Category Archives: Pain Medicine

Pregnant and addicted: the tough road to a healthy family

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Amanda Hensley holds her daughter Valencia

Amanda Hensley holds her daughter Valencia

By Sarah Jane Tribble, WCPN
Kaiser Health News

Amanda Hensley started abusing prescription painkillers when she was just a teenager. For years, she managed to function and hold down jobs. She even quit opioids for a while when she was pregnant with her now 4-year-old son. But she relapsed.

Hensley says she preferred drugs like Percocet and morphine, but opted for heroin when short on cash.

By the time she discovered she was pregnant last year, she couldn’t quit.

“It was just one thing after another, you know — I was sick with morning sickness or sick from using,” said Hensley, who is 25 and lives in Cleveland. “Either I was puking from morning sickness or I was puking from being high. That’s kind of how I was able to hide it for a while.”

Hensley said she was ashamed and hurt, and she wanted to stop using but didn’t know how. She had friends who would help her find drugs — even after they found out she was pregnant. But finding help to get sober and protect her child proved much more difficult, though.

The number of people dependent on opioids is increasing and that includes women of child-bearing age, like Hensley. Researchers estimated that every 25 minutes a baby was born dependent on opioids in 2012, the most recent year for which data are available.

By the time Hensley was about six months pregnant, she was living on couches, estranged from her mother and her baby’s father, Tyrell Shepherd. Her son went to live with her mother.

That’s when Hensley reached out for help. One moment, she dialed to get her fix. The next, she called hospitals and clinics.

“Nobody wants to touch a pregnant woman with an addiction issue,” she said.

Shepherd wasn’t happy when he realized Hensley was taking opioids while pregnant. “If you don’t care about yourself,” he said, “have enough common decency to care about the baby you’re carrying. Be adult. Own up to what it is you’re doing and take care of business. Regardless of how bad you’re going to feel, there’s a baby that didn’t ask to be there.”

After being rejected by two hospitals and several clinics, Hensley let herself go into withdrawal and then went to the emergency department of MetroHealth System, Cleveland’s safety-net hospital. Continue reading

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Demand surges for addiction treatment during pregnancy

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BOSTON — As soon as the home pregnancy test strip turned blue, Susan Bellone packed a few things and headed straight for Boston Medical Center’s emergency room. She’d been using heroin and knew she needed medical help to protect her baby.

“I felt so guilty. I still do,” said Bellone, a petite, energetic woman. At 32, and six years into her heroin addiction, having a baby was the last thing on her mind. “I was not in the right place to start a family,” she said. “But once it was happening, it was happening, so I couldn’t turn back.”

Nationwide, the number of pregnant women using heroin, prescription opioids or medications used to treat opioid addiction has increased more than five-fold and it’s expected to keep rising. With increased opioid and heroin use, the number of babies born with severe opioid withdrawal symptoms has also spiraled, leaving hospitals scrambling to find better ways to care for the burgeoning population of mothers and newborns.

Among the most important principles is that expectant mothers who are addicts should not try to quit cold turkey because doing so could cause a miscarriage. Trying to quit opioids without the help of medications also presents a high risk of relapse and fatal overdose.

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Until the opioid epidemic took hold about eight years ago, most hospitals saw only one or two cases a year of what is known as neonatal abstinence syndrome. Now, a baby is born suffering from opioid withdrawal every 25 minutes in the U.S., according to the National Institute on Drug Abuse. Continue reading

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Aid-in-dying laws only accentuate need for palliative care, providers say

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Dr. Carin van Zyl talks to patient Jose Garcia Flores about his treatment options for his advanced stage colon cancer on Tuesday, October 13, 2015 (Photo by Heidi de Marco/KHN).

Dr. Carin van Zyl talks to patient Jose Garcia Flores about his treatment options for his advanced stage colon cancer on Tuesday, October 13, 2015 (Photo by Heidi de Marco/KHN).

By Anna Gorman
KHN

LOS ANGELES — More times than she can count, Dr. Carin van Zyl has heard terminally ill patients beg to die. They tell her they can’t handle the pain, that the nausea is unbearable and the anxiety overwhelming.

If she were in the same situation, she too would want life-ending medication, even though she doubts she would ever take it. “I would want an escape hatch,” she said.

Earlier this month, California law became the fifth — and largest — state to allow physicians to prescribe lethal medications to certain patients who ask for it.

Yet van Zyl can’t see herself as one of those doctors.

“This is my life’s work, to relieve suffering,” said van Zyl, head of palliative care medicine at Los Angeles County-USC Medical Center. To her, that does not mean cutting short a life.

“I can’t imagine pulling the trigger,” she said.

Weeks after California Gov. Jerry Brown signed the “end-of-life option act” into law, palliative care physicians like van Zyl are trying to come to terms with what it means for them and their terminally ill patients. Continue reading

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Most Americans say they have a personal tie to prescription drug abuse

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By Lisa Gillespie
KHN

The growing abuse of prescription painkillers now touches home for a majority of Americans, according to a poll released Tuesday.

