[Reblog] The Global Health Impact Index

From the 30 January 2015 post  by Nicole Hassoun and Priya Bhimani at Impact Ethics

For much of 2014, the Ebola outbreak in Sub-Saharan Africa dominated headlines as the virus spread and eventually made its way to the United States and Europe. Unfortunately, while the world focused on graphic images of people dying from Ebola on the street, little attention was paid to other infectious diseases that continue to plague much of the developing world.

As media coverage of the Ebola outbreak slowly started to decline, however, news of a new strain of drug-resistant malaria started to catch the public’s attention. Drug-resistance is a silent but serious threat to public health. And, if drug-resistant malaria were to spread from its current location in Myanmar to the nearby nations of India and China, it could easily become the world’s next big global health emergency.

More generally, every year millions of people die from malaria, tuberculosis, and HIV/AIDs – aptly named neglected diseases. This fact invites the following questions: What efforts to combat these neglected diseases are working? Where is help still needed? And, what initiatives are actually making a difference?

A new Global Health Impact index, supported by a collaboration of university-based researchers and civil society organizations around the world, helps provide answers to these questions. The index evaluates the global health impact of particular drugs. This information can be used to increase awareness about particular diseases, and create national and international demand for drugs to treat these diseases.

A drug’s global health impact is determined by compiling information about: (1) the need for the drug; (2) access to the drug; and (3) effectiveness of the drug. In this way, the Global Health Impact index makes it possible to estimate the impact of each drug in each country, as well as the global impact of particular drugs on specific diseases such as malaria, tuberculosis and HIV/AIDS.

…

[News article] Study reveals lack of data on opioid drugs for chronic pain — ScienceDaily

Study reveals lack of data on opioid drugs for chronic pain — ScienceDaily.
http://www.cdc.gov/media/releases/2014/p0303-prescription-opioids.html

 

From the article

Date:January 15, 2015

Source:University of Connecticut

Summary:Researchers have found little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs.

Read the article here

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[News article] Emergency aid for overdoses — ScienceDaily

Emergency aid for overdoses — ScienceDaily.

From the 17 October 2014 news article

Every minute counts in the event of an overdose. ETH professor Jean-Christophe Leroux and his team have developed an agent to filter out toxins from the body more quickly and efficiently. It can also be used for dialysis in patients suffering from hepatic failure.

To date, antidotes exist for only a very few drugs. When treating overdoses, doctors are often limited to supportive therapy such as induced vomiting. Treatment is especially difficult if there is a combination of drugs involved. So what can be done if a child is playing and accidentally swallows his grandmother’s pills? ETH professor Jean-Christophe Leroux from the Institute of Pharmaceutical Sciences at ETH Zurich wanted to find an answer to this question. “The task was to develop an agent that could eliminate many different toxic substances from the body as quickly as possible,” he says.

Leroux and his team knew that lipid emulsions can bind to drugs when injected into the blood stream. The researchers pursued this approach in their own studies, developing an agent based on liposomes, which are tiny bubbles with a lipid membrane as an outer layer. Instead of an intravenous injection, the agent is used as a dialysis fluid for so-called peritoneal dialysis. This method of dialysis is less common than haemodialysis, which is mainly used as a long-term form of treatment of kidney failure.

…

[News Article] The Steep cost of Life Saving Drugs

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• FDA approves easy-to-use heroin overdose antidote

Medication Health News

With many new drugs being brought to market, there has been increased talk about the pricing of many agents. Today, drugs in question include Evzio, a new naloxone auto-injector and  Sovaldi, a new antiviral for hepatitis C. These agents could save many lives, but their potential high costs could be a barrier to many of the patients of need. How should we solve this dilemma?  Should the subsidies be provided to those in need of these therapies?  What are your thoughts?

For additional information, please see the news analysis in the New York Times.

Image courtesy of [ddpavumba]/FreeDigitalPhotos.Net

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[Reblog] One way to prevent deaths by opiate overdose – Naxolene

From the 6 February 2014 blog item by Mackenzie Fuller at 100 resumes- the perils and victories of starting a public health career

……..

