Author: Justin Mckibben
When discussing the very real devastation of the opioid crisis some people are still skeptical as to how big of a part prescription opioids play in the problem. While all patients should have access to comprehensive care for conditions relating to severe pain, ignoring the fact that prescription drug abuse is a crucial element of the epidemic is far too careless.
Many states had to face the issue of pill mill clinics and doctor shopping. Now one state, in particular, is now taking massive action in hopes of ending a very serious problem that has only grown over the years. Authorities in North Carolina took a close look at how prescription drugs wind up on the streets.
One of the key factors to narcotic medications hitting the illicit market was doctor shopping.
Doctor Shopping Stats
First, let us explain what doctor shopping is for those unfamiliar with the concept. Innovations in Clinical Neuroscience described the practice of doctor shopping, saying it:
“- entails the scheduling by patients of office visits with multiple clinicians for the same agenda, either for a continuing illness or to procure prescription drugs illicitly. As expected, the explicit definitions in the literature vary considerably, with a significant proportion focusing on a given illness episode.”
Essentially, doctor shopping is when patients visit multiple doctors with the intention of having a prescription given and then filled from each physician, giving them an abundance of medications.
Now in the case of North Carolina, this tactic grew a great deal of momentum as the opioid epidemic spiraled out of control in the past few years. According to WRAL, a Raleigh-based news outlet:
- In 2010, the State Bureau of Investigation says there were 88 doctor shopping cases.
- In 2016, that number rose to 184
- That is a 110% increase in doctor shopping incidents!
According to NBC Charlotte:
- Approximately three people North Carolina die every day in due to drug overdoses.
- Around half of those deaths are due to opioid painkillers.
So now, what moves is North Carolina making to try and fight back?
The Strengthen Opioid Misuse Prevent Act
After realizing just how big of an issue prescription drugs were playing into their current drug problem, officials in North Carolina have decided to put measures in place to try and prevent doctor shopping.
Starting January 1st with the new year, North Carolina enacted a new law, referred to as the Strengthen Opioid Misuse Prevent Act. So what does this new measure do?
- It allows doctors to only give a five day supply of opioids for pain from certain injuries, like broken bones.
- After a surgery, it allows doctors to prescribe a seven day supply.
- Refills can be given as needed, but the first refill will be limited.
North Carolina also gave some thought to protecting those in severe need of pain management resources. The new law does not apply to those with:
Local Authorities Unsure of the Future
The executive director of the North Carolina Board of Pharmacy, Jay Campbell, told reporters that while the action is being taken, it will probably never be completely eliminated. Campbell states,
“We’re certainly hoping that we can radically reduce the scope of drug diversion from pharmacies or any place else. But it is a problem that is never going to go away.”
However, Campbell believes there are certain indications of doctor shopping that pharmacists can keep an eye on as well, such as:
- The patient is visiting a pharmacy far outside their normal location.
- The patient brings in prescriptions from doctors the pharmacy is not familiar with.
Officials trying to stop doctor shopping in the area are asking pharmacists to be alert and ask questions when appropriate. Meanwhile, they are also working to develop other means of drug monitoring, including a system in which North Carolina doctors can register when they prescribe opioids to monitor records and catch patterns of doctor shopping.
There may now be some light at the end of the tunnel. Overdose death rates due to many legal prescription opioids are still rising, but they are rising far more slowly than that of fentanyl and other synthetic opioids according to a CDC report. While it is terrible that the death rates are still increasing, the fact that the rate of progression has slowed noticeably could suggest that many of the recent efforts aimed at curbing widespread over-prescribing practices could be starting to have a positive impact on the extent of the opioid crisis.
Medical Detox for Opioids
An important thing to remember is that for those suffering from substance use disorder or a physical dependency to opioids should always seek safe medical treatment in order to get off these powerful drugs. Opioid abuse presents an inherent risk to the body and the brain. Because of the often difficult and uncomfortable withdrawals, detoxing from opioids is best done in a safe medical environment.
