#smaller doses help with inducing labor

[bisexualalienss]

in what world does a judge think they have authority of drugs the fda approves. hell country

[painfulstretch]

i wanna pump you full with big heavy multiples and give you birth suppressants until you're uncomfortably overdue. one day i sneak labor inducing pills into your food, three times the amount that's recommended, and take you out into public. the dose i gave you is so high that you speedrun through early labor and dilate faster than you're prepared to handle. it doesn't take long before the first massive head comes barreling through your birth canal and the sheer pressure brings you to your knees. people stare but nobody cares enough to help or even ask if you're okay. i force you to your feet and make you keep walking, even though the contractions are coming faster and stronger by the second. i tell you to keep quiet and not to push. you try to be good for me even though i can see how much you want to drop down and scream those babies out of your tight tiny hole. you understand that i do this because i love you, right? i just love showing you and that big belly of yours off, showing everyone that you belong to me and what we've made together.

we move for two hours, your steps becoming increasingly unsteady and your breathing having turned into panicked panting. by the time we finally arrive home, there’s a huge bulge between your legs - despite your efforts to follow my orders, your body has pushed our baby down on its own.

i lead you to the bed, make you lie down and tell you you're allowed to push. your relief is shortlived because as the head inches ever so slightly forward, forming that famous teardrop shape, i stop its descend with my hand. your hips buck in surprise at the searing pain in your nether region and i use that moment to snap the chestity belt i've been holding, unbeknownst to you, into place around your hips.

i said you're allowed to push, not to birth. you really ought to pay more attention to what i say.

i can't be mad at you for not listening, of course. not when you look this beautiful - face red with exertion and glistening with sweat, writhing helplessly, trying and failing to find a position that relieves some of the agony, sobbing and screaming about how much it hurts, how big it is, begging to let you give birth. i just sit back and enjoy the show.

i let you suffer like that the entire night, watch as you wear yourself out with useless pushes. that baby's not going anywhere, darling, not until i decide it is. it's early morning when i finally do. you've earned the right to give birth, i think. i unlock the chastity belt but by now you're too weak to push properly. one would think your canal would be loose at this point but no, the baby still creeps forward at a torturous slow speed, making you feel every detail of the face. and those shoulders, wow, looks like we have a future quarterback in our family!

you've been in hard labor for almost 20 hours by the time the baby finally slides out of you. you're a sobbing mess but the tears of pain mix with tears of relief.

the next five minutes are nice for you. you hold our baby and even though your nether regions must still burn like hell, you're smiling weakly.

then your belly shrinks again, you wince, i see pure panic and horror flash over your face. i take the baby from you as you abruptly, uncontrollably start to bear down again, contractions hitting you again at full force as our next big baby forces its way through your body. despite the fact it's too huge for you, it's still a bit smaller than its sibling and slides forward quite fast. too fast for my liking. look at that, it's already beginning to crown. no, we can't have that, can we? where would be the fun in that?

you're so caught up in your pain that you don’t even notice me snapping the chastity belt back into place. even as you push fruitlessly, the head bulging grotesquely between your legs with no chance of escape.

don't worry, darling, i'll make sure there's a couple more fun days ahead for you. we have time, and there's still some babies left in that belly of yours.

[chipotlepepperspokemonandother]

I’m back with another half-baked writing resource!

Being in the hospital sucks. Avoid it if you can!

In honor of my divergence, I decided to FINALLY COMPLETE a writing resource that’s been pending for literally months. 

Writing Hospitals – The Intensive Care Unit

Disclaimer: I am not a med worker, just a person who has spent quite a bit of time in several hospitals as both a volunteer and a patient. This is a resource for writers based on my own research/experiences. Sources are at the bottom of this post and in tags. Refer to these for more details/clarification. Also, because I have only ever lived in the United States, this is US-centric. Please contribute to this post if you have additional information or spot an error that should be revised. 

The ICU

Alternative Names: Critical Care Unit, Emergency Unit, Intensive Treatment Unit, or Intensive Therapy Unit.

What it is: Where patients go if they are critically ill or just suffered from life-threatening injuries. 

What it is not: ICU is not synonymous with the Emergency Room (ER) which is a common error. If you are not at-risk for immediate death, then you will not be in the ICU unless you work there.

Location: ICUs are typically located on the ground floor of large hospitals not far from the ER. This is because it is generally the most accessible area. It’s not a hard/fast rule and can be altered with no major issues based on your personal preference/purposes.

Environment: The ICU tends to be one of the busiest parts of the hospital. Family/friends are usually not allowed to be in the same room as the ICU patient for more than a short window of time, and sometimes not at all depending on the level of care needed and/or size of the space. You will not see patients walking around, or many children, or people going into labor. Workers in the ICU will stick to their department for the entirety of their shift. Patients do not typically have their own room.

Workers/ICU Team:

-          Attending Physician/Intensivist is the person ultimately in charge of the patient. They have the final say in every decision. They are fully trained in internal medicine. This means many years of medical school—you need much more than a bachelor’s degree to have this position, and that training is specialized. They must have a certification specifically in critical care medicine. They may consultant other physicians but they make all the last calls. They tend to have little face-to-face interaction with the patient, who is often sedated (more on that later), but interacts heavily with the rest of the team.  

-          Nurses in the ICU have received specialized training in caring for critical care patients. They provide around the clock bedside care and monitoring. They are in close contact with the physician in charge as well as other members of the critical care team. They tend to interact more with the patient and their family than the intensivist.

-          Respiratory therapists are trained in monitoring the respiratory system and in handling any equipment required to assist in respiration (see list of equipment below). They administer any respiratory treatment used to improve a patient's breathing. Like nurses, they have quite a bit of interaction with the patient. Even if a patient is admitted to the ICU for a non-breathing related emergency, respiratory therapists are always involved to some degree.

-          ICU pharmacist assists and provides information on drug dosing and drug interactions. This is particularly complex in the critically ill patient and requires a highly experienced/trained pharmacist. They generally are in close contact with the intensivist but not with the patient or their family. They will consult the doctors who prescribed any medications the patient took before the incident that sent them to the ICU, such as a neurologist who prescribed anti-seizure meds or a psychiatrist who prescribed antidepressants.

-          Physical therapists are involved in the care of critically ill patients early on in their ICU stay. They help prevent disabilities and facilitate rehabilitation as soon as possible. It is not particularly common for ICU patients to require a physical therapist. For example, someone being admitted because of a seizure, stroke, or heart attack, they may not require one at all, whereas someone involved in a car accident or act of violence likely will. PTs are not always involved in the ICU, but every ICU will have at least one employed

-          Nutritionists calculate the nutritional needs of the patient and monitor the nutritional balance on an ongoing basis.  Someone who is in the ICU for less than 48 hours will typically not require a nutritionist. Nutritionists are not always involved in the ICU, but every ICU will have at least one.

-          Social workers/Patient care managers assist families in dealing with all aspects of the illness from financial, to accommodations for family members, to long-term planning following ICU and hospital discharge. Their precise roles/duties will depend on the specific needs of the patient and their family. Social workers are not always involved in the ICU, but every ICU will have at least one.

-          Other facts related to employment: The ICU Team includes some of the most highly trained professionals in the entire hospital. The wages vary depending on the person’s role, the size/type of hospital, state, and so forth. If you want to work in the ICU, you need specific certifications, even if you are already working in a different part of the hospital. Unlike many other departments, the ICU will not have volunteers, substitutes, or at-will employees.

 Commonly Used Equipment:

-          Cardiac or heart monitors: The monitor looks like a computer screen with lines, or tracings, moving across the screen. It has electrodes that are attached to the patient's chest with (usually thumb-sized) sticky pads. This device monitors the electrical activity of the heart. It is non-invasive and almost every patient in the ICU gets one.

-          Pulse oximeter: This looks like a clothespin and is attached to a patient's finger, or it may be smaller and clipped onto the earlobe. It is non-invasive and almost every patient in the ICU gets one. A pulse oximeter allows the critical care team to monitor the saturation of oxygen in the blood.

-          Swan-Ganz catheter: A Swan-Ganz, or pulmonary artery catheter, is used to measure the amount of fluid filling the heart as well as to determine how the heart is functioning. It is inserted through the large vessels of the neck or upper chest and threaded into the heart.

