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HealthDay News — For reversal of opioid overdose, higher-concentration intranasal naloxone has similar efficacy to that of intramuscular naloxone administered at the same dose, according to a review published online November 27 in the Annals of Internal Medicine.
Roger Chou, MD, from the Oregon Health & Science University in Portland, and colleagues conducted a systematic review to synthesize evidence on the effects of naloxone route of administration and dosing for suspected overdose in out-of-hospital settings, and the need for transport to a health care facility after reversal of overdose with naloxone. Data were included from 13 eligible studies.
The researchers found that 1 trial demonstrated similar efficacy between higher-concentration intranasal naloxone and intramuscular naloxone administered at the same dose (2mg/mL). One trial found that lower-concentration intranasal naloxone was less effective than intramuscular naloxone, but the risk for agitation was reduced (low strength of evidence). There was insufficient evidence to assess other comparisons for administration route. Low rates of death and serious adverse events were reported in 6 uncontrolled studies in non-transported patients after successful naloxone treatment.
"Higher-concentration intranasal naloxone (2mg/mL) seems to have efficacy similar to that of intramuscular naloxone for reversal of opioid overdose, with no difference in adverse events," the authors write. "Non-transport after reversal of overdose with naloxone seems to be associated with a low rate of serious harms, but no study evaluated risks of transport versus non-transport."
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More than half of Wisconsin counties have sued opioid manufacturers, as 20 more counties announced Tuesday that they are filing lawsuits.
The counties are led by the Milwaukee-based law firm Crueger Dickinson and Simmons Hanly Conroy, which has offices throughout the country and has filed similar suits in five other states.
The counties allege that the drug manufacturers' business strategies helped create the opioid epidemic.
Milwaukee County officials highlighted $2.6 million in grants that will help them expand addiction treatment programs at a press conference Monday.
County Executive Chris Abele said that the funding is “a huge step forward” and will support local efforts to fight the opioid epidemic.
“As a country, we need to use every dime we’ve got,” he said. “We need to focus on an issue that is growing faster and killing more people than just about anything you can imagine.”
Milwaukee County Family Drug Treatment Court is receiving $2.1 million over the next five years from the Substance Abuse Mental Health Services Administration.
“We are transforming these families,” said Milwaukee County Court Judge Joe Donald.
Robyn Ellis, who participated in the county’s family drug treatment court, started using alcohol as a child and illegal drugs as a teenager.
In 2013, she lost custody of her daughter. Then family drug treatment court got involved.
“It’s hard for me to stand up here and share all of this because I’m in such a different place today,” she said.
The court helped her get and stay sober, and she regained custody of her daughter in 2014.
An additional $506,000 grant from the Wisconsin Department of Health Services will allow the county’s Behavioral Health Administration to expand its alcohol and other drug addiction treatment and recovery services to 75 more people.
Those services include medication-assisted treatment, residential treatment, recovery housing and counseling.
The legislature is considering legislation based on proposals from the Workers Compensation Advisory Council. The proposals were developed Labor and Management representatives on the Council. But not all of the proposals share the support of the Council’s health care representatives, including a recommended fee schedule. Health care organizations will need to be even more active this session than last to again defeat the fee schedule proposal.
It is important to note that works compensation premiums have dropped – without a government mandated fee schedule. This year alone, employers received an 8.46 percent reduction in their worker’s compensation insurance premiums, saving employers an estimated $170 million. At the same time, Wisconsin’s health care system continues to lead the nation in outcomes with injured employees returning to work a full three weeks earlier than the national average. And health care costs per worker’s comp claim lower than the national average.
Your calls are needed to both the State Assembly and State Senate to explain why the proposed health care fee schedule could harm Wisconsin’s model worker’s compensation system. You can find your legislators contact information on the state legislature’s website.
Let your State Representative and State Senator know you are a physician in their district, serving patients who are also constituents and that you are opposed to an artificial fee schedule for a worker’s compensation system that provides the nation’s best care at a below-average worker’s compensation cost. Thank you for your time and action on this important issue.
November 27, Wisconsin Health News
The state’s Supreme Court agreed last week to review a lower court’s decision striking down a cap on how much patients can receive for some malpractice claims.
