Endo Pharma Agrees to Pull Abuse-Deterrent Opioid

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Endo Pharma Agrees to Pull Abuse-Deterrent Opioid

http://www.medscape.com/viewarticle/882578

Endo Pharmaceuticals has agreed to remove its abuse-deterrent extended-release formulation of oxymorphone (Opana ER) from the US market, about a month after the US Food and Drug Administration (FDA) asked the company to stop selling the pain medication.

In a statement, the company said it “continues to believe in the safety, efficacy, and favorable benefit-risk profile” of Opana ER when used as intended. “Nevertheless, after careful consideration and consultation with the FDA following the FDA’s June 2017 withdrawal request, the company has decided to voluntarily remove Opana ER from the market.”

As previously reported by Medscape Medical News, the FDA asked Endo Pharmaceuticals to take Opana ER off the market on the basis of a review of postmarketing data, which demonstrated a significant shift in the route of abuse of Opana ER from nasal administration to injection after the product’s reformulation.

Injection abuse of reformulated Opana ER has been associated with an outbreak of HIV infection and hepatitis C virus infection, as well as cases of thrombotic microangiopathy, the FDA said.

 “The abuse and manipulation of reformulated Opana ER by injection has resulted in a serious disease outbreak. When we determined that the product had dangerous unintended consequences, we made a decision to request its withdrawal from the market,” Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research, said in a news release in June. “This action will protect the public from further potential for misuse and abuse of this product.”

This is the first time the FDA has taken steps to remove a currently marketed opioid pain medication from sale because of the public health consequences of abuse.

The request by the FDA came on the heels of a March meeting of an FDA advisory panel of independent experts who voted 18 to 8 that the benefits of reformulated Opana ER for relief of severe pain no longer outweigh its risks.

Endo Pharmaceuticals said it will work with the FDA to coordinate the “orderly removal” of Opana ER to minimize treatment disruption for patients and allow patients sufficient time to seek guidance from their healthcare provider on other treatment options.

According to the company, net sales of Opana ER were $158.9 million in 2016 and $35.7 million in the first quarter of 2017.

 

Trump’s Surgeon General Pick Built Reputation Fighting HIV And Opioids In Indiana

Trump’s Surgeon General Pick Built Reputation Fighting HIV And Opioids In Indiana

http://www.npr.org/sections/health-shots/2017/07/05/535618770/surgeon-general-nominee-championed-policies-to-curb-indiana-s-opioid-epidemic

Several weeks before President Trump nominated Indiana’s state health commissioner Jerome Adams to be the next U.S. Surgeon General, Adams toured the Salvation Army Harbor Light detox center in Indianapolis, Ind., the only treatment facility in the state for people without insurance.

His supporters say the visit is an example of how he’s prioritized the opioid epidemic during his tenure as Indiana’s top health official. Addiction specialists and advocates say he’s led important progress in implementing lifesaving policies. They believe that if confirmed, Adams would use his on-the-ground experience to guide national policy.

“I believe that Dr. Adams understands the value of community grassroots efforts, that they should be included at the table with decision makers,” says Justin Phillips, founder of the prevention-focused group Overdose Lifeline, who toured the detox center with Adams. “They need to understand what’s realistic in the field.”

A practicing anesthesiologist, Adams was appointed Indiana Health Commissioner by then-Gov. Mike Pence in October 2014. Four months into the job, he announced an HIV outbreak in rural Scott County, Ind., after health workers documented 26 cases of HIV there. By May 2015, the number of confirmed infections had risen to 158, spread almost entirely through injection drug use. 88 percent of them also tested positive for hepatitis C. Today, the number of confirmed HIV cases has reached 219.

Pence had expressed moral reservations about syringe exchanges — a sentiment that Adams told the New York Times he originally shared. But in March 2015, the governor acted on advice from Adams and the Centers for Disease Control and Prevention and authorized a 30-day emergency syringe exchange, citing a public health emergency. Later that spring, Pence signed a law legalizing syringe exchanges in Indiana.