-          Arterial lines (a-lines): Arterial lines are used for continuous monitoring of blood pressure. Catheters are inserted into an artery, usually in the wrist or, less often, in the bend of the elbow or groin. These produce a tracing on a monitor that is similar to that of a heart monitor. Arterial lines can also be used for drawing blood so that a nurse doesn’t have to keep puncturing the vein.

-          Central venous catheter (CVC): A soft, pliable tube that is inserted into a vein in the neck, the upper chest, or groin. *getting that pain in the neck off your chest was a kick to the groin* sorry:) Patients are sedated and receive a local anesthetic before these tubes are inserted.  They are used to administer frequent/continually needed medication, to measure the amount of fluid in the blood vessels, and can work as one giant IV to do the work of multiple small IVs. This is not the go-to piece of equipment unless the patient had a super serious incident because unlike most other pieces of equipment used in this setting, this one leaves a mark and the risk of infection is much higher than that of a regular IV or injection.

-          Intravenous (IV): Almost every patient in the ICU will receive at least one. An IV is a flexible plastic tube that is inserted into the veins in the crook of the elbow, top of the hand, or in the underside of the wrist. IVs can also be placed in the neck, upper chest, or lower leg, really anywhere there is a healthy vein. Most IVs simply provide fluids that prevent dehydration. They may also provide medications (morphine, for example), nutrients, and blood products (like transfusions). Patients in ICU often have multiple IVs, with each one providing a separate service (so like one for fluids and another for medicine). IVs may be moved/removed several times a week to prevent damage to the vein and/or pain.

-          Chest tubes: Chest tubes are inserted through the chest wall into the space around the lung to drain fluid or air that has accumulated and prevent the lung from being able to expand.

-          Urinary catheter: (aka Foley catheters), are inserted through the urethra into the bladder. Once in the bladder, the catheter is kept in place by a balloon, which is inflated, at the end of the catheter. Urinary catheters continuously drain the bladder and allow for accurate measurement of urinary output (important to regulate kidneys). These can really hurt and often cause infections. For this reason, bedpans are sometimes used instead.

-          Other: with all these tubes and wires, a patient cannot be easily moved from place to place; if for some reason they must be moved, it requires patience, planning, and many hands.

Top Reasons People are brought to the ICU:

-          Severe traffic accident

-          Heart, brain, lung, kidney, and/or liver failure

-          Poisoning

-          Pneumonia

-          Heart attack

-          Grand mal seizure

-          Sepsis/septic shock

-          Blood poisoning/major infections

-          Any combination of these events

Procedures:

-          The procedures used to keep a patient alive largely depend on the patient’s situation.

-          Medically induced comas, use of analgesics (pain-relieving medications), and induced sedation are common ICU tools needed and used to reduce pain and prevent infections.

-          Surgery may be required based on the incident. People receiving surgery will always get it from a surgeon specialized in the affected area. If surgery must be prompt in a life/death situation and neither the patient nor a medical surrogate is available and cognizant, a surgeon might not need to get consent before operating. This is a highly controversial subject.

What does the ICU Look Like to an Outsider?

-          Especially in large hospitals, the ICU is divided into sections.

+ MICU: Medical Intensive Care Unit

+  CCU: Coronary Care Unit

+ SICU: Surgical Intensive Care Unit

+ Neuro ICU: Neurosciences Intensive Care Unit

+ T/SICU: Trauma SICU

+ CVICU: Cardiovascular Intensive Care Unit

+ MICU/SICU: A combined Medical/Surgical Intensive Care Unit

-          In U.S. hospitals especially, ICUs are loaded with equipment. There are big machines, tubes, wires, and monitors everywhere you look.

-          Flowers, foods, balloons, and similar gifts are not typically permitted in the ICU due to the extreme sensitivity of the patients/lack of space. Even a simple allergy can lead to a major infection in a critically ill or injured patient and private rooms are rare.  

-          Children are usually not allowed to visit, and never without adult supervision.

-          Bright fluorescent lights are almost always on. Even when they are not on, there is still light coming from somewhere. That combined with the noises of the machines and talking makes falling asleep without sedation very difficult.

-          The ICU can be somewhat dramatic. Medical workers almost always rushing to do something, so there’s loads of movement, and someone who is not used to this situation may be alarmed by all the unfamiliar noises/words used there. There is generally not a lot of screaming or crying in a real ICU (as is portrayed in many movies, books, and TV shows) but it is never quiet either.

-          The ICU itself can be traumatizing to cognizant patients, especially hyper-sensitive people such as individuals on the autism spectrum. It is not unusual for an advocate to alert medical workers to a patient’s beyond-medical needs.

Stereotypes/Overused Tropes You Should Probably Avoid:

-          The predator: Adult males tend to be portrayed as the chief perpetrators of domestic violence, especially when they are young black men. This is especially unsettling when a white woman or child is the victim/survivor.

-          The nagging nurse: The nurses in the ICU are often portrayed as being ‘pushy, ‘fussy’, ‘naggy’, or ‘rude’ towards the patient and/or the patient’s family. Really, they are just doing their job and which is incredibly difficult in most situations and many are some of the sweetest people you’ll ever meet. They are also commonly portrayed as older white women, when in reality there are plenty of young people of various genders and races working as ICU nurses.  

-          The dismissive doctor: Coincidentally, almost all my doctors have been old, white, dismissive men, but that doesn’t mean that every doctor is or should be this way.

-          The irresponsible male victim: Statistically, men are more likely to get into an accident and/or have a ’preventable’ illness than women. But just like everyone else, men might go to the ICU for something that is entirely not their fault even a little bit.

-          As is true with any writing, it is important to be inclusive. In a medical setting especially, it is common for afab individuals to always be referred to as ‘women’ and for amab individuals to be referred to as ‘men’. Since we know that gender is more complicated than body parts, writers should keep in mind that other genders (and gender-neutral terms/pronouns) exist and should be included. Referring to someone by their body parts in general is rude, though med works sometimes do this frequently without reflection. 

Please contribute to this post if you have additional information or spot an error that should be revised. 

 Sources:

http://www.healthcommunities.com/before-after-surgery/equipment.shtml

http://www.healthtalk.org/peoples-experiences/intensive-care/intensive-care-patients-experiences/emergency-admissions-icu

https://www.statnews.com/2016/09/07/hospital-icu-modernize/

https://www.bidmc.org/patient-and-visitor-information/adult-icu/frequently-asked-questions-about-the-icu

https://www.intensivecarefoundation.org.au/staff-in-the-icu/

https://www.webmd.com/health-insurance/insurance-doctor-types#1

[rehabhc]

How Methadone Addiction Can Be Dangerous For Your Health?

Often low dosage opioids are used to treat addicted people. Methadone is a medication that is widely used to treat opioid-related addiction like heroin, morphine, cocaine, etc. Since it is a synthetic opioid, patients do not have control over their recovery issues, and often they become dependent on it. It is a type of substance therapy that prevents a higher degree of substance abuse but encourages it indirectly on a smaller or lower scale.

But, Methadone, being a synthetic opioid itself, can cause long term addiction. It may lead to substance abuse and methadone is highly addictive. Hence, a lot of people often need treatment for Methadone addiction besides their conventional substance abuse. Rehab Healthcare is one of the best places in the UK that offers a practical and holistic approach to overcome methadone addiction in people.

Methadone addiction can lead to weak pulse, low blood pressure, stomach pain, and constipation, etc. Many people also suffer from a breathing disorder, shallow and labored breathing, drowsiness, passing out randomly, etc. It can also cause bluish nails and lips due to low blood pressure. Methadone can make immunity weak and may also lead to a coma.

Methadone addiction requires constant surveillance, counseling, medical detox, and comprehensive therapies to treat it. Besides that, a patient must have enough information about the health hazards of Methadone to provide them with guidance. The best way to treat this addiction is to contact Rehab Healthcare to get the best treatment so that the patient can return to a sober life.

Treatment Procedures

The treatment often requires customization. An expert analyses the status of the patient and suggests the proper methods with a holistic approach to help them overcome the addiction. Here are the conventional Methadone addiction treatments that are recommended-

Detoxification

If someone is suffering from Methadone addiction, the first thing recommend is going through a detoxification treatment. It is the method of providing regulated reducing doses of Methadone or other medications to the patient to stop the withdrawal symptoms the patient may experience. These includes –

Anxiety

Depression

Yawning, watery eyes, runny nose

Diarrhoea/vomiting

Insomnia

Muscle and body pain and aches

High blood pressure

Seizures and goose bumps

A patient also needs to have mental courage during this stage.