An appeals court ruled in July that a state law capping awards for noneconomic damages at $750,000 was unconstitutional. Noneconomic damages seek to compensate patients for pain and suffering. The Wisconsin Hospital Association and the Wisconsin Medical Society have raised concerns about the court’s decision and its potential ramifications for providers and accessibility to healthcare. In her opinion striking down the decision, Judge Joan Kessler said the law placed an “unfair and illogical burden only on catastrophically injured patients, thus denying them the equal protection of the laws.”
The case involves Ascaris Mayo, who lost her limbs after providers at a Milwaukee-area emergency room failed to notify her she had an infection. A jury awarded Mayo and her husband $16.5 million for noneconomic damages, which the state sought to reduce.
TUESDAY, Nov. 21, 2017 (HealthDay News) -- The U.S. opioid epidemic seems to be taking its biggest toll on the baby boomer and millennial generations, a new study suggests.
Researchers found that since 2010, boomers -- born between 1946 and 1964 -- have had heightened rates of death from prescription opioids and heroin. Meanwhile, millennials -- people in their 20s and 30s -- also have been hard hit by heroin overdoses.
"The opioid epidemic has affected everyone," said senior researcher Dr. Guohua Li. "But what we're seeing is that these two generations are at highest risk," said Li, a professor of epidemiology at Columbia University.
Li said he could only speculate on the reasons.
But the findings on boomers were not surprising, he noted. That generation is known to have a relatively high rate of drug abuse, versus other generations. Plus, Li said, they were middle-aged when prescriptions for opioids were taking off in the 1990s -- which means they were a "primary target" for the medications.
According to the U.S. National Institute on Drug Abuse, more than 2 million Americans were abusing opioids in 2015. That included heroin and prescription opioids, such as painkillers like Vicodin (hydrocodone), OxyContin (oxycodone) and codeine.
Recent research has found that Americans' prescription opioid abuse has leveled off. But overdose deaths are still climbing.
Earlier this year, a U.S government study highlighted the toll that heroin alone is taking. Between 2002 and 2016, deaths from the drug soared by 533 percent nationwide -- from just under 2,100 deaths to more than 13,200.
So while efforts to curtail opioid prescriptions have worked, opioid deaths overall have not yet declined, said Robert Heimer, a professor of epidemiology at Yale School of Public Health.
Unfortunately, some people addicted to prescription opioids switch to heroin or, more recently, illicitly made "synthetic" opioids such as fentanyl.
"Often, people on heroin started with prescription opioids," Heimer said. However, he added, these are typically illegally sold prescription drugs.
Heimer, who was not involved in the new study, said the findings are "useful."
"It really suggests it's the older and younger generations that are being most affected by this epidemic," he said.
The study analyzed national vital statistics for the years 1999 to 2014.
Li's team found that compared with people born in the late-1970s, boomers were up to 27 percent more likely to die of a prescription opioid overdose. And they were up to one-third more likely to die of a heroin overdose.
Meanwhile, the rate of heroin overdose death accelerated most among millennials -- people born in the 1980s to early '90s. For example, those born in 1989 and 1990 were 23 percent more likely to die of a heroin overdose compared with Americans born in the late 1970s.
According to Li, it's not clear why millennials face a higher risk than their "Generation X" predecessors. But he speculated that they have had relatively less economic security than Gen Xers.
On the prevention side, various medical groups have changed guidelines to rein in opioid prescriptions.
Also, U.S. states have launched drug monitoring programs, which electronically track prescriptions for controlled substances. Doctors can check them before prescribing opioids, to help catch "doctor shoppers" -- people who go from one provider to the next, seeking a new opioid prescription.
But those efforts only go so far, Heimer pointed out.
To cut down overdose rates, access to addiction treatment is vital, Heimer and Li agreed.
"Medication-assisted treatment" -- with the drugs methadone, buprenorphine or naltrexone -- is considered the most effective therapy for opioid dependence. The medications act on the same brain targets as opioids do, and help suppress withdrawal symptoms and cravings.
But there are big barriers to receiving that kind of treatment. Only a small number of U.S. doctors prescribe them, and lack of training is one reason, according to Heimer.
