lördag 26 mars 2016

Do not forget the worst opiate - Propoxyphene - that killed most people during 53 years - and caused the heroin epidemic

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

Data from: http://1.usa.gov/21M7Om7 and  Our own CV

Prescription opioids can be used to treat moderate-to-severe pain and are often prescribed following surgery or injury, or for health conditions such as cancer. In recent years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence about their long-term effectiveness.

When the Prescription Becomes the Problem

  • Providers wrote nearly a quarter of a billion opioid prescriptions in 2013—with wide variation across states. This is enough for every American adult to have their own bottle of pills.1
  • Health care providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii.2
  • Studies suggest that regional variation in use of prescription opioids cannot be explained by the underlying health status of the population.2
  • The most common drugs involved in prescription opioid overdose deaths include:
    • Methadone
    • Oxycodone (such as OxyContin®)
    • Hydrocodone (such as Vicodin®)3
To reverse this epidemic, we need to improve the way we treat pain. We must prevent abuse, addiction, and overdose before they start.
Addiction and Overdose
Anyone who takes prescription opioids can become addicted to them. In fact, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction.4,5,6 Once addicted, it can be hard to stop. In 2014, nearly two million Americans either abused or were dependent on prescription opioid pain relievers.
Taking too many prescription opioids can stop a person’s breathing—leading to death.
Prescription opioid overdose deaths also often involve benzodiazepines. Benzodiazepines are central nervous system depressants used to sedate, induce sleep, prevent seizures, and relieve anxiety. Examples include alprazolam (Xanax®), diazepam (Valium®), and lorazepam (Ativan®). Avoid taking benzodiazepines while taking prescription opioids whenever possible.
Side Effects
In addition to the serious risks of addiction, abuse, and overdose, the use of prescription opioid pain relievers can have a number of side effects, even when taken as directed:
  • Tolerance—meaning you might need to take more of the medication for the same pain relief
  • Physical dependence—meaning you have symptoms of withdrawal when the medication is stopped
  • Increased sensitivity to pain
  • Constipation
  • Nausea, vomiting, and dry mouth
  • Sleepiness and dizziness
  • Confusion
  • Depression
  • Low levels of testosterone that can result in lower sex drive, energy, and strength
  • Itching and sweating
When the Prescription Becomes the Problem
  • Providers wrote nearly a quarter of a billion opioid prescriptions in 2013—with wide variation across states. This is enough for every American adult to have their own bottle of pills.1
  • Health care providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii.2
  • Studies suggest that regional variation in use of prescription opioids cannot be explained by the underlying health status of the population.2
  • The most common drugs involved in prescription opioid overdose deaths include:
    • Methadone
    • Oxycodone (such as OxyContin®)
    • Hydrocodone (such as Vicodin®)3
To reverse this epidemic, we need to improve the way we treat pain. We must prevent abuse, addiction, and overdose before they start.

söndag 20 mars 2016

Rates of Opioid Dispensing and Overdose After Introduction of Abuse-Deterrent Extended-Release Oxycodone and Withdrawal of Propoxyphene


Published in JAMA Intern Med. 2015;175(6):978-987
Abstract:
http://www.ncbi.nlm.nih.gov/pubmed/25895077
Importance  In the second half of 2010, abuse-deterrent extended-release oxycodone hydrochloride (OxyContin; Purdue Pharma) was introduced and propoxyphene was withdrawn from the US market. The effect of these pharmaceutical market changes on opioid dispensing and overdose rates is unknown.
Objective  To evaluate the association between 2 temporally proximate changes in the opioid market and opioid dispensing and overdose rates.
Design, Setting, and Participants  Claims from a large national US health insurer were analyzed, using an interrupted time series study design. Participants included an open cohort of 31.3 million commercially insured members aged 18 to 64 years between January 1, 2003, and December 31, 2012, with median follow-up of 20 months (last follow-up, December 31, 2012).
Exposures  Introduction of abuse-deterrent OxyContin (resistant to crushing or dissolving) on August 9, 2010, and market withdrawal of propoxyphene on November 19, 2010.
Main Outcomes and Measures  Standardized opioid dispensing rates and prescription opioid and heroin overdose rates were the primary outcomes. We used segmented regression to analyze changes in outcomes from 30 quarters before to 8 quarters after the 2 interventions.
Results  Two years after the opioid market changes, total opioid dispensing decreased by 19% from the expected rate (absolute change, −32.2 mg morphine-equivalent dose per member per quarter [95% CI, −38.1 to −26.3]). By opioid subtype, the absolute change in dispensing by milligrams of morphine-equivalent dose per member per quarter at 2 years was −11.3 (95% CI, −12.4 to −10.1) for extended-release oxycodone, 3.26 (95% CI, 1.40 to 5.12) for other long-acting opioids, −8.19 (95% CI, −9.30 to −7.08) for propoxyphene, and −16.2 (95% CI, −18.8 to −13.5) for other immediate-release opioids. Two years after the market changes, the estimated overdose rate attributed to prescription opioids decreased by 20% (absolute change, −1.10 per 100 000 members per quarter [95% CI, −1.47 to −0.74]), but heroin overdose increased by 23% (absolute change, 0.26 per 100 000 members per quarter [95% CI, −0.01 to 0.53]).
Conclusions and Relevance  Opioid dispensing and prescription opioid overdoses decreased substantially after 2 major changes in the pharmaceutical market in late 2010. Pharmaceutical market interventions may have value in combatting the prescription opioid overdose epidemic, but heroin overdose rates continue to increase. 
Complementary strategies to identify and treat opioid abuse and addiction are urgently needed.

