Entries in Painkillers (18)


FDA to Consider Tighter Rules for Prescription Painkillers

iStockphoto/Thinkstock(NEW YORK) -- The Food and Drug Administration is considering tighter controls on prescription painkillers like Vicodin -- a response to a spike in addiction rates and overdose deaths.

High profile battles with Vicodin have been well documented; even Eminem once rapped about his addiction.  Now, the U.S. Drug Enforcement Administration wants tighter controls on Vicodin and other narcotic painkillers containing the drug hydrocodone.  

The DEA argues patients shouldn't be able to get as many prescriptions at once, and pharmacies should have to keep the drugs locked in secure cabinets -- the same way they treat narcotics like OxyContin and Percocet.  

The FDA will consider the request during two days of hearings, beginning Thursday.

Copyright 2013 ABC News Radio


A Doctor's Take on Painkiller Abuse

A Doctor's Take on Painkiller AbuseDoctor's Notebook by NORLEENA GULLETT, M.D.

(NEW YORK) -- Some doctors knowingly prescribe powerful painkillers to patients who abuse them, according to a new editorial in the New England Journal of Medicine.

And as upsetting as it is, I'm one of those doctors.

As a resident physician in radiation oncology, I prescribe narcotics daily. All my patients have cancer. And with cancer comes cancer treatments, some of the most painful procedures medicine has to offer.

One of my patients, a young woman, had lingering pain from surgery, chemo and radiation. Both the attending physician and I were very sympathetic, and continued to prescribe daily Percocet.

Then I got a call from Medicaid telling me the refill prescription I wrote was too soon -- that the patient didn't qualify for a refill yet as she had already received 90 tablets. My sympathy dissolved as, confused, I called the pharmacy to confirm the prescription.

Our clinic still uses handwritten prescription pads, and my patient had changed the number of tablets from 30 to 90 -- a simple alteration, and a misdemeanor or felony, depending on the state.

My patient had also changed a Percocet prescription from her chemotherapy doctor. She spent four days in jail and missed four radiation treatments.

Prescription forging happens. And while doctors are aware of the problem, we don't often consider it at the point of care -- the moment patients tell us they're in pain. A 2011 survey from Yale University found nearly a third of patients who abused narcotic painkillers reported obtaining them from a doctor.

Do I think my patient was abusing Percocet? Maybe, but the answer isn't quite that easy. Maybe she had more pain and was afraid to tell us. Maybe we had unconsciously communicated that her pain should have been well-controlled with the drugs we gave her. Or maybe she was selling the extra pills to help pay for her treatment.

So what was I to do when she returned for radiation treatment after her release from jail? She still had cancer, still had pain from her operation and was still undergoing daily treatment. Most important, she was still my patient.

My attending physician took over the patient's pain management and drafted a pain contract -- a document that detailed what medication would be prescribed, who would prescribe it, along with rules that the patient agreed to follow. We also kept close contact with the patient's other providers.

I keep hoping that our clinic will switch to electronic prescribing, which would make it harder for patients to alter prescriptions.

But while prescription drug abuse is a problem and needs to be recognized, the reasons doctors prescribe painkillers should not be forgotten.

Dr. Norleena Gullett is a resident physician in the Department of Radiation Oncology at Indiana University, The Simon Cancer Center

Copyright 2012 ABC News Radio


Painkillers May Pose Risks to Heart Attack Survivors

iStockphoto/Thinkstock(NEW YORK) -- A group of commonly used painkillers may increase the risk that first-time heart attack survivors will die sooner or have another heart attack, a new study released Monday suggests.

The study does not represent the first time doctors have warned that certain pain medicines may hold risks for heart attack survivors.  In 2007, the American Heart Association released recommendations for these patients and their doctors to balance risk factors and benefits when choosing a painkiller.

When it comes to these drugs, there is a wide variety on the market.  Among the choices is a group of very popular and widely used drugs called non-steroidal anti-inflammatory drugs, or NSAIDs for short.  Some of them are easily available over the counter, like ibuprofen.  Others, such as celecoxib -- commonly known by the brand name Celebrex -- require prescriptions.

The new Danish study, published in the journal Circulation, looked at the consequences of painkillers in almost 100,000 patients.  Of this number, nearly 44,000 filled at least one prescription for painkillers.

