Your living in pain can never be greater than my pain of losing a loved one to drugs ?

Posted on June 7, 2016 by Pharmaciststeve

Mother of Capitol Hill overdose victim: ‘There’s no way to describe this grief’

http://komonews.com/news/local/mother-of-capitol-hill-overdose-victim-theres-no-way-to-describe-this-grief

SEATTLE — Sitting inside her late daughter’s apartment Tuesday afternoon, Annie Horn was a mix of anger, grief and confusion.

Horn said she that her daughter Sara Valenzuela had a history of using drugs to handle heartbreak and injury, but she wasn’t sure why the 36-year-old woman would dabble in a lethal concoction of cocaine and a high-powered opiate during a weekend of partying.

Valenzuela and her friend Maria Paschell, 49, were found dead inside Valenzuela’s Capitol Hill apartment by Seattle police on June 1.

Horn said she had begged her daughter’s property manager to enter the when she hadn’t heard from her in days. When the property manager reported hearing Valenzuela’s dog barking, but no stirring from anyone inside, Horn pleaded with police to make a welfare check.

“There’s no way to describe this grief, it’s all encompassing. I don’t want another parent to have to go through this. This is hell. Truly hell,” Horn said.

Police, in a report released by a department spokesman, said they found the two women dead inside the living room.

Near the women’s bodies was a pile of white powder and a razor blade on the coffee table, the report said. Officers said they also spotted several prescription pill bottles and additional baggies containing white powder nearby.

The King County Medical Examiner’s Office determined that the women had died about two days earlier.

On Friday, Public Health Seattle & King County issued a warning about the toxic drug cocktail the women snorted – apparently a combination of cocaine and acetyl fentanyl.

Acetyl fentanyl can be 40 times more potent than heroin, 100 times more potent that morphine, according to the Drug Enforcement Administration (DEA). The drug is primarily mass produced in China and Mexico.

DEA spokeswoman Jodie Underwood said agents have become “increasingly alarmed” over the surge of fentanyl sold on the streets of the U.S. Last year the DEA issued a nationwide alert about the dangers of the narcotic.

Underwood said these two overdose deaths, combined with a raid they made on a South Seattle fentanyl lab in March, has left agents gravely concerned that the potent drug is here to stay in the region. There were more than 700 fentanyl overdose deaths nationwide between 2013 and 2015, according to the DEA.

“It’s very alarming to me that we’re seeing acetyl fentanyl here,” said Caleb Banta-Green, a senior research scientist at University of Washington’s Alcohol and Drug Abuse Institute.

Banta-Green, who is a regional expert on local drug trends, said surveys of King County drug users had indicated a lot of interest in fentanyl because of its potency.

“We’re very concerned that a small amount, a few ounces, could kill hundreds of people,” Banta-Green said. “The line between a good high and death is a fine one.”

Horn said she doesn’t know why her daughter had acetyl fentanyl in her system. While she copes with the loss of her best friend and eldest child she is overcome with anger directed at the people who sold Valenzuela the drugs.

“It’s beyond mad,” she said. “It ultimately comes down to profit. Someone else’s profit is my loss.”

Filed under: General Problems | 11 Comments »

Nursing groups support less treating of chronic pain pts and more focused on opiate abuse ?

Posted on June 7, 2016 by Pharmaciststeve

Nursing Groups Commit to Fighting Opioid Misuse

http://www.healthleadersmedia.com/nurse-leaders/nursing-groups-commit-fighting-opioid-misuse

Nursing organizations are uniting in a national effort to enhance education on opioid prescription and administration practices.

Seventy eight people die each day from an opioid overdose, says the Centers for Disease Control and Prevention, and half of opioid overdose deaths involve prescription opioids.

