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The inappropriate care approaching to back ache is a driving force behind the opioid epidemic, Dave Chase, co-founder of Health Rosetta, reports, 1 citing the 2018 JAMA Network Open paper, 2 “Opioid Prescribing for Low Back Pain: What Is the Role of Payers? ”
One of the reasons for this is the sheer prevalence of back pain. Statistics3 hint 8 in 10 American adults will be affected by it at some point in their life.
“It’s likewise a microcosm of all the things that are incorrect with the U.S. health system, including its contribution to the opioid crisis, ” Chase writes. 4 “Lower back ache puts people in desperate and vulnerable positions, and it puts physicians under pressure to Do Something Now.
From such a confluence arise many poor and potentially ravaging therapies and choices. Among the most difficult is doctors’ decisions to write opioid prescriptions as a care for lower back sorenes and their patients taking these drugs.
Lower back soreness is one of the most common reasons for an opioid prescription, 5 but here’s the kicker: There’s no evidence that opioids are effective at treating this problem.”
Opioids Are Inappropriate for Back Pain
Indeed, according to the JAMA paper: 6
“Recent data from the first randomized clinical test with long-term outcomes states clearly that opioid treatment did not bestow benefit with respect to pain-related part and that adverse medication-related occurrences were more common among patients receiving opioid therapy. In contrast, ache severity was improved among patients randomized to nonopioid treatment.”
Other research7 published in 2018 also shows opioids( including morphine, Vicodin, oxycodone and fentanyl) fail to control moderate to severe pain any better than over-the-counter( OTC) medicines such as acetaminophen, ibuprofen and naproxen.
In reality, those taking nonopioid pain relievers actually fared “significantly better” in terms of pain intensity. Lead author Dr. Erin Krebs with the Minneapolis VA Center for Care Delivery and Outcomes Research( formerly Chronic Disease Outcomes Research ), told WebMD :8
“We found that opioids has no such advantages over nonopioid drugs for suffering, role or quality of life in patients with low back agony … This is important information for physicians to share with patients who are considering opioids.”
How Insurance Companies Contribute to the Opioid Crisis
Despite the medical consensus that back pain is best treated with nonpharmacological entails, most insurance companies still favor opioids when it comes to reimbursement.
As noted in the American College of Physicians’ guideline9 “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain, ” heat, massage, acupuncture or chiropractic readjustments should be used as first-line therapies. When narcotics are desired, nonsteroidal anti-inflammatory medicines( NSAIDs) or muscle relaxants should be used.
Other key cares include exercise, multidisciplinary reclamation, mindfulness-based stress reduction, tai chi, yoga, relaxation, biofeedback, low-level laser therapy and cognitive behavioral therapy.
In a recent chapter of Full Measure, 10 Sharyl Attkisson interviewed Eileen Kopsaftis, a occupational therapist who employs a combining of diet, connective tissue run, proper figure dynamics and figure equilibrium to address back suffering.
As for opioids, they “should only be considered if other therapies are unsuccessful and when the potential benefits outweigh the risks for an individual patient, ” according to the American College of Physicians’ guideline. 11
Alas, while clinical practice guidelines call for nonpharmacological intervention for back agony, most insurance programmes don’t pay for such cares. They do pay for opioids, though. In his article, Chase clarifies: 12
“That doesn’t make sense until you look at the reason: For the carriers that administer health insurance schemes, there is far more profit in pills than physical therapy.( This is something that is precisely why the three largest pharmacy benefits directors have recently merged with insurance carriers .)
Our entire health system is built on a immense web of incentives that pushing patients down the wrong tracks. And in most cases it’s the entities that oversee the money — insurance carriers — that benefit from doing so.
They negotiate rates with health systems and pharmaceutical companies, all of which share the objective of increasing revenues, to craft and sell health plans that give trumped up’ discounts.’ As long as carriers negotiate a high price with a provider or a rebate strategy with a drug maker, they can still make a sizable gain even after a 50 percent discount.
This dynamic was accelerated by the Affordable Care Act’s Medical Loss Ratio, 13 which requires that 80 percent of insurance premium dollars pay for medical overheads and that carriers pocket merely 20 percentage. It doesn’t take much to see that the higher the premium, the more they induce from that 20 percentage …
An calculated 700,000 people are likely to die from opioid overdoses between 2015 and 2025,14 stirring it absolutely essential to understand the connections between insurance carriers, health plans, boss, the public, and the opioid crisis. We will never get out of this mess unless we stop craving before it starts … the opioid crisis isn’t an anomaly. It’s a side effect of our health care system.”
Physicians and Dentists Also Shoulder Blame
Other situations in which opioids are inappropriately prescribed, and massively so, are for tonsillectomies and wise teeth extractions.
