(Virgilio Marin) Painkillers are succor to people experiencing acute pain. Unfortunately, pharmaceutical painkillers cause a lot of adverse side effects that can make you feel even worse. These medications can give you constipation and nausea, and some even lead to long-term side effects, like drug addiction and kidney damage.
The first major trial of whether pharmaceutical companies bear responsibility for the opioid crisis is slated to start in Oklahoma on May 28. Three major drug manufacturers and 10 of their subsidiaries tried to convince Cleveland County District Judge Thad Balkman to delay the jury trial for 100 days, but Balkman ruled that it will move forward as scheduled. 
Following a nearly 2-hour hearing in his Norman, Oklahoma, courtroom, Balkman said:
“The wheels of justice … will continue to grind toward a trial date of May 28, 2019.”
Lawyers for the companies say they will appeal the judge’s decision.
In a statement, Purdue Pharma, maker of the blockbuster drug OxyContin, said it was “disappointed the court has denied its motion for a continuance. The facts show clearly that the state of Oklahoma has repeatedly failed to meet its obligations to produce critical information and documents to Purdue and the other defendants in this case.”
Purdue accused the state’s privacy attorneys of “flagrantly” violating court orders to turn over the material, “which has unfairly prejudiced Purdue’s ability to adequately prepare our defenses.”
The judge further enraged the drug companies by saying he will permit cameras in the courtroom.
The trial stems from a lawsuit brought by Oklahoma Attorney General Mike Hunter against some of the largest opioid manufacturers in the nation that alleges the companies’ deceptive marketing practices over the past decade fueled the opioid epidemic in that state. Hunter claims that Purdue, Johnson & Johnson, Teva Pharmaceuticals, Allergan, and others deceived the public into believing that opioids were safe for extended use. 
In response to the defendants’ claims that state attorneys had been “stonewalling” discovery for the past year, the attorney general called the drug companies “desperate” and grasping “at whatever straws they can find.”
In a court filing, Hunter wrote:
“The State did not manufacture opioids. The State did not target veterans. The State did not target legislators. The State did not target doctors. The defendants did all that.”
So far, 36 states have filed cases against pharmaceutical companies in state courts. The remaining 14 states are mulling bringing cases of their own. The Oklahoma case will be the first to reach trial.
In the past 3 years, 3,000 people have died of overdoses and more than 1,300 newborns have tested positive for the highly addictive painkillers in Oklahoma alone, the state attorney general’s office said.
In 2017, more than 47,000 Americans died of opioid overdoses, according to the U.S. Centers for Disease Control and Prevention (CDC).
Dentists who prescribe opioid painkillers to teenagers and young adults after pulling their wisdom teeth may be putting their patients at risk of addiction, a new study finds.The study, published in JAMA Internal Medicine Monday, shines a light on the largely overlooked role dental prescriptions play in an epidemic of addiction that has swept the United States, leading to a record 70,237 drug overdose deaths in 2017.
“Given the gravity of the opioid epidemic, the degree of persistent use and abuse we observed in adolescents and young adults, especially females, is alarming,” said researcher Alan Schroeder, a pediatrician and professor at Stanford University School of Medicine. “Our findings should trigger heightened scrutiny over the frequency of prescribing dental opioids.”
Adolescents and young adults often are introduced to highly addictive opioid painkillers when they have their third molars pulled. Millions of Americans undergo the procedure every year, and dentists routinely prescribe opioids to the vast majority. Only recently have dentists — the most frequent prescribers of opioids for youths between the ages of 10 and 19 in 2009 — started to reconsider the use of narcotics in managing post-surgical pain.
Nearly 6 percent of almost 15,000 people between 16 and 25 years old who received initial opioid prescriptions in 2015 from dentists were diagnosed with opioid abuse within a year, the study published by Schroeder and four other researchers shows. In comparison, 0.4 percent in a similar group who didn’t get dental opioids were diagnosed with opioid abuse during the same period.
