Search for tag: "drug overdose"
Treating Opioid Withdrawals with Imodium Can Be DangerousRather than seek professional help for opioid abuse some people addicted to those drugs turn to the Web for solutions for easing their withdrawals. One product being misused to treat opioid…
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July 29, 2016
Family Health and Wellness Interviewer: Using Imodium to treat opioid withdrawals: a bad idea. We'll find out more about this disturbing trend next on The Scope. Announcer: This is "From the Frontlines" with emergency room physician Doctor Troy Madsen on The Scope. On The Scope. Interviewer: Doctor Troy Madsen is an emergency room physician at University of Utah Health Care and he said he'd seen a couple instances where people are using Imodium, which is an anti-diarrhea medication, as a way of trying to treat their withdrawal symptoms from opioids. I find this hard to believe. What's going on? Dr. Madsen: Yeah. So this is really interesting. So as you may know, there's an opioid epidemic in our country and the Centers for Disease Control has acknowledged this and said we have so many people who are using opioids now. So prescription opioids, things like Percocet, Norco, Oxycodone are using that for to get high. Essentially what they may consider it legal high because they're getting a prescription or it's a prescription medication they're buying from someone. So then, these individuals may then be saying to themselves, "I really can't be doing this. I need to get off this medication." So they're finding things on the Internet that discuss using Imodium or loperamide is the generic name and using that to sort of detox, taking that as a bridge to give yourself some of the same effects as the opioids give you while allowing your body to adapt and adjust and then gradually get off the medication. Interviewer: So, first of all, bad idea trying to self-treat an addiction like that? Dr. Madsen: Absolutely, not a great idea. But the reason they're doing this is because it's probably been out there for years and then I think it's just gained steam with some people posting things on the Internet about this. But Imodium or loperamide is actually an opioid. It doesn't give you the same high as things like Oxycodone, but it has kind of the same effects, acts on some of the same receptors in the body. That's why it help with diarrhea because if you've ever heard of someone who says, "Hey, taking all these Percocets and I can't have a bowel movement. It constipates me." Well, that's kind of how this stuff works for diarrhea. Same kind of idea. It slows down the bowels but also then acts on somebody's same receptors in the body that opioids act on that people are using for highs. Interviewer: Yeah. So self-treating bad but, above and beyond that, Imodium causes other problems that you see then? Dr. Madsen: It does. And the big thing we're seeing is some of these people are just taking such incredibly high doses that it's been putting their heart into these arrhythmias, these abnormal heart rhythms that are life-threatening. And that's where we see it in the ER. I've seen cases of people coming in who are in just these crazy heart rhythms, these life-threatening heart rhythms and it's because they're taking large doses of Imodium and then that is triggering this heart rhythm. And really, it's the kind of heart rhythm where you've got to shock their heart to get them out of it, get them on medication, do something for it or their hearts just not going to keep working and they're going to die from this. Interviewer: That doesn't sound much better. Dr. Madsen: It doesn't. It's not a great thing to do. Interviewer: It doesn't sound like a great solution to the original problem. Dr. Madsen: Yeah, there's not. There are much better solutions to opioid addiction and to getting off that. It's a sort of thing where you've come into the ER, we will often get people into in-patient detox programs. We can also prescribe medications that can help with this. So I would not recommend taking Imodium or loperamide. Again, that's the generic name for it. I would not recommend taking that to treat an opioid addiction because of the threat of these abnormal heart rhythms. And this really comes up because there was actually just a study published or report in one of the big emergency medicine journals talking about increasing cases of this and increasing calls to poison centers for people who are taking more and more of these medications to try and treat opioid addictions and then are having very bad effects from this. Announcer: thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com. |
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Health Headlines and the Physician Perspective: Opioid Pain MedicationsOpioid-based prescription pain medications are the third leading cause of death for Utah adults under 65 years of age. Given their dangers, should physicians continue to prescribe opioid pain…
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May 10, 2016
Family Health and Wellness Announcer: We're your daily dose of health, science, conversation. This is The Scope, University of Utah Health Sciences Radio. Interviewer: Dr. Higgins, so when it comes to opioid pain pills, I'm getting the point personally, and I want to see how you would react to this with the physician perspective, that opioid pain medications, they're just really bad news and we really shouldn't have them in our medicine cabinets anymore. We really should look for other ways to treat pain because you continue to hear about deaths and overdoses and addictions. Am I being a little overstated on that? Dr. Higgins: Yes and no. Interviewer: Okay. Interview: What should we do about what seems to be going on? It seems almost like a national health epidemic. And there again, I may be overstating this. Dr. Higgins: It's absolutely not overstating it. It is a national health