Opioid crisis could keep chronic pain sufferers from getting medicine

http://www.kmov.com/story/36620554/opioids-chronic-pain

KMOV.com –

A 60 Minutes investigation may have brought to light an unintended consequence of the growing concern over the opioid epidemic. The CBS news magazine’s story concluded Congress passed legislation that crippled the DEA’s ability to fight opioid abuse.

Chronic pain sufferer Carolyn Bailey told News 4 that doctors have become reluctant to prescribe opioid painkillers recently because of concern over overdose deaths.

“This pain could not be more real and my doctors know it but they’re so terrified because it’s such a big deal in the news and the government’s all involved,” said Bailey.

Bailey said she suffers from nerve damage caused by diabetes and without an opioid painkiller she lives in constant, crippling pain. But recently her primary care physician and pain management doctor informed her that they’d no longer be prescribing oral medications and she would only get spinal injections for pain. Bailey said the injections don’t work. 

Dr. Alexander Garza, medical director for SSM Health acknowledged the natural reaction of physicians to the opioid crisis is to write fewer prescriptions for painkillers. But he said doctors have to be careful not to overreact.

“Somewhere in there has got to be the happy medium where people with legitimate chronic long-term pain do have access to things that help out their pain,” said Dr. Garza.

Bailey said without opioid painkillers she and others suffer unnecessarily. 

“There are so many people in so much pain for so many reasons and if there’s medicine available why not let them have it,” said Bailey.

News 4 reached out to Bailey’s primary care doctor to ask him about the pressure on physicians to write fewer prescriptions for painkillers, but he didn’t get back to us.

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The Terrifying New Trend in Heroin Addiction

https://www.vice.com/en_us/article/qvjgvb/the-terrifying-new-trend-in-heroin-addiction

Jeremy Lesser is one of the faces of America’s increasingly mainstream opioid crisis. Now in recovery for two years, he’s 27, white, and comes from a middle-class family in New Jersey. But he didn’t start using opioids with pills from a doctor—or even pills from a friend or the family medicine cabinet. Instead, his first opioid was heroin.

By now, many Americans have heard sad stories that begin with a white teen innocently ingesting a prescription obtained from a pharma-influenced doctor. Often, these tales end with the degradation of heroin—a good kid accidentally addicted, driven to crime, and maybe even dead.

But if legitimate prescriptions were ever the chief pathway to heroin—and strong evidence has long existed that they might not be—new research and stories like Lesser’s suggest the pathway for people who get addicted to opioids is changing. Just like I did in the 1980s, heroin users in America appear to be increasingly going straight to the street drug, skipping the flirtation with pharmaceuticals.

Not that the people making drug policy seems to be noticing.

Although a Washington Post-60 Minutes exposé finally derailed the troubling nomination of Tom Marino as drug czar on Tuesday, its key finding—that pharma lobbying helped curtail the DEA’s power to cut the prescription drug supply—fails to account for the fact that doing so without offering medication treatment might have just sped up the heroin and fentanyl crisis.

This tunnel vision focus on prescription drugs as the key factor in America’s opioid crisis is shared widely throughout the government. At a recent congressional hearing on the issue, FDA commissioner Scott Gottlieb testified that “most people become addicted after receiving the drugs for a medical condition,” according to USA Today. The CDC, even before Donald Trump became president, has long highlighted the fact that the vast majority of today’s heroin users previously took prescription opioids. And a bipartisan group of state attorney generals earlier this month released a letter claiming that people “often develop opioid addiction through prescribed medical usage, with no intent by the patient to engage in abusive behavior, simply because of the addictive properties of opioid drugs.”

Except this is an overly simplified picture. The fact is that the government’s own statistics show most people start misusing prescription pills that are not prescribed to them. And the myth of innocent white addiction has led to policy that relentlessly focuses on reducing medical access, regardless of harm to pain patients. With President Trump set to finally declare the opioid crisis an official national emergency next week, now is as good a time as any to take stock of what America’s prescription crackdown gets wrong—and how we can do better.

