Archives for July 2016

Is Suboxone the New Kleenex®?

Confusion About Suboxone

There is an interesting recent article in MEDPAGE TODAY titled “Suboxone Underused, Opioids Overused in Medicine.” To me, that is an oxymoron.

As I’ll explain, the title does make sense if you’re trying to communicate to the lay public, but it is an ambiguous and seemingly contradictory statement. Since there’s already way too much confusion in the discussion of opioids, let me clarify what the MEDPAGE TODAY article most likely is trying to convey.

Suboxone is a brand name for a specific product that is used to treat addiction. It is a combination of buprenorphine and naloxone. The active ingredient to treat addiction is buprenorphine.

Most Opioid Addictions Start In Teen Years: What you Need to Know

Ninety Percent of All Drug Addictions Start in the Teens

“Ninety percent of all drug addictions start in the teens — and 75 percent of prescription opioid misuse begins when (mainly young) people get pills from friends, family or dealers — not doctors. Opioids are rarely the first drug people misuse.”

This is an incredibly important idea, and I want to credit Maia Szalavitz for having the courage to state it in her recently published article, “What Science Says to Do If Your Loved One Has an Opioid Addiction.” (As an aside: Szalavitz is the author of the recently published book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction, which I hope you’ll consider adding to your reading list.)

This is the Reason Heroin Addiction Requires Critical Analysis

President Obama stands ready to sign the Comprehensive Addiction and Recovery Act (CARA). This bill will make available more treatments for opioid addiction and is intended to deter inappropriate prescribing of prescription opioids. As a recent Washington Post article points out, critics of CARA fear that this legislation could “cause prescription opioid users to switch to heroin, thereby feeding a second opioid epidemic.”

The Heroin Epidemic

I am also concerned about the heroin epidemic. But it’s important that we understand the actual reasons for the increase in heroin use. The Post article cited above, “The Real Reason That So Many More Americans Are Using Heroin” by Keith Humphreys, clarified some of the myths surrounding this issue.

The Reason CARA (Comprehensive Addiction and Recovery Act) is Not All That Comprehensive

What Is CARA (The Comprehensive Addiction and Recovery Act of 2016)?

By now, you may have heard of the Comprehensive Addiction and Recovery Act (CARA) of 2016. Designed to establish “a comprehensive, coordinated, balanced strategy through enhanced grant programs that would expand prevention and education efforts while also promoting treatment and recovery,” the bill passed the U.S. Senate on March 10, 2016 by a nearly unanimous vote. However, funding for the bill has not yet been approved as I write this blog.

Why You Need to Sign the White House Petition for National Pain Strategy

I’m pleased to say that I’ve signed the White House Petition that was recently launched by the National Fibromyalgia & Chronic Pain Association (NFMCPA) with Consumer Pain Advocacy Task Force (CPATF). The petition asks the White House to implement and fund the National Pain Strategy (NPS) toward a better future for people with debilitating, life-altering chronic pain.

I ask you to consider signing the White House Petition as well.

What the Latest @NatCounterPunch Opioid Article Doesn’t Want You To Know

I was troubled to see a recent story in the online publication, Counterpunch. It starts off by declaring the root cause of the opioid crisis is Pharma’s contribution to professional societies for “educational” programs. Counterpunch reports that the funding was provided to advocate for “more aggressive identification and treatment of pain.” Ironically, the tag line to the online media site is “Tells Facts, Names and Names.”

So let me discuss some of the facts that the Counterpunch reporter omits:

Opioid Educational Programs

The reporter states that “20,000 pain-related ‘educational’ programs were sponsored by Purdue Pharma,” and that the company “launched a multifaceted campaign to encourage long-term use of opioids for chronic non-cancer pain.”

The Reasons Democracy Invites All Perspectives

According to a Baltimore Sun article, Dr. Mary Lynn McPherson, who teaches in the School of Pharmacy and specializes in hospice and end-of-life care, was removed from an FDA medical advisory panel along with three other doctors. The panel was organized by the National Academies of Sciences, Engineering, and Medicine.

Grants and Funding

Although the National Academies of Sciences, Engineering, and Medicine will not officially disclose its reasons for removing Dr. McPherson and the other highly qualified doctors (such as Dr. Greg Terman who serves as president of the American Pain Society) from the panel, the ousting was apparently motivated by a letter that was sent to the panel by Senator Ron Wyden. In it, the senator pointed out that Dr. McPherson received grants and funding for medical residents worth at least $300,000.

This Is the Hazelton Betty Ford Institute’s Statement on Opioids

In a new press release posted by the Hazelden Betty Ford Institute for Recovery Advocacy, “The Hazelden Betty Ford Institute for Recovery Advocacy commends new steps taken by the American Medical Association (AMA) to help combat the national opioid crisis, and encourages continued action in the year ahead.”

According to the Hazelden Betty Ford Institute, those new steps include removing pain as a vital sign. In other words, the AMA and Hazelden believe it is better not to try to quantitate pain assessment because doctors may feel they have to prescribe an opioid if the patient reports they are in significant pain. They contend that line of thinking has contributed to the opioid crisis.

The Truth About Treating Pain in Senior Citizens

Objections to Senior Citizens Receiving Opioids

According to a recent report by the Office of Inspector General for the U.S. Department of Health and Human Services, opioids are commonly prescribed for senior citizens in pain. Almost 12 million Medicare beneficiaries received at least one prescription for an opioid painkiller last year. The report goes on to say the cost of those prescriptions was $4.1 billion.

The report includes opioids prescribed for all pain, not only for chronic pain, which is what makes the statements from the Office of the Inspector General especially puzzling. It seems that the Office of the Inspector General is confused about the realities.