Heroin Use in Pain Patients Signals Something Badly Amiss

https://goo.gl/5VLVmG

For patients prescribed opioids, use of heroin was highly tied to use of other illicit drugs, researchers reported here.

Among a collection of 171,061 urine samples from patients prescribed opioid therapy, about 1.3% also tested positive for heroin use, according to Mancia Ko, PharmD, MBA, of Ameritox, LLC, a company in Baltimore that provides physicians with urine drug monitoring and reporting services.

Most notable, however, the investigators said, was that heroin use was strongly tied to use of other drugs -- for example, a 12.8 higher odds of use of cocaine (19.2% versus 1.8%, 95% CI 11.4-14.3), and a 2.2 higher odds of testing positive for tetrahydrocannabinol (THC) (12.5% versus 9.0%, 95% CI 1.9-2.5) compared with those who did not use heroin.

The findings were presented at the American Pain Society's Scientific Summit.

"Four out of five heroin users started with prescription opioids," Ko told MedPage Today during the poster session that included the study. "But another starting point is that patients are getting more tolerant, so they are abusing heroin, which is purer and cheaper to get their psychoactive high compared to just prescription-strength medication."


ED Opioid Overdose Visits Jump 30% in One Year

Emergency department (ED) visits for suspected opioid overdoses rose by 30% throughout the U.S. in a year, according to the CDC.

"All five regions of the U.S. saw significant increases during this time period," said Anne Schuchat, MD, acting CDC director, in a CDC tele-briefing Tuesday.

The analysis, appearing in a new Vital Signs report, was based on about 91 million ED visits in 52 jurisdictions within 45 states from July 2016 to September 2017 from the CDC's National Syndromic Surveillance Program (NSSP) Biosense Platform. It included 142,557 visits that were suspected opioid overdose cases, a 29.7% hike from the previous 1-year period.

Midwestern states increased the most dramatically, with a 70% jump fueled by a doubling (109% increase) of overdose ED visits in Wisconsin. A similar rise of 105% was seen in Delaware. Pennsylvania experienced an 81% hike.

The largest drop was in Kentucky, where overdose ED visits declined by 15%. "The decrease in Kentucky during this period of time may reflect some fluctuations in drug supply," Schuchat said, adding that the CDC will investigate and confirm this data.

And the rise was not just in rural America: Overdose ED visits in large, metropolitan areas throughout 16 states in the Enhanced State Opioid Overdose Surveillance program increased steadily each quarter for a total increase of 54%, she said.

Until now, the CDC has reported mostly about overdose deaths, Schuchat noted, but "looking at ED data can help us get information before people die." Most states now use ED data (also called syndromic data) to identify where resources are needed or where gaps exist.


How Necessary Are Opioids for Chronic Pain?

Interesting....

https://goo.gl/3tAya6

The opioid group first tier was characterized by short-acting pain killers, then escalated to longer acting agents, and finally capped out with transdermal fentanyl.

The non-opioid regimen was a bit more clever, in my opinion. Tier 1 was acetaminophen and NSAIDs. Providers could then escalate to other oral meds (I particularly like the underused amitriptyline appearing in this tier) and topicals, and finally capped out with tramadol.

Now, I know what you're thinking. Isn't tramadol an opioid? I asked lead author Dr. Erin Krebs that very question. She reminded me that this trial started in 2010: "This was before all the concerns about opioid overdose and addiction and back then a big concern was is it ethical to deprive patients of opioids if they fail all these non-opioid medications."

Times have certainly changed. But regardless, only 13 patients in the non-opioid group ever required escalation all the way to tramadol.

And the results did not look good for opioids. The primary outcome was pain-related function which improved substantially in both groups but did not differ between the groups. Raw pain scores ended up being a bit better in the non-opioid arm.


Chronic Fatigue Patients Suffer 3 Major Brain Abnormalities; Findings May Lead To Clearer Diagnosis

The right arcuate fasciculus has been a mystery; the left arcuate fasciculus coordinates the different parts of the brain that understand and control speech.....

The incessant fatigue characterized by chronic fatigue syndrome (CFS) that affects between one and four million Americans is often quite difficult to diagnose. But a new study, which found three distinct differences between the brains of patients with CFS and those of healthy people, promises to revolutionize diagnosis and provide insight into the underlying mechanisms of the condition.

"CFS (Chronic Fatigue Syndrome) is one of the greatest scientific and medical challenges of our time," said Dr. Jose Montoya, from the Stanford University School of Medicine, in a press release. His words, in effect, summarize the difficulty doctors face in diagnosing CFS, which is often mistaken for other conditions. Up until now, researchers have also been unable to find any underlying medical conditions that explain its onset. Characterized by extreme fatigue that lasts for six months or longer, CFS worsens with physical and mental activity but doesn’t improve with rest.

