Give Pain a Voice – You Tube Channel
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Australia: denial of proper pain management is INTERNATIONAL ?
Posted on October 22, 2017 by Pharmaciststeve
Migraine Drug Used In ER May Not Be Best Option
Posted on October 22, 2017 by Pharmaciststeve
Migraine Drug Used In ER May Not Be Best Option
https://www.news-line.com/PH_news28506_enews
A drug commonly used in hospital emergency rooms for people with migraine is substantially less effective than an alternate drug and should not be used as a first choice treatment, according to a study published in the online issue of Neurology®, the medical journal of the American Academy of Neurology.
“People go to US emergency departments 1.2 million times a year with migraine, and the opioid drug hydromorphone is used in 25% of these visits, yet there have been no randomized, high-quality studies on its use for acute migraine,” said study author Benjamin W. Friedman, MD, MS, of Albert Einstein College of Medicine in the Bronx, N.Y.
The study found that the drug prochlorperazine, given along with the drug diphenhydramine to prevent the side effect of restlessness, was superior to hydromorphone. Prochlorperazine is a type of drug called a dopamine antagonist. It blocks the release of dopamine, which is one of the many chemical messengers in the brain. The drugs were all given intravenously.
The researchers were also looking at whether the use of an opioid drug led to addiction in some people, with return visits to emergency rooms for repeat treatments.
“While this study demonstrates the overwhelming superiority of prochlorperazine over hydromorphone for initial treatment of acute migraine, the results do not suggest that treatment with IV opioids leads to long-term addiction,” Friedman said.
“In addition, the results should not be used to avoid the use of opioids for people who have not responded well to anti-dopaminergic drugs.”
The study involved 127 people who went to two emergency departments in New York with migraine. Half of the participants received hydromorphone and half received prochlorperazine. The researchers were looking to see how many people had sustained headache relief after 48 hours, which was defined as having a mild headache or no headache two hours after receiving the drug and maintaining that level for 48 hours without needing a rescue medication to stop the migraine.
The study was stopped after 127 people had enrolled because the 48-hour results showed that prochlorperazine was overwhelmingly superior to hydromorphone.
After 48 hours, 37 of the 62 people, or 60%, receiving prochlorperazine had sustained headache relief, compared to 20 of the 64 people who received hydromorphone, or 31 percent. In the emergency room, 31% of those who received hydromorphone asked for a second dose of the drug, compared to 8% of those who received prochlorperazine. Of those receiving hydromorphone, 36% requested other pain-reliever drugs, compared to 6% of the other group.
There was no difference between the two groups in how often they returned to the ER for migraine within one month of the treatment.
Friedman said that one limitation of the study is that participants were required to have not used opioids during the previous month and to have no history of addiction to prescription or illicit opioids, so the participants may have been at lower risk for problems with opioid use than the general population.
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China already controls illegal fentanyl and 18 related compounds
Posted on October 21, 2017 by Pharmaciststeve
China firms happy to sell killer opioid “weapon” to anyone in U.S.
SHANGHAI — It’s one of the strongest opioids in circulation, so deadly an amount smaller than a poppy seed can kill a person. Until July, when reports of carfentanil overdoses began to surface in the U.S., the substance was best known for knocking out moose and elephants — or as a chemical weapon.
Despite the dangers, Chinese vendors offer to sell carfentanil openly online, for worldwide export, no questions asked, an Associated Press investigation has found. The AP identified 12 Chinese businesses that said they would export carfentanil to the United States, Canada, the United Kingdom, France, Germany, Belgium and Australia for as little as $2,750 a kilogram.
Elephant tranquilizer blamed for recent wave of heroin overdoses
Carfentanil burst into view this summer as the latest scourge in an epidemic of opioid abuse that has killed tens of thousands in the U.S. alone. In China, the top global source of synthetic drugs, carfentanil is not a controlled substance. The U.S. government is pressing China to blacklist it, but Beijing has yet to act.
