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23/Oct/2017

Some recognizable examples of Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil, Motrin), diclofenac, and  naproxen (Aleve).  They are frequently used as the first line of defence to reduce pain and inflammation.  Most NSAID medications are available without a prescription and are widely used to reduce fever and pain related to long- and short-term medical conditions such as headaches, arthritis, menstrual cramps, and flu symptoms. However, just because they are available without a prescription does not mean that they are 100% safe. New labeling requirements have raised awareness of potential risks for the estimated 30 million Americans taking nonsteroidal anti-inflammatory drugs each year.

The Food and Drug Administration has recently strengthened its warning on NSAIDs due to recent studies that shows even small amounts of NSAIDs present a risk of heart attack, heart failure, or stroke. The updated warning is a result of a growing body of research into these widely used over the counter (OTC) drugs. While it was always presented as a risk, the new strengthened warning clarifies that NSAIDs may increase the risk of heart attack or stroke in all patients, with or without heart disease or risk factors for heart disease as previously thought.  Those with risk factors of heart disease should be particularly cautious because they are already at a higher baseline for such complications. The FDA will require new labels to reflect this developing research.

Should you worry? Not if you are using these medications as directed. There seems to be a consensus from the medical community that more studies are needed before we empty out our medicine cabinets. Bruce Lambert, director of the Center for Communication and Health at Northwestern University, who specializes in drug safety communication shared his comments with the New York Times, “One of the underlying messages for this warning has to be there are no completely safe pain relievers, period.” Another article for NPR highlights the general rule of using caution with any medication.

Although the FDA’ s  new warnings need not cause alarm, the announcement is an important reminder to the millions of people that use NSAIDs on a daily basis that misuse or overuse of OTC drugs could result in severe health consequences. Patients that rely on these OTC painkillers long term should talk to their health care providers about reasonable alternatives.


23/Oct/2017

An amazingly informative video prepared and submitted by St. Michael’s Hospital physician Dr. Irfan Dhalla for the FDA. In the video are some very scary statistics about Opioid misuse in Ontario. Among the statistics Dr. Dhalla points out:

  • As many as 33% of opioid patients meet the criteria for an opioid use disorder
  • Elderly patients using opioid have much increased risk of falls and fractures
  • Patients using the drugs see their physicians an average of 18 times per year.

The Wall Street Journal covered the hearing and cited some scary statistics:

More than 16,000 people died of opioid overdoses in 2010, according to the Centers for Disease Control and Prevention, more than from heroin, cocaine and all other illegal drugs combined.


23/Oct/2017

Health Minister Leona Aglukkaq said the government would not block generic OxyContin. (Linked through the National Post Website and Copyright CANADIAN PRESS / Fred Chartrand

There are a number of media outlets covering the story of Oxycontin and the generic formula. Two worth reading can be found through the National Post:

The first is a news article, by Sharon Kirkey, and paints a very clear, balanced and detailed picture of the issue and debate. If you want to understand the real essence and challenge with the debate, and get an objective view of both sides of the discussion, this is a great place to start.

The second is a Comment, written by Jesse Kline (FULL DISCLOSURE: Jesse is related to one of our execs) that explains the political backdrop of the OxyNeo debate and Ontario Health Minister Deb Matthews fighting to keep generic Oxycontin from being available. Essentially, he points out, a lot of the responsibility for keeping the drugs in the right patients’  hands (and by extension off the streets) falls in the hands of the Physicians that are prescribing the pills.


23/Oct/2017

There are some very interesting studies being published about the link between migraine headaches and increasing likelihood of suicide:

From a pool of 4,765 persons randomly screened in the community (Detroit, Michigan area), the researchers arrived at a final sample of 1,186 respondents with full assessments via face-to-face interviews: 1) migraine (N = 496), 2) non-migraine severe headaches (N = 151), and 3) controls (N = 539). All participants were interviewed at baseline in 1997 and reassessed 2 years later, in 1999. On average, the age of the study population was 40 years, 79% were female, and 74% were white. Overall, 5.6% had at least one suicide attempt prior to the start of the observation period: 9.1% migraine, 5.3% severe headache, and 2.6% controls (however, the difference between migraine and severe headache groups was not statistically significant).

During the 2-year followup period, persons with migraine or severe headache were at least 4 times more likely to attempt suicide than controls. The odds ratio in migraineurs — adjusted for sex, psychiatric disorder, and previous history of suicide attempt at baseline — was 4.43 (95% Confidence Interval [CI] 1.93, 10.2). Persons with non-migraine headache of comparable intensity and disability also had a greatly increased likelihood of suicide attempt as compared with controls: odds ratio, adjusted for the same covariates, was 6.20 (95% CI 2.40, 16.0). [Due to the wide, overlapping CIs the difference between the 2 odds ratio estimates was not statistically significant.]

The likelihood of suicide attempt was not influenced by alcohol- or drug-use disorder, or by migraine with or without aura. However, the average pain intensity score of persons who attempted suicide during the follow-up period was significantly higher than in persons who did not attempt suicide: mean 7.58 (Standard Deviation [SD] = 2.75) on a 0-to-10 scale compared with 5.18 (SD = 3.70), respectively. Essentially, the risk of suicide attempt increased by 17% with each 1 point rise on the pain-intensity scale; or, in other terms, an increase in pain score of 1 SD unit raised the odds of suicide-attempt by 79% (OR = 1.79).

Oddly enough, the US Government has declared that the deaths related to the abuse of OxyContin and other painkiller additions are at “epidemic” levels, but have not recognized suicide rates as being in the same range of severity.  There were twice as many suicides in the US last year than their were reported cases of painkiller-related deaths.