New research is increasingly finding that cutting the supply of prescription opioids isn’t even stopping opioid initiation—just changing which drug people try first. A study released this year of nearly 6,000 people treated for opioid-use disorder across the US over a ten-year period found that in 2005, only 9 percent of new users reported losing their opioid virginity to heroin. By 2015, however, this number had more than tripled, to just more than a third. Although most users still get their first taste from one of several prescription pills, heroin is now the single most common individual opioid taken by people first trying this class of drugs, the study found.

“Supply-side efforts are beginning to show their effectiveness in bending the curve of prescription opioid use, which is both commendable and necessary,” study co-author Matthew Ellis, an epidemiologist at Washington University in St. Louis, told me. “However, using the balloon analogy, when you squeeze one side, another side expands.”

“It makes complete sense that in a context of suppressed prescription drug supplies, people are starting on alternative sources of opioids,” added Leo Beletsky, associate professor of law and health sciences at Northeastern University in Boston, who noted that without addressing factors that really drive demand like inequality, unemployment, mental illness and despair, substitution is hardly surprising.

In other words, cracking down on prescription drugs has not stopped people from starting opioid use. In fact, it may just be sending more first-time experimenters to the most dangerous stuff on the black market.

Another recent study published in Health Affairs found that while the number of hospital admissions related to prescription overdose fell by around 5 percent annually between 2010 and 2014, the number of admissions for heroin increased by 31 percent each year between 2008 and 2014. Similarly, CDC statistics show that while opioid prescribing rates peaked in 2010 and fell about 5 percent per year between 2012 and 2016, heroin overdose rates have quadrupled since 2010 and overdoses linked to synthetic opioids like fentanyl increased 72 percent between 2014 and 2015 alone.

The vast majority of opioid misusers don’t simply jump into the drug pool at the deep end: by the time they get to opioids, even those who do start by misusing a legitimate prescription have typically more than just experimented with recreational use of alcohol, cigarettes, weed, and often psychedelics and cocaine. Going hard or exclusively after prescription drugs is not going to disrupt that.

In another recently published paper, Ellis and his colleagues found that even among those whose opioid addiction apparently began with medical exposure, 95 percent had previously taken other drugs recreationally. “Even when discounting alcohol, tobacco and marijuana, 70.1 percent still had prior experience with other substances,” he told me—a rate far higher than that seen in the general population. In 2016, for example, just 21 percent of high school seniors and 36 percent of young adults had ever even tried an illicit drug other than pot.

Lesser, who is now studying for a degree in counseling psychology, recalled being anti-drug until he was around 17, having simply accepted that “drugs are bad,” as his parents and teachers claimed. In college, however, he began to question his hardline stance. “I had friends going to Ivy League schools, and all these smart, cool kids were doing these drugs,” he told me.

He smoked weed for several months without any disaster, and likewise enjoyed MDMA, cocaine, and mushrooms. “None of the bad stuff society told me would happen, happened,” Lesser said. And so, in 2009, when a kid he texted said he didn’t have weed, but did have heroin, he was game to try it.

Chloe*, also 27 and who preferred to remain anonymous to discuss her addiction, came to heroin via a similar route: What her parents and the government said about drugs like weed didn’t seem to square with reality. She had begun smoking regularly during her sophomore year of college and later learned that some of her friends were using heroin, too. “At the time, it sounded a little crazy, but so did smoking pot [at first],” she said. “My reasoning was, ‘Oh, they were lying to me about weed, why not?'”

She added of heroin, “It was just this calm rushing over you and feeling peaceful and less anxious and able to turn everything off.”

Lesser, who had always struggled with social anxiety, said that in his case, the first time using heroin was “underwhelming”—and definitely didn’t live up to the hype he’d seen in films like Trainspotting. But that gave him a false sense of security, and when he did it a few more times, he began to understand what the fuss was about.

“I felt like I never really had a handle on my emotions,” he told me. “I let them dominate me.” But with heroin, he added, “I really liked that feeling of social and emotional control. The euphoria was cool, but it was definitely not the hooking point for me.”

