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| IN THE NEWS | |
Opioid-Related Overdose Deaths Are a National Epidemic
A report on the increase in unintentional drug overdoses emphasizes the role of nonmedical opioid abuse, but also says physicians share some blame.
A recently released report authored by experts from the CDC, the University of North Carolina at Chapel Hill School of Medicine, and Duke University Medical Center shows that in 40% of US states, unintentional drug overdoses kill more people than motor vehicle accidents and suicides.
Calling this trend a "national epidemic," the authors of the report, published on the website of the Journal of Clinical Psychiatry, wrote that one potential contributor to the dramatic increase in unintentional overdose deaths in the US in the last two decades is that "psychiatrists and many primary care physicians might not be familiar with existing evidence-based guidelines for opioid prescribing or with programs designed to reduce the abuse of prescription drugs such as state prescription drug monitoring programs."
A University of North Carolina at Chapel Hill School of Medicine news release accompanying the publication of the report noted that prescription opioid pain medications "are driving this overdose epidemic," with data showing that in 2007 "unintentional deaths due to prescription opioid pain killers were involved in more overdose deaths than heroin and cocaine combined."
HCP Live
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WILLIAM STUART ON...
OPIOID-INDUCED HYPERALGESIA
Opioid-Induced Hyperalgesia. It's a condition that affects individuals suffering from chronic pain...patients who are treating that pain with opioids. Broadly defined as "a state of nociceptive sensitization caused when the receptors are agitated as the result of opioid interaction," it unfortunately produces more pain.
Opioids used to address initial pain accrue after a period of time (sometimes latent in treatment) and the activated neuro-immune receptors become altered. As you increase the dosage of opioids to treat the greater pain, you actually exacerbate their condition. More pain medication leads to increased clinical expression of pain.
Opioid-Induced Hyperalgesia is a phenomenon that has been discussed with increasing frequency over the last three years. I've known about it for at least that long, and it recently came into play when a doctor in Washington - apprised of my research in the area - asked some questions as to the progress of recent studies. Interest and awareness are growing as more and more studies are being performed to better understand the condition and the contra-indications.
What has been discovered is that reducing or eliminating the opioid dosage for a period of time - for the purpose of effecting a "washout" - is a treatment process that, although difficult, is mandatory in most instances. Once completed, the receptors are able to "reset" themselves and treatment can be reinitiated at a much smaller dose. I urge practitioners to feed their awareness of this treatment, embrace its efficacy, and move forward.
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MARK YOUR CALENDARS
I will be speaking at the upcoming Canadian Neuromodulation Society Meeting, June 10-12 in Vancouver, British Columbia
on the topic: Practical Safety Standards for Compounding Medications. Look forward to seeing you there!
For more information call: 888.671.2888 or visit: www.hartleymedical.com
AND DON'T FORGET...
The 18th Annual Napa Pain Conference, September 16th - 18th, 2011 at the Meritage Resort, Napa, CA.
Not able to attend the Vancouver Conference?
Consider this alternative:
PAIN 2011
June 10-12, 2011 at theHilton Waterfront Resort, Huntington Beach, CA
Dr. Timothy Deer, Course Director
David Caraway, MD, PhD Robert Levy, MD, PhD
Tory McJunkin, MD Jonathan Carlson, MD
Lorrie Brown, MD Sudhir Diwan, MD
Marc Huntoon, MD, PhD Porter McRoberts, MD
Claudio Feler, MD Paul Lynch, MD
Stan Golovac, MD Kenneth Alo, MD
Salim Hayek, MD, PhD Leo Kapural, MD, PhD
Nagy Mekhail, MD, PhD Lou Raso, MD
Allen Burton, MD Simon Thomson, MD
Mark Wallace, MD Paul Lynch, MD
Joshua Wellington, MD Joshua Prager, MD
David Abejon, MD Matthew Schocket, MD
Information and Registration:
Registration for this event has been fast and furious. The first block of rooms is already sold out and the final block has less than 12 rooms left. Register early!
Online registration: https://www.etouches.com/pain2011
FOR MORE INFO: Visit www.paineducationsociety.org/education.html
or contact Michelle Byers directly at: MichelleHByers@gmail.com
cell: 415-518-5391
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PHARMACOLOGY REVIEW: KETAMINE
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Ketamine is a drug that has been around for many, many years. Classified as an "NMDA Receptor Antagonist," it can be administered orally, parenterally, epidurally and intrathecally as a sedative, but is used most often by clinicians as an intrathecal treatment for pain that remains unrelieved following use of traditional opioids. It has proven very effective in this application and is often the injection considered for those suffering from cancer pain towards the end of life.
Ketamine has also been used to relieve non-cancerous chronic pain, albeit in very low doses (100 (mcg) micrograms or less per day). Studies indicate toxicity when administered in very high doses (60 milligrams per day).
