Smorgasbord Health Column – Prescribed #Medication #Opioids – Statistics and our responsibility as a patient.


Today I am going to be looking at prescription medication and whilst I am going to give you some overall figures for the UK it is likely that you will find similar statistics in whatever part of the world you live in. In effect this problem impacts the health and lives of billions around the globe.

This is particular relevant with the increase in opioid addiction

Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times.

The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50.

Although the data is preliminary, the Times’s best estimate is that deaths rose 19 percent over the 52,404 recorded in 2015. And all evidence suggests the problem has continued to worsen in 2017.

You can read the rest of this report: New York Times – Overdose Deaths Increase

After you have read the post you might like to take a peek in your medicine cabinet and review your own risk factors with regard to the pills you are taking!

Let me emphasise that on no account should you stop taking any prescribed medication without consulting your doctor. You were prescribed it for either an acute infection or chronic condition and it is important that you continue to follow the directions until safe to discontinue taking.

Discussions with your doctor or hospital.

What is important to remember, is that any communication or contact that you have with any health provider, should never be a one-sided interaction. With your health you need to be an active participant and a doctor can only prescribe medication based on accurate information that is either recorded in your existing health notes or what you tell them.

To put this into context let’s have a look at some of the figures for prescriptions in the UK and US

It is estimated that 4.25 billion prescriptions will be filled in retail pharmacies in 2019 in the US… this does not include prescribed medication in hospitals. This makes medication one of the most profitable industry making multi-billions per annum.

Americans are in more pain than any other population around the world. At least, that’s the conclusion that can be drawn from one startling number from recent years: Approximately 80 percent of the global opioid supply is consumed in the United States.

Pain drugs are the second-largest pharmaceutical class globally, after cancer medicines. “There was about 300 million pain prescriptions written in 2015,” Irina Koffler, senior analyst, specialty pharma, Mizuho Securities USA, told CNBC. Global opioid supply

Over 2.5 million prescriptions are written every day in the NHS with around 7000 medications prescribed in every average size hospital.

Errors in the prescription process.

An error can occur at any part of the process – prescribing, transcription, dispensing, administration and monitoring.

The phase that is the most vulnerable to error is at the prescribing stage when incomplete medical histories and incorrect verbal information between patient and doctor takes place.

Prescription faults represent up to 11% of those that are dispensed at a cost of an estimated £400million per year.

Around 16% of those prescription faults result in harm to patients.That is around 45,000 people per day!

Most of these could have been avoided with complete medical records and accurate information taken at the time of prescription.

Issues that need to be taken into consideration and are missed due to lack of communication or incomplete records.

  1. Some drugs have severe side effects that can cause illness or disease either directly or as part of an interaction.
  2. Certain drugs can mask serious illnesses that go undiagnosed and treated.
  3. Lifestyle issues such as alcohol consumption, self-medication with over the counter drugs such as pain-killers. Smoking,recreational drugs or a poor diet that has resulted in nutritional deficiencies.Even regular use of herbal remedies can impact the effectiveness and more importantly the safety of the prescribed medication.
  4. If the patient is very elderly, dehydrated and malnourished, oral medication may not be as effective as the digestive system is not able to process in that form. The delivery system then is not effective and needs to be changed to intravenously into a vein or by sublingual administration beneath the tongue directly into the bloodstream.

How to become part of the solution rather than part of the problem.

Those of you who read my blog will know that I advocate individuals taking responsibility for their own health as far as it is possible. This includes following a healthy diet with at least 80% of foods being fresh and unprocessed to maintain a healthy immune system.

Smoking, being very overweight and other activities that are harmful to your health are likely to result in the need for medical intervention at some point and certainly increases the requirement of prescribed medication.

Keeping your own records.

As we get older our list of health issues throughout our lifetime gets longer.. and longer! You are also more likely to require a hospital visit, and one of the most time consuming, and probably inaccurate activities, is the taking of a medical history on admission to the emergency room or a ward. This is particularly relevant when a patient is in extreme pain or with elderly admissions, as I have experienced when accompanying my mother. Hence the following recommendation that I found saved a great deal of time and stress.

