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Dangers of Opiate Pain Medications and NSAIDs 

Why not just put all patients on opiate narcotic pain-killers? Here's why. There is a far better alternative. Read the ACS Position Paper by clicking here.

Oct. 1, 2009 Report: Drugs More Lethal Than Car Crashes -- Government Agency Finds New Trend in Data From 16 States

(AP) In 16 states and counting, drugs now kill more people than auto accidents do, the government said Wednesday.

Experts said the startling shift reflects two opposite trends: Driving is becoming safer, and the legal and illegal use of powerful prescription painkillers is on the rise.

For decades, traffic accidents have been the biggest cause of injury-related death in the U.S., and they are still No. 1. But drug overdoses are pulling ahead in one state after another.

"People see a car accident as something that might happen to them," said Margaret Warner, an epidemiologist with the Centers for Disease Control and Prevention. But as for death from a drug overdose, "maybe they see it as something that's not going happen to them."

The drug-related death rate roughly doubled from the late 1990s to 2006, according to the most recent CDC data . . .

While cocaine and heroin continue to be significant killers, most of the increase is attributed to prescription opiates such as the painkillers methadone, Oxycontin and Vicodin . . . Read entire article by clicking here.

Prescriptions now biggest cause of fatal drug overdoses

By Liz Szabo, USA TODAY 10/02/09

Debra Jones didn't begin taking painkillers to get high.

Jones, 50, was trying to relieve chronic pain caused by rheumatoid arthritis.

Yet after taking the painkiller Percocet safely for 10 years, the stay-at-home mother of three became addicted after a friend suggested that crushing her pills could bring faster relief. It worked. The rush of medication also gave her more energy. Over time, she began to rely on that energy boost to get through the day. She began taking six or seven pills a day instead of the three to four a day as prescribed.

"I wasn't trying to abuse it," says Jones, from Holly Springs, N.C., who has since recovered from her battle with addiction. "But after 10 years, I couldn't help what it did to my body or my brain. It was hard to work without it."

Addiction to prescription painkillers — which kill thousands of Americans a year — has become a largely unrecognized epidemic, experts say. In fact, prescription drugs cause most of the more than 26,000 fatal overdoses each year, says Leonard Paulozzi of the Centers for Disease Control and Prevention.

The number of overdose deaths from opioid painkillers — opium-like drugs that include morphine and codeine — more than tripled from 1999 to 2006, to 13,800 deaths that year, according to CDC statistics released Wednesday.

In the past, most overdoses were due to illegal narcotics, such as heroin, with most deaths in big cities. Prescription painkillers have now surpassed heroin and cocaine, however, as the leading cause of fatal overdoses, Paulozzi says. And the rate of fatal overdoses is now about as high in rural areas — 7.8 deaths per 100,000 people — as in cities, where the rate is 7.9 deaths per 100,000 people, according to a paper he published last year in Pharmacoepidemiology and Drug Safety.

"The biggest and fastest-growing part of America's drug problem is prescription drug abuse," says Robert DuPont, a former White House drug czar and a former director of the National Institute on Drug Abuse. "The statistics are unmistakable."

Debra Jones, of Holy Springs, N.C., had become addicted to prescription Percocet, which she was taking for rheumatoid arthritis, and had to seek substance abuse treatment. She's been clean two years.

Click here to link to the full article on the USA Today webpage.

Reports and Articles About the Opiate Prescription Drug Epidemic

"Bad Medicine," Phoenix Magazine, April 2012: Even after high-profile tragedies, a silent epidemic of prescription drug overprescription, abuse and overdose continues to plague Arizona. 

Prescription painkillers now biggest cause of fatal drug overdoses: USA Today 08/10/10. Prescription painkillers now kill more people per year than heroin and cocaine combined. 

Drugs More Lethal Than Car Crashes CBS News 10/01/09: In 16 states, prescriptioin painkillers kill more people than car crashes.

Painkillers a gateway drug to heroin CNN 07/06/11: Prescription painkillers now proven to be a gateway drug leading to heroin addiction.

Abuse of Pain Relievers 1998 to 2008 The TEDS Report 2010: Abuse of prescription painkillers increased four-fold from 1998 to 2008 according to a government report.

Chronic Abuse of Painkillers on the Rise Live Science 06/25/12: The rate of chronic prescription painkiller abuse increased by 76% from 2002 to 2010.

F.D.A. Won’t Order Doctors to Get Pain-Drug Training New York Times 07/07/12: The FDA convened an expert panel to decide if MDs need a few hours of special training before it is safe for them to prescribe addictive, long-acting narcotic painkillers such as Oxycontin that are fueling a horrendous epidemic of overdose and death. The panel voted overwhelming in favor. The FDA overruled the panel and vetoed the expert recommendation.

Painkiller sales soar around U.S. and fuel addiction USA Today 04/05/12: Some parts of the country have seen sales of prescription painkillers increase by as much as sixteen-fold. Increases of five to ten-fold are not uncommon.

Abuse-Proof OxyContin Pushes Addicts to Heroin and Other Opioids, Survey Finds Time 07/12/12: Reformulating Oxycontin didn't solve the addiction problem, it just caused addicts to change drugs.

