Obama Weighs In On Opioid Crisis in America

February 23, 2016 / Thomas Cohn, MD

President Barack Obama shot down a proposal on Monday from the nation’s governors designed to curb America’s opioid and heroin crisis. The proposal called for limiting the number of high-powered painkillers a doctor could prescribe at a time, but Obama said the move could block access to drugs that people truly need.

“If we go to doctors right now and say ‘Don’t overprescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” Obama said. “In some cases, addiction is already there.”

The recommendation had received bipartisan support at the National Governors Association’s winter meeting, but President Obama rejected the sweeping proposal. The president thanked the governors for crossing party allegiances to come to a solution, but he didn’t think it adequately addressed the full scope of the problem.

“This is an area where I can get agreement from Bernie Sanders and Mitch McConnell. That doesn’t happen that often,” Obama said.

Opioids in America

According to the Centers for Disease Control and Prevention, heroin and prescription painkillers play a roll in the deaths of 78 Americans every day. Certain prescription opioids are seen as gateway drugs to heroin, which is cheaper and often much easier to obtain.

Vermont Govermor Peter Shumlin criticized Obama for rejecting the proposal, saying, “You can’t convince me that we’ve got 250 million Americans in chronic pain.”

The fact of the matter is that opioids are likely over-prescribed in this country, and while some doctors certainly hand them out too easily, for some patients, it is truly the only option that keeps their pain at bay. For others, surgery or costly therapy sessions are out of the question, so they rely on those painkillers to manage their pain. Dr. Steven Stack, president of the American Medical Association, praised Obama for shutting down the blanket rule which would have undoubtedly hurt a large portion of actual chronic pain sufferers.

“The complexity of the problem makes it difficult to create a successful one-size-fits-all approach,” Stack said.

Stack is right. There is no perfect one-size-fits-all approach to chronic pain care, just like there is no magic pill to solve one’s pain. In the end, we need comprehensive exams to understand to underlying cause of pain, and we need to work with patients to understand their treatment options and the potential implications of each. It’s much harder than simply prescribing a painkiller, and it also takes work on the patient’s end to work to get better and not just rely on their pain pills, but this duel-responsibility approach is what it’s going to take to start reversing the opioid crisis.

How To Properly Dispose of Pain Pills and Opioids

February 8, 2016October 25, 2017 / Thomas Cohn, MD

Opioid abuse has become a huge problem in the United States. After many minor procedures and trauma people are prescribed pain medication. Oftentimes people have leftover pills that end up sitting around the home. This is one source of pills that may be misused or abused by others, or the patient themselves and can lead to addiction. No one usually wants to waste their medicine, but with the abuse potential and danger of these opioids, disposal then becomes an issue.

Leftover pain medications that are opioids need to be handled properly. When storing them at home, due to the street value and abusive potential, they should be kept hidden and locked away securely. One does not want these medications to ever be lost or stolen. Furthermore, easy access may allow another household member or friend the ability to take the opioids and use or abuse them. Your safety and others is dependent on keeping all your medications secure and used only according to the directions of the prescriber.

Proper Disposal

Disposal of medications has become a major problem. Most drugs, no matter the category, are considered hazardous substances. Drugs can be toxic to other people, animals and the environment. Studies of wastewater have often showed traces of a wide variety of substances from birth control hormones, to antidepressants and narcotics. The most common recommendation for drug disposal has been to flush them down the toilet. Unfortunately this has led to the spread of many compounds into the water system and the environment. A better solution for personal disposal is to crush and mix the pills with dirt or cat litter making the drug unusable and disposing with the trash.

Currently, the best option for disposal is burning the medication in a commercial incinerator. This actually destroys and fairly safely vaporizes most medications. Minnesota does have a program coordinated by local law enforcement offices to take unused prescription medications, and these are sent for hazardous waste incineration. Unfortunately this is not the most convenient system for a lot of people. Physician offices usually do not have the ability to do this but often they can add prescription medications to other drugs and materials that are sent out as hazardous waste on a very limited basis. Pharmacies and drugstores do not generally have the ability to accept returned medications.