“We can supply carfentanil … for sure,” a saleswoman from Jilin Tely Import and Export Co. wrote in broken English in a September email. “And it’s one of our hot sales product.”
The AP did not actually order any drugs, or test whether the products on offer were genuine.
China’s Ministry of Public Security declined multiple requests for comment.
For decades before being discovered by drug dealers, carfentanil and substances like it were researched as chemical weapons by the U.S., U.K., Russia, Israel, China, the Czech Republic and India, according to publicly available documents. They are banned from the battlefield under the Chemical Weapons Convention.
“It’s a weapon,” said Andrew Weber, assistant secretary of defense for nuclear, chemical and biological defense programs from 2009 to 2014. “Companies shouldn’t be just sending it to anybody.”
Carfentanil is 100 times more powerful than fentanyl, a related drug that is itself up to 50 times stronger than heroin.
Forms of fentanyl are suspected in an unsuccessful 1997 attempt by Mossad agents to kill a Hamas leader in Jordan, and were used to lethal effect by Russian forces against Chechen separatists who took hundreds of hostages at a Moscow theater in 2002.
The theater siege prompted the U.S. to develop strategies to counter carfentanil’s potential use as a tool of war or terrorism, according to Weber. “Countries that we are concerned about were interested in using it for offensive purposes,” he said. “We are also concerned that groups like ISIS could order it commercially.”
Later, dealers discovered that vast profits could be made by cutting fentanyls into illicit drugs. In fiscal year 2014, U.S. authorities seized just 8.1 pounds of fentanyl. This fiscal year, through just mid-July, they seized 295 pounds, Customs and Border Protection data show. Overdose rates have been skyrocketing.
The DEA has “shared intelligence and scientific data” with China about controlling carfentanil, according to Russell Baer, a DEA special agent in Washington.
“I know China is looking at it very closely,” he said. Delegations of top Chinese and U.S. drug enforcement officials met in August and September to discuss opioids, but failed to produce a substantive announcement on carfentanil.
China is not blind to the key role its chemists play in the opioid supply chain. Most synthetic drugs that end up in the United States come from China, according to the DEA.
China already has controlled fentanyl and 18 related compounds, but despite periodic crackdowns, people willing to skirt the law are easy to find in China’s vast, freewheeling chemicals industry. Vendors said they lied on customs forms, guaranteed delivery to countries where carfentanil is banned and volunteered strategic advice on sneaking packages past law enforcement.
“The government should impose very serious limits, but in reality in China it’s so difficult to control because if I produce 1 or 2 kilograms, how will anyone know?” said Xu Liqun, president of Hangzhou Reward Technology, which offered to produce carfentanil to order. “They cannot control you, so many products, so many labs.”
Last October, China added 116 synthetic drugs to its controlled substances list. Acetylfentanyl, a weak fentanyl variant, was among them. Six months later, monthly seizures of acetylfentanyl in the U.S. were down 60 percent, DEA data obtained by the AP shows.
Several vendors contacted in September were willing to export carfentanil but refused to provide the far less potent acetylfentanyl.
Seven companies, however, offered to sell acetylfentanyl despite the ban. Five offered fentanyl and two offered alpha-PVP, commonly known as flakka, which are also controlled substances in China.
Several vendors recommended shipping by EMS, the express mail service of state-owned China Postal Express & Logistics Co.
“EMS is a little slow than Fedex or DHL but very safe, more than 99% pass rate,” a Yuntu Chemical Co. representative wrote in an email.
EMS declined comment. A Yuntu representative hung up the phone when contacted by the AP and did not reply to emails. Soon after, the company’s website vanished.
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The “SILENT KILLER”… not managed in >50% of adults – how many are under treated CPP’s ?
Posted on October 21, 2017 by Pharmaciststeve
CDC: Control not achieved in more than half of US adults with hypertension
Less than half of U.S. adults with hypertension have their BP under control, according to a data brief released by the CDC’s National Center for Health Statistics.
