Physicians writing on KevinMD about the drugs they prescribe and the ones they cannot get: prior authorization and step therapy, opioid prescribing and the tapers that followed the CDC guideline, the GLP-1 drugs from Ozempic to oral Wegovy and what happens when patients stop them, shortages, compounded versions, and what a prescription costs the patient. Three maintained records draw on this archive: Opioids: what physicians and pain patients say, in their own words, Prior authorization: what physicians say, in their own words, and GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words.
Colorado and Washington are the first states to legalize recreational marijuana. In my state of Colorado, Amendment 64 was passed by 55 percent of voters by ballot referendum last year and took effect on January 1 of this year. State government officials are giddy with the prospects of increased revenue from marijuana sales. Marijuana tourism is booming in Colorado, giving new meaning to “Rocky Mountain High.” Now, four months into this new experiment, it may be worth looking …
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The unintended consequences of marijuana legalization
It’s another Monday morning at the substance abuse clinic. It is my turn as the doctor in the black swivel chair in the corner office overlooking a half-vacant strip mall.
Today’s first inductee is a pregnant 22-year-old with track marks on her forearms. Her obstetrician and case worker at the Department of Human Services made her come. It is obvious she is less than thrilled.
“How long have you been doing opiates?” …
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A morning in the substance abuse clinic
The United States of America is addicted to narcotics. I do not mean the millions of individuals who are hooked. I mean the whole nation is jonesing for the stuff. I also do not mean the junk that slips into our nation in coffee cans or across midnight borders. I mean the billions of pills pouring off assembly lines. I could blame pharma or the FDA, but the truth is …
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It’s time for doctors to say no to drugs
I was recently on the Katie Couric Show to discuss integrative medicine. Somewhat ironically, I returned from Manhattan that same day to a waiting email from a colleague, forwarding me a rather excoriating critique of integrative medicine and asking me for my opinion.
The juxtaposition, it turns out, was something other than happenstance. The Cleveland Clinic has recently introduced the use of herbal medicines as an option for its patients, generating considerable media attention. Some of …
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A holistic view on integrative medicine
I give what could be lethal injections for a living.
That’s right. Nearly every day I give someone an injection of midazolam, vecuronium, and an IV solution containing potassium chloride–the three drugs in the “cocktail” that was supposed to kill convicted murderer Clayton Lockett quickly and humanely in Oklahoma.
Here’s the difference between an executioner and me. I use those medications as they are intended to be used, giving anesthesia to my …
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Lethal injection perverts the ethics of practicing medicine
I get asked a lot about essential oils. I answer very little. Why?
The answer is simply that we don’t know much about how or if they work. Except from stories about how they have helped certain people in certain situations, no one has done a large studies to truly evaluate their effectiveness or safety.
The main explanation for why they are used is that people (parents) are simply looking for something that’s an alternative to …
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A few thought-provoking questions about essential oils
It is noteworthy how certain vital and effective generic drugs for common diseases have become exorbitantly expensive. We are use to new pharmaceutical brands costing a small fortune. But generics, one of which goes back to use in Egyptian times? Really? Allopurinol and asthma inhalers that are cheap but effective medications have become unaffordable to those that need it the most: Simply stated, those that can’t breathe and those that …
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Why patients cannot afford to have asthma or gout
In November of last year the American Heart Association released to recommendations on who should be taking statins (drugs like Lipitor/atorvastatin), the most common medicines we use to control cholesterol levels. High cholesterol levels are associated with higher risk of heart attacks and strokes, and taking statins, which lower cholesterol, can reduce those risks. The drugs have pretty significant side effects, though, and not everyone with high cholesterol …
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What do European doctors say about our guidelines for statins?
Every year, it is estimated that more than 126,000 hospitalizations and nearly 17,000 deaths in this country are linked to overuse of over-the-counter (OTC) pain medicine ingredients — specifically acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs).
In my own practice, it’s not uncommon to find patients who are taking two to four times the recommended doses. This can have tragic results.
Recently, we had a young woman with liver failure. She had been …
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What physicians can do to curb over-the-counter medicine misuse
The debate over e-cigarettes has been heating up. Are the smokeless, battery-powered, nicotine-dispensing devices a gateway to smoking for young people or a helpful way for smokers to quit? Public health experts can be found on both sides of the debate.