Inpatient and Outpatient Addiction Program

Sometimes the slow reduction in the regulated doses of Methadone or other treatment medications can happen in the community. Often addicted people become impatient and unable to cope and may require constant surveillance. Inpatient treatment requires the patient to enter into the rehab or a clinic to get full analysis and systematic procedure for the detoxification and addiction treatment. Inpatient treatment can be better because the person is under constant surveillance. Patients also receives psychological interventions like group counseling or individual counseling that speeds up their recovery rate.

On the other hand, community/outpatient treatment is the method that allows the patient to continue their regular life beside the addiction treatment. A lot of patients move to outpatient therapy and rebuild their life skills after inpatient therapy. It allows individuals to return to their life with a sober lifestyle to ensure a healthy environment. They may continue to get counseling and therapy sessions during Outpatient treatment.

Rehab Treatment

Methadone, being a synthetic and chemical opioid, can induce addictive traits in people if they are receiving it for meditation. Often the addicted person starts to procure Methadone illegally to satisfy their addiction. Getting into Rehab healthcare is the best idea. The rehabilitation centers offer the best treatment so that the person can return to a healthy life. Here, the patients have a higher chance of recovery through the rehabilitation program. Rehabs offer structured treatment that can curb the addiction in individuals and also contributes to helping them get into society without any problem.

Individual Therapy and Group Counseling

In the case of methadone addiction, therapy, or counseling is crucial. Often patients start the habit due to mental trauma or illness. Some addicted people also have social and environmental issues. Hence, medical treatment cannot be fruitful without addressing those underlying issues. Due to this, mental counseling and psychological treatment are often considered one of the key points here. RehabHC offers advice to Methadone addicted individuals so that they can live past their addiction issues without any problem.

Patients receive personal counseling and group or peer counseling to understand how to curb addiction. Often sober professionals are out of addiction guides during the counseling session for a realistic approach. They can provide the best advice to help addicted people.

Treatment for Additional Disease or Health Conditions

Methadone addiction comes with many additional health problems. Hence, a patient also needs treatment for those health issues. Patients often suffer from neurological, gastroenterological, and other medical syndromes. Such incidents are called co-occurring disorders. In most cases, patients suffer from weight loss, vision loss, digestion problems, and psychological problems like mental guilt, trauma, and identity issues. Proper medication with counseling can help to cure these other health issues.

Often insurance policies cover the cost of rehabilitation and related treatments for methadone addiction. RehabHC is one of the best UK Addiction Treatment centers that offer complete and comprehensive addiction treatment for individuals; their customized and holistic approach can help a person to lead a happy and healthy life without addiction.

https://rehabhc.co.uk/how-methadone-addiction-can-be-dangerous-for-health/

[jesseneufeld]

Is an opioid really the best medication for my pain?

As physicians, many of our daily practices involve administration of substances that are shrouded in mystery. Certain medications, specifically opioids, have been part of tragic news stories, and have turned young children into orphans, happy spouses into widows and widowers, and once-aspirational youth into memories. The CDC reports that on average, 130 people die each day from an opioid overdose.

With such harrowing statistics, why take opioids in the first place? Well, if used appropriately, opioids can significantly improve pain with relatively tolerable side effects. A short-term course of opioids (typically three to seven days) prescribed following an injury, like a broken bone, or after a surgical procedure, is usually quite safe. It’s long-term use that can lead to problems, including the risk of addiction and overdose.

National guidelines for physicians recommend the shortest duration of opioids possible for acute pain, as a person’s chances of unintentional long-term use increase with the degree of exposure. One large study found that in first-time opioid users, one in seven people who received a refill or had a second opioid prescribed were on opioids one year later.

While widespread overuse of opioids has contributed to increased scrutiny regarding their administration, careful consideration of a variety of factors can help physicians and patients determine whether opioids are the right medication.

Here are several important things you may want to discuss with your doctor when considering taking opioids for the first time.

What kind of pain am I having?

Classification: This can be tricky, since many conditions include a wide variety of pain signals that can overlap. Two of the main types are:

Nociceptive: This is the most common form of pain. It occurs when some sort of stimulus (i.e., inflammatory, chemical, or physical) causes your skin, muscles, bones, joints, or organs to send a message by way of your nerves to your brain.

Neuropathic: This is a type of pain that is caused by a direct injury to the nerve itself. This type of pain is commonly seen in people with diabetes, neurologic issues, or prior amputations. Opioids are not effective in treating this type of pain.

Time course:

Acute: Pain lasting less than three to six months (often much less). It typically goes away when the underlying cause of pain is resolved. Classic examples include surgery, broken bones, and labor during childbirth.

Chronic: Pain lasting for more than three to six months. This tends to be more difficult to treat than acute pain, since the pain signals adapt over time, which can change the way the brain perceives painful sensations. Common conditions that may cause chronic pain include arthritis, some types of back injury (such as a bulging disc), and fibromyalgia.

What are some of the most common side effects?

Many of the side effects of opioids are due to their effects on your brain and gastrointestinal tract, so you are most likely to experience constipation, nausea, sleepiness, and confusion. Some ways for you to minimize your chances of experiencing these include using the smallest dose possible and treating the side effects directly. For instance, constipation can be initially treated with a high-fiber diet and increasing fluids, though you may be directed to prophylactically start taking treatment medication like stool softeners and/or stimulant laxatives. At times, adequate treatment of any underlying constipation may resolve any nausea you might be experiencing, though this will not help if your nausea is caused by direct activity of opioids on the part of your brain that induces nausea. When this is the case, your doctor may prescribe anti-nausea medications.

What’s my risk for tolerance, dependence, and addiction?

Tolerance occurs when a person’s response to a medication changes over time, in that they require a higher amount of a medication to achieve the same effect, such as pain control or euphoria. In the context of opioids and addiction (more below), with time the brain adjusts to the excess of the reward hormone, dopamine. As the brain adapts, it requires more opioid in order to feel the same effects or benefits. Tolerance is a gradual process that is highly dependent on the specific opioid being used, the dose of the medication, and a person’s biology. To some degree, everyone would eventually develop tolerance to opioids if taken long enough.

Dependence happens when a person requires a substance in order to feel normal and to prevent withdrawal. Many of us have experienced this on a much smaller scale on days we are deprived of coffee. With opioids, once a person is physically dependent, abrupt cessation of the medication can lead to gastrointestinal symptoms, anxiety, and agitation. Everyone exposed to a drug long enough will become dependent, though only a small percentage of people truly become addicted.

Addiction is a disease state that is seen when a person continues to use a drug despite harmful health, social, and/or economic consequences. Assessing individualized risk of becoming addicted is complex and involves many factors: biological, developmental, and environmental factors combine to influence a patient’s individual predisposition. Ultimately, a fatal overdose can happen when too much of the drug is taken or combined with other dangerous drugs, which may cause a person to stop breathing.

What other medications am I taking that may pose safety concerns?

As mentioned earlier, opioids affect your brain and can make you sleepy and slow your breathing. Certain medications or substances, when combined with opioids, can increase this effect. Medications commonly considered are those used to treat seizures, sleeping problems, psychiatric disorders, and muscle spasms. There are many things you can do to avoid drug interactions.

In our era of controversy related to excessive opioid use, there is a well-deserved focus on judicious prescribing. Procedural techniques, like injections and non-opioid medications, are being used more often as effective treatments for people in pain, as these interventions don’t carry the risk of serious side effects such as overdose. But there are times when an opioid is the right choice; it’s a matter of thoughtful discussion and understanding your risks.

If you find yourself on a course of treatment requiring opioids for chronic pain and are concerned about your likelihood of opioid misuse, discuss this with your doctor, along with a plan for addressing side effects of these medications. Together you can weigh the pros and cons of taking opioids and work to manage your particular type of pain.

Resources

CDC Injury Prevention & Control: Opioid Education Resources for Patients

Harvard Medical School Longwood Seminars: The Science of Pain

  The post Is an opioid really the best medication for my pain? appeared first on Harvard Health Blog.

Is an opioid really the best medication for my pain? published first on https://drugaddictionsrehab.tumblr.com/

[mhealthb007]

As physicians, many of our daily practices involve administration of substances that are shrouded in mystery. Certain medications, specifically opioids, have been part of tragic news stories, and have turned young children into orphans, happy spouses into widows and widowers, and once-aspirational youth into memories. The CDC reports that on average, 130 people die each day from an opioid overdose.