“Despite progress in hypertension control that has been noted in the United States over the years, the goal of Healthy People 2020 (61.2% by 2020) has not been met,” Cheryl D. Fryar, MSPH, from the division of Health and Nutrition Examination Surveys at the National Center for Health Statistics, and colleagues wrote in the brief. “Currently just less than one-half of adults with hypertension have their hypertension under control (48.3%).”
Although men had higher rates of hypertension than women among adults aged 18 to 39 years (9.2% vs. 5.6%) and aged 40 to 59 years (37.2% vs. 29.4%), men had lower prevalence of hypertension than women among adults aged at least 60 years (58.5% vs. 66.8%).
The researchers noted that hypertension prevalence was highest in non-Hispanic black adults (40.3%) compared with other races and ethnicities (non-Hispanic white adults, 27.8%; non-Hispanic Asian adults, 25%; Hispanic adults, 27.8%).
Among adults with hypertension, 32.5% of those aged 18 to 39 years had it controlled vs. 50.8% of those aged 40 to 59 years and 49.4% of those aged at least 60 years, according to the report.
Women were more likely than men to have their hypertension controlled (52.5% vs. 45.7%), especially in adults aged 18 to 39 years (62.6% vs. 15.5%).
Rates of hypertension control were higher in non-Hispanic white adults (50.8%) vs. non-Hispanic black adults (44.6%) and non-Hispanic Asian adults (37.4%).
According to the brief, there has been no significant change in hypertension prevalence among U.S. adults between 1999 and 2016. Although prevalence of controlled hypertension among those with hypertension rose from 31.6% in 1999-2000 to 53.1% in 2009-2010, it has not changed significantly since then, Fryar and colleagues wrote, noting the decline in controlled hypertension from 53.9% in 2013-2014 to 48.3% in 2015-2016 was not significant.
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To believe or NOT TO BELIEVE… that is the question ?
Posted on October 21, 2017 by Pharmaciststeve
I’ve Had to Swap My Stethoscope for a Magnifying Glass to Cope with Opioids
It should be simple, even if not so straight forward: If your patient is in pain, you treat them.
But what about a patient who’s been on opioids for years? How do you answer those who were led down the chronic opioid path by old school medicine, either rightly, or wrongly, so? Where do we draw the line?
Consider this example.
A patient walks in asking for a pain med refill. He’s had neck pain for years, and nothing has helped other than narcotics. His previous doctors gave him Percocets. Or Oxycontins. Or substitute whichever controlled substance you’d like here. What is my role in this given scenario, as his doctor? Classically, I’ve been trained to assess and treat the patient — simple as that.
But enter the dilemma of modern day medicine and the opioid epidemic. In this particular instance, as a PMD practicing today, I am expected to shed my doctor’s coat and stethoscope, while replacing them with the raincoat and magnifying glass of a sleuth. You can even add suspenders for dramatics. There’s only one problem: I have watched just a handful of episodes of Columbo in my youth and, while they were highly entertaining, I’m not quite ready to take on a role as understudy. I haven’t even rehearsed.
However, this growing epidemic expects me to do just that, to put on my detective gear and start interrogations.
But how can I do that? What if I miss an addict, and they in turn pass away of an overdose the following day? Or even worse, suspect ill of a patient and miss treating his real pain? And what of the patient’s opinion of me? Who would stay with a physician who constantly questions their honesty?
It’s a lose-lose.
The truth of it is that assessing for pain is tough. It’s subjective. If someone says they’re in pain, we often expect them to look like they’re in pain. But I know better, not only because I myself have held back pain, but also because I feel like I should trust my patients.
Then there’s the issue of physical examination. I use it as an investigational tool, but it certainly has its limitations. A patient who is seeking drugs can simply make up an ‘ouch.’ Think about it. You move the leg up, a patient utters in pain or grabs his backside. Who am I to judge if that grimace is real? It’s enough to have to scan through a myriad of possible diagnoses in my head, all by memory, gained through years of education and training, but to also have to call a bluff? Even the best of poker pros make mistakes. Plus, in real life, it’s easier to give people the benefit of the doubt. We want to believe them. I mean, sure, many of us in the field can recount instances in which patients theatrically put on a show to get what they want. But what about the instances that weren’t quite so obvious? I guarantee numerous Oscar-worthy performances could fool even the most seasoned of practitioners. And we are, after all, medical providers, not detectives.
