Opioid Epidemic (no humor here)

     We are reading and hearing more frequently that this country is in crisis regarding opioid use. What are opioids?

     "Opioid" is a "blanket term used for any drug which binds to the opioid receptors in the central nerous system or gastrointestinal tract" (Yahoo Answers:  difference between opioids, opiates, and benzodiazepines).
Opioids are used primarily to relieve pain.

Natural opiates are Morphine, Codiene, and Thebaine.
Semi-synthetic opioids are Heroin, Oxycodone, Hydrocodone, Dihydrocodene, Hydromorphone, Oxymorphone, Buprenorphine, Etorphine, Naloxone, and Nicomorphine.
Synthetic opioids include Methadone, Pethidine (Demerol), Fentanyl Alfentanil, Sufentanil, Remifentanil, Carfentanyl, Pentazocine, Phenazocine, Tramadol, and Loperamide.

     Before there were pain relievers, humans relied on the natural world to ease suffering.  The Sumerians used opium from the poppy by 3400 B..C.  They shared the pain-relieving potential of this plant with the Assyrians, who passed it to the Egyptians.  Alexander the Great took it to India, and from there opiates spread around the world.

     Opium, opiates, and opioids all produce similar effects.  At low doses they make effective painkillers.  At medium to high doses they produce euphoria, nausea, sleepiness, a sense of peace. They can be extremely addictive mentally and physically, the body craving more and more to reach the same state of euphoria over time. All are depressants.

     On August 31, 2016, the FDA announced it would require boxed warnings on prescription opioid analgesics, opioid-containing cough products, and a class of drugs called benzodiazepines regarding the serious risks when these medications are used together.  Overdose deaths tripled involving concomitant use of these drugs between 2004-2011 (AmericanAssociationFamilyPhysicians.org/news/health-of-the-public). For patients taking both classes of medications, there are non-sedating anti-depressants that can be used in place of benzodiazepines.

     What are benzodiazepines?  Benzodiazepines are among the most commonly prescribed depressant medications in the U.S. today.  More than fifteen different types exist to treat a wide array of psychological and physical maladies, whose treatment might be used for:  anxiety relief; hypnotic; muscle relaxant; anti-convulsant; or amnesiatic (mild memory-loss inducer).  These drugs affect a key neurotransmitter in the brain, slowing or stopping neuronal (nerve) impulses throughout the body. A short-acting benzodiazepine is cleaned from the body in a short time, whereas long-acting benzodiazepines may either accumulate in the bloodstream or take a much longer time to leave the body.

     The DEA has cracked down on the medical use of synthetic narcotics such as OxyContin and Lorcet, Lortab, Norco, and Vicodin.  Therefore, many physicians have been scared to prescribe such medications.  However, opioids play a key role in easing pain for people at the end of life.

     The controversy focuses on the treatment of chronic non-cancer pain.  The Center for Medicare and Medicaid Services has drafted a policy that would make it difficult or impossible for these patients to get prescriptions for such medications. Many of the chronic-pain patients are now suffering withdrawal symptoms because they can no longer access medications that allowed them to function (Palm Beach Post, "Health and Beauty," March 19, 2017, pg. F5).

     Palm Beach County, Florida, is in the midst of an opioid crisis. A person died every other day of a heroin-related overdose in 2015 - more than all fatal car crashes and double the number of homicides. In 2016, there were more than 500 deaths in the County from heroin (Palm Beach Post, "Opioid Crisis Puts County in Spotlight," pgs. 1 & 5, February 27, 2017).  At a recent conference in Washington, D.C., community leaders from across the nation shared horror stories and solutions. The most common recommendation was for all first-responders, including police and deputies, to carry and use the overdose antidote naloxone.

     In Palm Beach County, a few police departments use naloxone, but P.B.C. Sheriff Bradshaw refuses to let his deputies carry it, citing liability issues.

     "It still shocks me when I hear of jurisdictions that don't have a Narcan or naloxone program. There's no downside to it," said Assistant Police Chief Russ Hamill from Montgomery County, Md. "You're not going to hurt anybody."

