pain medication

Proper Opioid and Painkiller Disposal

/ Thomas Cohn, MD

Opioid Pill Disposal MinnesoraWith the increasing problems with drug abuse plaguing our society, there often is a question with regards to disposal of unused medications. The old training used to be to crush it up and throw it down the toilet. However, this is not a very environmentally friendly method of disposal. Tests performed at water treatment facilities often test positive for compounds like Prozac, an antidepressant. Fish are currently showing up with human hormones from ingesting residuals from birth control pills to testosterone. Clearly there are better solutions.

Recently, several different solutions have been proposed. A common suggestion has been to crush the pills and mix them with used coffee grounds and then throw them in the trash. Most likely, this is not much better than flushing them down the toilet. If the trash is incinerated, that would destroy the medications safely, but most trash is still placed in landfills, and again may end up in the environment.

Another solution offered by some pharmacies involves a special bag provided by the pharmacy with a chemical agent that neutralizes the drugs when they are placed inside the bag, making them unusable. The drugs then can be thrown away in the trash, or in some places returned to the pharmacy for disposal. There is a push on the state level to make it legal for pharmacies to take back unused drugs and then they can send them to an incinerator to be fully destroyed. High temperature burning leaves no significant chemical residual that may be harmful.

Police Intervention

One of the best solutions currently available is returning them to drug take back boxes that many police departments use. My local police department has a disposal box that is in the lobby, and is can be used 24 hours a day, 7 days a week. The police will then make sure the medications are sent for safe disposal at an appropriate incinerator.

The most important thing to be aware of is that unused medications sitting around the home are a significant safety hazard. They can be abused, misused, or even accidentally taken, which can lead to overdose and death. Proper disposal is essential. Currently, the best solutions are to use police disposal boxes, neutralizing pouches, or to return them to a pharmacy. Avoid flushing them down the toilet when possible.

Sometime in the future, hopefully some genius will figure out how to safely recycle medications. This would not be an easy task. Each individual medication would need to be separated, and then chemically reprocessed and purified to the same standard as the original production. Whether this would be cost effective, no one currently knows. In the meantime, old and unused medications need to be safely disposed on a timely basis since these are dangerous and toxic compounds.

Fentanyl – The Newest Deadly Drug

/ Thomas Cohn, MD

Fentanyl chronic painThe death toll from opioid overdoses keeps rising across the country, and the new culprit turning up everywhere is fentanyl. Authorities are suggesting that Prince died of Percocet laced with fentanyl. More and more street drugs are being laced with fentanyl to increase the high. It started with heroin and now many of the street drugs are being laced with this compound. Sometimes it is normal fentanyl, but other times it is a “designer” type of fentanyl that are created to be even stronger and more potent than regular fentanyl.

Drugs on the street have obvious danger, and what is in them is usually unknown. Drug addicts seek out potent opioids for the high that they will get. Typically the high started with plain prescription opioids, often given for relatively minor injuries. For those who are prone to addiction, the legal prescription starts the path toward severe problems with abuse. Initially, it is doctor shopping and doing what ever is necessary to convince a physician to prescribe. Since pain was considered the fifth vital sign and was heavily promoted, obtaining medications for vague pains used to be easy. With increased awareness of opioid abuse, the tide has turned and it is now much more difficult to legally obtain the medications. Most doctors have become scared to prescribe, and those who do by necessity oftentimes check the state Pharmacy Board for reported fills of a prescription by the patient, and they drug test the patients on their own.

Addicts are now turning to the street to obtain their opioid fix since the legal prescriptions are harder to obtain. The most common cheap drug is heroin. However this drug has a definite bad reputation, and prescription drugs have been the preferred safer option for many addicts. Even heroin is now being laced with fentanyl to make the drug stronger. The street drugs are often marketed as the same as those obtained by prescription. Some are actually the drug, such as hydrocodone or oxycodone. Now however they often are being laced with fentanyl to improve the high generated from the drug. Fentanyl is 100 times stronger than oxycodone, hydrocodone or morphine. It’s dosed in micrograms normally for medical uses. Lacing another medication with fentanyl is very tricky since it is easy to add a trace too much. The consequence of too much fentanyl is a significant overdose. Too much fentanyl hits the respiratory centers of the brain hard, preventing breathing. Reversal agents must be given in multiple doses immediately if a patient has any chance of surviving an overdose.

New Fentanyl Problems

The latest drug to be added or laced to street drugs is carfentanil. It is 10,000 times more potent than morphine. Therefore just a trace of this drug mixed with another opioid would obviously give an extreme high, but also would likely kill a person if not treated almost immediately. This drug is now turning up in Ohio and along the East coast, and has been seen in Europe. It was initially used apparently as an elephant tranquilizer. To reverse this drug it often takes a half dozen or more shots of Narcan, the reversal agent for opioids. The rash of deaths linked to drug overdoses is often linked to this compound. Unfortunately it is also attracting addicts to areas where overdoses are occurring, since they know they might be able to find their ultimate high.