For opiate users, one option for harm reduction is to provide individuals, their friends, or other people close to them with naloxone (aka Narcan), an antidote to opiate overdose that can be administered intranasally, intramuscularly, or intravenously. Paramedics carry it for responding to potential drug overdoses, but sometimes paramedics aren’t called or arrive too late.

The recent death of actor Philip Seymour Hoffman from a suspected overdose has increased the news coverage of heroin deaths and the importance of naloxone. In my opinion, this news coverage of such an excellent actor highlights that users of heroin and other life-threatening drugs are multi-faceted, complex people, rather than beyond-hope dregs of society. I’m sure to many people this is a no duh statement, yet stereotypes continue to exist.

In July of 2013, Outside In started training their clients to administer naloxone. According one of their Facebook posts, they have trained 600 people and have had 174 overdose reversals reported to them as of February 5th, 2014. That is a lot of lives. While administering naloxone does send a person into withdrawal, withdrawal is better than death. Outside In also runs a needle exchange program, another harm reduction strategy.

In 2013, Oregon passed  SB 384 A, a law allowing persons who have completedtraining (developed by Oregon Health Authority) to possess and administer naloxone for treatment of opiate overdose. The law also gives such individuals immunity from civil liability except for in the case of wanton misconduct. The law became effective June 6th, 2013.

There are naloxone laws expanding access to this antidote in 17 states plus the District of Columbia (though not all the laws are state-wide). See this informative document by the Network for Public Health Law for more information.

……

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• A swift lifesaver in heroin overdoses, but it’s not widely available
• Chief Fitch wants heroin antidote in County police cars

Overdose drug available for families of addicts

Seems to be a very humane law, even though it is controversial.

From the 20 November 2013 edition of The Oklahoman

Oklahoma House Bill 1782 allows a medical provider to prescribe naloxone to a family member of someone who has a chance of overdosing. The drug helps restart breathing of someone who has overdosed.

Gail Box said she knows it can be difficult for parents to have conversations with their children about drug use.

But parents should consider talking to their children and also carrying naloxone if they think it could help save their children’s lives, she said.

“I wish, if I could go back, I would try to act on those feelings that I had at that time,” she said. “You can tell me anything you want, but I will always shoulder a great deal of guilt as a result of what happened to my son because as a parent, as a mother, it’s my job to protect him, and I didn’t.”

….

“There are people who have complete unintentional overdose who think they’re taking the right amount of pain medication, or they legitimately have a prescription but it’s not working so they take a little bit more,” White said. “This can also be critical in saving lives of people who are trying to use their pain medication appropriately.”

 

The law comes at a time when Oklahoma continues to see high rates of prescription drug abuse and overdose deaths.

Oklahoma ranks among the top five states with the highest rate of prescription overdose deaths. And prescription drug abuse is one of the fastest growing types of drug abuse in the state.

Prescription drug overdoses kill more people in Oklahoma than car accidents.

Oklahoma leaders plan to release the state’s strategy for combating prescription drugs in the next few months.

“It’s really good that we’re addressing this now as opposed to 10 years from now,” White said.

Before House Bill 1782 passed, naloxone was carried on many, if not all, paramedic ambulances and fire engines across Oklahoma, said Dr. Jeffrey Goodloe, the medical director for the emergency medical services system for Oklahoma City and Tulsa metros.

However, the law expands who can administer the drug. That’s where Goodloe’s concern comes in. Goodloe said he’s concerned about whether people who aren’t trained in medicine, such as law enforcement officers, will be able to deliver the drug appropriately.

“The first tenet of medicine … is do no harm, so in the process of helping people, we take an oath not to purposely harm them, and my concern with this bill is that, while its intent is nothing but admirable, the end result is I truly believe we will harm some people in fully executing its authority in the commission of trying to help people,” Goodloe said.

Goodloe said when people are given naloxone, they can wake up into a life-threatening withdrawal situation, suffering from horrific vomiting, extreme sweating and dangerously high heart rate and blood pressure.

Not every person given naloxone will go into this type of withdrawal, he said. However, it does occur.

….

