Mark's Musings - August 12

Below is an aggregation of the stories I posted on LinkedIn since my last edition. I curate them through the prism of an "intersection of chronic pain and appropriate treatment" and so they come attached with my opinion.

=============================

Move Your Way (293 views)

Sounds like a great idea! Because, you know, "motion is lotion." The vast majority of human beings can find 150 minutes per week (average of 21 minutes per day) to do an aerobic activity that raises your heartbeat and two days per week of using your muscles. Of course, the more you do, the more fit you'll be. But to maintain health, that should be a relatively easy baseline to meet. But if you can't do that today, do something. Even five minutes every day starts to add up. Don't let the perfect (150 minutes / 2 days) be the enemy of progress (an attitude of activity).

=============================

Pregabalin Linked to Suicidal Behavior, Overdose (445 views)

With all the discussion about generics finally being available for LYRICA, I wanted to reiterate (again) that it's not just about cost but also about appropriate utilization. Here's something else to consider: "This very large trial provides important information that pregabalin - but not gabapentin - increased the risk of a range of adverse outcomes, including suicide thinking and completed suicide, head injuries, and road traffic accidents. The risk was 'dose-related' which is to say the more one takes, the more likely such outcomes were, and young people aged 15 to 24 seem particularly susceptible." If you go to LYRICA's website, this issue is very clearly shown (in bold) on the home page - "LYRICA and LYRICA CR may cause suicidal thoughts or actions in a very small number of people, about 1 in 500." One in 500 seems like a small number ... unless you're the "one." The symptoms of these mood changes include (but I'm sure are not limited to) "new or worsening depression, anxiety, restlessness, trouble sleeping, panic attacks, anger, irritability, agitation, aggression, dangerous impulses or violence, or extreme increases in activity or talking." Every single medication has a (sometimes long) list of potential side effects. Regardless of the drug, you should read that list. Every time. If the potential (or real) risks exceed the benefits, you need to find something else.

=============================

New Mexico Starts Wellness Program for State Employees (260 views)

For my friends in New Mexico, this is called leading by example. A #wellness work/life balance program for state employees makes a lot of sense, especially in a state that has issues with alcohol ("New Mexico’s death rate due to alcoholism is over two times the national average and its alcohol-related injury deaths are at 1.6 times the national rate.") Use of alcohol is often a mask for underlying psychosocial issues. Here's an interesting observation by the US Department of Labor’s Bureau of Labor Statistics - "Overall, those employed by a government body were far more likely to have access to benefits such as smoking cessation programs, exercise programs, nutrition education, physical examinations, lifestyle assessments, or other benefits." Why is that? Are governments more concerned about their employees or less worried about calculating ROI than private companies?

=============================

Everything you think you know about addiction is wrong (1,083 views)

This is brilliant from Johann Hari about #addiction. In his opinion, the primary difference between those that become addicted and those that don't (even when using the same chemical - he gives two examples) is isolation vs. happy & connected lives. Addiction isn't about the chemical hooks but the innate need to bond with others & society that is not met when isolated (by themselves and from others). Disconnection is a driver of addiction. Portugal is an interesting story (I knew they had decriminalized all drugs but had not heard about the results). Reversal: Rather than disconnecting from those with an addiction there should be a deepening of connection. "The opposite of addiction is not sobriety but connection." I appreciate my good friend (and inspiration for starting my RxProfessor journey) Stuart Colburn for sharing this with me last night via text. Invest 14 minutes and listen. You'll be enlightened. And encouraged. And motivated. I am constantly amazed at the number of stories about addiction I hear in personal conversations (at conferences, in business meetings, on Uber rides, at church, on social media). Unfortunately as many of them have a bad ending as a good ending. This issue touches so many people and has lifelong impacts on that one person and everyone they know / love, possibly for generations. So if you're in that situation - either needing recovery or supporting someone at that stage - focus on connection where there's a much better chance of success.

=============================

Iowa medical cannabidiol board approves one qualifying condition, denies three others (853 views)

ICYMI ... Last Friday (Aug 2) Iowa's advisory board voted to replace "untreatable pain" with "chronic pain" as a qualifying condition for their Medical Cannabidiol Program. During the same meeting "the board denied to allow generalized anxiety disorder as well as opioid dependence as qualifying conditions" (the latter is the new hot button around the country - read my 1/24/19 blogpost that I keep updating as things change, "Marijuana & Opioids"). The board also deferred a decision about PTSD. Note this is all discussion about #CBD - not the whole #cannabis plant. There seems to be news on a weekly basis from across the country on #MedicalMarijuana. When thinking about hot spots for medical marijuana, Iowa isn't typically top of the list ...