But, this isn’t what I signed up for.
Let’s dissect the nature of filling a controlled substance request for a moment. Are you familiar with the procedure?
At some point during a 15 minute office visit, I must check on my patient’s previous and current usage of controlled substances by logging on to a separate databank on the web, a step mandated by the state. Once in it (after manual insertion of full name and date of birth), I peruse through a patient’s ‘record.’ Even grandma Louise must be subjected to such a search. This is no simple task and can take up quite a bit of time. I must then interpret information gained and determine if said patient is legitimately asking for the medication or possibly requesting their next easy fix. Followed, by the way, by a two-step verification process in which the medication is actually ordered. The details are lengthy and involve not only entering my system password once again but also providing a virtual ‘key,’ a 6-digit number I obtain by using an app installed on my iPhone.
*gulp*
Is this really what I signed up for when I took the Hippocratic Oath?
Yes, because I’ve promised to do no harm. If a patient is abusing, I should identify their addiction. I should help them with awareness, admission, and recovery.
But also, no. I want to heal, but I’m not quite ready for police work.
And when I do identify potential abuse, just how difficult can it be to tell someone they may have a problem? Extremely. How often does a patient actually admit to an addiction? Rarely. The very nature of coming in and asking for the mediation is the cycle of abuse in action. If I ever suggest there may be a problem, no one openly embraces my suspicion with open arms and a smile, or with a weeping confession. Unfortunately, this scenario is only encountered on Hollywood big screens or in the dreams of naive medical students. Addicts don’t admit. Addicts lash out. They deny. They are genuinely surprised. They threaten. They scream.
They even kill. Just read about Dr. Todd Graham of Indiana, 56 years old when he died for saying no to such a script.
It may seem easy, to anyone on the outside, to identify those who may be abusing. But no one walks into my office and says, “Doc, please give me oxy to feed my addiction,” or, “Send a prescription in so I can get back on the streets and sell. My supply is running low.”
No, I didn’t sign up for this. I signed up to go to work every day and to heal. To help identify illness. To help alleviate medical conditions. To have a good rapport with those who seek my advice. To come to work with a smile and to leave with a gratifying sense of achievement.
I signed up to heal.
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Dr. Reddy’s, fighting to recover from FDA warning letter, recalls 500K heartburn tablets
Posted on October 21, 2017 by Pharmaciststeve
Dr. Reddy’s, fighting to recover from FDA warning letter, recalls 500K heartburn tablets
Still struggling to turn its manufacturing around, Dr. Reddy’s is recalling 569,000 store-brand famotidine tablets in the U.S., thanks to failed tests for impurities and degradation. It’s the India-based company’s second recall of the same medication since last July.
The meds were sold at CVS pharmacies as CVS Pharmacy Acid Controller and at Walmart under the Equate label, according to the FDA’s latest Enforcement Report. It’s a Class III recall, meaning the suspect drugs aren’t likely to cause injury to humans.
Dr. Reddys pulled more than 84,000 famotidine tablets, also produced for CVS, last July. In both cases, the company found an out-of-specification result during routine stability testing. The new recall is nationwide.
The latest recall comes as the generics maker continues to suffer FDA citations at multiple manufacturing plants, including some included in a 2015 warning letter. Its ongoing manufacturing problems triggered a decline in U.S. sales, making a dent in its fiscal 2017 results announced in May.
That same month, Dr. Reddy’s reported that an inspection of its Bachupally formulation plant in Hyderabad resulted in an FDA Form 483 with 11 observations.
That notice came as Harvard Drug Group recalled about 9,200 cartons of the antifungal drug fluconazole manufactured at the Bachupally plant. And it followed two other Form 483s, one in April and another in February, citing problems at active pharmaceutical ingredient (API) plants in Srikakulam and Miryalaguda that had featured in that 2015 warning letter.
