Doctor Housecalls Blog

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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.



Antibiotics – Are You Taking Them for Longer Than You Should?

According to a study published in JAMA Internal Medicine, many doctors are prescribing antibiotics to patients who are suffering with sinus infections for durations that are too long. Infectious disease doctors recommend only taking acute sinus infection antibiotics for five to seven days, yet many people are taking them for ten or more days.

“Any time antibiotics are used, they can cause side effects and lead to antibiotic resistance,” Dr. Katherine Fleming-Dutra, deputy director of the Office of Antibiotic Stewardship at the U.S. Centers for Disease Control and Prevention in Atlanta, explained. The findings published recommend that people only take antibiotics when absolutely necessary and to only take them for the minimum effective duration.

Side effects for antibiotics include: rash, dizziness, nausea, diarrhea, and yeast infections, as well as life threatening allergic reactions. They can also cause Clostridium difficile infection, which can lead to severe colon damage.

When antibiotics are over prescribed and used for longer time periods, bacteria develop the ability to beat the drug, causing the antibiotic to lose its effectiveness in the future. For acute sinus infections, patients typically  recover within 5-7 days. Therefore, there is no need to take an antibiotic for longer and risk becoming immune to it. The reason many people take antibiotics for too long is largely due to people firmly believing they should take their full prescription and many doctors have not yet switched to the new guidelines. Most doctors are still prescribing these antibiotics for 10 or more days.

“Older . . . acute bacterial sinusitis guidelines were written with the belief that if antibiotics were taken for shorter durations of time, that the bacteria would not be completely eradicated and that would risk persistent, recurrent and antibiotic resistant infections,” said Dr. Sharon Meropol, a researcher at Case Western Reserve University School of Medicine in Cleveland, Ohio, who wasn’t involved in the study. However, the recommendations for this have changed after several subsequent studies. The medical community learned that it not necessary to stay on antibiotics for acute sinus infections for 10 or more days, and doing so can make you resistant to the drug.



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



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).



Obama Administration Unveils Plan to Battle Antibiotic Resistance.

by Dr. Steven J. Lipsky MD, FACEP

Antibiotic resistance is on the rise and the Obama Administration has put together a plan to combat the issue. Major newspapers, wire services, and online healthcare-related outlets published coverage of the news conference held late last week. In a news conference, the President’s chief science advisor announced plans to improve antibiotics through new drug development; reining in antibiotic misuse and developing diagnostic testing to help doctors and veterinarians decide when antibiotics are truly needed.

John Holdren, director of the White House Office of Science and Technology Policy sees antibiotic resistance as a potential threat to not only the nation but the world. “The rise in antibiotic-resistant bacteria represents a serious domestic and international challenge to human and animal health, national security and the economy” USA Today (9/19, Weintraub).

According to Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention, combating antibiotic resistance is vital to maintaining our current standards of medical care. “Antibiotic resistance is linked to at least 23,000 death and two million illnesses each year.” Frieden also notes that in addition to treating bacterial infections, antibiotics also help with complications arising from conditions like cancer, arthritis and asthma. “If we lose the ability to treat these, we will undermine much of our current medical care system.”

Researchers have been warning for years that antibiotics are losing their strength due to overuse. The New York Times (9/19, A16, Tavernise, Subscription Publication) reports that if this trend of overuse is not “halted, we could return to the time before antibiotics, when it was common for people to die from ordinary infections and for children not to survive strep throat.” According to Holdren, the new strategy – established by an executive order signed by the President – is intended to jolt the federal government into action to begin aggressively addressing a health crisis experts have been slow to recognize.

The President is mobilizing a special task force comprised of key federal agencies. As reported in The Los Angeles Times (9/19, Morin) “Science Now” blog, the task force, co-chaired by the secretaries of Defense, Agriculture and Health and Human Services, “will oversee public, private and academic efforts to minimize the spread of superbugs by promoting the proper use of antibiotics; the acceleration of scientific research into new antibacterial drugs and novel therapies; and the creation of new diagnostic technologies that will identify drug-resistant bacteria.” In addition, the National Institutes of Health and the Biomedical Advanced Research and Development Authority are working in conjunction with the White House to co-sponsor a contestant for the development of diagnostic testing that will rapidly identify superbugs. On the line is a $20 million prize.

The administration’s national strategy with a five-year plan calls for the new presidential advisory council to make special recommendations to the White House by February 2015. It is a strategy with a targeted goal of reducing the overall incidences of Clostridium difficile, also known as C-diff, by 50 percent, and cutting the number of methicillin-resistant Staphylococcus aureus (MRSA) infections by 2020 in half. Additionally, the President’s Council of Advisors on Science and Technology (PCAST) released a 78-page document “outlining practical steps the government can take to both track resistant germs and develop novel antibiotics to treat bacterial infections” as reported in the Washington Post (9/19, Nutt).

Critics had hoped the White House would go one step further and address the use of antibiotics in animals, particularly those used for meat. The AP (9/19, Jalonick) reported that the executive order directs the Food and Drug Administration to “to continue taking steps to eliminate agricultural use of medically important antibiotics for growth-promotion purposes.”

For additional information on the subject, including information pertaining to the use Additional coverage of the issue can be found at the Wall Street Journal (9/19, A5, Tracy, Burton, Subscription Publication),  Reuters (9/19, Huffstutter), the NBC News (9/19, Fox) website, CNN (9/19, Young), CNBC (9/19, Mangan), The Hill (9/19, Goad), Congressional Quarterly (9/19, Gustin, Subscription Publication),Modern Healthcare (9/19, Johnson, Subscription Publication), Newsday (9/19, Ricks), and TIME (9/19, Park)


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