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Pain Management: One Size Doesn’t Fit All

When it comes to treating chronic pain such as arthritis or low back pain, it’s important to remember that what works for one patient may not work for the next patient. Some people are able to control their pain by taking a nonprescription medication such as acetaminophen (Tylenol), while others may need an opioid (also known as narcotics). Tablets or capsules containing the opioid hydrocodone plus acetaminophen (known as Vicodin or Lortab) are among the most commonly dispensed medications in the US. But remember: just because this medication is popular doesn’t make it the best pain reliever for everyone!

For example, a recent study showed the older adults who were prescribed a short-acting opioid such as hydrocodone or oxycodone (e.g., Percocet) were twice as likely to break a bone in the following year compared to those on a long-acting opioid or a different pain medication altogether. How can doctors tell which pain medication to prescribe to best treat your pain, without increasing the risk of side effects? People also frequently turn to their pharmacist for medication advice – how does the pharmacist know what to recommend for your pain?

It all starts with a careful description of your pain. Read more »

Painkiller Safety

Perhaps as many as one in every five American adults will get a prescription for a painkiller this year, and many more will buy over-the-counter medicines without a prescription. These drugs can do wonders — getting rid of pain can seem like a miracle — but sometimes there’s a high price to be paid.

Remember the heavily marketed COX-2 inhibitors? Rofecoxib, sold as Vioxx, and valdecoxib, sold as Bextra, were taken off the market in 2004 and 2005, respectively, after studies linked them to an increased risk of heart attack and stroke.

The nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen (sold as Advil and Motrin), and naproxen (sold as Aleve) seem like safe bets. But taken over long periods, they have potentially dangerous gastrointestinal side effects, including ulcers and bleeding. Kidney and liver damage are possible, too. More recently, some of the NSAIDs have been linked to an increased risk of cardiovascular disease. Low doses of aspirin (usually defined as 81 mg) is an exception and is often prescribed to lower the risk of heart and stroke.

Even acetaminophen, which is often viewed as the safest pain drug and a low-risk alternative to the NSAIDs because it doesn’t have their gastrointestinal side effects, comes with a caution about high doses possibly causing liver failure. Read more »

*This blog post was originally published at Harvard Health Blog*

Prescription Use On The Rise, More Awareness Of Side Effects Needed

Eighty eight percent of Americans 60 years or older take at least one prescription drug and more than two-thirds of this age group take five or more, according to a report by the National Center for Health Statistics. Spending for prescription drugs totaled $234.1 billion in 2008 — more than double what was spent in 1999.

The National Center for Health Statistics excerpted elements of its National Health and Nutrition Examination Surveys to prepare the report:

Gu Q, Dillon CF, Burt VL. Prescription drug use continues to increase: U.S. prescription drug data for 2007-2008. NCHS data brief, no 42. Hyattsville, MD: National Center for Health Statistics. 2010.Other key findings include:

— Over the last 10 years, the percentage of Americans who took at least one prescription drug in the past month increased from 44 percent to 48 percent. The use of two or more drugs increased from 25 percent to 31 percent. The use of five or more drugs increased from 6 percent to 11 percent. Read more »

*This blog post was originally published at ACP Internist*

Poppy Tea Claims Another Life

Papaver somniferum.jpgThe Boulder County coroner announced today that the July death of a Boulder teen was indeed due to opioid intoxication from preparation of a poppy pod tea.

Jeffrey Joseph Bohan, 19, of Boulder, was found dead in his friend’s Boulder home about 6 p.m. July 21 after drinking poppy-pod tea the night before with his brother, according to Boulder police.

Investigators suspected the Fairview High graduate, who was going to Colorado State University, died from the psychoactive tea, which is brewed from the plant that produces opium. But they couldn’t be sure until the Coroner’s Office confirmed Monday that Bohan’s cause of death was morphine overdose, and his manner of death was accident.

Here is also coverage from The Boulder Daily Camera.

This marks the second death in Boulder from young adults mixing up decoctions of seeds or pods from the poppy, Papaver somniferum. We reported in March on the death of CU-Boulder student, Alex McGuiggan, in March.

In a subsequent post, we expanded on a commenter’s story of his own efforts to raise awareness of the dangers of poppy seed tea following the death of his own son. Commenter Tom’s site can be viewed at Poppy Seed Tea Can Kill You (http://poppyseedtea.com).

Extracts from poppy pods can contain up to 10% morphine and 1-5% codeine together with several other benzomorphan compounds. Seeds themselves are intrinsically devoid of morphine but the drug can remain on the seeds in reasonable quantities simply from their processing. The Santa Clara County crime laboratory investigating the death of Tom’s son determined that a tea made with the same seeds he used contained 259 µg/mL of morphine.

Depending on the starting material, however, the extract may also contain thebaine, a natural intermediate used for semi-synthetic opioid synthesis that causes intense nausea, vomiting, and even convulsions.

*This blog post was originally published at Terra Sigillata*

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