     

   




   

   



   

   

   

How Not to Get Sick(er) in the Hospital

This is a recap of a Consumer Reports article of the same title, February, 2015, pages 32-37.  The information reinforces the experiences I relate in my book, ELDERLY PARENTS WITH ALL THEIR MARBLES: A SURVIVAL GUIDE FOR THE KIDS. In a future blog I'll discuss the physician's "squeeze."

TO INCREASE THE ODDS OF A GOOD HOSPITAL EXPERIENCE:

- Check infection rates at local hospitals before surgery.
   Go to www.LeapFrogGroup.org to check
   hospital performances on
   patient safety, high risk procedures, and intensive care.

- Pick a medical team that will involve you in decisions
   about your care and respect your capacity to make
   those decisions.

-  Make clear to the staff you want to be treated with patient respect and dignity.
   Among 1,200 recently hospitalized people surveyed by Consumer Reports,
   29% said they rarely received respect from the medical staff.  Those patients were
   2 1/2 times more likely to experience a hospital-acquired infection, a wrong
   diagnosis, an adverse drug reaction, or a prescribing mistake.

   Respectful treatment includes:
   Doctors minimizing use of medical jargon or explaining it
   Staffers introducing themselves before doing anything else
   Doctors and staff listening to your concerns, answering questions, honoring your
       wishes
   Medical teams acknowledging mistakes and treating you like a person

   If a patient doesn't think the staff is listening or his wishes aren't
   being met, he'll hesitate to ask questions, point out mistakes, or communicate
   in ways that could improve his situation.

   "The safest hospitals," according to a group of Harvard Medical School doctors and
   researchers as reported in Academic Medicine (journal), "share core values of
   transparency, accountability, and mutual respect."

   "Every day almost 2,000 people on average pick up an infection in the hospital and
   about 1,100 preventable drug errors occur.  Hospital medical errors are linked to
   440,000 deaths annually."

   The greatest danger for a patient in the hospital is NOT 
   infection or drug error.  
   It's REMAINING SILENT!
   Patient (or advocate) engagement
   has been nicknamed
   "the blockbuster drug of the century."

IF YOU'RE A PATIENT IN A HOSPITAL:

- Let a nurse know the extent of your pain.

- Find out what tests and procedures are for.

- Ask about drug side effects and interactions.

- Be a person to the staff, not a diagnosis.  Talk about your family or personal details

  about your life.

- Invite doctors to have a seat and look at them in the eye to initiate direct
  eye contact away from an electronic device or clipboard.

- Bring an advocate with you (family member, friend, health care proxy, 

   health care manager) to make sure you're comfortable, to get information 

   from the doctor written down, to help you make decisions, to speak for you 

   if you aren't able.  The advocate should meet the head nurse, attending physician, 

   therapist, and aide.

- Have an advocate with you when the most hospital errors occur (shift changes 

  and care transitions).

- Keep a journal and pen or e-device for questions and notes.

- Make a list of questions for the doctor when he makes his rounds.

- Ask your questions but try not to alienate the doctor or staff.

- Ask a doctor to repeat himself if you don't understand. 

- If you don't see your doctor or nurse wash his/her hands, make a respectful request

   that he does so.  Gloves don't necessarily stop the spread of infection.

Many thanks to my friend Al West for passing this article along to me!

   

                                         
 

Happiness Is a Cheap Drug Part II

In anticipation of the 2014 publication of my book, ELDERLY PARENTS WHO HAVE ALL THEIR MARBLES:  A SURVIVAL GUIDE FOR THE KIDS, I've invited fellow writer and practicing pharmacist Don (D.G.) Weiss to be a guest blogger.  The excerpt below is from his second mystery novel ALL THAT GLITTERS and concerns the importation of cheap drugs purchased on the internet from Canada.  This is in no way a reflection on the vast majority of legitimate drugs purchased from Canada, but as always, "caveat emptor."

     Part II

The emergency room doctor responded to the call from the nurses' station.  "We got a real winner here, Doctor Russell."  The ER nurse laughed.  The doctor looked at the chart and chuckled quietly to himself.