Lesser’s experience of medicating symptoms like anxiety and poor emotional control seems to be the rule, rather than the exception among people who develop opioid problems. “Psychiatric issues are very common,” Ellis explained. “Roughly two-thirds of our sample indicate they have been diagnosed and treated for a psychiatric disorder, primarily depression and anxiety.” In yet another study with the same sample, Ellis’s group found that a similar proportion “indicated they used prescription opioids to self-treat psychological issues, and 80 percent indicated they did so to ‘escape’ from daily stressors, past trauma, [or other] issues going in their lives,” he recalled.

It’s not just Ellis’s work, either. Fellow researchers’ data has long suggested that early life stress, trauma, and mental illness—not the first drug someone happens to try—are the real gateways to addiction. And overhyping the dangers of certain substances clearly also runs the risk of doing more harm than good.

Whether the sequence of use goes “alcohol, marijuana, cocaine, then heroin” or “alcohol, marijuana, methamphetamine, prescription opioids, then heroin,” or some other way, the result is the same. If America doesn’t address why people find opioid escape so compelling right now, cutting the supply of medical drugs with known strength and purity may just push users to more dangerous and unpredictable street substitutes like fentanyl.

Humans have always used chemicals as ways to change their moods. To prevent overdose death and help people avoid damaging addiction, we need to offer alternatives—and to be creative when addressing supply so that the inevitable substitution leads to less harm, not more.

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United Nations Says Untreated Pain Is “Inhumane and Cruel”

https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/united-nations-says-untreated-pain-inhumane-cruel

The national debate on the proper use of opioids continues to build as the high prevalence of addiction and overdoses fuel the continuing attention to this “public health crisis.”¹

Much of the anti-opioid rhetoric regarding the “opioid epidemic” implies that pain is a nuisance that really doesn’t require treatment. Instead of making the focus one of achieving good pain relief, far too much attention has been directed solely at the risks of opioid prescribing and how we must provide naloxone on every street corner where an opioid might be sold.

If Ever There Was a Need for a Call to Action, It Is Now

According to the Institute of Medicine (IOM), an estimated 100 million Americans suffer from pain—more than diabetes, heart disease, and cancer combined.²

What we need now is a proper discussion about the immense risks of untreated pain. Simply put, untreated severe and chronic pain are not only forms of torture but put patients on the road to death.³ We have known for ages that untreated moderate to severe pain, whether slowly or rapidly, may lead to hyperlipidemia, hypertension, tachycardia, adrenal exhaustion, cardiovascular collapse, and at times to suicide.³

All of the finger-pointing, blaming, and hand-wringing has escalated to a feverish pitch along with a lot of head-scratching. How about an earnest effort to come up with a viable solution? Clearly, a better approach is needed.

In the search for answers, I’d like to call immediate attention to the General Assembly of the United Nations (UN), which is on record as having declared that “untreated pain is tantamount to torture or cruel, inhuman or degrading treatment or punishment”.⁴ If only our legislators and government agency leaders would read the “Report of the Special Rapporteur on Torture and Other Cruel Degrading Treatment or Punishment”⁴ before acting to diminish patients’ access to needed pain medicines.

Following the UN report, Human Rights Watch weighed in, stating that “the poor availability of pain treatment is both perplexing and inexcusable”.⁵

Given the urgent need for a reasonable and responsible approach to pain care, every pain practitioner and all pain patients should become familiar with these reports, which make a case for profound governmental failures; but that’s not enough.

The time has come to demand that every pain treatment critic in the United States government, the insurance industry, members of the press, religious leaders, and anyone else for that matter who is addressing this subject seek solutions that do more than tie the hands of credentialed medical professionals who are treating patients with chronic pain. As well, there is a need to distinguish between addiction, abuse, and a medically confirmed need for opioid treatment in forming future programs.

