High Doses of Imodium Cause Serious Heart Problems, FDA Warns

  

Over-the-counter diarrhea drug loperamide (Imodium/Johnson & Johnson Consumer Inc.) has recently been in the news because opioid abusers have been using it to self-treat symptoms of opioid withdrawal. Others abuse it for its euphoric properties.
 
The alarming growth in the number of people abusing Imodium has led FDA officials to issue a warning that exceeding the recommended doses can mean serious, potentially fatal heart problems.

  

FDA

FDA Approves Implantable Device for Steady Release of Buprenorphine

  

Buprenorphine, unlike oxycodone and heroin, is a partial opioid receptor agonist. This property confers this drug a number of advantages over other opioid analogs: it has less potential for euphoria, physical dependence and misuse, a mild withdrawal profile, and provides a ceiling on opioid effects. Buprenorphine is therefore thought of as a drug of choice to treat opioid addiction.

Thus, when adequately prescribed, buprenorphine is effective in suppressing major symptoms of opioid withdrawal, reducing cravings for opioids, and in blocking the effects of other opioids. Patients have also been found to be compliant.

  

  

Long-Term Use More Likely With Opioids vs NSAIDs for Low Back Pain

  

ATLANTA, Georgia - Rates of long-term opioid use for chronic noncancer pain have increased over the last 15 years, though there is scant evidence supporting this practice.1 Meanwhile, the number of overdose deaths from prescription opioids more than tripled during a similar time period: between 2001 and 2014.2 The ongoing use of nonsteroidal anti-inflammatory drugs (NSAIDs) has also been linked with risks, including gastrointestinal bleeding and kidney disease.

Despite practices to the contrary, opioids and NSAIDs are both intended for short-term use. In a study that was partially funded by a grant from the National Institutes of Health, researchers at Henry Ford Health System in Detroit recently explored whether the initial prescription choice between these two medications influenced patterns of long-term use.1

Using electronic medical records and insurance claims, the investigators compared patterns of opioid and NSAID use among patients who received new prescriptions for either medication within 2 weeks of diagnosis of new-onset, noncancer-related lower back pain between 1998 and 2012. "Exclusion criteria were any prior back pain diagnosis, procedure, or surgery; any prior diagnosis of diabetes, cancer, gastrointestinal bleeding, or renal insufficiency; or any prior recorded opioid or NSAID prescription fill," according to the paper presented at the 2016 Annual Meeting of the American Psychiatric (APA) in Atlanta, Georgia. The researchers tracked continuous medication use for 1 year after the initial prescription, and they used logistic regression to adjust for age, sex, and race/ethnicity. To account for patients whose records indicated that they had stopped and then restarted their medication during the study period, analyses were performed to adjust for the amount of time between discontinuation and restart.

  

6 privacy landmines and how to avoid stepping on them

  

While the healthcare industry grapples with data breaches and privacy and security regulations, there are common pitfalls that are easy to run into without proper planning.

Erin Whaley, a partner at the law firm Troutman Sanders, outlined what those are and shared half-a-dozen tips for avoiding them.

Here is Whaley's advice:

1. As long as I have cybersecurity insurance I'll be covered in the event of a breach.It's not that simple. Whaley said that even healthcare organizations that stack policies to get to $50 million in coverage may not have enough - though she's not espousing that everyone simply plunk down for more insurance. Providers, instead, need to deploy solid security practices. "Having good security is a prerequisite to good coverage."

  

  

Healthcare IT news

The initial impression of ICD-10 implementation was that it went well for both providers and CMS, however, shortly after the October 1, 2015 date when Medicare claims began processing, providers found out otherwise. In some cases, Interventional Pain Management providers continue to struggle with "finding the right code" to report for their patient's condition.

CMS released a publication "Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities" http://tinyurl.com/CMS-ICD-10-ClarifyQ-A that provided additional details as to how this ICD-10 family of codes "free pass" was going to work.

 

In short, CMS stated, "The recent Guidance does not change the coding specificity required by the NCDs and LCDs. Coverage policies that currently require a specific diagnosis under ICD-9 will continue to require a specific diagnosis under ICD-10. It is important to note that these policies will require no greater specificity in ICD-10 than was required in ICD-9, with the exception of laterality, which does not exist in ICD-9. LCDs and NCDs that contain ICD-10 codes for right side, left side or bilateral do not allow for unspecified side."

What this means is that:

Don't be one of the providers that have the misunderstanding if they report a valid ICD-10-CM code in the same family of codes, Medicare will accept that.

 

Busy Interventional Pain Management providers don't have time to check the Medicare LCD each time they perform a procedure.

 

Make your medical practice easier and use the ASIPP® new ICD-10-CM Pocket Guide for assistance navigating through the complexity of ICD-10 coding.

Doctors Test Tools to Predict Your Odds of a Disease

  

Thomas McGinn, chairman of medicine at a major New York hospital system, is betting he can predict if a patient has strep, pneumonia or other ailments not by ordering traditional lab tests or imaging scans, but by calculating probabilities with  a software program.

Dr. McGinn believes using technology to help diagnose and treat patients can reduce the large number of unnecessary tests doctors order and antibiotics they prescribe by ruling out certain diseases. It also could expedite the appropriate care for patients by giving doctors grounds to treat them before lab tests can confirm a diagnosis.

