Crash Cart: Non-addictive painkiller alternatives?

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REAL PHYSICIANS DISCUSS RECENT HEALTHCARE HEADLINES

Below is an excerpt from the full conversation, which is available on epmonthly.com. Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.com.


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Study on animals discovers non-addictive painkiller alternative [https://tinyurl.com/yb55nm2n]

I’m still trying to figure out how researchers can figure out that mice had pain relief without having addiction or withdrawal while receiving the medication. It would be great if this medication really does have a potency 100 times that of morphine without any side effects. That would put a lot of opioids at a tremendous disadvantage. Then again, cost will be a major determinant of how much any such medication is actually prescribed. Recall IV acetaminophen. It’s pennies for an oral dose, but $40-$60 for an IV dose. Will patients, hospitals or insurers pay for expensive new pain medications when inexpensive opioids are available? I also wonder whether there will be a barrage of “allergic” reactions to this new medication so that doctors will be hesitant to administer it instead of that other medicine whose name I can’t remember but I think that it starts with a “D.”

William Sullivan, DO, JD

This is great.  Hope it works in humans like the apes.  If so, it will finally get the target off doctors’ backs for “causing” the opioid epidemic.  It won’t change the epidemic, of course, because people will still get in on the street.  But at least it won’t be on us.  A small victory.


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– Mark L. Plaster, MD, JD

Headline: “Scientists have developed a safe and non-addictive painkiller as an alternative to current opioids, according to a study of animals.” Would that it were true! The unanswered question is what effect it will have on their sixth vital sign? Don’t want to sound like the Eeyore here, but any drug has abuse potential, so I’ll believe it when I see it. The realist in me makes me think they should probably also include as part of their testing what effect it has when it is crushed, eaten, snorted and/or injected. I still find it ironic that the House of Medicine finds itself here after being told for so long that pain is a vital sign and I spent part of yesterday getting CME for MAT (Medication-Assisted Treatment) of opioid addiction. CME that will help me meet the new requirements of my state Board of Medicine.

– E. Paul DeKoning, MD, MS, FACEP, FAAEM

Blood shortage resolution might be found in gut enzymes [https://tinyurl.com/yaad8g8q]

Key word here: may. The alchemy of blood banking admittedly sounds kinda cool. But, the author doesn’t know much and the researchers aren’t talking. Perhaps a bit premature to say it may solve U.S. blood shortages and feels like a bit of a sensational take on “blood shortages,” but such is the nature of journalism—the headline made you read it. Now, if we could find an enzyme that would solve U.S. normal saline shortages or (gasp) droperidol shortages that would be something.


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– E. Paul DeKoning, MD, MS, FACEP, FAAEM

OK, I admit that I had a bit of a giggling fit when I first read this story — thinking about all kinds of weird scenarios with vampires and gastrointestinal distress. The “gut enzyme” referenced doesn’t create blood, but instead it cleaves antigens from surface of types A and B blood to make those cells type O — the “universal donor.” Great idea, but it doesn’t solve the problem of low supplies of blood overall. Get out there and donate blood, people! Now for the bigger question. How does Paul still have Droperidol on formulary at his hospital??

William Sullivan, DO, JD

Now that I work for the American Red Cross (my retirement job), I see how helpful this could be.  Blood acquisition costs, especially the rare blood types, is astronomical.  This could make our life so much easier.  Hope it works.

– Mark L. Plaster, MD, JD

Urgent care is troubling source of antibiotics-prescribing problem [https://tinyurl.com/y6u5foap]

The providers in urgent care tend to be more protocol driven.  And urgent care patients are more cost sensitive.  Many of them want a script for the trouble of coming to see the doctor.  Everyone knows it’s not likely to work.  But they want it just in case.

– Mark L. Plaster, MD, JD

I’m not the data cruncher that some are, but there a few statements here that are interesting. “Antibiotics are prescribed most freely in places where health care personnel are least likely to have an ongoing relationship with their patients, in urgent care centers, emergency departments, and the kind of clinics you find in big-box stores and drug stores.” To me, that seems to imply that providers in these settings over-prescribe because they don’t care. Not true. Talking patients/families out of a need for antibiotics does take time. There are more patients who don’t want antibiotics than many would think. The article did get that right.  Every clinician that doesn’t have their head in the ground knows (I hope) of the problem of antibiotic overuse, which again makes me think the role of the business model and time-sensitive nature of the encounter is what is really driving things. Oh, and patient desires/demands. But, what do I know? I don’t anticipate this going away any time soon. Perhaps we could make it the seventh vital sign.

– E. Paul DeKoning, MD, MS, FACEP, FAAEM

So many pet peeves in one article. First of all, we reap what we sow. Want to commercialize medicine and turn patients into “customers?”  You’re going to get no continuity of care and patients will flock to doctors who give them what they want — regardless of the medical appropriateness. Oops. Don’t call us “doctors” any longer. We’re “providers.” Inappropriate prescriptions, testing and even work notes suddenly become a product to sell to ensure satisfaction rather than a component of good medical care. While I’m at it: If satisfaction is such an overwhelming government goal, why isn’t the amount of taxes citizens pay determined by our satisfaction with our legislators?  Then, after creating the problem, the government has to get together with industry leaders in a “summit” to … figure out why the problem is occurring. One CMO assumes that patients only want “quality,” but doesn’t define what “quality” is. A CEO from another company has the perfect solution: Waste more patient care time by writing in the chart all about the antibiotic discussions you had with patients. Clueless. I like the idea of comparing prescribing habits of not just doctors, but all other medical providers as well. Want a simple solution to stop overprescribing antibiotics? Make antibiotics a controlled substance.

William Sullivan, DO, JD

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