In an effort to address this issue, the following nursing organizations have committed to educating nursing faculty, students, and clinicians, across the advanced practice registered nurse education continuum, regarding the CDC’s Guideline for Prescribing Opioids for Chronic Pain:

The American Association of Colleges of Nursing
The American Association of Nurse Anesthetists
The American Association of Nurse Practitioners
The American College of Nurse-Midwives
The American Nurses Association
The National Association of Clinical Nurse Specialists
The National Organization of Nurse Practitioner Faculties

“Our joint commitment reaffirms AANP’s dedication to promoting evidence-based standards for opioid abuse prevention and education, while recognizing the need for patients suffering from chronic and acute pain to access essential pain care,” said AANP President Cindy Cooke, DNP, FNP-C, FAANP, president of AANP, in a news release announcing the commitment.

AANP will provide continuing education. In addition, 191 schools of nursing with APRN programs have pledged to educate their APRN students on the CDC’s guidelines as a way to enhance existing education on managing pain through pharmacologic and non-pharmacologic interventions.

“Academic nursing is committed to protecting the public’s health by taking decisive action to address the nation’s opioid epidemic,” said Deborah Trautman, PhD, RN, FAAN, president and chief executive officer of AACN, in a news release.

“I applaud my colleagues in the nursing community who have made it a priority to prepare the next generation of APRNs on best practices for prescribing opioids.”

The CDC guidelines focus on three main areas:

Determining when to initiate or continue opioids for chronic pain
Opioid selection, dosage, duration, follow-up, and discontinuation
Assessing risk and addressing harms of opioid use

The announcement of the educational initiative took place on April 25 at a White House event Champions of Change for Prevention, Treatment, and Recovery event in Washington, D.C., which recognized those people and organizations taking steps to address the opioid epidemic.

Filed under: General Problems | 2 Comments »

Study Finds Genetic Variants Associated With Risk for Fibromyalgia

Posted on June 7, 2016 by Pharmaciststeve

Study Finds Genetic Variants Associated With Risk for Fibromyalgia

http://www.painmedicinenews.com/Science-Technology/Article/05-16/Study-Finds-Genetic-Variants-Associated-With-Risk-for-Fibromyalgia/36078/ses=ogst

Palm Springs, Calif.—A retrospective analysis has found two genetic polymorphisms with a statistically significant association with fibromyalgia: C-reactive protein (CRP; rs1205) and protein tyrosine phosphatase, nonreceptor type 11 (PTPN11; rs2301756). According to the researchers, these findings could contribute to the discovery of better diagnostic and treatment modalities for the disease.

“Collectively, our results show that genetic testing for CRP and PTPN11 may help determine the risk of fibromyalgia,” said Zoie Badura, MS, the primary author of the study, and a researcher at Proove Biosciences. “These findings need to be validated but suggest genetic testing may aid in diagnosis and, potentially, treatment intervention based on biomarker expression.”

Despite advances in research and better understanding of the disorder, as Ms. Badura reported at the 2016 annual meeting of the American Academy of Pain Medicine, fibromyalgia remains undiagnosed in as many as three of four people with the condition.

“The etiology of fibromyalgia is elusive,” said Natasha Anand, MS, study co-author and a researcher at Proove Biosciences. “Although the American College of Rheumatology has published criteria for diagnosis, there are no diagnostic tests for fibromyalgia, and standard laboratory tests do not typically reveal a physiological reason for symptoms.”

In fact, as Ms. Anand explained, patients often see several health care providers in an effort to establish the reasons for their symptoms and to find treatment.

The pathogenesis of fibromyalgia remains equally uncertain: It is not yet clear how genetic variables contribute to the development of the disorder, or whether they may be predictive of a person developing the disease.

CRP and PTPN11: Linked to Fibromyalgia

This multicenter, retrospective, case-control study was composed of 108 patients who had been diagnosed with fibromyalgia (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1) and 104 controls who were matched for age, race and sex. Data were collected from September 2014 to January 2015 from 26 different clinical research sites in the United States, and samples were genotyped for 128 single nucleotide polymorphisms. Association and regression analyses were then performed to determine associations between each genotype and pain phenotype.

<03C7>-square testing showed that genetic polymorphisms in eight genes had a statistically significant association with fibromyalgia (P<0.01). Of these, however, only polymorphisms in the CRP and PTPN11 genes passed significance testing following Bonferroni correction (P=0.004).

