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Entries in Opiods (6)

Thursday
Jul262012

Petition Combating Opioid Addiction Could Hurt Patients

iStockphoto/Thinkstock(WASHINGTON) -- Thirty-seven health care workers signed and submitted a petition to the Food and Drug Administration on Wednesday, urging officials to change labels on prescription opioids, such as OxyContin, morphine or Vicodin -- all part of an effort to curb prescription drug abuse.

"If the requested changes were adopted, drug companies would not be able to claim that the pain medications are safe and effective for long-term use by noncancer patients," read a statement from Public Citizen, the nonprofit advocacy group spearheading the petition.

The petition follows a wave of reports of increased addiction to opioid pain drugs.  Although pain management and addiction specialists agreed with the sentiment behind the petition, several doctors told ABC News it takes a step too far by limiting opioid access to noncancer patients with chronic pain.

"I believe this is not an appropriate way to address the disease of addiction," said Pam Kedziera, the clinical director of Fox Chase Cancer Center's pain program.  "Pain is a significant problem in the United States, and those who suffer deserve treatment."

The proposal suggests striking the word "moderate" from opioid labels to reserve it only for patients with severe pain; limiting the maximum daily dose to the equivalent of 100 milligrams of morphine; and limiting the maximum prescription duration to 90 days.

Dr. Joshua Prager, who directs the Center for Rehabilitation of Pain Syndromes at the University of California at Los Angeles, told ABC News he's treated chronic pain patients for nearly 30 years and believes a regulation that would make it harder for doctors to treat these "legitimate patients" would be "extremely regressive."

Prager's patients have included people who've had a failed back surgery or severe osteoarthritis.

Other chronic pain patients could have shingles, multiple sclerosis or pain from a nerve injury.

"We've seen the pendulum go from it being extremely difficult for physicians to prescribe opioids to patients who didn't have cancer… to where it was clearly being overprescribed," Prager said.  "What I would argue for is that there really has to be balance that doesn't have the pendulum swing back too fast and too far beyond what is reasonable."

Prager called the 90-day limit "draconian," and Kedziera called it "unbelievable."  After all, the definition of chronic is that it is long-lasting, and Kedziera said she's worried about arbitrarily taking chronic pain patients off medication just because time runs out.

An FDA spokesperson said the agency would respond to Public Citizen.  In the meantime, it will allow interested parties to provide input on the issue before it is approved or denied.

Copyright 2012 ABC News Radio

Wednesday
Jul182012

Young Woman's Death Sheds Light on Dangers of PCA Pumps

Courtesy Cindy and Brian Abbiehl(NEW YORK) -- When Amanda Abbiehl's parents kissed her goodnight on July 16, 2010, they never imagined it would be for the last time.

She had been admitted to an Indiana hospital the day before with a painful case of strep throat.  It ought to have been a fairly routine case.  Instead, she died hours later.

"We told her we'd see her in the morning, and we got a call later that night that she was in code blue," said Brian Abbiehl, Amanda's father.  "We were in total disbelief.  She was 18, and a strong, athletic girl." 

Amanda, from Granger, Ind., would have started college at Indiana University of South Bend in the fall.

Now, two years after her death, Cindy and Brian Abbiehl are honoring their daughter by launching a foundation, Promise to Amanda, to raise awareness about the dangers of patient-controlled analgesia (PCA) pumps. A PCA pump is a device designed to deliver a certain dose of opioid pain medication intravenously, either continuously or intermittently. It also allows the patient to self-administer a set dose of pain medication by pushing a button.

Amanda was receiving hydromorphone, an opioid pain medication, through a PCA pump when she died, and her parents believe it may have contributed to her death.

"We left the hospital Friday and she was getting a lot of relief.  We could tell when it really kicked in.  She was smiling, and we were quite happy to see that," Abbiehl said.