“These are kids who could have gotten Advil and Tylenol, and 6 percent showed evidence of becoming addicted,” said Andrew Kolodny, who co-directs opioid treatment research at Brandeis University. “That’s huge.”
The numbers are particularly troubling given that most people who have their wisdom teeth removed do just as well or better on over-the-counter pain relievers. An April study in the Journal of the American Dental Association found that anti-inflammatory analgesics, such as ibuprofen and acetaminophen, generally work better than opioids at easing acute dental pain.
“We certainly don’t need to expose adolescents to opioids after we take out their wisdom teeth,” said Kolodny, who was not involved with the study. “On that particular topic, the science is clear.”
Schroeder and his team examined the private health insurance claims of more than 750,000 patients from 16 to 25 years old. Close to 100,000, or a striking 13 percent, received at least one opioid prescription in 2015, and dental practitioners wrote 30 percent of them.
Schroeder assumes the bulk of the dental prescriptions were for wisdom-tooth extractions, though he had no way to determine why they were prescribed.
Of the almost 15,000 adolescents and young adults who received initial opioid prescriptions in 2015 from dentists, 6.9 percent received at least one more prescription three months to one year later — a red flag for persistent opioid use. Moreover, 5.8 percent were diagnosed with opioid abuse within a year of the first prescription.
The numbers looked especially troublesome for girls and women. More than 10 percent of female 16- to 25-year-olds who received a dental opioid prescription in 2015 were diagnosed with opioid abuse within the year.
“The key message here is we need to be careful with opioid prescribing from day one,” said Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.
“Your child’s receipt of opioids after a dental procedure may lead to long-term use or worse,” said Alexander, who was not involved with the study.
Kolodny called for a change in dental prescribing as a result of the new findings.
P. Angela Rake already has changed. Over the past two years, she has slashed the number of opioid pills she prescribes in her Minneapolis-area oral surgery practice.
She used to routinely prescribe 12 to 20 opioid pills to patients whose wisdom teeth she removed. Now she gives just half opioid prescriptions, and when she does, she prescribes half as many pills.
“Our prescribing patterns have greatly changed since 2015,” said Rake, a professor at the University of Minnesota School of Dentistry, who was not involved with the new study. “We have all reeducated ourselves and are in the process of changing prescribing patterns.”
“When opioids were brought onto the market, we didn’t know the risks. Now we do,” she said.
Almost six times as many people died of opioid overdoses in 2017 than in 1999, when pharmaceutical companies began promoting opioids as a means to extinguish pain.
In general, opioid prescribing has declined “modestly” since 2015, Alexander said.
Another recent study examined the insurance claims of almost 71,000 people between the ages of 13 and 30. Those who filled opioid prescriptions following wisdom-tooth extractions from 2009 through 2015 were nearly three times more likely than those who didn’t take home opioids to be filling narcotic painkiller prescriptions long after any surgical pain should have subsided.
That study and the new one are consistent with research in hospitals and other clinical settings showing that a single prescription can set up patients for long-term use and abuse, Schroeder said.
“Historically, we’ve tended to underestimate how important the first opioid prescription can be,” Alexander said. “This new study shows that the first prescription may be terribly important because it’s a powerful predictor of long-term opioid use.”
“We’ve tended to overestimate the benefits of opioids and underestimate the risks in so many clinical settings at great cost to public health,” he said.
For years, health-care researchers ignored dental prescribing as a contributor to the opioid epidemic, Kolodny said. Initially, they focused on nonmedical drug use, keeping kids out of their grandparents’ medicine cabinets. When investigators turned to the problem of overprescribing, they looked first at chronic pain patients.
Studying dental prescribing has been complicated by dentistry being managed separately from other parts of the health-care system, Schroeder said. Most researchers have not had access to dental claims, he said. He used a medical database and searched for dental prescribers.
Researchers have no way to predict who might develop an opioid addiction. “This is one of the reasons that it is so important that we prevent the overuse of opioids in the first place,” Alexander said. “Wisdom-tooth removal is a classic example of where opioids have been overused, and, unfortunately, at great expense.”
