As Overdose Deaths Soar To Record Highs, FDA Approves New Painkiller 1,000x MORE Powerful Than Morphine


 

Purdue Pharma and other pioneers of powerful opioid painkillers probably felt a twinge of regret on Friday when the FDA approved a powerful new opioid painkiller that’s 10 times stronger than fentanyl  – the deadly synthetic opioid that’s been blamed for the record number of drug overdose deaths recorded in 2017 – and 1,000 times more powerful than morphine, ignoring the objections of lawmakers and its own advisory committee in the process.

After all that trouble that purveyors of opioids like Purdue and the Sackler family went to in order to win approval –doctoring internal research and suborning doctors to convince the FDA to approve powerful painkillers like OxyContin despite wildly underestimating the drug’s abuse potential – the agency might very well have approved those drugs any way? And opioid makers might have been able to avoid some of the legal consequences stemming from this dishonesty, like the avalanche of lawsuits brought by state AGs.

What’s perhaps even more galling is that the FDA approved the drug after official data showed 2017 was the deadliest year for overdose deaths in US history, with more than 70,000 recorded drug-related fatalities, many of which were caused by powerful synthetic opioids like the main ingredient in Dsuvia, the brand name under which the new painkiller will be sold.

Dsuvia is a 3-millimeter tablet of sufentanil made by AcelRx. It’s a sublingual tablet intended to provide effective pain relief in patients for whom most oral painkillers aren’t effective. The FDA’s advisory committee voted 10-3 to recommend approval of the drug, a decision that was accepted by the FDA on Friday. The agency justified its decision by insisting that Dsuvia would be subject to “very tight” restrictions.

“There are very tight restrictions being placed on the distribution and use of this product,” said FDA Commissioner Scott Gottlieb in a written statement Friday regarding his agency’s approval of Dsuvia. “We’ve learned much from the harmful impact that other oral opioid products can have in the context of the opioid crisis. We’ve applied those hard lessons as part of the steps we’re taking to address safety concerns for Dsuvia.”

Still, some of the agency’s actions looked to critics like attempts to stifle internal criticism. For example, the agency scheduled the advisory committee vote on a day where the chairman of the committee, who was opposed to approval, could not attend – while circumventing its normal vetting process, despite the fact that the member in question had notified the agency of his unavailability months beforehand.

But the FDA rejected any and all criticisms related to Dsuvia being sold as a street drug by insisting that the risk of diversion (when doctor-prescribed drugs are illicitly sold on the black market) was low because the drug would only be prescribed in hospital settings, and wouldn’t be doled out at pharmacies. But critics said that, given its potency, Dsuvia would “for sure” be diverted at some level. They also rejected the FDA’s argument that Dsuvia satisfied an important need for pain treatment: offering rapid, effective relief for obese patients or others lacking easily accessible veins.

While a niche may eventually be found for Dsuvia, “it’s not like we need it…and it’s for sure, at some level, going to be diverted,” said Dr. Palmer MacKie, assistant professor at the Indiana University School of Medicine and director of the Eskenazi Health Integrative Pain Program in Indianapolis. “Do we really want an opportunity to divert another medicine?”

Fortunately for Dsuvia’s manufacturer, AcelRx, these public health risks pale in comparison to the enormous profits that the company stands to reap from sales. The company anticipates $1.1 billion in annual sales, and hopes to have its product in hospitals early next year.

It goes without saying that cancer patients and others suffering from life threatening illnesses have a legitimate need for effective pain relief. But when the FDA says Dsuvia is needed in the hospital setting, it probably isn’t telling the whole story. Because, as the Washington Post pointed out, the medication’s development was financed in part by the Department of Defense, which believes Dsuvia will be an effective treatment for emergency pain relief on the battlefield – like when a soldier gets his legs blown off after accidentally stepping on an IUD.

Top Ten Drugs Tied to Overdose Deaths


Deaths from drug overdose in the United States increased by 54% from 2011 to 2016 — with opioids, benzodiazepines (benzos), and stimulants the most commonly used drug classes involved, a new report released today by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS), shows.

The report notes that there were 41,340 drug overdose deaths in 2011 vs 63,632 such deaths in 2016.

Although the opioid oxycodone was the most cited drug in overdose death records in 2011, heroin took the top spot from 2012 to 2015.

The story around fentanyl may be even more troubling. The rate of overdose deaths involving it or one of its analogs doubled each year from 2013 through 2016, when it finally took the lead in becoming the most mentioned drug. In 2016, 29% of all overdose deaths involved fentanyl (n = 18,335).

In addition, the stimulant cocaine was the second or third most cited drug in the overdose death records throughout the entire study period.

The CDC’s list of the 10 most frequently mentioned drugs also included the opioids methadone, morphine, and hydrocodone; the benzos alprazolam and diazepam; and the stimulant methamphetamine.

Of all 10 drugs, only methadone was associated with a decreasing overdose death rate from 2011 to 2016.

“While the ranking changed from year to year, the top 10 drugs involved in overdose deaths remained consistent throughout the 6-year period,” note the investigators, led by Holly Hedegaard, MD, NCHS.

“This report identifies patterns in the specific drugs most frequently involved in drug overdose deaths…and highlights the importance of complete and accurate reporting in the literal text on death certificates,” they write.

The data were published online in the December 12 issue of the National Vital Statistics Reports.

Rise in Overdose Death Toll

An NCHS report released last year showed the age-adjusted rate of US drug overdose deaths increased dramatically from 1999 (6.1 per 100,000 population) to 2016 (19.8 per 100,000).