The predictive tool, which pops up on the screen of electronic medical records, prompts the doctor to answer a short series of questions about the patient's condition. Based on that information, a calculator predicts the probability that the person has the suspected ailment. It may also recommend a course of action.

  

  

Wall Street Journal

Doctors rip VA plan to give some nurses more authority

  

WASHINGTON - The Department of Veterans Affairs would dramatically expand the authority of nurses to treat patients without a doctor's supervision in a controversial proposal by the country's largest health-care system.

The plan, which would allow nurses with advanced training to broaden their responsibilities for patients, is drawing attention to a bitter debate over the relative roles of doctors and nurses. Because of VA's high visibility, it is likely to be closely watched.

  

Stars and Stripes

Interventional Treatments of Cancer Pain are Effective but Under-Utilized

A recent review by Drs. Jill Sindt and Shane Brogan of the University of Utah School of Medicine detailed the current status of a number of interventional techniques for the treatment of cancer-related pain: intrathecal drug delivery, vertebral augmentation, neurolytic plexus blocks, and image-guided percutaneous tumor ablation.1

The primary algorithm for the treatment of cancer pain in use today is a 3-step "analgesic ladder" developed by the World Health Organization (WHO). Non-opioid analgesics comprise the first step on the ladder; if pain persists, clinicians are advised to move onto the second step, which consists of non-opioids in combination with weak opioids. The third and final step consists of strong opioids plus non-opioids. Yet evidence from a 2007 systematic review of the medical literature shows that this approach to cancer pain management may be insufficient. Results showed that pain was prevalent in 64% of patients with metastatic, advanced or terminal cancer; 59% of patients undergoing cancer treatment; and 33% of patients who completed curative treatment. More than one-third of cancer patients who reported pain rated it as moderate or severe, suggesting that additional modalities may be warranted when conventional medications do not provide sufficient control.2 Due to these unmet needs, interventional techniques have been suggested as a "fourth step" in the WHO analgesic ladder.3

  

Clinical Pain Advisor

Doctors fire back at bad Yelp reviews - and reveal patients' information online

  

Burned by negative reviews, some health providers are casting their patients' privacy aside and sharing intimate details online as they try to rebut criticism.

In the course of these arguments -- which have spilled out publicly on ratings sites like Yelp - doctors, dentists, chiropractors and massage therapists, among others, have divulged details of patients' diagnoses, treatments and idiosyncrasies.

One Washington state dentist turned the tables on a patient who blamed him for the loss of a molar: "Due to your clenching and grinding habit, this is not the first molar tooth you have lost due to a fractured root," he wrote. "This tooth is no different."

  

  

Washington Post

Understanding Mechanisms of Neuropathic Pain to Design Effective Treatments

  

A review article recently published in Neuron1 by the groups of Yves de Koninck, PhD and Steven Prescott, MD, PhD at the Laval University, Quebec, Canada and the Hospital for Sick Children, Toronto, Canada, respectively, highlights the need to better target treatments for chronic neuropathic pain. Individuals experiencing chronic pain with neuropathic characteristics account for 7-8% of adults2 and report higher pain levels than patients with non-neuropathic chronic pain.

Altered potassium-chloride co-transporter (KCC2) function leads to dysregulation of intracellular chloride (Cl-) levels, which severely affects inhibitory signals normally blocking pain transmission. This results in hyperexcitability of spinal neurons transmitting pain signals, causing neuropathic pain3. A recent study from the Prescott laboratory shows that alterations in KCC2 function, although impacting inhibition of both excitatory pain-producing and inhibitory pain-reducing neurons, results in low levels of excitation, which, through spatial summation results in supra-threshold excitation, thus producing allodynia4.

  

Clinical Pain Advisor

Confirming off-the-record reports that drug abused figured in the April 21 death of the musician and composer Prince, the Midwest Medical Examiner's Office today released a report saying the 57-year old died of a self-administered dose of fentanyl. 

As reported in the Minneapolis Star Tribune, the investigation had long focused on Prince's abuse of painkillers. 

He reportedly had chronic pain from a hip injury due to years of jumping off speakers in high heels. 

Caution Needed When Prescribing Antidepressants to Treat Chronic Pain

  

HealthDay News -- Depression accounts for only a little more than half the antidepressant prescriptions issued by Quebec physicians during the past decade, and two out of every three non-depression prescriptions are for an off-label purpose, according to a research letter published in the May 24/31 issue of the Journal of the American Medical Association.

  

Robyn Tamblyn, Ph.D., a professor of epidemiology and biostatistics at McGill University in Montreal, and colleagues gathered electronic medical records generated by primary care physicians in Quebec between 2006 and 2015. During that period, 101,759 antidepressant prescriptions were written by 158 physicians for 119,734 patients.

Clinton backs Manchin plan to tax opioids

  

Charleston, West Virginia (CNN)Hillary Clinton on Tuesday backed Joe Manchin's plan to tax opiods, telling the West Virginia senator that his call to levy a 1-cent tax on prescription opioid pain pills was a "great idea."

Manchin, whose state is dealing with the highest rate of drug overdose deaths in the country,  proposed earlier this year a tax of "1 cent on each milligram of active opioid ingredient in a prescription pain pill to be paid by the manufacturer or importer."

During a roundtable on opiod addiction here Tuesday morning, Clinton embraced the idea.

  

  

CNN