With such harrowing statistics, why take opioids in the first place? Well, if used appropriately, opioids can significantly improve pain with relatively tolerable side effects. A short-term course of opioids (typically 3 to 7 days) prescribed following an injury, like a broken bone, or after a surgical procedure, is usually quite safe. It’s long-term use that can lead to problems, including the risk of addiction and overdose.

National guidelines for physicians recommend the shortest duration of opioids possible for acute pain, as a person’s chances of unintentional long-term use increase with the degree of exposure. One large study found that in first-time opioid users, one in seven people who received a refill or had a second opioid prescribed were on opioids one year later.

While widespread overuse of opioids has contributed to increased scrutiny regarding their administration, careful consideration of a variety of factors can help physicians and patients determine whether opioids are the right medication.

Here are several important things you may want to discuss with your doctor when considering taking opioids for the first time.

What kind of pain am I having?

Classification: This can be tricky, since many conditions include a wide variety of pain signals that can overlap. Two of the main types are:

Nociceptive: This is the most common form of pain. It occurs when some sort of stimulus (i.e., inflammatory, chemical, or physical) causes your skin, muscles, bones, joints, or organs to send a message by way of your nerves to your brain.

Neuropathic: This is a type of pain that is caused by a direct injury to the nerve itself. This type of pain is commonly seen in people with diabetes, neurologic issues, or prior amputations. Opioids are not effective in treating this type of pain.

Time course:

Acute: Pain lasting less than 3 to 6 months (often much less). It typically goes away when the underlying cause of pain is resolved. Classic examples include surgery, broken bones, and labor during childbirth.

Chronic: Pain lasting for more than 3 to 6 months. This tends to be more difficult to treat than acute pain, since the pain signals adapt over time, which can change the way the brain perceives painful sensations. Common conditions that may cause chronic pain include arthritis, some types of back injury (such as a bulging disc), and fibromyalgia.

What are some of the most common side effects?

Many of the side effects of opioids are due to their effects on your brain and gastrointestinal tract, so you are most likely to experience constipation, nausea, sleepiness, and confusion. Some ways for you to minimize your chances of experiencing these include using the smallest dose possible and treating the side effects directly. For instance, constipation can be initially treated with a high-fiber diet and increasing fluids, though you may be directed to prophylactically start taking treatment medication like stool softeners and/or stimulant laxatives. At times, adequate treatment of any underlying constipation may resolve any nausea you might be experiencing, though this will not help if your nausea is caused by direct activity of opioids on the part of your brain that induces nausea. When this is the case, your doctor may prescribe anti-nausea medications.

What’s my risk for tolerance, dependence, and addiction?

Tolerance occurs when a person’s response to a medication changes over time, in that they require a higher amount of a medication to achieve the same effect, such as pain control or euphoria. In the context of opioids and addiction (more below), with time the brain adjusts to the excess of the reward hormone, dopamine. As the brain adapts, it requires more opioid in order to feel the same effects or benefits. Tolerance is a gradual process that is highly dependent on the specific opioid being used, the dose of the medication, and a person’s biology. To some degree, everyone would eventually develop tolerance to opioids if taken long enough.

Dependence happens when a person requires a substance in order to feel normal and to prevent withdrawal. Many of us have experienced this on a much smaller scale on days we are deprived of coffee. With opioids, once a person is physically dependent, abrupt cessation of the medication can lead to gastrointestinal symptoms, anxiety, and agitation. Everyone exposed to a drug long enough will become dependent, though only a small percentage of people truly become addicted.

Addiction is a disease state that is seen when a person continues to use a drug despite harmful health, social, and/or economic consequences. Assessing individualized risk of becoming addicted is complex and involves many factors: biological, developmental, and environmental factors combine to influence a patient’s individual predisposition. Ultimately, a fatal overdose can happen when too much of the drug is taken or combined with other dangerous drugs, which may cause a person to stop breathing.

What other medications am I taking that may pose safety concerns?

As mentioned earlier, opioids affect your brain and can make you sleepy and slow your breathing. Certain medications or substances, when combined with opioids, can increase this effect. Medications commonly considered are those used to treat seizures, sleeping problems, psychiatric disorders, and muscle spasms. There are many things you can do to avoid drug interactions.

In our era of controversy related to excessive opioid use, there is a well-deserved focus on judicious prescribing. Procedural techniques, like injections and non-opioid medications, are being used more often as effective treatments for people in pain, as these interventions don’t carry the risk of serious side effects such as overdose. But there are times when an opioid is the right choice; it’s a matter of thoughtful discussion and understanding your risks.

If you find yourself on a course of treatment requiring opioids for chronic pain and are concerned about your likelihood of opioid misuse, discuss this with your doctor, along with a plan for addressing side effects of these medications. Together you can weigh the pros and cons of taking opioids and work to manage your particular type of pain.

Resources

CDC Injury Prevention & Control: Opioid Education Resources for Patients

Harvard Medical School Longwood Seminars: The Science of Pain

  The post Is an opioid really the best medication for my pain? appeared first on Harvard Health Blog.

from Harvard Health Blog http://bit.ly/2WRVAfU Original Content By : http://bit.ly/1UayBFY

[emlydunstan]