Although several previous studies on drug overdoses have used National Vital Statistics System-Mortality (NVSS-M) information, this data is coded using the International Classification of Diseases, Tenth Revision (ICD-10); and these ICD-10 codes focus on broad drug categories rather than on individual drugs, note the investigators.

In answer to this, the NCHS and the US Food and Drug Administration “collaboratively developed methods to search the literal text from death certificates to identify mentions of specific drugs and other substances, and to search contextual terms to identify involvement of the drug(s) or substance(s) in the death,” the researchers write.

They defined “literal text” as written information from the medical certifier on cause or circumstances related to a death.

For the current report, they examined NVSS-M data from 2011 through 2016. These data were linked to electronic files containing death certificate information.

In addition to the top 10 drugs involved in overdose deaths, drugs that held the number 11 through number 15 ranking throughout the 6-year study period included diphenhydramine, acetaminophen, citalopram, carisoprodol, oxymorphone, tramadol, amitriptyline, clonazepam, gabapentin, and amphetamine.

Threefold Increase in Heroin Deaths

The involvement of heroin in overdose deaths rose threefold from 4571 deaths in 2011 to 15,961 deaths in 2016. This made it the second-most mentioned drug in 2016, behind fentanyl.

Mentions of cocaine increased from 5892 overdose deaths in 2014 to 11,316 deaths in 2016, giving it that year’s number 3 ranking.

The fourth most mentioned drug in overdose deaths in 2016 was methamphetamine. Its 6762 related deaths signified a sharp increase from the 1887 related deaths in 2011.

“An analysis of trends…showed that, for several drugs, the age-adjusted rate of drug overdose deaths increased considerably within a relatively short period,” the investigators write.

Heroin, cocaine, and methamphetamine all showed significant increasing trends for age-adjusted rates of drug overdose deaths between 2011 and 2016 (1.5 vs 5.1 per 100,000 population; 1.6 vs 3.6 per 100,000; and 0.6 vs 2.1 per 100,000, respectively; all, P < .05).

Fentanyl showed a significant increasing trend between 2013 and 2016 (0.6 vs 5.9 per 100,000; P < .05).

The only decrease for a specific drug came from methadone, which was mentioned in 4545 overdose deaths in 2011 vs 3493 deaths in 2016 (1.4 vs 1.1 per 100,000). Still, it was the eighth most mentioned drug in 2016.

For the 2016 top 10 drugs, “the proportion of deaths involving both the referent drug and at least one other concomitant drug ranged from 50% for methamphetamine to 96% for alprazolam or diazepam,” the researchers report.

Finally, drugs most frequently recorded in unintentional overdose deaths in 2016 were fentanyl, heroin, and cocaine. The most frequently cited drugs in suicide by overdose were oxycodone, diphenhydramine, hydrocodone, and alprazolam.

Prescription for Change – How to End America’s Opioid Addiction


Story at-a-glance

  • More Americans now use prescription opioids than smoke cigarettes. Opiates such as oxycodone, hydrocodone, fentanyl and morphine also kill more Americans than car crashes each year
  • In 2015, 27 million Americans used illegal drugs like heroin and/or misused prescription drugs. Addiction to opioids and heroin is costing the U.S. more than $193 billion each year
  • Native Americans and Caucasians have the highest rate of death from opioids; 8.4 and 7.9 per 100,000 people respectively. African Americans and Latinos have a death rate of 3.3 and 2.2 per 100,000

The MTV production “Prescription for Change” highlights the struggles of drug addiction and includes interviews with President Obama, in which he urges users to seek help, and discusses the need for more and better treatment programs, regardless of the user’s ability to pay.

The video also discusses the history of opioids that led to the current addiction epidemic. Purdue Pharma, the manufacturer of OxyContin, lied to doctors and patients, convincing them that OxyContin — a narcotic pain killer — was safe and non-addictive when prescribed for pain.

Starting in 1996, Purdue unleashed more than 20,000 “educational programs” to encourage long-term use of opioids to control non-cancer pain,1 even though there were no studies to support the use of opioids long-term in patients with non-fatal conditions.2

In the first year (1996) sales of Oxycontin reached $45 million. By 2000, that number had ballooned to $1.1 billion.3 Ten years later sales had tripled to $3.1 billion, gobbling up 30 percent of the market.4

Addiction Epidemic Was No Fluke

Misinformation and manipulation of scientific facts by drug makers have led to a drug crisis of truly astounding proportions, with more Americans now using prescription opioids than those who smoke cigarettes.5

In Alabama, which has the highest opioid prescription rate in the U.S., there are 143 prescriptions for every 100 people.6 Clearly doctors bear a significant responsibility for creating this situation.

Surgeons also need to reevaluate current practices of routinely sending surgical patients home with a powerful painkiller.7 In fact, many of today’s addicts became hooked after being prescribed a narcotic pain reliever following dental surgery or a relatively minor injury.

Heroin use more than doubled in 18- to 25-year-olds between 2002 and 2011,8 and this rise in heroin addiction was a direct result of prescription opioid addiction among young patients.

Crazy enough, just last year — in the midst of rallying cries to get a better handle on the burgeoning crisis — the U.S. Food and Drug Administration (FDA) approved the use of opioids in children as young as 11.9 I shudder to imagine what this might do to an entire generation of children!

Opioids Top the List of Potentially Lethal Drugs

In 2015, 27 million Americans used illegal drugs like heroin and/or misused prescription pain killers. Oxycontin and other opioid pain killers have been identified as the primary gateway drugs to heroin10 — something every person out there needs to be fully aware of.

According to a study published in JAMA Internal Medicine,11 while most opioid drug abusers obtain the drug from a friend or relative, (23 percent pay for them; 26 percent get them for free), individuals who are at greatest risk for drug abuse are just as likely to get them from their doctor.

