Two new studies of Medicare patients taking opioid painkillers such as OxyContin, codeine, and Vicodin suggest that there may be a higher risk of health problems such as heart disease or bone fractures – possibly even death, than for those taking non-opioid pain relievers. However, critics argue that there could be other contributing factors involved.

The first study examined 6300 Medicare patients residing in two states. Those examined were prescribed one of the following five opioid painkillers during 1996 to 2005: codeine, hydrocodone (Vicodin), oxycodone (OxyContin), propoxyphene (Darvon), and tramadol (Ultram).

The results of the study showed that those taking codeine were 1.6 times more likely to have heart problems after 180 days. It also showed that hydrocodone users were at a higher risk of fractures than those taking tramadol and propoxyphene. And, those taking oxycodone for more than 30 days were 2.4 times more likely to die than those taking hydrocodone.

Dr. Russell K. Portenoy, chairman of the department of pain medicine and palliative care at Beth Israel Medical Center in New York City says to take the results of the study with a grain of salt. While the authors themselves admit that further research must be done, the results are nonetheless interesting.

Another study released in the same journal paired opioid painkillers against non-opioid painkillers. From 1999 to 2005, researchers studied 13,000 Medicare patients taking various forms of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen and coxib drugs such as Celebrex (celecoxib).

The research team discovered that those taking opioid pain relievers had a higher risk of adverse side effects than those taking an NSAID or coxib drug. For every 1000 prescription opioid users, 101 suffered a fracture each year. That number compares to only 19 out of every 1000 people taking the other types of painkillers. The team also found that people using coxibs and opioids had an elevated risk for heart problems over those using NSAIDs.

The message is that there is still a lot to know about the safety of opioid painkillers. Talk to your doctor about the risks and benefits to ensure you make the right decision for your pain management needs.

Many experts feel the education level offered to physicians toward how to safely prescribe and monitor controlled drugs is lacking and inadequate, in comparison to the rapid rate of their abuse. As prescription drug abuse continues to rise, more doctors are considering how they might be active in preventing the problem and stopping it for patients who have become addicted. Some proposed measures including mandating training in recognizing and diagnosing substance abuse problems and addictions in patients while medical school students are completing their programs.

A survey from Columbia University’s National Center on Addiction and Substance Abuse said that more than half (57 percent) of physicians believe they can play a part in reducing prescription drug abuse. However, many reported they only spent about two hours of time learning how to divert prescription drug abuse during medical school or training. The numbers equate to an estimated 520,000 physicians who may not be fully equipped to help recognize and stop patients’ abuse of prescribed medications.

In some cases, physicians will give medications to treat the patient’s symptoms but ignore the underlying condition, like anxiety disorder or depression. Doctors can also give a patient a prescription for a medication with addictive properties, and the patient can keep taking the medication, not realizing they have become dependent. The symptoms of an underlying condition can then remain masked and the patient will not seek treatment.

A conference in 2008, held at the Betty Ford Institute, addressed these issues and proposed some changes to policies and regulations to help doctors prevent prescription drug abuse. Among the recommendations are that knowledge of how to identify and diagnose substance abuse disorders, as well as how to correctly administer drugs that are controlled, should be part of the American Board of Medical Specialties competency standards.

Other changes proposed by the consensus include Medicare funds presented to medical school programs that include coursework for educating emerging physicians on how to handle controlled substances and patient needs with substance abuse. The coursework would be part of a standardized curriculum delivered by faculty members specially trained to teach it.

In addition, the conference attendees proposed that the Drug Enforcement Administration mandate that doctors clearly show knowledge and competence for using prescriptions for controlled substances before they receive their license from the DEA to prescribe the drugs.

As the problem of prescription drug abuse escalates, physician responsibility and knowledge toward giving prescriptions for controlled substances could also involve more regulations, including new courses, training requirements and national workshops. Patients are also responsible for knowing their family history of substance abuse and talking about their own issues with their doctor, before the problem grows into a life-destroying addiction.
 

Today, more and more health providers are realizing the benefits of music therapy and how it can increase the quality of their patients’ experience, not only in hospitals, but in centers for youth, counseling facilities, and correctional centers.

Music therapy may hold particular promise in terms of helping patients relax, breathe and focus – even to the point where they need fewer prescriptions for painkillers. Speech therapy is another area in which music therapy may show positive changes for patients, and could be applied as patients recover from accidents or surgeries involving their language skills.

One leader in the music and alternative therapy realm is Laruel Terreri, Santa Monica-UCLA Medical Center and Orthopedic Hospital, located in Los Angeles. Terreri coordinates a music therapy program for children with cleft palate impairments. Various types of kazoos, whistles and other items help patients express themselves and hear their voice, as well as build muscle strength in the mouth.

