Meds

A rush to judgment on acetaminophen?

Meds
December 6, 2022

Less than a year ago, a position paper/meta-analysis was published whose authors concluded that the pain reliever acetaminophen, and products containing this compound, were contraindicated in pregnancy as they could result in premature or stillborn births or developmental defects. Earlier studies appeared more positive and resulted in recommendations for its use by professional and governmental organizations. The present authors acknowledged this disjunction and made both the routine recommendations for further …

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Prudence and promise in psychedelic-assisted therapy

Meds
November 30, 2022

Psychedelic-assisted therapy (PAT) represents one of the most promising developments in psychiatry in decades. The treatment typically involves the infusion of a compound such as LSD, psilocybin, or MDMA during an extended therapy session with licensed professionals.

Although it lacks widespread regulatory approval or clinical use, significant advances have been made in the study of PAT in the past decade, with a pronounced increase in recent years. Recently, a Read more…

Think twice before prescribing opioids as a first-line treatment for pain

Meds
November 22, 2022

Everyone knows the terrible toll the opioid epidemic takes on our society. It doesn’t matter where you live and how wealthy or educated you are, no one is immune. I watched as a colleague tried to help a child struggling with addiction, spending countless hours of worry and thousands of dollars, only to have the child succumb to an accidental opioid overdose. The emotional and financial cost on individuals and …

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Depriving women of this drug is good public health

Meds
November 19, 2022

It’s a public health win that on October 19th, an FDA Advisory Committee voted 14-1 to remove Makena, a drug intended to prevent preterm birth, from the market. The FDA usually follows the advice of its advisory committee, and the briefing documents it supplied the committee make it clear that the agency wants the drug off the market. As well it should. Makena doesn’t work.

After a preliminary trial showed that …

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Integrated care is the key to optimizing cancer outcomes

Meds
November 16, 2022

The American Cancer Society released its annual report on cancer statistics, showing that we have made clear and significant progress in treating numerous forms of cancer. The overall rate of death has declined steadily since 1991, translating to over 3 million lives saved.

Despite this progress, I still see room for improvement in a care model where patients too often slip through the cracks.

The National Cancer Institute identified that …

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How to swallow a pill

Meds
November 11, 2022

You’ve been swallowing things your entire life: breast milk (or formula), food––maybe a marble or small Lego. But did you know that swallowing pills is different?

Let’s start with how not to swallow a pill.

Sorry, but Bruce Willis in all five Die Hard movies is incorrect. You don’t just take a small handful of aspirin, toss them into your mouth, and jerk your head back while swallowing.

Not to mention, if you have …

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Are antibiotics too much of a good thing?

Meds
October 3, 2022

Since the development of antibiotics in the 1940s, patients presenting with an infection could be expected to respond quickly to a prescribed course of antibiotics by their physician. While the antibiotic prescription model has helped countless lives, this paradigm has degraded over time due to the emergence of antimicrobial resistance (AMR). The net impact is a global health crisis, worsened by continuing the over-prescription and misuse of antibiotics.

The more drugs …

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How drug prices are manipulated

Meds
September 30, 2022

I wondered whether to recommend Nuedexta for my elderly relative with worsening Alzheimer’s disease and daily spontaneous crying. Often she would deny feeling sad and couldn’t account for her sobbing.   Avanir Pharmaceuticals released Nuedexta in 2010 to treat pseudobulbar affect: involuntary emotional outbursts due to certain neurologic conditions or brain injury. I wasn’t sure if these crying bouts qualified as pseudobulbar affect. But my biggest hesitation was the breathtaking …

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We must disrupt harm

Meds
August 6, 2022

In the mid-1980s, with the AIDS epidemic on the horizon, austere conservative Margaret Thatcher sanctioned the first needle exchanges in the U.K. to prevent the budgetary burden that HIV might otherwise have become on the National Health Service. Nearly forty years later, New York City opened its first supervised injection sites in November of 2021, where intravenous drug users inject their substances of choice under the watchful eye …

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Cancer of the future: diagnosis, treatment, and impact on the health care system and patients

Meds
August 3, 2022

While cancer has been around for decades, the fight for survival and treatment options are still very top of mind. Treatment is simply playing catch up. We continue to try and get rid of the disease that has already infiltrated one’s body rather than catching it before it develops. We need to shift the focus from therapeutics that fight the disease to ways we can catch it before the deterioration …