Beth Meyerson, co-director of Indiana University’s Rural Center for AIDS/STD Prevention, worked closely with Adams throughout that period. She says early on, when it became clear to legislators that a clean syringe exchange program was needed to reduce the spread of HIV and hepatitis C, Adams was able to bring public health evidence to the table.

“Dr. Adams navigated the very ideological political environment that was created by then-Gov. Pence,” she says. “There’s just no doubt the governor wouldn’t have listened to me or listened to the leaders in the legislature, but he would listen to Jerome Adams.”

She thinks Adams will have sway working with Vice President Pence on a national scale, too. “He will navigate [Washington], I suspect, the same way that he did in Indiana, which is to listen to communities, work with several partners across the arena, and bring public health evidence to the table again as an advocate for community health,” Meyerson says.

Adams has since supported other state laws aimed at curbing the opioid epidemic, including a bill that increased access to the overdose antidote naloxone, and another that restricts the amount of opioid medication a prescriber may give to adult patients who have not previously taken opioids and to children.

Still, Meyerson says expectations about what Adams might do in Washington have to be tempered by political reality. Even in Indiana, the laws he helped pass haven’t been as comprehensive as she and other public health workers would have liked. The original syringe exchange law “was an administrative nightmare,” she says. It has since been updated by Indiana Gov. Eric Holcomb, making it easier for counties to start exchanges.

Funding also remains an issue. Indiana ranks 49th in the country in public health spending. “So all of these counties who have tried to move forward for syringe access are doing so with both hand tied behind their backs, because they do not have the resources to make this happen,” Meyerson says.

If confirmed by the Senate, Adams would be the second health official from Pence’s home state to join the Trump administration. Seema Verma, who helped shape Indiana’s Medicaid expansion, now heads the Centers for Medicare and Medicaid Services.

This past March, this physician – head of the Indiana Health Dept – made a presentation to a meeting of the Indiana Pharmacist Alliance.  I came away impressed by the common sense of this young – at least to me – doctor.

I was not sitting far from where he was standing and had the opportunity to ask some pointed questions about content of his presentation…  after about the second question.. he turned to the audience and said ” he is actually NOT A PLANT” and then turn to me and said that “maybe I should take you with me to presentations”… at that time .. I extended my hand with my BUSINESS CARD… which he walked over to me and accepted and put in his coat pocket  🙂

According to this article he was first opposed to the clean needle program in Scott Co Indiana but upon realizing the alternatives, was able to make a intellectual change of mind.

That was two years ago and according to recent local news reports, there is a measurable change in Scott Co and the number of substance abusers.

Pharmacists Held Criminally Liable for Opioid Overdoses

Pharmacists Held Criminally Liable for Opioid Overdoses

http://www.medscape.com/viewarticle/882358

 

As the US opioid epidemic continues to soar, physicians have been held criminally responsible for patients’ overdose deaths. Now, it appears pharmacists are also criminally liable.

That’s the opinion of pharmacy law experts who have watched the crisis unfold during the past decade.

Keith Yoshizuka, PharmD, JD, assistant dean for administration at the Touro University College of Pharmacy, Vallejo, California, notes, for example, that in 2015, a California physician, Lisa Tseng, MD, was convicted of second-degree murder for the overdose deaths of three patients. She was later sentenced to 30 years to life in prison.

I did not reprint the entire article… it is four pages long… you can use the link to read it if you wish. 

If those in the chronic pain community has not figured it out by now… you are either part of a GENOCIDE or a unwitting participate in the war on drugs.

They are using our system of laws to “manage you”… it is like herding cows/pigs taking them to the SLAUGHTER.

The DEA has pushed Pharmacists into making “second opinions” on the prescriber’s diagnosis of a pt’s and the appropriateness of the medication being prescribed for a pt.  A Pharmacist does not have the legal authority to do a physical exam, nor do they have access to the pt’s complete medical history.  Now, the pharmacist is expected to do a mental health evaluation each time a controlled substance prescription is filled ?

And could be held liable if he/she is not RIGHT 100% OF THE TIME ?

The 51 Boards of Pharmacy (BOP) to date have done nothing to push back on these demands on Pharmacists.  It is just going to make more Pharmacist “not comfortable”.. and it is just easier/safer to JUST SAY NO !