“Interestingly,” said Ms. Badura, “the CRP C-allele has been associated with higher plasma concentrations of CRP. Our findings, which indicate the C-allele is associated with fibromyalgia, support the conclusions of previous research, and indicate that genetic testing could identify patients at higher risk of elevated CRP levels and fibromyalgia.”

CRP is a marker for inflammation, said Ms. Badura, which suggests that fibromyalgia patients may be genetically predisposed to inflammatory processes.

Researchers also found a significant and “novel” association between PTPN11 polymorphism and fibromyalgia. The PTPN11 codes for the SHP-2 protein, which is widely expressed in most tissues, and is responsible for cytokine signaling in the immune system as well as modulating the body’s response to stress by inducing inflammation.

“The PTPN11 polymorphism may play a yet unexplored role in the inflammatory component of fibromyalgia,” Ms. Anand noted. “PTPN11 is also involved in different gut reactions—a lot of people with fibromyalgia have gut diseases, too—but we’re still unsure of the association because this is a novel finding.”

Ms. Anand and her colleagues are continuing to evaluate potential associations between genetic polymorphisms and fibromyalgia in order to uncover therapeutic markers and develop objective diagnostic instruments.

“If we keep analyzing people’s genes and genetics, I think we might be able to see people who do have fibromyalgia and maybe people who have something else misdiagnosed,” Ms. Anand concluded.

Filed under: General Problems | 1 Comment »

Study conclusion: intentional abuse of many medications can have harmful outcomes… DUH !!

Posted on June 7, 2016 by Pharmaciststeve

FDA Warns of Heart Risk with Loperamide Overdose

Permanent and fatal arrhythmias tied to misuse of loperamide

http://www.medpagetoday.com/Cardiology/Arrhythmias/58365?isalert=1&uun=g578717d5074R5705800u&xid=NL_breakingnews_2016-06-07

Higher than recommended doses of diarrhea drug loperamide (Imodium) can cause serious and even fatal cardiac arrhythmias, the FDA warned.

Although some of the 48 cases of QT interval prolongation, torsades de pointes, cardiac arrest, syncope, and other serious cardiac events reported to the agency have been unintentional misuse of more than the maximum daily dose for adults (8 mg in over-the-counter products; 16 mg in prescription use), most have been intentional abuse.

“The majority of reported serious heart problems occurred in individuals who were intentionally misusing and abusing high doses of loperamide in attempts to self-treat opioid withdrawal symptoms or to achieve a feeling of euphoria,” the agency noted in a Drug Safety Communication.

Loperamide is a mu-opioid agonist that acts primarily in the gut but, in high doses, has psychoactive effects. It has recently been recognized as a drug of abuse and is recommended in internet chat forums for treating symptoms of opioid withdrawal.

Taking loperamide with drugs that interact with it, including ranitidine (Zantac), increases the risk. These combinations, too, are often intentional in “attempts to increase its absorption and penetration across the blood-brain barrier, inhibit loperamide metabolism, and enhance its euphoric effects.”

The problem appears to have exploded in recent years. More than half of the 48 cases of serious heart problems reported to the FDA since the drug was approved in 1976 occurred in the short span from 2010 to 2015. Of those cases, 31 resulted in hospitalization and 10 in death. The most severe cases were among people taking four to 100 times the recommended loperamide dose.

“Consider loperamide as a possible cause of unexplained cardiac events including QT interval prolongation, torsades de pointes or other ventricular arrhythmias, syncope, and cardiac arrest,” the FDA recommended to clinicians.

Standard toxicology and opioid drug screens don’t include an assay for loperamide and will turn up a negative result in the presence of loperamide. If loperamide toxicity is suspected, blood levels should be measured by specifically requesting the test for the drug, the FDA suggested.

Antiarrhythmic drugs have been ineffective in many reported cases of loperamide-associated torsades de pointes, the agency added, so electrical pacing or cardioversion should be considered.

The FDA said it will continue to watch this safety issue to see if additional actions are needed.

