Doctor Housecalls Blog

Healthcare related news and updates



Synthetic Opioids Cause More Overdose Deaths Than Prescription Opioids

In 2016, opioid overdose deaths involving synthetic opioids surpassed those involving prescription opioids. The LA Times reported that there were a total of 42,249 overdose deaths from opioids. Over 19,000 of those were from synthetic opioids, over 17,000 were from prescription opioids, and over 15,000 were from heroin (some cases involved more than one type of drug). That means 46% of all opioid deaths were due to synthetic opioids, as opposed to 40% from prescription opioids. 

In 2015 there were more opioid overdose deaths from prescription opioids than synthetic. However, there was a shift and the overdose deaths from synthetic opioids doubled between 2015 and 2016. According to Emily Einstein, of the of the National Institute on Drug Abuse, drug enforcers have been hyper focused on prescription opioids, when in more recent years the biggest threat has been the rise in synthetic opioids.

The increase in drug overdose deaths in the United States is largely due synthetic opioids, like the most common synthetic opioid, illicitly manufactured fentanyl (IMF). “IMF is mixed into counterfeit opioid and benzodiazepine pills, heroin, and cocaine, likely contributing to increases in overdoses involving these other substances,” according to the CDC. Fentanyl is extremely dangerous because the effects are active at much lower doses.



How to Get Rid of Knee Pain

About 18% of the population suffers from knee pain. For some people it comes from knee or hip injuries and for others it may just come with age. Knee pain can be so bad that it forces people to stop having an active lifestyle and become sedentary. However, that can only make the knee pain worse and there are many things you can do to reduce or even eliminate knee pain. Here are some tips to help alleviate knee pain. 

  1. Stay active. Exercising and maintaining an active lifestyle is one of the best ways to prevent and get rid of knee pain. Your joints need movement. Never stop exercising because you think it is causing knee pain, that will only make the pain worse. Just change up the kinds of exercise you engage in.  
  2. Low impact activities. Swimming and cycling are two examples of low impact activities that do not put as much pressure on your knees. These are both great ways to stay active and lessen the pain in your knees.  
  3. Stretch. Knee pain can be reduced when you stretch the muscles that surround your knee. That means stretching your calfs, thighs, hamstrings, quadriceps, gastrocnemius, and soleus on a regular basis.
  4. Buy good shoes. The shoes you wear effect the amount of impact your knees take. The amount of pressure to your knees can depend on how much cushion and support your walking and running shoes have. Be sure to find the best shoes for your body.  
  5. Alternate between hot and cold compressions. Both heat and ice treatments are good for stimulating blood flow and reducing inflammation in your knees.  
  6. Wear a brace. If you are suffering with knee pain while walking or exercising, wearing a brace can provide the support your knees need and help alleviate knee pain. 

 



CNBC reports that 80 percent of the world’s opioid supply is used in the United States, despite the fact that Americans only make up five percent of the world’s population. According to professor Vikesh Singh of the Pancreatitis Center at Johns Hopkins University, the figure goes up to 95 percent if Canada and Eastern Europe are included. This consumption of opioids is primarily in the form of pain medication, which indicates that Americans consume more pain drugs than any other population around the world.

http://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html



The Washington Post (10/22, Mufson, Zezima, 6.76M) reported that President Obama made his announcement in West Virginia, which has been so hard hit by the opiate epidemic.  The new measures by the Federal government will include increasing access to drug treatment as well as expanding the training of doctors who prescribe opiates.  Other specific programs include doubling the physicians who are able to prescribe buprenorphine to 60,000 over the next three years and doubling the number of providers that can prescribe naloxone.  Buprenorphine is a drug used to treat opiate addiction, and naloxone is used to reverse the effects of an opioid overdose. 

 Reuters (10/22, Edwards) also reported on the new measures and indicated that President Obama directed the Centers for Disease Control and Prevention to invest $8.5 million in opioid addiction prevention.  According to Reuters, the CDC reports that 45 percent of heroin users in the U.S. are also addicted to prescription opiates.