Unfortunately, as we become more aware of the latest problems with fentanyl, newer designer formulations are being made that are equally as strong or stronger. A brief search shows about a half dozen types of fentanyl possibly being made and all are deadly. These days, any street drug can be laced with a deadly compound, if you are an addict, death could be easily around the corner. Opioids are dangerous drugs, if addicted, seek appropriate medical treatment.

Chronic pain is a difficult problem. Clearly, opioids are dangerous drugs and are not the preferred treatment. There are multiple treatments available for pain. If your pain is not well managed, find a good pain specialist who will work with you to find alternative management options. Once pain becomes chronic it is extremely complex, and not able to be cured or fully treated. It often needs to be managed such that it is not the focus of life. It is not a perfect solution, but it can be made manageable.

Lessons From Prince On Chronic Pain

/ Thomas Cohn, MD

The death of Prince shocked the nation, a great artist lost to early, and his death has since been linked to opioids. Many celebrities have struggled with drug and alcohol addiction, but this story seems different. Prince did have a problem it appears with opioid addiction, as he died from an overdose most likely of fentanyl mixed in with oxycodone. He knew he had a problem, but for some reason he was slow to seek treatment, and help was just hours to late. The reason why this celebrity death is different is that Prince had chronic pain, and opioids were being used to help control symptoms.

Chronic pain is estimated to affect about 30 percent of the population in the United States as well as throughout the world. As a musician, Prince had apparently developed several injuries related to his work. He definitely had hip arthritis with deterioration of at least one of his joints. He may also have had other injuries, possibly pain related to repetitive stress on joints from hours of practice and playing multiple instruments. According to some reports, Prince would have definitely benefited from hip surgery and possibly a replacement. However he was a Jehovah’s Witness and this surgery was against his beliefs. Instead of taking care of it surgically, he chose other strategies.

Pain and the Pressure To Perform

Prince, like every other professional, felt the obligation to always be up and performing. Everyone wants to hide their suffering from others, and many people will go to any end to be able to look their best. For performers like Prince, either he showed up and gave a great show or he would probably no longer have a career. As far as his health, he made it a secondary priority. Chronic pain does not discriminate, and crosses all social, cultural and economic groups. No one gets special privileges, only you may be able to afford more treatments. Celebrities are also not immune from overdose, addiction, and certainly not death.

Chronic pain in Prince’s case was a result of hip joint destruction. As with all painful conditions, there are multiple ways to treat it.  The best way when it has become severe, and when the circumstances are similar to his, is surgical replacement. This usually solves the problem and mostly eliminates the pain while restoring near normal function. Unfortunately, personal religious convictions limited this option. Other good treatments would have been:

  • Exercise
  • Anti-inflammatory medication
  • Possible cognitive/behavioral therapies

Long-term opioids are not a good choice. The worst choice was self-medicating with opioids obtained illegally, since there is no way to know what they might contain. Chronic pain is not a sexy disease, and no one wants to be the poster child for such a disease. Maybe Prince will be the poster person. Unfortunately, he be a sobering reminder about the drawbacks of self-medication.

Chronic pain is extremely common, if you have pain, first start working with a primary care physician. If it is not responding to straight forward management, get a pain management specialist on the team to help find better solutions. Pain has many solutions, opioids are only one of many tools, and usually it is not one of the better ones, and it is generally extremely poor for long-term use. If medications are part of pain treatment, then one provider and one pharmacy is needed, and street drugs are off limits. Further, the primary prescriber needs to be screening all patients for abuse since it is difficult to determine who will be an abuser of medications. Lastly, if one does become addicted to medication, then it is time to get over embarrassment and get treatment so you do not end up overdosing.

Chronic pain is a difficult problem, it occurs in a third of the population in general. If you have pain, get good advice and obtain knowledgeable medical treatment.

The Dangers of Mixing Pain Medication

/ Thomas Cohn, MD

Pill Mixing Minnesota painThe Food and Drug Administration came out with a new warning this week, stating that mixing drugs that are opioids and either benzodiazepines or barbituates (anti-anxiety) can be especially dangerous and may result in coma or death. The recognition of the dangers of mixing these two classes of drugs is becoming increasingly evident. Both types of drugs – opioids and anti-anxiety drugs – have addictive natures. The use of these drugs is additive, and both can suppress the respiratory drive. When used together, one could easily “pass out” and stop breathing.

The FDA is ordering that some 400 products now carry a “black box warning.” This is one of the most severe categories of risk, indicating that these products have serious health risks and are potentially fatal. The products of concern are anxiety medications such as Valium (diazepam), Ativan (lorezepam), Xanax (alprazolam), Klonipin (clonazepam), Restoril (temazepam), Soma (carisoprodol), and phenobarbital. All these drugs make one relax and often fall asleep. Drugs in this class are also used as part of anesthesia to control anxiety during procedures. All these medications can decrease the ability to breathe. However, in a medical setting, they can be reversed with an IV medication flumazenil, but they can not be easily reversed often when taken orally or outside of medical settings. These are the same type of medications that are part of the cocktail used for putting a person to death with drugs for the death penalty.