Terreri suggests integrating music therapy into a live setting helps patients express themselves and allows a setting for music therapy to be incorporated within various forms of physical or occupational therapy, recreational therapy and social work efforts.

Recently music therapy has taken a leap toward become accessible in the mainstream, especially for patients with dementia or Alzheimer’s. Coro Health, LLC, has created web-based music therapy tools that can be accessed by patients living in residential-care facilities. The product is called Music First and is in clinical trials at the Davis Center for Mind and Brain at the University of California. The modules can be used independently in patients’ rooms and match that person’s schedule and needs. Developers hope the program will show strong results toward the mental and emotional well-being of assisted-living center patients.

Brain injury patients are also seeing positive changes with music therapy. The work of the frontal lobe – such as solving challenges, making decisions and managing behavior – can be severely impaired during car accidents. Many patients are unable to fully engage in treatments and therapies because they struggle with self-awareness or making choices, but music therapy seems to break down communication challenges and help set the stage for effective therapy.

Similar results have been shown in cases of patients with emotional and behavioral problems, in which the engagement in the music creates a connection to the self and to thoughts and allows for more successful therapy. Exercises conducted at New York’s Northeast Center for Special Care in Lake Katrine have shown that patients begin to see themselves in a positive way, and have feelings that they are creative and unique as they use music therapy to work through physical or cognitive disabilities.

Music therapists believe the use of music can help a patient take very tangible positive steps toward recovery – both physically and emotionally – where other methods have not been effective. Though still not fully mainstream, the practice helps reduce stress, relieve anxiety and change negative thought patterns, and some patients have shown reduced needs for prescribed pain medications when engaging in music therapy.
 

Prescription drugs are relatively easy for teens to obtain. An unlocked medicine cabinet at home or at another relative’s house may provide strong opiates or other types of painkillers that have very addictive properties. A recent study looked at the trend of prescription drug misuse specifically among youths in residential care for antisocial behavior.

The study, conducted by Martin T. Hall, Matthew O. Howard, and Sean Esteban McCabe examined the prevalence of nonmedical prescription drug abuse in a state population of youths. The researchers conducted interviews with 723 Missouri youths to assess substance use, psychiatric symptoms, antisocial traits/ behavior and traumatic life experiences. The youths interviewed were 87 percent male and averaged 15.5 years of age.

The results indicted that 314 of the youth interviewed (43.4 percent) reported lifetime prescription drug misuse. When broken down into the types of drugs misused, 33.7 percent had misused opioids, 32.0 percent had misused tranquilizers, and 11.2 percent had misused barbiturates.

The researchers were able to establish a profile of antisocial youth using prescription drugs for nonmedical purposes. The study revealed that prescription drug misusers were significantly older, and a larger proportion were girls, were White, and resided in small towns, compared with antisocial youth that were not prescription drug misusers.

The study also showed that prescription drug misusers also had histories of more varied, frequent and problematic psychoactive drug use, higher instances of distressing psychiatric symptoms, and were almost twice as likely to be diagnosed with a psychiatric disorder. In addition, there was a higher rate of traumatic life events, experiences of criminal victimization and suicidal ideation for those who reported prescription drug misuse.

The researchers conducted multiple logistic regression models to determine that older age, White racial status, prior inhalant, marijuana and LSD use combined with residence in a small town and impulsivity were each found to increase risk for prescription drug misuse.

The results of the study show the increased risk for antisocial youth to misuse prescription drugs. In order to address all aspects affecting antisocial behavior, administrators at residential care facilities for antisocial youth may be compelled to screen residents for prescription drug misuse at the time of registration.

Many of the prescriptions written to address pain involve the dispensing of narcotics and synthetic opium drugs. Many individuals with genuine pain issues quickly find themselves addicted to the medication as a result of a quickly developing dependence.

For doctors at the UT Medical Center’s Family Medicine Department, doctors must walk a fine line when handing out prescriptions. The goal of physicians at this facility is to address pain, but to do so in such a way that it does not lead the individual to an addiction.

This addiction develops simply because patients are trying to achieve the same effect they had when they first started taking the medication. As tolerance generally develops quickly, more and more of the drug is needed to achieve the same result.

Patients are known to come back for appointments and complain of increasing pain because their tolerance is increasing. As they increase their medication, they also increase the tolerance and work their way toward addiction.

When the patient sees more than one doctor, the problem escalates. A patient visiting the same physician every time is able to work with the doctor familiar with their case and one who understands the medication levels. When multiple doctors enter the picture, all may be prescribing the same dose, but multiple times without knowing it. As a result, the patient gains access to increased medication to feed the addiction – a vicious cycle that is hard to break.
 