Whatever age you are. I suggest you compile an accurate medical history of your own that includes the following:

  1. Past illnesses from childhood including measles, mumps, German measles and chicken pox. Whilst some cause no further problems, chicken pox for example can lie dormant and result in shingles in later life.
  2. Drugs that have been prescribed in the past such as repeated antibiotics. This can cause an imbalance in the intestinal flora leading to a fungal overgrowth that impacts your immune system. Crohn’s disease,IBS and Gluten intolerance for example can inhibit the absorbtion of vital nutrients for your health and also medications.
  3. Current medications for any diagnosed long-term illnesses and keep copies of your current prescriptions with the list. Also the dosage – 50mls twice a day – one 575mg every 12 hours etc.
  4. Any herbal remedies that you are taking and for what reason.
  5. Any vitamin or mineral supplements. For example taking Vitamin K could affect your blood clotting and the effect of anti-coagulant drugs such as Warfarin.
  6. Any over the counter medications that you take regularly including pain killers.
  7. Any allergies that you have including to foods, insect bites, drugs such as Penicillin, Tetanus, Aspirin etc.
  8. Any past adverse effects from taking medication with a note of the specific drug.
  9. Details of your GP including address and telephone number
  10. Details of your next of kin and give two names with one as prime and one as secondary with a telephone number.
  11. Also note your weekly alcohol consumption (truthful) and if you smoke and how many a day.
  12. There are some key indicators for health that are worth having measured regularly including LDL levels of cholesterol, blood sugar levels and blood pressure. Make a note of your last numbers as these are very useful as a guideline. A doctor is likely to measure your BP but it is still useful to have a recent record to compare.

Even if a doctor insists on retaking your medical notes – you have this with you as an accurate reference.

You should compile this for elderly parents and the other members of your immediate family. It will at the very least provide for a more detailed and therefore accurate record before diagnosis.

Rather than carry around the record in paper format for you and the rest of the family you might consider transferring to a small memory stick attached to your keys. This is very important if you are travelling abroad especially where language may be a barrier to accurate diagnosis so that your records are easily accessed and translated digitally. You can use a marker to put a large red cross on the cover.

When you are at the doctors.

Unfortunately, appointments at the doctors in the UK are invariably restricted to 10 minutes and that is not much time to discuss the problem, make a diagnosis and then prescribe the correct medication. But you can take your own record so that it is easy to refer to when answering questions from the doctor. A paper copy can be kept with your medical records since the majority are still in that format and not digital or if possible your computerised records can be updated.

If you are then prescribed medication it is time to participate again by asking important questions.  Here is a brief checklist that you can add to depending on your own health issues.

  1. What are the main causes of my condition?
  2. What does this drug do?
  3. Are there any changes I can make to diet or lifestyle that I could put in place immediately so that we can postpone this prescription?
  4. If I take this prescription now for the immediate problem what changes can I make so that I am only taking short-term?
  5. How often and when should I take the medication? (every 8 hours, after meals etc)
  6. Does it need to be kept in the fridge or any other specific storage instructions?
  7. What are the likely side-effects?
  8. Is there anything in my current prescribed or over the counter medications that this drug might interact with?
  9. What should I do if I begin to feel unwell after taking the drug?
  10. When do you want to see me again to monitor my progress?

You might like to visit the American Recall Centre for information regarding some specific drugs and medical appliances that may cause side-effects that can be serious. You will also find informative articles and news items on recently reported issues with prescribed medication.
https://www.recallcenter.com/drugs/

Medication errors: the importance of an accurate drug history by Richard J Fitzgerald http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723207/

Out of date medications

As a final note, please check your medicine cabinet and collect together drugs that are out of date or no longer required and take them to a pharmacy for safe disposal, Some doctors will also take them back but check with them. Do not tip down the toilet or down the sink as they will contaminate the ground water. Evidence suggests that this is already the case..

Don’t put unused medication in the trash (you don’t know who might find them including children. Also animals scavenge rubbish and might get hold of them. If you do put empty prescription bottles in the trash then remove the label with your information.

©Sally Cronin Just Food for Health – 1998- 2018

A little bit about me nutritionally.

A little about me from a nutritional perspective. Although I write a lot of fiction, I actually wrote my first two books on health, the first one, Size Matters, a weight loss programme 20 years ago. I qualified as a nutritional therapist and practiced in Ireland and the UK as well as being a consultant for radio. My first centre was in Ireland, the Cronin Diet Advisory Centre and my second book, Just Food for Health was written as my client’s workbook. Here are my health books including a men’s health manual and my anti-aging book.

