Category Archives: Uncategorized

How a Paraplegic Drug User Became a Victim of Involuntary Commitment– by Christopher Moraff – Feb 2019

New laws make it easy for anyone accused of having an addiction problem to be committed if they don’t agree to whatever treatment is recommended for them.

Involuntary commitment for people accused of having an addiction and not actively participating in treatment for it is becoming more common as more laws are being passed to make this legal.

Barely a day passes on my beat without my meeting someone with a harrowing story about the impact of zero-tolerance drug policies on their lives. But few of these stories have impacted me personally as much as that of a young man I’ll call “Jay.”

I edited the title because it’s been pointed out that “dependence” isn’t the right word. I knew this but was paraphrasing the article title, which uses that word instead of addiction, even though they are clearly talking about opioid misuse. We can thank the DSM-5 for this confusion.

Development of dependence following treatment with opioid analgesics for pain relief: a systematic view – June 2012

Aims: To assess the incidence or prevalence of opioid dependence syndrome in adults (with and without previous history of substance abuse) following treatment with opioid analgesics for pain relief.

Spoiler alert from the happy conclusion:

The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence.   

Opioid Use, Misuse, and Suicidal Behaviors in a Nationally Representative Sample of U.S. Adults. – PubMed – NCBI – just the abstract available – Mar 2019

This study proves that simply using opioids to treat a medical condition does not lead to increases in suicidal thoughts and behaviors.

Prior research has shown associations between opioid misuse and suicidal behaviors, but the relationship between medical opioid use and suicidal behaviors is not known.

We assessed associations between opioid use and misuse to suicidal ideation, suicide plans, and suicide attempts among adults 18-64 years old (n=86,186) using nationally representative cross-sectional data from the 2015-2016 National Survey on Drug Use and Health.  

Cohort Study of the Impact of High-Dose Opioid Analgesics on Overdose Mortality | Pain Medicine | Oxford Academic – January 2016

Objective.

Previous studies examining opioid dose and overdose risk provide limited granularity by milligram strength and instead rely on thresholds.

We quantify dose-dependent overdose.

Spoiler: there is no linear or incremental increase in overdose risk by dosage.  The 90MME limit proposed by the CDC Guideline isn’t based on science, but more like a consensus “best guess” by addiction doctors. 

Could Switching Opioids in Cancer Patients Provide Relief? – Lori Smith, BSN, MSN, CRNP – Nov 12, 2018

I’m disappointed to see this limited only to cancer patients. Since we know that there’s NO DIFFERENCE between cancer and non-cancer pain, these findings would also apply to other kinds of chronic pain.

Side effects and inadequate pain relief with the use of opioids in cancer patients is a challenge for healthcare providers to manage and can cause considerable problems for these patients.

While the topic is still debated within the medical community, opioid switching in cancer patients may provide relief of pain and alleviation of opioid-related side effects, according to the results of a recent Italian study.  

Limiting opioid prescriptions will do little to reduce overdose deaths, study says – by Felice J. Freyer Globe Staff  February 01, 2019

This article is about a very important, and for us very encouraging, new JAMA study that just came out showing that prescription limits barely reduce overdoses. We pain patients have known this all along, but when it’s officially researched and published it will be taken more seriously.

The anti-opioid zealots will try to explain away its findings, but it will be a piece of hard evidence that saner minds can use to push back against these ridiculously ineffective prescription opioid limits.

When the death toll from opioid overdoses began to soar a few years ago… Policy makers naturally sought to put a lid on opioid prescribing.

But a study published Friday in JAMA Network Open finds that reducing opioid prescriptions will have little effect on the death rate…

Complications of Uncontrolled, Persistent Pain – By Forest Tennant, MD, DrPH – Jan 2018

To the unfortunate patient who is afflicted and the practitioner who treats it, incurable, persistent pain is truly its own disease regardless of its underlying cause.

Persistent pain, which is also often characterized as chronic or intractable, has all the ramifications of a disease in that it may have pre-clinical and overt phases.

I like that he calls it “persistent pain” instead of “chronic pain”, a term which has become synonymous in the public’s eye as a whining, complaining, catastrophizing, gonna-be addict.   

Draft Report on Pain Management Best Practices | HHS.gov – Dec 2018

This document is so long and so detailed that I spent hours working it over to add my own voluminous commentary.

I posted the second, most significant part yesterday, HHS Report on Pain Mgmt Best Practices – part 2, and the first part the day before: HHS Report on Pain Mgmt Best Practices – part 1.  

This is the third and final part of my series, and covers the middle of the document, starting where I left off in the second part detailing interventional procedures.

This seems like the first good news in a while: a government agency admitting that most opioid overdoses are from illicit fentanyl. The report also documents the downsides of non-opioid medications and highlights the predicament of pain patients.

Draft Report on Pain Management Best Practices | HHS.gov

This document is so long and detailed that I spent hours picking it over to find the critical pieces and add my own commentary. It’s far from perfect, but still a welcome change from the usual PROPaganda – and I choose to celebrate.

Here’s the first part:  

Draft Report on Pain Management Best Practices | HHS.gov – Dec 2018

This document is so long and so detailed that I spent hours working it over to add my own voluminous commentary. I posted the first part yesterday: HHS Report on Pain Mgmt Best Practices – part 1.

Below is the second part, covering more about opioid medication with all its “risk” and then the final, most significant section, covering the problems and errors of the CDC Opioid Prescribing Guidelines:

2.2.1 Risk Assessment