FOLKS…  it is time to get your smart phones out and start recording all your interactions with healthcare professionals…  “NOT COMFORTABLE” is NOT a FACTUAL REASON to refuse to fill a prescriptions.. it is a LAME EXCUSE.. it is a DODGE…

Afraid to stand up because of “consequences”… just look at the horizon..  the “consequences ” are coming.. compliments of the DEA, DOJ, FDA, CDC and what other alphabet of Federal agencies that want to get a piece of the 81 billion/yr war on drugs budget.

“Even if you’re on the right track, you’ll get run over if you just sit there.” ~Will Rogers |

Orleans Parish man claims he was detained at Wal-Mart for asking to speak to a manager

Orleans Parish man claims he was detained at Wal-Mart for asking to speak to a manager

http://louisianarecord.com/stories/511130765-orleans-parish-man-claims-he-was-detained-at-wal-mart-for-asking-to-speak-to-a-manager

NEW ORLEANS – An Orleans Parish man is seeking damages, claiming that he was arrested after asking to speak with the manager of a Wal-Mart.

Michael E. Duronslet filed a lawsuit June 20 against Walmart Stores Inc. and Marlin N. Gusman, sheriff for Orleans Parish in Orleans Parish Civil District Court alleging negligence.

 According to the complaint, the plaintiff was in the Wal-Mart at 4301 Chef Menteur Highway, New Orleans on June 23, 2016, when the incident occurred. The suit states that the plaintiff was picking up a prescription from the pharmacy. When he asked to speak to the pharmacist to ask why the prescription was partially filled, the pharmacist allegedly didn’t respond and continued closing down the pharmacy. The plaintiff asked to speak with the manager but was ignored, and an employee called over a police officer who was in the store. 

The plaintiff was allegedly attacked by the officer, who threw him to the floor, detained him in a private room and threatened arrest unless the plaintiff signed an agreement to not enter the property again. The plaintiff signed the form but claims he was not in the wrong and that the actions of the police officer and the Walmart employee made him suffer emotional and physical distress.

The defendant is accused of excessive force, negligence, false arrest and deprivation of civil rights.

The plaintiff seeks all reasonable damages, court costs, attorney fees and all appropriate relief. The plaintiff is represented by attorney Vallerie Oxner in Metairie.

The case has been assigned to Division J Judge Cherrell S. Taplin.

Orleans Parish Civil District Court case number 17-5958

being denied medicine: Email us at eyewitnessnews@13wmaz.com

http://www.13wmaz.com/news/opioid-epidemic-may-be-keeping-legitimate-patients-from-getting-pain-meds/454309714

Almost every morning is the same for Lauri Nickel — the pain may fluctuate, but it is always there.

“Some days are better than others,” said Nickel.

A staunch advocate for people with chronic pain, Nickel is upset with her leaders and elected officials.

She believes their effort to combat opioid abuse is having a negative effect on people who desperately need the drugs.

“You are sentencing people to an early death,” she said.

She is convinced the extreme focus has scared doctors from prescribing opioids to longtime patients who desperately need pain medication.

The result, according to Nickel, is that many patients will simply give up and take their own life.

Barby Ingle has not given up but it has been a difficult and often gut-wrenching journey.

The former college cheerleader and coach has battled chronic pain more than 20 years.

“Chronic pain devastated my life,” Ingle said. “It took everything away.”

At one point the pain was so bad and the prospects ahead so dire she contemplated suicide.

“I did think about it,” she said.

For the millions of people like Ingle and Nickel, opioids serve a critical role in their lives.

“It’s about quality of life, about surviving day to day, minute to minute, second to second,” said Ingle.

The two women say they know of several friends who have been denied access to opioids by doctors afraid to continue to prescribe the medication.

“They don’t want the DEA to come knocking on their door,” said Ingle.

“The people suffering from chronic pain should be mad at the people abusing the system,” said Doug Coleman, the Special Agent in Charge of the Arizona DEA office.

The longtime DEA agent says his office doesn’t target doctors who are prescribing opioids to legitimate patients.

