Medications and Prescribing

Physicians writing on KevinMD about prescribing: the prior authorization that stands between a prescription and a pharmacy, opioids and the tapers that followed the CDC guideline, GLP-1 drugs and what happens when patients stop them, compounded and direct-to-consumer drugs, shortages, and what a prescription costs the patient. Three maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, and GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words.

What are the health risks of marijuana legalization?

Janice Boughton, MD

Medications

March 5, 2013

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Colorado and Washington state have legalized the recreational use of marijuana. I thought this would take longer to legislate, especially with the recent backlash from the federal government about medical marijuana. Eighteen states (including California, Alaska, Vermont and Oregon) allow marijuana to be used for medical reasons, but have restrictions on which conditions can be treated with it, which don’t necessarily correlate …

Big Pharma: There is nothing evil about making money

Michael Kirsch, MD

Medications

March 5, 2013

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Am I an apologist for the pharmaceutical companies? I don’t think so, but others may disagree based on some sympathetic Whistleblower posts that have appeared in this blog. It is without question that the drug companies have been demonized and portrayed as rapacious gangs of greed who seek profit over all. Haven’t you come across the pejorative term, Big Pharma? Linguistical note: …

Why long term use of opioids is not the answer

Richard Juman, PsyD

Medications

March 2, 2013

In 1804, Frederich Serturner experimented with opium and created something new—morphine—named after the Greek god of sleep and dreams, Morpheus. More than 200 years later, at least 8 million Americans fall asleep at night under the influence of an opioid. Every morning, 40 of them don’t wake up.

As described in a previous article on this subject, the United States is in the grip of a prescription opioid disaster: with 2 …

Why energy drinks should be considered stimulant drugs

Kevin Pho, MD

KevinMD

March 2, 2013

A version of this column was published on February 3, 2013 in USA Today.

I’m seeing more patients than ever consume so-called “energy drinks,” a rapidly emerging class of beverage which promise to increase energy, improve alertness, and boost attention span. The energy drink business is booming, with more than $12 billion sold last year, eclipsing established beverage categories like iced tea …

Do most patients with cancer receive proper prescriptions for pain?

James C. Salwitz, MD

Physician

February 28, 2013

To state the obvious: 1) most advanced cancer patients have pain, and 2) we have excellent pain medications which can effectively treat more than 90% of cancer pain. Therefore, most patients with cancer receive proper prescriptions for pain. Obvious, yes? True? No.

In Europe, Australia and North America narcotic analgesics are widely available, and frequently prescribed. While there is access, many patients, particularly those in certain groups such as seniors and …

Doctors don’t get investigated for being quacks

PalMD

Physician

February 27, 2013

A doctor in our area was recently indicted for allegedly running a “pill mill”. According to local news reports, patients were recruited to come in and ask for narcotics and the doctor received massive cash payments to write the prescriptions. After the guy was nabbed, his patients (the real ones and the others) spread out in the community looking for new doctors to take care of them (or to write …

Are generic drugs as safe and effective as name brand drugs?

Juliet K. Mavromatis, MD

Medications

February 26, 2013

Use of generic drugs has the potential to reduce annual consumer spending on prescriptions by billions. A study published in the New England Journal of Medicine and discussed in the New York Times’ Economix blog in 2012 looked at Medicare Part D expenditures and correlated them with drug prescribing patterns. The regions of the United States with the highest Medicare expenditures were those where …

Toradol in sports: A culture change is needed

Michele R. Berman, MD

Medications

February 23, 2013

Former Boston Red Sox closing pitcher Jonathan Papelbon may have opened up a can of worms with his remarks about his frequent use of the injectable anti-inflammatory drug Toradol (ketorolac) during his time with the Red Sox.

Papelbon, who now plays for the Philadelphia Phillies, told ESPNBoston.com that several Red Sox players were frequently injected with the drug:

“It was kind of …

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Toradol in sports: A culture change is needed

MKSAP: 28-year-old man with left calf deep venous thrombosis

mksap

Conditions and Diseases

February 23, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 28-year-old man is evaluated 24 hours after a new diagnosis of a left calf deep venous thrombosis. One week ago, he underwent orthopedic surgery. Two weeks ago, he returned from vacationing in Italy on an 8-hour flight. Current medications are enoxaparin, 80 mg subcutaneously twice daily, and warfarin, 5 mg/d.

