Tag Archives: vicodin

States and Painkiller Overdoses

States and Painkiller Overdoses

There are big differences among the states in the rates at which opioid painkillers are prescribed — differences that can’t be attributed to disparate rates of illness or injury. Unfortunately, in places where prescribing rates are high, so are death rates from overdoses.

Opioid painkillers like Vicodin and OxyContin may well be overprescribed in virtually every state, but they are egregiously overprescribed in several Southern states, led by Alabama and Tennessee. Doctors in Alabama, the highest-prescribing state, wrote three times as many prescriptions per person for opioid painkillers in 2012 as doctors in Hawaii, the lowest-prescribing state, and federal officials think even Hawaii’s rate is too high.

There is a lot that states can do to stop careless — or drug-dealing — doctors from driving the opioid crisis. In a report this week, the Centers for Disease Control and Prevention credited Florida with achieving the first substantial decline in prescription drug overdose deaths in the past decade. That death rate dropped by 23 percent from 2010 to 2012, and the death rate for oxycodone, one of the most widely abused drugs, dropped by more than half over the same period.

Nationally, Florida had been home to 98 of the 100 doctors dispensing the highest amounts of oxycodone directly from their offices. Now, none of Florida’s doctors are among the top 100. It accomplished this by cracking down on so-called pill mills, forcing 250 pain clinics to close, requiring pain clinics to register with the state, prohibiting doctors from dispensing opioids from their offices, and monitoring what narcotics were dispensed.

No other state is dealing with the same level of overprescribing that Florida has now managed to reduce. Each state is apt to face a different constellation of drug problems and questionable medical practices. But the lesson from Florida is that a multipronged approach and the will to crack down can save a lot of lives.


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Men, Opiods, and Low Testosterone Levels

As a man, with chronic pain, and taking long-acting pain meds, I found this article interesting and yet disturbing at the same time. What are we to do? We take pain meds to get through the day and then have to add a testosterone supplement later in life? I by no means think that life is fair, but can’t we catch a break? Just an itsy-bitsy one?

Men Taking Long-Acting Chronic Pain Meds Five Times More Likely to Have Low Testosterone Levels

Jan. 31, 2013 — Low testosterone levels occur five times more often among men who take long-acting instead of short-acting opioids for chronic pain, according to a new Kaiser Permanente study published in The Clinical Journal of Pain.

While it has been known that opioids cause low testosterone in men, this study is the first to show a significant difference in risk between short-acting (immediate release) and long-acting opioids.

The 81 men in the retrospective study were between 26 and 79 years old (median age 51) and were seen in the chronic-pain clinic at Kaiser Permanente’s Santa Rosa Medical Center (Calif.) between January 2009 and June 2010. All of the participants had been on a stable dose of an opioid for at least three months, and none had a previous diagnosis of low testosterone. A larger retrospective study of more than 1,500 male pain patients is currently under way.

“There’s a large gap in the evidence base with regard to opioids,” said Andrea Rubinstein, MD, of the Departments of Chronic Pain and Anesthesiology, Kaiser Permanente Santa Rosa Medical Center. “More safety and efficacy studies are needed. We need to know how we can prescribe these very useful medications in a way that brings the greatest benefits to our patients, without introducing additional risks.”

Once prescribed primarily to cancer patients, the use of opioid-based medications such as oxycodone (Oxycontin) and hydrocodone (Vicodin) for treating chronic, non-cancer pain has increased dramatically in recent decades. An estimated 4.3 million Americans use opioids on a daily basis for pain.

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What Your Doctor May Not Know About Your Pain Pills

I found this article in my twitter feed (@doesithurt2) this morning and thought it a worthwhile read.


What Your Doctor May Not Know About Your Pain Pills


Most people who have chronic pain — a bad back, arthritis, or many other ailments — see their primary care physician for treatment. If ibuprofen doesn’t ease the ache, these doctors often prescribe narcotic drugs like Vicodin, Percocet and OxyContin.

Although the drugs, which trace their roots to the opium poppy, reduce pain, they also carry significant risks and can cause breathing to stop in large doses or when mixed with other drugs or alcohol. Yet research shows that many primary care doctors aren’t monitoring their patients use of the medicines to make sure they aren’t abused or misused.

It’s not an academic issue. More people die from accidental overdoses of prescription opioids annually than they do from cocaine and heroin combined: 11,499 in 2007, according to the Centers for Disease Control and Prevention.

Patient monitoring can take many forms, all generally aimed at making sure that patients take only the drugs prescribed to them — and don’t share or sell them. Some doctors ask patient to sign “pain contracts” or “opioid treatment agreements” that spell out these measures. But a recent study found that three of the most common strategies to ensure patients comply with their drug regimens aren’t usedunderused by primary care doctors.

The study, published in February in the Journal of General Internal Medicine, examined the medical records of 1,612 chronic pain patients at eight primary care clinics in the Philadelphia area over a five-year period ending in 2008. It found that only 8 percent were given urine tests, half were scheduled for office visits at least once every six months, and 76 percent were restricted from refilling their prescriptions early.

Part of the problem is practical. “It’s easy to say that it’s useful to do prescription monitoring and urine screening, but building this stuff into day-to-day practice is hard,” says Perry Fine, president of the American Academy of Pain Medicine.

The other sticking point is a lack of education, of physicians and the general public, about how to prescribe and take these drugs safely, say experts. “Primary care doctors haven’t been taught a lot about pain management,” says Penney Cowan, founder and executive director of the American Chronic Pain Association, a patient advocacy group. This leads them to sometimes undertreat pain, on the one hand, or prescribe it without proper monitoring, on the other.

“Those who need those drugs should be able to get access,” she says. “But if a healthcare provider chooses to give them opoids, then patients need to be educated.”

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Posted by on April 5, 2011 in Pain - Physical


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