Ingle and Nickel are not blind to the opioid problem but are worried this intense focus to curb the unlawful distribution of opioids could end up with many of their friends suffering in silence.

Do you know someone suffering from chronic pain who is being denied medicine or is worried about not getting the medicine they need? Email us at eyewitnessnews@13wmaz.com

Legality of CBD oil on trial in federal courts

With DEA digging in its heels on “marijuana extracts,” legality of CBD oil on trial in federal courts

www.thecannabist.co/2017/07/05/cbd-hemp-dea-marijuana-extracts-federal-lawsuit/82623/

Cannabist Special Report: CBD, TBD || Outcome of lawsuit pitting the hemp industry against the DEA could chart a new course for CBD — and a booming new agricultural sector.

Cannabidiol is a non-psychoactive cannabis compound touted for its medicinal promise — but marijuana- and hemp-derived extracts rich in CBD and low in intoxicating THC are facing a future yet to be determined.

The Cannabist’s special report “CBD, TBD” explores a regulatory and legal landscape pockmarked by federal-state conflicts, and examines national drug policy, pioneering research efforts and disparate avenues toward the compound’s full legalization. This is the third installment in an ongoing series.

Part I – Forbidden medicine: Caught between a doctor’s CBD advice and federal laws

Part II – How advocates are inspiring congressional action on CBD legalization


There are two wildly different views on how the federal government has classified cannabidiol (CBD) with a new drug code for marijuana extracts:

It was a mere administrative maneuver meant to bring the U.S. in line with international drug control treaties and to better track medical research.

It was the opening salvo in a federal offensive against the emerging American hemp industry.

A proposed final rule notice posted to the Federal Register last December by the U.S. Drug Enforcement Administration established a Controlled Substances Code Number for “marihuana extracts.” The rule notice, which was finalized in January, maintained cannabis-derived extracts’ Schedule I status under the Controlled Substances Act (CSA).

What the DEA saw as innocuous, the hemp industry saw as an existential threat.

Overnight, a pall was cast across an industry pumping out products ranging from hemp seed butter to bio-plastics used in automobiles to CBD oil, a non-psychoactive cannabis compound that has been highly touted for its potential medicinal benefits.

Hysteria and confusion swelled after initial reports erroneously asserted that a scheduling action occurred and that CBD was now illegal and in the crosshairs of the government.

Shortly after the rule was announced, DEA officials reiterated to The Cannabist that no scheduling action took place. None was necessary — CBD oil and other extracts derived from marijuana and hemp “have been and will continue to be Schedule I controlled substances,” officials said.

The DEA has not changed its stance.

Hemp industry lawyers claimed the rule instantly subjected what were presumed lawful operations to DEA registration and drug code assignation, effectively treating their products as controlled. The coding also amounted to the DEA acting outside of its authority by attempting to schedule cannabinoids, or even marijuana extracts, which are not explicitly listed in the Controlled Substances Act, attorneys alleged.

A federal lawsuit filed in January by Denver’s Hoban Law Group on behalf of the Hemp Industries Association, Centuria Natural Foods and RMH Holdings LLC was intended to protect an American agricultural revival, attorney Bob Hoban told The Cannabist.

“The entire industry hinges on this,” Hoban said.

Now it’s up to the 9th U.S. Circuit Court of Appeals to make a decision that could chart a new course for the hemp industry.

Uncertain times, booming business

At least 16 states, including Colorado, have laws allowing cultivation of hemp for research and/or commercial purposes, according to the National Conference of State Legislatures.

In 2016, the hemp industry notched an estimated $688 million in U.S. sales, setting a new record, according to an analysis by the Hemp Business Journal. Hemp-derived CBD accounted for an estimated $130 million share of that total, the Denver-based trade publication reported.

However, questions have continuously swirled around the legality of the sourcing, manufacturing processes and distribution of the plant’s products and extracts.