Palm Healthcare Company’s detox facilities will offer a more comprehensive model for recovery from opioid addiction. Medical detox consists of both psychological treatment from professionals for both addiction and co-occurring mental health issues, as well as pharmacological treatment from medical specialists who can decide if there are optional medications to help ease the detox process.
What a medical detox for opioids should always do is provide a trained staff to monitor important vital signs like:
- Respiration levels
- Blood pressure
- Body temperature
- Heart rate
Abruptly discontinuing opioids can be painful or even damaging to the body. Make sure to seek the appropriate help. If you or someone you love is struggling, do not wait. Please call toll-free now. You are not alone.
CALL NOW 1-800-951-6135
Author: Justin Mckibben
Despite the fact that over 91 people die every day from an overdose due to prescription drugs, some people still struggle to realize that prescription drug abuse is the driving force behind the current opioid epidemic. According to the American Society of Addiction Medicine (ASAM):
- 4 out of 5 heroin users started out abusing prescription pain medication
- 94% of people in treatment for opioid addiction surveyed in 2014 switched to heroin from prescription opioids.
One of the biggest issues is that powerful opioid painkillers are being overprescribed. Whether due to aggressive marketing tactics used by Big Pharma companies or the corrupt ‘pill mills’ where doctors were dishing out excessive prescriptions of potent drugs to be sold on the street, prescription opioids flooded the neighborhoods across the nation, helping create one of the worst addiction outbreaks in American history.
But it wasn’t just the fact that drugs were making it onto the streets. In general, even legitimate opioid prescriptions were astonishingly high. While too many people still think the only problem is heroin or street drugs, the facts show us that opioid painkillers were still largely overprescribed in recent years, which contributed to the current crisis.
Too ‘Legit’ to Quit
According to the National Survey on Drug Use and Health, nearly 92 million U.S. adults in 2015 were taking a legitimately prescribed opioid. That translates to 38% of the adult American population.
There were an estimated 240 million opioid prescriptions in 2015, nearly one for every adult in the general population. Even the Deputy Director of the U.S. National Institute on Drug Abuse, Dr. Wilson Compton, said,
“The proportion of adults who receive these medications in any year seemed startling to me”..”It’s an awful lot of people who take these, mostly for medical purposes, but within that, a significant percentage end up misusing them,”
So while a lot of these prescriptions were going to treating serious conditions, how many ended up on the street or being abused at home because they were overprescribed?
The same NSDUH survey found that 11.5 million people misused prescription opioids they obtained through illicit means. Overall, Dr. Compton states that these results indicate medical professionals are doing a poor job of appropriately prescribing these medications.
The trend didn’t end there. According to a new report, nearly 3 million people who had surgery in 2016 became persistent opioid users, taking the drugs 3-6 months after a procedure. The report also states that due to overprescribing, 3.3 billion pills were left unused by patients, which left them open for diversion or misuse.
Some pain management advocates insist that pain may end up being undertreated due to the rising scrutiny of opioid prescriptions. Many of these advocates say it is extremely difficult to truly know if opioids are overprescribed because pain is too hard to objectively quantify. Therefore, some patients may actually need more relief resources than others.
Yet, prescribing rates are still, at the very least, questionably high. Especially considering by most estimates that over 50% of opioid pills legitimately prescribed are unused by patients, which suggests significant overprescribing certainly exists.
4 Doctors, 6 Million Pills, 1 Year
One recent case in particular that stands out concerning overprescribing of medications is the story of a small northwestern county in Arizona where 4 doctors prescribed nearly 6 million opioid pills in a 12 month period. The data provided by the Controlled Substances Prescription Monitoring Program did not list the doctors by name, but did give detailed information about the prescriptions.
Out of all 4, the top prescribing doctor is responsible for:
- More than 20,000 opioid prescriptions
- Equaling out to over 1.9 million pills
- That comes to 7,350 pills a day
The second-place prescriber is responsible for:
- More than 15,000 prescriptions
- Equaling out to nearly 1.6 million pills
The other two doctors totally a combined 2.4 million pills prescribed.
The four doctors in question are located in Mohave County, which as of 2016 is home to approximately only 205,249 people. That comes out to about a 30 opioid supply for every single person in that county.