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Protect the rights of licensed health care workers to take buprenorphine

Meds
July 13, 2022

Early in my addiction medicine fellowship, I met a patient for the second time while shadowing another physician in their practice. The patient was a former nurse with opioid use disorder on maintenance therapy with buprenorphine (commonly called Suboxone, the original brand name of a formulation combined with naloxone), a partial opioid agonist that is FDA-approved for the treatment of opioid use disorder and can be conveniently prescribed in the …

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Novavax may be able to provide equitable access to another vaccine alternative

Meds
July 7, 2022

On June 7th, 2022, the Novavax COVID-19 vaccine was approved for use in adults by the Vaccine Advisory Committee of the United States Food and Drug Administration. The vaccine has already been authorized in many other nations, including Indonesia, the United Kingdom, Canada, Australia, and more, making the U.S. one of the last major nations to approve the vaccine.

The technology behind Novavax differs from the already prominent …

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The promise of in silico drug development to improve patient outcomes

Meds
July 2, 2022

In the last two years, pharmaceutical companies have become increasingly interested in the possibilities in silico technologies bring to the world’s multi-billion-dollar drug development market. Among the factors that have been reported as drivers of recent interest in what is also known as virtual clinical trials are the COVID-19-related restrictions that began impacting traditional human-based clinical trials in 2020.

In silico drug development utilizes real-world data (RWD), artificial intelligence (AI), computational …

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Allow patients to continue their opioid of choice while starting microdoses of buprenorphine

Meds
June 16, 2022

Twenty-six hours into the shakes, sweats, crawling anxiety, and gripping nausea of opioid withdrawal, Faye caves in and takes a couple of fentanyl tabs. She knows that she must tough out a couple of days without fentanyl to start Suboxone (buprenorphine/naloxone) through a medication-assisted treatment program, but the sickness gets the better of her. Those couple of tablets reset the clock on her withdrawal.

Starting buprenorphine – an evidence-based …

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Automatic refill and 90-day fill programs don’t improve medication adherence

Meds
May 20, 2022

Health care has fooled us into believing a number of myths that—taken at face value—sound logical and true. Here’s one of the most pervasive and dangerous myths: Pharmacy’s value comes from convenience and access. And here’s another one: 90-day fills, and automatic refills on prescriptions improve medication adherence and patient health.

It’s not surprising that people might champion the efficacy of these tactics. It feels easier to get 90 days of …

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Are psychedelics the heroes or villains?

Meds
May 13, 2022

Like many fellow Americans, I had my first psychedelic experience in the middle of the pandemic, in a place where the use of psychedelics is decriminalized.

I grew up in a Communist country, and the ban and stigma against psychedelics were tremendous. There was no plant medicine available, and I didn’t know even one person using anything other than alcohol and prescription drugs.

I read Michael Pollan’s book How …

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Before taking Paxlovid, consider these drug interactions

Meds
April 7, 2022

FDA and Health Canada recently approved Paxlovid as an oral treatment option for mild-to-moderate COVID-19 who are at high risk of progression to severe COVID-19. It is a combination drug containing nirmatrelvir/ritonavir. Nirmatrelvir works by binding to SARS-CoV-2 3CL protease to ultimately stop viral replication. Ritonavir does not have any antiviral activity against COVID-19 but increases concentrations of nirmatrelvir by decreasing its metabolism by CYP3A4 enzyme. Ritonavir is …

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The true story of morphine milligram equivalents

Meds
March 26, 2022

They are the foundation of the CDC’s 2016 opioid guidelines, resulting in legislation limiting opioid prescribing in 36 states. Morphine milligram equivalents, or MMEs, are used to set arbitrary prescribing limits for opioids by physicians since many state legislators fail to understand — and translate into policy and law — the ’16 guidelines. If we had all known the history of MMEs, perhaps we would not have been so eager …

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Concerns about the generic formulations of ADHD medications

Meds
March 25, 2022

I love generic brand products. I will fight to the last breath for my Shoppers’ Choice Adhesive Bandages rather than pay an extra $0.49 for Band-Aids. So why, then, have I been paying up to $395 every month for brand-name medication for the last two years instead of getting the generic version for $7.56? After all, aren’t generic drugs the same as their brand-name counterparts?

Let’s go back to November 2019, …

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