The company’s manufacturing issues also prompted a fraud lawsuit from South Korea’s Mezzion. The FDA had rejected Mezzion’s drug candidate udenafil because of manufacturing problems. Mezzion alleged that Dr. Reddy’s repeatedly said it was compliant with FDA regulations when it was not and that Dr. Reddy’s “was the sole reason given by the FDA” for denying udenafil’s approval.
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Rep. Keating Introduces Bill Repealing 2016 Opioid Distribution Law
Posted on October 21, 2017 by Pharmaciststeve
Rep. Keating Introduces Bill Repealing 2016 Opioid Distribution Law
US Congressman William R. Keating, a Democrat from Bourne whose district includes Cape Cod, will introduce legislation repealing the Ensuring Patient Access and Effective Drug Enforcement Act of 2016.
As the House of Representatives is not currently in session, the bill will be introduced at the next opportunity, according to a release from Rep. Keating’s office on Monday, October 16.
Rep. Keating is a member of both the Congressional Addiction, Treatment, and Recovery Caucus, and the Bipartisan Heroin Task Force.
The Washington Post and “60 Minutes” jointly reported earlier this week that last year Congress helped derail the US Drug Enforcement Administration’s ability to keep addictive opioids off US streets. Their report followed an interview with Joseph T. Rannazzisi, who ran the DEA’s Office of Diversion Control, the division that regulates and investigates the pharmaceutical industry.
Mr. Rannazzisi told “60 Minutes” that Congress, lobbyists and the drug distribution industry helped allow the spread of hundreds of millions of pills to “rogue pharmacies” and pain clinics.
A handful of members of Congress, The Washington Post said, “prevailed upon the DEA and the Justice Department to agree to a more industry-friendly law, undermining efforts to stanch the flow of pain pills.” The DEA had long opposed the effort.
A chief advocate of the law was Rep. Thomas Marino, a Republican from Pennsylvania whom President Donald J. Trump had nominated as the nation’s next drug czar.
The president announced Monday that Rep. Marino had withdrawn his name from consideration for the position.
Rep. Keating said the Ensuring Patient Access and Effective Drug Enforcement Act of 2016 made it harder for law enforcement officials to crack down on unsafe practices in the pharmaceutical industry.
“Recent media reports have shown the law severely impeded the DEA’s ability to suspend opioid distributions when the agency detected suspicious activity, allowing an oversupply of opioids in the marketplace,” he said.
Rep. Keating’s legislation, the release said, “would help restore the effectiveness of the DEA’s efforts to protect the members of our communities at risk of overdose from prescription opioids.”
“We are in the throes of an epidemic, and we need every tool available at our disposal,” Rep. Keating said. “We cannot be making it unnecessarily harder for our law enforcement agencies to do their job.”
Congress normally passed 200-400 new bills every year and when is the last time that anyone heard of Congress REPEALING a law that they have passed in the previous Congressional session.
When is the last time that you are told about a very antiquated law on the books that is no longer appropriate and no longer enforced… BUT… there is never a consideration on repealing those antiquated laws ?
With reports coming out that legal opiate prescriptions have been declining since 2012 and recent data on OD’s continue to increase and in some areas illegal opiates are found in up to 99% of the toxicology of those who OD’d.
It would appear that the legal distribution channel(s) of prescription opiates are not part of the current problem…BUT… there is more money to be had by the DEA from that group of DEA licensees…
Has anyone noticed that the Pharmas and pharmacy wholesalers… never had assets seized… none are put out of business … no exec of these corporations every go to jail… the DEA just fine the crap out of them… The same thing happens with the chain pharmacy industry..
HOWEVER, when they go after a prescriber or independent pharmacy… they PUT THEM OUT OF BUSINESS… seize all their assets and the individual goes to JAIL for sometimes DECADES…
There is little/no money for the DEA – and more likely to be shot at — by going after drug cartel and seizing illegal substances.
