Articles Posted in Addiction

vaper-300x112The Trump Administration has sent disturbing signals on whether it will keep Big Tobacco from hooking more Americans on high-tech, nicotine-addictive products—so-called e-cigarettes used, especially by the young, for “vaping,” as well as cigars and hookahs.

The federal Food and Drug Administration, almost exactly a year ago, announced it would crack down, in particular, on e-cigarettes, forcing their makers to submit them for regulatory approval and oversight. Uncle Sam also barred makers from targeting the young with certain kinds of product advertising and giveaways. E-cigarettes still cannot be sold to consumers younger than 18 and free samples are still barred.

But the Washington Post has reported that the administration is delaying key aspects of its rules on vaping, cigars, and hookahs so newly installed federal health officials can get up to speed in their posts.

Back-Pain-300x188Back pain is one of Americans’ leading debilitating complaints, prompting us to spend billions of dollars annually for relief and costing more than $100 billion, especially in lost work and wages. But an influential physicians’ group, joining a growing number of other experts, now recommends that we buck up, exercise, keep moving—and stay away from a reflexive reach for drugs, especially powerful painkillers, to deal with aching backs.

The American College of Physicians, with guidelines published in the Annals of Internal Medicine, concedes it is breaking with longstanding medical views on treating low back pain. But the group’s experts said they conducted a “systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain.”

They found that many patients with low back pain recovered over time “regardless of treatment,” and these individuals might benefit most from heat, rest, exercise, and over the counter, non-steroidal medications. Another group of back pain sufferers might need physical therapy, stress reduction, acupuncture, yoga, or ta-chi. Only after patients have not found relief with “non-pharmacological therapy,” should doctors consider giving non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. If these don’t work, tramadol (Cymbalta) or duloxetine (Ultram) might be considered.

prescription-bottles-1-300x170Some diligent, grown-up sons and daughters may want to check in on mom, dad, and grandma, grandpa, all the aunties and uncles, too. That’s because there’s yet another warning that too many doctors are whipping out their prescription pads all too readily and writing scripts for retirement-age Americans, who now take on average three psychiatric drugs without any mental health history.

Research published in the JAMA Internal Medicine shows that over-prescribing of powerful psychotropic drugs, including sleeping pills, painkillers, and anti-depressants may be more common than believed. The study was based on an analysis of data from a big number of doctors’ office visits, with researchers finding the number of “polypharmacy” incidents (cases in which seniors received scripts for multiple drugs) increased between 2004 and 2013 from 1.5 million to 3.68 million.

This doubling resulted from seniors’ greater openness in talking with their doctors about mental health issues, and, in instances where visits were related to “anxiety, insomnia, or depression,” the researchers write. But, in disturbing fashion, a high number of women and rural patients were involved in cases where multiple psychotropics were prescribed, and many of the prescriptions were for painkillers.

vaping-300x200Some young users are experimenting with different ways to vape, modifying their e-cigarettes to increase the smoke and the high—and raising more concerns about the health harms of this hot pastime.

Researchers say they found that a quarter of the 1,800 or so of the youthful vapers they studied engaged in a practice dubbed “dripping.” They altered their e-cigarettes to expose the normally sealed heating element, and then they poured flavored vaping liquids directly on it. That created a bigger puff of smoke, which, when inhaled, produced a more intense high from the blast of nicotine and other chemicals vaporized from the flavored liquids.

This practice also potentially exposes them more to addictive nicotine and cancer-causing substances, especially byproducts that result from high-heat vaporizing of the flavored liquids, the researchers reported in their study, published in the medical journal Pediatrics.

top-selling_edited-300x163Big Pharma has ruthlessly exploited a well-intentioned measure that sought to provide medications to treat patients with rare diseases that might otherwise have been ignored. Drug companies, instead, have manipulated the 1983 Orphan Drug Act to create legally protected monopolies so they can gouge desperate patients with astronomically priced products that already were taken by as many as millions.

These findings, part of an investigation by Kaiser Health News, a nonpartisan service focused on health policy issues, were just some of the outrages that surfaced in recent days involving Big Pharma: Two big drug makers have just agreed to pay hundreds of millions in fines for anti-competitive practices or failing to report suspicious transactions, while two pharmacy operations also will fork over millions to settle suits with federal authorities over anti-kickback violations or lax controls.