Know the Facts Before Withholding Pain  Care

The UN report laid out the reality of suffering with pain and presented recommendations that need more widespread dissemination.⁴ In particular, people who use drugs are not necessarily addicts or substances abusers, as many are simply patients who developed a medical condition that has left them unable to function without adequate treatment for severe, chronic, or intractable pain.^2,6

In addressing marginalized groups, the UN report offered the following:⁴

• “People who use drugs are a highly stigmatized and criminalized population whose experience of healthcare is often one of humiliation, punishment, and cruelty.”
• “Actions by healthcare workers and police often deprive individuals of their civil rights and access to medical care.”
• “By denying effective drug treatment, State drug policies intentionally subject a large group of people to severe physical pain, suffering, and humiliation.”
• “Persons with disabilities are particularly affected by forced medical interventions and continue to be exposed to non-consensual medical practices” (A/63/175, para 40).

In conclusion, the report states that: “The right to an adequate standard of health care (‘right to health’) determines the States’ obligations towards persons suffering from illness…In that fashion, attention to the torture framework ensures that system inadequacies, lack of resources or services will not justify ill-treatment.

Although resource constraints may justify only partial fulfillment of some aspects of the right to health, a State cannot justify its non-compliance with core obligations, such as the absolute prohibition of torture, under any circumstances. (Committee on Economic, Social and Cultural Rights, general comment No. 14).”

Aiming to protect people with pain conditions, UN Special Rapporteur Juan E. Mendez recommended the following:⁴

“Safeguard free and informed consent on an equal basis for all individuals without any exception, through a legal framework and judicial and administrative mechanisms, including through policies and practices to protect against abuses.

Adopt policies and protocols that uphold autonomy, self-determination and human dignity. Ensure that information on health is fully available, acceptable, accessible and of good quality; and that it is imparted and comprehended by means of supportive and protective measures such as a wide range of community-based services and supports (A/64/272, para 93).”

To work against denial of pain relief, Juan E. Mendez recommended that all states:⁴

• “Adopt a human rights-based approach to drug control as a matter of priority to prevent the continuing violations of rights stemming from the current approaches to curtailing supply and demand (A/65/255, para. 48). Ensure that national drug control laws recognize the indispensable nature of narcotic and psychotropic drugs for the relief of pain and suffering; review national legislation and administrative procedures to guarantee adequate availability of those medicines for legitimate medical uses;
• Ensure full access to palliative care and overcome current regulatory, educational and attitudinal obstacles that restrict availability to essential palliative care medications, especially oral morphine. States should devise and implement policies that promote widespread understanding about the therapeutic usefulness of controlled substances and their rational use;
• Develop and integrate palliative care into the public health system by including it in all national health plans and policies, curricula and training programmes and developing the necessary standards, guidelines, and clinical protocols.”

Inadequate Pain Care Is a Worldwide Concern

In 2012, the World Health Organization (WHO) estimated that 5.5 billion people were living in countries with low or no access to controlled medicines and had no or insufficient access to treatment for moderate to severe pain.⁷ Since 2004, the WHO has supported efforts to recognize pain as a real issue, deserving of attention.

Eighty-three percent of the world population has either no or inadequate access to treatment for moderate to severe pain. Tens of millions of people, including those with terminal cancer and end-stage, acquired immune deficiency syndrome (AIDS), suffer from moderate to severe pain each year without sufficient treatment for their chronic, unrelenting pain.⁷

Many countries fail when it comes to assuring an adequate supply of pain medications for their citizens. In particular, low- and middle-income countries account for 6% of morphine use worldwide despite accounting for half of all cancer patients and 95% of all patients with newly diagnosed human immunodeficiency virus infection.^8,9

Thirty-two countries in Africa alone, for example, have almost no morphine available. In France, a study found that doctors underestimated pain in over half of their AIDS patients.¹⁰ In India, more than half of the country’s regional cancer centers do not have morphine or doctors trained in using it. This is despite the fact that 70% or more of their patients have advanced cancer and are likely to require pain treatment.

While relatively inexpensive, highly effective medications such as morphine and other opioids have proven essential for the relief of pain and suffering, these types of medications are virtually unavailable in more than 150 countries.

The issue remains equally compelling closer to home. Surprisingly, the UN report states that over a third of patients in the United States are not adequately treated.⁴

A Better Approach to Pain Is a US Imperative

It’s time that we openly acknowledge that we are in a most profound and serious battle over the most basic of human rights—the relief of pain and suffering. Let’s call it what it is. Many entities want to deprive patients who are suffering from moderate to severe pain their human right to adequate pain treatment.