Hopefully in the near future, Minnesota will develop a system to encourage medication return to pharmacies for disposal in a secure and proper way. A wide spread system of pharmacy return and transfer for incineration would be ideal. For this to occur, Minnesota would need to change its law and assist with the coordination of collection and proper disposal. This would be a major step forward in reducing medication available for abuse and it would lessen the toxic effects on the environment.

The Importance of An Anti-Inflammatory Diet, Part 2

February 4, 2016 / Thomas Cohn, MD

Earlier this week, we posted a blog titled “The Importance of An Anti-Inflammatory Diet, Part 1.” In the post, we discuss five tips for keeping chronic pain at bay through a healthy diet. Here’s Part 2, which includes five more tips.

Tip 6: Try adding onions to more dishes – Onions are packed with beneficial antioxidants. These may help reduce inflammation, lower bad cholesterol and reduce heart risks. Use more onions in your food preparation from sauces to salads and on things like sandwiches.

Tip 7: Watch out for some plants that may have the reverse effect of increasing inflammation – The most notable would be potatoes and corn since they are high in starches. Others are more controversial in effects, but are most likely beneficial. These include tomatoes, peppers and eggplant. All the latter are found significantly in the Mediterranean diet and are likely to have benefits from a number of compounds they contain that are antioxidants.

Tip 8: Fiber is your friend – Fiber lowers C-reactive protein levels and is a marker of inflammation that can be detected in the bloodstream. Fiber also fills up a person, and makes one feel full during a meal. This also helps in the overall digestive process and improves gastric motility, decreasing constipation. Fresh vegetables, some fruit, and unprocessed grains are good sources. Eat popcorn without extra salt and butter for snacks as an additional bonus.

Tip 9: Avoid processed foods, like white bread or rice, chips, cookies, and many prepackaged foods – These often are high in sugar, preservatives and salt and all are linked to being unhealthy. Many of these things tend to promote inflammation. Salt also promotes unnecessary fluid retention and high blood pressure and is found in large amounts in processed food.

Tip 10: Do everything with a degree of moderation – When you eat a meal, use a smaller plate, this will encourage one to eat less. There is no need to stuff oneself and constantly be eating. The brain needs time to receive the signals that you are full, so eat less and slow down. Eat more fresh food and prepare it yourself. Adding in a small amount of wine is a good treat and many wines contain resveratrol, another anti-inflammatory compound. Coffee has also been shown to be healthy with a number of anti-inflammatory and antioxidant compounds, so you can still enjoy your morning.

Changing your diet, eating less, eating more fresh fruit and vegetables, cooking your own food and improving your lifestyle can improve pain levels. Unfortunately, it does take a fair amount of dedication to change. However, if you keep doing things the same way all the time, the same results are going to occur. Consider the benefits of change to decrease pain and inflammation. For many chronic pain conditions there is no magical solution and changing your lifestyle is necessary to obtain the desired results.

The Importance of An Anti-Inflammatory Diet, Part 1

February 2, 2016 / Thomas Cohn, MD

The diet we eat appears to have more and more significant influence on how healthy we are overall. Diet crazes come and go, but more research is showing that the food we eat does affect many aspects of our life. The main problem is that it is easier to eat whatever foods are available than to choose things that are healthy and helpful to us.

Furthermore the food we eat is processed differently at least initially in each and every person depending on our own genetics and the bacteria that happens to be in our gastrointestinal tract. Lastly, if we are overweight, the fat in our body may be contributing to inflammation. Losing excessive fat, exercising and eating healthy foods are all part of controlling inflammation in our bodies, and that too can contribute to a healthy lifestyle.

Researchers have identified certain foods and diet characteristics that seem to help control inflammation. Below are some suggestions with regards to a diet to control inflammation.

Anti-Inflammatory Diet

1. Start eating fish regularly – At least two meals a week should contain fish that are rich in omega-3 fatty acids. These fatty acids are the ones that are good for you by reducing C-reactive protein and interlukin-6, two proteins that enhance inflammation in the body. Eating a portion of fish like salmon, tuna, sardines, or other cold water fish is ideal.