A legal settlement prohibits the Abbiehls from talking about the specific circumstances surrounding Amanda's death, and the family said it has not been officially determined what role, if any, the PCA pump played in Amanda's death or what the exact cause of death was.

According to several specialists not affiliated with the Abbiehl case, the number of pump-related deaths is increasing.

"The PCA pump is not in and of itself dangerous," said Dr. Matthew Weinger, a professor of anesthesiology, biomedical informatics, and medical education at Vanderbilt University School of Medicine.  "The opioid medications are dangerous."

"PCA is a very effective way to manage post-operative moderate to severe pain.  We get better pain control and higher satisfaction with pain control than with nurse-administered pain medications," said Dr. Frank Overdyk, a professor of anesthesiology at the Hofstra North Shore-LIJ School of Medicine in Hempstead, N.Y.  "But the most serious adverse event is an undetected respiratory depression, which causes you to breathe more slowly and accumulate carbon dioxide.  Then you get sedated, and you can go into cardiopulmonary arrest."

Overdyk is with a group called the Physician-Patient Alliance for Health & Safety.  The group says between 2005 and 2009, more than 700 patient deaths and 56,000 adverse events have been linked to PCA pumps.

One of the hazards of using PCA pumps, they say, is that there is inadequate monitoring of patient's levels of oxygen and carbon dioxide.  Nursing staff on general medical units typically track respiration rate and other vital signs every four hours, which Overdyk said is not enough -- there should be a way to monitor levels continuously.  Additionally, it can be hard to tell if a person's breathing rate is dangerously low in certain circumstances, like when the patient is sleeping.

Copyright 2012 ABC News Radio

Friday
Jan062012

200 Million People Use Illicit Drugs, Study Finds

Doug Menuez/Thinkstock(SYDNEY) -- Roughly 200 million people worldwide use illicit drugs such as marijuana, amphetamines, cocaine and opioids each year, according to a new study. The figure represents about one in 20 people between the ages of 15 and 64.

Using a review of published studies, Australian researchers estimated that as many as 203 million people use marijuana, 56 million people use amphetamines including meth, 21 million people use cocaine and 21 million people use opioids like heroin. The use of all four drug classes was highest in developed countries.

“Intelligent policy responses to drug problems need better data for the prevalence of different types of illicit drug use and the harms that their use causes globally,” reads the report, published Friday in The Lancet. “This need is especially urgent in high-income countries with substantial rates of illicit drug use and in low-income and middle-income countries close to illicit drug production areas.”

The 200 million number does not include people who use ecstasy, hallucinogenic drugs, inhalants, benzodiazepines or anabolic steroids -- just one reason it’s likely a vast underestimate of illicit drug use, according to lead author Louisa Degenhardt of the Sydney-based National Drug and Alcohol Research Center.

“Drug use is often hidden, particularly when people fear the consequences of being discovered for using drugs, such as being imprisoned,” Degenhardt said in a press conference.

Up to 39 million people are considered “problematic” or dependent drug users and up to 21 million people inject drugs, according to the report.

“It’s likely that injectable drug users have increased,” said Degenhardt, adding that the practice, “is a major direct cause of HIV, hepatitis C and to some extent hepatitis B transmission globally.”  Cocaine, amphetamine and heroin can be injected either alone or in combination.

Illicit drugs can have dangerous health effects, including overdosing, accidental injury caused by intoxication, dependence and long-term organ damage. While they may not cause immediate death, they’re thought to shave 13 million years off the life spans of users worldwide, according to the report.

Copyright 2012 ABC News Radio

Thursday
Apr142011

Pain Contracts: Would You Sign One to Get Treatment?

Keith Brofsky/Photodisc/Thinkstock(NEW YORK) -- An increasing number of patients are being required to sign pain agreements, and doctors who use them say the documents are an effective way to communicate what the expectations are for the treatment of chronic pain using opioids, and how patients can use these medications safely.

But critics of the agreements, sometimes called contracts, say they undermine the patient-provider relationship.

