#PewPerspectives - Week of Sep 11

Following are the stories that I posted on LinkedIn last week in case you missed them, along with my editorial comments. View counts are as of 1:00pm ET on September 26.

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Hocking College first to say it will test Ohio medical marijuana (141 views)

With medical marijuana legalized in Ohio effective Sep 2018, Hocking College has signed up to be testers. I assume not just students. There are 21 qualifying conditions (including "pain that is chronic and severe, or intractable" - heads up Work Comp - for more info about Ohio legalized marijuana go to https://bit.ly/2h0RuCX). The college looks at it as an opportunity to build up their "hands-on research and high-tech training." But they're not taking (at least a public) position on it's efficacy as I found this quote interesting - "The decision to lead this medical cannabis lab effort was not based on the merits or lack of merits regarding cannabis. The state legislators made a decision on the subject." The more testing that happens, hopefully the more evidence will become available as to what works and what doesn't. As I poll audiences around the country, there are typically three distinct opinions about whether marijuana/cannabis is medicinal: (1) Yes, without reservation (2) No, absolutely not (3) Maybe, depending upon the science and the story. And that's not just "regular" people - there are doctors in all three camps. For those in (3) - and to some degree (1) and (2) as well - the production of clinical research and studies done in the most robust scientific manner would be very helpful as most of the evidence is unclear (or very clear based on bias). We'll see what Hocking College can contribute to the overall discussion. Read more about the "Ohio Medical Marijuana Control Program" for an in-depth look at what needs to happen between now and next September.

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Solving America's drug crisis (1,162 views)

An interesting read in addressing the #opioid epidemic. It's worth 5 minutes of your time. The author distilled it down to four points: (1) An epidemic of overprescribing - "Reducing the rate of opioid addiction means staving off new cases of the disease" (2) Cheaper to get high than help - “In every county in the US there should be a treatment centre where someone can walk in and on that same day, regardless of their ability to pay for it, have access to opioid addiction treatment with buprenorphine or methadone.” (3) Policy and policing - "While this (focus on law enforcement) is certainly important, a single-minded focus south of the border is unlikely to solve the current crisis." (4) Shedding the stigma - "Outside the medical profession, a substantial portion of the population still sees addiction as some sort of moral defect." Obviously, these four points just touch on a small portion of tools being used to help people battle their addictions / find less lethal treatment options for their pain, but we need to continue the dialogue from multiple perspectives. There are two angles to this battle that can best be described in this analogy - plugging the holes in the dam to keep water from leaking and dealing with the after effects from the water that's already spilled. So #CleanUpTheMess has to not only help those who have become dependent/addicted to find better care ("already spilled") but also to do a better job of appropriate prescribing immediately after the injury/surgery ("plugging the holes"). We are making progress with both, but so much more to do.

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Trump hasn't formally declared the opioid epidemic a national emergency, and lawmakers want to know why (129 views)

So what's he waiting on? President Trump announced his "intention" on August 10. That is 47 days ago. If the prorated statistics remain true, that delay has cost an additional 4,371 lives (two thirds of 142 drug overdose deaths per day, on average). The July report from the Presidential Commission, formed in March, listed it as their "first and most urgent recommendation." Obviously, declaring a national emergency does not immediately solve the problem. In fact, tone of the individual tactics by themselves are the solution. However, it would be a tremendously enabling factor in devoting even more effort and dollars to the battle as it's the cumulative tactics used in this asynchronous battle that will make the difference.

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Is Your Personal Trainer Legit? (421 views)

Choose your trainer wisely. As we strive to #CleanUpTheMess and search for individualized non-opioid treatment options, it's important to select those that have the best scientific evidence supporting them but also the most qualified practitioners to deliver that care. A really good hammer in the hands of someone with really bad aim will result in a really crappy house. If you're in the market for a personal trainer, pay attention to their background. Following are Rachel Pew's #wisewords in her original share - "As an aspiring exercise physiologist (I graduate from my Masters of Exercise Science program in December), I've always thought that personal trainers should have a background in exercise science (or a related field) as well as a certification from an accredited company, such as "National Strength and Conditioning Association, the American Council on Exercise, the American College of Sports Medicine or the National Academy of Sports Medicine" but that's not how it works. So, in order to "separate the good apples from the bad," ask your potential personal trainer these four questions because "anyone with a sculpted physique (or at least access to photo-altering software) can cash in big on selling workout programs." My daughter is really smart.

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Texas Mutual Will Donate $10 Million to Policyholders Affected by Hurricane Harvey (135 views)

Kudos to Texas Mutual for their just-announced $10M grant to policyholders affected by Hurricane Harvey. It's so easy to move onto the next tragedy (Hurricane Irma) and quickly forget the unforgettable images in Houston and surrounding areas. Their rebuild will be long and arduous, just like that required in the Caribbean islands decimated by Irma. As mentioned on Twitter, I was followed aboard my flight from Austin to Atlanta by a physician heading to Key West to help an understaffed hospital with 600 patients needing care. They told him to bring his own food because they might not have any for the next 3 days. So thanks to Texas Mutual for their part in the recovery for their fellow state citizens, and thanks to Jeremiah Bentley (a fellow winner at least year's Comp Laude event) for the heads up. I'm certain there are others in #WorkComp that are also helping. It will take everyone. Add Hurricane Maria's "demolished" Puerto Rico along with the devastating earthquake in Mexico. So many needs in so many places - and not just in the Americas. These disasters often bring out the best in the human race.