HealthDay (10/22, Mundell, 5K) reported on these developments as well, relaying disturbing numbers from the Journal of the American Medical Association on the scope of the problem.  Their latest study found that the rate of fatal prescription drug overdoses has nearly doubled in the last decade.  The federal government has plans to work with the American Medical Association, the American College of Emergency Physicians, and other groups to help train more than 540,000 health care workers on matters relating to prescription opioids.

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Steven J. Lipsky MD, FACEP has been a Board Certified Emergency Physician in Arizona for the last 37 years, and a resident of the Town of Paradise Valley for the last 37 years. Steve Lipsky on Google Plus[/author_info] [/author]



Pain medicines like ibuprofen will be receiving new, stronger warnings from the Food and Drug Administration due to increased risk for heart attacks and strokes.  This includes over the counter brands like Advil, Motrin, and Aleve.

According to a June 9 article on Nytimes.com by Sabrina Tavernise, new data shows an increased risk of heart failure for those who take these drugs, otherwise known as NSAIDS.  While the change is subtle, the FDA is asking manufacturers to update their labels from the current verbiage (“may cause” increased risk), to “cause an increased risk.”  Additional changes include warning consumers that the risk can occur early in treatment and may increase the longer someone is taking the drugs.

“Everyone may be at risk, even people without an underlying risk for cardiovascular disease,”  says Dr. Judy Racoosin, the deputy director of the F.D.A.’s Division of Anesthesia, Analgesia and Addiction Products, in a statement.

An FDA spokesperson says the changes will affect both prescription and over the counter versions of the drug.  They also said in their statement that those with heart conditions should ask their doctor before taking any NSAIDS.

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Steven J. Lipsky MD, FACEP has been a Board Certified Emergency Physician in Arizona for the last 37 years, and a resident of the Town of Paradise Valley for the last 36 years. Steve Lipsky on Google Plus[/author_info] [/author]



Study: Medical marijuana may help rein in painkiller overdoses.

by Dr. Steven J. Lipsky MD, FACEP

The legalization of medical marijuana has been sweeping the nation. As of June 2014, 23 states have legalized medical marijuana with several others pending legislation. Recent research has sparked a new debate over whether medical marijuana could be the answer to help stem the rising tide of prescription painkiller overdoses. In an article published by USA Today (8/25, Hughes), federal officials pointed out that prescription painkillers are among the most abused prescription medicines in the U.S., responsible for the deaths of more than 15,000 Americans annually

The study  published in the journal JAMA Internal Medicine received national media coverage in major newspapers and at least one prominent news agency. While several media outlets highlighted that states that have medical marijuana laws in place reported declining deaths due to opioid overdoses, others suggested more studies were needed, quoting experts who cautioned against drawing a direct causal link.

In August, the Washington Post (8/25, Millman) picked up the study in their “Wonkblog.” Research found that states with medical marijuana laws saw 24.8% fewer deaths from painkiller overdoses compared to states that didn’t have such laws. This translated into 1,729 fewer deaths than expected in 2010 alone, and an improvement in overdose rates with medical marijuana laws.

The Los Angeles Times (8/26, Healy) also reported on the study, highlighting the decline in deaths linked to opiate drugs after legalizing medical marijuana in 13 states. In fact, the study points outs that states with formal laws allowing legal medical marijuana experienced a steady drop in opiate-related overdoses, reaching, on average, that 33%, five and six years after the states’ medical marijuana laws were implemented.

In an email to Reuters (8/26, Doyle) lead author of the study, Dr. Marcus A. Bachhuber commented on the studying saying, “Most of the discussion on medical marijuana has been about its effect on individuals in terms of reducing pain or other symptoms. The unique contribution of our study is the finding that medical marijuana laws and policies may have a broader impact on public health.” Dr. Bachhuber and his team at the Philadelphia Veterans Affairs Medical Center, examined state medical marijuana laws and opioid overdose deaths using death certificate data from all 50 states from 1999 to 2010. While overdose deaths continued to fall in states with medical marijuana law, overdose deaths across the US rose sharply, from 4,030 in 1999 to 16,651 in 2010, according to data from the CDC.