Addiction to opioids and heroin is now costing the U.S. more than $193 billion each year. Opiates such as oxycodone, hydrocodone, fentanyl and morphine
also kill more Americans than car crashes each year.12

As noted by Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC): “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently.”13

He has also warned that “Patients given just a single course may become addicted for life.”14 Doctors and patients simply must become fully cognizant of this immense risk.

Studies Do Not Support Use of Opioids for Long-Term Use

According to Frieden, studies show that addiction affects about 26 percent of those using opioids for chronic non-cancer pain. Worse, 1 in 550 patients on opioid therapy dies from opioid-related causes within 2.5 years of their first prescription.

Most studies investigating long-term use of opioids have lasted a mere six weeks or less, and those that lasted longer have, by and large, found “consistently poor results.”

Several of them found that opioid use worsened pain over time and led to decreased functioning — an effect thought to be related to increased pain perception.

3 Factors That Make You More Prone to Opioid Addiction

Opioid painkillers work by interacting with receptors in your brain resulting in a decrease in the perception of pain — at least temporarily. As mentioned, over time they can result in increased pain perception, setting into motion a cycle where you need increasingly larger doses, making a lethal overdose more likely.

Oxycontin’s high rate of addiction is the result of a short half-life (the amount of time the drug stays in your system before you are left wanting more). Opioids also create a temporary feeling of euphoria, followed by dysphoria, that can easily lead to physical dependence and addiction.

However, why certain people become addicted while others don’t has remained a mystery. Researchers from the University of Derby set out to determine what might be influencing painkiller addiction by conducting an anonymous survey of people who had pain and had used painkillers in the last month.

The three predictors that identified those most at risk of developing painkiller dependence included those who:15

  1. Used prescription painkillers more frequently
  2. Have a prior history of substance abuse (often unrelated to pain relief)
  3. Are less accepting of pain or less able to cope with pain

According to the authors “Based on these findings, a preliminary model is presented with three types of influence on the development of painkiller dependence: 1) pain leading to painkiller use, 2) risk factors for substance-related problems irrespective of pain and 3) psychological factors related to pain.”

From Prescriptions to Street Drugs

The transition from prescription opioids to street heroin is an easy one. Physical addiction to the drug drives behavior to seek more of the same drug.

When a prescription runs out, a physician refuses to renew, or the cost of the prescription becomes too high to manage, many addicts turn to heroin. Chemically, these drugs are very similar and they provide a similar kind of high.

Without additives, street heroin is as dangerous as Oxycontin, and just as addictive. However, when dealers cut the drug with other drugs, the result may be deadly. In just six days in August 2016, 174 overdoses of heroin were recorded in Cincinnati, Ohio, the largest number of overdoses in one week on record.16

On average, the city records between 20 and 25 overdoses each week. This unprecedented number of overdoses was precipitated by heroin cut with carfentanil.17 Meant to deliver a stronger and more extended high, it resulted in greater overdoses and deaths. This is to be expected, when you consider the drug was originally developed as a tranquilizer for large animals, such as elephants.

Carfentanil is the strongest commercially prepared opioid. Dealers find it delivers a stronger and more addictive high. Newtown Police Chief Tom Synan told Channel 9 WCPO:18

“These people are intentionally putting in drugs they know can kill someone. The benefit for them is if the user survives it is such a powerful high for them, they tend to come back … If one or two people die, they could care less. They know the supply is so big right now that if you lose some customers, in their eyes there’s always more in line.”

Drug Addiction — a Crime or a Disease?

As noted in the video, drug addiction has long been treated as a crime. Views are now changing, and in his recent report on substance abuse, U.S. surgeon general Dr. Vivek Murthy stresses the importance of recognizing drug addiction as a disease.19 He recently told NPR:20

“We now know from solid data that substance abuse disorders … affect the rich and the poor, all socioeconomic groups and ethnic groups. They affect people in urban areas and rural ones … For far too long people have thought about substance abuse disorders as a disease of choice, a character flaw or a moral failing.

We underestimated how exposure to addictive substances can lead to full blown addiction. Opioids are a good example. Now we understand that these disorders actually change the circuitry in your brain … That tells us that addiction is a chronic disease of the brain, and we need to treat it with the same urgency and compassion that we do with any other illness.

While this is good news for addicts and their families, this change did not occur until the victims of addiction were primarily Caucasian. Prior to the opioid epidemic, most people were convinced heroin was a problem relegated primarily to communities of color, and heroin users were viewed as a criminal element.

In 2001, 45 percent of Americans supported tough drug laws where users were simply sent to jail, and most of the federal spending relating to drug abuse was spent on law enforcement. Today, Native Americans and Caucasians have the highest rate of death from opioids; 8.4 and 7.9 per 100,000 people respectively. African Americans, Latinos and Asians are far less affected by this epidemic, with 3.3, 2.2 and 0.7 per 100,000 dying from pain killers respectively.

This shifting demographic of users has led to a change in how people view drug addiction. In 2015, 67 percent of Americans said they support treatment over incarceration for drug addicts, and the 2017 federal budget now includes $14.3 billion for treatment, compared to $9.5 billion for drug law enforcement.

Ending the Epidemic

At present, only 1 in 10 drug addicts receive the help they need, and those who do get into treatment typically face long wait times. About one-third of those who need treatment cannot afford it, or don’t have insurance coverage. There’s still an enormous amount of work that needs to be done to turn this epidemic around, but part of the answer is to become an educated patient, and to never fill that opioid prescription in the first place.