Most recently, this versatile drug has been shown effective for treatment of Reflex Sympathetic Dystrophy, aka Complex Regional Pain Syndrome (CRPS). The administering physician revealed that he is treating a patient with oral doses of 5-10 milligrams, 2 to 3 times a day, and experiencing significant relief of chronic pain. Doctors also report using it topically for other similar conditions and finding it quite effective.
Caution to my clients: While certainly a viable option for consideration when other traditional options have failed, Ketamine does cause drowsiness, lightheadedness and hallucinations when used in high doses. The caveat here is to start with low doses and bring said doses up slowly. Feel free to contact me if you'd like to know more about Ketamine...happy to share pertinent articles with you.
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PRACTICE CHECK-UP: IT'S TIME.
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Recently, I undertook a USP 797 Compliance Survey*. Solicited by a colleague and friend (as well as many other colleagues across the United States) to complete the study, I spent an hour and a half online addressing issues and providing answers to a host of targeted questions regarding conditions of sterile compounding.
What I enjoyed about this particular study was that it posed in-depth, self-assessment-provoking questions about the many facets of the USP 797 text and distilled them down to specific areas addressing specific parameters. This was not a "ho-hum" exercise. These were challengingly complex questions on microbiological testing - ones that make the individual carefully re-examine their conduct in the broader context of the industry at large.
I took it upon myself to speak with the originators of this detailed survey. The individual who answered my questions spoke to the fact that survey questions were in depth for a very important reason...so that they would "double" as an educational tool. The ultimate goal was not necessarily to gauge compliance as much as it was to first, expose all to the optimum standards involved in each area and, second, spark self-assessment and self improvement in regard to procedural practices and standards.
I argued (amiably) a few points with the representative, but overall I was impressed with the fact that these individuals were seriously on the ball and on target. He shared with me the observation that two years ago when a compliance survey was conducted, 50% of those surveyed were revealed to be 50% compliant...and we are still far behind US compliancy requirements as an industry.
I think back to when the USP 797 guidelines were issued. There was much industry outcry. Pharmacists were complaining that the standards were "too rigid," "too unrealistic." You can't tell me this can't be done. Hartley Medical is doing it...and if I can, you can too.
I believe this survey will help to bring us all on line when it comes to safe practices. It's good for the industry...and it's free. I encourage you to support and participate if given the opportunity. Ongoing self-assessment is (and always has been) a Priority A-1 at Hartley...as it should be for us all. Surveys like this can only serve to advance and distinguish our cause.
* Results of the confidential survey are scheduled to be published soon in a trade journal entitled Pharmacy Purchasing and Products.
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STANDARD BEARER
Jeffrey Reynolds
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As I have stated before upon numerous occasions and in a multitude of venues, Hartley Medical is all about standards. It is our adherence to and striving toward only the highest of standards that differentiates and distinguishes us.
That said, I'd like to introduce you to our latest Standard Bearer...the new addition to the Hartley team, Jeffrey Reynolds. His title is Sales and Business Development Executive...and his task is sales revenue enhancement.
According to Jeff, that means "anything that has to do with marketing and sales - including generating new marketing materials and getting those materials out to prospective/current clients...as well as knocking on doors, making sure our phones keep ringing, checking up on current clients to make sure everything is going well, constantly evaluating our brand promise and seeing to it that that promise is kept."
Born and raised in Southern California, Jeffrey became a sales and marketing intern while attending UCLA working to attain a BA in Economics. After graduating, he ventured out into the world of financial services, only to return to us with a wealth of experience and a toolbox full of growth strategies.
Needless to say, we're very excited about the potential and expertise he brings to the mix...and already quite pleased and impressed with the results he has produced for our company - including helping to attract new clients in new areas and augment our presence in the Western United States.
Asked what he likes most about Hartley, Mr. Reynolds answers simply "Family."
And then he continues... "Most pharmacy providers focus solely on product sales, but the similarity with Hartley ends there. In today's competitive business climate, when you approach a prospective client you have to bring something more than just quality products to the table. We exceed the standards that our competitors are striving to simply reach and providing a level of service that, to the best of my knowledge, no other pharmacy can match."
"We truly are like a family here. And we treat our clients as such. William makes himself readily available for consultations regarding drug reimbursement, dosing, drug regime or any other clinical matters - above and beyond. That welcoming environment carries over into our relationships with clients...and they treasure that feeling of family. We all help each other and support each other and excel together. Can't beat that."
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| ABOUT HARTLEY MEDICAL | | |
The national leader in intra-spinal therapy, Hartley Medical specializes in the compounding of quality sterile pharmaceuticals for infusion therapy clients throughout the United States.
Owned and directed by William A. Stuart, RPh, acknowledged pioneer in the field of pharmaceutical sterile compounding, Hartley- prior to its national expansion - established itself as one of the most successful and professionally distinguished pharmacies in the state of California.
We now serve over 400 leading pain physicians and premier health care institutions across the nation.
Visit our web site.
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Disclaimer. The information contained in this publication is provided "as is" and without warranty, express or implied. Hartley Medical assumes no responsibility for any damages of any kind resulting from the procedures contained herein.
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WWW.HARTLEYMEDICAL.COM
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