Chronic headaches, food intolerance, sore throat, enlargement of the lymph nodes, gastrointestinal problems, abnormal blood-pressure and heart-rate events, and hypersensitivity to light, noise or other sensations are the other hallmarks of this condition, say the researchers. An accurate estimation is difficult to determine for the one-to-four million range of Americans affected by the condition because the initial symptoms are often mistaken for conditions such as hypochondria.

But the new study, published in Radiology, will help in more accurate diagnosis. "Using a trio of sophisticated imaging methodologies, we found that CFS patients' brains diverge from those of healthy subjects in at least three distinct ways," said coauthor Michael Zeineh.

Montoya, who has been tracking around 200 suspected patients for several years, says that CFS can affect a patient long-term, even as long as 30 years. This new diagnosis will not only provide a CFS-specific diagnostic biomarker, but may also help in “identifying the area or areas of the brain where the disease has hijacked the central nervous system," Montoya said.

The investigators compared brain images of 15 CFS patients with 14 healthy age-and sex-matched controls. The study found the following key differences.

  • CFS patients had an overall reduction in brain white matter than healthy controls.
  • CFS patients showed a consistent abnormality in the right arcuate fasciculus, a particular part of a nerve tract that connects the frontal lobe and temporal lobe.
  • CFS patients had thickened gray matter at the two areas of the brain connected by the right arcuate fasciculus, compared to the controls.        

While reduction in the white matter was expected, what surprised the researchers was the abnormality in the right arcuate fasciculus. A relatively unexplored region of the brain, the team found that there was a strong correlation between the degree of abnormality in a CFS patient's right arcuate fasciculus and the severity of the patient's condition, as assessed by performance on a standard psychometric test used to evaluate fatigue.


Opioid overdose among children nearly doubles, study says

The number of children admitted to hospitals for opioid overdose has nearly doubled since 2004, according to a new study.

The study, which published Monday in the journalPediatrics, looked at children between ages 1 and 17 who were admitted to hospitals and pediatric intensive care units with opioid-related diagnoses from 2004 to 2015. Researchers found that the number of children admitted to hospitals for opioid overdose nearly doubled to 1,504 patients between 2012 and 2015, from 797 patients between 2004 and 2007.

The researchers cautioned that many of these children likely overdosed after stumbling upon their parents' prescription medications.
    "When they come in, they're going to fall into one of two categories: either they're teenagers with intentional or drug-seeking behavior because of recreational or self-injurious behavior, or they're kids who got into their parents' medication," said Dr. Jason Kane, an associate professor of pediatrics and critical care at Comer Children's Hospital in Chicago and a lead author on the study.
    "The thing that was a bit striking is that in the youngest children, those under six years of age, 20% of the ingestions were of methadone. So you sort of have to ask yourself: where are they getting all this methadone from?" Methadone is prescribed for the treatment of opioid withdrawal symptoms and also as a pain killer.


    Can you drink alcohol while taking antihistamines?

    https://goo.gl/AQxaHx

    Ten risks of mixing Benadryl and alcohol

    There are many potential risks when mixing Benadryl and alcohol. Ten of them are listed here.

    1. Drowsiness

    Benadryl can cause side effects, including sedation and drowsiness, which impair coordination and reaction speed.

    Mixing Benadryl with alcohol can intensify these side effects and will impair a person's daily functioning.

    This can be life-threatening if it involves certain activities, such as driving or operating heavy machinery.

    And there are nine more.....


    Depression Is Ravaging Our Young – The Depoliticization Of Mental Illness Must Be Challenged

    https://goo.gl/JdXkvi

    When Micheal Brown, 28, lost his job six months ago, he began to show the first signs of anxiety. “While looking for new work I tried UberEats to keep up with my bills. I think there’s something physical about working in this emerging ‘gig economy’ that does you no good,” Micheal tells me over the phone. “For me it all fell apart pretty fast, and the mental breakdown I felt was a result of the isolation and lack of long-term security. I gradually stopped being able to function normally. I felt trapped and inadequate.”

    As youth unemployment is rising, the majority of millennials believe the economy is not working for them. With news that depression is on the rapid upswing, especially among the young, it makes no sense to deny links between depression and the economy, fueled by growing worker insecurity. Although Micheal had been visiting a therapist, he felt that his experience of mental health problems was not taken seriously. “She discharged me and told me that I was healthy and need to keep myself busy with work. But actually I wasn’t better; I was just ashamed of opening up more.”

