Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Opioids. Show all posts
Showing posts with label Opioids. Show all posts

Monday, June 21, 2021

Drug Overdose Deaths Up 30% in Pandemic Year, Government Data Show

Joyce Frieden
MedPage Today 
Originally published 1 June 2021

Mortality from all types of drug overdoses increased by a whopping 30% over a 1-year period, Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), reported at the FDA Science Forum.

Data from the National Center for Health Statistics from October 2019 to October 2020 shows that mortality from overdoses from all types of drugs increased 30%, from 70,669 deaths in October 2019 to 91,862 deaths in October 2020, "and I think that that is a number that is very, very chilling," Volkow said at the forum. Among those overdose deaths in both years, more than half came from synthetic opiates -- "the most notable presence is fentanyl," she said. There was also a 46% increase in overdose deaths from other psychostimulants, mainly methamphetamine, and a 38% increase in deaths from cocaine overdoses.

Having any kind of substance use disorder (SUD) also affects the risk of getting COVID-19, she continued. According to a study done by Volkow and colleagues, "Regardless of the specific type of substance use disorder -- legal or illegal -- there was a significant increase in the likelihood of people that have a substance use disorder to become infected," she said. Their study, which included electronic health records from 7.5 million patients with an SUD diagnosis, found that patients with a recent SUD diagnosis -- within the past year -- were nearly nine times more likely to contract COVID-19 than patients without that diagnosis; for those with opioid use disorder in particular, their odds of contracting COVID were 10 times higher.

Friday, January 25, 2019

Study Links Drug Maker Gifts for Doctors to More Overdose Deaths

Abby Goodnough
The New York Times
Originally posted January 18, 2019

A new study offers some of the strongest evidence yet of the connection between the marketing of opioids to doctors and the nation’s addiction epidemic.

It found that counties where opioid manufacturers offered a large number of gifts and payments to doctors had more overdose deaths involving the drugs than counties where direct-to-physician marketing was less aggressive.

The study, published Friday in JAMA Network Open, said the industry spent about $40 million promoting opioid medications to nearly 68,000 doctors from 2013 through 2015, including by paying for meals, trips and consulting fees. And it found that for every three additional payments that companies made to doctors per 100,000 people in a county, overdose deaths involving prescription opioids there a year later were 18 percent higher.

Even as the opioid epidemic was killing more and more Americans, such marketing practices remained widespread. From 2013 through 2015, roughly 1 in 12 doctors received opioid-related marketing, according to the study, including 1 in 5 family practice doctors.

The info is here.

Tuesday, March 13, 2018

Doctors In Maine Say Halt In OxyContin Marketing Comes '20 Years Late'

Patty Wight
npr.org
Originally posted February 13, 2018

The maker of OxyContin, one of the most prescribed and aggressively marketed opioid painkillers, will no longer tout the drug or any other opioids to doctors.

The announcement, made Saturday, came as drugmaker Purdue Pharma faces lawsuits for deceptive marketing brought by cities and counties across the U.S., including several in Maine. The company said it's cutting its U.S. sales force by more than half.

Just how important are these steps against the backdrop of a raging opioid epidemic that took the lives of more than 300 Maine residents in 2016, and accounted for more than 42,000 deaths nationwide?

"They're 20 years late to the game," says Dr. Noah Nesin, a family physician and vice president of medical affairs at Penobscot Community Health Care.

Nesin says even after Purdue Pharma paid $600 million in fines about a decade ago for misleading doctors and regulators about the risks opioids posed for addiction and abuse, it continued marketing them.

The article is here.

Tuesday, January 9, 2018

Drug Companies’ Liability for the Opioid Epidemic

Rebecca L. Haffajee and Michelle M. Mello
N Engl J Med 2017; 377:2301-2305
December 14, 2017
DOI: 10.1056/NEJMp1710756

Here is an excerpt:

Opioid products, they alleged, were defectively designed because companies failed to include safety mechanisms, such as an antagonist agent or tamper-resistant formulation. Manufacturers also purportedly failed to adequately warn about addiction risks on drug packaging and in promotional activities. Some claims alleged that opioid manufacturers deliberately withheld information about their products’ dangers, misrepresenting them as safer than alternatives.