Those who took painkillers had a 59 percent higher risk of dying after one year and a 63 percent higher risk of dying after five years.  Moreover, these patients’ risk of experiencing another heart attack or dying from coronary artery disease was 30 percent higher after one year and 41 percent higher after five years.

“It is important to get the message out to clinicians taking care of patients with cardiovascular disease that NSAIDs are harmful, even several years after a heart attack,” said Dr. Anne-Marie Olsen, lead author of the study and a fellow in the cardiology department at Copenhagen University Hospital Gentofte in Denmark.

Still, patients have to manage pain -- and doctors say this study suggests that heart attack survivors and their doctors should be picky when choosing a painkiller.  

Alternatively, treatment of pain may also include no medications at all; some other pain relief options include physical therapy or heat and cold.  But if these non-medical options don’t cut it, physicians say, the risk profiles of some painkillers should be taken into consideration.

Copyright 2012 ABC News Radio


Aimee Copeland Pleads for Painkillers, Feels Like 'Patchwork Quilt'

ABC News(NEW YORK) -- Aimee Copeland, the Georgia student recovering from flesh-eating disease, is pleading for painkillers after surgery to replace swaths of bacteria-ravaged skin and muscle, her father said.

Copeland, 24, was hesitant to take morphine, telling her father she felt like "a traitor to her convictions."  But her preferred method of pain management, meditation, proved no match for the sting of skin grafts and muscle flaps to close a gaping wound on her abdomen and groin.

"Aimee is now taking pain medication in as liberal a dose as can be prescribed," Copeland's father, Andy Copeland, wrote in a blog post.  "If she even dared to refuse taking it, which she wouldn't, then the doctors would most certainly administer it in an IV drip."

It's been nearly seven weeks since Copeland cut open her calf in a fall from a homemade zip line near the Little Tallapoosa River, inviting a flesh-eating infection that claimed her left leg, right foot and hands.  Doctors also removed part of her torso, leaving a wound that was dutifully cleaned and covered with sterile bandages in advance of reconstructive surgery on Friday.

"During the most recent skin graft, her surgeons were forced to take muscle from Aimee's abdomen to create a flap over the iliac artery in her groin," Andy Copeland wrote.  "She says that she feels like a patchwork quilt, because her body is a collection of skin grafts and bandages."

A skin graft transplants a thin patch of skin surgically shaved from elsewhere on the body onto a wound.

"We can get sheets between 10 and 12 thousandths of an inch thick," said Dr. J. Blair Summitt, assistant professor of plastic surgery at Vanderbilt University Medical Center in Nashville, Tenn.  "Within two or three days, tiny little blood vessels start to grow into the graft.  It's a fairly straightforward procedure."

Straightforward, but not painless.  Summitt said narcotic painkillers like morphine and Fentanyl help patients power through the painful reconstructive surgery.  But Andy Copeland said no drug is powerful enough to relieve his daughter's pain.

"The allowable doses of Morphine, Fentanyl and Lyrica are often inadequate to deal with the pain that Aimee is now experiencing," he wrote.  "Please believe me when I say that Aimee's refusal to use pain medication has ceased following her most recent surgery.  She is now requesting it ahead of schedule."

Copyright 2012 ABC News Radio


Common Painkillers May Protect Against Skin Cancer

Brand X Pictures/Thinkstock(NEW YORK) -- Drugs that are famous for fighting pain may also protect against skin cancer, a new study found.

The Danish study of nearly 200,000 men and women found that those who took nonsteroidal anti-inflammatory painkillers such as aspirin and ibuprofen were less likely to develop squamous cell carcinoma or malignant melanoma, the deadliest form of skin cancer.

"Given the high skin cancer incidence and the widespread and frequent use of NSAIDs, a preventive effect of these agents may have important public health implications," the authors wrote in their study, which was published Tuesday in the journal Cancer.

The researchers used medical records from Denmark's government-funded health care system to probe NSAID use among 18,500 people with skin cancer and 178,655 without.  They found those who used NSAIDs were 15 percent less likely to develop squamous cell carcinoma, and 13 percent less likely to develop malignant melanoma than nonusers.

"The risk reduction was greatest among long-term and high-intensity users, suggesting a cumulative and dose-dependent, protective effect," the authors wrote.

The risk of basal cell carcinoma, the most common form of skin cancer linked to sun exposure, was no different among NSAID users and nonusers.