An article in the New York Times cited two leading figures, Dr. Michael Siegler from Boston University and Dr. Stanton A. Glantz from the University of California, San …
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E-cigarettes lack scientifically based guidance
I’ve been involved in several boisterous Twitter debates about vaccines, at least to the extent that one can debate using snippets of 140 characters or less. I’ve also been a “super moderator” at a very large Internet message board for many years and have seen my share of passionate vaccine debates there. I’ve been a pediatrician for over 30 years and trained in the subspecialty of pediatric infectious diseases before I went …
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Why do vaccines in particular give parents concern?
The statistics tell us that our children are getting sicker and sicker. Attention deficit hyperactivity disorder (ADHD) has more than tripled in just 20 years: It is now diagnosed in 11 percent of all kids, and in an astounding 20 percent of teenage boys. Autism is also on a rapid rise. The latest reported rate suggests that it occurs in one in every 68 kids — 20 years ago it …
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We are turning childhood into an illness
A Canadian study published in the Annals of Internal Medicine suggests that about one third of new prescriptions (written by primary care physicians) are never filled. Over 15,000 patients were followed from 2006 to 2009. Prescription and patient characteristics were analyzed, though patients were not directly interviewed about their rationale for not filling their prescriptions.
In short, patients were less likely to fill a prescription if the treatment was expensive, but certain …
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Explain the reasoning behind new prescriptions
You know those little packets of paper, folded over eight times, written in type that can’t possibly be seen? You’ve seen them glommed onto the side of stock bottles of medications, or shoved into the paper box alongside a tube of prescription ointment. That unreadable thing is the official “product information,” often called the “label,” required for every FDA-approved medication. It contains all sorts of information, including lists of Read more…
When pediatricians write prescriptions for off-label use
So you think your medicine is natural. Ever wonder what’s inside? A product can be labeled “natural” if the main ingredient is from an animal, plant, or mineral. Arsenic, horse urine, and cow brain are natural. But are they natural for you? Here are four drugs whose origins may surprise you.
Insulin was discovered in 1922. Until the 1980s, all insulin was …
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The shocking ingredient in natural medicine
Research and development is critical to battling disease. Now, more than ever, technology can rapidly impact a patient and their disease process in a very positive way. The process of developing a new drug or device is expensive and can be very time consuming. As government funding for projects continues to decline, more funding is coming from private sponsorship according to a recent New York Times piece.
Another critical source of …
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Negative results from clinical trials need to be reported
In March 2014, Zohydro ER (hydrocodone extended-release) was introduced to the market. Never in my medical lifetime do I recall a medication stirring such angst. Worries of mass overdoses, backdoor FDA conspiracies, and blatant disregard for the public well-being abound. Is there method to this madness?
Zohydro ER is a pain pill that, when taken by mouth, is released slowly over twelve hours. The active ingredient, hydrocodone, is an opioid (i.e. narcotic) that’s been around for decades …
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Understanding the uproar over Zohydro ER
As physicians, we often write prescriptions for our patients. Where, when, and how patients fill their prescriptions are usually outside of our realm of expertise. But should we be more involved?
On occasion, the cost of a medication and possible alternatives will be the subject of my conversation with a patient. I was surprised, however, when one of my patients complained about the price of an antidepressant that I had prescribed. …
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Be more involved in how patients fill their prescriptions
Readers have contacted me about a recent study that links acetaminophen use in pregnancy to the later development of ADHD in children. Is Tylenol yet another thing pregnant women need to avoid?
The study, titled “Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders” was published this month in JAMA Pediatrics. Dutch researchers looked at about 60,000 children born from 1996-2002. Their parents have been filling out questionnaires and …
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Is acetaminophen taken during pregnancy associated with ADHD?
When I was in medical school, our nutrition researchers taught us that vitamins didn’t do much good and only made expensive urine (where the water soluble ones end up). We did learn about the classic vitamin deficiencies like scurvy, beriberi, rickets, etc. But the evidence that healthy people should take vitamins was marginal at best.
Is our search for immortality the reason that we turn to the pill or potion? Do …
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Vitamin and mineral supplements for healthy individuals don’t work