2. Eat more fruit and vegetables because they are packed with antioxidants – These are compounds that support your immune system and help protect it from dangerous compounds in the environment. They also may help prevent inflammation by protecting compounds in the body from breaking down and needing to be removed and destroyed. The best sources are fresh fruit and vegetables, and when cooking vegetables, just lightly steam or cook them, keeping them crisp. The daily amount should be at 2-3 cups of each a day, that would likely equal at least 2-3 pieces of fresh fruit plus your vegetables. This could also include your salads.

3. Try eating nuts and seeds more often – They are great to substitute for snacks instead of empty calories like sweets. Nuts are full of anti-inflammatory monosaturated fats and are high in protein and fiber. Nuts also tend to fill you up and decrease the desire for more calories. A quarter cup of nuts, such as almonds, walnuts, sunflower seeds or pecans are great for snacks. Keep a jar available and take a few when hunger strikes. Stay away from coated or salted nuts.

4. Beans are often known as the “magical” fruit – They have some unwelcomed properties for some people, producing gas since they may be hard for some to fully digest, but beans have several anti-oxidant and anti-inflammatory compounds. They are also a low cost source of protein, packed with minerals like magnesium, iron and zinc and are high in fiber. Cooked beans can serve as a substitute for meat in sauces, and can be used as a main protein source if properly balanced in a diet. Many vegetarians use beans as their main source of dietary protein and extensive recipes are available in how to incorporate them into meals.

5. Use olive oil as one of your main monounsaturated sources of heart healthy fats – This compound is rich in antioxidants and oleocanthal, a compound that can lower inflammation and pain. The Mediterranean region uses olive oil in most of its cooking, and many use it for salad dressing. It is fine for coating hot pans, but do not try to fry foods with this oil.

On Thursday, we’ll share part 2 which includes five more tips on how an anti-inflammatory diet can help prevent chronic pain.

Improving Care by Listening and Explaining

December 9, 2015December 9, 2015 / Thomas Cohn, MD

An article in Sunday’s Star Tribune discussed a new program at the University of Chicago where doctors work to better explain medical problems to patients in order to provide better care. It sounds perfectly obvious to patients that doctors should be doing this, but doctors do not often understand this issue. What is obvious and simple to a doctor is a mystery to the patient. Being able to understand and explain the complex situation to a patient is what old time medicine is all about, and has often been lost in our high tech world.

Why The Change?

Medicine has changed significantly in the last twenty to thirty years. Technology and computers have taken a leading role. In the past, time was spent with the patient taking a history, doing an exam, and then discussing with the patient a plan of care. Afterwards a couple minutes was spent dictating a short note and checking off a sheet for a bill, then you were done. Most of the time was spent interacting with the patient. Today time is spent staring at a computer, first searching medical records, then filling out pages of forms to create a new report for the visit, then typing out orders for tests and bills. More time is spent interacting with the computer than with the patient. Government regulations demanding electronic medical records and ridiculous details for billing are partly to blame. Unfortunately, for many doctors it is easier to be quick and done than to spend time and effort explaining the complexities of the problem.

Pain management is no different, as many doctors do not spend the time to explain complex medical problems. Chronic pain is usually quite complex. There are often multiple factors contributing to the sensation of pain, and multiple areas affected. A lot of doctors just want things to be simple, and are not considering the full picture and how many issues may be present and interacting. Furthermore, they want to only deal with one problem at a time. Many pain doctors want to do only procedures and do not want to manage patients. Other pain doctors want to only deal with certain problems; they do not want to deal with medications, or have limited beliefs and are against many types of treatments from interventions to surgery. Finding a pain management doctor who is comprehensive, who understands the multiple complexities of pain problems and who can work with a patient as a partner to explain the problem and possible management options is difficult.

The solution to finding a good doctor is no easy task. There is no one place to look for a good doctor. Insurance companies set up panels of preferred providers that patients must pick from that have no correlation to quality. Physicians often have limited knowledge about their colleagues and their skills, and are even more reluctant to say anything negative about any other practice. Internet rating sites often have limited value since there is no good standard method to evaluate quality of medical care. Word of mouth from patients can sometimes be the best source of information. As rule of thumb, 90% of all physicians will do a good job, the trick is really to find the 10% who provide that exceptional level of care. Those 10% who are special in their level of skill will always be tough to find. When you do find those special quality providers, no matter what the profession, spread the word.