More details can be found at the very impressive resource, Pain-Topic.org.


23/Oct/2017

Despite the makers of OxyContin saying they are doing everything they can to limit or try and prevent the abuse of their products, statistics show an exploding rate of addition to their pain killers.  To make the medication harder for addicts to abuse or concentrate, the makers of the drug have released OxyNEO (details of the new medication are on our Facebook page).

Many of the Canadian provincial governments, including our own Ontario Government, are trying to curb abuse of OxyContin (OxyContin was easily crushable or mixed with liquid to be injected) and now OxyNEO by de-listing them, or saying they will not publicly fund the filling of those prescriptions. However, as this article in the Globe & Mail shows, many experts do not feel that this will really help:

John Burke, president of the National Association of Drug Diversion Investigators, a non-profit organization and commander of a drug task force in Ohio, is concerned that the move to de-list OxyNEO could lead to a bigger black market for pills brought in from other jurisdictions.

But restricting one drug will make only a dent in the country’s opioid problem. There are several medications that can – and, in all likelihood, will – fill the void created by the de-listing of OxyContin and OxyNEO.

As you can see in this article, British Columbia is the most recent province to curb paying for OxyNEO in an attempt to curb abuse.


23/Oct/2017

There is an impressively comprehensive article written on the Huffington Post website titled The War Over Prescription Painkillers by Radley Balko.  Worth a read because it’s well-researched and very clear if you’re wondering how and why the situation with respect to such a massive patient population has gotten this way.

He’s also done a good job of explaining how the painkiller issue ties into Chronic Pain as a medical issue:

The Problem of Chronic Pain

Chronic pain is different from short-term or end-of-life pain. It can persist for years, even after the associated injury or condition has gone away. For some patients it can be burdensome, for others it can be debilitating. Chronic pain can also cause depression, anxiety, sleep disorders, and affect decision-making. Because pain is more of a symptom than a disease, it can’t really be diagnosed, so it’s difficult to come up with a precise number of people affected. But in 1999, the Society for Neuroscience estimated that as many as 100 million Americans will suffer from some sort of chronic pain. The National Center for Health Statistics puts the number closer to 75 million.

Despite the recent headlines about the rise in sales of prescription painkillers, chronic pain is still significantly under-treated in America. There are a number of reasons why. For one, there’s no diagnostic test to diagnose pain, so doctors must rely on patient descriptions of what they’re feeling. That can be tricky, because tolerance for pain varies widely from person to person. Culturally, pain has also long been viewed as something we encounter and endure as part of the human condition. In many religions, noble suffering is considered pious. Pain treatment is also a relatively new medical specialty; it didn’t have its own medical society until the early 1980s.

But the biggest barrier to effective pain treatment continues to be bad public policy, much of it driven by the war on drugs. Opioids — morphine, oxycodone, methadone, and other drugs derived from the opium plant (or synthetically structured to mimic it) — are the most effective way to treat severe and chronic pain. Emerging (but still controversial) treatments like long-term, high-dose opioid therapy have shown particular promise with chronic pain. Just this month, an article in the journal Science described another promising new therapy, in which large doses of the drugs delivered over a short period of time, shortly after an injury, may help prevent chronic pain from developing at all.

But it’s also true that opioids can be abused. The potential for abuse has attached to opioids a social and cultural stigma that can make doctors reluctant to prescribe them, and patients reluctant to take them, even in end-of-life care. But pain patients and their advocates say the bigger problem is that drug control has taken priority over ensuring access to effective treatment. To be sure, there is a divide in the medical community over the effectiveness of long-term, high-dose therapy. But what ought to be a research-driven debate among medical professionals has been corrupted by policies aimed at preventing addicts and drug pushers from obtaining painkillers, not what’s in the best interest of pain patients. Police and prosecutors now dictate medical policy.


23/Oct/2017

There has been a dramatic increase in the number of babies born with additions to pain killers – additions they have because their mothers were on the drugs while pregnant.

USA Today reports that while there are no surveys that cover the entire US (or Canada) on this issue, here are few highlights of the increases in cases:

  • In Florida, the epicenter of the illicit prescription drug trade, the number of babies with withdrawal syndrome soared from 354 in 2006 to 1,374 in 2010, according to the Florida Agency for Health Care Administration.
  • Maine Medical Center in Portland treated 121 babies dependent on prescription painkillers in 2010, up from 18 in 2001, says Geri Tamborelli, nursing director at the Family Birth Center and neonatal intensive care unit.
  • East Tennessee Children’s Hospital in Knoxville adopted a program to treat drug-exposed babies a year ago. Of the 579 babies admitted to the neonatal intensive care unit since then, 106 needed treatment for withdrawal from oxycodone and other painkillers — up from fewer than 40 in 2008. In September, painkiller-addicted babies filled nearly half the neonatal intensive care unit’s 60 beds, the highest number ever.
  • It has just exploded,” says John Buchheit, director of neonatology at East Tennessee Children’s Hospital. “Narcotic use is just rampant in our society, and our area is particularly bad. The babies are caught in the middle.”
  • At St. Joseph’s Hospital in Tampa, 40 babies born in the first nine months of this year needed special care because of painkiller exposure — a 33% increase over all of 2010, says Ken Solomon, director of neonatology at three hospitals in the Tampa-St. Petersburg area.

23/Oct/2017

Loren Fishman, MD, Medical Director of Manhattan Physical Medicine and Rehabilitation in New York City put together a set of slides here that are worth looking at. They have a very important and practical list of things you can do to manage your chronic back pain: from sitting properly in a chair to having the right shoes and even taking warm baths properly and frequently.

Give this slide show a look, and take some notes.


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