LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

opioids

Medical Marijuana Use and Opioid Deaths; Surprising Findings

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The concerns with opioid use are becoming legendary.  Despite grave concerns, prescriptions for this class of drugs continue to rise.

The only thing I can figure is that the same group of physicians that are writing prescriptions for hydrocodone, Percocet and Vicodin are also ordering CT scans on every patient.  And maybe even writing antibiotic prescriptions for clearly viral related illnesses.

Regardless, there does not seem to be a clear end in sight to the overuse of opioids.  Sometime in 2010 the number of deaths associated with prescription pain killers (principally opioids) surpassed deaths from illegal drugs like heroin and cocaine.  Interesting when you consider the fact that the illegal drugs are obtained illegally with no type of gatekeeper (and so should be easier to get with the right connections) and the prescription drugs have to go through a gatekeeper that is supposed to restrict access to only those that need the drug.

Of course, the illegal drugs are purchased with cash that is paid for by the users while the prescription drugs are largely paid for by the insurance companies.  Kind of a sick system if you really think about it.

Despite all this, the uproar that accompanies medical marijuana legislation is quite loud.  Those who oppose legislation say it’s a bad idea and will cost society.  Ironically, this same group does not seem to have a problem with handing out opioids like Halloween candy to everyone who visits the ER or urgent care with so much as a sprained pinky.  And this overuse is actually supported by the insurance companies.  Crazy.

Considering that some people use medical marijuana for pain control, it would be interesting to see what happens to opioid overdosages in those states that have passed medical marijuana laws.  Conveniently enough, this particular article addresses just that question.

(Disclaimer:  Those who know me could easily confirm that I am NOT and have never used marijuana.  Not even an inhale.  So the opinion expressed in this article is in no way tied to my personal attachments or lack thereof for marijuana.)

In the study, researchers looked at opioid overdose deaths across all 50 states from 1999-2010 and compared the states with medical cannibis legislation.    Here’s what they found:

  • Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999.
  • Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010.
  • States with medical cannabis laws had a 24.8% lower rate of opioid overdose deaths.
  • In general, the longer the laws had been in effect, the lower that state’s risk of opioid overdose deaths.

Makes for kind of a hard argument supporting the use of medical marijuana for chronic pain control instead of opioids.  This protection (which can only come from a shift to marijuana away from opioids) is despite the fact that insurance covers prescription drugs and marijuana users are paying cash.  Talk about a windfall for the insurance companies.  You’d think they’d be lining up to get laws passed in all 50 states just to save money (opioid costs are a large chunk of chronic pain expenditures).

I think I’ll file this one under ‘natural pain relief.”

 

18 US Women Per Day Die From Common Drug: 3 Scary Stats

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For those of you into math, that’s about 550 deaths per month, or more than a Boeing 747 could hold.  Imagine the heat on the FAA if one was dropping out of the sky monthly.  Would you fly?

For those of you following the Rantings, you can begin to guess that it is prescription opioids I’m talking about.  Not just OxyContin and morphine, but also Percocet and Vicodin.  They are handed out like candy in urgent care and the ER and concern has been raised to the equivalent of a Homeland Security threat level RED.  Earlier this year, the FDA reached out to providers asking them to increase their training in the prescribing of this dangerous class of drugs.

If the FDA has to politely ask providers to better understand the use of these drugs (this IS, after all, the regulatory agency tasked with protecting the public), one has to assume that the education required to prescribe these drugs may be lacking.

Scary.  And profoundly upsetting because I am, after all, a chiropractor.  I can’t count how many times over the years that a patient came in for a problem that was resolved in a visit or two, and yet had been given opioids after an urgent care or ER visit.  Completely avoidable had the patient been steered towards chiropractic treatment.  We remain a profession at the red-headed-stepchild level and yet hold the answers to many of the ills in medicine today.