Although designed to help stop abuse and addiction of prescription painkillers, the measure is causing controversy among physicians, nursing homes and patients. In previous years, a phone call from a member of the nursing home medical team would initiate the process of getting a prescription filled for a pain medication like Percocet. Now, a written-out prescription brought in person or sent by fax from the doctor to the pharmacy is needed, but many care facilities for seniors have not yet become aware of the change.

The result is that some patients have to wait several days to get a prescription refilled, or longer if the doctor can’t be reached. The situation can become even more complicated when doctors who work on-call at residential care centers need to see the patient for a visit before changing or giving a prescription for pain medications. Some patients have reported enduring several days in severe pain while waiting for their medications to be filled.

In what it calls an effort to protect older patients, the Drug Enforcement Agency is leading investigations at pharmacies in some states where pain medications may have been given to patients in nursing homes without official doctor’s orders. The prescriptions may have either been called in by a nurse at the center, or filled by a pharmacist without obtaining the prescription. Narcotics abuse is an increasing problem nationwide, and patients of all age groups have reported addictions, even in some cases after only short-term use.
Prescription narcotics like Percocet are controlled substances, and cannot be issued without a prescription. However, some patients have had to wait for pain relief if they live in a rural part of the country and their doctor has to take extra steps to locate a fax machine or the ability to send a prescription with Internet-based methods. Others may wait due to miscommunications between medical staff at the nursing home and hospital physicians, once they have been discharged from a hospital procedure.

The Senate Special Committee on Aging has recently listened to reports from nursing home staff members revealing the challenges and time delays in giving their residents medications for pain. Meanwhile, many patients have continued to report experiencing time lags in receiving pain medications, because the process changes can result in phone and fax errors or delays in finding the physician.

In the U.S., around 1.4 million people list a nursing home as their residence. Some critics say the prescription drug situation is a result of too many medical needs at nursing homes and not enough on-site physicians to handle the load of needed prescriptions.

As debate continues toward restricting prescription painkillers at nursing homes, geriatrics experts have suggested that nurses be trained to perform as physician’s agents and give the prescribed drug as one solution to help prevent older patients from waiting for medications.
 

In addition to the wide array of drugs available with pain relievers in them, misuse is also sometimes not addressed because doctors are not aware of the combination of medications that their patients are using to treat a spectrum of chronic problems and everyday aches and pains.

A new study highlights the risks involved with addiction to codeine-ibuprofen. Though codeine-ibuprofen is not a strong drug, it is addictive and can cause physical problems when it is misused. Dr. Matthew Frei, clinical head at Southern and Eastern Health Alcohol and Drug Services and adjunct senior lecturer at the School of Psychology and Psychiatry at Monash University in Melbourne joined colleagues to investigate morbidity associated with the misuse of over-the-counter (OTC) codeine-ibuprofen analgesics.

The study, published in the Medical Journal of Australia, followed twenty-seven patients with serious morbidity between May 2005 and December 2008. The average dose among the patients was 435-602 mg of codeine phosphate and 6800-9400mg ibuprofen.

The authors of the study reported that the patients suffered from gastrointestinal disease, renal failure, and anemia. Most of the patients did not have any previous history of substance-use disorders. Dr. Frei said that with most of the patients, serious morbidity was due to pain reliever use introduced for therapeutic reasons, such as treating a chronic pain problem.

The authors of the study explain that the results show the need for physical involvement in patients’ self-treatment of analgesics. Taking a medication history is a necessary step to safely treating patients who are using OTC medications.

Pharmacy personnel should also be aware of the potential of misuse when they supply combination analgesic products.

The problems associated with the misuse of combination codeine-ibuprofen medications may require creativity to educate consumers about the dangers of addiction. Point of purchase warnings may be effective in raising awareness, or a warning that prints on the receipt when the medication is purchased may be a strategic way to prevent misuse.

Doctors may also be able to assess the risk of misuse of pain relievers when they talk with patients about strategies for managing persistent pain problems. Once the risk of addiction and the possible health outcomes are discussed, patients may be motivated to carefully monitor their pain reliever use and avoid misuse.
 

A recent study measured the use of prescription drugs for non-medical purposes among both urban and rural teens. The study will be published in the March 2011 issue of the journal Archives of Pediatrics & Adolescent Medicine.

The authors of the study indicate that the use of prescription drugs for recreational use is a common practice for American teens, with one in eight admitting having used opioids for non-medical purposes. The authors note that non-medical prescription drug use during adolescence is a concern because it is associated with the use of other illicit drugs like heroin and cocaine. Teens that use prescription drugs for recreation are also likely to be involved in other dangerous behaviors like gambling, sexual activity and impulsivity.

