Current reports from the International Narcotics Control Board (INCB) suggest that the United States is second on the list of countries with the highest per capita consumption of opiates. Data from 2014 quotes U.S. use of opiates at 700 mg per capita per year. The only country that has a higher per capita use is Canada at 967 mg per capita both in ME (morphine equivalents). This suggests that in …
America’s love affair with opiates
I spent one year working full-time as a pharmacy technician at a high-volume community pharmacy prior to entering medical school. Besides learning the intricacies of billing and the dispensing process, I was granted personal access into a world nearly all patients, but few providers are aware of. At the time my job was just that: a job. There were fun perks like counting pills in multiples of five and visualizing …
The need for pharmacy electives in the medical school curriculum
A couple of years ago, I inherited a patient who was on both a patch for the powerful painkiller fentanyl and a high dose of oxycodone four times daily — and she didn’t have cancer.
I had 15 minutes with that patient to get her medical history, review her medications, assess her current complaints, and decide whether or not to continue her opioid prescriptions. I had no paper records and a …
We need to speed up our acceptance of the opioid guidelines
When you hear people say, “I don’t want to vaccinate my kid. Why would I give them autism?” It’s hard not to get upset and meet your patients with some judgment.
John and Carly were middle-class Americans that had a lot of misconceptions about vaccines — mostly from the media. They loved their two-year-old daughter Leslie and wanted the best for her. They didn’t understand that we wanted the same thing. …
Don’t judge anti-vaxers. Talk to them.
If you’re going to indulge in anticipatory medicine, it is best to anticipate those at highest risk. An elegant study by Wald et al in the NEJM shows how precision primary prevention can be done. The researchers screened toddlers, who presented routinely to their general practitioners for vaccinations, for an uncommon, but not rare, familial predisposition to high cholesterol known as heterozygous familial hypercholesterolemia (FH), in which premature …
Let’s stop being skeptical about statins
The patient’s heart was beating dangerously slowly, and his EKG showed third-degree AV block: His heart’s electrical system had completely shut down in the middle. If this were TV, the doctors would have started shouting “Epi!” and “Get the pads!” immediately. This was real life, though, so his team decided to briefly sit down with him to try to determine why his heartbeat had slowed so dramatically. Was it something …
Drug names need to be simplified for our patients’ safety
On November 8, voters in California, Maine, Massachusetts and Nevada approved ballot measures to legalize recreational cannabis. It is now legal in a total of eight states. And this creates potential problems for road safety. How do we determine who’s impaired and who’s not?
The effects of alcohol vary based on a person’s size and weight, metabolism rate, related food intake and the type and amount of beverage consumed. Even so, …
With legal pot comes a problem: How do we weed out impaired drivers?
I have written about pain medicine, previously on this blog, and it generated some spirited responses. Let me be clear that I am completely against all forms of pain, whether foreign or domestic, physical, spiritual, psychic or even phantom. The medical profession has superb tools to combat and relieve pain, and physicians should utilize them, within the boundaries of appropriate use. We now have an actual specialty — …
Are doctors the new drug dealers?
“I’m not really a pill person.”
“I was never one for all those pills.”
“I don’t really like taking those pills.”
“I’m not really into taking pills.”
As a doctor, I hear some version of this phrase every day. It’s almost accusatory, like “Hey, Doc — don’t even think about pushing all those pills on me!”
Luckily, since I am a gastroenterologist, I don’t dispense nearly as many medications as doctors in some other fields …
People who aren’t “pill people”: What do they mean?
Opioid painkillers, such as Vicodin (hydrocodone) and OxyContin (oxycodone), are crucial medical tools that are addictive and widely abused. Tranquilizers and sleeping pills of the benzodiazepine class, like Xanax (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam), are safe and effective in limited, short-term use, but are often taken too freely, leading to drug tolerance and withdrawal risks. Stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine) ease the burden of ADHD but …
The fuzzy line between medication use and abuse
A 67-year-old patient, whom I’ll call Herb, recently came to see me for a check-up for his diabetes. He has suffered from complications from diabetes in the past, and his most recent numbers — including his A1c — were poor.
I sat down to talk with Herb, but before I could say anything, he got straight to the point. Herb lives on a fixed income. Although he has Medicare coverage, his …
Skyrocketing prescription prices force patients to skip meds
Codeine is a terrible choice for treating children’s pain and cough, and we ought to just stop using it. It’s like an old yogurt container, way at the back of your fridge — sure, it was once tasty, and then for a while, you held on to it for sentimental reasons. “Remember that yogurt?” you’d say to your spouse. But it’s well past time to throw that stinky stuff away.
For …
Codeine is a terrible choice for treating children’s pain and cough. Here’s why.
Most everyone has had the experience of sitting across from a doctor, being offered a prescription and walking out the door. Most patients will accept the instructions — maybe ask a few questions — and move on. For some of those patients, the medications are more than a one-off; they are intended to be taken indefinitely.
One of the most common of these medications is a statin. Imagine you exercise four …
Should I take a statin to lower my risk of a heart attack?
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In our current health care system, doctors should get to decide what medication is prescribed. Typically, the patient and doctor decide what is the best, then the prescription gets sent off to the pharmacy. When the patient goes to pick up the prescription, often they find a different one instead or are told that their health insurance coverage is not covering that prescription. Instead of receiving the best medication for …
Who’s really prescribing medicine? Hint: It’s not doctors.
Martha arrives for an appointment with her new primary care provider. She hesitantly hands over her pill boxes at the nurse’s request; it seems to take forever to enter them all into the computer.
“You are taking a lot of blood pressure pills,” he comments. The doctor comes in and after a brief introduction, notes that she is taking five medications for her blood pressure.
“Five?” Martha exclaims in disbelief. She hadn’t …
Patients are often the victims of medication creep
A friend asked me recently about statins. He takes a statin for primary prevention but is concerned that he has muscle pain and weakness as a side effect. So he posed the question: “How important is the statin?”
The Washington Post had this recent article: “Who should take statins? A vicious debate over cholesterol drugs.”
But while nearly all experts agree that statins are beneficial for people at a …
Statins as primary prevention: Helpful or harmful?
A provocative new study from Denmark supports a link between hormonal contraceptive methods (like birth control pills) and depression. The association seems to be strongest for adolescent girls.
Huge studies like this are based on huge datasets. In this case, the study relies on the Danish medical system’s longstanding penchant for meticulous and integrated medical records. You couldn’t do this kind of research in the USA, where medical records …
Does birth control cause depression?
A patient wrote in, asking what she ought to do with unused medications, including some psychiatric drugs and controlled substances. It’s good to get those out of the house, safely — but how?
Parents should make sure to keep their homes free of unused medications. The misuse of prescription medications (usually narcotic painkillers) has surpassed motor vehicle accidents as the leading accidental cause of death in the U.S. A lot …
What’s the best way to get rid of unused medications?
It is the beauty of evidence-based medicine (EBM) that a scientist can at once be a Pope and a Galileo. His transmutation is as effortless as it is discretionary. If you think you’ve met Galileo — a rebel, a free thinker, a rocker of the establishment — the following week he is a Pope, castigating detractors, censoring critics, and celebrating uniformity. He changes by a roll of the dice. His …
The statin wars expose 2 factions in medicine
Many men experience significant erectile problems after having a radical prostatectomy, and many of the men treated by the urologists I work with eventually land in my office. We talk frankly about the quality of their erections before the surgery, what they are like now, and what they have tried to do to resolve the problems they are having. After this, …
Sharing medications happens more often than we think
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