These same opioid epidemic-defenders would not admit publicly or to themselves that by withholding access to all available pharmacotherapies, they are in effect promoting torture, cruelty, or degrading treatment.  

In my opinion, the problem with our failed approach to pain care stems from a narrow view of pain that misses the point. Withholding all means of pain treatment goes against the view advocated by the UN, WHO, and Human Rights Watch.

It is past due for each and every one of us, including our pain patients and their families, to use our voices to tell all concerned parties that we support the UN view that untreated pain is tantamount to torture, and is cruel, inhuman, or degrading punishment. We need a more medically informed approach to treating people with severe, chronic, intractable pain.  

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Whaley proposes charging opioid distributors ‘nickel per dose’

http://fox45now.com/news/local/whaley-proposes-charging-opioid-distributors-nickel-per-dose

DAYTON, Ohio (WKEF/WRGT) – Dayton Mayor Nan Whaley says she has a plan she believes would help Ohio fight back against the state’s opioid crisis.

Whaley, who is also a gubernatorial candidate, says opioid manufacturers are to blame for the crisis and says they are the ones who will pay. Whaley is proposing that opioid distributors will pay a nickel per dose that is given out. Whaley says she would implement the plan if she’s elected governor. “With the dollars we’ll collect with the nickel per dose surcharge, we can begin to restore vital public safety services to the communities on the front lines fighting this epidemic,” Whaley said as she announced the plan Wednesday morning, October 18.

The State Board of Pharmacy reported 631 million doses of opioids were distributed in 2016 across Ohio. Whaley says under her plan, this would translate into $31.5 million for the state. Whaley, a Democrat, says the nickel per dose would give the state sustainable funding to “start repairing the damage across Ohio.”

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Patient with neck pain 8/10!

https://www.facebook.com/markmusheribsen/videos/10213636886091842/

CLICK ON LINK TO SEE VIDEO

If physicians are suppose to be HEALERS…  allowing a pt to ATTEMPT to live – have quality of life – in a pain level >5… which some consider a torturous level of pain..  Are they committing insurance fraud ? For billing for CARE that they are not providing ?

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Misdiagnosing Causes and Casualties in the Opioid War

http://reason.com/blog/2017/10/18/misdiagnosing-causes-and-casualties-in-t

“The opioid crisis is an emergency,” declared President Donald Trump in August. “And I am saying officially right now that it is an emergency, a national emergency. We are going to spend a lot of time, a lot of effort, and a lot of money on the opioid crisis.”

As of this week, President and his advisors have not yet completed the paperwork for an official national emergency declaration. So how much of a crisis is the “opioid epidemic”?

In 2015 some 33,000 Americans died from overdosing on various synthetic opioids. Some researchers forecast that as many as 500,000 Americans could die of opioid overdoses in the next decade. The drugs most associated with overdose deaths are prescription pain pills like oxycodone, along with black market heroin and fentanyl.

Lots of media reports have made pharmaceutical manufacturers, distributors, and “pill mill” physicians the chief villains in the rise of overdose deaths. “The Drug Industry’s Triumph Over the DEA,” published earlier this week by The Washington Post and CBS’ 60 Minutes, is one such “exposé.”

While it is true that some unscrupulous phyisicians and pharmacies have overprescribed opioid medications, Josh Bloom, director of Chemical and Pharmaceutical Sciences for the American Council of Science and Health provides a helpful guide to some of the deceptive claims being peddled by drug warriors. Specifically, Bloom decodes Andrew Kolodny’s “The opioid epidemic in 6 charts,” over at The Conversation.

Kolodny, executive director for Physicians for Responsible Opioid Prescribing, cites data from the National Institute on Drug Abuse showing that more 60,000 Americans died of drug overdoses in 2016. Bloom suggests that that assertion misleads readers into thinking that those deaths are mostly the result of taking prescription opioids.