"Stigma" is a wider, underlying issue, he said. The drugs used to treat opioid addiction are sometimes seen as nothing more than a substitution, and there is still a belief that total abstinence should be the goal.
"The biggest problem is that medication-based therapy is stigmatized," Heimer said. "We don't do that with any other chronic disease, and addiction is a chronic disease."
The findings were published online Nov. 21 in the American Journal of Public Health.
The U.S. National Institute on Drug Abuse has more on treating opioid addiction.
SOURCES: Guohua Li, M.D., Dr.PH., professor, epidemiology, Columbia University Mailman School of Public Health, New York City; Robert Heimer, Ph.D., professor, epidemiology, Yale School of Public Health, New Haven, Conn.; Nov. 21, 2017, American Journal of Public Health, online
Last Updated: Nov 21, 2017
Copyright © 2017 HealthDay. All rights reserved.
President Donald Trump delivers remarks on combatting drug demand and the opioid crisis on October 26, 2017 in the East Room of the White House in Washington, DC.
The White House says the true cost of the opioid drug epidemic in 2015 was $504 billion, or roughly half a trillion dollars.
In an analysis to be released Monday, the Council of Economic Advisers says the figure is more than six times larger than the most recent estimate. The council said a 2016 private study estimated that prescription opioid overdoes, abuse and dependence in the U.S. in 2013 cost $78.5 billion. Most of that was attributed to health care and criminal justice spending, along with lost productivity.
The council said its estimate is significantly larger because the epidemic has worsened, with overdose deaths doubling in the past decade, and that some previous studies didn't reflect the number of fatalities blamed on opioids, a powerful but addictive category of painkillers.
The council also said previous studies focused exclusively on prescription opioids, while its study also factors in illicit opioids, including heroin.
"Previous estimates of the economic cost of the opioid crisis greatly underestimate it by undervaluing the most important component of the loss — fatalities resulting from overdoses," said the report, which the White House released Sunday night.
Last month at the White House, President Donald Trump declared opioid abuse a national public health emergency. Trump announced an advertising campaign to combat what he said is the worst drug crisis in the nation's history, but he did not direct any new federal funding toward the effort.
Trump's declaration stopped short of the emergency declaration that had been sought by a federal commission the president created to study the problem. An interim report by the commission argued for an emergency declaration, saying it would free additional money and resources.
But in its final report earlier this month, the panel called only for more drug courts, more training for doctors and penalties for insurers that dodge covering addiction treatment. It did not call for new money to address the epidemic.
More than 64,000 Americans died from drug overdoses last year, most involving a prescription painkiller or an illicit opioid like heroin.
The Wisconsin Medical Society Board of Directors has named Clyde “Bud” Chumbley, MD, MBA, chief executive officer of the Wisconsin Medical Society.
“I’m excited to have the opportunity to serve as the next CEO of the Wisconsin Medical Society; I consider it a tremendous honor,” said Dr. Chumbley, who will begin on November 27. “Having been a Society member for 37 years, I’m a firm believer in its mission to advance the health of the people of Wisconsin by ensuring access to high-quality, cost-efficient care. And I look forward to drawing on my experience to further strengthen the Society so we can continue to make a difference for our patients and our profession.”
In addition to caring for patients as a board-certified obstetrician/gynecologist throughout his 36-year medical career, Dr. Chumbley has held numerous leadership and management positions, including serving nearly 20 years as president and CEO of a large, independent multi-specialty medical group practice. He currently serves as chief medical adviser for Wisconsin Medical Society Holdings and as chief medical officer for the Wisconsin Medical Society Holdings Association Health Plan.
Past leadership roles in Wisconsin include serving as chief medical officer/chief clinical integration officer for Aspirus Health and president of Aspirus Clinics, and as president and CEO of ProHealth Care Medical Associates. He also has served on the board of directors and as past chair and treasurer for the Wisconsin Collaborative for Healthcare Quality. In Texas, he served as chief medical officer for Scott & White Healthcare in the Austin region.
Doctor Chumbley is a graduate of the University of Missouri School of Medicine and the Kellogg School of Management at Northwestern University and holds medical licenses in Wisconsin and Texas.