These suits faced formidable barriers that persist today. As with other prescription drugs, persuading a jury that an opioid is defectively designed if the Food and Drug Administration approved it is challenging. Furthermore, in most states, a drug manufacturer’s duty to warn about risks is limited to issuing an adequate warning to prescribers, who are responsible for communicating with patients. Finally, juries may resist laying legal responsibility at the manufacturer’s feet when the prescriber’s decisions and the patient’s behavior contributed to the harm. Some individuals do not take opioids as prescribed or purchase them illegally. Companies may argue that such conduct precludes holding manufacturers liable, or at least should reduce damages awards.

One procedural strategy adopted in opioid litigation that can help overcome defenses based on users’ conduct is the class action suit, brought by a large group of similarly situated individuals. In such suits, the causal relationship between the companies’ business practices and the harm is assessed at the group level, with the focus on statistical associations between product use and injury. The use of class actions was instrumental in overcoming tobacco companies’ defenses based on smokers’ conduct. But early attempts to bring class actions against opioid manufacturers encountered procedural barriers. Because of different factual circumstances surrounding individuals’ opioid use and clinical conditions, judges often deemed proposed class members to lack sufficiently common claims.

The article is here.

Saturday, November 11, 2017

Did I just feed an addiction? Or ease a man’s pain? Welcome to modern medicine’s moral cage fight

Jay Baruch
STAT News
Originally published October 23, 2017

Here are two excerpts:

Will the opioid pills Sonny is asking for treat his pain, feed an addiction, or both? Will prescribing it fulfill my moral responsibility to alleviate his distress, contribute to the supply chain in the illicit pill economy, or both? Prescribing guidelines from the Centers for Disease Control and Prevention and recommendations from medical specialties and local hospitals are well-intentioned and necessary. But they do little to address the central anxiety that makes this decision a source of distress for physicians like me. It’s hard to evaluate pain without making some judgment about the patient and the patient’s story.

(cut)

A good story shortcuts analytical thinking. It can work its charms without our knowledge and sometimes against our better judgment. Once an emotional connection is made and the listener becomes invested in the story, the believability of the story matters less. In fact, the more extreme the story, the greater its capacity to enthrall the listener or reader.

Stories can elicit empathy and influence behavior in part by stimulating the release of the neurotransmitter oxytocin, which has ties to generosity, trustworthiness, and mother-infant bonding. I’m intrigued by the possibility that clinicians’ vulnerability to deceit is often grounded in the empathy they are reported to be lacking.

The article is here.

Tuesday, September 26, 2017

Drug company faked cancer patients to sell drug

Aaron M. Kessler
CNN.com
Originally published September 6, 2017

When Insys Therapeutics got approval to sell an ultra-powerful opioid for cancer patients with acute pain in 2012, it soon discovered a problem: finding enough cancer patients to use the drug.

To boost sales, the company allegedly took patients who didn't have cancer and made it look like they did.

The drug maker used a combination of tactics, such as falsifying medical records, misleading insurance companies and providing kickbacks to doctors in league with the company, according to a federal indictment and ongoing congressional investigation by Sen. Claire McCaskill, a Democrat from Missouri.

The new report by McCaskill's office released Wednesday includes allegations about just how far the company went to push prescriptions of its sprayable form of fentanyl, Subsys.

Because of the high cost associated with Subsys, most insurers wouldn't pay for it unless it was approved in advance. That process, likely familiar to anyone who's taken an expensive medication, is called "prior-authorization."

The article is here.

Friday, May 12, 2017

US Suicide Rates Display Growing Geographic Disparity.

JAMA.
2017;317(16):1616. doi:10.1001/jama.2017.4076

As the overall US suicide rate increases, a CDC study showed that the trend toward higher rates in less populated parts of the country and lower rates in large urban areas has become more pronounced.

Using data from the National Vital Statistics System and the US Census Bureau, the researchers reported that from 1999 to 2015, the annual suicide rate increased by 14%, from 12.6 to 14.4 per 100, 000 US residents aged 10 years or older.