Central to the issue are the parts of the cannabis plant that are refined into products. In the Controlled Substances Act, the government defines marijuana as:

“all parts of the plant Cannabis sativa L., whether growing or not; the seeds thereof; the resin extracted from any part of such plant; and every compound, manufacture, salt, derivative, mixture, or preparation of such plant, its seeds or resin. Such term does not include the mature stalks of such plant, fiber produced from such stalks, oil or cake made from the seeds of such plant, any other compound, manufacture, salt, derivative, mixture, or preparation of such mature stalks (except the resin extracted therefrom), fiber, oil, or cake, or the sterilized seed of such plant which is incapable of germination.”

What has been excluded from the CSA definition — mature stalks and unviable seed — is considered to contain only traces of cannabinoids such as psychoactive THC. Foods such as hemp-seed hearts and cooking oil made from seed fall into this category.

DEA officials confirmed to The Cannabist last December that the new code number would have no effect on the slew of hemp products not intended for human consumption that are already exempt from the CSA. That included the likes of lotions, shampoos, solvents, ropes, clothing and bird seed, officials said.

Questions arise when hemp plants that are naturally low in THC are used to make CBD oil.

“The uncertainty, frankly, is what has created this industry,” Hoban said. “Economics and business thrive in uncertainty.”

Surviving in uncertainty, however, is another matter.

Hoban said the industry can’t sit on the sidelines assuming state legalization and existing case law will shield producers, retailers and consumers of hemp-derived products.

He noted how companies in Texas and Kentucky had their CBD products seized by state police. He expressed concern that operations by the U.S. Customs and Border Patrol could lead to seizures of CBD oil and other hemp-derived products under the auspices of the DEA’s marijuana extract coding.

CBD oil’s legality has been questioned in places like Orchard Park, New York, where officials for a state-run special care facility said federal law prohibited them from administering doctor-recommended CBD oil for a patient.

“There’s no black and white about this,” Hoban said, and added that the fight in the courts is critical.

The U.S. Court of Appeals in San Francisco provides a familiar battleground for the DEA and the Hemp Industries Association. Nearly two decades ago, the 9th Circuit set precedents on hemp foods and cannabinoids that play heavily into this year’s case.

In 2003, the court ruled against the DEA’s “Interpretive Rule” banning all naturally occurring THC, including the trace amounts found in hemp seed and oil. In 2004, that same appellate court established bounds on the DEA’s authority related to natural and synthetic THC, according to court records:

The DEA’s Final Rules purport to regulate foodstuffs containing “natural and synthetic THC.” And so they can:  in keeping with the definitions of drugs controlled under Schedule I of the CSA, the Final Rules can regulate foodstuffs containing natural THC if it is contained within marijuana, and can regulate synthetic THC of any kind. But they cannot regulate naturally-occurring THC not contained within or derived from marijuana-i.e., non-psychoactive hemp products-because non-psychoactive hemp is not included in Schedule I. The DEA has no authority to regulate drugs that are not scheduled, and it has not followed procedures required to schedule a substance.

A decade later, Congress passed the Agricultural Act of 2014, also known as the Farm Bill, which allowed states to set laws on hemp production. The act defined industrial hemp as “the plant Cannabis sativa L. and any part of such plant, whether growing or not, with a delta-9 tetrahydrocannabinol concentration of not more than 0.3 percent on a dry weight basis.”

Under that legislation, a state department of agriculture or university could produce industrial hemp for research purposes, and others could grow the versatile crop under state-sanctioned pilot programs.

Poking the bear

Past circuit court rulings and hemp-friendly federal legislation have offered legal precedent for producers, retailers and consumers of CBD-rich extracts, but they didn’t necessarily provide security or stability to all.

Some advocates for CBD oil in therapeutic and medical applications said they prefer a clear-cut approach — the stakes are far too high for too many people and businesses to solely rely on the courts.

Paige Figi, a Colorado Springs-area mother, credits CBD oil with drastically reducing her daughter Charlotte’s seizures caused by Dravet syndrome, a type of epilepsy. She founded the nonprofit Coalition for Access Now to lobby for CBD laws.

CBD oil’s legality ultimately needs to be decided in the halls of Congress, Figi said.

Figi and Coalition for Access Now are supporting Congressional efforts to exclude CBD — and plants rich in cannabidiol and low in intoxicating THC — from the definition of marijuana in the Controlled Substances Act.

