Opioid Crisis. ““We got here in part because there was a paper done in the 1980s by a well-meaning physician that said opioids are not addictive….

… and they should not be withheld from anybody with acute or chronic pain,”
“Then we came out with the fifth vital sign, that every physician was held to the standard that we would do pain scores on everyone. Based on those studies, we couldn’t restrict opioids at all. In fact, physicians from a New England state went to jail because they did not prescribe opioids for somebody with severe pain.
“This hit the medical community like a bombshell, and therefore it was easy to give opioids.”
As it turns out, it was just one of the contributing factors.
Another was the way the treatment of pain was recorded, through Press Ganey customer satisfaction scores.
“In this state and other states, the fifth vital sign became the standard of care,” Rosenberg said. “If you have pain, we have to treat it. And the goal was to get you to zero on the pain scale.
“So, if you came into my emergency department or you went to the dentist, our options for treatment were either to give you Motrin or Tylenol, something benign or easy, or I just go all out and give you opioids.”” (A)

“In December 1995, Purdue received FDA approval for Oxycontin, an opioid which was itself supposed to deter abuse, through its allegedly rush-curbing, time-release formulation. Purdue lacked anything in the way of persuasive evidence for this claim at the time, and later studies would debunk it entirely, but, as detailed in Barry Meier’s Pain Killer, that didn’t stop the FDA from allowing them to include it in the drug’s labeling—an unprecedented decision which, in Meier’s words, “threw open the door to the drug’s widespread marketing,” and in turn generated precisely the catastrophic conditions which brought us there, to that Sheraton, in the first place.” (B)

“For the last 20 years, the pharmaceutical industry has been whitewashing the lasting impact of highly addictive narcotics through its use of marketing, effectively encouraging doctors and other providers to prescribe these powerful drugs in increasing, extremely dangerous levels.
In other words, Big Pharma found a way to turn a profit at the expense of American lives. By misleading doctors to overprescribe a drug powerful enough to treat the level of pain endured by patients recovering from major surgery for more routine issues, Big Pharma made possible the addiction of thousands in Philadelphia alone. But it doesn’t stop at prescription pills manufactured and distributed by these companies.
When that prescription runs out — and it will — users who are dependent are often drawn to a substance far less expensive and, unfortunately, extremely accessible on the black market: heroin…” (C)

NO FORMAL DECLARATION OF NATIONAL OPIOID EMERGENCY YET!
Two weeks ago, President Trump declared the opioid crisis a national emergency and called it “a serious problem the likes of which we have never had.”
“We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis,” the president insisted.
But so far, Trump hasn’t formally signed such a declaration and sent it to Congress.
And that means the millions the executive branch could direct towards expanding treatment facilities — or supplying police officers with the anti-overdose remedy naloxone — aren’t going anywhere because Trump has not yet followed through.
A White House spokesperson would not say when Trump would get around to it.
“The president recently instructed his administration to take all appropriate measures to confront the opioid crisis,” the spokesperson said. “Right now these actions are undergoing an expedited legal review.”” (D)

“The president’s budget ignores the findings of addiction treatment research. Recently Price suggested that Medication Assisted Treatment (MAT) was not the best way to treat opioid use disorder by saying, “if we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven’t moved the dial much…”” (E)

MORE CONSEQUENCES
““Too many people with migraines are prescribed potentially addictive opiate painkillers, while too few may be getting recommended medications, a new study suggests.
Researchers found that of nearly 2,900 Americans who visited the doctor for migraine relief, 15 percent were prescribed opioids such as oxycodone (OxyContin or Percocet) or hydrocodone (Norco, Vicoprofen).
That’s despite the fact that the drugs should really be used only as a “last resort,” said study lead researcher Dr. Larry Charleston IV.” (F)

The number of kids placed in foster care continues to increase as the opioid crisis worsens in Ohio, but there aren’t enough foster care families to meet the need.
It’s a heartbreaking problem, many people probably don’t realize is happening all around them. There are more than 15,000 kids in Ohio’s foster care system, but only 7,200 families to take them in. (G)

The nation’s opioid crisis has hit hard in Maine, where at least one person died every day last year of drug overdoses.
It’s also penetrated the state’s lobster industry. Some fishermen are suffering in silence in a community that rarely asks for help.
Josh Kane has spent more than 15 years fishing off the coast of Maine. For 10 of those years, he struggled with an opioid addiction as his fellow lobstermen looked the other way.
“It’s one of those things that’s kind of like, ‘Don’t ask, don’t tell,'” Kane said. “As long as you show up every day and do your job, nobody is really going to say anything.”
They’re a tough, proud and private bunch with grueling hours and serious, physical demands. But the payoff can easily be in the six-figure range for the short summer season. (H)