Now while pain may be hard to objectively quantify, these numbers are obviously unsettling. Even the executive director of the Arizona Board of Pharmacy, Kam Gandhi, could not explain why or how these four physicians were able to issue so many opioid pills.
A spokesperson for Attorney General Mark Brnovich declined to specify exactly what actions are being taken by his office concerning this development. However, according to AZ Central Doug Skvarla, who directs the Controlled Substances Prescription Monitoring Program, said that information has been passed on to Brnovich’s office for “an open investigation.”
Illicit Use of Prescriptions
There are plenty other issues with opioid prescriptions being taken advantage of all over the United States. Pain management advocates often argue that the problem isn’t about opioid prescriptions; it’s the people that misuse and divert the medications. In other words, that the people abusing opioids frequently don’t have a legitimate prescription. A lot of opioid pills being abused are obtained illicitly.
Many people won’t use their whole prescription. Many will actually give pills to a loved one who doesn’t have their own pain treatment. Or they will sell their remaining pills. Pill mills and ‘doctor shopping’ allowed for the even worse spread of excessive opioid prescriptions. Like in Illinois, where one individual received 73 prescriptions for opioid drugs from 11 different prescribers and filed them at 20 different pharmacies. In some cases, the individual filled prescriptions at multiple pharmacies in one day.
There is absolutely a high demand on the illegal drug market for prescription opioid painkillers. As a former addict who spent over 7 years using, buying and selling opioid medications on the street, I can say there is plenty of ways to get these drugs without a prescription.
However, if we back-track a little bit, how did so many potent medications get onto the streets if there is no overprescribing?
Feeling the Pain
Pain management is absolutely necessary. There must be resources and effective medications available for those suffering from serious medical conditions or recovering from life-altering procedures. There is no denying that we have to provide effective pain relief options for patients who desperately need it. So, of course, this is a difficult conversation to have, because many people can take these medications are directed and be fine when they are gone. Some people require long-term pain treatment, but it does not result in a severe addiction.
Still, the fact is that if these medications weren’t being prescribed more than medically necessary, they would have never flooded the underground drug marketplace as rapidly and as abundantly as they did. Between doctors overprescribing (sometimes for kickbacks), patients working the system and manipulating physicians, and the aggressive marketing tactics of Big Pharma going unchecked, there are plenty of elements at play.
Undoubtedly when we examine the opioid epidemic we cannot ignore any contribution. We have to make efforts to combat the spread of heroin addiction. There has to be an intensive effort to deal with the incredibly deadly synthetic opioids like fentanyl and carfentanil, and people also have to acknowledge their own choices and do their part to move forward. It might be a difficult and painful process, but it is necessary.
Still, overprescribing of opioid medications cannot be ignored. We should explore all options concerning prescription monitoring programs, enforce current regulations of drug distribution, and develop innovations in pain management therapy.
According to one report, even just a 10% reduction in surgery-related opioid prescribing would reduce:
- The number of excess post-surgical pills available for diversion or misuse by 332 million
- The annual number of patients who go on to persistent opioid use after surgery by 300,000
- Annual drug costs by $830 million
Not only can we do better to treat those suffering from chronic and severe pain, but we can do better to make sure these potent and habit-forming medications don’t end up in the wrong place. For those who abuse prescription opioids, or who have found themselves using heroin, we need to provide safe and effective treatment options. Palm Partners Recovery Center has been treating people struggling with drug dependence and substance use disorder for decades, focusing on holistic and comprehensive care. If you or someone you love is struggling, please call toll-free now.
CALL NOW 1-800-951-6135
While the entire country has been impacted by this ongoing issue, more options for prevention and treatment have become paramount to changing the tides. Just this week Rick Scott, the governor of the state of Florida, proposed a strategy for fighting the opioid epidemic that has gained a lot of attention. Scott has decided to ask local lawmakers to impose a three-day limit on opioid prescriptions during the upcoming legislative session. This latest development is one new piece of recent initiatives to combat the opioid crisis.
Florida Governor Opioid Initiatives
During two press conferences on Tuesday, the Florida Governor announced a pushback on an abundance of opioid prescriptions, while also introducing other ideas for fighting addiction.
