of administrative actions significantly decreased. That was in 2013, a full three years before the enactment of the Ensuring Patient Access and Effective Drug Enforcement Act.

Former DEA employees who say the decrease is because of the legislation would prefer to rewrite history.

During Joseph T. Rannazzisi’s tenure as the head of the Office of Diversion Control, oxycodone and hydrocodone limits increased by more than 300 percent. The idea that the DEA was simply responding to the demand in prescribing is fundamentally false. In the 1970s, the DEA significantly reduced the amphetamine quota to successfully combat rising abuse of speed pills. In the 1980s, the methaqualone quota was reduced to combat the illicit use of quaaludes. It is perplexing why the DEA did not address the opioid epidemic in the same manner.

Larry Cote, Washington

The writer leads Quarles & Brady’s
DEA compliance and litigation practice group.

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