How Fentanyl Hysteria Leads to Harmful and Ineffective Drug Laws

My only experience with fentanyl was when I was pregnant. I was on a hospital bed writhing in agony when a nurse injected me with the synthetic opioid commonly used for pain management in laboring women. The drug calmed me and I soon gave birth to a healthy baby girl.That was before fentanyl moved from the hospitals to the streets, tainting the illicit drug supply and ratcheting up an already alarming death toll from overdose.Since then, deaths from synthetic opioids (mostly fentanyl) have begun a steep climb, jumping 540% in the past three years alone. More than half of the opioids in the U.S. are now laced with fentanyl and the fear surrounding the drug is palpable. Some people claim you can overdose on the drug just from touching it. As a result of this hysteria, many first responders are afraid to respond to overdoses for fear of coming into contact with fentanyl. Meanwhile, states are scrambling to pass laws responding to the ever-changing landscape of fentanyl and its many derivatives.Alice Bell, who works to reduce overdose deaths through Prevention Point Pittsburgh, a syringe exchange program, says that there are reasons to be concerned about fentanyl. In Allegheny County, Pennsylvania, where her program operates, the opioid was involved in 20% of deaths in 2014. In 2016 the number tripled to 63% and today fentanyl is present in 74% of drug-related overdose deaths.“Fentanyl is much stronger than heroin and other opiates,” Bell explains. “It is easy to get a high dose without realizing it… Because it is fast acting there is a smaller window before people [overdose].”What Is Fentanyl and How Is It Dangerous?Fentanyl, a synthetic opioid created to mimic the effects of natural opioids (which are derived from opium poppy plants), was first introduced in 1959 as an anesthetic and pain reliever for surgery and cancer patients. It wasn’t until 2014 that unregulated forms of fentanyl began arriving in the U.S. from China. Because these analogues are cheap to buy and highly potent, they’re often mixed into supplies of other illicit drugs, such as heroin, cocaine, or pills. People buying or selling drugs on the streets may have no idea whether the product contains fentanyl, or how strong it is. This lack of knowledge has contributed to skyrocketing rates of overdose deaths across the country.As Bell explains, because illicit fentanyl is mixed into other drugs in unregulated environments, it is hard to mix it uniformly. Thus, one person might get a very strong dose while another might get a weaker dose, even though both samples came from the same supply. Bell likens it to “mixing pancake batter and getting chunks.”But although Bell acknowledges the dangers of a fentanyl-laced drug supply, she also emphasizes that much of the panic surrounding fentanyl and its effects is misleading—including false rumors about Narcan-resistant fentanyl or people overdosing just from touching the substance.Dan Ciccarone, a professor at the University of California, San Francisco who has spent the last four years studying fentanyl, agrees that while there are reasons to be concerned, responding to the challenge with policies rooted in fear and misinformation only makes matters worse. He points out that the problem is not so much fentanyl itself, but the fact that it’s being added to other drugs in unknown amounts.“We have to take some of the hysteria and the irrationally out of it,” he says. “If we say the problem is heroin and heroin contaminants, [we] treat the problem differently than if [we] say it’s a new drug and it’s killing our teenagers.”How to address the fentanyl-related overdoses is a question vexing many policymakers. In the past few years, state legislatures have spun off in wildly different directions. Some have attempted to curb overdoses through the introduction of 911 Good Samaritan laws and expanding availability of naloxone, syringe exchange programs, and treatment options for people who use drugs problematically. Some have implemented diversion programs and sentencing reforms designed to keep people who struggle with addiction out of jail and to connect them to programs that address the root cause of addiction. Others are enacting ever-harsher penalties for crimes involving fentanyl. In fact, many states are doing all of these things at once, oblivious, it seems, to the fact that some of these new policies contradict or even cancel each other out.Opioid Confusion and Contradictory Drug PoliciesIn 2017, Louisiana passed a bill that reduced prison sentences for drug possession convictions. But the same law created a new mandatory minimum sentence for illegally possessing opioid painkillers (such as fentanyl). Maryland likewise enacted legislation in 2016 to reduce penalties for drug users and sellers, but the very next year created a new penalty for drugs containing fentanyl that extends prison sentences up to 10 years. In 2017, North Carolina cracked down on synthetic fentanyl and created a task force to reform opioid sentencing laws in literally the same bill. On the federal level, the passage of The First Step Act, which reduces mandatory minimum and three-strike laws, came on the heels of the former Attorney General’s declaration to relentlessly prosecute every case involving any amount of fentanyl.In essence, many governments are passing laws that lessen penalties for opioid-related crimes, while simultaneously enacting laws that further criminalize fentanyl (an opioid).For Michael Collins, Director of the Office of National Affairs at the Drug Policy Alliance, the confusion stems from a desire to respond and a lack of knowledge about the most effective way to do so.“Policymakers feel pressure to do something,” he explains. “In the absence of public health measures that they are familiar with, legislators will dust off their Drug War playbook and go towards punitive measures…certainly there is no evidence that those penalties will decrease overdose deaths.”Collins’ explanation echoes my own experience as a lobbyist advocating against drug-induced homicide laws in North Carolina. Like many states, North Carolina is responding to increases in fentanyl-related deaths by introducing legislation that would allow prosecutors to charge people with murder if they distribute a drug that leads to an overdose. It’s a typical punish-first response that not only is proven ineffective at reducing overdose deaths, but could potentially increase overdose deaths by negating the state’s 911 Good Samaritan law, which was enacted in 2013 to encourage people to call 911 to report an overdose. If lawmakers agree that fear of being charged with possession of drugs is enough to deter someone from calling 911, surely they see that fear of being charged with murder would even further discourage life-saving medical calls.But, as I discovered, it is hard to reason with a politician, a prosecutor, or a law enforcement official who is under intense pressure from their community to “do something.” Of course to address the problem of people selling drugs that lead to overdose, we need to tackle the underlying factors that lead people to sell drugs in the first place, such as the need to support a personal drug habit or lack of economic alternatives. But proposing solutions such as more drug treatment centers, jobs programs for low-income neighborhoods, greater investment in vocational education…all these are high-cost, long-term solutions. And officials are being pressured to find answers now.Increasing penalties against drug dealers is quick, relatively simple, and the cost is picked up by local court systems, not by the politicians who passed the law. Better yet, harsher penalties sound like a solution that satisfies the public’s need for accountability.Incarceration and Stricter Laws Cause More Crime and DeathsThe problem with using the criminal justice system to address complex issues like drug use is that we imagine the system to be far more effective than it actually is. We probably wouldn’t celebrate laws that incarcerate more people if we realized that locking up one drug dealer merely causes another to take his place. We probably wouldn’t be so anxious to pour billions of dollars into law enforcement efforts to disrupt drug supplies if we realized that U.S. illicit drug market is estimated at $100 billion annually, while law enforcement only seize between $440 and $770 million in drug money per year—around 0.5% of the total value. We might not swallow the $1 trillion price tag of the War on Drugs if we realized that after all this money spent and all the families disrupted from incarceration due to nonviolent crimes, drugs are now cheaper, more plentiful, and more deadly than ever before.To effectively lower the demand for drugs or decrease overdose deaths, we need to think outside the box.Alice Bell explains, “If you want to encourage people to avoid more dangerous drugs, you have to allow people access to less dangerous drugs.”That is certainly not a solution that politicians want to hear. It doesn’t “sound good.” But it would do far more to reduce overdose deaths than all our efforts to slap people with longer prison sentences. We need to help politicians confront their fear of drugs and to understand that drugs always have been and always will be a part of our communities. We might as well accept reality and direct our efforts towards making drugs less deadly, in the same way that we accept the risks of driving a car, but also try to prevent accidents. Most people age out of addiction—if they live long enough to do so. There is no reason that taking a hit of a mood-altering substance should be akin to Russian Roulette.Conservative economist Milton Friedman once said, “Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes the politically inevitable.”Fentanyl may be that catalytic crisis needed to produce change. In that case, we should work to turn tragedy into opportunity.

from RSSMix.com Mix ID 8241841 https://www.thefix.com/how-fentanyl-hysteria-leads-harmful-and-ineffective-drug-laws

[pitz182]