The drug industry and prescribing doctors must also acknowledge their role and take responsibility for its resolution. As noted in the video:

“We need big pharma to be honest about the products they’re selling us. We need doctors to prescribe opiates only when they’re absolutely necessary. We need to think of addiction as a treatable medical condition so people can openly ask for help, like they would for any illness.

We need to improve treatment, so it’s scientific and long-term. We need to shift money away from incarceration and into expanding treatment, so everyone has access as soon as they need it. If you or a friend are struggling with drugs or alcohol, visit halfofus.com for ways to get help.”

Eliminate or radically reduce most grains and sugars from your diet

Avoiding grains and sugars will lower your insulin and leptin levels and decrease insulin and leptin resistance, which is one of the most important reasons why inflammatory prostaglandins are produced. That is why stopping sugar and sweets is so important to controlling your pain and other types of chronic illnesses.

Take a high-quality, animal-based omega-3 fat

My personal favorite is krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, by manipulating prostaglandins.)

Optimize your production of vitamin D

Optimize your vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain.

Medical cannabis

Medical marijuana has a long history as a natural analgesic. Its medicinal qualities are due to high amounts (up to 20 percent) of cannabidiol (CBD), medicinal terpenes and flavonoids. Varieties of cannabis exist that are very low in tetrahydrocannabinol (THC) — the psychoactive component of marijuana that makes you feel “stoned” — and high in medicinal CBD.

Medical marijuana is now legal in 28 states. You can learn more about the laws in your state on medicalmarijuana.procon.org.21

Kratom

Kratom (Mitragyna speciose) is another plant remedy that has become a popular opioid substitute.22 In August, the U.S. Drug Enforcement Administration (DEA) issued a notice saying it was planning to ban kratom, listing it as Schedule 1 controlled substance.

However, following massive outrage from kratom users who say opioids are their only alternative, the agency reversed its decision.23

Kratom is likely safer than an opioid for someone in serious and chronic pain. However, it’s important to recognize that it is a psychoactive substance and should not be used carelessly. There’s very little research showing how to use it safely and effectively, and it may have a very different effect from one person to the next.

Also, while it may be useful for weaning people off opioids, kratom is in itself addictive. So, while it appears to be a far safer alternative to opioids, it’s still a powerful and potentially addictive substance. So please, do your own research before trying it.

Emotional Freedom Techniques (EFT)

EFT is a drug-free approach for pain management of all kinds. EFT borrows from the principles of acupuncture in that it helps you balance out your subtle energy system. It helps resolve underlying, often subconscious, and negative emotions that may be exacerbating your physical pain.

By stimulating (tapping) well-established acupuncture points with your fingertips, you rebalance your energy system, which tends to dissipate pain.

Among volunteers who had never meditated before, those who attended four 20-minute classes to learn a meditation technique called focused attention (a form of mindfulness meditation), experienced significant pain relief — a 40 percent reduction in pain intensity and a 57 percent reduction in pain unpleasantness.24

K-Laser, Class 4 Laser Therapy

If you suffer pain from an injury, arthritis, or other inflammation-based pain, I’d strongly encourage you to try out K-Laser therapy. It can be an excellent choice for many painful conditions, including acute injuries. By addressing the underlying cause of the pain, you will no longer need to rely on painkillers

K-Laser is a class 4 infrared laser therapy treatment that helps reduce pain, reduce inflammation, and enhance tissue healing — both in hard and soft tissues, including muscles, ligaments or even bones. The infrared wavelengths used in the K-Laser allow for targeting specific areas of your body and can penetrate deeply into the body to reach areas such as your spine and hip.

Chiropractic

Many studies have confirmed that chiropractic management is much safer and less expensive than allopathic medical treatments, especially when used for pain such as low back pain.

Qualified chiropractic, osteopathic and naturopathic physicians are reliable, as they have received extensive training in the management of musculoskeletal disorders during their course of graduate healthcare training, which lasts between four to six years. These health experts have comprehensive training in musculoskeletal management.

Acupuncture

Research has discovered a “clear and robust” effect of acupuncture in the treatment of back, neck and shoulder pain, osteoarthritis and headaches.

Physical therapy

Physical therapy has been shown to be as good as surgery for painful conditions such as torn cartilage and arthritis.

Massage

A systematic review and meta-analysis published in the journal Pain Medicine included 60 high-quality and seven low-quality studies that looked into the use of massage for various types of pain, including muscle and bone pain, headaches, deep internal pain, fibromyalgia pain and spinal cord pain.25

The review revealed that massage therapy relieves pain better than getting no treatment at all. When compared to other pain treatments like acupuncture and physical therapy, massage therapy still proved beneficial and had few side effects. In addition to relieving pain, massage therapy also improved anxiety and health-related quality of life.

Astaxanthin

Astaxanthin is one of the most effective fat-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than anti-inflammatory drugs. Higher doses are typically required and you may need 8 milligrams (mg) or more per day to achieve this benefit.

Ginger

This herb has potent anti-inflammatory activity and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.

Curcumin

In a study of osteoarthritis patients, those who added 200 milligrams (mg) of curcumin a day to their treatment plan had reduced pain and increased mobility. A past study also found that a turmeric extract composed of curcuminoids blocked inflammatory pathways, effectively preventing the overproduction of a protein that triggers swelling and pain.26

Boswellia

Also known as boswellin or “Indian frankincense,” this herb contains specific active anti-inflammatory ingredients. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.

Bromelain

This enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form but eating fresh pineapple, including some of the bromelain-rich stem, may also be helpful.

Cetyl Myristoleate (CMO)

This oil, found in fish and dairy butter, acts as a “joint lubricant” and an anti-inflammatory. I have used this for myself to relieve ganglion cysts and a mildly annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards. I used a topical preparation for this.