The findings add to mounting evidence that common painkillers may help thwart cancer.  A March 2012 study found people who took daily aspirin for at least three years were 36 percent less likely to develop metastatic cancer and 15 percent less likely to die from cancer.

"The mechanism of action is not totally clear, but it's thought to be due to their anti-inflammatory effects," said Dr. Josh Zeichner, assistant professor of dermatology at Mount Sinai Medical Center in New York City, adding that inflammatory enzymes help feed tumor growth.

An NSAID cream is already approved for precancers of the skin caused by sun exposure.  But Zeichner said it's too soon to recommend drugs like Aspirin, Advil and Aleve for skin cancer prevention.

"This study is exciting, but we need more studies to continue to evaluate this as a possible treatment," said Zeichner, adding that chronic NSAID use can cause ulcers.  "Right now the best way to prevent skin cancer is to use sunscreen, wear protective clothing and avoid of the sun between peak hours."

Copyright 2012 ABC News Radio


Pharmacies Fueling Prescription Drug Trade?

iStockphoto/Thinkstock(WASHINGTON) -- The prescription drug trade is booming and the Drug Enforcement Administration believes some rogue pharmacies could be fueling the epidemic.

On Friday, the DEA confirmed that it is now investigating Walgreens, the nation’s biggest drugstore.

In Florida, six Walgreens stores were investigated after inspectors spotted a major red flag, a huge spike in the amount of the highly addictive painkiller Oxycodone the stores were ordering from distributors.

One of the stores under scrutiny bought 95,000 doses in 2009 and over 2.1 million doses in 2011, about 30 times the amount a typical pharmacy would buy.

Two Florida CVS pharmacies with similar massive purchases were recently banned from selling painkillers altogether after the DEA determined there was “imminent danger to the public health.”

Both pharmacy chains have said they are cooperating with the DEA.

The DEA fears rogue pharmacies could be illegally filing prescriptions for greedy doctors involved in black market distribution networks, or selling painkillers directly to addicts.

The potential profits are huge. One estimate put the number of prescription drug abusers at seven million.

Copyright 2012 ABC News Radio


Pharmacies Targeted by Dealers, Addicts Desperate for Painkillers

iStockphoto/Thinkstock(NEW YORK) -- In Phoenix, two men tied up pharmacy employees while another stole painkillers.

On New Year's Eve in 2011, an armed robber demanding Oxycontin and money at a Long Island, N.Y., pharmacy encountered an off-duty Bureau of Alcohol, Tobacco, Firearms and Explosives agent and two police officers as he was leaving. He and the ATF agent were killed.

Law enforcement say that armed robbers looking for prescription drugs are turning some neighborhood pharmacies into danger zones.

At another Long Island pharmacy, an addict in search of drugs for his wife fatally shot four people, including a 17-year-old clerk days from her high school graduation, in June 2011. He then left with a backpack full of prescription painkillers. He was sentenced to life in prison.

Since 2006, there has been an 82-percent rise in pharmacy robberies -- from 385 in 2006 to 701 in 2011 -- and 3,535 pharmacies have been hit.

Police say the surge is being fueled by the nation's prescription drug abuse epidemic. According to the Centers for Disease Control and Prevention, there were 14,800 prescription painkiller deaths.

Law enforcement says the robbers are typically drug dealers who know they can make huge profits -- up to $80 a pill -- on the street. But some of the thieves are simply desperate addicts.

In the summer of 2011, the bass player for the rock group Coheed and Cambria was accused of robbing a Massachusetts Walgreens pharmacy of Oxycontin. He allegedly threatened to detonate a bomb. He reportedly headed back to the band's concert venue with bottles of pills.

Bruce Goodarzi, a Rockville, Md., pharmacist, said the robbers who'd broken into his store twice in one month were after painkillers like Oxycontin or Vicodin.

"We're talking about thousands of the pills," he told ABC News. "They are going right to the drug cabinet."

Pharmacies are beefing up their security systems -- adding watchdogs and guards -- and also storing drugs in safes. Goodarzi said he built a steel cage to protect the painkillers.

Others are refusing to stock the medications or are getting guns to protect themselves in the hopes that potential criminals pass them by.

Copyright 2012 ABC News Radio


Do Opioids Play Role in Cancer Growth?

iStockphoto/Thinkstock(NEW YORK) -- When Dr. Jonathan Moss was developing a drug to relieve the severe constipation plaguing end-stage cancer patients taking opioid painkillers, he noticed a few of those patients lived longer than expected.

