Docs must stop over-prescribing pain pills, summit speakers say

When a statistic showed the number of opioid prescriptions increased from 76 million in 1991 to 219 million in 2011, Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, asked the seminal questions: "Do we really have this number of people requiring these prescriptions? Have we increased four times in terms of chronic pain? That's clearly not the case."

Dr. Ileana Arias, principal deputy director of the Centers for Disease Control and Prevention, said "opioid overdose death rates have risen in lock step with sales," reports Laura Ungar for The Courier-Journal. "In 2010, enough prescription painkillers were prescribed to medicate every American adult around the clock for a month."

These were more troubling statistics discussed at the National Rx Drug Abuse Summit, held in Orlando, Fla., and organized by Eastern Kentucky's Operation UNITE. "This is an epidemic. And at CDC, we do not use the word epidemic very lightly," Arias said.

Volkow pointed out opioids are very addictive, since they raise dopamine levels in the brain, which are triggered when people do pleasurable activities, such as eating or sex. Heroin and the painkiller OxyContin are nearly identical in their chemical structure, she said. OxyContin blocks pain but increases dopamine. "You are decreasing pain, but you are activating a reward," she said.

Treatment is one solution, but "we don't have sufficient treatments. We are far behind other conditions," such as cancer or HIV, Volkow said.

More research is needed to "develop better pain medications that are as effective as opioids that are not addictive," she added. Doctors also need to be aware of over-prescribing, with Arias recounting a story in which she was prescribed two-weeks worth of Demerol after she had her wisdom teeth taken out — an excessive amount, in her view.

U.S. Rep. Harold "Hal" Rogers of Kentucky's 5th District said he wasn't surprised. "Time and again, we've heard that doctors have prescribed, say, two weeks of medication when only a few days are necessary," he said. "Then the rest go in a medicine cabinet for (others) to pilfer." (Read more)

Troubling statistics discussed at prescription-drug summit

Staggering statistics were revealed this week at the Orlando-based National Rx Drug Abuse Summit, including one survey that found 2 million people age 12 and older started using prescription pain medicine for non-medical reasons in 2010. A troubling 11 percent of active-duty military personnel reported misusing pain medicine in the past month, Department of Defense research shows. And more than 15,000 people die each year because of pain killers, 1,000 of whom are Kentuckians, reports Laura Ungar of The Courier-Journal.

"Prescription-drug abuse is causing untold misery among our families," Gov. Steve Beshear said at the gathering, which was organized by Eastern Kentucky-based Operation UNITE. The problem is "wasting away the future of many people in the Commonwealth of Kentucky."

As he's done several times now, Beshear asked conference attendees to push legislators to pass House Bill 4, which should be voted on today in Frankfort. The bill would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney genera's office from the Cabinet for Health and Family Services.

Experts said prevention is key, which involves education youth, parents, as well as doctors and pharmacists. U.S. Surgeon General Dr. Regina Benjamin doctors "need to be more cognizant of the problem," Ungar reports, recounting an incident in which a patient stole one of her prescription pads by using her 4-year-old daughter to district Benjamin.

Gil Kerlikowske, known as the country's "drug czar," said general practitioners and family medicine doctors accounted for 27 percent of all prescribers of extended-release, long-acting opioids. Internal medicine physicians were the most common specialists to prescribe, accounting for almost 17 percent of prescriptions of pain pills.

One of the problems, Kerlikowske said, is prescription drug abuse is considered more acceptable than taking other kinds of drugs. Children "see their parents taking it. It's not heroin. It's not coke." (Read more)

Diabetes can cause gum disease and tooth decay

Though it's commonly known that diabetes can affect organ function and eyesight, an oral-health expert points out that the disease can also cause tooth decay and gum disease.

"Diabetics with uncontrolled glucose levels tend to develop more gum disease and may lose more teeth than diabetics who have good control of their glucose levels," writes Dr. John Novak, associate director of University of Kentucky's Center for Oral Health Research, in an op-ed piece for the Lexington Herald-Leader. A high carbohydrate/sugar diet can also lead to high levels of sugar in the blood, which can hamper the way the body deals with infection, he writes. Gum disease may be the result because the gums are inflamed by the increased levels of bacteria living in the mouth.

Diabetes can also cause dry mouth, which "creates the perfect environment for the growth of bacterial plaque and for fungal infections such as thrush," he writes. To avoid these problems, Novak recommends brushing teeth and gums twice a day with a fluoride toothpaste, flossing every day and using fluoride mouth wash before going to bed.

Signs of tooth decay or gum disease include tender gums that bleed easily when brushing or flossing; teeth sensitive to hot or cold temperatures; loose or broken teeth; sores, ulcers or a burning sensation in the mouth; and bad breath or a bad taste. (Read more)

Beshear vetoes parts of budget, but health spending is intact

Though Gov. Steve Beshear vetoed 45 parts of the state budget yesterday evening, health-related spending was safe from the cut.

The budget will help reduce caseloads for social workers who investigate child abuse and neglect, funds colon cancer screenings for 4,000 uninsured Kentuckians, substance-abuse treatment for Medicaid recipients and includes funding for an elder abuse registry to protect senior citizens from unscrupulous caretakers.

"This is the most difficult budget I have ever drafted, and it will also be a challenge to implement and manage over the next two years," the governor said in a statement.

In the two-year, $19 billion budget, Beshear voted more than three dozen line-item appropriations, including "portions of the General Fund budget that limited his ability to manage the state's budget or spent money that doesn't exist," reports Beth Musgrave of the Lexington Herald-Leader.

He also cut some earmarks, including $100,000 for Actors Theatre of Louisville and $150,000 for the International Mystery Writers' Festival in Owensboro. "I am vetoing these parts because they identify new spending earmarks yet the General Assembly failed to appropriate additional funds to finance them," Beshear said. (Read more)

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