How Fentanyl Hysteria Leads to Harmful and Ineffective Drug Laws

My only experience with fentanyl was when I was pregnant. I was on a hospital bed writhing in agony when a nurse injected me with the synthetic opioid commonly used for pain management in laboring women. The drug calmed me and I soon gave birth to a healthy baby girl.That was before fentanyl moved from the hospitals to the streets, tainting the illicit drug supply and ratcheting up an already alarming death toll from overdose.Since then, deaths from synthetic opioids (mostly fentanyl) have begun a steep climb, jumping 540% in the past three years alone. More than half of the opioids in the U.S. are now laced with fentanyl and the fear surrounding the drug is palpable. Some people claim you can overdose on the drug just from touching it. As a result of this hysteria, many first responders are afraid to respond to overdoses for fear of coming into contact with fentanyl. Meanwhile, states are scrambling to pass laws responding to the ever-changing landscape of fentanyl and its many derivatives.Alice Bell, who works to reduce overdose deaths through Prevention Point Pittsburgh, a syringe exchange program, says that there are reasons to be concerned about fentanyl. In Allegheny County, Pennsylvania, where her program operates, the opioid was involved in 20% of deaths in 2014. In 2016 the number tripled to 63% and today fentanyl is present in 74% of drug-related overdose deaths.“Fentanyl is much stronger than heroin and other opiates,” Bell explains. “It is easy to get a high dose without realizing it… Because it is fast acting there is a smaller window before people [overdose].”What Is Fentanyl and How Is It Dangerous?Fentanyl, a synthetic opioid created to mimic the effects of natural opioids (which are derived from opium poppy plants), was first introduced in 1959 as an anesthetic and pain reliever for surgery and cancer patients. It wasn’t until 2014 that unregulated forms of fentanyl began arriving in the U.S. from China. Because these analogues are cheap to buy and highly potent, they’re often mixed into supplies of other illicit drugs, such as heroin, cocaine, or pills. People buying or selling drugs on the streets may have no idea whether the product contains fentanyl, or how strong it is. This lack of knowledge has contributed to skyrocketing rates of overdose deaths across the country.As Bell explains, because illicit fentanyl is mixed into other drugs in unregulated environments, it is hard to mix it uniformly. Thus, one person might get a very strong dose while another might get a weaker dose, even though both samples came from the same supply. Bell likens it to “mixing pancake batter and getting chunks.”But although Bell acknowledges the dangers of a fentanyl-laced drug supply, she also emphasizes that much of the panic surrounding fentanyl and its effects is misleading—including false rumors about Narcan-resistant fentanyl or people overdosing just from touching the substance.Dan Ciccarone, a professor at the University of California, San Francisco who has spent the last four years studying fentanyl, agrees that while there are reasons to be concerned, responding to the challenge with policies rooted in fear and misinformation only makes matters worse. He points out that the problem is not so much fentanyl itself, but the fact that it’s being added to other drugs in unknown amounts.“We have to take some of the hysteria and the irrationally out of it,” he says. “If we say the problem is heroin and heroin contaminants, [we] treat the problem differently than if [we] say it’s a new drug and it’s killing our teenagers.”How to address the fentanyl-related overdoses is a question vexing many policymakers. In the past few years, state legislatures have spun off in wildly different directions. Some have attempted to curb overdoses through the introduction of 911 Good Samaritan laws and expanding availability of naloxone, syringe exchange programs, and treatment options for people who use drugs problematically. Some have implemented diversion programs and sentencing reforms designed to keep people who struggle with addiction out of jail and to connect them to programs that address the root cause of addiction. Others are enacting ever-harsher penalties for crimes involving fentanyl. In fact, many states are doing all of these things at once, oblivious, it seems, to the fact that some of these new policies contradict or even cancel each other out.Opioid Confusion and Contradictory Drug PoliciesIn 2017, Louisiana passed a bill that reduced prison sentences for drug possession convictions. But the same law created a new mandatory minimum sentence for illegally possessing opioid painkillers (such as fentanyl). Maryland likewise enacted legislation in 2016 to reduce penalties for drug users and sellers, but the very next year created a new penalty for drugs containing fentanyl that extends prison sentences up to 10 years. In 2017, North Carolina cracked down on synthetic fentanyl and created a task force to reform opioid sentencing laws in literally the same bill. On the federal level, the passage of The First Step Act, which reduces mandatory minimum and three-strike laws, came on the heels of the former Attorney General’s declaration to relentlessly prosecute every case involving any amount of fentanyl.In essence, many governments are passing laws that lessen penalties for opioid-related crimes, while simultaneously enacting laws that further criminalize fentanyl (an opioid).For Michael Collins, Director of the Office of National Affairs at the Drug Policy Alliance, the confusion stems from a desire to respond and a lack of knowledge about the most effective way to do so.“Policymakers feel pressure to do something,” he explains. “In the absence of public health measures that they are familiar with, legislators will dust off their Drug War playbook and go towards punitive measures…certainly there is no evidence that those penalties will decrease overdose deaths.”Collins’ explanation echoes my own experience as a lobbyist advocating against drug-induced homicide laws in North Carolina. Like many states, North Carolina is responding to increases in fentanyl-related deaths by introducing legislation that would allow prosecutors to charge people with murder if they distribute a drug that leads to an overdose. It’s a typical punish-first response that not only is proven ineffective at reducing overdose deaths, but could potentially increase overdose deaths by negating the state’s 911 Good Samaritan law, which was enacted in 2013 to encourage people to call 911 to report an overdose. If lawmakers agree that fear of being charged with possession of drugs is enough to deter someone from calling 911, surely they see that fear of being charged with murder would even further discourage life-saving medical calls.But, as I discovered, it is hard to reason with a politician, a prosecutor, or a law enforcement official who is under intense pressure from their community to “do something.” Of course to address the problem of people selling drugs that lead to overdose, we need to tackle the underlying factors that lead people to sell drugs in the first place, such as the need to support a personal drug habit or lack of economic alternatives. But proposing solutions such as more drug treatment centers, jobs programs for low-income neighborhoods, greater investment in vocational education…all these are high-cost, long-term solutions. And officials are being pressured to find answers now.Increasing penalties against drug dealers is quick, relatively simple, and the cost is picked up by local court systems, not by the politicians who passed the law. Better yet, harsher penalties sound like a solution that satisfies the public’s need for accountability.Incarceration and Stricter Laws Cause More Crime and DeathsThe problem with using the criminal justice system to address complex issues like drug use is that we imagine the system to be far more effective than it actually is. We probably wouldn’t celebrate laws that incarcerate more people if we realized that locking up one drug dealer merely causes another to take his place. We probably wouldn’t be so anxious to pour billions of dollars into law enforcement efforts to disrupt drug supplies if we realized that U.S. illicit drug market is estimated at $100 billion annually, while law enforcement only seize between $440 and $770 million in drug money per year—around 0.5% of the total value. We might not swallow the $1 trillion price tag of the War on Drugs if we realized that after all this money spent and all the families disrupted from incarceration due to nonviolent crimes, drugs are now cheaper, more plentiful, and more deadly than ever before.To effectively lower the demand for drugs or decrease overdose deaths, we need to think outside the box.Alice Bell explains, “If you want to encourage people to avoid more dangerous drugs, you have to allow people access to less dangerous drugs.”That is certainly not a solution that politicians want to hear. It doesn’t “sound good.” But it would do far more to reduce overdose deaths than all our efforts to slap people with longer prison sentences. We need to help politicians confront their fear of drugs and to understand that drugs always have been and always will be a part of our communities. We might as well accept reality and direct our efforts towards making drugs less deadly, in the same way that we accept the risks of driving a car, but also try to prevent accidents. Most people age out of addiction—if they live long enough to do so. There is no reason that taking a hit of a mood-altering substance should be akin to Russian Roulette.Conservative economist Milton Friedman once said, “Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes the politically inevitable.”Fentanyl may be that catalytic crisis needed to produce change. In that case, we should work to turn tragedy into opportunity.

[alexdmorgan30]