Although likely to die within a month, some "went on to live for five to six months," Moss said.  He began to think the methylnaltrexone (Relistor) might be doing more than simply improving their ability to eat.

"I began to wonder in my mind…could it be an effect on the progression of the tumor?" he said.

Subsequent laboratory studies confirmed that Relistor inhibited tumor growth and angiogenesis -- the sprouting of blood vessels that nourish tumors.

Now, almost a decade later, multiple laboratory and animal studies, are converging with some human research to suggest that opioid drugs and the body's natural opioids may play a role in the growth and spread of cancer, according to two studies and an accompanying commentary published Tuesday in a special issue of the journal Anesthesiology.

Moss, co-author of the commentary and one of the studies, cautioned that it would be premature for cancer patients or their doctors to give up on opioids, which have a 200-year history in relieving cancer pain and post-surgical pain.

"There are no double-blind human studies showing that if you take an opioid, that you are more or less likely to have tumor progression," said the professor of anesthesiology and critical care medicine at the University of Chicago.

Without proof provided by a "large human study," the findings are "very interesting," but "much too early" to change practices, said Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation and Hospital in Baton Rouge, La.  He expressed concern that cancer patients might become unnecessarily worried that pain meds will make their cancers grow.

In one of the new studies, breast cancer patients survived longer if they had a gene that made them resistant to opioids (meaning they probably needed more medication to control their pain).  In the Carolina Breast Cancer Study of more than 2,039 women diagnosed between 1993 and 2001, women with invasive breast cancer who had one copy of the gene variant survived twice as long.  Survival quadrupled for those with two copies of the gene variant, according to research led by Dr. Andrey V. Bortsov, an assistant professor of anesthesiology and his colleagues at the University of North Carolina, Chapel Hill.

In the other study, led by Patrick A. Singleton, an assistant professor of medicine at the University of Chicago, researchers found that naturally occurring opioids could fuel the growth of human non-small cell lung cancer in human lung cancer cells transplanted into mice with compromised immune systems.

"What we saw was a two-fold increase in tumor growth, and even more strikingly, a 20-fold increase in metastasis," he said in an interview.

"The two papers together are really bookends," Moss said.  The finding that lung cancer cells have lots of so-called mu opioid receptors involved in tumor growth and spread provides "a plausible explanation for what people in North Carolina have found.  The mu opioid receptor may be very importantly involved in the progression of tumors."

As a result, he said that receptor could become a therapeutic target for new cancer drugs.

Copyright 2012 ABC News Radio


Prescription Painkillers for Small Surgeries May Lead to Long-Term Use

iStockphoto/Thinkstock(TORONTO) -- Older adults who receive pain medications after surgery may be at higher risk of becoming addicted, according to a new study published in the journal Archives of Internal Medicine.

Physicians often prescribe opioids, including codeine and oxycodone, after outpatient surgeries.

While these drugs are proven to be effective for temporary pain relief, they are also associated with side effects including sedation, constipation and breathing problems, as well as addiction.

Researchers analyzed data from nearly 400,000 Canadian patients ages 66 and older who received an opioid prescription within seven days of undergoing surgery for cataracts, gallbladder removal, prostate tissue removal or varicose vein stripping.

What they found was that more than 10 percent of the patients who received an opioid after a surgery were identified as long-term opioid users one year after surgery. They also found patients were 3.7 times more likely to use non-steroidal anti-inflammatory drugs on a long-term basis if they received a prescription for the drug within seven days after surgery.

"We tried to look at what some of the events are that start people on the road to acute or chronic use of opioids," said Dr. Chaim Bell, associate professor of medicine at University of Toronto and co-author of the study. "It's much easier to prevent the initiation of the medication than wean people off it later. Everyone should get pain relief, but the painkiller and the dose should be tailored to the specific patient."

The findings align with the general experience of Dr. David Maine, director of the Center for Interventional Pain Medicine. He said the decision to start and prescribe an opioid at any time is a serious one. Treatment goals should be clearly defined when a prescription is first written, to ensure safety and effectiveness of the medication -- and to minimize the risk of addiction.

"Generally with older patients, if starting an opioid, we set up a short interval follow-up to ensure tolerability of the medication as well as efficacy," said Maine. "If either of those are an issue then we make a change. Sometimes that change is discontinuing the medication entirely. Ultimately, I think the decision to stop an opioid analgesic is as important as the decision to start."

