#PewPerspectives - Week of Jan 22

Following are the stories that I posted on LinkedIn during this week in case you missed them, along with my additional editorial comments in bold. View counts are as of 3:30pm ET on January 29.

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Stanford’s Darnall to Discuss Pain Relief at the World Economic Forum (433 views)

Attendees at the World Economic Forum are in for an awakening about true management of pain. Beth Darnall is a wonderful ambassador for rethinking pain -- "Living one’s best life within the context of pain requires learning how to steer the nervous system towards relief. I like to say that we are born motivated to escape pain, but we are not born knowing how to modulate pain or the distress that it causes us. This must be learned." Since the Forum is now complete (Jan 23-26), I'm hopeful of reading how Beth's message was received and the way forward. Pain is a driver of economies around the world, from the cost of treating pain to the impact of pain on productivity in the workplace and communities. So finding out the best ways to properly treat pain is not only important to those in pain but to everyone else as well.

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Suboxone vs. Vivitrol: A Head-to-Head Comparison (648 views)

Medication assisted treatment (MAT) is part of the #CleanUpTheMess conversation. IMO, detox & lifelong recovery can happen without MAT as I've seen from patient examples and discussions with physicians & psychologists. MAT can also be somewhat controversial (as former HHS Secretary Tom Price stated, "substituting one opioid for another"). Read my 10/22/15 blogpost "Obama, Opioids, and MAT" at for more context. However, MAT is the best option for many to achieve long-lasting recovery. So how to decide between the different options? I know some physicians that prefer one over the other, and I know others who choose the drug based on the patient's circumstances. This research article is an interesting comparison between buprenorphine (Suboxone) and naltrexone (Vivitrol). As near as I can tell the authors have no bias as they list pros and cons. Bottom line - It looks like Suboxone works best during the first 6 weeks and Vivitrol after 6 weeks. However, when the comparison was level-set with all "successful start" patients (required #opioid abstinence when starting Vivitrol reduces that #), results were very similar. Of course, the #BioPsychoSocial approach is key to BOTH drugs (and to non-MAT). The primary goal is to eliminate recidivism (i.e. relapse), and there is no "one size fits all" when it comes to creating lifelong change. I appreciated their final statement: "One key next step is learning about what can be added to medication and associated professional treatment (e.g., weekly counseling) to improve outcomes even more." Whatever the method chosen, a whole-person and individualized treatment plan must be developed because this process is complicated.

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National Drug and Alcohol Facts Week? (151 views)

This week (Jan 22-26) is "National Drug and Alcohol Facts Week?" as hosted by the National Institute on Drug Abuse (NIDA). While this was primarily focused on teenagers, drug and alcohol abuse is obviously not just an issue for them. Check out their "Opioids & Other Prescription Drugs Event Toolkit" that offers some excellent resources.

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Surprising stats on drugs in the workplace (787 views)

Interesting, and sad, statistics about the use of drugs in (like, while they are on the job at) the workplace. With some caveats. Obviously, the 70% number cannot be applied to all 323.1M Americans. First, they only interviewed 1,121 professionals (0.00000034%). Secondly, they only interviewed those who "admitted to having used drugs in the workplace" (so there was a selection bias as they didn't apparently interview anyone who did NOT take drugs at the workplace). Third, other than amphetamines and cocaine (obviously illicit drugs), the pollsters didn't qualify whether the opiates (17.83%), benzodiazepines (17.05%) used were medical or non-medical (i.e. recreational) use, although they implied the latter with their follow-up questions about how they passed drug tests, whether they used with co-workers or sold to/purchased from co-workers. You always have to be aware of the details beyond the headline - Don't just read the headline (or the first paragraph) and make assumptions but read the entire article from top-to-bottom. With all those caveats, it's still informative for how drug use that creates an impaired workforce actually fits into the work day, and how complex it is to be an employer in this culture. FYI ... Marijuana was excluded from the study due to varying legality around the U.S. I'm sure if it were, the statistics would be even more sobering for employers.

