Thursday, May 5, 2016

Take 2 Asprin, Call Me in the Morning

Remember that ad? Well maybe you are better off taking one or none or try an alternative, as long as it is not alcohol or marijuana as those are dangerous gateway drugs. 

 There is an obsession right now that pain killers is at epidemic levels. I suspect that once again the media is exaggerating it because more famous individuals are dying as a result - Phillip Seymour Hoffman, Prince - there has always been a drug problem in America and we rotate the type and significance depending on the politics at the time.  We have seen the drug wars evolve to the point that small town Police need a SWAT team to bust down a door of a "suspected" dealer; we have had billions of dollars seized from individuals under the law of Civil Asset Forfeiture; we have millions incarcerated for smoking dope; a serial killer being tried 20 years later for killing crack addicted women in his community.  And much of this is about the color of money and the color of one's skin.  I recall meth hysteria when it was a white problem and it led to banning of cough syrup and today it is heroin.  We are sure now that nice white suburban people are using it that we are at crisis level and now suddenly instead of stop and frisk it is stop and help.  I need a pain killer as this is painfully obvious.

What few know is that the biggest health crisis is acetaminophen, aka "Tylenol".  Hospitals over medicate almost all Patients with this drug and in a much stronger form and as a result patients overdose. Well at least it's in house.  But the wider reaching role is with regards to opioid addiction. 

FDA Cuts Acetaminophen Dose In Opioid Painkillers
 By Maia Szalavitz
Jan. 13, 2011 Time

 Though most people don’t know it, the acetaminophen (better known by its brand name Tylenol) can often be the most deadly ingredient in prescription pain medications that contain opioids like codeine.

 Although the damage linked to opioid overdose can be entirely reversed with an antidote if the victim is treated quickly, high doses of acetaminophen (which is also found in cold medications) can irreparably damage the liver—and there is no comparable antidote. That’s why the FDA Thursday began phasing in a requirement that painkillers that include both acetaminophen and opioids contain no more than 325 mg of acetaminophen per pill as well as display a boxed warning about the risk of irreversible liver damage from large doses.

 Although the inclusion of acetaminophen in the combination pain-killers is intended in part to deter abuse of mild opioids, ironically, for some pain patients it’s the ingredient that proves more dangerous.

 In a statement, Sandra Kweder, MD, deputy director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research said, “Overdose from prescription combination products containing acetaminophen account for nearly half of all cases of acetaminophen-related liver failure in the U.S., many of which result in liver transplant or death.”

 Similar attempts to deter alcohol abuse during Prohibition by including poisonous chemicals in industrial alcohol that was being diverted for use by bootleggers resulted in the deaths of roughly 10,000 people; more recently, chemicals added to anti-anxiety and pain medications to prevent injection have instead resulted in limb amputations after the substances caused blood clots or other complications.

 Still, the intention behind partnering opiods with acetaminophen is clearly laudable—as is the new regulation to limit its potential dangers in large doses.

And the same, only less deadly (well that also depends) is the over prescribing of antibiotics.

1 in 3 antibiotics prescribed in U.S. are unnecessary, major study finds


Nearly a third of antibiotics prescribed in doctors' offices, emergency rooms and hospital-based clinics in the United States are not needed, according to the most in-depth study yet to examine the use and misuse of these life-saving drugs.

The finding, which has implications for antibiotics' diminished efficacy, translates to about 47 million unnecessary prescriptions given out each year across the country to children and adults. Most of these are for conditions that don't respond to antibiotics, such as colds, sore throats, bronchitis, flu and other viral illnesses.

Although health officials have been warning for decades about the overuse of antibiotics and its contribution to the development of drug-resistant bacteria, the research from the Centers for Disease Control and Prevention and the Pew Charitable Trust is the first to quantify the depth of the problem.

"We've all been hearing, 'This is a problem, this is problem,' and we all understood the general concept that there is a lot of antibiotic use," said David Hyun, a senior officer with Pew's antibiotic resistance project and one of the authors of the report published Tuesday in JAMA. Pew also published a companion report using the same data.

"Why this study is so important: It actually provides concrete numbers," Hyun said.

The study analyzed data for all antibiotic use in the three settings as collected from two major CDC surveys from 2010 to 2011. Antibiotic prescriptions written there represent the majority of dollars spent on antibiotics in this country.

“Antibiotics are life-saving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said CDC Director Tom Frieden. “Losing these antibiotics would undermine our ability to treat patients with deadly infections [and] cancer, provide organ transplants and save victims of burns and trauma.”

Among the key findings:
• About 13 percent of all outpatient visits in the United States -- about 154 million visits annually -- result in an antibiotic prescription.
• More than four in 10 (44 percent) of antibiotic prescriptions are written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, sore throats, colds, bronchitis, asthma, allergies, flu, and pneumonia.
• Half of these prescriptions are unnecessary because many are for viral illnesses.

Doctors often wind up prescribing antibiotics because of pressure from patients or parents, said Katherine Fleming-Dutra, a CDC medical epidemiologist and report's lead author.

"Clinicians are concerned about patient satisfaction and the patient demand for antibiotics," she said. But the majority of individuals do trust their doctors to make the right diagnosis, and better communication by doctors about the dangers of antibiotic overuse can lead to more appropriate prescribing, she said.

An accompanying editorial in JAMA noted that the numbers provided in the report likely are an undercount because they don't include the times antibiotics are given when patients talk to doctors' offices over the telephone, or when patients seek medical care at urgent care clinics, retail pharmacies and dentists' offices.
Also not included are prescriptions written by nurse practitioners and physician assistants.
But even relatively simple steps, such as displaying a poster in patient waiting rooms can cut down on antibiotic prescribing, the editorial said.

The overuse of antibiotics has led to the frightening rise of drug-resistant superbugs in recent years. The CDC has warned that "nightmare bacteria" are increasingly resistant to even the strongest antibiotics, posing a growing threat to hospitals and nursing homes nationwide.

Last year, the White House announced an aggressive plan to combat antibiotic-resistant bacteria, which already cause an estimated 2 million illnesses and 23,000 deaths every year just in the United States. The administration set a target of reducing inappropriate antibiotic use in outpatient settings by half by 2020.

Based on the new report, this goal would be reached by cutting outpatient antibiotic use by 15 percent overall, which would result in approximately 23 million fewer antibiotics prescribed annually by 2020.

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