The actual number of deaths associated with overdosing on prescription opioids was around 17,000 last year. And as Bloom points out, most of those overdose deaths occurred in conjunction with benzodiazepines (like Valium and Xanax) and black market heroin and fentanyl.

A recent Center for Disease Control Morbidity and Mortality Weekly Report focusing on drug overdose deaths in Ohio found that 90 percent of the decedents tested positive for fentanyl, 31 percent for cocaine, 27 percent for benzodiazepines, 23 percent for prescription opioids, and 6 percent for heroin. Once these are taken into account, Bloom estimates that “the number of deaths from opioid pills alone will be much lower, perhaps in the neighborhood of 5,000.”

Bloom also objects to Kolodny’s observation that the “effects of hydrocodone and oxycodone on the brain are indistinguishable from the effects produced by heroin.” Both prescription opioids and heroin operate on the same receptors in the brain, but hydrocodone and oxycodone are four and two times less powerful, respectively, than heroin. And they are 200 and 100 times less powerful than fentanyl.

Long-term use of prescription “opioids are more likely to harm patients than help them because the risks of long-term use, such as addiction, outweigh potential benefit,” Kolodny says. Bloom counters that the “absence of evidence is not evidence of absence.” His main argument is that Kolodny cannot make his claim for the simple reason that no long term studies on the effects of opioids to manage chronic pain have been conducted.

In any case, Bloom cites 2010 research that the risk of addiction is below one percent for patients who use prescription opioids for short term pain control. A 2013 review similarly reports the risk of addiction is below one percent and concludes, “The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence.”

A 2015 review article in the Annals of Internal Medicine reported that “reliable conclusions about the effectiveness of long-term opioid therapy for chronic pain are not possible due to the paucity of research to date.” However, the Annals reviewers were less sanguine than Bloom about prescribing opioids to treat pain. “Accumulating evidence supports the increased risk for serious harms associated with long-term opioid therapy, including overdose, opioid abuse, fractures, myocardial infarction, and markers of sexual dysfunction.” The Annals review also notes that various studies found the prevalence of prescription opioid addiction ranging from 2 to 14 percent.

Some pharmaceutical companies, Bloom acknowledges, helped fuel the opioid problem by falsely claiming their medicines were less addictive and less subject to abuse than other pain medications. For example, Purdue Pharma, the manufacturer of Oxycontin, admitted it had misled physicians and paid in a fine of $653 million in 2007.

But given that most of the opioid deaths now result from consuming illicit drugs, Bloom argues Kolodny’s effort to blame the problem on drug companies is now irrelevant.

Kolodny rejects the claim that the reformulation of prescription opioids after 2010 to make them more difficult to snort or inject pushed many users to black market heroin and even more dangerous substances in search of highs. Bloom points out that after 2010 the number of deaths attributed to prescription opioids flattened while those from heroin and fentanyl increased almost five-fold.

Bloom decries what he calls the “opioid pain refugee crisis,” in which new federal rules restrict patient access to effective drugs to control severe pain. In 2012, the Institute of Medicine at the National Academy of Sciences issued a study, Relieving Pain in America, that reported: “Chronic pain affects about 100 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity.”

“We do not question that opioid misuse is a serious and growing public health problem,” writes Arthur Lipman, editor of the Journal of Pain & Palliative Care Pharmacotherapy. “We do not, however, accept the simplistic solution of limiting opioid use that is advocated by many commentators as being rational. Although opioid overprescribing and access undoubtedly contribute to the problem, opioids are still seriously underprescribed for and unavailable to many legitimate patients with moderate to severe pain who need these medications to function adequately.”

While Kolodny argues for substantially increasing restrictions on patient access to prescription opioids, he also urges federal and state governments to “ensure that millions of Americans now suffering from opioid addiction can access effective addiction treatment.”

Instead of pursuing the failed Drug War policies of restriction and prohibition, one good way for President Trump to “spend a lot of money” to help those opioid users who do become addicted is to increase access to medication-assisted therapy programs as recently suggested by my Reason colleague Mike Riggs.

