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

Tuesday, July 26, 2022

U.S. drug overdose deaths reached all-time high in 2021, CDC says

Berkeley Lovelace Jr.
NBC.com
Originally posted 11 MAY 22

More than 107,600 Americans died from drug overdoses last year, the highest annual death toll on record, the Centers for Disease Control and Prevention said Wednesday.

Overdose deaths increased 15 percent in 2021, up from an estimated 93,655 fatalities the year prior, according to a report from the CDC’s National Center for Health Statistics (NCHS), which collects data on a range of health topics, including drug use.

While the total number of deaths reached record highs, the increase appeared to slow compared to the change seen from 2019 to 2020, when overdose deaths rose 30 percent, according to the report.

It's still too early to say whether that slowdown will hold, said Farida Ahmad, a scientist at the health statistics center. The agency's latest report is considered provisional, meaning the data is incomplete and subject to change.

Even if the increase in overdose deaths is smaller compared to last year, the 2021 total is still a huge number, Ahmad said.

The data helps illustrate one of the consequences of the pandemic, which has seen an uptick in substance abuse amid widespread unemployment and more Americans reporting mental health issues.

Overdose-related deaths were already increasing before the pandemic, but there was "clearly a very sharp uptick during the pandemic," said Joseph Friedman, an addiction researcher at the University of California, Los Angeles. He published research in April that found drug overdose deaths among teenagers rose sharply over the last two years.

According to the NCHS report, fentanyl, a powerful synthetic opioid, was involved in the most overdose deaths in 2021: 71,238.

Wednesday, February 9, 2022

How FDA Failures Contributed to the Opioid Crisis

Andrew Kolodny, MD
AMA J Ethics. 2020;22(8):E743-750. 
doi: 10.1001/amajethics.2020.743.

Abstract

Over the past 25 years, pharmaceutical companies deceptively promoted opioid use in ways that were often neither safe nor effective, contributing to unprecedented increases in prescribing, opioid use disorder, and deaths by overdose. This article explores regulatory mistakes made by the US Food and Drug Administration (FDA) in approving and labeling new analgesics. By understanding and correcting these mistakes, future public health crises caused by improper pharmaceutical marketing might be prevented.

Introduction

In the United States, opioid use disorder (OUD) and opioid overdose were once rare. But over the past 25 years, the number of Americans suffering from OUD increased exponentially and in parallel with an unprecedented increase in opioid prescribing. Today, OUD is common, especially in patients with chronic pain treated with opioid analgesics, and opioid overdose is the leading cause of accidental death.

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Oversight Recommendations

While fewer clinicians are initiating long-term opioids, overprescribing is still a problem. According to a recently published report, more than 2.9 million people initiated opioid use in December 2017. The FDA’s continued approval of new opioids exacerbates this problem. Each time a branded opioid hits the market, the company, eager for return on its investment, is given an incentive and, in essence, a license to promote aggressive prescribing. The FDA’s continued approval of new opioids pits the financial interests of drug companies against city, state, and federal efforts to discourage initiation of long-term opioids.

To finally end the opioid crisis, the FDA must enforce the Food, Drug, and Cosmetic Act, and it must act on recommendations from the NAS for an overhaul of its opioid approval and removal policies. The broad indication on opioid labels must be narrowed, and an explicit warning against long-term use and high-dose prescribing should be added. The label should reinforce, rather than contradict, guidance from the CDC, the Department of Veterans Affairs, the Agency for Healthcare Research and Quality, and other public health agencies that are calling for more cautious prescribing.

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.

Friday, September 8, 2017

Study questions why thousands with developmental disabilities are prescribed antipsychotics

Peter Goffin
The Toronto Star
Originally published August 23, 2017

Researchers with the Centre for Addiction and Mental Health and the Institute for Clinical Evaluative Sciences have called for “guidelines and training around antipsychotic prescribing and monitoring” for doctors, pharmacists and care home staff after finding that nearly 40 per cent of people with developmental disabilities were prescribed antipsychotic drugs at some point over a six-year period.

One-third of the patients prescribed antipsychotics had no documented diagnosis of mental illness, according to the study, which tracked more than 51,000 people with developmental disabilities who are eligible for provincial drug benefits.