Related articles

• [Press Release] Prescription Drug Abuse: Strategies to Stop the Epidemic (jflahiff.wordpress.com)
• Oklahoma ranks 5th in drug overdose, expert explains how to lower that rank (kfor.com)
• Report says states are failing to curb prescription drug abuse (wqad.com)
• NM senator takes on prescription drug abuse (kansascity.com)
• Five more laws to help stop Maine’s prescription drug epidemic (bangordailynews.com)
• Prescription drug legislation unveiled (krqe.com)
• Report: W.Va. has highest rate of fatal overdoses (kansascity.com)

 

[Press Release] Prescription Drug Abuse: Strategies to Stop the Epidemic

From the 7 October 2013 press release at Trust for America’s Health – Preventing Epidemics. Protecting People.

Prescription Drug Abuse: More than Half of States Score 6 or Less out of 10 on New Policy Report Card, While Drug Overdose Deaths Doubled in 29 States in the Last Decade

Washington, D.C. October 7, 2013 – A new report, Prescription Drug Abuse: Strategies to Stop the Epidemic, finds that 28 states and Washington, D.C. scored six or less out of 10 possible indicators of promising strategies to help curb prescription drug abuse. Two states, New Mexico and Vermont, received the highest score receiving all 10 possible indicators, while South Dakota scored the lowest with two out of 10.

According to the report by the Trust for America’s Health (TFAH), prescription drug abuse has quickly become a top public health concern, as the number of drug overdose deaths – a majority of which are from prescription drugs – doubled in 29 states since 1999. The rates quadrupled in four of these states and tripled in 10 more of these states.

Prescription drug related deaths now outnumber those from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states and Washington, D.C. Misuse and abuse of prescription painkillers alone costs the country an estimated $53.4 billion each year in lost productivity, medical costs and criminal justice costs. Currently only one in 10 Americans with a substance abuse disorder receives treatment.

“Prescription drugs can be a miracle for many, but misuse can have dire consequences. The rapid rise of abuse requires nothing short of a full-scale response – starting with prevention and education all the way through to expanding and modernizing treatment,” said Jeffrey Levi, PhD, executive director of TFAH. “There are many promising signs that we can turn this around – but it requires urgent action.”

In the Prescription Drug Abuse report, TFAH – in consultation with a number of public health, clinical, injury prevention, law enforcement and community organization experts – reviewed a range of national recommendations and examined a set of 10 indicators of strategies being used in states to help curb the epidemic. There are indications that some of these efforts and strategies may be having a positive impact — the number of Americans abusing prescription drugs decreased from 7 million in 2010 to 6.1 in 2011, according to the National Survey on Drug Use and Health.

Some key findings from the report include:

• Appalachia and Southwest Have the Highest Overdose Death Rates: West Virginia had the highest number of drug overdose deaths, at 28.9 per every 100,000 people – a 605 percent increase from 1999, when the rate was only 4.1 per every 100,000. North Dakota had the lowest rate at 3.4 per every 100,000 people. Rates are lowest in the Midwestern states.
• Rescue Drug Laws: Just over one-third of states (17 and Washington, D.C.) have a law in place to expand access to, and use of naloxone – a prescription drug that can be effective in counteracting an overdose – by lay administrators.
• Good Samaritan Laws: Just over one-third of states (17 and Washington, D.C.) have laws in place to provide a degree of immunity from criminal charges or mitigation of sentencing for individuals seeking to help themselves or others experiencing an overdose.
• Medical Provider Education Laws: Fewer than half of states (22) have laws that require or recommend education for doctors and other healthcare providers who prescribe prescription pain medication.
• Support for Substance Abuse Treatment: Nearly half of states (24 and Washington, D.C.) are participating in Medicaid Expansion – which helps expand coverage of substance abuse services and treatment.
• ID Requirement: 32 states have a law requiring or permitting a pharmacist to require an ID prior to dispensing a controlled substance.
• Prescription Drug Monitoring Programs: While nearly every state (49) has a Prescription Drug Monitoring Program (PDMP) to help identify “doctor shoppers,” problem prescribers and individuals in need of treatment, these programs vary dramatically in funding, use and capabilities. For instance, only 16 states require medical providers to use PMDPs.