Evening Primrose, Black Currant and Borage Oils

These contain the essential fatty acid gamma-linolenic acid (GLA), which is useful for treating arthritic pain.

Cayenne Cream

Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body’s supply of substance P, a chemical component of nerve cells that transmits pain signals to your brain.

Methods such as yoga, Foundation Training, acupuncture, exercise, meditation, hot and cold packs and mind-body techniques can also result in astonishing pain relief without any drugs.

Grounding

Walking barefoot on the earth may also provide a certain measure of pain relief by combating inflammation.

Acupuncture Beats Injected Morphine for Pain: Groundbreaking Study


An amazing new study has found that acupuncture, the ancient practice of using needles to stimulate bodily self healing, is more effective than intravenous morphine for pain. 

A truly groundbreaking study published in the American Journal of Emergency Medicine titled, “Acupuncture vs intravenous morphine in the management of acute pain in the ED,” reveals that acupuncture — one of the oldest techniques to treat pain — is more effective, faster in relieving pain, and with less adverse effects, than intravenous morphine.

The study was conducted over the course of a 1-year period at the Fattouma Bourguiba University Hospital in Tunisia, a tertiary care facility with over 100,000 Emergency Department (ED) visits per year.

300 ED patients with acute pain were included in the study: 150 in the morphine group (administered up to 15 mg a day) and 150 in the acupuncture group. The two groups were comparable in terms of age, sex, and co-morbidities, with the only significant difference being that there were more abdominal pain patients in the morphine group and more low back pain cases in the acupuncture group.

The striking results were reported as follows:

Success rate was significantly different between the 2 groups (92% in the acupuncture group vs 78% in the morphine group P b .01). Resolution time was 16 ± 8 minutes in the acupuncture group vs 28 ± 14 minutes in the morphine group. The difference was statistically significant (P b .01). The mean absolute difference in pain score between the 2 groups was 7.7. This difference is not clinically significant because the minimal clinically significant absolute difference reported by Todd et al is 13. In morphine group, the mean total dose of morphine administered was 0.17 ± 0.08 mg/Kg (Table 2).

The pain scale change from baseline at each time point in the 2 groups is shown in Figure. From the 5-minute time point, the acupuncture group reported significantly larger pain decrease compared with the morphine group. This difference persisted during the entire study period. Change of blood pressure, HR, RR, and oxygen saturation was not significant in both groups.

Overall, 89 patients (29.3%) experienced minor adverse effects: 85(56.6%) in morphine group and 4 (2.6%) in acupuncture group; the difference was significant between the 2 groups (Table 3). The most frequent adverse effect was dizziness in the morphine group (42%) and needle breakage in the acupuncture group (2%). No major adverse effect was recorded during the study protocol. (See Table 4.)”

In short, the acupuncture group saw a great pain-relieving effect, which occurred faster, with significantly less side effects.

A graph from the study showing the pain-decreasing differences between morphine and acupuncture

Discussion

Since 1996, the World Health Organization has recognized acupuncture as a safe and effective therapy for the treatment of a wide range of conditions, including pain and discomfort.1 Despite this, the use of acupuncture within the conventional standard of care is still exceedingly rare. A deep skepticism exists for therapeutic modalities that do yet have a clearly characterized mechanism of action, as defined through conventional biomedical understanding and terminology. Often, in lieu of this, its therapeutic effects are written off as merely “placebo.”

Acupuncture Beats Injected Morphine for Pain: Groundbreaking Study

Placebo, however, is not as diminutive term as it may first seem.  The placebo effect actually reflects the deep power and regenerative capability of the body-mind to heal itself. And since its power translates directly into real, measurable improvements in terms of clinical outcomes, it does not matter if we fully understand “how” it works. Also, consider that “evidence-based” (EB) medicine not only depends entirely on clinical outcomes as final proof of an intervention’s efficacy, but also, the entire EB medicine model depends on “controlling” for the placebo effect, as it is already tacitly recognized as having immense power in influencing the outcomes in most interventions. And so, whether or not a fully known or plausible “mechanism of action” has been identified is secondary in importance to whether it works or not in clinical practice.

Acupuncture happens to be one of the most extensively supported alternative modalities, with clinical trial data supporting its value in over 100 different conditions. If you do a pubmed.gov search you’ll find over6,700 published studies related to the keywords “pain” and “acupuncture.” You can view the primary literature we have gathered on the topic on the GreenMedInfo.com Acupuncture portal:

Click to access the Acupuncture Database on GreenMedInfo.com

Clearly the new study reveals that acupuncture has a powerful role to play in pain management. With addiction to pain relieving drugs affecting millions around the world, acupuncture is perfectly poised to provide patients a time-tested, drug-free alternative. As you can see from the study’s graph, the adverse effects comparison is staggeringly in favor of acupuncture as the safer modality.

Finally, here are the study’s powerful conclusions:

Our study demonstrated that in patients with acute pain syndromes presenting to the ED, acupuncture is at least as efficacious and has a better safety profile than IV morphine. The results of this study suggest that acupuncture has a potential role in controlling acute pain conditions presenting to EDs and appears to be safe and effective. Future studies should be performed in international populations. “

Morphine blunts antiplatelet response in acute MI


Morphine weakens antiplatelet response among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) to restore blood flow to the heart.This was the key finding from a study presented at the recent ACC 2016 Scientific Sessions.

Patients treated with morphine had worse measures of platelet activity within an hour of receiving a loading dose of aspirin plus ticagrelor (Brilinta, AstraZeneca) or clopidogrel. [ACC 2016, abstract 1105-113]

“Morphine has been widely used to alleviate chest pain and anxiety of patients suffering from an acute MI,” said study author Dr. Manivannan Srinivasan from the East and North Hertfordshire NHS Trust in the UK. “But the drug can also delay gastric emptying and reduce the absorption of other oral medications.”