How Fentanyl Hysteria Leads to Harmful and Ineffective Drug Laws

My only experience with fentanyl was when I was pregnant. I was on a hospital bed writhing in agony when a nurse injected me with the synthetic opioid commonly used for pain management in laboring women. The drug calmed me and I soon gave birth to a healthy baby girl.That was before fentanyl moved from the hospitals to the streets, tainting the illicit drug supply and ratcheting up an already alarming death toll from overdose.Since then, deaths from synthetic opioids (mostly fentanyl) have begun a steep climb, jumping 540% in the past three years alone. More than half of the opioids in the U.S. are now laced with fentanyl and the fear surrounding the drug is palpable. Some people claim you can overdose on the drug just from touching it. As a result of this hysteria, many first responders are afraid to respond to overdoses for fear of coming into contact with fentanyl. Meanwhile, states are scrambling to pass laws responding to the ever-changing landscape of fentanyl and its many derivatives.Alice Bell, who works to reduce overdose deaths through Prevention Point Pittsburgh, a syringe exchange program, says that there are reasons to be concerned about fentanyl. In Allegheny County, Pennsylvania, where her program operates, the opioid was involved in 20% of deaths in 2014. In 2016 the number tripled to 63% and today fentanyl is present in 74% of drug-related overdose deaths.“Fentanyl is much stronger than heroin and other opiates,” Bell explains. “It is easy to get a high dose without realizing it… Because it is fast acting there is a smaller window before people [overdose].”What Is Fentanyl and How Is It Dangerous?Fentanyl, a synthetic opioid created to mimic the effects of natural opioids (which are derived from opium poppy plants), was first introduced in 1959 as an anesthetic and pain reliever for surgery and cancer patients. It wasn’t until 2014 that unregulated forms of fentanyl began arriving in the U.S. from China. Because these analogues are cheap to buy and highly potent, they’re often mixed into supplies of other illicit drugs, such as heroin, cocaine, or pills. People buying or selling drugs on the streets may have no idea whether the product contains fentanyl, or how strong it is. This lack of knowledge has contributed to skyrocketing rates of overdose deaths across the country.As Bell explains, because illicit fentanyl is mixed into other drugs in unregulated environments, it is hard to mix it uniformly. Thus, one person might get a very strong dose while another might get a weaker dose, even though both samples came from the same supply. Bell likens it to “mixing pancake batter and getting chunks.”But although Bell acknowledges the dangers of a fentanyl-laced drug supply, she also emphasizes that much of the panic surrounding fentanyl and its effects is misleading—including false rumors about Narcan-resistant fentanyl or people overdosing just from touching the substance.Dan Ciccarone, a professor at the University of California, San Francisco who has spent the last four years studying fentanyl, agrees that while there are reasons to be concerned, responding to the challenge with policies rooted in fear and misinformation only makes matters worse. He points out that the problem is not so much fentanyl itself, but the fact that it’s being added to other drugs in unknown amounts.“We have to take some of the hysteria and the irrationally out of it,” he says. “If we say the problem is heroin and heroin contaminants, [we] treat the problem differently than if [we] say it’s a new drug and it’s killing our teenagers.”How to address the fentanyl-related overdoses is a question vexing many policymakers. In the past few years, state legislatures have spun off in wildly different directions. Some have attempted to curb overdoses through the introduction of 911 Good Samaritan laws and expanding availability of naloxone, syringe exchange programs, and treatment options for people who use drugs problematically. Some have implemented diversion programs and sentencing reforms designed to keep people who struggle with addiction out of jail and to connect them to programs that address the root cause of addiction. Others are enacting ever-harsher penalties for crimes involving fentanyl. In fact, many states are doing all of these things at once, oblivious, it seems, to the fact that some of these new policies contradict or even cancel each other out.Opioid Confusion and Contradictory Drug PoliciesIn 2017, Louisiana passed a bill that reduced prison sentences for drug possession convictions. But the same law created a new mandatory minimum sentence for illegally possessing opioid painkillers (such as fentanyl). Maryland likewise enacted legislation in 2016 to reduce penalties for drug users and sellers, but the very next year created a new penalty for drugs containing fentanyl that extends prison sentences up to 10 years. In 2017, North Carolina cracked down on synthetic fentanyl and created a task force to reform opioid sentencing laws in literally the same bill. On the federal level, the passage of The First Step Act, which reduces mandatory minimum and three-strike laws, came on the heels of the former Attorney General’s declaration to relentlessly prosecute every case involving any amount of fentanyl.In essence, many governments are passing laws that lessen penalties for opioid-related crimes, while simultaneously enacting laws that further criminalize fentanyl (an opioid).For Michael Collins, Director of the Office of National Affairs at the Drug Policy Alliance, the confusion stems from a desire to respond and a lack of knowledge about the most effective way to do so.“Policymakers feel pressure to do something,” he explains. “In the absence of public health measures that they are familiar with, legislators will dust off their Drug War playbook and go towards punitive measures…certainly there is no evidence that those penalties will decrease overdose deaths.”Collins’ explanation echoes my own experience as a lobbyist advocating against drug-induced homicide laws in North Carolina. Like many states, North Carolina is responding to increases in fentanyl-related deaths by introducing legislation that would allow prosecutors to charge people with murder if they distribute a drug that leads to an overdose. It’s a typical punish-first response that not only is proven ineffective at reducing overdose deaths, but could potentially increase overdose deaths by negating the state’s 911 Good Samaritan law, which was enacted in 2013 to encourage people to call 911 to report an overdose. If lawmakers agree that fear of being charged with possession of drugs is enough to deter someone from calling 911, surely they see that fear of being charged with murder would even further discourage life-saving medical calls.But, as I discovered, it is hard to reason with a politician, a prosecutor, or a law enforcement official who is under intense pressure from their community to “do something.” Of course to address the problem of people selling drugs that lead to overdose, we need to tackle the underlying factors that lead people to sell drugs in the first place, such as the need to support a personal drug habit or lack of economic alternatives. But proposing solutions such as more drug treatment centers, jobs programs for low-income neighborhoods, greater investment in vocational education…all these are high-cost, long-term solutions. And officials are being pressured to find answers now.Increasing penalties against drug dealers is quick, relatively simple, and the cost is picked up by local court systems, not by the politicians who passed the law. Better yet, harsher penalties sound like a solution that satisfies the public’s need for accountability.Incarceration and Stricter Laws Cause More Crime and DeathsThe problem with using the criminal justice system to address complex issues like drug use is that we imagine the system to be far more effective than it actually is. We probably wouldn’t celebrate laws that incarcerate more people if we realized that locking up one drug dealer merely causes another to take his place. We probably wouldn’t be so anxious to pour billions of dollars into law enforcement efforts to disrupt drug supplies if we realized that U.S. illicit drug market is estimated at $100 billion annually, while law enforcement only seize between $440 and $770 million in drug money per year—around 0.5% of the total value. We might not swallow the $1 trillion price tag of the War on Drugs if we realized that after all this money spent and all the families disrupted from incarceration due to nonviolent crimes, drugs are now cheaper, more plentiful, and more deadly than ever before.To effectively lower the demand for drugs or decrease overdose deaths, we need to think outside the box.Alice Bell explains, “If you want to encourage people to avoid more dangerous drugs, you have to allow people access to less dangerous drugs.”That is certainly not a solution that politicians want to hear. It doesn’t “sound good.” But it would do far more to reduce overdose deaths than all our efforts to slap people with longer prison sentences. We need to help politicians confront their fear of drugs and to understand that drugs always have been and always will be a part of our communities. We might as well accept reality and direct our efforts towards making drugs less deadly, in the same way that we accept the risks of driving a car, but also try to prevent accidents. Most people age out of addiction—if they live long enough to do so. There is no reason that taking a hit of a mood-altering substance should be akin to Russian Roulette.Conservative economist Milton Friedman once said, “Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes the politically inevitable.”Fentanyl may be that catalytic crisis needed to produce change. In that case, we should work to turn tragedy into opportunity.

from RSSMix.com Mix ID 8241841 https://ift.tt/2TVdaz2

[type2diabetestreatments-blog]

C-Sections vs. Natural Birth in Diabetic Moms

New Post has been published on http://type2diabetestreatment.net/diabetes-mellitus/c-sections-vs-natural-birth-in-diabetic-moms/

C-Sections vs. Natural Birth in Diabetic Moms

Childbirth and diabetes were once considered mutually exclusive. Thankfully, those days are over. But aiming for a healthy baby — and an uncomplicated birth — when you're living with diabetes is still a very tall order. It can be scary. And no one really wants to have a C-section, right? (I sure didn't, x3). Today, D-author and fellow mother of three Amy Stockwell Mercer joins us once more for a special report on new research providing insight into the precise effects of the Big D during childbirth.

Special to the 'Mine by Amy Stockwell Mercer

The myth that women with diabetes can't have babies is almost extinct. Shelby's premature death in the movie Steel Magnolias has slowly been replaced by images of healthy, vibrant women like former Miss America Nicole Johnson and fellow D-blogger Kerri Morrone Sparling as they navigate diabetes, pregnancy and motherhood. We've come a long way in understanding the importance of prenatal care for women with diabetes and as a result, more women are having healthy babies than ever before. However, 45%-70% of these pregnancies result in cesarean births and until now, no one could explain why.

Researchers at the University of Liverpool have recently discovered that women with diabetes have "impaired uterine contractility." That means that even if we push for hours, some of us may never succeed. This groundbreaking research is based on 2010 United Kingdom government statistics, which show a high induction of labor rate (39%) and a high C-section rate (67%) in women with type 1 and type 2 diabetes (compared to 21% of the general maternal population).

"We need to think about the enormously high C-section rate rather than just accepting it," says co-author Dr. Susan Wray. "As scientists we asked the question, could it be that these women's uterus' cannot contract as well as other women's?"

Even though I'm personally finished having babies, the idea that my uterus might not contract as well as other women came as both a shock and a relief. For years I felt like a failure because of my three C-sections, as if I hadn't tried hard enough or labored long enough to get the baby out on my own. Instead of a natural birth like my mom had, I was induced, stuck with IV's, and rushed into the operating room for an emergency cesarean after 2 ½ hours of pushing. Two more C-sections followed, leaving me with three healthy boys and a permanent scar.

Seeking more information, I contacted Dr. Jennifer Ahn, one of the experts quoted in my book, The Smart Woman's Guide to Diabetes, to ask her opinion on diabetes and delivery. Director of the Diabetes in Pregnancy Program, and a type 1 diabetic Dr. Ahn explained that, "We tend to induce women with diabetes (pregestational or gestational) on medications (whether insulin or oral meds) around 39 weeks gestation. The reason for this is that women with diabetes are at a greater risk for stillbirth, and 39 weeks has been shown to be the time when the fetus is fully developed."

The downside of induced labor is that it may double the odds of a C-section birth, and for women with diabetes (I know this all too well), once you've had a C-section, your chances of delivering naturally are slim. "Vaginal deliveries are the best mode of delivery for any mom," adds Dr. Ahn. "There's a better recovery. A C-section is a major surgery with increased blood loss and risk of surgical complications. Plus, moms end up having multiple C-sections, and can have a lot of problems in subsequent pregnancies."

But sometimes there's no other option than surgery. Reasons for a cesarean vary from the development of pre-eclampasia (high blood pressure and excess protein in the urine after 20 weeks of pregnancy), to a previous C-section, failed induction, obstructed labor, excessive fetal growth and malpresentation.

Cheryl Alkon, author of Balancing Pregnancy with Pre-Existing Diabetes, actually chose a C-section because of her retinopathy. "I was given the choice to do an elective C-section at week 37 for my son's birth, or else a vaginal delivery with forceps and vacuum so I wouldn't put any pressure on my eyes. I didn't hesitate to pick the C-section, and honestly, it was really a great experience."