“Fifty Americans die a day from prescription drug overdoses, and more than 6 million suffer from prescription drug abuse disorders. This is a very real epidemic – and warrants a strong public health response,” said Andrea Gielen, ScD, Director of the Johns Hopkins Center for Injury Research and Policy. “We must use the best lessons we know from other public health and injury prevention success stories to work in partnership with clinical care, law enforcement, the business community, community-based organizations, and other partners to work together to curb this crisis.”

Key recommendations from the report include:

• Educate the public to understand the risks of prescription drug use to avoid misuse in the first place;
• Ensure responsible prescribing practices, including increasing education of healthcare providers and prescribers to better understand how medications can be misused and to identify patients in need of treatment;
• Increase understanding about safe storage of medication and proper disposal of unused medications, such as through “take back” programs;
• Make sure patients do receive the pain and other medications they need, and that patients have access to safe and effective drugs;
• Improve, modernize and fully-fund Prescription Drug Monitoring Programs, so they are real-time, interstate and incorporated into Electronic Health Records, to quickly identify patients in need of treatment and connect them with appropriate care and identify doctor shoppers and problem prescribers;
• Make rescue medications more widely available by increasing access for at-risk individuals to naloxone and provide immunity for individuals and others seeking help; and
• Expand access to and availability of effective treatment options as a key component of any strategy to combat prescription drug abuse.

According to the National Center for Injury Prevention and Control (NCIPC), nationally, sales of prescription painkillers per capita have quadrupled since 1999 – and the number of fatal poisonings due to prescription painkillers has also quadrupled. Enough prescription painkillers were prescribed in 2010 to medicate every American adult continually for a month.

“The release of the prescription drug abuse report by the Trust for America’s Health represents a significant step forward in elevating public awareness of the state of prescription drug abuse in the US”, according to Ginny Ehrlich, CEO of Clinton Health Matters Initiative (CHMI). “We are proud that the Trust has completed this important research as part of its CHMI Commitment to Action and congratulate the Trust on continuing to advocate for innovation and action towards addressing this public epidemic.”

The report was supported by a grant from the Robert Wood Johnson Foundation.

Score Summary: A full list of all of the indicators and scores, listed below, is available along with the full report on TFAH’s web site at www.healthyamericans.org and RWJF’s web site athttp://www.rwjf.org/RxReport. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. Data for the indicators were drawn from a number of sources, including the National Alliance for Model State Drug Laws, NCIPC, Centers for Disease Control and Prevention, the Alliance of States with Prescription Drug Monitoring Programs, the National Conference of State Legislators, the Network for Public Health Law, the Kaiser Family Foundation and a review of current state legislation and regulations by TFAH. In August 2013, state health departments were provided with opportunity to review and revise their information.

10 out of 10: New Mexico and Vermont

9 out of 10: Kentucky, Massachusetts, New York and Washington

8 out of 10: California, Colorado, Connecticut, Delaware, Illinois, Minnesota, North Carolina, Oklahoma, Oregon, Rhode Island and West Virginia

7 out of 10: Florida, Nevada, New Jersey, Tennessee and Virginia

6 out of 10: Arkansas, District of Columbia, Georgia, Hawaii, Iowa, Louisiana, Maryland, Michigan, North Dakota, Ohio, Texas and Utah

5 out of 10: Alaska, Idaho, Indiana, Maine, Mississippi, Montana, New Hampshire and South Carolina

4 out of 10: Alabama, Arizona, Kansas, Pennsylvania, Wisconsin and Wyoming

3 out of 10: Missouri and Nebraska

2 out of 10: South Dakota

STATE-BY-STATE DRUG OVERDOSE MORTALITY RANKINGS

Note: Rates include total drug overdose mortality rates, the majority of which are from prescription drugs. 1 = Highest rate of drug overdose fatalities, 51 = lowest rate of drug overdose fatalities. Rankings are based on data from CDC’s National Center for Health Statistics, WONDER Online Database, 2010. The numbers are based on the number of people per 100,000.