All available in Ebook from:  http://www.amazon.com/Sally-Cronin/e/B0096REZM2

And Amazon UK: http://www.amazon.co.uk/Sally-Georgina-Cronin/e/B003B7O0T6

I would love to connect to you on social media.

Facebook: https://www.facebook.com/sally.cronin
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LinkedIn: http://uk.linkedin.com/in/sallycronin1

Thank you for dropping in today and I hope you have found of interest.. thanks Sally.

Smorgasbord Health Column – Painkillers – Prescribed and Over the Counter – Side Effects and Addiction.


Over the last twenty years, the USA has been on a downward spiral with regard to opioid addiction.

In 2002, 5,000 people died from overdosing with prescription opioids such as extra strength Oxycontin – Pure Oxycodone  ( a semi-synthetic opioid loosely related to morphine and originally based on elements of the opium poppy) and from others such as Percocet, Percodan which are usually oxycodone mixed with Tylenol or Ibuprofen. Other opioid drugs include Fentanyl, Hydrocodone and codeine in various strengths and mixed with NSAIDs or paracetamol.

In 2015 these deaths caused by opioid overdose had increased to 52,000 per annum.

The UK has also seen an increase in addiction. However some of those who are afflicted go unreported, such as when associated with the very elderly. I have personal experience of this with the prescription of Tramadol in excessive doses, and also Oramorph which is a liquid opioid, to my mother in her late 80 and early 90s. And then with the safe withdrawal from those drugs over several months after taking issue with the prescription.

It is hard not to be cynical when our elderly are being given addictive opioids, that can severely impact breathing, and who may be only interested in the pain relief they offer, rather than the very small print on the leaflet enclosed.

The UK has a public health system which is far more regulated than in the US, and the pharmaceutical companies do not have such a lucrative market place. However, we have still managed to become a nation of pill-poppers at a cost of around £16 billion per year to the NHS.

In the USA, the prescriptions for Oxycontin had risen to 6 million a year by 2009 but the use of the pills became big business on street corners and became part of the overall drug problem facing the nation. Also there is often a transition to the use of illegal drugs such as heroin, when the prescribed source of the painkiller dries up. It is no longer the stereotypical junkie who is on the front pages of newspapers, but young mums and sometimes both parents passed out in cars with children in the back seat.

Here is an interesting statistic that caught my eye when reading various reports on opioid addiction.

“Other developed countries, including the UK, have been grappling with a rise in opioid addiction, too, although Britain’s public health system means the issue of massive over-prescription is less acute.

But the US is the epicentre and the origin of the crisis, consuming more than 80% of global opioid pills even though it has less than 5% of the world’s population and no monopoly on pain.”

Read more of this very informative article: https://www.theguardian.com/us-news/2017/oct/25/americas-opioid-crisis-how-prescription-drugs-sparked-a-national-trauma

There is no doubt that there are life saving drugs developed that are beneficial to mankind, and that for short term relief of extreme pain, opioids are one of the few options. But unfortunately once the body is no longer in pain, and the drugs are continued to be taken, the neurotransmission in the brain is disrupted.

This is the way that neurons (nerve cells) communicate in the brain and they determine the way we feel, think and behave.

Each of our neurons produces one or more neurotransmitters such as serotonin or dopamine. For example, dopamine is mostly found in areas of the brain that determine feelings of reward. Prescription opioids produce effects similar to the neurotransmitters such as dopamine as well as endorphins (creating the feel good factor) effecting pain relief but when production of the neurotransmitters is disrupted, it can also result in lack of focus, lack of inhibition and become life threatening by inhibiting the ability to breathe.

Withdrawal from these addictive prescribed painkillers after long term use, is not easy at all, and can be dangerous. It takes professional intervention and help to rid the body of the toxins and to also normalise the functionality of the neurotransmitters in the brain.

What about over the counter painkillers.

It is easy to assume that if a drug or painkiller is available over the counter then it cannot be harmful. Unfortunately this is not always the case, especially with the class of drugs known as NSAIDs or Non-steroidal anti-inflammatory drugs which includes Ibuprofen and Aspirin (Disprin).

Millions of us will walk into a pharmacy and buy both these painkillers to reduce the inflammation of certain common conditions such as arthritis. However, there is increasing concern about the long-term use for chronic conditions.

