Fentanyl

Cannabis Users Require More Sedation for Endoscopy

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Summary: Cannabis users undergoing gastric endoscopy procedures generally require more sedation than non-cannabis users, researchers report.

Source: American Gastroenterology Association

Patients who use cannabis required higher levels of sedation during gastric endoscopies than non-users, according to research to be presented at Digestive Disease Week (DDW) 2022.

As cannabis is legalized in more places and usage rises, clinicians should be aware of patients’ habits and prepare themselves and their patients for increased sedation and accompanying risks, researchers said.

“Patients didn’t have increased awareness or discomfort during procedures, but they did require more drugs,” said Yasmin Nasser, MD, Ph.D., lead researcher on the study and assistant professor at Snyder Institute for Chronic Diseases Cumming School of Medicine University of Calgary.

Researchers conducted a prospective cohort study of 419 adult outpatients undergoing endoscopic procedures at three Canadian centers. Procedures were conducted under conscious sedation, which leaves the patient relaxed and comfortable but partially conscious during the procedure.

Each patient completed two questionnaires, one before the procedure about their cannabis use and another afterwards indicating their awareness and comfort level during the procedure.

The questionnaires were analyzed along with details about the use of the sedatives midazolam, fentanyl and diphenhydramine during the procedure.

This shows cannabis leaves in a person's hands
Procedures were conducted under conscious sedation, which leaves the patient relaxed and comfortable but partially conscious during the procedure. Image is in the public domain

Cannabis use was associated with increased odds of requiring higher total sedation—defined as more than 5 mg of midazolam, or more than 100 mcg of fentanyl, or the need for diphenhydramine—during gastroscopy, an endoscopic procedure that begins with insertion of a tube and camera through the throat.

Cannabis use was not associated with higher use of sedation during colonoscopy. Gastroscopy generally requires more sedation than colonoscopy because the inserted scope causes irritation in the upper part of the gastrointestinal tract, often triggering the gag reflex.

Cannabinoid use was not independently associated with fentanyl use or adverse events, nor was it associated with intra-procedural awareness or discomfort.

This study looked at whether patients were users or non-users of cannabis, but did not examine the timing, quantity or route of cannabis intake prior to procedure, whether it was inhaled, vaporized, ingested or otherwise. Researchers say these variables could be the basis for future study. 

Also, researchers only examined the impacts of baseline cannabis use during procedures that use conscious sedation and did not examine its impact on propofol sedation, which is more commonly used in the U.S.

‘Passive’ fentanyl exposure: more myth than reality

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The shadow of Sen. Lindsey Graham (R-S.C.) is cast on a photograph of heroin and fentanyl during a news conference in March in Washington. Graham was introducing legislation that would increase the punishment for fentanyl distribution and trafficking. 

The news reports are alarming: Merely being in a room or in close contact with fentanyl, an increasingly popular opioid narcotic, can poison you, they say.

Perhaps the best known report of passive casualties from fentanyl is a 2017 news account that went viral. In it, an East Liverpool, Ohio, police officer brushed a white powder off his uniform, lost consciousness within an hour, and awakened after being given a dose of naloxone, a drug that quickly reverses the effects of opioids. The police chief ordered his officers to stop field testing for fentanyl or other opioids that they find while on duty.

Reports of fentanyl-related passive toxicity has led to the release of hyperbolic warnings and burdensome recommendations by Drug Enforcement Administration, including the use of extensive personal protective equipment, such as gloves, paper coveralls, eye protection, and even particulate respirators. We believe that such responses to passive casualties from fentanyl are excessive and may actually interfere with the ability of first responders and others to do their jobs.

In 2018, Massachusetts became the first state to ban from the courthouse evidence that may contain fentanyl or carfentanil (an extra-powerful fentanyl analog) out of concern that these substances are too dangerous to be in public places. In Pennsylvania, Gov. Tom Wolf made a dramatic declaration to “ensure the safety of corrections personnel” by implementing expensive new processes and technologies to prevent further drug exposures in prison. This came in response to an unproven exposure to a drug smuggled into prisons in Pennsylvania and Ohio that “sickened” more than four dozen prison guards.

All of these moves appear driven by concerns about the perceived risk of passive exposure to synthetic drugs, especially fentanyl and its analogs, by law enforcement personnel and first responders. Although mitigating risk is laudable, the risks of transient exposure have been blown out of proportion by media coverage.