ABC News (8/25, Zimmerman) also covered the story in its “Medical Unit” blog quoting that the researchers who conducted the new study suggest “that because legalizing medical marijuana makes it more available to chronic pain patients, it provides a potentially less lethal alternative to pain control on a long-term basis.”

The Boston Globe (8/25, Rice), however, wonders whether Massachusetts is an anomaly because in that state, where Gov. Deval Patrick (D) has “declared a ‘public health emergency,’ the number of deaths due to opioid overdoses has increased by 90 percent from 2000 to 2013.” The article notes that “voters legalized medical marijuana in a November 2012 ballot initiative.”

Criticism and skepticism surrounds the study, even from those closely tied to it. The strongest criticism of the study came from Kevin Sabet, director of the Drug Policy Institute at the University of Florida College of Medicine. In an interview with USA Today (8/25, Hughes) Sabet expresses his concerns about how the study’s authors collected and analyzed the data. “They failed to differentiate between states with strict and lax medical marijuana laws, and didn’t examine emergency-room admission and prescription data, and failed to see what impact methadone clinics might have had.” Sabet finds it hard to believe there has been such an across-the-board reduction in predicted deaths.

The study was also covered by CNN (8/26, Young), TIME (8/26, Sifferlin), Vox (8/26, Lopez), The Hill (8/26, Al-Faruque), Newsweek (8/26, Main), HealthDay(8/26, Thompson), Medscape (8/26, Anderson) and Modern Healthcare (8/26, Johnson, Subscription Publication).



Back Pain and Blood Pressure – Save Yourself this Holiday Season!
STEVEN J. LIPSKY MD, FACEP

This month we discuss drug-free ways to relieve back pain and lower your blood pressure:

1) Back Pain – It has been estimated that 1 to 4 out of 5 Americans will develop back pain sometime within their lifetime. Correct posture, standing and sitting tall instead of hunched over helps relieve discomfort caused by disk and vertebral compression.

Flatten the spine when standing as if sitting, and keep your weight evenly distributed on both feet — more on the heels than on the balls. Use a straight-back chair when sitting, with the buttocks square on the seat and feet flat on the floor. Align the spine by rolling the shoulders back and down 5 times. Then with the head in a neutral position looking forward, look as far upward and backward as possible, extending your neck. Return to the neutral position, and look upward and backward again even further. Return to the neutral position, and look upward and backward even further, a third time. Do this set of exercises hourly when sitting at a work desk/computer. This will help relieve upper back and neck tension/pain.

For lower back pain, lying on one’s back with pillows behind the knees and a 3″ wide rolled across the back of the neck relieves discomfort. Alternatively, lying on one’s side with a pillow between the knees and another under the side of the head works wonders.

Massage, Hatha Yoga, Pilates, spinal stretching, cold or heat applications, and acupuncture are other non-drug therapies that work as well. Furthermore, doing daily back and abdominal core muscle strengthening exercises both relieves and prevents back strain. And Finally, never sleep prone (i.e. on one’s stomach) or on a soft mattress.

2) Blood Pressure – At least 30minutes of aerobic exercise daily (e.g. brisk walking, swimming, or jogging) has been shown to reduce hypertension. Losing just 10 pounds of weight helps, especially for men and women with waistlines greater than 40″ and 30″, respectively.

Avoiding saturated fats and salt (no more that 1500mg/day has been recommended for everyone), and eating plenty of fresh fruits and vegetables, whole grains, low-fat dairy products, and at least 3 servings of cold water fish like wild salmon/wk (i.e. the DASH diet–Dietary Approaches to Stop Hypertension) is beneficial. Alcohol and tobacco products damage arteries, which can lead to hypertension, so limit or eliminate their use.

Cut back on caffeinated drinks such as coffee, tea, and soft drinks. Take Vitamin C, Calcium, and Magnesium supplements, which all have been shown to decrease blood pressure/arterial wall tension.

Finally, reduce stress and anxiety that can cause blood pressures to spike. Do this by trying any form of meditation, deep breathing exercises such as the East Indian study of Prahnayahma, or yoga.

No one likes the hassle or expense of having to take prescription medications. Hopefully by taking the above advice into consideration, anyone with these medical conditions can avoid or reduce the need.


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