Even the low-dose aspirin taken as a preventative against heart conditions, can contribute to some of the side effects that have been recorded.

Increased risk of Heart Failure.

NSAIDs encourage the body to retain sodium. The body then hangs on to water to dilute the concentration. You then have more fluid around individual cells and additional volume of blood in the cardiovascular system. This results in a lot of additional work and pressure on blood vessels which can harden, which in turn leads to high blood pressure, heart attack or a stroke. If you find yourself becoming breathless easily, developing puffy ankles, suffer from indigestion more frequently, tight feeling in the chest, nausea and sweating and a persistent cough, please go to the doctor immediately.

Kidney damage.

The anti-inflammatory and sodium retention properties of these drugs can lead to damage to the kidneys, and if after prolonged use of Aspirin of other NSAIDs you notice that you have poor energy levels, dry itchy skin, pain both sides of your lower back, frequent urination or blood in your urine, you should go to a doctor immediately.

Internal bleeding from stomach ulcers and gastrointestinal damage.

Although the 75mg preventative dose of aspirin has been thought to be less of a risk in relation to internal bleeding, there is growing evidence that in some people it can still result in damage throughout the digestive tract including the esophagus. Taking full strength aspirin for extended periods has been associated with stomach ulcers and intestinal bleeding. If you smoke, have a family history of ulcers of have other medical problems you should seek medical advice before taking this painkiller.

Allergic reaction.

My mother was allergic to aspirin and so am I. Possibly because we have the asthma gene from my grandmother. Asthma sufferers should be very careful about taking NSAIDs without medical advice and should be monitored carefully.. This is particularly important if you have children who have asthma, and in fact it is not recommended for under sixteens to take NSAIDs at all.

Paracetamol is generally considered safe as it does not have the same anti-inflammatory properties, select age appropriate dosages such as in children specific products, but again it is wise to ask the advice of the pharmacist.

You should also never give NSAIDs like aspirin to children with chickenpox or with influenza as it can result in damage to the liver and the brain.

What are the alternatives.

That is really tough because when it comes to acute short term pain such as following injury or post operative, it is difficult to beat NSAIDs, and in extreme cases opioids.

However, chronic pain management needs to be approached in a holistic way that maximises the effect on the pain, but minimises the damage to the whole body and its major organs.

Diet and exercise is very important as sitting all day and not using the body does not release natural endorphins that help with pain.

Eating sufficient good fats, vitamin C rich foods to help the production of collagen (for joint pain) and a wide range of anti-oxidants with a reduction in refined sugars.

Here is my basic nutritional shopping list and if you are eating these foods regularly you should see some benefit. Those with particular anti-inflammatory properties are tomatoes, green vegetables such as spinach, nuts, fatty fish and berries.

https://smorgasbordinvitation.wordpress.com/2014/05/19/a-basic-shopping-list-for-a-nutritionally-balanced-diet/

Sometimes diet and exercise is not sufficient, in which case it might be worth exploring acupuncture, which is a therapy that I have used for chronic knee pain successfully.

Physiotherapy can also help relieve muscle and join pain as can certain forms of exercise such as swimming.

Personally I use a daily turmeric spray as it has anti-inflammatory properties when used over an extended period of time.

Finally

At the end of the day, pain needs to be managed. If it is acute pain from an injury or post operative, then you may require prescribed medication in the short term. In which case you should work with your doctor to reduce the painkillers over a period of time as the pain becomes manageable with non-opiate alternatives.

If you suffer from chronic pain then also work with your doctor and pharmacist to manage with both physical therapies and the right pain medication that does not cause any serious side-effects. Do not be afraid to ask questions about any prescribed medication and read the leaflet carefully to maximise safe usage. For example taking with food to help prevent damage to the stomach or intestinal tract.

Also review your diet, lost weight if that might relieve joint pain in hips and knees and explore alternative health products that may work for you. Talk to a qualified assistant and check out online first. If you have any questions them please do not hesitate to ask. sally.cronin@moyhill.com.

For more information on Opioids and NSAIDs here are some links.

https://familydoctor.org/condition/opioid-addiction/

https://drugabuse.com/library/opiate-abuse/

https://www.health.harvard.edu/pain/pain-relief-taking-nsaids-safely

I hope you have found this of interest and I look forward to your feedback. Thanks Sally