(cut)

Higher suicide rates in less urban areas could be linked with limited access to mental health care, the opioid overdose epidemic, and social isolation, the investigators suggested. The 2007-2009 economic recession may have caused the sharp upswing, they added, because rural areas and small towns were hardest hit.

The article is here

Wednesday, August 17, 2016

After their children died of overdoses, these families chose to tell the truth

By Alexandra Rockey Fleming
The Washington Post
Originally posted August 1, 2016

Here is an excerpt:

As opioid abuse rages and its legacy of overdose deaths continues to climb, more bereaved families are responding by publicly exposing addiction as the demon. Swapping openness for ambiguity in death notices — “died after a long struggle with addiction” replaces “died suddenly at home” — they are challenging the stigma and shame often bound up in substance abuse. Maybe more important, they’re sounding alarms about the far-reaching grasp of addiction.

“We want people to know that this can happen to anyone,” says Rosemary Roche, the mother of Jordan, who died last year at age 21. “Nobody is immune.”

The article is here.

Thursday, June 30, 2016

State's top physician endorses opioid education mandate

By Rich Lord
Pittsburgh Post-Gazette
Originally posted June 8, 2016

Pennsylvania’s top physician said today that legislation compelling most doctors to take refresher courses in proper narcotic prescribing won’t overburden her colleagues in medicine -- and could help to counter the opioid and heroin epidemic.

“The bill that’s being discussed would be requirements for two hours of opioid education,” said Physician General Rachel Levine. “But it would also count toward [every doctor’s] quality and safety [education] requirement.”

Some doctors have said they don’t want to be told which continuing education courses to take. “But I think that there are sometimes topics that are so necessary to get updated on that all physicians should get updated,” Dr. Levine said. Opioid prescribing is one such topic, she said, “because of the very serious nature of the epidemic.”

The article is here.

When regulators close a 'pill mill,' patients sometimes turn to heroin

By Rich Lord
Pittsburgh Post-Gazette
Originally published May 25, 2016

Here is an excerpt:

In late 2013, Maryland launched its prescription drug monitoring program, allowing — but not requiring — doctors to access a database to see the drug histories of their patients. Nearly every state has such a system, designed to thwart people who seek drugs from multiple doctors. Some state medical boards use the data to flag physicians whose prescribing goes out of bounds.

Maryland’s board, though, can’t tap into the data “without going through major legal hoops,” Dr. Singh said. Physician groups, he said, have opposed efforts to ease access, because they fear “over-policing.”

Maryland has not adopted official opioid prescribing guidelines, as some states have.

The article is here.

Thursday, May 19, 2016

FDA Reconsiders Training Requirement for Painkillers

BY Matthew Perrone
AP HEALTH WRITER
Originally published April 29, 2016

The Food and Drug Administration is reconsidering whether doctors who prescribe painkillers like OxyContin should be required to take safety training courses, according to federal documents.

The review comes as regulators disclosed that the number of doctors who completed voluntary training programs is less than half that targeted by the agency.

A panel of FDA advisers meets next week to review risk-management plans put in place nearly four years ago to reduce misuse and abuse of long-acting painkillers, powerful opioid drugs at the center of a national wave of abuse and death.

The article is here.

Sunday, March 9, 2014

How A Big Drug Company Inadvertently Got Americans Hooked On Heroin

By Jillian Berman
The Huffington Post
Originally posted February 24, 2014

Here is an excerpt:

In recent years, more prescription drug abusers have started turning to heroin for a cheaper high as the price of pills skyrockets on the black market, Bunt said. Two factors have contributed to the cost increase: opioid addiction boosting demand and doctors becoming more cautious about prescribing opioids, decreasing supply, Bunt said.

Another reason for the price increase: The Drug War, according to a January 2012 report from Radley Balko. Government crackdowns have made it difficult for even reputable doctors to prescribe pain pills. To fill the void, doctors and others looking to make a buck off the prescription pills created so-called "pill mills" -- offices that prescribe pain medication in high volume and often serve people addicted to the drugs.

The entire article is here.