One of the initiatives Rick Scott is pushing is to require all health-care professionals who prescribe controlled substances to participate in the Florida Prescription Drug Monitoring Program, also known as the PDMP. This database involves health-care professionals to report important information on patients receiving powerful narcotic medications, including:
- Name of the doctor
- Patient name
- Prescription information after the prescription is filled
But this is not the last of Florida Governor Scott’s opioid initiatives. His office also plans to seek additional reforms such as:
- Fight unlicensed pain management clinics
- Requiring education on responsible opioid prescribing
- Creating more opportunities for federal grants
Scott apparently plans to put some more investments toward helping those already struggling. He is also pushing for more than $50 million for services including:
Part of this initiative is also boosting up the budget of the Florida Violent Crime and Drug Control Council.
At the moment the finer details of the Florida Governor’s proposals are not yet available. However, what it does tell us is that Scott is not ignoring the contribution Big Pharma makes in this current crisis. What we can tell from this outline is that Rick Scott says he is aiming to address prescription opioid pain medication, recognizing it as a key source of the growing problem.
Why 3 Days?
It has been reported time and time again that we should be paying attention to how powerful opioid medications impact rising addiction rates. Now the Centers for Disease Control and Prevention (CDC) has released a recent study showing how quickly someone could get hooked on these kinds of drugs. In this study it is shown:
- After three days of use, about 6% of patients were still using opioids a year later.
- Five days into use, about 10% of patients were still using opioids a year later.
- After 11 days of use, it jumps to 25% of patients still taking opioids a year later.
So it would seem that between 3-5 days, the chances of continued use almost doubled. Then between 5-11 days the chances of use more than doubled. This development may have helped inspire the idea to limit prescriptions to 3 days.
Back in March, Bradley Martin of the CDC, one of the study authors, told Vox magazine:
“There’s nothing magical about five days versus six days, but with each day your risk of dependency increases fairly dramatically,”
So while day 5 and day 6 may not be a dramatic leap over the edge, some may see this proposed limit as an attempt to at least slow a process down.
The Opposing Argument
The Florida Governor will probably face strong criticism, or at least skepticism, from crowds such as:
The opposition is still very real. This isn’t even the first time Florida lawmakers have seen something like this brought to the table. Just last year Florida legislatures quietly rejected an effort last year to impose a five-day cap on opioid prescriptions for acute pain.
Legislatures and doctors are the only concerns Florida Governor may have to tangle with in order to push this idea through. Other potential obstacles standing against this proposal include:
- Additional out-of-pocket co-pays that patients will incur
- The ability of patients with chronic pain and terminal illnesses to refill prescriptions
The Florida Society of Interventional Pain Physicians will discuss caps on prescriptions during a board meeting today. Dr. Sanford Silverman is a past president of the Florida Society of Interventional Pain Physicians. In regards to the 3 day limit he stated:
“We don’t think the cap is reasonable since it is a completely arbitrary number,”
“A better idea would be to mandate usage of the PDMP prior to writing an opioid for acute pain.”
Other states have created caps on prescriptions, although some may not seem as strict as the 3 day rule.
- Massachusetts limits the supply to seven days.
- New Jersey set it so that first-time prescriptions for acute pain cannot exceed a five-day supply. Also, patients being treated for cancer or under hospice care are exempt.
- Ohio caps distinguish between patients with chronic pain and those with acute pain.
At the end of the day, similar strategies may not be left up to the lawmakers. If pharmacies decide to impose their own limits on certain prescription drugs the Florida Governor might not have to push very hard to get the limits he is looking for.
CVS announced Friday that the company plans to:
- Limit the daily dosage of pain pills based on their strength
- Require the use of quick-release painkillers before extended-release opioids are dispensed
- Limit opioid prescriptions to seven days for certain conditions
This restriction will specifically apply to patients who are new to pain therapy.
Only time will tell how far Florida Governor Rick Scott’s new pitch will go, but it seems one thing people can agree on is that the opioid crisis does require some new approaches to prevention.
