The 5 Most Abused Prescription Drugs

April 29, 2015 / Thomas Cohn, MD

When taken in the correct dosage, prescription drugs can work wonders for people suffering from chronic pain. That said, medications can have a fairly strong effect on the body, and a person can develop a dependency if they aren’t careful. Below, we take a look at five of the most abused prescription drugs.

5. Syrups containing codeine and hydrocodone

Prescription cough syrups containing codeine and hyrdocodone are the first drugs to make the list, specifically because of their popularity among the young adult community. In larger doses, these types of syrups create a euphoric and pleasant feeling inside the body. These syrups aren’t typically abused to the point of fatal overdose, but they are often taken in combination with other drugs, like acetaminophen or guaifenesin, which can do serious damage to your body. Because it’s rather easy to obtain cough syrup, it’s easy to see how these drugs can be repeatedly abused.

4. Adderall

Adderral is becoming more popular on college campuses, as it has been touted for it’s ability to help the subject concentrate. College kids cramming for tests and pulling all nighters pop these pills like candy, especially since it’s relatively easy to fake an attention deficit disorder. The user feels energized, enthused, stimulated and euphoric after ingesting Adderral. Young adults and students can get addicted to those feelings, and they may continue to search for that high long after they’ve graduated.

3. Xanax

Xanax, a form of benzodiazepine, is a very common drug for self medicating users who are trying to relieve stress or anxiety. A physician may prescribe Xanax for panic attacks, insomnia and anxiety, as it offers a deep relaxation and lowers inhibitions. Users report a relaxed, zoned-out and dream-like state when under the influence of a heavy dose of Xanax. Withdrawals after dependence can lead to even greater panic attacks and anxiety, so it’s easy to see how someone can become addicted.

2. Opana oxymorphone

This drug is becoming more popular as drug manufacturers are beginning to fight back against Oxycodone abuse. It is likely that oxymorphone will become the next most popular drug for prescription pill abusers. The euphoric feelings offered by oxymorphone are almost unmatched, as some say it exceeds the sensation offered by oxycodone and heorin.

1. Oxycodone

Oxycodone, also referred to as Percocet with acetaminophen, comes in at the top spot on this list. The pill has probably done more harm than any other pill on this list over the last twenty years. The pill is typically prescribed to patients with chronic pain, cancer or disabilities, and it is said to provide a blissful, heavenly euphoria. It can certainly help people who live in constant pain, but it’s usually sought after by people who simply want to abuse the drug. Manufacturers are working on developing different types of drug formulas to make it harder for users to abuse the drug, but due to the nature of its intended effects, it will continue to be a sought after drug by abusers.

Texting May Be Causing Your Neck Pain

December 5, 2014 / Thomas Cohn, MD

As more and more people are becoming glued to their smartphones, medical professionals are warning people about a new condition called “text neck.”

If you’re at school or the breakroom at work it probably doesn’t take long to see more than a few individuals hunched over their cellphone. Responding to texts and sending that work email are important tasks, but you may be jeopardizing your neck health if you hunch your head down while typing away.

“It isn’t the best for our posture,” said Linda Scholl, a University of Utah physical therapist. “It’s not correct posture, but kind of leaning forward.”

Dr. Kenneth Hansraj, a spine surgeon in New York, coined the condition “text neck.” He says the condition is caused by tilting a your head down while staring at your smartphone. According to Dr. Hansraj, teens are especially at risk, as some teens have spent an additional 5,000 hours on their phone compared to older adults.

Scholl agrees, saying teens and colleges students are spending more time than ever buried in their smartphones.

“People are spending more time leaning forward, paying attention to what’s in front of them, instead of having their posture upright and looking at the world around them,” Scholl said.

Scholl noted that people have hunched their heads in the past – be it by reading books or working at their desks – but these activities rarely cause a person’s neck to be in a poor position for such a long duration.

Text Neck Pain

Scholl went on to discuss just how much pressure you can put on your neck by tilting it forward. According to her, the human head weights about 12 pounds, and the farther forward you lean, the more weight is placed on the cervical spine. Once your tilt reaches 60 degrees, “you have about 60 pounds worth of pressure going through your spine. So that soft tissue has to hold the weight of the head in this forward position.”