One of the issues with this dramatization of fentanyl toxicity is that it further stigmatizes substance users as contagious and dangerous. That can potentially delay care to those who need prompt rescue and treatment. This trepidation is reminiscent of the fear of caring for people with HIV in the 1980s.

There is clear evidence that passive exposure to fentanyl does not result in clinical toxicity. Descriptions of the signs and symptoms of those who have supposedly experienced passive toxicity vary widely. They include dizziness, blurry vision, pallor, weakness, sweatiness, high blood pressure, chest pain, heart palpitations, anxiety, and occasionally seizure-like activity. These findings are usually transient and resolve on their own, often far faster than would be expected, and are incompatible with the known duration of the drug’s effect. What’s more, they aren’t consistent with the signs and symptoms of opioid poisoning — the triad of slowed breathing, decreased consciousness, and pinpoint pupils.

Testing of biological specimens, though performed in very few cases, has been nearly uniformly negative for the presence of fentanyl. The positive response to naloxone that is occasionally seen among those with passive toxicity is likely due to the noxious effects of its intranasal administration.

It’s also important to put into context the practical risk of exposure to fentanyl. Pharmacists have been working with fentanyl for years, without reports of passive exposure. The same holds for surgeons, anesthesiologists, emergency physicians, and others working in operating rooms and emergency departments, where fentanyl is routinely administered as a pain reliever.

Doctors, nurses, and others in emergency departments who care for victims of fentanyl overdose are undoubtedly exposed to these drugs on patients’ clothing, skin, and paraphernalia. Workers in needle exchange programs and supervised consumption facilities are routinely exposed to the drugs their clients are using. Traffickers, dealers, and users themselves have direct contact with these substances at many stages in their distribution. None of these exposure scenarios has been accompanied by worrisome clinical effects.

An earnest online video documents (albeit unscientifically) that fentanyl isn’t absorbed through the skin.

So what might account for the effects among those passively exposed to fentanyl? Psychological stress presenting as anxiety and, when taken as a whole, mass sociogenic illness, is most likely. This is often described as the nocebo effect, in which the thought of an exposure causes the expected adverse effect, even if a substance is inactive. This is essentially the opposite of the more well-known placebo effect.

There are valid reasons for concern about exposure to fentanyl-containing products, although most of them are theoretical. Fentanyl and its analogs are exceedingly potent — small doses can lead to life-threatening toxicity. However, fentanyl is not volatile, meaning that the powdered drug, left undisturbed, can’t cause harm. Even following the use of aerosolized carfentanil to end the Moscow theater siege in 2002, in which more than 100 people died of carfentanil poisoning, rescuers wearing limited or no personal protective equipment are seen in photographs and footage carrying the injured and dead from the premises. Passive toxicity makes even less sense in conventional drug-use settings where other individuals are present and unaffected.

Despite newer guidance that urge a more rational approach to the risks of passive fentanyl exposure from the White House Office of National Drug Control Policy, the National Institute of Occupational Safety and Health, the American College of Medical Toxicology, the Interagency Board, Customs and Border Protection, and reviews by other expert groups, apprehension continues to grow with each alleged passive fentanyl poisoning event.

As fentanyl analogues are increasingly found in heroin, as well as in other substances such as crack cocaine and synthetic cannabinoids such as K2, we hope that law enforcement personnel, prehospital care providers, and others will grow increasingly more comfortable with the limited risks of passive fentanyl exposure and offer appropriate evaluation of patients without the undue burden of concern for potential self-poisoning.

The latest recommendations are reasonable. They nicely communicate the known and potential risks and provide sensible risk-mitigation strategies. For example, anyone who may come into contact with a product believed to contain fentanyl or its analogs should wear gloves — and wash hands before eating or touching the mouth or nose. It also makes sense not to enter an environment that appears risky, such as one in which powder is seen in the air, but if that must be done, donning appropriate high-level respiratory protection should be undertaken.

Individuals passively exposed to fentanyl and its analogues who do not display signs consistent with opioid poisoning could likely avoid an emergency department visit unless other concerns arise. Naloxone, an effective antidote for fentanyl poisoning, should available if a responder to an opioid overdose somehow becomes a victim.

There’s no question that fentanyl and its analogues can produce life-threatening effects. At the same time, it is important to respect the tenets of medical toxicology that require a sufficient dose delivered by an appropriate route, the production of consistent clinical findings, reasonable exclusion of alternative explanations, and analytical confirmation consistent with clinical poisoning.

None of those tenets have been satisfied for passive poisoning by fentanyl or related products.

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

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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.

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

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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.