Research shows that fewer opioid prescriptions are written in states that have access to legal marijuana. Could there be a connection between decreased opioid use and marijuana legalization? 
The report, released in JAMA Internal Medicine, suggests that some people turn to cannabis as a way to treat their pain, consequently avoiding more dangerous pharmaceutical drugs as a result.
Many people become addicted to opioid painkillers when they are prescribed the drugs to treat legitimate pain. The authors of the study say that people who avoid that first prescription are less likely to become addicted to opiates.
W. David Bradford, a professor of public policy at the University of Georgia, said:
“We do know that cannabis is much less risky than opiates, as far as likelihood of dependency.”
He added that “certainly there’s no mortality risk.”
No one has ever died from a marijuana overdose (no one!).
Based on the National Academy of Sciences, Engineering and Medicine’s own assessment that marijuana is useful in treating various types of pain, Bradford and 3 colleagues set out to determine whether people with easy access to medical marijuana are less likely to receive prescription opioids.
The answer is, yes.
The researchers pored over data from Medicare, which mostly covers people over the age of 65. They discovered a 14% reduction in opioid prescriptions in states that have medical marijuana laws. An estimated 3.7 million fewer daily doses of opiates are prescribed in states with medical marijuana dispensaries, the authors said.
States that allowed residents to grow their own medicinal marijuana saw an estimated 1.8 million fewer opioids dispensed each day. From 2010 to 2015, Medicare recipients received approximately 23 million daily doses of the analgesics.
During that same period, opioid use was skyrocketing, so the numbers reflect a slowing of the increase, rather than an actual decline in opioid use in these states, according to Bradford.
Some Study Limitations
The study merely shows a correlation and can’t prove that marijuana use led to a reduction in opioid prescriptions. What’s more, the authors focused on data revolving around a specific older-age group (65 and older), so that leaves out focus on similar correlations revolving around other age groups. Still, the evidence is compelling, and there’s plenty of it.
Further Evidence Shows Fewer Opioid Scripts Where Marijuana is Legal
A study published in September, 2016 showed that people were slightly less likely to test positive for opioids after a state legalized medical marijuana. Furthermore, the results of a small survey released in 2017 revealed that 63% of patients reported being able to replace their pharmaceuticals with marijuana – including opioids, sedatives, and antidepressants – when given legal access. Is the swap a perfect solution? Of course not, but it can certainly be an upgrade for many.
If cannabis wasn’t an effective pain reliever, drug companies wouldn’t be trying to harness its power or fight against legalization.
Of Course Marijuana isn’t a Perfect Solution. Duh – Downsides do Exist
That’s not to say that cannabis is a cure-all that suits everybody. In one study, Dr. Mark Olfson, a professor of psychiatry and epidemiology at Columbia University, found that pot users were 6 times more likely than non-users to abuse opioids. Of course this makes sense when considering the fact that those willing to use ANY drug are by default more likely to use even harder drugs than completely non-users – even if that chance is minimal for a large portion of drug users.
“A young person using marijuana is maybe putting him – or herself at increased risk. On the other hand, there may be a role – and there likely is a role – for medical marijuana in reducing the use of prescribed opioids for the management of pain.”
Olfson said studies that follow individuals to see whether marijuana is really a suitable replacement for opiates are needed. That’s easier said than done, however, because the federal government still considers marijuana a dangerous Schedule I drug and keeps tight reins on cannabis research. 
“That does make this a difficult area to study, and that’s unfortunate because we have a large problem with the opioid epidemic. And at the same time, with an aging population, we have lots of people who have pain conditions and who will benefit from appropriate management.”
Bradford chimed in, saying:
“In this time when we are so concerned – rightly so – about opiate misuse and abuse and the mortality that’s occurring, we need to be clear-eyed and use evidence to drive our policies.
If you’re interested in giving people options for pain management that don’t bring the particular risks that opiates do, states should contemplate turning on dispensary-based cannabis policies.” 