Srinivisan and team examined 125 consecutive patients (mean age 66; 93 percent male) with acute STEMI who were scheduled to undergo emergency primary PCI. Of these, 101 patients (81 percent) had received morphine in ambulance enroute to the hospital. About half had hypertension, 42 were smokers, and 16 percent had type 2 diabetes (T2D).

Once in the catheterization laboratory, 102 patients were each given a loading dose of aspirin 300 mg and clopidogrel 600 mg while the rest received ticagrelor 180 mg. Within 30 to 60 minutes, blood tests were done to determine occlusion time and lysis time.

Compared with the patients who had not received opiates, those who had received morphine had a shorter mean occlusion time (358 s vs 670 s; p<0.001) and a longer median lysis time (1392 s vs 1184 s; p=0.006).

However, by day 2, the two groups had similar occlusion times (485 s vs 552 s) and lysis times (1322 s vs 1184 s).

The study was not powered to determine hard safety end points, but there was a nonsignificant trend to greater in-hospital adverse events in the 101 patients who had received morphine vs the other 24 patients (1 vs 0 death, 1 vs 0 MI, and 2 vs 0 stroke).

“Whether this [morphine] affects recurrent early thrombosis risk and whether nonopiate analgesia may proffer advantages in this setting require further assessment,” said the researchers.

Large clinical trials are warranted to confirm the finding and to determine how this effect on platelets translates into patient outcomes. “Until then, caution should be exercised in the use of IV morphine and consideration given to other intravenous medication if morphine treatment is to be used,” said Srinivasan.

“There are other alternatives that we can explore, such as nonopioid medication such as IV paracetamol,” he noted. “Once morphine is given, we may consider giving other IV agents that bypass the gastric emptying, such as GP IIb/IIIa inhibitors or bivalirudin.”

Friends Provide Better Pain Relief Than Morphine, Oxford University Study Reveals


Social bonding has played a key role in our survival as a species. Some of the noted benefits of friendship from an evolutionary perspective include reduced vulnerability to predators, greater access to food resources, and protection from harassment. Today, though most of us no longer worry about being mauled by a predator as we go about our daily business, a healthy network of friends is still extremely valuable, acting like a safety net in life. Bolstered by the support of good friends, we can bound to great heights and celebrate the joys of life, and know that if we fall there will be someone there to offer comfort and assistance, to share our deepest fears and disappointments, and help make the dark moments much more bearable.

Friends 'better than morphine' for pain - University of Oxford reports

Recent studies have explored the science behind friendships and discovered that there are actually measurable differences between people who have strong, healthy social networks and those who don’t. In particular, people with strong friend connections were found to experience significantly better states of physical and mental health.

“People with social support have fewer cardiovascular problems and immune problems, and lower levels of cortisol — a stress hormone,” says Tasha R. Howe, PhD, associate professor of psychology at Humboldt State University.

Adding to the growing research on the benefits of friendship, a recent study conducted by researchers at Oxford University established that people with more friends have higher pain tolerance. Katerina Johnson, a doctoral student in the University’s Department of Experimental Psychology, wanted to investigate the relationship between our neurobiology and the size of our social networks.

“I was particularly interested in a chemical in the brain called endorphin. Endorphins are part of our pain and pleasure circuitry — they’re our body’s natural painkillers and also give us feelings of pleasure. Previous studies have suggested that endorphins promote social bonding in both humans and other animals. One theory, known as ‘the brain opioid theory of social attachment’, is that social interactions trigger positive emotions when endorphin binds to opioid receptors in the brain. This gives us that feel-good factor that we get from seeing our friends,” said Johnson. “To test this theory, we relied on the fact that endorphin has a powerful pain-killing effect — stronger even than morphine.”

The study was designed to use pain tolerance to test the brain’s endorphin activity. The researchers theorised that people with larger social networks would, as a result, have higher pain tolerance. The findings of the study supported their theory in that it showed that indeed, strong social connections were correlated with higher pain tolerance.

“These results are also interesting because recent research suggests that the endorphin system may be disrupted in psychological disorders such as depression. This may be part of the reason why depressed people often suffer from a lack of pleasure and become socially withdrawn,” explained Johnson.

The study also noted that people with higher levels of stress hormones were more likely to have smaller groups of friends.

“The finding relating to stress may indicate that larger social networks help people to manage stress better, or it may be that stress or its causes mean people have less time for social activity, shrinking their network.

“Studies suggest that the quantity and quality of our social relationships affect our physical and mental health and may even be a factor determining how long we live. Therefore, understanding why individuals have different social networks sizes and the possible neurobiological mechanisms involved is an important research topic. As a species, we’ve evolved to thrive in a rich social environment but in this digital era, deficiencies in our social interactions may be one of the overlooked factors contributing to the declining health of our modern society,” Katerina explained.

As mentioned in the final statement it is not just the size of our social network that is important to our wellbeing, but the quality of the friendships that matters as well. With the advent of the internet modern society is changing quickly, and our interactions are increasingly occurring online. Even though the internet can be a great way to connect with likeminded people, online friends just aren’t the same as those we can actually sit with and look directly in the eye when we communicate–and a digital hug is just nowhere near as good as a real one!

Tips-how to make real friends:

Get out: Some great ways to meet people in real life include volunteering, taking a class, or joining a club or interest group (websites like meetup.com list groups with various interests that meet up in real life locations around the world).