Tuesday, August 20, 2013

Medicare Drug Program Fails to Monitor Prescribers, Putting Seniors and Disabled at Risk

by Tracy Weber, Charles Ornstein and Jennifer LaFleur
ProPublica
Published: May 11, 2013

Ten years ago, a sharply divided Congress decided to pour billions of dollars into subsidizing the purchase of drugs by elderly and disabled Americans.

The initiative, the biggest expansion of Medicare since its creation in 1965, proved wildly popular. It now serves more than 35 million people, delivering critical medicines to patients who might otherwise be unable to afford them. Its price tag is far lower than expected.

But an investigation by ProPublica has found the program, in its drive to get drugs into patients' hands, has failed to properly monitor safety. An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive. Federal officials have done little to detect or deter these hazardous prescribing patterns.

The entire story is here.

Thursday, August 15, 2013

Increase in Urine Testing Raises Ethical Questions

By BARRY MEIER
The New York Times
Published: August 1, 2013

As doctors try to ensure their patients do not abuse prescription drugs, they are relying more and more on sophisticated urine-screening tests to learn which drugs patients are taking and — just as important — which ones they’re not.

The result has been a boom in profits for diagnostic testing laboratories that offer the tests. In 2013, sales at such companies are expected to reach $2 billion, up from $800 million in 1990, according to the Frost & Sullivan consulting firm.

The growing use of urine tests has mirrored the rise in prescriptions for narcotic painkillers, or opioids. But the tests, like earlier efforts to monitor opioid prescribing, have led to a host of vexing questions about what doctors should do with the information they obtain, about the accuracy of urine screens and about whether some companies and doctors are financially exploiting the testing boom.

The entire story is here.

Tuesday, July 16, 2013

Sharp Rise in Drug Overdoses Among U.S. Women: CDC

By Steven Reinberg
MedicineNet.com
Originally posted July 2, 2013

The rate of fatal overdoses of prescription painkillers and other drugs among U.S. women quadrupled between 1999 and 2010, federal officials reported Tuesday.

Long thought of as primarily a male problem, drug addiction is increasingly affecting women, and the new study from the Centers for Disease Control and Prevention estimates that 42 women in the United States die each day from prescription drug overdoses.

"Prescription drug overdose deaths have skyrocketed in women," CDC Director Dr. Thomas Frieden said during a noon press conference. "Mothers, wives, sisters and daughters are dying from overdoses at rates we have never seen before."

(cut)

Other statistics, based on 2010 data:

  • Suicides from these drugs accounted for 34 percent of all suicides among women, compared with 8 percent among men.
  • More than 940,000 women were seen in emergency departments for drug misuse or abuse.
  • More than 6,600 women, or 18 women every day, died from a prescription painkiller overdose.
  • Narcotic painkillers accounted for four times more deaths among women than deaths linked to cocaine and heroin combined.
  • More than 200,000 emergency department visits were for misuse or abuse of these drugs among women -- about one every three minutes.

The entire story is here.

Wednesday, April 10, 2013

Prescription drug-related deaths continue to rise in U.S.

By Scott Glover and Lisa Girion
The Los Angeles Times
March 29, 2013

Despite efforts by law enforcement and public health officials to curb prescription drug abuse, drug-related deaths in the United States have continued to rise, the latest data show.

Figures from the U.S. Centers for Disease Control and Prevention reveal that drug fatalities increased 3% in 2010, the most recent year for which complete data are available. Preliminary data for 2011 indicate the trend has continued.

The figures reflect all drug deaths, but the increase was propelled largely by prescription painkillers such as OxyContin and Vicodin, according to just-released analyses by CDC researchers.

The numbers were a disappointment for public health officials, who had expressed hope that educational and enforcement programs would stem the rise in fatal overdoses.

“While most things are getting better in the health world, this isn’t,” CDC director Tom Frieden said in an interview. “It’s a big problem, and it’s getting worse.”

Drugs overtook traffic accidents as a cause of death in the country in 2009, and the gap has continued to widen. (Italics and color added).

The entire story is here.