Insurance claims data from 2016 and 2017 reveal 60% of children between the ages of 1 and 18 with private insurance filled one or more opioid prescriptions after surgical tonsil removal, 15,16 and dentists wrote a staggering 18.1 million prescriptions for opioids in 2017.17
As noted by Ronnie Cohen in a March 2019 article1 8 in The Washington Post, “until recently, dentists seemed to have had no idea they may have been helping to feed an epidemic that resulted in a record 70,237 U.S. drug overdose deaths in 2017. ”1 9
Andrew Kolodny, co-director of opioid care experiment at Brandeis University, told Cohen: 20 “It’s almost a rite of passage in the United States having your wisdom teeth out. The aggressive prescribing of opioids to teens may be why we’re in an epidemic.”
While American family doctors prescribe an estimated 15% of all immediate-release opioids — the type most likely to be abused — dentists are not far behind, being responsible for 12% of prescriptions, according to a 2011 paper2 1 in the Journal of the American Dental Association.
According to a JAMA report2 2 published August 2018, opioids are “routinely” prescribed for wisdom tooth extractions. The Washington Post quotes a 2004 survey, which received 85% of oral surgeons prescribe opioids after the removal of wisdom teeth. 23
This practice is highly questionable, considering there’s no medical citation demonstrating opioid pain relievers is more efficient for this kind of post-surgical agony than NSAIDs. 24
On the contrary, an April 2018 medical review2 5 discover a combination of ibuprofen and acetaminophen offered the greatest pain relief, while opioids and opioid combinings had the highest number of adverse events in both children and adults.
Mind you, even though the ibuprofen/ acetaminophen combining is less addictive, it can still cause serious potential complications if taken long term, so you also need to be careful when using these drugs and make sure to address the foundational cause of your pain.
Common sense would tell you this practice is putting boy at significant hazard for addiction. Research2 6,27 demonstrates such feelings, demonstrating 6.9% of those receiving an opioid prescription from their dentist in 2015 should continue to be employing opioids between three and 12 months later. Among those who did not get an initial opioid prescription, merely 0.1% searched an opioid prescription in the 12 -months that followed.
The American Dental Association now urges dentists and oral surgeons to limit opioid prescriptions for acute pain to a maximum of seven days. 28 In a 2018 article2 9 in The Philadelphia Inquirer, Dr. Rima Himelstein, an adolescent medicine specialist, exhorts parents whose infants are undergoing oral surgery to 😛 TAGEND
“Be the gatekeeper for medications, including those prescribed after prudence teeth extraction. Don’t simply hand your teen the bottle of pills after surgery. And be sure to properly dispose of leftover prescription drugs … ”
Johnson& Johnson’s Role in the Opioid Crisis
While Purdue Pharma and the Sackler family appear to have played a central role in the creation of the opioid crisis, few opioid makers and distributors are free of accuse. An August 27, 2019, section in The New York Times3 0 highlightings the influence of Johnson& Johnson, a leading supplier of opioid parts.
August 26, 2019, Johnson& Johnson was ordered to pay Oklahoma $572 million for breach state public nuisance law, thereby creating decades of opioid craving and opioid-related deaths in the nation. 31,32 As reported by The New York Times: 33
“The judge cited the company’s too aggressive marketing tactics: Marketings representatives were coached to avoid the’ addiction ditch’ — the negatives associated with drug use and reliance — when fostering physicians to prescribe opioids for patients with moderate to severe pain …
Its marketing tactics followed a similar playbook to one Purdue and other opioid producers were utilizing, and also included so-called unbranded publicity, which was not tied to specific products and encouraged doctors to continue to prescribe more opioids.
Like its competitors, Johnson& Johnson sought to persuade doctors that ache was under-treated, civilize sales representatives to use’ emotional selling’ to get across the notion that patients were being harmed by undertreatment.
Another concept was’ pseudoaddiction, ’ or the notion that if patients were requesting a doctor for higher doses, “theyre not” inevitably addicted but needed more of the narcotic to treat their pain.”
According to The New York Times, 326 million opioid capsules were dispensed in Oklahoma in 2015 alone, “enough for every adult in the nation to receive 110 pills.”3 4 Oklahoma prosecutors also stressed that were it not for Johnson& Johnson, OxyContin would not have become a blockbuster drug.
In 1994, when Purdue Pharma tried Food and Drug Administration approval for OxyContin, Johnson& Johnson’s supplier subsidiary Tasmanian Alkaloids developed a fiction type of opium poppy, the Norman Poppy, which produces higher quantities of thebaine, the active painkilling part in OxyContin.
An Important Break in the Kentucky Case Against Purdue
Purdue is still in the news, though, and possibilities are we’ll hear a lot more about it in the course of the coming weeks and months. The reason for this is because the Kentucky Supreme Court was eventually ruled that sealed tribunal records detailing the company’s marketing of OxyContin are to be unsealed and made available to the public.
The cache is also said to include internal reports on the findings of the clinical experiments, communications relating to previous legal instances, and a 2015 deposition of Dr. Richard Sackler. All of these documents were obtained during legal breakthrough in a lawsuit where Kentucky sued Purdue over the illegal marketing of OxyContin.