Melissa Partridge, mother of 4, also had C-sections. I met Melissa at last year's DiabetesSisters conference, and emailed to ask about her experiences. "My doctor said he would induce me at 38 weeks with my first pregnancy. At the time my placenta looked great in the ultrasound and the baby didn't look too big, but I wasn't dilated or effaced at all, and the doctor wanted the baby out. After about 9 hours on pitocin (a synthetic hormone used to induce labor), he decided to break my water, hoping it would get things moving. Nothing happened. Four hours later, I was sent in for a C-section. My honest feeling is that my baby wanted to stay in and my body wasn't ready, but since it was nearing the middle of the night, and the doctor had already broken my water, he opted for a C-section." Melissa adds, "I often wonder if I had been more in control of my birthing experience if I would have been able to have a natural delivery."

But how do we get more control of our birthing experiences? Would Melissa's experience be different if she'd known about her uterus? The new Liverpool study is the first to show that contractions in women with diabetes are smaller and shorter lasting.

Dr. Wray says, "There is a reduction in muscle mass that could come from poor blood glucose control, but even with good control there is muscle mass reduction." They also discovered that the mechanism for getting calcium into the uterine muscle cells, needed to promote contractions, is decreased in women with diabetes. There's no way of knowing the strength of a woman's uterus before she goes into labor, and we can't improve our uteruses' with push-ups or yoga. "I don't want women to think 'why bother,'" Dr. Wray says, "There are women with diabetes who are able to contract well, and women without diabetes who are unable to contract well, so the answer is that one size does not fit all."

Elizabeth Edelman, co-founder of Diabetes Daily, is a good example of someone who was able to contract well. She told me she tried to do everything possible to prepare for a natural delivery. "I worked with a wonderful doula who had worked with another woman with type 1 diabetes, so I felt confident. My team of OB's was very supportive. They did say that if I went over 40 weeks they wanted to induce, but luckily for me they didn't have to. I went into labor at 39 weeks spontaneously. I worked very hard, counting every carb I ate, wearing a CGM, and practicing yoga to make sure that I could deliver naturally. I also took Bradley classes that helped me prepare."

Preparation is like second nature to those of us with diabetes, and giving birth should be no different. We need to be our own advocates and that means seeking the latest information, being engaged in decision-making, and communicating with our OB/GYN's. Dr. Wray says women should be individually monitored during pregnancy and delivery, and talk with doctors about the possible need for "a longer duration or higher dose of oxytocin (natural hormone to induce labor) during labor to counteract the inherent poor uterine contractility."

I also reached out to Dr. Lois Jovanovic CEO & Chief Scientific Officer of Sansum Diabetes Research Institute and a pioneer in her work with diabetes and pregnancy, to get an expert point of view. She's the one who called this new study groundbreaking.

"The results clearly show that independent of type of diabetes, glucose control or complications, the women with diabetes had poorer myometrial contractions than the women with normal glucose tolerance. The authors' conclusion that each pregnant diabetic women should thus be treated uniquely during labor and delivery proves that women with diabetes truly are special!" — diabetes & pregnancy expert Dr. Lois Jovanovic

Dr. Jovanovic is right, we are special and we've come a long way toward understanding the needs of a diabetic pregnancy from start to finish. The more we learn about our bodies, the better we can work with what we've got, and feel empowered about our birthing experience.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.

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Is an opioid really the best medication for my pain?

As physicians, many of our daily practices involve administration of substances that are shrouded in mystery. Certain medications, specifically opioids, have been part of tragic news stories, and have turned young children into orphans, happy spouses into widows and widowers, and once-aspirational youth into memories. The CDC reports that on average, 130 people die each day from an opioid overdose.

With such harrowing statistics, why take opioids in the first place? Well, if used appropriately, opioids can significantly improve pain with relatively tolerable side effects. A short-term course of opioids (typically 3 to 7 days) prescribed following an injury, like a broken bone, or after a surgical procedure, is usually quite safe. It’s long-term use that can lead to problems, including the risk of addiction and overdose.

National guidelines for physicians recommend the shortest duration of opioids possible for acute pain, as a person’s chances of unintentional long-term use increase with the degree of exposure. One large study found that in first-time opioid users, one in seven people who received a refill or had a second opioid prescribed were on opioids one year later.

While widespread overuse of opioids has contributed to increased scrutiny regarding their administration, careful consideration of a variety of factors can help physicians and patients determine whether opioids are the right medication.

Here are several important things you may want to discuss with your doctor when considering taking opioids for the first time.

What kind of pain am I having?

Classification: This can be tricky, since many conditions include a wide variety of pain signals that can overlap. Two of the main types are:

Nociceptive: This is the most common form of pain. It occurs when some sort of stimulus (i.e., inflammatory, chemical, or physical) causes your skin, muscles, bones, joints, or organs to send a message by way of your nerves to your brain.

Neuropathic: This is a type of pain that is caused by a direct injury to the nerve itself. This type of pain is commonly seen in people with diabetes, neurologic issues, or prior amputations. Opioids are not effective in treating this type of pain.

Time course:

Acute: Pain lasting less than 3 to 6 months (often much less). It typically goes away when the underlying cause of pain is resolved. Classic examples include surgery, broken bones, and labor during childbirth.

Chronic: Pain lasting for more than 3 to 6 months. This tends to be more difficult to treat than acute pain, since the pain signals adapt over time, which can change the way the brain perceives painful sensations. Common conditions that may cause chronic pain include arthritis, some types of back injury (such as a bulging disc), and fibromyalgia.

What are some of the most common side effects?

Many of the side effects of opioids are due to their effects on your brain and gastrointestinal tract, so you are most likely to experience constipation, nausea, sleepiness, and confusion. Some ways for you to minimize your chances of experiencing these include using the smallest dose possible and treating the side effects directly. For instance, constipation can be initially treated with a high-fiber diet and increasing fluids, though you may be directed to prophylactically start taking treatment medication like stool softeners and/or stimulant laxatives. At times, adequate treatment of any underlying constipation may resolve any nausea you might be experiencing, though this will not help if your nausea is caused by direct activity of opioids on the part of your brain that induces nausea. When this is the case, your doctor may prescribe anti-nausea medications.

What’s my risk for tolerance, dependence, and addiction?

Tolerance occurs when a person’s response to a medication changes over time, in that they require a higher amount of a medication to achieve the same effect, such as pain control or euphoria. In the context of opioids and addiction (more below), with time the brain adjusts to the excess of the reward hormone, dopamine. As the brain adapts, it requires more opioid in order to feel the same effects or benefits. Tolerance is a gradual process that is highly dependent on the specific opioid being used, the dose of the medication, and a person’s biology. To some degree, everyone would eventually develop tolerance to opioids if taken long enough.

Dependence happens when a person requires a substance in order to feel normal and to prevent withdrawal. Many of us have experienced this on a much smaller scale on days we are deprived of coffee. With opioids, once a person is physically dependent, abrupt cessation of the medication can lead to gastrointestinal symptoms, anxiety, and agitation. Everyone exposed to a drug long enough will become dependent, though only a small percentage of people truly become addicted.

Addiction is a disease state that is seen when a person continues to use a drug despite harmful health, social, and/or economic consequences. Assessing individualized risk of becoming addicted is complex and involves many factors: biological, developmental, and environmental factors combine to influence a patient’s individual predisposition. Ultimately, a fatal overdose can happen when too much of the drug is taken or combined with other dangerous drugs, which may cause a person to stop breathing.

What other medications am I taking that may pose safety concerns?

As mentioned earlier, opioids affect your brain and can make you sleepy and slow your breathing. Certain medications or substances, when combined with opioids, can increase this effect. Medications commonly considered are those used to treat seizures, sleeping problems, psychiatric disorders, and muscle spasms. There are many things you can do to avoid drug interactions.

In our era of controversy related to excessive opioid use, there is a well-deserved focus on judicious prescribing. Procedural techniques, like injections and non-opioid medications, are being used more often as effective treatments for people in pain, as these interventions don’t carry the risk of serious side effects such as overdose. But there are times when an opioid is the right choice; it’s a matter of thoughtful discussion and understanding your risks.

If you find yourself on a course of treatment requiring opioids for chronic pain and are concerned about your likelihood of opioid misuse, discuss this with your doctor, along with a plan for addressing side effects of these medications. Together you can weigh the pros and cons of taking opioids and work to manage your particular type of pain.

Resources

CDC Injury Prevention & Control: Opioid Education Resources for Patients

Harvard Medical School Longwood Seminars: The Science of Pain

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