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Minnesota struggles to rein in prescription opioids

http://www.bradenton.com/news/local/health-care/article178112216.html

ST. PAUL, Minn.

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As Eliquis Lawsuits Fall, New Study Heightens Bleeding Risk in Eliquis Class

https://www.lawyersandsettlements.com/articles/eliquis/eliquis-lawsuit-side-effects-blood-9-22651.html

Manhattan, NYA new study released earlier this month suggests that blood thinners in the non-vitamin K oral anticoagulant class, or NOACs, could see heightened risk of bleeding when the blood thinners are taken in combination with certain drugs. Amongst the drugs in the so-called NOAC class is Eliquis, a new-age blood thinner that has been the subject of many an Eliquis lawsuit alleging unnecessary bleeding risk.

The non-vitamin K oral anticoagulants reference a heritage blood thinner – warfarin, which is marketed as Coumadin – which has been on the market for over half a century. Requiring strict monitoring of diet and blood levels, warfarin is nonetheless proven effective as an anticoagulant with the added benefit of an antidote in the event of an unexpected bleeding event. To that end, an infusion of vitamin K succeeds in reversing the anticoagulant properties of warfarin, helping to stem an event that might otherwise place a patient in potential jeopardy.

Newer blood thinners such as Eliquis (apixaban) do not respond to vitamin K in the same fashion as warfarin. Plaintiffs considering Eliquis injury lawsuits allege the manufacturer was irresponsible in putting apixaban on the market without an antidote in place.

The study, published online in the Journal of the American Medical Association (JAMA) October 3, suggests a greater risk of bleeding events when NOACs are taken with drugs such as Rifadin, Diflucan and Dilantin.

Researchers in Taiwan studied data from more than 91,000 patients using the new crop of blood thinners, including Eliquis anticoagulant. The study authors found that the risk for a major bleeding event increased when patients on a NOAC anticoagulant for blood thinning were also prescribed amiodarone, or Rifadin (rifampin), Diflucan (fluconazole), and Dilantin (phenytoin).

“Among patients taking NOACs for nonvalvular atrial fibrillation, concurrent use of amiodarone, fluconazole, rifampin, and phenytoin compared with the use of NOACs alone, was associated with increased risk of major bleeding,” the researchers concluded. “Physicians prescribing NOAC medications should consider the potential risks associated with concomitant use of other drugs.”

Meanwhile there has been significant movement of late with regard to Eliquis lawsuits housed in multidistrict litigation.Law360 (10/13/17) reports that no fewer than 24 lawsuits against Pfizer Inc. and Bristol-Meyers Squibb Co. have been recently dismissed with prejudice resulting from a decision back in May by US District Judge Denise Cote with regard to an Eliquis lawsuit filed by plaintiffs Charlie and Clara Utts.

The plaintiffs in the Utts lawsuit argued that Eliquis labels lacked warnings with regard to the risk for internal bleeding. The Utts also argued that dosages should be tailored to the patient, with patients monitored after taking Eliquis in order to minimize risk.

However, Judge Cote ruled in May that pharmaceutical manufacturers can only alter labels given the availability of new information. That wasn’t relevant to the Utts action, which was filed in state court. The Judge Cote noted that claims stemming from more strict state laws would have been preempted by federal law, under which the US Food and Drug Administration (FDA) operates.

On October 12, Judge Cote dismissed four Eliquis lawsuits – including Utts et al v. Bristol-Myers Squibb Company et al. “Although permitted to file amended complaints in response to the guidance given in Utts, none of the plaintiffs in these four actions opted to do so,” the judge said in her order, released Thursday October 12, 2017. Judge Cote dismissed a further 20 lawsuits the following day, on Friday October 13.

According to Law360 the 24 lawsuits were originally filed in state court and quickly removed to federal court before the defendants had been properly served. Plaintiffs argued those circumstances created grounds for returning the litigation to state court. However the judge disagreed.