“We were fortunate to have a number of highly qualified candidates interested in this position,” said Jerry Halverson, MD, chair of the Society’s Board of Directors and co-chair of the search committee. “Doctor Chumbley is an excellent advocate for physicians and the patients we serve, and with his extensive administrative experience and medical expertise, we believe he is an outstanding choice to lead the Society. We look forward to all we can accomplish under his leadership.”
Doctor Chumbley is the eighth Society CEO in its 176-year history. Susan L. Turney, MD, MS, FACMPE, FACP, was the first physician to hold the position from 2004 to 2011.
WASHINGTON -- A first-in-class neurostimulation device to relieve symptoms of opioid withdrawal is approved for marketing, the FDA announced Wednesday.
The NSS-2 Bridge device is a small, battery-powered electrical nerve stimulator that is placed behind a patient's ear and emits electrical pulses to stimulate branches of certain cranial nerves. Patients can use the device for up to 5 days during the acute physical withdrawal phase.
The device, made by Innovative Health Solutions, was previously cleared by the FDA in 2014 for use in acupuncture.
"Given the scope of the epidemic of opioid addiction, we need to find innovative new ways to help those currently addicted live lives of sobriety with the assistance of medically assisted treatment," said FDA Commissioner Scott Gottlieb, MD, in an agency press release. "While we continue to pursue better medicines for the treatment of opioid use disorder, we also need to look to devices that can assist in this therapy."
Device approval was based on a study that evaluated the clinical opiate withdrawal scale (COWS) score -- measuring symptoms on a scale of 0 to more than 36 (0 being the least severe) -- in 73 patients undergoing opioid physical withdrawal. Study results showed that all patients had a reduction in COWS of at least 31% within 30 minutes of using the device and that 88% of patients transitioned to medication-assisted therapy after 5 days.
The device is available only by prescription and is contraindicated for patients with hemophilia, cardiac pacemakers, and psoriasis vulgaris.
Multidisciplinary and coordinated care delivery models effectively provide opioid use disorder treatment and increase access to medication-assisted treatment in primary care, according to data published in PLOS One.
“It’s hard to convince primary care physicians to do this work when they’re already busy and they don’t have additional addiction-related training or experience,” Pooja Lagisetty, MD, from the division of general internal medicine and the Institute for Health Policy and Innovation at the University of Michigan, Ann Arbor, and VA Ann Arbor Healthcare System, said in a press release. “But, if we can learn from others and find a way to offer physicians logistical support, then maybe it’s possible. There is a major need to do this.”
People who need addiction care outnumber the physicians willing to provide medication-assisted treatments (MATs) like buprenorphine and methadone in primary care, despite prior research showing that MAT can reduce mortality for patients with opioid use disorder. Researchers compiled data on evidence-based, primary care MAT interventions and program structures and processes that were associated with improved patient outcomes using clinical databases. They reviewed randomized controlled trials and observational studies that assessed MAT for adult patients with opioid use disorder to determine what kinds of primary care-based models may help guide future policy and implementation in primary care settings.
Lagisetty and colleagues included 35 interventions that tested MAT in primary care settings across eight countries in their systematic review. Analysis showed that patients were more likely to have successful opioid addiction treatment when their PCP worked with teams of nurses, medical assistants, social workers and pharmacists to deliver MAT. The successful interventions featured joint multidisciplinary and coordinated care by physician and nonphysician provider delivery models to offer MAT. Seven studies showed that 60% or more of patients continued their MAT regimen for 3 months or longer. Not all successful programs were the same in reported patient outcomes, processes and tools used, but they used similar key design factors, such as:
Lagisetty noted that it makes sense to provide MAT in primary care because the results are similar to providing it in specialty care. In addition, patients may be more likely to seek help from their PCP because of the lack of stigma and their ability to address other health concerns as well, according to the release.
“I don’t think that many primary care physicians went into medicine with a desire to focus on treating addiction. However, opioid addiction is increasingly becoming common in our practices and our patients are struggling to find help,” Lagisetty said. “Primary care doctors don’t need to all be treating 100 patients. It can just be five. We should just have the medication in our tool box and be able to screen and potentially treat patients in our own setting.” – by Savannah Demko
Disclosures: The authors report no relevant financial disclosures.
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