One in three say either they have been addicted to painkillers or they have known a family member or close friend who was.

More than 56 percent of the public say they have a personal connection to the issue, reports the latest monthly tracking poll of the Kaiser Family Foundation.

That share includes those who say they know someone who died from a painkiller overdose, have been addicted themselves or know someone who has and those who know someone who took painkillers not prescribed to them, the poll’s results show. (KHN is an editorially independent program of the Foundation.)

Details from the poll:

— 16 percent say they know someone who has died and 9 percent say that person was a close friend or family member.

— 27 percent say either they have been addicted to painkillers or they have known a family member or close friend who was.

— 63 percent of whites say they have a personal connection to the abuse of prescription painkillers compared with 44 percent of blacks and 37 percent of Hispanics.

Half of those surveyed rank prescription painkiller and heroin abuse as a top priority for their governor and legislature, behind improving public education and making health care more accessible and affordable, which drew 76 percent and 68 percent shares, respectively.

Sixty-two percent of those polled said the drug Naloxone, which can reverse an overdose and is handed out in some states without a prescription and for little or no cost, should only be available via prescription.

Efforts to reduce painkiller abuse would be at least somewhat effective, many Americans say. Providing treatment for addicts is cited by 85 percent, monitoring doctors’ prescribing habits by 82 percent and encouraging people to dispose of leftover medication by 69 percent.

Kaiser’s tracking poll was conducted Nov. 10 to 17 among 1,352 adults.The margin of error for the full sample is +/- 3 percentage points.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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From pills to pins: Oregon is changing how it deals with back pain

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Doris Keene (right) at Portland’s Quest Center for Integrative Health. (Photo by Kristian Foden-Vencil/Oregon Public Broadcasting)

By Kristian Foden-Vencil
Oregon Public Broadcasting

When Portland resident Doris Keene raised her four children, she walked everywhere and stayed active. But when she turned 59, she says, everything fell apart.

“My leg started bothering me. First it was my knees.” She ignored the pain, and thinks now it was it the sciatic nerve acting up, all along. “I just tried to deal with it,” Keene says.

But eventually, she went to a doctor who prescribed Vicodin and muscle relaxants. In 2012, about one in four Oregonians received an opioid prescription – more than 900,000 people. The state currently leads the nation in nonmedical use of opioids. And about a third of the hospitalizations related to drug abuse in Oregon are because of opioids.

Keene says the drugs helped her, but only to a degree. Continue reading

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Pain by the numbers

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 Illustration of the pain pathway in René Descartes' Traite de l'homme (Treatise of Man) 1664

Illustration of the pain pathway in René Descartes’ Traite de l’homme (Treatise of Man) 1664

By Rachel Gotbau
KHN

In one of the largest population studies on pain to date, researchers with the National Institutes of Health estimate that nearly 40 million Americans experience severe pain and more than 25 million have pain every day.

 

Those with severe pain were more likely to have worse health status, use more health care and suffer from more disability than those with less severe pain. Continue reading

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Pain patients say they can’t get medicine after crackdown on illegal Rx drug trade

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Lesley Young testified that she has driven 100 miles to try to find a pharmacy that would fill painkiller prescriptions for her husband Chris. (Photo by Jessica Palombo/For KHN)

By Rachel Gotbaum
KHN

The accident happened 10 years ago when Chris Young was 35.

He owned a salvage yard in Maui, Hawaii, and his employee had hoisted a junker on a machine called an excavator when the hydraulics gave out.

The car fell on him from above his head, smashing his spine.

“He was crushed accordion-style,” says his wife Lesley.

The accident left Young with a condition known as “partial paraplegia.” He can’t walk and he needs a wheelchair, but he does have some sensation in his legs. Unfortunately for Young, that sensation is often excruciating pain.

“It feels like electric shocks, like lightning bolts going down my legs. And when it gets down to the bottom, it feels like someone is driving a big metal spike up my legs,” says Young.

To control the pain, Young, who has since moved to Florida, needs high doses of narcotic painkillers, but he can’t always fill his doctor’s prescription.

He is not alone. In what may be an unintended side effect of a crackdown on prescription drug abuse, Young and other legitimate chronic pain patients are having increasing trouble getting the medicine that allows them to function on a daily basis. Continue reading

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The gray areas of assisted suicide

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When J.D. Falk was dying of stomach cancer in 2011, his wife says doctors would only talk about death in euphemisms. (Photo: courtesy of Hope Arnold)

By April Dembosky, KQED

SAN FRANCISCO — Physician-assisted suicide is illegal in all but five states. But that doesn’t mean it doesn’t happen in the rest. Sick patients sometimes ask for help in hastening their deaths, and some doctors will hint, vaguely, how to do it.

This leads to bizarre, veiled conversations between medical professionals and overwhelmed families.

Doctors and nurses want to help but also want to avoid prosecution, so they speak carefully, parsing their words. Family members, in the midst of one of the most confusing and emotional times of their lives, are left to interpret euphemisms.