"Priapism is no joke, nurse."  The doctor half-scolded her, but he was trying to control his own amusement. He was more concerned about the blood results he was reviewing.  He walked into Jim's room and introduced himself.

"I'm Doctor Russell, Mr. Tobias.  Let's see what we can do for you."

"What's the matter, Doc?" Jim asked.  "Why does it hurt so much, and why won't it go down?"

"How long has it been this way, Mr. Tobias?"

"I don't know, Doc.  Maybe ten or eleven hours.  Is that important?" Jim asked.

"Are you a diabetic, Mr. Tobias?  Do you use drugs of any sort?"

"I don't do drugs, Doc.  I only took a Viagra last night about eight-thirty," Jim replied, somewhat embarrassed by his admission.

"Do you have the bottle with you, by any chance?" Dr. Russell asked.

"I don't have a bottle but I have the pills with me.  Why do you ask?"  The level of pain his swollen penis was causing him was evident.

"There is some counterfeit Viagra floating around that comes from India.  It contains the main ingredient that comprises Viagra but also could contain other drugs like blood thinners or anti-psychotic agents.  My concern is that your blood tests indicate that your blood is taking longer to clot than it should, which may indicate the Viagra you took is not genuine.  It may also contain more of the active ingredient, which could account for your problem.  An erection lasting this long could result in permanent damage causing impotence.  Where did you purchase this?"

"I bought it on-line from a place in Canada."  The color had drained from Big Jim's face.

"Doc, this really hurts!  Can you help me?"  Big Jim was almost pleading now.

"Well, we can apply some ice to your penis and scrotum."

"Will that help me?"  Jim looked on the verge of tears.

"Well, if that doesn't help, we can drain some blood directly from your penis..."

Big Jim Tobias passed out cold!

Happiness Is a Cheap Drug Part I

In anticipation of the 2014 publication of my book, ELDERLY PARENTS WHO HAVE ALL THEIR MARBLES: A SURVIVAL GUIDE FOR THE KIDS, I've invited fellow writer and practicing pharmacist Don (D.G.) Weiss to be a guest blogger.  The excerpt below is from his second mystery novel ALL THAT GLITTERS and concerns the importation of cheap drugs purchased on the internet from Canada.  This is in no way a reflection on the vast majority of legitimate drugs purchased from Canada, but as always, "caveat emptor."

Big Jim Tobias knew that tonight he was going to get lucky.  His date Charlene more or less hinted at it.  What Charlene didn't know was that Big Jim wasn't necessarily big all over. He was having a certain issue with male function that required chemical help.  The cost of Viagra was outrageous but Big Jim was willing to pay the price.

While Charlene was in the ladies' room, Big Jim took the Viagra pill from the supply he had just purchased over the internet at www.Saveonprescriptiondrugsnow.com. He wouldn't disappoint Charlene later on.  Of that he was certain.  He'd also saved about $400.00 on his little blue friends.

An hour after they got home, he rolled off Charlene pretty pleased with his performance.  Charlene seemed happy as well.  After about ten minutes, she started nibbling his ear.  It didn't take Jim long to respond.  Again he lived up to their expectations.  She purred like a kitten and they both drifted off to sleep.

About two o'clock in the morning they made love again.  Jim didn't even have to wait for his erection. It was already there.  As a matter of fact, it had never gone away.

They slept until eight in the morning.  Jim's erection was still there but it was now painful. Charlene wanted to make love again and wanted to be on top.  He was grateful that she was facing away from him, because while she seemed to be satisfying herself, he was in agony.  He had to do something and soon!  Charlene finished and got up to go to the bathroom.  Big Jim pulled on his underwear and his jeans and tried with some difficulty to stuff his swollen, painful member into his pants.  Charlene came out of the bathroom.

"Where're you going, sweetheart?"

"I'm sorry, but I've got to meet a guy to talk about a drywall job in Ocala."  When he kissed her goodbye, Charlene swore she saw tears in Big Jim's eyes.  He put one foot in front of the other at half-speed all the way to his jeep, then headed for the nearest emergency room.

"What a sentimental guy he is, and my god what a lover!"   Charlene went back to bed, smiling.

Read Part II next week!