Beyond the need for full federal legality, Figi said she is concerned that continued court battles could ultimately backfire against the entire industry.

The DEA’s enforcement priorities have been elsewhere, she said, noting that agents have mostly taken a hands-off approach toward producers that adhere to state laws and consumer safety standards.

“When you poke the bear, the DEA can come back and say, ‘It’s scheduled,” and increase enforcement actions, Figi said.

DEA spokesman Russ Baer did not respond to The Cannabist’s requests for interview about the pending lawsuit and the broader debate involving CBD oil.

Last December, Baer told The Cannabist via email that the new rule on extracts would not change the DEA’s enforcement priorities, which are focused in the widely abused areas of heroin, fentanyl, meth and cocaine.

A decision in the 9th Circuit would be legally binding in only a collection of states and territories in the western United States, Hoban said. The 9th Circuit consists of Alaska, Arizona, California, Guam, Hawaii, Idaho, Montana, Nevada, Northern Mariana Islands, Oregon and Washington.

Still, he said, a legal victory in the 9th Circuit would both clarify the DEA’s rule notice in the interim and further set precedent for the future.

“This is the first inning of a very long ballgame,” he said.

 

Each lawsuit names the West Virginia Board of Pharmacy

Four drug distributor lawsuits removed to federal court

http://wvrecord.com/stories/511144093-four-drug-distributor-lawsuits-removed-to-federal-court

CHARLESTON – Four lawsuits against drug distributors for allegedly contributing to the opiate epidemic have been removed to federal court.

The lawsuits were filed by Mayor Charles Sparks, on behalf of the town of Kermit; Mayor Vivian Livinggood, on behalf of the town of Gilbert; Mayor Reba Honaker, on behalf of the city of Welch; and the Lincoln County Commission.

 

Each lawsuit names the West Virginia Board of Pharmacy; McKesson Corporation; AmerisourceBergen Drug Corporation; and Cardinal Health 110. Miami-Luken is also named in Gilbert, Lincoln and Kermit’s lawsuits. Dr. Harold Anthony Cofer Jr. is named in Welch’s. Chip RX and George W. Chapman III is named in Lincoln’s. Cameron Justice was also named in Kermit’s.

The lawsuits all allege the defendants contributed to the opiate epidemic across the state by flooding pharmacies with Hydrocodone and Oxycodone. The BOP allegedly failed to timely investigate and resolve suspicious order reports.

The defendants played a significant role in creating what amounts to a public nuisance by flooding the area with excessive amounts of dangerous and addictive medications, according to the suits. The plaintiffs claim the defendants’ actions are a serious breach of the public trust, which has resulted in drug abuse, misuse, overdose deaths and untold expenses for the plaintiffs.

The plaintiffs claim as distributors of inherently dangerous products like prescription narcotics, the defendants bore a significant duty to ensure that the drugs did not end up in the wrong hands and failed to do so.

In exchange for promising to honor their obligations, each of the defendant distributors was licensed and/or registered by the Board of Pharmacy and ultimately received compensation in the form of millions of dollars per year for shipping volumes of drugs well beyond what a reasonably company would expect, according to the suits.

The plaintiffs claim they were there to enforce codes, clean up streets and neighborhoods and repair and/or replace damaged and destroyed property.

In the notices of removal, the defendants claim complete diversity exists between the plaintiffs and defendants.

The plaintiffs are represented by H. Truman Chafin and Letitia N. Chafin of The Chafin Law Firm; Mark E. Troy of Troy Law Firm; Harry F. Bell Jr. of the Bell Law Firm; and John Yanchunis, Patrick Barthle and James Young of Morgan & Morgan Complex Litigation Group.

The defendants are represented by Brian A. Glasser and Steven R. Ruby of Bailey & Glasser; Enu Mainigi, F. Lane Heard and Steven M. Pyser of Williams & Connolly; Thomas Hurney Jr. and Laurie K. Miller of Jackson Kelly; A.L. Emch and Adam J. Schwendeman of Jackson Kelly; Meredith S. Auten and Eric W. Sitarchuk of Morgan Lewis & Bockius; Russell D. Jessee and Devon J. Stewart of Steptoe & Johnson; and Geoffrey Hobart and Matthew Benov of Covington & Burling.

