painkillers

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Mass. Receives Mixed Marks On Painkiller Prescription Report

Massachusetts ranks in the top 10 of all states for prescribing OxyContin and other long-acting painkillers, but in the bottom 10 for overall prescribing of opioids.

That’s according to a report from the Centers for Disease Control and Prevention.

The report, based on 2012 data, says Massachusetts ranks eighth in long-acting painkiller prescription rates and ninth in the use of the sedative benzodiazepine.

“State variation in prescribing shows us that the overprescribing of opioids can be reduced safely and feasibly,” said Daniel Sosin, acting director of CDC’s National Center for Injury Prevention and Control, in a statement. “Improving how opioids are prescribed will help us prevent the 46 prescription painkiller overdose deaths that occur each day in the United States.”

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Opinion: Why Zohydro Ban Is A Tough Call

Update 4/15:

The AP reports that a federal judge blocked Massachusetts from banning the powerful new painkiller Zohydro.

U.S. District Court Judge Rya Zobel on Tuesday issued the preliminary injunction after the maker of the drug, Zogenix, said in a lawsuit that the ban ordered by Gov. Deval Patrick was unconstitutional.

Zobel said in issuing the injunction that Massachusetts appears to have overstepped its authority in banning the drug, which had been approved by the U.S. Food and Drug Administration.

Patrick ordered the ban after declaring a public health emergency in light of widespread prescription drug abuse in the state.

The judge said federal law preempted the state’s order.

By Judy Foreman
Guest contributor

U.S. District Court Judge Rya W. Zobel today disappointed anyone who expected her to quickly strike down Gov. Deval Patrick’s ban on the sale of the new pain reliever Zohydro. She declined to rule on the drugmaker’s request to quickly but temporarily lift the ban, and is continuing to consider whether to lift the ban permanently.

Judge Zobel faces a difficult decision but not because Zohydro, as many media reports have said, is more potent than anything else on the market. It’s not, and we’ll get to that in a minute.

(wikimedia commons)

(Wikimedia Commons)

First, the legalities. It should be up to federal health officials, including the U.S. Food and Drug Administration, not governors, to make decisions about the safety (or lack thereof) of drugs. For better or worse, the FDA, after a long 2013 review, and against the vote of its own advisory committee, did approve Zohydro in October of last year.

Legally, and logically, it also made little sense in the first place – except politically — for a governor to focus on one particular drug when the whole class of drugs to which it belongs — opioids, also known as narcotics – is controversial precisely because that whole class of drugs has such a complex mix of risks and benefits.

In truth, Zohydro is probably not the wonder drug that its manufacturer, Zogenix, claims, nor is it the menace that critics assert. The furor over Zohydro is simply the latest example of how difficult it is to balance the legitimate needs of people in chronic pain who need long-acting opioids and the also-legitimate need to protect vulnerable people from getting their hands on drugs they might abuse.

The unique feature of extended-release Zohydro is that it contains the opioid hydrocodone, and only hydrocodone. Continue reading

Second Opinion: Doc Says Blue Cross Opioid Policy Is Flawed

Amidst concerns over a massive national increase in the use and abuse of prescription painkillers, health insurer Blue Cross Blue Shield of Massachusetts instituted a new policy to reduce pain medication addiction and misuse.

This week The Boston Globe reports that as a result of the new policy, Blue Cross has cut prescriptions of narcotic painkillers by an estimated 6.6 million pills in 18 months.

But Daniel P. Alford, MD, an associate professor of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program at Boston University School of Medicine and Boston Medical Center, calls the policy “flawed and irresponsible.” Here’s Alford’s response:

By Dr. Daniel P. Alford
Guest Contributor

The Blue Cross Blue Shield of Massachusetts opioid management program was implemented to provide members with “appropriate pain care” and reduce the risk of opioid addiction and diversion.

In a recent Boston Globe report they claim “very significant success” with this program after 18 months because they have cut opioid prescriptions by 6.6 million pills.

Dr. Dan Alford

Dr. Dan Alford

Is this really a measure of success and if so, for whom? It likely saves Blue Cross money but has it successfully achieved their program’s stated goals? Does decreased opioid prescribing mean more appropriate pain care? Does decreased opioid prescribing reduce the risk of addiction or diversion, or does it decrease access to a specific pain medication (opioids) for treating legitimate chronic pain? Is the observed decrease in opioid prescribing evidence that opioids have been overprescribed, as Blue Cross claims, or is it proof that instituting a barrier to opioid prescribing (prior authorization) will decrease prescribing even for legitimate need? Are patients with chronic pain really benefiting from this program? I doubt it.

Adding yet more paperwork for physicians will not improve pain care, decrease addiction or the numbers of accidental overdoses from prescription opioids. Those physicians who are unwilling (or ambivalent) to prescribe opioids even when indicated will use the prior authorization requirement as an excuse to continue not prescribing. Those who are overly liberal in prescribing will figure out the most efficient way to satisfy the insurance requirements for approvals. Physicians who responsibly prescribe opioids – that is, prescribing them only when the benefits outweigh any risks — will be saddled with more administrative burdens to justify their well thought-out treatment decisions.

Some physicians may ultimately decide that prescribing opioids isn’t worth the trouble despite known benefits for some patients. Continue reading

Citing Addiction Fears, Group Asks FDA To Revoke Painkiller Approval

Instant Vantage/flickr

Instant Vantage/flickr

By Judy Foreman
Guest Contributor

In an unusual move, a coalition of activists and physicians, concerned about the problem of prescription pain-reliever abuse, yesterday asked the U.S. Food and Drug Administration to revoke its approval of a new type of opioid called Zohydro. The medication is expected to be on the market soon.