Dr. Timothy Collins of the Pain and Palliative Care Program at Duke University Medical Center said the results of the study are surprising since patients who undergo such small surgeries should be finished with their pain medications after 10 to 14 days.

"Changes in the way pain medications are prescribed such as linking the pain medication to a specific outcome would help," said Collins. "Patients would have to have better function, or significant improvement on a pain scale, in order to continue on the medication. Frequently patients just say 'I feel better' or 'it helps some' but do not have any other evidence that the medication is actually helping them function better."

One in five American adults received a painkiller prescription in 2006, totaling more than 230 million total prescription painkiller purchases.

And in 2010, the Centers for Disease Control and Prevention reported that the number of fatal opioid poisonings more than tripled from 4,000 in 1999, to 13,800 in 2006.

Lack of communication between surgeons and family physicians may contribute to excessive painkiller prescriptions, along with the potential addiction and abuse of them, Bell said. Communication barriers, such as hearing or cognition deficits in older patients, also may hinder patients' understanding of when it is appropriate to taper a pain medicine or take it only on an as needed basis, said Dr. Doris Cope, director of the Pain Medicine Program at University of Pittsburgh Medical Center.

The study emphasizes the importance of tailoring patient education on a case-by-case basis, as well as the need for careful coordination of medical care among a patient's surgeons, doctors and caregivers, said Cope. Hopefully, she added, "this can be better achieved in the offices of busy primary care physicians."

Copyright 2012 ABC News Radio


SOPA Could Help Feds Close Illegal Online Pharmacies

John Foxx/Stockbyte/Thinkstock(WASHINGTON) -- Congressional leaders have stalled work on bills to combat Internet piracy amid charges of censorship.  But there are provisions in the Stop Online Piracy Act (SOPA) and the Stop Online Piracy Act (PIPA) that could give law enforcement the tools necessary to crack down on illegal online pharmacies.

Teens and adults looking to buy unprescribed painkillers often order them from foreign websites which the Food and Drug Administration has no power to regulate.

“Kids today are very creative and have access to a wide array of illicit drugs.” said Dr. Kevin Hill, an instructor of psychiatry at Harvard Medical School. “Not only do they know how to get drugs locally, they’re very technologically savvy and that can create a problem with more dangerous medications flooding into communities.”

Prescription drug abuse is the fastest growing and deadliest drug problem in America.  Deaths from opiate related overdoses topped those of heroin and cocaine, according to the U.S. Centers for Disease Control and Prevention.  Five percent of users are getting their drugs from an online source or drug dealer, the Office of National Drug Control Policy reports.

Section 105 of SOPA would help companies take independent action against sites that “endanger[s] public health.”  U.S.-based payment companies like MasterCard or American Express would be given a legal incentive to shut down payments to illegal online pharmacies.

Private companies that revoke service to the online pharmacies leave themselves vulnerable to a breach of contract lawsuit even if the plaintiff is an illegal business.  Section 105 would grant immunity to service providers that cut off service independently as long as they believe that the customer is engaging in illegal activity.

Under current law it is difficult to shut down a site hosting illegal activity unless it can be proven that the site’s owner is aware of that activity.  Sites that ignore the law can often evade prosecution if their operations are based overseas.

Authorities have had some success in prosecuting drug rings domestically but those investigations take years, while SOPA would allow private businesses servicing the illegal company to take action quickly, without the aid of law enforcement.

Hillel Parness is a litigation and intellectual property partner at Robins, Kaplan, Miller & Ciresi L.L.P. which filed piracy cases on behalf of companies.  He believes that the public is uninformed when it comes to anti-piracy legislation and Congress should move to pass the least-controversial parts of SOPA first.

“There’s a lot more in SOPA that’s getting zero coverage which raises the interesting question if in fact some of the more controversial parts get delayed -- is it possible that we see some of the other provisions show up somewhere else?” said Parness.

Only after public outcry over the measure, Senate Majority Leader Harry Reid delayed the vote indefinitely on the Senate version of the bill -- PIPA -- and it is unclear when Congress will take up the matter but lawmakers from both sides insist that the delay is only temporary.

“There’s no reason that legitimate issues raised about PROTECT IP can’t be resolved,” Reid tweeted last week.  “I’m optimistic that we can reach compromise on PROTECT IP in coming weeks.”

Copyright 2012 ABC News Radio

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