Must Reads, Opioid Safety

We Need to Rethink How We Use Opioids and Manage Pain

Financial responsibility for the opioid crisis is finally being meted out – Purdue Pharma is in the midst of settling thousands of opioid lawsuits and Johnson & Johnson has been ordered to pay $572 million for its opioid-related actions. These two pharmaceutical giants are likely just the tip of the defendant iceberg, with more lawsuits still to be filed and decided.

However, as much as some may wish to demonize opioids and their use, it should not be forgotten that opioids and their use are here to stay. Opioids are necessary for many medical procedures – could major surgery be done without opioids? As well, opioids are a necessity for many patients to manage their pain and for their chronic conditions.

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Patient Safety

How to Avoid Opioids and Surgery for Back Pain

Editor’s note: In this guest article, RJ Burr discusses how to avoid opioids and surgery for back pain.

By RJ Burr, DC, Cert. MDT, CSCS

The Opioid Epidemic. I’m sure you’ve heard of it and it’s very likely you have a personal experience whether it’s you or someone you know who has been affected by the opioid crisis.

Per the National Institute of Drug Abuse (NIDA), Every day, more than 130 people in the United States die after overdosing on opioids.

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Opioid Safety, Respiratory Compromise

PPAHS Remembers Amanda Abbiehl on Her 8th Death Anniversary

The Physician-Patient Alliance for Health & Safety remembers Amanda Abbiehl on her 8th death anniversary.

As reported by ABC News, “When Amanda Abbiehl’s parents kissed her goodnight on July 16, 2010, they never imagined it would be for the last time.”

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Must Reads

3 Ways We May Need to Change Our Perception of Opioids and Other Sedatives

Articles the Physician-Patient Alliance for Health & Safety (PPAHS) have been reading the week of July 9, 2018 ask us to consider 3 ways we need to change our perception of opioids, pain medications, and other sedatives

There is No Absolute Safety When Using an Opioid

In an interview with Christopher G. Gharibo, MD, a pain specialist and the director of pain medicine at NYU Langone Health, Dr. Gharibo discusses the use of opioids and pain medications. He cautions, “what we need to keep in mind is that there is no absolute safety in many of the medicines that we prescribe, whether it is an opioid or a nonopioid.”

To improve the safety when using opioids, he suggests a number of measures, including these two:

  • Individualize Treatment – “This is a category—that is clearly effective—that needs to be individualized to the patient, and that needs to be kept in check in terms of the dosing that’s provided to the patient, the pill counts, and the combination therapy that’s provided.”
  • Be Prepared for An Adverse Event – “What can also be available when opioids are prescribed—especially in the chronic setting—is a take-home naloxone. Now this comes in a variety of different forms. Whatever the form is, it needs to be easy to administer, and it needs to be reliably administered to reverse the effects of the opioid. Now that’s not so simple. I think it also concomitantly requires education of the patient as well as the caretaker for the patient. … This is something that is relatively low-cost and can make a huge difference in the ultimate outcome.”

To read the complete interview with  Dr. Gharibo, please go to Pain Medicine News.

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Opioids Aren’t necessarily the Culprit

Much has been discussed about the role of opioids in deaths. However, a recent study found that 82.5% of opioid-related overdose deaths in 2016 involved either fentanyl or heroin.

This is not to suggest that caution should not be used when prescribing or using opioids, but merely to point out that it is often opioid use in combination with other substances that is deadly.

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Under General Anesthesia May Not Mean “Out Cold”

Being under general anesthesia is often thought to be when the patient is “out cold.” However, recent research suggests that brain activity and responses to stimuli may persist. Harry Scheinin, MD, PhD, one of the project leaders, commented on the results:

“I don’t think it’s bad that brains are working more than we had previously thought and that anesthesia would resemble sleep more than we had previously thought. But there still is this problem of unintended awareness, so we need better ways to measure really objectively the level of sleep, especially when we are using these muscle relaxants because we are then putting the patients into a situation where they can’t show ‘hey, I’m awake.’”

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Must Reads, Patient Safety

8 Ways We Need to Reconsider How We Think About Patient Safety

Articles we have been reading this past week of April 16, 2018 ask us to reconsider how we think about patient safety.

#1 – COPD prevalence is nearly double in rural areas compared to metropolitan areas

The risk of COPD is nearly double in rural areas compared to that in urban areas, according to CDC’s Weekly Morbidity and Mortality Report.

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Opioid Safety, Patient Safety, Patient Stories

Are Patients Receiving Opioids Safer Today Than 6 Years Ago?

Six years ago on July 27, 2011, I posted the first article on a free WordPress blog for the Physician-Patient Alliance for Health & Safety. It was titled “Is it possible to survive 96-minutes without a heart beat?”. Howard Snitzer, a man who suffered a heart attack survived after two volunteer paramedics responded and began a 96-minute CPR marathon. The ordeal involved 20 others, who took turns pumping his chest. This life-saving feat was only possible with the use of capnography readings, which told the volunteer paramedics that Howard was still alive and that they needed to continue their efforts.

Little would I know that that article would lead to an invitation by the University of Notre Dame and the beginnings of a 6-year friendship with the parents of Amanda Abbiehl. Amanda was admitted to hospital for “severe strep throat.” Read More

Opioid Safety, Patient Stories, Practices & Tips, Respiratory Compromise

The Preventable Death of Paul Buisson: 3 Lessons on Preventing Opioid Death

The following is an excerpt of an article first published on The Doctor Weighs In on June 28, 2017. To read the full article, please click here.

In 2005, Paul Buisson, a celebrated Quebec animator and cameraman died as a result of opioid-related respiratory depression. What lessons can we learn more than a decade later? Read More

Opioid Safety, Position Statement, Respiratory Compromise

Patients Receiving Opioids Must Be Monitored With Continuous Electronic Monitoring

The following is a position statement published by PPAHS. If you would prefer to view our statement as a PDF, please click here.

Much of the public attention has been focused on the harm caused by prescription use and abuse of opioids. However, there is another facet that must be focused on: opioid-induced respiratory depression in clinical settings. This includes patients undergoing moderate and conscious sedation, or recovering from procedures and managing pain using a patient-controlled analgesia (PCA) pump, particularly those during the postoperative period. Read More