Kaiser said its scrutiny of orphan drugs, those targeted at diseases affecting fewer than 200,000 Americans nationwide, found that a third of the approvals by the federal Food and Drug Administration involved medications that already were approved for mass markets and were simply re-purposed.

oxycontin-150x150Big Pharma stayed in an unpleasant spotlight last week, with developments including:

How OxyContin reformulation may have hiked heroin-related deaths

A  new study has helped to explain the nationwide surge in heroin-related deaths, and how these likely are the unintended consequence of reformulations of OxyContin, a powerful, addictive painkiller. The study by the University of Pennsylvania and the RAND Corp., published by the National Bureau of Economic Research, scrutinized state-level data both on OxyContin abuse and heroin fatalities, which tripled from 3,000 in 2010 to 10,500 in 2014. Areas of highest misuse of the prescription painkiller dovetailed with those where heroin-related deaths spiked.

oxycontin-300x225The opioid drug abuse crisis isn’t going away with 2016’s end. If anything, even as the nation has just committed $1 billion to combating this scourge, news reports are disclosing how Big Pharma made it even worse than had been known in at least one ravaged state, and how industry players are threatening to export it so it becomes an international nightmare. Further, industry leaders may be undercutting federal law enforcement efforts crack down on its illegal aspects.

Prescription painkillers hyped in markets globally

The Los Angeles Times has landed yet another of its string of powerful investigations into Purdue, the family owned maker of OxyContin, one of the powerful painkillers at the heart of the prescription drug abuse crisis. The paper finds that Purdue responded to a tide of adverse publicity and declining sales in the United States by reorganizing its efforts into a web of related companies overseas, all under the umbrella name Mundipharma.

cdc death causesImportant indicators about Americans’ health and well-being are trending the wrong way: For the first time in almost a quarter century, the nation’s life expectancy has declined.  Meantime, fatal overdoses by Americans taking opioid drugs continued to surge and exceeded 30,000 in 2015. And abuse of heroin has exceeded that of traditional prescription painkillers, with deaths due to heroin-related causes surpassing gun homicides.

Experts were surprised by the life expectancy decline, which reflected an increase in eight of the top 10 causes of death (see figure right from the federal Centers for Disease Control and Prevention, National Center for Health Statistics) including heart disease, diabetes and kidney disease, and Alzheimer’s—but not cancer.

It may be a statistical blip from one particularly bad year. The last time a comparable dip occurred was in 1993 due to high rates of deaths from HIV-AIDS, flu, homicides, and accidental deaths. Some experts said the decline in life expectancy, which for men fell on average in years from 78.9 to 78.8, may be attributable to increasing issues with Americans and obesity, and health care hitting limits on progress against heart disease.

hep-c-imageAlthough the partisan wrangling over what’s next with American health care seems to ignore the maddening realities confronting patient-consumers,  a new look at the plight of poor Kentuckians provides a harsh look at the collision of many major health policy controversies including soaring drug prices, the Affordable Care Act, and the prescription drug abuse crisis.

Stat, the online health news site, deserves credit for the grim picture it painted of health care dysfunction in the nation’s heartland. Kentucky has been ravaged not only by opioid drug abuse, including record numbers of overdose deaths, it also is struggling with a stark, related rise in diseases.  In particular, cases of Hepatitis C have skyrocketed by 364 percent in Kentucky and surrounding states. Infections are growing most among young, rural whites, and to the growing concern of public health officials, Kentucky is recording increasing numbers of cases in which pregnant moms are infecting their babies.

Hepatitis C, a viral infection that damages the liver and is a factor in 19,000 Americans’ death annually, can lurk in the body for long periods before becoming deadly. As many as 4 million Americans may carry it and not know it until their liver damage becomes severe. The virus (depicted in the illustration above) spreads among addicts of pain-killing medications because they too often progress from prescription pill-popping to shooting up other increasingly powerful opioids like fentanyl and heroin.

Just how rapacious can Big Pharma be?

relistorMakers hype more drugs as nation faces opioid drug abuse epidemic

  • In the face of an epidemic of opioid painkiller abuse, the drug industry’s answer appears to be: push even more pills on the public. The Washington Post notes that “six in 10 American adults take prescription drugs, creating a vast market for new meds to treat the side effects of the old ones. Opioid prescriptions alone have skyrocketed from 112 million in 1992 to nearly 249 million in 2015, the latest year for which numbers are available, and America’s dependence on the drugs has reached crisis levels. Millions are addicted to or abusing prescription painkillers such as OxyContin, Vicodin and Percocet.” Drug makers’ response has been to “inundate” Americans with advertising, marketing, and promotions of new medications, including sky-high priced Super Bowl commercials. Some of the add-on meds assist in painkiller overdoses, and others provide alternatives that might ease addictions. But makers also are hyping drugs like Relistor and Movantik to deal with opioid side-effects like constipation. As the paper observes, “By promoting opioid-induced constipation as a condition in need of more targeted treatment, critics say the drug industry is creating incentives to maintain the painkillers at full strength and add another pill instead.” Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, says drug makers, by addressing small woes with painkillers, not only makes them more acceptable and increases their use, they increase their profits. He says added meds turn patients’ worth to Big Pharma from a few hundred dollars to several thousand dollars a month. “The pharmaceutical industry literally created the problem” of opioid induced constipation, Kolodny said. “They named it, and they started advertising what a serious issue it is. And now they’ve got the solution for it.”

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