With more prevention we may be able to slow down the rising rates of opioid addiction. Meanwhile, the need for safe and effective treatment still means a lot for helping those already suffering. Real treatment resources matter. If you or someone you love is struggling, please call toll-free now. We want to help.
CALL NOW 1-800-951-6135
Author: Shernide Delva
Pain management devices can drastically reduce, or eliminate, the need for opioid pain medication, according to a recent report. Could this be the shift we’ve been looking for?
I’ll be honest.
The first time I heard about pain management devices is when I skimmed through my Facebook and saw a fundraising campaign regarding a product claiming to help women with extremely painful menstrual cramps. It was touted as “The off Switch for Menstrual Pain” and claimed to be “the new solution for instant pain relief from your period – no more pills, no more nonsense.”
When I read the description of the product, I was intrigued by the idea. I figured it was a better alternative to me taking half a bottle of ibuprofen every month. Clearly, I was not the only intrigued person. The product has fundraised over 1.7 million dollars, raising 1339% of their target goal. Wow.
But how exactly do these pain management devices work?
Looking deeper into it, it turns out that menstrual pain device is basically a fancy version of a TENS device. TENS stands for Transcutaneous Electrical Nerve Stimulation. TENS machines operate by sending stimulating pulses across the surface of the skin and along the nerve strands. These pulses prevent pain signals from reaching the brain.
Every pain management device works in a slightly different way. Essentially, these pain management devices send small currents through the spinal cord where the pain is signaled. Scientists believe these electrical currents interrupt pain signals sent to the brain. The fancy name for this is neuromodulation or neurostimulation.
These devices may work due to The Gate Control Theory.
The reality is that scientists are not completely sure how these devices work, but one theory is The Gate Control Theory. The Gate Control Theory is a theory that states that through closing the “gates” to painful input, you prevent pain sensations from traveling to the central nervous system. Large amounts of sensory information scramble the pain sensors we have and reduce our bodies ability to feel pain.
The device mentioned in the research regarding opioids is a device that is surgically implanted. While the results are promising, not everyone is comfortable with having a device surgically implanted in their body. Therefore, this solution is often seen as a last resort. This must change, according to Nagy Mekhail, a pain physician at the Cleveland Clinic.
Now, the medical community is looking to develop a device that provides the same sort of relief without the need for surgical implementation. One device developed is the Neuro-stim System Bridge which is placed behind a patient’s ear and gives off electrical pulses to certain areas of the brain.
The device has been very effective for helping people overcome the pain of opioid withdrawals, and is now used in 30 states. Patients wear the device for the first five days after they stop using opioids; the toughest part of the opioid withdrawal process.
“This could be a game changer in terms of treatment of addiction,” said Jeff Mathews, who runs the Union County Opiate Treatment Center in Indiana.
Still, not everyone is as excited.
Some are not quite convinced these devices will solve America’s chronic pain problem. Edward Michna, a pain management specialist at Brigham and Women’s Hospital in Boston, states more research is needed to understand their long-term effectiveness.
“Have I seen patients do well on it? Yes. But I’ve also seen patients lose the relief over time,” he states.
However, despite the inconclusive research, the potential for this to be an opioid alternative is a significant first step.
“We need to stop thinking of pain control as just being about opioid medications,” Michael Leong, a pain specialist at the Stanford University School of Medicine, told Technology Review.
More and more people are aware of the negative side effects of opioid painkillers. With that awareness comes more attention directed toward pain management devices without a risk of addiction.
“People are afraid of opioids right now. There’s a stigma. Patients don’t want to be on opioids,” Leong said.
We will have to keep an eye out and see if more non-surgical pain management products hit the market in the near future.
Pain management is a controversial topic. People have different pain tolerances and needs. However, there is a serious need to come up with non-addictive alternatives to opioid painkillers.
We are in the middle of an opioid epidemic. There need to be other options available. If you are currently struggling with substance abuse, please call now. We want to help.