Doctors and nurses want to help but also want to avoid prosecution, so they speak carefully, parsing their words.

That’s what still frustrates Hope Arnold. She says throughout the 10 months her husband J.D. Falk was being treated for stomach cancer in 2011, no one would talk straight with them.

“All the nurses, all the doctors,” says Arnold. “everybody we ever interacted with, no one said, ‘You’re dying.’”

Until finally, one doctor did. And that’s when Falk, who was just 35, started to plan. He summoned his extended family. And Hope made arrangements for him to come home on hospice. Continue reading

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Most states list deadly methadone as a ‘preferred drug’

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465px-Methadone.svgBy Christine Vestal
Stateline

The federal government has been issuing warnings about the dangers of methadone for nearly a decade.

Two years ago, states started removing it from their Medicaid “preferred drug lists.” (Joe Amon/Getty Images)

As prescription drug overdose deaths soar nationwide, most states have failed to take a simple step that would make it harder for doctors to prescribe the deadliest of all narcotics.

Methadone is four times as likely to cause an overdose death as oxycodone, and more than twice as likely as morphine, yet as many as 33 states make it easy for doctors to prescribe. 

Methadone overdoses kill about 5,000 people every year, six times as many as in the late 1990s, when it was prescribed almost exclusively for use in hospitals and addiction clinics where it is tightly controlled.

It is four times as likely to cause an overdose death as oxycodone, and more than twice as likely as morphine. In addition, experts say it is the most addictive of all opiates.

Yet as many as 33 states make it easy for doctors to prescribe the pain medicine to Medicaid patients, no questions asked. Continue reading

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Narcotic Painkillers in Pregnancy Common, Harmful to Baby: Study – WebMD

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Blue Pregnant BellyUse of prescription narcotic painkillers is common in pregnancy and increases the likelihood a baby will be born small or early, or go through painful drug withdrawal, a new study finds.

These prescription painkillers, also called opioids, include drugs such as hydrocodone (Vicodin), oxycodone (Oxycontin), codeine and morphine.

Nearly 30 percent of the Tennessee mothers-to-be in the new study used at least one of these drugs while pregnant, and the associated risks went up if they also smoked or took antidepressants.

via Narcotic Painkillers in Pregnancy Common, Harmful to Baby: Study – WebMD.

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Too little, too late for many New Yorkers seeking hospice

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By Fred Mogul, WNYC

Sandra Lopez and her Chihuahua, Coco, were inseparable. He followed her everywhere, and kept Lopez’s mood up when she was in pain – which was often.

On Oct. 15, Lopez, died at age 49 of pancreatic and vaginal cancer that had slowly spread throughout her body over two years. She left behind a 15-year-old daughter and little Coco. But with hospice care, she spent her last weeks where she wanted to be — at home, with her pain under control.

Sandra was in and out of the hospital in 2014, but for the months she was home, a hospice nurse from Metropolitan Jewish Health System visited once a week to help manage the pain, backed up by a 24-hour, nurse-staffed phone line that Lopez called often.

“Some days the pain is so excruciating,” she told me in August from the couch in her Brooklyn apartment, “that the pain overrides the medication.”

But despite evidence that hospices can greatly relieve discomfort, extend life and save money, and despite a generous hospice benefit available through both Medicare and Medicaid, relatively few people in New York take advantage of it, compared to elsewhere in the country.

Continue reading

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Cambia gives its largest grant ever to UW Medicine: $10 million for palliative care – Puget Sound Business Journal

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Dr. Randy Curtis, right, director of the UW Palliative Care Center of Excellence.

Dr. Randy Curtis, right, director of the UW Palliative Care Center of Excellence.

The grant is Cambia’s largest ever given to any organization and will come in four separate parts, creating three endowments totaling $8 million and $2 million dedicated to immediately improving care at the center.

via Cambia gives its largest grant ever to UW Medicine: $10 million for palliative care – Puget Sound Business Journal.

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Vicodin, some other pain meds will be harder to get – DEA

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Patients who use drugs containing hydrocodone as a pain reliever or cough suppressant are going to have to jump through more hoops to get them starting next month.

The Drug Enforcement Administration is reclassifying so-called “hydrocodone combination products” (HCP) from Schedule III to Schedule II under the Controlled Substances Act, which will more tightly restrict access. Vicodin, for example, is an HCP because it has hydrocodone and acetaminophen.

The final regulation, which takes effect Oct. 6, will mean that patients generally must present a written prescription to receive the drug, and doctors will no longer be able to call in a prescription to the pharmacy in most instances.

Many patients with painful chronic diseases, including cancer, take hydrocodone combination products

.The regulation is a response to the widespread misuse of prescription pain killers.

In an emergency, doctors will still be able to call in a prescription, according to the new rule. And although prescription refills are prohibited, a doctor can, at his discretion, issue multiple prescriptions that would provide up to a 90-day supply.

These measures don’t satisfy consumer advocates or pharmacists who are opposed to the new rule. Continue reading

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