A Simple Letter Helped Curb Overprescribing Of Antipsychotics By Some Doctors

The antipsychotic drug Seroquel [is] …frequently the drug is also given to people who have Alzheimer’s disease or other forms of dementia. The problem with that? Seroquel can be deadly for dementia patients, according to the FDA.

…And for anyone who wants to stop the common practice of overmedicating dementia patients, curtailing the use of antipsychotics is just the beginning. …There are lots of other kinds of drugs that affect the brain.

…”The use of mood stabilizers [in dementia patients] … has actually accelerated.” Such drugs include the anti-seizure medicines Depakote and Tegretol.

…A consensus statement in the journal International Psychogeriatrics on the ways dementia behaviors like agitation and wandering should be treated [says] it’s usually better to find out what triggers the difficult behavior …or to modify the patient’s environment.

“The highest ranked and endorsed treatments are all non-pharmacological approaches,” Kales says.

But that kind of treatment takes more time, and has been slow to catch on, she says. It will never be as easy as dispensing a pill.

A Simple Letter Helped Curb Overprescribing Of Antipsychotics By Some Doctors : Shots – Health News : NPR

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Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain

Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5]).

Conclusions and Relevance Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network

 

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A Comprehensive Review of Opioid-Induced Hyperalgesia

4.2 Clinical Evidence
Similar to basic science evidence, supporting clinical evidence has also been established (14,21,30,43-55). Clinical OIH has been described after intraoperative remifentanil infusion (30), in patients with detoxification from high dose opioids with improvement in pain (43), and increased pain sensitivity with methadone (21).

…6.4 Practical Considerations
The treatment of OIH can be time-consuming and at times, impractical. Weaning patients from high dose opioids usually requires time and patience (for both the physician and patient). While reducing the opioid dose, patients might experience transient increases in pain or mild withdrawal which can exacerbate pain. The hyperalgesic effect might not be mitigated until a certain critical dose of opioid is reached.

(21) Compton P, Charuvastra VC, Ling W. Pain intolerance in opioid-maintained former opiate addicts: Effect of longacting maintenance agent. Drug Alcohol Depend 2001; 63:139-146.

(43) Baron MJ, McDonald PW. Significant pain reduction in chronic pain patients after detoxification from high dose opioids. J Opioid Manag 2006; 2:277-282

(45) Hay JL, White JM, Bochner F, Somogyi AA, Semple TJ, Rounsefell B. Hyperalgesia in opioid-managed chronic painand opioid-dependent patients. J Pain 2009; 10:316-322.
(47) Fishbain DA, Cole B, Lewis JE, Gao J, Rosomoff RS. Do opioids induce hyperalgesia in humans? An evidence-based structured review. Pain Med 2009; 10:829-839.

(48) Mitra S. Opioid-induced hyperalgesia:Pathophysiology and clinical implications. J Opioid Manage 2008; 4:123-130.
(49) Cohen SP, Christo PJ, Wang S, Chen L, Stojanovic MP, Shields CH, Brummett C, Mao J. The effect of opioid dose and treatment duration on the perception of a painful standardized clinical stimulus. Reg Anesth Pain Med 2008; 33:199-206.

A Comprehensive Review of Opioid-Induced Hyperalgesia 

There appears to be some connection with withdrawal and experiencing the sensation of pain. According to the above, continued opioid use has the capacity to increase the level of pain a subject experiences.

So…. when we are giving pain medicine recipients turn opioid dependent people more opioids, like methadone, wouldn’t it follow that we -in effect- worsening the pain problem they had originally? …And the longer they are on opioids, the worse their pain situation and the further into addiction they are sent?

Dennis Quaid: What cocaine does to your body

“Normally, dopamine recycles back into the cell that released it, shutting off the signal between nerve cells. However, cocaine prevents dopamine from being recycled, causing large amounts to build up. This flood of dopamine in the brain’s reward circuit strongly reinforces drug-taking behaviors, because the reward circuit eventually adapts to the excess of dopamine caused by cocaine, and becomes less sensitive to it. As a result, people take stronger and more frequent doses in an attempt to feel the same high.”

…While scientists are still researching exactly why cocaine and other stimulants cause sleep loss, recent studies have shown that the surge in dopamine affects the body’s circadian rhythms. Since circadian rhythms regulate sleep patterns, this leads to difficulty both staying and falling asleep.

Dennis Quaid: What cocaine does to your body

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Where Marijuana Is Legal, Opioid Prescriptions Fall – Scientific American

Two papers published Monday in JAMA Internal Medicine analyzing more than five years of Medicare Part D and Medicaid prescription data found that after states legalized weed, the number of opioid prescriptions and the daily dose of opioids went way down.

That indicates that some people may be shifting away from prescription drugs to cannabis, though the studies can’t say whether this substitution is actually happening or if patients or doctors are the driving force.

…Previous research has pointed to a similar correlation. A 2014 paper found that states with medical marijuana laws had nearly 25 percent fewer deaths from opioid overdoses.

…One of the two new studies found that people on Medicare filled 14 percent fewer prescriptions for opioids after medical marijuana laws were passed in their states. The second study found that Medicaid enrollees filled nearly 40 fewer opioid prescriptions per 1,000 people each year after their state passed any law making cannabis accessible—with greater drops seen in states that legalized both medical and recreational marijuana.

Where Marijuana Is Legal, Opioid Prescriptions Fall – Scientific American