My money is on that Rep Keating being an ATTORNEY – part of the judicial system – doesn’t want his fellow “fraternal brothers and sisters” and our judicial system to be at risk of losing some of their budgets and the number of employees gets reduced. We may also find out that Rep Keating has a family member or friend or some friend with a family member that has been caught up in the opiate crisis because they suffer from mental health issues.
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What We Lose When We Under treat Pain
Posted on October 20, 2017 by Pharmaciststeve
Kate Nicholson was working as a civil rights attorney for the Justice Department when a surgical error left her unable to sit or stand, largely bedridden, and in severe pain for almost 20 years. Using opioids as an appropriate pain management tool, she continued to function as a high-level federal prosecutor. In this talk, Kate pivots from her inspiring and excruciating story to examine the under-treatment of pain, showing how our approach to opioid abuse by 2.5 million Americans is hurting 50 million people in severe or persistent pain. Kate Nicholson served in the Civil Rights Division of the U.S. Department of Justice for more than 20 years, practicing health-related civil rights law and securing powerful victories including in the U.S. Supreme Court. She is currently writing a book about her personal experiences with severe chronic pain. Kate is also an arts writer and enthusiast who helped found the new non-profit, Tilt West, www.tiltwest.org, recently named by Westword as the “best think tank for arts and culture” in the area. Kate was a Senior Fellow at Dartmouth College and is a graduate of Harvard Law School. This talk was given at a TEDx event using the TED conference format but independently organized by a local community
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Justice – FRONTIER STYLE ?
Posted on October 20, 2017 by Pharmaciststeve
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ILLEGAL FENTANYLS increased 2600% in FOUR YEARS in TN
Posted on October 20, 2017 by Pharmaciststeve
TBI issues public warning: Cocaine samples test positive for Fentanyl
http://whnt.com/2017/10/20/tbi-issues-public-warning-cocaine-samples-test-positive-for-fentanyl/
NASHVILLE – The Tennessee Bureau of Investigation’s Drug Investigation Division (DID) is urging public caution, especially among recreational drug users, following recent evidence submissions to two TBI crime laboratories.
Several sample of cocaine, submitted by law enforcement agencies in Middle and East Tennessee in recent months, also tested positive for fentanyl, a powerful, narcotic painkiller, or one of its dangerous analogs. Previously, fentanyl had primarily been identified in samples of heroin or in clandestine pills compounded to resemble legitimate prescription opioids. The recent submissions mark the first time samples of cocaine have tested positive in a TBI laboratory for fentanyl. The investigation into the origins of the submitted samples remains active and ongoing by the local law enforcement agencies.
“For some time now, we’ve warned about the dangers surrounding fentanyl for those struggling with opioid or prescription drug addiction,” said T.J. Jordan, Assistant Director of the TBI’s Drug Investigation Division. “This submission, however, changes the game. It proves the serious risk now also applies to recreational drugs beyond opioids. To be blunt: What you might buy and use, thinking it’s a good time, could cost you your life.”
In certain doses, fentanyl can be 50 to 100 times as potent as morphine. The drug doesn’t necessarily need to be ingested to have an effect. It can absorb through the skin, so touching the substance can quickly put an individual at risk of opioid overdose.
The submission of substances submitted to TBI’s laboratories testing positive for fentanyl and its analogs continues to increase. In 2013, the TBI processed just 12 samples that tested positive for fentanyl. In 2016, the TBI’s Forensic Scientists tested 209 samples that tested positive for fentanyl or one of its analogs. With more than two months remaining in 2017, lab submissions of samples testing positive for fentanyl or one of its analogs total 320.
“Drug dealers don’t care about the lives of their customers. They only care about making money,” said TBI’s Tommy Farmer, who oversees the Tennessee Dangerous Drugs Task Force. “What you think might be high-quality cocaine may very well have been cut with any number of substances, some of them potentially deadly. Why take the risk with something that could kill you?”
Anyone struggling with drug addiction issues should contact the Tennessee REDLINE at 1-800-889-9789.
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