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The official numbers are in with regard to prescription drugs vs. Heroin/Fentanyl. Here are the take-aways:

1. From 2010 forward, various changes were made to “clamp down” on the use/abuse of prescription opioids. That included introducing “abuse-deterrent” OxyContin, mandatory checking of Prescription Drug Monitoring Program (PDMP) databases, and other things that reduced supply. Here is the result.
   1. If the five-year trendline from 2006 through 2010 had continued, the death rate from prescription opioids would have been 5.75 per 100,000. Because of these changes, that number in 2015 was actually 4.84 per 100,000. On the surface that appears to be a good thing, EXCEPT:
   2. If the five-year trendline from 2006 through 2010 had continued, the death rate from Heroin + Fentanyl would have been 2.62 per 100,000. Because of these changes, that number in 2015 was actually 6.30 per 100,000.
   3. In short, one (1) fewer person per 100,000 is dying from prescription opioids, BUT we are now killing nearly four (4) additional people per 100,000 from Heroin + Fentanyl. How’s that for a policy backfiring!

SUMMARY: Rather than saving lives, we are now killing three additional people per 100,000. It is true that one (1) fewer is overdosing on prescription drugs, but now four (4) more are overdosing from Heroin + Fentanyl. And in fact, the person that we think we are saving is probably just overdosing on street drugs, so we are not even saving that person. We are just killing them and 3 of their buddies as well. Insanity!

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President Trump doubles down on opioid epidemic

http://www.foxnews.com/opinion/2017/10/17/president-trump-doubles-down-on-opioid-epidemic.html

On Monday, from the Rose Garden, President Trump announced that he is doubling down on his commitment to battle the opioid epidemic.

I was asked to travel to Trump Tower recently, as a member of the president’s Media Advisory Board, to do a piece on the mental health effects of opioids and their social and economic impact. The President posted it on his Facebook page Monday night, hours after addressing the issue in the Rose Garden.

Nationally, employers are losing an estimated $10 billion per year from absenteeism and lost productivity due to opioid abuse. Castlight Health estimates that one-third of employees taking painkillers prescribed by employer plans become addicted. These numbers are staggering, and growing.

Thirty-five thousand Americans died of opioid addiction last year, and millions are addicted today and have no idea how to get better.

The problem is prolific in hospitals across the country, and is impacting our children as well.

Drug dealers are lacing street drugs with opioids. They know that if they can get young people addicted, it will mean cash flow into their drug cartels for years to come. So they lace drugs with fentanyl, a popular synthetic-opioid cousin. Fentanyl is 30-100 times stronger than heroin (according to the Centers for Disease Control and Prevention), and it is pouring across our borders.

Carfentanil is another one. It is 1000 times more toxic than fentanyl, and is so dangerous it is considered a weapon of mass destruction. Authorities can’t even handle it without hazmat precautions when a vehicle is suspected of having carfentanil aboard. Yet it is showing up in recreational drugs to addict our children. China refuses to stop producing it.

This addiction is terroristic in how it finds some of its victims. It preys on those who innocently go into the hospital and don’t realize they will come away with an addiction that could ruin their lives.

No one is safe. Children can be addicted when a brownie is laced with the drug. Adults can be addicted when prescribed pain medicine by a doctor. The elderly are even more susceptible, as they may battle more pain and surgeries than other populations. They also tend to be more trusting of medical professionals, and less suspicious of pharmaceuticals than younger populations. 

President Trump has waded into a deeply complicated issue with opioid addiction, one that is continually in the headlines as new facets of the crisis surface daily.

Tuesday morning, less than 24 hours after the Rose Garden event, the president announced that his drug czar nominee, Rep. Tom Marino, R-Penn., would be withdrawing his name from consideration following a “60 Minutes” report Sunday in which the congressman was cited as undermining legislation to bolster DEA enforcement to crack down on opioid manufacturers. Also Tuesday, Reuters reported that two Chinese men were charged with conspiring to distribute large amounts of fentanyl into the U.S.; this in addition to five Canadians and three Americans also indicted in this drug conspiracy with the Chinese importers.

Warning patients of the addictive qualities and how to wean themselves from these drugs, cracking down on the gangs bringing the substances across U.S. borders, and arresting internet distributors are all important first steps in the president’s commitment to curtail this epidemic threatening Americans of all ages.

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