Be yourself: A healthy relationship is built on truth and realness. People who attempt to come across as something they are not often have difficulty making real friends because people tend to sense a lack of genuineness in their approach. Trust that real friends worth having will value you for who you truly are. If you feel a bit shy or awkward try mentioning it. This can act to alleviate the tension, and a potential real friend will value your sincerity. Remember, people tend to feel more at ease with friends who are able to share their weakness as well as their strengths.

A healthy friendship is a two way street: While you can’t develop a real friendship without sharing aspects of yourself, it is important not to get so caught up in your own story that the other person doesn’t feel valued or heard. Don’t be afraid to show interest in the other person, pay attention, listen carefully, and ask questions about their life, opinions, and feelings about things. Both parties should feel enriched by the social interaction. If one person feels drained afterwards, it can be an indication that the dynamic is not balanced.

Try to focus on the positive: If you are someone who tends to focus on the negative, this could be affecting the quantity and quality of your friendships, as well as your worldview. Learning to lessen your focus on the negative will not only make you more appealing to others, it will likely make your whole life experience more uplifting.

Don’t rush: Though there are times when we meet someone and feel an instant connection that feels like it reaches beyond this life, these special friendships are not the norm. Usually a deep friendship takes time to cultivate; it certainly can’t be forced. Try not to catapult yourself into a person’s life. People are often inclined to withdraw when someone comes across as too forward, desperate or needy.

Alone time: In the same way that it is important to give others space, it is also important to take time to love and nourish ourselves. When we take responsibility for our own wellbeing we don’t need to rely on others to uplift us. Having a healthy internal foundation means that we approach a friendship from a space of desire rather than neediness.

Morphine blunts antiplatet response in acute MI


Morphine weakens antiplatelet response among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) to restore blood flow to the heart.This was the key finding from a study presented at the recent ACC 2016 Scientific Sessions.

Patients treated with morphine had worse measures of platelet activity within an hour of receiving a loading dose of aspirin plus ticagrelor (Brilinta, AstraZeneca) or clopidogrel. [ACC 2016, abstract 1105-113]

“Morphine has been widely used to alleviate chest pain and anxiety of patients suffering from an acute MI,” said study author Dr. Manivannan Srinivasan from the East and North Hertfordshire NHS Trust in the UK. “But the drug can also delay gastric emptying and reduce the absorption of other oral medications.”

Srinivisan and team examined 125 consecutive patients (mean age 66; 93 percent male) with acute STEMI who were scheduled to undergo emergency primary PCI. Of these, 101 patients (81 percent) had received morphine in ambulance enroute to the hospital. About half had hypertension, 42 were smokers, and 16 percent had type 2 diabetes (T2D).

Once in the catheterization laboratory, 102 patients were each given a loading dose of aspirin 300 mg and clopidogrel 600 mg while the rest received ticagrelor 180 mg. Within 30 to 60 minutes, blood tests were done to determine occlusion time and lysis time.

Compared with the patients who had not received opiates, those who had received morphine had a shorter mean occlusion time (358 s vs 670 s; p<0.001) and a longer median lysis time (1392 s vs 1184 s; p=0.006).

However, by day 2, the two groups had similar occlusion times (485 s vs 552 s) and lysis times (1322 s vs 1184 s).

The study was not powered to determine hard safety end points, but there was a nonsignificant trend to greater in-hospital adverse events in the 101 patients who had received morphine vs the other 24 patients (1 vs 0 death, 1 vs 0 MI, and 2 vs 0 stroke).

“Whether this [morphine] affects recurrent early thrombosis risk and whether nonopiate analgesia may proffer advantages in this setting require further assessment,” said the researchers.

Large clinical trials are warranted to confirm the finding and to determine how this effect on platelets translates into patient outcomes. “Until then, caution should be exercised in the use of IV morphine and consideration given to other intravenous medication if morphine treatment is to be used,” said Srinivasan.

“There are other alternatives that we can explore, such as nonopioid medication such as IV paracetamol,” he noted. “Once morphine is given, we may consider giving other IV agents that bypass the gastric emptying, such as GP IIb/IIIa inhibitors or bivalirudin.”

What Makes an Opioid Stronger or Weaker Than Morphine?


CDC classification of stronger, weaker, and morphine-equivalent opioids is confusing.

A February 2015 report from the Centers for Disease Control and Prevention provided updated estimates of prescription opioid analgesic use among adults ages 20 and over. The authors concluded that “the percentage who used only a ‘weaker-than-morphine-opioid’ in the past 30 days declined from 42.4% in 1999-2002 to 20% in 2011-2012, while the percentage who used a ‘stronger-than-morphine-opioid’ significantly increased from 17.0% in 1999-2002 to 37.0% in 2011-2012.”

Weaker-than-morphine opioids included codeine, dihydrocodeine, meperidine, pentazocine, propoxyphene, and tramadol; morphine-equivalent opioid analgesics included hydrocodone, morphine, and tapentadol; and stronger-than-morphine opioids included fentanyl, hydromorphone, methadone, oxycodone, and oxymorphone.

It is extremely concerning that a distinguished agency such as the CDC should use confusing terminology to classify the drugs whose use they reported.

It is true that the six drugs in the weaker-than-morphine category cannot provide pain relief of the magnitude provided by morphine. However, these drugs have very different pharmacologic characteristics. Furthermore, the fact that perhaps five of them are used less than they were a decade ago suggests that clinicians are making good decisions about the drugs to use for pain control.

Propoxyphene’s limitations led to its being removed from the market in November 2010. Meperidine has such significant limitations that guidelines warn clinicians to use it only for short procedures. It’s difficult to conceive of a reason for using pentazocine. The pain relief provided by codeine is due to the morphine to which it is metabolized; some individuals lack the enzyme required to bring about its metabolism and will not get pain relief from the drug, others metabolize it so rapidly that they can develop life-threatening respiratory depression.