With that intro, we need to move on to this particular article, which highlights just how dangerous this class of drugs has become.  Researchers looked at opioid deaths from 1999 to 2010 in women.  Here’s what they found:

  1. Nearly 48,000 women died of prescription painkiller overdoses  between 1999 and 2010.
  2. Deaths from prescription painkiller overdoses increased over 400%, compared to 265% in men.
  3. For every woman who dies of a prescription painkiller overdose, 30 go to the ER for misuse or abuse.

Despite these numbers, I still have patients coming into my office every week who have been given prescriptions for this class of drugs.  Much like the decades long delay that occurred to get pediatricians to stop giving antibiotics for ear infections, these statistics seem to be falling on deaf ears.

The next time a provider wants to given you a prescription of Percocet or Vicodin for some type of new-onset musculoskeletal disorder (neck pain, shoulder pain, low back pain…) but does NOT recommend seeing a chiropractor, maybe it’s time to find a new provider that keeps your best interests in mind.

 

RECIPE TO CREATE A DRUG USER

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The Federal Bureau of Narcotics was formed over 80 years ago in 1930.  In 1954, President Eisenhower formed a council to battle narcotics use here in the United States.  In 1971 President Nixon coined the term “war on drugs.”  This was further strengthened by President Reagan in 1982.  Overall, untold billions of federal dollars have been spent on this effort.  Man did we get it all wrong.

We were spending our money and efforts at illicit drug use, while slowly building a society that not only condoned prescription narcotic drug use, but PAID FOR IT!  Beginning at least in 2008, the number of deaths associated with prescription narcotic use exceeded those deaths caused by illicit drug use.

Codeine, OxyContin, Percocet, Vicodin, morphine,  Xanax and Valium (these 2 are benzodiazapines–but frequently abused), Valium, Tramadol, Tylenol 3.

It never ceases to amaze me how quickly prescriptions for narcotic pain relievers are given out.  In the ER it is almost a given.  High likelihood in urgent care.  Still far too common in a primary care settings.

And then there are the non-steroidal anti-inflammatory drugs (NSAIDs).  Why should we throw something as safe and harmless as NSAIDs in with the narcotic drugs?

I firmly believe that, as time progresses (decades, probably) we will begin to understand just how dangerous this class of drugs is.  Arthritis /  joint damage, heart attacks, strokes, impotence, GI bleeds, disruption of intestinal barriers, dementia…this list of known effects seems to lengthen every month.

The problem here is that of sheer scale of use. Between over the counter use and the 70 Million prescriptions per year, it is estimated that there are 30 BILLION doses used per year.  That’s with a “b.”  Even uncommon side effects become magnified by this volume of use.  Of course, bleeding ulcers, heart attacks and strokes are not uncommon, so the math just gets more complicated from there.

So what does all of this have to do with this particular article?  This article looked at analgesic use after low risk surgery (gall bladder, cataract, TURP for prostate enlargement and varicose vein stripping) and what happens after 7 days and one year.  The results were surprising:

  1. Opioids were newly prescribed to 7.1% within 7 days of being discharged from the hospital
  2. Opioids were prescribed to 7.7% at 1 year from surgery
  3. Instead of going down, the number of patients receiving a prescription for opioids at 1 year increased to 15.9%
  4. Overall, an opioid prescriptions within 7 days of surgery made it  44% more likely to be a long term user
  5.  NSAIDs were prescribed to 0.3% within 7 days of discharge
  6. NSAIDs prescriptions jumped to 7.8% at 1 year from surgery
  7. Those taking NSAIDs within 7 days of surgery were almost 400% more likely to become long-term NSAID users

Wow.  Talked about generating a society that is addicted to drugs.  And while this study looks at low risk surgery, how similar would the numbers be for neck pain?  Low back pain?  Knee pain or headache?  Makes me happy to be a chiropractor.

Again, I would ask…is the “War on Drugs” looking at the wrong side of the prescription pad?