The case was be set out in 2015, with Purdue being ordered to pay the state $24 million. Part of the settlement agreement called for the destruction of 17 million pages of litigation records held by the state attorney general’s office. Copies of some of the records, nonetheless, aimed up being placed under seal in a Pike County courthouse. On August 26, 2019, STAT news reported: 35
“The decision is a major victory for STAT, which first filed a motion3 6 to unseal the records in March 2016. Purdue has fought to keep the documents out of view, but the Supreme Court’s repudiation is final and can’t be appealed.
Now, the public stands to get a glimpse of new information about how Purdue promoted OxyContin and what executives knew about the hazards of addiction that came with the drug.
‘ The case against Purdue was one of our first decisions where reference is launched STAT, and we’re thrilled that the trove of documents will finally made available to the public, ’ said John W. Henry, the owner and publisher of STAT.
‘As the opioid crisis to continue its efforts to devastate communities across the country, it is vital that we all have more answers to so many outstanding questions about the genesis of the epidemic and Purdue’s aggressive marketing of OxyContin.’”
FDA Advisory Panel Riddled With Conflicts of Interest
In pertained news, The BMJ recently published an editorial3 7 highlighting a recent BMJ investigation3 8 that revealed the National Academy of Sciences, Engineering and Medicine( NASEM ), which advises FDA on opioid plans, has a number of hidden conflicts of interests, and this too may have played a role in the opioid crisis.
Among these undisclosed conflicts of interests was the fact that Victor Dzau, one of NASEM’s chairpeople, “had financial ties to Medtronic, a company that sells an implantable device to deliver pain medicine, until last year.”
What’s more, 7 of fifteen academics providing on the NASEM panel that admonished the FDA on opioid prescribing guidelines had ties to industry. On top of that, NASEM itself accepted $14 million from the Sackler family. The BMJ reports: 39
“NASEM responded4 0 to The BMJ’s investigation to say that it was reviewing its conflict of interest policies and its funding from the Sacklers. It said that it considers merely’ current’ fiscal ties; but past ties, specially if recent, substantial, or longstanding, are also conflicts of interest, which is why publications like The BMJ ask authors for revealings going back three years.
NASEM said that Dzau had complied with its policies; but necessitating the public disclosure of all rivalling interests is essential if policy makers, practitioners, and patients are to be fully informed of how NASEM drafts its guidance.
NASEM said that the$ 1m of shares Dzau held for previous Medtronic board membership while chairman of the National Academy of Medicine were managed by his bank without his involvement; but still they constituted a substantial and undeclared conflict of interest because Dzau stood to gain if their worth rose.”
Will Justice Be Done?
In an August 29, 2019 article4 1 in The Atlantic, Dr. James Hamblin addresses the lack of justice currently on the table 😛 TAGEND
“The role of marketing in the pharmaceutical industry — the apparatus that profits more from maximizing employ than optimizing outcomes — is at an intonation phase. A reckon could result in serious reform.
But a settlement deal currently on the table — in which Purdue Pharma … would pay about $11 billion4 2 — stands to repeat the mistakes of the past …
Several billion would come in the form of medications to help treat opioid addiction and overdoses. The Sackler family … would give up ownership of the company, which would file for bankruptcy and become a’ public recipient trust’ …
But no brand-new soil would be broken if the justice comes in the form of penalties for what amounts to serious crimes. In 2018, President Donald Trump proposed the extreme measure of using the death penalty for certain drug traffickers and pushers …
Trump did not suggest that these pushers simply pay back a portion of their gains. The importance of sending a message is rarely invoked when it comes to white-collar crime. When medicine dealing is done by firms, the punishment is to enforce penalties, and to debate what sort of punishment would be fair and productive.
In this case, the proposal on the table would require Purdue to pay a fraction of the $35 billion in profits it claims to have made from Oxycontin — and far less than even the republican estimates of the damage it induced … estimated in a 2017 White House report to be $504 billion.”
A Moral Reckoning Is Needed
I couldn’t agree more with Hamblin’s assertion that a settlement — and especially one that falls so short of the actual cost to society — will do nothing to change the medicine industry’s ways.
“It is not a criminal prosecution. It is not a moral reckon, ” Hamblin writes, and indeed, without criminal prosecution of corporate executives who played an active part in the decisions that were made, present trends of reckless malfeasance is bound to continue.
In 2007, Purdue pleaded guilty to accuses that it misinformed doctors and patients about OxyContin’s addictive potential and paid $634 million in penalties. They knew they were killing people, and the penalty did nothing to realign the company’s moral compass. Purdue kept up the same shady practices — putting earnings above public health — for another 12 times, delivering us to where we are today. As Hamblin so competently states: 43
“The job of the tribunals and regulatory apparatus is to help prevent future tragedy. This will not happen when penalties are meted out such that loss of life is treated as a cost of doing business.
The Justice Department could enforce criminal matters framework on concealing information that led to thousands of deaths. There is likely to be results … that make it clear to existing and future sellers of dangerous products that it is capable of never happen again.”
Read more: articles.mercola.com