1. West Virginia**** (28.9); 2. New Mexico (23.8); 3. Kentucky**** (23.6); 4. Nevada (20.7); 5. Oklahoma*** (19.4); 6. Arizona (17.5); 7. Missouri*** (17); 8. (tie) Tennessee** and Utah (16.9); 10. Delaware** (16.6); 11. Florida** (16.4); 12. Ohio*** (16.1); 13. Rhode Island** (15.5); 14. Pennsylvania (15.3); 15. Wyoming*** (15); 16. South Carolina*** (14.6); 17. Indiana**** (14.4); 18. Michigan*** (13.9); 19. Louisiana*** (13.2); 20. Washington (13.1); 21. (tie) District of Columbia and Montana** and Oregon** (12.9); 24. Colorado (12.7); 25. Arkansas** (12.5); 26. (tie) Alabama*** and Idaho** and New Hampshire** (11.8); 29. Alaska (11.6); 30. (tie) Mississippi***and North Carolina** (11.4); 32. (tie) Maryland and Massachusetts (11); 34. (tie) Hawaii and Wisconsin** (10.9); 36. Georgia*** (10.7); 37. California (10.6); 38. Maine (10.4); 39. Connecticut (10.1); 40. Illinois (10); 41. New Jersey (9.8); 42. Vermont** (9.7); 43. (tie) Kansas** and Texas (9.6); 45. Iowa**** (8.6); 46. New York (7.8); 47. Minnesota** (7.3); 48. Virginia (6.8); 49. Nebraska** (6.7); 50. South Dakota (6.3); 51. North Dakota (3.4).

** Drug Overdose Mortality Rates doubled from 1999 to 2010

*** Drug Overdose Mortality Rates tripled from 1999 to 2010

**** Drug Overdose Mortality Rates quadrupled from 1999 to 2010

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make diseaseprevention a national priority. For more information, visit www.healthyamericans.org.

 

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• Prescription drug abuse in Pennsylvania (fox43.com)
• NSC report: only three states adequately addressing prescription drug abuse (sacbee.com)

 

Misuse of over-the-counter pain medication is potential health threat

A few years back a relative told me he was taking a daily acetaminophen instead of aspirin to reduce heart attacks.
Needless to say I was a bit taken aback he didn’t know that aspirin and acetaminophen were two completely different drugs.
Not only does acetaminophen not act to reduce heart attacks, but over time it has the potential for serious adverse effects as liver and kidney damage.  He switched to aspirin when I showed him the article link in the previous sentence.

And, yes, I did also tell him to also consult with a doctor about his daily acetaminophen use.

Paracetamol/acetaminophen pills, 500 mg. (Photo credit: Wikipedia)

From the 31 May 2012 EurkAlert

Study uncovers the extent of OTC acetaminophen overdose risk

A significant number of adults are at risk of unintentionally overdosing on over-the-counter (OTC) pain medication, according to a new study in the US by Dr. Michael Wolf, from Northwestern University in Chicago, and his colleagues. Their work¹, looking at the prevalence and potential misuse of pain medication containing the active ingredient acetaminophen as well as the likelihood of overdosing, appears online in the Journal of General Internal Medicine², published by Springer.

Many adults in the US regularly use OTC pain medication containing the active ingredient acetaminophen, the most commonly used OTC pain medication in the US. They take it either on its own or in combination with other drugs, which may also contain acetaminophen. The ease of access to OTC drugs presents a challenge to patient safety as many individuals may lack the necessary health literacy skills to self-administer these medicines appropriately. Indeed, individuals make independent decisions that match an OTC product to a self-diagnosed symptom or condition. Worryingly, acetaminophen overdose is the leading cause of acute liver failure…

…

Wolf and team found that nearly a quarter of the participants were at risk of overdosing on pain medication using a single OTC acetaminophen product, by exceeding the dose of four grams in a 24-hour period; 5 percent made serious errors by dosing out more than six grams. In addition, nearly half were at risk of overdosing by ‘double-dipping’ with two acetaminophen containing products…

Related Websites

• Acetaminophen (MedlinePlus general information)
• Acetaminophen overdose (MedlinePlus)
• Summary of consumer health information (MedlinePlusTopics) 

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