Filed under: General Problems | 3 Comments »

It’s too early to access the patient benefits, but the agencie$ already are $eeing an up$ide.

Posted on June 6, 2016 by Pharmaciststeve

State Medicaid agencies limiting opioid prescriptions

http://www.modernhealthcare.com/article/20160526/NEWS/160529930

State Medicaid agencies around the country are limiting how many opioids providers can prescribe in an effort to curb the disproportionate number of beneficiaries who are at risk of overdose and death.

Medicaid beneficiaries are prescribed painkillers at twice the rate of other patients and are at three to six times the risk of opioid overdose, the CMS reports (PDF).

North Carolina, for example, found that while the Medicaid population represented approximately 20% of the overall state population (PDF), it accounted for one-third of drug overdose deaths, the majority of which were caused by prescription opioids.

In 2013, at least one Colorado resident died every day from unintentional drug poisonings. Since 2014, Colorado has limited short-acting opioid prescriptions to a maximum of four tablets a day or 120 tablets per 30 days. In February, it introduced a new policy that also limited use of long-acting opioids.

It’s one of 20 states that is limiting prescriptions. It’s too early to access the patient benefits, but the agencies already are seeing an upside.

Colorado has saved $629,000 as a result of the 2014 policy, according to state data.

“State Medicaid agencies need to make policies because we’re using taxpayer dollars and are a safety net for a large number of the population,” said Dr. Judy Zerzan, chief medical officer for the Colorado Department of Health Care Policy and Financing, the state’s Medicaid agency.

Starting Oct. 1, Medicaid providers in Nebraska, a state that doesn’t have a particularly high rate of opioid overdose, will limit prescribing five pills a day or 150 tablets per 30-day period for short-acting opioids.

“We’re trying to head something off before it starts,” said Calder Lynch, the state’s Medicaid director.

Pending CMS approval, the state also plans to add coverage for peer addiction specialists, he said.

Providers are overall supportive of the limitations. In fact, many of them developed the policies in their states, but some doctors are less enthusiastic.

“No one likes to have arbitrary numbers placed on them,” said Dr. Robert Wergin, chair of the American Academy of Family Physicians board. “There will likely be individual circumstances where they’ll need to go beyond the limit.”

There will likely be some patient push back, said Dr. John Massey, an interventional pain physician in Nebraska.

“Initially, patients are going to feel worried since what they think has been effective will not be an option anymore,” Massey said. “But in the long run, they’ll see it will help improve the management of their pain.”

Robert Twillman, executive director of the American Academy of Pain Management, a group that represents pain physicians and receives funding from painkiller manufacturers such as Purdue and Teva Pharmaceuticals, said he wasn’t crazy about the limits.

“You either have to build in many escapes or exceptions for cases to the point that the policy is ineffective or if you don’t, you limit access to those who may need the drugs,” Twillman said.

Experts agree that for any efforts to succeed, patient expectations must change.

“We live in a culture that believes in being pain free, even from minor aches,” said Dr. Mitra Ahadpour, medical officer at the Center for Substance Abuse Treatment at SAMHSA. “A little bit of pain is Ok.”

Medicaid agencies have exempted cancer and sickle cell patients and will allow doctors to argue for their own exemptions.

Shawn Lang, who leads a Connecticut overdose prevention task force, would like to see opioids return to their intended initial use: for cancer patients at the end of life. She thinks doctors should be trained in medical school on the issue.

Wergin agreed that education is key, not only for doctors, but for patients. He said the limitations should be just one of several methods used to battle the opioid epidemic. “It’s one tool and it’s not going to be the one way to solve the problem,” Wergin said.

Filed under: General Problems | 4 Comments »

I won’t worry about your cold turkey withdrawal.. I won’t feel a thing !

Posted on June 6, 2016 by Pharmaciststeve

I’ve had a huge Run in with my doctor. Needless to say I believe I have grounds to sue him and I’ve been talking with an attorney. But this isn’t the only thing I’m up to. I’m trying to start a class action lawsuit. I don’t know how to post this in a group. I would be honored if you would share this and or post it in some pain groups. Thank you so very much.