Lead author Jennifer R. Havens, Ph.D. M.P.H. of the University Of Kentucky College Of Medicine in Lexington and her colleagues analyzed data from the 2008 National Survey on Drug Use and Health. From the information gathered from 17,872 17-year-olds, they were able to determine that 53.2 percent of the participants lived in urban areas, 51 percent were male and 59 percent were white.

While there was no difference between urban and rural youth in terms of illicit drug use, there was a significant difference between the two groups for non-medical use of prescription drugs. Urban teens used prescription drugs at a rate of 10 percent, while rural teens used them at a rate of 13 percent.

There were also differences between the two groups in the types of prescription drugs used. Rural teens were more likely to use pain relievers and tranquilizers than teens in urban settings (11.5 versus 10.3 percent and 3.5 versus 2.5 percent, respectively).

The researchers adjusted for sociodemographic factors, health status and the use of other substances, and the results remained consistent. Rural teens were 26 percent more likely than urban teens to report that they had used prescription drugs for non-medical purposes. The authors believe that this difference may be partly explained by the lack of availability of other drugs in rural areas.

There were several factors that lowered the risk of a rural teen having reported using prescription drugs for non-medical purposes. Living in a household with two parents, enrollment in school and good mental health were all associated with an absence of prescription drug use.

However, illegal drug use is no longer the greatest public health threat; some legally prescribed drugs can be just as addictive and just as dangerous as cocaine or heroin. Employees who are under the influence of prescription drugs help contribute to industrial accidents, workplace injuries, and product defects.

A maker of employee drug tests reports that positive results for opiate-based prescription drugs increased forty percent from 2005 though 2009 and almost twenty percent from 2009 to 2010. More importantly, however, the study revealed that workers undergoing drug tests after workplace accidents were four times more likely to test positive for opiate-based prescription drugs than those undergoing routine pre-employment tests.

While in the past employees who were taking prescription drugs were largely immune to reprisals from employers after a positive drug test, the tide has begun to turn. Due to the side effects of some of these drugs, such as painkillers, that reduce reaction time and cause sleepiness or muddled thinking, employers are now realizing that even employees with valid prescriptions may be a threat to business interests.

Dura Automotive Systems is one of the first companies in the US to start terminating employees who test positive for “unsafe” prescription drugs. Company policy now allows employees to be tested for unsafe prescription drugs, such as Vicodin, in addition to illicit ones. Because it is impossible to predict whether an employee who is under the influence of prescription drugs will exhibit unsafe behavior in the workplace, employers often implement blanket policies that prohibit any use of drugs that carry warning a against driving or operating machinery. Those who are found to be taking the prohibited drugs can be terminated.

However, these new prescription drug policies can have perverse effects; workers who are taking “unsafe” drugs to treat complications from injuries received on-the-job are not immune from termination for drug use. Employees and employee rights groups are striking back at this new trend in employee-employer relations by filing suits based on discrimination and invasion of privacy. Other advocates argue that prescription drug prohibition policies may, in fact, violate the Americans with Disabilities Act (ADA) as the Act prohibits questioning employees about prescription drug use unless they are caught behaving in a way that is a threat to safety. Currently only public safety workers, such as police officers and fire fighters, and employees in other sensitive jobs are not afforded protection under the ADA. Instead these workers must self-report if they have been prescribed a drug that could impair their job performance.

Evidence suggests that implementation of these new prescription drug policies may be at the behest of workers’ compensation insurance carriers, which have seen policy payouts increase as a direct result of prescription drugs in the workplace. Some carriers have begun offering employers incentives to implement bans on dangerous prescription drugs.
 

A recent News Journal Online piece notes that pain management clinics represent a booming industry within both Volusia and Flagler counties. It appears the government is taking notice and in four cities, including South Daytona, Port Orange, Ponce Inlet and Edgewater, new pain clinics have been banned.

Even with this movement, registered pain clinics within the two counties jumped 25 percent. Tougher regulations in South Florida are sending pain management clinics north and without a registry to track painkiller prescriptions in the state, addicts and drug dealers find Florida an attractive place to do business.

A new law is expected to go into effect in Florida that will limit the number of pills that can be prescribed for any one person at a given time. Another state law took effect on January 1 of this year that requires registration with the state Health Department for all pain management clinics.

West Palm Beach dermatologist, Dr. Steven Rosenberg has stressed that the number of pain clinics within the state is not likely to change until authorities decide to start cracking down on them and their methods of operation. Florida has become a shopping destination for opiate dealers and pill eaters who will continue to move according to easier legislation in the state.

The 39 residents who lost their lives to oxycodone within Volusia County represent a 77 percent jump from the number lost in 2008. The 13 lost in Flagler County did not change from the previous year.