A Pained Life: Build a Better Mousetrap

By Carol Levy, PNN Columnist

I was watching an old TV series – “Diagnosis Murder” -- about a doctor who also solves mysteries. In one episode, Dr. Mark Sloan (Dick Van Dyke) was in a patient's room with her family. He told them their mother was in the early stages of Alzheimer's.

Her son asked, in a tremulous voice, “What can we do?”

Dr. Sloan smiles and said there was good news, along with the bad.

“It's a terrible disease, but on the positive side there are new drugs being developed all the time,” he said.

That got me mad. And it seemed as if every commercial I saw during and after the show was touting new medications, for everything from cancer to erectile dysfunction. Listening to them made me ever madder.

According to the National Cancer Institute, about 40% of us will be diagnosed with cancer at some point in our lives. Developing new cancer treatments, especially ones that are less harmful and painful to patients, is a necessity. After all, cancer kills.

Studies have found that erectile dysfunction affects about 18% of men. ED is a troublesome and embarrassing problem to have, but you won’t die from it.

Why do they spend so much time and money developing new drugs (and commercials) for medical conditions? Simple answer: the drugs make a lot of money for the pharmaceutical industry, even when a relatively small number of people may benefit from them.

Chronic pain may not kill in the typical sense, although many deaths can be traced back to poorly treated pain as an ancillary cause. According to a recent study, there are more new cases of chronic pain among U.S. adults than diabetes, depression and high blood pressure.

Given that the number of people with chronic pain is larger than many other conditions for which they are developing new drugs, why are we left out?

Many of us have had the experience of a doctor taking us off opioids or significantly reducing the dose, even when we’ve taken them safely and responsibly for years. The government has created fear among medical providers, especially those who specialize in pain management, making them uncomfortable prescribing opioids.

So, the question arises: Why isn't more being done to research and develop new non-opioid treatments for pain?

What comes to mind are mousetraps. Until they build a better mousetrap, until they create new and effective pain medications that are not opioid-based, we're stuck with what we have. Build a better mousetrap and the world will beat a path to a pharmaceutical company's door.

There is big money to be made in finding new pain medications. And there are plenty of mice. Why not build a better mousetrap?

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here. 

Study Identifies Medications Most Involved in ER Visits

By Pat Anson, PNN Editor

Here’s a question for you: What type of medication is most likely to be involved in a visit to a hospital emergency room?

1. Opioid pain relievers

2. Blood thinners

3. Psychiatric drugs

4. Insulin

5. Antibiotics

Given the well-publicized risks of addiction and overdose associated with opioids, you might assume it was opioid pain relievers. You’d also be wrong, according to a large new study that looked at medications associated with emergency department (ED) visits in the U.S. from 2017 to 2019.

CDC researchers looked at a representative sample of nearly 97,000 cases of adverse events involving medication and found that warfarin (Coumadin) and other anti-coagulant blood thinners – typically prescribed to reduce the risk of heart attack and stroke -- were the leading cause of ED visits.

Among patients of all ages, insulin was the second leading cause of medication-related adverse events, followed by psychiatric drugs, antibiotics and the over-the-counter pain relievers ibuprofen and acetaminophen. The opioid oxycodone came in last on a Top 10 list of drugs involved in ED visits.

TOP 10 MEDICATIONS INVOLVED IN EMERGENCY DEPARTMENT VISITS

SOURCE: CDC

The study findings, published in JAMA, help dispel many of the myths associated with the risks of opioids — at least in comparison to other widely used medications.

There are many reasons for someone to have an adverse reaction to medication, ranging from allergies to dosage errors to taking drugs intended for someone else. About a third of the ED visits were so serious, the patient was admitted for hospitalization.

Compared to seniors age 65 and older, young adults were significantly more likely to abuse a medication or to use it for intentional self-harm. Seniors were far more likely to only take a drug for its intended therapeutics use.

SOURCE: jama

The age of a patient also plays a significant role in the type of drug they have an adverse reaction to. For example, the antibiotic amoxicillin was the leading cause of medication harm for patients under the age of 14; while the anti-anxiety drug alprazolam (Xanax) was the leading cause of adverse events for patients aged 15 to 44.  Insulin ranked first for patients aged 45-64; while warfarin was first for patients aged 65 and older.

Analgesics, sedatives and antidepressants were the drugs most likely to be abused. About 63% of adverse events involving prescription opioids were cases of “non-therapeutic” abuse, while 89% of cases involving benzodiazepines were classified as abuse. The vast majority of cases involving blood thinners, insulin or antibiotics were for their intended therapeutic use.    

The role of opioids in ED visits has been falling for over a decade. A 2017 study showed a significant decline in the number of patients admitted to U.S. hospitals for abusing opioid medication. Hospital admissions for overdoses from opioid medication started falling in 2010, the same year that opioid prescriptions peaked in the U.S.

DEA Warns of Sharp Increase in Counterfeit Prescription Pills

By Pat Anson, PNN Editor

The U.S. Drug Enforcement Administration has issued a public safety alert warning of a sharp increase in the black market of fake painkillers and other counterfeit medications containing illicit fentanyl and methamphetamine. The alert, the DEA’s first in six years, coincides with the launch of a public awareness campaign to educate the public about the dangers of counterfeit pills.