Tuesday, February 28, 2012

Chronic Pain Fuels Boom in Opioids

By John Fauber
Milwaukee Journal Sentinel/MedPage Today
Originally published on February 19, 2012

Prescriptions for narcotic painkillers soared so much over the last decade that by 2010 enough were being dispensed to medicate every adult in the U.S. around-the-clock for a month.

Fueling that surge was a network of pain organizations, doctors, and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the very companies that made them, a Journal Sentinel/MedPage Today investigation found.

Last year, the Journal Sentinel/MedPage Today found that a University of Wisconsin-Madison-based organization had been a national force in helping liberalize the way opioids are prescribed and viewed. During a decade-long campaign that promoted expanded use of opioids -- an agenda that critics say was not supported by rigorous science -- the UW Pain & Policy Studies Group received $2.5 million from makers of opioid analgesics.

After that article was published last April, the UW Pain group said it had decided to stop taking money from the drug industry.

(cut)

The Pendulum Swings Back

Several of the pain industry's core beliefs about chronic pain and opioids are not supported by good science and contributed to the growing use of the drugs, a Journal Sentinel/MedPage Today review of records and interviews found.

Among the misconceptions:
  • The risk of addiction is low in patients who obtain their narcotic painkillers legitimately.
  • There is no maximum dose of the drugs that can't be safely prescribed.
  • People who seek more frequent prescriptions or higher doses of the drugs aren't addicts, they are "pseudoaddicts" who just need more pain relief and more opioids.

Underlying those fallacies, critics say, is an even larger one: That the use of narcotic painkillers to treat non-cancer pain lasting many months or years is supported by rigorous science.

Even doctors who have financial relationships with companies that make narcotic painkillers concede that the practice of pain medicine got ahead of the science.
Lynn Webster, MD, a Utah pain specialist who has worked as a consultant and adviser to most of the companies in the opioid analgesic market, said the pain community got some of it wrong.

"We overshot our mark, all well-intended, I believe," Webster, an officer of the American Academy of Pain Medicine, said in an interview. "We certainly have a lot of reverse education that needs to occur."

Some chronic pain sufferers do benefit from the drugs, Webster said.

"The problem is pain is complex," he said. "There is a whole family of opioids and we have not figured out how to best identify the individuals who can benefit long term.

"I don't think industry was trying to harm anyone. I think industry was trying to fill a need that we as physicians saw."

Others say that Webster is too forgiving in his analysis: they claim that the pharmaceutical industry chose profits over patient safety.

Friday, August 5, 2011

Prescription pain medication addiction prevalent among chronic pain patients

News Release

A new study by Geisinger Health System researchers finds a high prevalence of prescription pain medication addiction among chronic pain patients. In addition, researchers found that the American Psychiatric Association’s (APA) new definition of addiction, which was expected to reduce the number of people considered addicts who take these medicines, actually resulted in the same percentage of people meeting the criteria of addiction.

Published in the Journal of Addictive Diseases, the study found that 35 percent of patients undergoing long-term pain therapy with opioids like morphine, OxyContin, Percocet and Vicodin, meet the criteria for addiction.

“Most patients will not know if they carry the genetic risk factors for addiction,” said study lead Joseph Boscarino, senior investigator II, Geisinger Health System. “Improper or illegal use of prescription pain medication can become a lifelong problem with serious repercussions for users and their families.”
Boscarino added that “genetic predisposition to addiction further exacerbates the risks associated with misuse of prescription pain medication.”

Using electronic health records, a random sample of outpatients undergoing long-term opioid therapy for non-cancer pain was identified and 705 participants completed telephone interviews from August 2007 through November 2008.

When comparing the APA’s newly revised criteria for addiction with the old criteria, researchers were surprised to find the prevalence of and risk factors for addiction to be virtually the same. It was determined that different symptoms now qualify the same patients for inclusion who would have been excluded under the previous classification system.

The study states that pain medication addiction often happens in people under 65, with a history of opioid abuse, withdrawal symptoms and substance abuse treatment. Risk factors for severe pain medication addiction also include a history of anti-social personality disorder.

“Ultimately, we hope our research will aid the development of newer classes of medications that don’t negatively impact the brain and therefore avoid addiction entirely,” Boscarino said.

Researchers from New York University also contributed to the study.