Fentanyl alongside other medications are on the WHO list of essential medications... It’s important to remember that when discussing this overdose crisis. The fentanyl that has been implicated in ODs are not made in a pharmaceutical lab.. Fentanyl has been used safely for decades
It’s also important to note that the illicit synthesis of these fentanyl analogues are usually from completely novel sources not from the pharmaceutical Janssen products as noted below
It’s important to make this distinction because many patients utilize pharmaceutical fentanyl products safely and for a myriad of different reasons.. We need to be careful and specific regarding the drugs we are discussing in the overdose crisis..
I don’t know if PROP is intentionally trying to be misleading but at this point there is no way they can be this willfully blind to the data.. This new article written today by their organization is highly misleading. I want to go through some of the things they
mention in their article.. So below they mention deaths from prescription opioids continue to contribute to drug overdose deaths.. 1st problem is that is not entirely accurate, 2nd is they don’t define what a prescription opioid death means.. This statement needs to be qualified.
What is the source, what drugs are involved. The data does not parse this out.. Many of the Rx opioid deaths involves drugs that were diverted, also combined with other drugs as well (psychostimulants, benzos, antidepressants, barbiturates etc) Rx deaths alone is most likely alot
There has been a disturbing trend of some healthcare providers discussing how racial disparities and socioeconomic disparities have been a protective role for African Americans in order to prevent them from getting opioid therapy and getting “addicted” below documents
some of this.. Thanks @life_is_art___ for sharing this video below. This is a video by Dr. Tauben from the University of Washington School of medicine giving a lecture in 2018 regarding the opioid epidemic.. Quote listed below:
“Like all things socioeconomic disparities abound which is good for people of color because their less likely to be exposed to opioids because we dont prescribe them opioids because we dont trust them based on the color of their skin
Interesting article from pharmacy times.. Once again i think it greatly misses the mark.. Their answer to slowing the opioid crisis is to reduce opioid prescribing in the hospital.. Once again this obsession with focusing on Rx opioids is misguided
For almost the past 10 years this crisis has been dominated by illicit fentanyl, and polysubstance abuse.. Stimulants are also on the rise, and some experts are saying we could see a 4th wave involving stimulants.. This crisis is being dominated by an adulterated supply
The way to solve this is to have safe consumption sites, drug testing strips, expanding MAT, etc.. If we know what drugs are causing overdose deaths we can understand how to solve this problem.. Truth is rx opioid deaths alone have been decreasing for some time now as well as
Kolodny frequently states that just because Rx opioids have declined around the same time as increases in overdose deaths climbed up doesn’t mean A caused B.. It’s ironic in his lecture below he states that around the same time opioid sales went up as well as opioid death and
addiction and one caused the other. These all happened around the same time but does that mean one caused the other? Correlation doesn’t equate to causation right? it’s interesting he says that regarding decrease in Rx opioids and increase in ODs, but doesn’t apply the same logic
in his lecture above.. Why is that? It’s because his worldview is so focused on Rx opioids being the cause of everything in this crisis that he doesn’t stay consistent in his reasoning.
Another crazy aspect of kolodny lecture with @Pharmed_Out yesterday was when he stated in the beginning of his lecture that one of the wrong ways to frame the opioid crisis is to focus mainly on overdose deaths and the drugs involved. As a pharmacist who works in the hospital I
Cringed so hard at that statement.. When a patient comes in the ER with an OD situation its kind of important to know what drug is involved so we can give proper treatment (opioids, beta blockers, Tylenol etc).. Also its very important to know what drugs are involved because
Its important to understand what source, and the nature of the overdose.. Is it from an illicit or an Rx source? Also how many drugs were involved.. A person may have uses an Rx but also combined many other illicit drugs that ultimately caused the death.. Also
I don’t know how folks continue to take her seriously but George Floyd DID NOT die from a drug overdose.. The autopsy said he had 11ng/ml in his system based on the postmortem reports.. First of all you can’t properly determine antemortem drug concentrations
based solely on postmortem drug concentrations.. It is highly variable and many factors need to be understood as shown below.. Utilizing the postmortem data alone to characterize Floyd as a drug addict does not correlate.
So let’s discuss the level of fentanyl he had in his system which was 11ng/ml. Is this a fatal level? As was mentioned above to base this postmortem level as if this accurately describes his antemortem level is not correct. As I mentioned the postmortem data is highly variable
Are medications like oxycodone and hydrocodone essentially heroin pills??
Kolodny recently did a townhall discussion last year on the opioid crisis and COVID... and he made some interesting assertions regarding the semi synthetic medications like oxycodone
He stated when you make molecules like oxycodone, hydrocodone you’re essentially making drugs that cross the BBB easier and are more lipophilic. He continued in the video clip above and stated that they are like heroin in creating a rewarding effect due to it crossing the BBB
His assertion that semi synthetic pain medications such as hydrocodone, and oxycodone are essentially “heroin pills” I think is somewhat hyperbolic and I will try to explain why below...
Molecules like heroin, hydromorphone, oxycodone, etc even though they are made to target
Interesting study done last year looking at the toxicology OD data in British Columbia, Canada.. “They identified by the BC Coroners Service in 2015–2017, were linked to the prescription drug histories of individuals as recorded in BC’s PharmaNet database”
What I like about this descriptive analysis is that they disaggregated the OD data in order to see what drugs were involved in Overdose deaths.. Usually a lot of times you see reported in the media this number so and so died of drug overdose, but what you don’t see reported is
The data disaggregated in order to figure out what drugs were involved.. The chart below shows that from the sample only about 2% of deaths involved prescribed opioids alone in the absence of non-prescribed opioids. The majority of OD deaths involved non prescribed stimulants,
I have been seeing this flyer around social media and i wanted to do a quick thread on the difference between the 2.. I think alot of times we tend to mesh these two concepts together or often conflate these terms which can
Cause issues as well.. To start off this flyer states "If you get prescribed opioids, you may end up wishing you hadn't. That's because anyone could become dependent on painkillers like hydrocodone, oxycodone, and fentanyl which can ruin your relationships, health and career"
So this flyer states that dependence can happen when taking opioids Which can cause you to ruin your relationships, career, etc.. So what is dependence? It is considered when you have physical or physiological dependence it is indicated by tolerance and withdrawal symptoms.