Anti-drug abuse measure drives many addicts to heroin LA Times 07/11/12: Our best efforts to date are just creating more heroin addicts. The entire approach needs to be reinvented.

Pain Pills Add Cost and Delays to Job Injuries New York Times 06/02/12: Workers treated with high doses of prescription opiod painkillers stayed out of work three times longer than with similar injures treated with lower doses.

Studies Prove Chiropractic Equally or More Effective at Pain Relief as Opiate Narcotic Prescription Painkillers and is Cost Effective -- Read full ACS Position Paper by clicking here

The North American Spine Society, in a study which reviewed the findings of 699 studies and published its results in the premier medical journal Spine in 2010, concluded that “5 to 10 sessions of spinal manipulation administered over 2 to 4 weeks achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions such as medication.” Authors included MDs, PhDs and chiropractors. (Simon Dagenais, DC, PhD, Ralph E. Gay, DC, MD, Andrea C. Tricco, PhD, Michael D. Freeman, PhD, MPH, DC, John M. Mayer, DC, PhD: “NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain,” The Spine Journal 10 (2010) 918–940.) Click here to read the full study.

Another very common pain complaint frequently treated with addictive and dangerous painkillers is neck pain even though a 2012 study published in the prestigious Annals of Internal Medicine concluded that spinal manipulation was actually more effective in reducing pain than medication for neck pain both in the short and long term. (Gert Bronfort, DC, PhD; Roni Evans, DC, MS; Alfred V. Anderson, DC, MD; Kenneth H. Svendsen, MS; Yiscah Bracha, MS;and Richard H. Grimm, MD, MPH, PhD: “Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain,” Ann Intern Med. 2012;156:1-10.) Click here to read the full study.

Chiropractic is a cost effective alternative to medical care of back and neck problems. A recent study of the Tennessee Blue Cross Blue Shield plan found that when chiropractors were first contact providers for neck and back pain, overall costs of care were 40% lower than when medical doctors were first contact providers. When adjusted for severity of condition, the costs were still 20% lower when patients were first seen by chiropractors. (Richard L. Liliedahl, MD, Michael D. Finch, PhD, David V. Axene, FSA, FCA, MAAA and Christine M. Goertz, DC, PhD:  “Cost Of Care For Common Back Pain Conditions Initiated With Chiropractic Doctor Vs Medical Doctor/Doctor Of Osteopathy As First Physician: “Experience Of One Tennessee-Based General Health Insurer,” J Manipulative Physiol Ther 2010;Xx:1-4.) Click here to read the full study.

A previous study from UCLA of a health plan with hundreds of thousands of members found the same cost savings with chiropractic versus medical care of back pain. (Antonio P. Legorreta, MD, MPH; R. Douglas Metz, DC; Craig F. Nelson, DC, MS; Saurabh Ray, PhD; Helen Oster Chernicoff, MD, MSHS; Nicholas A. DiNubile, MD: Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Cost,” Arch Intern Med. 2004;164:1985-1992.” Click here to read the full study.

Back and neck pain patients should first be seen by chiropractors and only be exposed to addictive, dangerous, opiate narcotic painkillers in the rare cases where chiropractic care fails. This policy must be implemented immediately across society to stem the current deadly epidemic of addiction and death caused by prescription painkillers.

The Documented Dangerous "Silent Epidemic" of NSAIDs

Why not just put all patients on NSAIDs? Here's why. From The New England Journal of Medicine, June 7, 1999: "It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States. This figure is similar to the number of deaths from the acquired immunodeficiency syndrome and considerably greater than the number of deaths from multiple myeloma, asthma, cervical cancer, or Hodgkin's disease. (Fig. 1). If deaths from gastrointestinal toxic effects of NSAIDS were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects, a largely "silent epidemic," with many physicians and patients unaware of the magnitude of the problem. Furthermore, the mortality statistics do not include deaths ascribed to the use of over-the counter NSAIDs. "Gastrointestinal Toxicity of Nonsteroidal Antiinflammatory Drugs," M. Michael Wolfe, MD, David R. Lichtenstein, M.D., Gurkirpal Singh, MD, The New England Journal of Medicine, June 17, 1999, v. 340, n. 24. Click here to read the full study.

And there's more. Researchers reviewed all studies of NSAIDs and published their results in the eminent British Medical Journalin 2011. Their conclusion was none of the NSAIDs tested were safe for the cardiovascular system. This means all of the drugs increased patient risk of heart attacks and strokes. Is a temporary decrease in pain worth this risk especially considering chiropractic can reduce the pain at least as much with no cardiovascular risk? Of course not. The study is "Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis,”Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, Egger M, Ju¨ni P, British Medical Journal  2011;342:c7086 doi:10.1136/bmj.c7086. Click here to read the full study.

Conclusion

Patients with back and neck pain and with headaches should first be treated without NSAIDs and without prescription opiate narcotic painkillers. They should be treated by chiropractors with spinal adjustments/manipulations and ancillary measures. If these efforts fail, then the patient should be referred for medical and/or surgical management. Read the full ACS Position Paper on the subject by clicking here.