onsdag 16 mars 2016

President Obama Nominates Judge Danny C. Reeves to Serve on the United States Sentencing Commission

This article comes from the White House Office of the Press Secretary

http://1.usa.gov/1PbMiA0

My remarks:


How will it now be with the hundreds of trial - about the pain killing substances (Dextropropoxyphene - that are planned to be in Kentucky East under the Judge Danny C Reeves. The judge will leave for his new job that he was appointed by president Obama March 15th. The Senate will formally decides if Danny C Reeves will get the job.

DXP was banned in US Nov 19th 2010, it is more than five years ago and the trials has not even started yet

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WASHINGTON, DC – Today, President Obama nominated Judge Danny C. Reeves to serve on the United States Sentencing Commission.
“Throughout his career, Judge Danny C. Reeves has demonstrated an unwavering commitment to justice,” said President Obama. “I am confident he will continue to serve with excellence and integrity on the United States Sentencing Commission.”
Judge Danny C. Reeves:  Nominee for the United States Sentencing Commission
Judge Danny C. Reeves is a United States District Judge for the Eastern District of Kentucky, a position he has held since 2001.  Prior to his appointment to the bench, Judge Reeves was a partner in the Lexington, Kentucky office of Bingham Greenebaum Doll LLP (formerly Greenebaum Doll & McDonald PLLC), where he practiced civil litigation from 1983 to 2001.  Judge Reeves began his legal career as a law clerk to the Honorable Eugene E. Siler, Jr., then of the United States District Court for the Eastern and Western Districts of Kentucky from 1981 to 1983.  He received his J.D. from Salmon P. Chase College of Law, Northern Kentucky University in 1981 and his B.A. from Eastern Kentucky University in 1978

onsdag 2 mars 2016

We have studied the opiate (Dextro) Propoxyphene for more than 20 years - and have important results to share


Sir,

We started to study the pain killing substance (Dextro) Propoxyphene more than 20 years ago. As a matter of fact, nobody in the research world have studied this opiate as long and as serious - as we have.

The most known brands of this substance in US were Darvon and Darvocet. These drugs are banned since Nov 19, 2010 - more than five year ago. 

Hundreds of lawyers now are working full time for the Pharmaceutical Companies, they have earned millions of dollar - already. 

Here are some of our most important tweets:


We have published a lot about the fatal dangers with Propoxyphene (Darvon & Darvocet) bit.ly/1QgkHla

We have studied the Darvon and Darvocet since 1993 and contributed strongly to the drugs now banned bit.ly/1QLEeHn

The heroin epidemic in US started with Propoxyophene (Darvon & Darvocet) many years ago bit.ly/1Tsj72V

523 000 persons in the world could have been poisoned to death due to Propoxyphene during 1985–2011 bit.ly/1PAAMUg

People who are addicted to opioid painkillers are 40 x more likely to be addicted to heroin" bit.ly/1PJ0ZhD

We got some good attention to our research on DextroPropoxyphene (Darvon & Darvocet) bit.ly/1RWoYwo

In 2011 India consumed 92% of the world-consumption of Dextropropoxyphene bit.ly/1PLRG14


Around 178 000 fatalities due to Darvon and Darvocet in US in 29 years. bit.ly/1OdansN