On physical examination, temperature …

Why the American problem with opioids and chronic pain is here to stay

Jennifer Gunter, MD

Physician

February 22, 2013

America consumes 80% of the world opioid supply (99% of the world hydrocodone supply), but has about 5% of the world’s population. If you don’t think America has some kind of opioid problem, then move along because this rational, evidence-based, experience-laden way in which I’m going to discuss opioid use and misuse will not interest you.

To combat our opioidification the Read more…

Why the American problem with opioids and chronic pain is here to stay

The path to data driven public policy: Ask the right questions first

David L. Katz, MD

Health Policy

February 21, 2013

Should marijuana be legal, for either medical or recreational use? I think the best initial answer to this is: It’s a crummy question! We are good at those.

It’s a crummy question, because it calls for answers based on unsubstantiated opinion. Answering it does not invoke or even encourage any relevant evidence, or precedent. So what would a better question be? How about: On what basis should any particular substance be …

Make patients more accountable for their own health

Shirie Leng, MD

Physician

February 20, 2013

Let’s talk a little about health accountability. Two news items have provoked the following rant: why is it always someone else’s responsibility?

The first item was on NPR. The FDA, reacting to the epidemic of prescription drug abuse in this country, is offering incentives to the pharmaceutical company that can come up with a less addictive painkiller. Such a drug would be a gold-mine for that pharma company because it could …

Stopping prescription drug abuse starts with primary care

Julie Craig, MD

Physician

February 18, 2013

As with any disease, prevalence of this narcotics abuse is region-specific; an hour north of the office where I practice, Rio Arriba County in New Mexico is home to one of the highest opioid overdose rates in America – up to five times higher than the national average. Our patients routinely lose family to addictions; our clinic has been home to a …

A patient cheats death and changes two lives

Monica Williams-Murphy, MD

Physician

February 10, 2013

Throughout the course of my career I have probably been with hundreds of people as they transitioned into and out of death. Although I am familiar with what this journey looks like, I have not yet been privy to the journey myself. Rarely though, I have had the pleasure of listening to someone who has journeyed back from death and arrived with a story to tell. Regardless of your position …

Why I hold off on antibiotics for my cough

Edward Pullen, MD

Medications

February 9, 2013

For as long as I can remember I have tended to develop a bad cough nearly every time I get sick in the cold and flu season. I’m not sure if I have a minor tendency to bronchospasm or if my years of passive smoke exposure as a child somehow damaged my lungs. Who knows, but I seem to have the tendency for every URI become a lingering bronchitic cough.

In …

Will Mayor Bloomberg win the war on prescription drug abuse?

Shadowfax, MD

Physician

February 7, 2013

Recently, there was a bit of hue and cry regarding Mayor Bloomberg’s report on the matter of prescription drug abuse and restrictions on new prescriptions for painkillers through the emergency department.

Initially, I was concerned. I completely agree with the comment from the linked article: “Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians … “It prevents me …

What are the different types of anesthesia?

Shirie Leng, MD

Physician

February 5, 2013

For most people, anesthesia is one of the more mysterious branches of medicine. What we do for patients is done, generally, when they are asleep. You the patient don’t exactly know what we are going to do, or how it’s done, but you put yourselves in our hands willingly. It’s sort of a weird relationship we have with other humans. We have done our job right if our patients don’t …

Should medical school deans have ties to pharma?

Deep Ramachandran, MD

Physician

February 5, 2013

One of the first posts I wrote was a about how pharmaceutical reps provide lunch for physicians while presenting information about a medication that they are promoting. The post, and others like it, have generated visceral reactions on the part of the public. A similar article to the one that I wrote prompted comments like “Get over yourself and buy your own lunch” and “I’m certainly glad …

Behind the fetish of vitamin B12 shots

Roy Benaroch, MD

Conditions and Diseases

February 3, 2013

Medicines and other treatments need to be tested. We want reliable proof that something works and is safe before we recommend it. We don’t like the false dichotomy of “alternative medicine”. If there is good evidence that it works, it’s medicine. If it doesn’t work, it’s quackery.

It doesn’t matter who’s doing the quacking. A quack is a quack, even if …

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Behind the fetish of vitamin B12 shots

The irony and the agony of our prescription opioid problem

Richard Juman, PsyD

Medications

February 3, 2013

It’s almost unthinkable that in an era preoccupied with “evidence-based” medicine and “best practice” advice, one of the worst drug problems in the United States flows right out of our health care system. Unlike other major epidemics such as those connected to methamphetamine, crack cocaine or other illegal drugs, our prescription opioid problem is full of irony and agony, because it has been fueled, to a certain extent, by the …

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