In addition to neck issues, poor head position can lead to other side effects like reduced lung capacity, neurological problems and heart disease.

Preventing Text Neck

Text neck is a serious problem, but it can be prevented pretty easily. Follow these tips to avoid neck problems while texting.

Mentally note where your neck location is every time you use your phone. When using your phone, try to keep it out in front of you. If it’s in your lap, you’re going to need to lean forward to use it.

Regularly stretch and exercise your neck. Rotate your shoulders and neck at regular intervals.

Don’t be glued to your cell phone. Sure, sometimes it’s very necessary to be on your phone, but the more you’re on it, the more likely you are to subconsciously slip into a poor posture.

If you suffer from neck pain, take a close look at your cell phone use. You may be doing harm without even realizing it!

Related source: Deseret News

Insurance Coverage and Pain Management

November 26, 2014December 3, 2014 / Thomas Cohn, MD

Every time someone goes to the doctor, they want to know if the visit and treatment is covered by insurance. Unfortunately, there is no simple answer to that question. In the distant past, care was much simpler and each visit with your family doctor had a small set cost that covered everything preformed.

Today it is a complex financial industry with thousands of players each getting paid, from the insurance industry, to the medical suppliers, to the manufacturers of every widget and needle to lastly, the physician.

The cost of everything gets itemized and factored into the cost of each visit and treatment. The insurance industry and Medicare have complex formulas to figure out how much every service is worth and what can be charged. Unlike going to an auto mechanic who tells you the cost of the parts and labor, the medical industry is very different. A physician can determine how much it will cost in order to provide a service, but each insurance company decides how much they are willing to pay on their end, and the doctor is stuck with that amount. Rarely is a medical service fully reimbursed to the provider; often it is at 30-40 cents on the dollar.

Am I Covered?

The first question on coverage is whether you have medical insurance. Every person now can qualify for insurance and there are a variety of plans available. Total cost and coverage are the remaining issues. The benefit of the Affordable Care Act (nicknamed Obamacare) is now everyone can get medical insurance and no one can be denied. Unfortunately, that means everyone needs to understand the insurance they have purchased, and realize every service provided is set by the coverage that you bought. Most physicians try to work with the patient and insurance to determine the best option in management of any medical problem. To stay in business, most physicians must have specialists in their offices to make sure they have the necessary prior authorizations in order to see and treat an individual.

The insurance industry has set a guideline that a service should be covered if it is deemed medically necessary. The amount of coverage depends on the individual plan, deductibles and co-payments required. Furthermore, the service may need to be approved by a primary physician in addition to the ordering physician, and it may need special approval by an insurance company’s medical expert.

Wait, What?

At this point, most people are totally confused and are concerned about the cost of seeing a doctor. If you have a problem that is not going away, then you should always start with your primary physician. A good history and physical exam should tell most physicians what is wrong and the treatment that will solve 90 percent or more of the problems without expensive intervention. If the problem does not resolve, then involving the next level of experts, tests and treatments may be necessary. Obtaining referrals, checking for authorizations and determining your copays and deductibles are now issues. Both your referring doctor and specialists can help explain the particular costs that may occur if you contact their business offices.

If you have insurance, the cost of your medical care is dependent on the insurance coverage, especially the amount each visit costs due to the deductible amount and copay required. Each insurance company sets a reimbursement rate for every conceivable medical service provided. The answer to how much anything will cost you can only come from a physician’s billing office and your insurance company. Unfortunately this is not a simple answer. If you ask a physician how much it will cost you, they will have no idea since they get paid at the whim of each and every insurance payer at different rates for the same services.

The Dangers of Prescribing Pain Pills

November 10, 2014 / Thomas Cohn, MD

Opioid overdoses are a rampant problem in the United States, and the abuse of opioids is an epidemic. Multiple drugs are being abused, and those who are abusing are using multiple drugs. Deaths linked to opioid overdoses often involve multiple medications. Furthermore, unfortunately, some physicians contribute to the problem by running clinics that readily handout prescriptions for opioids without even really evaluating a patient for real disorders.