In an unrelenting opioid epidemic, hepatitis C is infecting tens of thousands of mostly young, white injection drug users, with the highest prevalence in the same Appalachian, Midwestern and New England states that are seeing the steepest overdose death rates.
Like the opioid epidemic that is driving it, the rate of new hepatitis C cases has spiked in the last five years. After declining for two decades, new hepatitis C cases shot to an estimated 34,000 in 2015, nearly triple the number in 2010, according to a recent report from the U.S. Centers for Disease Control and Prevention (CDC).
With better screening for the bloodborne disease and more treatment using costly but highly effective new drugs, hepatitis C could be eradicated, according to a new study from the National Academies of Sciences, Engineering, and Medicine…
“We have two public health problems that are related — it’s called a syndemic — and we can’t address one without addressing the other,” said James Galbraith, an emergency room physician at the University of Alabama at Birmingham Hospital. (I)

SOLUTIONS
“Virginia Governor Terry McAuliffe announced his state’s drive to stem the state’s opioid addiction problem by crunching healthcare data. The move is the latest in a series of efforts by governments and large healthcare organizations to get a handle on the problem.
The governor’s announcement comes amid widespread concern over a deepening addiction crisis, with the state’s commissioner of health declaring opioid and heroin overdoses a public health emergency last year.
Using data currently being collected by interns from George Washington University and George Mason University, 15 teams will collaborate with a variety of subject matter experts to develop solutions to the myriad challenges facing communities and the commonwealth.
“We know that if collected and used correctly, data can help us fight this opioid epidemic by identifying the communities and populations that are most vulnerable,” said Virginia Secretary of Health and Human Resources Dr. Bill Hazel.”” (J)

“The good news is that many technology-based alternatives to opioids are already available. Spinal cord stimulation is an underutilized pain management alternative for patients struggling with chronic pain. This implanted pacemaker-like device is shown to effectively manage pain while significantly reducing opioid use. Regional pain pumps are a promising alternative for acute pain. They deliver local, non-opioid anesthetics directly to nerves feeding the surgical site, and can provide significant pain relief for several days after a procedure. These types of technologies enable what is known as multi-modal pain control, promoting a combination of devices and analgesics that have a low risk of addiction, such as ibuprofen, to manage pain – thus reserving opioids as a last resort.
But, weighing the value of these alternatives requires a shift in thinking that prioritizes investment in opioid avoidance. Today, these alternatives are often viewed as financially unviable or cumbersome to implement. And newer technologies that show promising initial results face even greater barriers. When not given a choice, clinicians have no other option but opioids. We must now create the pathways that facilitate alternative treatments.” (K)

(A) The opioid discussion: In the beginning — How did we get here? How did we become the nation with the biggest (perhaps the only) problem with opioid abuse?, http://www.njbiz.com/apps/pbcs.dll/article?AID=/20170814/NJBIZ01/170819953/the-opioid-discussion-in-the-beginning–how-did-we-get-here-how-did-we-become-the-nation-with-the-biggest-perhaps-the-only-problem-with-opioid-abuse&template=mobileart
(B) Why the FDA Can’t Fix the Opioid Crisis, by Daniel Kolitz, http://gizmodo.com/why-the-fda-cant-fix-the-opioid-crisis-1797950053
(C) Big Pharma must be held accountable for its role in opioid crisis, by Joe Torsella, http://www.philly.com/philly/opinion/commentary/big-pharma-must-be-held-accountable-for-its-role-in-opioid-crisis-20170828.html
(D) Trump Calls Opioid Crisis a National Emergency But Still Hasn’t Made It Official, by ALI VITALI and CORKY SIEMASZKO, https://www.nbcnews.com/storyline/americas-heroin-epidemic/trump-calls-opioid-crisis-national-emergency-still-hasn-t-made-n795351
(E) Trump and Tom Price are making it harder to combat opioid epidemic, BY RICHARD G. FRANK AND KEITH HUMPHREYS, http://thehill.com/blogs/pundits-blog/healthcare/348315-trump-and-tom-price-are-making-it-harder-to-combat-opioids
(F) Many Migraine Patients Given Unnecessary Opioids, Addictive painkillers should be treatment of last resort, headache expert says, by Amy Norton, http://www.webmd.com/migraines-headaches/news/20170825/many-migraine-patients-given-unnecessary-opioids#1
(G) Opioid crisis leaves thousands of kids trapped in foster care, by Shelby Miller, http://m.cleveland19.com/19actionnews/db_348172/contentdetail.htm?contentguid=sIfgvu2E
(H) Opioid crisis takes toll in Maine lobster industry, by Kenneth Craig, https://www.cbsnews.com/news/opioid-crisis-maine-lobster-industry/
(I) With Opioid Crisis, A Surge In Hepatitis C, By Christine Vestal, http://www.huffingtonpost.com/entry/with-opioid-crisis-a-surge-in-hepatitis-c_us_59a41ed5e4b0a62d0987b0c4
(J) Virginia turns to data analytics to fight opioid crisis; Intermountain Healthcare EHR effort cuts prescriptions, by Matt Kuhrt, http://www.fiercehealthcare.com/technology/virginia-turns-to-data-to-solve-opioid-crisis
(K) Are We Doing All We Can to Stop the Opioid Crisis?, by Cummings, http://health.usnews.com/health-care/for-better/articles/2017-08-31/are-we-doing-all-we-can-to-stop-the-opioid-crisis

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