epidemic. If you set aside cancer and heart disease, the thing that was most likely to kill an American under 65 was their car with some sort of motor vehicle accident. It was that way for some time. In 2003, it was the first year in the state of Utah where a prescription opiate was more than likely to lead your demise than a motor vehicle wreck. That was kind of revolutionary at the time. Now, it's that way in greater than half the states. Interviewer: Okay. So we were kind of ahead of the curve. Dr. Higgins: Yeah, it's nothing to be proud of. Interviewer: Yeah, in a bad way, yeah. So it is something that we need to address. As a patient, if my doctor says, "I'm going to prescribe you some pain medication that's opioid-based," should I say, "I'd rather look for a different solution?" Dr. Higgins: If you want to do that, your doctor should definitely respond. The old teaching was that as long as you had discomfort, the opioids [Audio skips 00:02:12] likely to be taking someone else's medicines. The people in the 40 to 60 age group are more likely to be taking their own medicine and they were on it chronically and they were on higher doses. And there are people here doing some pretty fascinating research on what the susceptibilities are. We may all have genetic susceptibilities to flip that switch. So even if you don't think you have "an addictive personality," then you can certainly develop one rapidly even if you don't think it's in you. Interviewer: So at the end of the day, a physician perspective, what do we do to solve the problem? Dr. Higgins: I think it's critically important of late that the public becomes aware and this happens through the lay press. And then, from a physician standpoint, we have to educate the patient at the beginning, the initiation of treatment. Secondly, have an exit strategy. Thirdly, entertain other modalities we can be using besides these medicines to treat the pain. Announcer: TheScopeRadio.com is University of Utah health sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com |
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The Controversy Behind Naloxone and How One Utah Group Promotes Its Usage to Save LivesUtah ranks fourth in the nation in deaths related to opioid overdoses. That equates to more than 10 Utahns dying each week from an overdose – and that rate is rising. Naloxone is a legal drug…
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May 11, 2016
Family Health and Wellness Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope. Interviewer: You may have heard recently of a drug called Naloxone. What it does is it reverses opioid-based overdoses. So if you have an opioid-based pain pill or if somebody has a drug overdose that's based on opioids, it can actually reverse it and save their lives. Dr. Jennifer Plumb is one of the founders of UtahNaloxone.org, is also in pediatric emergency medicine here at University of Utah Healthcare, and Sam Plumb is the program's manager at UtahNaloxone.org. I wanted to ask you both, why is this important to you? I've gone to the website. I see that you've put a lot of work into it. I see on my Facebook feed a lot of times you're trying to increase awareness. Dr. Plumb, why? Dr. Plumb: We are in this position, I think, at a position of passion, but also at a position of a true desire that we can bring awareness to the epidemic that's gripping our state with opioid overdoses. We are fourth in the nation, which is a distinction that certainly nobody wants. We're not talking about it a whole lot, and I think that there are a lot of people out there who have at-risk family members. We unfortunately lost our brother in 1996 to a heroin overdose, and since that time the situation has just gotten worse and worse. Naloxone was not legal to have in the home setting when Andy died, and it is legal now. So I think that we both feel very passionately that if one family can be spared what we went through, it's all worth it. Interviewer: It would've saved his life you believe? Dr. Plumb: Absolutely, I believe it would've saved his life. It would've saved his life. Interviewer: So when you say we have opioid-based overdoses, are you talking about pain pill overdoses, intentional, accidental? I mean, what are we talking about here, people abusing? Dr. Plumb: When the figures all come out, the Health Department puts them together and the CDC also puts them together, and they do look at all of those categories. They look at intentional or suicides. They look at accidental or poisonings. We are seeing in this state that we have continued accidental overdose increases. So what do these look like from an opioid perspective? Most of these poisonings and overdose deaths in Utah are from opioid substances. There are some others, cocaine, methamphetamine, alcohol, that can also kill people, and unfortunately does kill people. But the majority are from the opioid-based substances. Of those, the majority probably still is prescribed pain medications. So the pain pills, OxyContins, Percocets, codeines, these medications that we all have heard about in different incarnations in our lives, but heroin is another big one. The CDC just this year basically released data and released recommendations calling it an epidemic. It's truly an epidemic what's happening. Since 2000, I believe, we're almost up 400% for heroin overdoses nationwide. It's everywhere. Interviewer: Not a problem here, though, right? Not in Utah. Dr. Plumb: You certainly wouldn't think so. Interviewer: But it is. Dr. Plumb: It absolutely is. It's really challenging, because I get that people don't want to talk about it. There's a lot of stigma around it. But to me, it really is just another medical problem, a critical one and one that will kill someone if it's not dealt with, and if we don't get people help. But we don't talk about it. You're exactly right. It doesn't exist if we don't talk about it. We don't see billboards