Heroin deaths surpass gun homicides for the first time, CDC data shows.

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Opioid deaths continued to surge in 2015, surpassing 30,000 for the first time in recent history, according to CDC data released Thursday.

That marks an increase of nearly 5,000 deaths from 2014. Deaths involving powerful synthetic opiates, like fentanyl, rose by nearly 75 percent from 2014 to 2015.

 

Heroin deaths spiked too, rising by more than 2,000 cases. For the first time since at least the late 1990s, there were more deaths due to heroin than to traditional opioid painkillers, like hydrocodone and oxycodone.

“The epidemic of deaths involving opioids continues to worsen,” said CDC Director Tom Frieden in a statement. “Prescription opioid misuse and use of heroin and illicitly manufactured fentanyl are intertwined and deeply troubling problems.”

In the CDC’s opioid death data, deaths may involve more than one individual drug category, so numbers in the chart above aren’t mutually exclusive. Many opioid fatalities involve a combination of drugs, often multiple types of opioids, or opioids in conjunction with other sedative substances like alcohol.

In a grim milestone, more people died from heroin-related causes than from gun homicides in 2015. As recently as 2007, gun homicides outnumbered heroin deaths by more than 5 to 1.

 

These increases come amid a year-over-year increase in mortality across the board, resulting in the first decline in American life expectancy since 1993.

Congress recently passed a spending bill containing $1 billion to combat the opioid epidemic, including money for addiction treatment and prevention.

“The prescription opioid and heroin epidemic continues to devastate communities and families across the country—in large part because too many people still do not get effective substance use disorder treatment,” said Michael Botticelli, Director of National Drug Control Policy, in a statement. “That is why the President has called since February for $1 billion in new funding to expand access to treatment.”

Much of the current opioid predicament stems from the explosion of prescription painkiller use in the late 1990s and early 2000s. Widespread painkiller use led to many Americans developing dependencies on the drugs. When various authorities at the state and federal levels began issuing tighter restrictions on painkillers in the late 2000s, much of that demand shifted over to the illicit market, feeding the heroin boom of the past several years.

DEA alert says Fentanyl is ‘real threat’ to law enforcement

The Drug Enforcement Administration warns people about the dangers of Fentanyl, a synthetic opioid that can be 40 to 50 times stronger than heroin. (Drug Enforcement Administration)

Drug policy reformers say the criminalization of illicit and off-label drug use is a barrier to reversing the growing epidemic.

“Criminalization drives people to the margins and dissuades them from getting help,” said Grant Smith, deputy director of national affairs at the Drug Policy Alliance. “It drives a wedge between people who need help and the services they need. Because of criminalization and stigma, people hide their addictions from others.”

Fentanyl is so dangerous that some cops now carry an antidote in case they touch it

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Many police officers and first responders in North America already carry the overdose antidote naloxone to save dying opioid users. But the rise of fentanyl — a synthetic opioid that’s around 50 times more powerful than heroin — has led cops in Canada to take a new precaution: carrying naloxone to use on themselves.

Touching or inhaling even a small amount of fentanyl can be fatal, so officers with Canada’s federal police force are now carrying naloxone nasal spray in case they come in contact with it while on duty. The police force will also begin distributing naloxone kits that officers may use on overdose victims.

Bob Paulson, commissioner of the Royal Mounted Canadian Police (RCMP), told reporters on Tuesday that he cannot overstate the dangers of fentanyl. The force also released a video that shows two officers discussing how they got sick after accidentally coming in contact with the painkiller.

“It’s spreading across the country, leaving a trail of misery and death,” Paulson wrote in a news release. “First responders and the public need to know that even being near it can make you sick, or worse.”

‘First responders and the public need to know that even being near it can make you sick, or worse.’

A number of other police forces in the US and Canada have also begun equipping themselves with naloxone — sold under the brand name Narcan — in the event they see someone with fentanyl, or suspect they might have ingested it somehow.

Last week, police in Vancouver, British Columbia, which is on pace to experience more than 800 fatal overdoses this year, announced they would carry naloxone. The city’s police chief told reporters that his officers regularly come in contact with fentanyl.

In August, the RCMP awarded a nearly $2 million (CAD) contract to Adapt Pharma Canada, makers of Narcan, although the tender notice gives little detail about the purchase, beyond that it is for ‘drugs and biologicals.’

Earlier this year, New Jersey detective Dan Kallen told the Associated Press about an incident where he and his detectives got sick after opening a box of drug accessories while searching a home. Kallen suspected fentanyl was to blame.

