Mark's Musings - July 1

Below is an aggregation of the stories I posted on LinkedIn since my last edition. I curate them through the prism of an "intersection of chronic pain and appropriate treatment" and so they come attached with my opinion.

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Applause for the CDC opioid guideline authors (681 views)

"The assumption that 'less opioids is always better, for everyone,' is just as flawed as assuming that an opioid is right for everyone; absolutes in either direction confer risk." Beth Darnall talks about how the CDC opioid guidelines in 2016 were "less controversial in content" but have sometimes been "misapplied". The target is always a balance ("Appropriate, Not Zero, Opioids") but nuance isn't always our society's strong suit when confronted with a complicated and difficult issue (as the evolving #opioid epidemic was and continues to be). The "CDC clarified this critical point today: dose thresholds were designed only for the initiating of opioid therapy, and were never intended to justify forcing patients taking long-term opioids down to these thresholds, or being denied these medications at all." It's a red flag for me when somebody articulates a binary argument - it's either true or false, yes or no - in the midst of a very complex circumstance. In the case of Rx opioids, the real answer is ... it depends.

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15 Stretches You Should Do Every Day (1,174 views)

A lot of these stretches look familiar (I didn't know their official name). Many people that I know living with #ChronicPain incorporate stretching into their daily routine. The best thing? It's free! You can do it at any time! It doesn't require a "prescription"! It does not require a clinician's involvement (or wasting time in the appropriately named waiting room)! You just need to be disciplined enough to do them. I often do stretches #1, #2, #4 and #13 but the others look equally interesting (and helpful) so I'm printing out the article to remind me of all fifteen. I appreciated their noting "deep breathing" as I do that in conjunction with the stretches for a mental break. It's never a bad time to get your body ready for the day!

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These commonly prescribed medications may increase your risk of dementia, study finds (1,065 views)

"If you or someone you love is 60+ years and takes over-the-counter allergy, mood, or sleep aid medications, consult your doctor or pharmacist immediately. There’s a good chance the drug is an anticholinergic. These drugs are linked to dementia." Look at the list of medications and you'll find many you recognize, in #WorkersComp and among family/friends. And the drugs you recognize are often used long-term ("1,095 daily doses within a 10-year period"), which is the primary issue. While "this is an observational study so no firm conclusions can be drawn about whether these anticholinergic drugs cause dementia" ... the drugs "resulted in nearly '50% increased odds of dementia'." Cause or not, this should be a warning. Like I always say - Understand the (now and future) implications of everything you put in your mouth. It's important to note that an individual should not do anything about this themselves but consult with their prescriber(s) on whether there is a concern for ongoing use. There was an original rationale for the prescription so deciding to not take the medications on your own might be the wrong response.

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Employee wellness programs do pay off, the research is wrong (711 views)

Remember when a much publicized JAMA study came out saying that wellness programs did not have a ROI because measurables like "health, health care spending and utilization, or employment outcomes" didn't change? Well ... "not so fast, my friends." I talked about my contrarian view of that conclusion in my April 29 Musings. A new study from WebMD confirms a similar perspective about the "snowball effect of good health practices" by "looking at comprehensive health factors -- rather than isolated variables." So don't bury wellness programs just yet! This comment from Jason Parker helps provide even more insight: "I think this is key in their position, 'So by making employees happier and less likely to leave, well-being programs can save employers money even without directly lowering health-care spending'. Where wellness programs have failed is in incentivizing, reduction of co-pays for health outcomes, etc. There is an argument to be made that wellness programs can be a 'benefit' that an employer can offer but when it is tied to cost reduction, or cost utilization is when it tends to falter. Cost containment as an outcome is a zero-sum game (IMHO) - somebody wins and somebody loses and the employer/insurer are the house...and the house never loses. The article makes the case that wellness programs is actually an engagement tool rather than a health-based outcome tool. And that is great...lets just be clear on what we are spending our money on, why, and what are we measuring as success. I think that employers shouldn't be looking at health outcomes but the indirect consequences of an 'unwell' organization such as frequency and duration of absences."

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Provisional Data Predict Overdose Death Rates Will Fall for First Time in Decades (386 views)

This is good news about the (so far - the CDC is still counting) change in trajectory of drug #overdose deaths. But it's obviously not a victory when a projected 69,100 people will have died in 2018. And when you realize that #Naloxone is likely a primary driver of the decline in deaths. Obviously, it's a good thing to save people's lives - we should do that at every opportunity. But reversing an overdose is treating the symptom and not the cause. My guess (based on what I've read and heard) is that the number of overdoses continues to increase thanks to the growing prevalence of illicit #fentanyl and it's analogues ("predicted 32,159 deaths from synthetic #opioids ... up from the predicted 29,092 deaths ... in 2017"). Here's an example: At Bonnaroo a couple of weeks ago, local TV announced every member of law enforcement was going to have naloxone and there were standalone naloxone kiosks for attendees to access. The week prior there had been an outbreak in overdoses because the local marijuana had fentanyl in it. So now is not the time to pause but to press on. These are obviously national statistics. Changes are different in each state. For example, Ohio is trending towards a 23.3 percent decrease while Missouri has a 15.3 percent increase and New Jersey has a 11.6 percent increase. It's important to keep both a macro and micro viewpoint because each have different strategies and tactics. And it's important to realize that victory over this societal scourge is still on the horizon and not in our grasp ... yet.

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Legal weed: Should past crimes be cleared? (242 views)

"Legal weed: Should past crimes be cleared?" An interesting dialogue on #marijuana - one that is being / will be repeated in other states beyond Illinois. I appreciate Yahoo's approach on this, and other issues, as a balanced review of both sides of a specific question. This issue (more specifically, a social justice narrative) is the latest evolution (proponents have moved among various arguments since the 60's) in the NORMLization of #cannabis. That evolution in arguments is yet another reason why marijuana - absent a calamitous event - is not reversing the trends toward legalization and decriminalization. So, as I keep saying, it's all about risk management.

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In addition, I published two blogposts:

• "Mark's Musings - June 24" on June 26
• "What’s Next for Pain – Pharma?" on June 25 by WorkCompWire

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#PreventTheMess + #CleanUpTheMess = The Answer.