Why Mixing Medications Is Dangerous

Opioid addiction and abuse has been a major problem, becoming worse over the last ten years. Death rates have skyrocketed and now are about 30,000 people each year in the US, putting it in the same range as the number of people killed in motor vehicle accidents. A person can die just from overdosing on an opioid. The illegal use of narcotics makes death especially easy since the dose of drug is often uncontrolled. Prince died due to such an illegal mixture of oxycodone and fentanyl. The only good thing is that the drug naloxone (Narcan) can reverse most opioids rapidly and prevent death. Examination of those dying from opioid overdoses has found a disturbing trend that many of those people have had both opioids and benzodiazepines in their bodies. Furthermore, just giving naloxone may not rescue an overdose victim.

Patients with chronic pain are often dependent on medications to control symptoms. When pain is not well managed, and there is no successful treatment, many doctors resort to the use of opioid medications. For select patients, these drugs may be very helpful to manage symptoms. With chronic pain, the brain also tends to show changes, and the central receptors for painful sensations become overly active. These regions in the brain are right next to the same regions responsible for depression and anxiety. Patients with chronic pain often develop depression and anxiety, possibly related to the fact that the centers in the brain involved in pain and anxiety are next to each other. Treating chronic pain patients who have anxiety with both opioids and benzodiazepines now has become especially dangerous, and potentially fatal.

The bottom line for chronic pain patients is that if you have pain and anxiety, do not mix opioids and anxiety medications. If as a patient, opioids are felt to be necessary, try to find an alternative treatment. Long-term management with opioids for pain is often unsuccessful, and using other options may be more beneficial. Anxiety is a form of depression. If you also have pain, do not use an anxiety drug. Instead, work with a professional to treat the symptoms and the depression. There are many anti-depressant medications that may help along with working with a psychology management team.

The mixing of medications when one has pain can be highly dangerous. A good pain provider will want to know all the medications a patient is taking such that they can reduce the risks of serious interactions.

Does The Daith Piercing Work For Migraines or Headaches?

/ Thomas Cohn, MD

Our blog on daith piercings for headaches and migraines has been by far our most popular blog. So many people have asked us about the piercing or shared their story in the comments section of the blog. In fact, we’d go out on a limb and say that the comments section on the original blog is one of the best places on the internet for honest reviews about the success of the piercing.

Instead of forcing you to sift through all the comments, we thought we’d share some personal stories in a blog so it’s easier to learn what people have to say. We did something similar to this in a blog a few months ago, but we’ve received so many new comments that we wanted to do it again. So without further adieu, here’s what people are saying about the daith piercing.

Stories About Daith Piercings

My 23-year-old daughter had her right daith done and I had my left done two weeks apart this summer. Neither of us has had a significant migraine since. She’s had virtually none and I’ve just had a couple of smallish headaches and felt some pressure. I’m a 10-15 a month migraine person and she’s on a daily preventative and used to get 6-7. I hope this stays helping. It was so totally worth it. ~N.C.

I have had my daith and tragus pierced foe just over 10 years now…and was always super skeptical when I would read articles like this and how the daith piercings helped with migraines…..however….last week I had to take my earrings out to play indoor netball (I forgot to cover them up at home)….. I couldn’t get the earrings back in at the end of the game so I decided that I would leave them out permanently (being a good role model to my babies)… In the week that I had them out I had horrendous migraines and over ten spasmodic and intense nose bleeds…. I decided to put the earrings back in because I missed having them in my ear…and to be quite honest…this week I’ve had no severe migraines and zero nosebleeds…could just be a coincidence..but might not be … ~ J.R.

I had it done on February 13th and it is the best thing I ever did.  Have only taken my Maxalt 4 times and today is July 16th it has truly made a difference in my life with my migraines and headaches in general ~ H.S.

I just recently received my Daith Piercing and was able to wake up migraine free after more than 10 years of crippling migraine pain. Not only do I have multiple sclerosis but I also suffer from a large chairi malformation. I have tried every intervention and medication out there to receive little to none relief from my migraines. Since getting my piercing, I have actually had the blessing of waking up migraine free (something I truly couldn’t remember the last time it had happened). Not to mention, the piercing was next to nothing in cost when compared to other treatments I have tried so this was worth the try for me. I would recommend the piercing for anyone who suffers enough migraines that interrupt their lives for days at a time. The piercing itself was about 10 seconds of pain and nothing compared to a 5-6 day migraine. ~ V.E.

I live in MN. I went to a place today called The Holy Mackerel to get my daith pierced. I highly recommend it. I actually was getting a headache prior to my piercing and within hours it went away. I’m praying that’s a sign that it is going to work. The piercing itself doesn’t hurt that much and Verno at the Holy Mackerel is great ~ H.M.

Have had mine 4 months and no migraine. A few dull headaches but no migranes! ~ T.L.