The most interesting articles I came across this past week brought both a heartbreaking personal story of how deadly the wrong prescription medicine can be, as well as some potentially uplifting advancement in chronic pain research. Below you’ll find these articles and my thoughts on their implications.
Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.
In 2015, a man committed suicide after suffering severe side effects from taking Atvian, a prescription benzodiazepine often used to help with anxiety. He was prescribed the drug 2-3 years before his death and encountered many side effects but was unable to receive the proper medical help he needed. His suicide letter was released stating that he was murdered by the prescription drug, that he initially took for clinical reasons, but it ended up destroying his life.
A sad excerpt from a suicide note that a Toronto man left behind in April 2015:
“I would like to report a murder…the name of the murderer; I know the name…his name is Ativan (also lorazepam)…The important thing to remember is that this was a murder. I had zero choice in this decision. All I could do was delay it.”
I have consistently – from the beginning – talked about the dangers of #benzodiazepines. The epidemic of their use. The complexity of their actions/interactions. The difficulty in their weaning. The fatality in their mixture with #opioids.
There IS a place for them from personal experience. When my Dad was in hospice, dying from the complications of Parkinsons in 2014, Ativan (along with Morphine) helped him die with dignity, reducing his anxiety and pain. I was VERY thankful for those Rx drugs while I sat in his room for almost two weeks. But that was because I did not care about the side effects, the potential of addiction, the possibility of euphoria. Obviously benzos help some people with anxiety or chronic pain. Not everyone has negative effects, although discontinuance should never happen without strategic weaning. But don’t be naive to their danger.
There is a reason why the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain recommends not mixing opioids and benzodiazepines (along with every other published treatment guideline). And yet I saw them consistently mixed together when I first started addressing the opioid issue in 2003 and even now. While there is a role for them, it’s definitely not at the scope at which they’re prescribed. For patients, inventory everything you put into your mouth and why and identify potential alternatives (Rx and non-Rx) – in this case, Google is your friend. For providers/prescribers, educate yourselves on the benefits and risks, appropriate and inappropriate uses, side effects, drug-to-drug interactions and alternative treatment option(s) so together with the patient the absolute best choice can be made at this specific point in time.
A new program has been launched by The National Institutes of Health to examine the potential biological characteristics that contribute to an individual developing chronic pain from an acute injury. The program will collect data from patients who have developed chronic pain from prior surgeries and musculoskeletal trauma. The goal is to ultimately provide meaningful insight into how humans differ in their transition to chronic pain versus their resilience.
“The National Institutes of Health has launched the Acute to Chronic Pain Signatures (A2CPS) program to investigate the biological characteristics underlying the transition from acute to chronic pain. The effort will also seek to determine the mechanisms that make some people susceptible and others resilient to the development of chronic pain.” The ability to (hopefully) identify “predictive signatures of transition or resilience to chronic pain” would be valuable. Obviously there’s no mention of psychosocial considerations, but they have their own screening tools (which aren’t used as often as they should).
One of the keys in addressing the opioid epidemic is doing a better job of reducing the number of times acute pain becomes chronic pain. I know that’s not possible in all situations given the severity of the injury/condition, but I’ve observed many times that people can devolve into chronic pain (physical, emotional, psychological) when they didn’t have to if the most appropriate treatment choices were made, early and quickly. Bad choices, or delayed good choices, often create long-term unintended consequences. Hopefully this research can help add to the toolset of proactively identifying problems before they occur.
To read everything on my mind this past week, please visit me on LinkedIn at https://www.linkedin.com/pulse/marks-musings-october-1-mark-rxprofessor-pew/.
Until next week,