Pain agreements vary from provider to provider, but in general, they outline conditions patients must meet to continue treatment for chronic pain.

"For example, the agreement may say patients have to keep the medication out of of other people's reach, the medication has to be kept in a locked container, there are no early refills, no sharing of medication, they may be required to submit to random tests to determine whether there's compliance and so forth," said Dr. Melvin Gitlin, chairman of the Department of Anesthesiology, Perioperative and Pain Management Medicine at the University of Miami's Miller School of Medicine.

In addition to random testing, doctors may require patients to have their pills counted to make sure they're the only ones taking them, or require them to use only one pharmacy.

The American Academy of Pain Medicine, the American Pain Society and the Federation of State Medical Boards all recommend the use of opioid agreements in certain circumstances.  They started recommending the use of agreements in the late 1990s, according to Gitlin.

But the Center for Practical Bioethics, a Kansas City, Missouri, nonprofit policy institute, believes these agreements can create an adversarial relationships between patients and providers.

Last November, a panel of pain and policy experts, including some from the Center for Practical Bioethics, published an in-depth discussion of pain contracts.

One criticism was that the contracts put chronic sufferers, often in a weakened and vulnerable state, at the mercy of providers, shifting the balance in the patient-provider relationship.  Another concern is that the language could offend patients.

Copyright 2011 ABC News Radio

Tuesday
Dec142010

Some Painkillers Safer Than Others, Study Finds

Photo Courtesy - Getty Images(BOSTON) -- For the first time, research has compared the safety of some of the most commonly used painkillers.  And the drugs that raised the biggest questions?  Opioids -- the regularly prescribed class of painkillers that include Vicodin and OxyContin.

In two new reports published in the Archives of Internal Medicine, researchers from Brigham and Women's Hospital in Boston found that opioid users experienced higher rates of serious problems than patients taking other types of painkillers, such as coxibs or nonsteroidal anti-inflammatory drugs, or NSAIDs.

The use of hydrocodone, brand name Vicodin, and oxycodone, brand name OxyContin, nearly doubled between 2001 and 2006.  Doctors said a major reason for the spike came from noncancer patients taking the painkiller.

And last year, the Centers for Disease Control and Prevention reported that the number of fatal opioid poisonings more than tripled from 4,000 to 13,800 deaths between 1999 and 2006.

In the first report, researchers collected Medicare data between the years 1996 and 2005, including information from more than 31,000 older Americans who had been prescribed an NSAID, coxib or opioid.  The report found that opioid users experienced higher rates of cardiovascular problems and fractures than patients taking other types of painkillers.

In the second report, the authors compared the rates of serious problems occurring after 30 and 180 days among patients taking one of five opioids: codeine, hydrocodone, oxycodone, propoxyphene and tramadol.  They found that patients taking codeine or oxycodone were about twice as likely to die from any cause compared with patients taking hydrocodone, an opioid similar to oxycodone and stronger than codeine.

Copyright 2010 ABC News Radio

Wednesday
Oct132010

Revolutionary New Device Could Help Drug Addicts

Photo Courtesy - Getty Images(LOS ANGELES) -- People trying to kick addictions to heroin or painkillers often say that withdrawal symptoms make them feel like there’s something crawling under their skin.

Scientists now believe that a device implanted in the skin can help addicts finally break free of their habits.

Researchers at the University of California Los Angeles say they’ve come up with an implanted device that administers the medication buprenorphine, which helps end dependence on heroin and opioids that are found in many prescription painkillers.

In a report published in the Journal of the American Medical Association, the researchers wrote, “Those who received  implants also had fewer clinician-rated and patient-rated withdrawal symptoms, had lower patient ratings of craving and experienced a greater change...[than] those who received placebo implants.”

Buprenorphine was previously tested to treat addiction by administering the drug under the tongue, but ultimately failed because patients were remiss in adhering to a regular dosing schedule.

Copyright 2010 ABC News Radio







ABC News Radio