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How and Why CBT Relieves Chronic Pain – Part II (657 views)

If you don't know much about Cognitive Behavioral Therapy (CBT), this is a great starting point from one of the leaders in its implementation in Work Comp, Michael Coupland. He and I have had many discussions over the past several years (and I've seen him present on several occasions) and this article is a great explanation. I have seen a growing acceptance of CBT by Work Comp payers since I first started advocating for it in 2013, but that acceptance is not universal and to some degree based on geography (anecdotal evidence, I know, but in some recent presentations many more people confirm paying for CBT in CA than in GA or NY). So we still have a long way to go. Since every journey starts with a single step, reading this article will be help plant firmly that first step. Most doctors - and all psychologists - I know strongly advocate for the use of CBT when dealing with pain. And all agree that it should be part of the detox / functional restoration process of helping someone taper off an inappropriate polypharmacy regimen. Support of CBT is growing in the payer community but it is still too often either not approved or not paid for at market rates. We need to do better.

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New York City Sues Companies Over Opioid Abuse (1,435 views)

NYC joins the #lawsuit trend in relation to the #opioid epidemic - 5 manufacturers and 3 distributors. What they say they need to help reverse the problem? Almost $500M. This is obviously a big development given the size of NYC. Check out my 11/7/17 blogpost "Making BOP Pay" for context as lawsuits have unfolded. In case you don't have a subscription to the Wall Street Journal, here's a NY Times article covering NYC's decision.

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How to Store and Dispose of Your Prescription Pain Relievers (1,152 views)

If you, your family or friends, your co-workers and community members, are using prescription drugs for pain (opioids like Percocet or OxyContin, benzos like Xanax or Valium, the muscle relaxant Soma), then it is IMPERATIVE that you either secure them in your house or dispose of them. Unused drugs stored for a "rainy day" are extremely dangerous. First, your condition may have changed since the date they were prescribed for you which means they are potentially no longer appropriate for you. Secondly, the medicine cabinet is a target for those that abuse, misuse or divert (sell) those drugs (it doesn't matter whether you're a stranger or a brother - so many stories of guests rifling thru medicine cabinets for their supply). Thirdly, the potential of fatal results for a child taking these drugs - on purpose or by accident - is off the charts bad. This article outlines the options for safe storage & proper disposal. Read and react - before it's too late. I have used both a disposal kiosk in a nearby Walgreens ("My Opioid Experiment") and the DEA's designated take-back day for unused medications (from my daughter's ACL reconstructive surgery). Each were convenient and anonymous (in case someone is concerned about that). The location / method is less important than the outcome (they are out of harm's way).

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Powerful opioids are easily sold through the Internet and shipped in the mail, investigation finds (241 views)

And this is why law enforcement is part of #CleanUpTheMess - illicit fentanyl shipped thru normal channels to buyers with easy access to sellers (often in China). The "war on drugs" is not well liked on social media, but in this case it really is a "war" that must be waged as such. The purveyors of death and destruction that manufacture or sell these drugs need to be found and held accountable.

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FDA, FTC warn companies for selling illegal, unapproved opioid cessation products using deceptive claims (573 views)

Unfortunately it appears as though the #opioid epidemic has created a business opportunity. The FDA just warned several companies with "opioid cessation" products that their claims better match their outcomes. Their press release even used the term "health fraud scam" to describe "unscrupulous vendors". Obviously I'm just stating what the FDA said and will leave it to them to explain why these vendors were singled out. Desperation can sometimes lead to poor decisions, and when something comes along with "unsubstantiated claims" that sounds good (and maybe cheap), it may be easy to use them as opposed to perform due diligence as to whether they are beneficial. Given some of the marketing phrases quoted that are on these vendor's websites, they're obviously built for search engine optimization (i.e. common keywords that people type into search engines that might lead these products to come up on page one). As I continually say, it's each individual's responsibility to perform their own due diligence on what they put into their mouth. In this case, just because they say it doesn't mean it's necessarily true. From highway billboards to TV commercials to websites, many solutions are being sold. Do your homework!

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In addition, I published one blogpost:

• "#PewPerspectives - Week of Jan 15" on January 24

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

#CleanUpTheMess