“It hit us like a ton of bricks,” he said. “It became very difficult to breathe. Our hearts were racing. We were nauseous, close to backing out… I felt like, ‘Holy crap, I’m going to die right now.'”

This summer, 23 police departments in Delaware started carrying naloxone to protect themselves and save others from overdose deaths. The kits were purchased with funds seized during drug busts.

According to the Centers for Disease Control and Prevention, there’s been a spike in drug seizures by law enforcement testing positive for fentanyl since 2013, especially in Ohio, New Hampshire, and Massachusetts.

Why the Pain Drug That Killed Prince Can Be Especially Dangerous

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Fentanyl’s fast action is great for pain relief but adds to its risks.

Many questions still remain about the tragic and untimely death of musician and cultural icon Prince, but a report released last Thursday by the Anoka County, Minn., Midwest Medical Examiner’s Office answered a big one: Prince’s death was caused by an accidental overdose of the powerful opioid drug fentanyl. Little is known for certain about the circumstances leading up to his death but it now appears that, like millions of Americans, Prince was taking opioids to manage chronic pain.

Fentanyl is an opioid drug—a chemically synthesized relative of opiates such as morphine and heroin, which are derived from the opium poppy. The drugs mimic our brains’ own pain-regulating molecules called endogenous opioids, which act at receptors found throughout the nervous system. All opioid drugs have the ability to dampen pain. In fact, opioids are so good at relieving pain that they are considered the gold standard against which all other analgesic drugs are measured. But that relief comes with significant risks. Opioids carry a range of side effects, the most severe of which apparently took Prince’s life: death by respiratory depression, meaning that he stopped breathing.

“In a way, Prince is a poster child for what can happen with chronic use—and increasing doses—of these very powerful drugs,” says Gary Franklin, a researcher at the University of Washington and medical director of the Washington State Department of Labor and Industries. Franklin speculates that Prince, like so many others, may have been being treated with opioids for chronic pain and developed tolerance—meaning that over time higher and higher doses are required to achieve the same pain relief. As doses escalate, so do risks. “It turns out that it doesn’t take long to develop physical dependence, which means that when you try to cut back on the dose, you get withdrawal symptoms. It’s a vicious cycle,” Franklin adds.

If Prince had built up tolerance to opioids, how did he die of an overdose? The specific drug—fentanyl—found in Prince’s body is particularly powerful; it is 100 times more potent than morphine. For example, the effects of a standard 10-milligram dose of morphine can be achieved with just 100 micrograms of fentanyl. Among opioid drugs, fentanyl is particularly fast-acting, which can make it more lethal in some situations.

Prince had a long history of clean, drug-free living, suggesting that he would not use street drugs. However, fentanyl is often mixed with heroinor other drugs and sold illegally, which accounts for many of the other deaths in which it is involved—as users may be unaware that their heroin is cut with the stronger drug. And pharmaceutical fentanyl was once prescribed only for severe short-term pain, such as after surgery, but patients are increasingly receiving it to manage chronic pain, often in a patch that delivers the drug through the skin. Fentanyl is also administered in lollipop form, typically to terminal cancer patients with otherwise untreatable pain. Whatever the source, “we don’t know if Prince took the drug as directed or in excess,” says Lynn Webster, a pain and addiction specialist based in Salt Lake City and past president of the American Academy of Pain Medicine.

The death certificate did not name any other drugs in his system but a number of medications—from other types of opioids to sleeping pills—would have increased fentanyl’s risks in any user. Prince’s small stature—the medical report listed him as 1.6 meters and 50 kilograms at death—did not likely contribute to an overdose death, according to Webster. “Most people who die from respiratory depression—they go to sleep and don’t wake up,” Franklin says. “This was different in the sense that he [presumably] passed out while awake” in the elevator where he was found an estimated six hours after his death.

Despite the fact that Prince died of an overdose of an opioid drug, whether or not he might have been addicted is another matter. “I’m not so sure he was addicted,” Webster says. “I have not seen evidence that he was addicted.” An opioid user can develop tolerance and even physical dependence on the drugs without being addicted. Less than 10 percent of patients taking opioids for chronic pain develop addiction in the classical sense, Webster says.

Prince’s plane did make an emergency landing a few days before his death in order to get a life-saving dose of Narcan, or naloxone, a drug that counteracts opioids and can prevent overdose death. “The fact that he had already had an overdose episode—when death is prevented once by naloxone—that indicates big trouble,” Franklin says.