Its interesting even during the time of the mid 90s and the whole Purdue Pharma fiasco that it was mainly fueled by shady, and illicit activity (whether it was shady Pharma practices, pill mills, non medical use, etc) Patients who use pain medications medically based on the
data don't tend to OD.. Throughout the whole history of this opioid crisis its always been fueled by illicit activity.. Having a legal safe supply regulated market can prevent black market activity.. Imagine if we had sensible drug policy i believe we could have
avoided alot of the OD deaths that we have seen throughout the history of the opioid crisis.. We have a chance to implement sensible drug policy. What will the next 10 years look like regarding OD deaths?? Who knows, but i know if we continue on the trajectory were on now
The Drug War here in the U.S and abroad has always been intricately linked with racism and racial tropes against blacks and other minorities as well...
1. In 1914 Dr. Edward Huntington Williams wrote an article in the
NYT titled NEGRO COCAINE "FIENDS" NEW SOUTHERN MENACE. in his piece he argued how cocaine made the negro more savage, and made him a uniquely murderous individual
2. Harry Anslinger the 1st commissioner of the U.S. Treasury Department's Federal Bureau of Narcotics in the 30s
linked drug use like marijuana among others to the black musicians during that time like Billie Holliday etc, and said how the drugs they would use made them make freakish music like jazz and as some reporters mentioned he stated he longed to see them behind bars
Well didn’t take too long until he posted this smh 🤦♂️ lol.. His worldview is so focused on prescription opioids being the main catalyst for addiction that he will admit that our record lows of rx opioid prescribing is not low enough smh.. He really can’t connect the dots
with Rx opioid prescribing down at record lows and OD deaths still climbing.. It never occurred to him to analyze what drugs are actually causing the overdose deaths.. He then argues that deaths were also soaring when people were using heroin etc when rx prescribing was also high
What he fails to realize is that we have had data describing increase in overdose deaths decades before the mid 90s high prescribing and the fiasco with Purdue Pharma and OxyContin... Once again to only focus on prescription opioids is to miss so many other variables at play
After listening to NPRs new podcast episode with kolodny and others on How to fight the opioid epidemic I came across many things that were problematic but the two issues that stuck out to me I will highlight below...
The 1st issue I had was kolodny’s narrow view of addiction.. Throughout the episode we heard tragic stories of people succumbing to addiction and dying of overdose.. In these stories we heard how they suffered with substance abuse issues, psychiatric issues, also people with
Socioeconomic issues as well.. Instead of discussing all these factors and how they can attribute to why someone can succumb to addiction kolodny wanted to focus on 1 thing being the main catalyst: Prescription opioids.. Dr. Carl Hart who is a neuroscientist has been doing some
Sickle cell disease will always be a disease that means so much to me.. Growing up seeing my brother battle with this disease was hard. Many nights my family would be in the hospital with him watching him in excruciating pain. Many nights i would see the
stress on my parents face as their youngest son was going through horrific pain. Sometimes i would pray that God would take this disease away from my brother and give it to me so he wouldn't have to suffer anymore. #sicklecell patients already have it hard enough
with this disease now add on top of that racial bias that they have to deal with. Many times either me or my dad would have to advocate for him in the ER to get proper and urgent care and make sure his pain is adequately managed... The treatment my brother has received
I truly feel for those who suffer with addiction and i am glad we have medications and tools to help with that as well.. It is truly devastating to lose someone to addiction and i hate hearing stories about it. I also have the same type of compassion for those
who suffer with chronic pain. My brother has #sicklecell and he suffers with chronic pain. Whenever he has his crisis he suffers excruciating pain that cuts deep to the core... We have a class of medications called opioids that have helped patients in pain for centuries..
It saddens me to see people demonize this class of medications which Have helped so many people cope with their pain. Yesterday I was taking care of this lady in our hospital who was going to be going to hospice the next day
I came across this article in the Journal of Pain Research by Dr. Jeffrey Singer et al. The title is called "Today's Nonmedical opioid users are not yesterday's patients: implications of data indicating stable rates of Nonmedical use and pain
Reliever use disorder". If you Havnt read this i would highly recommend it. When we discuss the opioid crisis we like to assign more blame to certain entities. The entity i hear alot in this discussion is pharmaceutical companies like Purdue Pharma and overprescribing that
Took place during the 90s when they marketed the drug Oxycontin. Alot of times we hear they were the cause of this crisis along with doctor overprescribing. Now this was Definately a contributing factor in getting this drug in the wrong hands resulting in NON-MEDICAL use
Excerpt from article A Painful reality: Unequal access to Opioids in Developing Nations
"It is clear that the ripples of the American opioid epidemic are being felt around the globe. Because of this epidemic the word "opioid" has acquired a harshly negative subtext. Legislators
And philanthropists in the developing world are now opposing the import of opioids out of fear that increasing availability will trigger another epidemic of addiction abroad. Meg O'Brien founder of Treat the pain, a group devoted to bringing palliative care to developing
Countries believes this "opiophobia" is illogical. As she stated in a recent interview, "The U.S. also has an obesity epidemic, but no one is proposing we withhold food aid from South Sudan". The most recent World Health Organization List of Essential Medicines