about it. We don't see PSAs. We need to. We need to start encouraging conversations surrounding these substances so other families don't go through what we have gone through. Interviewer: Sam, you're also involved in UtahNaloxone.org. You're the program's manager, and I understand you do a lot of outreach to people that have a drug addiction problem. Talk about that a little bit, and how Naloxone can change things. Sam: Well, I think it could potentially have a drug addiction problem. When you're doing community street outreach, you're dealing with a population that they obviously aren't in a good place. If they themselves aren't active users, they could know people who are at risk of an overdose, for instance. So the idea is these are people that are typically missed by other realms of the medical field. They don't typically go to the doctor. They don't have access to the pharmacy. They don't often have insurance. So for that reason, these people are most at risk for having an overdose and not having the access to Naloxone, which can save them. Interviewer: You actually make these available to those at-risk individuals. Sam: Yes. We go out to different areas, and you start to have an understanding of more at-risk areas of the city. For instance, I know Pioneer Park is one that people typically think of. The Road Home, places where there are typically going to be people that are living outside or don't have the means to often take care of themselves, or provide themselves the shelter. We will go out and we will educate each and every person that gets a kit so that they know everything that they need to do should they witness an overdose, or should they themselves have an overdose. Then, we distribute the kits, and we've really had a great response for that matter from that group of people, and they're very willing to be honest about it. If you ask them if they're using, they will tell you frankly, "Yes, I am." When you tell them that you're willing to help them, to say that they're gracious is an understatement. Interviewer: I'm going to be cynical here for a moment and say, what do you say to individuals that would say, "Well, they have a drug addiction, that's their own problem?" Sam: I mean, that is probably what we hear the most frequently about that population. But these are people that do not have the typical resources that even somebody of no means may have, for instance family, support, friends, a place to stay, any type of income. Without some type of help, that doesn't mean that they should just die as a result. For these people, you can't recover if you're dead. So Naloxone gives them that chance to actually recover from a potentially fatal overdose, and then also have the opportunity to seek some type of treatment or go into recovery. It's really surprising, and I think that if you have a doctor or an EMS responder, they revive you, well that person is just doing their job. But if you have a friend, or a mother, a father, actually revive you, I think that that has more of an impact on your future usage as well. Dr. Plumb: We've seen that too. We've seen firsthand, as well as anecdotal reports from other states. But we've seen firsthand, if someone is revived by their mom, and they wake up and their mom is begging them not to die, there's a different lightbulb that goes off. There is a realization that, "Wow. Somebody really wants me to be alive. I need to be here for myself. I need to be here for them. My life does matter to them." It's been reported in the literature too that actually bystander-administered Naloxone is a much more powerful tool to get people to have that realization that their rock bottom has come. Interviewer: So that very much near death experience is actually the thing that will help turn them around and perhaps get them unaddicted, or more willing to seek treatment? Dr. Plumb: On a healthier path, basically. Interviewer: Yeah. Dr. Plumb: Just to have that realization that, "Wow. I actually need to be here. Someone else sees that I need to be here, not just someone whose job it was to save me. Someone else made the conscious decision to save my life. They're not medical. They just care about me." Sam: It also is very important to mention that the experience of having Naloxone administered to you, especially if you are an active user, an addict, it is something that is terribly painful. It kicks them into instant withdrawals. Some of the people that we've spoken to have said, "I'd rather be tazed or shot before I get that Naloxone again." You're like, "Well, would you rather be dead?" "No. Well, if I'm going to die, then yes you can give it to me." But other than that, I mean, it's a terribly painful experience. So it's not something that people would use or to . . . Interviewer: Yeah. Because I was going to ask, I was going to say, now I've got my safety net so, woo, party's on. Right? Dr. Plumb: Your parachute, kind of. We hear people say, "Oh, you're providing a parachute to people," and that's just not the reality. Sam: Because if you think about it too, these people who are active users, number one, nobody wants to overdose, nobody wants to be an addict, and beyond that they don't want to waste their last fix. So if you give them Naloxone and they've overdosed, they've just lost their last high. So it's another way to think about it. Dr. Plumb: Yeah. We do get questions about that, though. "Well, aren't you just enabling use? Aren't you just enabling riskier use? Aren't you just basically telling people you're okay with this choice that they make?" The reality of it is, no, we're not. What we're telling them is, "Hey, listen. We want you to get to a healthier place. We want you to get to a place where your life is not so encompassed by your addiction. But we can't get you there and you can't get yourself there if you're not alive." Naloxone will get you basically breathing again if you've overdosed. That's all