In 2013, the FDA issued a warning that addressed safety concerns about codeine, particularly about its use in children. Tramadol has a different mechanism of action than does morphine; there is a ceiling to the pain relief that tramadol can provide. It makes no sense to put it in the same category as the other drugs.

It is puzzling that the authors put hydrocodone, morphine, and tapentadol in the “morphine-equivalent” category.

Hydrocodone may indeed be a “morphine equivalent” analgesic, but only in the last year has it been marketed without a non-opioid such as acetaminophen. Such a non-opioid limits the dose that can be administered. Furthermore, hydrocodone is not available for intravenous administration.

Tapentadol does not have the same mechanism of action as morphine; it has a dose ceiling whereas morphine does not. Therefore, it does not make sense to classify it as a morphine-equivalent analgesic.

The authors assert that fentanyl, hydromorphone, methadone, oxycodone, and oxymorphone are “stronger” than morphine.

While it is true that a smaller dose of these drugs may be required to obtain the same analgesic response as can be obtained with morphine, that fact does not mean that they have greater effectiveness.

Morphine is a very effective analgesic and can be given in very large doses to control very severe pain in persons at the end of life. About 20 mg of oral oxycodone and 7.5 mg of oral hydromorphone are required to obtain the same amount of pain relief as is obtained with 30 mg of oral morphine. Are those the data the authors used to classify these drugs as stronger than morphine?

 There is a great deal of controversy and confusion about opioid analgesics and the role they should play in the control of persistent pain. Clarity about the meaning of terms and about opioid pharmacology is essential if there is to be a constructive dialog about the role of these drugs in pain control.

It is unfortunate that this report adds to the confusion by providing inappropriate classifications of analgesics. One might conclude from the data that there has been an increase in the use of appropriate analgesics (the pure opioid agonists) and a decrease in the use of inappropriate analgesics (drugs with limited efficacy and limiting side effects), but is that the message the authors meant to convey?

New painkiller found in coffee – stronger than morphine .


Coffee contains a protein that has an effect similar to morphine, specialists at the University of Brasilia and Brazilian agriculture research company Embrapa have discovered. Moreover, the new substance’s effect lasts longer.

The research was conducted by Felipe Vinecky of the Molecular Biology Department at the University of Brasilia (UnB) in cooperation with the Genetics and Biotechnology Division of state owned agriculture and livestock research company Embrapa. The research involved searching for and combining coffee genes to affect quality. In the course of study, the scientists managed to find new substances in the product.

While analyzing the coffee genome sequence and corresponding proteins, Vinecky and his research adviser Carlos Bloch Junior found some proteins similar to those typical for humans. So they decided to synthesize their structural analogues and test their properties.

The researchers “identified previously unknown fragments of protein — peptides — in coffee that have an effect similar to morphine, in other words they have an analgesic and sedative activity,” the Embrapa company press release said.

Both the University and Embrapa applied for patents to the Brazilian government for seven proteins they called “opioid peptides.”

Those peptides “have a positive differential: their effects last longer in experiments with laboratory mice,”the press release said. According to the scientists, it lasted up to four hours and no side effects were recorded.

Embrapa believes their discovery has great “biotechnological potential” for the health food industry, and could also help to minimize stress in animals at slaughterhouses.

In 2004, Embrapa succeeded in determining the sequence of coffee’s functional genome and the discovery made it possible to combine coffee genes with a view to improving the quality of coffee grains. Thanks to this achievement, the researchers managed to discover the new peptides.

Embrapa is a state-owned company affiliated with the Brazilian Ministry of Agriculture. Embrapa conducts agricultural research in many areas including livestock and crops.

Codeine risky for kids after certain surgeries, FDA says.


Children who are given codeine for pain relief after surgery to remove tonsils or adenoids are at risk for overdose and death, U.S. health officials said.

The U.S. Food and Drug Administration said a new boxed warning—the agency’s strongest caution—will be added to the labels of codeine-containing products to warn about this danger.

The FDA strongly recommends against the use of codeine to manage pain in children after surgery to remove tonsils or adenoids, and suggests that doctors use an alternate pain reliever. The agency also said parents and caregivers need to be aware of the risks and ask for a different pain medicine if their children are prescribed codeine after having their tonsils or adenoids removed.

Codeine is an opioid (narcotic) medication used to treat mild to moderate pain and is often prescribed to children after tonsil or adenoid removal. However, some children have died after being given codeine within the recommended dose range.

 

In August 2012, the FDA warned about the danger in children who are “ultra-rapid metabolizers” of codeine, which means their liver converts codeine to morphine in higher-than-normal amounts. High levels of morphine can result in potentially fatal breathing problems.

Since then, a safety review by the FDA identified 10 deaths and three overdosesassociated with codeine that occurred among children in the United States between 1969 and May 2012. Many of these children were recovering from surgery to remove tonsils or adenoids.

All of the children, aged 21 months to 9 years old, received doses of codeine within the normal dose range. Signs of morphine overdose developed within one to two days after the children began taking codeine, the FDA said in an agency news release.

 

Codeine is available by prescription either alone or in combination with acetaminophen and aspirin, and in some cough and cold medications.

When prescribed to treat pain, codeine should not be given on a fixed schedule, but only when a child needs relief from pain. They should never receive more than six doses in a day, the FDA said.

Children receiving codeine for pain should be closely monitored for signs of morphine overdose. These include: unusual sleepiness, such as being difficult to wake up; confusion or disorientation; breathing problems; and blueness on the lips or around the mouth