I know I’m really new in here. I want to try and help those of you who have had their prescription pain medication taken away without provocation or warning.

Last Friday my longtime physician refused to fill my order of tramadol. He said he was apparat how high the dosage was and that I’d need to go to a pain clinic for my pain from now. He cut me cold turkey. He wouldn’t taper me down, he wouldn’t decrease the dose either. He said the DEA is on their way here as we speak. There is no way I will fill your script. I reminded him that he had ordered me to be on more. I was able to cut back some on my own. He said absolutely not. Then I asked him about withdrawal. He didn’t offer any advice about what to look for as I withdrawal, he wouldn’t treat withdrawal symptoms, he wouldn’t even get me a bed in a treatment/detox facility so I could be monitored and comfortable. Sunday I went to the ER and told the ef Doctor what had happened. He was appalled and agreed with me when I told him it was abusive, negligent, unethical, and dangerous for him to do that. That is my story. I’m currently working to get a lawyer to fight my case against him. I also want to start a class action suit against the medical profession, DEA, big government. Whomever is responsible for the intimidation our doctors are feeling. They are looking at us as junkies, drug seekers, derelicts. This is an update as to where I’m at in my fight.

I am making some progress on my medical neglect/medical malpractice suit. I talk with an attorney tomorrow morning. This is a definite strep in the right direction. I even told them that there are way too many people in my same position. They are prescribed meds by their doctor and for no reason and out of the blue they stop the medication totally. They don’t decrease the medication, won’t taper them off gradually, won’t offer withdrawal support, or offer them a bed in a detox/rehab clinic so they can safely go through withdrawal and detox in a safe and monitored setting where they can also be treated for some of the hell withdrawal can lead to. Many of these pain medications cannot be stopped cold turkey. The risks of seizures, suicide, cardiac arrest, and many more horrendous possibilities when pain medications are abruptly stopped with no intervention, monitoring, or medical assistance. Whether I have a case or not with my personal doctor I plan on working towards a class action lawsuit. I know of one other person who had this happen to her just like me, and from the same doctor. I would like people to do a little thinking. If I’m able to get this attorney to file a class action lawsuit against the medical community, DEA, big government, whoever is responsible behind our doctors shutting the doors on us and our pain. Please think about your situation with pain meds and your doctors. If I’m able to get a class action lawsuit formed, would you be interested. I am getting a little ahead of myself right now. But if such a case comes along I’m assuming the bare minimum information they would need is: patients name, physicians name and clinic, city and state,date it occurred, anything like injuries, medical stuff like cardiac arrest, suicide attempt, medication, any complications to going cold turkey. What were some of the things you weren’t able to do while detoxing or after your pain medication was stopped, how was your life affected. Think about these things if you might be interested. I’m not taking names or information right now. I am however really curious as to how many people have had to suffer because their pain meds were taken away and had no help with withdrawal. Please feel free to share this post if you would like. If you would like to let me know I’m not alone in this type of situation please message me privately. As a reminder, I do have an appointment with an attorney in the morning. I’ve already spoken to two different paralegals in the last 24 hours. Something must be done for chronic pain patients. We are not drug seekers, junkies, or doctor shoppers. They way they have been treating some of us is illegal, unethical, dangerous, and abusive. Patients have rights.

Filed under: General Problems | 33 Comments »

lack of a common standard for reporting opioid-related deaths

Posted on June 6, 2016 by Pharmaciststeve

Specify drugs in overdoses

http://thetimes-tribune.com/opinion/specify-drugs-in-overdoses-1.2051154

We know now that pop superstar Prince died from an overdose of fentanyl, a powerful opioid pain reliever 50 times more potent than heroin, because he was famous and his death was of global interest.

But as the national opioid epidemic rages on, one of its problems is the lack of a common standard for reporting opioid-related deaths. That’s important not only in terms of individual death investigations, but for steering public policy and resources to best address this important public health issue.

Death certificates are the province of state governments, and there is a wide array of practice among the states.

And in states like Pennsylvania, there is variance county-by-county on specifying overdose deaths on death certificates.