it does. Interviewer: So I know that you're an advocate for having the conversation. It's not just for people that are homeless or at The Road Home. There are plenty of other people that have drug addictions, that have families and live in homes. What would you say to a person that's in that situation that's listening? Dr. Plumb: Well, I think probably the best way to speak to them would be to provide some examples of folks that have reached out to us. Sam and I can both give you examples of different conversations that we've had with people. I think one of the most powerful ones for me thus far, since we have embarked on this, has come from a mom who desperately reached out to us to get Naloxone. She had asked multiple providers, her physician, other physicians, emergency department physicians, addiction physicians. She'd asked for a prescription for Naloxone for her son, who was a heroin addict, and at the time he was clean. We all know that one of the times that you're most at risk of overdosing is when you've had a period of sobriety. So your body is not at all accustomed to opiates, even as short as a period of three days and you go back to using what you used before, and you can overdose. So this mom reached out to us and in desperation said, "Can you please help me get Naloxone?" She came up to Primary Children's and met with me. I educated her on how to use that. I was willing to write her a prescription. She was so uncomfortable getting it from the pharmacy that I ended up just giving her a free kit, which we have the ability to do. She didn't want that on her record. She didn't want that anywhere in the medical record. Despite the fact that it's completely legal, insurance companies cover it, that it's been done for two decades now in the U.S., she had that stigmatization worry. She got the kit, and within a week she had to use it to save her son. I mean, it gives me chills even now thinking about it, because whether it was her motherly sixth sense or her experiences from the past, but she knew, and she almost didn't have that opportunity to save her son's life. Sam took a call today from a gentleman . . . Sam: He has some type of chronic back disorder and he's in tremendous pain, and surprisingly he told me that his prescription for pain relief is morphine. He's receiving six doses of morphine throughout one single day of 60 milligrams each dose. Typically, 100 milligrams is something where you start to think of somebody as very high risk, or is a very high dosage, and he's taking 360 milligrams a day. He's bedridden, he can't work, but he made the effort to call out to get Naloxone, because he said, "I fear for my life with the amount of medication that I am being prescribed, and I worry that my doctor may prescribe more. I want my family to be able to save me if I overdose." This is a similar story that we hear from other people as well. These aren't just people that are down on their luck. These are people who are taking their medication as prescribed. Dr. Plumb: And are still just at risk, because at the bottom line, end of the day, these are risky substances. It isn't about a risky person. It isn't about a moral character judgment. It's about these are risky substances, and they are everywhere in our society. I think all of us should take a little thought about, "Do I have these in my home? Do I have these in my home for a legitimate reason, or what may be an illegitimate reason?" It doesn't matter to me. If they're in the home, they don't discriminate. They can absolutely cause an overdose and a death, and being prepared is really just not only smart, but it's appropriate. It's not asking for anything wrong by asking to be able to keep yourself or the people that you love alive. Interviewer: It's like having a fire extinguisher or a first-aid kit, or an EpiPen, or an inhaler, or any of those things that you would use. Dr. Plumb: Absolutely. Although, interestingly, an EpiPen which is absolutely vital for people who have anaphylaxis or allergic reactions to things, an EpiPen can actually hurt you. It's epinephrine, adrenaline. That can cause heart arrhythmias. That can actually hurt you. Naloxone can't hurt you. So I mean, even a level beyond it, I absolutely advocate for EpiPens and think they should be everywhere we know where they should be, but Naloxone is even safer. But it is very much the same thinking, that if there were to be that worst case scenario, you'd be prepared. Sam: I think that's something that is particularly salient here in Utah, because we have our own culture here and it is a very stigmatized issue, whether it's an opioid pain medication or if it's an illicit substance. But we do hear from people that call us to talk about Naloxone after it's too late. Oftentimes in Utah, unfortunately, the conversation starts too late, when somebody has already been lost and there's nothing that can be done. So given how simple it is and how safe it is, it just makes complete sense to have it. Interviewer: That's right. This can be that conversation. Dr. Plumb: Right. Absolutely. Interviewer: Right? Dr. Plumb: Think about it. Interviewer: This is the conversation and now go out and get . . . So do you just, prescription from your physician? Dr. Plumb: Yeah. Your physician can absolutely prescribe it there. It's 100% legal for them to do so. Some physicians are a little uncomfortable with it, and I think that this will come in time. The law is pretty fresh still. I think physicians will become more comfortable with it. But if you do run into a conversation where your physician states they're not comfortable, reach out to us. I can absolutely call in a prescription statewide, and we have done so from St. George to Brigham City and Wendover to Vernal, statewide. It's absolutely legal for me to call in a prescription for anyone who's either at risk of an overdose or at risk of witnessing an overdose. Sam: For more information or to view our training videos, or even for other resources such as treatment and medication-assisted treatment, we have all of that listed at www.UtahNaloxone.org. Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com. |