=============================

Cardinal Health, 2 other drug distributors offer $10 billion to settle opioid suits (236 views)

NEWS: The three companies (McKesson, Cardinal Health and AmerisourceBergen) responsible for distributing the majority of Rx #opioids and sued for the role they played in the resulting epidemic have offered a $10 Billion (with a 'B') to settle lawsuits from state attorneys general (except for Ohio). The counter-offer was $45 Billion (with a 'B'). So there's a $35 Billion (with a 'B') discrepancy but according to the article's author (and anonymous sources) "reaching a compromise might not be the toughest hurdle." According to some analysis, the cost to settle for both distributors and manufacturers could be in the range of $30 Billion to $55 Billion (both with a 'B'). Meanwhile, the negotiation in Cleveland of around 1,600 total cases against opioid manufacturers like Purdue Pharma continues with a trial currently set for October. Obviously, if it goes to trial, it will be the center of media attention.

=============================

John Morgan: Let’s vote to make recreational marijuana legal in Florida next year (137 views)

NEWS: John Morgan is now pushing for legalization of recreational #marijuana in Florida. This should come as NO surprise to anyone that has followed his efforts (and money) regarding #cannabis. Legalizing CBD / low-THC in 2014 wasn't enough so Amendment 2 (2014) was proposed that November for broader legalization of medical marijuana (not just low-THC) - pushed by "United for Care" whose Chairman was ... John Morgan. Since that failed, Amendment 2 (2016) - pushed again by John Morgan - was proposed and passed. But that excluded smoking, so John Morgan sued to include that as a delivery mechanism and ultimately smoking was legalized in March 2019. And, now, John Morgan completes his journey by advocating for full recreational legalization. If you connect the dots for what he has done since 2014, there obviously was a strategy behind his tactics. And he has "won" every time. I have heard his radio commercials in Georgia for the past two years so it appears as though he's taking his advocacy on the road, just so you're aware.

=============================

Study Links Injured Workers' Initial Opioid Prescriptions, Long-Term Use, Subscription Required (663 views)

Day supply of Rx #opioids (5-9 days) is the most predictable predictor of long-term Rx opioid use per a study done by the TN Department of Health. That’s why focusing very clearly on that first opioid script is so important to ensure (1) it is the most clinically appropriate method for pain relief (2) if so, the least day supply / number of pills possible to move the patient towards a return to function. What society has found out over the past decade is that, for many, zero opioids are necessary. Whatever the method, thoughtful consideration (and not rote status quo) is required. Thanks to Elaine Goodman for publishing this important insight on WorkCompCentral (subscription required). The Tennessee study found that 45 percent (that's a large number) of the 128,885 injured workers received Rx opioids in the 90 days after injury. Eighty percent of those had not received any opioids within 60 days prior to the injury (what they classified as "opioid free"). Four percent of those "opioid free" ended up taking opioids for 45 days or more during the 90 days after the injury. Obviously, four is a low number ... unless you're part of the "four." The article mentioned other studies, from WCRI to the University of Arkansas, that corroborated those conclusions. So it's about finding the balance of "Appropriate, Not Zero, Opioids."

=============================

NaloxBox (593 views)

I've mentioned in presentations over the past couple of years, as a prediction, that eventually Naloxone will be right next to the AED at employer sites. Well, here's an employer that did just that. According to a NIOSH study, 760 opioid overdoses occurred at a workplace between 2011-2016. The CDC has even created a whitepaper about "Using Naloxone to Reverse Opioid Overdose in the Workplace". I would be surprised if there weren't other employers that have deployed a similar cluster of emergency preparedness tools. Have you? Should you? Why haven't you?

=============================

Happy Days, Restful Nights: Optimistic People Are Better Sleepers, Study Finds (440 views)

The more optimistic (positive) you are, the better sleep you get. Common sense because if you're worried or angry (negative) your mind is not restful. "The study found that for each data point increase in a participant’s optimism score, their chances of reporting very good sleep quality increased by 78%." Like I've said many times, negativity is a death (maybe literally) spiral because the more negative you are the more negative you become (often because you're surrounded by other negative people). Figure out a way to be positive - optimistic - and let that be a "life" spiral. Given your circumstances you might have to be creative in finding something to be positive about, but I think everybody can find at least one thing in their life to be thankful for. Maybe, to start small, that one thing is you're still alive, which gives you another 24-hours to try and turn things around to "the bright side of life."

=============================

What do you need to stop talking about and start doing?

=============================

In addition, I published two blogposts:

• "Mark's Musings - August 5" on August 6
• "How Do We Treat Opioid Addiction?" on August 8 by WorkCompWire

=============================

"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#PreventTheMess + #CleanUpTheMess = The Answer.