“Too many people have already become addicted to similar opioid medications and too many lives have been lost,” said the Feb. 26 letter to the FDA, signed by a coalition of consumer health advocates, addiction treatment and health care providers.

But that request is provoking outrage and anxiety among chronic pain patients who applauded the FDA’s approval of the new medication last fall and would like to see Zohydro added to the list of prescription pain-relievers now on the market.

Zohydro is a type of opioid called hydrocodone and, in its chemical structure, is similar to morphine, said June Dahl, a professor of neuroscience at the University of Wisconsin School of Medicine and Public Health, in a telephone interview and email conversation.

“It’s an advantage to have another pure opioid agonist on the market and to have that agonist in a controlled release formulation,” said Dahl. She questioned, however, whether it is wise to allow the current formulation of Zohydro on the market right away, instead of waiting a few years for an abuse-deterrent, a formulation specifically designed to thwart abusers.

Until recently, the only hydrocodone-containing products on the market were combination medications such as Vicodin which contains both hydrocodone and acetaminophen. The major concern about Vicodin is actually not the opioid it contains but the acetaminophen (which is also the active ingredient in Tylenol), noted Dahl. (Last fall, the FDA took the first steps toward moving medications like Vicodin to a more restrictive category, which would limit the how easily patients could get refills.)

Zohydro is different from Vicodin in that it contains only hydrocodone, with no other ingredients. The company that makes Zohydro argues that this formulation makes the drug safer than the combination products.

Dr. James Cleary, a palliative care specialist at the University of Wisconsin, said in a telephone interview that “it is reasonable to have this product [Zohydro] out there.” Opioids are defined as “essential medications” by the World Health Organization and several other major groups, he added.

“Therefore we need to make sure they are available to appropriate patients and we need to establish a balanced system that also reduces abuse and diversion. We need to understand the opioid crisis much better.” Continue reading

Why Are More Women Overdosing On Painkillers?

By Judy Foreman
Guest Contributor

Overdose deaths linked to prescription pain relievers have increased dramatically among women in recent years, the Centers for Disease Control and Prevention announced yesterday.

And nobody really knows why.

Part of the increase may be due simply to a higher prevalence of chronic pain conditions in women, the CDC said, adding that “some of the most common forms of pain are more prevalent among women,” including abdominal pain, migraine and musculoskeletal pain.

Indeed, one of the more puzzling findings from the latest CDC figures is that the opioid-related overdose death rate was not highest among younger women, but among women aged 45 to 54.

painchartDr. Nora Volkow, director of the National Institute on Drug Abuse, suggested in an interview with The New York Times that this may in part reflect the fact that older women are appropriately prescribed pain relievers because they have more chronic pain. If death rates were driven purely by abuse, she said, then one would expect the death rates to be highest among younger women who are more likely to be abusers.

In addition, women on average weigh less than men – a fact that doctors may not sufficiently take into account – and therefore, at the same dose, may suffer more adverse effects. Continue reading

Dealing With Suffering Patients And The New Painkiller Rules

By Annie Ropeik
Guest Contributor

Imagine you’re a doctor facing a patient who has tried a host of different medications to treat his severe back pain. “Doctor,” he tells you, “nothing is working and I’m still in agony. I can’t work. I can’t sleep. You have to help me.”

Among the few options left to you is an opioid painkiller, such as morphine. You want to help your patient, but you’re caught in a dilemma: Opioids are not right for everyone, and they run the risk of addiction. But if you don’t prescribe them and your patient really needs them, he’ll suffer.

Dr. Dan Alford, Boston University School of Medicine

Finding the right alternative, or deciding if morphine is the right choice, can be tricky. You didn’t get enough training on the topic in medical school. And if you do prescribe the morphine, time-consuming paperwork (with added potential for error) now awaits you, under new insurance regulations that just came into effect this week.

This type of scenario concerns Dr. Dan Alford. He teaches at Boston University School of Medicine and directs the state program that trains doctors in how to safely handle the complexities of prescribing painkillers.

Opioid painkillers such as morphine, codeine, methadone and oxycodone are a complicated family of drugs that pose a serious addiction risk for many people. The state’s largest insurer, Blue Cross Blue Shield of Massachusetts is aiming to curb those risks with new regulations that tighten control on access to these drugs. Continue reading

Taking It To Feel Normal: My Oxycodone Experience

(AP)

It was a Sunday night. Perched on my bed, I went through my ritual and took a swig of water and swallowed the two small white pills in my orange prescription bottle. “This is it,” I told myself, “back to normal life.” After a successful spinal fusion surgery, I was ready to rid myself of the last of the oxycodone I had been taking for six weeks to manage the pain in my back.

“Sales of painkillers reached about $8.5 billion last year, compared with $4.4 billion in 2001, according to the consulting firm IMS Health.”
– The New York Times

The next morning, I skipped all of my daily doses. Nausea and weakness slowly started to creep into my body. I lay on my couch and flipped through the cable channels on TV, intent on not letting it get to me. But by Monday night, I lay in bed practically twitching, as an intense jittery feeling spread through my upper torso. I tossed and turned until dawn, breaking a sweat as I repeatedly stretched one arm, then the other, as something akin to having consumed several cans of Red Bull continued to wreak an internal havoc inside of me.

So on Tuesday night, after taking the day off from my part-time, work-from-home status, I gave up. I reached back into that bottle and swallowed two more pills. Within minutes, I started to feel more normal again.

This is what withdrawal feels like. Continue reading