U.S. District Court for the Southern District of West Virginia case number: 2:17-cv-03369, 2:17-cv-03372, 2:17-cv-03366, 1:17-cv-03364

The vast majority of Boards of Pharmacy ( BOP) takes their primary charge to protect the public’s health and safety in a very limited manner.  If this BOP is found liable for contributing to the opiate epidemic  in WV.  This could open the flood gates for BOP’s to be sued for a number of issues that they have chosen to ignore  that should be within their primary charge.

Dayton Ohio area: 99% of opiate OD’s tested positive for ILLEGAL FENTANYL ANALOG

Dayton Ohio area: 99% of opiate OD’s tested positive for ILLEGAL FENTANYL ANALOG

 

 

 

 

 

 

https://ndews.umd.edu/sites/ndews.umd.edu/files/update-on-fentanyl-outbreaks-in-dayton-ohio-ou-r21-da042757-05-02-2017.pdf

 

Popular stomach acid blockers linked to higher death rates

http://media.spokesman.com/photos/2017/07/03/26_GAMBLE_PRILOSEC_OTC.JPG_I1jfV5p_t2500.jpg?6913dd5f0afa17a0b7a91a88b4e808d586264d13

Popular stomach acid blockers linked to higher death rates

http://www.spokesman.com/stories/2017/jul/04/popular-stomach-acid-blockers-linked-to-higher-dea/

A higher risk of death is associated with long-term use of popular stomach acid reducers known as proton pump inhibitors, according to a study of prescribed drugs published Monday.

These drugs are sold under brand names such as Prilosec, Nexium, Protonix and Zegerid, along with generic versions such as omeprazole, lansoprazole and pantoprazole. Originally sold only by prescription, they are increasingly available over the counter. The study didn’t examine over-the-counter use.

Previous studies have indicated elevated disease risks from PPI use. This study goes further by linking them to higher death rates.

Use of the drugs was associated with a 25 percent greater risk of death, compared with those using another class of acid reducers called H2 blockers. H2 blockers are sold under brand names including Pepcid, Tagamet and Zantac. They are also sold under generic names, including famotidine, cimetidine and ranitidine.

Millions of veterans’ prescription records were examined across an average of nearly six years for the study. It was published in the journal BMJ Open. The senior author was Dr. Ziyad Al-Aly of VA Saint Louis Health Care System. Go to j.mp/acidppi for the study.

Doctors shouldn’t be deterred from prescribing these drugs when medically indicated, the study said, but only long enough to provide benefits that outweighs the risks. The increased mortality associated with PPIs was proportionately linked to their duration of use.

Acid reducers treat painful ailments including GERD (gastroesophogeal reflux disease), heartburn and peptic ulcers. According to prescription records, more than 15 million Americans are estimated to use proton pump inhibitors, a number that doesn’t include those who buy them over the counter.

For the study’s main analysis, Department of Veterans Affairs records of 349,312 patients were used. Of those, 275,977 were prescribed PPIs, and 73,335 prescribed H2 blockers. This produced the 25 percent increase in death rate among PPI users.

Two secondary comparisons were also made. One found a 15 percent increased death rate for PPI users compared to those who didn’t use PPIs but may have used another kind of acid suppressor. Records from 3,288,092 patients were examined for that comparison.

In the other comparison, the death rate was 23 percent higher among PPI users compared to those who didn’t use any acid suppressors at all. A total of 2,887,070 patient records were examined for that analysis.

The study’s comparisons were observational, so the conclusions are not as definitive as a randomized placebo-controlled study.

Another limitation is that the patients were “mostly older, white male U.S. veterans,” the study said, so the results may not apply to a larger population. Also, the study didn’t get information on the cause of deaths.

However, the study is consistent with previous ones finding long-term use of PPIs, but not H2 blockers, is associated with higher disease rates. These include kidney disease, dementia, infection by the antibiotic-resistant superbug C. difficile and other ailments.