    Eventually, Micheal got advice from a friend to volunteer at the local sanctuary, which provides basic help for homeless youth, and he has been confronting his depression ever since. “For me, it’s coming together, and the wellbeing I feel as a result of getting involved in my community. I saw a general improvement in my mental health. I’m learning to look at myself in a more positive light; it gave me a real sense of purpose and of course made new friends too.”

    This wasn’t an isolated case; a cursory look at statistics for the US suggests that over 10 million adults aged 18 or older have had at least one major depressive episode. That’s about 4.2% of all US adults. According to the World Health Organization, over 450 million people globally have struggled with mental health issues. Yet, mental health is rarely debated in the political space. The intention is to depoliticize mental illness. By ignoring its pervasive nature in our society, mental health as an urgent political issue becomes invisible. Its causes — such as economic policies, social circumstances, and the erosion of communities — seamlessly go undetected.


    The diet that could reduce the risk of depression

    https://goo.gl/Lv28iL

    Researchers have found that people with closer adherence to the Dietary Approaches to Stop Hypertension (DASH) were less likely to have depression over 6.5 years than people with lower adherence to the diet.

    The DASH diet is an eating plan that is high in fruits, vegetables, and whole grains but low in foods that are high in sugar and saturated fats. It was created by the National Heart, Lung and Blood Institute as a way to lower blood pressure.

    The study participants were also assessed for symptoms of depression during the follow-up period.

    Compared with subjects who had the lowest adherence to the DASH diet, those who had the highest adherence were found to be 11 percent less likely to develop depression.

    But a Western diet was found to have the opposite effect, and the closer the subjects' adherence to this diet — which is high in saturated fats and low in fruits, vegetables, and whole grains — the greater their risk of developing depression.


    MRI identifies brain abnormalities in chronic fatigue syndrome patients

    https://goo.gl/RXcxER

    Researchers using a combination of different imaging techniques have found structural abnormalities in the brains of people with chronic fatigue syndrome (CFS), according to a new study published online in the journal Radiology. The results suggest a potential role for imaging in diagnosing and treating the condition.

    CFS is characterized by profound fatigue and "brain fog" that do not improve with bed rest, lasting for at least six months. The condition affects more than 1 million adults and children in the United States, according to the Centers for Disease Control and Prevention. Diagnosis is complicated and usually involves ruling out many other conditions. There is no standalone test to diagnose CFS.

    "This is a very common and debilitating disease," said the study lead author Michael M. Zeineh, M.D., Ph.D., assistant professor of radiology at Stanford University School of Medicine in Stanford, Calif. "It's very frustrating for patients because they feel tired and are experiencing difficulty thinking, and the science has yet to determine what has gone wrong."

    "Within CFS patients, right anterior arcuate FA increased with disease severity," Dr. Zeineh said. "The differences correlated with their fatigue--the more abnormal the tract, the worse the fatigue."

    The results suggest that FA at the right arcuate fasciculus may serve as a biomarker for CFS that can help track the disease.

    The imaging study also found abnormalities among CFS patients at the two points in the brain that connect the right arcuate fasciculus. Each connection point, known as a cortex, was thicker in CFS patients.


    Researchers tie Gulf War illness to brain damage

    https://goo.gl/Eet9ju

    Researchers say they have found physical proof that Gulf War illness is caused by damage to the brain — and that proof may ultimately help civilians who suffer from chronic fatigue syndrome and fibromyalgia.

    Using fMRI machines, the Georgetown University researchers were able to see anomalies in the bundle of nerve fibers that interpret pain signals in the brain in 31 Gulf War veterans. The research will be published Wednesday in PLOS ONE journal.

    The findings are "huge," because an fMRI allows doctors to diagnose a person with Gulf War illness quickly, said James Baraniuk, senior author and professor of medicine at Georgetown University Medical Center. The research, he said, also shows that Gulf War illness is not psychological.

    An fMRI, or "functional" MRI, is a scan that measures activity by detecting how blood flows through the brain.

    Many veterans have had difficulties getting benefits and treatment for a service-connected condition because doctors assumed they were either faking it or suffering from post-traumatic stress. "That's a problem with all physicians — VA, military or civilian," Baraniuk said. "If it doesn't fall within their small world of known diseases, then the patient is nuts."

    Gulf War illness is a series of symptoms that has affected more than 250,000 veterans of the 1991 war against Iraq in response to Iraq's invasion of Kuwait.

    Baraniuk said the correlation of anomalies in the brain's white matter with Gulf War illness has not been studied before. Researchers, he said, also found that fatigue and pain worsen congruently in the veterans.