In Connecticut, as reported recently by National Public Radio, there is a centralized system under which the state chief medical examiner specifies on the death certificate the actual drug involved in the death — whether the culprit is a particular prescription drug, heroin or a combination.

Part of the reason that the opioid epidemic is so difficult to fight is that most opioids are legal prescription painkillers with an important medical purpose. Their development and use is a significant advancement in fighting debilitating pain and improving patients’ quality of life.

So the question of just what drugs are involved in overdoses is a crucial one. A wave of fatal heroin overdoses mandates one kind of response, whereas a spike in prescription opioid doses would require another, in terms of public health policy and law enforcement.

The Legislature and the state Department of Health should require coroners to specify drugs that are at play when they issue a death certificate resulting from an overdose. Doing so could help tailor a response that could result in fewer overdose deaths.

Filed under: General Problems | 1 Comment »

What happens when more and more doctors stop treating pts with complex issues ?

Posted on June 6, 2016 by Pharmaciststeve

It’s time for physicians to stop being pushovers

www.kevinmd.com/blog/2016/06/time-physicians-stop-pushovers.html

Like many physicians, I’m a people pleaser. On my medical school application, my personal statement was a literary cliché filled with my dreams of helping others, easing pain, soothing suffering — and I really meant it. What I didn’t know then was how difficult it would be to negotiate making patients happy while doing the right thing medically.

Medical school and residency didn’t adequately prepare me for the emotional strain of saying “no” over and over to my patients. How to harden my heart against the tears of a patient requesting an early refill for pain medication. How to listen to all of the other modalities that have been tried and failed: “This is the only thing that works!” How to guard against the emotional manipulation, charm, and charisma that many patients with addiction exude. What to do when a patient reports coldly that they went to another doctor after you refused to prescribe an antibiotic for their cold, and got a Z-pack, which “worked like a charm.”

Doctors are stuck in a pinball game of guilt and blame. We are blasted in the media for overprescribing antibiotics for viral infections, yet face angry and upset patients who criticize us on doctor-grading sites when we don’t prescribe them. And while good communication helps ameliorate negative patient attitudes, the truth is that doctors get tired, and it gets harder and harder to “sell” the correct medical treatment as the work day progresses.

More recently, doctors are being criticized for overprescribing pain medication, with a recent CNN report from Dr. Sanjay Gupta titled, “Doctors are responsible for the opioid crisis.” This, after years of medical societies lambasting doctors to consider pain as the “fifth vital sign,” and even threatening physicians with possible legal action for failure to control pain adequately.

No wonder doctors are burning out.

The trend towards rewarding (or punishing) physicians based on patient satisfaction makes the dilemma of providing the best care even more difficult. The reality is that patient satisfaction does not seem to correlate with quality of care. In fact, more satisfied patients have worse outcomes and higher health care costs, partly due to doctors ordering tests just to satisfy patients.

But despite this data, hospitals continue to rate physicians based on patient satisfaction scores, and Medicare’s new merit-based payment system will likely include patient satisfaction (or “experience”) as a factor in payment. This mixed signal hits physicians hard. We have to choose: are we going to be pushovers with great satisfaction scores? Or will we refuse to be scapegoats, the cause of all of society’s ills?

I have spent the last fifteen years walking the fine line between quality medical care and patient satisfaction. And I will admit it: there have been times that I have taken the path of least resistance when it comes to yet another extended discussion about why the treatment that my patient wants is not the best choice, and just given in. This usually happens when I’m mentally exhausted and dealing with a particularly demanding patient.

But now I see that this is no longer an option. It’s time for me to stop being a pushover and take a harder line. It will be emotionally draining, my patient satisfaction scores will probably drop, and some people will leave my practice. But if I can stand firm, I know that eventually it will get easier.

I don’t want to be a scapegoat anymore.

Rebekah Bernard is a family physician and the author of How to Be a Rock Star Doctor: The Complete Guide to Taking Back Control of Your Life and Your Profession. She can be reached at How to Be a Rock Star Doctor.