“We don’t know, with the data, why this one person was prescribed or this (other) person was prescribed so we’re trying to almost guess at why,” said psychologist Yona Lunsky, lead author of the study.

“It could be behaviour, aggression, self-injury, agitation.”

For people with developmental disabilities who live in group homes, the rate of antipsychotic prescriptions was even higher.

About 56 percent of developmentally disabled group home residents were prescribed antipsychotics. Of those, around 43 percent had no documented mental health issues.

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.

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, April 17, 2012

Military's increased use of medications under fire

Army has seen eightfold increase since 2005
by Kim Murphy
The Los Angeles Times
Originally published April 8, 2012

U.S. Air Force pilot Patrick Burke’s day started in the cockpit of a B-1B bomber near the Persian Gulf and proceeded across nine time zones as he ferried the aircraft home to South Dakota.

Every four hours during the 19-hour flight, Burke swallowed a tablet of Dexedrine, the prescribed amphetamine known as “go pills.” After landing, he went out for dinner and drinks with a fellow crewman. They were driving back to Ellsworth Air Force Base when Burke began striking his friend in the head.

“Jack Bauer told me this was going to happen – you guys are trying to kidnap me!” he yelled, as if he were a character in the TV show “24.”

When the woman giving them a lift pulled the car over, Burke leaped on her and wrestled her to the ground. “Me and my platoon are looking for terrorists,” he told her before grabbing her keys, driving away and crashing into a guardrail.

Burke was charged with auto theft, drunken driving and two counts of assault. But in October, a court-martial judge found the young lieutenant not guilty “by reason of lack of mental responsibility” – the almost unprecedented equivalent, at least in modern-day military courts, of an insanity acquittal.

The entire story is here.

Wednesday, September 21, 2011

Antipsychotics overprescribed in nursing homes

By M. Price
September 2011, Volume 42, No. 8
Print Version: Page 11

Physicians are widely prescribing antipsychotics to people in nursing homes for off-label conditions such as dementia, and Medicare is largely picking up the bill, even though Medicare guidelines don't allow for off-label prescription reimbursements, according to an audit released in May by the U.S. Department of Health and Human Services Office of the Inspector General.

The findings underscore the fact that antipsychotics are often used when behavioral treatments would be more effective, psychologists say.

The office reviewed Medicare claims of people age 65 and older living in nursing homes in 2007—the most recent data at the time the study began—and found that 51 percent of all claims contained errors, resulting $116 million worth of antipsychotics such as Abilify, Risperdal and Zyprexa being charged to Medicare by people whose conditions didn't match the drugs' intended uses. Among the audit's findings are:
  • 14 percent of the 2.1 million elderly people living in nursing homes use Medicare to pay for at least one antipsychotic prescription.
  • 83 percent of all Medicare claims for antipsychotics are, based on medical reviews, prescribed for off-label conditions, specifically dementia.
  • 22 percent of the claims for antipsychotics do not comply with the Centers for Medicare and Medicaid Services' guidelines outlining how drugs should be administered, including those guidelines stating that nursing home residents should not receive excessive doses and doses over excessive periods of time.
The report suggests that Medicare overseers reassess their nursing home certification processes and develop methods besides medical review to confirm that medications are prescribed for appropriate conditions.

Why such high rates of overprescription for antipsychotics? HHS Inspector General Daniel Levinson argued in the report that pharmaceutical companies' marketing tactics are often to blame for antipsychotics' overprescribing. Victor Molinari, PhD, a geropsychologist at the University of South Florida in Tampa, says that another important issue is the dearth of psychologists trained to provide behavioral interventions to people in nursing homes. While he agrees that people in nursing homes are taking too much antipsychotic medication, he believes nursing home physicians are often responding to a lack of options.

Many nursing home administrators are quite savvy in their mental health knowledge and would prefer to offer their residents the option of behavioral treatments, Molinari says, but when residents need immediate calming, physicians will turn to antipsychotic medication because it's quick and available. Additionally, he says, many nursing home staff aren't educated enough about nonmedical options, so they go straight for the antipsychotics.

"It follows the saying, 'If your only tool is a hammer, everything is a nail,'" he says. "Nursing homes are not just straitjacketing residents with medications as a matter of course, but because there are a host of barriers to giving them optimal care."