CALL NOW 1-800-951-6135
Author: Shernide Delva
In an effort to curb what many consider to be the worst public health drug crisis in decades, the CDC has issued a series of guidelines and restrictions intended to reduce the abuse of prescription painkillers. On Tuesday, the federal government released these CDC standards, ending months and months of disagreements with pain doctors, and drug industry groups. However, many are still asking the same vital question: will these guidelines even work?
The CDC guidelines will be the first national standard for prescription painkillers. The guidelines are intended to provide a more sensible approach to prescribing highly addictive medicines. In the past, drugs like OxyContin and Vicodin were easily prescribed to patients. Although efforts have been made to reduce the amount of prescriptions prescribed in the medical community, these guidelines will further limit how opioid medications are distributed.
“This is the first time the federal government is communicating clearly to the medical community that the risks outweigh the potential benefits of these drugs,” said Dr. Andrew Kolodny, head of Physicians for Responsible Opioid Prescribing, which supports the guidelines. “It’s one of the most significant interventions by the federal government.”
These guidelines recommend what many addiction experts have long called for which is pushing doctors to recommend other pain management options. The CDC guidelines also limit the amount of prescriptions a doctor can prescribed at one time.While these new guidelines are non-binding, they are likely to have a huge influence in the medical community.
New CDC Painkiller Prescription Guidelines
Just to give a brief overview, here are some of the main specific guidelines that will be implemented in the next coming months.
- Doctors should first try ibuprofen and aspirin to treat pain prior to prescribing more high-risk drugs such as opioid medications.
- Opioid treatment for short-term pain should last only three days, at the longest seven days. This will be a significant change. Currently, doctors prescribe for anywhere from two weeks to a month of opioid medications for short-term pain management.
- Doctors should have patients undergo urine tests prior to getting prescriptions.
- Doctors are to participate in a drug tracking system to ensure patients are not getting medicine from somewhere else. Currently, 49 states have these systems yet only 16 are required to use them.
- These guidelines will not apply to patients receiving cancer treatment or end-of life treatment.
The new guidelines are a dramatic shift from the ideology of the 1990s. Back then, an initiative to fight for pain management resulted in opioid prescription painkillers soaring in popularity in the medical field. Pharmaceutical companies and medical experts pushed to have these drugs readily available because at the time, they were thought to be effective solutions to treat back pain and arthritis without the fear of addiction. Boy, were they wrong back then.
Now, as overdoses continue to mount, and addiction claims more and more lives each year, the country is desperate for an answer. While these guidelines may have good intentions, other professionals argue that more rules can cause more harm than good. Recent tighter restrictions on painkillers have resulted in the drugs soaring in cost on the black market. As a result, a significant number of addicts turn to heroin to satisfy cravings.
For nearly two years, these standards have been bitterly opposed by Big Pharma and pain doctors who feel that these guidelines will only post unfair hurdles for patients who really do suffer from chronic pain. They argue that drug addicts will simply find another way to get their fix, like heroin. Opponents of the new guidelines also believe that these rules are an incursion into the role of doctors.
Dr. Thomas R. Frieden, director of the disease centers, responded,
“It’s become increasingly clear that opioids carry substantial risk but only uncertain benefits — especially compared with other treatments for chronic pain.”
He continues to support the guidelines, stating they are meant to be “a tool for doctors and for patients to chart a safer course,” describing them as a benchmark for medical practice, not an unbending dictate. The idea, he said, is to balance the risks of addiction with the needs of patients.
“For the vast majority of patients with chronic pain,” Frieden said, “the known, serious and far too often fatal risks far outweigh the transient benefits. We lose sight of the fact that the prescription opioids are just as addictive as heroin. Prescribing opioids really is a momentous decision, and I think that has been lost.”
Essentially, Frieden is saying these new guidelines are meant to help with the addiction crisis and certainly are not meant to prevent those with chronic pain from receiving medications they need. Furthermore, it is uncertain the effects opioid medications have on chronic pain in the long run, so we can not assume that restricting these drugs cause any harm to those patients.
Considering how urgent the addiction epidemic is, something has to be done, and at least these new guidelines encourage conversation. Education and prevention is the key. Each year, the data is increasingly more frightening. There clearly is not a one-stop solution to all of this. Do you think these guidelines will be effective? If your or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135.