Proton pump inhibitors work by a different mechanism than H2 blockers, explaining the differing responses. PPIs block stomach cells called parietal cells from releasing positively charged hydrogen atoms, or protons, into the stomach. This inhibits production of stomach acid, chemically known as hydrochloric acid.

H2 blockers stop the action of histamine, which stimulates parietal cells to produce hydrochloric acid. This indirect method is less efficient than that of PPIs, but is sufficient for many patients.

A 2016 study in JAMA Neurology found a 44 percent increased risk of dementia among those using PPIs.

PPIs can cause nutritional deficiencies, since acid is needed to release essential nutrients such as vitamin B12. Since stomach acid kills pathogenic bacteria; use of acid reducers has been linked to increased rates of food poisoning.

A 2015 study led by Stanford University researchers found that use of PPIs, but not H2 blockers, is associated with higher risk of heart attacks.

And in one of the most unusual side effects, proton pump inhibitors have been found to cause visual hallucinations in some patients with wet macular degeneration.

Dr. Anne Hanneken, a San Diego ophthalmologist, co-authored a 2013 study describing the phenomenon in the journal Investigative Ophthalmology & Visual Science. Go to j.mp/retinappi for the study.

It started with an 89-year-old patient who suddenly developed vivid hallucinations of little black polka dots. The hallucinations were severe enough to prevent her from living independently.

Hanneken couldn’t find a cause, but kept the record until she encountered another macular degeneration patient with a similar complaint, and found they were both taking PPIs.

After teaming up with retinal expert Wallace B. Thoreson, they figured out that the PPIs reached the retina through leaky blood vessels caused by wet macular degeneration. There, the PPIs interfered with proton pumps in retinal cells.

These hallucinations occur in a minority of patients, Hanneken said. Moreover, if people stop taking the PPIs quickly, the hallucinations dissipate readily.

In another twist, Hanneken discovered that the hallucinations can be suppressed with the drug gabapentin, sold under the trade name Neurontin. This drug reduces neuronal activity, and is used to treat epilepsy and neuropathic pain. However, the drug can also caused blurred vision, because it can also interfere with visual processing.

“Every year I see about three people who come in for unexplained visual loss,” Hanneken said. “They say everything’s sort of blurry and they don’t know why. And it turns out that their neurologist started them on Neurontin for some leg pain.”

I Love FACTOIDS… they are typically so easily BUSTED

There was enough opiate prescriptions filled in ONE YEAR to give each resident a bottle of OPIATES

https://www.statista.com/statistics/261303/total-number-of-retail-prescriptions-filled-annually-in-the-us/

In 2016 there was 4.51 BILLION prescriptions filled in the USA… with a population of abt 320 MILLION that comes out to abt 14 prescription for EACH PERSON.

Let’s assume that the one prescription per person is a FACT… meaning that there would be 320 million opiate prescriptions filled..

BUT WAIT… a chronic pain pt would need – TWELVE PRESCRIPTIONS PER YEAR – presuming 30 days supply of each…  Suggesting that those 320 million prescription would only take care of abt 26 million chronic pain pts..  or about EIGHT PER-CENT OF THE POPULATION.

BUT WAIT… there are people having to deal with acute… surgery, broken bones and the like..  let’s presume that 15% of the 320 million are for acute pain…  subtract 48 million … leaving 272 million for chronic pain pts…or  some 22 million chronic pain pts get 12 prescriptions a year..

BUT WAIT… standard of care and best practices indicates that a chronic pain pt should be getting both a long action and short acting – for breakthru – opiate.  Which would mean that abt 11 million chronic pain pts would get opiate therapy that conforms to accepted best practices and standard of care.

BUT WAIT… there is an estimated 100+ million chronic pain pts…

BUT WAIT… when the bureaucrats state that having enough opiate prescriptions to furnish everyone a prescription…  IS A BAD THING…  Are they really saying that they support/endorse under treating/un-treating the vast majority of chronic pain pts is a GOOD THING or a BAD THING ?

Since PAIN is generally considered a part of TORTURE… are our politicians and bureaucrats encouraging the TORTURING of our citizens ?

FACTOID DISPELLED !!