Pain pill abuse is clearly a problem in our society. Unfortunately, the problems of abuse reflects on everyone, including those trying to prescribe correctly and the patients who have legitimate problems. Pain physicians have a large stake in the issue. Treating pain requires many tools, and using opioids is only one option. Since every patient a pain physician sees does have some sort of pain problem, it is invariable that they may prescribe opioid medications occasionally. Pain physicians, since they tend to prescribe dangerous medications, try to be extra careful in their use of these medications.

Treating The Complex Problem

The first thing to realize is that pain is a complex problem, and there are multiple ways of treating these issues. A pain physician will usually try to find a solution that is the most appropriate for every patient based on the diagnosis and patient needs. There is no risk-free magical pill that will cure a person of their ailment. Treatment is complex and often requires management of multiple interacting problems. The best solutions usually involve quite a bit of work by the patient to change various aspects of their lifestyle, like eating healthy, getting more exercise and drinking fluids.

All physicians need to pay attention to treating pain appropriately. Throwing a pill at a pain problem is not always appropriate. Finding a diagnosis and treating the problem in a comprehensive fashion is necessary. Patients may need to be drug tested to determine if they are using medication appropriately, and the state drug database should be checked to see if a person is doctor shopping for medication. Setting down rules for the use of controlled medications is always necessary, and if long term prescribing is being done, a contract with the patient may be reasonable.

The fact of the matter is that most pain pill addictions and overdoses begin with a legitimate prescription and worsen from there. The medications are not stolen or illegally produced. To control abuse, physicians must take responsibility to prescribe medications appropriately. If a patient has pain that is not improving, a pain specialist is beneficial to help a patient find a comprehensive approach to managing the symptoms. Chronic pain problems often do not have quick or easy solutions. Solving the issue of opioid abuse will require physicians to take an active role in finding solutions to difficult problems.

Sciatica Pain: Causes, Symptoms, and Treatments

July 7, 2014February 17, 2016 / Thomas Cohn, MD

Sciatica is a term used to describe pain that radiates down the back of the leg. The name comes from the main large nerve, the sciatic nerve, that travels from the pelvis down the back of the leg. The sciatic nerve forms from the nerve roots in the lumbar and sacral region of the spine, and it is home to the motor and sensory nerves of the leg. The term sciatica is used to describe the sensation of pain in the leg generally from the buttock to the foot.

Causes of Sciatica

The causes of sciatica are numerous, and they are often the same causes of most low back and leg pain. Any structure that relays sensation through the sciatic nerve can produce sciatica pain. Low back, gluteal (butt), and leg muscles when irritated or strained, tendons, bones, and nerves can all produce these sensations. The pain can be acute or it can be chronic. Everyone describes their pain in different terms, as it is a personal experience. Most of these pains are self-limited, temporary and often resolve quickly within days with rest and possibly over-the-counter medications, heat or ice.

If the pain is due to trauma or is not resolving in a week or two, then seeing a physician may be worthwhile. The benefit of seeing a doctor is to get a good treatment strategy to resolve the problem as quickly and easily as possible. A full medical history, a history about the onset and course of the symptoms, and what has been done in treatment is necessary. An accompanying exam will include looking at the low back, pelvis, legs, and evaluating all the structures, including performing test of muscles, joints, nerves, and overall neurologic status. From a history and exam, a good physician can determine a starting diagnosis and treatment plan. 98% of the issues should resolve with good conservative treatment such as ice, heat, over-the-counter medications, physical therapy, massage and manipulation or adjustments. X-rays, CT scans and MRI scans early on in treatment are usually not necessary.

Long-Term Treatment

If the sciatica is continuing despite conservative care for 6-8 weeks, then the skills of a Physical Medicine and Rehabilitation Pain Specialist can be especially beneficial. These physicians are experts in musculoskeletal medicine and can usually figure out what is wrong and the best treatment options for you that will help resolve the problems. They also can determine if further tests are necessary such as MRI scans or nerve studies, and they can also perform specialized injections that may speed the healing. There are many physicians that treat back pain, but a Physical Medicine Pain Specialist has the added expertise needed to help find the conservative options and guide the decisions for the more complex problems when issues are prolonged.

Sciatica pain can be especially challenging, especially since 85% of the population does have this problem at some point in their lives. If the simple treatment is not working, the best solution is finding the expert with experience. Every person has different circumstances, and a pain specialist has the broadest set of tools to find the matching solution to each puzzle.