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Monitoring Multiple Prescriptions from Different Doctors May Cut Overdose DeathsIn Utah, 21 people die every month from prescription drug overdoses. Modern computer databases are capable of identifying multiple prescriptions from different doctors for the same patient, which may…
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December 03, 2014 Aaron: Prescription drug monitoring, that's next on The Scope. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Aaron: I'm here with Peter Kreiner PhD, he's a senior scientist at the Institute of Behavioral Health of the Schneider Institutes for Health Policy, a researcher for the Heller School for Social Policy and Management and he's an expert in prescription drug monitoring. Welcome Dr. Kreiner. Dr. Kreiner: Thanks, Aaron. Aaron: Dr. Kreiner, here in Utah, deaths due to prescription overdose have been increasing since about 2001 and we have about 21 Utahans die from prescription overdose every month. Is this a nation wide problem? Dr. Kreiner: It certainly is, Aaron. Probably from the early 2000's on, public health officials started recognizing opioid and prescription drug overdose death as a huge and increasing problem and recognition has just grown from there. So in the last few years, all federal agencies and national organizations, state governments have grown increasingly concerned with the problem and have started reaching out in a lot of different directions to look for solutions. Aaron: Now what is a prescription drug monitoring program? I understand that's one of the solutions that they're looking at. Dr. Kreiner: Prescription monitoring programs are essentially a data repository. Forty-nine states have now passed legislation authorizing such a program. Forty-eight states have actual operating programs. The hold outs are Missouri for legislation and New Hampshire is just about to have an operating program. They're repositories of filled or dispensed prescriptions for controlled substances that pharmacies are required to submit to each state program. So they are databases that are intended to serve multiple stake holders, typically prescribers and pharmacists and often other individuals can establish an account with a prescription monitoring program and log in and query it about a patient to inform their clinical decision making. Aaron: What sort of data is maintained by these monitoring programs? Dr. Kreiner: It's a record of each prescription that's dispensed, includes information about the patient, the prescriber, and the pharmacy that dispensed it, including dates the prescription was written, the date it was dispensed and info about the specific drug prescribed, the dosage the, date of supply, often whether or not it was a refill or if refills are allowed. In many states it includes information about the payment source. So, kind of insurance, cash, that sort of thing. Aaron: What's the value of the program overall for patient safety? Dr. Kreiner: For patient safety, again if a patient presents a prescriber or their physician, could be an emergency room or could be their primary care physician, that physician may or may not know about the prescription history of that patient. Often physicians think this is a legitimate patient, have legitimate symptoms. I'm interested in prescribing a pain medication opioid analgesics and yet when they check the monitoring program, they find that person may have obtained half a dozen prescriptions from a number of different prescribers in the last month. That's a very different picture of that patient then they might have had. Aaron: So ultimately this can help a health care provider help a patient stop an addiction or at least get help for an addiction before it goes too far. Is that safe to say? Dr. Kreiner: Patients may be obtaining multiple prescriptions for lots of different reasons. So they may be misusing or abusing, they may be addicted, they may be diverting. And certainly the prescriber, it's intended that they might have a discussion with that patient and really try to help that patient to seek appropriate help. It's an ongoing issue about what treatment resources are available and that's an issue in every state. Aaron: Utah has a prescription drug monitoring program. I don't know how familiar you are with Utah's particular program, but based on what you've seen nation wide in your experience, how do you think Utah could better use its prescription drug monitoring program to prevent overdosing? Dr. Kreiner: Our center, so we have a prescription drug monitoring program center of excellence at Brandeis University, studies best and promising innovative practices that monitoring programs are doing nation wide. So we've identified 30 some odd practices that keep increasing all the time. Some of the more impactful ones that we've seen in other states that I believe Utah is not currently implementing include what's called unsolicited reporting where a monitoring program proactively analyzes this data and pushes out a report or sometimes an electronic alert to a prescriber or pharmacist for a patient to bring that information to their attention. Some other practices that seem very valuable that we've been using in Massachusetts is use of de-identified prescription monitoring program for public health surveillance purposes in particular to provide it to counties and communities, we're working to prevent and reduce prescription overdoses, prescription drug related problems. I could go on, but those are some leading practices that I think Utahans could benefit from. Announcer: TheScopeRadio.com is University of Utah Health Sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com. |