Face It – Most People Think Marijuana Should be Legalized
And while neither Medicare nor Medicaid reimburses patients for what they spend on medical marijuana, the amount of money spent on the drugs in legal states fell by about 8%, so the costs of both treatments might be comparable.
“I did a back-of-the-envelope calculation that suggested that a daily pain management dose of hydrocodone would be about $10 out of pocket in the U.S.”
Medicare Part D would cover most of that, but a daily pain management dose of cannabis was only about $6 last year, and is likely lower now.
A survey released by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) shows that more people in the U.S. use opioid painkillers than tobacco, highlighting the tragic opioid crisis gripping the country. 
A federal review published in the spring showed that opioid prescriptions in the U.S. decreased for the 1st time in 2 decades, which suggests that doctors are finally starting to heed warnings about the drugs’ addictive properties. However, that decrease has not translated into fewer deaths. The SAMHSA report illustrates just how widespread the problem remains.
The problem is especially severe in Tennessee, where there are more opioid prescriptions written than people actually living in the state. There are 1.18 opioid prescriptions per every resident of Tennessee. More people died from overdoses in the state in 2014 than from car crashes or shootings. 
Nationally, 37.8% of American adults are using some type of opioid painkiller, while 31.1% of U.S. adults use tobacco problems.
According to the 2015 National Survey on Drug Use and Health (NSDUH), a division of the Department of Health and Human Services (DHHS), more than 91.8 million Americans 18 and older used prescription painkillers last year. By comparison, 75.4 million U.S. adults used tobacco products. 
Those numbers creep even higher when children 12 and older are included; to 97.5 million and 78.3 million, respectively. And more than 12.5% of those users admitted to misusing the painkillers.
Danny Winder, director of the Vanderbilt Center for Addiction Research in Nashville, said:
“You’d like to think that is good news and reflects a reduction of tobacco use, but unfortunately that’s not the case. It’s a particularly pernicious problem because of its prevalence…Anytime you have a substance that is legally available and has addictive properties, that’s setting up the problem.” 
Actually, smoking rates have declined significantly in the U.S. in the last 50 years. From 2005 to 2015, smoking among adults declined from 20.9% to, or 45.1 million, to 15.1%, or 36.5 million. In the last year alone, the overall smoking rate fell 1.7 percentage points, resulting in the lowest prevalence since the CDC began collecting data in 1965.
However, you don’t generally associate tobacco use with hard drugs, yet many people who die from heroin overdoses begin with a dependence on prescription opioids. Even in those who don’t overdose or graduate to heroin, painkiller addiction can be devastating. In 2015, approximately 40% of unemployed people in the U.S. used a prescription opioid. 
Another disturbing finding from the survey is that in 2014, 27.0 million people aged 12 and older had reported using an illicit drug (10.2%). This percentage in 2014 was higher than those in every year from 2002 to 2013. 
The 2nd most common type of illicit drug use remained nonmedical painkiller use, but the percentage of people aged 12 or older in 2014 who were current nonmedical users of pain relievers (1.6%) was lower than the percentages in most years from 2002 to 2012.
The 2014 NSDUH estimated 66.9 million people aged 12 or older were tobacco users.
Dr. Richard Soper, chief at the Center for Behavioral Wellness in Nashville, said:
“We require tobacco companies to put warning labels on tobacco products; you don’t really see that in opioid products. As long as the FDA is continuing to approve opioids, there will still be access to it. There will still be doctors writing prescriptions.” 
In early 2016, the U.S. Food and Drug Administration (FDA) published draft guidelines outlining testing standards for generic drugs that have been produced to be harder to crush and dissolve or snort. The agency requires that generic drug makers be able to prove that their product is bioequivalent to the name brand drug. But under the new guidelines, manufacturers will also have to prove that their generic drug has the same anti-abuse properties as its name brand equivalent.
However, this is the same agency that approved OxyContin for use in children in August 2015.