“The United States is facing an unprecedented crisis of overdose deaths fueled by illegally manufactured fentanyl and methamphetamine,” DEA Administrator Anne Milgram said in a statement. “Counterfeit pills that contain these dangerous and extremely addictive drugs are more lethal and more accessible than ever before. In fact, DEA lab analyses reveal that two out of every five fake pills with fentanyl contain a potentially lethal dose.

It takes only two milligrams of fentanyl – an amount small enough to fit on the tip of a pencil – to constitute a lethal dose. The DEA says it has seized over 9.5 million fake pills so far this year, which is more than the last two years combined.

A recent raid on a home in Perris, California resulted in the seizure of 46 pounds of carafentanil,  – a chemical cousin of fentanyl – which is potentially enough to kill more than 50 million people, according to the Riverside County District Attorney.

Carfentanil is a synthethic opioid 100 times more potent than fentanyl and 10,000 times more potent than morphine.

FAKE OXYCODONE PILLS

The DEA says most of the counterfeit pills manufactured or smuggled into the U.S are produced by Mexican drug cartels, using illicit chemicals that originate in China.

One of the most commonly produced fake pills are tablets made to look like 30mg oxycodone pills. Known on the street as “Mexican Oxy” or “M30s,” the tablets are virtually indistinguishable from legitimate oxycodone pills used for pain relief.   

Law enforcement agencies are also finding counterfeit anti-anxiety medications made to look like Xanax and fake pills that look like the stimulant Adderall, which are made with methamphetamine.  

‘One Pill Can Kill’

The goal of the DEA’s “One Pill Can Kill” campaign is to make the public more aware of the proliferation of counterfeit medications — now found in every state — and to warn drug users not trust any pill that doesn’t come from a pharmacist.  

“Counterfeit pills have become a real and viable threat to the American People,” said Daniel Comeaux, Special Agent in Charge of the DEA’s Houston Division.  “We caution every person to never consume any pill that is not sourced from a licensed pharmacy. These illicit counterfeit pills often contain fentanyl, where just a miniscule amount can result in death.”

Ironically, the DEA itself has played a significant role in the profusion of fake pills and its PR campaign is little more than a fig leaf covering years of disastrous policies.

Counterfeit medication made with illicit fentanyl first began appearing in quantity in the U.S. in 2016, around the same time federal and state regulators began recommending more cautious opioid prescribing for pain.

Faced with pressure from Congress to combat the so-called opioid epidemic by cracking down on painkillers, the DEA began cutting the legal supply of opioids in 2017. It has reduced opioid production quotas for five consecutive years, cutting the legal supply of hydrocodone and oxycodone in half.

The agency also began arresting and prosecuting doctors and pharmacists thought to be prescribing or dispensing opioids excessively, and revoked the DEA registrations of hundreds of physicians. As a result, opioid prescribing fell to 20-year lows, but the crackdown has had a negligible impact on drug overdoses, which rose to record levels.

With opioid medication harder to obtain, illegal online pharmacies began to proliferate and legitimate patients turned to street drugs for relief. A recent PNN survey of pain patients found that nearly 10% have obtained prescription opioids from family, friends or the black market.

In a 2020 report, the DEA said drug cartels were actively targeting pain sufferers as potential customers for counterfeit medication.  The report said nearly two-thirds (64%) of people who misuse painkillers “identified relieving pain as the main purpose” of their drug use.

A Matter of Interpretation

By Carol Levy, PNN Columnist

I recently read a post in one of the online chronic pain support groups. “Sue” had just left an appointment with her pain management doctor. She was enraged, so angry about the way the meeting had gone, that she went right to her computer and complained about it.  

“My doctor asked, ‘What do you think about my lowering the pain meds you're on?’” Sue wrote.

“How dare he reduce them!” was her response. Sue said the medications were helping her and the doctor had some nerve to ask. All these doctors want to do is hurt us, she wrote, and if it wasn't for the CDC and FDA, this wouldn’t be happening.

I read her post and was somewhat confounded by her anger. She did not include any information on how the meeting ended. Did he lower her dosage or the number of pills? I could see how upset that would make someone, especially if the drugs were helping.

But he didn't say, “I am going to lower the level of opiates I am giving you.” He said it in a way that seemed, to me, like he meant to open a discussion.

It reminded me of a difficult crossword puzzle I had just completed. It was so frustrating. I had it all done, but for one four-letter word. The clue was “wind.” All I could think of was “blow,” as in the wind blowing, but the letters didn’t fit.

There was a “C” for the first letter but I could not think of one word that started with “C” that fit the clue. No matter what letters I tried, I could not think of any other answer but “blow.”

Finally, I was able to figure out the word. The answer was “coil.”  

“Coil,” I thought. “Oh, for goodness’ sake.”

I was so obsessed with my one interpretation, it never occurred to me to consider another. It wasn't wind, as in the wind blows. It was wind, as in winding a clock or a windy road.

I think we do this often, and not just with medical people. They make a statement or ask a question that seems clear. But to the listener it carries a whole different meaning.

It’s harder when you're right there. Reading about it online made it easier for me to see it as the doctor asking, not demanding or insisting. In the heat of the moment, it may well sound like, “I'm not going to help you anymore. I'm stopping the drugs that have been helping you.”

There are crosswords and cross words. Sometimes we have to stop, take a deep breath, and instead of responding with angry or impulsive words, ask for an explanation.

“Are you asking me about lowering my meds or are you telling me you will?”

 If it’s the latter, it may well be the time to be upset. If it’s the former, it’s time to open the discussion.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.”