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Comp and Cannabis: Access to Medical Marijuana in GA and the 'Gaping Hole' Issue of How to Obtain It (496 views)

John Morgan has started his push for medical marijuana in Georgia per a radio commercial I heard on the way to the airport this morning. if you're not familiar with he and his firm, they contributed $10M and lots of effort over the past few years to legalize medical cannabis in Florida that resulted in a 71% approval on 11/8/16 to expand their limited program to a full medical marijuana program and signed into law by Gov. Scott on on 6/23/17 (see https://bit.ly/2x1udF3 for more info on the Florida Office of Medical Marijuana Use). In this morning's commercial, Mr. Morgan used the keywords that were successful to his efforts - "compassion" and "bad drugs". In other words, he is drawing the comparison between cannabis and painkillers like opioids. That has been a winning combination that I've observed in other states. Georgia already has a limited access medical marijuana program - read this recent WorkersCompensation.com article about it. So what does this commercial mean for my home state? Likely a lot more commercials from Morgan & Morgan. And likely requests to expand the program. For the other states with limited access programs - Alabama, Iowa, Kentucky, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Texas, Utah, Virginia, Wisconsin - expect the same increased pressure.

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Americans Prefer Drug-Free Pain Management Over Opioids (302 views)

TURNING POINT - Gallup confirms that Americans understand #opioid dangers and prefer non-drug treatment of pain. Their polling was done Feb-Mar 2017 so it's recent/relevant. Of the 6,206 respondents, 78% said they'd "prefer to try OTHER ways to address physical pain before I take pain medication prescribed by a doctor." That's because 44% see "prescription painkillers as a “crisis” or “very serious problem” in their local area." Interestingly, 49% said a contributing factor was "a lack of public knowledge about the dangers of opioids” while 47% said “patients demanding that they be given a prescription to ease their pain”, so it's a nuanced understanding than just blaming Big Opioid Pharma (55%) or doctors over-prescribing opioids (53%). Those polled know pain - 64% have significant enough neck/back pain to see a doctor - 27% in the last 12 months. Granted, the survey was sponsored by the Palmer College of Chiropractic so they are very interested in acceptance of non-drug options. But educated consumers (i.e. patients) will help drive #CleanUpTheMess. As I said, this nuanced understanding of the issue and options is a "turning point" in this battle. Let's hope that patients turn this education into action by selecting the less lethal treatment options.

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Antidepressants raise the risk of an early death by 33% (1,619 views)

Do anti-depressants create a 33% higher likelihood of early death? A new analysis of 17 studies and 380K people thinks so. Those that did not take anti-depressants over 50 years old died at a rate of 8 in every 1,000 people. That increased to 10.64 per 1,000 for those taking the pills. They reasoned it's because these drugs not only treat depression but are also a blood thinner. That "protects the health of people with heart disease because it stops blood clotting, but among people without heart disease, this is dangerous because it increases the risk of a major hemorrhage or internal bleed." Psychiatrists differed with the conclusions of the scientists, saying that anti-depressants have been used for years and help people manage their depression. Who's right? I'm not a scientist, psychiatrist or clinician so I'm not sure. But this statement is absolutely correct - "They suggest that we shouldn’t be taking antidepressant drugs without understanding precisely how they interact with the body." THAT'S TRUE FOR EVERY DRUG YOU TAKE. Be an educated consumer (patient) and know the benefits AND risks in order to make the best strategic decision for YOU.

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The FDA just approved the first app for treating substance abuse (824 views)

So there really is "an app for that". In this case, CBT. This "digital therapeutic" was approved by the FDA yesterday to treat SUD (substance use disorder). It has to be prescribed by a doctor and used in conjunction with counseling. While not specifically approved for opioid dependence/addiction, it's been submitted for review of that purpose and it seems forthcoming. Innovative. I'm interested to see if it offers more reporting / compliance statistics than "human" CBT (i.e. non app), but also if the lack of direct human interaction is an issue. Technology is changing our lives. And now our treatment. I'm sure this is only the beginning. Separating the good from the not-so-good from the bad may be increasingly difficult to do with more choices on more platforms. If there's research behind it that shows the tool is based on evidence based medicine, then it comes down to which tool(s) work for an individual. The more choices, the more possibilities that every single person can find the tool(s) that work for them.

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In addition, I published two blogposts:

• "My Opioid Experiment" on September 15
• "#Pew Perspectives - Week of September 4" on September 17

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

#CleanUpTheMess